Hon Chairperson, my colleague, the Minister of Home Affairs, Dr Nkosazana Dlamini-Zuma; Deputy Minister of Home Affairs, Mr Malusi Gigaba; MECs for health from various provinces - I can see they are all here, except Limpopo and Western Cape, who have representatives - hon members; distinguished guests, and ladies and gentlemen, I am honoured to present to this esteemed House the national Department of Health's policy priorities and budget for 2010-11 for your consideration.
Throughout this week, Parliament has been paying tribute to a gallant son of the soil, who was also a member of the National Assembly, hon Dr Molefi Sefularo, the Deputy Minister of Health, who passed away on 5 April 2010. I had personally known him for over 30 years, as a comrade in the struggle for the emancipation of the people of South Africa as well as a colleague, friend and a fellow student and, subsequently, a medical practitioner.
He was a highly talented, gifted and astute person, who was always humble and easy to work with. It is fitting that so many ceremonies were held in his honour including the one by the ANC on Tuesday and the NA yesterday. May his soul rest in peace!
This year marks the second year of the implementation of our 10-point programme for transforming the health sector into a well-functioning health system capable of producing improved health outcomes.
I just want to refresh your memories by mentioning what our 10-point programme for consists of: First, we must provide strategic leadership and create a social compact for better health outcomes and we think we have successfully been doing so over the past year; second, we must also implement the National Health Insurance; third, improve the quality of health services; fourth, overhaul the health care system and improve its management; fifth, improve planning, development and management of human resources; sixth, revitalise the infrastructure; seventh, accelerate the implementation of the HIV and Aids strategic plan 2007-11 including the focus on TB - I will come to this point later in detail; eighth, we need mass mobilisation for better health for the population; ninth, we need to review the drug policy; and tenth, we need to strengthen research and development.
Since our last budget speech, which we delivered in this very House on 30 June 2009, a solid foundation has been laid for the attainment of these goals.
Our 10-point programme has been endorsed by a wide range of stakeholders in the health sector, including trade unions, medical associations, nursing organisations, most of the private health sector and indeed even the NGOs and civil society. Our 10-point programme received a boost when it got support from the Public Service Summit, which was held between 10 and 12 March 2010.
Having successfully popularised our 10-point programme, I wish to draw this Council's attention to the outcome-based approach for improving service delivery, which was announced by the President in his state of the nation address earlier this year.
I wish to inform this Council that the health situation in the country that requires our collective and sustained attention is as follows: Firstly, the life expectancy in South Africa has declined; secondly, we have an unreasonably high maternal and infant mortality rate; thirdly, we are carrying a very big load of HIV/Aids and TB infections and, fourthly, South Africa has a predominantly curative health care system that places less emphasis on disease prevention and health promotion.
Since our first democratic elections in 1994, the Department of Health adopted primary health care as the foundation of our health care delivery system. Unfortunately, over the past 10 years, we inadvertently have been shifting emphasis from primary health care to a largely curative health care system.
A prominent health expert, who has contributed significantly to the strengthening of the National Health Service in the United Kingdom, recently remarked to me that it is ironic that South Africa has a larger private health care sector than the UK, which is much richer than theirs, where they are using the public health system more than we are doing. One of the things that we are going to be doing is to make sure that we refocus on primary health care as we had agreed in 1994.
The Cabinet agreed in January 2010 on a set of concrete outcomes that must emerge from our interventions to transform the health sector over the next four years. These can be classified into four broad categories: Firstly, we need to increase the life expectancy of our people; secondly, we need to combat HIV and Aids; thirdly, we have to decrease the burden of diseases from tuberculosis; and fourthly, improve the health system's effectiveness, by strengthening primary health care and reducing the costs of health care, which are ever escalating in our country.
Based on these four broad categories, the health sector needs to, during the period 2010 to 2014, produce the following outcomes: increase life expectancy, as I've already mentioned; reduce child mortality; decrease maternal mortality; deal with HIV and Aids; expand the prevention of mother- to-child transmission; improve the TB case load; improve TB outcomes; make sure that people who are TB and HIV coinfected are treated as a priority; revitalise primary health care; improve physical infrastructure; improve patient care; have accredited health facilities; improve operational management; improve health care financing by establishing the National Health Insurance, and expand home-based care and community health workers. These are the 20 outcomes which, together with our 10-point programme, we need to be implementing over the next years.
