Chairperson, as many speakers have said, by and large this has been a very constructive debate. I think we are all on the same side. We are all in agreement on most things, but I need to highlight a few things that have been said here that I regard as very important.
Let me start with the issue raised by hon Dudley of the ACDP. The issue of human resources is extremely important. Unfortunately, she thought that we were perhaps not paying enough attention to it. I want to reassure her that we are definitely paying attention to it, and, in accordance with our ten point programme, we will release our HR strategy in August this year. We know it is long overdue, but by August we will release it.
We need to increase the number of health care workers produced in our country. For instance, we cannot keep on producing 1 200 doctors per annum, as we have been doing for the past decade.
We have a two-pronged approach which you will see in the HR strategy. The first prong is a temporary measure. Last week, I met with the deans of all the medical schools in our country to discuss this temporary measure. What we are telling them is that they need to find innovative ways of increasing the intake of medical students, even under the current circumstances of restricted space in which they find themselves.
I can report to the hon Dudley that we have worked very hard with the University of the Witwatersrand. They have taken in 40 extra medical students this year, something they have never done before. It has happened because we worked together. Of course, for Wits to take in the 40 extra medical students needed resources. We obliged as a department. We gave them R8 million to do that. [Applause.]
We then sold the story to the other deans, so I am eagerly waiting for the deans of the seven remaining medical schools to respond. They asked us to give them eight weeks to respond to this suggestion, so that we will implement it at all of those universities by next year.
The second strategy in this regard is the establishment of a ninth medical school in Limpopo, because we have only eight in the country. You are already aware that the President announced this.
Furthermore, we announced our intention to put up infrastructure in four tertiary hospitals and their medical schools - it is not only the hospitals. Perhaps we have not announced that before. We subsequently met with the Development Bank of Southern Africa, DBSA, and the Minister of Finance. We agreed that it was not only the tertiary hospitals that needed to be rebuilt, but even the faculties of medicine. This means that with the Dr George Mukhari Hospital, it is not only going to be the hospital; we are also going to look at the faculty. At Chris Hani Baragwanath Hospital, we will do so too. It is already agreed and finalised at King Edward VIII Hospital. We are going to build a new hospital and a new medical school altogether. [Applause.] At the Nelson R Mandela School of Medicine we are also looking at a similar issue.
We have already met the vice chancellors of all these universities to discuss the issue with them. They have put together teams who are looking at this matter, because our aim is that at the end of this we will triple the number of medical students in our country. That is the aim of this exercise.
Let's come to nursing. You are aware that in April we had a very successful National Nursing Summit, which was addressed by the President. All the issues, including those pertaining to the training of nurses, compliance, rules, regulations and the occupation-specific dispensation, OSD - which did not go very well, as you know - were discussed at that summit, to the extent that we produced the Nursing Compact. I may remind you that we published this compact in most newspapers on International Nurses Day to show what the Nursing Compact consists of.
The task team that organised that nursing summit has not been disbanded. After the summit, they sat and worked around the clock to ensure that the issues emanating from the summit would be implemented. Only yesterday they presented that plan to the department and we are going to be looking at it. So, the issue of human resources is very important to us.
The other issue which was mentioned very passionately by hon Segale-Diswai from my own party, and also by hon More from the DA, is primary health care. I want to reassure you that the centre, the core, of the health care system is going to be based on primary health care. [Applause.] I have already told you that we have no option but this.
I said the present health care system can be defined by four things, and I do not want them. No country can be defined in this way.
In the first place, it is a very unsustainable health care system we are running. It cannot go any further and it will crash in the next decade if we do not do something. I actually have facts and figures to prove this, but maybe today is not the day to do so. The day will come, perhaps, when we debate the National Health Insurance, NHI, because these things must come out. We have this information that must come out. We are running a very unsustainable health care system.
Secondly, we are running a very destructive health care system. Hon Papi Kganare put this to the House. He mentioned two things. He first praised the director-general. "Congratulations to you, director-general," hon Papi Kganare said. "You are doing very well." And he is right - in the department we all know that, and we hoped that they would also notice it.
He also mentioned a second thing. He said Caesarean section deliveries are becoming a commodity in the private health care sector and we should look into it. He is right. Moreover, it is not only Caesarean sections, but many other things. How does it happen? It is this destructive, extremely costly, hospicentric, curative health care system that I am talking about.
