Mr. Chairman, with reference to the announcement made by the hon. the Minister of Internal Affairs. I want to take this opportunity to say a few words about the salaries of social workers. During a debate in Parliament I also promised that we would discuss this matter further on this occasion.

In pursuance of the Press statement by hon. the Minister of Internal Affairs on a professional dispensation specifically for the social work profession, I should like to furnish a few more particulars on the new dispensation for social workers.

As departments and other administrations were only notified of the new dispensation on 19 May 1983, hon. member will appreciate that I cannot give them full particulars of the dispensation at this stage. I am therefore only going to mention a few aspects on which I have information at present.

Two new professional categories, namely those of probation officer and assistant social worker, are being created now. These two professional categories should make a major contribution to facilitating the task of the social worker in the field.

As far as the departmental control structure of the profession is concerned, provision is now being made for the rank of Chief Director as against the existing provision for a Director. This development is being welcomed and should in my opinion solve the problems foreseen by various persons and bodies in connection with this matter.

On the basis of the recommended new dispensation the department will also under take further investigations into the creation of more posts in the promotion ranks in order to establish better opportunities for advancement for officials in the lower ranks.

As the adjustments which will have to be made because of the new dispensation will have to be considered in respect of each individual case, I am both unable and unwilling to mention percentages or general amounts, since such statements could only lead to wrong impressions being created.

However, I want to quote a few examples of basic salary scales to give hon. members an idea of the extent of the possible adjustments, but I want to repeat that hon. members should not summarily apply to persons the amounts I am going to mention.

Here are a few examples. The starting salary for the rank of social worker now rises from R6 534 per annum to R9 648 per annum, with an increase in the top of the scale from R10 062 per annum to R12 600 per annum and in some cases to R16 020.

The existing Chief Social Worker’s salary shows an increase from a commencing salary of R14 310 per annum to R18 288 per annum, and in the top of the scale from R18 288 per annum to R21 684 per annum.

The commencing salary attached to the rank of Assistant Director now rises from R18 288 per annum to R21 684 per annum, and the top salary rises from R22 533 per annum to R25 080 per annum.

Hon. members will allow me to convey, as I did in the past, the Government’s and my own thanks and appreciation to those social workers currently in the Service for the unselfish service they have rendered to the Republic in the past and up to the present day. This is not a profession in which one can draw up a balance sheet every day to determine one’s achievements. On the contrary, the task involves fatiguing and sustained dedication whilst it is not always possible to reckon on success in real terms.

The demands which will be made on us in the future—I am referring here specifically to the President’s Council’s report on community development—makes it imperative for us to decide on the expertise of social workers now. I cannot emphasize this aspect too strongly.

I am, therefore, also making an appeal to young people who feel the call, to come forward for training in the field. I know, and am reassured by the fact, that the professors and other lecturers associated with the faculties of social work share my views on the importance of this profession.

In conclusion I want to give the assurance that the Department of Health and Welfare and I myself in particular will continue to negotiate the best deal for social and associated workers, and in this respect I also have the support of the Council for Social and Associated Workers.

Mr. Chairman, I request the privilege of the half-hour.

In view of the fact that this is the first time the hon. the Minister is handling this Vote, I think it is appropriate for me to congratulate him on this occasion. I should also like to congratulate him on and thank him for his first statement in respect of this Vote. If this is the kind of achievement we are going to have in future from the new hon. the Minister’s handling of this Vote, I think we may have great expectations.

I also want to welcome the Director-General: Health and Welfare and his staff. I also want to congratulate the hon. the Deputy Minister of Health and Welfare on his appointment and express the hope that his term of office will be a very fruitful one. In addition I have to apologize for our failure to congratulate him on a previous occasion.

Next I want to thank the hon. the Minister and the Department for the 1982 report. I also want to thank those responsible for making available to us the report of the National Advisory Board on Rehabilitation Matters, the report of the Research Council as well as the report on industrial diseases by the medical profession. All these reports greatly assist one in knowing what is happening as far as the activities of this Department are concerned. I am in earnest when I say that we must know what we are talking about when discussing this Vote.

