Hansard: NA: Mini-plenary 1
House: National Assembly
Date of Meeting: 13 May 2021
Summary
No summary available.
Minutes
UNREVISED HANSARD
MINI PLENARY - NATIONAL ASSEMBLY THURSDAY, 13 MAY 2021
Watch the video herer: VOTE NO 18 – HEALTH
THURSDAY, 13 MAY 2021
PROCEEDINGS OF MINIPLENARY SESSION – NATIONAL ASSEMBLY CHAMBER
Members of the mini-plenary session met on the virtual platform at 14:00.
House Chairperson Mr C T Frolick took the Chair and requested members to observe a moment of silence for prayer or meditation.
The HOUSE CHAIRPESON (Mr C T Frolick): Thank you, hon members before we proceed. I would like to remind you that the virtual mini plenary is deemed to be in the precincts of Parliament, and, it constitutes a meeting of the National Assembly for debating purposes only. In addition to the rules of virtual sittings, the rules of the National Assembly, including the rules of debate, will apply.
Members enjoy the same powers and privileges that apply in a sitting of the National Assembly. Members should equally note
that anything said on this platform is deemed to have been said in the House and it may be ruled upon. All members who have logged in shall be considered to be present. And, are requested to mute their microphones and only unmute when they are recognised to speak. The microphones are very sensitive and it will pick up noise which may disturb, the attention of other members.
When requested to speak, please unmute your microphone and connect your video. Members may make use of the icons on the bar at the bottom of the screens, which has an option that allows a member to put up his or her hand to raise a point of order. The secretariat will assist me in identifying such members. When using the virtual system, members are urged to refrain and desist from making unnecessary points of order or interjections.
We shall now proceed to the order, which is debate on Vote no 18, Health - Appropriation Bill. I now recognise the hon Minister.
APPROPRIATION BILL
(Policy debate)
Debate on Vote No 18 – Health:
The MINISTER OF HEALTH: Thank you, hon House Chairperson. Hon members of the National Assembly and Members of the Portfolio Committee, MECs for Health from various provinces, Heads of Public Health Entities and Statutory Councils, Deans of Faculties of Medical Sciences, Health professionals who have joined us today; Distinguished guests, ladies and gentlemen.
Thank you for the opportunity to table this Health budget vote and policy statement for 2021/ 2022.
Our country is emerging from a tumultuous year of 2020, which has seen huge global devastation from Covid-19. In our country, this has resulted in 1,6 million positive cases, 10,9 million tests have been done, 54 968 associated lives have been lost, though 95% of those affected have recovered. The Covid-19 positive cases have started to rise significantly and we may find ourselves in the third wave. Of concern has been the emergence of the B.1.351 variant in our country and the importation of B1.617.2 variant from India and B.1.1.7 from
the UK. We all have a responsibility to use the non- pharmaceutical interventions to protect ourselves and reduce the risk of infection.
Our country is set to begin phase 2 of the vaccination program on 17th May 2021 targeting 130 sites in the public sector to be active by the end of the week, focusing on the population aged 60 and above as well as the vulnerable groups, using Johnson and Johnson and Pfizer vaccine; as vaccination of the remainder of health care workers is being concluded. The Private sector will open later on during the same week.
Over the medium term, the department’s most urgent focus is combatting the Coronavirus through our comprehensive local intervention programmes, for which R9 billion has been allocated. We continue to play our strategic roles as co-chair of the ACT-Accelerator and Covid-19 champion of the African Union, following his excellency, President Cyril Ramaphosa’s outstanding leadership in his capacity as chair of the AU in 2020.
Globally, the lessons from the impact of Covid-19 has emphasised the necessity of investing in long term resilience
and sustainability of health systems to enable us to better respond to future health emergencies and crises.
The Covid-19 pandemic has caused significant health seeking deterrence and a various results have pointed to this challenge. The mandates set out in the Performance Agreement that I signed with the President for the Period of 2019 to 2024, indicate the need for innovation to close these service delivery gaps. Chief amongst these include the establishment of the National Health Insurance Fund, NHI, implementing the recommendations of the Health Market Inquiry Report, building human resource capacity, quality improvement, expansion of health infrastructure, risk management, uprooting corruption and ensuring clean governance as well as building partnerships through social compact.
Today I rise to table a budget of R62,5 billion for the National Department of Health for 2021/22. For members and for the records I will table the table that separates all these amounts.
Health expenditure is expected to increase by 0,8% per year, for the year 2020/21 to R59 billion for 2023/24. An estimated
85,9 per cent of the department’s budget over the MTEF period will be transferred to provinces through conditional grants. Cabinet has approved that there will be reductions in various department’s baseline amounting to R15 billion for the period ahead.
Needless to state that the backlog, current and future needs for health services far exceed the current allocation of resources; and all indications point to chronic underfunding of this sector. Despite the challenges and the reductions, we have also stretched our resources through strengthened donations with multilateral organisations such as the UNAIDS and UNICEF, Global Fund, PEPFAR, the Clinton foundation, Solidarity and so on and we appreciate their support.
The implementation of the National Health Insurance, NHI, remains one of governments main objectives. Following the introduction of the NHI Bill in Parliament in 2019, the Portfolio Committee of Health convened public hearings in all provinces during the latter part of 2019. These public hearings provided a platform for ordinary South Africans to be heard and contribute towards the NHI Bill. The Department attended these hearings to get feedback and to attend to
service delivery issues. We understand that this process is going to be resumed very soon.
In the MTEF, R7,5 billion has been allocated to the NHI unit, to strengthen the system and contract service providers. Dr Nicholas Crisp has been appointed as the Deputy Director General of NHI unit, bringing a wealth of experience and passion to the portfolio. Tremendous progress has been made in Health Patient Registration System (HPRS) which has recorded
57 million individuals in over 3000 public health facilities.
The NHI fund will be set up, as soon as the NHI Bill has been passed.
On infrastructure, we commit R20,6 billion in the MTEF, for health facility revitalisation, to establish parity in the quality of public and private infrastructure through the Infrastructure Refurbishment Programme. From 2014 to 2020/21,
10 hospitals have been completed or replaced and an additional
23 have been revitalised. A total of 151 Community Health Centres and clinics have been constructed and replaced and a total of 1232 facilities have either been refurbished or renovated. Of these, 116 were maintained and repaired and the
Health Facilities Revitalisation and other grants have been the main financial contributors to these achievements.
Through the implementation of the Ideal Clinic Initiative, the MTSF targeted to have 100% of these Primary Health Care facilities maintaining their Ideal Clinic status. As at the end of December 1 286 Primary Health Care facilities obtained this ideal status.
In June we will be piloting 16 Quality Learning Centres, defined as clusters of health facilities at different levels of care servicing the same population. The pilot cluster will comprise 80 hospitals, 64 Health Care facilities. After incorporating the learnings from the pilot phase, the programme will gradually expand until all facilities belong to a quality learning centre. R13,7 billion has been allocated to support the tertiary health care services which are offered at tertiary and central hospital levels in those provinces that have such facilities so that we can deal with the inequality that results from the movement of patients from other provinces.
On Human Resource Development, Human Resources for Health, we have adopted the strategy and it is pleasing for us to say that last year from 2020/21 a record 50 614 new posts were created, both related to support personnel as well as the health personnel to strengthen the health services and in particular to respond to the rising pressure from Covid-19. We utilised the grant which was over R20 billion that came from the special allocation for Covid-19 as well as other sectors stimulus packages, the Presidential Stimulus Package and the Cuban Medical Brigade allowances. This has actually gone a long way to us ensuring that we can strengthen our movement towards the NHI.
Despite disruptions 2 469 Medical Interns and 10 589 Community Service Personnel including, doctors, nurses and pharmacists were placed last year. We thank the National Department and the Provincial Department as well as the Professional Councils for their collaboration that made this possible.
In response to Covid-19, the Department was able to develop surge capacity guidelines for Human Resources and a Strategy to protect the health and to ensure the safety of health care workers. We want to salute all our health workers for their
dedication and their hard work. We say, you are the heroes that saved our nation!
A key development over the Covid-19 period was the deployment of community health workers for the community screening and testing campaign. This programme is now a seminal case study for all countries seeking to strengthen their primary health care systems. As of March 2021, a total of 47 630 community health workers received remuneration against the MTSF 2024 target where we want to ensure that we ultimately integrate and place on persal over 50 000 community health workers in the whole country. A committee has been established by the National Health Council to attend to the various issues that relate to the issues of community health workers, their role and scope of work and all their related issues.
When we focus on the Programmes for prevention and treatment of communicable and non-communicable disease we have allocated R82,6 billion to deal with this. HIV, TB and other communicable diseases of interest and non-communicable diseases remain the greatest threats to the overall public health of the people of South Africa. I therefor table the status of the pathologies that we see in the country.
South Africa’s performance against the UNAIDS 90-90-90 targets strategy for control of the HIV pandemic has resulted to a figure of 90-70-88. Meaning 93% of people living with HIV know their status and 70% of them living with the status are on anti-retroviral treatment (ART). Of those that are on the
anti-retroviral treatment, 88% of them are virally suppressed. The public health management of HIV, as with all communicable diseases, focuses on early detection, early initiation and treatment and prevention of onward spread.
Despite a difficult year, a cumulative total of 14,6 million test for HIV were performed during last year. The Department intensified community testing modalities to reach untested and under-tested areas, using index testing in communities and facilities so as to ensure that there is HIV self-screening and self-testing as well.
