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.]
Chair, my hon brother, Minister Aaron Motsoaledi, MECs, hon members of the NCOP, Chairperson of the Select Committee on Social Services, distinguished guests, I take this opportunity to thank the Chairperson of the Select Committee, hon R N Rasmeni and the hon members of the select committee for their support and oversight. I would also like to extend my appreciation to the hon Deputy Minister, Malusi Gigaba, as well as the director-general and his team of hardworking senior officials - especially those who are honest - for their dedication and commitment.
We would also like to join the rest of the country in expressing our heartfelt condolences to the family and friends of our late Deputy Minister of Health, Dr Molefi Sefularo. He has joined the rest of our heroes, heroines and forebears who liberated this country - heroes like Chris Hani, Oliver Tambo, Solomon Mahlangu and many others who made sure that we are here today, after liberating us from the oppression that started in this very month in 1652, and ended in this very month in 1994.
Everyone will recall that, last year, standing on this podium, we announced that we would embark on a birth registration and identity document, ID, campaign. I'm happy to report that, led by His Excellency President Jacob Zuma, we indeed launched the campaign in Libode in the O R Tambo District Municipality in the Eastern Cape, on 23 March. The launch of this massive national campaign was preceded by two pilot projects in the Sisonke District Municipality in KwaZulu-Natal and the O R Tambo District Municipality in the Eastern Cape.
The reason for the pilot was to make sure that, when we started the campaign, all the building blocks were there and we would have learned some lessons. Some of these building blocks are the launching of a number of stakeholder forums at local level and in all provinces. To date, we have established 10 district municipality stakeholder forums and 67 local municipality stakeholder forums, and we will be completing the establishment of these forums in the rest of the country during the course of the year.
The reason for establishing these forums is to make sure that people in all the provinces participate directly in the processes of service delivery at Home Affairs, in a manner that will empower them to monitor performance, combat corruption and provide support to the department, as well as assist members of their communities who may be experiencing problems in accessing the services.
The campaign's key objective is to secure and protect the National Population Register, NPR, and make sure that it is accurate. The outcomes of this campaign should be the birth registration of every child within 30 days of delivery; the issuing of identity documents to every South African 16 years and above; and the eradication of late registration of birth by December 2010. Late registration of birth refers to everyone who is over 30 days old, but, more importantly, those who are over 15 years of age, trying to get an ID, but not having birth certificates. They have to start with the process of late registration.
I'm happy to say that, in order to clear the backlog of late registration of birth, we have established 176 screening committees countrywide, and these committees have processed 354 840 people since the campaign started. I would like to say that the trends show that the provinces that have a bigger backlog on late registration are KwaZulu-Natal, the Eastern Cape and Mpumalanga. The majority of those are people between the ages of 15 and 30, and women. These provinces should take note and make sure that they join us in this campaign to eradicate this problem.
The difficulty is that if women are not registered and they have children, they can't register those children. This means that those children are not able to access the grants or any of the social services that the country provides. As a result, we can't take them out of poverty. Therefore, this campaign is also trying to assist in the eradication of poverty.
I'm also happy to say that we registered 1 147 000 children last year, and that, since the launch of this campaign, we have also issued IDs to 834 453 first-time applicants. This is 200 000 more people than the previous year. The department is also implementing an urgent review of legislation impacting on registration, births, deaths and marriages.
I would also like to say to the members here, particularly because they are from the provinces, that Home Affairs considers the ID important for life in general and not only for elections. I am asking them to join us in the campaign now, because there'll be no special campaign during election time from now on, not even for the 2011 local government elections. This means that the ID campaign is now and not then. So, please join us.
As everyone is aware, we, as a country, are about to host the most spectacular world event, the 2010 Fifa World Cup. As Home Affairs we are ready to welcome the world to our beautiful shores in the spirit of ubuntu and love. We are proud to report that, in preparation for this event, and in line with the Fifa guarantees, we are introducing, for the first time ever, an events visa. This means that anyone who has a ticket for the World Cup will get a visa free of charge at our missions abroad.
We're also introducing what we call an Advanced Passenger Processing system. We have trained airline liaison officers who will be based abroad, who will process the passengers at the points of departure, before they even board the planes, so that we try and eliminate those who may be hooligans, or other people who are involved in any offences, who would not be welcome. We are going to deploy these airline liaison officers in May this year.
At our airports, particularly the major international airports, there will be dedicated lanes to speed up the processing of Fifa World Cup visitors.
At the land ports of entry - Lebombo, Ficksburg, Maseru Bridge, Oshoek, Beitbridge and Kopfontein - there will be one-stop border posts for the purposes of the 2010 World Cup, so a person won't have to go through two border posts; we'll all be colocated with the neighbouring countries and a person will go through one stop only. These are some of the preparations that are in place. We have established a 24-hour operation centre which will look at all the incidents and collate information.
I'm happy to say that, in partnership with the SA Revenue Service and other relevant departments, we are going to roll out a movement control system that will enable us to both secure and facilitate movement of people at our ports of entry. That system is already in place at O R Tambo International Airport and will be rolled out at the other 33 ports which we have designated as priority points before the 2010 World Cup, and the rest after the World Cup.
Concerning the department and its challenges, one of the challenges that we are facing is, of course, corruption. As a department we have started to build on what is there and we are enhancing our anticorruption unit. From now on that unit will be headed by a deputy director-general, DDG, and we'll be appointing specialists in this area. In addition to the unit we are also improving our systems to make sure that it's not easy to engage in illegal activities.
We have introduced what we call biometric access control. Instead of just using one's user number, one must also use one's fingerprint so that we know exactly who dealt with what, in order to be able to follow the trail if we find some signs of corruption.
We're also happy that, having taken these measures during this campaign and also having conscientised the people in the provinces about corruption, we have, in the O R Tambo District in the Eastern Cape, already arrested two women and a nurse who colluded in the production of fraudulent clinic cards. Women were paying R150 for every fraudulent clinic card, and they were bringing the cards to us for us to produce birth certificates. The nurse and the two other women have been arrested. So, we are beginning to see the results of our campaign, but we would like everyone to assist us to make sure that this campaign is successful.
Last year I stood here apologising for problems we were experiencing with the backlog of passports, but today I'm happy to say that we have cleared that backlog. We don't have problems. [Applause.]
I'm also happy to announce that we have extended our track-and-trace system to the other documents. So now, whether a person is applying for a passport, a late registration or a marriage certificate, we are able to track and trace the document, link it to the person, and, via SMS, inform them about the stage at which everything is. We had said that we were going to open 13 new offices to expand access and our footprint. I would like to report that we indeed met and even exceeded our target. We opened 21 new offices: one in Gauteng; one in the Northern Cape; three in the Western Cape; three in KwaZulu-Natal; 11 in Mpumalanga; and two in the Eastern Cape. We have also upgraded others.
We also opened one refugee centre in Musina. We have relocated the refugee centre at Nyanga - it was creating a lot of problems for all of us and for the refugees - to Maitland, which has a bigger and more efficient office. The Deputy Minister will expand on some of those areas.
We are piloting an electronic queue management system in Khayelitsha. We hope that this system will assist us to manage queues better and also to determine how much time people spend standing in the queues, so that we can try and improve all the time. In Khayelitsha, just by using the electronic queue management system, we have already seen an improvement from 45 minutes to between 25 and 30 minutes.
Last year we said that to assist women to register their babies, we were going to connect hospitals to Home Affairs, so that women are able to register their babies whilst in hospital. We are happy to say that we now have 142 hospitals connected. We are hoping to connect 120 more this year. [Applause.]
I would like to give you a breakdown of this figure. Of the connected hospitals, 24 are in the Eastern Cape, 17 in Free State, 20 in Gauteng, 29 in KZN, 19 in Limpopo, 12 in Mpumalanga, eight in the North West, five in the Northern Cape and eight in the Western Cape. Those are the ones we have connected and, as I have said, we will be connecting more.
I would like to thank KwaZulu-Natal in particular, because they have agreed that they will accommodate Home Affairs offices in their one-stop development centres that they are building across the province. We are very happy about that, and we hope other provinces will do the same. [Applause.]
Of course, we had also committed ourselves to reviewing the immigration policy, and I'm happy to report that we have started with consultations. Some of you may have heard that we started consultations with Cosatu, and we are going to be continuing with other stakeholders. Once we have finished the consultations, we will come here for legislation.
Last year we had many vacancies for deputy directors-general, chief directors and directors. The vast majority of these posts have been filled and we'll continue to finalise the others.
I would like to introduce to you our new director-general, Mr Mkuseli Apleni, who replaces our former director-general, Mr Mavuso Msimang, and we hope that he will receive your support. We wish the former director- general, Mr Mavuso Msimang, all the best in his future endeavours.
I think I will leave the remaining minutes and have them added to my response time. I request that you support our Budget Vote. Thank you. [Applause.]
Chairperson, hon Minister, Dr Dlamini-Zuma, hon Minister Motsoaledi, Deputy Minister Gigaba, members of the NCOP, and distinguished guests, let me first express the select committee's condolences on the department's loss of Deputy Minister Sefularo.
Kusapho lwakwaSefularo, sithi akuhlanga lungehlanga. [We convey our condolences to the Sefularo family; as we are saying, may they find solace and comfort in these trying times.]
I am honoured, today, to focus on the broad policy perspective of the ANC on health and home affairs, respectively.
From the Freedom Charter to the Reconstruction and Development Programme until the present juncture, our movement has regarded health as a priority. It remains a basic need of our people and, therefore, has enshrined it in our Constitution. What is critical is that we ensure that the majority of our people have access to quality health care and that should in the future be free at point of entry. We have never regarded health as a commodity and it should not be treated as such. Section 27(1) of the Constitution states that:
Everyone has the right to have access to -
a) health care services' including reproductive health care; b) sufficient food and water; c) and social security.
The ANC seeks to ensure the necessary funding and delivery of health services for an efficient, equitable and sustainable health system. This is premised on the principle of the right to health, social solidarity and universal coverage.
The ANC is guided by the Freedom Charter's clarion call that, "there shall be access to health for all". The Freedom Charter commits us all to promote a preventive health scheme under the state, free medical care and hospitalisation with special care for mothers and young children. As a consequence there have been many achievements in improving access to health since 1994.
Our historic policy documents speak to the nature and form of the national health system that we envisaged. As this is a policy debate it is only correct that I reflect on the evolution of our health policy since 1994. An overview and assessment of this policy reflect the following:
That the provision of equitable health care should be guided by the aspiration of our people as enshrined in the Freedom Charter and by principles which reflect the Primary Health Care Approach adopted by the World Health Organisation, and the United Nations Children's Fund at Alma Ata in 1978. The primary health care approach is essentially that of community development. It aims to reduce inequalities in access to health services, promotes equitable distribution based on appropriate technology and integrates the many sectors of modern life such as education and housing. Further, it is based on full community participation.
Access to health care is a basic human right. This right is incorporated in the Constitution and the Bill of Rights and will be enforced by law.
Chairperson, let me state up front that the current policy priority of the ANC government of the introduction of the National Health Insurance system should not be conflated with or confused with a national health system. The first is a system of operational functioning in totality. The other is a funding model to unlock resources into the national health system and make health access free at the point of entry for all citizens of South Africa.
Getting back to policy evolution, and the creation of a comprehensive, equitable and integrated health service, there will be a single governmental structure dealing with health for the whole country. It will co-ordinate all aspects of both public and private health care delivery. It will be accountable to the people of South Africa through democratic structures.
The oversight visit of the Select Committee on Social Services gave us a first-hand impression of how health services are provided to our people. While doing oversight work in Hlabisa Hospital in KwaNongoma, KwaZulu- Natal, the outpatient department, OPD, was full to capacity of patients waiting to be examined by a doctor. During our interaction with the patients, we discovered that they slept at the OPD waiting to be examined by a doctor, but no doctor came to see them up until 16h30 on the day we were there. After talking to the chief executive officer, CEO, of the hospital, I was informed that the hospital on that day had about nine doctors on duty, but surprisingly there was no doctor allocated to the OPD to attend to the patients. This experience directly shows a certain degree of poor management and a dereliction of duty.
