Chairperson, Deputy Minister of Health Dr Molefi Sefularo, hon chairperson of the portfolio committee Dr Bevan Goqwana, members of the committee, hon members of the House, distinguished guests, ladies and gentlemen, good afternoon! I know that everybody here is listening attentively to hear about the occupation-specific dispensation. I am deliberately leaving it till the end, so that when my time is over, you will ask the Chairperson to increase my time, so that I can tell you what is happening!
It is an honour for me to present to this House the budget of the national Department of Health for 2009-10 for your consideration. I am presenting this budget at a very challenging time in the history of health care in our country, and also around the world as a whole.
Let me start with the world. There are two contemporary issues in health care around the world which I shall mention. The first one is the ever- threatening H1N1 influenza, which has spread so widely that it has moved up to stage 6 alert. Fortunately, it is not virulent, but just spreading widely. However, I must state that it is under control throughout the whole world.
In our country we are able to control it, despite the fact that we have had many visitors from all over the world in recent weeks, attending various sporting activities.
The second issue in health around the world is the global economic meltdown. It has a great bearing on health care around the world, and especially in Third World countries such as ours. For this reason, the United Nations Secretary-General, Mr Ban Ki-Moon, convened the Secretary- General's Forum on Advancing Global Health in the Face of Crisis two weeks ago, at the United Nations headquarters in New York.
His rationale was that the world has learnt during previous economic crises that social outcomes are the first to suffer during such crises, and recover least after such crises.
He went on to point out that during such crises countries are tempted to cut on social spending such as health. The results are that while rich people inside rich nations may lose their jobs and assets, such as their mansions, luxury cars and other property, these may be recovered when the economy recovers, but in poor countries poor people may lose their lives through extreme poverty and poor health care, and they will never ever recover these lost lives, even after the crisis is over.
Hence I wish to bring this message home to my own country, that this is the time the poor need protection more than ever before, to cushion them from the devastating effects of this global economic meltdown.
Coming back home, the challenges in health are overwhelming. During the state of the nation address, the President of the country, His Excellency Mr Jacob Zuma, said, and I quote:
Fellow South Africans, we are seriously concerned about the degeneration of the quality of health care, aggravated by the steady increase in the burden of disease, in the past decade and a half.
We have no option but to be fired up to take the bull by the horns in tackling this state of affairs, as the President has said, and we are going to deal with it decisively.
Unfortunately, present events within the public health sector do not help the situation either. I need to mention that we as the governing party started getting concerned some time back. Hence the resolution of the ANC at the 2007 Limpopo conference, that health and education be top priorities for the next five years and beyond.
To this end, the government then adopted a 10-point plan, which is going to be our programme of action for the next five years. The public health system is also forced to carry an ever-increasing burden of diseases, obviously made worse by poverty, HIV and Aids, and other communicable diseases.
However, let me take this opportunity to accept and acknowledge upfront that some of the factors contributing in no small measure to the deterioration in health care are the following: Lack of managerial skills within some health institutions; failure to act timeously on identified deficiencies; delayed response to quality improvement requirements; unsatisfactory maintenance and repair services; poor technological management; poor supply chain management; inability of individuals to take responsibility for their actions; poor disciplinary procedures and corruption; significant problems in clinical areas related to training and poor attitude of staff; and inadequate staffing levels in all areas.
We are going to be facing all these issues head-on, and we will do so without fear or favour. [Applause.] We owe it to our country that these issues will be tackled head-on.
Hon Chairperson, some of the issues I have mentioned as contributing factors to the problems the health system is facing are very urgent, and will be dealt with very urgently. For instance, the Gauteng Department of Health last week already launched Operation Kuyasheshwa-la to deal with such matters urgently.
Our programme of action, however, with its 10-point plan, has been designed to deal with these issues systematically and in a sustainable manner. Its implementation will be both decisive and incisive.
Hence, our 2009-10 to 2013-14 programme of action will allocate resources for the following ten priorities, in line with this programme of action.
The first priority is the provision of strategic leadership and the creation of a social compact for better health outcomes. While issues of strategic leadership are very clear, I wish to add that the social compact part of this point speaks to "working together we shall achieve more". Mooney states in 2008, and I quote:
The view of patients as passive receivers of health care is being replaced by one of communities as equal partners in decision-making about health care priorities, contributing their opinions alongside those of bureaucrats and policy-makers.
We shall follow this line very closely.
The second issue on our programme of action is the implementation of national health insurance, or NHI. In recent weeks there has been a raging debate in the public arena about the intended introduction of the NHI by government. This debate was introduced prematurely by people who wanted to scuttle the NHI as an unworkable system. South Africans were urged to run for cover because the NHI was going to be a marauding monster that would destroy everything that we hold dear in the health care system of the country.
Hon Chairperson, while I am not yet presenting an official document on the NHI, because it is policy in the making - it is going to come, very soon for that matter - I wish to make the following points known. Firstly, the present system of health care financing can no longer be allowed to go on, because it is simply unsustainable. In no way can we perpetuate a system where we spend 8,5% of GDP, with 5% catering for 14% of the population, or 7 million people, while we spend the remaining 3,5% to cater for a whopping 84% of the population, or 41 million people. Nowhere in the civilised world can you find that state of affairs.
The second point I want to make is that the present model of health care financing is outright primitive, and we are going to abandon it. The Secretary-General of the United Nations, Mr Ban Ki-Moon, on 15 June 2009, just two weeks ago, had this to say at the United Nations, and I quote:
Out-of-pocket expenditure on health is the worst form of health care financing.
That says it all.
