Chairperson, fellow Cabinet colleagues, Deputy Minister of Health and other Deputy Ministers, hon members of the House, distinguished guests, ladies and gentlemen, it's a great honour and privilege to present to the House the national Department of Health's policy priorities and budget for the financial year 2011-12 for its consideration.
I am presenting 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 worse than it is now. The choice lies with us as South Africans in general, and as elected leaders in particular.
Last year I signed a performance agreement with the President, what we call a "negotiated service level agreement". According to this agreement the health sector must provide four identifiable and measurable outputs with the ultimate aim of ensuring a healthy life for all South Africans.
Over and above these four identifiable outcomes that we have set ourselves to achieve, we also have a Ten Point Plan, which I presented to this House in 2009. This plan further guides us on how to go about achieving our outcomes.
Extensive studies commissioned by the prestigious British medical journal The Lancet but conducted by our own scientists and researchers in South Africa, have clearly revealed that South Africa is going through four major pandemics. Put differently, the country is faced with a quadruple burden of disease. It is important for members to understand what these four pandemics are in order for them to understand how we arrived at the outcomes agreed upon with the President.
The first, most severe and extensive burden or pandemic is that of HIV/Aids, and the second is TB. The second results in unacceptably high, and I emphasise "unacceptably high", maternal and child mortality rates.
The third is the alarming and ever-increasing incidence of noncommunicable diseases, that is, high blood pressure and other cardiovascular diseases, diabetes mellitus, chronic respiratory disease, various cancers, and mental illness.
The fourth and last is the one that every South African knows about because we worry about it on a daily basis, and that is because the media, both print and electronic, have taken it upon themselves to speak about it on a daily basis. That is the pandemic of violence and injury.
If only all four pandemics could be spoken about together on a daily basis, that would be a very good start for our country. Yes, I do accept that some of the media and members of the public talk a lot about child mortality. They do not do so, however, with an interest in helping our country to achieve solutions to the four pandemics that our country is sadly faced with. They do so as an instrument with which to attack individual public hospitals and individual health workers in the form of witch hunts. Of course, this is not helpful in our daily search for solutions for our country.
Having said so, I must say that these four pandemics are occurring in the face of a reasonable amount of health expenditure as a proportion of the gross domestic product, GDP. Available evidence indicates that we spend 8,7% of the GDP on health, the bulk of which, as is commonly known, is unfairly spent in the private sector.
This expenditure is significantly more than that of any other country on the African continent and in some instances even of countries outside our continent. A serious anomaly here is that our health outcomes are much worse than those of countries spending much less than us.
Evidently there is a very serious underlying problem that needs our attention. The effects of our burden of disease are clearly aggravated by inequitable distribution of human and financial resources between the public and the private sectors, in which resources are seriously skewed in favour of the private sector. The private sector serves only 16% of the population, in contrast to the public sector, which serves a whopping 84% of the population.
I will now go through these pandemics one by one because I want each and every member to understand fully what our country is faced with.
The first pandemic, as I have said, is that of HIV/Aids and TB. If I were to summarise it, I would say that South Africans make up only 0,7% of the world's population, but we are carrying 17% of the HIV/Aids burden of the world. We have the highest TB infection rate per population and our TB and HIV coinfection rate is the highest in the world, at 73%. A total of 35% of child mortalities and 43% of maternal mortalities are attributable to HIV and Aids. One in every three pregnant women presenting at our public antenatal clinics is HIV-positive.
Surely this needs very serious and extraordinary measures. Hence the announcement by the President, on World Aids Day in December 2009, came as a big relief to many people who are given the responsibility of fighting this illness. These measures of starting antiretrovirals, ARVs, when the CD4 count is 350 or less in pregnant women and HIV and TB coinfected people; of starting prevention of mother-to-child transmission, PMTCT, at 14 weeks rather than 28 weeks; and of treating HIV-positive newborns regardless of CD4 count, have gone a long way in reversing the tide of HIV/Aids. We started these measures in April 2010.
We are looking forward to a day, not very far away, when commencing treatment at a CD4 count of 350 will be universal and not only for specific target groups. This is imperative in the light of the newly released research findings that starting ARVs very early has huge benefits for the prevention of HIV infection and for protecting individuals against TB.
Before these new measures were implemented, the scenario as of the end February 2010, which was the end of the last financial year, was as follows: Only 490 health centres were then able to provide ARVs as accredited ARV service points. I am very proud to announce that the figure has grown to 2 205 health care centres providing ARVs. This has increased access to treatment in a manner unimagined just over a year ago. Our target is that all 4 000 health care outlets should be accredited as ARV centres by the end of the year.
Only 250 nurses were certified to provide ARVs by February last year. I am proud to mention that the number has now grown from 250 to 2 000 nurses who are certified and trained, further increasing access. Our target still remains 4 000 nurses to be certified by the end of the year.
Before the HIV counselling and testing campaign, HCT, was launched by the President on 25 April 2010 at Natalspruit Hospital, only 2 million South Africans were being tested annually. I am very happy to mention that since the launch of the campaign only a year ago, 11,9 million South Africans have already been tested and the figure is growing every month.
Many South Africans want to know their status. We will, therefore, take the campaign further. I wish to announce that on 12 June we will, together with the National House of Traditional Leaders and the Congress of Traditional Leaders of South Africa, Contralesa, launch a massive HIV counselling and testing campaign at village level. The launch will be at Mafefe village in Limpopo. Before the campaign, as at the end of February 2010, we had 923 000 people on ARVs and now, due to the campaign and the increase in access made possible by the expansion programme I mentioned earlier, 1,4 million people are on treatment.
We have been able to reduce the prices of ARVs by 53%. The significance of this is that we can now expand coverage of treatment and put more patients on treatment. As we achieve universal coverage at 350, it means that a further reduction process will be necessary.
As part of our programme to expand treatment, and in an effort to reduce the burden of HIV/Aids and TB, we will be providing treatment to inmates in all our Correctional Services institutions, who have been diagnosed and put on HIV/Aids and TB treatment. We will be working with the Department of Correctional Services and have already signed an agreement in this regard.
I have time and again expressed my worry about and regret at the number of newborns who are born HIV-positive. It is a big strain on our emotions and the psyche of the nation, and it causes untold problems in the health care system, as I mentioned earlier.
I am extremely excited to inform you that in the next few days, at the HIV conference in Durban, the Medical Research Council, MRC, researchers will release figures that show that there has been a significant reduction in the transmission of HIV/Aids from mother to child by six weeks post delivery. They reveal that a reduction of 50% transmission has been achieved. Of note is the significant reduction in the province of KwaZulu- Natal because of the very effective PMTCT programme there. This is to be celebrated, because it is a first sign that by 2015 we may be able to eliminate the phenomenon of mother-to-child transmission of HIV.
On 24 March 2011, World TB Day, I announced our three-pronged strategy to deal with TB. Firstly, we have acquired the new GeneXpert technology. This total revolution in the diagnosis of TB is the first breakthrough that has been developed after more than 50 years of relying on microscopy and cultures.
With the GeneXpert technology, diagnosis of TB takes only two hours. It used to take up to a week. Whilst the microscopy method has served us well for the past 50 years, its sensitivity was only 72%, meaning that 28% of people with TB could be misdiagnosed or missed. The sensitivity with GeneXpert is 98%, meaning that we may only miss 2% of the diagnosis. Moreover, it used to take us at least three months to know that a patient had multidrug-resistant TB, MDR-TB. Now we are able to know that within only two hours.
We have distributed 30 of these machines in districts that have high case loads of TB. We will be rolling these out to every district in the next six months and to every facility in the next 18 months.
The second strategy that we have implemented is that of active case-finding for TB. Starting in February this year, we have put together teams of five people each to trace TB contacts, that is, to visit families of patients on our database who are being treated for TB. There are 407 000 such families in South Africa and all of them need to be screened for TB, in the light of our knowledge that every TB patient has the capacity to infect 15 others in his or her lifetime.
I am happy to announce that since we started these household visits in February this year, we have already visited 41 000 families and screened 112 000 people. Our aim is that by World TB Day next year we will have visited at least 200 000 families.
It is important for me to disclose that in the past, before the advent of GeneXpert technology, when tracing TB contacts and screening them using ordinary microscopy, as we have been doing for the past 50 years, we would detect between 2% and 7% of TB in the screened population. Since the introduction of GeneXpert in March this year, we are now detecting 18% of TB cases.
The simple fact here is that we have been underdetecting TB, even when it was there. This means that we are now putting more people on treatment early on and reducing the pool of infective people. This also means that we stand a better chance, more than ever before, to turn the tide of TB.
We know that it will mean more money from the fiscus, as happened with HIV/Aids, and more work for health workers in the initial stages. However, in the long run the amount of money needed and the demands on health workers will be markedly reduced.
This, then, is the miracle brought to us by GeneXpert technology and house visits. May I add that we are the first country in the whole of Africa to have acquired this technology. [Applause]. Yes, you can applaud! It's not illegal! We wish to thank the World Health Organisation, WHO, for making it available to us and the United States Agency for International Development, USAID, for helping us to acquire it.
The third strategy against TB is that we have unveiled nine specially designed MDR-TB hospitals using technology from the Council for Scientific and Industrial Research, CSIR. These hospitals, at least one per province, have been made possible by a generous donation of R100 million from the Global Fund.
The design markedly reduces the chances of health workers, particularly nurses, being infected with MDR-TB by their patients. Unfortunately, patients have to stay in these hospitals for 18 months. Hence, it is imperative that we increase our household visits so that we stop TB from spreading and prevent our people from developing MDR-TB.
A lot has been said about the high maternal and child mortality rates in our country. You will have noted that most of our interventions in HIV and Aids are directed at pregnant women and children. We will work hard to reduce these mortalities in these targeted groups.
Remember that maternal mortality is not just the death of a woman; it is the death of a woman because she dared to fall pregnant! She becomes vulnerable by bringing somebody into this world!
We know that the mortalities brought about by HIV/Aids are disproportionately affecting young women of childbearing age more than men. This can't be right. It leaves the country with lots of orphans. We now have no less than 1,3 million orphans in our country, and most of them are maternal orphans.
This type of situation cannot be allowed to go on. It has other negative societal consequences beyond health care, such as crime, poor educational outcomes, teenage pregnancies and abortions, and the total social disorientation of young husbands. It is a well-known fact that young husbands lose direction in life if they lose their partners early on.
This does not happen to women, of course. Female partners are known to have a stabilising effect on the lives of young people. South Africa is fast losing this social stability due to the high maternal mortality rate which, according to evidence at our disposal, affects young women more than older ones. We will have to run a serious campaign on immunisation.
We also know that breastfeeding is a time-honoured strategy in child survival; medical science has proven that. For this reason, we will call together a big summit on breastfeeding in August this year.
The issue of noncommunicable diseases is very seldom spoken about in our country, and it's our third pandemic. It is also not very clearly understood, even though it preceded HIV and Aids by several decades. This is because HIV and Aids came as such a shock to the whole nation, to the extent that many strong civil society groups were formed.
Last week I tried to bring this issue of noncommunicable diseases to the attention of members of the Portfolio Committee on Health, but unfortunately some people in the media got excited because they thought I was specifically raising the issue of the dietary behaviour of Members of Parliament! [Laughter.] It is, therefore, very important for me to explain this matter clearly in order for Parliament to understand.
