Deputy Chairperson, my Cabinet colleagues, the Deputy Minister of Health, Dr Ramokgopa, MECs for health from various provinces, hon members of the House, distinguished guests, ladies and gentlemen, I'm delivering this speech to you with a very sore heart. It is just a few days since the brutal killing of Dr Mkhize in Mpumalanga at the hands of somebody he was supposed to be helping. It is very painful. The incident happened in my absence when I was attending an Aids Conference with the Deputy President in New York. We wish to express our condolences to the family and thank MEC Dhlomo for having attended the funeral on our behalf.
I am delivering this speech at a time when the health care system is at a crossroads. We may choose the best route, or the worst one ever, which will, of course, make our situation even worse than before. The choice lies with us as South Africans in general, but as elected leaders in particular.
Last year I signed a performance agreement with the President as part of the national service level agreement. We have identified four measurable outputs which we must achieve in order to ensure "long and healthy life for all South Africans". You also know that we have a 10-point programme on top of these.
Deputy Chairperson, extensive studies commissioned by the prestigious medical journal, The Lancet, were conducted by our own scientists and researchers in South Africa, and revealed that countries go through four different types of disease, which we call a quadruple burden of disease. These are first and foremost HIV/Aids and TB. The second is an unacceptably high maternal and child mortality. The third is an alarming and ever- increasing incidence of noncommunicable diseases, ie high blood pressure and other cardiovascular diseases, diabetes mellitus, chronic respiratory disease, and various cancers, as well as mental health. The fourth and last is violence and injury.
Having said this, Hon Deputy Chairperson, let me also say that it is a known fact that South Africa spends more money on health than any other country on the continent, and even beyond, but our health outcomes are worse than in some of these countries. We know that that is because of health care resources that are skewed in favour of the rich.
Hon Deputy Chairperson, let me take this opportunity to go through the aspects of the quadruple burden of disease one by one, because I want members to understand exactly what we are talking about.
Let me start with the first pandemic, HIV/Aids and TB. To summarise it, South Africa has only 0,7% of the world's population, but we are carrying 17% of the HIV burden of the world. We have the highest TB infection rate per population, and our co-infection rate between TB and HIV is the highest in the world, at 73%. A total of 35% of child mortality and 43% of maternal mortality is attributable to HIV and Aids. One in every three pregnant women presenting at our antenatal clinics is HIV-positive.
Surely this needs very serious and extraordinary measures. Hence the announcement by the President on World Aids Day, when we started using new measures to combat HIV/Aids. If I may remind you of the measures, all pregnant women are treated when their CD4 count is 350, and all HIV and TB co-infected people are also treated at 350. The prevention of mother-to- child transmission, PMTCT, now starts at 14 rather than 28 weeks, as it used to do before. Fourthly, all infants who are born HIV-positive are treated immediately on diagnosis, and we don't wait for the CD4 count.
Hon Deputy Chairperson, we need to understand what the scenario was in February 2010, before these new measures. This was the scenario. Only 490 health centres were able to provide ARVs. I am happy to announce today that the number of centres that can now provide ARVs has grown to 2 205. At that time, in February last year, only 250 nurses were certified to initiate ARV treatment. I'm proud to mention that the figure has now grown to 2 000. Before the HIV Counselling and Testing, HCT, Campaign was launched by the President at Natalspruit Hospital on 25 August last year, 2 million South Africans per annum used to be tested to know their status. I'm happy to announce that at the last count, last month, 12 million South Africans had been tested.
Many South Africans want to know their status. Hence, last Sunday, 12 June, exactly two days ago, I, together with the House of Traditional Leaders and Congress of Traditional Leaders of South Africa, Contralesa, launched a massive HIV Counselling and Testing Campaign for all our villages, and the village of Mafefe in Limpopo was chosen for the launch. It was a very great success. Six kings attended the event, and a lot of other traditional leaders. They all pledged that they would open their villages for us to come to test people, and that they would be the ones to take the lead.
Before the campaign at the end of February last year only 928 000 South Africans were on ARVs. Because of the campaign we have 1,4 million people on ARVs today. Deputy Chairperson, I also announce with pride that in November last year we were able to reduce the prices of ARVs by a staggering 53%, as we promised that we would do.
