Thank you, hon Deputy Chair. Hon Minister, Deputy Minister, MECs ...
... ka ho qolleha, Motlatsi wa Modulasetulo, ha ke hlomphe Letona la tsa Bophelo bo Botle, Mme Mohlomphehi Fezi Ngubentombi, ho tswa mane porofensing ya Freistata. [... in particular let me show my respect to the MEC for health, hon Fezi Ngubentombi, from the Free State.]
Hon Deputy Chairperson, hon members and colleagues, I am rising in support of the Budget Vote. Mindful of the many challenges that still face the health care sector in South Africa, I want to congratulate the hon Minister, the Department of Health and the relevant role-players for the remarkable and visible progress that has been made during the past year under the competent leadership and guidance of the hon Minister.
As the Minister has pointed out today, we are:
... 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 worse than before. The choice lies with us as South Africans in general, but as elected leaders in particular.
It is common cause that South Africa's health care sector is characterised as fragmented and inequitable due to the huge disparities that exist between the public and private health care sectors with regard to accessibility, funding and delivery of health care services.
As a result of this state of affairs, the delivery of health care is rendered unequally and disproportionately, as far as the majority of the population relying on the public health care system are concerned. This part of the population have a disproportionately lower level of financial and human resources at their disposal relative to the private sector. It is exactly this state of affairs that the hon Minister and the government need to balance.
It is therefore necessary and important to design, develop and implement innovative measures and policies to address the disproportionate situation of the public and private health care sectors with regard to human resources and financial strength. It is necessary to develop a model that provides a benefit package, of which the main aim must be to provide most benefits for most people, given the pool of funds available.
It is necessary to unpack and address the challenges that lie ahead within the limited time allocated to me. I will deal briefly with only some of them.
The most important measure or vehicle to address the imbalances and transform the health system into an integrated prepayment-based health financial system that efficiently promotes the progressive realisation of the right to health care for all is the National Health Insurance, NHI.
The hon Minister alluded to this in his budget speech in the National Assembly on 31 May 2011, when he said that there were two schools of thought about the National Health Insurance. I quote:
Those who correctly and legitimately hope that the NHI will bring relief in their everyday hardships as far as their health care is concerned.
... those consumed by self-interest and greed that will shame even the devil.
Section 27(1) of the Constitution of 1996 especially provides, among others, that:
Everyone has the right to have access to -
(a) health care services, including reproductive health care
This means that:
(2) The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.
It also means that:
(3) No one may be refused emergency medical treatment.
Mindful of this obligation to all the people of South Africa, the ANC, prior to 1994, adopted the national health insurance policy that was contained in the ANC Health Plan in May 1994 which has guided the transformation of the health sector. In fact, since the Freedom Charter in 1955 the ANC has regarded health as a priority. It remains a basic need of our people, and it is therefore enshrined in our Constitution. It is no longer a matter of whether there will be a national health insurance in South Africa, but when. The concept of universal coverage enjoys the support of most people.
The medical aid industry has consistently failed to control the cost of health care. It has been unable to address efficiency and equality in the private sector. Premiums and contributions cost a medical aid member thousands of rands per year, while the health benefits deriving from such high contributions are being cut or they are exhausted before the end of the year. Furthermore, instead of the money paid by members being used for health care, it is used for administrative purposes such as marketing. The key lasting solution, therefore, lies in addressing the needs not only of the more than 40 million uninsured, but also the millions who are currently insured or underinsured by the medical schemes.
It is precisely due to the current problems associated with the medical schemes that the ANC has embarked on a policy process of ensuring that South Africa reorganises the manner in which health care is financed, by introducing the National Health Insurance. It is therefore our duty to support the Minister and government in finalising the National Health Insurance policy framework and developing an appropriate model to suit South Africa.
Another serious challenge that needs to be addressed is the severe and serious shortage of professional staff, such as nurses and doctors, in the health care sector. The work nurses do is of such a nature that a hospital or a clinic would not be able to function without them. Research on nursing indicates that there is currently a shortage of well over 30 000 registered nurses in the public health care sector, with a further shortage in the private sector. In some public hospitals and clinics, especially in the rural areas, there is a 60% shortage of nurses. A shortage is also being suffered in crucial areas such as intensive care units, operating theatres, the work of midwives and mental health. Hospital care is not the only aspect that is affected by the shortage of nurses in relation to the number of patients.
There is also an additional pressure on hospital staff. An inadequate nurse- patient ratio can even lead to violence being directed against nurses. Patients who have to wait a long time for attention do not come into contact with hospital management; they only see the nurses walking past to treat someone else, and this often leads to verbal abuse and physical attacks on nurses. Nursing shortages can have a negative effect, such as an increase in work load, in deaths and in nursing turnover.
The launch of the new Nchebeko Skills Consultancy nursing college for trainee nurses in Limpopo, with branches elsewhere, including Cape Town, is therefore welcome as a step in addressing the shortage of nurses. Like in other countries, we may also have to consider the implementation of legally enforceable nurse-patient ratios as a measure to address the shortage of nurses.
Another serious concern and challenge is the critical shortage of capable doctors. Apart from there being a shortage of doctors, the question should also be asked: Where are doctors currently working and where are they needed most? Statistics indicate a serious disparity and inequality in the distribution of doctors over the country between the more affluent areas, and the poor and rural areas.
The distribution of doctors between public and private practice exacerbates the inequality further. Resources indicate that 85% of the population do not have medical aid and are reliant on public health care, whereas a much smaller percentage of doctors are working in the public health sector.
The Minister and the government have already done much to address the shortage of doctors and to prevent doctors from leaving the country, as well as attract doctors to the public sector. Some of these measures are: the introduction of a scarce skill allowance; a rural allowance; legislation aligned to boosting other forms of health care; control of the geographical distribution of newly registered doctors; and the introduction of compulsory community service.
A concern, however, is the shortage of family doctors. Fewer women currently choose the medical profession as career. Some of the reasons listed by a prominent woman doctor are: a lack of part-time training opportunities and rewarding jobs; the absence of professional locums for pregnant doctors; and a lack of child care facilities at the workplace. [Time expired.]
In conclusion, I support the Budget Vote. [Applause.]