In February, 5 million people were on ART and in the last financial year 93% of antenatal HIV positive patients were initiated on ART. Our target was around 98%. To improve this indicator towards the 90:90:90, the Department is scaling up and promoting same day initiations of treatment at every point of care including mobile clinics and also using the standard
operating procedures for ART. This includes Post-Exposure and Pre-Exposure Prophylaxis, PEP and PrEP. We also embarked on a “Welcome Back” campaign to make sure that those who fell off the treatment must be brought back. We still promote the use of condoms to prevent STIs and HIV. At this point over 537 million condoms have been distributed.
On Tuberculosis, TB, the Department has committed to finding all persons living with active TB in our communities and to meeting the target of 90-90-90 as outlined in the National Strategic Plan for HIV, TB and STIs 2017 – 2022. Achieving this goal is even more important as we noted that a 50% of reduction happened on those people that were undergoing TB treatment during the Covid-19 period last year. A suboptimal TB success rate was 78% against a target of 90%, so that in fact need to be corrected.
TB catch-up plans have been developed in line with the recommendations of the National TB Prevalence Survey Reports and this for us is something that we have to use now. We need to adopt e-technologies and also use TB self-screening mobile applications to deal with a catch-up in this regard. We have also deployed Gene-Xpert machines to test with our mobile
Covid-19 units, so that at the same we test for TB and Covid- 19, which allows us to integrate at that kind of level.
We are also developing other programmes on Social and Behavioral Change Communication to make sure that we reach out to as many people as possible, particularly the males. Also focusing now on adherence of treatment, we intend to introduce new, shorter acting options such as Rifapentine and Isoniazid (3HP) and Rifampicin and Isoniazid (3RH), which are three- months treatments, as oppose to six months. These are going to helps us to improve compliance.
On malaria, a number of malaria cases decreased by 32% from 2019 to 2021. Similarly, the deaths have also been reduced by 48% from 103 to 53 in 2021. We believe in our target of eliminating malaria by 2023 and we think this is attainable. We have to do this by ensuring cross-border collaboration and investing in thorough interventions and synchronising operations across the borders.
On Non-Communicable Diseases (NCDs), the MTSF 2024 targets to have 25 million people screened annually for high blood pressure and elevated blood glucose respectively. A total of
22,7 million screenings for high blood pressure and 21,7 million for blood glucose were conducted in April 2020 up to February 2021. We are working in partnership with the Astra Zeneca company which has offered us 10 000 BP cuffs to monitor blood pressures using our Ward Based Primary Health Care Outreach Teams (WBPHCOTs) and the empowerment of community health workers. This will be piloted in four districts in Kwa- Zulu Natal- which is Amajuba; uMzinyathi; uMgungundlovu, and uGu. We will then be spreading this to all the provinces because we are moving out the services to the people, this is in preparation for National Health Insurance, NHI. In addition, our programme for the Chronic Medicines Dispensing and Distribution (CCMDD) has moved on to actually net more than 4,3 million users in the past financial year exceeding our target of 3,5 million.
On Sexual and Reproductive Health Services, SRH, we also noticed that they were affected by the Covid-19 situation and therefor decreasing the attention from 55% to 47% and therefor we need to make sure that we recover from that particular setback.
Similarly, on Child Health, paediatrics continues also to gain strength. There was an overall decline in childhood vaccinations in 2020 which needs to be recovered from. We were at 78.5% infants and in this case we actually were supposed to have reached a target of 90% by 2024.
Working with the United Nations agencies, private health sector, non-government organisations and vaccine manufacturers to implement a catch-up programme for children who have missed their vaccination even for earlier years, beyond Covid-19. Our MTSF targets for under-5 years’ indicators fell marginally short, threatening the gains we have made over the years. It is important now that we must reactivate all these programmes.
Medico-Legal Claims, we have also appointed a company to analyze the purported R100 million liability and their audit has reduced them by R32 million. We believe that by conducting forensic audits we will be able to reduce these claims, particularly using the precedent set by the Gauteng High Court where we can actually remove the costs of future care and carry it ourselves as government. Therefore, we have to also wait for the ratification of The State Liability Amendment Bill of 2018 so that it must be helpful in this process.
We also want to commend and pay tribute to the Cuban Medical Brigade for the work that they have done. We believe that it is correct that they should be given the award, the Nobel Peace Prize, because of the work that they’ve done. They have gone across different countries where they have shown a gesture of love and solidarity. Therefor we continue to thank the Cuban government for the graduates. Last year and up to now we had 1 841 doctors through the Nelson Mandela Fidel Castro Medical Training Programme, of which 669 graduated in the past financial year alone.
I wish to close this address by inspiring confidence in our ability to build local manufacturing. The government has undertaken some key collaborative initiatives and investments to ensure that South Africa can independently meet its own biotech needs. These include attracting the BRICS Vaccine Research and Development Centre and using the newly acquired consensus around the issue of IP waivers that South Africa must become the manufacturing hub for vaccines and other pharmaceutical patents and also supporting our programmes such as Biovac as well as Ketlaphela.
With that, I wish to at this point say, we would like to contribute to Africa being and independent continent, capable of leading and being able to protect its own people through their own quintessential African innovation and resilience.
Let me thank you Chairperson, the Director General, the MECs, the Portfolio Committee, Statutory Entities and all health officials for all the support that they have given us. I table the Budget. Thank you.
Dr S M DHLOMO: Okay! Hon House Chair, hon Minister, hon Deputy Minister, all other Ministers and Deputy Ministers, my colleagues, Members of Parliament, MECs present on this platform, officials of the department led by the director- general, leaders of various health entities, CEOs and board members, partners of the Department of Health, ladies and gentlemen, media houses, I rise on behalf of the ANC to support this budget that has been tabled by Minister Dr Mkhize. Together with my other colleagues and comrades, we will indicate some of the challenges that the department has. There is a saying in Zulu that says,
IsiZulu:
Akukho soka elingenasici.
IsiXhosa:
Akukho nzwana ingenasiphako.
English:
None of us is perfect.
IsiZulu:
Nathi esizophakama lapha sizogxeka sizobe sikuqonda kahle lokho ukuthi kunjalo.
English:
It is important to highlight the success stories of the departments so that we could place the challenges and some very serious challenges of the department within the context of ...
IsiZulu:
... akukho soka elingenasici.
English:
Your Annual Performance Plan may not be realised because of the budget cuts, Minister Mkhize, and that is our concern. Hence we have resolved as the Portfolio Committee on Health to write a letter to the Minister of Finance, and we await his response. We seek a meeting as the portfolio committee because we probably need to be educated to understand how would this Annual Performance Plan you be able to realise issues that are there with the budget cuts that are in there. We commend you on this very innovative programme that you have just talked about, the Central Chronic Medicine Dispensing and Distribution, CCMDD, of taking medication closer to where our people live because now it is shown that it improves the compliance and adherence whilst saving patients time and money. Please accelerate this programme. I am delighted to hear that it is now at the level of more than 4 million.
The health system strengthening the infrastructure development that we saw during the height of COVID-19, the oxygen capacity enhancement, the new equipment like ventilators. So some of the private health facilities even referring patients to public health in various provinces, especially during the second wave.
The private-public partnership and collaboration that we saw brings hope to us for the realisation of the National Health Insurance, NHI. The Department of Health needs to accelerate its IT connectivity on health facilities. We cannot postpone this, Minister, any longer. It is really very key and important that we work on it.
The budget cuts have not, however, affected some of these very key programmes that we have in the department in maternal and women’s health, child health, HIV and TB. We already witnessed disturbances of these services during the lockdown period. We were encouraged, however, during the Annual Performance Plan tabling, when one of your officials spoke passionately about keeping a vigilant eye on the maternal services in South Africa before, during, and after COVID-19. I do not know whether we are ever going to have an after COVID-19 because it looks like COVID-19 is probably here to stay with us. One of my colleagues will speak in detail about health entities. Save to mention just a few that we are actually encouraged to notice that the SA Medical Research Council remains one of the world-class research organization.
Its contribution on the J and J Sisonke clinical trials, and its excellent governance with successive clean audit outcome is something that needs to be actually commended. You just have to understand and trace the history of the Medicines Control Council to appreciate the contribution that is made by the SA Health Products Regulatory Authority, SAHPRA. It is a well-known regulator that is responsive to the urgent needs of our country. They do not generate data. They wait for the data, credible data for them to be able to regulate and actually indicate that this is passing the test of time.
On the National Health Laboratory Service, NHLS, we observed the good relationship with the provinces and please that must be maintained and be continued. The NHLS was very candid and open with us to say they have noticed the high failure rate of registrars training within their pathology field. We would wish that we could hear a report regarding ... but of course not today because we are not going to ... but some day as to health faculties in the country, what is the programme like of the postgraduate training, especially making sure that African women also do come in to pass these postgraduates and probably take leadership positions in various health faculties.
The Office of the Health Standards Compliance, hon Minister, is an enabler of the NHI. There are challenges there and we hope that you will find time and space to deal really with those challenges, especially in regard to when staff is involved. They need to go around the country and do continued inspections of the sites of the facilities to be ready for the NHI. The challenges, however, that are there also need to be mentioned. We are happy as the portfolio committee to get a date from yourself and your office to discuss with you and all the MECs.
While we had such a report from the Auditor-General with regards to the procurement of the Personal Protective Equipment, PPE, I would like to leave it at that and not go too much into details. But maybe it is a situation that too many cooks spoil the broth. Maybe you were correct. Then this time around to centralise the procurement of vaccines, at least in as far as financial management thereof. The rationale to host the Presidential Health Summit that gave birth to the Presidential Health Compact was a good idea. That programme is an enabler, again, of the National Health Insurance. It cannot be abandoned or be postponed. That is why, among other things, we would like to have the time and space with the Minister of
Finance. We commend the World Trade Organization that is joining South Africa and India, saying that by the end of this year we must have the pragmatic solution over whether to waiver COVID-19 vaccines patents. It is actually towards the realisation that health is a public good and should not be available to the most important or the rich countries only.
