House Chairperson, the hon Chair of the Portfolio Committee on Health and Members of Parliament, my colleague the Deputy Minister and other Deputy Ministers, Ministers and Cabinet members present, MECs of Health in the various provinces, heads of public entities and statutory councils, professional bodies, unions, civil society, deans of faculties of medical sciences and other academic institutions including medical
research councils and other councils, members of the public, ladies and gentlemen and fellow South Africans.
It is a indeed a pleasure for us to table today the National Department of Health Budget for 2019-20 of R51.46 billion.
The President, in the state of the nation address of the Sixth Parliament, indicated that we have to attend to the capacity of our hospitals and clinics. To this end, we have a social compact which has emanated from the discussions in the Presidential Health Summit held in October 2018. It will be signed by the President to confirm the partnership between government, the private sector, academia, health professionals, civil society including organized labour to build a health system for the country that will be ready to implement universal health coverage.
And, therefore, I welcome the presence today of all the stakeholder who are partners in health who are amongst us here, as I've indicated form the private sector, members of the public, patients' associations, advocacy groups, the academic and research community, the various other sectors such as the representatives of various professional bodies and regulatory bodies who are here, I really do appreciate your support throughout all this process.
We recently attended the G20 Summit in which Health and Finance Ministers reconfirmed the commitment on our shared understanding about the need to strengthen health systems and health financing with the aim to achieve universal health coverage. And the point we made is that expenditure on health must be seen as investment in economic growth.
The Director-General of the World Health Organisation, WHO, Dr Tedros Adhanom Ghebreyesus, put nicely regarding the potential pay off, the universal health coverage, when said:
It is children who survive beyond their fifth birthday because they are immunized. It is women who are able to start small businesses because they don't spend all their capital on health care. It is men who don't die before their time from a noncommunicable disease.
So, it's from this backdrop that we have to express our confidence to commit to this cause despite the existing challenges of the staff shortage, shortage of medicine, ageing infrastructure, inequity in the access and inadequate equipment amongst others.
We have to use the critical levers of health to narrow the gaps and bring about the resolution of the country's woes such as low economic growth, inequality, poverty and unemployment and prevent the recurrence of human rights violations such as the Life Esidimeni.
It is on this basis on which through their President have sent a strong messages demanding improved services and elimination of long queues in health facilities.
What we have to do in health is in line with our goals on the National Development Plan, NDP, and the Sustainable Development Goals.
The major challenge of the health system is increasing burden of disease and the twin epidemics of communicable and non-communicable diseases.
So, based on the outcomes of the Presidential Health Summit we've put together some steps to intervene and deal with the health system. These interventions to help transform the health system, correct weaknesses but also create a platform on which to implement the NHI. Which is a way of providing social solidarity and providing
good healthcare for all by sharing the money available for healthcare amongst all our people. The health benefits that you receive will depend on how sick you are, not on how wealthy you are.
Under the NHI, health facilities and health workers will also be available to provide health services to all, more equitably. It all depends on our willingness to share as one nation. And if we can feel and act in unity about sports, surely, we can do the same when it comes to matters of life and death. The National Health Insurance is a chance, therefore, for South Africans to hold their hands together and really work together regardless of race, gender or creed.
Now, we have said that there have been concerns about the readiness of our system to implement NHI. I believe that too much of discussions have happened; analysis and diagnosis have been done, I think it's time for us to just jump in to implementation
NgesiZulu kunesisho esithi umkhonto wegwala uphelela etsheni.
If we continue analysing the whole problem, we'll end up never actually getting to battle. And for that reason we believe, therefore, that there are a number of issues that we must tackle immediately and we do so we are both resolving the problems in the health system and at the same time creating a platform for the implementation of the NHI.
The first of the problems is the issue of equitable funding for the public sector. I think as we have been discussion across with my colleagues, all provinces have got a feeling that health is significantly underfunded and therefore, the current baseline needs to be corrected, particularly if you look at the size of the health service, the burden of disease and the quality that is expected out of it. To this end, we are engaging National Treasury to explore various modalities to adequately fund the health services. But, in the long-term investment in NHI will create funding mechanism that will permanently resolve this problem.