Critics of the NHI were hard at work to prove that we were going to overburden the rich, and that the economy would not cope.
Hon Chairperson, what is the NHI? It is a system of universal health care coverage where every citizen is covered by health care insurance, rich or poor, employed or unemployed, young or old, sick or very healthy, black, white, yellow or people of whatever colour or persuasion. It is this part about covering the poor and the unemployed that is bringing discomfort and unprecedented anger in the minds of the enemies of the NHI.
Let me read the following paragraph of a speech made by Dr Margaret Chan, director-general of the World Health Organisation, at the meeting of the United Nations, also two weeks ago. For those who don't know, Dr Margaret Chan was the minister of health in Hong Kong before taking over the post as director-general of the World Health Organisation. She said, and I quote:
Fairness, I believe, is at the heart of our ambition in global health.
A quest for greater fairness dominated the agenda of the UN Forum. We see this in our concern about vulnerable populations and about health systems that exclude the poor. We see this in your support for global health initiatives and funding mechanisms that redistribute some of the world's riches towards the health needs of the poor.
On the issue of fairness, let me again state the obvious. Our world is dangerously out of balance, also on matters of health. Differences within and between countries, in income levels, opportunities, and health status are greater today than at any time in recent history. She went on to say:
Let me make another obvious point - a health system is a social institution. It does not just deliver pills and babies the way a post office delivers letters. Properly managed and financed health systems that strive for universal coverage contribute to social cohesion and stability.
Hon Chairperson, the aims and objectives of the NHI are to achieve exactly what the World Health Organisation's director-general has alluded to - we are going to add nothing, and subtract nothing.
The third issue on our programme of action is the accelerated implementation of the HIV and Aids plan and increased focus on TB and other communicable diseases. Let me go back to the President's state of the nation address, and I quote:
We must work together in the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and Aids so as to reduce the rate of new HIV infections by 50% in the year 2011. We want to reach 80% of those in need of ARV treatment by 2011.
Hon Chairperson, here is the scorecard on HIV and Aids challenges that South Africa is facing.
This year, on 9 June, the Human Sciences Research Council, together with its partners the Medical Research Council, the Centre for Aids Development, Research and Evaluation, and the National Institute of Communicable Diseases, published a report on HIV and Aids, based on interviews and testing of a random sample of the population of South Africa during 2008. The survey included people of all races, age groups, rural and urban, and from all provinces.
The research concluded that: The epidemic was stabilising at 11% between 2002 and 2008; HIV prevalence at national level decreased by nearly half among children aged two to fourteen years between 2002 and 2008; and HIV prevalence decreased slightly among youth aged 15 to 24 from 2005 to 2008.
Encouragingly, there was a substantial decrease in new HIV/Aids infections in 2008, in comparison to 2002 and 2005, especially for the single age groups 15, 16, 17, 18 and 19. What was most encouraging was the change in behaviour among South Africans. More South Africans for all age groups protected themselves against HIV infections by using condoms, more than 95% knew where to access condoms and the use of condoms had indeed increased, according to this research.
Furthermore, half of South Africans now know their HIV status, which means that the message of the "know your status" campaign is being heeded. The researchers also reported that there has been an increase in exposure to one or more HIV/Aids communication programmes from 2005 to 2008, with 90,2% of youth aged 15 to 24 years being reached, followed by 83,6% of adults aged 25 to 49 years and 62,2% of adults aged 50 years and older.
However, despite these successes, there is still some unevenness in infections as well as in behavioural change. Worryingly, HIV/Aids prevalence is still highest in KwaZulu-Natal, at 16,8%, followed by Mpumalanga, at 15,4%. It is also still highest among young women in this country aged 25 to 29 years, where a third of the women are HIV positive. Among all provinces, the Free State continues to have high rates of multiple partnerships, perhaps due to the migratory labour patterns in that area.
We take note of the recommendations made by the researchers, especially that we need to introduce targeted interventions in some of the provinces with very high HIV prevalence, and secondly, that we assist young women who want to have children to do so without risking HIV/Aids infection. We plan to support research that will generate evidence to be used in attaining this goal.
We furthermore support that we intensify our efforts to help provinces implement interventions aimed at reducing rates of multiple sexual partners, including intergenerational sex.
We also take the recommendation that we should consider implementing provider-initiated HIV/Aids testing in all health care facilities. This is as distinct from demand-initiated testing.
Finally, we take seriously the concern that Khomanani should increase its reach and coverage to all South Africans, particularly those who are aged 50 years and older, because most of them believe that they are out of reach of HIV and Aids, that is, people of my age, hon Chairperson.
I would like to thank the following people for continuing to undertake research that informs policy and programme development on HIV and Aids. These are Dr Olive Shisana, Prof Leickness Simbayi, Prof Thomas Rehle and their staff at the Human Sciences Research Council, as well as their colleagues from the Medical Research Council and the Centre for Aids Development, Research and Evaluation, especially Dr Warren Parker. Finally, the support of the US President's Emergency Plan for Aids Relief in conducting this important study is very much appreciated.
Hence, hon Chairperson, we will work with provinces in 2009-10 to ensure that 80% of HIV-exposed infants receive ARVs for preventing mother-to-child transmission, based on dual therapy. This figure will increase to 95% over the two years of the Medium-Term Expenditure Framework, 2010-11 and 2011- 12. The proportion of pregnant women who are tested for HIV/Aids will be increased from 80% in 2009-10 to 95% in the 2010-11 and 2011-12 financial years.
To strengthen the prevention of mother-to-child transmission of HIV/Aids, 80% of pregnant women who are eligible will be placed on ARV prophylaxis based on dual therapy in 2009-10.