Deputy Chairperson, my Cabinet colleagues, the Deputy Minister of Health, Dr Ramokgopa, MECs for health from various provinces, hon members of the House, distinguished guests, ladies and gentlemen, I'm delivering this speech to you with a very sore heart. It is just a few days since the brutal killing of Dr Mkhize in Mpumalanga at the hands of somebody he was supposed to be helping. It is very painful. The incident happened in my absence when I was attending an Aids Conference with the Deputy President in New York. We wish to express our condolences to the family and thank MEC Dhlomo for having attended the funeral on our behalf.
I am delivering this speech at a time when the health care system is at a crossroads. We may choose the best route, or the worst one ever, which will, of course, make our situation even worse than before. The choice lies with us as South Africans in general, but as elected leaders in particular.
Last year I signed a performance agreement with the President as part of the national service level agreement. We have identified four measurable outputs which we must achieve in order to ensure "long and healthy life for all South Africans". You also know that we have a 10-point programme on top of these.
Deputy Chairperson, extensive studies commissioned by the prestigious medical journal, The Lancet, were conducted by our own scientists and researchers in South Africa, and revealed that countries go through four different types of disease, which we call a quadruple burden of disease. These are first and foremost HIV/Aids and TB. The second is an unacceptably high maternal and child mortality. The third is an alarming and ever- increasing incidence of noncommunicable diseases, ie high blood pressure and other cardiovascular diseases, diabetes mellitus, chronic respiratory disease, and various cancers, as well as mental health. The fourth and last is violence and injury.
Having said this, Hon Deputy Chairperson, let me also say that it is a known fact that South Africa spends more money on health than any other country on the continent, and even beyond, but our health outcomes are worse than in some of these countries. We know that that is because of health care resources that are skewed in favour of the rich.
Hon Deputy Chairperson, let me take this opportunity to go through the aspects of the quadruple burden of disease one by one, because I want members to understand exactly what we are talking about.
Let me start with the first pandemic, HIV/Aids and TB. To summarise it, South Africa has only 0,7% of the world's population, but we are carrying 17% of the HIV burden of the world. We have the highest TB infection rate per population, and our co-infection rate between TB and HIV is the highest in the world, at 73%. A total of 35% of child mortality and 43% of maternal mortality is attributable to HIV and Aids. One in every three pregnant women presenting at our antenatal clinics is HIV-positive.
Surely this needs very serious and extraordinary measures. Hence the announcement by the President on World Aids Day, when we started using new measures to combat HIV/Aids. If I may remind you of the measures, all pregnant women are treated when their CD4 count is 350, and all HIV and TB co-infected people are also treated at 350. The prevention of mother-to- child transmission, PMTCT, now starts at 14 rather than 28 weeks, as it used to do before. Fourthly, all infants who are born HIV-positive are treated immediately on diagnosis, and we don't wait for the CD4 count.
Hon Deputy Chairperson, we need to understand what the scenario was in February 2010, before these new measures. This was the scenario. Only 490 health centres were able to provide ARVs. I am happy to announce today that the number of centres that can now provide ARVs has grown to 2 205. At that time, in February last year, only 250 nurses were certified to initiate ARV treatment. I'm proud to mention that the figure has now grown to 2 000. Before the HIV Counselling and Testing, HCT, Campaign was launched by the President at Natalspruit Hospital on 25 August last year, 2 million South Africans per annum used to be tested to know their status. I'm happy to announce that at the last count, last month, 12 million South Africans had been tested.
Many South Africans want to know their status. Hence, last Sunday, 12 June, exactly two days ago, I, together with the House of Traditional Leaders and Congress of Traditional Leaders of South Africa, Contralesa, launched a massive HIV Counselling and Testing Campaign for all our villages, and the village of Mafefe in Limpopo was chosen for the launch. It was a very great success. Six kings attended the event, and a lot of other traditional leaders. They all pledged that they would open their villages for us to come to test people, and that they would be the ones to take the lead.
Before the campaign at the end of February last year only 928 000 South Africans were on ARVs. Because of the campaign we have 1,4 million people on ARVs today. Deputy Chairperson, I also announce with pride that in November last year we were able to reduce the prices of ARVs by a staggering 53%, as we promised that we would do.
I have also worried time and again about the number of newborns in South Africa who are born HIV-positive. At one stage the figure was put at 70 000 children born HIV-positive. I am happy to announce today that the studies done by the Medical Research Council show that we have been able to reduce mother-to-child transmission by 50% at about six weeks post delivery. This is a very big achievement and the significant reduction has actually happened in the province of KwaZulu-Natal which, as you know, has the highest prevalence of HIV. When it came to reducing mother-to-child transmission, KZN was number one. Deputy Chairperson, this is to be celebrated because it means that, if we work hard enough together with the MECs, we can eliminate the phenomenon of mother-to-child transmission by 2015, and we intend to do so. The declaration of heads of state in New York last week stated that by 2015 no child in the world should be born HIV-positive.
Deputy Chairperson, 24 March 2010 was World TB Day. We released three strategies to combat TB.
The first one was the GeneXpert technology that we had acquired. This is a new technology which, of course, has not been in use over the past 50 years. In the past 50 years only one technology has been used to diagnose TB and it was microscopy. If that failed, one did a culture. It used to take about a week for us to know the diagnosis, but with GeneXpert technology we know in two hours whether a person has TB or not. Secondly, microscopy had a sensitivity of 72%, meaning that you could miss 28% of people who had TB, but with GeneXpert the sensitivity is 98%, meaning that only 2% can be missed. Moreover, it used to take us three months to know whether a person had drug-resistant TB. With GeneXpert technology, we know in two hours, and not three months.
The second strategy we unveiled was that of active case finding. We have put together teams of five people each, who visit families, and there are 407 000 families in South Africa where there is TB. These teams have been visiting them at home to screen other members of the family. We are doing this because every person who has TB can infect 15 other people in their lifetime. So, it is important to visit them. I am happy to announce that since we started in February we have already visited 41 000 families and screened 112 000 people.
Deputy Chairperson, the third strategy is that with money from the Global Fund we have built nine multidrug-resistant TB, or MDR-TB, hospitals. The difference between them and other hospitals is that the nurses won't be easily infected by TB from the patients they are nursing.
Let me move to the second pandemic, which is the high maternal and child mortality. A lot has been said about this in newspapers, all over the media and even in this House. You have noted, hon members, that most of our interventions in HIV and Aids are directed at pregnant women and children because of these high mortalities, and we will work hard to reduce them.
I want to remind this House that maternal mortality is not just the death of a woman. It is the death of a woman because she dared to fall pregnant! We also know that HIV mortality disproportionally affects young women of childbearing age more than men. This can't be right, hon Deputy Chairperson.
We now have no fewer than 1,3 million orphans in our country. Most of them are maternal orphans, meaning that it is their mothers that have died. This has serious consequences in society beyond health care, such as crime, poor educational outcomes, teenage pregnancies and abortions, and the total social disorientation of young men.
Hon Deputy Chairperson, it is a well-known fact that young husbands lose direction in life when their partners die. The same does not happen to women because a female partner is known to be a stabilising influence on a young man's life. South Africa is fast losing this social stability due to the high maternal mortality which, according to evidence at our disposal, as I said, affects younger women more than older ones.
Let me go on to the third pandemic, which is the noncommunicable diseases. Deputy Chairperson, noncommunicable diseases are spoken about less, maybe because we speak a lot about HIV/Aids, as it has shocked us, and there are many more strong nongovernmental organisations, NGOs, that are fighting HIV/Aids than noncommunicable diseases.
I tried to bring this issue of noncommunicable diseases to the attention of hon elected members by presenting it to the Health Portfolio Committee. Unfortunately, the media got very excited and put into print that I was specifically raising the issue because of the dietary behaviour of Members of Parliament. It is very important for me to explain what I actually meant.
Noncommunicable diseases, which are referred to as NCDs, are diseases that are not propagated by germs from one person to the other. In fact, it would be safe to say that the germ, bacteria or virus that propagates an NCD is the human being. I am saying this because NCDs are not only biomedical but largely diseases of lifestyle.
These are divided roughly into four categories: high blood pressure and other diseases of the heart and blood vessels; diabetes and a few other metabolic disorders; chronic respiratory disease and asthma; and cancers. One should realise that mental health is also classified under that.
Moreover, there are four identifiable factors that predispose one to these noncommunicable diseases: smoking, which is most important; harmful use of alcohol; unhealthy eating behaviour, one's diet; and lack of physical exercise - always sitting, or sitting in the car and even using your car to go to the toilet, Deputy Chairperson, which is very common these days! [Laughter.] If all four of these risk factors could be removed, the world would be a very safe place to live in.
The question is: How serious are these noncommunicable diseases? Deputy Chairperson, they are a global phenomenon, but they are also growing fast in sub-Saharan Africa. So serious is the issue that the World Health Organisation and the Russian Federation called a meeting of all Ministers of health in Moscow on 28 to 29 April this year, in what was called the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control.
The Moscow Declaration was passed. It is a very long document but let me mention two facts from the whole. It says that countries must develop and rapidly implement policies that address behavioural, social, economic and environmental factors associated with noncommunicable diseases. Effective noncommunicable disease control requires concerted leadership at all government levels - national, subnational and local - and across a number of sectors such as health, education, energy, agriculture, sports, transport and urban planning, environment, labour, trade and industry, and finance and economic development.
Deputy Chairperson, it is against this background that I said a couple of weeks back that Members of Parliament should take the lead in the matter of a healthy lifestyle, especially diet and exercise. For example, I don't expect you to smoke, as you are the ones who passed the law against smoking. Unfortunately, in the media they said the Minister was saying there was a "gravy train" in Parliament and he wanted to stop it. Deputy Chairperson, this is not a circus, but a serious matter affecting humanity.
In 2009 there was a question in Parliament about the number of people who were on renal dialysis. They were asking why the government couldn't increase the number of dialysis machines in public hospitals. I argue that that is the wrong debate. It is no different from asking the Minister why he can't build more mortuaries because there is a high demand! I say this because the intelligent question to ask is: Why do so many South Africans have failing kidneys? Why do we need to be on dialysis and why do we have so many people who need a kidney transplant?
Just as an example, Gauteng alone has 561 people on dialysis, and there are 238 on the waiting-list. And this is a province that has facilities. What about all those receiving dialysis at R150 000 per patient per annum in the public sector, and R300 000 in the private sector? This is something that the country simply cannot afford. Moreover, to be on dialysis one needs to be in hospital 3 times a week for a minimum of 4 hours, whether one is employed or not. It is a difficult task.
What causes this? We know that in 40% to 60% of people with end-stage renal failure it is due to high blood pressure at an average age of 39 years. What are the main risk factors for high blood pressure? They are smoking, lack of exercise and diet, and also high salt intake.
So, we should not be demanding more dialysis machines, and subsequently demanding new kidneys, to the extent that, as has happened here in South Africa, the rich are trying to concoct schemes to steal kidneys from the poor! We cannot allow that. What we must do is reduce the prevalence of hypertension by eliminating the risk factors.
I am not going to debate with you about tobacco. I want to come back and strengthen the laws against smoking. In the case of alcohol, we are going to ban the adverts. I make this point time and again because the sooner the tobacco and alcohol industries understand this, the better for all of us. We will never pull back.
On the issue of salt, I am going to ask Parliament to pass a law, which will also go through this House, to reduce salt in foodstuffs. This is because the average amount of salt that is needed in the human body is 4 g to 6 g per day, but South Africans are known to consume 9,8g per day. Deputy Chairperson, this is not a joke. In Britain, just by reducing salt in foodstuffs by 10% they save 6 000 lives per annum. Our own research in South Africa shows that if we reduce the amount of salt in just one foodstuff, bread, we will save 6 500 lives per annum. So, hon Deputy Chairperson, we are going to do that. Obesity, which means extreme excess body weight, is a fast-growing phenomenon, even among our children. Statistics from research by the Medical Research Council show that 23% of schoolchildren are classified either as obese or as overweight, and this cannot be allowed, Deputy Chairperson. For us adults it is known that at least 60% of women and 31% of men are either obese or overweight. If we consider people above 37 years, the figure goes to 70%.
Countries are doing something about this and we want our country also to do something. For instance, Australia has come up with a policy of regulating the advertising of junk food during children's programmes on TV. In fact, during children's programmes they have banned all advertising of junk food. We are aware that they want to do the same thing in the United States. They want to ban the hamburger, which has made them bulge. So, we must also look at what makes us fat and get rid of it.
