Chairperson, hon members of the House, distinguished guests, ladies and gentlemen, I am honoured to present to this esteemed House the national Department of Health's policy priorities and budget for 2010-11 for your consideration. I wish to start by paying tribute to a gallant son of the soil who was also a member of this House and who would have been sitting next to me here today, hon Dr Molefi Sefularo, who passed away on 05 April 2010.
For over 30 years, I have personally known the hon Sefularo as a comrade in the struggle for the emancipation of the people of South Africa, as well as a colleague, friend and fellow student, and, subsequently, a fellow medical practitioner. He was a highly talented, gifted and astute person who was always humble and easy to work with.
Testimony to these characteristics were the many people who paid similar tributes to his life and work during the official memorial ceremony held in Pretoria on 8 April, and again during the funeral service held at the University of Limpopo's medical campus on Saturday, 10 April, and at many other memorial services, including the one that just took place in this very House 10 minutes ago. It was, indeed, appropriate that Dr Sefularo's funeral service was held on the campus that he transformed as a student leader and at which he studied and graduated as a medical doctor.
The late Dr Sefularo was a stalwart in the mammoth task of liberating this country from the bondage of oppression and inequality, as well as in the transformation of the health sector to an accessible and equitable system providing quality services to all South Africans. We all know that he was passionate about communities and their welfare. He was particularly interested in ensuring that we strengthen primary health care in our country.
Among many other projects, the late Deputy Minister of Health worked tirelessly to ensure the health sector's readiness for the Fifa World Cup in 2010. Our health services are ready to provide comprehensive health services to hundreds of thousands of football fans from the 31 nations that will visit our shores in 2010, as well as people from our own country. Dr Sefularo dedicated his time and energy to visiting all the health facilities in the cities where World Cup games will be held to ensure that we are indeed ready.
He has fought a good fight, he has finished the race, and he has kept his faith. What is left is for us to honour him by dedicating ourselves to completing the work. I, therefore, wish to dedicate this budget speech to the memory of Dr Sefularo. I request members of the House to join me in conveying our deepest condolences to Mrs Kgomotso Sefularo, their children and the extended family.
Chairperson, this is a historic year in many respects. Apart from the Fifa World Cup - which this year will be held for the first time on African soil - in which the Department of Health played a very prominent role, it is also the 20th anniversary of the release from prison of our icon, former President Nelson Mandela.
Nelson Mandela dedicated 66 years of his life to the struggle for emancipation. He sacrificed his own freedom for almost three decades to ensure that all South Africans can enjoy liberty. No tribute to Madiba can ever be adequate or commensurate with his contribution to the attainment of our freedom. The least that we can do is to strive to perpetuate his legacy in our lifetime.
This year marks the second year of implementation of our 10-point programme for transforming the health sector into a well-functioning health system capable of producing improved health outcomes. I just want to take this opportunity to remind you that we have a 10-point programme, and there's no way we can deliver a budget speech without referring to it.
Our 10-point programme has the following priorities: the provision of strategic leadership and the creation of a social compact for better health outcomes; the implementation of National Health Insurance; improving the quality of health care; the overhauling of the health-care system and improvement of its management; the improvement of human resource management; the revitalisation of infrastructure; the accelerated implementation of the HIV and Aids and sexually transmitted diseases national strategic plan 2007-2011; the reduction of mortality due to TB and associated diseases; the mobilisation of our communities for better health for the population; a review of the drug policy and the logistics of drug supply; and the strengthening of research and development.
Since our last budget speech, which I delivered in this very House on 30 June 2009, a solid foundation has been laid for the attainment of the goals we have set ourselves in the 10-point programme. Our 10-point programme has been endorsed by a wide range of stakeholders in the health sector, including trade unions, medical associations, nursing organisations, most of the private health sector, and, indeed, NGOs and civil society.
The 10-point programme also received support at the public service summit held between 10 and 12 March 2010. We wish to thank all our partners for endorsing this programme. This means that they will all support us in its implementation. We hope that the hon House will do the same.
Having successfully popularised the 10-point programme, we wish to draw the attention of the House to the outcome-based approach for improving health service delivery, which was announced by the President of the Republic in his state of the nation address earlier this year. President Jacob Zuma also emphasised the need to fundamentally transform the health system. He also listed health as one of the five key priorities of government. I wish to remind this House of the health situation in the country that requires our collective and sustained attention. One, life expectancy in South Africa has declined. For the period between 1985 to 1994, Statistics SA estimated life expectancy at birth to be about 54,12 years for males and 64,38 years for females. In 2009, Statistics SA estimated life expectancy at 53,5 years for males and 57,2 years for females.