Noncommunicable diseases, generally referred to as NCDs, are diseases that are not propagated by germs moving from one person to another. In fact, it is safe to say that the "germ" that propagates NCDs is the human being!
I am saying so because NCDs are not only biomedical; they are largely diseases of lifestyle. These are divided roughly into four categories: high blood pressure and other diseases of the heart and blood vessels; diabetes mellitus and a few other metabolic disorders; chronic respiratory diseases and asthma; and cancers. Let me not forget mental illness. I am adding to these the increasingly high incidence of mental illness.
These diseases are driven by four identifiable risk factors. They are smoking; the harmful use of alcohol; unhealthy eating behaviour, that is, diet; and lack of physical activity. If these four risk factors and related unhealthy behaviours were removed, the world would be a safer place to live in.
The question is: Just how serious is this problem of noncommunicable diseases? Is it global, or is it only in a few countries? Well, the answer is it is a fast growing global phenomenon and becoming more devastating in sub-Saharan Africa because it is adding to the already existing problems of communicable or infectious diseases that have been plaguing Africa for centuries.
So serious is the issue of NCDs that the WHO and the UN called all Ministers of Health to Moscow on 28 to 29 April 2011, for what was called the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control.
The outcome of this conference was a document formally referred to as the Moscow Declaration. I have decided to make copies of this declaration available to members. Even those in the public gallery must get copies of this declaration. It's important for humanity.
In summary, the Moscow Declaration deals with the following issues. It notes that policies that address behavioural, social, economic and environmental factors associated with NCDs should be rapidly and fully implemented. It further emphasises that prevention and control of NCDs require leadership at all levels. It recognises that a paradigm shift is imperative in dealing with NCDs, as NCDs are not only caused by biomedical factors, but also influenced by behaviour.
The Moscow Declaration says that the rationale for action is that, worldwide, NCDs are important causes of premature deaths, striking hard at the most vulnerable and poorest populations. Subsequently they impact on the lives of billions of people and can have a devastating financial impact that impoverishes individuals and their families, especially in low and middle-income countries.
It goes on to state categorically that examples of cost-effective interventions to reduce the risk of NCDs, which are affordable in low- income countries and could prevent millions of premature deaths every year, include measures to control tobacco, reduce salt intake and reduce the harmful use of alcohol.
It says particular attention should be paid to promoting a healthy diet; that means low consumption of saturated fats and transfats, salt and sugar, and high consumption of fruit and vegetables and physical activity in all our daily living.
According to the Moscow Declaration the control and prevention of NCDs needs the whole of government at all levels. Lastly it states that the effective control and prevention of NCDs needs the active and informed participation of leadership, individuals, families and communities, civil society, the private sector and, where appropriate, employers, health care providers and the international community.
It is with this as background that I mentioned this issue to Members of Parliament last week. Unfortunately they said I was mentioning it because there's some gravy train activity going on in Parliament. I want to state that this is a very serious matter, and it can't be turned into a circus.
Just to demonstrate what I'm talking about, let me give you a few figures. In South Africa, for instance, out of 100 percentage points, the following points have been allocated by the MRC as risk factors in diseases. It says that as a risk factor unsafe sex is allocated 31,5 points; interpersonal violence, 8,4 points; alcohol harm, 7 points; tobacco smoking, 4 points; excess body weight, 2,9 points; childhood and maternal underweight, 2,7 points; unsafe water and sanitation, 2,6 points; high blood pressure, 2,4 points; diabetes, 1,26 points; high cholesterol, 1,4 points; low food and vegetable intake, 1,1 points; low physical activity, 1,1 points; etc.
Sometime in 2009 members of this Parliament questioned me about renal dialysis for people with kidney failure. A wrong debate about why government does not increase the number of dialysis machines in public hospitals ensued. This is the wrong debate. It is no different from asking why government is not increasing the number of mortuaries in our country because they are in demand. The intelligent question we should be asking is why so many people need dialysis.
In Gauteng alone the total number of patients on chronic dialysis is 561, with 238 on the waiting list. This is in a province that is regarded as being well-resourced. What happens in the other provinces? A single patient on dialysis will cost R150 000 per annum in the public sector and about R300 000 in the private sector. Moreover, these patients have to be in hospital three times a week for a minimum of four hours a day, whether they are employed or not.
What causes this? We know that in 40% to 60% of people with end-stage renal failure, it's 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 a high salt intake. So, instead of demanding more dialysis machines and subsequently demanding new kidneys, to the extent that the rich are trying to concoct schemes to steal kidneys from the poor - as happened recently in our country - we must reduce the prevalence of hypertension by eliminating the risk factors.
The need for targeting tobacco and alcohol has already been outlined. No matter how much noise financially powerful people and institutions make about it, I can stake my life on the fact that we are going to fight with our bare knuckles to achieve this, particularly with a ban on the advertising of tobacco and alcohol. This is the point of no return, and the sooner the tobacco and alcohol industries understand this, the better. There's no way of pulling back. [Applause.]
In South Africa the average consumption of salt is 9,8g per day, when physiologically you need only 4g to 6g. So, we are consuming more than twice the required amount. In Britain they have taken the lead; since 2006 they have reduced the salt content in foodstuffs by 40%.
In South Africa scientists have demonstrated that if we reduce salt in just one food commodity, eg bread, we will save 6 500 lives per annum. In Britain, in just the second year of a reduction of salt intake by 10%, they saved 6 000 lives and saved ?1,5 billion sterling.
Another issue which is extremely important and ranks at No 5 on the MRC list - after unsafe sex, injuries and violence, alcohol and tobacco - is high body mass index or excess body weight. This, coupled with a lack of exercise, which is ranked as risk no 12, is very important.
It is an international problem, so it is not only in South Africa. It is a fast-growing phenomenon. In South Africa, it is increasing amongst school- going children. In 2002 only 17,2% of schoolchildren were regarded as overweight, but now it is 19,7%. This means that those who moved from being overweight to being obese were 4% in 2002, and they are now 5,3%.
What this means is that at present 23% of schoolchildren can be classified as either obese or overweight. This is fast approaching a quarter of the school-going population! Consequently there will be a devastating impact on the population.
In the general population the National Income Dynamic Study shows that 60% of women and 35% of men are either obese or overweight. If you consider women over 37 years, the figure rises to 70% of women who are classified as either overweight or obese. This is why the Moscow Declaration is so important.
Let me give just one example from Australia. They have agreed to ban advertising of foodstuffs on free-to-air TV from 18:00 to 09:00, and 16:00 to 09:00 on weekdays. On weekend mornings, when children tend to watch more TV, they have banned it from 06:00 to 12:00. On children's programmes, like cartoon networks, they've banned advertising of foodstuffs altogether. Eighty-six per cent of Australians agree with this. [Applause.]
On the issue of injury and violence, Unisa, together with the MRC, has proved that when we talk about Arrive Alive, we talk only about those who have died. They have also proved that for every person who dies of their injuries, 30 more are hospitalised and 3 more are treated for less serious injuries and discharged. They further state that, depending on the cause, severity and circumstances of the injuries, many of these result in varying degrees of physical, psychological, educational, social and economic disadvantages.
I know that many people believe that my speech will not be complete until I have spoken about the National Health Insurance, NHI. There are two groups of people in this case. There are those who are very concerned, and legitimately so. There are also those who are driven by a greed that would shame even the devil, and who believe that they can do anything in their power to stop the NHI. I just want to mention that we haven't stopped; we are very busy with it.
The present health care system, whether public or private, can be identified by four very clearly identifiable negatives. Firstly, it is extremely unsustainable; secondly, it is very destructive; thirdly, it is extremely costly; fourthly and lastly, it is hospicentric or curative.
We are going to make sure that we re-engineer the health system so that its is in three basic streams - at the district level, in the community and at school level. I will give you the details later.
Hon Minister, your time has expired.
Can I just then request the House to adopt the departmental budget for 2011-12 amounting to R25 307 554. Thank you. [Applause.]
Hon members, we thank the Minister in particular for making us aware of obesity. We fight the same battle in karate.
Chairperson, hon Minister, Deputy Minister, I see there are a lot of people from the various entities that have to do with health. We welcome them. I see there are deans, and the chairperson of the Health Professions Council of South Africa, HPCSA, is also here.
Director-General, this is probably the first budget that the ANC feels must be passed and this is the first time that you are here with us. We hope that you are going to handle this budget very well. We congratulate you on being appointed as the Director-General for Health, and we welcome you.
Let me start from the beginning. We are overseeing a department that I think is very important. It is important in the sense that for all of us here and all over the world the first entry into this world is through health, and we exit through health. The health workers and the department are trying to increase the gap between this entry and exit.
If you want to do it well, it obviously has to be done by people who are honest, humble and passionate, and who work with integrity. If you happen to make a mistake, obviously you shorten that gap between the entry and the exit.
Last year we voted a certain amount of money to the department and gave them the money under the umbrella of hope, hope that they were going to do the things they promised to do. I must say, we commend the department and its leadership because they did exactly what they said they were going to do. We therefore commend them and we are happy with how they have done things.
We have seen drug prices drop, especially the HIV/Aids antiretroviral drugs, and I am sure all of us have seen that.
We have seen medical schools getting more money to make sure that we produce more doctors, nurses and health workers. We have seen Medunsa becoming a stand-alone university, as against combining with another university; and a new medical faculty is going to come in Limpopo.
We have seen plans to upgrade five big hospitals, including Mthatha General Hospital. I am not going to mention the other hospitals because of time constraints. We have seen hospitals and clinics being built, including a multidrug-resistant TB, MDR-TB, hospital in KwaZulu-Natal.
We have seen people coming for testing for HIV and Aids without fear because of the HIV counselling and testing, HCT, campaign that has been started by the department. We have seen HIV-positive patients, babies and mothers with CD4 counts below 350 getting ARVs. While we applaud the fact that they are being treated, the most important thing, other than the treatment that they are getting, is that those people who are on ARVs have found that their viral load has dropped so low that they can't infect the people they go out with. We have seen primary health care being prioritised by the department and, in fact, being re-engineered. In KwaZulu-Natal, we have seen people walking from house to house doing primary health care. We have also seen the impact of GeneXpert, which the Minister was talking about. All these things are being done by the department on the budget that we have given them, and that is why we commend the department.
We have seen the Nursing Summit, which was hosted here in South Africa, boosting the morale of the nurses and making them want to stay in South Africa, probably contributing to a very high morale regarding what we are doing in South Africa.
We have seen the auditing of the chief executive officers, although we have not received the reports and audit results in regard to the nursing colleges in South Africa. We therefore again commend the department.
Though we are happy with the budget that we gave the Minister and the department, we are not oblivious to the fact that we are still faced with huge challenges, and these are obviously known to others. These challenges include the quality of our health care, and there is still a lot that needs to be done, but we know that the department is doing something about it.
The child mortality rate and the challenges that go with it are still very big challenges. The maternal mortality rate and the burden of tuberculosis, TB, HIV and the noncommunicable diseases that we talked about are very big challenges. The bottom line in all these things is that if we can have universal coverage - it is going to cover everybody - that will help us to make sure that everybody is covered and all these challenging things are going to be sorted out.
We have seen human resource shortages, especially in the rural areas, Mr Minister - I'm sorry, I nearly said Madam Minister ...
Let's forget the past.
I have forgotten the past. We have seen universities trying to help with regard to these shortages.