†The first point I should like to make is that if one has to speak on the Vote of the hon. the Minister of Health and Welfare and wants to discuss health matters, it is important that one has a clear understanding of the whole health structure in South Africa and its importance. To quote a previous political head of the central Government, health does not only include the central Government, it also includes the provincial level and local level. There are also the self-governing and independent homelands with their own health departments. In South Africa the health structure is also divided into the private and public sector. There are therefore a large number of organizations, personal and Government departments that are responsible for health. I should like to thank the hon. the Minister once again for allowing me this year once again to visit hospitals. He gave me the opportunity to bring a visit to a hospital in Port Alfred. I should like to tell him what I found there. This hospital has 320 beds for both male and female psychiatric patients. It is filled to capacity. It accommodates Black and Coloured patients, most of whom who are apparently chronically ill. There is no water-borne sewerage in that hospital. All the toilets are of the bucket type in wards. The reason that is given for this is that a water-borne sewerage system cannot be installed because the water table is too high. However, next to the hospital building and in the hospital grounds are beautifully maintained bowling greens and a club house used by the staff and the population of the town. The only functioning ablution facility in the hospital consists of one large bathroom with four open baths and five open showers. These are used by male as well as female patients. This is a hospital in South Africa! The conditions existing there are very difficult to understand. However, to the credit of the department, these hospitals are slowly being phased out and new, very good institutions are built. We can only be thankful for that, but at the same time must deplore a very unhappy past.

As I have said, I think it is very important for us to know about these things. I should like to ask the hon. the Minister for his views on a rule that was brought in by his predecessor and in terms of which we have to apply to the Minister and his department for leave to visit provincial and Government hospitals. I do not think such a rule is necessary. A public representative should be able to visit these hospitals and institutions and I believe should be treated in the same way as any other member of the public. To my mind we should be able to get in touch with the superintendent of the institution concerned and ask whether the institution may be visited. The superintendent can then either say yes or no. This will help us to visit these institutions. I should like to ask the hon. the Minister whether he agrees with me that it is important for public representatives to be able to visit these institutions. In this regard I should like to quote a letter that was written to a colleague of mine. It reads as follows—

This letter was signed by P. J. Loubser, M.E.C. I find this totally unacceptable and should like the hon. the Minister to tell me whether he agrees with the statement that members of Parliament should not visit provincial hospitals in view of the fact that health remains health whether it is dealt with by Government institutions or provincial institutions. I think the hon. the Minister is a very reasonable man and I should like him to repudiate this statement and also to open these hospitals to people who are interested in visiting them. We only do it because we are interested. We do it because we want to find out what is going on. I think it is our right to be able to visit these hospitals.

I should like the hon. the Minister to tell us briefly how he sees hospitals in the future constitutional setup in South Africa. I think we have to be very clear when we talk about common and own affairs. I should like the hon. the Minister’s guidance in this respect. As it stands now, a hospital is either for one racial group or it is divided into a White side and a non-White side. As hon. members know the non-White wards cater for Coloureds, Asians and Blacks in one ward. Under the new constitutional setup and with hospitals being own affairs, can the hon. the Minister tell us how he sees the division of hospitals in the light of the fact that we now have Coloureds, Asians and Blacks in the same wards? I should also like to ask him how he sees the future development of the Department of Health. Will there be different Ministers for own wards and own hospitals or will all hospitals and wards still fall under one Minister? I would like to plead that health matters fall under one person. I think the breaking down of health matters into different departments will only weaken the state of health in South Africa. A chain is only as strong as its weakest link. If that health link in our various geographical areas weakens, the health of South Africa will weaken. I should like the hon. the Minister to give us this opinion on this.