The key priorities for the health sector for 2010-11 and 2012-13 will strengthen our ability to meet the health-related Millennium Development Goals.
Our maternal mortality ratio must decrease from an estimated 400 to 625 per 100 000 births to about 100 or less. We also need to make sure that our infant mortality rate is reduced from 69 per 1000 live births to about 30 to 45 deaths per 1000 live births.
The health sector will continue to ensure that children younger than one year of age are fully vaccinated against pneumococcal infection and rotavirus.
International evidence has shown this to be an effective intervention in ensuring child survival, together with other key strategies, which we are going to adopt. We shall accelerate child survival strategies at the primary health care level, including the fight against HIV and Aids among children and also by introducing school health programmes.
We need to prepare to deal with the H1N1 influenza virus as we are entering the winter season because it gave us a lot of problems last year. Unlike last year, I'm happy to announce that this year we do have a vaccine.
Following the advice from the World Health Organisation and our own experts within the country, starting from 5 April and ending on 30 April 2010, we will be vaccinating the following priority groups: firstly, 80 000 children under the age of 15 years, who are HIV positive. We have already started and vaccinated 5 000 on the very first day we started; secondly, 10 000 officials at our ports of entry; thirdly, 700 000 pregnant women; fourthly, 1 million adults with HIV and Aids who are on antiretrovirals at our clinics and, lastly, 900 000 people with chronic heart and lung diseases. These are the people that are going to be vaccinated. [Applause.] I officially launched the national Measles and Polio Vaccination Campaign at Benoni West Primary School three days ago, on Monday, 12 April 2010. This campaign will end on 28 May 2010. Our target is to vaccinate 15 million children between the ages of 6 months and 15 years against measles, and 5 million children under the age 5 years against polio. By the end of the first day, we had already vaccinated 290 461 children against measles and 161 598 children against polio.
Hon members are requested to assist the Department of Health by speaking to our constituencies about the importance of immunisation against these diseases. We have to eliminate measles and polio - this means having a fully immunised community now and in the future.
In keeping with the targets in our outcomes-based approach, we must increase the TB cure rate from 64% to 85% by the 2014-15 financial year. We are implementing our key strategy to strengthen TB control with the Desmond Tutu TB Centre as our development partner and we have launched the "Kick TB" campaign, which is based on the 2010 Fifa World Cup, to focus on children. We are targeting 250 000 schoolchildren in that regard, 10 000 of whom have already been provided with soccer balls engraved with TB messages.
As announced by President Zuma on World Aids Day in December 2009, we started 15 days ago, on 1 April 2010, to provide antiretroviral treatment to pregnant women when their CD4 count is 350 or less, rather than the initial 200. We are also doing so with TB and HIV coinfected people. We have also started treatment to stop mother-to-child transmission when pregnant women are 15 weeks pregnant instead of the initial 28 weeks. We are also treating our children who are under one year of age as long as they are positive, regardless of their CD4 count.
By the end of March 2010, only 496 public health facilities were accredited and providing antiretrovirals. I am happy to announce that we had added 519 more centres by 1 April, meaning that we now have 1000 health facilities that are able and initiating treatment. By March next year, we must have reached all 4 300 health facilities.
Even with this success, we are not pretending that we are not going through teething problems in the implementation of these strategies, such as our low human resource base and the problems of logistical supply in some of the health centres. However, we wish to emphasise that these problems are not insurmountable.
As I mentioned earlier, South Africa is paying for very expensive ARVs, unlike other countries. We have made a decision that, with the next tender, we are going to buy the cheapest ARVs. Whether we buy in or outside the country, we are going to have to do that; we have no option as a country. Carrying these loads of diseases and being the biggest consumer in the world means that we must get the lowest possible price.
After the President's speech on World Aids Day, many people, especially the media, put a lot of emphasis on only one aspect of his speech - the issue of treatment. The most important things which he also mentioned, issues of treatment and prevention, were not picked up. I want to tell this Council that, while we are treating people who are infected and helping those who are affected, the mainstay of this battle is still prevention, prevention, prevention.
