Speaker, Ministers and colleagues, allow me, while I have the opportunity, to bid the hon Mike Ellis farewell. I remember he was one of the few people from the opposition benches who actually welcomed me to this House in 1994. I thank you, Mike. Go well.
In terms of the topic - as far as health care is concerned and how we view health care - human rights is a universal guarantee protecting individuals and groups against actions which interfere with fundamental freedoms and human dignity.
Some of the most important characteristics of human rights are that they are guaranteed by international standards, legally protected, focus on the dignity of the human being, oblige states and state actors to act, cannot be waived or taken away, are interdependent and interrelated and are universal.
The right to the highest attainable standard of health, referred to as the right to health, was first reflected in the World Health Organisation, WHO, Constitution in 1946. It was then reiterated in 1978 in the Declaration of Alma-Ata in the World Health Declaration adopted by the World Health Assembly in 1998.
It has been firmly endorsed in a wide range of international and regional human rights instruments. The right to the highest attainable standard of health in international human rights law is the entitlement to a set of social arrangement norms, institutions, laws and an enabling environment that can best secure enjoyment of this right.
The most authoritative interpretation of the right to health is outlined in article 12 of the International Covenant on Civil and Political Rights, which has been ratified by 145 countries. The general comment from that covenant recognises that the right to health is closely related to and dependent upon the realisation of other human rights.
These include the right to food, housing, work, education, participation, the enjoyment of the benefits of scientific progress and its applications, life, nondiscrimination, equality, the prohibition against torture, privacy, access to information and the freedom of association, assembly and movement.
In South Africa, access to health care is a constitutionally recognised right under section 27 of the South African Constitution. It specifically recognises the right to access to health care, food, water and social security. Everyone has the right to have access to health care services, including reproductive health care. The state must take reasonable, legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights. No one may be refused emergency medical treatment.
In 1997 the South African Human Rights Commission, a statutory body assigned to evaluate the realisation of access to health care, held a public enquiry into the matter. The report was finally released in early 2009. This report found that the public health care system was - and continues to be - in a lamentable state. That is the view of the commission.
It further alluded to the fact that South Africa faces a number of challenges that complicate the progressive realisation of access to health care. The HIV and Aids statistics, for example, are amongst the highest in the world, placing a burden on public health. South Africa has the highest income inequality, globally, and the gap between public and private health care - with specific reference to affordability and quality of services - remains a major concern.
The South African government has obligations under the international and regional legal standards to ensure that all human rights are fulfilled, including the right to health, to life, to remedy, to be free from cruel, inhumane and degrading treatment and to nondiscrimination. The South African Constitution requires that international law must be taken into account when interpreting domestic legislation.
South Africa is party to many international and regional human rights treaties relevant to health care and access to remedies. At the international level, South Africa has ratified the following international instruments: The International Covenant on Civil and Political Rights, the Convention on the Elimination of all Forms of Discrimination Against Women and the Convention on the Rights of the Child. The convention protects children's rights by setting standards in health care, education, and legal, civil and social services.
Four of the Millennium Development Goals, MDGs, relate to health care, thus underlining the importance of the status of the health of a nation on the path to development. A number of laudable development targets for health had been agreed to at the Millennium Summit and at other United Nations, UN, conferences and international forums.
These targets include, for example, reducing the mortality rate for children under five by two-thirds, and measles, mumps and rubella by three- quarters by 2015; reducing HIV prevalence in all young people aged 15 to 24 years by 25% and the proportion of infants infected with HIV by 50%; and reducing TB-related deaths and prevalence and the burden of disease associated with malaria by 50% by 2010. South Africa has pledged to meet the eighth MDG goal by 2015.
In terms of regional instruments, we have the African Charter on Human and People's Rights and the African Charter on the Rights and Welfare of the Child. They are regional instruments that we are party to and we are obliged to observe and promote them.
The South African health care system is characterised as a fragmented and inequitable system due to the huge disparities that exist between the public and private health sector, with reference to the accessibility, funding and delivery of services. As a result, access to health care is unequal, with the majority of the population relying heavily on a public health care system that has a disproportionately lower amount of financial and human resources at its disposal in comparison to the private sector.
