Hon Chairperson, hon Minister and Deputy Minister, any other Ministers present, hon members and guests, my focus is going to be on human resources for health.
It is now widely accepted that the dire shortage of health workers in many places is among the most significant constraints to achieving the three health-related Millennium Development Goals: to reduce child mortality, improve maternal health, and combat HIV/Aids and other diseases, such as tuberculosis and malaria. Shortfalls exist in all categories of health workers.
The World Health Organisation clearly articulates the view that central to every health system, the health workforce is central in advancing a nation's health. It is the backbone.
It has been suggested that a nation's budget provides a clear indication of its policy priorities. In the case of the national health Budget Vote, it should however be taken into account that while provincial health budgets give effect to health priorities, via implementing departments, the national department provides leadership and co-ordination for health services in South Africa. Therefore its budget does not reflect actual implementation of health strategies and programmes.
The national Department of Health received a total allocation of just over R17 billion for the 2009-10 financial year, which translates to 3,9% of the total Budget. Of this, R306,5 million was allocated to personnel expenditure. This includes compensation of employees, as well as training and development. Therefore personnel expenditure constitutes 1,8% of the departmental allocation for 2009-10. On examining the budget allocation, our portfolio committee came to the conclusion that this R17 billion was quite inadequate. As a caring government, we would like to receive more and do more. A constraining budget is a handicap.
Compensation of employees increased from R287,7 million in the 2008-09 adjusted appropriation to R299,9 million in the present year. While this suggests a nominal increase of 4,24% from the previous financial year, in real terms expenditure on compensation of employees declined by 1,1%, when taking into account the impact of inflation.
Further, training expenditure as a percentage of compensation of employees remained stable. However, it declined significantly since 2007-08, when it constituted 3,7% of compensation of employees. The number of persons trained in the department declined to 261 in 2008-09, from 625 in 2007-08, so there is a remarkable decline there.
Human resources for health cannot afford not to be seen within the context of primary health care. With the advent of democracy in 1994, South Africa's newly elected democratic government was faced with the challenge of transforming a highly inequitable and fragmented health care system. In addition, the health care system was biased towards curative care and the private sector. The transformation of the health system was operationalised through government's commitment to developing a unified health care system capable of delivering quality care to all, as envisioned in our Freedom Charter.
Key to efforts to ensure quality health services available to all South Africans, government adopted a district-based health care model, driven by the primary health care approach. This approach has at its core the reorientation and reorganisation of the health workforce. A more equitable distribution of the health workforce, broadening of the cadre of workers, sufficient numbers of health workers, as well as skills development to ensure appropriate and adequate care, have been at the centre of policy debates since 1994.
Research conducted during the late 1990s and early 2000s indicated that doctors and nurses were often ill-prepared to render services in primary care settings. Since then there has been significant expansion in needs and service expectations of the primary health care system, brought about by the HIV and Aids and TB epidemics. A related shift in disease burden towards chronic noncommunicable diseases will exacerbate this in future, and perhaps we will see that we will be having chronic noncommunicable diseases for quite some time in the future, unless we concentrate on things such as nutrition.
Skills requirements have therefore changed, and health sciences faculties are confronted with the need to restructure curricula and make decisions about teaching priorities, but to varying degrees, and focusing primarily on medical curricula. The general focus has been towards strengthening community-based education, to alter teaching methods to improve problem- solving and critical thinking skills, and to foster multidisciplinarity. However, the impact of these reforms has been not evaluated, and a comprehensive audit of health science curricula is urgently required, Minister, particularly in light of changing needs and service expectations. Questions need to be asked as to whether health professionals in general, and nurses in particular, are indeed prepared to address the changing burden of disease, and to function effectively in primary and community care settings. An important step in this direction is the Collaboration for Health Equity through Education and Research initiative, a research collaboration between all universities in the country to assess the educational factors that would improve the supply and retention of health professionals in rural and underserved areas.
Early evaluations of the community service programme suggest that new graduates continue to feel ill-prepared for service in rural areas and primary health care settings. Many expressed "a disjuncture between the academic training expectations and the actual conditions in the Public Service".
One graduate described his experiences as follows: "There wasn't enough emphasis on patient management in a lower level institution ..." [Time expired.] [Applause.]