Chairperson, Ministers and Deputy Ministers present here today, my colleague, the Deputy Minister of Health, Dr Gwen Ramokgopa, MECs from the various provinces, hon chairperson of the portfolio committee, Dr Monwabisi Goqwana, and members of your committee, hon members of the House, the Director-General of Health, Ms Precious Matsoso, Your Excellencies, High Commissioners and Ambassadors, leaders of the various statutory bodies, health unions and other health-related organisations, our special guest, the Roll Back Malaria and Unicef Goodwill Ambassador and UN Envoy for Africa, Ms Yvonne Chaka Chaka, distinguished guests, ladies and gentlemen, it is a great honour and privilege to present to this House the national Department of Health's policy priorities and budgets for the financial year 2012-13 for your consideration.
This period falls in the mid-term of our office. It is very important for me to do some form of review of our health care system. This will shape our understanding of how we can protect and maximise our gains for the remaining half of the term. We started the term by putting forward a 10- point plan, which you are familiar with by now.
The Department of Health's outcome is "A long and healthy life for all South Africans". It is one of the 12 outcomes of government. This "long and healthy life" is not going to be achieved through wishes or sloganeering. It is not going to roll in on the wheels of inevitability. There has to be a well-thought-out and well-executed plan to achieve this. We have selected four outputs that must be achieved to realise the goal of a long and healthy life for all South Africans.
The first output is to improve the life expectancy of all South Africans. We all know that the life expectancy figures in our country have taken a serious knock as a result of the quadruple burden of disease, or the four pandemics, that the country is experiencing. These four pandemics, as you know, are the scourge of HIV/Aids and tuberculosis; the unacceptably high incidence of maternal and child mortality; the ever-expanding burden of noncommunicable diseases and the high incidence of violence and injury, including motor vehicle accidents.
We need to do everything in our power as a country to defeat the four pandemics, hence our second output is decreasing maternal and child mortality. The third output is dealing with the scourge of HIV/Aids and tuberculosis.
Chairperson, to facilitate on understanding of what I am trying to convey to this House, please allow me to deal with these first three outputs, before I even mention the fourth one. I have a special reason for doing so, and I will explain it later as I go along.
With regard to the issue of HIV/Aids and tuberculosis, as a country we started the early decades of HIV/Aids on the wrong foot, but recently, in typical South African style, we have bounced back. We have shown that a common goal and collaboration and solidarity against a shared threat is desired and can produce results.
Through our combined efforts and collaborative undertakings, we launched a huge campaign to test and counsel 15 million South Africans with regard to HIV. We have achieved this and even exceeded the target, and today more than 20 million South Africans know their status.
Through this programme, we have been able to counsel and place 1,6 million South Africans on antiretroviral treatment. We have achieved this by increasing ARV sites from 490 in February 2010 to 3 000 in April 2012. We have increased the number of nurses certified to initiate ARV treatment from 250 in February 2010, to 10 000 in April 2012.
Within the same period, we conducted 320 000 medical male circumcisions. We have reduced mother-to-child transmission of HIV from 8% in 2008 to 3,5% in 2011, or even to 2,5%, in the case of KwaZulu-Natal. This is a reduction of 50%.
This success has allowed us to save 30 000 babies from contracting HIV from their mothers. In order not to be complacent, we have unveiled a new National Strategic Plan on HIV/Aids and tuberculosis for the period 2012- 16. This strategic plan was officially launched by President Jacob Zuma on World Aids Day last year.
The provincial implementation programme was launched by Deputy President Kgalema Motlanthe on World TB Day on 24 March this year. For the first time in the history of our country, we have integrated HIV/Aids and tuberculosis in the same strategic plan. This new plan outlines a 20-year vision for the country in the fight against the double scourge of HIV/Aids and tuberculosis.
Hon members, we need your support and leadership to make the four strategic objectives in the country's National Strategic Plan a success. These four strategic objectives are: addressing the social structural drivers of HIV, sexually transmitted diseases, as well as tuberculosis care, prevention and support; preventing new HIV, STD and tuberculosis infections; sustaining health and wellness; and, lastly, ensuring the protection of human rights and improving access to justice.
The new National Strategic Plan further requires that every South African must be tested at least once a year. We believe that if all South Africans can play their role, these goals will be achieved. We need to make sure that every pregnant woman undergoes routine HIV-testing. We need to make sure every male is circumcised and so, this year, we are targeting 600 000 men.
The problems of the high maternal and child mortality rate, high rates of pregnancy-related deaths, the disproportionate number of women exposed to sexual violence - with the worst incident of all shaming the country just this past week - are cause for concern.
You will have noted that most of our interventions on HIV/Aids are directed at saving pregnant women and children. It is important to note 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 runs the risk of dying because she is trying to bring new life into this world.
We know that even mortality as a result of HIV/Aids, as well as malaria, is disproportionally affecting young women of child-bearing age. This disproportionate assault on women of child-bearing age is happening more on the continent of Africa than in any other part of the world. Therefore the African Union came up with a programme called the Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa, or Carmma. In our country, we will launch Carmma on 4 2012 May, at the Osindisweni Hospital in the province of KwaZulu-Natal. Members of the portfolio committee have been invited to this event through their chairperson. We will outline concrete steps to reduce the maternal and child mortality rate during that event. During that event we will elaborate further on how we shall roll out the strategy called the Essential Steps in Managing Obstetric Emergencies and the strategy called Emergency Obstetric Simulation Training.
The output on increasing life expectancy, which is our first output, does not only depend on our fight against HIV/Aids and reducing maternal and child mortality but also depends largely on bringing noncommunicable diseases under control and decreasing the scourge of violence as well as injuries on our roads. Until very recently, the issue of noncommunicable diseases was not spoken about much in the public arena. Many people didn't understand it, though it preceded HIV/Aids by several decades. This is because, unlike the NCDs, HIV/Aids arrived abruptly and brutally on this planet. It came as such a shock to the world that many strong civil society groups were formed to deal with it.
This is why there is a measure of success in the battle against HIV/Aids. The NCDs, as the name implies, are not transmitted from one person to the another by a germ or a biological agent. They are not only biomedical but, by and large, lifestyle diseases.
They are divided into four categories and have four identifiable risk factors. I advise people to remember them as the 4X4s, because there are four categories with four risk factors. These categories are: high blood pressure and other diseases of the heart and blood vessels; diabetes mellitus and a few other metabolic disorders; chronic respiratory diseases like asthma; and cancer.
We would like to add mental health as a problem that falls within these categories. The four risks factors, as you know and I will keep on reminding you, are: smoking, excessive use of alcohol, unhealthy eating behaviour or poor diet and a continued lack of physical exercise - and these risks can be repeated 10 times over. The President spoke about these problems in the state of the nation address, when he advised us not to allow our bodies to bulge uncontrollably, as many of us are unfortunately prone to doing. [Laughter.]
We are going to announce far-reaching measures to deal with these risk factors. The United Nations General Assembly took a resolution on these issues in September last year. The measures we will announce will leave no sacred cows untouched, and that includes alcohol control, an issue in regard to which some have attempted to intimidate us never to mention it, just as they have tried to intimidate us in regard to the issue of tobacco and tobacco products. The fourth output is improving the efficiency and effectiveness of the health care system. Chairperson, I promised earlier that I would raise the fourth outcome after I had mentioned the other three. The fourth outcome merits special attention in its own right because of the extraordinary challenges we are faced with in this area. In fact, in recent days, whenever South Africans have been talking about health, they have mostly referred to the efficiency and effectiveness of the health care system, or the inefficiency and ineffectiveness of the health care system.
We have identified five areas of activity, or five programmes. The first is the improvement of infrastructure. The second is the issue of human resources, its planning, development and management. The third is the quality of health care in our institutions. The fourth is the re- engineering of primary health care. The fifth is the cost of health care. The much-talked-about National Health Insurance, falls within the last programme category. Due to a lack of time, I will deal with only two of these problems today, namely the issue of quality in our public facilities and the issue of the NHI.
The President addressed this issue during the state of the nation address when he said, and I quote:
Fellow South Africans, we are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half.
We haven't rested on our laurels since that time. We also did not want to work on the basis of anecdotes or common sense in dealing with quality. Therefore we embarked on a process of health-facility audits. This entails sending teams to all of the 4 200 public health facilities to audit their infrastructure, human resources, cleanliness, attitude of staff, safety and security of staff, infection control, drug stock-outs and the long queues that citizens have to endure when visiting our facilities.
Since we have completed 90% of the audit process, we think we fully comprehend the nature of the problems. Therefore we have put together four health facility improvement teams to go to these facilities and work with the provincial management in order to correct all the anomalies and findings identified during the audits.
The teams have already started working in Motheo District in the Free State, Sedibeng in Gauteng, Zululand in KwaZulu-Natal and Pixley ka Seme in the Northern Cape. The portfolio committee is busy going through the draft legislation we have presented to it to establish the Office of Health Standards Compliance. This office will deal with the issues of quality as described above, without fear or favour. I would like to repeat this, Chairperson: We would like the Office of Health Standards Compliance to deal with issues of health standards without fear or favour.
On the topic of the NHI, there is no way on efficient and effective health care system can ever be realised without dealing with the cost of health care and health care financing. There are people who wrongly believe that the concept of health care financing, as envisaged in the NHI, is a pipe dream concocted by the ANC government. I wish to advise them that the NHI is not just a unique South African concept. The World Health Organisation is actively promoting this concept and describes it as "universal health coverage". Universal health coverage is a system that does not discriminate against any citizen of a country.
Let me quote from a presentation given by Dr Margaret Chan, the Director- General of the WHO, on 2 April - three weeks ago - in Mexico, where she was addressing a conference on this issue.