There is one challenging aspect, which is the interface between the public and the private sectors. We have not done very well in looking at the private health care system, but this is something that we probably have to work on; not in a bad way, but in a way that makes sure that everybody gets coverage.
There is another challenge, Minister, which I think we should have a policy on. We talk about resistance to the antiretrovirals, but we should consider the resistance to antibiotics. It is so easy for every doctor to prescribe antibiotics, but that causes a problem for the whole country. In fact, I include myself; if somebody tells me that they have flu, it's so easy for me to prescribe antibiotics. We are going to reach a stage where we are not going to have any antibiotics that work in South Africa if we don't develop a policy.
Even the veterinary surgeons need to assist us, because they give antibiotics to animals, we eat the meat of those animals and so we end up eating the antibiotics. When we make that policy, we should make sure that we combine it with a policy for veterinary surgeons.
Madam Chair ... [Laughter.] ... another challenge is that of the traditional healers in South Africa. [Interjections.]
Order! I am not "Madam".
Okay, maybe I like 50% and I go by 50%, so I like the "Madams"!
Chairperson, another challenge is the traditional healers. I am not going into details about the traditional healers. I am just going to say two things about them: Firstly, we as a committee need to call them in, because we need to understand the way they operate. I want to say that a big percentage of South Africans are consulting them, either "Nicodemusly" or during the day. A lot of us are consulting them.
The reason why I want to talk about them is the fact that, while conventional or Western medicine is my background, I am a descendant of Sotjhenge, of Malalaza, of Sibakhulu, of Dlamini, of Solomon. On the other side, I am a descendant of Khuboni, of Bhele, of Langa and of Nodoli. I mention these names because they lived before 1652. Before 1652 there were no conventional medicines or Western medicines. [Applause.]
You can't tell me that in those times people didn't become ill; they became ill at some stage. The fact that I am here standing in front of you today means that somebody treated them well at that particular time. That is why I am standing in front of you and, if that is the case, it means there are good traditional healers. The question is: Do we know the good ones and do we know the bad ones? I think that is the challenge. [Applause.]
Chairperson, when you get solutions to a problem, the solutions usually present a challenge after that. It should not be a question of not acknowledging the solution, even if there are challenges brought about by the solution.
What I want to say is that the child and maternal mortality rates have increased in South Africa; what they aren't saying is that the statistics we have today cover each and every corner, unlike during apartheid times when the statistics were only for the homelands, when they wanted to bring things down. We cover every area in a very honest fashion.
What they say is that there is a shortage of personnel in our institutions, but what they don't say is that the personnel that we train are so good that they are wanted by the whole world, especially the developing countries.
What they do not say is that because of the good clinics and hospitals that have built, we have outgrown the number of personnel required there. It does not, however, mean that we are not actually handling that situation.
What they are saying is that in 17 years very little has been done by the ANC. But what they do not say is that 17 years is not even a quarter of 300 years of indignity, dispossession, dehumanisation and oppression.
That compels me to say: Let's not be derailed by those who do not recognise the challenges we are trying to sort out, but let us be focused and endeavour to make sure that we go forward. I want to say that I am a descendant of Dlamini. Thank you. [Applause.]
We thank the hon Dr Goqwana, who has reminded the House about many things, including our roots.
Thank you, Chairperson. It is very refreshing to have a Minister who is passionate about health and has his finger on the pulse. I have been on the committee for several years and I come from, if I may call them that, the "dark days" when we were on the Health Committee. So, I would say it is really refreshing, hon Minister.
I would like to welcome the appointment of the Deputy Minister. We have not actually formally met, but welcome, Deputy Minister, and we wish you all the best in your position. Also to the director-general, DG, sitting behind me, welcome DG, and congratulations on your appointment to the department.
In last year's budget speech I raised the issue of the dire financial situation many provincial health departments find themselves in. It is still unclear if there has been any improvement in the situation.
We hope that the Minister can shed some light on the matter as to why there is a need for the stabilisation fund, and which provinces will be benefiting from it. We need to know how the situation is being managed, and obviously we need complete transparency in this regard.
Hopefully the chief financial officer, CFO, will now be appointed permanently and not simply act as CFO. I think she has been the acting CFO now for about two or three years, Minister.
Today I will speak on a few of the pandemics the Minister raised in his speech; unfortunately, due to time constraints, I will not be able to touch on all of them.
Our country's Achilles heel is now undoubtedly our shocking child and maternal mortality figures, which the Minister has mentioned. Our inability to save the lives of mothers and children is an indictment of the way we have prioritised the Millennium Development Goals, MDGs, since they were first set some 11 years ago. When one in 10 children will not live to see their fifth birthday, it must surely set the alarm bells ringing, and serious questions need to be asked as to why a country with our infrastructure and budget will in all probability fail to meet our Millennium Development Goals, while countries with far fewer resources have left us wanting, and will reach their goals.
In 1998, our under-5 mortality rate was 59 per 1 000, or 5,9%. In 2010, it rose to 104 per 1 000, or 10,4%. That is a massive 76% increase in the very period when we as a nation were supposed to be working tirelessly towards reducing child mortality and achieving our MDG target. Our target, by the way, is 20 deaths per 1000 - that is 2%. This means that our current child mortality rate is five times higher than it should be!
The situation with regard to maternal mortality is far less certain, simply because 11 years into the MDG programme we still have not determined a uniform measuring tool for maternal mortality. The most obvious course of action would have been back in 2000 to have established how we were going to measure our maternal mortality rate in order for us to track our progress and monitor our interventions. Without a standardised measuring tool one wonders how the government was going to measure with any level of accuracy whether we were on track to meet our goal.
According to our own country's report, our maternal mortality rate has increased from 369 deaths per 100 000 live births in 2001 to 626 deaths per 100 000 in 2007. This is a 70% increase. Our country's target is 38 out of every 100 000 deaths. So, we are currently at 16 times higher than that rate. While the department may dispute the figures in the country's report, saying it is not as high as 626 deaths, we do not know what the actual figure is.
Why are we facing such a dramatic increase in child and maternal mortality rates? When the Minister came before the Portfolio Committee on Health last week - and today he has repeated a lot of what he said to us - it was clear that the department sees HIV/Aids as one of the main reasons for increased child and maternal mortality.
It is evident that the number of people dying in their prime between the ages of 20 and 40 years is increasing year on year, and that the majority of these people are women. In essence, HIV/Aids is a gender-biased disease; it affects more women than men.
The Minister also attributed the doubling of the number of deaths in South Africa over the past decade to Aids and stated that there were roughly 1 000 deaths per day due to HIV/Aids.
Let me be clear when I say this. Individuals must take responsibility for their own health, and remaining HIV-negative is one such responsibility. Similarly, if a person is HIV-positive, then living a healthy lifestyle too is that individual's responsibility.
However, one has to look deeper in order to understand why it was that the HIV pandemic managed to obtain such an iron grip on our country, and why so many people not only became infected, but ignored sound scientific evidence. Unfortunately you do not have to look too far. Do you all remember the decade of denialism? [Interjections.]
HON MEMBERS: Yes!
The decade of denialism is not the only reason for the spread of HIV in South Africa, but it certainly was one of the major contributing factors, which we live with today.
Do you remember when the President of our country questioned the link between a virus and a syndrome; when the Minister of Health said - no, not you, Minister, the previous Health Minister - that ARVs were poisonous; and when concoctions of lemon juice, beetroot and garlic were promoted instead of approved medicine?
Say something new.
Someone who remained silent during the decade of denialism has got a mouth now!
Every quack in the world was allowed to promote their deadly, untested potions with impunity.
I remember, and so many of you in this House remember that. We must never again be intimidated into silence as we were during the decade of denialism. Never again! [Applause.] So, I am glad to hear hon Turok has found his voice.
We are now witnessing, at first hand, the consequences of this denial in the 1 000 deaths per day, and the increased child and maternal mortality rates. Our health system is creaking under the additional pressure placed on it, and it is simply not coping.
In addition, we now have, according to the government's own report, 2,1 million maternal orphans. I know the Minister mentioned a figure of 1,3 million. Whether it is 2,1 million or 1,3 million, the figure is a disgrace!
We have 870 000 double orphans, meaning that they have lost both mom and dad, in this country. While nothing will bring back the hundreds of thousands of people who have died from Aids, an apology and recognition of our failures would be a start. There is great relief that the decade of denialism is over and that sound, proven scientific evidence is the order of the day.
While recognising the immediate past, we must now as MPs and society as a whole, join hands in combating the scourge once and for all through supporting the efforts that the Minister has mentioned here today, and what the department is trying to achieve in breaking down the walls of stigma and ignorance. As I have said, we must never again be intimidated into silence.
Minister, the DA welcomes the initiatives announced by the President on World Aids Day last year, and would encourage the department to look at the recommendations of the latest report, which we alluded to, that suggest that by hitting hard and hitting early, we can combat the scourge of HIV/Aids.
Another consequence of the HIV pandemic is that of tuberculosis, TB, which the Minister has also mentioned. It has become the biggest natural killer in South Africa. Today we have one of the highest rates of TB in the world, with over 74 000 people dying of TB in 2008, up from 22 000 dying of TB in 1995; that is a 339% increase.
It is estimated that over 480 000 South Africans are infected with TB and that we have 28% of the world's population with dual HIV and TB infections. In general, South Africa is not succeeding in getting TB under control, which is clearly demonstrated by cure rates which remain below the World Health Organisation, WHO, target of 85%.
A progressively increasing incidence and prevalence of multi-drug-resistant tuberculosis, MDR-TB, and extensively drug-resistant tuberculosis, XDR-TB, are also reported. If cure rates are not at least 85%, then the residual untreated TB that exists in communities will spread to more people. Rather than seeing that it is brought under control, what we are doing by not having a cure rate of 85% is basically breeding TB! We are not curing it.
There are many factors that need to be addressed in order to improve cure rates. One important one that South Africa is addressing quite well is the detection rate, which the Minister has alluded to. South Africa also has good treatment regimes and good approaches to the isolation and treatment of TB, and MDR-TB and XDR-TB.
Where we are weak is in treatment adherence support. The WHO gold standard is Directly Observed Treatment, DOT, which South Africa has implemented relatively well. However, despite good DOT coverage, we are not seeing improved outcomes. Many agree that this is because patients do not take their medication correctly and do not complete their courses.
Government has invested heavily in infrastructure development, for example, the new TB hospitals which the Minister mentioned. However, these hospitals focus on treating the failure of TB control and do little to improve broader cure rates.
The DA believes improving cure rates rests primarily on improving treatment adherence, which requires two fundamental areas of investment: better, which is not only training but far more regular, meaningful mentoring; and building better relationships with patients.
In conclusion, I reiterate the DA's commitment to fighting HIV and the associated consequences. I thank you very much. [Time expired.] [Applause.]
Chairperson, Ministers and Deputy Ministers present here, and hon Members of Parliament, this Budget Vote debate takes place when the health challenges are immense and require progressive resolution.
For us to assess progress, we have to look at the challenges and compare them with the achievements, and then we have chart the way forward to ensure that the challenges are reduced. We also have to assess whether the budget allocated will enable the department to make a dent in the health challenges facing the country.
In dealing with these health challenges, we should be guided by the Freedom Charter which states, and I quote:
A preventive health scheme shall be run by the state;
Free medical care and hospitalisation shall be provided for all, with special care for mothers and children.
[Interjections.]
I'll deal with you later! In addition, section 27(1)(a) of the Constitution states, and I quote:
1) Everyone has the right to have access to -
a) health care services, including reproductive health care ...
