Health: Minister's Budget Vote Speech & responses by ANC,IFP and DA
Briefing
15 May 2013
Minister of Health, Dr Aaron Motsoaledi, gave his Budget Vote Speech on the 15 May 2013
____________________________________________________________________
Honourable Speaker
My colleague the Deputy Minister of Health
MECs for Health present
The Chairperson and members of the Health Portfolio Committee
Honourable Members of Parliament
Invited Guests
Ladies and Gentlemen
Honourable Speaker, it is now well documented and generally understood that South Africa faces a quadruple burden of disease. Many other countries are faced only with a double burden.
These four are:
- A very high prevalence of HIV and AIDS which has now entered into a synergistic relationship with TB;
- Maternal and Child morbidity and mortality;
- Exploding prevalence of non-communicable diseases mostly driven by risk factors related to life-style; and
- Violence, injuries and trauma.
These four colliding epidemics resulted in death notification doubling between 1998 and 2008 to 700 000 per year as noted by the National Planning Commission. Life expectancy in the country also took a knock and declined to worrying levels.
We had to respond to these very urgently and very decisively.
In addition to our Ten Point Programme, the Department of Health signed the Negotiated Service Delivery Agreement with the President. We committed to four (4) objectives which we called outputs during this term of government.
These are:
- Increasing Life Expectancy;
- Reducing maternal and child mortality;
- Reducing the burden of disease from HIV and AIDS and TB;
- Improving the effectiveness of the health system
After going into a deep analysis of the problems, it became clear that unless we deal decisively with HIV and AIDS and TB, it would be foolhardy to believe that we could ever decrease the high levels of mortality and morbidity in our country. Hence our plans had to have a very strong element of a desire, commitment and passion as far as HIV/AIDS and TB are concerned.
This did not mean that the other epidemics were less important, it simply emphasised that the central driver of morbidity and mortality in South Africa was largely HIV and AIDS and TB.
Honourable Speaker, we responded comprehensively through well designed plans to deal with HIV and AIDS and TB, and the implementation of these plans was well executed.
Among others Honourable Speaker, we increased the health facilities providing antiretrovirals (ARVs) from only 490 in February 2010 to 3 540 to date. The number of nurses trained and certified to initiate ARV treatment in the absence of a doctor were increased from only 250 in February 2010 to 23 000 nurses to date. This programme is called NIMART or Nurse Initiated Management of Antiretroviral Therapy. NIMART made it possible to increase the number of people on treatment from 923 000 in February 2010 to 1,9 million to date – that is actually doubling the number on treatment.
I wish to take this opportunity to thank all the health workers for this sterling performance – especially the nurses without whom this numbers would have been impossible to achieve.
Very recently Honourable Speaker, we have introduced the ground breaking fixed dose combination (FDC) therapy which made it necessary to train 7 000 health workers for smooth implementation.
Another very important windfall from these FDCs is that by February 2010, it used to cost us R313.99 per patient per month to provide ARVs. With the FDCs, it is now costing us only R89,37 per patient per month. We are now able to treat many more people per month with the amount of money that we used to treat one person with in 2009.
The results we achieved from these endeavours are very sweet indeed.
By the end of last year, researchers, local and international started reporting a dramatic increase in life expectancy in our country. They also reported a decline in under five mortality and maternal mortality ratio. Our biggest challenge is the neonatal mortality rate. These researchers include our Medical Research Council’s Rapid Mortality Surveillance Report, the Lancet, and United Nations agencies like the UNAIDS.
All these researchers attributed the decline in mortality and the concomitant increase in life expectancy to our comprehensive response to the HIV epidemic, especially the ARV treatment programme.
The fact that we are testing large numbers of our people and large numbers are on treatment has brought much relief to individuals, families and communities.
As far as TB is concerned Honourable Speaker, we started in earnest on 24 March 2011 to introduce new programmes. We unveiled new strategies to combat TB.
(a) Firstly, we unveiled the GeneXpert technology. Honourable Speaker, the last time in the world that a new technology do diagnose TB was unveiled was more than fifty (50) years ago. The World had then thought we had defeated TB. We now know better. We are hence immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation’s Stop TB Partnerships.
Before GeneXpert technology, it used to take us a whole week to diagnose TB. Now it takes us only two (2) hours.
It used to take us three (3) months to conclude that a person has multi-drug resistant TB, now it takes us only two (2) hours to know that.
I am very proud that South Africa was the very first country on this continent to unveil the GeneXpert technology. Since its unveiling on 23 March 2013, we have distributed 242 GeneXpert units around the country. This 242 constitute 80% of all facilities we would like to cover. We had spent R117 million shared by the National Department of Health, the Global Fund and the Center for Disease Control in the USA to achieve this 80% coverage. We have conducted 1,3 million tests using this technology since 2011. This constitutes more than 50% of the total tests conducted in the whole world.
In five (5) months’ time, we will achieve 100% coverage of all the district hospitals with the GeneXpert technology. From there we will move to the big community health centers.
The biggest of these machines, that can diagnose forty-eight (48) patients at a time, the others can do only 4 or 16, are called GeneXpert 48. We only have two (2) in the whole country. We have placed one at the Ethekwini Municipality at Prince Mshiyeni Hospital. The second one is in the Cape Metro at Greenpoint National Health Laboratory Service (NHLS) laboratory.
We have done this because both Ethekwini and the Cape Metro are the most very heavily challenged cities as far as TB is concerned.
On World TB Day, on 24 March this year, you are aware that the Deputy President of the Republic unveiled a GeneXpert technology at Pollsmoor Prison, on behalf of all Correctional Services facilities. This was in response to a Constitutional Court ruling where an inmate took the government to court, and the State was held liable for inmates contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in correctional service facilities. They too, will be supplied with GeneXpert units to screen all inmates on entry to facilities and also to screen them twice a year once they are inside.
We will also request for the names of those who are found by the GeneXpert to be having TB, from the Minister of Correctional Services in order to send health workers to their families so that the whole family of an inmate can be screened. One person with TB has a potential to infect 15 others in their life time.
Honourable Speaker, the second strategy we have adopted was to establish family teams. On our database, we have 405 000 families in South Africa who have a member diagnosed with TB. The family teams are visiting these families to screen all members within such a family.
About four (4) weeks ago, the Statistician-General went to Thabo Mofutsanyane Region to release StatsSA’s yearly figures on the cause of death. He released the 2010 figures and announced that TB was found to be the number one (1) killer in the country – not surprising given the synergistic relationship between TB and HIV and AIDS as I said earlier.
We are eagerly waiting for the 2011 and 2012 figures to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was 67,5% but in 2012 it has improved to 75,9%. The target set by the World Health Organisation is 85% cure rate. We are steadily but surely moving in that direction.
However Honourable Speaker, I have one very serious request to make. Having turned the corner should not be regarded as a signal for South Africans to be complacent. We still have a very long road to travel with HIV/AIDS and TB.
The National Development Plan has clearly indicated that by 2030, we must have a generation of under twenties (20) being free of HIV and AIDS and we must have a decrease in TB contact indices.
At the recent SANAC Plenary we have decided that the Presidency will we need to re-launch for us the HIV Counselling and Testing (HCT) Campaign in the country. This launch must happen at Gert Sibande District in Mpumalanga. It is now officially declared a district with the highest prevalence rate of HIV in the country.