Deputy Chairperson, on the issue of violence and injury, we know very well that in regard to Arrive Alive people talk about the people who die. But research from Unisa and the Medical Research Council of South Africa shows that for every person who dies in a car accident, 30 are hospitalised and 300 are treated for minor injuries. That is for every one person! So, as we talk about Arrive Alive, let us talk not only about the dead; let us talk about those who go to hospital and the effect this has on the health care system. Deputy Chairperson, as regards the National Health Insurance, NHI, I am painfully aware that for some people in this country what I have said up to now won't mean anything if I don't talk about the NHI. There are two different groups of people in this country in relation to the National Health Insurance. One group is those who want relief. [Interjections.] Is my time over, Deputy Chairperson?
Will the House allow me to give the Minister five minutes to wrap up? [Interjections.] Thank you.
Deputy Chairperson, I just want to say that as far as the NHI is concerned, it is not just an important document that everybody is waiting for. There is the preparedness of the health care sector, and we are busy preparing it.
Why do we need to prepare the health care sector? It is because the present health care system can be characterised by four clearly identifiable negatives. It is unsustainable, it is very destructive, it is extremely costly, and it is hospicentric or curative.
We need to change it to primary health care. We have three methods of primary health care engineering which we are involved in. There is a school health system which we are going to implement, a district health system by clinicians and, lastly, the ward-based primary health care system, in which we want to put at least ten primary health care workers in a ward.
Other countries have done more than us. Brazil has 30 000 primary health care workers. India has 800 000 primary health care workers distributed in the villages. In South Africa we want to put in only 40 000.
Deputy Chairperson, regarding the issue of workforce development and human resources, HR, we will have completed our HR strategy by August. Suffice it to say that for now we are producing only 1 200 doctors per annum in our 8 medical schools. That is why the President announced that we needed to build a ninth medical school, in Limpopo. Plans are afoot, but we are also going to improve hospitals and have five mega hospitals to make sure that the intake of medical students increases.
Hon Deputy Chairperson, allow me then to present the budget to you. It has increased by 15% from R21,7 billion in 2010-11 to R25,7 billion in 2011-12. At the national level an additional amount of R422 million was allocated for 2011-12 and R692 million for 2012-13. I wish to take this opportunity to present this budget of the Department of Health for the financial year 2011-12, amounting to R25 731 554 000 - without the three extra noughts it is R25,7 million! - to the Council for adoption.
In conclusion, I want to thank numerous people. These are the President, the Deputy President who is also the President of the SA National Aids Council, Sanac, the Minister of Finance and the Cabinet for their understanding. I also want to thank my colleague, the Deputy Minister of Health, Dr Gwen Ramokgopa. We have complemented each other very well and I wish my colleague to continue in this way.
I also wish to thank the director-general, DG, of the department for steering the ship through very rough waters. I thank the chairperson of the portfolio committee and the Social Development chairperson in this honourable House for the way in which we have worked together. I wish this to continue so that South Africans have "a long and healthy life". Thank you. [Applause.]
Hon Deputy Chairperson, hon Minister Aaron Motsoaledi, hon Deputy Minister Gwen Ramokgopa, hon Members of Parliament and comrades, let me take this opportunity to express our condolences to the Mkhize family.
Sithi akuhlanga lungehli. [We send our condolences to you.]
The sections of the Freedom Charter on health commit us to a preventive health scheme run by the state, and free medical care and hospitalisation provided for all, with special care for mothers and young children. Although there have been many achievements in improving access to health care, much more needs to be done in regard to quality of care and making services available to all South Africans through ensuring better health outcomes.
South Africa commands huge health care resources, as compared with many middle-income countries. Yet, the bulk of these resources are in the private sector and serve a minority of the population, thereby undermining the country's ability to provide quality care and improve health care outcomes. The ANC is determined to end the huge inequalities that exist in the public and private sectors by making sure that these sectors work together.
It has been impossible to correct the disparities and contradictions we have inherited in the short space of 17 years, but we do need to speed up service delivery to our people. Health being a fundamental basic human right compels our government, led by the ANC, the party that received the support of the overwhelming majority of South Africans, to fulfil this basic right.
Hence, we are beginning the process of implementing the National Health Insurance, or NHI as it is more commonly referred to. There has been a great deal of speculation in various quarters, mostly negative, but what is it based on? We are still waiting for the tabling of a document that will guide the process to a conclusion that will hopefully satisfy all stakeholders.
Parliament should track the use of the hospital revitalisation grant by establishing how far the department is in regard to modernising or transforming infrastructure and equipment in hospitals, and monitoring whether the quality of care in hospitals is in line with the national policy objectives.
Some may continue to argue for a free market in health, but this cannot be justified when it hampers the fulfilment of a basic human right to which our people are entitled. Through the NHI we can achieve equity in health care, as the current disparities cannot be allowed to continue.
Also, through the consultation process we will address the fears and confusion of the general public. To correct the inequities in health requires a process that moves our country towards universal access. This also requires us to address the socioeconomic disparities that prevail in our country.
The process of developing the NHI will require reaching consensus with all relevant stakeholders on a few key elements, namely a basic benefit package, a National Health Fund, and the role of private funders and providers. The above will naturally follow the normal democratic process of in-depth discussion and engagement, with a view to finding the best solution which is practical and affordable.
Chairperson, in addressing the health care inequities and as a key component of the NHI, we also have to address the issue of human resources. The retention of staff is critical if we want to succeed, particularly in the rural and remote areas, where staff experience a lack of equipment and, more critically, a lack of support.
The intervention by the department to deal with the long-standing problem of damaged medical equipment piling up in hospital corridors and the recruitment of 36 junior engineers to repair these instruments is highly applauded. No more purchasing of equipment, one piece on top of the other. This initiative encourages youth to take issues of skilling and development seriously, and job creation is also addressed by this initiative. It is critical for government to review the incentives it offers to attract health care professionals, but it is equally important to address the issues of equipment, structural deficiencies and support.
The increased burden of disease is placing enormous strain on our resources and the wellbeing of health care professionals and health workers in general. As the burden of disease increases, it negates the advances we are making in filling vacancies.
South Africa is faced with a quadruple burden of disease. It is thus important for Parliament to assess the department's interventions and programmes to curb disease and illness.
Tuberculosis, TB, is rife in South Africa, especially with the links with HIV and Aids that have been found. It is thus important to minimise the number of TB cases, and to ensure compliance with treatment. That is why we support the department, which has acquired the new GeneXpert technology. This total revolution in the diagnosis of TB is the first breakthrough developed after more than 50 years of relying on microscopy and culture run issues. We welcome this innovation, Deputy Chairperson.
These are challenges we need to confront and resolve as we progress towards the implementation of the NHI. In addressing these we must also be mindful that the budget for Health has been declining in real terms. As a key priority of government, we expect the budget for Health to receive far more urgent attention in order for it to meet the demands of our people.
Chairperson, a key priority is the programme of hospital revitalisation, which also incorporates preventative maintenance to ensure good maintenance of our health facilities in the provinces. This demonstrates the urgent need for us to explore public-private partnerships more vigorously and it also demonstrates the urgent need for the sharing of resources to improve the health profile of our country and achieving social solidarity.
A lot has been said about the high maternal and child mortality in our country, and the challenges we face. You have noted, hon members, that most of our interventions in HIV and Aids are directed at pregnant women and children. We will work hard to reduce the mortalities of these targeted groups.
Deputy Chairperson, we need to move beyond making primary health care a slogan, and make it a reality for us and our children and grandchildren. We need it because it benefits the majority of South Africans, who look to the state to help them. These are the people that have put us where we are today, and the only favour we can return is for us to strive for a better health system, which will guarantee them better health. We want to ask the department to double its efforts to give adequate attention to the primary health care programme as our hope for the future. The hope for a better life for some of our people is based on better health.
The initiative taken by the department to improve its management at all levels is welcomed. Deputy Chairperson, this area of management has contributed to lots of the problems experienced by the Health department nationally. Properly qualified people and people with relevant skills and experience will be appointed to these critical positions in future.
Teenage pregnancy is a worry. It is still prevalent in our schools. As the ANC we believe that the introduction of the school nurse programme will alleviate the health problems we have in our schools. We believe that recruiting retired nurses will yield positive results, because they are more experienced at all levels, particularly in educating boys and girls on issues of sex, prevention and pregnancy.
In the NCOP's programme of "Taking Parliament to the People", provinces such as Limpopo and the Free State were visited. Deputy Chairperson, it will be interesting to hear from the MECs to what extent they have addressed the challenges identified and reported by the NCOP visit. The same applies to KwaZulu-Natal, KZN. The Social Services select committee also paid a visit to this province, where a number of problems were identified and reported to the relevant office.
In conclusion, the ANC-led government will continue to invest in research and development in the health sector, including infant mortality research, HIV prevention technologies, health status surveys, development of new medicines and indigenous knowledge systems. Lastly, I would like to support the report from the department. I thank you. [Applause.]
Deputy Chairperson, hon Minister, Deputy Minister, members of the executive councils, hon members of the Council, ladies and gentlemen, it is a great honour and privilege for me to inform the NCOP that the Eastern Cape department supports the Health Budget Vote 16 policy speech, as presented by the hon Minister. This is because the department is absolutely forthright in directly targeting the basic health needs of the poor, highlighting the need for the re-engineering of the health care system, learning from best practice from other developing countries, and defending the right of the people of the Republic of South Africa to have a health service which is affordable, effective, sustainable and preventive in nature.
This budget policy speech has been all-encompassing in that it has educated us on the extreme importance of preventing diseases, injury and death, and of promoting healthy lifestyles, in contrast with the present obsession with the treatment of individual diseases, when it is already too late for many individuals, and at great cost to the fiscus and the gross domestic product, GDP, of the country.
We agree with the hon Minister that South Africa is faced with a quadruple burden of disease and state that the Eastern Cape is committed, with all its energy and resources, to working as a collective, supporting the hon Minister in decreasing, and ultimately in the long term eradicating, these four challenging areas of disease.
As he has already indicated, the Minister signed a performance agreement with the President, and subsequently with us in the various provinces, to ensure a long and healthy life for South Africans. The health sector has adopted a 10-point plan which speaks to priorities which the Minister alluded to in his policy priorities and budget speech. The hon Minister's speech also addressed the issues that are critical in the eight government priorities.
Allow me, therefore, to highlight some of the major achievements of the Eastern Cape department of health in answering the department's policy priorities, its 10-point plan, and how we are living the negotiated service level agreement.
With regard to HIV and Aids and TB, the number of patients on antiretroviral treatment, ART, has increased from 123 552 to 152 357. The number of people who have been tested for HIV is 1,2 million, whilst 1,3 million have been counselled. The number of those who have been tested and are positive is 138 541, and 513 736 have been screened for TB. The number of ARV sites has increased from 147 to 659. The uptake of nevirapine by newborn babies has increased from 83,3% to 98,5%. The number of nurses trained on the Nurse Initiated Management of ART, Nimart, is 943. We were supplied with four GeneXpert machines to diagnose TB and to detect it in the early stages. Eighty-five nurses have been appointed for community- based management of multidrug-resistant TB, MDR-TB, and intensified case- finding teams. We have achieved a cure rate of 66% according to the electronic TB register. In answering the Minister's directive to focus our attention on HIV and Aids, we have established a special directorate to deal with HIV and Aids and it is headed by a chief director.
In working together as a collective for the achievement of the ultimate objective of ensuring "a long and healthy life for all South Africans", the Department of Health has started preparing the health care system in the Eastern Cape for the eventual implementation of the National Health Insurance, NHI, and facilitating the gradual re-engineering of the health care system according to the following three main streams, as indicated by the hon Minister.
Firstly, the department has commenced revitalising its organisational structure so that it is in line with the district-based model, with a team of five specialists focusing specifically on maternal and child mortality. We are doing this gradually, because we want to draw some lessons from the national process.
Secondly, the department has proactively engaged in the revitalisation of primary health care service delivery in the Eastern Cape by piloting this stream in five subdistricts. Since mid-2010, all five health subdistricts have been involved in the development of a social compact for community mobilisation, including the facilitation of job creation via co-operatives focused on providing soft services.
Thirdly, the department has obtained executive council support for the implementation of the stream encompassing the ward-based primary health care model deploying ten or more well-trained primary health care practitioners per ward.
We are in agreement with the Minister's comments on noncommunicable diseases.
We are also busy attending to the issue of health care management by making it less complex and ensuring that form follows function. Furthermore, the department has employed 1 667 health professionals from October to date, and 1 247 nurses as well as 22 clinic associates graduated last year.