Some of the challenges can be summarised as: poor response times by ambulances, lack of staff in hospitals, shortages of medicine, and a lack of appropriate equipment.
At the workshop on the planned National Health Insurance Scheme, NHIS, held in Johannesburg, the participants raised concerns about how often patients' lives are put at risk in public health institutions. At the same workshop, stories were told about hospitals with new equipment, but none of the staff knew how to use it.
On 17 August 2010, hon Minister, I wrote you a letter concerning the bad treatment a patient, Ms Eunice Thembani, received at Worcester Hospital. Hon Minister, you neither bothered to acknowledge receipt of such letter, nor to respond to it. I don't know what to make of this, but probably that is how the ANC defines democracy, which is, to paraphrase Abraham Lincoln "government of the ANC, by the ANC, for the ANC".
Whilst on the issue of women and children, let me say that the private hospitals have created a new industry: birth by Caesarean section. This is despite the World Health Organisation's stating that Caesarean sections should be performed only as life-saving measures when there is a risk of fetal or maternal death. There are gynaecologists who allocate a day a week just to perform Caesarean sections. Apart from this being driven by greed, it is a violation of women's right to give normal, noninterventional vaginal birth.
This is done in private hospitals because they believe that what they do in their hospitals is their business. Since the hon Minister is the Minister of Health and not the Minister of public health, I therefore call upon him to monitor this unethical conduct in private hospitals and to take appropriate action in this regard.
I will not even talk about illegal body part transplants, which have been well reported by the media. Maybe the Portfolio Committee on Health should start calling the private hospitals to account for these unethical activities.
I hope that the establishment of the Office of Standards Compliance will ensure that private hospitals are also monitored and evaluated as public facilities will be.
One of the most serious challenges is the shortage of staff. The department should develop a clear human resources development strategy with clear achievable targets. This strategy is long overdue after more than 16 years of democracy. We don't have to wait for 300 years! The President in his state of the nation address emphasised the training of doctors and nurses, as well as the revitalisation of 105 nursing colleges and the refurbishment and renovation of hospitals and clinics. This should be one of the department's performance indicators.
Infrastructure development is vital, because the Treasury report highlighted the programme to upgrade existing hospitals as one of the most disappointing projects. Though they overspent on staff, the nine provincial health departments together left a quarter of the capital budget unused. The hon Minister has, in this regard, been quoted as saying, and I quote:
... in February this year, R813 million of infrastructure money could not be spent and had to be taken back to Treasury. It's a tragedy that we are faced with. It needs an urgent solution ...
Hon Minister, the solution must be provided by you and your colleagues in Public Works. I'm raising this because if one goes to Chris Hani Baragwanath Hospital, one finds committed and determined management and staff until one goes to the wards. In these wards, not only does the roof leak, but one can lie in bed and count the stars on a clear night! The staff can do nothing about this, because it is due to the failure of Public Works to perform, despite the availability of funds.
This leads me to raise the issue of security at public hospitals and clinics. Hon Minister, I asked you a question for written response concerning security at the Dr James Moroka Hospital in Thaba Nchu. Whilst the question is specific, it represents a general concern about all our hospitals. The question is: Are we waiting for what happened at Pelonomi Hospital to happen again before we do anything?
At Moroka Hospital, staff and patients are at risk. At month end and on Saturday evenings, drunken hooligans can get in and out of the hospital and threaten the staff. At the gate there is one person, who is clearly waiting for his pension and is more like a gatekeeper than a security guard. Yet he is expected to provide security for the whole hospital.
I am aware that the bulk of the budget will be transferred to provinces and municipalities. This transfer should be monitored and the necessary intervention be made where there are lapses. That's why Cope believes that the whole Eastern Cape Department of Health should be under administration. Hon Minister, this province is in crisis and requires urgent intervention. The fact that it does not appear in the media regularly does not mean that all is well.
I wish to thank the director-general and her staff for the manner in which they interact with the portfolio committee. In this regard, I wish to congratulate the hon Minister for the good appointment. I also wish to thank all the institutions that have appeared before the portfolio committee during the last year. I thank you. [Applause.]
Chairperson, adequate health care for all citizens is paramount in any country in the world. In South Africa, and during the current Medium-Term Expenditure Framework, MTEF, period, the department is aiming to level the playing field by providing equal levels of health care to all. This is to be done by reducing inequality in the health system and increasing and improving the quality of care at public facilities.
In order to achieve these aims, we are spending a greater percentage of our gross domestic product on health than any of the other Brazil, Russia, India, China Bric, countries, and yet we still score worse on indicators such as tuberculosis and mortality rates.
Our hospitals remain ill-equipped or have damaged equipment. Sanitary conditions in most of our hospitals are below standard and this has in many instances led to the deaths of infants and adults.
Whilst we are making progress in the fight against HIV and Aids, the question must always be asked: Are we doing all that we can? We applaud government's turnaround plan in launching the national HIV counselling and testing campaign last year, but we still have much to recover. Nearly one in three women aged 25 to 29 years and more than a quarter of men aged 30 to 34 years are living with HIV. National proportions indicate that between 17% and 19% of the male and female population aged 15 to 49 years are HIV- positive. Antiretroviral, ARV, medication must be provided to these people and we urge the department to set a goal that triples the current number of people on ARV medication by 2015.
HIV/Aids also hinders us in our efforts at the eradication of the most sinister of illnesses. We want to see greater efforts made by the department at the community level and the strengthening of critical health systems at the national level. In Khayelitsha in the Western Cape, 73% of HIV-infected residents also have tuberculosis. This makes these two diseases jointly one of the greatest scourges we have ever faced in this country. Every effort should be made to eliminate them from our population.
We now have young women resorting to the practice of abortion as a form of birth control. The results of this practice can be disastrous and potentially harmful, both physically and psychologically, to the mother. We wish to see far greater initiatives by the department aimed at educating our young adults about this practice and the potential health risks associated with it.
Within the department itself the IFP would like to see the implementation of and adherence to strict governance and accountability measures, and the improvement of primary health care services.
In conclusion, we wish the Minister and his department every success for 2011. The IFP supports the Budget Vote.
Chairperson, allow me first to thank the hon Minister for his very frank assessment of some of the challenges that lie ahead of this department.
Whilst we recognise the many advances that have been made, there is, indeed, much work that needs to be done in order to provide more effective and better quality health care services, especially to the very poor in our country.
Our public health care sector remains largely curative in nature and more attention must be focused on prevention. This recognition has to be the first step in building a healthier nation for the future. In line with our belief that health education forms the cornerstone of any preventative health care strategy, we must advocate greater investment in preventative health care, whilst at the same time addressing the current challenges reducing the burden of disease.
We are encouraged by the mass education campaigns on tuberculosis, and the immunisation of children across the country. The outreach programmes to conduct home visits for TB testing are a positive step, but there are insufficient treatment centres to arrest the spread of TB. Whilst the establishment of new TB centres is a step in the right direction, the more we test the more we will have to treat.
Notwithstanding all of these entirely positive measures, South Africa still remains one of the leading countries in the world in respect of TB infections. Unless we make a greater investment in finding a vaccine for TB, we will continue chasing a moving target. In a recent presentation to the portfolio committee, the South African TB Vaccine Initiative, which comprises the world leaders in TB vaccine research and development, estimated that we could have a vaccine by 2016 if we make a greater investment in the research. This disease is more prevalent in the poorest communities. They are the most vulnerable in our society and we must therefore make a much greater investment in TB vaccine research and development.
Alcohol abuse in our country significantly impacts on our ability to address the huge health care challenges, especially in relation to HIV/Aids, TB and other diseases. Irresponsible behaviour linked to the high rates of alcohol abuse contributes directly to the violent crime rate, high vehicle accident rate and many other social contact crime rate.
In the end, the public health care sector has to shoulder the burden of treating millions of South Africans who are victims of crime as a result of alcohol abuse. The millions of rands that we spend annually on alcohol- related trauma treatment could have been better spent on reducing our burden of disease and building a healthier nation. We must therefore continue to advocate for a more sober society and fight alcohol abuse with the same vigour as we do smoking.
In closing, with today being World No Tobacco Day, the World Health Organisation estimates that in about 10 years' time smoking will kill more people than HIV/Aids, TB, car accidents, suicide and murder combined. The ID would like to add its voice to support for the initiative to encourage more South Africans to abstain from smoking for at least 24 hours. I thank you.
Chairperson, hon Minister and Deputy Minister, hon Members of Parliament, ladies and gentlemen, let me start by saying the ANC supports the budget.
Accelerated work must be undertaken to further revitalise and improve our public health care system and to attend to the intense pressures and challenges facing health services. Intervention must include appointing qualified personnel and improving infrastructure, such as rebuilding dilapidated clinics and hospitals.
I want to talk about noncommunicable disease. When we are hungry, we buy food to eat, and, if we are looking for entertainment, we watch movies or go to our friends and chill with some bottles. When we fall ill, we have no choice but to go to a doctor but, unlike food and movies, no one really enjoys getting sick. There is wisdom in the old saying, "prevention is better than cure."
To improve the health status of the population and achieve the health- related Millennium Development Goals 4, 5 and 6, which are to "Reduce Child Mortality", "Improve Maternal Health", and combat TB, malaria and other communicable diseases, it has become more urgent and critical to intervene to reduce child mortality and maternal mortality rates, which are unacceptably high. The ANC government is working hard to ensure an uptake in the prevention of mother-to-child transmission, PMTCT, of HIV, the main cause of child mortality.
Strengthening community organisation and mobilisation is central to ANC-led government efforts to improve the health status of all South Africans. The ANC government will continue with existing campaigns and develop new ones, whilst overseeing, implementing and monitoring them.
This is part of raising awareness and informing the public about changing harmful practices and adopting protective practices, including campaigns against tobacco, alcohol and substance abuse. There are also campaigns to mobilise the community to adopt a healthy diet and exercise, encourage pregnant women to use the prevention of mother-to-child transmission treatment and encourage people to get tested for HIV, high blood pressure and diabetes.
The existing national drug policy and strategy are undergoing review so as to support effective implementation of the National Health Insurance, NHI, and strengthen the managerial and technical capacity of government.
The government should conduct a feasibility survey for the establishment of a state-owned pharmaceutical company. Government will continue to invest in research and development in the health sector, including infant mortality research, HIV prevention technologies, health status surveys and the development of new medicines and indigenous knowledge systems.
The ANC has an enormous responsibility, as the leader of society and as the only organisation capable of uniting all the people of South Africa around a common vision, to encourage people to adopt a healthy lifestyle. I am confident that we can control obesity in South Africa. Obesity is the second most important cause of global mortality and morbidity after smoking, and both of them are preventable.
The pursuit of household and national food security is a constitutional mandate of the ANC government. We have to create an environment which ensures that there is adequate food available to all, now and in the future, and that hunger is eradicated.
The ANC is already putting in place an emergency food relief programme on a mass scale in the form of food assistance projects, like soup kitchens, to the poorest households and communities. This programme will be linked to existing mass mobilisation activities on the ground.
I therefore call upon government and our social partners to absorb and apply cost-effective interventions at the individual and community levels with a view to addressing preventable diseases. Actions recommended include embarking on methodical awareness campaigns, spreading the word diligently and sensitising people to the importance of a healthy diet and exercise; building capacity for the detection, prevention and treatment of overweight, high blood pressure, diabetes, ulcers, asthma and cancer; and implementing and scaling up early detection and interventions, and providing adequate treatment, including paying attention to patients' wellbeing and spiritual support.