I have a serious complaint Honourable Speaker, that since the campaign started, there is one extremely powerful place in this country were the HCT campaign was never launched. It is called the Parliament of the Republic of South Africa.
Please Honourable Speaker, may I humbly ask that you choose a date where we will come and publicly launch this campaign here in Parliament with you and the Chairperson of the National Council of Provinces (NCOP) taking the lead, followed by leaders of all political parties in this hallowed chambers. Then the provincial legislatures, District Councils and local councils will follow suite. I will then have the power and courage to ask churches, schools and all other centers of our civil life to choose their own days to do so.
I promise to supply a GeneXpert unit as well as a mobile XR unit for the benefit of Members in this Parliament because you also will need to be screened for TB as well, on top of testing for HIV and AIDS.
Honourable Speaker, let me now deal with the intractable problems that the health care system is faced with. It is output number four, i.e the efficiency and effectiveness of the healthcare system in the country.
You are well aware Honourable Speaker, that our flagship programme to change the efficiency and the effectiveness of the healthcare system in this country is the NHI – the National Health Insurance system.
While South Africans have been throwing mud at each other about NHI, I need to indicate that we need to stop wasting our time. NHI has gone global. The World Health Organisation (WHO), the United Nations (UN), the World Bank, prestigious institutions of high learning such as the Harvard University, have recently entered the fray in support of NHI and in giving well researched guidance to countries on how to get about to implement NHI – not to debate whether it is needed or not. The world has gone far beyond that stage.
Recently the World Bank and Harvard University organised a workshop of all Ministers of Finance to guide them on how their treasuries can support NHI for the benefit of economic growth.
It is of course not called NHI in every country. The World Health Organisation and all the UN agencies are calling the generic term, Universal Health Coverage. We will stick to the term NHI.
The Prestigious British medical journal, the Lancet has launched a series since late last year to allow academics, health activists and researchers to write articles to guide countries about this concept of Universal Health Coverage.
It doesn’t matter what you call it – the concept is the same i.e every citizen has a right to access to good quality, affordable health care, and that the access should not be determined by the socio-economic condition of the individual.
Hence whether you call it NHI as we are doing here in South Africa, or NHS as they do in England, or Seguro Popular as they say in Mexico or Obama Care as the Americans call theirs, the concept is the same.
In the editorial of Vol. 380 of September 8, 2012 of the Lancet it states that “certain concepts resonate so naturally with the innate sense of dignity and justice within the hearts of men and women that they seem an insuppressible right. That healthcare should be accessible to all is surely one such concept. Yet in the past, this notion has struggled against barriers of self-interest and poor understanding”.
The editorial goes further to say: Building on several previous Lancet Series that have examined health systems in Mexico, China, India, South East Asia, Brazil and Japan, today we try to challenge those barriers with a collection of papers that make the ethical political, economic and health arguments in favour of Universal Health Coverage and will be presented in New York on September 26 to coincide with the United Nations General Assembly. The series was facilitated by the Rockefeller Foundation and edited by David de Ferranti of the Results for Development Institute in Washington DC. The conclusions support the World Health Organisation (WHO) Director-General Dr Margaret Chan’s assertion that Universal Health Coverage is the single most powerful concept that public health has to offer”.
Honourable Speaker, the editorial goes on to say and I quote again: “Universal Health Coverage, like any other health system, must be accountable for the quality of its outcome and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for share holders”.
It is very clear Honourable Speaker and Honourable Members that the whole world, and not only our country is gearing to rid itself of archaic healthcare financing systems that cater for the privileged few, and punishes the poor, in favour of healthcare systems that will benefit all – and all citizens of a country.
This assertion, led to another article in the Lancet series I have just mentioned. It argues that Universal Health Coverage is poised to be a third global health transition.
The argument is based on the fact that since humanity came into being, there have been only two great transitions in health on this planet.
The first was the demographic transition that began in the late 18th century and changed the planet in the 20th century through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths greatly.
The second transition was the epidemiological transition that began in the 20th century and eventually reached even the most challenged countries in the 21st century.
Communicable diseases, from smallpox to poliomyelitis were vanquished or controlled on a scale never imagined, opening the way for contemporary action to tackle non-communicable diseases.
Now a third great transition seems to be sweeping the globe, changing how healthcare is financed and how health systems are organised. For a along time, getting healthcare has meant first paying a fee to the provider – a practice that effectively burdens sick and needy people, that has meant choosing between going without needed services or facing financial ruin”.
Honourable Speaker in implementing NHI or Universal Health Coverage countries are clearly going to pay different prices for different durations in time, depending on internal objective factors and dynamics within each country. Hence a country like Qatar, is going to implement NHI starting in July this year and completing in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same.
Unlike Qatar, there are two main prices we are going to have to pay for successful implementation of NHI.
The first price is that the quality of services in the public health system has to drastically undergo a metamorphosis – the quality simply has to improve and there is no running away from that.
The second price is that the cost of private healthcare has to drastically reduce. We need to firmly regulate the prices in private healthcare.
Honourable Members, as a Department of Health, we strongly welcome last week’s announcement by the Minister of Economic Development, Honourable Minister Patel, that through the amended Competition Act, the Competition Commission will launch a public market inquiry into the cost of private healthcare. We as a Department are fully behind Minister Patel and the Competition Commission on this one and we are ready to engage and offer all evidence we have at our disposal. We are eagerly waiting for the Commission to call us! For those who don’t understand where this is coming from, I wish to refer you to our National Development Plan, Vision 2030 and I quote:
“A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private medical care and supported by better human capacity and systems in the public health sector”.
As to how we are going to pay the first price I have mentioned earlier, i.e on the issue of quality in the public health system, we shall outline that in the White Paper that will be released soon. We did indeed take a very long time since the Green Paper was launched. There were lots of inputs and developments that needed our very careful attention and considerations.
We will be ready very soon.
It will be released with a clear plan on how NHI is to be implemented based on the two main prices which I said the country has to pay.
Because these are elaborate plans, it will not be possible at all to outline them here. They will be made available in due course. They will include the whole concept of non-negotiables in healthcare, the delegation of powers to CEOs who are being newly appointed and trained. This will also include abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.
But I wish to take this opportunity to emphasize over and over again, that the NHI will be based on a preventative and not a curative healthcare system.
I will then repeat in many more occasions to come that Primary Health Care, meaning prevention of diseases and promotion of health is going to be the heartbeat of NHI in South Africa.
We will drive this healthcare system according to the dictates of the National Planning Commission which clearly states that among the important things to be done, is to reduce the burden of disease, not to allow them to flourish and then try to run helter skelter in trying to cure them, with very limited facilities, both human and financial, which is the hallmark of public health systems on the African continent.
We wish to demonstrate with a few examples on what prevention of diseases and promotion of health can do to a country’s health system.
A report compiled by the Mail & Guardian’s newly established BHEKISISA health reporting center and published on Friday last week demonstrates one of the examples
It shows how four years ago, the Department of Health introduced two very new vaccines, Prevenor, to reduce the risk of children contracting Pneumonia, and Rotarix to prevent incidences of diarrhoea in children. Remember that diarrhoea was killing 25 South African children under the age of five (5) each day.
At the time of the inception of the two vaccines, National Institute of Communicable Diseases, the NICD, was tasked with the work of monitoring and evaluating the impact of these vaccines on hospitalisations in three South African hospitals – in Cape Town, KwaZulu-Natal and Gauteng.