To all our nurses, you are like wounded tigers from the wars of COVID-19 especially during 2020. Please walk tall with all those scars, emotional, psychological and physical that you have. You are noticeable to have lost your colleagues, family members, patients. It felt like you thought you were losing everything. We need you as the backbone of our health services. Happy belated International Nurses’ Day.
But to all our health care workers, thank you for holding on to the fort. We wish that indeed Minister Mkhize can finish the vaccinations programme of all of you as the department is planning to start phase two now next week. We are going to be visiting provinces starting tomorrow to check, Minister Mkhize, the readiness of rolling out of the vaccines starting with the Northern Cape as of tomorrow.
We want just to, as I close, to say we do not think some of us that the Cuban-trained South African doctors are properly placed. They come with a very rich background of public health and get submerged into a hospice-centric approach, and I think we need to look into that because in any event the NHI will be embedded on knowing what is actually public health. I thank you. And again we support the budget on behalf of the ANC. Thank you.
Ms S GWARUBE: Thank you, House Chairperson, House Chairperson, it has undoubtedly been a difficult year for the globe, for South Africa, for the Health Department, and most devastatingly, the people of this country. We have been languishing in the throes of this pandemic for exactly
14 months now. While we were not able to prevent COVID-19 from arriving at the shores of the country, we were very much responsible for how we dealt with this crisis. Ultimately, it all comes down to how many lives we are able to save. Simply put, we can only save lives and livelihoods by vaccinating as many people as possible. But this has not been the case.
In fact, to the contrary, the South African government has thus far failed in a spectacular fashion to begin vaccinating
our citizens at pace. Let me put this in context, South Africa has vaccinated less than 1% of its population. This is 1% of the 40 million people meant to be targeted by year end. We have since been surpassed by our peers on the continent, such as Zimbabwe, Ghana, Rwanda, and Nigeria. Countries the world over have been vaccinating hundreds of their citizens daily and inoculating them against this virus, while we are expected to be celebrating 350 000 doses that will be delivered a week.
To make matters worse, three days from now, we are expected to roll out phase two of the vaccinations programme in the country. This is all while over 700 000 health care workers are yet to receive their jabs. They will once again be expected to lay their lives on the frontlines while we are continuously being let down by this government. This poor and criminally slow vaccination programme has to be one of the biggest failure of our government.
A capable government is one that would spring into action, negotiate for securing of enough vaccines for the country and move with speed to roll it out to as many people as possible. Ours is not a capable government. Ours is a government that took time to look for various sources of the supply of
vaccine, ours is a government that took time to set processes in place for the procurement of the vaccine, and ours is a government that has for the past four months failed to cover its greatest assets against this pandemic, its health care workers.
Fourteen months later, we continue to languish as we face the third wave of infections of COVID-19. It has been confirmed now by the Minister again that the variant dominant in India has been detected in the country, and experts have started to warn of a possibility of a new domestic variants that could emerge during this third wave of infections. This poses a threat to our health system, to the lives and livelihoods of the people of this country. But let us make no mistake, this could have been avoided. This is not a crisis that was beyond solid government intervention, but ours is a government of inaction, obfuscation, and a government that evades accountability.
House Chairperson, we have repeatedly come to this House to reiterate the same thing, to highlight the looming crisis and to offer solutions. Looking at the budget process of the upcoming financial year, it is clear that COVID-19 has come to
exacerbate an existing mess. The department has been plagued by grand corruption that saw thieves fleecing public money at the expense of basic personal protective equipments, PPE, for health care workers, the filling of vacancies and massive infrastructure backlogs which compromised the quality of care.
As the country sinks deeper into the economic crisis that this government has plunged us into, there is less money to do even the basic things needed to deliver quality health care for our people. That is why, Dr Mkhize, it is now critical to ensure that the most crucial functions are prioritized for the next financial year. Firstly, we need to make sure that frontline facing and ... [Inaudible.] ... positions are filled. Many of the ... [Inaudible.] ... I visited across the country have flagged this as ... [Inaudible.] ... What we ... [Interjections.] ... Excuse me, House Chairperson.
The HOUSE CHAIRPERSON (Mr C T Frolick): Order, hon member, there are disturbances on the line.
Ms S GWARUBE: What we cannot have is a bloated administration, while those ...
The HOUSE CHAIRPERSON (Mr C T Frolick): Please, switch off your microphones so that we can listen to the speaker.
Ms S GWARUBE: ... who deliver clinical services are stretched beyond the limits. You must take an active role in ensuring that systems are in place across all provinces to roll out mass vaccinations.
Primary health care facilities remain the weakest link in the chain, and this must be rectified if we are going to successfully rollout the vaccine. Communication around the registration of people online and in facilities must be ramped up. Community media platforms, local leaders and community health care workers must form part of the strategy because many people that I have met on the ground are saying registration is poor, not because people do not want a vaccine, but because they do not know enough.
Finally, you must present to this House plans in place on dealing with the third wave while also trying to rollout a vaccine and contending with possible new variants. The job ahead is difficult, but it is going to require tough decisions, stringent public spending and prioritizing the
people of South Africa. The plan to vaccinate 40 million people by year end seems like a far-fetched fantasy at this rate. Without political will, coupled with well-run health system that is adequately funded, will be facing more avoidable deaths in the months to come, and unless drastic measures are taken, those deaths will squarely be on this government. Thank you.
Dr S S THEMBEKWAYO: House Chairperson, the EFF rejects Budget Vote 18 of the Department of Health. It is now over 14 months since we’ve had our first case of COVID-19 in this country, and during this time, we have seen the absolute devastation brought by the virus to the country and the world.
We have observed firsthand what years of neglect of the public health system has done to the ability of our public hospitals to provide the most basic of services to the people. We have watched with horror as those who are supposed to lead us to health have all abandoned this mission, and have chosen to rather lead in the looting of resources meant to help health care workers deal with the growing numbers of sick and dying patients.
Minister, you have made no provisions for fixing the public health mess that had almost collapsed public hospitals in Gqeberha during the second wave of the coronavirus. You have not employed any more health workers in that part of the world. The entire Eastern Cape was a mess before COVID-19, it is still a mess today, and you have not lifted a finger to fix the situation in that province.
You committed to vaccinate all health workers during this first phase of vaccine rollout, and your own estimations puts the number of health workers at 1,2 million. To date, just less than
400 000 health workers have been vaccinated. The target of vaccinating 67% of the population in order to achieve head immunity is a distant dream, and will possibly never be attained at the rate at which we are going.
The risks are far too obvious, Minister. Soon enough, we will be faced with a rising number of hospitalizations and preventable deaths, and this will be all on you. You will be personally responsible for the death of so many of our people because of your incompetence.
You have no vaccination plan worthy of the name, even as we speak today, you have not acquired the sufficient number of vaccines because you are preoccupied with buying vaccines from those who can corrupt you. You have learnt nothing from the past two waves of the virus, and you have not prepared our hospitals sufficiently to deal with the virus.
Minister, we need s strong public health system, to deal not only with COVID-19, but with a number of health threats faced by our people.
It is all common cause the HIV and TB care took a serious knock as a result of the focus on COVID-19. You have to date, developed no plan to integrate COVID-19 treatment with the treatment of HIV and Aids. The result of this is too dire to even imagine.
It will be no surprise if the excess deaths we have seen over the past year are not a direct consequence of COVID-19, but rather as a result of the neglect you have shown to other diseases.
Minister, the failure to deal with COVID-19 should provide you with a clearest indication of what needs to be done to
reconfigure South Africa’s health system. We need to build new hospitals that would provide cutting edge medical care to the majority of people across the country. We need to train a range of health workers, and employ them in the public service. We need to pay specific attention to primary health care in order to prevent the flooding of our hospitals by people with lifestyle diseases. But at the moment, we need a decisive leadership from you and your government, that will get our people vaccinated before the end of the year, in order to prevent the calamities that will surely follow if we fail to do so. You have proven that this job is way above your level of competence Minister, and if you had any trace of dignity in you, you would have resigned by now. We reject this Budget Vote.
Ms M D HLENGWA: House Chair, hon Minister, hon members, we considered the committee report on the Department of Health and related entities’ budgets. We cannot ignore the grim reality of our current situation. We undermined the deadly pandemic that calls directly into question the government’s efforts to rollout vaccines. The President, in his recent newsletter of 10 May 2021, called on Global Solidarity to ensure that covid-19 technology is accessible to all the allowed and local production of the vaccine.
The IFP fully agrees that the equitable access to a vaccine is critical. However, this does not answer the looming question about our government’s slow rollout response. We must face the facts - South Africa fares very poorly in the global rollout of the vaccinations. This is not only in comparison with rich countries, but also in comparison with our neighbouring countries. In the United Kingdom, according to a researchers’ group, Our World in Data, 52,25% of the population had already been vaccinated by 10 May with one dose of vaccine. Namibia, at this date, had already vacillated 1,29% of the population.
However, South Africa, in the comparison, had only vaccinating 0,67% of the population.
IsiZulu:
Into engekho-ke leyo.
English:
We cannot afford our government’s slow response. The public has a right to be properly informed of the government’s vaccine programme, and we fully support the committee’s, view that the department should strengthen its communication regarding the rollout programme.
IsiZulu:
Abantu abazi lutho lapha ngaphandle, Khabazela.
English:
However, hon members, the enormous task of vaccinating at least 40 million people by the end of 2021 - the Department of Health’s vision - must be seen against the fact that our primary health care facilities, as noted by the report, are not properly equipped to assist this programme.