We are dealing with money here, not health care. We are dealing with money. I was not exaggerating when I said some of the things would shame the devil.
The whole world knows I have received letters of complaint. For instance, one of them is from a member of the World Health Organisation, WHO, who stays in Botswana. She happened to have brought her child here, who developed an ischiorectal abscess. Those who are in the health care sector will know what this is. Just for the draining of that abscess her child was charged R30 000 in a private hospital here.
I can also give the hon Kganare the example of a patient from Swaziland who presented with a peritoneal abscess. Just for a laparotomy to drain that he was charged R500 000. [Interjections.] He died while they were demanding an extra R700 000 - a cool R1,2 million just to do this! That cannot be called health. It is very destructive. If the day ever arrives when we start doing brain transplants, I do not think even that will cost R1,2 million! [Laughter.] I do not think so. But we are already in this space.
Through you, Chairperson, I can tell hon Kganare we have looked into this type of issue. We think something can be done, legally. I have met with the Competition Commission on this issue. I will never rest until it is resolved. I have also met with the Minister of Economic Development, and I can assure you that very soon we are going to make a serious announcement on this issue. If it is left as is, we are all going to collapse somewhere. There is no way health care can cost this much.
We kept on being told that we had to leave it to market forces. The health of the people cannot be market-related. It cannot be. Moreover, it is against section 27(2) of the Constitution of the Republic of South Africa, which hon Papi Kganare was quoting here, and which says health is a right. How can this right be bought?
We know of the situation in countries like the United States. The hon member of the FF Plus says I must be careful, because Obama is in trouble over this issue. Yes, he is in trouble - because he cannot let it go. We have a graph that shows how much money the United States is spending, without any good outcomes - far, far more than many countries in Europe! Their outcomes are poor, however, because they also fell into this trap where they are no longer providing health care. In Africa, South Africa has found itself in that situation, where it is no longer a health care system but a form of commodity.
We are going to look into it. The Minister of Economic Development has agreed on this. We will make a far-reaching announcement in the coming weeks in regard to looking into this issue, because members of the public will come in.
You know, I have also experienced this - where just to have your blood pressure and temperature taken costs R100. Yes, and I have got invoices to show that somebody will just put a cuff around your arm to take your blood pressure, and charge you. As for taking one's temperature, they have new methods these days. During my time, we used to, you know, just put it here. [Laughter.] These days there is an instrument; they just "shoo!" Yes, it is over in seconds and then it costs R100. How can that be? We are going to look into it.
Let me come to the issue of primary health care. We are going to restructure primary health care into three streams.
The first stream will be a district model. This district model is more clinical, because we want it to be a bridge between the curative and primary health care systems. In this model, we will deploy five specialists to each and every one of the 52 districts. Municipalities keep on changing, so I am no longer sure whether we do have 52 districts in South Africa, but when we planned it, it was on the basis of 52 districts. It will also help us to arrive at the Millennium Development Goals. These teams will consist of a principal gynaecologist, a principal paediatrician, a principal family physician, an advanced midwife and a senior primary health care nurse.
I have already consulted the deans of all the medical schools in our country. I have consulted the professional associations of paediatricians, obstetricians, and family care physicians. I have consulted the colleges of medicine in South Africa responsible for specialist training, and I consulted all the nurses of the country during the recent, successful National Nursing Summit.
I am happy to announce that there is overwhelming support for this method from all the people I have mentioned; so we are absolutely determined that this model will be implemented. Furthermore, we will implement it before the end of this year - not the end of the current financial year, but at the end of the calendar year. We are dead sure. [Applause.]
Once these teams are appointed, they will deal with guidelines and protocols at our antenatal clinics, and in the labour wards, postnatal health care, and paediatric and child clinics.
They will follow up on every case of mortality to make sure that mortality meetings are held for every single incident of death of a woman or a child in any hospital. This will deal with the cause at hospital level immediately. This is preferable to the present method, where we wait for research and studies to determine how many children died and what the reason was. The specialist teams will deal with that.