On the issue of infrastructure, on which both the chairperson of the select committee and the Minister have spoken, we have committed R1,9 billion for the revitalisation of the following hospitals: Livingstone, Cecilia Makiwane, Frere, St Elizabeth's, St Patrick's, Frontier, Nkqubela TB Hospital and Jose Pearson. We have created 1 500 jobs and we project creating 2 275 and further training 3 000 people at Cecilia Makiwane.
We have also opened five clinics and a state-of-the-art EMS base, also containing a call centre, the latter costing 18 million. We have also finished the construction of the Mthatha base at R9,6 million and the Queenstown EMS base at R21,9 million. On emergency services, we have handed over 100 ambulances at a cost of R57,7 million, and we have recruited 109 people and eliminated one-man ambulance crews. We are stamping out the abuse of ambulances by our personnel, as we have installed a tracking system in order to know where the ambulances are. We are decentralising the ambulances and attaching them to district and tertiary hospitals.
Due to improved protocols on mother-to-child transmission and comprehensive treatment, there has been a decrease in the number of babies born HIV- positive.
There are other challenges that we face. There is pilfering of medicines and drugs in our depots. However, we are working with law enforcement agencies in order to deal with this. The systems have collapsed, but we are working on installing them and putting control measures in place. We have arrested the culprits and are continuing with the investigations.
There is an intergovernmental team that deals with corruption and that comprises the Organised Crime Unit, Sars, Health and the Asset Forfeiture Unit.
On the issue of conditional grants, while we have improved with regard to expenditure, there are still challenges in regard to three of those grants. One of them is HIV and Aids. We, together with the affected managers, are dealing with that. We can now indicate that the department is effectively starting this new financial year from a negative position, with expenditure expected to exceed the budget by approximately R978 million, including accruals and carry-through costs, which will be carried over to the 2011-12 fiscal year. We would like this Council, whenever it debates provincial matters, to give attention to this matter.
In conclusion, through you, Deputy Chairperson, we thank the hon Minister and the members of this Council, and we urge the Council to support the hon Minister. We are fortunate to have leadership that is passionate and hardworking, and if this time around we do not change the situation in Health, I don't know what will happen going forward. Thank you. [Applause.]
Deputy Chair, hon Minister, Deputy Minister, hon MECs present and all hon members, the merger of the departments of health and social development soon after the 2009 elections presented us with an opportunity to tackle challenges which face our province holistically.
It is a fact that poverty contributes to poor health outcomes; therefore, programmes which seek to eradicate poverty will have an impact on the health status of the people of Gauteng.
As government, we have come to accept that budgets that are appropriated to eradicate poverty and improve the health status of our people are not mere expenditure. We regard these as investments. A population that is ravaged by poverty and poor health care can never be productive. This approach to budget allocations underpins the manner in which we prioritise our interventions. Sustainable development and improved health outcomes will ultimately impact on the productivity of the people of Gauteng.
We are guided by the following outputs as set out in the negotiated service delivery agreement, the Millennium Development Goals and our five-year strategic plan. These are: increasing life expectancy; decreasing maternal and child mortality; combating HIV/Aids and decreasing the burden of disease from tuberculosis; strengthening the health system's effectiveness; strengthening early childhood development; preventing and reducing substance abuse; strengthening services for older persons; waging war on poverty; and mainstreaming gender, youth and disability.
Chairperson, we have prioritised reduction of child and maternal mortality. All hospitals and clinics with maternal obstetric units in Gauteng are implementing the 10 recommendations of the Saving Mothers report.
The availability of maternal obstetric ambulances and their quick response is crucial to saving the lives of women who are in labour and their infants. To this end, we will increase the number of these ambulances, which are especially dedicated to the transportation of women who are in labour emergencies, from 5 to 10.
We have also initiated a campaign to encourage pregnant women to book for antenatal visits before 20 weeks of pregnancy. This campaign is born of the fact that our records attest to low figures for women who attend antenatal clinics. The rate of antenatal visits before 20 weeks increased from 27,3% in the first quarter to 30,7% in the fourth quarter. Although the increase is encouraging, a lot of work still needs to be done to increase this number.
In order to reduce maternal and child mortality in Gauteng, we have established two committees to advise the department on methods and interventions to reduce maternal, neonatal, infant and child morbidity and mortality. These committees are called the Maternal Morbidity and Mortality Committee and the Neonatal, Infant and Child Committee. They will ensure rigorous monitoring and analysis of maternal and infant mortality in 2011- 12.
In addition, all district, regional and central hospitals, including specialised hospitals, conduct morbidity and mortality meetings each month to investigate every death and improve management of hospitals. Maternal and prenatal morbidity and mortality meetings are held in all hospitals offering maternity services on a regular basis. At these meetings, the causes of death are investigated, and issues of commonality are identified and discussed, and the appropriate interventions are implemented to reduce the occurrence of avoidable deaths and reduce mortality rates.
We will strengthen our immunisation programme to reach children who could have been missed, especially those in informal settlements. In 2010-11 the department improved measles immunisation coverage, reaching 111,5% by end of the financial year. This was possible through monitoring and evaluation visits to districts and in-service training on expanded programmes on immunisation and vaccine stock management. Vitamin A coverage for children under the age of one year and new mothers reached 104,4% and 97,8% respectively. Through the expanded programme on immunisation, which encompassed the Reach Every District Programme and the availability of vaccines, measles coverage reached 111,2%. The target on rotavirus dosage coverage was reached due to training, campaigns conducted and health education to postnatal mothers on the importance of ensuring that rotavirus vaccine is given within a 6-month period after birth.
The fact that targets for immunisation are exceeded is testament to our efforts to ensure that children whose birth has not been registered, as well as children born in other provinces and even other countries, receive their immunisation in Gauteng. Hon members, I take this opportunity to urge you to remind your constituents that every day is immunisation day at our clinics. Even our hospitals have established vaccination points for catch- up in case of missed opportunities.
We have already taken steps to increase the number of neonatal beds at Charlotte Maxeke Johannesburg Academic Hospital, Dr George Mukhari Academic Hospital and Natalspruit Hospital. Strict adherence to infection control measures is monitored very closely. Every death of a child from preventable diseases is one too many. The prevention of mother-to-child transmission of HIV programme is bearing fruit. We will continue to strengthen this programme in order to reduce the overall incidence of HIV.
This year we will also strengthen our school health services. The focus will be on screening obstacles to learning among Grade R, Grade 1 and Grade 7 pupils. Currently, school health teams visit 1 431 schools, and we will collaborate with the Gauteng department of education in this regard to reach more schools.
Chairperson, we are breaking the back of HIV/Aids. By the end of March 2010 we had 412 191 people on antiretroviral treatment, ART. Our target is to increase this number to 520 000 by the end of March 2012. In order to provide treatment closer to where people live, the number of ART sites will be increased from 162 to 366. Timeous enrolment of people on ART, while also taking into account their CD4 count, goes a long way towards warding off the onset of Aids; hence we have trained professional nurses to initiate treatment. To date, more than 600 professional nurses who work in clinics have been trained to initiate ART.
Hon members know that HIV is incurable. Therefore, our focus on prevention can never be overemphasised. Medical male circumcision will therefore be upscaled to reach 100 000 males by the end of March 2012. We have already tested more than 1 million people since the launch of the HIV Counselling and Testing Campaign. Our research shows that there is an increase in the use of condoms across all ages of the sexually active population.
Tuberculosis, TB, remains a burden to our health system. Early diagnosis and treatment will ensure that we increase the cure rate and reduce the spread of TB. TB is also the number one killer amongst HIV-positive patients. Hence we have decided that all TB patients will be screened for HIV/Aids in order to ensure that those who are co-infected and have a CD4 count which is below 350 are initiated into ART. We have noted that admission of multidrug-resistant TB patients for six months at Sizwe Hospital disrupts their livelihoods, especially if they are breadwinners. That is why we will soon launch a community multidrug-resistant programme to ensure that these patients continue receiving treatment while living with their own families.
We have procured the GeneXpert technology, which will ensure the shortening of time with regard to availability of sputum results from a whole week to two hours. This will greatly reduce the loss of patients to follow-up, as some do not come back for results. This technology is already available at Chris Hani Baragwanath Academic Hospital and Edenvale Hospital. We will also make this equipment available to the rest of the districts in the course of this financial year.
To reduce the spread of TB among families of patients, we will visit their homes and screen them for TB. Those found to be already infected will be placed on treatment immediately. Deputy Chairperson, since we embarked on this process, we have found 53 038 new cases of TB, exceeding a target of 52 000. This has been achieved through intensified case finding in door-to- door campaigns and the HIV Counselling and Testing Campaign. We will continue to ensure that TB cases are detected early so that those who are infected are placed on treatment, thus curbing the spread of infection in the community at large.
All of the above can only be achieved if we have an effective health system. An effective health system hinges on primary health care services which inspire confidence. We are re-engineering primary health care in order to improve health outcomes and reduce the need for curative services.
We have already begun to establish health posts which are located in communities. This is a service unit that is embedded in the community and at the periphery of a clinic or community health centre in which comprehensive primary health care is rendered to a definite number of households. The aim of health posts is to ensure that community-based services, including outreach services, are provided to communities on a door-to-door basis. In Gauteng, a block of 250 to 300 households or families in a community will be served by a health post.
The health and social development teams will consist of a health post doctor, professional nurse, social worker, health promoter, enrolled nurse or nursing assistant, and counsellor. They will work with appropriately trained community health workers and social auxiliary workers who are placed within specifically designated communities.
This model will reduce waiting times in the clinics, because services will be brought closer to the people. This will be achieved by taking chronic medication directly to patients at their homes, attending to minor ailments, and providing elementary care closer to where communities live.
Furthermore, health and social development problems will be detected early and attended to in time, thus increasing chances of recovery and minimising defaults on treatment. It is hoped the perceptions in the community about the quality of care ...
Hon member, thank you. Your time has expired.
Let me take this opportunity once more to support the Minister's efforts to drive the implementation of the National Health Insurance, which will ensure that the district system functions optimally and inspires confidence. Thank you very much, Deputy Chair. [Applause.]
Deputy Chairperson, Ministers, Deputy Ministers, members and guests, indeed the health standards of the Health department of government and the health departments in all the provinces are very important for the people of South Africa if we are serious about service delivery.
In 2010, the department identified four key areas to focus on, namely: increasing life expectancy, combating HIV/Aids, decreasing the burden of disease from tuberculosis, and improving health systems' effectiveness.
The Department of Health received R21,5 billion for the 2010-11 financial year, compared to the budget of 2009-10, which was R18,4 billion. This shows an increase of 4,65% of the total national Budget, which represents 9,36% in real terms. Chairperson, 94,9% of the department's budget goes to transfers and subsidies, 4,9% to current expenditure, and 0,2% to payments for capital assets. This means that the national Department of Health must play a pivotal role in the monitoring and evaluation of effectiveness of implementation and performance in provinces. The national Department of Health must have an IT system with a dashboard programme which shows how, when, and on whom monies have been spent, the outcome performance regarding quality, and the effectiveness of service delivery.
This will arrest ineffectiveness in service delivery, like the previous shortfall in antiretroviral drugs in the Free State; the underspending of budgets; the deaths of babies, like in the Eastern Cape and Gauteng; and the nondelivery of medicine to depots, hospitals and clinics, etc.
Management and leadership across the department were identified as a weakness. Yes, the departments across the provinces have started with the upgrading of senior management, but we must take cognisance of the fact that only fit-for-purpose and competent staff must be employed in vacant posts advertised. No unfit and unqualified persons should be appointed, or political deployments made. This must not be the criterion to fill posts.
Deputy Chairperson, tuberculosis is an illness which can be cured, but too many people are diagnosed with tuberculosis. An increase of 948 per 100 000 incidents has been identified, as well as a rate of 1 in 105 people in South Africa. A TB cure rate of 64% as against a target of 65% was achieved. I would like to express much appreciation to the department in this regard.
Tuberculosis is very much related to poverty, no food or hunger, joblessness or low income, and negligence in regard to health. We must concentrate on the prevalence and giving support to families in difficult circumstances.
The community development workers employed by government, provinces and municipalities must concentrate on the comprehensive gathering of information on people's quality of life and their health status, and supply it to our community health clinics. Then an ample number of staff must be available to assist with food supplements and other support immediately after their receiving the survey done by them.