Basically I would like to discuss with the hon. the Minister this afternoon matters which he had raised. I think he raised very important matters and I want to refer to his speech during the Second Reading of the Constitution Bill. The hon. the Minister now has the Health and Welfare portfolio and I would like to ask him not to enter into politics too much as I believe that the Minister of Health and Welfare should be apolitical as possible. I think a previous Minister has made this mistake. Being a Member of Parliament a Minister must enter into politics but I think he should try to keep it out of health matters as much as possible. I think that would be the best way for us to work. [Interjections.] I will promise the hon. the Minister that I will do exactly the same.

*I want to quote what the hon. the Minister said. He made three very important points, and in the time at my disposal I should like to deal with those three points. Firstly, I quote as follows from his speech (Hansard, 17 May 1983, col. 7193)—

I assume that the hon. the Minister was also referring to Blacks although he omitted to mention them here. This is the first point which the hon. the Minister made. In this regard I am in full agreement with the hon. the Minister, but at the same time I should like to ask him how he and his Department are going to do this? A look at the records of the past years reveals large-scale negligence and that we are so far behind that we shall hardly be in a position to eliminate the backlog. Although I am unable to draw a comparison as far as nurses, social workers and other paramedical professions are concerned, I am able to point out that the White population group produces one doctor for every 450 members of that population. Asians produce one doctor for every 640 members of their population group and in the case of the Coloureds this figure is 23 275 for each doctor produced by that group. As far as the Blacks are concerned, one doctor is produced for every 112 405 members of that population group. These are 1964 figures…

What does that prove?

It proves that as yet we have not achieved great success in recruiting people from these population groups. Therefore we shall have to do better. That is all it proves. The hon. the Minister must touch on important problems today. He is a new hon. Minister, and today he is going to give us his vision of the future and whether the position is going to improve. This is all I want to say.

I should like to come back to the question of the doctor/population ratio. In a place like Durban there is one doctor for every 600 people. As far as the Whites are concerned, there is one doctor for every 200 people and, as far as the non-Whites are concerned, there is one doctor for every 400 people. In Eshowe this ratio is 1:8 400. As far as the Whites are concerned, it is 1:200 and 1:8 200 for non-Whites. In the Free State the ratio is 1:2 500 as far as the total is concerned and 1:400 for Whites and 1:2 100 for non-Whites. At the moment, therefore, we do not have the staff if we are to do what the hon. the Minister advises us to do. Now let us look at the nurse/population ratio. According to the hon. the Minister’s own 1981 report, the ratio is virtually 30 000 for 15% of the population as far as the Whites are concerned, and in the case of Blacks it is 22 000 for 70% of the population. Therefore, the dream of the hon. the Minister is quite correct, but what I want to know from the hon. the Minister is his view of how we shall be able to improve on this.

The second point made by the hon. the Minister, is as important. I quote again (Hansard, 17 May 1983, col. 7193)—

It is interesting to consult the report, because from the report it is clear that not even R30 million is being spent on South Africa’s priority number one whereas spending in respect of defence amounts to R3 000 million. Therefore, priority number one, according to the hon. the Minister, receives R30 million and defence R3 000 million. There are 1 204 nurses, 1 089 doctors, etc. However, I want to ask the hon. the Minister how many of these people are full-time and how many part-time?

†In spite of the Department’s efforts between 1970 en 1979 the birth rate amongst the Coloureds dropped from 35,9 to 28,5 per 1 000 of the population. The corresponding figure for Blacks indicates a minimal decrease from 40 to 36 per 1 000 of the population. The natural increase of our population is 8,2 per 1 000 Whites and for the Blacks it is 30 per 1 000 and in the case of the Coloureds and Asians the figure is 18 per 1 000. If we examine these figures I think the hon. the Minister is absolutely correct in telling this Committee that he considers that the population explosion is priority number one. However, I am going to ask the hon. the Minister what he is going to do about it. There is no doubt that when one reads this President Council report one must agree that South Africa cannot afford to have this population.

