Minister of Health on programmes pertaining to women, children, youth and people with disabilities

Meeting report

Introduction
The Chairperson welcomed all Members and the Minister of Health, the Hon. Dr. Aaron Motsoaledi. She extended apologies from Members who could not attend - Ms P Duncan (DA) and Ms I Ditshetelo (UCDP).

Minister of Health on programmes pertaining to women, children, youth and people with disabilities The Minister stated that the Department had tried to answer as many Members’ questions as possible in previous meetings, and that he hoped the presentation would answer these questions and concerns to cover the overall picture of health in this country.

The Minister noted that South Africa was a complex country with regards to its disease patterns. He presented findings from a commissioned study done by The Lancet, which was a leading British medical periodical. These indicated that South Africa, as a country with 0.7% of the world’s population, had twice the global average per capita burden of ill-health and the highest health burden per capita of any middle-income country. With regards to HIV/AIDS, South Africa currently had 17% of the global burden and 5% of the global burden when it came to tuberculosis (TB). Other health issues addressed were maternal, newborn, and child health (MNCH), non-communicable disease, and violence and injury.

The HIV prevalence epidemic curve among antenatal women for 1990-2008 was then presented. This showed that in 1990 the prevalence rate was 0.7% infected pregnant women. However, this dramatically increased to 29.3% in 2008. The HIV prevalence among 15-49 year olds by province indicated that Kwazulu-Natal (KZN) had the highest rate, with 25.8% of pregnant women infected, and Mpumalanga the second highest with 20.1%. The Northern and Western Cape provinces had the lowest incidence rates, with the Northern Cape at 9.0% and the Western Cape at 5.3%.

The Minister then outlined maps of each province, indicating each specific district within each province and its HIV/AIDS antenatal prevalence rates. The conclusions from the antenatal survey indicated that the average was 29.3%. Four districts recorded HIV prevalence above 40% and 17 districts recorded between 30% and 40%. Six of these districts were in KZN, three in Gauteng, four in Free State, two in Mpumalanga and two in the North West. 19 districts recorded HIV prevalence between 20% and 30%.

Next the Minister spoke about life expectancy in South Africa. The Actuarial Society of South Africa estimated life expectancy in South Africa to be 13 years below what it would be without HlV. According to United Nations Population Division (UNPD), world population prospects in 2006 estimated that the average life expectancy for a female was 56 years and for a male it was 51 years.

According to Stats SA, in 2006, 59.3% of deaths (6 out of 10) were deaths of those younger than 50 years. This was very troubling to the Department as more people were dying at a younger rate due to HIV/AIDS and not other chronic diseases which came with the natural progression of old age. The Minister then showed graphs depicting the number of deaths and age distribution of those deaths for every year from 1997-2005.
           
The next topic discussed was tuberculosis (TB). TB was the main cause of death of people with HIV. 22,071people died of TB in 1997 and this number increased to 73 903 dead of TB in 2005 (334.8% increase). Estimated number of South Africans with TB in 2007 was 481 584. South Africa had 28% of the world’s population living with dual HIV and TB.

The Daily Expected Life Years (DALY) measures the rate of absenteeism from work or school due to illness or accidents. According to this study HIV and TB combined contributed 34.6% of the burden of ill-health. This figure was higher than any other illness or accident related injuries having contributed to absenteeism. Combined, HIV/AIDS and TB contributed to a higher percentage of ill-health than interpersonal violence and injury and road traffic injury combined.

With regards to the Maternal Mortality Rate (MMR), 59% of maternal deaths were tested for HIV from 2005-2007. 79% of those tested were HIV infected. Also, MMR was related to age and hypertension deaths. Most deaths among those persons 25 years old and less were due to eclampsia. The Minister said that this indicated a need for family planning to become more accessible.

The Primary Healthcare Centre (PHC) utilisation rate was discussed. The Department was concerned that people were not utilising these services enough, contributing to the issue of overcrowding at state hospitals. The rate, at which PHC services were utilised by the catchment population, was at a national average of 2.5 visits per person per annum in the catchment population. The denominator was usually Census-derived population estimates. The national target for PHC utilisation was 3.5 visits per person per annum by 2014.

Another issue around PHC was supervision. The PHC supervision rate was defined as the percentage of PHC clinics and community health centres (CHCs) visited by a supervisor at least once a month. lmplicit in such a visit was a written visit report and feedback to facility staff.  lt was one of the most important determinants of quality of care as these supervisory visits were meant to highlight problem areas which the supervisor was expected to assist clinic staff to help resolve. The national average PHC supervision rate for 2009/2010 was 69.9% and the department was hoping to increase this to 100% in 2014.

The Minister then continued with the implementation plan to scale up HIV/AIDS prevention and treatment. The National Strategic Plan on HIV/AIDS 2007-2011 goals were to reduce the rate of infection by 50% by 2011. In addition, 80% of people that needed treatment were to be provided with antiretroviral treatment.

The Minister highlighted that the turning point was on 01 December 2009 when President Jacob Zuma made a major announcement. This included new treatment regimens which stated that pregnant women were to start treatment at CD-4 count of 350 or less and that all TB/HlV co-infected people to start treatment at CD-4 count 350 or less. Also, a new package of preventative measures was introduced whereby all HIV positive pregnant women not on treatment were to start prevention of mother-to-child transmission (PMTCT) at 14 weeks and all HIV positive infants (1 year or less) were to start treatment on diagnosis, regardless of their CD-4 count  as 70 000 children were born HIV positive annually in SA.