I have also worried time and again about the number of newborns in South Africa who are born HIV-positive. At one stage the figure was put at 70 000 children born HIV-positive. I am happy to announce today that the studies done by the Medical Research Council show that we have been able to reduce mother-to-child transmission by 50% at about six weeks post delivery. This is a very big achievement and the significant reduction has actually happened in the province of KwaZulu-Natal which, as you know, has the highest prevalence of HIV. When it came to reducing mother-to-child transmission, KZN was number one. Deputy Chairperson, this is to be celebrated because it means that, if we work hard enough together with the MECs, we can eliminate the phenomenon of mother-to-child transmission by 2015, and we intend to do so. The declaration of heads of state in New York last week stated that by 2015 no child in the world should be born HIV-positive.
Deputy Chairperson, 24 March 2010 was World TB Day. We released three strategies to combat TB.
The first one was the GeneXpert technology that we had acquired. This is a new technology which, of course, has not been in use over the past 50 years. In the past 50 years only one technology has been used to diagnose TB and it was microscopy. If that failed, one did a culture. It used to take about a week for us to know the diagnosis, but with GeneXpert technology we know in two hours whether a person has TB or not. Secondly, microscopy had a sensitivity of 72%, meaning that you could miss 28% of people who had TB, but with GeneXpert the sensitivity is 98%, meaning that only 2% can be missed. Moreover, it used to take us three months to know whether a person had drug-resistant TB. With GeneXpert technology, we know in two hours, and not three months.
The second strategy we unveiled was that of active case finding. We have put together teams of five people each, who visit families, and there are 407 000 families in South Africa where there is TB. These teams have been visiting them at home to screen other members of the family. We are doing this because every person who has TB can infect 15 other people in their lifetime. So, it is important to visit them. I am happy to announce that since we started in February we have already visited 41 000 families and screened 112 000 people.
Deputy Chairperson, the third strategy is that with money from the Global Fund we have built nine multidrug-resistant TB, or MDR-TB, hospitals. The difference between them and other hospitals is that the nurses won't be easily infected by TB from the patients they are nursing.
Let me move to the second pandemic, which is the high maternal and child mortality. A lot has been said about this in newspapers, all over the media and even in this House. You have noted, hon members, that most of our interventions in HIV and Aids are directed at pregnant women and children because of these high mortalities, and we will work hard to reduce them.
I want to remind this House that maternal mortality is not just the death of a woman. It is the death of a woman because she dared to fall pregnant! We also know that HIV mortality disproportionally affects young women of childbearing age more than men. This can't be right, hon Deputy Chairperson.
We now have no fewer than 1,3 million orphans in our country. Most of them are maternal orphans, meaning that it is their mothers that have died. This has serious consequences in society beyond health care, such as crime, poor educational outcomes, teenage pregnancies and abortions, and the total social disorientation of young men.
Hon Deputy Chairperson, it is a well-known fact that young husbands lose direction in life when their partners die. The same does not happen to women because a female partner is known to be a stabilising influence on a young man's life. South Africa is fast losing this social stability due to the high maternal mortality which, according to evidence at our disposal, as I said, affects younger women more than older ones.
Let me go on to the third pandemic, which is the noncommunicable diseases. Deputy Chairperson, noncommunicable diseases are spoken about less, maybe because we speak a lot about HIV/Aids, as it has shocked us, and there are many more strong nongovernmental organisations, NGOs, that are fighting HIV/Aids than noncommunicable diseases.
I tried to bring this issue of noncommunicable diseases to the attention of hon elected members by presenting it to the Health Portfolio Committee. Unfortunately, the media got very excited and put into print that I was specifically raising the issue because of the dietary behaviour of Members of Parliament. It is very important for me to explain what I actually meant.
Noncommunicable diseases, which are referred to as NCDs, are diseases that are not propagated by germs from one person to the other. In fact, it would be safe to say that the germ, bacteria or virus that propagates an NCD is the human being. I am saying this because NCDs are not only biomedical but largely diseases of lifestyle.
These are divided roughly into four categories: high blood pressure and other diseases of the heart and blood vessels; diabetes and a few other metabolic disorders; chronic respiratory disease and asthma; and cancers. One should realise that mental health is also classified under that.
Moreover, there are four identifiable factors that predispose one to these noncommunicable diseases: smoking, which is most important; harmful use of alcohol; unhealthy eating behaviour, one's diet; and lack of physical exercise - always sitting, or sitting in the car and even using your car to go to the toilet, Deputy Chairperson, which is very common these days! [Laughter.] If all four of these risk factors could be removed, the world would be a very safe place to live in.
The question is: How serious are these noncommunicable diseases? Deputy Chairperson, they are a global phenomenon, but they are also growing fast in sub-Saharan Africa. So serious is the issue that the World Health Organisation and the Russian Federation called a meeting of all Ministers of health in Moscow on 28 to 29 April this year, in what was called the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control.