I would like to ask the hon. the Minister what steps he is taking to improve child health, primary health and community health. If one looks at the recent budget for the funds that he is going to spend in the 1983-’84 financial year, it is clear that there is basically no increase in the funds needed for the health of South Africa. There is basically an increase in salaries and only an additional R9 million is provided. As far as family planning is concerned which, in the hon. the Minister’s own words, is priority number one, there is an increase of only R5 million. I would like to ask the hon. the Minister whether he has taken any notice of this report and what he is going to do about it. I agree that the Department of Health and Welfare should lead the way in this regard. First of all, they have the necessary experience and secondly it is possibly the most apolitical—or it should be—Ministry that we have. Thirdly I think there is no one better qualified than the Director-General: Health and Welfare to lead such a project. There are many recommendations as to whom should serve on the council to plan this project. However, let me tell the hon. the Minister—and this is not politics—that no measure of family planning and no Minister of Health and Welfare and no Director-General: Health and Welfare or council will succeed unless the people who are most involved in this population explosion are recognized and represented. I want to ask the hon. the Minister whether he has discussed this problem with the Ministers of Health of the self-governing homelands and the Ministers of Health of the national States and with the Black leaders. There is no chance of curbing this population explosion—and using words such as “excessive breeding” serves no purpose either—unless the Black community is involved and we can get their co-operation and their confidence. No planning in this Committee or elsewhere will succeed because of this.

I have received a memorandum from the Council of Family Planning and I have read it with interest. I think what they say should be taken note of because it is quite important. I do not say that they should be the people who should lead the way, but I sincerely want to ask the hon. the Minister to tell us today what his plans are in regard to his priority number one.

Over-population goes hand in hand with malnutrition. Increasing numbers of reports are being received of malnutrition, especially in the drought-stricken areas of South Africa. The hon. the Minister’s own Department has given statistics that one out of every three children living in South Africa and in the homelands under the age of 15 show signs of malnutrition. I would like to ask the hon. the Minister whether he has taken any steps to verify the accuracy of these reports, because I think it is very important.

May I make a request to the hon. member? Will he make the same statement that over-population goes hand in hand with malnutrition to The Star? I have been criticized for saying exactly the same.

I did not say it is the same problem. It is the same cycle.

I also said it was the same cycle.

I am not responsible to The Star.

I am not criticizing you.

Fine. I should like the hon. the Minister to tell us today if he has recognized this problem of malnutrition because it is stated in his own report of 1981 that one out of three children under 15 show these signs. There are 2,9 million children in South Africa and the hon. the Minister knows that those showing evidence of malnutrition are mostly Black. Secondly, in view of the existing drought conditions, are there any plans to relieve this problem? I believe that this is a problem that is vital, not only for the benefit of the children but it is also vital in the family planning programme.

Mr. Chairman, in the time at my disposal I am not going to try to reply to what the hon. member for Park-town said, except to associate myself with his congratulations to the hon. the Minister on his appointment to this very important post. I should also like to congratulate him on the way in which he is handling things. In the hon. the Minister of Health and Welfare I think we have someone who is, in a very balanced way, introducing order and stability into the overall health and welfare set-up. We also want to congratulate the new Director General of Health and Welfare—someone for whom we also have only the utmost respect and appreciation—on his appointment to that post, and I should like to wish him and his whole department everything of the best.

I should like to exchange a few ideas in this Committee this afternoon, placing particular emphasis on that facet of our health policy relating to the availability of medicines, something to which one could refer as health services in South Africa. I want to state, firstly, that the physical provision of medical care, including medicines and the costs involved in such medicines, is a matter that is continually receiving a great deal of attention, not only internationally, but also on the national level. If, for example, one looks at the situation in which the developed and underdeveloped countries find themselves—the countries of the First and Third World—one sees that the higher the per capita income, the more expensive the health services. On the other hand, the lower the per capita income, the lower the cost of the services, but that applies equally to the quality of the services available. What is more, taking the argument further and placing the emphasis on the infrastructure relating to health services in First and Third World countries, it is clear that there are two problems that tower head and shoulders above numerous others. It has specifically been the Western industrial countries which have, in the past decade, found that if they administered their health services on a socialized basis, they ended up in a bottomless pit from which there was no escape, because the costs involved in the health services got totally out of hand. I shall come back to that again in a moment. On the other hand, the countries of the Third World do not have the basic infrastructure to furnish the necessary health services. This afternoon I should also like to refer to an objective the World Health Organization has set itself—and I think one must accept the fact that their ideals and attitudes are very sound ones, though somewhat naïve—and that is, in accordance with the name of the scheme, to bring health to everyone by the year 2000. There is not, however, a single reference to the need for adequate health services anywhere in the world in order to achieve that ideal, and we therefore see that their endeavours are based on false suppositions. If we therefore look at the unrealistic policy of the WHO, we must ask—or else we cannot take them seriously—them to look at the basic infrastructure and the systems within which they wish to achieve their ideals.