The Cabinet agreed on 10 March that we needed to launch the biggest ever HIV counselling and testing campaign. The Cabinet agreed that we must launch the campaign on 15 April 2010, which is today. But we postponed it because the President and the Deputy President are out of the country, and they insisted that we can only launch this campaign in their presence and they are going to lead it. So, we will inform you in due course about the date, which has been set.
This ambitious campaign seeks to mobilise South Africans to fight against HIV and Aids and we believe that by June next year, we would have tested no fewer than 15 million South Africans.
When we call on people to get tested for HIV and get counselling, we are also mindful of the report we received from prestigious medical journal. It commissioned researchers in our own country who came up with the finding that the country is going through a quadruple burden of diseases, meaning that we are facing four pandemics, the most well-known ones being HIV/Aids and TB. But we are also going through a pandemic of a high maternal and child mortality rate and of noncommunicable diseases like high blood pressure, diabetes, cardiac disease and, finally injury and violence.
Because of this, we have taken a decision that when people arrive at the testing stations, we will not only test for HIV/Aids. We will also test for their blood pressure to see if they've got hypertension; blood sugar to see if they've got diabetes; and haemoglobin to see if they've got anaemia. They will also go for oral screening for TB, because 1% of South Africa's population is suffering from TB. These are the tests that you'll receive when arriving at the testing station.
We are calling upon leaders in all sectors to lead this campaign. The President and the Deputy President have agreed to lead nationally. Premiers have agreed to lead together with Ministers who'll be present in respective provinces. Principals of our universities will be the first ones to test when their universities start conducting the campaign. Chief executive officers of our hospitals have agreed that in their respective hospitals they'll be the first to get tested. Ministers of religion have agreed that in their churches they'll be the first to get tested.
In the villages, we believe traditional leaders must be the first to be tested when the time comes. We are calling upon members of this Council, the NCOP, the hon Chairperson and leaders of various political parties to, as will happen in the NA, also be the first to be tested. We believe ward councillors will be the first to be tested in their wards. Every South African must take leadership.
We are also launching a number of interventions, including the massive distribution of condoms, both male and female, much more than we have ever done before. We are happy to announce that His Majesty, King Zwelithini, has launched a massive campaign for circumcision on Saturday whereby the Department of Health in KwaZulu-Natal, together with the King, is targeting 2,5 million circumcisions in the next five years. Our next target is Mpumalanga province where we want a similar thing to happen. By next year, all the other provinces should be doing a similar thing. The MEC for Mpumalanga will know why I'm targeting Mpumalanga, especially the Gert Sibande region, where we would like to do a massive campaign for circumcision.
One of the huge outcomes that must be achieved in the health sector delivery is the issue of revitalising infrastructure, improving quality of care, overhauling the health care system and reducing the ever escalating cost of health care.
To this end you are aware that the Minister of Finance has already announced the building of five mega hospitals from scratch: the Nelson Mandela Academic Hospital in the Eastern Cape; Dr George Mukhari in Ga- Rankuwa, North West; Chris Hani Baragwanath Hospital in Gauteng; King Edward VIII Hospital in KwaZulu-Natal and Polokwane Academic Hospital in Limpopo.
In terms of the quality of care, we will make sure that the safety of our patients, infection control, availability of medicine, cleanliness of our health facilities, waiting times and positive and caring attitudes are implemented.
Globally, people are searching to reduce the cost of health care delivery while improving access and quality. The establishment of a National Health Insurance, NHI, system will go a long way in ensuring this.
With the NHI, we will ensure universal access to good quality and affordable health services for all South Africans. Our major objective of pursuing an NHI is to put in place the necessary funding and health service delivery mechanisms. This will enable the creation of an efficient, equitable and sustainable health system for all South Africans. With the ever-widening gap between the rich and the poor in South Africa, a gap regarded as being one of the biggest in the world, we believe South Africa needs such a system.
With regard to allocations to provincial departments of health for the 2010- 11 financial year, I wish to report that the overall budget for the provinces has increased by R10 billion, from R86,6 billion in 2009-10 to R98,6 billion.
I am concluding this by thanking everybody who has worked with us, including our provincial MECs and the hon Chairperson of the Select Committee on Social Services, Comrade Nomonde Rasmeni. I'm requesting this House to approve the budget of the Department of Health for 2010-11 and 2012-13. I thank you. [Applause.]