Hon House Chair, Ministers and members, we have heard much today about the state of health in South Africa, some good and some bad. I do want to acknowledge the role of Dr Motsoaledi in bringing about a more enlightened attitude to much that was previously ignored or deliberately misrepresented.
We are grateful that the age of denialism regarding HIV and Aids is now behind us. Indeed, the DA welcomes the fact that there has been a 40% reduction in the rate of new HIV infections, with HIV antiretroviral treatment being broadened by 75% in the past two years, and the number of children newly infected with HIV being reduced by at least 40%.
The Western Cape increased its ARV treatment provision from 14 370 to 132 279, and brought down the mother-to-child HIV transmission rate to 1,8%, the lowest in the country. This can also be attributed to the fact that ARV treatment was started here in the Western Cape long before it was rolled out in other provinces. The positive outcomes in the Western Cape, Deputy Minister, also contribute to the good reputation of South African health care. While the TB rate in the province is still unacceptably high at 768 cases per 100 000 people, it is reported that the province has the highest cure rate in the country, at 82%.
The DA welcomes the improvement in analysis and planning, but there are many areas where decisive action still needs to be taken to eradicate problems, Minister, particularly with provincial departments, where there is inefficiency, poor management of staff, inadequate financial controls or proper procurement procedures.
Why is it that the Madwaleni Hospital in the Eastern Cape was allowed to function without X-ray machines for more than six years? Why was there only one doctor at this 150-bed hospital for many months? Political rivalry and factionalism cannot be tolerated when the health of the nation is at stake. Heads must roll where malpractices are revealed. Culprits should not be transferred to other districts or be redeployed. The DA urges Minister Motsoaledi to be decisive, cut to the quick and lance the boil so that healing can take place at all levels.
Let us look at primary health, maternal and infant mortality and mental health. Warning lights flashed when I read that the budget allocated for primary health care had been reduced. Only 0,4% of the Health budget has been allocated to primary health care - R109,4 million - less than Programme 4: Administration, and the only programme to decline in nominal and real terms. Noncommunicable includes monitoring chronic, disability, elderly, mental health and substance abuse.
These budget cuts seem illogical when the Department of Health has indicated that it wishes to focus less on hospice-centric health care and more on re-engineering primary health care, in order to be close and accessible to the people. Primary health care is the very foundation of National Health Insurance, but if that is weak and crumbling, how can NHI succeed, apart from the financial problems, of course?
We welcome the establishment of school health programmes as well as the creation of specialist teams in each district, including gynaecologists, paediatricians, anaesthetists, family physicians, midwives, paediatric nurses and primary health care nurses. However, I would suggest that an 8th member be added to the team: a psychiatric nurse who is able to pick up developmental, neurological or psychological problems at an early stage.
Mental health is the cornerstone of maternal and child health outcomes, as it does not affect only the individual but also children, families and society in general. Mental health in pregnant women is linked to poor foetal growth and premature delivery. It can also result in their infants being more vulnerable to infections and diseases.
Children of mothers with mental illnesses are also more likely to be abused or perform poorly at school. They could also develop mental illnesses at a later stage.
South Africa has a sad history of abuse, and gender and domestic violence. This gives great concern that the budget for maternal and reproductive health care has also been reduced, from R17,6 million to R17,2 million.
South Africa's infant mortality rate is frighteningly high. Currently it stands at 44 deaths per 1 000 births, whereas the global average is only 39 deaths per 1 000 births. These findings show that there are critical shortcomings in infant care.
In the report of the State of the World's Mothers of 2013 we read that a baby dies on its first day almost every hour in South Africa, or that 7 500 babies die per year in the first 24 hours, 21 deaths per day - a shocking and saddening state of affairs. In the same report it is stated that 3 000 mothers die from childbirth complications. That so many mothers should die when giving life is unacceptable.
In South Africa, more than one in three women living in poverty will experience mental health problems during and after pregnancy. This is often related to violence, abuse, and HIV and Aids. Adolescent and young mothers are particularly vulnerable to mental distress and depression.
Poverty, violence and poor education exacerbate these problems, so it is suggested by the Perinatal Mental Health Project at the University of Cape Town that a mental health dimension be integrated into the re-engineered plan of primary health care. Foetal alcohol syndrome is also a major cause of developmental or learning problems amongst children. All these factors could be contributory to the culture of violence, crime and abuse which South Africans experience. These are major social problems, which could be related to undiagnosed mental or psychological problems, instead of being regarded as criminality or delinquency.
Autism is a condition which is increasing in frequency. Previously children living with autism were regarded as badly behaved, disruptive or stupid, but now it is recognised as a neurological condition of people who are often highly intelligent. This condition can be remedied with specialised education and nutrition.
However, we are not equipped to deal with these challenges, so may I ask, Mr Minister, why the total of Programme 4 decreased by 17,6% despite the stated aim of delivering, based on primary health care. How can one explain the 13% nominal and 17,6% real reduction in primary health care services? The decline in funding for primary health care is very worrying. This is exactly where the greatest needs are.
The Democratic Nursing Organisation of SA, Denosa, concurs that there is a decline in specialist skills for intensive care, theatre work, midwifery and psychiatric nursing. I wish to pay tribute to many hardworking, caring and dedicated nurses and thank them for their selfless work. I pay tribute also to our doctors, but especially to the endangered species, the psychiatrists, in our hospitals. They, like many of the pathologists ...