The second problem is shortage of staff. We believe that the shortage of staff in the frontline service delivery needs to be eliminated once and for all. [Applause.] So, of the 4 143 medical officer positions, we are ready to fill 2 680 of those this year. And of course, a proportion of the nurses, Allied Health Professions
and Community Health Workers that also have to be given attention. We give the figures in the detail of the text of the numbers that we think can be accommodated. But to be able to do this, we have actually instructed our departments to go and look for possible sources of funding to divert to this particular priority. And, therefore, the Department of Health and Treasury now have a team that's working on reprioritising the budget, looking at vacant posts, looking at structures that are bloated that need to be downsized, looking at projects that need to be abandoned and also looking at restructuring conditional grants. All of these, we'll report as we move on but effectively we are looking for alternative additional sources of funding. Mind you, I've said that even the original baseline does need to be looked at.
The third one is the supply of medicine. I also believe here that we need to give this attention. Budget for medicine needs to be ring- fenced and protected to prevent drug stockouts. So, we are looking at a mobile App which allows immediate reporting by patients and civil society every time that vital medications is not available in clinics and hospitals so that there's a quicker feedback to the management to correct the situation, both at provincial and at national level.
We have also identified situations where there are global shortages we will always endeavour to ensure timeous alternatives that must be supplied so that people don't go without any medication.
The SA Health Products Regulatory Authority, SAHPRA, will also be strengthened to ensure that they speed up the registration of medicines and also build capacity for local production of active ingredients as well as removal of application backlogs and accelerate the applications to make it easy for drugs to be accessed.
We also exploring procurement of available software to ensure that we can dispense medicine closer to where the patients are and we are partnering non-governmental organisations, NGOs, that have already done work on this particular area, focussing on the areas of townships, informal settlements and rural areas. There are areas already where we are able to get medication delivered without patients having to go to hospitals. This, again, will assist to reduce the patients' waiting time and people just walking to the hospital just for medication.
The impact of these steps that I have indicated will be that of reduction of patient waiting time, less overcrowding at hospitals
and managing patient workload for both staff in the clinics and hospitals, and ensure that our people have medication without the inconvenience of wieldy queues in the hospitals.
The other issue to focus on is that of quality improvement. Here we welcome the reports by The Global and National Lancet Commissions on quality care. The quality of health care in the government-run facilities must improve to make the public sector a service of choice in terms of access, affordability, availability and appropriateness, technical competence, skills, effectiveness, efficacy, respect and caring amongst others. [Applause.]
So, when people approach our public sector they will be doing so because it's their service of choice, not because they've got no other way to go.
We will, therefore, be using the office of Health Standards Compliance to monitor the improvement of quality at different levels. We'll also be working on client satisfaction surveys to track some of the very sensitive issues which we believe that management needs to be alerted quickly enough to be able to ensure corrections, such as quality of food, hospital linen, cleanliness, attitude of staff etc. [Applause.] All of these for us are
nonnegotiable for which we need to make sure we partner with advocacy groups, civil society, our patients or our clients in ensuring that they give us feedback to help to correct the system.
The fourth one is, of course, we want to strengthen the office of the ombudsperson which is a channel where communities can raise concerns about the quality of health services. This one, we will strengthen and also work on a combined strategy of improved clinical care, efficient administration backed by strong legal interventions to reduce medicolegal claims by more than 50%.
The fifth one is improvement of governance. Here we intend to strengthen leadership at various levels to bolster service delivery and place the patient at the centre of care. We'll review organograms and also look at bloated and inappropriate structures, adjust delegations and ensure that there's authority at the correct levels for effective decision-making processes. In that way also, fight corruption and promote ethical leadership and eliminate wastage.
Consultation with the heads of specialist disciplines will be undertaken to strengthen clinical guidelines at tertiary and regional hospitals that we build capacity for all managers and
strengthen the system.
To improve governance also at our health facilities will ensure that clinic committees and hospital boards are up and running by the end of this year. These structures will be trained so that whenever these feedback mechanisms begin to kick in, they are able to effectively assist management of a clinic or a hospital to make amends and correct the system so that the patient service is improved.
The sixth on is infrastructure build. Here we believe that for the public to believe in NHI, the quality of the infrastructure has to be improved. Currently, there's about R19 billion which has been set aside for the MTEF period to refurbish a number of hospitals and build new hospitals - at the same time - and clinics. But this is a lost of work that has been done but we also believe it's not enough.
The department, at the moment, has actually done a whole cost analysis and audit of the quality of the services and the cost it would take to revamp literally every hospital or facility in the country. so, I've set up a team of experts in finance, health and health infrastructure from Treasury and Health to seek creative financing mechanisms and alternative models of delivering health
infrastructure. We've given them a clear directive to look at a programme that can actually start delivering, literally refurbishment of all the hospitals and building new ones within a horizon of five to seven years. This is the basis on which NHI will be operating.