The mismatch of resources in the public and private health sectors relative to the size of the population each sector serves and the inefficiencies in the use of available resources has significantly contributed to the very poor health status of South Africans. This is particularly the case in the lowest income groups of the population.
I do not have much time left. I just want to quickly talk about the National Health Act, which actually gave effect to the provision in the Constitution. To ensure universal access to health care, South Africa proposed a national health insurance. Plans are already advanced to start with the phased-in implementation of the national health insurance scheme.
Therefore, South Africa is forced to strengthen delivery of quality health care services to its people as a fundamental right, which is entrenched in the Constitution of the Republic and which South African citizens should enjoy. The South African national health insurance is founded on a number of principles which I shall not go into.
In conclusion, South Africa has come a long way in providing greater access to health care. The country has a world-renowned Constitution that provides for the realisation of the right to health care.
South Africa has made progress in terms of the realisation of access to basic health care through legislation and policy development. South Africa is a member of international and regional instruments.
Therefore, it is essential that human rights are taken into account when delivering services to ensure quality care. Putting human rights at the heart of the way health care services are designed and delivered can make for better services for everyone, with patient and staff experiences reflecting the core values of fairness, respect, equality, dignity and autonomy. I thank you.
Hon members, you are conversing too loudly. You are drowning out the speakers!
Chair ... [Applause.] Thank you very much, colleagues! South Africa has made great strides in ensuring access to health care for women and children. We have free primary health care for all children under the age of six, to mention just one example. The number of health care facilities has, over the past 17 years, increased from approximately just over 3 600 to 4 200. So, much has been achieved with regard to access.
Why is it then that our child and maternal mortality rates keep increasing? In fact, we are only one of a handful of countries that are failing to reduce the rate at which mothers and children are dying.
As far as our Millennium Development Goals are concerned, our infant mortality target is to reduce to 18 the number of deaths per 1 000 live births. Our current rate is 53. That is nearly 200% higher than the 2015 target.
The under-5 child mortality rate is even worse, with our current levels hovering around 104 deaths per 1 000 live births, while our target is 20. That means our child mortality rate is thus 420% higher than our MDG target.
When we look at the maternal mortality rate, the situation is far worse. The 2015 target is to reduce maternal mortality to 38 out of each 100 000 live births. However, our current level is 625 per 100 000 live births. That is a staggering 1 500% higher than our target.
I know the Department of Health is about to publish the official maternal mortality rates based on confidential death inquiries. However, these inquiries understate the true maternal mortality rate as they only focus on facility-based deaths and exclude those who die at home. In this regard, South Africa is notorious worldwide for its poor quality in reporting.
Why then are we failing our women and children so spectacularly? Is it money? The simple answer is no. Even Minister Manuel alluded to this last week during the MDG workshop. Evidence shows, time and time again, that countries with lower or similar GDPs to ours are actually reducing child and maternal mortality rates. Some examples are Brazil, Vietnam, Algeria, Peru and Namibia, to mention a few who are all out-performing us.
So, is it HIV/Aids? Increasingly, the government is blaming HIV for the high rate of child deaths. It is ironic that the party that allowed Aids to obtain such a powerful iron grip across our country through their decade of denialism is now using this as an excuse.
Although baby deaths may, in some instances, be related to HIV and Aids, these and other causal factors are preventable. The main reason for babies and mothers dying in hospitals or during the postpartum period are largely attributable to the poor quality of health care provided in our hospitals.
Despite the availability of antenatal care, despite the availability of skilled birth attendants, and despite the hospital referral system, mothers and children continue to die. The main reasons for babies and mothers dying in our health care facilities are attributable to broken accountability structures resulting from the politicisation of service delivery in health care.
Another reason for the high mortality rate is corruption. An International Monetary Fund paper, titled Corruption and the Provision of Health Care and Education Services, directly links the increasing child and maternal mortality rates in a country to that of the levels of corruption. I quote from the report:
The empirical analysis shows that a high level of corruption has adverse consequences for a country's child and infant mortality rates, percentage of low birth-weight babies in total births, and dropout rates in primary school. In particular, child mortality rates in countries with high corruption are about one third higher than in countries with low corruption, and infant mortality rates are almost twice as high.