The findings were that at Ngwelezele Hospital in Kwa-Zulu/Natal the under five mortality rate was three times higher than in Soweto. However, the Ngwelezene Hospital ward that deals specifically with diarrhoea i.e the gastrointestinal ward, has recently been closed down as a result of the introduction of this vaccine. Around 2006, this ward used to admit close to 1 000 children annually. It is now closed down – no more need!!
On average, in all these three sites there has been a 70% reduction in admission due to diarrhoeal diseases attributable to Rotavirus.
Seeing the successes that vaccines can bring Honourable Speaker, our next target is cancer of the cervix of the uterus. One of the biggest killers of women.
According to Prof Lynette Deny, and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at Groote Schuur Hospital and Chris Hani Baragwanath Hospital respectively, cervical cancer affect 6 000 South African women annually. 80% of them are African women.
Out of these 6 000 affected, between 3 000 and 3 500 die annually as a result of this cancer.
More than 50% of women affected are between 35 and 55 years of age. Only 20% are older than 65 years of age.
HIV positive women are five times more likely to get it than HIV negative women.
This cancer is caused by another dangerous virus – the human papilloma virus. The good news is that there is now a vaccine against this virus. The very bad news is that it is available in the private sector but the costs are prohibitive between R500 and R750 a dose (3 doses are needed for protection) - even in the private sector the uptake is very slow due to this prohibitive costs.
At the moment Honourable Speaker, to make these vaccines affordable, the Bill and Melinda Gates Foundation established GAVI (Gates Action for Vaccines and Immunisation) to help poor countries.
Unfortunately, South Africa does not qualify for GAVI prices which we are made to understand, are at only $4,00 per dose.
We are also aware that the PAHO (Pan American Health Organisation) has negotiated a price of $13,00 a dose for Latin American countries.
I am extremely happy to announce that in consultation with the Minister of Finance and the Minister of Basic Education, we have decided that we shall commence to administer the HPV vaccines as part of our School Health Programme as from February next year.
We will enter negotiations in our own right to also be given a fair deal in the interest of the lives of the women of this country.
We are advised by scientists that the vaccine is only fully effective before sexual activity commences.
For this reason, we shall administer it to all 9 year and 10 year old girls in Quintiles 1, 2, 3 and 4 schools.
This will cover 385 000 of the 9 and 10 year olds. We are not unduly discriminating against Quintile 5 schools. Children from poor families who find themselves for one reason or the other in Quintile 5 schools will also be covered.
I am calling for parents of all remaining learners in that category of schools, that since they can afford, for now they must try to acquire the vaccines themselves until we are able to cover all learners in the mentioned age bracket in all the schools. I am calling on all Medical Aid Schemes in the country to pay for these vaccines to help parents in the category of learners who will not be covered when we commence the programme. The benefits far outweigh all the costs. It costs up to R100 000 per patient in the public sector to treat each of the 6 000 cervical cancer patients.
I am scared to quote you the figures for the private sector treatment.
Honourable Speaker, this week, very bad news emerged from our health facilities about an entity called RWOPS – Remunerated Work Outside the Public Service – whereby doctors fully employed by the State conduct their own private work during certain hours. RWOPS is not illegal. It was passed by the Cabinet around 1994.
The only problem is that it is being abused by some unscrupulous individuals.
I must emphasise Honourable Speaker, the overwhelming number of doctors in the public service are very decent law abiding hard working citizens who are deeply committed to their patients.
It is only a few who are tarnishing the name of the profession. I am appealing that the events that unfolded over the media this week must not be misconstrued that most doctors are involved in this practice and start regarding all doctors as some form of criminals. I want to repeat, the majority are very ethical citizens who understand their calling.
The few individuals who are involved, are not only punishing patients, they are also destroying the medical training in the country because they leave medical students to their own devices. Even specialists in training are badly affected by being abandoned by people who are supposed to guide them in every step of their training.
I have already warned the private sector, who are benefitting from this bad practice, that in the long run, they also will suffer because the country will produce poorly trained doctors.
I have given this matter to the Deans of all our medical schools where this practice seems to be very rife, to discuss the matter and come up with recommendations which will be presented to all stakeholders in health. We will call a press conference to determine the way forward. But we can’t avoid criminal charges to those who have been caught red-handed because we have their names and know their activities.
We will also refer their names to the South African Revenue Service (SARS) to see if they are paying tax in the double income they are getting.
We are also appealing to the private sector who are hell-bent on attracting this public servants with lots and lots of perverse incentives. This is going to destroy everybody in the long run.
I wish to take this opportunity to thank the Deputy Minister, the Director-General and all managers in our Head Offices and facilities. Our health workers still remain our heroes and heroines despite a few who want to tarnish their good names. I wish to thank them for the sterling work performance done under very trying circumstances.
I thank you.
Health 2013/14 Budget Vote Speech by the Deputy Minister of Health, Gwen Ramokgopa
Honourable Chairperson,
Honourable Minister of Health, Dr Aaron Motsoaledi,
Honorable Ministers and Deputy Ministers present here today,
Honourable Chairperson of the Portfolio Committee on Health, Dr Bevan Goqwana
Honourable Members,
Distinguished guests,
Ladies and gentlemen,
Non-Communicable diseases
NCDs are the number one killer in the world, with more than 63% of all global deaths due to cardiovascular and chronic lung diseases, cancers and diabetes.
Globally, 90% of preventable, premature deaths due to NCDs occur in low-and middle-income countries. In two-days time, this trend can be reversed with political will and sound action.
Over the past few years scientists have been highlighting the quadrupple burden of disease and alerting South Africans of what Professor Mayosi et al in the Lancet Medical Journal refer to as a cocktail of four colliding epidemics.
In asking this august house to support the Health Budget Vote 2013/14 as an enable to tackle these major challenges, we also say to you and our people that we bring good news. Good News that our children and young people are living longer ! Good news that our working population is more productive and alive and to nurture their children and our elderly are not burying their children and grand children at a rate of yesteryear.
An increase in life expectancy of any nation by 4 years over a short period of time as happened in our country is by no means a small occurance, it is profound and demonstrates the fortuitous and tenacious resolve by a people to survive. This occurance has left the global community and scientist in awe , refered ro this success as of this success refered ( Slim Karim) .................
Our vision of a long and healthy life of South Africans is in the making, in our lifetime under the leadership of the ANC government through our collective effort as a nation! Six important success factors have been the love for our people, dicisive leadership, social cohesion, evidence based medicine, a dedicated health workforce and the appreciation that this high burden of disease not only threatens our development agenda but also mocks the democracy our people fought. As we enter the second decade of our democracy the ANC is not only celebrating with our people her legacy as a liberation movement against political bondage but also a liberation movement against illhealth, suffering and threaths to our democracy and prosperity.
Tor Lancet article further warns however that we should not be complacent with the progress we have made to date as major challenges still exist relating to:-
- the adverse social determinants of health and persisting racial disparities
- the need to Intergrate and coordinate the Health system
- the need to improve surveillance and information systems
- the scaling up of innovative interventions for the benefit of the whole system
The budget we present today aims to consolidate our efforts, respond to the remaining challenges and to rally our nation to respond successfully the the NDP which calls amongst others for the increase of life expectancy from the current 60 to 70 years. Through strengthening evidence based approach and stakeholder involvement in our work we are well positioned to succeed.
