Chairperson, may I start by expressing our condolences to the ANC, Dr Sefularo's colleagues, and his friends and family on his untimely death. I know we are going to have a debate on condolences tomorrow in the House, and I will express the DA's full respects then.
Health care, or the lack of it, is a matter of life and death. For too long, the vast majority of South Africans in the public sector have been subjected to a declining quality of health care, longer queues and ever- increasing waiting lists for treatments and operations. Without sound financial management, it is impossible to provide basic health care on a day-to-day basis, let alone project what amount will be needed in subsequent years.
There is an urgent need for an improved financial management process within the South African public health sector. Expenditure in many provincial health departments is currently inefficient and ineffective. These provincial departments and the national department in general do not have the ability to undertake a comprehensive budgeting process, reliably project expenditure, manage and control expenditure and evaluate cost- effectiveness.
This lack of capacity has resulted in significant overexpenditure in key areas, an inability to adequately determine clear cost drivers and causes for expenditure, a lack of strategic planning with clear objectives when additional funds are required and inefficient expenditure and losses.
In a reply to a parliamentary question, the nine provincial health departments had, as of 31 December 2009, an estimated budget deficit of R5,7 billion, which is more than double that of the previous financial year. This may not reflect the severity of the situation, as economists predict that a probable R6 billion to R7 billion has been deferred to the 2010-11 financial year. This reflects a massive funding gap, and it is uncertain how exactly the department and Treasury plan to address this huge shortfall.
It appears that the unannounced strategy is to fund the shortfall indirectly by clawing back R2 billion through below-inflation remuneration increases. Given, however, that a minimum of R7 billion is needed to deal with the Occupational Specific Dispensation, OSD, this will leave a R5 billion shortfall.
The DA's concern is that this has not been made explicit and most of the provinces and Treasury are hiding the real health deficit. So, what has caused the financial crisis? Due to the lack of skills within the department and a hopelessly outdated Persal system, the cost of OSD was grossly underestimated, as the department did not know how many nurses it had, what skills they had, and on what level they were employed.
While the OSD underestimation exacerbated the financial crisis in health care, this was, in fact, the final straw that broke the back of what is, for the most part, a shambolic and disgraceful administration of health care. The reason for this crisis lies in the inept management prevailing in most provincial health departments.
The Auditor-General's report for most provincial health departments comprises long lists of reports on wasteful expenditure, expenditure that cannot be accounted for, assets that have vanished, debts that had not been paid, duplicated payments, lack of sufficient controls, staff who cannot be found - ghost workers, performance payments that cannot be justified, payment for goods and services which were not received, and on and on. For the past five years, the national health department has received qualified Auditor-General reports, largely because it has not been able to obtain quarterly performance reports from the provinces.
Despite this, Minister, there has been no accountability with regard to financial management or mismanagement. Unless there are consequences for mismanagement, the current unacceptable and unsustainable situation will continue. We need to know, in addition to the overspent amount, how much has been deferred to the 2010-11 financial year.
In order to rectify the situation, the DA would like to make a few proposals. For effective budget management, it requires active strategic leadership from the head of the department, HOD, or the accounting officer and the chief financial officer who provides support to the HOD.
Since there may be different levels of commitment and capacity within the provinces, it is necessary to assist the HOD with guidance and, where necessary, instruction from the national Department of Health. It is key that these issues be a standing agenda item at report-back sessions to the HODs and when the Minister meets with the provincial MECs for health on a regular basis. Secondly, financial leadership and management are required to develop and manage the process on a day-to-day basis. This requires in-depth data analysis skills, understanding of the information available, understanding of budget management, understanding of health finances, the ability to interact with health managers and understand the businesses of health. The managers in the financial management component must be able to confidently communicate with and advise the chief financial officers and the HODs of the various departments on the financial status of their respective departments at all times.
Thirdly, due to the lack of budgeting and technical skills at institutional level, as well as the inability to understand and interpret data, urgent training of line managers and financial staff in the districts and at health institutions is needed. With the hopefully overall improved data and a better understanding of the data, health as a sector would be able to provide better motivations to national and provincial treasuries for funding.