The 25,9% growth in the HIV/Aids budget is significant and highly appreciated in the combating of this pandemic. Deputy Chairperson, the 29,3% prevalence rate, according to the 2008 National Antenatal Sentinel HIV and Syphilis Prevalence Survey is still too high, and programmes in regard to this issue must be more focused, and must be intensified.
We must be mindful of the fact that the life expectancy of babies and mothers can only improve with our supporting the mothers' rights from the start of and even before pregnancy. A healthy mother gives birth to a healthy baby. Our hospital and maternity wards should be high quality. Staff, nurses and doctors must be high-quality health professionals. Our equipment and other support materials should also be high quality. If we fail, then loss, sadness, trauma and negative emotions are inevitable.
A lot of savings can be made on expenditure, such as on food during internal meetings, accommodation, and flight arrangements, to name just a few. This has already been done by one of our sister departments in government.
Deputy Chairperson, our Health department must succeed in all its endeavours to create a healthy, competent and excellent health sector in South Africa. If we are serious about service delivery, then we must speed up this quality health system. Thank you. [Applause.]
Hon Deputy Chairperson and Chairperson for this sitting, hon Minister of Health, Dr Aaron Motsoaledi, Ministers and Deputy Ministers present, hon chairperson of the select committee, hon members, colleagues, MECs for health, distinguished guests, and our senior management, led by the director-general, I wish to join those members who have extended condolences to the family of Dr Mkhize, a young, 27-year-old doctor who was killed by a patient he was supposed to be assisting. Our condolences go especially to his daughter, who shared with me that she herself would like to become a doctor one day. It is important that the health sector work together with provinces to continuously look at, and relook at, the issue of security in our facilities, although indeed plans cannot necessarily be made to deal with some of the incidents. However, it is our duty and responsibility to continuously review the rigour of the security system, both for our patients and our health workers.
It is indeed my privilege to address this honourable House on this occasion in support of the Health Budget Vote for the 2011-12 Medium-Term Expenditure Framework, MTEF, as presented by the Minister.
In participating in this budget debate, I wish to acknowledge the significant turnaround the department has achieved under the visionary and passionate leadership of Minister Aaron Motsoaledi and through the contribution of my predecessor, the late Dr Molefi Sefularo, working with the MECs of various provinces on the National Health Council. I would also like to acknowledge the input of the director-general and senior management in the national head office and in the provinces.
This turnaround has been profound, especially with respect to investing in strategic partnerships and in research and innovation, and using knowledge to save lives, particularly in the HIV/Aids programme. This budget we are debating today will build on these successes and achievements as we advance towards "a long and healthy life for all South Africans".
Since the advent of democracy, the diseases of extreme poverty like kwashiorkor and marasmus are not as prevalent as before. South Africa is on course to eradicate malaria. The prevalence of oesophageal cancer in the Eastern Cape is on the decline as a result of our interventions. Access to primary health care has significantly improved, with over 40% of clinics built during this era.
In this current term we have already reported a 50% decrease in the mother- to-child transmission of HIV, and 12 million South Africans have come forward to respond to the HIV Counselling and Testing Programme. Over 1,4 million patients who would otherwise be in hospices waiting to die are now alive on antiretroviral treatment, ART. Through innovations in technology the time it takes to diagnose TB and multidrug-resistant TB has been greatly reduced, by about six weeks and almost three months respectively. These achievements that South Africa has made, especially in the fight against HIV, have been acknowledged widely as the world observes 30 years this year since the first Aids patient was diagnosed.
We have now reached a turning point, but it is not as yet uhuru. We dare not be complacent. This is just the beginning. We still have a long way to go in order to ensure that we do indeed push back the frontiers of HIV/Aids and TB in our lifetime.
One of the key lessons that we must learn during this period is that we need to be better prepared for new and emerging diseases. Above all, we must leverage the best available scientific knowledge and evidence, as well as appreciate the need to continuously innovate, looking at new and better ways to achieve health and wellness goals. We have also learnt that strategic leadership and effective partnerships are catalysts in tackling complex problems that humanity faces from time to time, problems of the magnitude of HIV and Aids.
The Minister has aptly outlined the quadruple burden of disease, the four epidemics that the country is facing now, with HIV/Aids, TB and maternal and child morbidity and mortality in the lead. On noncommunicable diseases, trauma and violence, we must not wait until we are overwhelmed, as was the case with HIV in our country, or as is the case in the developed countries with cardiovascular and metabolic diseases.
In preparation also for the National Health Insurance system we have prioritised interventions that promote wellness, prevent ill health and improve the effectiveness of treatment and care.
It is estimated that the indirect cost of hypertension and cardiovascular diseases alone to the South African economy and society is about R8 billion annually. What is more concerning is that 70% of these deaths are of economically active members of society who are younger than 55 years of age, and that almost 195 people a day die from these diseases. The good news, however, is that 80% of these diseases are preventable. I think we must really imagine this daily, so that we actually realise that we have a duty and responsibility to opt for prevention.
Our goal is to reduce the burden of noncommunicable diseases by 5% to 10% in this term and to ensure coverage of about 25% of districts in regard to integrated programmes in this financial year. The strengthened primary health care model, as announced by the Minister, with the district-based specialists, community health teams and school health programmes is a platform we will use to achieve this goal.
We believe that South Africa must be spared another massive wave of catastrophic epidemic, something which resulted in the doubling of the death rate in the past decade when we experienced the HIV/Aids epidemic. We will learn lessons from past failures and recent successes, as well as successes in combating malaria and hosting the 2010 Fifa Soccer World Cup Tournament, in the way that we manage the growing burden of noncommunicable diseases.
We aim to host a multisectoral national lekgotla on noncommunicable diseases, which will precede the global heads of state summit to be held in September this year. We must emerge from this summit with a strategic partnership similar to that of the SA National Aids Council, Sanac, ready to begin a social movement for promoting wellness and healthy lifestyles. Health must be a way of life, a choice that South Africa makes as a contribution to "a long and healthy life for all". We can no longer afford to be oblivious to the high price being paid by current and future generations socially and economically. The huge burden of ill health is a risk to sustainable development.
It is in this context, alongside the HIV/Aids Counselling and Testing Campaign, that we called on South Africans to be tested and screened and to know their status for diabetes, hypertension, obesity and cancers. We will work together in ensuring that a district and municipal ward-based disease surveillance system is in place to enable us to have targeted prevention and treatment programmes.
When I was in Ga-Rankuwa last month with the Move for Health Campaign, together with the Tshwane University of Technology community, the demand for testing in all these various screening programmes was very high. This necessitated the various service providers coming back the next day to assist the student community in getting to know their status and taking positive action. South Africans are responding positively.
Chronic disease care will also form an integral part of the National Health Insurance system. As part of strengthening the health system, we are rolling out a long-term care model for diabetes and hypertension throughout the health care system. This intervention aims to improve the quality of life of patients and also to reduce the high cost of complications like strokes, blindness, diabetic amputations and kidney failure. The chronic disease management register will be used as a monitoring tool for districts.
Regulations for organ transplants have already been published for comment in order to avoid the unethical conduct that was reported a few months ago.
We will continue to work with all stakeholders to achieve the World Health Organisation Vision 2020 goal of eliminating blindness through, amongst other things, cataract surgery.
We are in consultation with the Ministry responsible for water services to finalise investigations and consultation on water fluoridation for the prevention of tooth decay. As part of the school health programme, primary prevention oral health services will be implemented in schools, targeting a minimum of 10 primary schools per province in this financial year. We support the Minister in his ensuring that we implement the Mini Drug Master Plan that was approved by the National Health Council, NHC, earlier this year. We are concerned about the massive increase in alcohol advertisements, which seem to be targeting the populations at risk, especially young people. We will engage with the industry, the media, research institutions and society, as we aim to strengthen measures to protect society, and also to protect our economy, from the negative impacts of alcohol. We have already commissioned research to examine the impact of alcohol on TB outcomes. Such studies will also advise us on similar impacts on treatment outcomes for other diseases. Industry and the media cannot and must not be allowed to maximise profits from various commodities and from advertorials at the expense of our youth, society and the economy.
Tobacco regulations have yielded positive results. We are, however, concerned that there are about 7 million South Africans that still use tobacco, resulting in about 44 000 deaths annually. [Interjections.]
On mental health, we aim to strengthen the implementation of the Mental Health Care Act, Act 17 of 2002, by supporting and monitoring provincial incorporation of community mental health services as part of the primary health care, PHC, package. Interventions to reduce the turnaround time for forensic observations, including the recognition of forensic nursing as a registered speciality with the Nursing Council, are under way.
On injury prevention and emergency medical services, the high morbidity and mortality burden of injuries in South Africa is driven by a high rate of road accident injuries and interpersonal violence, the latter accounting for 46%. It has been estimated that around 3,5 million people per annum seek health care for injuries. The Medical Research Council of South Africa, MRC, reports that injury and violence is the second leading cause of death in South Africa after HIV.
The health sector is an important player in the attainment of the objectives of the five pillars of the United Nations-led Decade of Action for Road Safety, especially Pillar 5, which deals with post-crash responses. A report developed by the MRC setting out practical and cost- effective interventions will be released later this year.
Violence against women and children is still very high. The rate of female homicide by an intimate partner is 6 times the global average, with a woman killed every 6 hours. Chair, 25% of women in the general population have been a victim of physical violence by an intimate partner, and 40% of men have perpetrated violence against a female partner. As per an MRC report, 40% of all rapes reported to the police are of children under 18 years of age and 15% of those are under 12 years of age. The recent reports in the media on the brutal attacks on and killings of lesbian women, including that of a 13-year-old girl, are no less an indicator of this scourge in society than the daily reported cases of rape and domestic violence.
As we participate in the 365 Days of Activism for No Violence against Women and Children, we will work with the Social Development department, the police, and the National Prosecuting Authority under the Thuthuzela programme to strengthen the victim support services programmes and mainstream the treatment and support of survivors. Measures have also been put in place to reduce the backlog in forensic laboratories.
We will be releasing an e-Health policy and strategy, after extensive consultation. Currently, we are on the 19th draft of this process.
We will also leverage the experience gained from various panels, and specifically the 2010 Fifa Soccer World Cup Tournament last year, to introduce mobile health solutions.
Currently, priority will be given to developing electronically based surveillance systems able to deal with monitoring the Millennium Development Goals, MDGs, and the nationally negotiated service delivery agreements, which will be monitoring the prevalence and incidence of HIV/Aids, and also the risk factors.
Hon members, any effective health system must operate an effective, reliable, quality, expert-driven epidemiology and disease surveillance system. We need to identify new emerging diseases early on, track our successes in various interventions, and also remain vigilant for outbreaks and re-emerging diseases.
Next month, the National Health Research Committee will be convening a health and innovation summit, where researchers in the health sector will identify research and innovation gaps and priorities aligned to the mandate in the negotiated service delivery agreements that the Minister has signed with the President. The Department of Science and Technology, academics, research institutions, and the private sector have been invited to contribute to this task.
On health technology, the National Health Council has approved the Health Technology Strategy. This strategy includes the recruitment of bio- engineering and clinical engineering technicians to maintain the many pieces of equipment, some of which are highly complex and expensive, in hospitals and clinics. The Ministerial Advisory Committee on Health Technology has already begun to work on developing norms and standards for health technology. An essential equipment list for various levels of the health care system is already before them and will be released for consultation.
In his speech the Minister also referred to the reduction in price achieved through the central drug procurement approach adopted by the NHC. Learning from this achievement, we will establish a central drug procurement authority working jointly with provinces to act as an enabler towards affordable and reliable access to pharmaceuticals.
We want to thank the Minister for his leadership, and colleagues and MECs for their co-operation and the leadership they provide in their various provinces. Working together, we will consolidate our achievements, especially in fighting the scourges of HIV/Aids and TB, as well as improving mother and child health and ensuring that they live a long and healthy life.
I want to thank the House for this opportunity, and say that its support for this Budget Vote is support for contributing to the MDGs and the national renegotiated service delivery agreements. Thank you. [Applause.]
Deputy Chairperson, hon Minister and Deputy Minister, my colleagues, and hon members of this House, let me join other members who have extended condolences to the Mkhize family. I also want to extend condolences to the family of one of our Cuban doctors who passed in a car accident yesterday.
I am honoured to be part of this important debate in the House on the national Health Budget Vote, which the Northern Cape fully supports. The hon Minister is indeed correct when he makes the seminal point that the entire health sector is currently at a crossroads in our country. The choices that we have to make today will determine our destiny for many years to come.
Minister Aaron Motsoaledi's service level agreement is indeed a worthy endeavour, directed at addressing the communicable and noncommunicable diseases that we face today, as well as revitalising the entire health system.
