Hansard: NCOP: Debate on an effective health care system: “Continuing in our collective path to ensure a comprehensive healthcare system in South Africa” ; Consideration of the Division of Revenue Amendment Bill

House: National Council of Provinces

Date of Meeting: 20 Nov 2014


No summary available.




Thursday, 20 November 2014                                        Take:









The Council met at 14:00.


The Deputy Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.






Start of Day






Ms E C VAN LINGEN: Hon Chairperson, I hereby give notice that on the next sitting day of the Council I shall move on behalf of the DA:


That the Council–


  1. notes that the Minister of Co-operative Governance and Traditional Affairs must take note that the proposed section 139 Intervention of Makana Municipality has not served before the select committee of the NCOP or this House;


  1. further notes that the administrator, Pam Yako, was appointed on 1 October and visits said municipality on Tuesdays, Wednesdays and Thursdays, after which she flies back to her business in Johannesburg;


  1. further notes that the employment contract of Pam Yako as administrator had not been tabled in Council;


  1. further notes that in a reply to a question in the National Assembly, it was made known that she earns over R350 000 a month for three days’ work;


  1. notes that she rejected the Paya application to make known the Kabuso report about the Makana municipality.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! Hon Nzimande, do you have an objectionf?


Mr L P M NZIMANDE: I do indeed, Chair. The committee has scheduled a visit to Makana, because the motion was tabled to the committee and accordingly referred to us. It was presented to us, Chair. So, this is a misleading motion.


Ms E C VAN LINGEN: It has not being tabled, Chair. It is not in this House, hon Chairperson.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): You may proceed, hon Van Lingen.


Ms E C VAN LINGEN: Thank you, Chair.


  1. notes that the DA calls on the Minister of Co-operative Governance and Traditional Affairs to ensure that all legal compliance is followed for the section 139 administrative intervention;


  1. calls on MEC Xasa to verify her expectations in terms of section 139 and the progress made to date;


  1. notes the need to clarify the dark and dingy smokescreens around the employment of Pam Yako as administrator for the Makana municipality; and


  1. requests the release of the Kabusa report on the Makana Council and to have it submitted to the NCOP Select Committee on Co-operative Governance and Traditional Affairs.











(Draft Resolution)


Mr E MAKUE: Chairperson, I move without notice on behalf of the ANC:


That the Council–


  1. notes that the Gauteng department of human settlements has allocated R65,5 million to help municipalities deal with informal settlement problems in mining towns in the 2014-15 financial year;


  1. further notes that the four municipalities identified for immediate intervention are the City of Johannesburg, which has been allocated R32,8 million; Merafong City Local Municipality, which has been allocated R6,9 million; Randfontein Local Municipality, which has been allocated R8,7 million; and Westonaria Local Municipality, which has been allocated R17,1 million;


  1. congratulates the Gauteng provincial government on their programme to address problems in these informal settlements; and


  1. hopes that this will assist with improving the lives and living conditions of mineworkers in the province.


Motion agreed to in accordance with section 65 of the Constitution.











(Draft Resolution)


Mr M RAYI: Deputy Chairperson, I move without notice:


That the Council–


  1. notes that the 16 Days of Activism for No Violence Against Women and Children is an international campaign that takes place every year from 25 November, which is the International Day for the Elimination of Violence Against Women, to 10 December, which is International Human Rights Day. The period includes Universal Children’s Day and World Aids Day;


  1. further notes that during this time the South African government runs the 16 Days of Activism for no Violence Against Women and Children campaign to make people aware of the negative impact of violence against women and children and to act against abuse;


  1. requests the civil sector, the business sector, as well as traditional and religious leaders to work together with government to broaden the impact of the campaign; and


  1. finally notes that thousands of South Africans have also helped to increase awareness of abuse and build support for victims and survivors of abuse by supporting this campaign.


Motion agreed to in accordance with section 65 of the Constitution.










(Draft Resolution)


Ms E C VAN LINGEN: Deputy Chairperson, on behalf of the DA I move without notice:


That the Council-


  1. notes that the Sarah Baartman District Municipality performed well in the Auditor-General’s report and that for the 2013-14 audit report, this district municipality received a clean audit report;


  1. further notes that, for the first time, the Blue Crane Route, which includes the Baviaans, Camdeboo, Kouga and Koukamma Local Municipalities, received unqualified audits with findings;


  1. also notes that unfortunately Ikwezi, Ndlambe, Sunday’s River Valley and Makana Local Municipalities received disclaimers;


  1. wishes to congratulate the Sarah Baartman District Municipality as well as the Blue Crane Route - the Baviaans, Camdeboo, Kouga and Koukamma Local Municipalities - and


  1. calls on the Minister of Co-operative Governance and Traditional Affairs to intervene in the other four municipalities in this district to ensure that taxpayers’ money is spent according to the law.


Motion agreed to in accordance with section 65 of the Constitution.











(Draft Resolution)


Ms E PRINS: Deputy Chair, I move without notice:


That the Council-


  1. notes that several classrooms were vandalised at the Joe Slovo Secondary School in Khayelitsha over the weekend, including the ones where matriculants had to write their examinations;


  1. further notes that criminals left the classrooms with gaping holes in the ceilings, with no light fittings and cables, and with paper and glass strewn over the floors in the fourth incident in two weeks at this school;


  1.  calls on the Western Cape’s department of education to tighten security around the schools at this critical time of examinations; and


  1. calls on the community surrounding the school to assist the police in identifying the vandals so that they can be arrested and face the full might of the law.


Motion agreed to in accordance with section 65 of the Constitution.













(Draft Resolution)


Mr L SUKA: Deputy Chairperson, I move without notice:


That the Council-


  1. notes that the President has led a government delegation to the G20 Leaders’ Summit that took place in Brisbane, Australia;


  1. further notes that one of the outcomes of the G20 summit was the commitment to uplift the G20’s gross domestic product by at least 2% by 2018 with a view to significantly increasing job creation and enhance investment and trade;


  1. also notes that the matter of the infrastructure funding gap of the African continent of about R1 trillion per annum received much attention at the summit; and


  1. congratulates the President and his delegation for their participation in the summit and for ensuring that the African voice is taken into cognisance in the international agenda.


Motion agreed to in accordance with section 65 of the Constitution.













(Draft Resolution)


Mr C J DE BEER: Deputy Chairperson, I move without notice:


That the Council-


  1. notes that over 3,84 million South Africans have submitted their tax returns, that just over 2 million of those returns were completed via e-filing and that over 1,8 million were completed electronically at the SA Revenue Service branches;


  1. further notes that only about 3 929 physical paper returns have been submitted by Monday, 17 November 2014;


  1. also notes that tax season 2014 will end tomorrow, on Friday, 21 November, for most South African taxpayers;


  1. therefore urges all those who have not yet submitted their returns to do so as soon as possible as it is inevitable that queues at Sars branches will be long and the volume of calls handled by the Sars contact centre will increase; and


  1. congratulates Sars on their contribution to the national fiscus by putting in place an efficient system and qualified and competent staff and by ensuring continuously that the tax return system is tightened up and well managed.


Motion agreed to in accordance with section 65 of the Constitution.











(Draft Resolution)


Mr B G NTHEBE: Deputy Chair, I move without notice:


That the Council-


  1. notes that on Tuesday, 18 November, the Constitutional Court dismissed an urgent application to interdict the removal of councillors and municipal administrators from their posts in the Ngaka Modiri Molema District Municipality in the North West;


  1. further notes that section 139(1)(c) of the Constitution allows a provincial government to dissolve a municipality that has failed to fulfil an executive obligation in terms of the Constitution or legislation, but only if exceptional circumstances warrant such a step; and


  1. therefore calls on the administrators, now that they have been appointed by the provincial government, to concentrate on the provision of services, especially water and sanitation, for the people of the district.


Motion agreed to in accordance with section 65 of the Constitution.












(Draft Resolution)


Ms L C DLAMINI: Deputy Chair, I move without notice:


That the Council-


  1. notes that eight people, including four City Power employees, have been arrested for copper cable theft, which left many residents of Gauteng without power in September;


  1. further notes that the City of Tshwane, City of Johannesburg and Ekurhuleni Metropolitan Municipalities were left without water when the electricity cables needed for the reservoirs’ pumps were stolen;


  1. also notes that following a joint operation between City Power and the SA Police Service, they were able to arrest members of the syndicate that is operating in Gauteng;


  1. therefore calls on the SA Police Service and City Power to strengthen their efforts to arrest the outstanding members of this syndicate so that the people of this country can receive the services they deserve without disruption.


Motion agreed to in accordance with section 65 of the Constitution.











(Draft Resolution)


Mr M KHAWULA: Deputy Chairperson, I move without notice:


That the Council-


  1. commends the recent implementation of green electricity generation by the students and faculty at the University of the Western Cape;


  1. notes that this green electricity is generated by using a bank of hydrogen cylinders connected to a hydrogen fuel cell generator;


  1. further notes that this prototype was developed by the Hydrogen SA Systems Centre of Competence and is a source of clean energy; and


  1. encourages and supports calls for greater resource allocation and innovation in renewable and clean energy sources.


Motion agreed to in accordance with section 65 of the Constitution.













(Draft Resolution)


Mr L P M NZIMANDE: Deputy Chairperson, I move without notice:


     That the Council—

  1. notes that the President of the ANC and the country has appeared in Parliament at least five times in six months, almost averaging one visit per month;


  1. further notes that he came and subjected himself to accounting on the state of governance and the running of the country amidst his busy schedule ...


Mr W F FABER: Deputy Chairperson, on a point of order: The hon member is misleading the House. Appearing here and standing there but not answering questions is not “giving account”.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! Hon member, no! No! [Interjections.]


Mr L P M NZIMANDE: May I continue, Chair?


The DEPUTY CHAIRPERSON OF THE NCOP: Order! Just hold it, hon Nzimande. I want to make a ruling on that point of order. That was not a point of order. We are dealing with motions without notice. You have the opportunity to object if you wish to object. You may proceed, hon Nzimande.


Mr L P M NZIMANDE: Chair, just to mention the time in case we suffer from memory loss.


     (3) also notes that he appeared—


  1. twice in June, to give the state of the nation address to the nation, the world and Africa about what we do and what our policies and service delivery are;
  2. in July, to present, account and subject himself to the authority of Parliament on the budget and the money that the President has spent on behalf of the people in running the country;
  3. in our sister House, the National Assembly, to answer questions, where he was disrupted and interrupted and where people refused to subject themselves to authority and the proper democratic practices that are prescribed and directed by our Constitution; and
  4. in this House for an annual address; and


     (4) rejects with the utmost contempt the notions and publicity stunts by the DA and its cronies, the EFF, as they spread the misinformation that the President does not subject himself to the authority and accountability of this country.




The DEPUTY CHAIRPERSON OF THE NCOP: Order! Is there any objection to the motion?




The DEPUTY CHAIRPERSON OF THE NCOP: In light of the objection, the motion may not be proceeded with. The motion without notice now becomes a notice of motion on the Order Paper.











(Draft Resolution)


Mr S G MTHIMUNYE: Deputy Chairperson, I move the draft resolution printed in the name of the Chief Whip of the Council on the Order Paper, as follows:


That the Council, on the recommendation of the Speaker of the National Assembly and the Chairperson of the National Council of Provinces, and in concurrence with the National Assembly, appoints Mr Gengezi Mgidlana as Secretary to Parliament on a five-year performance-based contract, with effect from 1 December 2014.



Question put: That the motion be agreed to.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West, Western Cape.


Motion accordingly agreed to in accordance with section 65 of the Constitution.













(Draft Resolution)



Mr S G MTHIMUNYE: Deputy Chairperson, I move the draft resolution printed in the name of the Chief Whip of the Council on the Order Paper, as follows:


That Rule 239(1), which provides inter alia that the consideration of a Bill may not commence before at least three working days have lapsed since the committee’s report was tabled, be suspended for the purposes of consideration of the Division of Revenue Amendment Bill.


Ms E C VAN LINGEN: Deputy Chairperson, just on a point of clarity: It says here that the Rule must be waived because of the three-day Rule. As far as I have it, the report was tabled in this House on 11 November, and the National Assembly voted on this Bill last week Thursday. So, this motion is not necessary.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! They are not objecting to anything, even if it was wrong. What is it that you are correcting, therefore?


Ms E C VAN LINGEN: It is not necessary to do this motion, Deputy Chairperson. [Interjections.]


The DEPUTY CHAIRPERSON OF THE NCOP: Order! No, no, no, hon members! Hon Van Lingen rose on a point of order. I want to clarify matters for myself in terms of this point of order.


Ms E C VAN LINGEN: Chairperson, it is a technical issue. The report was tabled in this House on 11 November. The Division of Revenue Bill was discussed and debated in the National Assembly, so more than three working days have lapsed. So, it is not necessary for this motion. I should object to it.


The DEPUTY CHAIRPERSON OF THE NCOP: Thank you very much, the issue is clear to me now. Hon Van Lingen, the report was tabled on 18 November in the National Council of Provinces, which means that it should have been debated three days after that. This means the three days have not lapsed. It is for that reason that the Chief Whip then requests the suspension of the three-day Rule in order for the report to be presented in the National Council of Provinces - not to subject ourselves to the Rules of the National Assembly, but rather what is happening in our House. The motion is therefore in order. The point of order as raised by the hon Van Lingen is therefore not carried.


Question put: That the motion be agreed to.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West.


ABSTAIN: Western Cape.


Motion accordingly agreed to in accordance with section 65 of the Constitution.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! Hon members, a notice of motion was presented earlier on to which there was an objection. That was the notice of motion by hon Van Lingen on behalf of the DA. I ruled that I would allow for us to check whether the objection was in order. Yes, the records prove that the Makana Municipality notice or report was referred to the Select Committee on Co-operative Governance and Traditional Affairs on 13 November 2014. Therefore, hon Van Lingen’s notice of motion will not be printed - it is required that notices of motion be printed. We shall proceed in that light.





















Mr L SUKA: Deputy Chairperson, ladies and gentlemen, comrades and friends, I will speak as briefly as possible because great work has been done through the Select Committee on Economic and Business Development. I should acknowledge the diligent work of all members in considering all the international agreements.


I stand before you to present for adoption the following international agreement reports. The first one is Annex IV, Annex VI and the explanatory memorandum to Annex IV and Annex VI of the International Convention for the Prevention of Marine Pollution from Ships, known as Marpol, of 1973 or 1978, which was adopted by the committee on 16 September 2014. The second one is the 1986 Instrument for the Amendment of the Constitution of the International Labour Organisation with Explanatory Memorandum, which was adopted by the committee on 27 August 2014.


The third one is the Adoption of an Automatic Recommendation on the Social Protection Floor by the International Labour Organisation with Explanatory Memorandum, which was adopted by the committee on 27 August 2014


The last one is the Treaty on the Grand Inga Hydropower Project between the Republic of South Africa and the Democratic Republic of Congo and the accompanying Explanatory Memorandum, which was considered and adopted by the committee on 4 November 2014.