The report highlights important policy implications in the light of the role played by governments in the provision of health care. I am going to mention one due to time constraints. It says:
Improvements in indicators of health care and education services do not necessarily require higher public spending. It is equally, if not more, important to institute transparent procurement procedures and enhance financial accountability of public spending.
Evidence from across the globe proves that we can reduce infant, child and maternal mortality rates, but we just need the political will to fix the accountability structures within the health system, depoliticise the delivery of services and combat corruption. I thank you very much. [Applause.]
Chairperson, in 1948 the World Health Organisation, WHO, defined health as:
A state of complete physical, mental, and social wellbeing and not merely the absence of disease or medical conditions.
Section 27(1)(a) of our Constitution states that -
Everyone has the right to have access to -
a) health care services, including reproductive health care. ...
Section 27(2) qualifies that -
(2) The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.
Lastly, section 27(3) instructs all health workers that -
(3) No one may be refused emergency medical treatment.
When we speak of access to health, the challenges which come to mind should be: What is happening in the lives of the ordinary people? On 30 January 2005, Nomhlobo Siyatha died at Site B Clinic in Khayelitsha as a result of severe loss of blood.
At Eikenhof Clinic it is normal to have a regular shortage of medicine and pain killers, on the one hand. On the other hand, Mameli Msindwana, after he was shot by car hijackers, was discharged from a community health care centre in Gugulethu with a punctured lung. This was after he was handed two packets of pain killers and told to come back the following day if he experienced any problems.
To make matters worse, chronically ill patients, the elderly, mothers with small babies and pregnant patients brave icy early morning temperatures, on a daily basis, to secure places in queues outside clinics in every poor area of our country. This is clearly an indication that there are enormous disparities in health status and access to health services in our country.
The health of people depends on a large number of factors, many of which are interconnected, and most of which go considerably beyond access to health services. It stands to reason that health and economic matters are intimately linked in a number of ways. We all know that health is an important contributor to people's ability to be productive and to accumulate the knowledge and skills they need to be productive.
Women in rural areas are still trapped in poverty. These women lack access to their basic human rights and yet they have voted. Women are responsible for heavier household burdens. Gathering and transporting water falls on women and children, a task that can take many hours each day in drought- prone areas.
On average, half an hour is spent collecting water. This includes walking to the source, and sometimes waiting to collect the water and return. Because it takes time to collect water and fuel, the available time for education or other economic and political activities decreases. Already the majority of children in our country who do not attend school are girls.
Travelling long distances to collect water and fuel puts women and girls at risk of violence. Poverty and poor access to health care exacerbates these risks. Women and children are prone to diseases. Twenty nine percent of pregnant women are HIV positive.
South Africa has committed itself to achieving the Millennium Development Goals, MDGs. One of these goals is to reduce the death of mothers by 75% between 1990 and 2015. A report looking at South Africa's MDG progress, which used data from the community survey of 2007, found that 625 mothers died for every 100 000 live births.
In addition to this, the National Committee on Confidential Enquiries into Maternal Deaths found that 3 959 cases of maternal deaths were reported between 2005 and 2007. This was a 20,1% increase from the previous report. This is a far cry from the MDG to reduce maternal mortality by 2015.
About 80% of deaths are of children under five years of age, and the cause is diseases such as HIV and pneumonia. Other factors which contribute to this high mortality rate are lack of access to drinking water and basic sanitation, which lead to diarrhoea; societal inequalities; lack of access to health facilities; and 40% of children having to travel long distances to get to the nearest clinic. [Time expired.] [Applause.]
Chairperson, women around the world struggle to access their basic human rights. Yet it is clear around the world that women and children are two of the most vulnerable groups and are struggling to find a voice and, more importantly, value in their society.
The struggles common to all women are human rights struggles - the struggle for equality, justice, full participation and inclusion. The rights are simply words. As legislators we need to ensure that these words translate into action.
Therefore, while we can situate South African women's rights struggles as part of both gender and multicultural struggles, we need to go one step further. The only way we can truly recognise and meet the demands of complex identities is through a human rights approach.
Empowerment is a critical aspect of such an approach. The High Commissioner for Human Rights, Judge Navi Pillay, had the following to say:
Empowerment is predicated on the removal of discriminatory laws and harmful practices that hold women back, frustrate their resourcefulness, and curtail their access to a fair share of the common wealth.