All members of society should protect their own health by preventing the aforementioned diseases, seeking the right information on risk factors, avoiding occupational and environmental hazards, and taking part in decision-making on all issues that affect their health and that of their families.
A lack of knowledge is leading to the causes of chronic diseases. Public education and awareness is critical in our fight against chronic disease. I want to encourage all South Africans to go for regular health screening. Our government is encouraging people to know their health status by being tested for blood pressure, glucose levels, cholesterol, etc.
I am heartened by the fact that the ANC-led government is concerned about the impact of breast cancer on females. Through the various initiatives undertaken since the dawn of democracy in South Africa, we have made significant progress in the fight against breast cancer. Unsafe food causes many acute and lifelong diseases, ranging from diarrhoeal diseases to various forms of cancer.
In health, progress has been recorded in the expansion of free primary health care. We have expanded health infrastructure, including the building and upgrading of 1 600 clinics and 18 new hospitals. Many public hospitals have been revitalised and refurbished.
We have increased the antiretroviral treatment roll-out programme with more than 480 000 people having been enrolled. There have been a number of successful initiatives to combat smoking to. The ANC government is expanding access to food production schemes in rural and semi-urban areas in order for them to grow their own food with the implementation of food gardens, and by providing tractors, fertilisers and pesticides.
Other measures support existing community schemes which utilise land for food production at schools, health facilities and churches, and in urban and traditional authority areas.
In summing up, I would like to emphasise that there is a great need to raise awareness of the importance and benefit of physical activity among the population. We must educate all South Africans by conducting physical activity programmes, and build capacity among individuals to engage in physical activity. We must create a supportive environment that facilitates participation in physical activity.
I would also like to congratulate the Minister, the Deputy Minister and the director-general, who are heading in the right direction with this department. Thank you. [Applause.]
Chairperson, I want to acknowledge the presence of the Minister and Deputy Ministers that are here, Members of the Executive Councils, MECs, members of the portfolio committee, members of the Select Committee on Health and distinguished guests, as well as leaders from the various institutions in the health sector that are here with us today. It is my privilege to address this august House on the occasion of the Health Budget Vote debate for the financial year 2011-12.
I want to start, lest I do not have enough time, by thanking the Minister of Health, Dr Aaron Motsoaledi, for his stewardship of the health sector. I also want to thank MECs, officials from both the national and provincial departments, and our various partners in the health sector for their contribution to ensuring that we set the health sector on course to provide a long and healthy life for our people.
I also want to acknowledge the contribution of my predecessor, the late Dr Molefi Sefularo. We are indeed building on the gains and the progress that has been made in the past years, led by the ANC government.
I want to remind members that although we have this high burden of disease, as outlined by the Minister, with the four epidemics that we are facing, South Africa has shown that it has what it takes to deal decisively with the problems that afflict it from time to time. I would like to remind members that we are building the health system for a better life for all South Africans.
We have to date almost done away with some of the diseases of extreme poverty, which medical students of today hardly see in their training. They include diseases like kwashiorkor and marasmus. We also hardly see measles, whereas before it was rife in our communities.
We have early reports that the policies for reducing the use of tobacco in our country are yielding results.
It is reported that oesophageal cancer in the Eastern Cape is also on the decline.
Forty per cent of the primary health care facilities that we have in our country have been built during this democratic era.
We are also on track to being recognised as having eliminated malaria during this period. The Minister has outlined what we are facing, these challenges before us.
I would also like to share with you that the burden of disease and death in our country is not only problematic at the social level, but is also strangulating our economy. It is estimated that the indirect cost to our economy and society due to cardiovascular diseases is about R8 billion annually.
What is of greater concern is that 70% of the deaths are of people younger than 55 years of age, and almost 195 people a day die from cardiovascular diseases. The good news, however, is that 80% of these diseases and deaths are preventable.
Our story line, therefore, is that we need to realise that our health is in our hands. As we move towards the end of the Move for Health, move to live campaign, which promotes the prevention of noncommunicable diseases, we expect every municipal ward and district in our country to know about the burden of noncommunicable diseases, and the burden of HIV/Aids and maternal and child mortality in their communities.
We expect every municipal ward and district in our country to understand the risk factors, and we have already begun programmes for reducing these risks. It is important, as member Dube has said, that we be methodical as we tackle these challenges that face us.
We recognise that people with HIV are also vulnerable to noncommunicable diseases, pregnant mothers may have underlying noncommunicable diseases, and our children are facing an increased risk of obesity. We have to realise that our collective efforts in dealing with the total disease burden in our communities is essential.
It is in this regard that we are leveraging the Soul City Aids campaign in order to encourage people to be tested for the various risk factors for noncommunicable diseases, such as high blood pressure, and raised glucose and cholesterol levels, as well as to know their body mass index, BMI.
We aim to reduce the burden of noncommunicable diseases and conditions in our country by 5% to 10% by 2014. We will focus specifically on hypertension, diabetes, obesity, mental illness, blindness and oral diseases.
Over the Medium-Term Expenditure Framework, MTEF, we will verify baselines of noncommunicable diseases per district, alongside those of communicable diseases, and aim to reach 25% of districts this year.
The strength and primary health care model, which the Minister alluded to, will be discussed later, led by the Minister himself. Also, the family teams that will be introduced in each of the 4 000 or so wards in our country, as well as the school health programmes, will serve as a platform that we will use to achieve these goals.
The health sector's Mini Drug Master Plan to deal with, amongst other things, alcohol abuse, has already been approved by the National Health Council on which MECs sit. We have also commissioned research to examine the impact of alcohol abuse on TB outcomes.
On the matter of mental health, we will adopt and implement strategies to improve Forensic Mental Health Services and assist provinces to build community mental health services as part of the Provincial Aids Campaign, PAC, package, including building partnerships with nongovernmental organisations and community-based organisations. The implementation of the Mental Health Care Act, Act 17 of 2002, will be closely monitored.
We will be hosting a multisectoral summit later this year, where we will launch the multisectoral strategy against noncommunicable diseases, as part of preparing for the health summit meeting on noncommunicable diseases in September.
A national healthy lifestyle programme with high-profile multisectoral leadership in society, similar to the South African National Aids Council, Sanac, under the Move for Health, move to live, campaign, will be built.
We will also identify research and innovation gaps, as well as priorities for surveillance, in order to enhance the effectiveness of preventing and treating lifestyle diseases.
It is clear that whilst we have a major programme to deal decisively with lethal communicable diseases, LCDs, we need more resources and must ensure that the resources that we do have are used efficiently. We should also ensure that the budget allocated by provincial departments is adequate and used efficiently. In this regard, prevention remains more affordable and better than cure. Any effective health system must operate an effective, reliable and quality- driven epidemiology and disease surveillance system, so that we identify new, emerging diseases early, track our success in various interventions and remain vigilant to outbreaks and re-emerging diseases.
Currently we are developing an electronically based surveillance system able to deal with monitoring the Millennium Development Goals, as well as the national service delivery agreements. We will also establish an on-time integrated surveillance system in the public health facilities and districts.
This system will not only be for monitoring LCDs, but also for leveraging the work we are already doing with monitoring the HIV counselling and testing, HCT, and antiretroviral treatment programmes. We will also include the burden of injuries in this regard.
We have adopted a three-tiered approach to strengthening our recording of and reporting on patients on ARVs. This approach takes into consideration the diverse access to information and communication technology in our facilities.
We have many pilot programmes that seek to use mobile technology in our country. Together with the Department of Communications, we are developing a strategy to use mobile technology applications to strengthen recording, reporting and support of patients who are on chronic medication.
One example is the use of cellphones by community health workers to report on their house visits so that we can have realtime information on health conditions in the families that they visit. This is building on the work that was started during the Fifa Soccer World Cup and is part of the legacy.
On research and development, we will support and monitor the functions of the National Health Research Ethics Council, NHREC, and the National Health Research Committee, NHRC, which act in an advisory capacity to the Minister, as well as institutions such as the Medical Research Council, MRC, and the Health Systems Trust, HST, in order to ensure that the research agenda is aligned to the priorities of the country.
It is our conviction that the alignment of all of us with the four priority areas for the country will indeed help us succeed in increasing the life expectancy of South Africans, and also achieving the MDGs and the Negotiated Service Delivery Agreement, NSDA, objectives.
In regard to health facilities infrastructure management, we have made an effort to ensure that health technology is enhanced. We will soon be publishing the essential health technology package for comment, and will be discussing this, not only with our sister departments at the provincial level, but also with the private sector.
The Minister has already alluded to the achievements we have had in reducing the cost of pharmaceuticals, particularly ARVs. We have set up a process of establishing a central drug procurement authority working with Treasury and the various provinces.
In this regard, we will ensure that we have an enabling system to help the South African purse to save resources, and also to afford South Africans reliable access to pharmaceutical products and medical devices. It will be part of our preparation for a more effective and sustainable national insurance system.
The registration of medicines will be improved. We know that there is a backlog in this regard, and we will reduce the time taken for them to reach the market by reducing the existing backlogs through training and aggressively recruiting evaluators, managing clinical trials and performing inspections on an ongoing basis. This will entail the recruitment of and retention strategies for pharmacists and other experts.
The Council for Medical Schemes will receive R4,194 million from this budget, and its primary objective is to protect the rights and entitlements of all members of medical schemes. With the leadership of the Minister, we are in communication with the medical aid schemes to invest in health promotion and disease prevention and not only in the treatment of diseases and their complications.
The National Health Laboratory Service will receive R82,167 million to provide quality, affordable and sustainable health laboratory and related public health services. We have already interacted with the laboratory services, and seen in this budget a reduction in essential laboratory services. This will be a relief to provinces and the various institutions that use the service.
I have already mentioned the eHealth programme and I would like to conclude by saying that in regard to making sure that we achieve our health objectives, we have ensured that we work not only with provinces, but also with various stakeholders. This is so that all of us can embrace these changes that we are coming up with for the health sector.
It is important as well to note that the burden of disease and death is not only a burden on individual families, but also a burden on breadwinners, mothers and fathers, and the workers of our country. It is a burden on our economy and any success in reducing the burden of disease and death - some members have alluded to the fact that it has doubled over the past decade or so - will bring relief to our economy. Thank you very much. [Applause.]
Chair, the Minister and his department must be commended for taking health care in South Africa in the right direction.
However, a lot of work still remains for many hospitals and clinics, as many do not pass the basic sanitary quality levels and are inadequately staffed. The inadequate stock of basic and critical medical supplies and medicines also remains worrying.
If a woman who is about to give birth contacts our party and pleads with us to move her to another hospital, as the one she is in is known for its high fatality rates, then we must understand that our health care system is still Third World in many respects. Even more can be said about a maternity ward where newborn babies have a better chance of dying than being given the care they deserve - also a sad reality in our country.
Over and above the material lack in many hospitals and clinics, it is also quite evident that there exists a lack in the spiritual dimension. For instance, when hospital workers go on strike without regard for human life, then something is seriously wrong in our country.
The FF Plus agrees that hospital staff must be paid a decent wage as their task, like that of the police force and teachers, is a thankless one. However, when human life comes into play, unions must be more responsible in their approach and government more amenable.