Part of the reason that we are doing this is this. I once worked in hospitals and I know their protocols. Many simple protocols on how to deal with a woman in labour have just been thrown out of the window. I do not understand why and some of these things we see surprise us. For those who are working in hospitals I know that this is an era of computers, etc. I know that. However, I still want to find somebody who will influence me as to what the best method of monitoring a woman in labour is, other than the partogram. It might look primitive, but it saved women. These days that has just been thrown out. There are no partograms; people just rely on computers.
I used to have professors who could examine a woman and tell her what the weight of the child was. Yes, there were professors who could do that. These days, they use the computer, so doctors are losing their clinical skills. They are becoming technicians rather than being clinicians, and we want to change these issues.
These specialist teams in the districts will also deal with the training of interns, as well as community doctors and medical officers. I can see the President of the Health Professions Council of South Africa, Prof Mokgokong, sitting somewhere here behind me. I am going to be approaching you, sir, to determine afresh what it is that an intern needs to be able to do before we allow them to pass their internship. How many Caesarean sections should they be able to do? How many newborns can they resuscitate? Can they intubate? Can they give anaesthesia?
In our day, some of these procedures were very simple, but all of a sudden we find them very difficult. I, personally, have visited hospitals where I am surprised to see interns not being able to do things which I thought were basics. I remember having to take off my jacket one day to help an intern insert an intercostal drain. I do not remember leaving medical school not knowing how to put in an intercostal drain. However, after 10 years of not working in a hospital, I was forced to do it because the intern just could not do it. So, there is something wrong in our training; something that we are not doing very well.
With regard to the method of providing district clinicians, we have asked that, if we cannot find a principal paediatrician to go into a rural district, the universities and the medical schools will provide one for at least a year. After that, he can go back to medical school and they can provide another one. We will create the seats and the universities will see how they can fill those seats, so that every district has these senior people. Then our women and children will no longer die as they are doing now.
The second stream of our primary health care to be engineered is the school health system. I agree with you, it is very curious that nurses no longer go to the schools in this country. For the past eight weeks we have been putting together a team to work on this model. I am going to launch it officially with the Minister of Basic Education and the Minister of Social Development.
These teams at schools will deal with basic things like eye care for the children. Some children go to school, but they cannot see, and the teachers punish them because they are not even aware that the child cannot see. They are not trained to detect such things. Some children cannot hear, and the teachers keep on shouting at them because they are not even aware that the child has a hearing problem. Some children have dental problems, but in the curative health care model we do not go to schools to detect this. No, we sit in the hospital ward waiting for the dental cases to arrive and then we remove the teeth!
In this destructive model - and I need to mention these things - one specialist tried to do it to me. My daughter had a few problems with her teeth and the specialist wanted to do a root canal treatment on my ten-year- old daughter. Root canal treatment means he was going to remove the nerves. The child still has milk teeth! I mean, she is going to outgrow them and get permanent teeth, and they will find no nerves there! Of course, I was shocked. I know why the specialist was doing that - he was going to charge me R20 000! [Interjections.] I took the child to a public hospital, and they did a procedure that cost R200.
The question is: what about members of the public who do not know these things? I saved my daughter because I know. It is a criminal thing that the specialists want to do, and many people are subjected to that every day. We are told that this is a good health care system and we must not fix it. There is no way we are going to leave this issue. We cannot leave it!
The primary health care teams at schools will deal with this. They will also deal with immunisation. They will deal with the more complex issues of contraceptive health rights, and of teenage pregnancies and abortions, which we know are on the increase. They will also deal with the HIV/Aids problem and the issue of alcohol and drugs in schools.
The last stream of primary health care we are going to look at very carefully is the primary health care model based on the ward. We need to put 10 well-trained primary health care workers in every ward.
In Brazil they are making use of this method to good effect. They have deployed 30 000 of these people, whom they call community health care agents. I was also greatly encouraged when we were in Moscow for the development of the Moscow Declaration. The Minister of Health in India announced that they were deploying 800 000 of these people in the villages of India. They call them health care activists.
In our country, we know that the province using a method closest to this is KwaZulu-Natal. It was not by accident that they were able to reduce the incidence of mother-to-child HIV transmission in KwaZulu-Natal. It is because they have these primary health care teams co-ordinated in the Premier's office right at ward level.
We want them to move further and implement primary health care as they do in Brazil and India, so that we do not wait for people to get ill in hospital and then start charging them the amounts of money that they are being charged. [Time expired.] [Applause.]
Debate concluded.