Her presentation was titled "More countries move towards universal health coverage". She said: This was the tipping point, when the world woke up to the dangers of assuming that market forces, by themselves, will solve social problems. They will not.
She went further to say:
This world will never become a fair place by itself. Fairness, especially in matters of health, comes only when equity is an explicit policy objective. Universal coverage is a clear pursuit of equity and social justice. Universal coverage is also a powerful equaliser.
She continued by saying that:
... moving towards universal coverage is never easy, but every country, at every level of development, and with any level of resources, can take immediate and sustainable steps in that direction.
We have reached a point of no return on this issue of universal coverage through NHI. at 22 March 2012, I announced the names of NHI pilot districts on 10 sites. You remember them in all the districts. As was announced by the Minister of Finance, hon Pravin Gordhan, in Budget 2012, R1 billion has been allocated over the Medium-Term Expenditure Framework for purposes of supporting the pilots. When we launched the Green Paper in August 2011, we also unveiled the timetable of what should happen in the first five years of the NHI. On that day, I said that there were two preconditions that the country had to meet for the successful implementation of the NHI. The first precondition, as I said, was that the quality of health care in the Public Service had to improve tremendously and, hence, public health care needed to be overhauled. This overhaul, I said, was nonnegotiable. I also said that the second precondition was that pricing in the private health sector had to be regulated. I am repeating that today.
I am going to spend three days in each of the 10 pilot districts to meet various stakeholders and discuss these pilots. Piloting means doing all the things that are needed to meet these preconditions, especially the precondition dealing with the quality of service in the Public Service. We believe that within a five-year period, we will have covered the rest of the 52 districts of the country and will be able to march towards the 14- year period for implementing the NHI.
The success of the NHI also depends on certain basics in health care being adhered to. We need to understand that the main reason for the existence of any health care delivery system is to take care of the sick and the vulnerable. Health care delivery systems do not exist to create millionaires at the expense of the health of our people. This tendency of putting business before health - yesterday I called it a "tendercare system" because it is done in the form of tenders - is no longer a health care system but another form of uncontrolled commercialism, against which the WHO has warned us.
The manifestation of this tendency is the disappearance of funds meant for the most basic tenets of health care, through the nonpayment of pharmaceutical suppliers, resulting in shortages of medicines, vaccines, dry dispensary and other consumables. It also results in the nonpayment of laboratory services and blood supply services; shortages of equipment and devices for neonatal, perinatal and maternal services; and nonmaintenance of health infrastructure and equipment. I have agreed with the MECs that this must come to an end. To bring this to an end, we have termed these issues "nonnegotiables". We want to see these nonnegotiables being paid for every month, and we shall monitor it on a monthly basis.
The Budget includes new allocations of R97,6 million for the 2012-13 financial year, R619,4 million for 2013-14 and R1,4 billion for 2014-15. The allocations were divided as set out below.
An amount of R10 million per annum is provided for the forensic laboratories to purchase equipment and appoint staff to address backlogs. We recently appointed 70 unemployed graduates with degrees in chemistry, biochemistry and chemical engineering in order to improve the performance and turnaround times of the forensic laboratories.
Provision has been made for amounts of R9 million, R10,3 million and R11 million to establish a unit to monitor and support provincial finances and improve audit outcomes. As part of the support to the provinces to improve the audit outcomes, the department has appointed 100 unemploymed graduates with BCom degrees to undergo an internship programme.
The department is requesting this august House to support the allocation for Vote No 16: Health, amounting to R27,6 billion for the year 2012-13 and growing to R33,9 billion over the MTEF in the 2014-15 financial year.
In conclusion, I wish to thank everybody who contributed to the success of this department: the Deputy Minister, Dr Gwen Ramokgopa, with whom we worked tirelessly to make sure that we shared the functions; the director- general, Ms Precious Matsoso, and her team; all the structures from the South African National Aids Council, which helped us with the national strategic plan; the office of the Deputy President and the Deputy President himself for chairing Sanac and guiding us in the fight against the scourge of HIV/Aids; the health-related unions; our development partners; and everybody else involved because, as you know, our slogan is that if we work together, we will achieve more. I thank you. [Applause.]
MR M B GOQWANA: Chairperson, Minister and other Ministers present, hon Deputy Minister and other Deputy Ministers present, the director-general and her team; the MECs who are here; I have noticed that the Board of Healthcare Funders is here; as are representatives from the Council for Medical Schemes, the Hospital Association of South Africa, the Health Professions Council of South Africa and the SA Medical Research Council - I acknowledge all of you, Members of Parliament, ladies and gentlemen.
I am not going to take a long time, but I want to start by saying that at this second half of our term in Parliament, my response to this budget speech on health will focus on oversight. We have been voting on funds for the Department of Health, trusting that the deployees are going to transform the department so that it improves life expectancy in a qualitative and quantitative manner.
I always ask myself: Who sets the agenda in any given situation? In this instance, who sets the health agenda of South Africa? I stand here without fear of contradiction and say that, under the leadership of Dr Aaron Motsoaledi, it is very clear that there is the passion and zeal to come up with solutions to pressing health issues.
However, I must say with sadness that I have noted that this passion and zeal have not filtered through to some of the provinces ...
Especially in the Eastern Cape!
MR M B GOQWANA: ... and it is in the provinces where most of the work is actually done.
We have observed that there is transformation in the health sector, and the agenda is set by the citizens of the country. We have seen drug prices tumbling, to the delight of the citizens. We have seen HIV and Aids patients with CD4 counts of 350 getting antiretrovirals. We have seen TB patients with HIV also getting antiretrovirals. We have seen pregnant females that are HIV-positive getting antiretroviral drugs. As a result of the above, the HIV infection for unborn babies has decreased, especially in the Gauteng and KwaZulu-Natal provinces. Cure rates for TB have improved, especially in the North West province. Citizens are no longer reluctant to go to be tested for HIV, and I know that there are more than 12 million or 13 million who have been tested in the past year.
The drive for male medical circumcision in KwaZulu-Natal has improved and this decreases the incidence of sexuallytransmitted diseases, including HIV infections. We have seen summits with all the stakeholders being convened by the Department of Health, and we have seen, for the first time, that a human resources plan has been developed by the department. We have seen the piloting of the National Health Insurance in these areas.
All of the above reinforced our confidence in the ability of the department to transform and respond to the needs of the citizens of the country. Hence, we support the requested budget. However, we have noticed that there are challenges with regard to certain aspects of health provision. I want to take this opportunity to give a synopsis of observations made during our oversight visits and meetings with the department and other stakeholders.
Our health policies, as good as they are, have a shortcoming in the sense that they seem to be focusing mostly on the gap between the rich and the poor. They overlook the challenge of the urban-rural divide, which I briefly want to talk about.
Rural health is a big challenge in our country. To elaborate on this, I will give some statistics that illustrate the challenge at hand by comparing rural and urban provinces. If you look at life expectancy at birth in Gauteng, you will find that it is 60 years of age. In the Western Cape, life expectancy is 64. However, if you go to provinces like the Eastern Cape, it is 55, and in the North West, it is 58. [Interjections.] I mentioned Gauteng too!
Looking at the prevalence of disability, if you go to Gauteng province, it is 3,3. If you go to the Western Cape, it is 5. If you go to the Eastern Cape, it is 7,9. In the North West, it is 8,5.
If you look at delivery in the facilities, you will find that in Gauteng it is more than 87%. In the Western Cape, it is about 98%. In the Eastern Cape, it is as low as 75%. In the North West, it is 77%. [Interjections.]
The maternal mortality figure in Gauteng is 100. If you go to the Eastern Cape, it goes up to 144. In the North West, it is 121.
If you look at infant mortality, in Gauteng province it is about 20. In the Western Cape, it is 27. If you go to the Eastern Cape, it is 53, and if you go to the North West, it is 32.
This, for me, again reflects the relationship between survival rates and the number of health workers - if you look at maternal and child survival statistics and you compare it with the number of health workers. It is always said that the number of health workers in a particular area reduces the incidence of maternal and child deaths. We are not even looking at the quality of the health workers; just the number of health workers changes the situation.
The rural provinces have fewer health professionals per population numbers compared to the urban provinces. If you look at the number of doctors per 100 000 people in the communities in Limpopo, which is 90% rural, there are only 17 doctors per 100 000 in the communities. In the Western Cape, you have about 135 doctors. If you go to the Eastern Cape, you find that there are 31 doctors per 100 000 in the communities. If you go to Gauteng, you find that there are 102 doctors per 100 000. All of this shows that there is a problem as far as the rural-urban divide is concerned. Therefore I am talking about rural health. We have observed that the private health care sector is not assisting in this regard. In Limpopo we have a population of five million, of which 90% is rural. They have only five private hospitals. I am not going to go into detail, but all I want to say is that there is not much that is being done by the private sector as far as primary health care is concerned.
However, I must say that there is a primary health care television programme that I always enjoy. It is sponsored by the private health care sector and is run by Dr Victor Ramathisele. It always runs on a Saturday. I think we need to applaud this primary health care initiative run by the private sector. [Applause.]
If what we are talking about with regard to the private health care sector, namely going to these rural provinces, does not make good business sense, we could think of public-private partnerships.
If, as a country, we are to meet the health Millennium Development Goals or we are to get the universal coverage that we want, we definitely need to look at rural health care. In addition, we need to make sure that human resources and even our budget must be skewed towards rural health.
The oversight work we do covers the whole health sector, private and public, but the point that I want to raise here is that there always seems to be an element of paranoia in the relationship between the private and public health care industries. I think the vision is the same for all of us. Therefore we need to make sure that we find a way of ensuring that this divide is done away with, so that we can have good health indicators.