'n Ander voorbeeld van die gebrek aan etiek is die houding van baie van die hospitaalpersoneel wat nie met die nodige empatie met hulle pasinte omgaan nie. Terwyl daar baie is wie pasinte met respek behandel, is daar ook diegene wat afgestomp van die pyn van hul pasinte te werk gaan.
Indien ons daarop wil reken dat ons 'n gemeenskap is wat respek vir ons medemens het en wat menseregte hoog op prys stel, moet ons ingesteldheid ook reg wees. Die VF Plus beskou die behandeling van pasinte met die nodige empatie en sorg as deel van die Christelike etos wat die lewe op aarde meer draaglik maak. Minister, dit is ons plig om dit in Suid-Afrika se hospitale en klinieke uit te leef. (Translation of Afrikaans paragraphs follows.)
[Another example of the lack of ethics is the attitude of a lot of hospital staff, who treat their patients without the necessary empathy. While many of them do treat patients with respect, there are also those who treat them as if totally unfeeling to the pain of their patients.
If we want to count on being a society with respect for our fellow man, highly appreciative of human rights, then our attitude should also be correct. The FF Plus regards treating patients with the necessary empathy and care as part of the Christian ethos that makes life on earth more bearable. Minister, it is our duty to live up to this in South Africa's hospitals and clinics.]
Related to the above is the manner in which we deal with Aids. The department states that prevention remains the cornerstone of HIV and Aids interventions, and that, indeed, makes sense.
However, prevention undertaken by the promotion of safe sex is not the only answer. What we need in South Africa is a sense of responsibility stemming from the Christian perspective of abstinence and responsible, stable relationships. Over time, this ethos will ensure that the vexing problems of single parents, broken families, unwanted children, the abuse of children and a proliferation of abortions, which is in essence murder of the unborn, become a relic of the past.
Ons wil dit ook aan die minister stel om versigtig te werk te gaan met die nasionale gesondheidsversekering. Selfs president Obama het aspekte van gesondheidsorg ongereguleerd gelaat juis omdat die VSA nie genoeg fondse het om Obamacare in sy volle omvang te dra nie. Suid-Afrika, 'n ontwikkelende staat, is nog minder in staat om so 'n enorme program van stapel te laat loop.
Die kernrede is ons klein belastingbasis wat al hoe meer onder druk geplaas word. Met verskeie skuilbelastings wat in werking gestel word, soos tolhekfooie en koolstofbelasting, word die klein middelklas belastingbetaler al hoe meer ontneem van die vermo om self entrepreneur te word en werk te skep, en ons moet daarop ag slaan in die toekoms. (Translation of Afrikaans paragraphs follows.)
[We also want to appeal to the Minister to treat the National Health Insurance with circumspection. Even President Obama has left aspects of health care unregulated for the very reason that America doesn't have enough funds to carry Obamacare to its full extent. South Africa, a developing nation, is even less able to launch such an enormous programme.
The central reason is our small tax basis, which is coming under increased pressure. With various types of concealed taxation coming into force, such as tollgate fees and carbon taxation, the small middle class taxpayer is becoming more and more deprived of the ability to become an entrepreneur himself and create employment, and we should keep that in mind in the future.]
I thank you, Chairperson.
Chair, the ACDP is acutely conscious of the fact that maternal and child mortality rates have escalated and show no signs of decreasing. We are, however, encouraged by the Minister's proactive, considered approach to the multiple challenges impacting on these statistics and we support efforts to get to and target the real causes. The ACDP will support the budget.
The ACDP is concerned that nationally we are continuing to provide equitable funding for increasingly inequitable services. Provinces are funded for a full range of services at the various levels of care, but they have not developed the capacity to deliver those services.
Because of this, patients migrate to provinces where services are delivered. It is inconvenient for patients and a tremendous burden on these provinces that are not funded for the additional load. So, funding hospitals at the national level, as you have suggested, may be a necessary response. However, would it not be better to ensure that where capacity does exist, provinces receive the increased funding to facilitate that capacity?
In recent years, the issue of a critical shortage of doctors has been acknowledged and the department has spoken about steps being taken to alleviate the situation. The ACDP is concerned that measures have either been inadequate or not prioritised, as no visible improvement in the situation is evident.
What incentives are in place at the moment to attract doctors and surgeons to, or back to, South Africa? There are only 27 paediatric surgeons registered in this country - one paediatric surgeon for almost two million children!
What do we have to do to attract and retain health professionals, and are we doing it? Hon Minister, are we taking seriously the continued dissatisfaction and growing concerns of the few doctors that we do have left working in South Africa?
The ACDP has called for a re-evaluation of legislation and the consideration of the need to establish an independent regulatory body for doctors and dentists. This will not only ensure greater integrity in dealing with professional misconduct and clinical negligence, but will also build confidence within the medical profession.
We know primary health care delivery presently faces many problems, and doctors are saying that for poorer communities access to a general practitioner is often impossible. Clinics are swamped and people with conditions like tonsillitis and appendicitis who cannot get a doctor's attention are at risk.
The SA National Aids Council, Sanac, is increasingly conspicuous in its lack of engagement on important HIV and tuberculosis challenges. The council receives substantial funding, has a clear mandate and over a dozen staff members, but it is not delivering. Stakeholders want to see Sanac driving the development of a new national strategic plan on HIV/Aids, which presently takes approximately 1 000 lives a day.
Lastly, concerns regarding the new Nursing Act stem from the fact that regulations are still not available, so the Act is not fully operational. I am sure this is a concern for you too. Thank you. [Time expired.]
Chairperson, hon Minister, hon Deputy Minister, hon Members of Parliament, treasured guests in the gallery, ladies and gentlemen, the Freedom Charter of the ANC commits us to a preventive health service run by the state - 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 the quality of care and making services available to all South Africans to ensure better health outcomes.
South Africa commands huge health resources compared with some of the developing countries, yet the bulk of these resources are in the private sector, as the Minister has already said. However, they serve a minority of the population, thereby undermining the country's ability to produce quality care and improve health care.
The ANC is determined to end the many inequalities that exist between the public and private sectors by making sure that these sectors work together.
South Africa is one of the few countries in the world where the transformation of the health system began with a clear political commitment to ensuring equity in resource allocation, restructuring the health system as a district health system, and delivering health care according to a primary health care approach.
The ANC-led government inherited a highly fragmented and bureaucratic system that provided health services in a discriminatory manner. Services for whites were better than those for blacks. Those in the rural areas were significantly worse off in regard to access to services compared to their urban counterparts. Expenditure on tertiary services was prioritised above primary health care services.
The ruling party, the ANC, takes the health of the nation very seriously. This is reflected in the manner in which it has been behaving since we came back from the Polokwane conference. Very serious actions and steps have been taken since then.
These include, among other things, the appointment of the Minister, Dr Aaron Motsoaledi, who works hands-on with his department. The Minister and the Deputy Minister have been tasked with the responsibility of steering the Department of Health so that it can achieve a long and healthy life for all South Africans.
Given how far we have come as a country, I am confident that this mammoth task is not insurmountable. All it needs is that no one should take his or her eye off the ball because, if we do, we may reverse the gains that we have achieved over many years.
I am not about to say that the road has been easy because, indeed, no one said that the road would be easy; but our energy and determination must match the long stretch that we still have to travel.
We are, thus far, fully aware that whatever we have achieved has been made possible by the ever hard-working and dedicated staff. They do their best under trying circumstances to deliver health services to the communities. These communities are not like you, me and others who are privileged. They have no second choice. They look to the nurses to help them, come rain or shine.
Some of these nurses work in far-flung areas of our country. Others are in areas where there is no network connection for mobile phones. Some are in areas where there is no access to reliable public transport, no choice of schools for their children, and no shopping centres, etc. In spite of all these problems, they continue to deliver services no matter what, most of the time against all odds. I know this because I come from among these people, both as a resident and as a health professional and former manager.
There are areas of concern, such as shortage of drugs, dirty facilities, an uncaring ethos and poor infection control. These are the service delivery problems that do not need money to solve them; they need sheer management.
I know for a fact that some of the reports that we read in the media about our health services are, indeed, correct and that the patients are treated badly. However, I also know, as we all do, that there are hundreds of health care workers who are doing their jobs with such selfless commitment. I do not think the few should spoil the good work that is being done. I want to pay special tribute to these nurses.
The government, as we have already heard, has built over 1 600 new clinics in the past 17 years, as part of the endeavour to increase access, expand service and ensure equitable distribution of health services.
This has enabled the old lady, who was previously forced to use her last cent to catch a taxi to the clinic, money which was supposed to be used to feed her grandchildren, now to visit the clinic just where she lives. This has enabled the young woman who would have missed her chance of family planning to easily pop in and have the service provided. This has enabled the mother with a mentally ill child to have the child seen to by the nurse on the day of her appointment with greater ease. This has also assisted the man with a small welding workshop, who cut his finger, to easily get it sutured at the clinic.
These are the things that have been achieved, among other things, but we know that a lot more still has to be done because, indeed, a journey of 1 000 miles begins with a step. I am confident that we are on course to getting to the apex of this long and steep mountain called "health for all". This goal is attainable in our lifetime.
We are of the firm view that it remains the responsibility of the state to care for its population, hence our undying commitment to the introduction of the National Health Insurance.
We are not oblivious either to the fact that a lot of work still needs to be done to ensure that the introduction of a national health system is a success, much against the expectations of the doomsayers.
The foundation of the success of the introduction of the National Health Insurance is an effective health care system. The success of an effective health care system is a well-grounded and well-founded primary health care system because, indeed, primary health care remains the bedrock and the bone marrow of the health service. In this regard, I would like to urge the Department of Health to fast-track the revitalisation of primary health care as it is captured in the annual performance plan. This is the only hope that the service delivery to our people can improve for the better. We as a portfolio committee must be ready to lend a hand to ensure that the good plans that the department has produced come to fruition.
I am making this clarion call because it has been discovered that a healthy nation needs a healthy health care system, and a healthy health care system needs a healthy primary health care approach. For everything to be achieved, we need stronger and more effective primary health care, now more than ever.
The ANC wants the Department of Health to spend the money that it has been allocated on starting to improve primary health care, and the rest will follow. Perhaps we need to say, "Primary health care first, and the rest shall be added onto it." The Department of Health must demonstrate that it is serious about primary health care and, as we work together with the department, we need to see that very clearly.
I want to say that people cannot be denied good health because they choose to live in rural areas. They cannot be punished for being born in Mamelodi, Ledig, Musina, Umlazi, Mareetsane and Khayelitsha. They have a right to access to health.
Modulasetilo, mo bofelong ke batla go gwetlha ntlo e e tlotlegang gore a re diriseng dikliniki tsa rona re le baemedi ba Palamente, gore baoki le bona ba re bona re tla kwa tliniking. Re tshwana le mosadi o a tleng apeele balelapa la gagwe dijo. Fa a sena go di apaya a bo a ba tsholela. Fa a fetsa go ba tsholela ena a bo a itira montle a ya go ja kwa lebentleleng la dijo gonne a gopola gore dijo tse a di apeileng di phalwa ke tsa kwa lebentleleng la dijo. ANC e tshegetsa ka maatla tekanyetsokabo e.[Legofi.] (Translation of Setswana paragraph follows.)
[Finally, Chairperson, I would like to challenge this honourable House, as Members of Parliament. Let us use our clinics. Let the nurses see us, too, consulting in the clinics. We are just like a woman who cooks food for her family and after dishing up for them, she titivates herself and goes out to eat at a restaurant, thinking that the restaurant food is better than what she cooked. The ANC fully supports this Budget Vote.] [Applause.]]