The Moscow Declaration was passed. It is a very long document but let me mention two facts from the whole. It says that countries must develop and rapidly implement policies that address behavioural, social, economic and environmental factors associated with noncommunicable diseases. Effective noncommunicable disease control requires concerted leadership at all government levels - national, subnational and local - and across a number of sectors such as health, education, energy, agriculture, sports, transport and urban planning, environment, labour, trade and industry, and finance and economic development.
Deputy Chairperson, it is against this background that I said a couple of weeks back that Members of Parliament should take the lead in the matter of a healthy lifestyle, especially diet and exercise. For example, I don't expect you to smoke, as you are the ones who passed the law against smoking. Unfortunately, in the media they said the Minister was saying there was a "gravy train" in Parliament and he wanted to stop it. Deputy Chairperson, this is not a circus, but a serious matter affecting humanity.
In 2009 there was a question in Parliament about the number of people who were on renal dialysis. They were asking why the government couldn't increase the number of dialysis machines in public hospitals. I argue that that is the wrong debate. It is no different from asking the Minister why he can't build more mortuaries because there is a high demand! I say this because the intelligent question to ask is: Why do so many South Africans have failing kidneys? Why do we need to be on dialysis and why do we have so many people who need a kidney transplant?
Just as an example, Gauteng alone has 561 people on dialysis, and there are 238 on the waiting-list. And this is a province that has facilities. What about all those receiving dialysis at R150 000 per patient per annum in the public sector, and R300 000 in the private sector? This is something that the country simply cannot afford. Moreover, to be on dialysis one needs to be in hospital 3 times a week for a minimum of 4 hours, whether one is employed or not. It is a difficult task.
What causes this? We know that in 40% to 60% of people with end-stage renal failure it is due to high blood pressure at an average age of 39 years. What are the main risk factors for high blood pressure? They are smoking, lack of exercise and diet, and also high salt intake.
So, we should not be demanding more dialysis machines, and subsequently demanding new kidneys, to the extent that, as has happened here in South Africa, the rich are trying to concoct schemes to steal kidneys from the poor! We cannot allow that. What we must do is reduce the prevalence of hypertension by eliminating the risk factors.
I am not going to debate with you about tobacco. I want to come back and strengthen the laws against smoking. In the case of alcohol, we are going to ban the adverts. I make this point time and again because the sooner the tobacco and alcohol industries understand this, the better for all of us. We will never pull back.
On the issue of salt, I am going to ask Parliament to pass a law, which will also go through this House, to reduce salt in foodstuffs. This is because the average amount of salt that is needed in the human body is 4 g to 6 g per day, but South Africans are known to consume 9,8g per day. Deputy Chairperson, this is not a joke. In Britain, just by reducing salt in foodstuffs by 10% they save 6 000 lives per annum. Our own research in South Africa shows that if we reduce the amount of salt in just one foodstuff, bread, we will save 6 500 lives per annum. So, hon Deputy Chairperson, we are going to do that. Obesity, which means extreme excess body weight, is a fast-growing phenomenon, even among our children. Statistics from research by the Medical Research Council show that 23% of schoolchildren are classified either as obese or as overweight, and this cannot be allowed, Deputy Chairperson. For us adults it is known that at least 60% of women and 31% of men are either obese or overweight. If we consider people above 37 years, the figure goes to 70%.
Countries are doing something about this and we want our country also to do something. For instance, Australia has come up with a policy of regulating the advertising of junk food during children's programmes on TV. In fact, during children's programmes they have banned all advertising of junk food. We are aware that they want to do the same thing in the United States. They want to ban the hamburger, which has made them bulge. So, we must also look at what makes us fat and get rid of it.
Deputy Chairperson, on the issue of violence and injury, we know very well that in regard to Arrive Alive people talk about the people who die. But research from Unisa and the Medical Research Council of South Africa shows that for every person who dies in a car accident, 30 are hospitalised and 300 are treated for minor injuries. That is for every one person! So, as we talk about Arrive Alive, let us talk not only about the dead; let us talk about those who go to hospital and the effect this has on the health care system. Deputy Chairperson, as regards the National Health Insurance, NHI, I am painfully aware that for some people in this country what I have said up to now won't mean anything if I don't talk about the NHI. There are two different groups of people in this country in relation to the National Health Insurance. One group is those who want relief. [Interjections.] Is my time over, Deputy Chairperson?