In the quest for health care, whether maternal rights or accessing antiretroviral, ARV, treatment or not, it is imperative that access has no barriers. This means that health budgets must be adequately resourced, financially and with manpower. It is only then that human rights for all South Africans can become a reality.
As the nation's primary health care consumers, women have a critical stake in the shape and function of the health care system. Because of women's reproductive health needs and longer life span, women use more health services than men. We must look to the health care delivery system as a primary resource.
In conclusion, yes, health rights are human rights and what is required from parliamentarians across party lines is a commitment to action. Action! Action! We need to begin to act so that infant mortality rates drop and MDR- TB and XDR-TB become nonexistent, simply by accessing immunisation. Thank you. [Time expired.] [Applause.]
Chairperson, the role of Parliament in the provision of health care for women and children should not be limited merely to oversight. The ID believes not only in the constitutional right of health care for all, but in adequate, effective and equal health care for all.
The divides of our apartheid past are still very evident in the provision of health care. This is clearly visible, not only in terms of access to private or public health care, but also in the quality of health care that is received. Why is it that after almost two decades of freedom there are still millions of poor South Africans who do not receive the same levels of health care as wealthy South Africans?
It is a fact that in our country one's chances of survival are greater if one is wealthy. It cannot be right that only the wealthy have proper and quality access to health care. It is a sad reality that every MP and councillor has access to good, quality health care, but the very people that we represent still suffer. It is sad that, while companies make a killing from obscene profits through pharmaceuticals in private health care, the poor still suffer.
I was shocked to learn today in the Portfolio Committee on Health that the data we have on HIV/Aids statistics is not reliable. There is the very real possibility that we do not know exactly how many people are infected with HIV/Aids in South Africa, because we are unable to detect duplication in testing. Many patients visit more than one testing centre in order to get a second opinion and, because we are unable to detect whether or not a patient has visited more than one centre, that data is not reliable.
The recent figures on testing announced by the Minister are also unreliable. This was confirmed this morning by the CEO of the National Health Laboratory Services. The figures reported on HIV/Aids in South Africa may, in fact, be much lower than we think.
The ID calls on the Ministry to address this as a matter of urgency. Without the correct statistics we will never be able to curb this disease. I thank you. [Applause.]
Chairperson, over and above the right to health in section 27(1)(a) of the Constitution that government must adhere to, South Africa has also ratified the International Covenant on Economic, Social and Cultural Rights.
The UN Committee on Economic, Social and Cultural Rights has stated that this treaty obligation must be understood as requiring measures to improve child and maternal health, amongst other things. In this respect, monitoring and accountability are central human rights principles which are integral to the realisation of the right to health.
Human Rights Watch states that South Africa's maternal mortality rate has more than quadrupled in the past decade. It further states:
Underlying this problem, are shortcomings in accountability and oversight mechanisms that authorities use to monitor health care system performance, identify failings and needs, and make timely interventions.
Die organisasie wys ook dat Suid-Afrika eintlik al die hulpbronne het om goeie gesondheidsdienste te lewer. Die kern van die probleem is dat die relevante oorsigliggame nog nie funksioneer nie. Ons gesondheidsprobleme onstaan dus vanuit 'n diensleweringsgebrek eerder as net 'n tekort aan fondse of fasiliteite.
Daarom wil ons adviseer dat die regering eerder die basiese diensleweringsprobleme uit die weg moet ruim voordat daar beplan word aan 'n reuseprojek soos die Nasionale Gesondheidsversekering.
Belastingbetalers in Suid-Afrika word reeds swaar belas en om nog 'n belasting in die huidige ekonomiese klimaat in te stel, sal die werkende middelklas net verder verklein. (Translation of Afrikaans paragraphs follows.)
[The organisation has also indicated that South Africa actually has all the resources to deliver good health services. The root of the problem is that the relevant oversight bodies are not yet functioning. Our health care problems thus originate from a lack of service delivery rather than merely a shortage in funds or facilities.
Therefore we want to advise that the government should rather sort out the basic service delivery problems prior to embarking on a huge project such as the National Health Insurance.
Taxpayers in South Africa are already heavily taxed and imposing another form of tax in the current economic climate will only further shrink the working middle class.]
