Speaker, agb President Jacob Zuma, agb Adjunkpresident Kgalema Motlanthe, agb lede en geerde gaste, tydens die dekades van apartheid en die voorafgaande eeue van koloniale en rassistiese regering, het vele organisasies, groepe en individue tot die rigiede segregasie, growwe ongelykhede, verwaarlosing en diepgaande rassediskriminasie in alle aspekte van gesondheidsdienste bygedra.
Sedert Suid-Afrika se eerste demokratiese verkiesing in 1994 het die ANC- beheerde regering met rasse skrede vooruitgegaan ten opsigte van die heropbou en ontwikkeling van die gesondheidsektor. (Translation of Afrikaans paragraphs follows.)
[Ms M N PHALISO: Speaker, hon President Jacob Zuma, hon Deputy President Kgalema Motlanthe, hon members and distinguished guests, during the decades of apartheid and the preceding centuries of colonial and racist government many organisations, groups and individuals had contributed to the rigid segregation, harsh inequalities, neglect and deep-rooted racial discrimination in all aspects of health care services.
Since South Africa's first democratic election in 1994, the ANC-led government has made rapid strides in progress with regard to the reconstruction and development of the health care sector.]
The Bill of Rights in the Constitution provides for the right to access health care services, as well as the underlying determinants of health.
Since 1994, the ANC-led government has implemented a range of health- related policies. Much has been achieved since the dawn of our political democracy in the expansion of the primary health care system and the development of health care systems and structures.
The focus on primary health care has resulted in the reprioritisation of budgets and resources to bring about an equitable redistribution between primary health care and the sophisticated curative and tertiary care. An essential primary health care package was formulated, which set the norms for the provision of comprehensive primary health care services.
Dit is darem so. [It is the case, after all.]
To increase access to these services, user fees for public primary health care and all fees, including hospitals, for pregnant women and children under the age of 6 years were removed. To support the expansion of these services, hospital infrastructure was improved significantly, beginning with the Hospital Revitalisation Programme that focused on the improvement of infrastructure, equipment, management and quality of care.
A total of 1 800 clinics and community health centres and 18 new hospitals have been built and 250 hospitals revitalised since 1994. Today, 95% of the South African population can access health care within a 5 km radius of their homes.
In order to remedy shortages in the number of health professionals in rural areas, the ANC-led government recruited Cuban doctors in the immediate post- 1994 period and introduced compulsory community service for recently graduated medical doctors.
In order to ensure that health workers were both retained and sustained in rural areas and in the profession more broadly, the introduction of the occupation-specific salary dispensation allowances and rural allowances has begun. These initiatives are aimed at ensuring that our nurses, doctors and skilled professionals form part of our rural development strategy and provide the necessary health care services.
To make medicine more affordable, a comprehensive national drug policy was introduced in 1996 with the Essential Drug List for the public sector as one of the main pillars. It provided for greater rationalised drug prescribing and the introduction of generic medicines throughout the health system. This policy has had a major impact on lowering the costs of medicine and in this way has provided a huge increase in accessibility to health care for the poor.
Many other targeted health care programmes were introduced, for example those focusing on women and children, and those focusing on diseases such as HIV/Aids and tuberculosis, and targeted programmes on tobacco use, malaria control, mental health and nutrition.
Special mention needs to be made of the programmes that have been focused on violence against women. These have brought about substantial changes in the lives of thousands of women and provided both a platform to raise consciousness and give practical support to women and the women's networks.
In early January 2009, both the ANC and the Department of Health adopted a 10-point, five-year plan. This has already directly contributed to the restructuring of our health system. As we debate, we need to recall the priorities that we set ourselves at that time. These priorities were designed to ensure improvements in the health care system and assist the country in meeting the Millennium Development Goals.