As the Select Committee on Social Services, we are convinced that the plans to overhaul the health system and the hands-on approach of Minister Motsoaledi will bring a huge change to these unacceptable practices.
The health service actively promotes community participation in the planning, provision, control and monitoring of services. Fundamental to this approach will be accountability to local communities and decentralisation of decision-making. The responsibility of health care will be co-ordinated between national, regional and district authorities. These will, as far as possible, coincide with regional and local government boundaries. Authority over, responsibility for and control over funds will be as decentralised as is compatible with rational planning and the maintenance of good quality care. Clinics and health care centres will be the points of first referral for medical ailments.
Rural health services will be given priority and made accessible with particular attention given to improving transport. The health service will give priority to children, mothers, the elderly, the mentally ill, workers, the unemployed, and the disabled. Appropriate services to adolescents and to young adults will also be provided. In addition, there will be a focus on the eradication and control of major diseases, especially Aids, tuberculosis, measles, and others. Attention will also be given to sex education, family planning, oral health, substance abuse, and environmental and occupational health.
Within the health service, health workers must respect the right of their patients to be treated as equals in all respects. Furthermore, individuals, interest groups, and the whole communities will be able to participate in the process of formulating and implementing a health policy.
Appropriate and efficient data collection will be an essential part of the health system; it will allow for rational management and planning and also relevant research to address the most important problems facing the community. The private sector will also be required to collect and submit both financial and clinical data in order to facilitate planning at local, regional and national levels.
The health service will be planned and regulated to ensure that resources are used in the best way possible to make essential health care available to all South Africans, giving priority to the most vulnerable groups. Health workers at all levels will promote general health and encourage healthy lifestyles. The health service seeks to establish appropriate mechanisms that will lead to the integration of traditional and other complementary healers into the health service.
At all levels of government the health sector should promote intersectoral co-operation to promote the health of communities. The health service will play a role in co-ordination of government authorities responsible for sanitation, water supply, fuel supply, food and agriculture, housing, and other social services. In the event that a threat to public health is identified, the health services will ensure that the necessary steps are taken to remove such a threat.
In the longer term, most health care should be provided by the public health service. The public services will be strengthened and made accountable to the communities they serve. At the same time, we envisage active co-operation between the two sectors, namely private and public, with the common goal of improving the health of the nation.
The statutory bodies governing the registration of health workers and the maintenance of standards are being restructured to protect the interests of all South Africans. Training of all health workers should be appropriate and community oriented. Training programmes are being implemented to continually upgrade the skills of existing health workers. In the light of this, the present health worker training institutions, particularly medical schools, are being transformed.
The health service provides sensitive and supportive care to victims of sexual violence and other forms of abuse against women. Special counselling and support for victims of rape and incest will be provided. Women have the right to control their own bodies. Contraceptive services will be based on informed choice, will be free and accessible, and will protect fertility. They are gender-sensitive and engage both men and women.
Women and female children are being provided with information to enable them to make free and informed choices about all matters relating to their fertility with the objective of quality health care and making services available to all to ensure better health outcomes. This has included one of the most comprehensive programmes in the world in the fight against HIV and Aids, TB and other diseases. In this regard, work to accelerate the mobilisation of available resources in both private and public health sectors is to ensure improved health outcomes for all South Africans.
To achieve this, the ANC has focused on public-sector-led development. It is the public-sector-led health system that can ensure access to health for all. The majority of our people are poor and need access to quality health in their millions. In this regard, the resources of the public health system need to be strengthened in the areas of personnel so as to deal effectively with disease control associated with HIV and Aids, tuberculosis, high infant mortality, and low life expectancy.
Towards the end of 2008, the ANC concluded a draft 10-point strategy for the revitalisation of health services. I have to go to Home Affairs quickly, Madam.
Hon members, in a constitutional democracy, the state becomes an important institution. The ANC supports both the Home Affairs and Health Budget Votes. Thank you very much. [Applause.] [Time expired.]
Chairperson, hon Ministers, hon members and friends, it is an honour and pleasure to take part in this debate, especially on Vote 15 - Health. U sien, agb Voorsitter, dat gesondheid 'n sleutelprioriteit van 'n regering is. Dis geensins 'n guns of 'n buitengewone stap ten opsigte van die kiesers of die land nie. Allermins is dit die regering se plig of verantwoordelikheid om te sorg dat die gesondheidstelsel van die land in goeie kwaliteit en effektiewe werkende omstandighede verkeer. Anders word die nasie bedreig met uitwissing deur siektes wat erger is as oorlog. (Translation of Afrikaans paragraph follows.)
[You see, hon Chairperson, that health is a key priority of a government. It is by no means a favour or an extraordinary step in respect of the voters or that country. At the very least it is the government's duty or responsibility to see to it that the health system of the country is of a good quality and in an effectively working condition. Otherwise the nation will be under threat of eradication by diseases that are worse than war.]
I fully agree that value for money is a must, and it is the ultimate goal for Health.
The Minister said in his presentation to the select committee that we have a problem with managing our health institutions; that is rightfully so. One of the reasons for this is the incompetent appointees as managers and, directly, the appointment of cadres. This is a huge mistake and disgrace to the people of our country. It is the poor who suffer when poor service delivery is rendered. Poor delivery also degrades and does enormous harm to the innocent and most of the people who are already suffering under unemployment, poverty, shortage of food and others. This must be stopped now and forever.
Chairperson, poor management in Health can clearly be seen in the line item of consultants used by the department, because they must fill in where incompetent officials fail in their responsibilities. Let us look at the statistics. Under administration for consultants, the allocation for 2009- 10 is R7,6 million; for 2010-11 it is R7,9 million; for 2011-12 it is R9,013 million; and for 2012-13 it is R9,3 million. Under the same programme, there is another item for consultants. This allocation comprises R7,06 million for 2009-10, R3,1 million for 2010-11, R3,5 million for 2011- 12, and R3,6 million for 2012-13.
For strategic health programmes the allocation for consultants is as follows: R97,77 million for 2009-10, R105,59 million for 2010-2011, R110,73 million for 2011-12, and R110,73 million for 2012-13. For health planning and monitoring, the allocation is as follows: R10,56 million for 2009-10, R12,58 million for 2010-11, R12,35 million for 2011-12, and R9,023 million for 2012-13.
Chairperson, this department spends R133,85 million on consultants for the 2009-10 financial year and R129,28 million for the 2010-11 financial year. Like this, you can add the amounts for the 2011-12 and 2012-13 financial years too. This is clearly a statement that Health is being run and managed by consultancies. This can't be true and if it is then it must be stopped.
Voorsitter, ons mense verkies om eerder dienste by hospitale te gaan soek en vermy die kliniekdienste. Dit is ook die woorde van die Minister tydens die voorlegging aan die komitee. Primre gesondheidsorg misluk dus. (Translation of Afrikaans paragraph follows.)
[Chairperson, our people prefer to look for services at hospitals and to avoid the services at the clinics. These were also the Minister's words at the submission to the committee. Primary health care is therefore a failure.]
The problem lies squarely in poor service delivery by staff in clinics. This puts unnecessary pressure on the staff of hospitals. Our people don't receive quality and workable medicine delivery for their illnesses at clinics. I can actually say that these phenomena only happen in other provinces, and not in the Western Cape. The Western Cape's programmes and monitoring systems work and are in place.
Here is just one example. During our oversight visit in KwaZulu-Natal, a very sick old lady was lying in the passage on a bed waiting for the papers and administration to be completed to admit her to a ward to receive the necessary support. What is this, Chairperson and hon Minister? Is it total abuse and inhumane service delivery? This is unacceptable behaviour, and someone must account for this.
All of us agree that the HIV/Aids and TB pandemic must be stopped and controlled. We cannot do it by distributing millions and millions of condoms and by circumcisions. The wrong signals are being sent out. More and more advocacy must be done to better the morals and standards of our people. We must get the buy-in of people, as the government wants them to make use of the programmes and plans of government. Good money is wasted, which could be spent on other service delivery items.
The reimplementing of nursing colleges is a must. Not only will this help our youth to get earlier access to the job market, but it will also address the shortage of nurses and provide a better quality service in hospitals where needed.
Chairperson, hospitals cannot be supplied with medical machines and equipment that they cannot use or do not know how to use. Again in Limpopo, a hospital is furnished with this equipment, and it is a white elephant there. This equipment is expensive and must be used in hospitals where doctors and officials are trained and know how to use it.
Our state hospitals have the responsibility to render an effective and quality service to our people. Our government must guarantee this. I thank you. [Applause.]
Chairperson, hon Minister, Ministers present, hon Deputy Minister, colleagues, MECs, hon members of this august House, I am also privileged and honoured to participate in the debate on behalf of the province and, from the outset, we should join the President and the Minister in equally expressing our condolences to the family of none other than Dr Sefularo, the Deputy Minister of Health. We, in the province, have benefited from his wealth of wisdom and his leadership, though we would have loved to have had more. We believe that the most important monument we could have to mark his memory is to work tirelessly for a radically transformed public health care system that contributes to the overall health care of the country to benefit the poor of our country for whom he worked so hard.
Chairperson, from the outset we would like to state our appreciation and our unequivocal support for the Budget Vote, as presented by the Minister. In spite of the challenges we are confronted with as a province, we have joined the Minister and answered the clarion call that we should go back to basics, which is building a strong, sustainable primary health care foundation, a system that will ensure that we build towards the implementation of a National Health Insurance for the whole country. In that respect, we have undertaken to mobilise our communities and various stakeholders to ensure a social compact that will ensure that our platform for the provision of health care is advanced. We have taken into account that it will not only take the Department of Health but also other critical stakeholders who have a contribution to make, as there other social determinants that impact on the health of our nation. The issue of water is one that comes to mind. Therefore, the Department of Water and Environmental Affairs is central to this cause. There is also the issue of sanitation, as well as decent housing for our people.
To the hon member who spoke just before me, particularly when we make comparisons, it really hits a nerve. It tends to remind us that at some time in the history of our country, we were governed from a place that was called the Cape of Good Hope, even though for the majority of our people there was nothing to hope for. [Interjections.] Of course, it could have been that the good was then left here, because we do know that all the areas here were adequately served, compared to where the majority were left with unattended infrastructure, with water problems that today impact on health. It is really not advisable, when we have for years neglected some of these areas, to come here and make unfortunate comparisons.
Are you going to burn us?
We have also, in welcoming the Minister's address here, taken cognisance of the question of strengthening our hospital-based services that will not substitute but support our primary health care programme. In this respect, we welcome the announcement about the priority hospitals that will receive attention in the revitalisation programme, for example the Nelson Mandela Academic Hospital in our province. This will go a long way in supporting our primary health care initiative. We have also undertaken other initiatives to mitigate the situation in which we find ourselves and have looked at where we could improve the ability and the performance of our hospitals. There are income- generating projects that we've undertaken to look at supporting resource mobilisation for a very needy public health care system.
We will also be focusing on the patient-centred quality improvement programme, again in response to the clarion call made by the Minister who called for cleanliness in our hospitals, patient safety, infection-control programmes, caring amongst the employees and those who serve our communities, and reducing the waiting times as well as ensuring continuous availability of drugs and medicines in our facilities. We support the Minister wholeheartedly, even as we respect and acknowledge the contribution made by some of the reputable pharmaceutical companies that have served the country by providing jobs and providing us with much-needed drugs, but we cannot do so at all costs. We support the Minister's call that if we cannot get them to lower the prices of drugs, we should get drugs elsewhere when we can, to be able to serve our people. So the Minister has our full support in that regard.
As part of the drive responding to the call made by the President and the Minister, we will also be targeting, during the period of the focused campaign on testing, two million people in the province to be tested. In this respect we have assured readiness across all spheres and increased the number of testing sites in order to be able to respond to the call. With our home-based care programme, we will be targeting more than 60 000 patients in the coming financial year. This is thanks to the support we received from the budget.