Chairperson, hon Minister, hon Deputy Minister and distinguished guests, I listened carefully as you mentioned the pandemics South Africa is facing. I could not but note that all four are by and large preventable or, if one is already infected, their impact on one's body can be controlled or managed.
As we talk about the statistics, we have to always remind ourselves that we are talking about human beings here. That is why Azapo rejoices at every announcement of an improvement in our health system.
We welcome the increase in the number of clinics that are licensed or accredited to administer antiretroviral drugs and the increase in the number of nurses who can administer these. The decision to start ARV treatment for people with a CD4 count of 350 is a welcome one, because people who have a CD4 count of 200 are already very sick, and therefore need more care.
Hon Minister, there are just two issues that we want you to grapple with. You have stated that the budget of the Department of Health is 8,7% of the gross domestic product, GDP. That is not bad for a developing country like South Africa.
If you say it is R25 billion, how much of this money is being spent on the public health system? We are asking this question because we hold the view that private health providers are making huge profits while public health facilities are struggling to make ends meet.
With the best intentions and all the money being pumped into the health system, something has to be said and done about the people who work in our health facilities. Without tarring all health workers with the same brush, let me say we are always disturbed when we hear or read about the bad treatment that our people receive at the hands of some of the health workers. We do not have time to enumerate these incidents, but the country needs the assurance that your department will deal with the errant workers.
Azapo supports Budget Vote No 16. I thank you. [Applause.]
Chairperson, hon Minister, Deputy Ministers present, members of the House and guests, my speech will focus more on primary health care and the overall budget.
About 17 years into democracy South Africans are facing a new challenge, for which the highest calibre of leadership, vision and commitment is needed. Fortunately for South Africans we have Dr Motsoaledi, a man with enthusiasm, who is going to lead this department.
The challenges exist. Universal access to care and equity, and sound information management and technology form the essential components of primary health care. Quality health statistics promote better monitoring and evaluation of services, and empower good decision-making.
The total spending on public health services has increased drastically over the past two years, and we are currently at R113 billion of which R41,9 billion, which is 7,6%, is allocated for primary or district health. Also provided in the department's budget is an additional R1,4 billion, part of which will be used for the training of 400 nurses and midwives. Minister, we can only hope that after their training 50%, if not more, will be placed in clinics to encourage primary health care. If possible, ensure that 50% of these trainees, if not more, specialise in primary health care nursing.
Primary health care requires a change in the socioeconomic status of our country; redistribution of resources, particularly in rural areas; a focus on health system development; and an emphasis on basic health services.
Hence the government needs to ensure that it addresses the socio-economic status of the country, especially for the poorest of the poor. It needs to ensure that there are intersectoral activities between the Department of Health and other departments, particularly in order to provide access to quality housing, to clean water, proper sanitation, and also to some extent to create employment - as soon as yesterday! - to ensure that the vision of better health for all is realised.
The ANC-led government's efforts in addressing root-cause issues have not responded adequately to the interrelationship between socioeconomic development and health efficiency and effectiveness. During oversight visits, the chief executive officers of most hospitals still complained of the malfunctioning and ineffective district health system.
To date, most primary health care facilities countrywide are still in a very bad state, and this means that most are still badly managed. Queues are still long, medicine shortage is still a daily battle in some rural clinics particularly, and working conditions are unbearable due to increased demand for primary health care services, and therefore increased workloads.
The DA welcomes the notion by the department of finally completing an audit to generate comprehensive information on primary health care infrastructure and services by 2011-12. This is long overdue.
In 1997 the government adopted a White Paper on Batho Pele principles and in 2007 the Policy on Quality in Health Care for South Africa, but to date the primary health care services are still lacking. One wonders what will happen to the health standards compliance office after March next year, and one only hopes that it does not become worthless and the standards compliance not adhered to. All we need is to enforce compliance and adherence to the service principles, policies and set standards or we will end up merely changing the names of strategic interventions every five years until we run out of synonyms for name changes! [Applause.] These will only be achieved if managers act responsibly and are held accountable for their facilities, the performance management and development system is adhered to in principle, and proper monitoring and evaluation are consistent.
Hon Minister, you mentioned in the Service Delivery Review, vol 7 no 3 of 2010, that utilisation of primary health care facilities by the poor has increased, but physical access to these clinics in many rural areas still remains a challenge. The Department of Health needs to fast-track the delivery and implementation of the Telemedicine System across the rural areas as this provides rural communities with access to physicians and specialist expertise available in major medical centres and will further support primary health care services.
During its first phase of implementation, funds were available to start a teleradiography pilot project in the Free State and North West provinces, a telepathology project in the Eastern Cape and a teleophthalmology project in KwaZulu-Natal. That was in September 1998, but to date the communities around those provinces have still not felt the real effects of telemedicine. It would be very interesting to analyse where we are as a country in regard to health technology.
The extent and nature of the changing profile of diseases, particularly the growing threat of noncommunicable diseases, which you have already alluded to, Minister, continue to increase demand and put severe pressure on primary health care services. This has negative and substantial implications for the poorly managed and understaffed centres, which are unable to absorb this significant emerging burden.
The decline in life expectancy, high levels of maternal and infant mortality and increase in the rate of HIV infections indicate the inability of the current district health system to cope with the emerging needs of the population.
The three health-related Millennium Development Goals, MDGs, may to the greatest extent be realised through strengthening primary health care. A lot still needs to be done to address funding constraints, procurement irregularities, corruption, investment in critical health care skills shortages and essential equipment.
Corruption in health care is derailing progress in infrastructure development, an example of which is the construction of Zola Gateway Hospital. The project was unveiled on 5 June 2007 by the former Gauteng Premier Mbhazima Shilowa, and to date it is still incomplete due to tender malpractices, which unfortunately might in future be regarded as classified information under the proposed Protection of Information Bill! Thank you. [Time expired.] [Applause.]
Chairperson and hon members, guests and members of the department, as we support this Budget Vote, we are vigilantly going to monitor the expenditure performance and value for money of the department.
Health is one of the priorities of the government. Progress to date on meeting the MDGs is slim, but we hope that they will be met in our lifetime.
In the 1980s, the world health slogan was "Health for All by the Year 2000". In reaction to that, clinics were built, health care was taken closer to where the people lived, and health care was made free for children from birth to six years and for women that were pregnant. The year 2000 saw the declaration of the MDGs by various countries and these were to be met by 2015.
Family planning was well established, but somehow it fell by the way, because women were dying due to backstreet abortions. In 1996 the Choice on Termination of Pregnancy Act was promulgated and it was amended in 2004. Backstreet abortions had been procured by about 44 000 women and hundreds died annually. After the Choice on Termination of Pregnancy Act, conditions improved.
There is a line of thinking that the Choice on Termination of Pregnancy Act is family planning. It is not. Family planning is family planning and abortion is intended to deal with unplanned pregnancies.
The Choice on Termination of Pregnancy Act is intended to assist those women who would like to terminate their pregnancies within 12 weeks. Anything beyond 12 weeks, Minister, is no longer in line with the Act. It is something else. Maybe we need to deal with that "something else". I would not say it is murder, but we need to deal with it. Anything beyond 12 weeks is really outside the Act. Only a doctor can do a termination of pregnancy at his discretion after 12 weeks, because of medical reasons in regard to the patient.
The problem these days is that young women are becoming pregnant by men older than themselves. They decide to terminate their pregnancies long after 12 weeks, and they will have inherited the pregnancy, as well as HIV. The babies are born prematurely, because they accept any help that they can get. They are given pills to take by mouth and also those pills that need to be inserted, as well. They are told that once they go into labour, they should go to the hospital. They do so and they give birth to small babies. Some of these babies are born and then thrown away anywhere in the country, even in the streets. They are collected and taken to the hospital as premature babies. So the neonatal wards are full of these types of babies and most of the time the babies tend to die. That is the problem we have.
Attendance at antenatal clinics for pregnant women is supposed to commence at 14 weeks, so that the complications can be dealt with if diseases are detected early. For example, if there is anaemia, iron supplements will be given. If they are HIV-positive and have a low CD4 count of 350 or below, they will be started on antiretroviral drugs straight away. Where there is TB, TB treatment will be given. This is a way of trying to help the mother to deliver a healthy baby, and the baby at birth will be given nevirapine.
Deliveries taking place in health facilities will be increased from 88% to 95%. Postnatal care for mothers and babies, six days after delivery, will increase to 80%. Breastfeeding is being encouraged, so that babies get the best formula, because breast milk is the best formula.
We are now proposing the kangaroo method of warming the baby and keeping it warm. We put the baby between the mother's breasts so as to get it warm. Baby death in neonatal wards is a problem and it is being dealt with.
I think we need to go back to the basics and begin to revamp family planning, so that people plan their pregnancies. Family planning education should be given at schools as part of Life Orientation. It should be given at the workplace and in clinics, so that it becomes the norm, rather than the termination of pregnancy.
Before I conclude, Minister ... uyis'khokho mfana kithi. [... you are smart, my man.]
Everybody in this debate supports what you have said, and everybody agrees with the department - we are quite excited that hon Waters, for a change, is on our side! [Applause.]
Is it safe to say that TB is on the increase? Yes, TB is on the increase, because most people with HIV have not revealed their status. Therefore, with his or her high viral load, TB takes the opportunity to affect the person, and we have a high TB rate.
Hon Kganare, we were aware that you would be talking about the provinces, but we do have our counterparts in the NCOP and in the provinces. Provincial staff can be dealt with by dealing with the provincial representatives. We can even go to the MEC or CEOs to deal with such issues. Maybe hon Kganare should have been in the NCOP or the provincial legislature.
There is a problem with advertisements. We have advertisements for free termination of pregnancy, safe abortions, etc, available all over. We have advertisements of alcohol and of money loans. We have a whole range of advertisements. Minister, these will be knocking at your door before long. What must we as a country and as Parliament do? It is important that we begin to address this. It should not be addressed only by you and your department, Minister, but also by us as public representatives. Where do we go from here? I think a march should take place to deal with all these scourges, so that even if we do not reach the MDGs by 2015, we will still reach them in our lifetime. Thank you. [Applause.]
Chairperson, as many speakers have said, by and large this has been a very constructive debate. I think we are all on the same side. We are all in agreement on most things, but I need to highlight a few things that have been said here that I regard as very important.
Let me start with the issue raised by hon Dudley of the ACDP. The issue of human resources is extremely important. Unfortunately, she thought that we were perhaps not paying enough attention to it. I want to reassure her that we are definitely paying attention to it, and, in accordance with our ten point programme, we will release our HR strategy in August this year. We know it is long overdue, but by August we will release it.
We need to increase the number of health care workers produced in our country. For instance, we cannot keep on producing 1 200 doctors per annum, as we have been doing for the past decade.
We have a two-pronged approach which you will see in the HR strategy. The first prong is a temporary measure. Last week, I met with the deans of all the medical schools in our country to discuss this temporary measure. What we are telling them is that they need to find innovative ways of increasing the intake of medical students, even under the current circumstances of restricted space in which they find themselves.
I can report to the hon Dudley that we have worked very hard with the University of the Witwatersrand. They have taken in 40 extra medical students this year, something they have never done before. It has happened because we worked together. Of course, for Wits to take in the 40 extra medical students needed resources. We obliged as a department. We gave them R8 million to do that. [Applause.]