South Africa has other stakeholders in the health sector. I always mention this fact. In South Africa, 70% of our people are still going to traditional healers and I do not think they can be ignored. Whether they are doing the right thing or the wrong thing, for us to be able to meet what we want to meet, we need to make sure that we engage them in one way or another. We even have to make sure that there are proper regulations that are going to deal with this matter. This is something that we have found during our oversight work.
We have observed that most of our hospitals, be they private or public, deal with acute emergencies. We do not have a situation where we have subacute and chronic hospitals, yet they are cheaper and easier to run. They do not need a lot of staff. We need to look at finding a way of doing that.
If we are talking about a situation where we want to increase the life expectancy of our citizens, then it means at a certain stage we are going to need geriatric care. If geriatric care is going to be needed, we need these subacute and chronic hospitals in both the public and private sectors.
The challenges I have highlighted here are not insurmountable. I am confident Dr Motsoaledi, leading the Department of Health, and his team will come up with appropriate solutions to rural health challenges and the other challenges facing South Africa that I have spoken about.
I recommend that we pass the health budget, as the department has shown commitment to transforming health services in response to the agenda of the citizens of South Africa. I thank you. [Applause.]
Modulasetulo ya kgabane le Maloko a Palamente a hlomphehang, ntlafatso ya bophelo bo botle ke e nngwe ya dintho tse ntle tse tla etsang hore re lokise masalla a kgethollo. Kgethollo e ile ya qhelela batho ba rona ba batsho ka thoko ditshebeletsong tsa bophelo bo botle. Ba ile ba iphumana ba tlameha ho tiisetsa le ho mamella mahlonoko a kotelo le ho se natswe. Kahoo mmuso o tlameha ho etsa makgobonthithi wohle hore ho be le tekano le boleng ditshebeletsong tsa bophelo bo botle ho Maafrika Borwa wohle ho sa natswe hore mang ke mang, haholoholo batho ba bileng mahlatsipa a kgethollo. (Translation of Sesotho paragraph follows.)
[Mrs S P KOPANE: Hon chairperson and Members of Parliament, the improvement of the health system is one of the decent things that will address backlogs that were caused by apartheid. Black people had been disadvantaged in the past in terms of health services due to discrimination. They were obliged to accept the bitter fact that they were not considered as people. As a result, government should come up with initiatives to bring equality and quality in health care services for all South Africans, irrespective of who they are, especially those who were previously disadvantaged.]
Every South African deserves quality health care because, as we all know, a sick nation can never be a successful nation. The provision of accessible, affordable and quality medical care to our people is not only a right but a moral and economic imperative. Therefore it is the responsibility of the House, together with the Minister of Health and the Department of Health, to make sure that we are provided with a plan that is going to fix our public health care system and provide every South African with quality health care.
Let us face the fact, hon members, that the system we have now is failing our people. We are constantly confronted by its failures on a daily basis. When I visited the Marantha Clinic in Brandfort in the Free State last month, I saw nurses and doctors dutifully trying to help the community of Majwemasweu, even though there was no water at the clinic. I was struck and inspired by the commitment and determination of the medical professionals to help the people of the community, even in the face of immense challenges. However, the nurses told me they could not help everyone because there was no water.
The workers there have done their utmost to make the best of their circumstances, but we have not kept our side of the bargain. As hon members, we should be ashamed of what happened at Marantha. Needless to say, there are countless other clinics and communities across the country, just like the Marantha Clinic, that we have left behind and forgotten about.
So, let us come to one of the critical questions of our time: What are we going to do to address the situation? I have no doubt that hon Minister Motsoaledi, together with his team from the Department of Health, has worked tirelessly to find the solution.
I have the utmost respect for Minister Motsoaledi. Minister, I respect your commitment and work ethic, and I fully understand that you have approached this problem with the best of intentions. However, with due respect, the hon Minister and the Department of Health have used the wrong approach in dealing with this issue.
Chairperson, let me state it clearly that the National Health Insurance, is going to be a complete disaster for the very people who hope to benefit from it. I say this because the NHI will be an enormous drain on the fiscus. Nobody knows what the actual cost of the NHI will be over a long period.
Hon Minister, I am sure you are going to give the House some assurances today regarding an accurate costing of NHI. Could you please tell this House how much it is going to cost the taxpayer? What we do know is that it is going to drain resources away from service delivery objectives. The poor will pay for the few available NHI resources, and that is a fact.
Secondly, the NHI will create an inefficient and bureaucratic health superstructure. It is highly unlikely that a bigger bureaucracy will solve our problems in health care.
Thirdly, the NHI will not fix the real problem in our system, which is the provision of low-quality health care. Instead, the Green Paper on the NHI focuses on accessibility and financing. As we all know, we already have universal accessibility and enough funding to run a good public health care system. The problem is that the quality produced by our system at the moment is not good enough. Nothing in the NHI proposal will solve the quality problem.
In the fourth place, the NHI does not adequately address the matter of accountability or management structures. The ministerial task team report on health care funding states that:
No part of the health care system is held properly accountable for the poor health outcomes or poor service delivery.
While the Green Paper calls for the establishment of an office of Health Standards Compliance, its members will be appointed by and answerable to the Minister of Health. With such a set-up this office will not really and truly be independent. This will make it vulnerable to political interference, not necessarily by the current Minister but from future Ministers who might not have the same good intentions as you, hon Minister.
Fifth, we lack the human resources to implement the NHI. We need to triple the 27 000 doctors that we currently have in our country, for the NHI to be effective. However, we train only enough doctors each year to keep pace with the number of doctors who retire or emigrate. The state is unable to train the necessary number of doctors or nurses in our country. Hon members, let us be honest about this issue: The numbers do not add up to what we are looking for.
Finally, throwing money at a problem does not always solve it. A good health care system requires a minimum threshold of funding to be effective. However, greater expenditure beyond that threshold does not guarantee better results. Other factors, such as accountability, governance and functionality, determine the quality of health care.
What does the DA suggest we do about our health care system? I hope this is the intention of all of us as Members of Parliament today. We have to focus on fixing the accountability, governance and functionality of the system that we already have. To attempt to build a complex, highly bureaucratic superstructure on top of a broken system is a recipe for disaster. Instead, we must focus on fixing the system we already have.
We need to create a national framework with national targets and minimum norms and standards for health care providers and effective oversight for both private and public health care sectors. We need to strengthen the capacity of the provincial health departments for better delivery by giving them more freedom in policy-making and holding them to account not only for compliance but also for health outcomes. The Western Cape has shown that this can be a success - just look at the world-class hospital the Western Cape government has built in Khayelitsha.
We need to capacitate health care providers to take responsibility for their performance. Public hospitals and clinics need increased autonomy and accountability and less micromanagement.
We need to create an independent health care oversight body with the powers to investigate complaints of poor health care services and hold those to account. This should be coupled with a quality-rating system applied to all private and public health care providers.
We need to promote public-private partnerships to increase the quality of health care in the public sector by allowing private companies to run public hospitals and by making private resources available to the public sector. We also need to work aggressively to reduce the medical skills shortage by promoting the establishment of private medical schools, increasing mentoring and apprenticeships and retaining the number of doctors and nurses in our country.
Spending on these programmes will benefit all South Africans more through improved health care, rather than spending on a bloated NHI system, which will never benefit all. The time has come for all of us to start thinking about what is practical and possible, given our constraints in human and other resources.
Re le mokgatlo wa DA re dumela ka hohlehohle hore bokamoso ba naha ya rona bo itshetlehile hodima diqeto tse nkwang ke rona batho ba etsang molao. Ho hlakile hore re na le matla a ho phahamisa dintle le ditoro tsa Maafrika Borwa le ditakatso tsa Ntate Mandela tsa Afrika Borwa ya setjhaba se le seng se nang le bokamoso bo le bong. Ke a leboha [Mahofi.] (Translation of Sesotho paragraph follows.)
[As the DA we fully believe that the future of our country depends on decisions that we take as lawmakers. It is evident that we have the power to uplift the morals and the vision of South Africans as well as President Nelson Mandela's wish of a united South African nation that has one vision. Thank you [Applause.]]
Hon Chairperson, let me acknowledge the presence of everybody that Dr Goqwana already acknowledged. A budget is a resource, which should be utilised by the department to ensure that its plans, strategies and objectives are achieved. These intentions can only be assessed and evaluated by looking at and appreciating its outcomes.
When a budget is debated, we hear the intentions, look at the past outcomes and decide whether to support the Budget Vote or not. We also make suggestions concerning the implementation of and the allocation to programmes. Hon Minister, there are a lot of visible and encouraging interventions from your side, but unfortunately the implementation of health services occurs at provincial and municipal level.
Whether we achieve the Millennium Development Goals or not depends on what happens at hospitals, clinics and communities. There are people who continuously argue that although South Africa spends a significant amount on health, its health system provides poor value for money. This statement is premised on the fact that South Africa spends 8,6% of its Gross Domestic Product on health services, roughly the same as Brazil, England and Italy, and they all have better health outcomes. This argument is disingenuous because these countries have different histories from ours and never had to deal with the legacy of apartheid like us.
Cope's assessment of whether the department is dysfunctional or not depends on whether patients and staff feel safe and welcomed at our health facilities. We can be safe if the clinics and hospitals are clean, have adequate medication and laboratory services thats provide feedback to doctors on time, and there is equipment to provide quality health care services.
Chairperson, the Auditor-General made some disconcerting findings last year concerning financial management in the provinces. Let me list just a few of those that Cope feels demand urgent attention, and I quote:
Firstly, provincial departments of health across the country are breaking the rules and regulations when awarding multimillion rand tenders; secondly, it is a contravention of the Construction Industry Development Board Act to appoint a contractor that is not registered according to the correct grading.
Despite this, health departments from various provinces awarded tenders to the value of R876,8 million to contractors with no grade or with lower grades. In Soweto, the construction of Jabulani Hospital began in 2003 and dragged on until 2010, at a cost of R537 million, instead of R256 million.