Statistical sources state that over 90% of all trade between countries is carried by ships. Some 50 000 merchant ships sail the world’s oceans, transporting everything from food and fuel to construction materials, chemicals and household items. The level of pollution caused by shipping increases, as does the chance of spills and accidents.


This is a global problem because shipping is an international business. Invariably, this problem affects all nations. It was the marine pollution caused by the Liberian vessel the Torrey Canyon in 1967 that raised international concern and collective arrangements for the regulation and enforcement of regulations on marine pollution for the protection and preservation of the marine environment.


The strategic focus of Marpol 1973/1978 is one of the most important international marine conventions to minimise pollution of the seas, including dumping, oil and exhaust pollution. The objective is to preserve the marine environment through the complete elimination of pollution by oil and other harmful substances and the minimisation of accidental discharge of such substances.


The Marpol Treaty is the combination of two treaties adopted in 1973 and 1978 respectively and is continuously updated by amendments over the years. South Africa, as a member of the International Marine Organisation, the IMO, has a responsibility to protect the environment and to fight against pollution of the world’s oceans.


On 27 August, as the select committee, we had a full briefing by the Department of Transport with regard to Marpol. After deliberations, the committee unanimously agreed to the ratification of the convention in its current form. Furthermore we say: Forward for the ocean economy! We have regulations for the sustainable development of the ocean economy.


In 1986, the International Labour Conference discussed and adopted an instrument of amendments proposing changes that affect 11 of the 40 articles in the constitution of the International Labour Organisation. The main objective of the proposed amendment is to make membership of the governing body of the International Labour Organisation more representative by providing a means of appointment which takes into account the various geographic, economic and social interests of its constituent groups.


The composition of the governing body has been of significant interest to the African Group. The African Group views that Africa has been historically discriminated against with regard to the composition of the governing body, and thus the amendments reflect the equitable and nondiscriminatory representation of all regions within the governing body.


As at 3 February 2014, ratification stands at 102 member states, which include India, one of the countries in Brics, and 44 African countries have ratified the instrument. This means it is our time, as the Republic of South Africa, to ratify the instrument and to add more weight in terms of representation in the global discourse in order to address world socioeconomic challenges.


The International Labour Organisation, in deepening its work in addressing global labour policy issues, has provided recommendations on the Social Protection Floor. These recommendations serve as nonbinding guidelines. The new recommendations provide guidance to member states on how to build comprehensive social security systems and extend social security coverage by prioritising the establishment of national floors of social protection accessible to all in need.


The recommendation attempts to assist member states in covering the unprotected, the poor, the most vulnerable, including workers in the informal economy and their families. The strategic objective of the recommendations is to ensure that all members of society enjoy at least a basic level of social security throughout their lives.


As a country we pride ourselves on a wonderful Constitution which guarantees human rights, and in our country the social protection system is a human right issue. I must say the new recommendations received a warm reception in our committee. Indeed, South Africa is a constitutional democratic country with an enshrined Bill of Rights!


The recent reports of the Grand lnga Project paint a picture of a better economic and political outlook for Africa. However, more needs to be done on both the economic and political front, and more with regard to the wellbeing of the African population. The International Energy Agency, IEA, estimates that 1,5 billion people were without access to electricity in 2008 – this is more than one-fifth of the world’s population. Some 85% of those without electricity live in rural areas, mainly in sub-Saharan Africa and South Asia. By way of comparison, electrification rates in the Organisation for Economic Co-operation and Development, OECD, countries have reached almost universal access, says the IEA.


The IEA further states that North Africa has an access rate of 99%, Latin America 93%, East Asia and the Pacific 90%, and the Middle East 89%. By contrast, South Asia has an electrification rate of 60% and Sub-Saharan Africa only 29%. Sub-Saharan Africa has by far the lowest urban and rural access rates, at 58% and 12% respectively.


Poverty and unemployment still remain a serious socioeconomic cost in the region. The Grand lnga Hydropower Project possess the potential to play a critical role in the economy of the southern subregion of the African continent in relation to industrial development and energy generation.


The Grand lnga Hydropower Project fits to the energy sector’s role in the subregion, and it could play a significant role in fostering economic development. It remains a vital source that could further accelerate the subregion’s economic performance in various economic sectors and in industries such as tourism, energy, mining, agriculture and manufacturing.


We do not downplay the risks associated with this project, such as political, social and environmental issues, including governance issues. However, the involvement of the World Bank, and including other development finance institutions, would insulate the risk factors. The commitment of the World Bank to social and environmental considerations offers hope that the Grand Inga project would be implemented much better than the previous hydro power projects in the region.


Better economic and political views about Africa and a commitment by the Democratic Republic of Congo to peace and stability in that territory provide an improvement in relation to political management. The leadership shown by the African Union, AU, including SADC, in bringing peace and stability to the continent should be commended. Our efforts as a country to bringing about peace, stability and economic prosperity should not be underestimated!


There is no doubt that the Grand lnga Hydropower Project offers a great integrationist opportunity for the African continent’s economic development initiatives. Africa must rise!


Again, I must extend my appreciation to the members of the select committee for demonstrating their patriotism in the work of the committee, putting the interest of the country, the continent and the world above selfish, narrow and hollow political interests.


The select committee, without exception, recommended the adoption of the international agreements. I thank you, Chairperson. Pride! [Applause.]


Debate concluded.


Question put: That the Reports be adopted.


Declaration(s) of vote:

Ms C LABUSCHAGNE: Deputy Chair, the Western Cape wants to make a declaration on the Grand Inga Hydropower Project. The Grand Inga Hydropower Project has enormous potential for all of Sub-Saharan Africa. The DA is mindful of the numerous financial political and construction challenges that must be overcome before the electricity that is produced over 5 000 km away reaches us here in South Africa. Here we have a project with the potential to power Southern Africa and bring much needed development to the people of the Democratic Republic of the Congo, and we have an ANC government with a poor track record of delivering on mega construction projects such as this.


Our government must not only ensure that South Africa can one day buy electricity produced from this scheme but also that ordinary South Africans will be able to afford it. The DA believes that South Africa must set an internal ceiling price, which will take into account the enormous costs incurred in getting this power from the Congo River across the breadth of the African continent to South Africa. This will require both the building of long transmission lines through the war-torn Congo, as well as the massive upgrade of the South African Power Pool grid.


These costs must be factored into the consideration of whether we are supporting something that we will one day be able to afford. The ANC government’s policy of going full steam ahead without considering whether the end consumer can afford to buy electricity must end. We can finalise policy documents such as the Integrated Resource Plan, IRP, update, the gas utilisation master plan and a procurement process for cogeneration projects, which have been on the table for over three years. These are solutions that can be brought on line within two years. The DA, however, supports the treaty on the Grand Inga Hydropower Project in principle. However, we cannot do so blindly and without raising valid concerns about the future cost implications for ordinary South Africans. I thank you.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Thank you very much, hon member. Before we proceed, may I just explain something? Because we have dealt with all those orders and the statement by the chair of the committee dealt with all the orders collectively, the objection or the declaration is on the Fourth Order - the Grand Inga Hydropower Project. [Interjections.] Yes, I just thought that provinces must be alert to that so that we do not come back to that order later. Once we have dealt with this order, we are done with it.










Mr B G NTHEBE: Deputy Chair, I stand here to declare that the clarion call by the chairperson of the select committee responsible for economic and business development is well received. The clarion call by the select committee says that Africa must rise. If Africa must rise, then we must appreciate the realities. The realities are that South Africa needs to push on its commitment of a comprehensive energy mix but must also ensure that there is energy security and that it is consistent with our National Development Plan commitment.


South Africa needs to continue with its regional economic integration consistent with Agenda 2063 of the African Union but also with the South African protocols on energy - the Southern African Development Community, SADC, protocols on energy. South Africa needs to reach its goal of ensuring that 95% of our people have access to electricity come 2030. Massive industrialisation and economic development needs energy security to be achieved.


We must remind our friends that you cannot cherry-pick in respect of the National Development Plan. When they agreed with the National Development Plan and stood here, saying that they agreed in principle, the principle is that we must reduce the cost of electricity and power to our own people – the poorest of the poor. This agreement in this treaty seeks to do exactly that. This agreement is in harmony with the SADC energy protocols and it seeks to bring about peace and stability in the region by extending the social needs to the poorest of the poor. Through this agreement Africa will rise and Africa must rise by agreeing that infrastructural development and economic development needs energy security. We therefore want to declare that South Africa is ready for this agreement and we must appreciate it as such. Thank you, Chair. [Applause.]


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R Tau): Order! Does any other province wish to make a declaration? In the absence of any, we shall now proceed the voting on the question.


Declaration of votes made on behalf of the Western Cape and North West.


Question put: That the Report be adopted.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, North West, Northern Cape, Western Cape.


Report of Select Committee on Economic and Business Development on Treaty on Grand Inga Hydropower Project between Republic of South Africa and Democratic Republic of Congo, and accompanying Explanatory Memorandum accordingly adopted in accordance with section 65 of the Constitution.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! To avoid jumping around between reports, can we just follow the sequence now. Let us go back to the First Order now and then to the Second Order and proceed like that. We do not want to go to the Third Order, then back to the Second Order, and so forth. So, we are voting on the First Order next.













Question put: That the Report be adopted.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, North West, Northern Cape, Western Cape.


Report accordingly adopted in accordance with section 65 of the Constitution.














Question put: That the Report be adopted.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West , Western Cape.


Report accordingly adopted in accordance with section 65 of the Constitution.














Question put: That the Report be adopted.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, North West, Northern Cape, Western Cape.


Report accordingly adopted in accordance of section 65 of the Constitution.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! Hon members, as I said, earlier on we dealt ... [Interjections.] Order, order, hon members! Earlier on we dealt with the Fourth Order. Now we shall proceed to the Fifth Order.











(Consideration of Bill and Report of Select Committee on Security and Justice thereon)


Mr D L XIMBI: Deputy Chairperson, Ministers, members of the executive councils, MECs, hon members and distinguished guests, Legal Aid SA provides independent and impartial legal aid to needy people and provides legal representation at the state’s expense to eligible people in terms of the Constitution. It provides services in all District, Regional and High Courts.


Currently Legal Aid SA’s mandate is regulated by the Legal Aid Act, Act 22 of 1969, which has been amended numerous times over the years. As matters pertaining to legal aid were dealt with as they arose, the Legal Aid SA Bill has now been introduced to deal comprehensively with Legal Aid SA. The Bill essentially establishes Legal Aid SA as an independent and impartial entity and defines its objectives, powers, functions, duties and composition.


Legal Aid SA already exists under the current 1969 Act. The objective is therefore to replace or repeal the outdated 1969 Act and establish Legal Aid SA under a new framework Act — the Legal Aid South Africa Act of 2014 — that will be aligned with the current constitutional framework and prevailing circumstances.


The Bill establishes Legal Aid SA with its board of directors and sets out the criteria for board members, including their terms of appointment, termination and the board’s meetings and quorum procedures. The Bill also provides for the delegation of powers and the assignment of duties or functions to the board.


In addition, the Bill provides for the appointment of a chief executive officer and his or her functions, the appointment of staff, and the designation of certain officials as Legal Aid SA agents, as well as their terms and conditions of employment.


Regarding the provision of legal aid, the Bill provides for the protection of client privilege in certain circumstances such as the recovery of costs, Legal Aid SA finances, and the provision of legal aid in criminal matters when so instructed by the courts.


The Select Committee on Security and Justice, having considered the subject of the Legal Aid South Africa Bill, Bill 8B of 2014, referred to it, recommends that the council passes the Bill without amendments. I thank you, Chairperson. [Applause.]


Debate concluded.


Question put: That the Bill be agreed to.


Bill accordingly agreed to in accordance with section 75 of the Constitution.














(Consideration of Bill and of Report of Select Committee on Appropriations thereon)


Mr S J MOHAI: Deputy Speaker, the Division of Revenue Amendment Bill was tabled in Parliament on 22 October 2014 by the Minister of Finance, as required by section 12(4) of the Money Bills Amendment Procedure and Related Matters Act, Act 9 of 2009, during the tabling of the Medium-Term Budget Policy Statement.


Since the Bill includes provisions affecting the financial interest of provincial spheres of government as contemplated in section 76(4)(b) of the Constitution, the Bill was accordingly dealt with by the committee in terms of section 76(1) of the Constitution. The Bill was further processed in accordance with sections 5 and 6 of the Mandating Procedures of Provinces Act, Act 52 of 2008, to solicit negotiating and final mandates from provinces.


The Bill makes provision for changes to provincial allocations, as well as changes to local government allocations in the form of rollovers, the conversion of some conditional grant allocations for unforeseen and unavoidable expenditure, disaster funding and the reallocation of funds for function shifts.


The committee made some observations and findings that will require a formal response from the Minister of Finance during the 2015 Budget tabling. Some of the recommendations made by the committee include government having to look into areas of project planning, implementation and management. Government must also look into the need for collaboration between stakeholders supporting municipalities; the need for municipalities to explore share services so as to maximise the utilisation of scarce skills; and the need to strengthen efforts around the implementation of multiyear planning to avoid underspending and unnecessary rollovers, particularly now that the country has adopted long-term plans. This will ensure that there is discipline in the planning and execution of programmes.


To conclude, having considered the Division of Revenue Amendment Bill referred to and classified by the Joint Tagging Mechanism as a section 76(1) Bill, the committee recommends to the House that it be adopted as tabled. I want to thank all members of the committee. Thank you.


Debate concluded.


Question put: That the Bill be agreed to.


IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West, Western Cape.


Bill accordingly agreed to in accordance with section 75 of the Constitution.













(Subject for discussion)


The MINISTER OF HEALTH: Hon Deputy Chairperson, colleagues, MECs and members of the House, I am in a very difficult, unique situation, even before I start to speak. As you can see, “to be confirmed” is written there on the Order Paper. This is because this very important debate is taking place on the day when another important event is happening: the passing of the Adjustments Appropriation Bill in the National Assembly, for which I am also wanted. So I am double parked - very seriously double-parked! But I thought I needed to respect this House. I am just wondering, hon Deputy Chairperson, whether it would be extremely abnormal for me to speak and then join the National Assembly thereafter, because I need to answer questions there about my budget. I am just making a request. Is that acceptable to the House? It is a very abnormal request, I know, but the situation is beyond my control. I think I need a response to my request before we continue. [Laughter.]


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! With the capacity and skill you possess, hon Minister, I am sure you will be able to present the subject for discussion. And we have the presence of the MECs, so if you are needed that side, I am sure it will be fine. We take note of your request. [Inaudible.]


The MINISTER OF HEALTH: Thank you, hon Deputy Chair.


This debate on an effective health care system is a very important one. It has the theme of “Continuing on our collective path to ensure a comprehensive health system in South Africa”.


The war – if I may put that way – for an effective health care system started long ago. It is not a South African problem only; it is a global problem.


You are aware that the highest global authority on health is the World Health Organisation, WHO. The WHO has been aware for ages that there are problems with effective health care systems around the world. These problems, time and again, show themselves in various ways, especially in those parts of the world that are still developing and are troublesome.