Two, maternal mortality and child mortality in our country are unacceptably high. Three, South Africa carries a significant burden of diseases from HIV/Aids and TB, which are regarded to be the highest in the whole world. Four, South Africa has a predominantly curative health system that places less emphasis on prevention of diseases and health promotion. Over the past 10 years, there has been an inadvertent shift on emphasis from primary health care, which was adopted by the first democratic government as the foundation of our health care delivery system, towards a predominantly curative health system.
Five, the ineffectiveness of the health system and provision of poor quality of health services has led to many people wrongly but increasingly believing that private health care is the only way possible towards meeting the health care needs of the whole country.
A prominent health expert, who has contributed significantly to strengthening the national health service in the United Kingdom, recently remarked to me that South Africa's health care system has a larger private health care sector even than that found in the United Kingdom. He also remarked on how little preventive and promotive care we are providing in our health care system, as compared to curative health care
Clearly, decisive, systematic and quantifiable interventions must be implemented to address these adverse trends. In response to this, in January 2010 the Cabinet agreed on a set of concrete outcomes that must emerge from our interventions to transform the health care sector over the next four years. These outcomes can be classified into four broad main categories, namely: one, increasing the life expectancy of South Africans; two, combating HIV and Aids; three, decreasing the burden of diseases from tuberculosis; and, four, improving the health system's effectiveness by strengthening primary health care and reducing the cost of health care in our country.
Based on these four broad categories, during the period 2010-2014 the health sector needs to produce the following 20 outcomes: increased life expectancy at birth; reduced child mortality; decreased maternal mortality; managing HIV prevalence and improving the quality of life of people living with HIV and Aids; reduction of new HIV infections; expanding access to the prevention of mother-to-child transmission programme; improved TB case finding; improved TB treatment outcomes; improved access to antiretroviral treatment for HIV and TB co-infected patients; decreased prevalence of drug- resistant TB; revitalisation of primary health care; improved physical infrastructure for health care delivery; improved patient care and satisfaction; accreditation of health facilities for quality; enhanced operational management of health facilities; improved access to human resources for health; improved health care financing; strengthened health information systems, including strengthening information, communication and technology; improved child services for the youth; and, lastly, expanded access to home-based care and community health workers.
These 20 deliverables provide additional specificity to the 10-point programme of the health sector for the period between 2010 and 2014. The prioritisation of these outcomes does not imply that we will not do everything else that needs to be done. These priorities, however, do reflect things we must do with added urgency. The key policy priorities for the health sector for the period 2010-11 to 2012-13 will strengthen our ability to meet the health-related millennium development goals.
Our maternal mortality ratio must decrease from the estimated 400 to 625 per 100 000 live births to 100 or less per 100 000 live births over the next four years. We will implement a number of interventions to achieve this. These include: one, increasing access to health care facilities, including the possible provision of waiting-mothers homes; increasing the percentage of pregnant women who book for antenatal care before 20 weeks' gestation; increasing the percentage of maternal care facilities which review maternal and prenatal deaths and address identified deficiencies; and, lastly, enhancing the clinical skills of health workers and improving the use of clinical guidelines and protocols, which, unfortunately, are no longer used much in our health facilities.
We have also developed strategies to enhance our prevention of mother-to- child transmission programme to ensure that by 2014-15 less than 5% of babies are born HIV-positive. In fact, the executive director of UNAIDS, Mr Michel Sidibe, has asked all countries to implement plans to virtually eliminate mother-to-child transmission of HIV. We are determined to achieve this because we believe no child should be born HIV-positive.
Our child mortality must decrease from the current 69 deaths per 1 000 live births to not more than 30 to 45 deaths per 1 000 live births. The health sector will continue to ensure that children less than one year of age are fully vaccinated against pneumococcal infection and rotavirus. International evidence has shown this - together with other key strategies - to be an effective intervention in ensuring child survival.
Other key interventions to improve child health will include increasing the percentage of eligible infants receiving treatment for HIV/Aids; increasing the percentage of mothers and babies who receive postnatal care within six days of delivery; increasing the proportion of nursing and training institutions that teach the Integrated Management of Childhood Illnesses; increasing the proportion of schools which are visited by a school health nurse; and, lastly, conducting health screening of learners in Grade 1 in poor schools.