The national Ministry of Health must be applauded for the manner in which it has mobilised the entire sector towards the achievement of a clear set of goals. These goals are the four identifiable and measurable outcomes, and the 10-point plan of health. All the planning tools of the provinces have already been significantly aligned with these objectives, so that there is a clear articulation of what the intended purpose of our national health system is.
Needless to say, in the provinces our challenges differ, sometimes remarkably. This imposes particular areas of emphasis for each of the provinces, as we strive to address the health needs of our people and those of the health system itself.
Amongst the most critical of our health system challenges in the Northern Cape is the Emergency Medical Services, EMS. The national norm for the number of EMS ambulances required is 1 per 10 000 citizens. This ratio works well in urban and semiurban areas. However, due to the vast distances in rural areas that have their own peculiar and harsh conditions, this has been increased to 1,6 ambulances per 10 000 citizens.
In the Northern Cape the actual distribution of ambulances is as follows: 1 ambulance per 10 000 citizens in Frances Baard District Municipality, which is one of our biggest districts; 1,2 ambulances per 10 000 citizens in Siyanda District Municipality; 1,2 ambulances per 10 000 citizens in John Taolo Gaetsewe District Municipality; 2,3 ambulances per 10 000 citizens in Pixley ka Seme District Municipality; and 3,2 ambulances per 10 000 citizens in Namakwa District Municipality.
Clearly the backlog is huge, and the reality of having to annually replace obsolete vehicles increases this burden, given the vast distances and road conditions that ambulances have to travel in in the Northern Cape, perhaps a minimum of 400 km to 700 km from the other districts to the only facility that offers tertiary services in the Northern Cape.
It means that at any given moment we exceed the acceptable ratio of vehicles that are unavailable due to maintenance. This has the effect of dramatically reducing the number of vehicles that are available to serve the population. The reality is that countrywide you will have about 15% to 20% of vehicles being serviced at any given moment. However, in the Northern Cape this figure rises to a staggering 40%.
The national norm for the replacement of an EMS ambulance is every two years or 250 000 km, whichever comes first. In the Northern Cape we are failing to achieve this by a significant margin, with many ambulances that are significantly older than this and have travelled more than the maximum recommended number of kilometres.
This means that, in addition to routine maintenance, our ambulances repeatedly break down and require major repair work, including engine replacements. This impacts on the important function of transferring patients. We all know that in many instances the time factor in this regard is critical. Importantly, the coachwork of an ambulance needs to be in good shape.
The department is often asked why it undertakes costly major repairs of old ambulances, rather than spending that money on purchasing a new vehicle. The calculation is not always that simple. A new EMS ambulance costs an average of R450 000 which, when depreciated over three years, is equivalent to R150 000 each year. This suggests that, provided the refurbishment, repair and maintenance of an old vehicle is less than R150 000 for one year, additional service extending its lifespan may still be cost- effective. For each decision, it's a difficult prospective calculation that can often only be proven in retrospect. The Northern Cape has a total of 46 planned patient transport services vehicles. These vehicles are experiencing the same problems as the EMS ambulances: high mileage, badly damaged internal coachwork and high maintenance costs. Furthermore, these vehicles are old and out of service for long periods of time.
If the department were to replace these vehicles every three years or 300 000 km, this would necessitate replacing one third of the fleet each year, and that is 15 planned patient transport services vehicles. Typically, over recent years the department has had sufficient capital funds to replace only two to three vehicles each year.
The national norm for staffing the EMS ambulances - which is also a critical point for the Northern Cape - as prescribed by the Health Professions Council of South Africa, HPCSA, is two qualified personnel. Planned patient transport vehicles do not always require two people. However, when travelling long distances this is always the case in order to ensure the safety of the crew and patients.
Furthermore, each ambulance station needs a station manager; each subdistrict needs a subdistrict manager; and each district needs a district manager. Currently, just two districts run their own control room, and this needs to be established in all five districts. In order for the Northern Cape to achieve the prescribed minimum level of staffing, it needs to increase the number of staff from the current level of 560 to a new level of 1 823.
The estimated total spending per annum required for EMS and planned patient transport services vehicles is about R35 million. The current capital budget for these vehicles is only R12 million, giving a shortfall of R23 million a year. The estimated total spending per annum required for EMS and planned patient transport services staff is R269 million. The current budget for staff is only R87 million, giving a shortfall of R182 million. [Interjections.]
Hon Deputy Chairperson, our country is now being lauded by the global community, based on the immense work that has been accomplished in fighting the scourge of HIV and Aids, as well as TB. The department of health in the Northern Cape in its ministerial imbizo also embarked on a new strategy to prevent chronic diseases and promote healthy lifestyles. This was done in conjunction with the HIV Counselling and Testing, HCT, Campaign and TB screening in all the districts.
Stalls were set up at all the strategic places in a community, and the communities were screened for blood pressure and blood glucose, ophthalmic examinations were conducted, and women were referred to the nearest clinic for pap smears. Community members were also educated regarding the benefit of having gardens to grow their own healthy food, and eating a balanced diet. Seeds were distributed. Communities were encouraged to visit health facilities on time when they had health problems. Home visits were also conducted. Pregnant women were educated on the dangers of drinking alcohol and smoking during pregnancy. Emphasis was put on early booking and its benefits, so that they could be counselled and tested for HIV and Aids, and be put on treatment early if they were HIV-positive in order to reduce mother-to-child transmission.
Schools were also visited and learners were given health talks on substance abuse, regular exercise, general hygiene, healthy eating and also playing sport to keep fit. Kick TB soccer competitions were held, schools were presented with soccer balls, and certificates were handed out to participants.
There has been an increase in maternal deaths due to the scourge of HIV and Aids. As a result, women who visit our antenatal clinics are offered routine testing and screening for HIV and Aids, TB and chronic conditions as part of routine screening for pregnant women.
There is also a campaign that encourages women to book early or visit the nearest clinic when they have missed a period. The new clinical guidelines for the prevention of mother-to-child transmission are being implemented in all our facilities and pregnant women are being prioritised for antiretrovirals, ARVs.
Lastly, let me take this opportunity to thank the Ministry for their efforts to make sure that they implement the National Health Insurance and for their leadership. Thank you very much. [Applause.]
Hon Minister of Health, Dr Motsoaledi, Deputy Minister Ramokgopa, hon members of the House, guests, the director-general and staff, ladies and gentlemen, I would like to take this opportunity to congratulate and thank the hon Minister for his leadership. He is leading the sector at a time when South Africa's health is at a crossroads and going through the pandemics, as he has described. In fact, I think health systems all over the world are facing particular challenges. I agree that we, as elected leaders, face some important decisions.
In his speech the Minister highlighted HIV and Aids, TB, maternal and child mortality, the incidence of noncommunicable diseases, violence and injury. In my address to the House today, I would like to point out the programmes that the Western Cape department of health has implemented to address these pandemics in support of the national challenge.
With regard to HIV and Aids and TB, the Western Cape department of health has allocated R661 million to the HIV/Aids and TB programme. This is augmented by a further R166 million from the Global Fund. We are extremely appreciative of the ongoing support of the Global Fund, and their contribution over the Medium-Term Expenditure Framework, MTEF, period is R579 million.
The Western Cape is the only provincial recipient in the country of this grant. It will enable the department to strengthen grant programmes and the management thereof, while expanding antiretroviral treatment, ART, infrastructure, antiretroviral, ARV, services, the prevention of mother-to- child transmission, PMTCT, system, peer education and palliative care services in this regard. The second phase will follow directly after this original period funded by the Global Fund, and a further three-year period will be funded by this grant.
Measures to reduce the burden of HIV and Aids and TB include: the treatment, care and support of 80% of all people diagnosed with HIV; antiretroviral therapy to 116 000 adults and children in the province during 2011-12, whereas two years ago we had 36 000 people on ARVs; PMTCT services, aiming to reduce the transmission to below 3%, although we believe we are already below 3%; and HIV and TB services at all district, secondary and central hospitals for clients with complex HIV or TB. We will also meet the target of 1,1 million and we will administer ARVs and HIV counselling and testing, HCT, at all facilities in the Western Cape.
With regard to maternal and child mortality, the shockingly high rate of child mortality, and a major cause of the burden of disease, is addressed through more prevention and promotion activities at district level and in the strengthening of the maternal, child and women's health care programmes. The Western Cape department of health aims to reduce the mortality rate of children under the age of five years to 30 per 1 000 live births and the maternal mortality rate to 90 per 100 000 live births by 2015.
We launched the Road to Health booklet at the Mowbray Maternity Hospital on 31 May. Every mother will be issued with one of these booklets when a child is born in this province, in both the private and public sectors. We believe that these booklets, with a special focus on prevention, are the key rallying tool to enhance the wellness of children. All key partners, including nonprofit organisations, NPOs, universities and the private sector, are involved.
Focus areas for improving women's health include: motivating more pregnant women to seek antenatal care before the 20th week of their pregnancy; targeting the reduction in the delivery rate of women under the age of 18 years; increasing the cervical cancer screening rate; and improving family planning services.
With regard to the incidence of noncommunicable diseases, the Western Cape department of health is committed to increasing awareness of, and drives initiatives to address the factors that contribute to the burden of disease. These include poverty, lack of sanitation and potable water, and unhealthy lifestyles.
In addition, in the Western Cape we have continuously spoken about the upstream causes of ill health, but we have decided that the seriousness of these causes requires the issue to be taken to the next level in our province. It is for this reason that the Western Cape provincial government has implemented a platform to address these issues intersectorally amongst spheres of government, different departments in provincial government, nongovernmental organisations and the private sector. Four working groups have been established to address the upstream issues that contribute to the burden of disease. We believe that the strategies and action plans emerging from these working groups will have a long-term benefit in regard to the disease profile of our people.
With regard to violence and injury, the injury burden, which includes intentional injuries such as homicides and suicides and unintentional injuries such as road traffic injuries and fire-related injuries, accounts for approximately 23,9% of the burden of disease in the Western Cape. In comparison to the rest of the world, violence is a particular problem in our province, where the injury-related mortality rate for men is 10 times the global average, and for women 7 times the average. The Deputy Minister referred to it as being 6 times, so I might be called a liar for 1 time. [Interjections.] Substance abuse, particularly alcohol abuse, is one of the most important drivers of the burden of disease in the Western Cape, as it fuels both violence and road traffic injuries. There are two primary drivers that place a burden of injury on the health system - road accidents, and violence related to substance abuse, especially the abuse of alcohol. To address these, two main strategies are now being developed and implemented in our province. Firstly, there is a strategy to increase road safety with the aim of halving fatalities caused by road accidents; and, secondly, there is a strategy to reduce the incidence and harmful effects of substance abuse, including, and especially, alcohol abuse.
The Western Cape department of health is at a momentous time in its history. We have come to the end of the Health Care 2010 vision. Our evaluations show that the objectives of this plan have been successfully achieved. The establishment of a primary health care infrastructure has been completed. We are now standing at the gate of the second decade of this millennium, with the vision for health services to 2020 in mind.
The Western Cape department of health has put its focus on placing the patient, patient experience and the quality of care for patients back at the heart of our vision. This vision will be aligned with the values of the provincial government of the Western Cape. These are: caring, competency, accountability, integrity and responsiveness. The strategy will provide the framework for future service, personnel, infrastructure and financial planning. This can be achieved by positioning and strengthening our district health services to form a solid base, with regional and central hospitals and other support services as a strong support.
On this journey, the Western Cape department of health had a major shift in focus, which sets the Western Cape apart, not only from the rest of the country, but also from other governments. It is a fresh approach to public health care that is certainly new and has the potential to direct the debate on public health management in a new direction. We gave it the name Strategic Objective 4: Increasing Wellness. We launched this strategic objective last year. In terms of this vision, the early detection and prevention of disease have been prioritised through educational interventions. Effective strategies in these areas will have a long-term benefit with regard the disease profile of our people in the province.
In conclusion, the DA supports the budget. We congratulate the Minister, and our province will not overspend. Thank you. [Time expired.] [Applause.]
Thank you, hon Deputy Chair. Hon Minister, Deputy Minister, MECs ...
... ka ho qolleha, Motlatsi wa Modulasetulo, ha ke hlomphe Letona la tsa Bophelo bo Botle, Mme Mohlomphehi Fezi Ngubentombi, ho tswa mane porofensing ya Freistata. [... in particular let me show my respect to the MEC for health, hon Fezi Ngubentombi, from the Free State.]