The most recent example is what is happening in West Africa as far as ebola is concerned. While ebola is propagated by a biological organism, the truth of the matter is that if health care systems over there were effective, they would have been able to deal with it. HIV and Aids started 30 years ago in America, but the continent that is suffering the most is Africa, sub-Saharan Africa specifically, because of ineffective health care systems.


Next year, when the UN sits to evaluate what has happened over the past 15 years since the Millennium Development Goals, MDGs, were declared, there will be no debate about the fact that most of the countries that will not have met those MDGs declared by the UN 15 years ago will mostly be in sub-Saharan Africa, and it is because of this issue of ineffective health care systems. So, this is an age-old problem that we have to deal with.


The WHO tried to deal with this matter as far back as 1978 at a conference that was held in the small town of Alma-Ata. Alma-Ata was then in the Soviet Union. Today it is in the state of Kazakhstan. As you know, the Soviet Union no longer exists as a union. In that state of Kazakhstan, in the small town on Alma-Ata, the WHO met in 1978. Their starting point was to define health. Health has a clear definition that is accepted internationally. Unfortunately, time and again, we come up with our own definitions.


One of the most common definitions of health in South Africa, which is prevalent even in the corridors of power, is to regard health as curative medicine; to regard health as what happens when you meet a doctor or a nurse with injections or pills and it ends there. All our thinking is in that direction. That is not the definition of health agreed to by the WHO in Alma-Ata.


That definition of health is this — and I think it is important for me to read it as it is: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It goes on to say that the attainment of a higher standard of health is the most important worldwide social goal, and that its realisation needs action from other sectors — economic and social — in addition to the health sector.


Now, the Alma-Ata Declaration went on to define some of the problems that the world experienced then that made effective health care unavailable. The declaration says:


The existing gross inequalities in 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.


This is one of the problems that needed to be solved. In other words, it is talking about inequality. As long as inequality is allowed to exist, the whole concept of an effective health care system in many countries of the world will just be a pipe dream.


But now, I want to read the last article of the Alma-Ata Declaration. It has many articles. This one says:


Governments have a responsibility for the health care of their people which can only be fulfilled by the provision of adequate health and social measures. A main social target of governments, international organisations and the whole community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life.


Because of this last article, Alma-Ata ended with the slogan, “Health for all by 2000”. They said countries must chase those goals.


Remember, in 1978 the year 2000 was 22 years away. I remember I was a first-year medical student at the time. We used to complain that the year 2000 was too far away! If Alma-Ata says all people of the world must attain an acceptable standard of health that will make them live socially and economically acceptable lives, why did we have to wait for 22 years?


The bad news is that the 22 years came and went. We never arrived there in the way that is described here. Instead of arriving there, when those 22 years arrived by the year 2000, another declaration was made. This one you know very well. It is called the Millenium Development Goals.


Of those eight goals, which were agreed to by the UN – coincidentally, it was on our own soil, if you remember - it is instructive to know that three are all in the area of health. Of the eight, three belong to health alone. All the other government departments share the remaining five goals. We in health were given three.


Millennium Development Goal 4 says me must reduce the number of children who die before they reach the age of five by two thirds. Millennium Development Goal 5 says we must reduce by three quarters – not two thirds this time – the number of women who die during pregnancy and childbirth. Millennium Development Goal 6 says we must reduce remarkably the incidence of HIV/Aids, TB and malaria.


We were supposed to reach these goals by December next year. That was decided in the year 2000. It is not December 2015 yet, so we will not say we have not reached them, but I have already said it and I will repeat it: Most countries that will not be able to reach those goals will be in sub-Saharan Africa and in the developing part of the world. This expresses what was known in Alma-Ata in 1978, 36 years ago. So, it means there must be a problem here. The will is there. The recognition is there. The goals are there. But why are they not being reached?


If you look at the MDGs, you are going to find that education is going to reach their goal easily. And many other areas, like gender equality, we are already doing well. The struggle is always going to be in the health-related MDGs. There must be a problem. What is the problem? We think we know now, after all these many years. We think we now know where the problem lies. If you will allow me, I can summarise the problem as follows.


At the World Health Assembly, where all the Ministers of Health gather in May of every year, we usually, every five years, vote for the person who must be the Director-General of the WHO. This is done by popular vote, even though the person eventually has the title of director-general.


The year 2012 was a year for voting, and we voted in Dr Margaret Chan, the former director-general of health in Hong Kong. In her acceptance speech, which she delivered on 23 May 2012, she said that the reason the world is failing to attain all these goals, especially in poorer parts of the world, is that there are seven structural problems in health worldwide that we need to solve. If we do not solve those structural problems, we are going to encounter problems.


In other words, she meant that yes, we do have diseases, and we do have burdens of disease, like HIV and Aids, TB, malaria and now ebola. We have problems around child mortality, maternal mortality, etc. But she said that in order to resolve those, you need to deal with the structural problems of health in the world. And these problems are mostly political.


After the Alma-Ata Declaration was adopted in 1978, the WHO held a conference in 1981 in Brazzaville in the Congo. That conference was specifically called about South Africa. It took place in Brazzaville in Congo, where the WHO said that since South Africa had adopted the concept of health for all by the year 2000, how were we going to achieve that goal under apartheid? The conclusion was that the concept of health for all by the year 2000 was impossible in South Africa as long as apartheid existed.


So, these issues are political and for that reason, Dr Margaret Chan said what she said, and she meant the problem was in the whole world. Apartheid is gone in South Africa, which means we are now at the level where we must achieve this goal, but she was saying that this problem of structure existed for the whole world.


So, what are the seven structural problems of health? She said the first one was that we were experiencing rising health care costs, yet there was poor access to essential medicines, especially affordable generic medicines. This is the first problem.


When I cried genocide last year when pharmaceutical companies were refusing to let us change our intellectual property regime, my thinking was informed by this issue - that unless we have affordable generic medicines, the rising health care costs could never be afforded by the poor.


The second structural problem, she said, was that our emphasis was on cure. That leaves prevention by the wayside. In all the corridors of power, when people debate health, they will be talking about curative medicine, not preventive medicine.


Those of us who come from the Congress of the People movement will know that in 1955, this issue was discussed and finalised. At that time, the conclusion was written under “There shall be housing, security and comfort for all”. There are two areas that are mentioned, namely a preventive health care scheme that shall be run by the state, and secondly, that free health care shall be provided, with special emphasis on women and children. That is what is written in the Freedom Charter.


Many years later, Dr Margaret Chan said that the world still placed the emphasis on curing disease but left their prevention by the wayside. It means that a preventive health care scheme has not happened yet. That is why we have to put prevention at the centre of our new health care system.


The only country in the world — whether we like it or not, because I know many people challenge this — that can stand on top of a mountain and say that they are practicing preventive and not curative medicine is Cuba. Because of that, they have done away with many diseases that we still have here. They have done away with measles; they have done away with malaria; they have a very small percentage of TB and HIV and Aids, etc, because their medicine is preventive.


In 2012, when they got cholera for the first time in 50 years, some people were laughing and saying, yes, even Cuba has it, instead of saying that Cuba was able to hold it back for 50 years. How many times does cholera occur in our countries? There, they held it back for 50 years through preventive medicine.


So, they were saying that one of the structural problems is that unless health care systems start the issue of prevention, we will be in trouble.


The third structural problem, she said, is costly private health care for the privileged few, but second-rate care for everybody else. We know the figures here in South Africa. We are not saying - and I want people to be very attentive - there should not be private health care. What she is saying is that the costly private health care is for the privileged few, while, for everybody else, there is second-rate care.


In our country we even have the figures. We know that costly private health care is for 16% of the population. That is 8 million people. The second-rate care, which is everybody else, is for 84% of the population. That is 42 million people. So it is a problem that needs to be solved politically. It cannot be solved in the hospital ward or in the office of the hospital’s CEO. In the corridors of power - that is where the problem needs to be solved.


She said the fourth problem was grossly inadequate numbers of staff, or the wrong mix of staff. I cannot debate that.


The fifth one is weak or inappropriate information. I cannot debate that.


The sixth, she said, is weak regulatory control. In South Africa, this is very clear. Judge Jody Kollapen, in 2009, wrote about this when he was the chairperson of the Human Rights Commission and was doing an enquiry into health as a human right. He came across this problem that there is weak regulatory control in South Africa. What is he talking about?


At the moment, in terms of a law passed by Parliament, only medical aid is being controlled in private health care. The service providers, the private hospitals and the specialists - there are no rules to control them; they do whatever they want. You can go there now; they can charge you half-a-million rand and there is nothing you can do. You can go there now; they can tell you they are removing you from ICU because your medical aid benefits are finished and there is nothing you can do. You can go there now; the ambulance may refuse to take you on the basis that you have no medical aid and there is nothing you can do. That is the weak regulatory regime that we need to change.


She said that the last problem, the seventh one, was that we devised schemes for financing care that punished poor people.


So what is the solution? The solution is what we call universal health care coverage. You are aware that we are in the process of implementing it.


But to implement universal health coverage, South Africa first needs to solve two problems - two. There will be many more, but there are two main problems — and these are also indicated in the National Development Plan. The first problem that we need to solve is the exorbitant cost of private health care. The second problem we need to solve is the poor quality of health care in the public health care system which, for various reasons, I do not have time to discuss, but which Dr Margaret Chan mentioned.


It is for this reason that the President, on Tuesday, launched what we call the “ideal clinic” in Gauteng for the whole country. We are saying that we need to rearrange and restructure the public health service, starting from primary health care, as was decided at Alma-Ata has, whereby our clinics must be ideal. We have defined what an ideal clinic must look like in terms of the buildings, the administration, the health care systems, the operations, the everyday operations, etc. We have a model of what the ideal clinic looks like. We are preparing that ideal clinic as part of preparing for universal health coverage in order to have an effective health care system. Thank you. [Applause.]














Ms T G MPAMBO-SIBHUKWANA: I am checking my time, thank you, Chair. Hon Chairperson, hon members, distinguished guests in the gallery, firstly, I would like to thank the Minister, Aaron Motsoaledi, for addressing the NCOP today. Minister, I just want to say to you that your commitment to speaking frankly and admitting to the state of the health care system and the problems that exist in our country gives us confidence that we can make strides in improving and bettering the lives of our South Africans as a constitutional right. This is highly appreciated, Minister.


Unfortunately, this is not an easy task – it is easier said than done. Our health system is in a precarious state. We have a system that has daily struggles to provide for a complex society where the majority of our population face many social and economic ills on a daily basis. Where I have seen functioning health care and a functioning health care system, this has been due to good leadership and accountability in management


Last week I took the liberty of visiting Khayelitsha District Hospital in the Western Cape. I was curious to see how the health care facility is able to effectively serve one of the biggest townships in South Africa.



NjengomXhosa, ndiye ndaqonda ukuba ukuba andina kuthi tsii gxada, ndifake umnwe wam enxebeni ndizenze uTomas, ndibone apha ukuba indaba yotyelo ayikholi. Ndazivela ke.



I wanted to know if it was accessible, affordable and if it provided excellent service to our communities. My findings were that it went beyond that by addressing the needs for healthy behaviours and engaging the community on health issues specific to their environment. That was a good story to tell.


With almost 600 staff members, this hospital was planned to cater for the 1 million people living in Khayelitsha as the referral hospital. Here, patients are referred from local communities, health centres and clinics for hospital care. Having heard that the President has just opened an ideal clinic, I would like to say that we, in the Western Cape, have that on the go already. We have men’s clinics and youth clinics and we are addressing the real issues facing ideal clinics.


Currently, the Khayelitsha District Hospital receives over 2 700 emergencies and trauma patients monthly and it has an average occupancy rate of 131%. They deal with approximately 300 births per month. Mental health issues are prevalent due to substance abuse, and the HIV and TB medicine dispensed internally is quite high due to chronic lifestyle diseases. You just mentioned, Minister, how this was avoidable and preventable if people followed the right lifestyle.


Through all these challenges, I found that the hospital has become a bedrock for the community; a hospital that puts its client, the Khayelitsha community, and increasingly the Western Cape and South Africa, first; a hospital that is supported by the Western Cape provincial government, which constantly strives to provide more than what the hospital was initially built to do.


Not only has this hospital achieved acclaim for its well managed budget, administrative leadership, exemplary pharmaceutical service, dedicated staff and world-class facilities, as rated by the national Department of Health, but its green philosophy and state-of-the-art design put it as the leader in health care in our country. Now that is the best story to tell - and it comes down to co-operative government in the Western Cape.


Sadly, this is not representative of the state of our national health system. Around South Africa, the health services for the poor and the marginalised, who do not have access to private health facilities and medical aid, are under-resourced and in a state of disorder. It is for this reason that I want to bring the following to your attention: In Gauteng, many hospitals are in desperate need of refurbishment and repair, while the Gauteng department of health continues to underspend on its allocated budget for this year. According to the department’s second quarterly report, tabled in the Gauteng Legislature, only 54% of the budget was spent out of the R914 million that was allocated for the period April to September 2014.


Such underspending is damaging to the health care system and compromises hospitals’ ability to deal with health problems due to the lack of basic necessities for care, such as staff and resources. Underspending by the Gauteng health care department has also led to the inability of the Chris Hani Baragwanath Hospital and Charlotte Maxeke Hospital to fix major sewerage problems, creating a health hazard for both patients and staff at the hospital. As a medical professional, you will know what this means. I do not need to remind you of the various communicable diseases and illnesses that thrive and rapidly spread under such unsanitary conditions.


In the case of Nessie Knight Hospital, which we visited during our oversight visit to the Eastern Cape, the poor infrastructure of the hospital, which was built during missionary times, is a cause for concern and it has had a detrimental effect on the running of the health services at the hospital. After 20 years of democracy, it is a concern that our citizens are still desperate for redevelopment. To use Afrikaans words that are quite true: “Beloftes maak skuld.” The community did say to us that they had been promised that there would be development - up until now. That is for your attention, Minister.


The dilapidated buildings not only affect the quality of the stay for patients but also have an effect on staff turnover. At present, the hospital functions without an isolation ward and, as a result, patients have to travel for four hours to receive care in East London. This is cause for concern. We have to bring services to the people, so let us get them closer to the people. That is justice and human rights. Currently the Nessie Knight Hospital has a staff vacancy rate of 36%, and the hospital has trouble filling vacancies due to the state of the staff accommodation buildings, which are old and gradually deteriorating.


The Rob Ferreira Hospital in Mpumalanga is another cause for concern, Minister, and I want to bring to your attention that it is plagued by maladministration and poor leadership. The problems range from dysfunctional boilers to an exorbitant vacancy rate, water shortages and a lack of proper theatre tables. These are great cause for concern. This compromises people’s constitutional rights and their right to life.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Hon member, your time is up.


Ms T G MPAMBO-SIBHUKWANA: I await the next report with bated breath – let me finish off, please...


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! I have given you extra seconds but now your time is up.









Ms L C DLAMINI: Hon Chair, I notice that the hon Mpambo-Sibhukwana cannot wait to be the chairperson of this committee because she is reporting on the Nessie Knight hospital. This is an outstanding report and as the Select Committee on Health we still have to present it, but anyway, I will allow her to do that.