We need to prepare to deal with H1N1 influenza as we are entering the winter season. Unlike last year, this year we do have a vaccine. Following advice from the World Health Organisation, WHO, and our own experts, between 5 and 10 April 2010 - we have actually started already - we will prioritise vaccination against H1N1 in the following manner: we will vaccinate 80 000 children under the age of 15 years who are living with HIV/Aids; we will vaccinate 10 000 officials at our ports of entry; we will vaccinate 700 000 pregnant women; we will vaccinate 1 million adults with HIV/Aids who receive treatment at our antiretroviral treatment, ART, clinics; and we will also target 900 000 people living with chronic heart and lung diseases because of what H1N1 did to them last year.
During this month, we will also have a national measles and polio vaccination campaign. I am happy to announce that I launched this massive campaign at Benoni West Primary School yesterday. It will end on 28 May 2010. Our target is to vaccinate 15 million children between the ages of six months and 15 years against measles. Yesterday, the preliminary report indicated that we have vaccinated 210 209 in one day. [Applause.] We need, also, to vaccinate 5 million children under the age of 5 years against polio. By yesterday, the preliminary vaccination which was started was completed, and 148 380 children were vaccinated. [Applause.]
I request you to assist the Department of Health by speaking to our constituencies about the importance of immunisation. Prevention is better than cure. We have the means to eliminate measles and polio. This means having a fully immunised community now and in the future. That is why reaching these 15 million children and 5 million is children important for us.
In keeping with our targets in our outcome-based approach, we must increase the tuberculosis, TB, cure rate from the present 64% to 85% by 2014-15. Based on a review of the TB Control Programme by the WHO, we have developed concrete and clear strategies in each province.
During this financial year, we will train 3 000 health workers in the management of TB. We will also expand our TB DOTS Programme and train 2 500 community health workers.
A key strategy to strengthen TB control is social mobilisation. Working together with the Desmond Tutu TB Centre and other development partners, we have developed a social mobilisation campaign called Kick TB 2010. This campaign builds on the excitement generated by the 2010 Fifa World Cup and aims to help combat TB and the stigma associated with it by linking it with soccer.
The campaign will target 250 000 learners who will be drawn from diverse schools and backgrounds across all nine provinces to be agents for TB control and management. We have already started with 10 000 children who received soccer balls that have TB messages all over them.
As mentioned earlier, the largest public health problem that faces South Africa today and drives many of our pandemics and significantly reduces our life expectancy is HIV/Aids. The most important task that faces us is to reduce by 50% the number of new HIV infections by 2011-12 and to initiate on antiretroviral treatment, ART, 80% of eligible people living with HIV/Aids.
As announced by President Zuma on World Aids Day in December 2009, we started on 1 April 2010 to provide ART to pregnant women with a CD4 count of 350 or less to enhance maternal survival.
Antiretroviral treatment is also being provided to people co-infected with TB and HIV/Aids with a CD4 count of 350 or less. This will contribute significantly to reducing morbidity, disease progression and mortality associated with TB and HIV/Aids.
In addition, HIV-positive pregnant women are now receiving dual therapy from 14 weeks of pregnancy and not 28 weeks, as was previously the case. This will happen until post delivery. Most importantly, HIV/Aids and TB are being integrated and will be treated under one roof. This means that all public health facilities that provide TB treatment must, over this financial year, be strengthened to also provide treatment for HIV/Aids.
By the end of March 2010, only 496 accredited public health facilities were providing antiretroviral treatment. We have decided that all our public health care facilities should, over time, provide antiretrovirals, ARVs. I am happy to report that we have prepared an additional 519 public health facilities and they have started to provide ARVs as from 1 April 2010 - that is 13 days ago. [Applause.] We now have more than 1 000 public health facilities that are initiating eligible patients on treatment.
Some people were sceptical about our resolve to implement the new treatment guidelines as announced on World Aids Day. I wish to assure this House that we are extremely determined. [Applause.] However, this does not mean that we are not experiencing a few teething problems in the implementation of these new treatment policies and strategies. We do have our own problems, such as human resource capacity, supply and logistical problems in some facilities. However, these are not insurmountable problems and we are addressing them. I mentioned, possibly as early as last year, that the prices that South Africa pays for ARVs are significantly higher than all other countries. This has been confirmed by our international development partners and has been said publicly by the executive director of UNAIDS during his speech at the World Aids Day event last year, when he shared a platform with President Zuma.
This is despite the fact that South Africa has the largest ARV programme in the whole world. To us it does not make sense. We must be able to purchase ARVs at the lowest prices as we are the largest consumer of ARVs in the whole world. We must benefit from economies of scale. If we continue doing things the way we are doing, the fiscals will be overburdened.
Let me put it to you here in this House once and for all, there is no choice. We must purchase ARVs at the lowest possible cost from whatever source can guarantee us the lowest prices, whether inside or outside the country. We will do so.