Since the Declaration of the National Summit on Non Communicable Diseases identified the 10 priorities, the NHC has approved a strategic implementation plan, the Ministerial Advisory Committee on Cancer has begun its work. The introduction of HPV vaccine will go a long way in reducing cancer of the cervix which is the leading cancer amongst women. Cervical Cancer presents a good example of the co- morbidity of infectious and non communicable diseases.
Patients who are also HIV positive are also more vulnerable to having this cancer and on the other hand smoking increases the risk.
Already there is emerging evidence from the 3 pilot sites in the country that the Intergrated Management of Chronic Diseases is an ideal, practical and patient centred effective manner to manage the double burden of HIV and NCD's. This year we will roll out the model to the NHI sites. Silent killers especially, but not limited to, amongst the poor and rural communities. Breast cancer, cervical cancer, diabetes and hypertension. This model will assist to pick up risk factors and early signs of disease to prevent complications such as amputations, strokes, kidney failure and blindness. Screening and early detection will also save costs in treating advanced disease, absenteeism, loss of income and the burden on the family to provide care.
The media platform the Minister has announced will certainly go a long way in ensuring an intergrated and effective approach to public awareness and health promotion campaigns.
We will also leverage the various other programs such as the Intergrated School Health and the Ward Based Programs as we strengthen PHC approach. We have begun to pilot the Intergrated Management of Chronic Diseases Model to ensure a patient Centred approach. As we honor and salute our health workers for their role in halting the HIV and AIDS epidemic and saving our children, we call on them to be at the forefront to consolidate our gains and decisively tackle maternal mortality, NCD's as well as injuries in an Intergrated manner. There should not be a missed opportunity to reverse all quadruple epidemic onslaught.
We will fastrack the process of establishing a National Health Commission as a multisectoral partnership forum to strengthen our capacity to make Health a Societal Priority in tackling the socio-economic determinants of illhealth. We should remember that globally as well as in South Africa the major NCD's are cardiovacsular diseases like hypertension and stokes, metabolic diseases like diabetes, cancers, chronic respiratory illnesses like asthma and mental illnesses like depression and anxiety disorders.
The Commission will also help in focussing our society to find lasting solutions in tackling the four risk factors namely poor diet , physical inactivity, tobacco use and harmful use of alcohol.
- The process of legislation to prohibit alcohol advertising is at an advanced stage and regulations on warning labels on alcohol containers will be revised.
- Regulations will be enhanced to further reduce passive smoking at the workplace and other public places and to educate the public effectively about the health dangers of smoking through graphic warnings.
- A Health Promotion Strategy incorporating the promotion of physical activity and nutrition will be finalised this year.
- Working with industry we will ensure that preparations to meet the the 2016 deadline for the reduction of salt and for fatty acids in food are met and together we will also launch a public awareness campaign. 60% of intake of salt in South Africa is through industrial supplies and in line with WHO recommendations we call on our people lets limit salt intake to not more than 5 grams per day.
The effectiveness and efficiency of the Health System remains a top priority.
In endorsing World Health Organisation and the International Telecommunications Union (ITU) on eHealth being at the core of responsive health systems and that expectations are that the health sector must inevitably integrate technology into its way of doing business, last year we finalised the eHealth Strategy and have completed a Normative Standards Framework, in partnership with the MRC and the Council for Scientific and Industrial Research (CSIR). In 2013, we will apply this framework to mitigate against the current 42 health information systems in the public sector many of which are not interoperable.
Honoured members, the National Development Plan 2030 indicates that ' given the escalating costs of services in both the public and private sectors and the high proportion of the GDP that goes to health service funding, it is essential to create a culture of using evidence to inform planning, resource allocation and clinical practice.' To achieve this goal and in implementing the National Health Research Summit of 2011 the National Health Scholars Programme has been established with an aim to produce 1 000 PhD graduates over the next 10 years. Already 13 PhD scholars have been funded for this financial year. In the near future, these PhD Scholars will become the new generation of health researchers, and also contribute to clinical teaching and training and health service delivery.
The National Health Surveillance System is assisting the Department to swiftly contain infectious disease outbreaks. This year we will finalise the Intergrated National Plan on Disease Surveillance with the aim of aligning to the quadruple burden of disease, to strengthen monitoring and to measure the impact of our interventions on a continuous systemating basis.
Chairperson, the billions of rands saved through a more efficient drug procurement system has enable more patients to access medication. The National Essential Medicine List Committee periodically reviews the Treatment Guidelines and updates the Essential Drug List. A national monitoring system has been designed and implemented for the early detection of facility stock outs. With the inefficiencies, losses and expiry of medicines experienced through the Medical Depot System, we are encouraged that a number of provinces have begun a model of Direct Deliveries to Point Care in health facilities. The National Central Procurement Unit will be assisting provinces to move with greater speed.
In partnership with the World Health Organisation, the Tshwane University of Technology as well as the Japanese International Cooperation respectively training in Health Technology Audit and Maintainance has already benefitted more that 50 Clinical Engineering Technicians from six provinces. This program augments the capacity of facilities in various districts to be compliant to the Essential Equipment List approved by the NHC.
Chairperson, later this year in KZN we will officially open the National Forensic Chemistry Laboratory in Durban and had started functioning with the first 15 employees from 2 April 2013. This laboratory will be performing post-mortem and ante-mortem blood alcohol analysis for KwaZulu-Natal and some parts of the Eastern Cape – the borders of which will still be announced. It is envisioned that the first samples would be received for analysis in July 2013, and the procurement of analytical equipment is currently in the final stages.
This would enable us to decrease the current blood alcohol backlogs more effectively. The department made funding available for the building of a brand new Forensic Chemistry Laboratory in Phoenix, in the KZN province as well. This facility will be responsible for post-mortem and ante-mortem blood alcohol analysis, toxicology analysis in cases of unnatural death, as well as food analysis in terms of the Foodstuffs Act. Furthermore, 70 Forensic Interns have been enrolled for the Forensic Toxicology Certificate at Continuous Education at the University of Pretoria in April 2012. These interns successfully completed the course and have been absorbed within the four Forensic Chemistry Laboratories, namely 13 in Cape Town, 12 in Durban, 30 in Johannesburg and 15 in Pretoria.
This significant increase in human resources will also contribute to the Directorate’s strategy of decreasing toxicology backlogs and to decrease the turn-around time of toxicology analysis in cases of unnatural death.
In this financial year the National policy on Emergency Medical Services Training and the Regulations governing the provision of Emergency Medical services will be published for comment and approved. With the Framework on the management of EMS data finalised training provided by Health Information System to provinces. The introduction of Obstertrics Ambulances will help to further halt the increase in maternal morbidity and mortality, Western Cape. The number of community members trained in first AID in partnership with Red Cross.
Chairperson and the house, please allow me to thank the Minister for his goal orientated leadership, Colleagues MECs for Health, the Director-General and staff throughout the health system, especially our management, professionals and support staff for placing the health of our people as their occupation. Working with our people and partners, focused on excellence, equity and effectiveness we are well poised to halt and reverse the cocktail of the four colliding epidemics.
I thank you all.