These things, hon members, happened because some government officials meddled in the awarding of tenders. In most cases the supply chain management, SCM, process is compromised so that the anointed bidder is awarded the tender by hook or by crook.
In this instance hon Minister, I urge you to discuss the Lejweleputswa District SCM with your colleagues in the Free State. The suppliers in that area, who approached me, told me that all the staff members in the SCM knew who managed corruption and how it was managed.
They believe that senior management, which is aware of what is happening in the district, is either part of the corruption or those involved in the corruption are doing something. They are doing something that might be compromising senior management; hence they are intimidating or harassing any staff member who raises concerns about how corruption is being nicely managed, more so than the institution.
Hon Chairperson, whenever corruption is exposed, the ANC-led government will tell us that heads are going to roll, but every time I just see very big heads nodding. [Laughter.] Hon members, no one is corrupt by accident, hence I urge you and your colleagues to make an example of the Lejweleputswa District's SCM.
Corruption affects the poorest of the poor more than the affluent. The affluent can buy any service, but the poor will not be able to do that. It directly affects the provision of quality health care that can be directly linked to women and children's mortality rates. Hon Minister, millions of newborn children and mothers continue to die needlessly. Earlier this year, Carolyn Miles, the president and chief executive officer of Save the Children, said that although there has been a reduction in the mortality rate of under-fives, the deaths of newborns were still a stubborn part of the problem.
She also revealed that over 40% of children who die before they reach the age of five years will die within the first month after birth. Babies are dying of common diseases such as pneumonia, diarrhoea, preterm complications and asphyxia. Surely, hon Minister, these are not things children should be dying of.
If Malawi, as poor as it is, succeeded in achieving a 29% decline in newborn deaths since 2009 and is on track to meet the MDGs, we can surely learn a thing or two from them.
Hon Minister, one of the main strategies of reducing maternal deaths is the provision of contraceptives, on the one hand. On the other hand, one of the causes of maternal deaths is illegal abortions. Whilst on this subject of abortion, you might enlighten me as to whether there are other countries that advertise death to desperate people like we do. Newspapers and streetlight poles in our country are plastered with adverts for abortion. At the same time there are these people who advertise cures for Aids and cancer, and also talk about helping people to win the lotto in the same pamphlet. They continue to operate in our country. I want to check if there is any law that prohibits this type of practice. If not, can we look into formulating a law will prohibit these activities?
Minister, I am not going to talk too much about the NHI. As Cope, we support access to universal health care, but the issue should be clarified because the politicisation of the concept of a NHI is really a problem.
The private sector, which projected the NHI as the nationalisation of health, is at the forefront of challenging the NHI as projected. I think it is really up to us to clarify whether it is a financing model or a ... [Interjections.] [Time expired.] Thank you. [Applause.]
Hon Chairperson, health remains a key portfolio in our growing democracy, with its issues affecting the entire socioeconomic spectrum. It is, therefore, of utmost importance that the Minister achieves maximum impact with the limited allocation of resources received from the Treasury.
The IFP believes that the shortage of hospitals and clinics in rural areas means that there is a problem in foundational and mandatory areas. That is where the department should focus its limited resources and to which it should pay greater attention.
There is a dire need for more hospitals and clinics in rural areas and an even more pressing need for qualified doctors and nursing staff in our existing care facilities. Since this problem has been acknowledged and is currently being addressed by the department, the IFP would urge greater attention to be paid to the issue. This is because it is of paramount importance that we have able human capital capacity on the ground if we are to deliver adequate and competent health care services to our citizens.
We must also ensure that our rural hospitals and clinics are adequately resourced with the necessary sanitation and consumable supplies, in order to avoid unnecessary adverse health issues arising in our care facilities as a result of unhygienic conditions.
With regard to training institutions for medical practitioners, we welcome the allocation of R1,2 billion allocated to develop nursing homes, colleges and the establishment of a national institute that will provide leadership training in health to our health care personnel.
However, the continuing exodus of newly qualified doctors to foreign countries remains a most worrisome trend. What is the department doing to ensure that our health care professionals stay in South Africa? Why do we make it so difficult for our young, newly qualified doctors to obtain medical internships at our hospitals? These are all questions that must be addressed and workable solutions must be found.
Women and children's health improvement and the reduction of the infant and child mortality rate, although less than the previous years, require our continued and renewed effort. In addition, with levels of violence against women and children remaining alarmingly high in South Africa, specifically with regard to rape, sexual abuse and domestic violence, we need to ensure that all our medical institutions are adequately capacitated in order to render the necessary assistance to victims of these abuses, in both a timeous and professional manner. This is particularly necessary yet lacking in our rural areas.
The HIV/Aids levels need to be greatly reduced. It remains a scourge in both our country and on our continent.
In conclusion, the IFP urges the Minister and the department to leave no stone unturned in pursuing excellence in delivery that is optimal for all the people of our country and to continue to pursue an outcomes-based approach to service delivery, which is their solemn obligation and duty. We fully support the Budget Vote. Thank you. [Applause.]
Hon Chairperson, hon Minister and members of the executive present, hon Deputy Minister, hon MECs, members of the department and distinguished guests, it is a great privilege for me to stand at this podium once more. By the way, the ANC supports the budget.
Now, and even more so in the future, the pursuit of a better health status in our society will be determined, to a large extent, by how effectively we are able to prevent and control noncommunicable diseases such as diseases of the heart and lungs, cancer, diabetes and mental disorders.
Last year, in your Budget Vote speech, hon Minister, you emphasised that these diseases were increasing, that you would be paying greater attention to addressing the main risk factors, as well as increasing screening and aiming for better control of chronic conditions. We see you and your department indeed making progress in this regard.
The additional actions that are outlined in your plan this year are absolutely in line with the recommendations arising from the Summit of Non- Communicable Diseases that was held in September last year. The General Council of the United Nations also held a meeting on noncommunicable diseases last year.
A healthy lifestyle combines two main approaches. The first is to facilitate better health through government interventions that support population health and the second is getting people themselves to change the unhealthy aspects of their lives and embark on healthy practices. More work must indeed be done to strengthen both of these levels.
Last year, hon Minister, you promised that you would bring out regulations for the reduction of salt in processed foods, as salt is a major contributor to hypertension and high blood pressure. It affects, on average, 31% of men and 36% of women in South Africa. We understand that since you made this promise, you have embarked on wider consultations, both locally and internationally, regarding reasonable targets and time frames for achieving them. We are encouraged by the work done thus far, although there is still a long way to go to achieve the goal of reducing noncommunicable diseases, morbidity and mortality.
Another risk factor inherent in noncommunicable diseases, but also communicable diseases like maternal disorders, child health and injuries, is alcohol. Hon Minister, we are encouraged by your commitment to fighting this serious issue and we are even more encouraged that you will be bringing out legislation on the advertising and marketing of alcohol. This is a great step indeed.
The evidence that is out there on what alcohol does to our society is very clear and all efforts must be employed to fight this disaster. Research shows that alcohol is the third-highest global risk factor for disability and it shortens our lifespan.
In South Africa, alcohol accounts for around 130 deaths per day. According to the WHO, we fall into the category of countries that have the highest consumption of alcohol. One study has put us as the tenth highest country for alcohol consumption in the world. In the past year, research has shown that we fall into the second-highest category of the WHO countries that have harmful patterns of drinking and heavy episodic drinking with over 30% for both male and female drinkers.
We also note from the survey conducted in 2008 by the Medical Research Council on youth risk behaviour that 34% of males and 24% of females in Grade 8 to Grade 11 are binge drinkers. This is different from the 29% for males and 18% for females figures discovered in 2002. Hon Minister, if we neglect to take heed of all this information and do not act on it, we surely would be failing in our duties as the custodians of and activists for health, and especially as government.
We note with concern that there are those who are opposed to your call for banning alcohol advertising and sponsorship. They argue that such action will not reduce alcohol-related harm. Hon Minister, we support you in this endeavour and we beg to differ with them on this matter. Research indicates that alcohol advertising and sponsorship bring about positive beliefs about drinking, and young people are encouraged to drink alcohol sooner and in greater quantities than they would otherwise. These are reasons enough for us to act. We must try to shift away from advertising harmful products, and we look forward to working with you.
Our success and great achievements with regard to restricting tobacco use in this country are well documented and we should be proud of that. This reminds me of all those sceptics who lamented and argued so strongly that the banning of tobacco advertising would result in massive job losses and revenue for this country. It is now clear, hon Minister and the House, that these arguments and claims were futile and are now history.
If I may, I want to take a step back to the topic of a healthy lifestyle and reiterate that we need a serious change in the attitudes of both government and citizens. Eating healthy food and exercising is a goal that we would like every person in South Africa to take very seriously.
We must do our utmost, through partnerships, to make healthier food more available and affordable, especially to poor people. We should facilitate more physical activities for children at school, but I also want to challenge our communities and every person in South Africa to start taking a healthy lifestyle more seriously.
We have serious behaviours that we need to change as a society, so that our health and that of our children can improve. These behaviours include eating junk food or fast food, lack of exercise, engaging in unsafe sex, excessive and irresponsible use of alcohol and smoking.
We must bring back and instil the culture that our parents had in the past, such as having small vegetable gardens at our homes and schools and walking to school rather than being driven there. We must distance ourselves from smoking and the use of alcohol. Our grandparents and parents were stronger and healthier because of these practices. [Time expired.]