Hon Chairperson, hon Ministers in our midst, MECs from different provinces, hon Members of the NCOP, Salga representatives, if they are here, allow me to start off by saying that we are debating this very important debate about an effective health care system under the theme, “Continuing on Our Collective Path to Ensure a Comprehensive Health Care System in SA”. We are hosting this debate just five days before the international campaign of 16 Days of Activism for No violence Against Women and Children. It is a bad thing that this violence is perpetrated by the very people whom we expect to provide care and protection to us. We are saying to them: We deserve your love and protection. It must stop; and it must stop now!


Perhaps, as this council, we have reached a tipping point where we need to put aside our political affiliations, our class, gender and our race to confront the issues of the health system in order to benefit our people, whom we represent in this House. Through their votes our people have entrusted to us the duty to ensure that the services we provide are of benefit to them.  


Maybe we should stop criticising each other and stop standing in the way of the current government when we try to implement these progressive policies. This calls for united action to move South Africa forward, as has been said by the ANC through its manifesto.


To do so, or to be able or relevant, we need new levels of thinking, or a paradigm shift, to deal with the issues affecting our health systems. Those who were there during the apartheid system may have to change their thinking, because their thinking when they created the problems in the health system may not be relevant now when we are trying to change the issues of the health system to make it effective.


Also, those who came to this House to prove a point - that the ANC is not doing enough - will have to change their thinking. According to Steven Covey:


We need a new level, a deeper level of thinking; a paradigm based on the principles that accurately describe the territory of effective human being and interacting to solve these deep concerns. This new level of thinking is what Seven Habits of Highly Effective People are all about.


Transforming the health system in the country has not been an easy journey. It has been a long journey. If you look back to 20 years ago and recognise where we are today, we should thank you very much, hon Minister, and the ANC which is leading this government, as well as their health plan, which was introduced even before we got into power. We can proudly say that we have come this far and we are proud of what we have done so far.


I must congratulate the ANC-led government for having passed the test of highly effective people, as described by Stephen Covey, without knowing that they were doing so. In the first place, Stephen Covey uses the words, “Be proactive.” The ANC had a plan before it was in power. Secondly, he says, “Begin with an end in mind.” That is the vision of the promotion of comprehensive primary health care that will benefit all people, regardless of their colour, class and economic status. Thirdly, he says, “Put first things first.” That is what we did.


We transformed the apartheid laws. We made access available to people who did not have access before. We dealt with issues of money: Our people were not able to access health services, as the Minister was saying, because it was very expensive.


Fourthly, Steven Covey said, “Think win-win.” This health system that the ANC came up with benefits everyone. It does not discriminate because of colour, status or class. It benefits everyone. Fifthly, he says, “Seek first to understand in order for you to be understood.” As I am speaking now, we are talking about 3 507 health facilities that this ANC-led government has produced so far to ensure access to health care. We are now at the level of sharpening our saw. That is why we are inviting all of you to join us. Otherwise you will not be relevant to the people who elected you into this position of power.


It has been difficult to achieve this because the former SA government, through apartheid policies, developed a health care system that was sustained through the years by the promulgation of racist legislation and the creation of institutions such as political and statutory bodies for the control of the health care professions and facilities. These institutions and facilities were built and managed with the specific aim of sustaining racial segregation and discrimination in health care. That is why we cannot ask, “Why is this happening in this hospital.” This is the legacy of apartheid. They have answers where they are sitting. You cannot be asked to respond to those issues. That is why we are calling them to join us in cleaning the mess they have created, even if we were not in the House then. [Interjections.] [Laughter.]


Allow me to borrow from the words of the hon President when he was launching Operation Phakisa 2. According to the hon President,


This history [of community oriented primary care] dates back to the 1940s, when the late Professor Sydney Kark and his wife Professor Emily Kark established the health centre approach in Pholela, in KwaZulu-Natal, and introduced a community-based approach to health care delivery. The seminal work done in Pholela became a beacon for many countries.


When the apartheid Nationalist-led government – which some on my other side still represent - ascended to power in 1948, the pioneering work of Prof Kark and his family was reversed. However, their work was not in vain, because community-orientated primary health care remains highly relevant to health care delivery in South Africa today.


Over the 20 years of democracy, our country has made major strides in ensuring that we reach our dream as perceived before 1994, when we took over. Our National Health Act of 2004 provides a framework for public accountability through community involvement in health issues. We are saying that health cannot be an issue of government only; our people have to be part of it.


The hon Minister spoke about the ideal clinic and a maintenance programme that are rooted in the ethos of primary health care. Allow me to borrow again from the words of the hon President when he said on Tuesday:


I am convinced that the masses of our country would define an Ideal Clinic as a health facility that possesses the following characteristics:

It will be a clinic that opens on time in the morning, according to its set operating hours, and which does not close until the last patient has been assisted, even if this is beyond the normal closing hours. […]

The ideal clinic will provide community-based health promotion and disease prevention programmes in collaboration with the community.

It is very clean, promotes hygiene and takes all precautionary measures to prevent the spread of diseases.

It has reasonable waiting times and community members do not have to sacrifice their entire working day to seek health care.

It provides a comprehensive package of good quality health services every day and community members do not have to return on different days for different services.

It has the basic necessities available, such as essential medicines.

It refers people to higher levels of care timeously when this is required.

It works together with the community it serves, with diverse stakeholders, in promoting health and socio-economic development.


Finally, I would like to invite these hon members to join us as we achieve these ideal clinics. I thank you. [Time expired.] [Applause.]












Mr G P MASHEGO (Mpumalanga): Hon Chairperson, the hon Minister in our midst, hon members, colleagues in the executive councils and special delegates, I greet you. I am humbled to be in this House and share with you Mpumalanga’s contribution to the continuity of our collective path towards ensuring a comprehensive health care system. Let me first start by saying that, in terms of government structures, in Mpumalanga we have reached a milestone because we have functional hospital boards and functional clinic committee structures. As a member of the executive council, I have embarked on a programme of outreaching these structures by putting them under one roof, so as to find a way of integrating them, as we confront the challenges that this sector is facing.


Our new democratic government focuses on building an integrated and comprehensive national care system, redressing historical inequalities and enhancing access to health care by all South Africans, in particular those from disadvantaged communities. Mpumalanga’s population is 4,04 million and, according to the 2011 population census, 88% of this population does not have medical aid. This simply means that the 88% depends on our Public Service. The National Development Plan envisions a health system that works for everyone, produces positive health outcomes and is not out of reach.


It is for these reasons that the implementation of the National Health Insurance, NHI, which seeks to ensure universal coverage in terms of health care to all South Africans, irrespective of their socioeconomic status, is currently being piloted at the Gert Sibande District Municipality, an area with the highest HIV/Aids prevalence in the province. However, we are noting progress in respect of this prevalence, which has declined from 46,1% in 2011 to 40,5% in 2012. The department will continue to implement preventive and promotive strategies, with the aim of furthering the reduction of new infections.


In terms of the implementation of the NHI, we are modelling two facilities as ideal clinics in the district. These include Ubuhle Bempilo in Msukaligwa Local Municipality and Nthoroane in Dipaleseng Local Municipality. We will continue to roll out the implementation of the National Health Insurance in other districts. The department has the daunting task to ensure maximum performance in terms of service delivery in our health facilities, while re-engineering an effective health system.   


The department was placed under curatorship due to financial management challenges. During this period the department has reviewed internal control processes to address the challenges. I can report that the curatorship has now been lifted from the department. This followed the development of a turnaround strategy by the department, detailing how we are going to effectively manage the financial resources, thus ensuring that the financial status does not fall into the red again.


The department had serious challenges of high vacancy rate which contributed to the negative performance. Progress has been made as we have managed to advertise a number of critical posts. This has resulted in the appointment of the head of the department. We are currently finalising the appointment of some of the critical posts such as hospital chief executive officers and senior managers, which includes the supply chain. We have done an honest assessment of the level of performance of our health facilities in the provision of quality health care.


Throughout, we have observed consistently that there is a shortage of skilled health personnel. We have ageing infrastructure, inadequate medical equipment, ageing boilers, a shortage of linen, the poor management of medical waste, problematic staff attitudes, inadequate security measures and the overpricing of food supplies. The department is in the process of addressing these challenges. We are replacing some of the ageing boilers in some of the hospitals, such as Bethal Hospital. The department has taken the resolution to demolish and reconstruct some of the oldest hospitals, such as Mapulaneng and the asbestos-built Sabi Hospital, with the intention to build new ones. We have set aside R70 million for that.


We have also standardised the pricing of food provisions in all the hospitals and ensured that the supply of linen remains effective. The department had challenges regarding medical waste removal in our health facilities and we have already advertised the tender for medical waste removal. The department also experienced serious challenges with the payment of overtime for our health professionals, grading, pay progression and translations that date back to previous financial years. These are some of the reasons that we have seen a number of strikes in our hospitals, in particular at Rob Ferreira Hospital. These challenges will now be addressed as the department was allocated an amount of R35,234 million in the Mid-Term Budget Adjustment and we believe that we will be able to close the gaps.


The department has also provincialised all 65 of the local municipality clinics, as mandated by the National Health Act. Our department continues to lose medical and nursing personnel to the private sector, as it pays better salaries than the public sector. We are also faced with the challenge of the high rate of resignation by our nursing personnel because they want to cash in their pensions. The nursing personnel reapplied to our facilities after they had received their pension payout, and because of the demand, we are forced to re-employ them.


The department is performing well in terms of malaria control in the country and our programme is now aiming for malaria elimination, which means that zero local malaria cases should be reported by 2018.


Our province was hit by the death of young initiates in some of the initiation schools. Our tightened relationship with the Department of Co-operative Governance and Traditional Affairs, the House of Traditional Leaders, and in particular the Ingoma Forum, assisted us to address this matter. Jointly we have managed to reduce the death of initiates from 31 to five this year, in 2014. Our continuous campaign is, “Get wise. Get tested. Get circumcised.” [Interjections.]


The department is continuing its efforts to reduce fatalities in our initiation schools through pretesting, prescreening and the provision of medical services by our medical staff through Ingoma Forum. A total of 93 353 medical male circumcisions were performed, against the target of 50 000. The numbers of high transmission area intervention sites were increased from 64 to 70 sites in 2013-14.


The continued preventable death of mothers and children due to the complications that arise as a result of pregnancy and childbirth is still a worrying factor. We have reduced maternal mortality through the implementation of primary health care re-engineering and the functional referral system. We also hope that the recently launched programme, Mom Connect, which was launched by the hon Minister of Health, Dr Motsoaledi, will play a vital role in ensuring that pregnant mothers report to our health facilities in the early stages of their pregnancies.


The department is focusing on several interventions to decrease the high maternal and child mortality rate. Five maternity waiting homes have been established in 2013-14 and three will be established in the current year in district hospitals in order to address the long distances and the inhospitable terrain that make access for women and children difficult or impossible in case of emergencies. The Mpumalanga province shows improvement in maternal mortality from 166 in 2012-13 to 133 per 100 000. However, the increase in child mortality from 8,3% to 10,7% per 1 000 live births is a concern.


Renovations are currently being done in the following hospitals at an cost of R71,326 million: Amajuba, Evander, Embhuleni, Middelburg, Tintswalo, Matikwana and Mapulaneng Hospitals. As a province we have roped in the private sector to address some of the backlogs. Ferrometals, part of the Samancor group, is currently building a clinic in Ackerville, which falls under the Emalahleni Local Municipality. Sasol has built a clinic at Bethal and they have given a commitment to the Deputy President, the hon Cyril Ramaphosa, to build another one soon at Embalenhle under the Govan Mbeki Municipality. That was when the SA National Health Council’s plenary meeting was held in Secunda.


Glencoe Mine is about to build a clinic at Kwazamokuhle in Hendrina, which falls under the Steve Tshwete Local Municipality. PHB Billiton has committed to build two clinics, one at Phola in Emalahleni and the other one in Mhluzi in the Steve Tshwete Local Municipality.


Against the background of the vision of our Minister, Dr Aaron Motsoaledi, we can summarise the challenges and the problems that the health sector faces as, mainly, human resource problems, financial management problems, procurement problems and infrastructure development needs. As a province we commit to improving our performance in respect of these identified challenges. I thank you. [Applause.]     











Mr M KHAWULA: Hon Chairperson, hon Minister, I want to start by acknowledging the honesty with which you always approach health issues. It is indeed unacceptable that some people just want to politicise health issues, while people are suffering.


Our health system is facing challenges and many of our people feel the brunt of this overwhelming phenomenon. Government has continually striven to ensure that our people are taken care of and to assure them that access to basic health care is a priority.


At the national level, we have seen how the Department of Health has specifically striven to tackle diseases on a broader level, with specific drives to tackle HIV/Aids and TB and even being prepared to tackle any ebola-related cases to ensure that it would not spread to the population. We must also commend the department, as well as the Minister, for their effective communication and the preparedness they have shown to deal with any suspicions of reported ebola cases in South Africa, should these arise.


On the ground level, however, things are not as focused. Many clinics and hospitals continue to be short-staffed and many of those who do not work are ill equipped to deal with the overwhelming number of cases they encounter.


There are issues that do not require mostly financial resources but commitment and dedication. I remember that in 2009, the former Minister of Finance introduced the concept of “doing more with less”.


Horror stories also emerged from many communities of how some staff members treat patients. In other cases, the lives of patients are put at risk by staff members’ attempts to obtain high salaries. Children have been born on the streets outside hospitals because expectant mothers were being abused. In other places, people have to travel long distances to get to these hospitals and clinics and in some cases these journeys are a waste of time and money as they can hardly find a doctor to see them. This cannot be allowed to continue.


In order for us to truly have a comprehensive health care system, we cannot just hope that all communities are on the same page. We need provincial government to not only be fully on board with the idea, but also involve communities that need these services and supply not just staff but the much needed equipment that most hospitals and clinics sorely lack.


We need to be on the same page, reading from the same book. We cannot have a national government saying one thing, while provincial and local government go their own road, which does not help us to walk a collective path.


All our people need access to comprehensive health care. However, the current structure in our society favours those with the financial ability to pay for their comprehensive health care needs. One’s health cannot be allowed to rely on whether or not they have access to large sums of money. This sends a message that one’s life is measured by one’s circumstances.


If we are to walk the same path, we must all hear the same message. Our people need health care, especially in the rural areas and isolated areas. We must not fail them in our drive to build a comprehensive health care system. I thank you, Chairperson.







Mr S M DHLOMO (KwaZulu-Natal): Hon Chairperson and members of this House, our hon Minister, my colleagues, MECs and our chairperson of this select committee, Mme Dlamini, thank you very much for once more inviting us to come and actually present what I would call - hon Khawula - our showcasing of what our directives from the Minister are in the various provinces.


On 4 September this year, at Richards Bay Airport, led by our hon Premier Senzo Mchunu, we launched the revolutionary aero-medical night vision goggles. These goggles allow us to fly helicopters not only between 07h00 in the morning and 17h00 in the evening. The night vision goggles are specially designed and are generally used in military and settings. Our crew on board can now see a patient or a person 140 m away, even on a moonless, cloudy night. With this kind of technology, we would like to and we are now able to improve the quality of life of our people, by reducing morbidity and mortality. [Applause.]