Adequate infrastructure is a critical aspect, which needs to be urgently addressed.
IsiZulu:
Basho njalo abantu nakwi-NHI.
English:
We must ensure that our primary health facilities have adequate storage, infrastructure and systems available to administer the vaccine programme.
The IFP is also concerned about the impact of the enormous cut off 16,3% on the Indirect grant, which will inevitably have a
great effect on the national programme, especially infrastructure projects, it seems. It is alarming that the report notes that the establishment of economic service in vulnerable provinces, which is a longstanding and critical issue, will be further delayed by these budget cuts.
The IFP strongly endorses the committee’s recommendation that the department must furnish the committee with an action plan aimed at addressing the infrastructure backlogs.
The fight against corruption remains a consistent battle. In these desperate times, we cannot allow health care services to be undermined by corruption and lack of governance. The Auditor-General and its team are working endlessly to monitor the financial management of covid-19 initiatives, and we salute the work committed to ensuring accountability.
The IFP strongly supports the committee’s recommendation that the department should provide feedback on the implementation of the Auditor-General‘s recommendation and the IFP will closely monitor. The IFP supports the report. Thank you.
Mr P A VAN STADEN: Chairperson, every year we see and hear from this department the most beautiful plans regarding strategic plans, annual performance plans and annual targets, but the question never gets answered on how these targets will be reached. Never do we see any concrete plans from this department on how to eradicate the huge problems we are currently having in our public hospitals and clinics like, for example, service delivery problems, halting of life threatening operations, the shortage of doctors and nurses, the problems regarding the placement of payment of interns, the shortage of medicine and equipment, the shortage of water in hospitals, the burning down of hospitals, shortage of hospitals and clinics, the massive amount on litigations against this department that is a staggering R111 billion rand, R14 billion rand more than in 2018-19, infrastructure problems at hospitals and clinics, and the massive corruption cancer in this department.
Due to all of these, patients are dying in our hospitals and it is all over the news in the last few weeks. The cherry on top was when the Auditor-General came and told the committee last week there was massive corruption with PPEs. And we all know that, but what we did not know was while there was a huge
shortage of PPEs is in the middle of the pandemic last year, hospitals in eight of the nine provinces had just threw the PPE stocks outside under a cell in the rain, due to a lack of storage facilities. They have even showed us pictures of that situation.
The FF Plus said that the portfolio committee must intervene in these matters and that it is totally unacceptable that PPEs were not handled with any care at all. The FF Plus demands that the heads should roll in this Ministry and in this department on this matter. Therefore, the Minister together with all the MECs of nine provinces must appear before the Portfolio Committee of Health to come and explain this unacceptable behaviour and state of affairs.
It is a shame that 600 health care workers had to die because of a shortage of PPE, but meanwhile it is lying outside in the rain. The AG described it as an ineffective stock management processes, inadequate storage facilities and poor storage practices. This government is a total failure.
On field hospitals, the AG said that certain provinces that made plans to upgrade existing facilities did not follow
competitive procurement processes. Contracts were not always concluded and approved as required. Minister Mkhize and Minister De Lille, you need to start explaining yourself. The quarantine facilities debate also needs further explanation.
This department is spending millions and billions of rands on the NHI system that will not be able to be launched, unless all of these problems in our public hospitals are completely eradicated. We are looking at the NHI programme, at an amount of R121 billion and the NHI Indirect grant stands at R2,1 billion. Rather take this money that you are wasting now on the NHI system, that we as taxpayers cannot afford and use that money to buy more vaccines to try and stop this pandemic.
Then the Minister of Health can stop complaining about the so- called vaccine apartheid.
Afrikaans:
Hou op om ander lande van ’n sogenaamde entstofapartheid te beskuldig. Julle het verlede jaar gesit en slaap gedurende die onderhandelings en aankope van entstowwe. Julle het ’n gemors van die halsoorkop-aankoop van die astraZeneca-entstof gemaak, nadat hier reeds ’n nuwe variant in die land uitgebreek het.
Julle het ’n gemors van die sogenaamde uitrolprogram gemaak, deur kort-kort teikens se doelpale te verskuif en op die oueinde op 30 Maart weer ’n nuwe uitrolprogram aan te kondig.
Julle weerhou die privaatsektor om self die aankope, berging en verspreiding van die entstowwe te behartig, omdat julle van hierdie uitrolprogam ... [Onhoorbaar.] ... wil maak. Nou vra julle waarom slegs 840 00 mense ouer as 60 jaar oud uit ’n groep van 5 miljoen mense vir fase 2 van julle sogenaamde entstofprogram geregistreer het. Die regering word nie meer deur die burgerry van hierdie land vertrou nie.
Abg Meneer die President en Meneer die Minister, hou op om die vinger na ander lande te wys en begin self voor julle eie deur vee.
Daar bestaan hogenaamd geen waarborg dat 40 miljoen mense teen die einde van die jaar of selfs vroeg in 2022 ingeënt sal wees nie. die Adjunkminister van Gesondheid sê gister aan gesonheidswerkers wat hul inentings binne die volgende twee weke afgehandel sal wees. Hoe kan u sulke uitlatings maak as u voor u siel weet dat dit nie gaan gebeur nie? Van 1,5 miljoen gesondheidswerkers is daar maar nou eers 430 000 mense
ingeënt. Hou op om beloftes en uitsprake te maak, wat nie nagekom kan word nie.
Hierdie regering is nie meer bevoegd om aan die bevolking van Suid-Afrika gesondheidsdienste te kan lewer nie. Weg met die Nasionale Gesondheidsversekering. Weg met die ANC.
Die tyd het aangebreek dat ons ophou om net oor die probleme in ons openbare gesondheidstelsel te praat, maar dat daar nou werkbare planne en oplossings op die tafel geplaas word, om hierdie probleem op te los. Dit is duidelik dat die Nasionale Gesondheidsversekering nie daardie roete is of mag wees nie en dit is duidelik dat die ANC nie daardie roete is of mag wees nie. Dit is duidelik dat die medici, die burgerry en privaatorganisasies nou na vore moet tree om self daardie probleme op te los. Die VF Plus is bereid om daarmee te help. Dankie.
The DEPUTY MINISTER OF HEALTH: Chairperson, greetings to the Chair of the Portfolio Committee for Health, hon Dr Dhlomo and all other members of the committee, the hon Minister of Health Dr Mkhize, members of the NA, MECs present, heads of entities and statutory councils, distinguished guest’s ladies and
gentlemen good afternoon. I am indeed very honoured to be taking part in the debate on the Budget Vote 18 for the Department of Health, which is taking place just a day after a very important day International Nurses Day, when we celebrated the gallant contribution of our nurses in ensuring that our people can get a long and healthy life.
I wish to take this opportunity to say again as I said at the commemoration of this day yesterday to members of Democratic Nursing Organisation of SA, DENOSA, that as a Ministry and Department of Health we have indeed no hesitation in acknowledging that our nurses are the backbone of our health services at all levels from the basic primary health services at the local community level and also at the outreach, but also at the advanced tertiary services level, whether we talk about the provision of oncology services, theatre services and all the advanced services. Without the nurses none of these services will be viable.
Hon Chairperson, our country and the world still remain in the grip of COVID-19 pandemic which has been with us for just over a year now. In this last challenging 15-months we have been blessed with the outstanding leadership of our President
Ramaphosa his Cabinet colleagues, Coronavirus Command Council and of course, the TeamHealth led by my colleague Minister Mkhize and all our members of the executive co, MECs and heads of departments, HODs.
We extend our thanks to the co-operation we have enjoyed from colleagues in provinces MECs and HODs. We appreciate the support and co-operation we enjoyed from also leaders of civil society, community leaders. Without co-operation from traditional leaders, religious leaders, political leaders, labour and business. We would not be where we are with the relative stability we have, where our health services have not been overwhelmed.
You can imagine hon members where we would be if leaders of big organisation such as some of the big changes like the Zion Christian Church, the St. Engenus Church, the Nazareth Baptist Church if they decided not to co-operate with government, things would have really fallen apart. So, we thank them for their co-operation.
We indeed owe a lot to our health workers not only the nurses I have mentioned already but starting right at the health
facility, from the security guards right up to the heads of clinical departments. Our health workforce has been resilient and we want to say to them that the fact that our Fiscus has not enabled us to show the gratitude in monetary terms, it is only because the pandemic has also battered our economy because when the pandemic descended on us we know our economy was already weak. But it was weekend even further by the pandemic and the measures which had to take to mitigate against its impact.
The health workers are indeed the heroes of all South Africans. And many of your colleagues have indeed paid ... [Inaudible.] ... through life itself losing life itself. We mourn with their families and we hope that their families may get solace in the knowledge that their loved one’s death was not in vain and that they actually left a lot for the people of South Africa.
Hon Chairperson and members, it is common knowledge that our Annual Performance Plans 2020-21 were vastly disrupted. A lot of adjustments had to be made as was the case with the disruption of lives of many South Africans. We now have more than 12-months experience in dealing with the pandemic, but
the reality remains that what will happen in the next weeks and months remain unpredictable. Minister Mkhize has already spoken about disruptions to services such as HIV/Aids testing and treatment, Tuberculosis, TB services, maternal child services etc and the fact that we are doing everything to claw back on lost ground in this area so that we can catch up on these services.