Hon Deputy Chairperson, hon members and colleagues, I am rising in support of the Budget Vote. Mindful of the many challenges that still face the health care sector in South Africa, I want to congratulate the hon Minister, the Department of Health and the relevant role-players for the remarkable and visible progress that has been made during the past year under the competent leadership and guidance of the hon Minister.
As the Minister has pointed out today, we are:
... at a time when the health care system is at a crossroads. We may choose the best route, or the worst one ever, which will, of course, make our situation worse than before. The choice lies with us as South Africans in general, but as elected leaders in particular.
It is common cause that South Africa's health care sector is characterised as fragmented and inequitable due to the huge disparities that exist between the public and private health care sectors with regard to accessibility, funding and delivery of health care services.
As a result of this state of affairs, the delivery of health care is rendered unequally and disproportionately, as far as the majority of the population relying on the public health care system are concerned. This part of the population have a disproportionately lower level of financial and human resources at their disposal relative to the private sector. It is exactly this state of affairs that the hon Minister and the government need to balance.
It is therefore necessary and important to design, develop and implement innovative measures and policies to address the disproportionate situation of the public and private health care sectors with regard to human resources and financial strength. It is necessary to develop a model that provides a benefit package, of which the main aim must be to provide most benefits for most people, given the pool of funds available.
It is necessary to unpack and address the challenges that lie ahead within the limited time allocated to me. I will deal briefly with only some of them.
The most important measure or vehicle to address the imbalances and transform the health system into an integrated prepayment-based health financial system that efficiently promotes the progressive realisation of the right to health care for all is the National Health Insurance, NHI.
The hon Minister alluded to this in his budget speech in the National Assembly on 31 May 2011, when he said that there were two schools of thought about the National Health Insurance. I quote:
Those who correctly and legitimately hope that the NHI will bring relief in their everyday hardships as far as their health care is concerned.
... those consumed by self-interest and greed that will shame even the devil.
Section 27(1) of the Constitution of 1996 especially provides, among others, that:
Everyone has the right to have access to -
(a) health care services, including reproductive health care
This means that:
(2) The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.
It also means that:
(3) No one may be refused emergency medical treatment.
Mindful of this obligation to all the people of South Africa, the ANC, prior to 1994, adopted the national health insurance policy that was contained in the ANC Health Plan in May 1994 which has guided the transformation of the health sector. In fact, since the Freedom Charter in 1955 the ANC has regarded health as a priority. It remains a basic need of our people, and it is therefore enshrined in our Constitution. It is no longer a matter of whether there will be a national health insurance in South Africa, but when. The concept of universal coverage enjoys the support of most people.
The medical aid industry has consistently failed to control the cost of health care. It has been unable to address efficiency and equality in the private sector. Premiums and contributions cost a medical aid member thousands of rands per year, while the health benefits deriving from such high contributions are being cut or they are exhausted before the end of the year. Furthermore, instead of the money paid by members being used for health care, it is used for administrative purposes such as marketing. The key lasting solution, therefore, lies in addressing the needs not only of the more than 40 million uninsured, but also the millions who are currently insured or underinsured by the medical schemes.
It is precisely due to the current problems associated with the medical schemes that the ANC has embarked on a policy process of ensuring that South Africa reorganises the manner in which health care is financed, by introducing the National Health Insurance. It is therefore our duty to support the Minister and government in finalising the National Health Insurance policy framework and developing an appropriate model to suit South Africa.
Another serious challenge that needs to be addressed is the severe and serious shortage of professional staff, such as nurses and doctors, in the health care sector. The work nurses do is of such a nature that a hospital or a clinic would not be able to function without them. Research on nursing indicates that there is currently a shortage of well over 30 000 registered nurses in the public health care sector, with a further shortage in the private sector. In some public hospitals and clinics, especially in the rural areas, there is a 60% shortage of nurses. A shortage is also being suffered in crucial areas such as intensive care units, operating theatres, the work of midwives and mental health. Hospital care is not the only aspect that is affected by the shortage of nurses in relation to the number of patients.
There is also an additional pressure on hospital staff. An inadequate nurse- patient ratio can even lead to violence being directed against nurses. Patients who have to wait a long time for attention do not come into contact with hospital management; they only see the nurses walking past to treat someone else, and this often leads to verbal abuse and physical attacks on nurses. Nursing shortages can have a negative effect, such as an increase in work load, in deaths and in nursing turnover.
The launch of the new Nchebeko Skills Consultancy nursing college for trainee nurses in Limpopo, with branches elsewhere, including Cape Town, is therefore welcome as a step in addressing the shortage of nurses. Like in other countries, we may also have to consider the implementation of legally enforceable nurse-patient ratios as a measure to address the shortage of nurses.
Another serious concern and challenge is the critical shortage of capable doctors. Apart from there being a shortage of doctors, the question should also be asked: Where are doctors currently working and where are they needed most? Statistics indicate a serious disparity and inequality in the distribution of doctors over the country between the more affluent areas, and the poor and rural areas.
The distribution of doctors between public and private practice exacerbates the inequality further. Resources indicate that 85% of the population do not have medical aid and are reliant on public health care, whereas a much smaller percentage of doctors are working in the public health sector.
The Minister and the government have already done much to address the shortage of doctors and to prevent doctors from leaving the country, as well as attract doctors to the public sector. Some of these measures are: the introduction of a scarce skill allowance; a rural allowance; legislation aligned to boosting other forms of health care; control of the geographical distribution of newly registered doctors; and the introduction of compulsory community service.
A concern, however, is the shortage of family doctors. Fewer women currently choose the medical profession as career. Some of the reasons listed by a prominent woman doctor are: a lack of part-time training opportunities and rewarding jobs; the absence of professional locums for pregnant doctors; and a lack of child care facilities at the workplace. [Time expired.]
In conclusion, I support the Budget Vote. [Applause.]
Deputy Chairperson, hon Minister and Deputy Minister, we are profoundly conscious of the complexity of the challenges facing our health sector. We know perfectly well that no budget is enough to drastically address and reform the health services. It is therefore clear that even the current budget is not consistent with the impossible challenges, ranging from HIV and Aids, TB, noncommunicable diseases, child and maternal mortality, and infrastructure, to the training of nurses and doctors. The list is long.
According to a United Nations, UN, report, the progress of ARV treatment in South Africa is still well below the estimated need. And then, annually 500 000 South Africans are estimated to have been newly infected with TB. The conservative estimates are that there are almost 50 000 children under the age of 15 in the country who have TB.
UCT's Prof Di McIntyre revealed that 58% of the North West province's population live in rural areas, compared to the South African average of 43%. In spite of this the province has the smallest number of doctors working in the state health sector, with big swathes of rural areas having little or no access to district or provincial hospitals.
Millions of South Africans are faced with drug shortages, fraud and the collapse of public health facilities. I could not help but pay attention to President Jacob Zuma's address at the first nursing summit this year. According to the TC guide, Zuma said that the health of the nation was in the hands of the nurses and that the summit was a moment of renewal for the profession.
He further said that nurses - ... are the backbone of our hospitals and clinics and the engine of our health care system.
The three-day summit ended on a high note with the signing of a compact.
However, South Africa is desperately short of nurses. At the end of March 2010 the vacancy rate was 42%, with approximately 109 000 more nurses needed, according to the Persal system. In Limpopo and the Eastern Cape only about one third of the professional nurses' posts were filled.
According to the 2009 General Household Survey by Statistics SA, 59% of citizens use public clinics frequently. However, the attitude of nurses needs a serious overhaul. South Africa's vision of a caring government and caring society will not be realised as long as we still have nurses in public facilities who are rude, uncaring and impatient.
I would like to commend the Minister for the commitment he has made to hiring more nurses to address the shortfall. We also urge the Minister to nudge the South African Nursing Council and Africa Health Placements to speed up the memorandum of understanding negotiations. Cope supports the Budget Vote.
Hon Deputy Chairperson, hon Minister, hon Deputy Minister, my colleagues from different provinces, and hon members of this august House, it gives me great pleasure to be one of the people who will contribute to and support the health priorities of 2011-12, and also Budget Vote 16 in the NCOP.
We are meeting here today and we all have to agree with what the Minister has said, that there is an urgent need to drastically deal with the quadruple burden of disease. This is what we cannot avoid.
We in Limpopo can proudly say, in adhering to what the Minister has said, that we have already counselled 1,2 million people, of whom 900 came to be tested. These numbers will actually be increased by the fact that we have taken the campaign to the villages around the province. As has been stated by the Minister, on 12 June 2011 we were in the village of Mafefe, together with traditional leaders from all over the country. The successes of this campaign have inspired us as the Limpopo province so much that we will be continuing with the programme of HIV Counselling and Testing, HCT, in our rural villages throughout the districts of the province.
We will also make sure that we intensify our campaign in institutions of higher learning, thus ensuring that we reach all sectors of our society.
We are doing this, very well aware of the fact that we are all responsible, as we all have to know our status. In Limpopo province, in working in partnership with many of the organisations, we are strengthening the medical male circumcision campaign, distributing both female and male condoms, and making sure of prevention of mother-to-child transmission. These are some of the programmes that we are intensifying and popularising. Of course, we are conscious of the fact that, as we are doing this, knowing one's status is important.
We are also conscious of the fact that yet another problem burdens people who are infected, and that is TB, which is wreaking havoc, particularly in some of the rural villages. As a province, by way of contributing to job creation and making sure that we deal with the challenges of TB, we have bought 20 tracer cars and employed over 40 people who can trace our TB- infected people and make sure that they take their treatment regularly, as we work with the DOTS supporters. Our outreach programmes in the communities by way of making household visits, and making sure that we screen TB patients, are also yielding fruit in this regard.
In our endeavour to realise "a long and healthy life for all South Africans", we are also insisting on physical training for all our people, knowing well that exercise is one of the potential ways to prevent noncommunicable diseases. We are working very closely with a number of stakeholders and in this regard I need to say that, together with the departments of sport, arts and culture and of social development, we have taken this programme very seriously to our communities out there. As a result, we have started to identify groups, particularly amongst the elderly, that we are working with.
At the moment the internationally acclaimed soccer team, Vhakhegula Vhakhegula, who are the world champions, are our healthy lifestyle ambassadors. These elderly women are not only fit and healthy as grannies, but able to dribble and play soccer. They are also elderly women who champion indigenous food and styles of working. We are working very closely with them so that our indigenous knowledge system can improve.
This deliberate move that we are making indicates that we must move away from an expensive, unsustainable and curative health system towards a more desirable preventive health care system, as a way of achieving a long and healthy life as South Africans. I dare to say that preventive medicine is the only way to go, because it is affordable, particularly to us in the rural provinces. It is also how we can make sure that we contribute to the Millennium Development Goals.
We are aware that this system requires, amongst other things, strengthening primary health care; reducing the costs of medicine; making sure that we control infections; and increasing access to health care and many other things. As a province we went out on a campaign to make sure that we recruit as many professional staff as possible. Our infrastructure is being revamped, and we are partnering with many different organisations in a quest to make sure that we live up to some of these ideals. In this regard, we have partnered with several institutions, such as clinics, to assist and make sure that we reach out to rural communities. There are several specialists who are working with us in the rural community of Phalaborwa, and we believe that with their doing so we will definitely be able to deal with some of the challenges that we are faced with in the public sector, which include a lack of professionals.
Let me indicate that our hospital revitalisation is bearing fruit, with several of our villagers not travelling many kilometres to their nearest health centres. We also welcome the new medical school, as announced by the President, to be built in Limpopo. This is a clear indication that we can better the lives of our people. We can also safely state that, as much as we have state-of-the-art hospital facilities, there are still challenges, like a lack of medicine, basic equipment and professionals. These are some of the things that we are still faced with.
It is in this context that we as a province have decided to standardise the procurement of medical equipment, including developing a comprehensive procurement plan, so that we are able to maximise the spreading of equipment to the different hospitals. The standardisation programme will assist a great deal in making sure that our facilities are properly equipped, and that we do not send people to faraway places, which exacerbates the condition of their ailments. The same strategy will be employed in making sure that there is a stocking-up of medicines and other related things where there are shortages, so that what we are experiencing is dealt with.
A considerable number of patients found in our health facilities are brought in by our emergency medical services, which sometimes transport them through planned patient services. We as a department have made sure that we have brought all these programmes under one roof so that we can optimise the access of our people to transport. We are proud to say that our emergency services have been set up in the rural heartland so that in time of need our people can have easy help and access to them.