We are proud of the fact that these night vision goggles can now be used in aero-medical services. The fact that these goggles can now be used by a medical programme is a first of its kind in the province and the first of its kind in the country.


Eskom has been hailed once again for supporting in a remarkable way the HIV antigen testing campaign, which was launched by the hon President in 2009. Among the things that Eskom has done was to support us in this campaigns at the Medupi and Kusile sites in 2011 and 2012.


Just recently, in KwaZulu-Natal, Eskom had a similar initiative, which was launched in September this year, at the Ingula Pumped Storage Scheme. Our premier, the premier of the Free State, the Minister in the Presidency, Jeff Radebe, who was representing the chairperson of SA National Aids Council, His Excellency the Deputy President, came and launched this programme.


At this particular event, Eskom donated a primary health care mobile clinic, better termed a “miracle on wheels”. This mobile clinic is customised to provide high-end health care services to primary school learners from both the uThukela District in KwaZulu-Natal and the Thabo Mofutsanyane District in the Free State. The learners will have access to much-needed eye care, dental hygiene and general health check-ups. This is something that is extremely revolutionary.


On the performance of Mom Connect, which my hon colleague Mashego spoke about, this initiative provides the mother with a toll-free number that she can use to send messages, including a “please call me” number. We are very grateful to our Minister for launching such an innovative programme because, among other things, it has the capacity to reduce child mortality and to improve on maternal and health outcomes. [Applause.] The statistics that we have indicate that in KwaZulu-Natal, 20 523 KwaZulu-Natal mothers-to-be registered with Mom Connect by the end of October.


These mothers are also free to use the number to place complaints about the service they receive at a particular health facility. Complaints have indeed been registered. At our National Health Council meeting in October, a report was shared with all of us as MECs about what women were saying In my province I can record the following: There were two complaints. One woman was continuously getting messages and she actually wanted those messages to stop because she had a miscarriage. We just did not pick up on it in time.


On that occasion we also heard the accolades and compliments that this system was receiving. Thank you very much for this, hon Minister. One woman said, and I quote:


I would like to compliment one nurse at Ntuzuma Clinic. Her name is Nomalanga. She is very kind and she treats us patiently since the day I came to this clinic.


A second woman said, “There is 100% service support at Ngcolosi Clinic.” A third woman, a patient at KwaMsane Clinic at Mtubatuba, had this to say: “Thank you very much for this communication for all of us mothers to be; it really means a lot to us.”


We are therefore very encouraged that these programmes are not only giving a lot of ammunition to our patients, but is also giving them support. Already, the province is sitting at a Prevention of Mother to Child Transmission, PMTCT, rate of 1,2%. We are extremely grateful for this because it means we are going down every year. Last year we were at 1,6% and this year we are at 1,2%, which is something that is very important.


One of the prevention programmes that the Minister put in place this year, among other things, was the launch of a human papilloma virus vaccine programme. It focused on all Grade 4 girls, nine years younger. In KwaZulu-Natal, in the first round of this campaign, which ran from March 10 until 11 April, of the 79 750 girls we were able to immunise 68 000, which came to 86%. A total of 11 000 girls were not found and not immunised, either because they were not at school or they are under age and did not have parental consent for this.


The second round started on 29 September and has just ended, on 31 October. In this second round, we did not do very well. We just had 72% of the girls that were targeted. Among other reasons, this was because we had to catch up with those who had missed out in the first round.


Another of the preventive programmes that we hail our Minister for and thank him for giving us support on is the very important programme on Implanon that he launched last year. This is like hot cakes in our province. Currently we have recorded that 189 503 women have taken this Implanon programme. It largely focuses on the female age group of 18 to 25 years.


We think Implanon has been such a wonderful preventive programme because, among other reasons, the insertion takes a very short while - just one minute – and it is conducted under local anaesthetic. Also, women do not have to come back to the clinic to have it removed or whatever and the rod actually sits there for three years. It is effective for three years, but should any woman decide within that period that they do not want it, they can come back to have it removed and their fertility comes back immediately.


One of the things that we are not that proud of, but that we have to do is curative. Just last week we launched a Medical Orthotics and Prosthetics Unit, which is the second one, after the one at the Tshwane University of Technology. We launched this with the Durban University of Technology and we have admitted 25 students. This is actually the biggest programme that we have in the country. We have found that the people who are working in this type of service are ageing, and we do not have people to replace them. Now, through this partnership with the Durban University of Technology, we have students who are being trained as midlevel workers for this programme, where they will be building artificial limbs for people who have been involved in accidents or had to have diabetic amputations.


We currently have three students from Angola who are studying there too. That country supported our country during those wars and there are too many people who are without legs and limbs in that country.


The other programme that we are proud of and which is part of preventive medicine – again, the Minister is underpinning this - we have decided to take health services to the taxi ranks in our province. We have worked on this with SA National Taxi Council, Santaco, and the leadership of all taxi ranks. Currently, we have clinics at taxi ranks that are operational daily at Ethekwini, Amajuba, Ulundi, Umzinyathi and Umgungundlovu.


The reason we are doing this is that we want to give the benefit of the doubt to males, because they are not using our facilities. It is not so much that they are scared but they are just not there. So, our clinics open early in the morning. When they are already in their taxis and cars on the way to work, that is too late. So we are catching them early at the taxi rank and they are extremely happy to use our services.


To refer to one of the programmes that our Minister has touched on, that of the one country that has been able to focus successfully on preventive medicine, Cuba, we have 85 medical students who have now graduated and who are working in our province as doctors from Cuba since the programme started. We have 702 other students who are training in Cuba in various years of study. Just last week we sent another group of 96, which in the end makes the number for KwaZulu-Natal to be 798. [Applause.]


I also want to say that we are always going to need nurses all over our country. We are very proud that we continue to train nurses, but also that we are focusing on areas of specialising. There are certain nurses who have just qualified in specialised areas this year: 61 specialised in midwifery and neonatal nursing science, while 36 other nurses qualified in advanced midwifery. We also have 100 nurses that completed the programme on ophthalmology. That is now nurses that are going to be fighting ...


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Please summarise, hon MEC, your speaking time is running out.


Mr S M DHLOMO: We have 200 nurses who have just completed primary health care training. My colleagues have spoken very well on Operation Phakisa and we want to say to the Minister that we will take that process forward.


We have three districts in the province that are focusing on the National Health Insurance initiative and if time allowed I would have reported on the progress that we are making there. However, we want to assure the Minister and this House that we have it; that we are focusing on this programme and that we are actually going to do very well on this programme, under the leadership of Dr Aaron Motsoaledi. Thank you very much. [Applause.]







Mr S M DHLOMO (KwaZulu-Natal)





Ms M F TLAKE: Hon Deputy Chairperson, I think I have to start by first correcting hon Kawhula of the IFP and hon Mpambo-Sibhukwana. They misled the public by saying that the hon Minister actually accepted that South African society was suffering and that the South African health system was collapsing. What the hon Minister said was merely that he was making a comparative study with the Alma-Ata conference that he attended. He actually said that developing countries had many challenges when it comes to meeting health standards. He did not say that our health systems were collapsing and that our people were suffering. You have just misled the community out there and you were out of order. [Interjections.]


Let me then tell you how our systems are doing in South Africa. As the Mpumalanga and KwaZulu-Natal health MECs just said... [Interjections.]


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! Just hold on, hon Tlake. Yes, hon member, do you have a point of order?


Ms T G MPAMBO-SIBHUKWANA: Yes, hon Deputy Chairperson, I would like to make a point of order to the hon Tlake...


The DEPUTY CHAIRPERSON OF THE NCOP: Order! May I hear your point of order?




The DEPUTY CHAIRPERSON OF THE NCOP: No, you must address me. No, no, no, hon Mpambo-Sibhukwana, you need to address me!


Ms T G MPAMBO-SIBHUKWANA: Chairperson...


The DEPUTY CHAIRPERSON OF THE NCOP: ... on your point of order.


Ms T G MPAMBO-SIBHUKWANA: Chairperson, on a point of order...



Nkabe ke buile Sesotho ha e be...


The DEPUTY CHAIRPERSON OF THE NCOP: Order! No, you must address me, hon Mpambo-Sibhukwana.



Mof T G MPAMBO-SIBHUKWANA: Nkabe ke buile Sesotho...


The DEPUTY CHAIRPERSON OF THE NCOP: Hon Mpambo-Sibhukwana, you need to address me on a point of order.



Mof T G MPAMBO-SIBHUKWANA: Motlatsa Modulasetulo, ntlha ya tokiso: Ke batla hore ho motlotlehi Tlake, ha e be ke ne ke tsebile hore ha a utlwisisi sekgowa, nkabe ke buile ka Sesotho.


The DEPUTY CHAIRPERSON OF THE NCOP: No, no, no! Now we are debating.



Dula mo fatshe! Dula mo fatshe!



Mof T G MPAMBO-SIBHUKWANA: Nkabe ke buile ka Sesotho. Ke bolela hore, ha a sa tsebe disemantiki [semantics], ne ke tla mo hlalosetsa.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! No, no, no, you are now debating! Hon member, you are out of order. Please sit down.


Hon members, do not raise a point of order only to then want to start a debate. If you are on the speakers’ list, you will have the opportunity to debate. Hon Khawula, on what point are you rising?


Mr M KHAWULA: I rise on a point of order, hon Deputy Chairperson.


The DEPUTY CHAIRPERSON OF THE NCOP: May I hear your point of order?


Mr M KHAWULA: I want to state that the hon member was misquoting me.


The DEPUTY CHAIRPERSON OF THE NCOP: Order! Please speak into the microphone. I did not hear what you said.


Mr M KHAWULA: I want to state that the hon member was misquoting me, Chairperson.


The DEPUTY CHAIRPERSON OF THE NCOP: By saying what, hon member?


Mr M KHAWULA: By saying that I said the Minister had said that the health system was crumbling. I did not say that. I only acknowledged the honesty of...


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): No, that is not a point of order. Please continue with the debate, hon Tlake.


Ms M F TLAKE: Hon Deputy Chair, I have always said that listening was a skill.


So let me tell you, over and above what the Mpumulanga and KwaZulu-Natal MECs for health said, what the South African health system looks like.


The National Development Plan Vision 2030 mandates South Africa, in respect of health, to raise the life expectancy of South Africans to at least 70 years. It calls for the prevention of tuberculosis, HIV and Aids, and malaria. Furthermore, it calls for a reduction in maternal and infant mortality. The ANC-led government, as a caring government of the people, has realised that in order for the NDP mandate to be given effect, the following needs to happen.


Health services must be brought to where the people are and should be accessible to communities. The ANC has taken a sound resolution that no man, woman, child or elderly person will have to walk for long distances on hot, cold or any other day, looking for health facilities. So, through what we call the district health system, health care is brought to the people.


Furthermore, we have clinics in every municipality, which are ward based. As the Western Cape MEC said, we are witnessing active public participation in these ward-based clinics, where communities are able to advise the health workers. They actually participate through clinic committees. They are part of primary health care in their communities. They have a say in the health care given to them. They are no longer passive beneficiaries of health care, as it used to be.


Let me ask you a question, hon colleagues. Have any one of you, during these 20 years of democracy, ever frequently heard the breaking news that a woman had died while giving birth, or that an infant had died during its birth? Unless there are very, very exceptional cases, the answer will be no. Do you know why? Because of the caring governance of the people; the caring ANC under President Jacob Zuma. For me, families, men and women of South Africa, this is a very good story to tell. [Interjections.] Yes, a good story indeed. South Africa is ranked as one of the leading countries in the reduction of the maternal, infant and child mortality rate, which is one of the Millennium Development Goals.


In our wards we have district hospitals that perform initiation that is clean, healthy and free of charge. Ke re mahala hala. [I say, free of charge.] This is all because of the ANC – the glorious government of the glorious ANC.


Notwithstanding the above, we acknowledge the fact that we still have challenges, like at the Pelonomi Hospital in the Free State, which is said to be collapsing. In the wink of an eye, Minister Motsoaledi intervened. This shows how this glorious ANC cares for its people.


In conclusion, I want to say, as a healthy society, we can become a healthy nation, united in our diversity. We can hold hands as we take South Africa with its healthy South Africans forward. Thank you.


Mr M MASIKE (North West)





Mr M MASIKE (North West): Hon Chair, hon Minister, hon colleagues, hon members, our collective journey towards a comprehensive health care system in South Africa is a matter of national interest. It is in our national interest to develop an effective health care system that will lead us towards achieving our goal of a long and healthy life for all South Africans. All South Africans, tall, short, brown – all South Africans. This is the goal we embark on as we continue to build on the gains of our freedom, which we attained through the sound principles of the Freedom Charter.


In 1994, the ANC introduced a National Health Plan for South Africa, which is the basis for the transformation of the health care system in South Africa. We recognised through this plan that every person had the right to achieve optimal health, and the ANC is committed to the promotion of health, using the primary health care approach as the underlying philosophy for restructuring the health system. Primary health care is thus an integral part of both the country's health system and of the overall social and economic development of the community.


Central to the primary health care approach is full community participation in the planning, provision, control and monitoring of services. We have a full complement of hospital boards and clinic committees that work with us. We strongly believe that the communities experience the health care system; they feel it. They are therefore better qualified to advise us on how best we can improve it. We strongly believe in total quality management, that there can never be the best way of doing anything. There must always be a way of improving everything all the time.


We have strategies in place to ensure a comprehensive health care system in South Africa and these are, as we all know, the National Health Plan for South Africa, as I have said; the 10 Point Plan for Health; National Negotiated Service Delivery Agreements; National Health Insurance, NHI; Re-engineering of Primary Health Care; and, ultimately, the Vision – the National Development Plan, specifically chapter 10 of the NDP.


We have started to earnestly implement these strategies. The purpose of the NHI is to make health affordable and to make sure everyone has access to health, especially the poor. This is an innovative system of health care funding that is state mandated, state managed and free at the point of care. With the NHI, we are in the process of improving health systems through a phased-in pilot implementation programme.


With the Re-engineering of Primary Health Care, the purpose is the prevention of diseases. The primary health care teams visit households – these are ward-based outreach teams - and these outreach teams are from local communities, led by a professional nurse. Their purpose is to assess household health and social needs and then refer to the relevant institutions. We accept that the challenges of health are not necessarily a departmental issue; they are actually societal issues in which members of the community must participate.


On a broad scale of collective engagement on our path to ensuring a comprehensive health care system, we introduced the Negotiated Service Delivery Agreement. This is a charter that reflects the commitment of key sectoral and intersectoral partners linked to the delivery of identified outputs as they relate to a particular sector of government. Each outcome is linked to a number of outputs that inform the priority implementation activities that will have to be undertaken over the given time frame to achieve the outcomes associated with a particular output.