As I conclude, Chair, let me say that we have also enhanced our readiness for the purposes of 2010. The portfolio committee visited a number of facilities as recently as last Friday. They were visiting our province to look at the state of readiness in terms of the Fifa 2010 Soccer World Cup. We are assured of success, in spite of the challenges that we have, and we all welcome the leadership and the guidance that the Minister is giving. We will, without hesitation, call for support of this Budget Vote. Thank you. [Applause.]
Deputy Chairperson, and all protocol observed, as the ANC, the Freedom Charter commits us to a preventative health scheme run by the state; free medical health and hospitalisation provided for all, with special care for mothers and young children. The social impact for continued health transformation should be strengthened and consolidated through ensuring that the people participate in decision-making and community mobilisation for a healthy and long-living society.
The commitment to improve health standards for both public and private sectors, upgrade and improve public hospitals, reduce the rate of HIV- related infections by 50%, and achieve the Millennium Development Goals, MDGs, should be actualised in order to improve the quality of health care services.
There has been a notable deterioration in health care, despite a quantitative improvement in access to health services. Equally, it is pivotal that efforts to improve the quality of health services escalate concurrently with the equality of quality access by all, regardless of gender, race, or class. Progressive legislation and the continued improvement of the health infrastructure are insufficient to resolve the contradictions between the private health care system and public health care system. This duality has caused access to quality health care to be unequal based on differences in the economic abilities of patients, such that those who are more economically favoured would access better health care and, as a consequence, live a longer and better life than their opposites.
Our Constitution is very clear regarding the fact that everyone has a right to have access to health care services and, thus, the ANC government has put in place a 10-point plan to improve access to health care and to reduce inequality in the health system. This position is compatible with the ANC national executive committee's January 8 Statement and the 2009 election manifesto. It is, therefore, necessary that the quantity and capacity of teaching hospitals be increased; human resources be strengthened; health financing and information systems be strengthened; and health services be integrated. The fact is that the current command of health resources by the private health sector, which services a minority section of the population, has been to the detriment of the public sector on which the vast majority of the people depend.
It must be emphasised that the National Health Insurance, NHI, will address both capacity and access in relation to health care. It will be publicly funded and administered and ensure respect for the right of all to access quality health care, which will be free at the point of service. People will be able to choose a service provider of preference within a district without being fettered by financial considerations. The ANC is committed to introducing the NHI in the next financial year, and it should not be delayed any further.
HIV and Aids remain a considerable threat in our country and a lot of ground has been lost in the last few years to the extent that a delayed response has a potency to occasion a situation where fatality will be significantly lower than mortality. It is in this light that the ANC commits to working hard towards the target of cutting new HIV and Aids infections by half by 2011 and ensuring that 80% of those infected have access to ARVs. I have no doubt that this commitment requires our budget to be utilised appropriately in order to ensure that we do not fail our people. We commend the stance taken by the Minister and his department to campaign vigorously on testing, knowing your status and for leaders to lead by example - by doing it.
The ANC shall mobilise our people to practice safe sex in partnership with faith-based organisations, FBOs. It shall embark on a moral regeneration campaign to encourage our people to assist in strengthening the moral fibre of society. Working together with other social formations, the ANC shall encourage HIV counselling and treatment, and the destigmatisation of the disease, thus championing efforts to support those who are already attacked by opportunistic infections. Support shall be rendered to hospices and traditional healers who offer support to those who are ill.
We also commend His Majesty King Goodwill Zwelithini for the bold step he has taken in partnership with the KwaZulu-Natal government and the Department of Health to circumcise men and boys to promote prevention. We also commend the Minister for rendering his services free of charge to circumcise those who have not yet been circumcised. We hope that the hon members will also make themselves available to the Minister. [Laughter.]
The African National Congress commends the Department of Health for its approval of the new HIV treatment guidelines which bring South Africa in line with international best practice. It is noticeable that the introduction of the new treatment guidelines ...
Order, hon members!
... is a direct response to President Zuma's instruction for the revision of the treatment guidelines by 1 April 2010.
The current system of funding health care in South Africa appears to be a two-tier system which grossly discriminates against the working class and the poor in favour of the rich and propertied classes.
In the words of Comrade Minister Aaron Motsoaledi in the recent debate on the state of the nation address, one of the most glaring and obvious reasons why the public sector is not doing well is what the people who have started engaging are trying their best to hide. This subsidy contributes to inequalities in the system. It does not make sense to subsidise the wealthy who largely benefit more from this subsidy. The high income earners tend to benefit more since they are in higher income tax brackets than lower and modest-income workers.
Interestingly, the private sector insists that government must not interfere with the private health care system. The rising costs of contributions to private medical aid schemes make it unaffordable for many people to continue their membership of private medical aid schemes or to use private health care services, let alone the 42 million who cannot afford to subscribe to such schemes. The efficiency of the private sector hospitals seems questionable and cannot be ascertained as there is little or no transparency about their costs; yet they stringently demand transparency on the part of the state.
So, it is the poorest 25% that should receive 36% of the benefits and not the richest, as happens now. But the private sector still insists that government must not interfere with the private medical aid and health care systems.
Hon member, your time is up.
The ANC supports Budget Vote 15 - Health. Thank you. [Applause.]
Chairperson, hon Ministers, hon members, whilst the national health budget deserves praise for the objectives and priorities, the speech outlines almost no details on the budget allocated to various projects.
In a broad context, and together with a wide range of key stakeholders, we support the 10-point programme, with the exception of the National Health Insurance, because we believe alternative ways and means should be researched to strengthen the delivery of health services throughout the country.
However, the budget speech is severely lacking in details and, more specifically, the tactics that must be implemented to address the estimated shortfall of almost R6 billion, which is more than double that of the previous financial year. In fact, with the gross underestimation of the occupation-specific dispensation, the real health deficit is a guessing game.
Die oorspandering van die ander agt provinsies tot 'n bedrag van ongeveer R7 miljard - met Gauteng op R1,75 miljard; KwaZulu-Natal op R2,3 miljard, en die Oos-Kaap op R1,6 miljard - bewys dat dit 'n standaardprosedure geword het vir die provinsies om nie hul aanwas te betaal nie en dat hulle by hulle krediteure agterstallig is. (Translation of Afrikaans paragraph follows.)
[The overspending by the other eight provinces to the amount of about R7 billion - with Gauteng at R1,75 billion, KwaZulu-Natal at R2,3 billion and the Eastern Cape at R1,6 billion - proves that it has become standard practice for the provinces not to pay their accretion and that they are in arrears with their creditors.]
The goals and objectives set out in this week's budget speech remain only concepts if specific amounts, tight financial control and strict fiscal discipline to manage and pay back these shortfalls are not built into the implementation.
Die verbetering in die kwaliteit van dienslewering as 'n prioriteit word verwelkom.
Die effektiwiteit van dienslewering word onder geweldige druk geplaas deur, onder meer, migrasie en immigrasie. Volgens Demographics Online, word die vloei van mense in Gauteng op 446 900, in KwaZulu-Natal op 12 100 en in die Wes-Kaap op 137 000 bereken.
Die Departement van Binnelandse Sake se sake is so deurmekaar en oneffektief dat die werklike getal immigrante nie geregistreer word nie. Sodoende kan die provinsie nie behoorlik beplan en begroot vir die dienslewering van gesondheidsorg nie.
Verdere probleme kom voor waar migrante van byvoorbeeld die Oos-Kaap meer gebruik maak van dienslewering in die Wes-Kaap. Die Oos-Kaap het 83 staatshospitale teenoor die 55 van die Wes-Kaap. Di in die Oos-Kaap staan leeg of het geen toerusting, personeel of medikasie nie en daarom is daar 'n toestroming na die hospitale in die Wes-Kaap.
Hierdie soort van situasie behoort en moet dringend aangepak te word, hetsy deurdat 'n pro rata-toewysing van meer fondse aan die Wes-Kaap of 'n verbetering in dienste en omstandighede in die Oos-Kaap.
Op 9 Maart verskyn 'n berig in die Cape Argus waarin die Minister van Binnelandse Sake haar kommer uitspreek oor die groot getal kinders onder 15 jaar wat geen amptelike status in Suid-Afrika het nie en nie in 'n inskrywingsboek of die bevolkingsregister voorkom nie. Hulle het ook geen geboortesertifikate nie. Die feit is dat babas nie meer op 'n gereelde basis by hospitale geregistreer word nie. Binnelandse Sake se kantore is nie toeganklik vir mense van verafgele gebiede nie. En, indien wel toeganklik, is die dienslewering so stadig en ondoeltreffend dat ouers net nie daarvoor kans sien nie. (Translation of Afrikaans paragraphs follows.)
[The improvement in the quality of service delivery as a priority is also welcomed.
The effectiveness of service delivery is placed under tremendous pressure by, among others, migration and immigration. According to Demographics Online, the estimated flow of people in Gauteng is at 446 900, in KwaZulu- Natal at 12 100 and in the Western Cape at 137 000.
The affairs of the Department of Home Affairs are so mixed up and ineffective that the true number of immigrants cannot be registered. As such, the province cannot properly plan and budget for health service delivery.
Further problems arise where migrants from for instance, the Eastern Cape are making more use of service delivery in the Western Cape. The Eastern Cape has 83 state hospitals as opposed to 55 in the Western Cape. Those in the Eastern Cape are standing empty or have no equipment, personnel or medication, and therefore there is a convergence on the hospitals in the Western Cape.
This type of situation ought to and must be addressed urgently, either by allocating more funds pro rata to the Western Cape or by improving services and conditions in the Eastern Cape.
On 9 March a report appeared in the Cape Argus in which the Minister of Home Affairs expressed her concern regarding the large number of children under the age of 15 who do not have official status in South Africa and who do not appear in a registration index or in the population register. They also have no birth certificates. It is a fact that babies are no longer being registered hospitals on a regular basis by hospitals. The offices of Home Affairs are not accessible for people from remote areas. And when they are accessible, the service delivery is so slow and ineffective that parents are just not up to it.]
However, I want to congratulate Minister Dlamini-Zuma for all her efforts and what she has achieved so far.
Ontoeganklikheid ten opsigte van primre gesondheidsorg kan bydra tot die swangerskap- en kindersterftesyfers. Die feit dat al drie bogenoemdes prioriteite in die Begroting is, word waardeer, maar daar is geen spesifieke planne om die toepassing daarvan te verseker nie, soos byvoorbeeld deur middle van befondsing, vervoer, die aantal gesondheidswerkers en die toerusting wat benodig word.
Weereens dra Binnelandse Sake se werksetiek by tot die bykans onmoontlike registrasie van opgeleide, vaardige immigrante. Die Cape Argus van November 2009 berig, en ek haal aan:
To aggravate matters, the Department of Home Affairs officials make it virtually impossible for the genuinely skilled among these African migrants to get permits for legal employment; consequently, Nigerian theatre nurses are selling mangoes at the side of the road.
In die Wes-Kaap word kinders uit noodsaaklikheid van geboorte tot vyf jaar teen polio, en van ses maande tot 15 jaar teen masels ingent. Die gesondheidswerkers het vrywillige hulp van ouers en die gemeenskap gekry en oor die afgelope twee dae is 20 000 kinders in Khayelitsha alleen ingent.
'n AGB LID: Baie mooi!
Me A MARAIS (Wes-Kaap): Soos Minister Motsoaledi genoem het, moet 190 000 kinders nog ingent word en 700 000 swanger vroue teen, onder meer , die N1H1 griepvirus gevaksineer word. Dit is voorwaar 'n grootse taak. (Translation of Afrikaans paragraphs follows.)
[A lack of accessibility in respect of primary health care can contribute to the pregnancy and child mortality rates. The fact that all three of the above-mentioned are priorities in the budget is appreciated, but there are no specific plans to ensure implementation, such as for instance by way of funding, transportation, the number of health care workers and the equipment required.
Once again the work ethic of Home Affairs is contributing to the virtually impossible registration of trained, skilled immigrants. The Cape Argus of November 2009 reports, and I quote:]
To aggravate matters, the Department of Home Affairs officials make it virtually impossible for the genuinely skilled among these African migrants to get permits for legal employment; consequently, Nigerian theatre nurses are selling mangoes at the side of the road.