We are of course concerned about the signs of rising numbers and the fact that the third wave maybe on us sooner than expected. As we battle with this pandemic we must not lose sight of some of the quadruple burden of disease such as the non-communicable diseases which Minister Mkhize has also alluded to. Diseases of lifestyle remains a serious challenge in our society which include diabetes, mellitus or hypertension, cardiovascular diseases kidney diseases, various cancer and mental illness. As you know, most of these diseases are associated with unhealthy died and lack of physical activity. I am aware that at some stage during the lockdown government was criticised for not allowing opportunities for exercise but this was just a temporary measure to try and control the epidemic. On the other hand, we have had some good gains in encouraging people to be wind off some of the smoking
tendency and excessive use of alcohol. During the closure of some of these many people were assisted to actually stop some of these habits. So indeed, the lockdown did play a constructive impact and we hope that some of those have continued even beyond the lockdown.
What adds more pressure on all of us not to take our eyes off this issue of non-communicable diseases such as diabetes, hypertension and obesity, is that it has been proven all over the world that when you have these commodities your ... [Inaudible.] ... is also very high so we need to focus on making sure that we guide and encourage our people to make sure that they can live healthy lifestyle.
I know that also during the lockdown people who meant very well were also clamouring that the closure of alcohol and tobacco could actually go on for long but using the national disaster provisions, but this was actually not legally sustainable. So, what we need now is to urgently speed up the tabling of laws such as the Tobacco Amendment Bill and also to finalise the Bill on the control of alcohol advertising. As we know South Africa is ranked amongst the highest consumers of alcohol in the world so the sooner we can tighten up on some
of the regulations while also upping our messages because the Legislative and Regulatory Framework will not in itself be able to reduce this if we do not also increase our advocacy, our advocacy remains very important.
Another area which need our focus is the area of mental health services. As you know the Life Esidimeni debacle exposed the weakness of our mental health services. The COVID-19 pandemic has added more mental stress - not only amongst the general public - but also amongst our health workers. There are many families who lost both parents and many more lost livelihoods adding more mental stress. In the current Fiscal year, we need to pay more attention to this. And indeed, in our Annual Performance Plans there are plans which are outlined to make sure that we can improve on the provision of our health services to make sure that our people including our health workers can get more mental health services.
We are conscious of the fact that a key answer to improve on these services is the integrated approach. As we deal with COVID-19 screening testing and management we will also be including HIV/Aids, TB, mother and child and the non- communicable diseases, NCDs, mentioned already.
As both our financial and human resources get stretched we are going to depend on integration from community outreach right up to tertiary services. Even as we roll out vaccination and I must say that the hon Gwarube is always sounding like a scratched record when it comes to this - no matter how often we emphasise the fact that if we were not vigilant, if our scientists were not vigilant and had not picked up the variants which was not reacting to the AstraZeneca indeed, we would have been equally criticised but we are in the process of catching up.
In the process of vaccinating we are including basic screening for covid and other health risks. We urge hon members also to promote healthy lifestyles at your constituencies following on the footsteps of President Ramaphosa with his “Thuma Mina” walks which he had initiated.
Hon Chairperson and members, provision of adequate and suitable human resources is fundamental in managing the pandemic and improving our health service platform. One of the major contributors to the supply of well-equipped medical personnel as already alluded to by Minister Mkhize, is the Nelson Mandela/Fidel Castro Medical Collaboration Programme
which also hon Dhlomo has alluded to. Since its inception in 1997, the programme which started modestly with a maximum of
80 students per year in Cuba but expanded in 2012 when the Cuban government provided an expanded programme. Thanks to the visionary leadership of some of our leaders including provincial MECs including hon Dhlomo being a leader in this when he was MEC in Kwazulu-Natal who sent hundreds of young people from rural and township areas and from disadvantaged families to Cuba to study medicine.
Since 1997, the total number of graduates who have contributed to our health services through this programme is 1979. Out of this, more than half of these 1374 are those who came through the expanded programme which was largely funded through the South African Government since 2012. And they have started coming back in numbers of 700 and above to complete their local integration since July 2018. In the last three years, graduates from this programme, just in the last three years alone, this programme has contributed more than one third of all medical graduates in South Africa.
Currently, we are having another 643 final year students in local medical schools who will finish their clinical
integration in December this year. Another 463 final year students are expected in July this year to start their 18- months integration. By the end 2022, we expect this programme to have contributed more than 3 000 doctors who are well- trained in primary health care more than just curative medicine as many of us who trained in our local medical school know and which is a weakness in our medical training.
One of the weaknesses which hon Dhlomo has alluded which we must address is that we need to use these graduates more efficiently in the promotion of primary health care as we roll out the National Health Insurance, NHI, because this is their strength. Thus far, we have been weak in just absorbing them continue the curative system.
The Health Professions Council has continued to look at better ways to enable South African medical graduates who qualify in universities not from the recognised list of universities to be given a chance to go through requirements for registration so that they can practice in South Africa. There are currently existing systems including a non-exam route for those from recognised universities and an exam and clinical training route for those from non-recognised universities.
We will continue to work with the Health Professions Council, HPCSA, to look at ways to streamline these processes so that these young people can actually be absorbed in our health system. In the meantime, we urge parents and students
to check with the, HPCSA, before they sent their youngsters to study medicine so that they can verify that those universities are indeed in the list recognised by a HPCSA.
Hon Chair, on the transformation of nursing education eight of the nine provincial nursing colleges as well as the South African Military Health Services have been fully accredited to offer the three-year diploma in nursing leading to a registration in general nursing. They have started to offer this as from January last year 2020. The Eastern Cape which is the only one still remaining is at an advanced stage of finalising the three-year diploma. In addition, all these colleges have been designated to offer certificated, degrees, postgraduate diplomas, which are being offered in a phased manner from this year.
Hon Chair, Dr Dhlomo has already mentioned The National Health Laboratory Service remains a cornerstone of provision of diagnostic pathology services in our country with a network of
more than 233 laboratories across the country catering for 80% of our laboratory services. It runs the largest HIV and TB programme in the continent and test for other priority diseases. After some difficulties in the earlier years it has now stabilised, it has turned the corner it is also it has also been able to tackle corruption where it was rearing its head.
We thank our provincial counterparts for co-operating with the energy and as in the National Health Laboratory Services, NHLS, as already mentioned is providing vital training of pathology and other medical scientists not only for South Africans but also a continent wide. In dealing with the COVID- 19, it has grown its capacity very rapidly from a start of two laps to do covid to now 130 across the country. Together with the National Institute for Communicable Diseases, NICD, they provide daily information to us as to where the pandemic is.
We acknowledge and thank the private let us also for co- operating with the NHLS.
The other entity which is playing a pivotal role is South African Health Product Regulator Authority, SAPHRA, which has upped its game in making sure that we get speedy access to
diagnostics treatment and vaccines. This young entity has risen to the occasion under tremendous pressure and over the medium term it will focus on accelerating the clearing up of backlogs of the approval of licensing of medicines.
The Medical Research Council also very outstanding with research and as the hon members would be aware also playing a pivotal role in the genomic studies which is why we have been able to identify variance which are prevalent in our country. [Time Expired.]
The HOUSE CHAIRPERSON (Mr C T Frolick: Hon members, I will now invite the hon Mhlaule who will preside over the remainder of this mini-plenary.
Ms M E SUKERS: Hon Chairperson, the ACDP wishes to acknowledge our nurses today a grateful nation. Thank you for your service. While we could work online you had to touch the sick and comfort the dying. Florence Nightingale stated, how little can be done under the spirit of fear. Fear paralyses people and knowledge enables us to take action. The ACDP has consistently engaged with the department in this portfolio committee to urge the development of a comprehensive response
to COVID-19 that include the provision of the optimal care of those infected. This must be supported by a communication plan that ensures that those who suffered from comorbidities are made aware of the importance of disease control resulting in better outcomes when infected with this virus.
Government must focus on research to tackle the underlying causes of comorbidities and the long-term effect of COVID-19 on sufferers. This budget is inadequate for this. This urgent need cannot be addressed by a 100 health promotional messages that will be broadcasted in social media in order to reduce premature mortality due to noncommunicable diseases. Given that the majority of the people who are most at risk and who do not receive care are the poor and the aged. The youth for social media to reach them is to put a bluntly ludicracy. We raised concerns with the Minister regarding vaccine hesitancy on the grounds of ethical objections and the need to source as an option an ethical vaccine that in no way uses cell line from [Inaudible.]
We also questioned the department’s capacity to strategically source vaccines. We have been outmaneuverered by corporations whose primary aim is to make profits. Government must fight
for what money cannot buy, life. We should use everything in our arsenal to save lives. How do you unify efforts to fight diseases when you regulate people on what they choose as treatment? We have only heard one message consistently, vaccine, and the very thing you promote as the only long-term solution you are unable to effectively roll-out within timeline stipulated by your own department.
Tell us, are you developing a comprehensive multipronged approach response that will involve all role-players to focus on prevention, optimal treatment and is open for considering alternative treatments that have positive benefits? And will you effectively communicate this to all sectors of society?
Repeated government failure has meant that the only message that government has successfully conveyed was the one of fear. When you monopolise health care and steal the resources needed to keep people alive it is entirely reasonable that our people live in fear, and fear paralyses people. But perhaps that was the aim. All South Africans desperately hope that you will perform your duties competently because we are a long way [Inaudible.] [Time expired.] comprehensive plan against COVID-
19 and an effective vaccine roll-out. I thank you.
Mr N L S KWANKWA: Chairperson, the UDM does not support Budget Vote 18. Hon Minister, the second wave brought South Africa’s health care system to the brink of collapse. You will recall that in provinces such as the Eastern Cape the basic health care system completely collapsed. Patients were fighting each other for basic health care and others in hospitals like Livingstone in Port Elizabeth were lying and dying on the floor due to lack of proper basic health care. This occurred in the context of a basic health care system that was under strain and on the brink of collapse nationally. This occurred at a time where vaccination is at a snail’s pace, infections and deaths keep on increasing and yet the Minister has warned us that there is a third wave coming up.