THE DEPUTY MINISTER OF HEALTH: Hon Chairperson, Minister of Health, Dr Aaron Motsoaledi, Ministers and Deputy Ministers present, colleagues, MECs, the hon Chairperson of the Portfolio Committee on Health, Dr Monwabisi Gogwana, members of the Committee, hon members of the House, the Director- General, management at national and provincial levels, leaders of various statutory bodies, health unions and other health-related organisations, a special acknowledgement of Mme Yvonne Chaka Chaka - morwedi wa Machaka [daughter of Machaka], distinguished guests, ladies and gentlemen, it is my privilege to address the honourable House during the debate on the Health Budget Vote for the financial year 2012-13 within the medium-term framework.
This debate takes place as we celebrate the centenary of our liberation movement, the ANC, which represents the unstoppable determination of millions of peace-loving people of our nation and the world to usher in justice and democracy and a better life for all in our country.
In this month of April we also recall the hanging of Solomon Kalushi Mahlangu, the death of Mita Ngobeni and many other children and young people, who paid the ultimate price for the freedom we are enjoying today. For them a long and healthy life was not to be because of the apartheid regime.
Going down this painful but inspirational legacy of the triumph of humanity in our young democracy, I invite you to join me in paying tribute to all progressive health workers, who, individually and through organisations, were part of the liberation struggle in various ways.
Many remained true to their professional ethic and human conscience as they provided essential health services to the oppressed under difficult circumstances. They cared for survivors of the injuries inflicted during the mass protests and refused to trade their scientific knowledge for human healing for activities involving biological murder - or what is called biological warfare.
We pay tribute to the then aspirant and practising health workers who understood that peace, justice, freedom and democracy were also the foundation for, amongst other things, reducing the high levels of severe malnutrition, of which our children were dying. Today, they are no longer dying of this.
We have succeeded in reducing the high levels of trauma as a result of violence and shooting. We are also winning the battle against the ravages of tuberculosis, which first begins in unhealthy conditions in the mining and farming sectors.
We salute, amongst others, Dr Xuma, Dr Naicker and Dr Dadoo, who provided leadership under what was referred to as the Doctors' Pact, which unified our people across racial divides and paved the way for the adoption of the Freedom Charter, which pronounced on the rights of all South Africans. We pay tribute to Steve Bantu Biko and many aspirant health workers who suffered and died as human rights activists.
We honour Mrs Ruth Bowen, who is now 91 years old, Mrs Albertina Sisulu and Mrs Rosina Mphahlele, who have since passed on. In a disciplined and tenacious manner they nursed our people with distinction and with great care and compassion, despite the apartheid system.
We remember Dr Abu-Baker Asvat and Dr Ribeiro and his dear wife, who were murdered at their consulting rooms and homes respectively, within communities they served and for whom they were prepared to do whatever it took to improve their wellbeing.
As we build a developmental state today that has as one of its outcomes a vision for a long and healthy life for all, we remain inspired by the contributions that these and many others made to change the underlying sociopolitical and economic conditions that were a danger to our nation. We will commit ourselves with determination, and invite all within the health system to do so, as we recognise that the constitutionally protected health and reproductive rights are not yet accessible to all South Africans, especially in rural provinces.
Dr Gogwana, we sadly acknowledge that the interventions in the health departments of the provinces of Limpopo and Gauteng by Cabinet, through the provisions of section 100 of the Constitution, were indeed necessary to protect the health system for the benefit of mainly the poor in these provinces. We would have no choice when it comes to other health care services. We also wish to call on all stakeholders to work with us to defend the progress that we have made today.
We should continue to construct a society that is ready at all times, especially with regard to the health system, to democratically and in a disciplined manner intervene without fear or favour to combat the many ills and inexcusable actions or inactions of inefficiency, incompetence, fraud and corruption that put the heroes and heroines of our liberation struggle to shame because they threaten the health and wellbeing of our people. We believe that the introduction of the Office of Health Standards Compliance, which oversees the offices of the ombudsperson, norms and standards and the inspectorate, will certainly be valuable in guarding against these ills.
We want to thank the provincial leadership under the MECs, the premiers of these provinces and the heads of departments, who have worked with us in a very constructive manner to deal with many of these ills.
Some of these ills were inherited and some in fact happened whilst these HODs were in office. We would also like to call on those who are involved in these ills to be subjected to disciplinary action. You can discipline someone for incompetence as provision is made for this. We can discipline someone for fraud and corruption. Actually, we must do that to protect the interests of our people and the institutions for which many have struggled and died.
We must also guard against shallow and narrow political opportunism and the prejudices that underlie racism. For now I'll call it "prejudices" when some tend to dismiss the historical reality referred to by hon Kganare.
Indeed, there are provinces - Gauteng and the Western Cape, in particular - that benefited from the inequities of the past. Even previously, the resources of the Cape province were mainly invested in the Western Cape - around Cape Town, in particular - to the detriment of our people throughout the province. [Applause.]
We acknowledge the statement that was made in an interview and referred to our people, who are accessing services available in their country, as refugees. We really ask the DA party and its leader to have the integrity to formally apologise to the nation and to the people of the Eastern Cape, in particular. [Applause.] [Interjections.] Yes, I'm aware that you apologised, but it was a "by the way". The interview was not called specifically for that. [Interjections.]
Let me also acknowledge that it is important and it is our common goal to have a common vision, work together and redress imbalances. We will remember that South Africans have a right to access services throughout the country. We are all South Africans before we belong or live in one or the other city or province. We shouldn't reinforce the past, when people's birthright were not even acknowledged in the country of their birth.
We agree with hon Kganare that the context of a country is important. In this case, hon Kganare, in terms of the 8% expenditure that you referred to, only 3% of this expenditure is in the public sector to look after the majority of the population, whilst around 5% is in the private sector.
Over the next three days here in Cape Town, the Department of Health, Department of Science and Technology, as well as the Council of Health Research and Development, are hosting the Global Forum for Health Research conference under the theme "Beyond aid - research and innovation as key drivers for equity and development". This issue of equity and development is not unique to South Africa. It's a worldwide phenomenon, which we must work together to deal with.
We have begun to utilise evidence-based research to inform our policies and programmes. Already we are seeing significant progress and, amongst other things, the reduction of mother-to-child transmission of HIV by more than 50%, as referred to by the Minister.
We have also invested in convening various summits with experts, health workers and other stakeholders in the areas of noncommunicable diseases, mental health, breastfeeding and the NHI.
Indeed, hon Dube, the regulations on salt content control for industry are ready for the Minister's consideration and will be signed within the next few months. [Applause.] Beyond these regulations, together, we must empower our people to understand the vegetables that we eat contain naturally occurring salt. Over time, our tongues will get used to those levels of salt. Currently, we are using very large quantities of salt, and many of us pour raw salt onto our food even before we taste it. We want South Africans to live long and healthy lives.
The NHI system is a catalytic programme to ensure equity in and sustainability of the health system. We are very encouraged that all provinces, including the Western Cape, have agreed to participate in pilot projects. We have no doubt that your participation in these pilot projects will prove that what we have presented to you is a solution for the country; a solution that will work in the Western Cape and everywhere else throughout our country.
Led by Prof Mayosi and the National Health Research Committee, we have began to align scientific research and the innovation capacity available in our country and globally to find solutions to reduce the burden of diseases and premature deaths, as well as to strengthen the quality, efficiency and effectiveness of the health care system.
The work that Dr Bomela and the Ministerial Advisory Committee on Health Technology are doing will be enhanced by the enactment and the establishment of the South African Health Products Regulatory Agency later this year. Already, the National Health Council has approved the essential equipment list. This will help us to know what the minimum amount of equipment is that should be available in every facility throughout the country in order to ensure that our health workers have these tools and that our patients receive high-quality services.
We can also leverage technology better in an integrated approach for the benefit of health workers and the public. We have already presented a draft of the e-Health Strategy to the National Health Council. The strategy will incorporate information and communication technologies for health, such as telemedicine, mobile health technologies and other technologies.
We want to thank Prof William Pick, who has just retired, for his valuable contribution made as the chairperson of the Council of Medical Schemes, which we will leverage in terms of experience in protecting consumers, as we construct and pilot the NHI scheme throughout the country this year. The experience of regulating the medical aid schemes in the industry will indeed be very valuable.
We appreciate, and we will certainly support, the Minister's efforts to visit each of the 10 NHI pilot sites and districts, in order to meet with stakeholders and the public, as well as the private sector. However, we also call on you to support the Minister.
My office will also continue to visit other districts to ensure that management remains effective, that it improves accordingly and that the quality and impact of health services continue to improve significantly.
Indeed, Dr Goqwana, these changes must be visible. Our audits have indicated where the challenges are and, as the Minister has said, management teams have already been deployed from the national office to ensure that they work with provinces to deal with the gaps that have been found.
During the visits that we paid to Namaqualand, Amathole and Gariep Districts respectively, we were already able to interact with provincial and local government colleagues as well as stakeholders in the area. Indeed, we must share the excitement of the progress that we see in terms of public health being transformed locally. I want to thank everybody and state that we support the Budget Vote. Thank you. [Applause.]
Hon Minister, last year I commended you and your department for taking health care in South Africa in the right direction through your vision for drastically improving the quality of our health. Clearly, as we sit here today, a lot of work still remains to be done.
The press is filled with horror stories about public medical malpractice and the state of disrepair of hospital equipment. The FF Plus has its own stories to tell, as members of the public approach us to intervene when they are fighting an inaccessible and unsympathetic public health care system. Here is an example.
Mej Candice Midgley, 'n jong vrou met twee kinders, is met kanker gediagnoseer, maar het maande gesukkel om toegang tot behandeling te kry. Van die verskonings is dat die mediese apparate nie herstel word nie en dus nie gebruik kan word nie omdat die regering nie uitstaande rekeninge vereffen het nie.
Daar is ook die persberig van nog 'n ma wat gesterf het omdat die krities- nodige mediese apparaat nie gewerk het nie weens 'n gebrek aan onderhoud. (Translation of Afrikaans paragraphs follows.)