We have a vision. This vision is that by 2030 we want to see a health system that works for everyone and produces positive health outcomes. We believe with this vision that, collectively, it is possible for us to raise the life expectancy of South Africans to at least 70 years; ensure that the generation of under-20s is largely free of HIV; significantly reduce the burden of disease; achieve an infant mortality rate of less than 20 deaths per 1 000 live-births; including an under-5 mortality rate of less than 30 per 1 000.


Ensuring a comprehensive health care system in South Africa therefore indeed requires a collective effort by all. It is a responsibility that we cannot afford to fail in achieving. We have 100 nurses that have just recently qualified for Nurse Initiated Management of Antiretrovirals. We are beginning to be creative by exploiting our expertise over the years to use the platform of HIV/Aids. We have recently relaunched our revitalised HIV Counselling and Testing campaign and in the same approach we invited our first lady, Mme Thobeka Zuma, to be with us to be able to influence chronic disease management as a champion of cancer in our communities so that we begin to use our infrastructure in terms of HIV/Aids; to be able to promote a healthy lifestyle and cancer prevention.


We have recently bought the first helicopter ambulance for the province. It does not only transport patients, but also takes specialists to remote areas. You would know that the North West is 60% rural and sometimes you need specialists to be able to access very distant hospitals. We recently bought 10 obstetric ambulances and we hope to make sure that we buy eight others before the end of the financial year.


We have said and we are continuing to say that we need a critical mass of like-minded people to transform society. We used to send 10 students to Cuba and we have increased this by a 1000%, because at no stage over the last four years have we taken less than 110 students. If you look at this mathematically, if it was 10 and you increased it by another 10, the number becomes 100%, increase by another 10 and it becomes 300%. So we have actually increased this 1000%. We are very happy that ultimately we will be able to solve our problems. [Interjections.]


We must also say that we have been consistent in making sure that government funds are safe in the hands of the North West department of health. We have once again been able to receive an unqualified audit report.


We have also increased our tertiary services plan. Medunsa will take Rustenburg and train some of their students and Wits will use the Klerksdorp Hospital. We are busy. We are improving our infrastructure. We have recently opened our Brits Hospital and in Taung we have finished building three clinics. We have just finished Buxton clinic and we are busy with Sekhing. Thank you very much.









Mr J J LONDT: Hon Chair, there are some topics where we as public representatives – sorry, can I have my starting time, please? Can you please give me an indication?


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Is there something wrong with the timer?


Mr J J LONDT: The last time I did not get my…


An HON MEMBER: You are wasting time now!


Mr J J LONDT: No, no, I am not wasting time.


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): All right, we are going to start from zero, using this timer. You must listen for that sound.


Mr J J LONDT: Thank you. Hon Chairperson, there are some topics where we as public representatives should look at ourselves and ask if we are truly delivering the best possible services to the citizens of our beautiful country. Education and health are definitely, in my opinion, the top two departments were we must honestly look at ourselves, irrespective of party political affiliation and give credit where it is due, but also be honest and acknowledge where we must improve.


Firstly, South Africa is definitely better off now for the majority of South Africans than we were in 1994. Secondly, we have a national health Minister who, had he been in charge of this department since 1994, would not have had to fix so many of his predecessors’ work. However, as is the DA’s experience in the City of Cape Town, in the Western Cape province - and what we will soon experience in the Nelson Mandela Metropolitan - you are held responsible when you govern, even if you have to account for the mess of your predecessors.


So, hon Minister, if we are honest today, we must acknowledge that we have a serious problem in South Africa in our health system. The national Department of Health should provide norms and standards and not try to do the management and the administration of health services at arm’s length. This is the responsibility of provinces and districts and it is here, in the NCOP, where we are failing as an institution. We should hold our provinces responsible if they provide second rate health care, as referred to by the Minister. [Interjections.]


The ANC speakers here today, and also in previous debates, are becoming expects in hypocrisy. Listen to every speech - almost every single DA speech gives credit where it is due, but we also highlight areas where we need to improve. Very few ANC speakers do the same. If colleagues wrote their own speeches, try to do that, or ask the speech writers to do it. [Interjections.]


Hon Dlamini, I am not going to comment on the speech that you read out. You mentioned leaving a bad legacy; I guess you are an expert after leaving Mbombela. [Interjections.]


Hon Mashego, you complained about losing health professionals in your province to the private sector. Maybe the curatorship should not have been lifted after only four months and maybe those health professionals would have received their outstanding overtime - and I am not even going to mention all the other financial woes.


Hon Dhlomo, even though there are problems, you, together with the Western Cape, are setting the example for the other provinces to follow. Well done to KwaZulu-Natal.


Hon Tlake, listening is indeed a skill; a skill you seem to lack. However, we will consider giving you a written speech so that while we talk next time, you can follow, so that you do not quote us out of context.


Hon Tlake, the DA mourns each and every woman who has lost her life. Unfortunately I do not have the time now, but I am going to sent you a link so that you can see what the real facts and figures are about the maternal death rate. Please report the correct figures when you stand here in front of everyone.


The National Health Insurance Fund is on the table because all the provinces do not perform and deliver the quality health care that citizens deserve. It is our responsibility to raise the issues affecting our provinces and in general for the country as a whole. In the Western Cape, we still have a lot to do. The work will never be done but I can stand here without lying to myself or to the people out there and say that we have done the best we can with what is available to us. The Western Cape has displayed the model that works. As a caring government, its strategic goals are around creating a universal health care system with proper management structures in place, with a core focus on the needs of the society it serves.


With great respect to the hon Minister’s expertise as a medical professional, South Africa’s hospitals require sound and efficient management in order to serve the communities. As the various branches of government, South Africans look to us to fulfil their constitutional rights, including the right to access to universal health care. As Theodore Roosevelt said, “The best executive is the one who has sense enough to pick good men to do what he wants to be done and self-restraint to keep from meddling with them while they do it.”


Inkunkuma ininzi ezindleleni kodwa bambalwa abasebenzi abaqeshiweyo. [There is a lot of dirt in the streets but few workers employed.] I believe that it is our duty, our responsibility to deliver services that will in turn be beneficial to the people we serve. Thank you.











Ms P DYANTYI (Eastern Cape): Hon Chairperson, hon Minister, hon members of the NCOP, colleagues from the provincial legislatures, distinguished guests, ladies and gentlemen, good afternoon. Hon members, our gathering here today during an important month, the Red Ribbon month in the South African health calendar, could not have been more befitting for provinces to take time and deliberate on a topic which seeks to accelerate the agenda of a collective path towards a comprehensive health care system in South Africa.


The supreme law of the country, the South African Constitution, provides that all South African citizens have a right to health care, which the state must progressively realise within the limits of its resources. I repeat: within the limits of its resources. [Interjections.]


The DEPUTY CHAIRPERSON OF THE NCOP (Mr R J Tau): Order! MEC, there is a request that you lower the microphone so that you can speak into it.


Ms P DYANTYI: I can do that, thank you, Chair. The National Health Act was therefore developed to provide a legislative framework for the provisioning of comprehensive health services to all citizens of South Africa. The National Health Act and other supportive pieces of legislation of government seek to ensure that all South Africans have access to quality health services and are afforded respect and dignity when services are administered by caring and supportive health care professionals.


We can never turn a blind eye on the negative impact created by the disparities of the apartheid government to our health system. It is therefore critical that we objectively look at negative outcomes to enable us to take corrective measures as these past disparities of the health system in the country reflect on the social determinants of health, which are a product of a long period of unjust service.


The South African government, in response to the constitutional dispensation of 1994, has a unitary health system that serves all citizens of the country without any form of discrimination, whether based on race, gender, religion or otherwise.


The ANC government, as a demonstration of its commitment to a unified and equal society, further conducted a diagnostic evaluation of obstacles for the provision of comprehensive health services to the South African community and came up with a 10-point plan to redress these imbalances of the past. The plan includes the provision of strategic leadership and the creation of a social compact for better health outcomes; the implementation of National Health Insurance; improving the quality of health services; overhauling the health care system and improving its management; improving human resources management, planning and development; revitalisation of health infrastructure, accelerated implementation of the National HIV and Aids and STI National Strategic Plan and increased focus on TB and other communicable diseases; mass mobilisation for better health for the population; review of the drug policies; and strengthening research and development.


These were subsequently set as formalised commitments of government through the Negotiated Service Delivery Agreement. Going forward, the new policy, the National Development Plan, provides the collective pathway on how the country is going to transform the health services by 2030. The NDP vision is that South Africans would achieve a life expectancy of 70 years and an Aids-free generation under 20 years of age. The Health Minister’s call for strengthened efforts in the fight against the quadruple burden of diseases like HIV and TB, as well as maternal and child mortality, noncommunicable diseases and violence, injuries and trauma requires a collective effort from government to ensure that we achieve the targets set for 2030.


The transformation of health services in terms of the Act and the NDP ensures that district health services are used as a vehicle for the delivery of a comprehensive health system to citizens. The implementation of district health services will thus create a collective platform where all three spheres of government provide a comprehensive health care service at all levels. Programmes like Re-engineering of Primary Health Care, Back to Basics and the schools health programmes become of critical importance to achieve our objectives.


In various provinces I know that various MECs signed performance agreements with their premiers. The main focus was on ensuring a longer and a healthier life for the people of this country. In my province, our emergency medical services front is our priority and we will increase our capacity, as we have already started doing, by providing 110 new ambulances. We are in the process of attaining the 167 that will be delivered at the end of next month. We have recently acquired three helicopter ambulances, which are based in Port Elizabeth, East London and in Mthatha.


The backbone of any health system is the nursing fraternity and I am ecstatic to say that our nursing colleges, as well as nurses’ accommodation, have received our serious attention. We will continue on that front so that our aspiring nurses can have access to training closest to their homes. A brilliant case in point, which is demonstrative of our commitment, is the new nurses’ accommodation at Cecilia Makiwane Hospital, which shows our commitment in its entirety.


I would like to share with you a quote from Fidel Castro, the Cuban leader. He once said:


If there is some activity at which we should aspire to perfection to the maximum, that activity is public health. If there is a work from where all revolutionaries have obligations which are sacred, that is the health front. If there is one front where moral obligation is very high and where revolutionary human sensitivity is tested, that is the health front. These principles therefore become critical in achieving the best in the public health sector.


In closing, I would like to pose a challenge to this hon House and its members that health is broader than the department. It requires co­operation from all spheres of government and across all government departments. The decentralisation of health services is important in the efforts to address past injustices. We therefore need to strike a balance between all these spheres and come up with the best collaborative strategies to ensure that our mandate of a transformation agenda for the lives of our people is achieved.


We need to build stronger municipalities. They must be able to produce IDPs that reflect a commitment to economic development and transformation of their citizen’s lives. They must have the ability to provide bulk services to our communities. We need responsive public servants who are able to work with communities as the recipients of all government services. I thank you.











Mr V E MTILENI: Hon Deputy Chair, hon Minister and guests in the gallery, the jarring disparity in access and care between public and private sector patients in South Africa is fundamental and the most significant issue in the present status of health services in this country. There are many instances of patients dying in the public health system, when hospitals cannot keep them any longer. In the public sector, for example, kidney dialysis is rationed; medication is too often unavailable, and in some instances beds are insufficient for all hospital admissions.


The differential in health services stretches its ugly tentacles even into the private health care sector. Those members on low-cost schemes come off worse, with a narrower range of services covered. They then need to spend a higher proportion of their incomes to supplement their service. If you have got money, yes, you can buy and save lives. There is also a marked disparity between urban and rural care, with many rural patients having to travel into cities to access services.


Of the roughly 10% of the GDP of this country that is spent on health, about 8,5% is used in the private sector, which cares for less than 20% of the population, while the balance of 1,5% is spent on the public sector. Government spending on health care comprises less than half of the total health expenditure, even though the public system serves more than 80% of the population. That leaves around 40 million South Africans without private health insurance. Around 70% of all doctors, and most specialists, only work in the private sector, while the remaining 30% serves in the public sector. The public sector covers 68% of people who do not use any private care at all, spending about R1 900 per person. Another 16% of the population relies on the private sector for hospital care, but use the private sector for primary care, paying out of their own pockets, with a total spend of about R2 500 per person.


Because of lack of foresight and ineptness on the part of government, over the past 20 years failure to secure a greater share of the GDP has seen the compromise of a reasonably well-functioning infrastructure. Professor Di McIntyre, from the University of Cape Town’s Health Economics Unit, states in a recent analysis:


An integrated pool of funds is the only way to ensure that all the available human resources are used more effectively and efficiently. Then everyone will be able to access health services on the basis of their need for care and not on the basis of their ability to pay.


Government’s spending on health care is expected to exceed R500 billion over the next three years. The national health spending is expected to grow at a higher rate over the next few years, in line with the much-needed vision of a cheaper health sector that works for all South Africans. The national health grant and the national health insurance grant have more than R19 billion earmarked for refurbishment programmes for hospitals and clinics and more than R1,2 billion set aside for doctors’ contracts. Yes, hon Minister, in as much as these allocations may be commendable, the reality is that this is scratching the surface.


In conclusion, we have provinces such as the Eastern Cape whose health care systems have all but collapsed - and not only because of deteriorating infrastructure but also because of the stretched medical professionals who are forced to work impossible hours because of shortages of health care workers in public hospitals. Hospitals such as Cecilia Makiwane, Grey Provincial Hospital and others have become extermination camps where people go and die rather than to get medical care. The health system needs a complete overhaul and, as the EFF, we are here to assist the government only if it is willing to listen.



Ndza khensa. Inkomu.



Mr W G MTILENI (Limpopo)








Mr W G MTILENI (Limpopo): Hon Chairperson, Minister of Health, hon Dr Aaron Motsoaledi, hon MECs present, hon members, comrades and friends and ladies and gentlemen, I must start off by indicating that my name is Goodman Mtileni from the ANC. I am a Member of the Limpopo Provincial Legislature.


This debate takes place at a time when our country is celebrating 20 years of freedom and democracy. This freedom and democracy came as a result of major sacrifices by different generations of freedom fighters. In paying tribute to these gallant heroes and heroines of our struggle, former President Nelson Mandela said the following words at his inauguration on 10 May:


We dedicate this day to all the heroes and heroines in this country and the rest of the world who sacrificed in many ways and surrendered their lives so that we could be free. Their dreams have become reality. Freedom is their reward.


He concluded this powerful speech on that special occasion with these words of inspiration: “The sun shall never set on so glorious a human achievement!”


Our task as both permanent and special delegates to this Council of the NCOP and in our respective provincial legislatures is to ensure that the instruction of the father of our nation, uTata Nelson Mandela, is carried out without fail.



Ri khomeni ri nga peli.



Ulibambe lingashoni.



Today’s debate on an effective health care system is being held under the theme, “Continuing on Our Collective Path to Ensure a Comprehensive Health Care System in South Africa”.


The HOUSE CHAIRPERSON (Ms M C Dikgale): Order! Your time has expired. [Interjections.] Oh, we are using this timer! My apologies, I was looking at this timer. I apologise, hon member, please continue.