The 10-point plan specifically addresses the following: providing strategic leadership in the health sector and creating a social compact for better health outcomes and unified action across the health sector; producing a White Paper, setting out the framework for the implementation of a National Health Insurance which has to be followed by draft legislation and be subjected to public comment; improving the quality of health care delivered at health facilities through measured standards against actual practice and filling gaps in order to ensure the delivery of high quality clinical care and effective support systems; putting financial management systems in place to improve audit outcomes with provincial expenditure patterns being monitored on a monthly basis and quarterly visits to each province taking place; improving human resource planning, development and management consistent with service delivery objectives and the reopening of nursing colleges in order to ensure the accelerated production of nurses; implementing a preventative maintenance of physical health infrastructure and primary level care facilities, in order to improve quality of service; accelerating the implementation of the National Strategic Plan on HIV/Aids and sexually transmitted infections and increasing focus on tuberculosis and other communicable diseases and to ensure existing treatment guidelines and strengthening prevention interventions; mass mobilisation for better health of the population with a national initiative to improve maternal, neonatal and child health in 18 priority districts and thereby reducing mortality as part of the Integrated Management of Childhood Illnesses programme; and reviewing of the drug policy to maintain a 0% stock-out rate of antiretroviral and tuberculosis drugs and strengthening research and development to generate key reliable information for health planning and service delivery monitoring.
Hospitals are important vehicles for the delivery of health care. The standard of cleanliness of our health care institutions, the standard of infection control, staff attitudes, safety and security of our patients and the long queues that our people have to endure in our hospitals are the challenges.
Our public health facilities will therefore be required to conform to agreed-upon quality standards that have been approved by the National Health Council, if they are to be accredited to deliver health services within the incoming national health insurance system. Management capacity in the health sector equally remains a challenge.
The skills development programme of managers at all levels must be aimed at enhancing leadership capacity in the health sector. As most of the health workers are located in the urban areas, this has resulted in a serious shortage in rural areas. There is a serious maldistribution of health workers, with only 60% of nurses and 40% of doctors in the country serving 85% of the population using the public health sector. The National Health Insurance system will address this.
Shortages of medical practitioners and other allied professionals negatively affect the access to quality health care for the majority of South Africans. Speaking on the occasion of the 2011 ANC January 8 Statement, President Jacob Zuma reiterated that -
... interventions must include appointing qualified personnel and improving infrastructure such as rebuilding dilapidated clinics and hospitals. The ANC must also ensure that government increases the training and employment of doctors, nurses, health technicians and other health professionals.
Nurses form the backbone of the health care system, and yet they are in short supply. It is therefore encouraging that the President announced the plan to revitalise 105 nursing colleges countrywide to train more nurses. This will not only improve the quality of our bedside nursing but will also give children from poor families access to professional training.
A major access problem for our people is that of affordability of health services. Real medical scheme expenditure per beneficiary has doubled in the past decade with excessive cost increases in key parts of the private health sector.
At the same time, and despite policy efforts, public sector health services continued to face budget constraints and still fall significantly short of the goal of a unified, comprehensive, equitable and integrated national system.
The tax policy on an expenditure subsidy for medical scheme contributors also has major flaws in that it is inconsistent with the principles of universal access, efficiency and equity. Those in the high-income brackets continue to benefit more from the subsidy than the middle- and low-income groups.
The mismatch of resources in the public and private health sectors, relative to the size of the population each serves, and the inefficiencies in the use of available resources, contribute to the very poor health status of our people, particularly in the lowest income bracket. This is basically due to massive inequalities in the distribution of income as well as health and other social services, which also contribute to poor health.
In contrast to the public sector, expenditure in the private sector is continuing to increase at annual rates far exceeding the inflation rate. As expenditure increases, so do the contribution rates that are charged by medical schemes with the result that membership of medical schemes has become completely unaffordable for South Africans.
We are all only too familiar with the situation where members of medical aids are disqualified from seeing private practitioners because they have exhausted their annual medical scheme allocations by the middle of the year. That is why the ANC National Policy Conference in June 2007 affirmed the need for the implementation of the National Health Insurance system.
At the ANC's 52nd National Conference in Polokwane, the vision was taken forward with the resolve that the National Health Insurance programme must be founded on the principles of the right to health care, universal coverage, social solidarity and a single public administration in which access to health will be based on need. It must ensure universal free access to health care at the point of service to all South Africans, rather than basing it on the ability to pay.
The primary health care approach that seeks to improve access to quality health care services will be at the core of revitalising and strengthening the South African health system. The first phase of the National Health Insurance system will involve improved primary health services in rural areas and underserved communities and an expanded programme of improvement, expansion and revitalisation of public health care infrastructure and services that are critical to the realisation of the principle of universal coverage and reduced inequalities of access.