In the Western Cape children are perforce inoculated against polio from birth to five years, and against measles from 6 months to 15 years. The health workers have received voluntary help from parents and the community and in the past two days 20 000 children were inoculated in Khayelitsha alone.
As Minister Motsoaledi has mentioned, 190 000 children must still be inoculated and 700 000 pregnant women must be vaccinated against, among others, the N1H1 flu virus. This is indeed an ambitious task.]
I want to thank the national Minister for the strong leadership that he has shown in the past year with regard to the stricter management of health facilities throughout the country. I believe we will see the fruits of these actions in the year to come. It is heart-warming that the Minister recognises the ineffectiveness of the health system and that the quality of health services is poor.
Private health care is the only way possible towards meeting the health care needs in this country. [Interjections.] We are not the only country facing this challenge. It is a global challenge. There is no way that the needs of South Africa's health sector can be met if we continue separating public health care and private health care. As long as these services operate in silos, health services will continue to see-saw between the two.
The challenge for both the public and private health facilities is to approach the challenges as a common challenge and together find ways and means to address these challenges. I thank you. [Applause.]
Chairperson, hon Ministers, Cope appreciates the efforts the Minister has made to improve services and curb corruption in the Department of Home Affairs. However, we wish to raise a few debatable questions.
The Home Affairs National Identification System, Hanis, was meant to implement two fingerprint systems, namely a civil system for citizens and a separate criminal system for lawbreakers. What is the progress in this regard?
A tender for the implementation was awarded to a MarPless Consortium in 1999. Where is the project at this stage and what percentage of the project can now be regarded as completed? Also, to what extent is the technology being upgraded to prevent the system from becoming obsolete?
One month ago the SA Banking Risk Information Centre and the department signed an agreement that will allow banks in South Africa to conduct online fingerprint verification of bank clients by having access to Hanis. When will this be implemented?
In 2008-09 the department implemented the Who Am I Online project. This is a R2,2 billion project. What percentage of the work has now been completed and when will implementation occur? Will the Minister please elaborate a little on the use of the advanced passenger profiling programme at our ports of entry and explain what benefits and results have come from its implementation?
I now turn my attention to Health. In this regard, Cope welcomes the programme to vaccinate children.
The revitalisation of health facilities through conditional grants is very important. Cope has acknowledged and noted that the revitalisation of hospitals, the procurement of health technology and keeping hospitals in a good condition, will need more than conditional grants. The department must examine additional models that will allow hospitals to be well maintained and to have the necessary technology to support good health care.
The Minister has come out strongly on the question of overpricing of antiretroviral medicines in South Africa. Will he engage with pharmaceutical companies in the country to find a solution? [Interjections.]
Finally, I wish to raise the question of procurement policy. The Minister of Finance has been asking for full value for every rand spent by government. How is the department progressing in this regard? Is the country getting full value? Also, are the items and medicines that are being procured at the top of the list and in accordance with this demand? [Interjections.]
Recently, in the Free State, a substantial quantity of medicines had to be thrown away because they had reached their expiry dates. Is there any system that will ensure that wastages that occur during the transfer of surplus medicines from one hospital to another don't ever happen? Will the department consider setting up a database to monitor the medicine situation in hospitals?
Cope recognises that there is a new determination to achieve a turnaround in Health. This is welcomed. Thank you.
Chairperson, I dedicate my speech in memory of Dr Molefi Sefularo. The work and the footprint of the late Deputy Minister of Health speak volumes. What it proved once and for all to us is that once in a while a leader is born who is complete and comes with all the attributes of a good leader. Very few leaders are what Dr Sefularo was. We thank Mrs Sefularo and the family for allowing him to serve the nation.
Chairperson, hon Ministers, Dr Nkosazana Dlamini-Zuma and Dr Motsoaledi, the Deputy Minister, Ntate Malusi Gigaba, my colleagues, MECs, hon members, in supporting Budget Vote No 15, the department, management committee and executive of the North West have developed comprehensive plans to address the Minister of Health's directives. These provincial plans guide the planning and implementation at facility level.
Every management meeting of the department and of each facility has these key elements on the agenda. A detailed operational plan containing inputs, activities, outputs, outcomes and impact is in place.
The following elements are addressed in detail in this plan. I will outline some elements of the detailed plan to illustrate that the North West department of health and social development is determined to turn the performance and perceptions of health services around.
The first of these elements is clean hospitals. A clean health care facility environment will be maintained through daily supervisory inspections and hourly inspections of high-use areas, such as public toilets in outpatient departments. Adequate budget allocations will be necessary to ensure that a sufficient number of staff is on the premises, and to cover cleaning as well as gardening contracts. Clean facilities will result in an improved image of the hospital, improved patient satisfaction, outcomes and a reduction in patient costs through reduced average length of stay and cost per patient day equivalent.
Secondly, improved patient file management will shorten patient waiting time, and improve booking and fast queue systems through development of kaizen projects, at all areas with patients waiting. There will be provision of consistent quality packages of service at each level of care, and clear referral mechanisms to ensure that cost-effective health care services with health care are delivered at the right level, at the right time and at the right amount.
We will promote active community involvement in the process by setting monitoring, displaying standards at all reception areas, and signing of new service delivery agreements with communities. Facilities will market their complaints mechanism and display monthly complaints with management responses in reception areas.
Thirdly, safe health care facilities for patients must be given. This will be achieved through implementing hospital-wide risk management plans, policies and procedures, functional patient safety groups, infection control, quality control, and occupational health and safety committees. These elements will be managed through daily risk and near-miss reports with interventions on all reported adverse events managed through a just culture system.
General security of the facilities will be maintained through closed circuit television, CCTV, surveillance of key areas, security surveillance and controls managed through service level agreements. These measures will result in a reduction in adverse events and litigation, improved patient experience, perception of public hospitals by the community as well as improved morale of staff. Additional measures are in place to address the needs of the mental health patients who have additional safety needs within the psychiatric facilities.
Fourthly, a number of initiatives are necessary to change staff attitudes for the better and to maintain this situation. These include a reinduction and reorientation of all hospital staff on organisational culture; a revision and improvement of the new improved caring ethos campaign; customer care training for all staff specific to their departments; linking attitude performance per staff member to the performance management and development system, PMDS, and performance management agreement, PMA, and appraisal scores. Each staff member will have to sign a commitment to customer service agreement, with public and peer recognition of the best customer service performers in facilities. This will result not only in improved patient experience and satisfaction regarding hospital services in the public sector, but also in safer health care facilities and fewer adverse events and litigations.
Fifthly, ongoing and sustained measures are necessary to manage infection control, prevent and reduce nosocomial infections. These include the prevention of overcrowding, correct administration of waiting patients - especially coughing patients - biohazardous waste management, maintenance and the development of infrastructure. This is to be done through the implementation of risk and infection control procedures and policies, continuous in-service training and attention to details - simple basics like washing of hands before each patient encounter. Improved infection control will result in better patient outcomes, reduced costs and reductions in the average length of stay.
Chairperson, I am not going to bore the House talking about the budgetary constraints or budget pressures that we have in the province, but all these above-mentioned measures must be implemented with the following reality in mind: The North West has the lowest per capita health funding in the country.
So, with the recent presidential and ministerial announcements regarding the implementation of the HIV counselling and testing campaign, we are going to really do this with high spirits. We want to say to the Minister that we are really behind her and we are going to make sure that this campaign succeeds. Even if there was no additional funding received for this massive intervention, all the additional resources required for this campaign and treatment expansion are going to be funded from the conditional grant. This is clearly not sustainable and not assisting the province to expand its planned HIV and Aids services, but we are going to make sure that we win this battle.
The department commits itself to strengthen quality health services through the primary health care system approach. It is important to recognise that the North West department of health and social development is experiencing financial pressures due to the inadequate funding received for the financial year 2010. The department will, however, do the best it can with the resources available.
We want to thank the Minister for the leadership and direction to all of us as MECs. I support Budget Vote No 15. Thank you. [Applause.]
Chairperson, hon Minister Dr Dlamini- Zuma, hon Dr Motsoaledi the Minister of Health, hon MECs of health, hon members, ladies and gentlemen, in presenting this Budget Vote we are cognisant of the responsibility we carry on our shoulders to assist in the fulfilment of our liberation's historic vision to ensure that South Africa belongs to all who live in it, black and white. Several volatile and unfortunate incidents recently have threatened to shake the core of our beliefs in this very same historic vision that transcends the divisions and fault lines of our programmed prejudice. These incidents have led us to question the character and the soul of what we have built thus far. It is in these times of social introspection that we have risen above petty squabbles and racial parochialism to cement the idea of a new identity, an identity that encompasses all the facets to one commonality that all South Africans can relate to. That commonality is the hope that we are part of developing a whole, a whole that warrants citizenship of pride.
It became clear that there are still a few amongst us who hanker for the past, choosing to be identified more with hatred than reconciliation. These nostalgic few have purposely placed themselves at odds with our pluralistic view of a nonracial and nonsexist South Africa. However, we take solace in the knowledge that these hidebound racists have become an even smaller minority in our society. In spite of their flawed ideological provocation and emotional, racial instigation, they have been answered by patriotic South Africans with the calm and dignity that pacifies expected racial turmoil. South Africans are seeing themselves more and more as one people, united in their diversity. They are rapidly recognising the commonalities in their hopes for the future.
If it is true that one should win through action and not argument or rhetoric, then our Fifa World Cup preparations are a bold exhibition of common nationhood. Our single-mindedness in striving to host a successful event has already deemed us victors, even before the anticipated moment of the kickoff. In the past few months, we have displayed our pride and unity by donning Bafana Bafana jerseys in observance of Football Friday. We are now moving in harmony to the melody of the soccer dance, passionately waving our flags and chanting out our support for South Africa and Africa at large. This euphoria has not been halted or disintegrated by the sad murder of Mr Eugne Terre'Blanche because, as a nation, we have wholeheartedly condemned this challenging incident. Our objections to his bigotry in the past and the present lay in the fact it represented a step backwards and resembled a call for violence. It is therefore fitting at this point to quote a man of peace, Oliver Reginald Tambo, who said, "The fight for freedom must go on until it is won; until our country is free and happy and peaceful as part of the community of man, we cannot rest."
That is why we are not resting. We are committed to ensuring the project of transformation and integration does not change direction. Every day, we battle heavy constraints and obstacles, to be further tomorrow than we were yesterday. We have committed ourselves unreservedly, whilst comprehending the dynamic and continuous task that lies ahead, a task of safeguarding the identity and citizenship of the new South Africa, as well as empowering our citizens with rightful belonging and proof of being.
It is partly for these reasons that we have enunciated the above, which challenge us continuously to nation-building, that we in the Department of Home Affairs have defined our vision as, "a safe, secure South Africa, where its entire people are proud of, and value, their identity and citizenship." We have defined, for ourselves, three important and interrelated outcomes which are: a secured South African citizenship and identity; managing immigration effectively and securely in the national interest to facilitate economic, social and cultural development; and a service that is efficient, accessible and corruption free.
In pursuit of this vision and these outcomes, we believe that we will be able to fulfil the vision we have set for ourselves and contribute to the common pursuit of our people for social cohesion. We are part of a broader social movement for transformation, and our activities could never be isolated from the common and noble endeavours of millions of ordinary South Africans and their dreams.
Last year we announced plans to establish the Home Affairs Learning Academy. The academy will also deal with policy development, as well as knowledge management. Major strides have been made in this regard. For this financial year, our training will focus on the training of supervisors and front office officials in customer service, operational excellence and other needs-based interventions. Towards this end, we further requested the secondment of managers from particularly the banks to train our officials, especially those involved in front office operations in customer service. We will further contribute towards government's youth development programmes by recruiting 244 interns, as well as 300 young people in the National Youth Service Programme. The recruitment of interns is already under way.
In the last financial year, we committed ourselves to improving the operational efficiency and effectiveness of refugee affairs. We are happy to report that we have improved the number of days it takes to issue section 22 permits, from seven days to one day. We have increased the staff in our refugee reception offices and have also increased the number of their decisions from an average of five decisions per week to an average of seven decisions per day.
