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.]