Similarly, we are making sure that communication in this regard becomes effective, as we are trying to network with the traffic officers and the police so that as emergencies happen we are all able to help one other. Of course, the challenges of infrastructure networks, such as digital and data networks in the rural areas, still exist. The challenge of roadwork networks is also one of the things that hamper our response time.
We have also embarked on making sure that we convert several of our ambulances into obstetric ambulances. We know that maternal and child mortality is one of the challenges, particularly in rural areas. We believe that by working together and making sure that we have the necessary equipment and human resources we will be able to deal with this. I support the budget. Thank you. [Applause.]
Dr S M DHLOMO (KwaZulu-Natal): Deputy Chairperson and members of the Council, hon Minister Motsoaledi, and two other Ministers, Minister Gigaba and Minister Mahlangu-Nkabinde, Deputy Minister, the chair of the select committee, senior officials from the national Department of Health, my colleagues, MECs, and ladies and gentlemen, I support the budget of the hon Minister, which will accelerate the programmes that have been outlined by the Minister, and will also ensure "a long and healthy life for all South Africans".
Our health workers are under attack. In the month of May we buried a member of our emergency medical rescue services, who died tragically in Estcourt after he was attacked when responding to a distress call. In the incident a young man had stabbed his parents, and the family called an ambulance. On its arrival and while our member of staff was trying to help the stabbed mother, the assailant stabbed our member to death, as well as a policeman who was also at the scene.
We have also heard the Minister and other colleagues extending condolences to the Mkhize family. This doctor was laid to rest in Durban on 11 June 2011. On the prevention of mother-to-child transmission of HIV, from 7 to 10 June, last week, the 5th South African Aids Conference was held in Durban. Opening the conference, Chief Justice Sandile Ngcobo made a profound statement. He said that we are not achieving the desired results not so much because of the stubbornness of the virus but because of ourselves.
Deputy Chairperson, in KwaZulu-Natal 20 000 children are infected with HIV by their mothers each year. However, the conference was briefed on the great strides that our province has made in reducing the rate of transmission from mother to child. In 2008 it stood at 21% and now, by improving the quality of service at our facilities, and by offering medication preventing mother-to-child transmission of HIV to women at the correct time, it has been brought down to below 3%. A number of interventions have been put in place to ensure that we eventually eradicate the transmission of HIV from mother to child. It is actually possible to have HIV-positive mothers giving birth to HIV-negative babies.
We have achieved 100% Azidothymidine, AZT, initiation for all pregnant women who have attended our antenatal clinics. However, early booking is still a challenge in many areas of the province, and I have called on all sectors to work with us in this regard.
What has strengthened this programme, however, are the following, amongst other things. There are now 470 institutions, which include 63 hospitals and 407 primary care clinics, where we provide antiretroviral drugs, ARVs, in various areas in the province, and we have 2 331 nurses who have been trained in the initiation of ARVs. Of the 1,3 million South Africans on ARVs, 459 670 are in KwaZulu-Natal, which is more than a third of the patients in the country on treatment.
A challenge that we still have, and that also contributes to maternal morbidity and mortality, is starting antenatal care very late. Our President made a call for initiation of ARVs in HIV-positive pregnant mothers at 14 weeks, and this can only help to improve this picture. Another challenge is teenage pregnancy, where some of our teenagers report it very late because of fear. In fact, World Health Organisation, WHO, guidelines mention that any pregnancy of a woman of 18 years and younger is a risky pregnancy.
The quadruple burden of disease that the Minister has alluded to is worse in KwaZulu-Natal than in any other part of the country. Therefore, we have to double our efforts in dealing with this matter.
In KwaZulu-Natal, since the launch of the campaign last year, we have tested 2,3 million people out of the target of 3 million that we set ourselves to achieve by the end of June this year. It is worth noting that we have reached an average of 78%, but there are districts that are still lagging behind. These districts are eThekwini, iLembe and uMgungundlovu. The House will also note that these are the three districts where the prevalence is above 40%. In moving forward we will intensify our campaign towards the 3 million milestone at the end of June, and our efforts will be in these three districts.
With regard to intensifying the fight against tuberculosis, TB, on 24 March 2011 our hon Minister, Dr Motsoaledi, unveiled a GeneXpert Infinity 48 machine at Prince Mshiyeni Memorial Hospital in uMlazi, Durban. That machine has to date processed 12 331 specimens with 22% positivity, and 6,5% is multi drug-resistant TB, MDR-TB. What it means, hon members, is that within a period of two and half months we now have 12 000 South Africans who know that they do or do not have TB and, amongst those, they now know that they have TB that is normal or not normal. All this information is made available on the same day as patients present their sputum. It means treatment can be started immediately. We thank the Minister for this.
In April this year the Deputy President officially opened the MDR-TB Unit at Catherine Booth Hospital in the uThungulu district near Stanger. It is a highly specialised 40-bed unit. This brings to four the number of MDR units in our province, as the King George V Hospital designated certain beds as MDR beds when we started having this problem. There is also the Church of Scotland Hospital in Msinga, where the extensively drug-resistant TB, XDR- TB, started, and the other one is Manguzi Provincial Hospital next to the Swaziland border.
On medical male circumcision, I had the great pleasure of attending the Scientific Advisory Board meeting of the Centre for the Aids Programme of Research in South Africa, Caprisa, last week, where researchers were making presentations to the board. I was elated when there was unanimity on the number of prevention methods that have been implemented by government. Scientists singled out the roll-out of medical male circumcision in our province as having opened the way for the uptake of this prevention method throughout the country. We were informed that 140 120 men and boys have been circumcised throughout the country and 25% of those, which translates to 35 000, were from KwaZulu-Natal. As we approach the June holidays, we will be having camps throughout the province to continue with the programme of circumcision.
On the Nursing Summit, we had presummit consulting in the province, which took place on 28 February, and out of the 2 000 participants in the Nursing Summit 217 came from KwaZulu-Natal. This groundbreaking summit was also graced by the attendance of our President, the hon J G Zuma, as well as that of the Minister of Health. The summit ended with the adoption of a Nursing Compact, which is a declaration of better nursing service delivery to all the people of South Africa.
On the progress of recruitment of nurses and the filling of posts, hon members, allow me to agree with the Minister of Health when he said that throughout the world nurses were the backbone of health care service delivery, and without them we could not begin to talk of any health care system. We would like to report to this House that as part of our bulk recruitment strategy we appointed 759 nursing assistants and 626 staff nurses in all districts in January and February this year. A total of 183 professional nurses were also appointed during the same period. It is with great pleasure that I also report that since April this year we have actually instituted what we call maintenance teams in all districts, and we have also asked hospitals to prioritise the filling of vacant artisan posts, as well as related support personnel.
Community health care workers are the backbone of the mobilisation committee, and we have appointed 2 567 community caregivers in the department, including community caregiver supervisors.
We are also happy to note that this year marks 15 years since the start of Cuba-South Africa co-operation with regard to the training of medical students. To date, hon members, 58 students who come from our province have graduated as doctors, and we recently sent 14 more to Cuba for training. These are students from poor backgrounds, who would not otherwise have been able to achieve their dream of being medical officers.
In ensuring that students from poor communities and backgrounds have an opportunity to study towards a health-related qualification, we have also granted 283 nursing student bursaries for two-year and three-year course programmes.
We have, among other things, also made the following appointments. Deputy Chairperson, 24 pharmacy assistants were appointed; 256 new learners commenced their nursing training for the four-year course; 342 professional nurses who are doing community service started in January this year; 26 students are registered at Pretoria University and Wits University, training as clinical associates; a group of 51 occupational therapy technicians will be trained at the University of KwaZulu-Natal; the department has 313 vacant funded basic ambulance assistant posts, which should be filled in August this year; and, furthermore, the department has ring-fenced funding of R82 million for the further training of 583 people for basic life support posts. In summary, hon members, for the period from January to date, the department has appointed a total of 5 122 personnel in various categories.
According to an update on corruption and misconduct, in the month of May alone the KwaZulu-Natal department of health suspended 20 officials to allow our officials to finalise investigations and for internal disciplinary processes to continue without hindrance. We have never suspended any official for longer than three months without starting disciplinary hearings. Currently, 47 officials have either resigned or been dismissed, or they are appearing in various courts for acts of misconduct relating to corrupt activities in the department. What is striking is that these officials are alleged to have siphoned off millions of rands of public funds from the department that could have been best utilised to train nurses and do many other things.
On the programme announced by the Minister, which we have called Make Me Look Like a Hospital, in KwaZulu-Natal, the Minister visited our province in 2009. Thank you very much. [Time expired.] [Applause.]
Hon Deputy Chairperson, hon Minister of Health, Dr Motsoaledi, hon Minister of Public Works, Gwen Mahlangu- Nkabinde, hon Minister of Public Enterprises, hon Gigaba, our hon Deputy Minister of Health, chairperson of the select committee, hon members of the House, the director-general of the department, my colleagues, ladies and gentlemen, it is my privilege and honour to be afforded this opportunity to address the House on the state of affairs pertaining to the delivery of services in the Free State, and also to respond to the Minister's call to re-engineer health care services. We support the Minister's Budget Vote No 16. I must also join my colleagues in expressing our condolences to the Mkhize family on the passing away of their son.
Today's debate takes place two days before the 35th commemoration of the historic day, 16 June 1976. The ever courageous youth of the oldest liberation movement in Africa are today still geared to liberating the oppressed and the marginalised majority of our people on the continent.
In line with the theme of the current Youth Month, which is Youth Action for Economic Freedom in Our Lifetime, the department of health in the Free State will launch a programme called Thakaneng. Amongst other things, this will involve youth activities for the current financial year. These will be as follows: the launch of the sanitary towel campaign on 21 June 2011 and Thakaneng Health Youth Indaba on 1 and 2 July 2011. These and other programmes will form part of the Youth Month activities for this year.
Our situation in regard to being responsive to the health needs of the communities of our province, our country and the world is gradually improving. We are putting in place systems that will ensure the provision of quality health care through the implementation of the 10-point plan that was presented by the Minister, and by negotiated service delivery agreements.
Our budget in the Free State stands at R6,8 billion. Of that, R2,6 billion, or 38,2%, focuses on Programme 2, which addresses district health services.
As in the rest of the country, maternal and child mortality remains a challenge to the Free State department of health. Pneumonia and diarrhoea are amongst the five leading causes of death in infants and children. The Free State department of health's maternal mortality rate for 2010 is 243 per 100 000 live births. These are deaths that occur in the facilities, and which are reported to the National Committee on Confidential Enquiries into Maternal Deaths. They exclude maternal deaths occurring outside health facilities.
The Expanded Programme on Immunisation is among the strategies implemented that have been proven to be effective in reducing infant and child mortality. Two new vaccines, against rotavirus and pneumococcal conjugate, were introduced in 2010. The Expanded Programme on Immunisation is at 90% for the province. The Integrated Management of Childhood Illnesses, IMCI, is another key strategy for the reduction of infant and child mortality. Paediatric antiretrovirals, ARVs, have been included in the IMCI to increase capacity for the roll-out of ARVs.
To combat the scourge of HIV and Aids, the HIV Counselling and Testing, HCT, Campaign was launched in April 2010. The programme is ongoing in various government activities. The Free State target for the campaign was pre-test counselling of 1 059 396 clients and testing of 957 889. The HCT policy also included TB screening of all the clients that were pre-test counselled and this means that the target for pre-test counselling and TB screening is the same. To date, three of the five districts in the province have tested more than 200 000 people each since the beginning of the campaign. However, the Free State province has pre-test counselled 946 195 people and tested 800 702 in total, of which 400 000 were done between January and May this year. This places the province at 83,6% of reaching its target. The prevalence of HIV for the Free State province is 17,5%, based on the HCT data. The province has accumulated a total of 84 325 patients who have been on treatment from the inception of the programme up to April 2011. During the period January to April 2011, a total of 10 602 adults and 1 019 children were put on treatment.
To date the province has a total of 22 operating sites for medical male circumcision. Four of the five districts have exceeded their targets and an additional 232 clients were operated on.
The programme for drug-susceptible tuberculosis is offered in all our public health facilities. The two mines at Goldfields and the Mangaung Prison are private sector institutions managing the drug-susceptible TB. The multidrug-resistant tuberculosis, MDR-TB, programme is offered in two public health facilities in the province - at the Dr J S Moroka District Hospital in Thaba Nchu, and at a facility in Welkom, where we opened the new MDR-TB unit during World TB Day. I cannot mention the other facilities at this point.
In re-engineering primary health care, PHC, services, the Free State is part of the broader process of transformation of health services, which was called for by the Minister. The service transformation plan is centred around PHC re-engineering with all its ramifications and ripple effects on other levels of care.