We then sold the story to the other deans, so I am eagerly waiting for the deans of the seven remaining medical schools to respond. They asked us to give them eight weeks to respond to this suggestion, so that we will implement it at all of those universities by next year.
The second strategy in this regard is the establishment of a ninth medical school in Limpopo, because we have only eight in the country. You are already aware that the President announced this.
Furthermore, we announced our intention to put up infrastructure in four tertiary hospitals and their medical schools - it is not only the hospitals. Perhaps we have not announced that before. We subsequently met with the Development Bank of Southern Africa, DBSA, and the Minister of Finance. We agreed that it was not only the tertiary hospitals that needed to be rebuilt, but even the faculties of medicine. This means that with the Dr George Mukhari Hospital, it is not only going to be the hospital; we are also going to look at the faculty. At Chris Hani Baragwanath Hospital, we will do so too. It is already agreed and finalised at King Edward VIII Hospital. We are going to build a new hospital and a new medical school altogether. [Applause.] At the Nelson R Mandela School of Medicine we are also looking at a similar issue.
We have already met the vice chancellors of all these universities to discuss the issue with them. They have put together teams who are looking at this matter, because our aim is that at the end of this we will triple the number of medical students in our country. That is the aim of this exercise.
Let's come to nursing. You are aware that in April we had a very successful National Nursing Summit, which was addressed by the President. All the issues, including those pertaining to the training of nurses, compliance, rules, regulations and the occupation-specific dispensation, OSD - which did not go very well, as you know - were discussed at that summit, to the extent that we produced the Nursing Compact. I may remind you that we published this compact in most newspapers on International Nurses Day to show what the Nursing Compact consists of.
The task team that organised that nursing summit has not been disbanded. After the summit, they sat and worked around the clock to ensure that the issues emanating from the summit would be implemented. Only yesterday they presented that plan to the department and we are going to be looking at it. So, the issue of human resources is very important to us.
The other issue which was mentioned very passionately by hon Segale-Diswai from my own party, and also by hon More from the DA, is primary health care. I want to reassure you that the centre, the core, of the health care system is going to be based on primary health care. [Applause.] I have already told you that we have no option but this.
I said the present health care system can be defined by four things, and I do not want them. No country can be defined in this way.
In the first place, it is a very unsustainable health care system we are running. It cannot go any further and it will crash in the next decade if we do not do something. I actually have facts and figures to prove this, but maybe today is not the day to do so. The day will come, perhaps, when we debate the National Health Insurance, NHI, because these things must come out. We have this information that must come out. We are running a very unsustainable health care system.
Secondly, we are running a very destructive health care system. Hon Papi Kganare put this to the House. He mentioned two things. He first praised the director-general. "Congratulations to you, director-general," hon Papi Kganare said. "You are doing very well." And he is right - in the department we all know that, and we hoped that they would also notice it.
He also mentioned a second thing. He said Caesarean section deliveries are becoming a commodity in the private health care sector and we should look into it. He is right. Moreover, it is not only Caesarean sections, but many other things. How does it happen? It is this destructive, extremely costly, hospicentric, curative health care system that I am talking about.
We are dealing with money here, not health care. We are dealing with money. I was not exaggerating when I said some of the things would shame the devil.
The whole world knows I have received letters of complaint. For instance, one of them is from a member of the World Health Organisation, WHO, who stays in Botswana. She happened to have brought her child here, who developed an ischiorectal abscess. Those who are in the health care sector will know what this is. Just for the draining of that abscess her child was charged R30 000 in a private hospital here.
I can also give the hon Kganare the example of a patient from Swaziland who presented with a peritoneal abscess. Just for a laparotomy to drain that he was charged R500 000. [Interjections.] He died while they were demanding an extra R700 000 - a cool R1,2 million just to do this! That cannot be called health. It is very destructive. If the day ever arrives when we start doing brain transplants, I do not think even that will cost R1,2 million! [Laughter.] I do not think so. But we are already in this space.
Through you, Chairperson, I can tell hon Kganare we have looked into this type of issue. We think something can be done, legally. I have met with the Competition Commission on this issue. I will never rest until it is resolved. I have also met with the Minister of Economic Development, and I can assure you that very soon we are going to make a serious announcement on this issue. If it is left as is, we are all going to collapse somewhere. There is no way health care can cost this much.
We kept on being told that we had to leave it to market forces. The health of the people cannot be market-related. It cannot be. Moreover, it is against section 27(2) of the Constitution of the Republic of South Africa, which hon Papi Kganare was quoting here, and which says health is a right. How can this right be bought?
We know of the situation in countries like the United States. The hon member of the FF Plus says I must be careful, because Obama is in trouble over this issue. Yes, he is in trouble - because he cannot let it go. We have a graph that shows how much money the United States is spending, without any good outcomes - far, far more than many countries in Europe! Their outcomes are poor, however, because they also fell into this trap where they are no longer providing health care. In Africa, South Africa has found itself in that situation, where it is no longer a health care system but a form of commodity.
We are going to look into it. The Minister of Economic Development has agreed on this. We will make a far-reaching announcement in the coming weeks in regard to looking into this issue, because members of the public will come in.
You know, I have also experienced this - where just to have your blood pressure and temperature taken costs R100. Yes, and I have got invoices to show that somebody will just put a cuff around your arm to take your blood pressure, and charge you. As for taking one's temperature, they have new methods these days. During my time, we used to, you know, just put it here. [Laughter.] These days there is an instrument; they just "shoo!" Yes, it is over in seconds and then it costs R100. How can that be? We are going to look into it.
Let me come to the issue of primary health care. We are going to restructure primary health care into three streams.
The first stream will be a district model. This district model is more clinical, because we want it to be a bridge between the curative and primary health care systems. In this model, we will deploy five specialists to each and every one of the 52 districts. Municipalities keep on changing, so I am no longer sure whether we do have 52 districts in South Africa, but when we planned it, it was on the basis of 52 districts. It will also help us to arrive at the Millennium Development Goals. These teams will consist of a principal gynaecologist, a principal paediatrician, a principal family physician, an advanced midwife and a senior primary health care nurse.
I have already consulted the deans of all the medical schools in our country. I have consulted the professional associations of paediatricians, obstetricians, and family care physicians. I have consulted the colleges of medicine in South Africa responsible for specialist training, and I consulted all the nurses of the country during the recent, successful National Nursing Summit.
I am happy to announce that there is overwhelming support for this method from all the people I have mentioned; so we are absolutely determined that this model will be implemented. Furthermore, we will implement it before the end of this year - not the end of the current financial year, but at the end of the calendar year. We are dead sure. [Applause.]
Once these teams are appointed, they will deal with guidelines and protocols at our antenatal clinics, and in the labour wards, postnatal health care, and paediatric and child clinics.
They will follow up on every case of mortality to make sure that mortality meetings are held for every single incident of death of a woman or a child in any hospital. This will deal with the cause at hospital level immediately. This is preferable to the present method, where we wait for research and studies to determine how many children died and what the reason was. The specialist teams will deal with that.
Part of the reason that we are doing this is this. I once worked in hospitals and I know their protocols. Many simple protocols on how to deal with a woman in labour have just been thrown out of the window. I do not understand why and some of these things we see surprise us. For those who are working in hospitals I know that this is an era of computers, etc. I know that. However, I still want to find somebody who will influence me as to what the best method of monitoring a woman in labour is, other than the partogram. It might look primitive, but it saved women. These days that has just been thrown out. There are no partograms; people just rely on computers.
I used to have professors who could examine a woman and tell her what the weight of the child was. Yes, there were professors who could do that. These days, they use the computer, so doctors are losing their clinical skills. They are becoming technicians rather than being clinicians, and we want to change these issues.
These specialist teams in the districts will also deal with the training of interns, as well as community doctors and medical officers. I can see the President of the Health Professions Council of South Africa, Prof Mokgokong, sitting somewhere here behind me. I am going to be approaching you, sir, to determine afresh what it is that an intern needs to be able to do before we allow them to pass their internship. How many Caesarean sections should they be able to do? How many newborns can they resuscitate? Can they intubate? Can they give anaesthesia?
In our day, some of these procedures were very simple, but all of a sudden we find them very difficult. I, personally, have visited hospitals where I am surprised to see interns not being able to do things which I thought were basics. I remember having to take off my jacket one day to help an intern insert an intercostal drain. I do not remember leaving medical school not knowing how to put in an intercostal drain. However, after 10 years of not working in a hospital, I was forced to do it because the intern just could not do it. So, there is something wrong in our training; something that we are not doing very well.
With regard to the method of providing district clinicians, we have asked that, if we cannot find a principal paediatrician to go into a rural district, the universities and the medical schools will provide one for at least a year. After that, he can go back to medical school and they can provide another one. We will create the seats and the universities will see how they can fill those seats, so that every district has these senior people. Then our women and children will no longer die as they are doing now.
The second stream of our primary health care to be engineered is the school health system. I agree with you, it is very curious that nurses no longer go to the schools in this country. For the past eight weeks we have been putting together a team to work on this model. I am going to launch it officially with the Minister of Basic Education and the Minister of Social Development.
These teams at schools will deal with basic things like eye care for the children. Some children go to school, but they cannot see, and the teachers punish them because they are not even aware that the child cannot see. They are not trained to detect such things. Some children cannot hear, and the teachers keep on shouting at them because they are not even aware that the child has a hearing problem. Some children have dental problems, but in the curative health care model we do not go to schools to detect this. No, we sit in the hospital ward waiting for the dental cases to arrive and then we remove the teeth!
In this destructive model - and I need to mention these things - one specialist tried to do it to me. My daughter had a few problems with her teeth and the specialist wanted to do a root canal treatment on my ten-year- old daughter. Root canal treatment means he was going to remove the nerves. The child still has milk teeth! I mean, she is going to outgrow them and get permanent teeth, and they will find no nerves there! Of course, I was shocked. I know why the specialist was doing that - he was going to charge me R20 000! [Interjections.] I took the child to a public hospital, and they did a procedure that cost R200.
The question is: what about members of the public who do not know these things? I saved my daughter because I know. It is a criminal thing that the specialists want to do, and many people are subjected to that every day. We are told that this is a good health care system and we must not fix it. There is no way we are going to leave this issue. We cannot leave it!
The primary health care teams at schools will deal with this. They will also deal with immunisation. They will deal with the more complex issues of contraceptive health rights, and of teenage pregnancies and abortions, which we know are on the increase. They will also deal with the HIV/Aids problem and the issue of alcohol and drugs in schools.
The last stream of primary health care we are going to look at very carefully is the primary health care model based on the ward. We need to put 10 well-trained primary health care workers in every ward.
In Brazil they are making use of this method to good effect. They have deployed 30 000 of these people, whom they call community health care agents. I was also greatly encouraged when we were in Moscow for the development of the Moscow Declaration. The Minister of Health in India announced that they were deploying 800 000 of these people in the villages of India. They call them health care activists.
In our country, we know that the province using a method closest to this is KwaZulu-Natal. It was not by accident that they were able to reduce the incidence of mother-to-child HIV transmission in KwaZulu-Natal. It is because they have these primary health care teams co-ordinated in the Premier's office right at ward level.
We want them to move further and implement primary health care as they do in Brazil and India, so that we do not wait for people to get ill in hospital and then start charging them the amounts of money that they are being charged. [Time expired.] [Applause.]
Debate concluded.