More importantly, we intend to begin this year to review the refugee policy and legislation and extensively overhaul the asylum processes. The details of these will be announced during the course of the year. Through this exercise, amongst others, we hope to separate economic migrants from genuine asylumseekers and refugees, in order to enhance the protection of genuine asylumseekers and refugees.
Furthermore, we will continue to hold regular consultations with local and national refugee stakeholders in order both to benefit from their opinions, expertise and insight as well as to regularly brief them on the progress and challenges in the implementation of our programmes. Last year we also committed ourselves to intensify the campaign against xenophobia. In this regard, we trained 102 community development workers and 23 secondary schools in affected areas in Gauteng. However, fighting xenophobia is ultimately the responsibility of the public as a whole, and so this programme must be premised on mobilising communities at large. To improve the department's institutional capacity to lead and co-ordinate sustainable interventions in this regard, we are going to create a directorate and finalise our programme against xenophobia.
The President finally signed the Films and Publications Amendment Act into law. Both the Act and regulations are now operational. This means that among the priorities for this financial year, we must develop a turnaround strategy to ensure the alignment of the Film and Publication Board, FPB, structure and systems and processes in compliance with the amended Act. We will within 30 days finalise the appointment of the council of the FPB.
We have continued to make strides in the past financial year, particularly in the campaign against child pornography. We are still waiting for a report from the SA Law Reform Commission on our request for advice on the possibility of prohibiting pornography on television, the Internet and mobile phones. We are determined to have legislation in this regard. We are further heartened that most South Africans firmly rejected the idea by MultiChoice to establish a 24-hour pornography channel. We regret that MultiChoice even thought of this in the first instance. We must continue steadfastly to refuse to accept pornography being brought into our living rooms. For the 2010 Fifa Soccer World Cup, the FPB has dedicated R15 million to the related public awareness campaign to ensure the protection of children during this tournament.
Over the past few years, we have been seized by the challenge of the transformation of the Government Printing Works, GPW, to position it as a security printer of choice for government and the Southern African Development Community region. We want to position it as a key player in the smart card and passport industry. We have completed its conversion into the government component, and we shall soon complete the appointment of its advisory board and finalise the migration of its staff into the new structure. This conversion has made it possible for us to negotiate and implement a special salary dispensation for artisans, which should address the challenge of recruitment and retention of skilled artisans for the organisation. After all, the majority of the staff of the Government Printing Works must be made up of artisans and technicians, and there must be fewer officials dealing with administration. We've also recruited a well- qualified and experienced chief financial officer in order to ensure that we strive towards an unqualified and, eventually, clean audit. Further to enhance its position as a security printing agency, we will procure new equipment, as well as complete the second pavilion in a few months, so that we relocate the entire factory to a new and refurbished plant.
I would like to commend hon Plaatjie on the issues he raised. He raised many questions, and we will deal with them when we write our final exams. [Laughter.] The Home Affairs National Identification System, Hanis, was a Home Affairs National Identification System and had nothing to do with the police. The police had their own SA Police Service Automated Fingerprint Identification System called Afis. These are two separate programmes. Now, as you would know, had you read your reports, we completed this process quite a few years ago. I have actually even forgotten when it was. All the questions that you have asked have been answered in many of the reports that we have provided in the past. I would like to recommend that you read those reports. [Applause.] We are offering also, hon member, to assist you in the pursuit of your responsibilities by providing you with the answers to all those questions.
Hon Marais, we appreciate your grudging applause for what we have achieved, but many of the issues that you raised have actually been answered, even today, by the statement the Minister made about the new offices we are building and the changes in our offices that we are implementing, even as we speak, to address issues of the disabled, of women and of the elderly. There are many offices where we are going to either build new offices or change some of the present offices, so that they are accessible to people, in particular those with special needs.
Insofar as skills are concerned, there are many changes that we have announced that we are implementing. It is inaccurate to make a sweeping statement as you did. There are many immigrants in South Africa with skills, who are working in our country. In fact, the biggest problem in South Africa is not faced by immigrants with skills; it is faced by immigrants without skills. That is why the Minister announced here, just a few hours ago, that we are meeting with unions; we are meeting with Cosatu, and we are going to meet with other unions and business to deal with the issue of economic migrants, because most of the immigrants in South Africa who have skills are employed. It is those without skills who are facing challenges. One of the issues that we are dealing with in our refugee policy is the issue of asylumseekers who are in our country, whether they have skills or not. In terms of the law, they are permitted to seek employment.
I wish to conclude by thanking the Minister for her studious leadership and wise counsel, as well as to thank the old and the new directors-general, the senior managers, and all the officials in the Ministry and department for their support in the execution of our mandate. We are confident, hon members, that together with you, we can and will do more to achieve the objective we have set ourselves to manage both immigration and civic services and to fight corruption in a manner that not only secures the identity and citizenship of South Africans but also enhances our sense of nationhood and social cohesion. Thank you very much. [Applause.]
House Chairperson, hon Minister Dr Dlamini-Zuma, hon Minister Dr Aaron Motsoaledi, members of the NCOP, my colleagues, MECs from various provinces, directors-general, and heads of departments and former colleagues ...
... ha ke latele basebetsi mmoho le nna ho lelapa la Dr Molefi Sefularo ya seng a re siile, ka hore kannete re re phephi ka sena se etsahetseng, mme le rona re utlwile bohloko jwalokaha ba bo utlwile. (Translation of Sesotho paragraph follows.)
[... let me follow my colleagues and say to the family of Dr Molefi Sefularo who has left us that we truly sympathise with you about what has happened; we also feel the pain just as much as you do.]
Chairperson, 15 years ago we set out on a journey to change the health system in this country. We constructed clinics and hospitals and supplied them with health workers and medicines so that our people could have easy and free access to health facilities so that they could improve their health and the quality of their lives.
The Budget Vote presented by the Minister in the National Assembly and in this august House vindicates the path that we chose many years ago and affirms that it is indeed the correct one. The right to health for all is a fundamental necessity in our quest to build a prosperous South Africa. The challenges facing our health system cannot be overemphasised. The biggest question, though, is what to do to resolve those. The Minister has correctly captured this in his speech. Accordingly, it was only logical and correct that the ruling party, the ANC, took a decision to place health high on the national agenda.
The Budget Vote presented by Dr Aaron Motsoaledi is an indication of the visionary leadership and the decisiveness of this government to overhaul the health system for the better. In December 2009 on the occasion of World Aids Day, the President of the Republic of South Africa announced the steps government was going to take to strengthen the fight against HIV and Aids, including TB. This is particularly important because South Africa is experiencing unacceptably high levels of infection, with young people being the most affected.
In the Free State - not the imaginary province that the hon member referred to - we have taken steps to respond to the challenges of the day. As a result, our TB cure rate has stabilised and our defaulter rate has decreased from 4,9% to 4,7%. This is so because we have strong TB defaulter tracer teams, which we are going to increase during this financial year.
In addition, a new multidrug-resistant tuberculosis, MDR-TB, unit is being built in Welkom in Lejweleputswa District and is expected to be completed by the end of August this year. As part of strengthening our infection control to prevent the TB spread, we will be rolling out a massive TB awareness campaign in the Free State. This campaign will be launched in Phiritona, Heilbron, on Saturday, 17 April 2010.
It will primarily target school-going and out-of-school youth under the theme "Motjha o reng" [What do the youth say]. The aim here is to empower the youth with the knowledge and skills to prevent the spread of TB infections at their schools and communities.
As the province, we have also taken steps to respond to the call by the President of the Republic to mobilise our people to respond in their numbers to the call of the national HIV counselling and testing campaign.
To this end, we have already set up the nerve centre co-ordinating structures at provincial, district and institution levels. In addition, we have increased the number of sites that provide treatment. The availability of drugs, including ARVs, has since stabilised in our facilities. We started at 40% and have improved to a comfortable 90%, but we are still aiming to achieving 100%.
As part of our efforts to respond to one of the critical outcomes the Minister spoke about - that of increasing life expectancy - we have taken seriously campaigns to immunise our people. In this regard, I am proud to share with this House that, on the first day of this programme, we registered the following progress in terms of children who have received vaccines: Regarding polio, we have, to date, been able to provide the service to 1 800 infants 0-59 months of age; regarding measles, we have, to date, been able to provide the service to 1 875 infants 6-59 months of age; and with the 5-15 years group, we have reached 3 799 children.
As part of our response to one of the critical priorities of the 10-point plan, namely improving human resource planning, development and management, we have taken a conscious decision to reopen hospital-based nursing schools. To this end, one of the schools was opened two days ago, on 13 April 2010, at the Dr J S Moroka Hospital in Thaba Nchu.
We reopened a school with learners already recruited and ready to be taught and lecturers ready to teach. As we speak, the school is up and running. We did this with the conviction that nurses play a critical role in securing sustainable care for all. In addition, the Free State government has issued 184 bursaries to deserving medical students as from the beginning of this academic year. We have also moved swiftly to fill our critical attrition posts and, to date, we have made appointments in about 1 329 posts in different categories.
During 2009, the occupation-specific dispensation, OSD, for medical doctors - one of the key categories in the department's workforce - was processed. The department has spent R111,3 million on this endeavour. Other critical categories such as specialists, dentists, pharmacists and emergency medical services, EMS, have also benefited from this dispensation.
With regard to the 2010 Fifa World Cup extravaganza, we, as a province, are ready. The experience gained during the Confederations Cup has put us in a better position to perfect our systems and facilities. The recent inspection by the late Deputy Minister of Health, Dr Molefi Sefularo, and the NCOP delegation on 8 April 2010, confirms that we are ready to deliver on our commitment to ensure availability of a comprehensive response on a 24-hour basis for the duration of the tournament.
We have noted, however, the concerns which were raised by the NCOP delegation regarding the following: our ability to contain communicable diseases like Rift Valley fever; the shortage of personnel in the ICU at the Pelonomi Regional Hospital; general security; and additional beds for casualty at the Pelonomi Regional Hospital. I must tell this House now, however, that we are trying, using all means, to rectify the situation and make sure that everything is in place. I would also like to remind my colleagues here who said that they will make sure that we are given something, to engage with those in power to assist us to achieve what we really need to achieve.
We have also intimated to the delegation that we are faced with a shortfall of R100 million to adequately address the following imperatives related to the tournament: medical equipment, including ambulances; personnel; and payment of additional overtime.
However, we want to assure this House that these matters are receiving our undivided attention and will be resolved long before the tournament. In addition, 60 ambulances have been procured already and we are awaiting delivery. The process is currently under way to appoint 200 additional emergency medical services and equipment to the value of R18 million. These will be delivered and placed at hospitals along the N1, N3 and N8 before the tournament begins in June 2010.
We will maintain a balance between catering to the Soccer World Cup as well as our day-to-day emergencies. However, I want to assure this House that our emergency services will never interfere with our day-to-day services. We support the Budget Vote. I thank you. [Applause.]
House Chairperson, hon Ministers, hon MECs, allow me to firstly pay tribute to one of our dear colleagues who, sadly, is not here with us today: the hard-working, dedicated, late Deputy Minister of Health, Dr Molefi Sefularo.
Hon Minister Motsoaledi's candid and honest recognition of the many challenges in our public health care sector is very encouraging and gives us hope that our Health department is in the right hands.
Until now, our health care sector has been largely curative in nature and little attention has been focused on prevention. This recognition has to be the first step in building a healthy nation for the future. The ID is therefore encouraged by the mass education programme campaigns on TB and the immunisation of children across the country. In line with our belief that health education forms the cornerstone of any preventative health care strategy, the ID calls for the reintroduction of health education in all schools across the country.
The ID fully supports the 10-point plan and welcomes the prioritisation of its 20 deliverables. However, the plan will fail without strict monitoring and evaluation.
The release of the recent burden of disease report brought to light some extremely worrying trends. The high incidence of alcohol abuse in our country is having a devastating impact on our ability to address the huge health care challenges, especially in relation to HIV and Aids, TB and other diseases. The government had a vigorous campaign against smoking and we would like to challenge the Minister to have the very same vigorous campaign against the abuse of alcohol. This should include a complete ban on alcohol advertising. Irresponsible behaviour linked with high levels of alcohol abuse also has a direct impact on the violent crime rate.