Our current preliminary indications are that such is feasible and therefore, we are going to work on a plan and once it's developed we'll then be approaching provinces and all other stakeholders to ensure that we can start that massive infrastructure build.
The seventh one is strengthening the public health care and reorganizing the district health system. Here, we believe that strengthening various cadres, community care givers, community health workers, clinics and hospitals, nursing care as well as district hospitals, working together particularly with outreach programmes from doctors to ensure that patients can be seen without having to go to hospitals. And in the process also, bring in the services of general practitioners in private to be part of this whole base of which the NHI is going to be build. This move also has support from South African Medical Association, Unity Forum of Family Practitioners and Progressive Health Forum and so on. So, we
have lots of guidance on this area to try and take that process forward. [Applause.]
It's important also to understand that there's a role for traditional practitioners and other allied complimentary health professions in the building of this primary health care and we are going on with the discussions on how those roles must be further defined.
We also have support from the Health Professions Council of SA, HPCSA, the Pharmacy Nursing Council and the Traditional Health Practitioners Council, all of whom are also looking at what role they can play in strengthening that whole system.
The eighth one is stakeholder management. We believe that we have deal on this matter as a partnership, literally all of us here have got an interest in the building of the health services and therefore, we will be looking at strong angles of dialogue to be able to deal with various aspects that will strengthen the health system.
We are, therefore, going to be setting up an office for the implementation of the NHI that is going to give us the preliminary
plan of how this unit is going to operate. This is about building on the NHI fund, building on the capacity that is needed to manage the NHI, looking at the various models from various countries in terms of accounting, purchase of service, actuarial calculations; all of those issues are going to be worked on by this team.
In the process, we also have decided that a number of people must be trained in this regard. To start off with, there's also patient registration system which at this moment has registered 42 million South Africans and by the end of the year we intend to ensure that all South Africans are already registered for NHI on a single registration.
We'll also be working with the Department of Home Affairs for birth registrations so that children are loaded onto the system, all of this on the timeframes of the Department of Home Affairs.
We have worked with the deans and heads of specialist disciplines to look at how to strengthen the capacity at the hospitals as well as in the administration. So, we are identifying 30 managers within the next four weeks who must go out and be placed in institutions across the world who are practicing the national health system or NHI system so that they can actually learn on the spot. And here we used
the agreements that have come from Japan International Cooperation Agency, JICA, Department for International Development, DFID, French government, then in addition, the academic institutions will identify academics who will also be part of this programme and then we'll use twinning to be able to build capacity in South Africa so that ongoing capacity on management of NHI will be resident inside the country. [Applause.]
Amongst the programmes that we will be identifying for purposes of initial loading on the identified districts using the report on the pilots as well as the report of the health office of standards and compliance will then identify about 20 districts from which the first load of various programmes will be focussed on.
HIV/AIDS is one of those and we spoke about the 90/90/90 goals and the need to raise two million other patients for treatment as well as elimination of defaulters with tuberculosis, TB, that will be focussed on. The campaigns that we are going to deal with for focussing on vulnerable groups particularly the younger women and men for testing, all of these we are going to be focussing on. We not the progress that has been made in the improvement of the life expectancy because of the antiretroviral treatment but we are concerned that the numbers are still rising and so, we have to
reduce the incidents of TB as well as of HIV. All of these are issues that we are going to be loading for earlier focus as we start the programme of NHI. So, the other area is going to be access to rehabilitation for psychological and mental health services for all our people to deal with the issues, particularly those who have HIV and TB; but also on issues on unnatural causes, the issues of domestic violence, other crimes and so on, we have to work together on all of these.
The other area that needs to be strengthened is that of the National Health Laboratory Services which is doing brilliant work now in supporting all the hospitals and therefore, their turnaround times have improved and their cost-effectiveness has improved, and this is going to be fundamental in dealing with supporting the NHI.
So, amongst the services that we will be focussing on immediately for those districts where we will be strengthening NHI immediately is maternal and child and neonatal health services; sexual, reproductive and adolescent health; issues of support and rehabilitation for the disabled people; services for the older people; palliative care and particularly those patients with cancer and HIV terminal stages; we will then be tackling both communicable
and noncommunicable diseases [Time expired.] thank you very much. [Applause.]
THE HOUSE CHAIRPERSON (Mr CT FROLICK): Before I call the next speaker to the podium I would like to welcome our guests in the public gallery. But I will request you that you switch off your cellphones please. I didn't want to disrupt the Minister when he was busy with his speech but there's a number of cellphones that went off. Please switch it off so that we don't have any further disturbances.