The province has thus far made progress in the following matters pertaining to the re-engineering of PHC. It has identified and created posts relevant to the re-engineering. We have funded posts meant for family health-based teams. We have held a workshop to conceptualise the process and market it internally to the members of top management of the department and districts. We have established task teams working on different aspects of re-engineering. We have planned a workshop for all the stakeholders and partners for the end of June 2011 - this June.
In conclusion, as we have already established the new HIV/Aids and TB chief directorate in line with the re-engineering, we have also strengthened the supply of drugs through the review of the medical depot. I believe we as a province have reached reasonable stability, in that we are at 92% drug availability. Of this, what is at 100% is ARVs, and TB and chronic medication. This success can be attributed to the review of our drug policy and the functioning of the medical depot. We thank you for the opportunity to address the House. [Time expired.] [Applause.]
Hon Deputy Chairperson, hon Minister Motsoaledi, Deputy Minister Ramokgopa, hon MECs, hon members and special delegates, allow me to acknowledge the leadership, far-sightedness and innovation of the ANC and its leaders, even from long before 1994, because it is through this innovative and caring leadership, guided by the Freedom Charter of 1956, the Reconstruction and Development Programme, and ANC policy, as well as the assistance of the World Health Organisation and the United Nations Children's Fund, Unicef, that the government has since 1994 developed and implemented a comprehensive health policy and health plan to consistently improve the health care delivery system in South Africa by focusing on access, equity, quality and sustainability in the health sector.
At the outset I really want to commend and thank the Ministry, as well as the government, for having delivered on their promises in regard to the policy and plan, despite the many obstacles and challenges still facing the health care sector in South Africa. Last year we were introduced to the 10- point plan. We have followed it and realised that it is working.
I must say that today in this House we are blessed. What shows how this Ministry is working is the fact that we have seven MECs for health in the House, and you may check, for it is a fact. [Applause.] That shows that what we want is here, that the three spheres of government should come together in this House and state what they are doing in their different provinces. We really acknowledge your presence here, MECs. It shows we are working in this Ministry, and I also thank you, Minister.
This tells me the following. When the Deputy Minister said that it was not yet uhuru, I said to myself that although it was not yet uhuru, we should assess and evaluate the tremendous progress in the health sector up to where we are today, and to understand where we are heading. For that it is also necessary to know where we come from.
As I talk on this, I also want to say to the people from the Western Cape and the DA that they should please stop talking about cadre deployment. Maybe at this time you don't really believe that Africans are capable. However, if you check the statistics and the website you will know the qualifications of the people - they are highly qualified. Our President emphasised that when we put people into positions, we must look at the qualifications. How could we deviate from that? Please! Make sure of that if you have problems. If people belong to the ANC, are affiliated to it, and are educated and qualified, should we not put them into positions just because you are going to talk cadre deployment? That is unfair. Let us remember what happened when the DA took over the Western Cape. What happened to our ANC managers there? They as senior managers were replaced with the newer liberals. Let me leave it there. [Applause.]
Hon Deputy Minister, the ANC government has inherited a society with massive disparities in access to health care, income and other things. It was the apartheid government that developed a health care system that was sustained through the years by the promulgation of racist legislation, and the creation of institutions for the control of the health care sector with the specific aim of maintaining racial segregation and discrimination in health care.
Siyakwazi lokho, sibuya khona. [We know that; we are from there.]
The health result was a system that was highly fragmented, and biased towards curative care and the private sector - ineffective and inequitable. Health care services were furthermore geared to the needs of the minority of the population and sharply divided between the private sector for those who could afford to pay and to belong to medical aid schemes, and the public sector for the poor.
But, we didn't just sit there. We in the ANC tried to address those inequities and we have addressed them. In doing so the government had to design and redesign a comprehensive policy and programme to redress social and economic injustices, to completely transform the health care delivery system, and to review legislation and institutions relating to health, with the main objective being to do the following, and we did this because of what we inherited.
We placed emphasis on health care, and not only on medical care. There was also redressing the harmful effects of apartheid health care services, and achieving health for all through equitable social and economic development. We had to develop comprehensive health care practices that were in line with international norms, ethics and standards. That had never happened before the coming of the ANC government. There was also recognising that the communities were the most important components of our health system.
One of the hon members talked about community development workers, CDWs. CDWs are not trained health workers; they have their line of march. Please ask the Minister for the Public Service and Administration for the handbook on CDWs. Whilst we expect them to assist us in our different communities, we must bear in mind that they are actually not health workers. However, they can assist us in a way.
In terms of section 27 of the Constitution of South Africa every person has a right to have access to health care services, and the state is responsible for creating the framework within which health is promoted and health care is delivered. It is also a major provider of health services and a single comprehensive, equitable integrated national health care system must therefore be created and legislated for.
Chairperson, I now turn to certain issues facing the health sector. Firstly, health problems have many complex causes, whose solutions demand an intersectoral approach. The health sector has an important role in ensuring that policies, programmes and plans in other sectors take account of health. Health in this case has been defined by the World Health Organisation as:
... a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.
Therefore, social welfare has, for instance, a major role to play in improving health status, as there are a number of areas that overlap between social welfare and health, such as violence, alcoholism, care for the elderly and services for people with disabilities.
A further challenge is the provision of adequate and equitable primary health care services in the rural areas. The need to make them accessible is of prime importance, with particular attention also to be given to improving and providing health facilities, human and financial resources, and transport.
The elderly and other vulnerable groups were neglected by an uncaring apartheid regime. Elderly Africans, particularly those living in rural areas, suffered even more. Particular attention will therefore have to be given to the development of outreach and home care services. I must acknowledge, though, that the mobile clinic service that we have in our different provinces is assisting.
Maybe I must also talk about transport and the carrying of people across the provinces. There we still have a problem, where you find that a person comes from KwaNdebele which is between Pretoria and Limpopo, but when you take the person to certain hospitals, they are turned away. For instance, if you go to Dennilton, you will be told to go to Polokwane Hospital, which is about 200 km away. We would like to have control so that our people get access to facilities near them, irrespective of which province they are in. My place is 30 km away from Limpopo and 70 km away from Pretoria, but I cannot access those services. I think we have to look into that and make sure that it works.
On HIV/Aids, hon Chairperson, ga ke sa nyaka go bolela t?e nt?i [I don't want to say much any more].
What is significant about this is to note that South Africa has the largest ARV therapy programme in the world, which has contributed to stabilising HIV prevalence. The Medical Research Council recently announced that the government's programme to prevent HIV in babies has achieved a 96,5% success rate in wiping out transmission from pregnant mothers to children.
Okusele nje ukuthi, uma lingekho ijazi lomkhwenyana, umuntu akatholi lutho. [It boils down to no condom, no sex.]
I think we have done enough.
In conclusion, hon Chair, the National Health Insurance is based on the principle of the right to health. Let us understand it in that way. There is nothing new in the visions that the hon Botha was talking about. I don't have time; otherwise I would talk about them. [Interjections.]
Lastly, I call upon all political parties and the role-players to join hands to support the Minister and government in their continued effort to transform the health sector and to improve health care delivery. I thank you. [Applause.]
Chairperson, on a point of order: I want to hear, because I didn't hear this thing. No thola, no ...? [Laughter.]
Hon Bloem, if you want any clarity on that, meet Ms Boroto outside the Chamber.
Deputy Chairperson, let me acknowledge the presence of my colleagues in the House, the Minister of Women, Children and People with Disabilities, Mme Xingwana, the Minister of Public Works, Mme Mahlangu- Nkabinde, and the Minister of Public Enterprises, Rre Gigaba. Welcome colleagues, and thank you very much.
The newly found phenomenon or slogan of "No condom, no thola [sex]" is not the policy of the Department of Health, but we welcome it today. [Laughter.] We, together with the MECs, will embrace it with both arms. Even though it has not been our policy, we will start propagating it very strongly, because we got it from this House.
Chairperson, thank you for this very powerful debate, which I think was very constructive. We agreed on lots of things, but I just want to highlight a few things, especially the issue of human resources, which was touched on by the hon Plaatjie and others. Unfortunately, he is absent, because he has left, but there are some things which have not been understood.
There is a general belief, especially among the elected members in this country, that the shortage of health care workers and doctors is a South African phenomenon. It is a global phenomenon; it is not just South African. In fact, there is a shortage of a total of four million health workers worldwide. If we want to have enough doctors, nurses and pharmacists, etc, the whole world must produce four million people. That is a big problem. Unfortunately, 80% of this shortage is in sub-Saharan Africa.
I am saying this because time and again we are told the following. The Nursing Council is very strict and it does not want people to come and work in this country. The Ministry is not making it possible for people to come and work here. The Health Professions Council must issue permits for people to come and work here. It is good to say this type of thing.
Because this phenomenon is global and not just South African, the World Health Organisation discusses it in the World Health Assembly every year. They have even passed certain regulations about what actually needs to be done. There is no Minister anywhere in the world who wants to lose health workers to another country; it doesn't happen. So, there are rules, and one of the resolutions passed is that we must try very hard not to recruit health workers from a developing country because that country will collapse.
Chairperson, I could open up the situation tomorrow for all the doctors and nurses from the African continent who want to work in South Africa. If I could do that, they would come in their thousands and I assure you of that because we have got thousands of applications. But the moment you did that, the patients would have to follow them. They couldn't stay in their countries on the other side of the Limpopo River when all the doctors had come to South Africa. So, you must understand this phenomenon, and we are trying to respect this. We are trying to respect those who are already in the country, but we can't actively recruit people. To show that this is a global phenomenon, when we debated this issue at the World Health Assembly, representatives from Canada said that if it had not been for South Africa, they would have been in trouble. That is because all their doctors were going to the United States. It means that the richer the country is, the more doctors it gets. Doctors from Canada were migrating to the United States, while Canada was making use of South Africa to fill up that space. Now you want us to make use of the whole African continent to fill our space - but they are still developing countries. Instead, we must have our own home-grown staff.
Firstly, we started by calling for the Nursing Summit in order to discuss the issue of the training of nurses in order to increase their numbers. Secondly, with regard to doctors, we started with mid-level workers. In that regard, I want to thank the Walter Sisulu University for being the first university in the country which has produced mid-level workers - there are 22 of them - and we are encouraging other universities to follow. These are workers who are trained for four years and will work somewhere between nurses and doctors to help in situations where there is a lack of doctors. We want other universities to start doing that.
In addition, we spoke to universities on this matter only two weeks ago. We started with Wits at the beginning of this year. We asked them to take 40 more medical students than they usually do. We gave them money to do that, R8 million. They took 40 more students than they usually do, and that R8 million is to help them to expand that programme. I have spoken to the deans of all the medical schools, and they said that we should give them eight weeks to report back to us, because we want all of them to implement this next year, so that we can have our own home-grown personnel. It doesn't help to believe that we can just allow other countries to train personnel and we will take them from them.
Lastly, one of the reasons why we are working with the Minister of Higher Education and Training is to effect the demerger of Limpopo University and Medunsa, because we want Medunsa to be a standalone university and train more and more doctors, and Limpopo to get a new medical school. This is so that we expand institutions rather than merge them and decrease, because we want to grow our own doctors.
With regard to medical male circumcision, many MECs have mentioned the hospitals where this is happening. At Chris Hani Baragwanath Hospital in Gauteng they do 50 circumcisions a day, more than in any other part of the country and they originally invited me to launch that. I would just like to call on the MECs, colleagues, to let every hospital do at least a few circumcisions per day. Every hospital can do that. There is no hospital in the country which can fail to do that. I mean it is one of the biggest weapons in the fight against HIV and Aids.
In fact, in KwaZulu-Natal the MEC challenged general practitioners in this regard, and because I was addressing some of them last week, I also gave them a challenge: If every general practitioner, every person in private practice, every doctor, as a contribution to society, could do just one free circumcision a day, we would be getting somewhere. So, I am asking the MECs to challenge private practitioners in their own ... [Inaudible.] ... to do just one circumcision a day as a contribution to society. It would go a long way in helping us.
With regard to the Office of Standards Compliance, which you will very soon debate in this House, we have chosen six standards which every hospital must comply with: cleanliness, attitudes of staff, safety and security of patients, infection control, the long queues and drug stock-outs. These are the standards we want to enforce. [Applause.] The Bill to establish the Office of Standards Compliance will very soon come to this House. The Treasury has already given us R116 million in this current financial year to establish the office that will make sure that these standards are actually complied with. Thank you, Deputy Chairperson. [Applause.]