In looking at the overall set-up, however, there is another matter which is a source of great concern to me. I have just referred to the cost of health care. In the past decade it has exceeded the inflation rate. That was the case throughout the world. Industrial countries in the Free World are wrestling with the problem of paying their health and welfare accounts. It gets more and more difficult as time goes by. Well, there is basically only two ways in which one can deal with the matter. Firstly one can emulate the French and increase taxation or, secondly, like the Germans, try to curtail expenditure in connection with these services. We know what the result is. If they increase taxes, it is the taxes on the luxuries they permit themselves that are increased. On the other hand, if expenditure is curtailed cutting costs, the quality of the available services must suffer as a result. There is another matter that is also very important, and that is that Governments, with the very best of intentions, have found that in this crisis situation in which they find themselves, they have never taken cognizance of the deceptive nature of social programmes. It is not possible to anticipate, 10 or 20 years in advance, what the socioeconomic position of the Western world or any other part of the world will be. This is one of the reasons why the fine socialization ideals of the post-World War II period led to nothing more than one of the biggest problems present-day health services have ever had to wrestle with. As far as socialization in South Africa is concerned, I think it only fitting to state categorically that in view of what we have seen in countries of the Western free world, for South Africa it would be an exercise in futility. We could not afford it, anyway, and cannot consider moving in that direction. Getting nearer home now, and speaking more specifically about South Africa, let me say that when one talks about health services and about policy, one must always bear in mind that in South Africa we have a two-world situation. There is a First-world component and a Third-world component: A developed country on the one hand an underdeveloped or developing country on the other. I am very glad that the Government has got round to appointing a commission of inquiry to carry out an in-depth investigation into the present-day situation in South Africa.

When do we get the answer?

We know that it is necessary to examine this matter plainly and simply because countries in the Free World have come up against these problems and because we can learn from their mistakes. In reply to the hon. member for Parktown’s question, let me just tell him to curb his feminine curiosity for a moment. The Minister will presently be making an announcement in this connection. If not today, then at a later stage. A second comment in regard to this commission is that a re-evaluation of our situation in South Africa is an urgent necessity. In particular I want to highlight three facets that are of cardinal importance. I am referring to the State’s role in this connection, the role of the private sector and the role of the individual. Reference has been made here to the very good progress that has been made in other spheres in South Africa. On the analogy of the Government’s new housing policy, in terms of which, as far as possible, every citizen is to be placed in a position to obtain his own home or accommodation, I want to use or apply the same guidelines in regard to health services in South Africa. This brings me immediately to the two conferences convened by the Prime Minister, the Carlton Conference and the Good Hope Conference. There the Prime Minister said, amongst other things—

It seems to me as if various people are viewing this policy or philosophy of the Prime Minister and the Government in different ways. [Time expired.]

Mr. Chairman, I rise merely to give the hon. member an opportunity to continue his speech.

My sincere thanks to the hon. Whip. It would appear to me that what this basically boils down to is that the Prime Minister has called upon the private sector, in regard to all facets of our health services, to allow the principle of the free-market mechanism to apply. In other words, anything that smacks of socialization is diametrically opposed to the basic economic policy of the Government. Seen against this background, this brings me to a few priority considerations for health services in South Africa. I want to request this Committee’s attention so as to look at a few of them. As a point of departure—and that is the password—we must tell ourselves and the members of the general public that health care is a privilege that one can lay claim to and not a right that everyone can or wants to lay claim to.