Mr W G MTILENI (Limpopo): I hope I am not being punished for the other Mtileni in the House. [Laughter.] Thank you, hon Chair. I was saying today’s debate on effective health care system is being held under the theme, “Continuing on Our Collective Path to Ensure a Comprehensive Health Care System in South Africa”.


There would have been no better time for this august House to debate an effective health care system than now, when our country is making serious strides in improving the health conditions and status of our communities. As a consequence, the life expectancy of South Africans will inevitably increase. Programmes like the National Health Insurance Scheme, the Maternal, Child and Women’s Health programme, the MCWH, the nutrition programme, and voluntary counselling and testing, among other programmes, are aimed at achieving the aforementioned objectives.


Today, as we debate the effectiveness of the health care system, the MEC for health in my home province, hon Ishmael Kgetjepe, is officially a state-of-the-art clinic with modern facilities in the rural village of Rhelela, outside Tzaneen. In September, during the second half of the month, the Chief Whip of the NCOP, Dr Hunadi Mateme, led a delegation of members of this House, the NCOP, and members of the provincial legislature to the village of Rhelela. One of the grievances that the community members raised was that the facility had been completed but was not functional. Dr Hunadi Mateme made a commitment on behalf of this House, over whose activities you preside, that the clinic would be operational before the end of this year, 2014. The act of MEC Kgetjepe opening the facility today is monumental testimony that the hon Hunadi did not lie to the people of Rhelela on that day in September.


Finally, the NCOP can record this as an achievement in its oversight role. This major development will be followed by the official opening of Muyexe’s state-of-the-art clinic before the end of this financial year. [Applause.] This was one of the major commitments made during the NCOP week and this is a project that is being followed up on by the President.


In dealing with the apartheid legacy, the ANC-led government has chosen a health care system that combines the role of the public and private sector, with a specific role played by the state in ensuring that all our people, both black and white, have access to health as enshrined in the Constitution. Accordingly, the newly elected government in 1994 gave black people access to health care facilities that were meant for whites only, such as Voortrekker Hospital in Limpopo and many others across the country.


This was accompanied by the massive implementation of primary health care, in line with the Alma-Ata declaration. Access to health care was further enhanced by the introduction of free health care for children under 6 years of age and pregnant mothers. This was under the leadership of Nelson Mandela.


To address the high vacancy rate, the democratic government signed a bilateral agreement with Cuba on the employment of Cuban doctors, particularly in rural areas and the training of our medical students in Cuba. The result of this intervention by our democratic government continues to be felt right up to this day.


As the province of Limpopo, we have sent 110 students to Cuba during the last financial year to go and study medicine. We take further comfort as the people of Limpopo from the knowledge that another extraordinary initiative - that of opening a medical school - in January next year is a certainty. This week, when the MEC for provincial treasury tabled the Adjustment Appropriation Bill, provision was made for the first intake of students in that school.


The province has committed to buying 50 ambulances during this financial year. Thhis will go a long way in dealing with the challenge of emergency services in the province.


In its 2009 election manifesto the ANC identified health as one of the five key priorities. In implementing this manifesto, the government under President Jacob Zuma identified the quadruple burden of disease as the greatest threat to the health and lives of our people. The Zuma administration further acknowledged that the scourge of HIV/Aids is the single biggest threat to a dream of long and healthy lives for our people and accordingly developed the comprehensive strategy to fight this scourge. The comprehensive strategy includes but is not limited to ...


The HOUSE CHAIRPERSON (Ms M C Dikgale): Order! Do you have a point of order, hon member?


Mr J W W JULIUS: Yes, Chairperson. Is it parliamentary to say “the Zuma administration”?


The HOUSE CHAIRPERSON (Ms M C Dikgale): That is not a point of order. Continue, hon Mtileni.


Mr W G MTILENI (Limpopo): Thank you, hon Chair, for managing that. The comprehensive strategy includes but is not limited to the provision of ARVs and the spread of the ABC message. This effort has yielded immediate results, in that within the first three years, the life expectancy of South Africans has increased to 60 years on average - a development that has also been acknowledged by the United Nations.


The recent launch of Operation Phakisa Phase 2 by President Jacob Zuma, which aims to improve services in our public clinics and making them the primary health care facilities of choice by 2030, is another milestone. The National Development Plan envisages a South Africa with a life expectancy of at least 70 years for men and women by 2030. Co-incidentally, the United Nations HIV/Aids programme, UNAIDS, has said in its report ahead of World Aids Day on 1 December that global HIV/Aids could be ended by 2030 if the world met a set of ambitious fast-tracked targets within the next five years, but also warned that if the global community failed to accelerate its current momentum the epidemic could worsen. Thank you. [Time expired.] [Applause.]


The HOUSE CHAIRPERSON (Ms M C Dikgale): Order! I must apologise again because we are used to this timer. I did not notice that we were using the other one today. So, I must apologise to the hon member.









Mr T BOTHA (Western Cape): Hon Chairperson, thank you for the opportunity to debate on this important topic in this House today. I want to acknowledge the presence of the Minister of Health, Dr Motsoaledi, other MECs, the chairperson, members, guests and media. This is a very important debate. I think it should be followed by a debate of similar importance where we, as provinces, should highlight the indicators and successes that we have achieved thus far, so that we can have a global picture of the state of health in our country.


I also want to congratulate the national Minister on the input he made in his speech and especially on the honest manner in which he identifies and approaches the problems in our health society. It is really regrettable that he has not been the Minister of Health in this country since 1994 because then we would have had a very different scenario and state of health. I also want to congratulate my colleagues, the MECs from other provinces, on the progress and achievements they have made and have been able to report on. I want to congratulate them on that.


Health is by far the single biggest budget - the single biggest expense - of government in our country and therefore it is a very important topic. I noticed that two of our very important role players, the Gauteng MEC and the Northern Cape MEC, are not present here today. I want to say that during important debates like this we should always make ourselves available to come and address this Assembly.


The Department of Health is, in many instance, the net recipient of the ills of our society, whether that be physically, psychologically, financially, morally or whatever. Health is the recipient of many of the problems and therefore requires no less than the whole-of-government approach. We deal with the consequences, but we cannot change the prevalence and the causes of this. This is a problem of the whole government and society. These illnesses will persist as long as we have socioeconomic inequalities in our country. Therefore, as government, we should address this with seriousness.


The solutions to the health care problems are not simple; they are complex. Many wise words were spoken here today about what we needed to do in order to rectify our system. I want to mention a few components that in our province we regard as important in order to have a functional and effective health system. In doing so, I first want to reflect on those we do not regard as problems in health care.


Firstly, we do not find any problem with private health care. We have no problem with the fact that people can afford to have insurance to pay for private health care just as we have no problem that some people - such as the Members of this House – earn higher salaries than the average South African. It is as such not abnormal for some people to live in more luxurious houses and not in economic houses. It is not abnormal for some people to drive expensive German cars and not be dependent on a taxi. Those issues are not abnormal. But what it does require is that when you use these other facilities, they must be accessible and of a normal standard. I think that is something we need to address.


To achieve that in our health system we need four things. We do not need more money for health care in South Africa - our spending on health is already among the highest spending in the world. We do not need to reprioritise health care - these priorities have already been identified. We do not need to restructure or “re-system” health care - it must simply be implemented. To be able to do that, we must have: an excellent and stable management system, rigorous financial control, an excellent human resource management system and political accountability.


Very often when you analyse the problems of health care you find contrary opinions - during today’s debate some members argued that we have a collapsed state of health; some said no, we do not. The fact of the matter is that the National Development Plan, which we all accepted in South Africa, indicated that health in this country was a national crisis. And the Minister will agree with that, as he has on many previous occasions. So, to be able to solve these problems, we need to address those four issues. We need people who can deliver this service in terms of their competency and not in terms of their party affiliation. We need managers to be appointed and not redeployed.


As we stand here today there is an instance in Gauteng where four different people had been appointed to the head of department, HOD, position over the past four years - and the position is of vacant again. No department with the budget and the importance of the Department of Health can effectively function under management and conditions such as this. It is not possible - whether you refer to apartheid or not, you cannot do it. You can refer to apartheid a hundred times; this is a reality of contemporary South Africa now.


The second issue is financial discipline. It is unacceptable that in our provinces, where the biggest budgets are allocated to health, we either overspend or underspend. It is simply unacceptable in an important service such as health, where our clientele have no other choice of service. They only have us. So, if we budget the money for them, we have got to spend it! And we cannot overspend either, because then it would be an illegal action.


In this quest for financial control and financial responsibility, I think it is also very important that we form successful partnerships with the private sector instead of alienating them as the enemy - as we have done in numerous cases in the Western Cape. I wish I had time to elaborate on this.


Political accountability is very important. And I want to refer to our Health Care 2030 Plan, in which we explain our strategy for achieving a healthy society by 2030. It was mentioned here today by numerous speakers as well, no less by the national Minister, that we are spending money in South African health care mainly on illnesses that already exist. We have a curative system instead of a preventive system. We need to invest more money, put up the structures and develop systems on how we can actively implement and promote wellness in our society by preventing illness through early detection and knowledge.


In this regard, the Western Cape has declared wellness its single biggest objective. We are focusing on contributing to a healthy society by having less ill people in the future. We run this programme exclusively, in partnership with the private sector. It is very comprehensive and has ties and connections with our own facilities – dedicated mobile facilities. In this province, we are busy setting up infrastructure and systems in order to build capacity. I think it is the first department of health in the world where this is happening in this way. When we are done with the system, it will be of such nature that every citizen in our province will have the ability to visit one of our wellness centres once a year to have a proper medical assessment before they fall ill – doing so in order to prevent illness and to ensure early detection. Only by achieving that would we be able to have a successful health system and a healthy population in the years to come.


In conclusion, I would welcome a motion to debate in this House the specific performance of every individual and division under the Department of Health in this country. I thank you. [Time expired.] [Applause.]


The HOUSE CHAIRPERSON (Ms M C Dikgale): Order! Hon members, there is an urgent announcement. Order, hon members! Presiding officers have agreed that hon members can wear T-shirts in the Joint Sitting tomorrow. Hon members are kindly requested to submit their individual sizes for 16 Days of Activism T-shirts before they go home tonight.













Cllr S NKATLO (Salga): Hon House Chairperson of the NCOP, hon Minister of Health, hon MECs, hon members of the NCOP, distinguished guests, ladies and gentlemen, good afternoon. Allow me to take this opportunity to first acknowledge that it is a great privilege and honour for the South African Local Government Association, Salga, to participate in this important debate. This takes place at a very opportune time, following the launch of Operation Phakisa 2: The Ideal Clinic Initiative by His Excellency, hon J G Zuma on Tuesday, 18 November 2014.


The National Development Plan holds that the effective implementation of the health system will require a constant desire to improve by all sectors and role-players. The state needs to be proactively involved in identifying and overcoming obstacles to implementation.


South Africa’s governance system is founded on the principle of co-operative governance, as set out in Chapter 3 of the Constitution. We also have a number of laws that are meant to ensure that the different spheres of government and departments within a sphere work together. With this legal framework in place and the experience of the past few years, it is clear that we do not need new laws. Rather we need to work together and co-ordinate our efforts at all levels.


The Salga leadership will continue to support an effective health care service by ensuring that the processes in putting commitments into action are realised. Salga has embarked on a number of programmes in order to support municipalities in their implementation of municipal health services, namely the establishment of the Environmental Health Technical Working Group, consisting of the national Department of Health, the South African Institute of Environmental Health and the Health Professions Council of South Africa. Then there is the development of the Salga position on the National Health Insurance, focusing on the role of environmental health. We also conducted an audit on the provision of health services by municipalities in 2013 and 2014 respectively.


The emerging findings of the audit indicate clearly that urgent attention and action is required by all role-players in the sector to respond holistically to the challenges; that there should be the annual hosting of the Municipal Health Services Summit in partnership with other key stakeholders in the Health sector; and the establishment of the Municipal Health Manager’s Forum is important as a way to allow a structured engagement in tackling challenges in the implementation of municipal health services at local level.


It is our considered view that for local government to be able to play its role meaningfully in contributing to effective health services in the country, key reforms in legislation and policies guiding the implementation of health services will need to be considered. This is elaborated on in the following: the review of the funding model for municipal health services, as well as the provincialisation of personal primary health care services and the National Health Insurance, NHI.


There is also some degree of ambiguity about the specific role and accountability of both provinces and local government in respect of health functions. As a result, this complicates planning, budgeting, and makes accountability difficult to manage. This, in turn, results in continuously underfunded or unfunded mandates, the non-performance of functions, and blurred accountability for delivery failures that occur when health services are performed across the spheres. It is the firm view of Salga that the key bottleneck is the way in which municipal health services are currently funded. Some research is therefore necessary on the costing of municipal health services and international practice in this regard.


A decentralised system was designed to maximise efficiency in the state and ensure the provision of services to communities at the levels where they are most appropriate and more likely to be performed effectively. But decentralisation can only work if the institutional arrangements give expression to the policy goal. In this case, a reconfiguration of how powers and functions are managed in the health system is needed if we are to realise the objectives of an effective health care system.


While co-operative governance is intended to guide against the encroachment of powers and functions within each sphere, the system has also created some levels of uncertainty about functional responsibilities - and when the sectoral legislations are blurred, it is bound to exacerbate confusion and overlap. The fact that municipal health services are not defined in the Schedules of the Constitution exacerbates this problem.


In most cases the devolution of powers and functions has happened on an ad hoc basis and in an unco-ordinated manner. In some cases primary health care services are continuing to be shared between the province and municipality even though a good case can be made that local government has the capacity to administer the function fully.


The roll-out of the National Health Insurance is a good initiative for government in the transformation of the health system in South Africa. It is in this context that we are of the view that for the NHI to be implemented adequately, it will require the reconfiguration of the institutions and organisations involved in the provision of health care systems in the country.


With 2015 fast approaching, it is now time to consider policy and legislative reform in order to position different levels of government appropriately and give effect to the constitutional intent, including that local government play a meaningful and developmental role in communities. What is evident is the need for a more optimal, structured arrangement, including a more appropriate distribution of health services within the three spheres of government to constrain duplication and unnecessary complexities in co-ordination. An effective and efficient publicly sponsored health care delivery system can increase access to care, improve health care outcomes and decrease spending.


In conclusion, together we have a responsibility to ensure that we improve the health of our people. It is our hope as the SA Local Government Association that all key stakeholders across national, provincial and local levels will work harmoniously and, most importantly, in consultation with one another to carve out our ideal future, as envisioned in the Constitution, of our beautiful country which I so dearly love. I thank you.








Cllr S Nkatlo






Nks P C MQUQU: Sihlalo weNdlu ohloniphekileyo, ...



Mr V E MTILENI: Hon Chairperson, I just want to congratulate the hon member for wearing the EFF colours. She looks very nice. [Laughter.]


The HOUSE CHAIRPERSON (Ms M C Dikgale): Hon Mtileni, please do not waste our time. Please take your seat.