Billions are needed to overcome health care inequalities. The ID reiterates its support for the National Health Insurance scheme, because it will help poor South Africans, including our people who have been suffering for such a long time. However, we call on the Minister to take the nation into his confidence and release the scheme's plans and costs as a matter of urgency.
We are encouraged by the department's recent acquisition of flu vaccine to treat millions of South Africans. However, South Africans who visit private doctors are now unable to access this vaccine as the department has bought the whole lot.
Lastly, the ID would like to hear from the Minister when he plans to make these vaccines available to the public. The ID supports the Budget Vote. I thank you. [Applause.]
Dr S M DHLOMO (KwaZulu-Natal): Deputy Chair, hon Minister of Health Dr Motsoaledi, hon Minister of Home Affairs Dr Nkosazana Dlamini-Zuma, our Deputy Minister, hon members of the NCOP, my colleagues, MECs, hon chairperson of the portfolio committee of the province where I come from, Ms Z Ludidi, and the other member of the portfolio committee, Dr Roopnarain, allow me also to offer my condolences to the Sefularo family and to our Minister of Health who, together with the Deputy Minister, has been providing a cohesive and united leadership in guiding and supporting us as MECs for health.
I am expected to participate in this Budget Vote and also give account of what is expected of my province. I hope to do just that and not be tempted to speak about other provinces where leaders of those provinces can greatly assist us to understand the issues there. There are challenges in the Department of Health nationally and that is the accumulative picture of all provinces. We, in KwaZulu-Natal, are very mindful that of the four districts that have an HIV prevalence of above 40%, three of those are in KwaZulu-Natal, and those are: eThekwini, uMgungundlovu and Ugu.
We are, therefore, very mindful that what we do or do not do in KwaZulu- Natal has a significant positive or negative impact on the health outcomes, not only of KwaZulu-Natal but of the whole country. It is this understanding, therefore, that makes us realise that we have to accelerate health service delivery in the province. Our Minister has given his Budget Vote, which we support, and in view of this therefore I have decided to actually indicate some of the 10-point plan achievements in the province.
The department has appointed hospital boards and clinic committees at major hospitals, community health centres and clinics. Even though these posts have not all been filled and it's a work in progress, we are happy with the progress that has been made thus far. The management of health facilities is strengthened in various ways including unannounced visits, encouragement of walkabouts by managers in their institutions and attending to patient complaints timeously.
Over the past 11 months one has been fortunate to visit 30 hospitals, 3 community health care centres and 12 clinics. Those visits were mainly to go about thanking the management, hold hands and give them support, identify challenges and work with them in giving support and also thank our workers who are dedicated to continue doing their work.
We, under the instruction of our Minister, commenced with what we called the "Look like a hospital campaign" last year, where we had six areas of focus. These were cleanliness, staff attitudes, infection control, safety and security of patients, accessibility to services, availability of drugs, blood and laboratory testing, as well as a reduction of waiting times, as our hon member Rasmeni mentioned. Negative media publicity still exists despite the successes in most hospitals in the province. Quality in emergency services has improved with the addition of 124 new ambulances that strengthen our fleet to about 423. We have two helicopters as support, with one fixed wing for aerial medical services. However, this remains a challenge. Our province is largely rural and some of our people still wait long hours before they get ambulance support. There are 37 telemedicine sites that are used for training and patient management. We need to maximise this technology, as it has the potential to enhance patient care.
The department has put in place plans to revitalise the primary health care approach with a strong focus on community-based services. It is acknowledged that the department is experiencing a shortage of professionals. On the issue of human resources, the department is in the process of splitting the posts of finance and systems managers in order to fill the finance posts with candidates who have appropriate finance experience, among other things, because we have been noticing serious challenges with regard to this matter. The department has put 17 chief executive officers on the Master's Programme for Public Health.
Health care professionals can be seen as a scarce resource for developing countries. It is difficult to retain health care professionals in the country. It is even worse to get them to work in the rural areas. For example, a doctor who lives in Durban will be reluctant to drive 50km every day to go and work at Stanger Hospital. The same doctor will have absolutely no desire to go and work at Rietvlei Hospital in Umzimkhulu. How then do we go about getting the health care professionals to work in these remote areas? In our province, we are considering various options. These include, amongst others, the case where the government, for example, allocates you a bursary on the basis that you were born in Umzimkhulu; you should then serve not just the whole province, but go and start serving at Umzimkhulu before you can move around the whole province.
The department is focusing on appropriate skilled management for infrastructure development and maintenance of existing facilities in KwaZulu-Natal. We must actually say this up front so that members don't get shocked that in the KwaZulu-Natal department of health we underspent close to about R2 million on infrastructure last year. I must mention that I raised this matter in the KwaZulu-Natal cabinet yesterday, and we should go beyond complaining and maybe get reasons why we are not doing well on the infrastructure grant and revitalisation programmes.
All districts have drawn up their detailed plans for the HIV counselling and testing campaign which will kick in shortly. Currently, the department has 304 999 patients who are on treatment, which is a third of what we have in the whole country. We aim to reach about 470 000 by the end of this year. I notice that my time is ticking very quickly. HIV/Aids counselling is provided for in all our facilities currently, which include hospitals, clinical advisory committees and even mobile clinics. We have actually strengthened this by employing more lay counsellors and mentors for these patients.
The department has expanded the scope of the HIV programmes by integrating TB services into the HIV programmes. This integration therefore will ensure that all HIV-positive patients are routinely screened for TB infections, as our Minister has indicated, and that all patients identified with TB are put on treatment, while patients found to have no TB are started on isoniazid prophylaxis. While we have seen an improvement from 55% to 62%, the target cure rate for the country is 85%, and we are far from that. We are very excited, Minister, about your bold reminder and an announcement that all HIV-positive women should have a pap smear done. Also, all rape victims should be seen and examined before they go and look for police stations, and have that done first, before going to the police stations.
I should mention here that we are excited about the announcement that was made by His Majesty our king, on 5 December 2009, which has since been pronounced by our premier as one of the programmes that this department must run with, and we actually have over the past week circumcised 300 males out of an overwhelming surprise of over 500 males. The remaining number will be circumcised this coming weekend. Of the 2,5 million males to be circumcised, we are leaving 1000 for our Minister, and we will hear from him about when he is actually coming to circumcise them.
On the training of nurses, last year we had more than 2 255 nurses who graduated, and some are already starting their community service.
We would like to thank our Minister, the premier, and the chairperson of the portfolio committee in the province for all the support that they have given our department. I would like to actually reiterate, as the speech of the Minister indicated, that our province will be maximising our focus on TB and HIV maternal outcomes, perinatal and neonatal outcomes and the outcomes for children under five. Maybe what underpins these is the realisation that, after all, health is about mothers, babies and children. The death of a mother, such as an event related to pregnancy, is a disaster. If I were to borrow from the words of our premier, Dr Zweli Mkhize, he says in isiZulu: "Inyanda imuke nezibopho" [One has lost everything].
For those who collect firewood, it means that you have lost everything. We noted the comments that were raised by the member of the NCOP when they visited our province, and we will be working on that. Thank you. [Applause.]
Chair, colleagues, I want to recognise the presence of the Minister of Health, Dr Aaron Motsoaledi; the Minister of Home Affairs, Dr Nkosazana Dlamini-Zuma, my role model; the Deputy Minister of Home Affairs, Malusi Gigaba, my friend; colleagues from other provinces, and also the hon members of this august House. Indeed, it's good to be back in the NCOP. Comrades, friends, ladies and gentlemen, it is my honour and privilege to stand before you to elaborate on the plans of the Gauteng department of health and social development, and the things that we are doing to try and respond to the policies pronounced by the Minister and our President.
The improvement of a health care system depends on having competent managers who know their story. We are happy to report that we have almost completed the task in the province. Where there were no chief executive officers, they are appointed. In turn, we are expecting CEOs to make sure that the resources of the state are properly utilised; and to ensure, at the end of the day, the quality care of the ordinary citizens is improved for the better as well as minimising the adverse incidents that we have been registering over the past few years.
I'd like to inform this august House that we are gradually kicking the bad elements out of the system; that is part of strengthening the health care system. Those who are stealing patients' food, medicines and other things are being kicked out of the system. We have, with members of the portfolio committee in the legislature, launched a programme called Operation Buyisa, which is simply about returning things that belong to the hospitals because, indeed, they don't belong where they are in our communities. We want to say to our communities that they should be vigilant. Wherever you see something that is engraved with the name of the hospital, please return it. This is part of our effort to make sure that the state resources are efficiently utilised.
In improving the primary health care systems, we are focusing on strengthening our clinics in the province as they are required to treat patients before they walk into any hospital. Half of the cases that are dealt with in hospitals are required to be dealt with at hospital level. Some of the challenges are caused by nurses who turn people away. They take long lunch hours and tea breaks and we want to end that culture. We are working with unions in dealing with this issue because it compromises the quality of care to our patients. Hon members, we want this to come to an end because it has been going on for too long.
We are working with Cuban doctors in Gauteng. Those Gauteng doctors were trained in Cuba to strengthen the primary health care system. I am confident that we are going to realise this and to ensure that the ordinary citizens in our province are able to get care at the appropriate level.
Furthermore, we want to ensure that all our clinics have appropriate medication and people going there get cough mixtures, Panado and whatever they need should be available. The CEO of the medical depot knows what to do if there is a shortage in availability of medication; otherwise his job is on the line. We are, in turn, expecting all nurses who are running clinics to make sure that stock is available in all clinics because those who are heading those institutions have a responsibility and a duty. We are also saying that patients cannot be turned away because nurses are having lunch. Patients cannot be turned away because nurses do not want to treat them; this must come to an end.
In addition, after the World Cup all the new ambulances we are procuring will be deployed in each and every clinic. We are confident that patients are going to arrive on time at hospitals, especially those who need to be transferred from the clinics to hospitals.
During this financial year, again as part of strengthening the primary health care system, we are extending operating hours at a lot of clinics in the province as well as at community health centres because we believe that Gauteng is a cosmopolitan province. Sometimes people work until after 16h00. By 19h00 they want to walk into a clinic; there must be someone who can help them, including on weekends. The majority of our clinics now do open on Saturdays between 08h00 and 13h00. Very few are operating on Sundays. As part of strengthening the health care system, again, we are making sure that the services that were procured by our Gauteng Shared Service Centre, GSSC, in the past on the procurement of medication, equipment, linen and food are decentralised to hospitals so that I hold the CEOs accountable on what is happening at hospital level. It shoud not be that everything must be done by the GSSC or head office. We believe that those things are central to the success of what we want to do, including the advertisement of posts as well as the employment of people, which must be done at hospital level so that the head office focuses on issues of monitoring and evaluation and making sure that the right policies are implemented by those who are at service level.
The Minister is calling for a partnership with the private sector which talks to the 10-point plan. We are working very closely with the private sector. Some doctors' and nurses' rooms have already been refurbished and the conditions are much better than they were before. We are renovating the mother and child wards. The following hospitals have benefited so far and many more are still likely to benefit: Chris Hani-Baragwanath; Dr George Mukhari; the Far East Rand; Lilian Ngoyi; Charlotte Maxeke; and many more are in line. We are working with the private sector and the following has been done: the doctors' quarters and nurses' rest rooms and the mother and child wards and theatres. Discovery is paying for some of our specialists as part of the support given by the private sector. The private sector is also donating equipment that we need in the province, which includes stethoscopes, haemoglobin, HB, meters and many other things. We are confident that, with the mobilisation of the private sector across the board, the province will improve the health care system for the better and the citizens will be much happier as a result.
We are working very hard to reduce maternal mortality in the province. As the Minister and the late Deputy Minister stated before, too many women are dying due to a shortage of blood. We have engaged with the blood bank and many of the hospitals are going to be having a 24-hour availability of blood. Where we cannot have the blood bank full-time, fridges given by the blood bank will be available.