And if they pay for it…?

I shall come back to that later. If we look at the future, at the social development in South Africa, there are certain trends that give cause for great concern. I want to refer, in particular, to the tremendous population explosion that is taking place. I am not going to quote a lot of figures this afternoon to weary the spirit of members of this Committee. Looking at the situation of urbanization in South Africa, particularly amongst the Blacks, making certain projections for the year 1990 and the year 2000 and noting the percentage of the urban population that is Black, one realizes that there is a flashing red light that means we must give the matter urgent, in-depth and dramatic attention. I want to come back to the excellent report of the Scientific Committee of the President’s Council on demographic trends in South Africa. That committee also expresses its concern at the situation. In the health care field the report recommends that the service be decentralized in such a way as to effectively reach the masses. The Department has already begun working towards this, in contrast with the hospital-orientated or clinic-orientated approach. Here it is a matter of the extent to which one can increase a citizen’s socioeconomic living standards because this is the best, in fact the only, way of looking after his health and his development and dealing with other problems. The hon. member referred to the fiscal allocation to this department. If one looks at the Department as a whole, including pensions and all that entails, one finds it to rank second only to defence on the Government’s list of priorities. If one looks at the high priority that health care enjoys, one is forced to admit that this must consistently be viewed against the broader backdrop of external defence, internal security, the provision of infrastructure and development means to ensure the creation of job opportunities.

If I may be so bold, I want to mention a few matters here this afternoon which, I believe, must be given exceptionally high priority in the field we are discussing this afternoon. Firstly, the emphasis must be shifted from the curative aspect of health care to the preventative aspect. The Department of Health and welfare is engaged in dramatic campaigns which were started with the object of devoting attention to this priority. This brings me, secondly, to the cardinal question of whether the individual should not assume greater responsibility for his own health. There are so many people who think that it is the State’s responsibility to look after the health of everybody in South Africa. I want to refer you to the Kennedy policy of the State having to carry out this task “from the cradle to the grave”. That State, health services and all, would be dead and buried long before the patients were, because that is a policy that could never succeed. Because my time is limited, I also briefly want to advocate that attention be given to the concept of self-medication, i.e. responsible medication under sound control. Let me put it in the following terms: Logic and sound common sense indicate that when necessary people can take suitable steps to look after themselves. Not every trifling complaint or injury necessarily needs expensive professional medical care which is often also in short supply. By far the majority of conditions of that nature cure themselves, needing little more than symptomatic relief. As far as that is concerned I want to reiterate that this will not be allowed to take place without qualification. There is legislation in terms of which proper control can be exercised. It is, in the first place, a question of responsible education in regard to this concept.

My next priority involves the fact that with people receiving medical care and medicines from the State, we cannot in anyway go along with the fact that the State is in reality shouldering the burden of a large sector of the public who are in a position to pay for their own medical services. This is manifesting itself in an improper fashion.

The State also carries the medical aid funds.

Let me interrupt the hon. member for Parktown’s monologue by saying that a further priority is that the employer should also realize his own personal responsibility for the health care of his employees. The sixth item in my health-care priority survey involves the role of the participants in the health team, the fact being that we fully endorse the multi-disciplinary approach. As far as medical aid schemes are concerned, I ask myself whether they are flexible enough to meet the various requirements of the respective income groups in our economy. With reference to what I said a moment ago about the Carlton Conference and the Prime Minister’s standpoint, I wonder whether the Department is giving enough attention to the policy of regional development as opposed to that of centralization. Penultimately I again want to underline the fact that it is extremely important that the report of the Commission of Inquiry into Health Services in South Africa be made available as quickly as possible because I think it will also bring about a turning point in our entire future health policy. Within the limits of the 18 minutes at my disposal, I have briefly tried to place the emphasis on a possible policy for health care in South Africa. I have also tried to indicate a few priority areas that we should have a look at. I do not want to imply that these things are not receiving attention. I want to thank the hon. the Minister, who will have the answers to certain of the problems I set out, in advance, but I do think that if we in South Africa are not honest with ourselves about the services that are furnished, and are not prepared to look at the bottlenecks either, we will not be in a position to make the best health services available to the public.