The Department had current goals and targets to be reached as well as goals for the next 12 months. Some of them were that over the next 12 months, 15 million people were to be tested, and 1.5 billion male and 6 million female condoms were to be distributed. Also, for the past 12 months medical male circumcision was only rolled out in small pilot projects, mostly in the Gauteng province. The Department wanted to change this in the next 12 months by adding KZN immediately to the project and all other provinces by the end of 2011 to have a goal of 2.5 million males circumcised by 2015.

The Minister admitted that one of the problems in getting treatment to patients was the lack of appropriately trained nurses to initiate treatment. Currently, there were less than 250 nurses initiating treatment. He said that over the next 12 months 4 800 nurses would be trained and of those nurses, at least 1 500 nurses trained would have been starting to initiate treatment by April 2011. Summary estimates showed that by the end of June 2011 the total number of people tested would have been 15 million, and the total number of positive patients would have been 1.65 million.

The Minister went outlined some of the strategies and interventions in combating HIV and AIDS and decreasing the burden of disease from TB. He said that the Department was to rapidly scale up access to ART for people living with HIV/AIDS, especially identified vulnerable groups. Progress thus far had been that over 1.2 million patients were on ART and the department planned to increase access to 1.5 million patients by the end of the financial year.

The Minister discussed a few upcoming campaigns with regards to children’s health. This would consist of well-known child survival strategies. He highlighted a new GOBI FFF strategy which entailed Growth monitoring, Oral hydration, Breastfeeding and Immunisation as well as Family planning, Female education and Food supplementation. This strategy would also mean exclusive breast feeding for the first 6 months of the child’s life. Dealing with infant mortality, the Minister mentioned that immunisation campaigns would be rolled out. The Department wanted to have 5 million children immunized by the end of 2011. In addition to this, focus would also be on women campaigns to promote testing by doing pap smears and mammograms.

Discussion
Ms D Robinson (DA) thanked the Minister for his comprehensive and detailed presentation. She wanted to know what the strategy would be going forward with regards to clinics and PHC services.

The Minister responded that an overhaul of PHC services would be needed in order for them to be more effective. He added that there was a current plan in place and it would be ending in June, so the Department would know by then whether it was effective or not. These turn-around strategies were part of the National Health Insurance (NHI).

Ms P Lebenya (IFP) said applauded the Departments’ plans going forward and said that the Committee should have encouraged them. She commented that with regards to the use of PHC, her own experience was that, at most clinics, the service was not up to standard. She asked the Minister what was being done to ensure that clinic staff adhered to the Batho Pele principles.

The Minister agreed that PHC services were not up to standard but mentioned that a new Bill was currently under review in Parliament to address this issue. The Department was currently working on a new Office of Standards Compliance bill to ensure that every healthcare facility in the country had to comply with certain standards. These included cleanliness, a positive attitude of staff towards patients, infection control, drug stock control, the reduction of long waiting times, and adequate security. This was part of the National Health Insurance roll-out and the Office of Standards Compliance would include three units - Inspection, Accreditation, and the Medical Ombudsman.   

Ms S Rwexana (COPE) wanted to know whether the incidence rates of HIV/AIDS as depicted in the provincial maps (pages 5-9) showed an decrease in certain areas due to a decrease in infection rates or pregnancy overall.

The Minister explained that if studied carefully, the maps indicated no major change. It showed that over the four year period collectively the same areas had the same level of infection. These maps showed that every year, it had been the same districts which experienced problems.

Mr G Selau (ANC) said that he was concerned with the small amount of hospitals available in rural villages. He said that although there are clinics available, these were only operational during the day. Also, there were many clinics run by nursing staff only as no doctors were available. He suggested that clinics should have been made more effective to accommodate those living in villages.

Ms B Ngobo (ANC) was concerned about the high rate of infection in the Karoo area of the Western Cape. She asked whether this could have been attributed to the fact that this area had a truck-stop with many sex workers in the area.

The Minister agreed that this was a major problem. He said that this was of concern, considering that the Western Cape had the lowest overall incidence of infection. He said that a truck driver initiative was needed. He mentioned that in countries like India, such an initiative was currently running that kept track of truck drivers coming and going through such towns where major national roads were, and that health departments could then keep track of those infected to try and reduce rates of infection.

With regards to sex workers, the Minister suggested that they too needed a higher level of healthcare and he suggested that other facets of Government needed to acknowledge this in order to control HIV infection; an open mind was needed to address this issue.

Ms Robinson commented that she was concerned about the effectiveness of inquiries into child mortalities at certain hospitals. She wanted to know about the rumours regarding the appointment of chief executive officers (CEOs) at these hospitals without the relevant qualifications.

The Minister admitted that the issue of qualifications was a problem for the Department. He highlighted that the CEO was not appointed by himself or the Department, rather by the Manager of the particular hospital. 12 years ago it was decided that it was not necessary for the CEO of a hospital to be a doctor or hold a nursing degree. This was done because in Australia and in England that was the case. However, to accommodate this change, these two countries introduced courses leading to the Master of Business Administration (MBA) degree in medicine that taught individuals how to manage hospitals. In South Africa, this qualification was not available; therefore candidates had misused this fact to their advantage to the detriment of the state of healthcare.   

The meeting was adjourned.