If this government wishes to ensure that it fulfils its national and international obligations, then getting the basics right, like service delivery, is the place to start. The only way to ensure that service delivery takes place according to acceptable standards is by ensuring that the oversight bodies for health care are given life and appropriate strong instruments to punish bad service delivery.
Chair, many factors contribute to the poor health of women and children, namely poverty, income inequalities, gender disparities, discrimination, poor education and gender-based violence. Gender equality and women's empowerment are central to securing the health of women and children.
As parliamentarians we represent women and children who make up a significant proportion of all our constituencies. We speak on their behalf and work to ensure that their rights and concerns are reflected in national development strategies and budgets. Our role is critical to the health and wellbeing of women and children, and we cannot rest until every pregnancy is wanted, every birth is safe and every child and newborn baby is healthy.
The UN Millennium Development Goals 4 and 5, Reducing Child Mortality and Improving Maternal Health, focus parliaments on maternal, newborn and child health, and our role in holding the executive accountable on these goals will require dogged commitment.
It is critical that we start by determining where and why women and children are dying prematurely, identifying barriers that prevent people accessing services and interventions and locating the bottlenecks in delivering them.
It is also important to identify areas in which parliamentarians lack capacity and are limited in their effectiveness. Having access - as we have just heard - to sound and timely data, for example, better equips parliamentarians. Improving national statistical capacity is, therefore, important. A strong health system is essential in securing the health of women and children, and a political system that implements a right to health care will, of necessity, involve transfers of wealth to pay for relevant programmes.
We must have safeguards and accountability to minimise corruption. South Africa will do well to pay close attention to the experience of others in instituting the new National Health Insurance. As parliamentarians we will have an ever-increasing watchdog role to play in demanding integrity and honesty in the system in order to secure the health of women and children.
Lastly, without an active civil society, paper commitments to rights are in danger of meaning very little. A well-organised civil society is invaluable. Thank you. [Applause.]
Before the hon member speaks, allow me to state that I have been given to understand that this is the hon member's maiden speech. [Applause.] Therefore, the tradition is that we give the hon member due honour and listen attentively. Go ahead, hon member.
Ngiyetsemba Sihlalo kutsi angeke ungidvonse ngelibheshu. Sihlalo lohloniphekile neMalunga ePhalamende, iPhalamende idlala indzima lenkhulu ekuvikeleni bomake nebantfwana kutemphilo.
Kungako iPhalemnde yakitsi ikhuluma ngemalungelo etemphilo kuwo wonkhe umuntfu lohlala lapha eNingizimu Afrika. Ngisho umntfwana asengakatalwa, lePhalamende leholwa yi-ANC ishaye umtsetfo wekutsi bomake labatetfwele kufanele baye emitfolamphilo bayohlolwa kutsi bobabili nemntfwana baphilile yini. Kungako iPhalamende ibita Litiko Letemphilo kutosho kutsi lentani kubomake nebantfwana nekutsi lentani kulesive salapha eMzansi Afrika.
Ngabe bomake bavikelekile yini ku-HIV ne-Aids, kumdlavuta wemabele, ngisho nesifo sesifuba. Ngabe bantfwana bayakalwa yini emitfolamphilo futsi bayagonywa. Ngabe abesuleleki yini ngeligciwane lelitsatselwanako. Konkhe loku, Sihlalo, kwentiwa ngiyo lePhalamende yetfu ngoba iyanakekela. [Lihlombe.]
Bomake nebantfwana banelilungelo lelikhulu lelilingana nelebantfu bonkhe bakuleli. Kugagadlelwa nekushaywa kwabomake nebantfwana akufuneki kantsi kuvikelwe nguwo lomtsetfo loshaywe kulePhalamende. Noma ngubani lowenta loku utawotsa ubovu. [Lihlombe.]
Sihlalo, i-ANC ngekubambisana nePhalamende kuvumelene kutsi kwelashwe mahhala, kulaliswa etibhedlela tahulumende kwabo bonkhe labagulako kungakhokhelwa, kunakekelwa kwabomake nebantfwana kubemahhala, nekukhipha tintfo letivikela tifo kubomake njengelijazi lemkhwenyane kutfolakale mahhala, nekuhlela umndeni kubomake; konkhe loku kwentiwe mahhala kute sibe nabomake nebantfwana labaphilile futsi labanemphilo; ngiyo lePhalamende nenhlangano lebusako i-ANC.