With such skills, the health sector would also be able to accurately determine whether the sector is adequately funded for new policy mandates, determine needs by comparing current staffing and funding levels to accepted norms, determine the cost of proposals with detailed supporting documents for submission to national and provincial treasuries and determine the levels of funding of various provinces, compared to the numbers of patients they see. Chairperson, we heard today from the Minister the 10 priorities of the department, of which the DA supports most. The second priority, the National Health Insurance, NHI, we cannot comment on because we still waiting for the document, Minister. You promised that on 30 June last year. These priorities were also mentioned in last year's budget, and we hope that this year will be the year of action, where we start meeting targets specifically with regard to child and maternal mortality rates.
We welcome the u-turn in the fight against HIV/Aids, and the DA supports the campaign that the Minister mentioned of encouraging people to get tested and to know their status with regard to prevention. The Minister also mentioned that the President will be leading this campaign, and I hope he understands that it's a great responsibility and all eyes, particularly of the youth, will be on him, and he dare not falter again, if he is going to lead the campaign in prevention.
The Minister also mentioned the cost of antiretroviral drugs, ARVs, and I have raised this with the Minister before in the portfolio committee. The Medicines Control Council, MCC, has not approved generic ARV drugs for nearly four years, which would greatly reduce the cost of ARVs to the country, and the Minister needs to address this as a matter of urgency with the MCC. Incidentally, the Minister mentioned that the H1N1 vaccine still hasn't been approved by the MCC, so that also needs to be addressed as a matter of urgency. While South Africa currently offers near-universal health cover, the quality of health care in the public sector is of great concern to the DA. One driving factor of the poor quality of health care is the chronic lack of medical professionals. In a reply to a parliamentary question - that's another one - the number of doctors qualifying in South Africa actually fell between 2004 and 2008, from 1 394 doctors to 1 306, despite our country's desperate need for more doctors.
When one puts this together with the fact that about 17% of doctors leave South Africa after they have qualified, it is obvious we are facing a very grim scenario. The drop in graduates was largely the result of a decline in output at universities in provinces where the need for doctors is the most acute - Limpopo, the Eastern Cape and the Free State. At the University of Limpopo, for example, the number of graduates fell by more than a third, from 238 to 150. One solution is to bring in the private health sector to assist, particularly with the practical side of the training of medical students.
The lack of nurses is another concern and, if it were not for the private sector that now produces about 52% of all nurses, our health system would be on its knees. We hear year after year that the nursing colleges that were closed down by this government are to be reopened, but as far as I know not one has yet been reopened. Given the fact that we need to produce tens of thousands of nurses, one would have expected this government to act in an urgent manner, given the severity of the crisis.
Our human resources plan is basically nonexistent, and the old plan is based on questionable figures and deliberately excluded the private sector. We urgently need a new plan that is based on accurate figures of how many nurses and doctors are actually working in our country and how, as a country, we can effectively optimise all available resources to increase our work force.
The unacceptable level of the maternal mortality rate needs urgent attention, which the Minister did mention in his speech. One of the driving factors, but not the only one by any stretch of the imagination, is that mothers are deterred from attending antenatal and postnatal clinics, due to the fact that they have to wait in long queues for the entire day before they are seen to. It is high time that scheduling of appointments is implemented at all antenatal clinics. This will allow a woman to arrive, say, half an hour before her appointment and not waste her entire day when she could be doing other things.
Chairperson, if we are to improve the quality of health care for all the people, we must start moving to a health system that allows choice - open opportunity - such as allowing patients to choose a pharmacy of their choice near their places of work or home in order to collect their repeat prescriptions instead of having to take a day's leave, travel a long distance to their hospital, only to find the queue snaking out the door, then having to wait in the queue all day and sometimes not being able to collect their medication, due to stock running out or due to the fact that they never reached the front of the queue.
There are many innovative measures that can be put in place that will improve the quality of health care without increasing the cost of health care. In fact, some of the measures I have mentioned today will actually reduce the costs. We need, as a matter of urgency, to investigate all these possibilities in order to improve the quality of health care for the vast majority of our people. I thank you, Chairperson. [Applause.]