Regarding the programme on immunisation against polio and measles, our target is to reach 100% coverage in the province with the major emphasis on the Tshwane region; and that is what we are focusing on now. In 2009, we reached more than one million children. Considering the work we are doing currently, we are confident with the private sector as our strategic partner. For example, ER24 are even supplying us with vehicles and employing nurses for us to be able to complete this hard task of immunisation. We want to sincerely thank them.
On the soccer World Cup, more than 50% of the soccer World Cup games will be played in Gauteng. Our state of readiness was given impetus by the recent visit of the late Deputy Minister Sefularo. I'm happy to say to the hon members that, in his memory, we guarantee as a province that everything we committed to, to him and the delegation when they came to visit the province, is going to be delivered.
These are the things we promised to deliver: To make sure that the state of our hospitals is such that they are ready for accidents and emergencies; where intensive care units, ICUs, will be required, those facilities will be made available as well as making sure that our ambulance services stand ready to service the nations that will be coming here; and also to make sure that those designated neighbouring clinics and pharmacies are going to be operating 24 hours a day, as well as ensuring that employees who are due for leave in June do not go on leave.
Lastly, we are working with the army to obtain services such as helicopter services as well as securing the additional space we need in case we are going to need this for mortuary services, but two of our mortuaries stand ready to be utilised for the 2010 World Cup. Hon members, the Gauteng province supports the Budget Vote and we stand ready to support the national policies. Thank you very much.
House Chairperson, hon Minister of Health Dr Aaron Motsoaledi, hon Minister of Home Affairs Dr Nkosazana Dlamini- Zuma, Deputy Minister of Home Affairs Malusi Gigaba, my colleagues from provinces, hon members of this Council, distinguished guests, comrades and friends, ladies and gentlemen, let me also take this opportunity to share the provincial condolences regarding the passing of our Deputy Minister Sefularo. Even though I only worked with him for a very short time, I learnt a lot from him. May his soul rest in peace.
Chairperson, never before has community participation been as indispensable as it is today. Allow me to look back at the year that has just ended and share with this House some of the exciting moments we experienced, and the challenges we encountered in delivering health care in the Northern Cape province.
In search of solutions and innovative ideas from those who do not source them from books and websites, I undertook a campaign to establish ministerial advisory bodies in the form of provincial and district councils, hospital boards and clinic committees. I visited health facilities where I met the most amazing people from our province who, through our programmes, saw the quality of their lives improve. This proved to be a great source of information on how government services impact on the lives our people.
It is important to point out that, arising from these stakeholders' deliberations, a common understanding has emerged regarding critical areas affecting the health sector: Firstly, there is the broader context underpinning our legislative framework, including the objectives of our policies and their redistributive role in better health outcomes towards improving the health profile of our people in the province. Most importantly, the focus is on the four broad categories the Minister of Health alluded to in his Budget Vote, namely increasing life expectancy, combating HIV and Aids, decreasing the burden of diseases such as tuberculosis and improving health system effectiveness by strengthening primary health care and reducing the costs of health care.
Secondly, we have begun dealing with the institutional operational weaknesses identified in our discussions with key stakeholders. For the first time, we now have objective data that confirms our long-held suspicion that our patients are not safe. Cleanliness leaves a lot to be desired. There is a poor quality of care and dilapidated infrastructure, and the capacity of our facilities to deliver quality health care resulted in medico-legal litigations. Thanks go to the stewardship of our Minister on the above issues as confirmed by our stakeholders.
In as far as health care effectiveness is concerned, strides made in this regard can be ascribed to the health policies that prioritised the poor and the marginalised. That included massive expansion of health infrastructure for the delivery of primary health care services through the building and upgrading of more than eight facilities and 18 sites accredited as ARV sites, and increases in the number of health facilities from 152 to 228.
However, a new set of challenges includes the upgrade of facilities, poor road conditions, inadequate staffing and increases in the number of health professionals employed in the public health sector, including training of mid-level workers in a range of health disciplines.
Lastly, most important to our province is that we will have a new intake of nurses, about 90 of them, where they would be trained in our own facility in the province.
However, disturbing incidents in a few facilities have created the false impression that we are not doing enough to address issues of maternal and child health. I wish to state categorically that the department is fully committed to improving the health status of women, mothers and children of our country and to achieving the Millennium Development Goals.
Let me provide some of the information that I referred to above: Firstly, we have strengthened various health programmes to improve service delivery. In 2009-10, we fully immunised about 93% of children under the age of one year to protect them against vaccine preventable diseases. However, important cases remain a major threat to the progress we have made in this area.
Secondly, we also provided vitamin A supplementation to 70% of children aged six to twelve months as well as to children aged one to six years who were seen at public health facilities, and 72% of post-partum mothers, and our aim is to reach about 90% of this group.
Thirdly, about 203 of our health workers have been trained in advanced midwifery, maternal health and basic antenatal care to reduce maternal mortality.
Lastly, we rolled out the child health programme in all districts in September 2009, and 70% of children were reached. We have also made sure that the H1N1 vaccine and measles and polio immunisation campaign was launched in the province by me in Deben on 5 pril 2010, and it is going on very well in our province.
Yesterday and the day before yesterday, Cabinet had a door-to-door campaign in three of our towns and we could see that our people are well aware of this campaign. And by now we have reached about 3 065 children as far as the vaccinations are concerned.
The estimated HIV prevalence rate amongst pregnant women has decreased significantly since 2005. In a year-to-year comparison, the provincial HIV prevalence rate amongst pregnant women decreased from 16,5% in 2007 to 16,2% in 2008. The observed trends in the past three years suggest stabilisation but trends in the epidemic should be observed over a period of time in order to avoid incorrect conclusions and perceptions. The Northern Cape department of health has planned its response to the above message through a massive HIV counselling and testing campaign, which will be done as soon as the Minister has outlined that a date will be set. We have made sure as a province that we made our institutions ready. We have got co-opted centres in the provincial office and co-opted centres in the districts and in all our facilities.
Hon members, this debate coincides with the day of the TB indaba that is taking place today in our province today, which intends to make sure that we measure our TB cases and make sure that we come up with plans to make sure that we combat TB.
The advent of the multi-drug-resistant tuberculosis, MDRT, and extensively drug-resistant TB, XDR-TB, in 2006 poses a particular challenge to the public health care in our province. The number of TB, MDR-TB and XDR-TB cases in the province is on the rise. The number of new TB cases increased from 6 127 in 2004 to 8 192 in 2008. However, we are already seeing signs of success through the steady improvement in the cure rate, which was about 62% in 2008 with a defaulter rate of 5,9% in that particular year, compared to the defaulter rate of 13% in the previous year, which was 2007.
Due to the implementation of the tracer projects in both the Pixley Ka Seme and Frances Baard districts, more than 80% of the TB defaulters have been traced through the TB tracer project and resumed TB treatment.
Hon members, our human resources constitute one of the most important assets in the delivery of health services. It is therefore essential that we continue to create a conducive and productive working environment for them. Our vacancy rate, hon House Chair, was standing at 41%, which has been reduced significantly to 39% with a target of a further 25% reduction for the year 2010-11.
We have made two strategic appointments at management level to strengthen both the strategic and operational management. Our skills development strategy is yielding results as more than 10 students on the Cuban medical programme will be returning in July this year to South African universities to conclude their final year.
The department will ensure that the health care system is properly managed by appointing our hospital managers who are trained in leadership, health management and governance. All districts will produce district health expenditure reports to give an indication of how public funds have been spent and also guide the department as to how much resources are needed per district.
I am cutting out some content, hon Chairperson, because this speech is so long. If I were in my own house, I could have spent more time, but now I am in a different House. [Laughter.] Lastly, we have completed construction and officially opened some of our clinics. We have opened one in Pampierstad, Hartswater, Olifantshoek and Hondeklipbaai. And we are also planning to make sure that we are going to build new clinics - one in Norvalspont, Groot Mier, Mapoteng ... [Interjections.] As a department from the Northern Cape, we support this Budget Vote. [Time expired.] [Applause.]
Hon Minister Dr Nkosazana Dlamini-Zuma, Deputy Minister Malusi Gigaba, MECs, members of the NCOP and guests, I greet you all. Hon Minister and Deputy Minister, did you hear the complaints from the opposition party? These are due to the fact that this department is moving.
NgesiXhosa sithi: Izinja zikhonkotha inqwelo ehambayo, xa imile ... Uyakuzigqibezelela ke lawundini. [In isiXhosa we say: Dogs bark at a moving vehicle only; when it is stationary ... the reader will complete the saying for himself.]
This Budget Vote debate takes place within the overarching role of the department with regard to regulation of movements of the people. This relates to issues of immigration, refugee asylum seekers and active citizenry. The ANC recognises the Department of Home Affairs with its central role in building constitutional democracy with regular multiparty elections. It enhances popular participation of the citizens to shape their own destiny. The campaign that has been launched by this ANC government has proved this democracy.
We regard Home Affairs as a strategic piece of state machinery to contribute to the building of a developmental state. It continues to keep the relationship between the state and its people. This relationship should be mutual, permitting active involvement of our people to advance the cause of democracy. It is against this background that we can assess the extent of the budget allocation. The allocation of the budget reflects a steady decline. This objective reality needs to be assessed against the priorities of the strategic plan of the Department of Home Affairs and the centrality of immigration policies and functions.
The ANC policy on migration, immigration and refugees is very clear. Our point of departure is that if migration is managed properly, it can lead to development, economic and gross domestic product, GDP, growth of the country, with benefits to all. We need to understand that we are talking about different categories of people such as economic migrants and those who believe that certain circumstances militate against their interests in such a manner that one is compelled to seek refuge in a foreign country.
Many countries face a pattern of migration, namely forced migration experienced by people who are victims of war, violence, human trafficking and so on. This is an internationally prevalent challenge. Migration has become more complex due to the globalisation process. Labour migrants have the potential to contribute towards the growth of the economy if their skills are utilised appropriately for development.
My comradely advice to the Minister and Deputy Minister is that managing migration flow needs strengthening of ports of entry and border control mechanisms. It requires the department to be able to read and regulate the movement of people in and out of our borders. With the hosting of the Fifa World Cup, this becomes more urgent. Communities that are situated near the borders seem to point at the lack of control at our borders and ports of entry, ingakumbi kwela cala lam [especially in my area].
However, significant progress has also been made with regard to capacity constraints and improvement of infrastructure. The Department of Home Affairs has consistently treated the fight against corruption as a priority and has given its full support to the anticorruption partnerships. A national anticorruption programme was developed and adopted by the public, business and civil society. Even the opposition parties do agree today that this department is doing away with corruption.
With regard to the flow of skills into the public sector, the customisation of the induction and orientation programme for pilot departments is progressing. However, there are challenges. Basic service delivery, infrastructure development and municipal capacity require specific intervention. Access to services and the quality of services need to be accelerated. Infrastructure development requires specific focus on infrastructure rehabilitation and the capacity to manage infrastructure. The Department of Home Affairs currently has a wide variety of software and hardware.
In order for the Department of Home Affairs to achieve its strategic imperative of service delivery improvement, one of the key projects to embark on is office connectivity which seeks to address connectivity and standardise infrastructure. This will increase the productivity of end users; ease support and maintenance; enhance reliability; improve security control; and reduce cost of ownership. Acceleration of service delivery also needs offices to be accessible to communities.
Ndimvile uMphathiswa xa ebesithi masivule ii-ofisi zethu, eyam sele ivulekile. ISebe leMicimbi yezeKhaya liyayisebenzisa kwingingqi yam yovoto. (Translation of isiXhosa paragraph follows.)
[I heard the Minister when she was saying we must open our offices; mine is already open. The Department of Home Affairs is using it in my constituency.]
The department has to accelerate the partnership-based approach. This recognises that the Department of Home Affairs needs co-operation from other government departments, and society at large. There is also a need to strengthen the border posts. While on the one hand it is necessary to speed up satellite infrastructure to ensure connectivity, it is equally important to have the border posts network incorporated into the overall departmental network. This approach could help in integrating these border posts into the Department of Home Affairs' single network.
