Chairperson, hon Minister and members, may I take this opportunity to wish my twin brother a very happy birthday today. [Applause.]
Minister, in your speech you mentioned the national health insurance - you dedicated about 25% of your speech to it. You promised during the presidential debate that we would have a document on the national health insurance by the end of June. Today is the end of June, and we do not have that document. I shall reserve the DA's comments on the national health insurance for when we actually have a document in front of us.
We respect your honesty and we appreciate it: It is very refreshing to hear a Minister talk about the challenges facing health care. The previous Minister of Health, Manto Tshabalala-Msimang, was a denialist, to say the least, and we appreciate your candour.
But if we are going to be honest, we have to say that the current crisis in the public health sector with regard to the doctors' strike has been a long time in the making. It is extremely unfortunate that doctors have been forced to go on strike in order to have their grievances heard.
The groundswell of support for the strike among doctors must set alarm bells ringing for the ANC government. The fact that a junior doctor in the public sector earns the same amount as a bus driver is indicative of the indifference with which this government has taken doctors' concerns over the years and the degree to which it has taken advantage of their commitment and compassion. It also clearly demonstrates where in the ANC's priorities health care really sits, and it is not at the top of your priorities.
If one looks historically at the budget allocation for public health, it is obvious that from 1998 to 2003, in per capita terms, the budget flatlined, because the government had other priorities, such as recurring arms deals, in order to fight nonexistent enemies. In 2003 the government began to realise its mistake and the budget did start to increase in real per capita terms. However, the automatic notch and rank increases of 1998 and budget constraints meant that as people left the public health system, they were not replaced, and an estimated 60 000 people left during this period. Hospitals have still not recovered.
And while the government may say that from 2003 there were significant budget increases, most of this allocation went to clinics and to the new antiretroviral programme. No compensation has really ever been made available to reduce the strain the whole health system was placed under during those years.
We must remember that the burden of disease has increased dramatically, placing an ever-increasing strain on hospitals. Given that hospitals' budget allocations have been on the same trajectory since 1998, we have the current meltdown. There were insufficient funds to replace doctors and nurses who left the Public Service, and therefore the workload increased and working conditions deteriorated.
You simply cannot offer a health service with 12 000 vacancies for doctors and 42 000 vacancies for nurses.
Equally, you cannot neglect a system for so long and expect to fix it in a once-off adjustment - it is obviously beyond this government's capabilities. The department mishandled nurses' occupation-specific dispensation increases through grossly underestimating the cost to the fiscus, and now you cannot or won't deliver on the doctors' occupation- specific dispensation increases. This ongoing neglect of 11 years is finally taking its toll.
Back in July 2007, some two years ago, the government promised, through Resolution 1 of that year, that they would implement OSD increases for doctors in July 2008. The ANC government reneged on that promise.
My question to you, Minister, is: If the government made a promise some 24 months ago, why then were no budget allocations made in the 2008-09 budget or even this year's budget? The answer is clear: This government had no intention of honouring its promise to the doctors.
It was only after the doctors started marching and threatening industrial action that you, your department and this government sat up and started to take them seriously.
The doctors have been asking for a 50% increase, which may seem excessive to most South Africans. However, research commissioned by the SA Medical Association into doctors' remuneration shows that in the South African public sector, doctors are paid 50% less than other professionals such as accountants, engineers and lawyers. That is what I call a disgrace.
Since the threat of industrial action, the doctors' association and yourselves have been shut behind closed doors negotiating, when an agreement was expected to be announced last Wednesday.
However, in what can only be described as bizarre, you made a public announcement on the doctors' increases while negotiations were still ongoing - thus undermining the entire bargaining process and showing bad faith. You announced in your media conference that doctors would receive increases of between 29% and 53%, which most organisations welcomed, including the DA. However, this was misleading, to say the least.
When one scrutinises the finer detail, it is clear that the offer was not genuine, and either you deliberately misled the nation or your officials misled you. I believe it was the latter, hon Minister. Whose idea was it to hold a press conference while negotiations were still ongoing?
The real increases for most doctors range between 2% and 13% over a two- year period. The offer excludes experience and only commits itself to looking at this principle again in April 2011, subject to availability of funds.
There are also questions hanging over whether doctors have the right to strike, but it is entrenched in the Constitution, with a limitation clause, meaning that, as an essential service, skeleton staff must be in place. After the 2004 and 2007 public sector strikes, the government agreed to negotiate a minimum service level agreement which would stipulate the conditions of industrial action - and surprise, surprise, the government still has not fulfilled this promise. How many more promises are you actually going to break?
When I was at Groote Schuur yesterday to witness for myself the strike by the doctors, I was impressed to see that they did not close down the trauma or emergency services and they are dealing with this strike in a very responsible manner indeed. They are implementing their own minimum service level agreements.
The attitude of the MEC in KwaZulu-Natal is also of concern. On what basis does the MEC state that there is a third force at play and that doctors are destabilising the country? Dismissing doctors won't help either. There are so few of them, you will have to re-employ them anyway when the strike is over, unless you want a further meltdown of the public health system.
If the government can find an extra R1 billion for expanding the cabinet, or R2 billion to R4 billion for saving the SABC, it can surely find the money to pay the doctors. [Applause.]
The question of budget allocations also needs to be seriously looked at. The ramifications of the miscalculations of nurses' OSD allowances continue to eat into the budgets of the provinces, and some health experts believe that by August this year provinces will be running out of money and we will see a repeat of what happened in the Free State in the last financial year, but on a much wider scale. The department also admitted that due to a lack of funds not everyone who is entitled to ARVs will actually be enrolled into the programme, as there simply is not enough money. This, Minister, means people are going to die, and you stated that this was the third priority of the government; I think you said this in your speech. If it is such a high priority, why is there not enough money? One thing that has been proved around the world, Minister, is that if you want to reduce the number of new infections, you need political leadership, from yourself and the President, and this has been lacking in this country over the past 15 years. [Interjections.]
We need to separate the HIV/Aids budget from the rest of the health budget. It should be treated as a grant where central government underwrites it and guarantees that all who need ARVs can actually access them, and it should not be limited to provincial budgets.
Minister, whether you were misled by your officials with regard to the doctors' increases, only you will ever know. Whether you were set up for failure by hosting a premature press conference, only you will ever know. However, as the political head of the Department of Health, you, Sir, and only you, must take political responsibility for the atrocious mess we find ourselves in. I thank you. [Applause.]