Speech by Hon Beatrice Ngcobo during the National Assembly Budget Vote Debate on Health
Topic: Health Infrastructure and Revitalisation
Honourable Speaker
Honourable Minister
Honourable Deputy Minister
Honourable Members of Parliament
Distinguished guests in the Gallery
Ladies and Gentlemen
We Congratulate and welcome news that Professor Cyril Karabus will soon be reunited with his friends and family following his harrowing 8 months ordeal in the United Arab Emirates. The ANC congratulates the legal team on the outcome and we further commend the Department of International Relations and Cooperation, under the guidance of the Deputy Minister, Cde Marius Fransman. Since 1994, the ANC has led the way to provide an integrated, holistic approach to major social and economic questions, including the provision of infrastructure. One of our major tasks when we took government was to conduct a massive survey of infrastructure needs in the face of the obvious backlogs that we faced.
Chairperson it is people working together for a common vision that connects the past to the present and makes a better future possible. Looking back on the path we have travelled since 1994, we see the importance of a long term perspective on development and change. At the same time the challenges facing South Africa are enormous. Only a comprehensive approach to harnessing the resources of our country can reverse the crisis created by apartheid. The National Development Plan (NDP) supported by New Growth Path and other programmes, invites us to look beyond the constraints of the present to the transformation imperatives of the next twenty and thirty years.
Chairperson the infrastructure upgrade is one of ANC Government`s priorities and a central pillar in the roll out of National Health Insurance. In his 2011 state of the nation address, President Jacob Zuma said 105 nursing colleges were to be re-opened. The reopening of nursing colleges is urgent as they are expected to ease the burden of universities, which are battling to scale up on doctors.
Health facilities infrastructure management focuses on coordinating and funding health infrastructure to enable provinces to plan, manage modernize, improve the quality of care in line with the national policy objectives and responsible for conditional grants for health infrastructure. Chairperson in this budget the three health infrastructure related conditional grants, hospital revitilisation, health infrastructure and nursing colleges will be merged to create new schedule 5A grant: health facility revitalisation conditional grant. Savings of R531 million over the MTEF period have been effected in the new health facility revitalisation grant.
Expenditure on transfers and subsidies grew significantly between 2009/10 and 2012/13due to increased spending on infrastructure grants to the provinces, in order to upgrade health infrastructure. In 2012/13 R49 million was rolled over in the health facilities infrastructure management subprogramme, R40 million of which was for the infrastructure unit support systems programme and 9 million for the master plan and feasibility study of the revitalisation of nursing colleges. Spending on the health infrastructure related conditional grants increased from R4.2 billion in 2009/10 to R5.9 billion in 2012/13 and is expected to increase to R6.7 billion over the medium term. The two infrastructure grants are allocated R19 billion over the MTEF period. Of this R5.1 billion, R4.7 billion and R5 billion will be transferred as direct conditional grant funding to provinces under health facility revitalisation.
Infrastructure delivery is a key priority of ANC government. Large amounts are budgeted each year for this objective across various sectors of government. Over the next three years, the budget for public sector infrastructure is R827 billion. This follows the spending of an estimated R642 billion over the past three years. ANC Government`s infrastructure priorities are guided by the broad framework proposed in the National Development Plan.
Pilot national health insurance projects have been initiated in ten districts and include improvements to health facilities, contracting with general practitioners and financial management reforms. A new conditional grant is introduced to enable the national department of health to play a greater role in coordinating. Chairperson the initial phase of NHI development will not place new revenue demands on the fiscus. Over the long term, it is anticipated that a tax increase will be needed.
Chairperson by the end of 2011/12, four state of the art hospitals were completed. Modern well equipped and top of the range. These represent the standard, which ANC government would like all public health facilities to be at. Naturally, that will require a lot more money, and time. At the same time, 1,967 health facilities and 49 nursing colleges were in different stages of completion, whether it be the planning stage, construction or refurbishment.
The Portfolio Committee on Health, for example, visited state of the art TB (tuberculosis) Hospitals which use latest design innovations developed by the CSIR (Council for Scientific and Industrial Research) in South Africa. The ANC Government has reported on its new sophisticated system of infrastructure planning, where the key issue is access. Using geo-spatial technology (GPS), it is now able to map out where the greatest need for health services is likely to be.
It takes into account the difficulty of transport in the area, and a number of other factors, and plans accordingly. Whilst the World Health Organisation (WHO) uses 5 km as a benchmark, the ANC government is using 2 km as a benchmark for access to a clinic. Where terrain and other factors impede delivery, mobile clinics are used. These include mobile clinics which visit schools, dealing with dental, and ophthalmic (eye) problems. The public health infrastructure (or “Health Estateâ€) of the country comprises over 4,333 health facilities and is worth more than R300 billion. However, 30 per cent need be fixed. The ANC government has specified that at least 5 per cent of the budgeted amount for infrastructure must be set aside for preventative and routine maintenance.
Chairperson the successes within health infrastructure delivery are largely due to Infrastructure Units within the health departments. These units include professional engineers. However, whilst capacity is scarce, not to mention costly, it is an investment well-made. In addition, National Treasury`s Projects Support Unit has been helping the national department and provinces with capital and maintenance projects. It provides technical assistance and training in planning, procurement and management systems.
Chairperson some provincial departments have been sluggish in some key capital projects, causing backlogs. Gauteng spent only 34% of its budgeted expenditure on hospital revitalisation in the past financial year, despite a large number of clinics and hospitals needing renovation. As of the end of 2012 over 1900 health facilities and 49 nursing colleges were in different stages of planning, construction and refurbishment. Spending on HIV/Aids continues to grow as ANC Government enrols more people on antiretroviral treatment. We have started feeling the pinch following the withdrawal of donor funds. In this fiscus, we had to allocate an additional R484m to offset a 50% reduction in US donor support for Aids programmes.
It is important to acknowledge the successes of ANC government in the area of health infrastructure delivery. However, a number of key challenges remain.
Chairperson work is under way to enable provinces to plan, manage, modernise, rationalise and transform infrastructure. Refurbishment and equipping nursing colleges to date over 70 nursing colleges and schools are being refurbished as follows:
Province Number of Nursing Colleges refurbished
Eastern Cape 11
Free State 4
Gauteng 15
KwaZulu-Natal 12
Limpopo 6
Mpumalanga 4
Northern Cape 1
North West 8
Western Cape 11
Chairperson the ANC Government is now following up with provinces for them to respond to the issues identified in the facilities audit. This include expanding on existing facilities where there are problems with space, but where there is room for expansion. Fixing and repairing problems that were identified in the audit, such as dilapidated facilities. Building new infrastructure where long-term solutions are required and where there are acute problems of access, supplying services through mobile or prefabricated facilities.
Major infrastructure projects are also underway in the tertiary centres. Feasibility studies are at an advance stage in five centres. Polokwane Academic Hospital in Limpopo. Chris Hani Baragwanath Academic Hospital in Gauteng. Dr George Mukhari Hospital in Gauteng. Nelson Mandela Academic Hospital in Eastern Cape and King Edward VIII Hospital in KwaZulu-Natal. The National Human Resource for Health Strategy was launched in October 2011.
Work has started on the determination of norms and staffing needs for the country for primary and secondary care. This is being done with support from the Word Health Organization (WHO), using the Workload Indicators of Staffing Needs (WISN), method with the aim of improving the HR data extraction, capture and analysis.