The transformation of Home Affairs gradually gained momentum. We are witnessing deep and fundamental change. However, it is noticeable that the transformation process within the department will not be an overnight exercise and as a result it requires more budget allocation to ensure the necessary resources.
The new systems and re-engineered processes are crucial. The changes at Home Affairs will be driven and sustained only if there are enough budgetary resources, together with skilled and patriotic people to implement the departmental plan. The ANC refers to the entrenchment of a consciousness that seeks to serve the people with dignity and dedication.
However, it also means that as the transition from the old Department of Home Affairs model to the new one takes place, there is a need to consolidate some gains. The department should ensure that people are able to do the jobs that they are required to do and are placed in positions in terms of their strength, skill level and experience. Much of this hinges on training and equipping people with skills. During the presentation we will show some of the things that have already been done in this regard.
The department offers various services to the citizens of South Africa as well as to foreigners who wish to visit or stay in the country. Most of the time, the successful delivery of these services relies not only on internal efforts, but also on the public taking the responsibility to provide the department with the correct documentation at the correct service delivery points.
Through effective use of the budget there is a need to harness all the support and energy. This includes building a developmental state capacity to mobilise both human and capital resources for a better life for all. In this regard, the key task is to implement plans and service delivery, including the mobilisation of other stakeholders to accelerate service delivery. This relates to the overhaul of the system and practices to create conducive conditions for delivery. Furthermore, this requires consistent training and development of all staff in order for them to champion transformation.
The role of the Department of Home Affairs is ... The ANC supports the Department of Home Affairs' Budget Vote. I thank you, Chairperson. [Time expired.]
Chairperson, I just want to remind you that I have two and a half minutes from my opening speech.
Thank you very much for being here and thank you to those who participated in the debate, both on Health and Home Affairs. I think the three hours have re-educated me on health. Thank you very much. I am even tempted to comment, but I will not. I will just give some of my remaining minutes to the Minister of Health.
Hon Plaatjie asked a number of questions, some of which were answered by the Deputy Minister. I just want to talk about how the advance passenger processing works. The airline checks in people and sends the information to the airline liaison person. The airline liaison person then puts the information on the system. Our system is linked to the police, to Interpol and also to our own stop list. So if there is a hit on any of the lists, we then inform the airline and we advise that the person does not board the plane. Of course, it is only advice. If they allow that person to board the plane, we inform them that we will not accept that person into the country. They will then have to take him or her back.
In short, that is how it works. By the time the passengers arrive, we already know that most of them have been cleared. If there are any of them who have boarded and are not cleared, we know who to stop.
We think that will facilitate not only the movement of people but also security because we are linked to all the other agencies as well. That is thus how it works.
He also talked about the Who Am I Online project. The system that is running at O R Tambo District Municipality that will be rolled out, is part of the Who am I Online project. If you recall, it was said that we will start with those that involve 2010. That is what we have prioritised. The other aspects of the Who Am I Online project will happen after 2010. At the moment it is really about the ports of entry. I think that I have answered the questions that remained after the Deputy Minister replied.
I think it was hon Marais who spoke about immigration, migrants and permits. I said in my initial input that we are reviewing the whole immigration policy. Part of that would be the permitting system. Where there is a problem with permitting, we will address it.
What I also want to say is that we should look at migrants in two ways. There are those who are asylumseekers. If we give them refugee status, they are allowed to stay in South Africa and work as long as they have a problem where they came from. Then there are those who say that they are asylumseekers but they are actually economic migrants.
We want to review our policy and separate it because if somebody comes from Nigeria, most of them would not actually be true asylumseekers. They will be mostly economic migrants. Once they have come through the asylumseeking route, we have to go through that route, finish it and tell them that they are not asylumseekers. If there is an economic migrants' side, we might be able to look at it.
You also talked about access. It is true that our footprint in Home Affairs does not mirror the demographics of the country. Most of the offices of Home Affairs are located where the apartheid offices were in the cities. Therefore, we are opening new offices, using centres and using everything we can to expand our footprint.
Last year we expanded it by 21 offices. This year we are planning 10. In addition, we will have the ones that will be made available by provinces and all of you. The previous Minister had started using mobile units, precisely because she was trying to make sure that rural areas are reached. We are still using those mobile units. We have 117 of those mobile units.
We have recognised that they are ordinary trucks. They are not able to travel on very bad roads. Therefore, in addition, this year, we have added 25 Land Rover 4x4s which are really mobile offices. They can connect with Home Affairs and do everything that an office can do. We have added these 25 Land Rovers but we will be very happy if Western Cape or any province can also add to these mobile units so that we can reach the rural areas.
Lastly, I want to thank hon Rantho for the input. Most of it was really self-explanatory. Regarding your friendly advice, I just want to say that the government is looking at how to have a single border agency so that we can all work together. In fact, the IT system that I am talking about will also be of assistance once that agency is there because it is working together with Home Affairs, Sars and the police. We are aware of what you are talking about and we will try and do our best. We must take into account that we have a very long land and maritime border. Home Affairs is only responsible for ports of entry. The other security agencies are responsible for the borderline.
I think I will end there. My four and a half minutes will go to the Minister if he wants to use it. Thank you.
House Chair, I would like to thank hon Minister Dlamini-Zuma for her contribution. We still welcome her inputs.
I only have three things to say. The first one pertains to hon De Villiers. He said something along the lines of condoms and circumcision not being effective or working in our fight against HIV and Aids. I just want to reassure you there that the presentation of what we are going to be doing takes two hours. This budget speech was only 20 minutes long.
Yesterday I presented it to the CEOs of all the hospitals in the Western Cape. We are going to email copies of that presentation for you to look at. But - just to summarise - we have a series of things we are going to do in prevention: Firstly, we will have massive information education and mass mobilisation. In this case, we have already met with all 19 SADC sectors in terms of the work they are going to be doing. In the SA National Aids Council, Sanac, you have labour, religion, traditional healers, youth formations, children's and women's groups, as well as people living with HIV/Aids. Every citizen is represented there.
Secondly we are going to do a massive sexually transmitted infection detection and management exercise.
Thirdly, we are going to launch the Know Your Status campaign.
Fourthly, there will be widespread provisioning of condoms. Please don't discourage it. Don't discourage it; the whole world is encouraging it. In fact, we are going to increase the provisioning of condoms from 450 million male condoms to 2,5 billion male condoms, and increase 1 million female condoms to 6 million. Don't discourage that either.
Do you see, hon De Villiers, that our approach on the issue of medical male circumcision is not opposition-based; it is evidence-based and scientific? It is very scientific and evidence-based and there is massive research about it. That is why it is so important. Don't discourage it. We welcome the fact that His Majesty the king said that there are going to be 2,5 million circumcisions in KwaZulu-Natal. We are throwing everything at our disposal at this issue.
Chair, on a point of order: In terms of Rule 50, in a debate in the Council, a member may be allowed to explain a previous speech to the extent that the speech is being misquoted or misunderstood in a material respect.
Now, I understand that the Minister's quoted position on hon De Villiers's speech was incorrect with regard to the condoms and the circumcision.
So, Mr De Villiers would like the right, in terms of Rule 50, to explain that speech.
No, I think what we are trying to do - and I want to believe that all of us understand this in the same manner - is to allow the Minister to conclude the debate. In concluding the debate, nothing stops the Minister from highlighting some of the issues that he thinks are important and need to be clarified. Therefore, I do not take the point of order, and request the Minister to proceed.
Chair, may I specify that the specific concern is that hon De Villiers's speech was misquoted or misunderstood?
Hon Harris, if you do have a problem with the quoting of hon De Villiers's statement, you still have an opportunity, even after the House has adjourned, to raise that particular matter but, in this particular instance, the Minister is summarising the debate. Therefore I request that you sit down and allow the Minister to conclude the debate.
Chair, can you ...
Can we allow the Minister to conclude the debate?
Only if you will rule that, in terms of Rule 50, I am out of order.
That's exactly ... You see, I don't want to say that you are out of order, because the very same Rule ... you must go further down to it, you see. We cannot allow any interference, in actual fact, or explanations on this particular matter. Therefore I order you to sit down.
So Rule 50 does not apply?
Can I order you to sit down and allow the Minister to conclude?
Mr Chair, you are not answering ...
Can I order you to sit down?
Without answering my question?
Okay, will you sit down?
House Chair, hon members, it is very important to understand that the scientific evidence doesn't say that circumcision is the be-all and end-all. It is not necessarily a panacea. Scientific evidence simply shows that circumcision reduces the chance of infection by between 50% and 60%. We still have to encourage people to use condoms and other measures. It is still very important, but when you put all these things I have mentioned, together, we believe it will actually help.
The next intervention is the massive prevention-of-mother-to-child transmission programme. It is a treatment programme but also a prevention programme at the same time and it is also important. The next programme concerns safe blood transfusion. In this case, I can assure you that we are winning. Two months ago I officially opened a state- of-the-art unit at the SA Blood Transfusion Service with funds donated by the President's Emergency Plan For Aids Relief, Pepfar, to make sure that blood in South Africa is safe. Today, I can put my head on the block and say that it won't be easy for someone to get HIV/Aids from a blood transfusion or from any of our hospitals. It will only be as a result of an accident.
The last programme is the postexposure prophylaxis programme, which MEC Dhlomo mentioned. At the moment, when a woman is raped and she goes to our health institutions asking to be protected from HIV/Aids because she doesn't know the status of the rapist, she would usually be sent back to the police to report the case and look for case numbers. The instruction we gave to the CEOs of hospitals is that any woman who enters a hospital claiming to have been raped must be treated first and questioned later. That is all we are saying. [Applause.]
Many children are being abandoned, but we don't know their status. All the children that have been abandoned must immediately be tested and, if they are positive, treated, in line with what the President said on World Aids Day, namely that all the positive children below one year of age must be treated without even their CD4 count being known.
Last is the issue of life skills, which is going to be followed up very closely. These programmes, when taken together as a package, form our prevention strategy and they appear on the presentation that we have made.
Hon Marais, I am not sure whether I am misquoting you, because sometimes when members speak Afrikaans I listen to the interpretation. If what I heard over the interpretation is wrong, it is not my fault; I responded to what I heard there.
Before you start talking in public about people from the Eastern Cape who come and cause problems in the Western Cape, etc, I am going to ask you about The Lancet report you have mentioned. The Lancet is a very prestigious British medical journal. They don't just write any report there. When they write a report it is very, very clearly scientific.
If you study the report, you will find that one of the professors who did the research is a paediatrician. He is a professor of paediatrics and child health. He gave a historical background as to why the Western Cape is experiencing and getting what it is getting. It is very historical and very scientific. I am not going to teach you that. Before you say people are moving here to come and cause trouble, please go and read it. It appears in a medical journal and is very clearly researched. It will help you very much. Next time when you speak in public, you will know what you are talking about. I am not sure about the last issue, hon J J Gunda. You know, I have actually been phoned by many doctors who said that we have taken everything. I don't understand what they mean. All we did was acquire 1,3 million doses of what is called a trivalent vaccine for H1N1. Trivalent means it has the strain of H1N1 and two strains of seasonal influenza. We bought those from the pharmaceutical industry. We are going to get the other 3,5 million doses from the World Health Organisation as a donation. So we are going to vaccinate these groups of people I have mentioned.
Now I am getting calls from the private sector saying that we have taken everything. I don't understand what they mean, because we ordered those doses long ago. I suspect the private sector did not plan very well and they want to blame government. We just bought 1,3 million doses because we needed those for pregnant mothers, for children who are HIV-positive, for adults who are HIV-positive, and for people living with chronic heart disease and lung disease. You are aware of the fact that they were being killed by H1N1 and that we needed to protect them. So, let the private sector manufacture more, and then all of us will have enough. Thank you.
Hon members, let me take the opportunity to thank hon Minister Nkosazana Dlamini-Zuma, hon Minister Motsoaledi, Deputy Minister Gigaba and the MECs who participated in the debate. We hope that you will encourage your colleagues to participate in the debates in this important House, because this is the only platform through which provinces are able to express the challenges and opportunities that exist. Your presence here empowers members of the NCOP in the performance of their oversight work. I thank you.