Our concern with that statement is that the third wave is coming up and yet the President not so long ago indicated that he wants the elections of the country to continue towards the end of the year. Surprisingly, from where we are sitting the Minister does not seem to be advising against that whereas a number of infections keeps on increasing on a daily basis.
Minister, you know that it is a known fact that coronavirus has served as a looting spree for many individuals in the
department and the national leadership. For instance, we are aware that competitive bidding process were not followed in the procurement of personal protective equipments, PPEs. There were inadequate storage facilities and some hospitals did not even get enough PPEs while some hospitals had oversupply of PPEs. It is unforgivable, Minister, that while most of the people died in South Africa died due to many hospitals having no PPEs that there were hospitals in the country with oversupply of PPEs that had no storage facilities resulting in a situation where PPEs were stored negligently by those hospitals.
We have a situation in our country where nurses and doctors work overtime as a result of the shortage of staff. Unresolved community workers were laid off due to insufficient funds to pay them. The department still fails to provide adequate supply of the protective gears to frontline workers. Also all of these occur in the context of a country that is expecting a third wave. We want you Minister to take the nation into confidence by explaining what comprehensive plan the department has to try and expedite, firstly, the vaccination process and, secondly, how to deal with the third wave in particular.
We are of the view that on the 2021 state of the nation address, the President highlighted the need to intensify the prevention efforts, strengthen the health care system and to roll on a maximum vaccination programme with millions of vaccine having to be procured and delivered. It has been three months since the President made those promises and the practical implications are just otherwise.
Currently, the vaccination process has been disappointed to be a slow with only even just half of a percent of the population vaccinated so far. It is important that you use this platform to explain to South Africans how that picture is going to be improved, how are we going to make sure that more people are vaccinated over the next three months especially in the light of the fact that we are going to have elections ... [Time expired.]
Mr A M SHAIK EMAM: Chairperson, at the very outset we would say the NFP supports this Budget Vote here today. Allow me, first of all, to start by saying that the Department of Health as a frontline department in the fight against the spread of COVID-19 its success depends heavily on the financial support available. Unfortunately, the country is at the brink of
fiscal cliff this force the Department of Health to fight the spread of COVID-19 with limited resources.
Minister, we understand and accept the fact that you inherited a department that has already in serious trouble with COVID- 19, and there is no doubt about that. But what you must understand, Minister, is that on paper everything appears to be okay, but on the ground and reality our people have great difficulty. We can talk about building more hospitals, we can talk about building more clinics. What is important is ensuringthat you provide quality health care service to our people. It is normal today at very many hospital and clinics when you go around today the lifts are not working and there is not enough medication, the queues are long. People have to go there in the early hours of the morning and spend the entire day there. There is no passion and commitment from some of these health care workers.
Having said that I was expecting the national department to talk about creating a special compensation fund for those that have succumbed to COVID-19 as a result of the selfless commitment and dedication during COVID-19. That has not actually happened.
The other issue that we have and is a matter of serious concern is the SA Health Products Regulatory Authority, Sahpra, and the way they conduct themselves. If you look at the issue of [Inaudible.] which is one of the safest drug in the world, one of the cheapest drug that was made available. The fact that there was lack of urgency on the part of Sahpra to even review the drug. And they admitted that documentation applications were given and they did not even look at it. That makes suspicious on the relationship between the CEO of Sahpra and Mackenzie. We know that Mackenzie has involvement with the World Health Organisation. We know the involvement of Johnson and Johnson, we know Aspen pharmaceutical, we know exactly what has been happening for a period of time.
The other thing, Minister, is that let us be realistic with what you are expecting to achieve before the end of the year is impossible for you to do it. First, you are not getting enough vaccines coming into the country; and secondly, you do not have a proper plan in place to be able to achieve it. Let us be realistic that you have a health care system at this point that is in crisis. ... because many of your people that are being your best and yet are trying to do their job under very, very difficult circumstances.
Now, look at the issue of HIV and tuberculosis how badly we have been infected in this country. Look at the budget cuts particularly in the relevant areas. What is going to happen is that all the successes and gains you have made in the last ten
10 or 20 years you are now taking us back again. That is basically what is going to happen.
I think what is very important, Minister, while we believe that you are doing quite a bit of work there is no doubt about it ... [Time expired.]
Ms H ISMAIL: Chair, the provision of essential health services is the core responsibility of the Department of Health. These services are crucial to the health and quality of life of our people. However, the department’s mandate is severely impeded by tight budgets and additional fiscal pressure brought on by the pandemic. This is pressure however, that can be mitigated by implementing mechanisms to rule out corruption in the department.
The implications of PPE corruption results in poor service delivery, poor delivery of quality PPE, massive staff vacancies and loss of health care professionals' lives.
The Auditor-General, AG, report brings to light major issues being attributed to an inefficient budget. Financial processes are not being followed, procurement is riddled with mismanagement and noncompliance leading to payments of higher prices for PPE, poor quality control, late deliveries, irregular expenditures, irregular payments to service providers and alleged financial irregularities in awarding of Covid-19 tenders.
Even though the Public Finance Management Act, PFMA, and the National Treasure Instruction 1 of 2015-16 states the rules for procurement in terms of what must be published, for how long, and who gets the tender and those who did not, this is not being done. A major contributor to procurement failures and high corruption costs is government’s inability or lack of political will to monitor these processes, as is stipulated by legislation.
We have currently R13,3 billion under investigation and e- tender or provincial portals do not follow what was stated in the above law and instruction. In the e-tender site 46% of unsuccessful bidders were not published. This means the public cannot compare the prices to ensure the best possible company
was awarded the deal. In the North West only 46 of tenders from 2018 to 2020 were published. There is a clear lack of transparency in government procurement processes and that is why we have seen such high corruption.
The Financial and Fiscal Commission has highlighted its grim state. The Office of the Health Standards Compliance is mandated to monitor and enforce compliance by health establishments with prescribed norms and standards. Due to budget constraints, the Office of the Health Standards Compliance, OHSC, has announced their projected target for 2021, being a mere 8%. Monitoring norms and standards is crucial for quality control and in the health care system this could mean life and death.
With regards to the Council for Medical Scheme, the entity is riddled with vacant posts and have run out of money. The SA Health Products Regulatory Authority, Sahpra, cannot get through their application backlogs due to human resource shortages and in October 2019 there was a proclamation of an the Special Investigating Unit, SIU, investigation on alleged serious maladministration in connection with the affairs of Sahpra.
The National Health Laboratories Services, NHLS, is not adequately equipped with some laboratories not having necessary resources for proper functioning. This is in addition to reports of irregular payments to service providers with regard to the procurement of PPEs and an SIU investigation for alleged financial irregularities in awarding R170 million worth of COVID- 19 tenders as well as alleged R113 million worth of fraud and theft from the NHLS alone. How can we ensure the NHI will be free from fraud and corruption and ensure quality health care when we cannot currently function properly?
The department must engage with the Treasury to ensure that adequate funding is allocated for the entities to function properly and effectively execute their mandate. We still need to procure and administer much more vaccines in order to reach population immunity.
Minister, the DA has solutions for you. Firstly, create a minimum compliance and policy framework that tender reporting must abide by; secondly create an independent regulatory body to ensure that due processes are followed; and third, ensure the proper implementation of National Treasury Instruction 1of
2015-16. Minister, insufficient budget means a nonefficient health system. Corruption in the department leads to nonservice delivery on the ground. We need a capable state with political leadership that will attend to this crisis now. Loss of time leads to loss of precious life.
Ms X HARVARD: Hon Chairperson, let me start by saying that the ANC support this budget work. It has been a challenging year since 2020 budget. That changed the ... [Inaudible.] ... due to the COVID-19 pandemic. COVID-19 has resulted to budget allocation in adjustments in all sectors, including health.
This new normal has hit us most badly, as it is this portfolio that has mammoth task of fighting pandemic. In 2021 budget, our priority in fighting the pandemic remains the same.
Hon Chairperson, the President highlighted the need to intensify prevention efforts, understanding ... [Inaudible.]
... vaccination programme is managed of vaccines procured, and this is being rolled out. More effort is being done to skill this up. Furthermore, it must be emphasised, assigned, ... [Inaudible.] ... approach will continue to be used for all medication and vaccines being empowered into the country. I am here today to talk about the great walk the Department of
Health and its entities have done, and continues doing in 2021-22 financial year.
Their key priorities and achievements is clear indication of the ANC manifesto commitments of quality health for all state or all the general ... [Inaudible.] ... statement. Under state of the nation address, these are fight against the COVID-19.
The SA Health Products Regulatory Authority priority areas are: Claims of backlog applications for registration of medicines under COVID-19 vaccines. At 24 March 2021, the backlog was cleared by 79%. Emergency authorisation was put in place to fast track the registration of COVID-19 vaccine and the three vaccines were authorised.
The Compensation Commissioner for Occupational Disease will expand the economic claims management system, and the ... [Inaudible.] ... base to cover workers in mines and ... [Inaudible.] ... The National Health Laboratory Service Priority Programmes have been impacted negatively by the pandemic. As ... [Inaudible.] ... perform, compared to the previous financial year, this was due to patients not accessing health facilities during lockdown. This takes the challenge. The NHI continue to enhance the provision of ...
[Inaudible.] ... reliable, efficient service delivery at a low cost.