LePhalamende ilwa kakhulu ngekuhlukunyetwa kwabomake nebantfwana. Ngalesikhatsi ingakabikhona lePhalamende yentsandvo yelinyenti bomake bebalindzeleke kutsi bayokha emanti emifuleni, batfote tinkhuni, bawashe, bapheke nekutsi batfole bantfwana labanyenti ngaphandle kwekubuka temphilo kutsi kufanele yini. Bantfwana bona bebalindzeleke kutsi beluse imfuyo, basebente emapulazini, batsengise, bebaganiswa ngisho noma basesebancane kakhulu. Loku bekubalimata kutemphilo.
Kunele kutsi kube nalePhalamende kwaphela konkhe loko ngoba likhulumile ngemalungelo abomake nebantfwana kutemphilo. Ngiyabonga. [Lihlombe.] (Translation of Siswati paragraphs follows.)
[Mr V V MAGAGULA: Chairperson, I hope you will not stop me from saying this. Hon Chairperson and Members of Parliament, Parliament plays an important role in protecting the health of women and children.
That is why our Parliament talks about health rights to every person who resides in South Africa. Even as far as an unborn child is concerned, the Parliament that is led by the ANC passed a law that states that a pregnant woman must go to the clinic for a check whether she and the baby are healthy or not. That is why Parliament is able to summon the Department of Health to come and give an account of their role regarding women and children as well as the entire South African nation.
Are women protected from HIV and Aids, breast cancer and tuberculosis? Are children weighed and vaccinated at clinics? Are they not infected with an infectious virus? All of these, Chairperson, are done by our Parliament, because it cares. [Applause.]
Women and children have the same equal rights like all people of this country. Rape and the physical abuse of women and children are condemned and are also prohibited by the laws passed in this Parliament. Anyone who commits these crimes will face the full might of the law. [Applause.]
Chairperson, the ANC together with Parliament, agreed that medical treatment should be given free of charge, admission of all patients at government hospitals should be free of charge, health care for women and children should be free of charge, accessing things that prevent the spread of diseases in women, like condoms, should be free of charge, and there should be family planning for women. All of these things are done free of charge in order to have living and healthy women and children. It is this Parliament and the ruling party, the ANC, that brought about all these changes.
This Parliament is vigorously fighting against the abuse of women and children. Before the democratic government was introduced, women were expected to fetch water from rivers, fetch firewood, do laundry, cook and bear a lot of children without considering their health. Children were expected to look after the livestock, work on the farms, and sell produce. They were even forced to marry when they were still young. This affected their health.
Since the inception of this Parliament, all of these things came to an end because it talked about women and children's rights on health issues. I thank you. [Applause.]]
Chairperson, hon members and guests, access to health care starts at primary health care level, but unfortunately the poor quality of health care services becomes a huge barrier in terms of access.
According to the Department of Health, access to primary health care services has increased but the level of quality has deteriorated drastically. What is interesting is that no research has been conducted to assess the cause of the increase because it might be due to lack of efficient and effective primary health care, shortage of drugs or that people have to visit the facilities twice or thrice until they get medication.
Women are the custodians of family health and they play a critical role in maintaining the health and wellbeing of their families. Therefore, a healthy woman equals a healthy nation.
Women are the pillars of the society, therefore basic health care, family planning, including access to female condoms, and obstetric and emergency services are essential for women. Yet these things remain inaccessible to millions of women in rural and remote areas with no easy access to secondary or tertiary care.
The human papillomavirus, vaccination has to be explored as well. In South Africa, 70% of cervical cancer cases in girls can be prevented through this vaccination, but the cost makes it inaccessible. This is where we as parliamentarians come in to revisit and scrutinise the budgets.
We would like to thank organisations like the Centre for the Aids Programme of Research in South Africa, Caprisa, that are busy doing research on microbicides to respond to the urgent need for HIV and STI prevention methods for women.
According to the Global Health Council, maternal mortality and maternal conditions are leading causes of death and disability among women.
Every year about 10 million women globally endure life-threatening complications during pregnancy and childbirth. In sub-Saharan Africa 61% of adults living with HIV/Aids are women.
