Modulasetulo, Maloko a Palamente a hlomphehang le baahi ba rona kwano Afrika Borwa ... [Chairperson, hon Members of Parliament, fellow South Africans ...]
...we must confront the hard truth about our public health care system if we want to ensure the welfare and the constitutional rights of all South Africans. By only examining the ailments of our health care sector - and successfully diagnosing the problem - we will find the remedies that will heal it.
According to the National Development Plan:
The overall performance of the health system since 1994 has been poor despite the development of good policy and high spending as a proportion of GDP.
Mohlomong re hloka ho ipotsa hore na ebe re fositse ha re le hokae. [Perhaps we should ask ourselves where we went wrong.]
One of the many challenges facing our health care system is the lack of qualified doctors, nurses and competent administrative staff, which has led to the unresponsive and cumbersome bureaucracy in the health sector, lack of accountability and good decision-making. This is a tragedy and it is unnecessary. South Africans have the resources and skills base to provide excellent quality health care for all who need it.
It was Mahatma Gandhi who said: "A nation's greatness is measured by how it treats its weakest members." If that is so, it means the Department of Health must be held responsible for holding us back from the greatness we aspire to.
Where the DA governs, we have filled nearly 100% of nursing positions in this province. This is because we treat our staff well and we manage the department's human resources carefully. This is the difference between where the DA governs and where the ANC governs. [Applause.]
In addition, life expectancy in the Western Cape is currently 61 years for men and 67 years for women, while the national average is 52 for men and 56 for women. The maternal mortality rate in the Western Cape stands at 98 deaths per 100 000 live births, while the national average is 140 to 160 deaths per 100 000 live births. The child mortality rate in the Western Cape is 38,8 deaths per 1 000 births, while the national average stands at 69 deaths per 1 000 births. The Western Cape has an antenatal HIV prevalence rate of 18,5%, while the national average is 30,2%. The TB cure rate in the Western Cape is 79%, while the national average is only 65%.
During my oversight visit, I realised that most of the institutions still face the challenge of not having enough nurses and doctors, with an unnecessarily long procedure to fill the vacancies. At the Jabulani Gateway Clinic in Soweto, they are operating only at 27% staff capacity. The nursing vacancy at this hospital is the highest, with 549 posts that are not filled according to the parliamentary reply.
At the Charlotte Maxeke Hospital, nearly half of anaesthetists have resigned due to unresolved overtime grievances, and the hospital could lose its accreditation. With only a handful of specialists left to train the registrars, many operations will be delayed and many patients will be forced to wait until such time that the doctors are ready to operate on them. It is a great pity that the hospital's management has mishandled the overtime issue that has led to the resignation of nearly half of the anesthesiology department. With the current situation, there are about 10 021 patients awaiting operations in Gauteng hospitals alone, according to a reply to a DA question.
According to the MEC of health in Gauteng, the long waiting lists are due to service demands or loads that exceed the capacity of our resources.
My view is that the mismanagement is the major factor, and a proper use of resources can bring down the waiting lists. In the short term, private providers should be contracted to bring down the unacceptable waiting times. Patients suffer while waiting for surgery. So, every effort must be taken to reduce this backlog.
Hon Minister, poor management at facility level is the most cited reason why most doctors are leaving our public sector. Fixing the management by providing hospitals with sufficient resources, and implementing stringent targets and accountability policies will help to address this retention problem.
There is great concern regarding the shortage and maintenance of health technology, medical devices and the infrastructure which are essential for uninterrupted and effective service delivery. During my oversight visit to Limpopo last year to the Lebowakgomo Hospital, the X-ray department was completely closed because all the X-ray machines were not working. They were all labelled "out of order". This is because the department had failed to pay the service provider R90 000. On that day, there were about four radiographers on duty, but they could not do anything to assist their patients. The only thing they could do was to just look at the patients suffering in front of them.
During my visit to various health care facilities across the provinces, I have discovered that buildings are dilapidated; beds are in short supply; and, in many cases, there is still a lack of basic services like water. Last year, I talked about the Brandfort Municipal Clinic. As I am speaking to you today, the situation is still the same. This is totally unacceptable, given the fact that there are millions of rands available to solve these problems.
The Jabulani Hospital in Soweto was initially scheduled for completion by May 2008. However, five years later, in 2013, this hospital hasn't been completed yet. Repeated delays have doubled the initial development budget from R334 millions to at least R680 millions. Given the slow spending of just 58,6% for the revitalisation grant, the slow spending of just 32,2% for the nursing colleges, and the slow spending of just 10% for National Health Insurance, NHI, it is clear that money is not the problem. The people in charge of our public health care are the problem.
Hon Minister, the success of the NHI is dependent on the functioning of the public health care system. Spending on the NHI conditional grant is extremely poor given the fact that R150 million was allocated, and that only R14,9 million had been spent by the end of December 2012. Provinces are spending poorly, with the worst being Limpopo which spent only 1,2%, the Eastern Cape at 2,4% and KwaZulu-Natal at 3,3%.
Of particular concern has been that the grant is not really being used to pilot the new interventions, which need to test the NHI, but that it is being used to strengthen the general health care system. A further problem is that there is no credible evaluation strategy which could lead to favourable outcomes.
Hon Minister, maybe we need to honestly ask ourselves: If the NHI is the solution for our public health care system, why are the pilot projects struggling to sustain themselves? We need to make sure that we have the right people in the right positions, and they must be held accountable for their performance. According to the Ministerial Finance Task Team, no part of the system is held properly accountable for poor health outcomes or poor service delivery.
Hon Chairperson, the DA is concerned about the cost of private health care that is rising above the inflation rate, and also about the alarming increase in the fraud that has become a nightmare for almost 100 medical aid schemes by doctors, pharmacists, physiotherapists, radiologists and pathologists. According to the Board of Healthcare Funders of Southern Africa, R22 billion is being claimed by corrupt health professionals annually, resulting in members of the public having to pay extra on their premiums.
In one instance, a doctor billed a medical scheme for 107 appointments in one day, each taking two hours, which would have meant he worked 214 hours in one day. That is totally surprising and unacceptable. About 101 KwaZulu- Natal doctors have claimed more than R22 million from the medical aid schemes for private work carried out at a time when they were supposed to have been attending to their patients in state hospitals. This is according to the Sunday Tribune. According to a report presented to the KwaZulu-Natal department of health, it is indicated that from June 2011 to June 2012 patients in public hospitals were neglected by doctors who were working privately. The DA urges the Health Professions Council of SA to investigate the report and immediately institute disciplinary hearing proceedings against those who are responsible.
We welcome the announcement by Minister Patel that the Competition Commission will launch a long-awaited market inquiry into pricing in the private sector. No society can prosper without an affordable, high-quality and easily accessible health care. That is why as the DA we build and run world-class hospitals in places where we govern, in places like Khayelitsha and Mitchells Plain. We manage properly patients' medical records right down to the level of clinics. We are also progressively rolling out the system where chronic medication is delivered to a public health care patient's doorstep - that is good governance and service delivery. The DA has noted all the progress that their democracy has made. Thank you. [Time expired.] [Applause.]