[Miss Candice Midgley, a young woman with two children, had been diagnosed with cancer, but struggled for months to get access to treatment. Some of the excuses are that medical equipment is in a state of disrepair and thus cannot be used since the government has neglected to settle outstanding accounts.
The media also reported about another mother who died because the much- needed medical equipment was not functioning due to a lack of maintenance.]
A domestic worker's toddler dies because the ambulance took hours to arrive after the event. Minister, I can recount many stories like this and they cut across all race groups. The poor state of public health care affects all the poor.
Against the background of this lack of social justice, one has to question the viability of introducing such a huge programme as the NHI scheme. It is surely logical that the department should at the very least get the basics of service delivery right within the current system before any other grand schemes can be launched.
Dienslewering in die openbare gesondheidsektor is, in die algemeen, steeds uiters swak vanwe 'n gebrek aan behoorlik opgeleide personeel, veral mediese praktisyns. Mense wat aangewese is op die staat vir mediese hulp moet nie uitgelewer wees aan elemente van swak diens wat hul gesondheid verder affekteer en selfs tot hul dood kan lei nie. Dit reduseer die Handves van Regte vir Pasente, die "Patients' Rights Charter", tot net 'n waardelose stuk papier.
Verder, soos ons ook verlede jaar gemaan het, wil ons dit weer aan die Minister stel dat hul versigtig te werk moet gaan met die nasionale gesondheidsversekering. Suid-Afrika is nie werklik in staat om so 'n enorme program van stapel te stuur nie. Die kernrede is ons klein belastingbasis wat al hoe meer onder druk geplaas word deur die eise van die fiskus.
Daarom sou dit ons gerade wees om eers aandag te skenk aan basiese dienslewering in die openbare gesondheidsektor, sodat die armes onmiddelik kwaliteitdienste kan ontvang en die middelklas kan weet dat hul belastinggeld effektief in die openbare belang aangewend word. Enigiets anders is 'n skending van basiese menseregte. (Translation of Afrikaans paragraphs follows.)
[Service delivery in the public health sector remains, in general, extremely poor due to the lack of properly trained staff, especially medical practitioners. People reliant on the state for medical assistance should not be at the mercy of bad service delivery that could further impact on their health, even resulting in their death. This simply reduces the Patients' Rights Charter to a worthless piece of paper.
Furthermore, as we also urged last year, we would like to put it to the Minister again that they should approach the NHI with caution. South Africa does not really have the capacity to implement such an enormous programme. The main reason for this is our small tax base, which is put under increasing pressure by the demands of the fiscus.
It would therefore be advisable to focus in the first instance on basic service delivery in the public health sector, in order for the poor to receive quality services immediately and for the middle class to know that their taxes are utilised effectively in the public's interests. Anything else is an infringement of basic human rights.]
Minister, we therefore implore you to use your budget to tackle the basic issues of service delivery before any grand schemes like the NHI is embarked upon. Thank you. [Applause.]
Chairperson, the ACDP acknowledges the efforts being made to grasp the issues and address the challenges we are facing in South Africa in improving access to quality health services for everyone. Because we have a Minister of Health who is prepared to confront even the most difficult challenges with an openness and energy that is contagious, we have high hopes that progress is possible. We are, however, painfully aware that unless we see significant progress, people's lives are going to be increasingly at risk.
This budget will have to meet expectations raised regarding infrastructure development, hospital revitalisation, training of medical practitioners, women and child health, HIV and Aids, the NHI and so much more. The department must make sure that last year's underspending does not happen again, as it will seriously weaken any prospect of progress.
While the budget for HIV/Aids and TB has increased, the budget for maternal, child and women's health has decreased and, at face value, this does seem to be a concern, even though is clear that all programmes should impact significantly on maternal, child and women's health.
Primary health care services are crucial, and the relatively small allocation to this programme does raise questions as to whether plans to achieve a more "primary health care" approach as opposed to a hospicentric approach, will stay in focus. The ACDP, like the rest of the country, is acutely aware that education and training for the health sector in South Africa has not grown sufficiently to meet our health needs and this must continue to be driven, hon Minister.
It seems that, while we are struggling with issues of noncompliance and a lack of accountability in South Africa, we are facing another side of the coin. The escalating cost of legal claims, across both state and private sectors, undermines service delivery and has adverse consequences for patients, the public and those delivering care.
Careful thought will have to be given to the issues of noncompliance and accountability on the one hand and, on the other hand, to the growing problem of litigation, excessive premiums and defensive medicine, potentially crippling the health sector.
The protection of the public and the delivery of quality services are complex. A balance must be found between the need for health professionals to be able to do their work free of fear and with proper accountability.
With time running out, I will just comment quickly on the National Health Laboratory Service, NHLS, which is vital to our health system. It conducts virtually all diagnostics for the public health system. These include HIV viral load tests, CD4 counts and TB culture and resistance tests. It is a functioning institution that has been facing bankruptcy and collapse because two provincial Departments of Health have failed to pay some R2billion.
Whilst no longer facing bankruptcy, the institution is functioning on austerity measures in case the financial problems reoccur. It is unable to employ anyone, except those in core and critical positions, and it is understaffed due to the number of staff members who resigned last year during the crisis.
The ACDP calls for decisive action to be taken by the national Department of Health and the Treasury to prevent a reoccurrence, which could result in the collapse of the NHLS. [Time expired.] Thank you. [Applause.]
Hon Chairperson, hon Minister and Deputy Minister, hon Members of Parliament and distinguished guests, I am very excited that since the Minister took over this portfolio, health as a sector and discipline has been received positively by South Africans. Minister, you are being celebrated by fellow South Africans as the light that has come to shine for many.
The leadership of this department has brought hope to many hopeless South Africans. They have done so with clear minds, knowing that there is a need to better the lives of ordinary South Africans, who depend on the public health sector for a healthy life. This department, under the leadership of the Minister, Deputy Minister and director-general, is being steered in the direction of improving the health of South Africans. The efforts that they have made are there for all of us to see, even the opposition.
This government, under the 100-year-old movement, the ANC, shows that you will not find an old man of 100 years of age who does not know what to do when there is a problem in his house. This movement of the people is aware of what the people on the ground need because it has been on their side long before it became fashionable to be on the side of the people.
The movement has listened to the following: the rural women of Rankelenyane in North West, when they cried about their children who died from pneumonia; the retired mineworker from Driekop in Limpopo, when he complained about asbestosis and that he has not been able to afford treatment at the private hospital; a young teenage girl from Jozini in northern KwaZulu-Natal, when she cried out for help after she had been raped by a group of youngsters; and to an old man at Matengteng in Bushbuckridge, Mpumalanga, when he could not afford to go to the nearest clinic to collect chronic medication because he could not walk. Indeed, it listened to an old woman in Muyexe, Limpopo, when she said that she was unable to collect her TB treatment because the rain had washed away the bridge.
After listening to the cries of those South Africans, the government, under the movement that has a rich history of hearing the cries of ordinary people, decided that it would implement a strategy. The strategy would ensure that health care was accessible, available and indeed affordable to the poor, rural, remote and farming communities.
It is after having heard these painful cries and pleas that this government decided that it would look at the best strategy, which would address the plight of those South Africans and many others, whose cries and pleas come to us through the Presidential Helpline.
The strategy is called the NHI. This is the strategy that will bring equality and equity to access to health care services for all South Africans, irrespective of where they live. This will ensure that a granny from Manthe in North West gets the same health care as the person in Klerksdorp; that a school child from Griekwastad in the Northern Cape and a pregnant mother in Matatiele, in the Eastern Cape get the same service as the person living in Port Elizabeth, and a young man from the Cape Flats gets the same care and treatment as the person in Chapman's Peak. This strategy will ensure that all South Africans get the same quality service because they are all equal citizens of this beautiful motherland of ours.
In this regard, I would like to congratulate the leadership of the department for the giant, bold step it has taken to ensure that the country moves forward and that access to quality health care is not the privilege of a few, but a right for all South Africans. I am convinced that the strategy will be able to address the key problems that the health department has been experiencing. I am excited because the department has identified the problems of the health sector, some of which have tarnished the image of this glorious profession.
Having said those things, I would need to advise the department that they need to ensure that they implement the strategy in health service systematically so that it continues to be sustainable after all these efforts have been made. Our people are waiting patiently for the day when they can confidently go to a facility and come back feeling better, both mentally and physically.
I know that the department has good intentions. However, I want to caution that unless these plans are systematically implemented, we are bound to be counted amongst the generations that had good intentions but meant nothing to the ordinary citizens. These ordinary citizens are interested in service delivery, not talking about the problem.
I will say to the Minister: "Beware of the prophets of doom." If we implement the NHI but still fail to reduce maternal mortality, we will have failed. If we implement the NHI but continue to have children and infants dying from preventable and curable causes of ill health, we will have done nothing worth celebrating. If we continue to have no medication in our facilities, we will still have failed the people we are representing.
My learned member over there will have to agree with me as far as the NHI is concerned. [Interjections.] I am so delighted that you agree with me. [Laughter.]
The implementation of the NHI should be followed by an improvement in the health outcomes, because that is what people want to hear. In order for us to achieve these things, we need clarity of mind and thought. We need to focus on the goal and keep our eyes on the ball, irrespective of any negative talk. We should spare no time or effort to deliver on the goals we have set for ourselves. It is also my belief that, unless the department strengthens primary health care and the district health system, all the wonderful dreams that it has will fail.
I really want to say that if you look at the plans that the hon Kopane has talked about, they are plans that the department already has - it is just that they speak a different language. It has become common practice for the DA to come here and tell us of their dreams of what their plans would be when they take over. Can they please support the plans that are here? How can they stand here and shoot down a plan that is going to take South Africa to another level?