Early and unwanted childbearing, HIV, STIs, pregnancy-related illnesses and deaths account for a significant proportion of the burden of illnesses experienced by women, especially the poor. Nearly 50% of maternal deaths are preventable through timely prenatal and postnatal care, skilled birth attendance during delivery and the availability of emergency care to deal with complications.
Children under the age of 15 years account for one in every 6 Aids-related deaths in the world. We need to take care of the overall health of our children to ensure a better future and a healthy nation. According to Child Gauge in 2002, the Department of Health set for itself 14 child health goals, but to date, a decade after the target deadline, they have only achieved one goal.
Children who are subjected to illness and lack of access to adequate health services are at risk of shortened lifespans, poor physical and mental health and educational problems, including dropping out. We have only four years left to realising the Millennium Development Goals, but unfortunately our country's rate of maternal and child mortality has doubled since 1990. Therefore, it is a huge concern for us as to whether we will meet this target.
No woman should die giving birth to a child and no child should die due to unnecessary medical negligence. So far the government has failed the women and children of this country. The government has missed a big opportunity in addressing maternal and child mortality by, firstly, not putting in place quality assurance measures for MDGs earlier; secondly, by not conducting an audit to generate comprehensive information on primary health care infrastructure and services; and further by not monitoring and evaluating the use of resources versus the delivery of the Permanent Health Company, PHC, package since 1997.
This would have ensured that there would be no suboptimal implementation of interventions and, in turn, have prevented most if not all avoidable deaths. We welcome the recent establishment of the new office of health standards compliance and the recent commitment by the Department of Health to finally conduct the long overdue audit commissioned in 2007-08.
The Department of Health has not been performing adequately since the inception of democracy in SA, and this has not only impacted negatively on the health of women and children, but also on the socioeconomic development of our country. In order for this Parliament to fulfil its functions with regard to addressing these key challenges, we need to strengthen research capacity, advocate for the upliftment of the socioeconomic conditions women and children are living under because poverty compromises women and children ... Thank you. [Time expired.] [Applause.]
Modulasetulo, maloko ao a hlomphegago a Palamente ... [Chairperson, hon Members of Parliament ...]
As we conclude the debate on the 125th Inter-Parliamentary Union, IPU, Assembly topic, we need to look at how the topic was decided upon and what were the critical areas which were forcing or making the third Standing Committee of the IPU to decide on this.
When hon P Turyahikayo from Uganda proposed this subject, it was taking into consideration the challenges that are faced by women and children, especially on the African continent. These are challenges of access to health and the many challenges of women and children dying because of the lack of health facilities.
Today, women and children in countries faced with conflict are bearing the brunt of those conflicts as their right to health is infringed. You take a look at the women and children of African countries such as Somalia, who can't access health to survive. This has led to many fatalities.
We need to commend the good work done by the South African team that is currently in Mogadishu, ensuring that women and children in that country get access to health care. They are working under difficult conditions, trying to save lives with limited resources and medical equipment. Their bravery and dedication to their call to serve indeed inspires many of us.
I am hoping that many of us in the House are contributing to the initiative and supporting pledges towards the work being done by the Gift of Givers and the South African government in supporting the Somalian people.
The results of the conflicts lead to migration and refugees. The refugee and migration rights are human rights. A number of challenges and bottlenecks still hamper access to health care for many migrants women and children. More women die each year due to complications during pregnancy and childbirth.
Co-operation with the international community is needed, to reinvigorate their efforts aimed at achieving the Millennium Development Goals, thus contributing to the elimination of conditions that force people to migrate, such as poverty; the negative impact of human activities on the environment; the failure to apply international law; the continued existence of agricultural subsidies; the lack of official development assistance; and the deficit of good governance and of the rule of law.
International migration requires a holistic and coherent approach based on shared responsibilities, which also and concurrently addresses the root causes and consequences of migration for women, as for men, such as inadequate potable water, sanitation and waste disposal in urban and rural areas in Africa which leave populations vulnerable to waterborne diseases and other environmental diseases such as malaria, lung and other respiratory diseases, which are still major killers in Africa.
These conditions are compounded for women by some unhelpful or even dangerous religious norms and practices centred on their reproductive and productive functions, their heavy workloads, high birth rates and sociocultural factors that limit their dietary intake.