The Council for medical schemes, but hopefully the new regime to promote an affordable and accessible health cover towards universal health coverage for all citizens. Hon Chairperson, the SA Medical Research Council is also advocating against vaccine national ... [Inaudible.] ... It helps ... [Inaudible.] ... for frail, equitable, untimely allocation of COVID-19 vaccines in Africa, with funding from open society foundation for South Africa, and establish the Health Ethics Advisory Panel, HEAP, the entities working with Africa Union and Africa centres for disease control and prevention.
Lastly, the office of health standards compliance will align with the proposed National Health Insurance, NHI, by intensifying inspection and satisfying compliant public and private health establishments. At the end of 2020-21 financial year, the three certificates of compliance were issued, and more work will be done during 2020-21. Hon Chairperson, it is through great strides of working together that we shall overcome challenges.
Now is time to work towards the course of NHI. Let us work to make sure that everyone has equal opportunity to quality health care in our country. We therefore ask this House to approve this Budget Vote. I thank you.
Mr T B MUNYAI: On behalf of the ANC I rise to support the Budget Vote 18 on National Department of Health, tabled by the hon Minister, Dr Zweli Mkhize, this afternoon. It is imperative that we in the ANC who is solid behind this budget support, must also equally raise some concerns, which is the basis on which we invited the Minister of Finance to engage in appeal for the support of the National Health Insurance, NHI, despite the R11 billion contribution for vaccine funding, which we welcome, indeed.
As the ANC, we are listening to this call, and we are duty- bound to ensure that the kind of budget we pass truly reflects the values and principles of the ANC, and make sure that we indeed support what has been outlined in our manifesto commitments. The massive budget cuts cannot be blamed on hon Minister, Dr Zweli Mkhize, either corruption of the personal protective equipments, PPEs, because in the National Department of Health, there is no corruption at all. Any
allegation of corruption to our ministry is misplaced because those who sing corruption every broad daylight are nothing, are ignoring the Steinhoff heist corrupt activities of the and 20th century.
Hon Chairperson, as one of our government leaders would have said, I quote:
NHI is fundamentally about social justice. NHI will ensure that all our people, whether you are black or white, rich or poor, you will be able to access comprehensive range of health care services.
Those who claim that we do not have concrete plan, are politically blind. One of the PSL Fifa accredited referee who passed on during the fatal car accident did not have medical aid. These are the people, hon Chair, that really need NHI for survival, May His Soul Rest in Peace because, as the ANC or the NHI, we would want to provide quality health for all our people, regardless of their employment status.
Hon Chair, as you remember, the White Paper notes, as also reflected in the Bill, I quote:
NHI represent a substantial policy shift that will necessitate massive reorganisation of the current healthcare system to address the structural challenges that exists in both the public and private sectors. It refers the kind of society we wish to live in, one based on values of justice, fairness and social solidarity.
Implementation of the NHI is consistent with the global vision that health care should be social investment.
Hon Chair, the budget must speak of avoiding massive lay off of the public health workers or the wage freezes or cuts of their benefits. Hon Chair, we call upon the increase of health budget in real terms, while we support the substantial funding of the distribution of vaccines we urgently need. Funding of health care systems overall will suffer in the next three years without increased funding, in real terms. That is above inflation. This is critical because, all well-funded public health care sector, is the backbone of the future of National Health Insurance.
Just nearly two years ago, we have been elected to implement the most progressive policies of our movement contained in election manifesto. It has been hard and difficult election
year, and we will listen to our peoples cries and emerge victorious. Hon Chair, the NHI is a key and central policy that we immediately need to implement as practical and urgent as possible. Therefore, Parliament has agreed in our portfolio committee, is starting with 121 organisation, public hearings.
On the other hand, we are caring. We are making a clarion call to our parliamentary staff to really quickly process the NHI as a matter of urgency. The Parliament staff really must be cautioned because as the ANC, we cannot and will not technically delay the NHI to roll over to the Seventh Administration, through the possible well-calculated, deliberate effort to undermine our portfolio committee’s decision to appoint a competent of graduate from the project management unit that have done the job before and done it successfully, through the support of the former President, Kgalema Motlanthe, panel report.
No party or any staff should be allowed to be worried that the ANC has rejected and also the portfolio committees, the outsourcing of the NHI. Hon Chair, we know that COVID-19 has brought some unprecedented consequences, that indeed for some degree left us with a lot of unemployment and a lot of
negative consequences, but we are very grateful that the Minister, I have a clear programme of vaccine roll-out to respond to this pandemic. Thank you, hon Chairperson.
The ACTING HOUSE CHAIR (Mr M G Mahlaule): Thank you very much, hon Munyai, may I make a plea, hon members, that we be positioned in areas where we are not going to hear other people speaking. Thank you very much. Our next speaker will be hon Hendricks from Al Jama’Ah.
Mr M G E HENDRICKS: Thank you very much, House Chair. Hon House Chair, the presentation that we just heard from the hon Munyai has been a breath of fresh air and gives us a sense of excitement that the National Health Insurance, NHI, is on the radar. We remain concerned by the reports of preparations, however, to acquire and administer the vaccine, but we acknowledge the best endeavours of the Minister of Health. He is leaving behind a legacy that he can be proud of. President Ramaphosa is becoming a world leader, respected for his dynamic leadership to save lives not only for South Africans, but the African continent as far as the pandemic is concerned, providing vaccines for African refugees ... [Interjections.]
... especially now that we are in Africa Month, and we promote
the “United States of Africa”.
ALJAMA-AH calls for the immediate transfer of tax benefits on medical aid to the budget of the Health department to bolster the NHI roll-out. ALJAMA-AH supports the budget, and we look forward to the presentation and the signs of Dr Jacobs later on, information and guidance to this House that ... [Interjections.] ... it can expect from the official opposition. Thank you very much, hon House Chair.
The ACTING HOUSE CHAIR (Mr M G Mahlaule): Thank you very much, hon member. We now move on to the hon E R Wilson from the DA.
Ms E R WILSON: Thank you, House Chairperson. Every person in this House took a solemn oath to protect the Constitution, and in doing so all the people of South Africa. It is beyond comprehension therefore that members of this House, particularly from the ANC benches, can come before us and say that what has been presented to us is acceptable. A lot is not acceptable. It severely impacts on the health and wellbeing of every citizen in this country, particularly the poor and vulnerable. The personal protective equipment, PPE,
corruption, and in particular the inadequate storage of PPE supplies and the purchasing of PPE equipment that did not meet standards to protect our frontline workers from COVID-19 has potentially resulted in the loss of lives of health care workers who were working tirelessly to save the lives of others. This is not acceptable.
The compensation of employees was reduced by 12%, which has resulted in reductions across all programmes. Hospitals and clinics are already seriously understaffed, and we are advised that budget cuts are going to result in loss of staffing and inability to employ further staff at a time when there is a crisis. This is not acceptable.
The grants for construction and refurbishment had been reduced by R170 million. Refurbishment projects, construction on an academic hospital and the maintenance of facilities that are already in a horrific condition in many areas, have been put on hold. Machinery and equipment desperately needed in some areas will not be purchased, leaving the sick and vulnerable in an even more precarious position. This is not acceptable.
In some provinces a single ambulance is required to cover an area of up to twenty thousand square kilometres. This results in victims in need of emergency care lying in wait and even dying, as ambulances take hours to get to them to assist. This is not acceptable.
The arrival of the third wave of COVID-19 is here and people are dying in droves on a daily basis, but our vaccination programme has been an absolute disaster, marred by slow start to purchase vaccines and hold ups on a regular basis. Half of the frontline workers are not yet vaccinated. The citizens of South Africa have been left abandoned in the cold as another “tsunami” is fast approaching. This is unacceptable.
Minister, no person in this House with a conscience can say this report and budget as acceptable. It cannot be, unless of course they really do not care about the poor and vulnerable in South Africa, which appears to be closer to the ... [Inaudible.] ... and that is unacceptable. Cry, the beloved country!
Dr K L JACOBS: Chairperson, the ANC does want to say from the outset that this Annual Performance Plan, APP, and budget is
acceptable, contrary to what hon Wilson had to say. Yes, we do have a conscience, and it is our conscience that makes us speak in the way that we do. Given our understanding of where South Africa and, indeed, the world is with regard to the fiscal constraints caused by the COVID pandemic, the ANC supports the 2021-22 annual performance plan, budget as well as allocations of the national Department of Health and its entities over the Medium-term Expenditure Framework, MTEF, period.
We recognise that the national Department of Health provides leadership and co-ordination of health services to promote the health of all the people of South Africa in an accessible, caring and high-quality health system based on the primary health care approach.
We also note that the department’s main focus over the medium term will be to respond to the COVID-19 pandemic, including the various stages of the vaccine roll-out strategy, and the plan to vaccinate at least 40 million people by the end of the 2021-22 financial year.
We also note the phased implementation of the national health insurance, NHI, and the continued prevention and treatment of communicable and non-communicable diseases, and the investment in health infrastructure and supporting tertiary health care services.
We note that the department has done everything within its power to structure this budget such that no programme is left behind. We agree with what they have structured for us.
We know that the department has completed the first phase of a five-year preparatory work plan to improve the health system’s performance and improve service delivery towards delivering on universal health care in South Africa.
The ANC seems to be one of the few parties which understand the importance of universal health care.
We want to thank Al-Jama’ah, the NFP and the other parties who support this universal health care that is required by all the people of South Africa.
The department is aiming to implement the NHI by 2026 and will be guided by the Presidential Health Compact which is a collaborative effort of multiple stakeholders who came together to contribute towards improving the health sector.
The committee noted the good work done by the department over the past year, but also expressed concern, about the following, amongst others: The underfunding of vital programmes such as the HIV and TB programme, which might result in regression in the control and prevention of these conditions.