Mike, Mike, talk to her!
To the hon Mike, I think you miss Health, and they have made a mistake by removing you. That is why they have put you here today, so that you can howl on their behalf. Thank you. [Laughter.] [Applause.]
Hon Chairperson, members and guests, the DA is heartened by the enthusiasm, zeal and hands-on approach that the Minister has displayed since his appointment. However, if we look at some recent newspaper headlines, we will see that he has inherited a health department that is in deep trouble: "State health care in crisis", according to the Sunday Times.
In the Weekend Post, referring to the dilapidated Elizabeth Donkin Psychiatric Hospital in Port Elizabeth, I read of this hospital of horrors, where a disturbed patient recently committed suicide ... [Interjections.] ... after ward conditions became unbearable because of overcrowding and other factors. There was no proper monitoring by nurses because their station had been removed to accommodate yet more patients.
Is this the mark of a country that has a Patients' Rights Charter and a Constitution that upholds human rights, dignity and the right to a safe and healthy environment? Why do we read of abusive and uncaring nursing staff? Can it be that their working conditions are so bad that they are demoralised and at the end their tether? [Interjections.]
I believe that nurses at Cacadu have not yet been paid for January, February or March. In some municipalities, cash collections have had to be made to buy electricity to keep the fridges in hospitals running so that the medication and vaccines for babies does not go off. Is this perhaps one of the reasons we have had so many tragic deaths of babies in neonatal units?
The overcrowding and lack of resources at the Charlotte Maxeke Academic Hospital, horrific conditions at the Dr George Mukhari Hospital, the shortage of drugs, Disprins and equipment at Chris Hani Baragwanath Hospital and the deaths of 180 babies at the Nelson Mandela Academic Hospital in Mthatha, all bring shame to our nation. What will the national department do to wake up hospitals and management and get competent, dedicated professionals into state institutions? Minister, why was the Hospital Revitalisation Programme budget underspent by R1 billion in 2010- 11? How is it possible that there is underspending if so many of our hospitals and clinics are falling apart and their needs are so critical?
In The Herald, I read about the critical staff shortages. This resulted in the country's first acute surgical unit, at the Livingstone Hospital, having to be closed because of the dire staff shortage in the casualty unit. It is regrettable that this unit, which was to provide expert treatment and was a signal of progress, had to be closed.
The shortage of medical practitioners - on average, 30% of the registrar training posts of the Health Professions Council of South Africa and 75% of subspecialist positions are vacant - is a matter of grave concern. Is this perhaps because the hospital managers do not have the required skills and financial expertise to run the hospitals properly? Staff appointments must be based not on favours for comrades, but on qualifications, fitness for purpose and experience - as we see in the Western Cape. All South Africans, particularly the poor, who suffer the most, need to know what programmes your Ministry has in place to ensure competent and dedicated staff members are appointed.
Minister, why did the key activities for improving training facilities not take place in 2011, for example, the accreditation of facilities, external audits of health facilities and the establishment of the Ombudsman Office?
We have massive problems with health compliance in South Africa. Why is only 2% of the health budget being spent on health regulation and compliance management? The budget of R62 million for the Office of Health Standards Compliance may not be sufficient. All across the country, there are doctors, nurses and health institutions that are not complying with the basic minimum standards in health care.
The chaos and lack of quality health care, especially in the Eastern Cape, must be improved. It is a basic right, one which the Western Cape administration adheres to and where the life expectancy is 65 years. [Interjections.]
The NHI, your plan to turn the system around, will be stillborn without sufficient doctors and without specialists in every district. We need to be assured that the vast amount of money, the R900 million, to be spent on the NHI over the three years will be well spent.
President Zuma said in his state of the nation address that women's health care programmes would be a focus area for the financial year. In the build- up to 2015, when we assess our progress in reaching the Millennium Development Goals, particularly regarding maternal and infant mortality, the decrease of almost 40% in the budget is a concern. Women's health care is not covered adequately in the strategic plan. To talk about maternal, child and women's health is not enough. We need decisive action to make a difference. We need to utilise our resources correctly to make sure that the most vulnerable people in society get the care they deserve. Primary health care services have also received a relatively small allocation in the budget. This does not gel with the Minister's stated intention to achieve a primary health care approach as opposed to the current hospicentric approach.
The spending of R800 million on the use of consultants is very worrying. We need to know what they will be doing, the projects they will be involved in and whether the department will be getting value for money.
The Auditor-General of South Africa has found significant challenges in infrastructure delivery at provincial departments of health. The current meltdown in the national Department of Public Works is harming the poor in all provinces, as they are the people who suffer most when clinics and schools cannot be built, due to interminable delays caused by government red tape.
After 17 years of freedom, the government has failed us. South Africans deserve better health care. Minister, we trust that you will be able to act as a catalyst and turn the situation around to improve it. We look forward to an improvement under your care. I thank you. [Applause.]
Chairperson and hon members, the department has corrected all the issues that were pointed out by the Auditor-General in the Audit Report. It further established an electronic register, which is really welcomed. We also welcome the fact that the Minister is going to ensure that the provincial departments are provided with support so that they can do their audits properly.
It can only be a non-South African who is not aware of the aggressive work that is being done and has been done with regards to HIV and TB. Real South Africans are aware that a lot of work has been and is still being done in regard to HIV.
Chairperson and hon members, the major problem with HIV and TB is the issue of defaulters. We are aware that most of our people live in informal settlements and on the mines. When they go home, they either never come back or they come back in a state close to death. Surely the current government, and the previous government, would have been unable to follow these people to wherever they were. After all, the health of each individual is his responsibility.
We are aware that when these people come back, they are on the verge of death. Some have multidrug-resistant tuberculosis, or MDR-TB, and that is a very difficult disease to treat. We know that there are special wards that can be built for these conditions.
A big difference has been made in the lives of extensively drug-resistant tuberculosis, or XDR-TB, and MDR-TB sufferers. We applaud the North West for the three MDR-TB patients who were completely cured. [Applause.]
In South Africa, pregnant women are required to attend clinic programmes even before the period of 20 weeks - at least at 14 weeks - so that any complications with the mother or baby can be detected and treated.
Although our learned friends on my right claim to be against the NHI, never mind everything they say, they support the NHI. That includes Mike Waters.
The Minister has reported that the department is going to employ its own engineers, not only nationally but also provincially. We are aware that the Minister keeps integrating the department and the provinces to move away from fragmentation. These engineers are going to work with the public- private private partnerships to deal with the departmental infrastructure projects. There is hope that the infrastructure projects that are in the pipeline will be completed on time. These projects include hospitals such as the Nelson Mandela Academic, Chris Hani Baragwanath, Dr George Mukhari, King Edward VIII and Limpopo Academic Hospitals. We are hoping that these projects will be completed on time.
The resource envelope that has been given to the department is spread throughout the provinces. Therefore, as the Portfolio Committee of Health, we will monitor whether the provinces are using these conditional grants properly, effectively and to the benefit of the health of South Africans.
Funding has been given to universities by the department to improve the doctors' pipeline and to ensure that we get more doctors. With regard to the funding that has been given to the Department of Education via universities, is the department sure that this funding will do what it is intended for? If it is also intended to address the issue of disadvantaged student doctors, will it do so or will the universities do as they deem fit?
We are encouraged by the fact that the budget for the nursing colleges as well as the training of community health workers is already in place. The major challenges that the country is facing, although we are aware that Minister is dealing with them, is to integrate the health system across the board; improve service; reduce the high cost of care; and improve the lives of all South Africans.
Provinces and departments have to integrate their services and improve communication and accountability, particularly for the conditional grants that have been given for that purpose.
The NHI projects are focused on improving the districts' health system as well as for the districts to assume greater responsibility towards the health of the nation. The projects will start in 10 districts across provinces that will deliver this service.
Angisho nje ngesintu ngithi, ngizozibala lezi zifunda ukuze bonke abantu abalapha nabasemakhaya bazi ukuthi yiziphi zona lezi zifunda, nokuthi yini okuzodingeka bayilindele. Ngikhuluma ngalezi ziFunda; i-O R Tambo eseMpumalanga Kapa, iThabo Mofutsanyana eFreyistata, iTshwane eGauteng, uMzinyathi noMgungundlovu KwaZulu Natali - yilapho kuphela lapho kukhethwe izifunda ezimbili, mhlawumbe kwenza nokuthi izinkinga zakhona zingangezifunda zakhona. I-Gert Sibande eMpumalanga, i-Pixley ka Seme eNyakatho Kapa, i-Dr Kenneth Kaunda eNyakatho Ntshonalanga, iVhembe eLimpopo kanye ne-Eden eNtshonalanga Kapa - yize noma laba bengakweseki lokhu kodwa kuzofanele babhekane nesimo ngoba imali yombuso iphumele ukuba ifeze lowo msebenzi, ngaphandle-ke uma bengasitshela ukuthi le mali yombuso bazoyenzani. (Translation of isiZulu paragraph follows.)
[Let me say it in my mother tongue - I will point out these districts so that all the people here and those at home will know which districts I am referring to and what they should expect. They are the following: O R Tambo in the Eastern Cape, Thabo Mofutsanyana in the Free State, Tshwane in Gauteng, Umzinyathi and uMgungundlovu in KwaZulu-Natal - the only province where two districts have been selected, maybe because the problems there are as many as its districts. The rest include Gert Sibande in Mpumalanga, Pixley ka Seme in the Northern Cape, Dr Kenneth Kaunda in the North West, Vhembe in Limpopo and Eden in the Western Cape - even though they do not support this, they will have to face the situation because state funds have been allocated specifically for this purpose - unless they are prepared to explain to us what they are otherwise going to use them for.]