Maternal and infant mortality remain high, which is a concern. Gender inequality affects each individual's opportunity of labour, market participation and migration; and the gendered effects of states, migration policies make women more vulnerable to the violation of their human rights.
While reproductive health issues are important, there is also a need to focus on women's general wellbeing. For instance, infertility is a problem in some parts of Central and East Africa, where 20% of women aged 45 to 49 are estimated to be childless.
Insufficient housekeeping money, desertions and divorce, stress and the insecurities of daily life also threaten women's mental health. Parliaments should use their legislative roles to remove barriers and facilitate access to health care by amending existing laws. The Universal Declaration of Human Rights states that all humans are born free and equal in dignity and rights.
It is parliaments that rectify international conventions, pass legislation and monitor government programmes. In 2001 during the World Conference against Racism, the IPU declaration pledged that parliaments and their members would work with the United Nations and other organizations to eliminate all forms of discrimination. It then urged parliaments to adopt laws that ensured this, and called on the IPU to follow up on the programmes of action adopted by the World Conference against Racism.
States are obliged to guarantee that all individuals, without distinction of any kind, whether immigrant or refugees, enjoy the rights enumerated in the International Covenant on Civil and Political Rights; the International Covenant on Economic, Social and Cultural Rights; the Convention on the Political Rights of Women; the Convention on the Elimination of All Forms of Discrimination against Women; the Convention on the Rights of the Child; the Unesco Declaration on Race and Racial Prejudice; the International Convention on the Elimination of All Forms of Racial Discrimination; the United Nations Convention against Transnational Organized Crime and its Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children; and the International Convention on the Protection of the Rights of all Migrant Workers and Members of their Families.
One of the direct negative consequences of the lack of a broad and comprehensive multilateral approach to migration policy, and of restrictions on legitimate migration, is an increase in rejection, abuse, ill-treatment, aggression and marginalisation of migrants. This in turn results in criminal behaviour such as human trafficking and xenophobic hate crimes, and many who suffer or bear the brunt of this are women.
Parliaments must pledge to increase budget allocations to health sectors and press for a clear budget line for maternal health. Removing inequalities gives societies a better chance to develop. When women and men have relative equality, economies grow faster and children's health improves.
In conclusion, I want to respond to some of the issue raised by members. Firstly, hon Waters raised the issue that the South African government has failed the women of this country, which I think is completely untrue. When you look at the past, women were not able to get some of the benefits that they are getting today.
When you had to go to hospital for your antenatal clinic, you had to pay, had to travel long distances, had to go to hospitals where facilities were either not available or not adequate to give birth.
Today, under the ANC-led government, these health care facilities are there for women, even in rural and remote areas. Today, even where there are difficulties in accessing facilities or where there is no infrastructure and buildings, there are mobile clinics to support these women. [Applause.]
It is the ANC-led government that has done the majority of this work. We have to understand, we acknowledge that there are challenges in the health care system, hence the proposal for the National Health Insurance is on the table.
The Green Paper is there, let us engage with it because it is one of the ways of improving an integrated approach to health care. [Applause.] You are in the portfolio committee; you should know better. The issue here is that when we talk about ... [Interjections.] You just shut up! The issue of ...
Hon member, withdraw that statement.
I withdraw it, Chair. [Laughter.] The issue here, hon members, is that you cannot say that women are worse off. Ask us, the black women who grew up in the townships and rural areas. There was nothing for us until 1994. Today we are better off. Today you can walk to the clinic. You do not have to pay anything as a woman.
That is why I am saying that antenatal clinics are free and that is why there is education continually. Antiretrovirals are free, migrant women and children in this country get access to health care facilities without even paying anything ... [Interjections.]
Order! Order, please!
... and without even being asked to give their identity. You can go to countries like the US; it does not happen there. Migrants and refugees in the US are not given access to health care; it is the South African government that gives this equally.
That is why today we can pride ourselves that we are a country that acknowledges that it does not matter who you are, you are able to access these health care facilities. [Applause.] Black and white, everybody accesses these health care facilities. [Applause.]
I want to say that, just to end this day in honour of hon Ellis, let us treat each other like hon members, please. Just to honour hon Ellis, let us be friendly - just pretend. [Laughter.]
Debate concluded.