I have to inform this House that this position has already generated opposition from some of our local pharmaceutical manufacturers. They have claimed that this approach will result in job losses. I believe this is a type of blackmail and I will never bow down to it. We need to understand that, unless we take decisive action, we will not overcome the challenge that HIV/Aids presents.
This is why the new ARV tender specifications will be prepared in a way that opens the way for us to purchase ARVs at the lowest possible price. I will not compromise on this one. Let me say, however, that this policy applies to antiretrovirals only and not to other pharmaceutical products that are sold in our country.
Many people, especially the media, focussed on the aspects of President Zuma's speech on World Aids Day which dealt with treatment only. In his speech, he focused on both treatment and the importance of prevention. As I have already mentioned, we commenced the implementation of new treatment guidelines on 1 April 2010. However, the mainstay of our approach must remain prevention, prevention and prevention. [Applause.]
As you might have heard already, South Africa will initiate the largest HIV counselling and testing campaign ever undertaken. The Cabinet has taken a decision on 10 March 2010 that the campaign must be launched on 15 April 2010, with the President and Deputy President leading the campaign and being the first to be tested.
They have subsequently requested that 15 April be reviewed, as both of them will be out of the country on that date. We have accordingly postponed the launch of the HIV counselling and testing, both nationally and provincially, to a later date, which will be announced as soon as the Presidency is available.
This ambitious campaign seeks to mobilise the majority of South Africans to get tested for HIV/Aids. We aim to provide HIV counselling and testing to 15 million South Africans by the end of June 2011. The President will lead the campaign nationally. We have met with colleges and universities. Rectors will lead the campaign and be the first to be tested in their universities. The superintendents and chief executive officers, CEOs, of hospitals will do the same in their hospitals. We hope that in this House, the hon Speaker, Chief Whips and leaders of parties will be the first to be tested. [Applause.]
We hope that hon members will be the first to be tested in their constituencies. All leaders must lead their flock. We are also hoping equally that ministers of religion will be the first to be tested in their churches. [Applause.] Traditional leaders will be the first to be tested in their villages. Every leader must take responsibility.
We also have a report from the Lancet that shows that South Africa is going through four main pandemics, not only HIV/Aids. The report mentions the pandemic of HIV/Aids as being number one. Then there is the issue of maternal and child mortality; noncommunicable diseases; and violence and injuries.
For this reason, when you arrive at the testing station for HIV/Aids tests, we will also take your blood pressure to see if you have hypertension; we will do a blood-sugar test to see if you have diabetes; we will do a haemoglobin test to see if you have anaemia; and we will also do a TB screening. We believe that all these tests will be offered in all the testing stations.
A huge outcome that must also be achieved is the effectiveness of the health sector in terms of the revitalisation of infrastructure; improving the quality of health care; overhauling the health system; and reducing the ever-escalating costs of health care provisioning.
We are going to go through this House to pass a law that will help us establish an office of standard compliance that will guide us on patient safety; infection and prevention control; availability of medicine; cleanliness; waiting times; and positive and caring attitudes to patients.
We also promise in our 10-point programme the overhauling of the health care system in terms of turning it towards primary health care and also improving the efficiency and functionality of our health care institutions. With the help of the Development Bank of Southern Africa, DBSA, we are already far advanced in that function.
Most countries globally are searching for strategies to reduce the costs of health care delivery while improving access and quality. The establishment of a National Health Insurance system will go a long way to ensure this. Through the NHI we will ensure universal access to quality and affordable health services for all South Africans.
Our major objective of pursuing the NHI is to put in place the necessary funding and health service delivery mechanisms that will enable the creation of an efficient, equitable and sustainable health system for all South Africans. With the ever-widening gap between the rich and the poor - a gap regarded as one of the biggest in the world - we have no option morally, economically, socially or otherwise but to move in this direction. More than any other country, South Africa needs to establish an NHI.
I shall now turn to the budget of the national Department of Health for 2010-11. The budget of this department grows by 16% from R18 billion in the 2009-10 financial year to R21,5 billion in 2010-11. Policy areas that received additional funding include the HIV/Aids grant; hospital revitalisation; mass immunisation; and stabilisation of personnel. The Department has also received donor funding to help us in our indabas.
In conclusion, let me take this opportunity to thank the many people whom I worked with last year for their significant contributions to the turning around of our health system.
Finally, we believe that we are on course towards improving the health profile of all South Africans. As we have done today, we will return to this House in the future to report on the milestones that we are achieving in partnership with the people of South Africa. I request this House to approve the budget of the Department of Health for 2010-11 and 2012-13. I thank you. [Applause.]