Nks P C MQUQU: Sihlalo wale Ndlu, uMphathiswa okhoyo kule Ndlu, abaPhathiswa bamaphondo, amaLungu ePalamente ale Ndlu, zidwesha zelizwe lakowethu, manene nani manenekazi, mandinibulise ngokuhlwa nje. Okokuqala mandinqwenelele uSekela Mphathiswa wezeNzululwazi nobuChwepheshe, uMama uMsibi, othe yena wangena esibhedlela ngecawa efe icala. Wanga angakhawuleza aphakame, aphile, aphume kulaa ndlu ukuze abenathi.


Sihlalo wale Ndlu, mandiqale ndilungise ohloniphekileyo uMtileni. Ukuba ngaba ufuna ukuyazi iMpuma Koloni, eli phondo ndiphuma kulo, mandikumeme, uye phaya ekhaya ikhona indawo yokuhlala. Uza kulala khona sivuke siye kwiNdlu yoWiso-mthetho yephondo, ekhokelwe nguMama uNoxolo Kiviet. Le nto uyithetha apha ulahlekisa abantu belaa phondo. Yitsho kohloniphekileyo uMathys xa uza kuthi ume kweli qonga uxoxe, akunike ulwazi ngesebe eli likazwelonke ukuba limi kanjani.



Mr V E MTILENI: Hon House Chair, I stand to ask if it is parliamentary for an hon member to address me directly. She seems to be talking to me on a person-to-person basis ...


The HOUSE CHAIRPERSON (Ms M C Dikgale): Order! You did not listen to the hon member.


Mr V E MTILENI: ...because she says she will take me with her to a particular place. [Laughter.]


The HOUSE CHAIRPERSON (Ms M C Dikgale): She is addressing the Chair! You did not listen to the hon member. Please take your seat. Continue, Mama.



Nks P C MQUQU: Makamcele ohloniphekileyo uMathys kuba kaloku yena uya manqapha-nqapha kulaa komiti. Akabaniki ingxelo yokuba kwenzeka ntoni kweli sebe. Yiyo ke le nto aza kufika ame kweli qonga athethe izinto ezingekhoyo ngeMpuma Koloni okanye ngezinto ezenzekayo kurhulumente kazwelonke, ingakumbi kwiSebe lezeMpilo.


Mandikunike ke ohloniphekileyo imfundo esisiseko yabantu abadala ngaphandle kokuhlawula. Ukuba wawugqibele kusithiwa iyawa iMpuma Koloni, yimbali leyo. Ngoku ndithetha nawe nje, le Makhiwane uyibiza ngokuba yiMatiwane, yiCecilia Makhiwane Hospital. Yiya phaya ngoku uza kubona ukuba kuqhuma uthuli; siyaqhuba eMpuma Koloni. Yiya eSt Elizabeth, eyayifudula ibizwa ngokuba yiMfabantu; ubone ukuba kwenzeka ntoni. Ukanti neNessie Knight le iseMvumelwano kuQumbu; le besiye kuyo, Sihlalo weNdlu.


Kufuneka xa simi kweli qonga sithethe esikwaziyo singqine esikubonileyo ukuze singabalahlekisi abantu. Kule ofisi yoMphathiswa ohloniphekileyo nohleli apha namhlanje sifike saxelelwa ukuba kukho inkqubo eza kuqhumisa uthuli kulo nyakamali uzayo. Umcimbi usezandleni uphethwe, kuyakhiwa ngoku. Leliphi ke eli phondo kuthiwa liyawa? [Kwaqhwatywa.] Sithetha esikwaziyo, singqine esikubonileyo, nize ningabamkeli ubungqina bethu.


Phaya eMpuma Koloni, urhulumente uthumele abantwana abangama-93 eCuba ukuba baye kuqeqeshelwa ubugqirha ukuze babuye baze kunceda apha. [Kwaqhwatywa.] Uyabona ke, urhulumente akoneli nje ukuba athathe abantwana apha edolophini kuphela. Ndiza kwenzela umzekelo ngomntwana abemnye. ULumka Nodada uthathwe ngulo rhulumente wamsa eCuba. Namhlanje ungugqirha eCecilia Makhiwane, eMpuma Koloni. Ndithi sithetha esikwaziyo singqine esikubonileyo, nize ningabamkeli ubungqina bethu.


Kwintetho yakhe iNkulumbuso yephondo leMpuma Koloni ithe ihelikopta ezintathu ziza kuchola abantu abenzakele ezindleleni. Yinto engazange ibekhona koorhulumente bangaphambili ukuba kuphephezele iihelikopta zichola abantu abonzakele ezindleleni. Namhlanje eMpuma Koloni sineehelikopta ezintathu. Ndilungiselela le nto kuthiwa iMpuma Koloni iyawa. Iinqwelo zezigulane apha zili-167. Ama-67 ezi nqwelo zezigulana, zijongene nabantu ababelekayo ukuze zibathuthe ziye kubabeka kwizibhedlele ukuze bafumane uncedo. Kule nto ke kuthiwa urhulumente waseMpuma Koloni uyawa.


Uyabona ke nindiphethe emanyeni okanye i-ANC niyiphatha emanyeni ngokuba nime apha nithethe izinto ezingekhoyo. Niyabona ke, niyasonzakalisa ngolo hlobo. Umbutho okhokeleyo kulo rhulumente uyakwazi ukuba azilungise iimpazamo azibonayo. Urhulumente obonayo oneliso elibanzi elifana nelikaKarl Marx ngurhulumente obaphulaphulayo abantu ukuze alungise kuba singaba bantu babuza, abantu balapha eMzantsi Afrika ukuba bafuna ntoni ukuze sihlale phantsi sithi siza kwenza ntoni singurhulumente emva kokuba abantu bethethile. Asilali siphuphe, sivuke sisithi bathi abantu. Siya kubo, basivotele ngesininzi ukuze sime apha sithi nazi izinto urhulumente aza kuzenza. Sithetha esikwaziyo, singqine esikubonileyo, nize ningabamkeli ubungqina bethu.


Isihloko sanamhlanje sithi, “Sisaqhubeka sisonke, siqinisekisa ngonyango lwezifo zonke kubantu bonke ngokuzisa iinkonzo kuluntu lwaseMzantsi Afrika”. Uthi uMphathiswa xa emi apha, owu wandiphatha emanyeni, singa singathi xa sithetha ngezempilo, singajongi ukuba sithetha ngeyeza, sithetha ngesibhedlele, sithetha ngomongikazi. Xa uthetha ngezempilo uqala endlwini. Uqala ekutyeni, utyise abantu ukutya okuya egazini ukuze babenempilo.


Urhulumente okhokelwe yi-ANC angazakha zibe zininzi izibhedlele, bangakhona abongikazi ngaphakathi, kodwa ukuba ngaba akukho nto bayityayo abantu, naloo mayeza akasayi kusebenza kuba kaloku balambe eziswini. Yiyo le nto uMphathiswa kweli Sebe lezeMpilo, ohloniphekileyo uMotsoaledi, athi bebambisene neSebe lezeMfundo, nephulo leSebe lezoLimo elaziwa ngokuba nguSiyazondla, ukuba singalima amasimi, silime imifuno sibuyele embo apho sisuka khona, singahlukana nale meko sikuyo. Sifundise abantu ukuba yintoni into yokuqala esisiseko emntwini ukuze akwazi ukuphila. Ayaqali yezeni. Kufuneka uzivocavoce ukuze ukwazi ukuba sempilweni. Nokuba ungasela iyeza, ukuba ngaba awuzivocavoci uza kudumba amaqatha la njengoPhindiwe lo kuba ehlala apha. [Kwaqhwatywa.]


KuMgaqo-siseko weli lizwe, kwiCandelo lesixhenxe kwiSahluko seSibini sithi, umbuso kumele uhloniphe, ukhusele amalungelo ngokuqulethwe phaya kwiSahluko seSibini kumaLungelo oLuntu ... [Kwaphela ixesha.] [Kwaqhwatywa.]



The Minister of Health







The MINISTER OF HEALTH: Hon Chair, I was ahead of myself when I stood here and asked to be released early. I was not aware that we would finish this debate before they needed me over there. So, I am happy that we were able to complete the debate. I listened to everybody and I am quite happy. This type of debate must continue so that we understand where we are going. I am sure it is important for me to repeat that we are debating an effective health care system in the context of “Continuing on our collective path to ensure a comprehensive health care system”.


Of course, because we are politicians here from different parties, time and again we will be tempted to jab at each other, but as we do so we should not forget the goal, which is to set up the National Development Plan, the NDP. Maybe I should remind you what that means. The NDP Vision 2030, which we have all adopted, has a very clear path for Health, which has been set out for us as follows.


Firstly, it says that by 2030 – meaning we are starting now but by 2030 we must have arrived there – life expectancy in South Africa must be 70 years for men and women. We must work towards the goal of getting people to live for 70 years. The only thing I regret is that sometimes we force people to live for 70 years when they are clearly unwilling to do so, but the job of a Minister of Health is to make people live, even those who are unwilling. One can see from certain people’s activities that they are unwilling to reach 70 years of age ... [Laughter] ... but it is our collective job to do this because the plan says so.


Secondly, the plan also says we must have a generation of under 20s who is largely free of the Human Immunodeficiency Virus. We must work together to make sure that by 2030 children who are 20 years and younger have no HIV. That is another huge task.


Thirdly, the plan goes further to say that the quadruple burden of disease must have been radically reduced by 2030, compared to the previous two decades. You are aware that South Africa is going through what we have termed “the quadruple burden of disease” and the plan says we must reduce that.


Fourthly, the plan says that the infant mortality rate must be below 20 per 1 000 live births and the under-five mortality rate must be less than 30 per 1 000 live births;


Fifthly, the plan continues to say that by that time there should have been a significant shift in the equity, efficiency, effectiveness and quality of health care provision. It says that universal health care must be available.


Lastly, the plan says that the risks posed by the social determinants of disease and adverse ecological factors should have been significantly reduced.


So, there is a clear plan on what we need to do. Quite a number of things must be brought on board to reach these targets, because they are clearly set out for us.


Now, I would like to answer a few questions. Let me start with hon Mtileni – the red one ... [Laughter.] ... not the other one, because there are two Mtilenis here. [Interjections.] He mentioned something about dialysis being rationed, and all that. Actually, the issue of dialysis is a good example of what I was talking about and what I referred to earlier – and this is also in the Freedom Charter. In addition, many of you here spoke about it too. That is the issue of preventive health care and the fact that it is better to prevent the need for health care than to try to treat yourself out of a health issue.


In reference to the NDP, it says that the quadruple burden of disease must have been radically reduced. Which raises the question of why we need so many dialysis units. I am mentioning this issue because it came up once in the National Assembly. Why do we need so many dialysis units in the country – which, by the way, are extremely expensive? To put one person on dialysis will cost the state R150 000 per person, per year. In the private sector, it will cost you R300 000 per year just to put you on and make you live on dialysis. Calculate the number of people and multiply it by that R150 000, and then multiply the millions.


Why am I saying this? It is because there is an easy way out. Why do people need dialysis? It is because their kidneys stop functioning. What is the biggest cause of dysfunctional kidneys? It is high blood pressure. What is the biggest cause of high blood pressure? It is high salt intake. So, instead of building dialysis units, we must stop eating a lot of salt. That is why we want your support, hon members. [Interjections.]


Yes, we have a focus on wellness, which the MEC talked about; it happens to be true. Wellness entails eating less salt and less sugar! That is why we battled with the food industry and said that they must reduce the amount of salt in six foodstuffs: bread, brine, chicken, spices ... We even have targets that the industry must reach, firstly by 2016, while the second set of targets must be reached by 2019.


So, we are going to bring these types of issues to you to ask for your support and to say, allow us to pass a law to reduce this; allow us to pass a law to control that. So understand what we are doing when it comes to that event.


I was just using the example of dialysis. We can put in all the dialysis units we need around the country. Believe you me, it will not help because dialysis is not an end in itself. We put people on dialysis while they are waiting for new kidneys and, believe you me, I have stacks and stacks of letters from people writing to me, asking me to help them get new kidneys. Yes, it is not easy, so the best thing is for us to agree that South Africans need to eat less salt. We are not saying eat salt-free foods, but our research has shown that South Africans eat more than what their bodies require - sometimes more than twice what their bodies’ normal requirement would be.


So, if we make a law here with regard to your food in the dining hall, as Members of Parliament, do not come and fight with us. Come and agree with us and say, yes, we must also reduce our salt intake. Thanks a lot. [Applause.]


The HOUSE CHAIRPERSON (Ms M C Dikgale): Order! Thank you, hon Minister. It is a pity that time is not on our side, otherwise we would have allowed you to educate us further on health matters.















The HOUSE CHAIRPERSON (Ms M C Dikgale): Hon members, I would like to make a ruling on a point of order that was raised ... [Interjections.] Order, hon members! I would like to make a ruling on a point of order raised by the hon L C Dlamini during our sitting on Tuesday, 11 November 2014.


During the first Question session to the Economic cluster, the hon member rose on a point of order, as follows: “I just want to check if it is parliamentary to call a Presiding Officer ‘a chaos’. Hon Londt said there was chaos because you are a chaos yourself. Is that parliamentary?”


Hon members, in our previous sitting I undertook to peruse the unrevised Hansard and deliver a ruling because I did not hear what the hon Londt had said. After perusing the unrevised Hansard, I have ascertained that the hon member did not refer to the Presiding Officer as “a chaos”. According to the unrevised Hansard, hon Londt said the following: “The chaos that is reigning in this House is being caused by the example set by hon Mampuru. So, you cannot complain about how the EFF behaves if the example is being set in that way by the hon Mampuru. This is a Question session and not a Statement session. So, ask your question and do not make a statement.”


Although the statement was not directed at the Presiding Officer, I would like to caution members not to refer to any hon member as a cause of chaos. This is undesirable and not permissible in terms of Rule 46 of the NCOP, which stipulates that no member may use unbecoming language in the Council.


In view thereof, I would like the hon member to withdraw the statement. [Interjections.] Order, hon members!


Mr J J LONDT: I withdraw the statement, Chairperson.


The HOUSE CHAIRPERSON (Ms M C Dikgale): I also want to ask hon Dlamini to apologise because the hon member Londt did not call the Presiding Officer “a chaos”.


Ms L C Dlamini: I apologise, Chair.


The HOUSE CHAIRPERSON (Ms M C Dikgale): Thank you. Hon members, there is an announcement.














The HOUSE CHAIRPERSON (Ms M C Dikgale): Hon members, the Minister of Women in the Presidency will be hosting the signing of a pledge and the lighting of the torch of peace in front of the National Assembly steps prior to the start of the Joint Sitting tomorrow. The activities will start at 8 o’clock tomorrow morning and conclude before the start of the Joint Sitting at 9 o’clock. Thank you, hon members. [Interjections.]


Oh yes, people want to know about the T-shirts. Do we have an announcement about the T-shirts, Acting Chief Whip?


The ACTING CHIEF WHIP OF THE COUNCIL (Mr S G Mthimunye): Hon House Chair, I have just communicated with the officials. They are coming here to the Chamber immediately after the adjournment to distribute the T-shirts. [Interjections.] [Laughter.]


Debate concluded.


The Council adjourned at 17:44.



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