Chairperson as envisaged in the Human Resources for Health (HRH) strategy the Leadership and Management Academy was launched in October 2012. Its vision is to be a centre of excellence and a beacon of good practice in health leadership and management. Its aim is to develop outstanding leadership and management in health in order to improve people`s health and their experience of the NHI.
Training of new doctors has been increased through increasing the intake in training institutions and sending 1000 medical students to Cuba to be trained. Since the launch of the strategy, an extra 40 doctors started training in South Africa in 2011/12 and 125 in 2012/13. Also 95 medical specialists are being recruited from Cuba. The number of professionals undertaking community services is increasing with 7 162 placements across all provinces in 2012, covering doctors, dentists, pharmacists and other specialties.
Chairperson the Auditor General`s report on infrastructure delivery in both the health and education sectors listed a number of challenges. These include, amongst others: Unsatisfactory planning escalating the cost of projects, lack of capacity at the Department of Public Works causing delays, challenges with procurement, challenges in project management, low quality of work resulting in new contractors being appointed to re-do work at added expense.
Of great concern Chairperson is the fact that service delivery is delayed when hospitals and clinics are not completed on time. Some provinces tend to start a number of infrastructure projects at the same time; and find that they cannot finish them. Some projects which commence whilst the facility is still in use, cause great inconvenience and hardship to the patients. This is made worse when long delays in the construction occur. One of the biggest challenges is the contractors who do not deliver on time. Some are engaged in numerous projects within the same province or across different provinces, at the same time. These contractors need to be black-listed across government.
Chairperson health infrastructure delivery has been identified as a key to achieving fundamental reform of the health system in the country. Undoing a legacy of separate development policies, including the unequal distribution of infrastructure between urban and rural areas, is a tremendous challenge. However, especially as South Africa prepares for the implementation of the NHI, it is a challenge that must be met. I would like to conclude by reminding this house that in October 2011 the ANC Government appointed a task team on Nurse Education and Training to take forward the recommendations from the April 2011 Nursing Summit. This has resulted in a National Strategic Plan being completed in February 2013. ANC Government launched e-Health strategy to harness information communication technologies to help transform the health system. This strategy aims to resolve the problems of the past, clearly articulated in the NSDA 2010-2014.
Chairperson although sums of money have been used to procure health ICT and Health Information Systems (HIS) in South Africa in the past, the ICT and HIS within the health system is not meeting the requirements to support the business processes of the health system, thus rendering the healthcare system incapable of adequately producing data and information for management and for monitoring and evaluating the performance of the national health system. This results from the lack of technology regulations and a lack of policy frameworks for all aspects of infrastructure delivery.
ANC support this budget vote
I thank you
Speech by Hon Morwesi Segale-Diswai during the National Assembly Budget Vote Debate on Health
Topic: Achievements in the Primary Health-Care
Honourable Speaker
Honourable Minister
Honourable Deputy Minister
Honourable Members of Parliament
Distinguished guests in the Gallery
Ladies and Gentlemen
ANC believes that we are on course towards improving the health profile of all South Africans. Chairperson at the most basic level, health is a fundamental human right. The United Nations Declaration of Human Rights proclaims that everyone has the right to access the services required to live a healthy life, with mothers and children being entitled to special care and assistance. Besides the moral and ethical case for saving a woman and her baby`s life, there are strong social and economic justifications for investing in maternal health. The link between health and long-term economic growth and poverty reduction is much more powerful than generally understood. Health is both an end goal of development, as well as a means to achieving development goals and poverty reduction. In particular, women and children are central to human development and economic prosperity.
Primary health care is at the heart of the plans to transform the health services in South Africa. An integrated package of essential primary health care services available to the entire population will provide the solid foundations of a single, unified health system. There is no way the efficiency and effectiveness of the healthcare system can ever be realised without dealing with the cost of healthcare and healthcare financing. There are people who wrongly believe that the concept of healthcare financing, as envisaged in National Health Insurance (NHI), is a pipe dream concocted by ANC. I wish to advise them that NHI is not a unique South African concept.
Whilst there is still a lot more to be done, we are proud of our achievements to date in Primary Health-Care, in eradicating institutionalised racism; our country is a model of democracy and human rights. It is because of these successes since 1994 that we are able to move to the second phase of our transition. The National Development Plan provides us with a vision and roadmap to confront these socio-economic challenges facing our people. To expect that the challenges that confront us, as nation, would have been eradicated in only 19 years would be to deny the existence of an extraordinary human disaster that lasted too long.
Honourable Speaker, whenever I stand before this august house to respond to the speech of the Minister of Health Dr Aaron Motsoaledi I get enthused at the manner in which he takes his work under the guidance of ANC. The ANC Government has made leadership of the health system so simple for all people to understand and have passion. ANC government makes the work of leading a health sector very simple and doable.
Having said that we need to remind the department of health that much still needs to be done and having done what they did, all what remains to be done is will be achieved in our lifetime. There are still people who still have to walk a few kilometres to access health, there are still facilities that do not operate 24 hours, there are those facilities where patients for long hours before receiving care, there are still reports of lack of medications in the facilities and there are still some of the reports that show that our staff are rude to the patients. These are the things that must continue to keep us awake at night, but we are hopeful that they will be addressed because as people know, Rome was not built on one day.
Having said these things Hon speaker and members, allow me to attempt to reflect on what I have observed about this department since I became a member of this Committee in 2009. All of us remember where this Minister, after being deployed by the ANC took the department from. When he first opened his mouth in May 2009, many of people must have thought here comes a daydreamer; and little did they know that there was coming a steamroller and caterpillar which was going to move health into the position and the road of no return. With what the minister has done, Health will never be the same again.
Those who though the ANC government was dreaming were made to eat a humble pie, as they watched as it move from one success to another. There are some that may have thought the first success was a fluke, but when the next plan became a success and the next a success and they could not count them anymore, they realised that this is the right step.
Hon Speaker, most of were part of this very house in 2009, when the Department announced the grand plan to tackle HIV and AIDS, and how it planned to reverse the declining life expectancy of the South Africans. When the Minister announced the new plan for tackling HIV and AIDS, many sceptics must have thought to themselves that this minster was planning the impossible. As people always compare South Africa with other wealthy countries, some people said even rich and developed countries did not achieve, and how does he hope to achieve it. When he announced that there will be 15 million South Africans who will be tested for the virus within one year between May 2010 to May 2011, most people never gave him a chance. When the results were announced in 2011, that the campaign has led to the testing of above 14 million people, this was not considered news worthy and nobody celebrated with the department. This is the department that performed against all odd
ANC Government went on the path for transformation of the health sector, and in this way, the department identified key pillars of the health system which needed attention. Allow me Hon Speaker to take a few of those pillars and reflect on how we have watched the department perform under each, as an illustration of what has been done.
As members would know that when the fish rots it starts from the head. The department realised that in order to correct the ills of the hospitals, there had to be some work done to improve the performance of the hospital CEO`s. The department did the assessment of the Chief Executive Officers of the hospitals in the public health sector to see if the right people were appointed to the right jobs.
The results pointed into a particular direction that confirmed some of the suspicions. The department did not hesitate to follow the direction that the assessment was showing. They swiftly went on to advertise the posts of the CEO`s in the hospitals, proceeded with the selection process, issued appointment letters, conducted induction of the CEO`s and then sent them to the field to go and do the job. We do accept that this was not an easy road, and that there are some areas that need to be finalised, but we are happy that the first moves have been made and these are actually the sizeable steps in a right direction that deserve praise.
