Chairperson, hon Minister and hon members, I wish to express my sincerest condolences to the family of the Deputy Minister, Comrade Molefi Sefularo. It is indeed a tragic loss for his family and the people of South Africa. We are grateful for his tireless efforts to improve health care, and we must all continue with what he has started. Hamba kahle [Go well.], comrade.
It is not possible to reverse decades of inequity and oppression in such a short period of our democracy. However, despite this, the ANC-led government has achieved much since 1994, namely the expansion of free primary health care; an expanded health infrastructure; the building of clinics and hospitals; the ongoing revitalisation of health care facilities; the largest antiretroviral, ARV, roll-out programme in the world; and numerous pieces of legislation.
Despite these achievements and improving access to health care, much more needs to be done to improve the quality of care that, in turn, ensures better health outcomes.
Our apartheid legacy left us with a fragmented, inequitable and fractured health system, creating enormous challenges to ensuring delivery of health care. A bold and more holistic approach is needed, hence the need for the National Health Insurance, NHI, for which the basis has been laid.
Further to this, the ministerial advisory committee, MAC, has been established, as envisaged in the National Health Act, Act 61 of 2003. This will not solve our challenges but will assist in expanding the delivery of health services to our people. It will also create the public-private partnerships that are so necessary to achieve the kind of outcomes we desire and to which our people are entitled.
Members of the Portfolio Committee on Health will provide the support that the Minister of Health needs to advance the transformation of the health system and give expression to the ideas of the Freedom Charter and our Constitution.
The more fortunate should become more conscious of the plight of the 86% of our population who do not enjoy the benefits of medical aid. This consciousness or social solidarity must mobilise all of us to ensure that no one in South Africa is being deprived of the right to health care. [Applause.]
South Africa enjoys a much bigger health budget than most developing countries, but we are faced with the challenge of an increasing burden of disease, HIV/Aids, and our most regrettable legacy of apartheid - poverty.
The constant migration of people from rural to urban areas seeking work opportunities places an enormous burden on provinces to deliver services. This raises the question of creating a flexible budget that takes into account the migration issue, not only of our own people but of citizens from other African states.
The Department of Health, in motivation for Budget Vote 15, has given us their strategic plan. There are six programmes along with the key outcomes that are expected to be achieved. As parliamentarians, we must hold them to account and monitor their progress towards achieving these outcomes.
It is unacceptable for the department to receive qualified audits, year after year, while we acknowledge that there have been obvious improvements. As parliamentarians, it is our duty to ensure that this does not continue. We urge the department to be open and honest with us at all times about the challenges it faces and which impact on delivery. There are plans to implement.
We have to work together to achieve the kind of outcomes we all desire. This can be achieved through open, honest and robust engagement with each other. After all, we are doing this for the people who gave us, the ANC, the mandate to implement our policies determined at Polokwane.
To achieve the desired outcomes requires greater leadership at national level. In this regard, the national level will need to focus its attention on placing greater emphasis on primary health care which will strengthen the district health system.
In 2008, the world celebrated three decades of the Declaration of Alma-Ata on primary health care. In the South African political context, this celebration had a profound impact, having seen the transformation of our country into a democratic dispensation where access to health care had been enshrined as a human right in our Constitution. Much has changed in the world since the signing of the declaration, and this has presented us with opportunities and threats also.
The transformation in our country affords us the opportunity to implement primary health care policies and programmes that benefit our people. In whatever way we look at it, we are seized with the challenge of translating the democratic culture into community-based health care delivery. It is clear that we need to merge modernised technical processes and aspects of primary health care with a humane, people-centred approach.
It is gratifying to see that there is an attempt at greater efficiency and providing a more cost-effective service through efficiency savings. The 2010-11 Budget provides for a number of key policy priorities that will take the country forward to improve health care, such as expanding the treatment of HIV/Aids; ongoing hospital revitalisation; stabilising personnel expenditure; and addressing backlogs in the forensic laboratories.
Of utmost importance is the strategic health programmes that focus on HIV/Aids and TB control and management. Now, TB has its own complications of drug resistance, that is, multidrug resistant TB, MDR-TB, and extremely drug resistance TB, XDR-TB.
Another key objective is reducing maternal and child mortality and increasing immunisation coverage. Equally critical is reducing the malaria fatality rate. It is envisaged to reduce it by 1% annually. It is correct to acknowledge that there are many challenges to improving health care. At the same time, it is correct to also admit that with the department's new 10 Point Plan, and through identifying key outcomes, these challenges can be overcome.
As parliamentarians given the responsibility of exercising oversight over the Department of Health, it is critical to discharge our duties diligently and without fear or favour. Working together, we can do more. This is what is demanded of us by the people who mandated the ANC to implement this policy that will transform their lives and lead to a better life for all.
Health care certainly has its own challenges. Recently, in March this year, there were threats of disruption of services due to the delay in implementing the Occupation Specific Dispensation, OSD.
Since 1996, the heath care system in the country has continued to be underfunded with regard to its needs. The funding levels have failed to keep pace with current medical inflation, which is running at 10%; the growing population and emerging burden of diseases that is driven by HIV/Aids; noncommunicable diseases; and alcohol-related traffic deaths and trauma.
The unintended consequences of this scenario have been the ever-expanding unequal expenditure between the private and public sectors. In the public sector, this has resulted in the erosion of primary health care and district health services. The changing burden of diseases has exacerbated this and brought more pressure to bear on our primary health care system.
What is also disturbing is the continued interdistrict funding inequity. In 2007-08, the district with the highest per capita budget expenditure was Namakwa in the Northern Cape, with R633 per capita expenditure as compared with the worst district of Lejweleputswa in the Free State, with R191 per capita expenditure.
We propose that more funding must be directed at primary health care level. It is not only politically correct but more cost effective and makes a lot of business sense. When we are faced with challenges of financial resources, we need to do more with the little we have - that is the primary health care approach.
The Department of Health conducted a 15-year review of the performance of the health sector and identified management and leadership at all levels as key elements. Another challenge is the appointment of permanent staff in senior management because we find people acting in a position for long periods. This causes instability in the system, which we can ill afford.
Having said this, we are certain that these challenges will be addressed and resolved. Therefore, we must work together, side by side, throughout our term, for the betterment of the lives of our people until we achieve a better life for all. Therefore, the ANC supports this Budget. I thank you. [Applause.]