May I go back to the responses of the people who have contributed to this debate. The hon Kopane spoke about the National Health Bill, which looks into the matter of the Office of Health Standards Compliance.
And he spoke sense.
Surely we cannot talk about or discuss that Bill while it is still under discussion by the committee. The committee is still talking about it. [Interjections.]
It is not classified information.
We were listening to briefings only two weeks ago. We are still going to be talking about the Bill. The issue of independence is always a problem in this House. Whatever structure is established, its independence will be doubted because it will be reporting to so and so. [Interjections.]
Hon Kopane, how exorbitant and expensive would private sector medical schools be for the disadvantaged, whom we are talking about today? For the elite and the rich that would do very well. [Interjections.]
Order, hon members! Allow the member to be heard.
The reason is that the elite would be able to afford what should be paid to that medical school. Medical schools, as we see, are expensive, but private sector medical schools ...
You'd better speak to Malema. Maybe he could support you. [Interjections.]
Do that, You do that!
So, we are looking forward to working with the province and the national department and also to monitor and do oversight in the provinces, as well as in the national department because we would like the quality of health services to South Africans to improve. If I may just ask the people on my right, if it were 17 years ago, would you be talking about health as you are talking about it today, or would you be talking "nie-blankes, blankes"?
What would you be doing, if we were to roll back the clock by 17 or 18 years? So, government is doing the best that it can to improve the lives and the quality of life of all South Africans.
Secondly, we have a very committed department and Ministry working towards improving the quality of life of all South Africans. Regardless of who you are, wherever you are, how rich or how poor. Your quality of life will be improved.
Hon Robinson, public servants are paid from the coffers of the Public Service and Administration, not by Health. They are public servants and they are paid as public servants, not by any department they are serving.
Thirdly, regarding the issue of energy in the Eastern Cape in 2010, I was working in another committee at that time. We went to the Eastern Cape. The Department of Energy had not used its electricity grant to actually make sure that there was electricity in the rural clinics and schools. At the same time, Water Affairs had not used its budget for clinics and schools. Therefore, that cannot really be blamed on the Department of Health. Chairperson, I thank you. [Applause.]
Hon Chairperson, thank you to those who participated, including those who participated in a negative way. I started by saying that we have a special guest today, Ms Yvonne Chaka Chaka, who is a Roll Back Malaria and Unicef Goodwill Ambassador and UN Envoy for Africa. We have invited her to celebrate her achievement. [Applause.]
She is the first African women to receive the World Economic Forum's Crystal Award for artists who improve the world through their work. She became involved in the malaria campaign after one of her back-up singers, Phumzile Ntuli, died of malaria in 2004. She is also engaged in the daily battle against HIV/Aids and TB. She's a South African. [Applause.] That is why we need to celebrate her success.
In July 2010, when I accompanied the President to the African Union - she was accompanying the AU Social Affairs Commissioner, Adv Gawans, to convince heads of state in Africa to support the Campaign on Accelerated Reduction of Maternal and Child Mortality, which we are going to launch on 4 May, as I have already said. Please give her another round of applause. [Applause.]
South Africa is one country with nine provinces. For some reason, I am not sure why, people believe that I must begin competing with the provinces that fall under us. This issue of continually mentioning what's happening in the Western Cape, as if it were not part and parcel of the country, must come to an end.
I was listening to this story of the Khayelitsha District Hospital. It is not in my nature and I don't want to begin doing certain types of things, but you're provoking me to do things that are not in my nature. Khayelitsha District Hospital was planned as far back as 2007, before the DA came to power. If you think this is an issue of competition, let me inform you that this was part of the conditional grant from national government. We give conditional grants and the R700 million is that conditional grant.
Let me tell you how conditional grants work. We provide a framework from the national side and the provinces must comply. Whatever they submit is based on the framework that we prescribe. They submit the business plan and we pass it and give the money. That is what we have done. [Interjections.]
The Bertha Gxowa Hospital in Gauteng ... [Interjections.] ... Can you shut up, please, and listen. When you spoke, I was quiet.
The Bertha Gxowa Hospital in Gauteng was built in the same manner. It is a state-of-the-art hospital, a green hospital. I was not there when MEC Mekgwe and the premier opened it, but this is not a competition. It so happened that I came to Khayelitsha because I was available.
I told Premier Zille this because my office confirmed very late that I was coming. They had written the plaque in her name. She said, "Minister, I am sorry. This plaque is written in my name, but I will have it changed and written in your name." I said that it was not necessary as I was not in a competition and that she should leave the plaque in her name. I would just open the hospital. That is the spirit in which we are working here and I don't know what spirit you are bringing to the country with this kind of competing. [Applause.]
We want to rebuild Tygerberg Hospital here in the Western Cape as a state- of-the-art hospital. We have already given R3 million for planning. Should I then start competing? We gave that money and we are going to give no less than R1billion for the refurbishment of Tygerberg Hospital. [Applause.]
I am doing so because this is the Republic of South Africa, it's not the republic of the ANC or the DA. It's the Republic of South Africa for the people of South Africa. The people who go there are South Africans. [Applause.]
We have built Inkhosi Albert Luthuli Hospital in KwaZulu-Natal, another state-of-the-art hospital. We are going to build the Dr George Mukhari Hospital and the Chris Hani Baragwanath Hospital. We have named six hospitals; they are all going to be state-of-the art hospitals - something you have never done before. There is going to be no competition. We are all South Africans. Please, let's avoid that.
Let me correct the issue of underspending. I am the one who brought this issue of underspending to the fore and I even gave you the figures. We didn't know. Most of the things that you keep on talking about and criticizing - you actually got the information from me. [Laughter.] Yes, I told you ... [Interjections] ... that the underspending on infrastructure has been doubling since 2007. It started at R199 million in 2007, until it was R813 million in 2010, not R1billion, and I said we would correct it. We hired engineers, as Mrs Ngcobo has said.
I can announce to this House that while the underspending was R813 million in 2010-11, in the financial year that has just ended we have decreased it to R390 million. I am standing here to tell you that during this financial year we will eliminate it. Next time you will come and say that again. [Laughter.] We will eliminate it. We decreased it and I was the one who announced that we were going to decrease it. What I promise we will do, we always do in this department. I don't just promise, we promise and do what we promise.
With regard to the issue of the NHI, I am not sure whether you want to sleep through the revolution. This disaster you are talking about is yours and not ours. [Interjections.] If you are planning a disaster, go on! Why do you want to involve us? [Laughter.] I am not moving with you in the direction of that disaster. I cannot take the country to the brink of disaster. [Laughter.]
The issue of universal health coverage is a worldwide phenomenon - you can be left behind - and it is supported and defined by the WHO. Hon Kganare, you talked about politicisation, it is not we who are politicising it. This is a worldwide phenomenon because which citizen of the world should be left behind when health care is financed?
Why is the WHO leading it? Because in 1978 when the WHO passed the Declaration of Alma-Ata, they said that the attainment of the highest standard of health is a worldwide social, goal. And its realisation needs action from all sectors, economic and social in addition to the health sector. That is what we are pursuing.
Let me read the Bangkok Declaration to you. You can go and Google what the WHO was saying about Mexico. That is what I was quoting from. Go and read it. Universal health coverage, sometimes referred to as UC, is a widely shared political aim of most countries, and it has gathered increasing international attention recently. The International Forum on Sustaining Universal Coverage: Sharing Experiences and Supporting Progress, organised by the government of Mexico on 1 to 2 April 2012 in Mexico City, is the latest international high-profile event on universal coverage.
In Mexico City, high-level participants from 21 countries from the six WHO regions, including the Ministers of Health of Mexico and South Africa, as well as the WHO Director-General, Dr Margaret Chan, and Assistant Director- General, Dr Carissa Etienne, gathered to exchange experiences and promote international co-operation on efforts to sustain progress towards universal health coverage.
The participants heard about various pathways taken and challenges on the way - challenges, not obstacles - faced by countries on the way to universal coverage. They also discussed and identified supportive action that could be taken at international level, recognising the importance of universal coverage for sustainable development, equity and population wellbeing. Go and check it out. There is the Bangkok Declaration, which was passed in Thailand during the visit by the Portfolio Committee on Health.
Let me tell you what is going to happen. I am going to give you copies of this ... [Interjections.] Please shut up and learn to listen and show respect for that matter, especially to elderly people ... [Interjections.]
Hon Minister, please take your seat.
Chairperson, I submit that the phrase "shut up" is unparliamentary ... [Interjections.] ... and I would like him to withdraw it ... [Interjections.] ... especially from a person who holds as high a position as Minister.
I will rule at the end of the debate. Hon Minister, you may conclude.
It does not matter, I can withdraw it. [Laughter.]
Eup?a tsebe ga e na sekhurumelo, sesi. [But the message is loud and clear, sister]. [Laughter.]
I can withdraw it and I am withdrawing. [Laughter.]
Let me tell you what is going to happen. This issue is going to the United Nations for it to be universal and international. That is the decision taken at Bangkok and Mexico. Lastly, members of the DA, in Sepedi it is said that ...
... o seila kgaka, senwa moro. [... you are opposing this while you indirectly support it.]
It is very funny: you are attacking the NHI. They will not be able to interpret that, so forget about it. [Laughter.]
Seila kgaka, senwa moro. [Opposing while indirectly supporting this.]
Nobody will interpret that easily. [Laughter.] Come to my office and I will explain. You are attacking the NHI, but piloting it. When you do that, in my language we say that ...
... o seila kgaka, senwa moro. T?wela pele go ila kgaka le go nwa moro. [... you are opposing yet supporting this indirectly. Keep on doing that.]
We will continue implementing the NHI successfully. Thank you. [Laughter.] [Applause.]
In terms of the point of order, the Minister voluntarily withdrew the phrase "shut up". It is indeed unparliamentary.
Debate concluded.