Seeing that the foundation of health system was having serious problem, the department ordered the audit of health facilities. The outcomes of the audit confirmed that there are serious problems that need to be sorted out sooner rather than later in the health facilities. The results will assist the department to be more targeted in its intervention. Facility improvement teams, were established in anticipation of the outcomes of the facilities audits. The teams have been allocated to focus on the districts with special focus on the areas of weaknesses identified during the audit.
Transformation of the health system is never complete until ordinary persons have access to health services irrespective of the ability to pay. Both health facility audit and facility improvement teams were meant to support the implementation of the National Health Insurance. This is the programme that clearly divided South African with the pro-rich on one side and the pro-poor on the other side. I am tempted to put the pro-rich on the right and the pro-poor on the left, because naturally that is where they both belong. The pro-rich were critical of the NHI, because for them life is normal when the rich are healthy and the poor are unhealthy; when the rich have access to services and the poor have no access; when the rich are treated in the first class setting and the poor in the second class setting. That is the society they want, whereas the pro-poor on one side, want everything for everybody so that nobody must suffer simply because of the size of their purse. NHI is seen by some of as key to unlocking the gates that are blocking the access of services. Some of us that come from and still live in rural areas look up to NHI for solution of the problems of the health system.
This is the system that is geared towards the poor, and because this government is pro-poor, it will ensure that the poor that have voted to the government into power receive good care so that they can live long and healthy life. Without access to health, long and healthy life will remain a pipe dream, so the department wants to move from a dream to reality, move from concepts to implementation, from theory to practice.
The department went on an uncharted road of reengineering of Primary Health Care. This process succeeded in three main areas which were made public for the people of South Africa to know. The launch of school health services which officiated the number citizen of the Country, Rre President Jacob Zuma in October 2012. The establishment to the ward based PHC outreach teams with a focus on the NHI Pilot districts. The department has established these teams in an effort of streamlining the community based health intervention. The department appointed the District Clinical Specialist in all nine provinces. These programmes had some problems, but the committee is excited that this is a move in the right direction. We would like to congratulate the department on its bravery and steadfastness and resoluteness in pursuing the goal of improving the lives of the South Africans.
As we all know that health is a labour intensive sector. In this area, the department worked with the deans of medical schools to increase the intake of medical students, and this was supported by the increase in the number of students that were sent to Cuba for medical training. I am of the view that the department did very well, despite the media reports about some of the students that were on strike in Cuba, in which also the department moved swiftly to deal with the situation.
The department brought the National Health Act Amendment Bill which was debated by the house. This is the piece of legislation that will surely contribute to taking the transformation of health to a new level. It is my wish and hope that the office that will be established in line with the act will contribute to improving the conditions in which our people are treated. Will help to improve quality of health-care. We know that the office to be established will be an added resource, outside of the department to help improve the situation in our public health facilities.
ANC Government responded in the most appropriate way to the need to accelerate performance towards attainment of Millennium Development Goals by launching the Campaign on Accelerated Reduction of Maternal Mortality (CARMMA). This launch was once more a sign that the department is more concerned with the unwarranted and preventable causes of deaths of mothers during and around pregnancy. When the department invited this committee to the launch, there was an overwhelming feeling that indeed there is commitment to attaining the plans as outlined in the Negotiated Service Delivery Agreement and the MDG`s. This Hon Speaker is testimony that the lives of the mothers is valued and taken serious because honestly it is a shame for the woman to die simply because she has fallen pregnant.
I would like to say to the Department of health a Setswana expression, "Nko ya kgomo mogala tshwara ka thata e sere o utlwa sebodu wa kgaoga". This is simply translated in Afrikaans as "Hou vas" and in English "hold tight". This is so right in that we do not want you to be complacent, because our people still need more health services. The mothers need vaccines for the babies, the old people still need their chronic medication and the people with disabilities still need their assistive devices. The goals you have scored must spur you to greater heights and must serve as a motivation to do more. What lies ahead is not the finishing line, but a horizon. After that horizon, another one lies ahead, so you cannot afford to rest on your laurels, bask in the glory of the success, and think you have arrived. The road ahead is still long and bumpy at some points. But the work done, will guarantee that whatever storms that come your way, you will ride the crest and succeed.
Let the department adopt an attitude of the Archimedes of Syracuse, a Greek mathematician who said, "Give me a leaver long, long enough, and a place stand, then I can move the world". This is the attitude that must help you to move further and faster as you strive to improve the health of our people. This house needs to give the department a long leaver and long enough to move us forward
In conclusion a major challenge facing the health systems in Sub Saharan Africa is the medical brain-drain, the migration of skilled healthcare providers to richer countries offering more favourable economic and professional environments. This migration has devastating implications for health systems in the countries that the doctors emigrate from. Given the importance of medical interventions in obstetric emergencies, the medical brain drain denies patients access to services by trained healthcare providers. This significantly compromises maternal and new-born health in the affected countries. The African National Congress calls upon all South Africans to work together, continuing to create the society of which all humanity will be proud as envisioned with the inauguration of President Rholihlahla Mandela 19 years ago.
ANC Support this Budget Vote.
I thank you
Patricia Kopane, Shadow Minister of Health
Highlights:
· One of the many challenges facing our healthcare system is a lack of qualified doctors, nurses and competent administrative staff
· According to the Auditor-General, the Department of Health lacks the capacity to oversee complex infrastructure projects
· There are currently 10,021 patients waiting for operations in public hospitals across Gauteng
· Where the DA governs, we have filled almost 100% of our nursing positions
· Life expectancy in the Western Cape is currently 61.6 years for men and 67.9 years for women while the national average is 52.7 for men and 56.4 for women
· The TB cure rate in the Western Cape is 79% while the national average is only 65%.
Honourable Members we must confront some hard truths about our public healthcare system if we want to ensure the welfare and Constitutional rights of all South Africa’s citizens. Only by examining the ailments of our health sector and successfully diagnosing its problems will we find remedies that will heal it.
According to the National Development Plan: “The overall performance of the health system since 1994 has been poor despite the development of good policy and high spending as a proportion of GDP.”
We need to ask ourselves what went wrong.
One of the many challenges facing our healthcare system is a lack of qualified doctors, nurses and competent administrative staff, which has led to the unresponsive and cumbersome bureaucracy in the public health sector currently crippling innovation and public access. This situation – or crisis – is truly tragic and completely unnecessary considering the fact that South Africans has the resources and the skills base to provide quality health care for all who need it.
In the words of Mahadma Ghandi: “A nation’s greatness is measured by how it treats its weakest members.” If that is so, then the Department of Health must be held responsible for holding us back from the greatness we aspire to.
Mohlomong re hloka ho ipotsa hore na ebe re fositse ha re le hokae.
During my oversight visits I realised that most medical institutions suffered from staff shortages which were only prolonged and amplified by the arduous process in place to fill the vacancies. According to Gauteng Health MEC Hope Papo only 287 (27%) of 1,047 staff posts at the province’s newly-built Jabulane Hospital have been filled; nursing vacancies were the highest, with 549 out of 650 posts still unfilled.