We nevertheless commend the department of the deployment of mobile HIV testing ... [Inaudible.] ... using the GeneXpert machines, which are currently in use for COVID-19 detection.
There are infrastructure backlogs, but we note the commitment to establish parity between public and private infrastructure. The need for more awareness campaigns aimed at addressing stigmas around HIV and Aids are noted, and we want the department to react to our request in this regard.
We note the plans to address challenges at health care facilities such as staff shortages and equipment shortages.
The committee notes the good work of the department to employ all medical interns and community service personnel in the past year, and we are very grateful to the department for that. It would not bode well for any highly trained person to be sitting at home unemployed, especially when they have a commitment towards the department and towards South Africa.
The committee commended the department on the Ideal Phoenix initiative. These are appreciated, especially in the rural areas. As an indicator of the good work done by the department, we note the increase in life expectancy of South Africans over the past number of years. The aim is to reach a life expectancy of at least 66 years this year, and 70 years by 2030.
We have heard at length about the good work done by the entities of the department. I want to mention just two of the entities. I don’t wish to single them out, but I wish to emphasise some of their roles, such as the commitment by the SA Medical Research Council, SAMRC, to lead the generation of
new knowledge for translation into policies and practices to improve the health outcomes of all people.
The core mandate of the SA Health Products Regulatory Authority, Sapra, is to ensure that all health products for human and animal health available in South Africa are safe, are of good quality, are effective and ... performance medical devices ... It is important to know that Sapra makes these decisions purely on the evaluation of the scientific data made available by those who apply for those licenses. Although some members of the public and other stakeholders may not agree with all decisions taken, it is critical for the credibility of the regulator to have a solid base on which decisions are taken.
Thus it is important that, as a nation, we support Sapra and jealously guard its autonomy and independence for the sake of the lives of people in South Africa.
We notice the call yesterday by the Minister of Health, hon Dr Zweli Mkhize, that provinces should start intensive containment measures to curb a further increase in COVID-19 numbers. This should be seen as a wakeup call by all South
Africans who must ensure that they practice the non- pharmaceutical intervention measures of mask wearing, social distancing, washing of hands with soap and water and sanitising in order to minimise possible transmission of the virus.
All eyes are focused on the vaccine programme of the department as part of its COVID response plan. We know agreements reached with the manufacturers of the Johnson & Johnson and Pfizer vaccines – a total number of 31 200 000 Johnson & Johnson vaccines and 20 100 150 Pfizer vaccines – are expected to be received over the next three quarters as per the agreement. That gives us a total of 51 301 150 vaccines doses.
We understand there are ongoing discussions to additionally procure 10 million doses of Sputnik and Sinovac manufacturers, pending Sapra approval.
We are very thankful for the Sisonke Early Access programme, which ensured that the vaccination programme is initiated in South Africa. This programme is currently operating in 78
sites, including rural sites, and open to everyone who works in the health sector.
The Portfolio Committee on Health welcomes the inclusion in the vaccination programme of health care workers in rural areas as well as traditional healers. We know that there have been incremental increases in the number of healthcare workers vaccinated on a daily basis from 28 April 2021. We thank the health care workers for taking the lead by their commitment to receive the vaccines. On 12 May, this number stood at 430 730. Vaccinations of health care workers for a single day recorded on the electronic vaccine data system, EVDS, for 12 May alone was at 90 699 as per the Sisonke study. It is expected to rise more than threefold over the next few days of the study’s implementation.
This is contrary to what hon Gwarube wants to paint as a failure. Once again, we are very thankful to our healthcare workers for taking the lead, this time in showing the population that vaccination is the way to go. We are also certain that these vaccines are available to the people of South Africa as per the agreements already reached by the national Department of Health with the manufacturers.
Another welcome number is the number of persons over 60 years of age who had registered by 10 May. This number stood at
854 686 on that day. People are encouraged to please register on the EVDS system. The committee is of the view that the department should do more to create sufficient awareness for people to register or to educate them on how to do the registration.
The question everybody would probably have in mind is what the future vaccine roll-out plan after the Sisonke Early Access programme would look like. The committee notes the phases as the following.
Phase one is for health care workers people. This is immediately after the Sisonke Early Access Programme ends tomorrow. Phase two afterwards will include people according to age, starting with those over 60 and workers across all sector where the risk of transmission of infection is greatest. Workers will be vaccinated at workplaces using their occupational health services. People in congregate settings such as old-age homes are also part of the phase two plans.
We wish the department well with these plans and we again want to really urge South Africans to please register themselves on the EVDS system and to make themselves available for vaccination because vaccinations save lives.
Let me also join the hon members in honouring our nurses on the commemoration of Nurses’ Day yesterday. Nurses have been at the forefront of managing the COVID-19 pandemic. We wish to thank them and all other health care and essential workers for their selfless service to the people of South Africa. Thank you.
The MINISTER OF HEALTH: Hon Chairperson, let me thank all the hon members for your comments, contributions and suggestions. I note your comments and your concerns, and must say that we do take those very seriously. I also want to reiterate our best wishes to all our nurses on the celebration of International Nurses Day. We do remind them, as my colleague, the Deputy Minister has said, that they are the foundation on which our health system is based, and we really thank them sincerely for all their hard work.
We have had quite a lot of concern around the issue of the vaccination. We do accept that this vaccination has not moved to the extent that you wanted it to be, but we do want to remind hon members and fellow South Africans that we have actually had challenges that are outside our hands, particularly the delay on the AstraZeneca vaccine, which was already in the country, and we couldn’t use it because of the results indicated that had indicated less efficacy.
We have also secured the Johnson and Johnson, and there are two delays that have been on occasion. The first one was because of the clotting disorders which were detected and there had to be an evaluation of this problem. Whilst that has been reactivated, there is now an issue of the audit in terms of the manufacturing procedures in the US, and we have been phoning and talking to them almost every day. We do expect that our doses which are manufactured in Gqeberha are actually ready. We have been assured that they are free of any form of challenges or contaminations. We expect them to be released as soon as the Food and Drug Administration, FDA, has concluded its side.
Again, that being the delay has been occasioned not so much by us but by the fact that we are part of the global chain of manufacturing. By Monday when we start we will be aiming just under a million or almost a million doses of the Pfizer vaccine. We want to again encourage all our health workers that they will be vaccinated as part of the completion of the first phase. At the same time, we will also be encouraging the general public, particularly those over 60 and those with comorbidities, that they will actually be approached to indicate when they should be starting. So, will start with those who are over 60 years of age.
I think that’s very important for us to indicate that it would like to see the speed of vaccinations picking up, and we expect that it should be so. Hopefully during the course of this delay with Johnson and Johnson would be released and therefore will not only have one million but two million, so that we are able to pick up the speed. We do want to see the speed of vaccinations being accelerated. We want our people to know that we have the utmost concern and a high regard for the health and safety. Part of the duties of South African Health Products Regulatory Authority, SAHPRA, is to make sure that our people are protected. They have to very rigorous in
analysing the contents of the various vaccines and medication that is being brought to us so that everything that we use is absolutely of high standard.
The other concerns that have been raised that relate to the various manifestations of the challenges in the health sector, we do accept. We have increased employment of some of the human resources in the Eastern Cape. In fact, last year more than 8000 people were employed as part of responding to this particular challenge. We do understand as well that we need more funding and more resources. What we have seen in the reduction is something that obviously is affecting all departments in government. But in reality we are saying that the health services do need to be funded more than what is happening now. We understand that there are constraints at the government level.
We are also quite determined to deal with, fight and uproot the corruption, and so we are co-operating in the interMinisterial committee to deal with this particular issue where various departments are involved. We will be coming to meet with the portfolio committee to respond to the Auditor- General’s report, and all of us were concerned about some of
the irregularities that related to the PPEs. We do not believe it is absolutely correct to say that all the people who have suffered was necessarily because of the PPEs, but we do understand that the issue of the shortage of PPEs, quality, storage, supplies and everything was a matter of concern. We went all out to resolve these, and towards the end of the year we had all agreed with the unions that there was no challenge of the PPEs but that we needed to correct historical problem that led to the challenge that we have seen.
We will do everything to ensure that all the programmes do not suffer; HIV, tuberculosis, malaria and the lifestyle diseases of diabetes, cardiovascular diseases and renal diseases. We are going to work very hard to make sure that we expand all the services to the level at we can. The National Health Insurance is a very, very important programme for us. It is an issue about social justice; it is about ensuring that there is equitable access to quality healthcare, irrespective of their employment status, racial profile, whether someone lives in urban or rural areas. It is a must for South Africa. It is an investment into the future. We need to make sure that South Africans are protected equally in this one way of ensuring that our human rights are actually restored, where all our
people have access to quality health services, based on what is available and what the need is from the condition they suffer from. This we have to do — there is no going back.
We understand that some people have their own reservations about it, maybe because they do not understand what it means. We have people who are poor, who are old, vulnerable, who are in rural areas, who have poor transport, who have no savings and now must decide whether they must put money aside instead of looking after their families they must pay for health services. The National Health Insurance is a must and therefore we thank you very much for all the support. All those who have supported the National Health Insurance, we will disappoint you; we will go ahead and implement it. Thank you very much, hon Chairperson.
The ACTING HOUSE CHAIRPERSON (Mr M G Mahlaule): Thank you very much, hon Minister. Members are reminded that the debate on Agriculture, Land Reform and Rural Development Budget Vote; Higher Education and Training Budget Vote; and Sports, Arts and Culture Budget Vote will take place at 16:30 on the virtual platform. That concludes the debate and the business
of this virtual mini-plenary session. The mini-plenary will now rise.
Debate concluded.
Mini-plenary rose at: 16:03
Audio
No related