At Charlotte Maxeke Johannesburg Hospital nearly half of the anaesthetist department has resigned due to an unresolved overtime grievance and hospital could lose its accreditation. With only a handful of specialists left to train the remaining staff, many operations will be delayed and patients will – and have been – forced to wait months for operations.
There are currently 10,021 patients waiting for operations in public hospitals across Gauteng, and Cataract International Institute Hospital in Alexandria is the worst surgery backlog offender; with 5,844 patients waiting from 8 to 18 months for their operations.
In the same province, 1,899 patients will wait up to a year for knee surgery, and 1,662 patients are on the list for a hip replacement. Furthermore, there are 560 patients waiting for heart operations, and 56 patients in need of spinal procedures.
According to Ms Papo, the long waiting lists are due to “service demands or load that exceeds the capacity of our resources”.
My view is that mismanagement is a major factor, and proper use of resources can bring down the waiting lists.
Patients suffer while waiting for surgery, so every effort must be made to reduce backlogs. Hospitals should explore every possibility and in the short term, consider contracting private providers to decrease unacceptable waiting times.
Honourable Minister, poor management at facilities level is the most cited reason for doctors leaving the public sector. Fixing the management by providing hospitals with sufficient resources and implement stringent targets and accountability policies will help address – and hopefully resolve – this retention problem.
Where the DA governs, we have filled almost 100% of our nursing positions. This is because we treat our staff well and manage the Department’s human resources carefully. This is one of the many positive differences between areas where the DA governs, and where the ANC govern. In addition:
· The building of a world class hospital in Khayelitsha was completed in 2012;
· Life expectancy in the Western Cape is currently 61.6 years for men and 67.9 years for women while the national average is 52.7 for men and 56.4 for women;
· Maternal mortality rates in the Western Cape stand at 98 deaths per 100,000 live births, while the national average is 140-160 deaths per 100,000 births;
· Child mortality rates in the Western Cape are 38.8 deaths per 1,000 live births while the national average stands at 69 deaths per 1,000 births;
· The Western Cape has an antenatal HIV prevalence rate of 18.5% while the national average is 30.2%; and
· The TB cure rate in the Western Cape is 79% while the national average is only 65%.
There is also great concern regarding the shortage and maintenance of health technology, medical devices and essential infrastructure for uninterrupted and effective service in ANC-governed provinces.
During my oversight visit in Limpopo last year at Lebowakgomo Hospital the X- ray department was closed because all the X-ray machines were broken and not scheduled for repair because the service provider was not paid a mere R90,000. As a result the orthopaedic clinic was beyond dysfunctional and many operations were cancelled.
Honourable Chairperson, on that day there were about four radiologists on duty who could not do anything to assist their patients and were forced to send scores of them away despite their suffering. The outsourcing of repairs is costing the department a fortune and a lot of the time the equipment is not even functional.
Honourable Chairperson, During my visit to various healthcare facilities across the provinces I have discovered numerous problems ranging from building dilapidation, severe bed shortages, and a lack of basic services like water in many clinics. This is totally unacceptable given that there are millions of rands available to solve these problems.
Jabulani Hospital in Soweto was initially scheduled to for completion by May 2008. However, it is now May 2013 - five years later - and the hospital is still incomplete. Repeated delays have doubled the initial development budget from R334 million to at least R680 million.
According to the Premier of Gauteng, Nomvula Mokonyane, as of 30 April 2013 no one has been discipline and no wasted money has been recovered.
In 2011 the Auditor General of SA reported on the poor delivery of health infrastructure and highlighted the following issues:
· Lack of skills and capacity in the Department to oversee complex infrastructure projects
· Multiple contracts were awarded to contractors or consultants without taking their capacity into account
· Since capacity was never taken into consideration during the evaluation process, contracts with the same contractors were subsequently terminated due to insufficient progress or poor workmanship. As a result they were replaced by other contractors which led to higher project costs and project delays.
Given the 58.6% revitalization grant budget expenditure, 35.2% nursing colleges’ budget expenditure on and mere 10% National Health Insurance (NHI) budget expenditure, it is clear that the Department is incapable of fully utilising the resources at its disposal.
Honourable Minister, the success of the NHI is depending on the functioning of the public healthcare system. Spending on the NHI conditional grant is extremely poor; of R150 million allocated only R14.9 million was spent by the end of December 2012. Provinces are spending badly with the worst being Limpopo (1.2%), Eastern Cape (2.4%) and KwaZulu-Natal (3.3%). Essentially the National Department of Health provided inadequate support accountability measures to the provinces. Reports that the grant is not really being used to pilot new interventions, which need to be tested for NHI, but is rather being used for general health systems-strengthening has been of particular concern.
That was revealed by the National Treasury on the 18 February 2013 before the Appropriation and Standing Committee of Finance. Treasury further revealed that they have written to your Department regarding the weaknesses in your business plans, quarterly reports and lack of credible evaluation strategy.
Honourable Minister, we need to honestly ask ourselves if the NHI is the solution for the poor healthcare system and why the pilot projects are struggling to succeed.
According to the Ministerial Finance Technical Task Team’s report on funding healthcare, “radical restructuring of the healthcare system is unwarranted and will harm performance.” This same conclusion was reached by the National Development Planning Commission when it assessed earlier reform efforts made by ANC after it took power in 1994: “There was a misguided attempt to change everything simultaneously, when many aspects of the system were not faulty.” And this comprehensive overhaul of the healthcare system put everyone at risk if it fails.
We need to make sure that we have the right people in the right positions and that they are held accountable for their performance in the healthcare system. According to the same task team: “No part of the health system is held properly accountable for poor health outcomes or poor service delivery.”
Honourable Chairperson, the Democratic Alliance is concerned about the rate of the rising cost of private healthcare – which is above the inflation rate - and also the alarming increase in fraud has become an industry nightmare.
According to the Board of Healthcare Funders R22 billion is being claimed by corrupt health professionals annually, resulting in members having to fork out thousands of rands in premiums.
In one instance a doctor billed a scheme for 107 appointments in one day, each taking two hours, which would have meant he worked 214 hours in one day. There were even cases of a men claiming for hysterectomy or women for a circumcision.
According to a Sunday Tribune report, an estimated 101 KwaZulu-Natal doctors have claimed more than R22 million from medical aid schemes for private work carried out at when they should have been attending to patients in State hospitals.
The DA is urging the Health Professional Council of South Africa to investigate the report and immediately institute disciplinary proceedings. Furthermore, the Council should work with law enforcement to ensure criminal charges are laid and assist with the recovery of money paid out through illegal claims.
Honourable Chairperson, the DA welcomes the announcement made by Economic Development Minister, Ebrahim Patel, that the Competition Commission will launch a long-awaited market inquiry into pricing in the Private Healthcare sector. No society can prosper without an affordable, high quality, and easily accessible healthcare system.
Honourable Minister, the DA acknowledges the progress made by your Department – particularly regarding the fight against HIV/ AIDS, but there is still a long way to go. Implementation of some of your Department’s policies and programmes is still a serious challenge due to the poor leadership, inconsistent management and inadequate capacity within your Department.
Honourable members our people want the delivery and they deserve better.
In conclusion, Honourable Minister, let me reassure you; the DA will rally behind you to see to it that you succeed in taking this Department to the right direction for the sake of all South Africans. It is within this context that the DA raises their concern.
Ke a leboha.
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Vote 16 - Health Budget Vote Debate |
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