I agree with the hon. member for Brits as regards his representations in connection with the dangers of socialism in medical services in South Africa. I feel that this is a source of great danger to that sector of our society. I shall return to other matters he mentioned in the course of my speech. I also want to associate myself with the two previous speakers by expressing my sincere congratulations to the hon. the Minister who is handling his first budget debate and also to the hon. the Deputy Minister. I hope that their work in the department will be to the benefit of the entire population. I also want to wish the new Director, Dr. Retief, everything of the best in his task in this department. While I am being congratulatory, I want to congratulate the hon. the Minister and the department most sincerely on the quality of the annual report we received. It has been well produced, it gives a good overall impression of what is going on in the department and one can ascertain from it exactly what the activities of the department are.

High ethical and moral codes have always been maintained throughout the entire spectrum of health services in South Africa. This has been the cases for decades from the private professional medical services to all the branches of both State and provincial health services. For that reason it is a pity that there are certain factors that harm this ethically correct image. I feel these matters should be rectified. I believe it is up to the hon. the Minister to make a major contribution in this connection. In the first place, as far as private medical services are concerned, I want to mention the fact that we have had problems since the ’sixties, for example in determining the tariffs of medical practitioners in private practice. After all these years it is still not functioning satisfactorily. It has a long history and time does not permit me to go into this matter now. In the process, however, the image of the profession generally has suffered. We cannot get away from that. It is unjustified, totally unjustified. It is a fact that all that most medical practitioners in South Africa expect is a reasonable return for honest, high quality medical services to the public of South Africa. There are exceptions, as is the case in every profession under the sun.

In the second place, there are allegations of irregularities in the State sector as far as State medicine tenders and other matters are concerned. An investigation is in progress in one of the provinces at the moment and I am not going to elaborate on this matter. I just want to express the hope that the hon. the Minister will not hesitate once the investigation has been completed to take the necessary corrective steps if there were irregularities. If this appears to have been the case, I hope that the hon. the Minister will order a country-wide investigation.

Allow me to say a few words about a Bill which the hon. the Minister piloted through Parliament recently for the discussion of which I could unfortunately not be present. It was the Human Tissue Bill. In connection with this Bill, the hon. the Minister was in complete agreement with the standpoint adopted on principle by this side of the House in connection with the transplantation of a human gamete. I want to quote from column 6430 of the Hansard report of the debate of 5 May—

One now asks oneself the question whether this was the Government’s argument in respect of other matters that conform with this one. An example of this is the prohibition of work on Sundays. When this was done away with, when organized sport was allowed, when the participation by a Springbok cricket team in matches on a Sunday was taken into virtually every home in South Africa by means of television, I want to ask: Did this happen because we felt that the others might need this and did we neglect to put our principles first in this process? The Governing party has just approved a new constitution for this country in principle. In it high priority has been given to Christian principles. That is correct. In the preamble, for example, the first aim is stated as being the maintenance of Christian and civilized values. However, I contend that if, as has been the case here, this is the way Christian values are dealt with, that specific sentence in the preamble is meaningless and worthless. I note that in his reply to the Second Reading debate, the hon. the Minister did not reply to the question of the member for Koedoespoort regarding the motivation for the clause providing for the importing and exporting of gametes. I want again to ask the Minister pertinently this afternoon why it is necessary to import gametes to this country from abroad. We want an answer. I simply cannot understand it.

When I consider this aspect of health in conjunction with item 5 of the explanatory memorandum on the Constitution which deals with health matters, I find that this matter falls under general affairs. A Coloured or Indian Minister can have a joint say in or ministerial control over this. That is the situation. I should like to ask the hon. the Minister whether this is so although he said during the debate that the Whites had to retain the balance of power in their hands at all costs. We on this side of the House say that this is totally unacceptable to the CP and I maintain it is also unacceptable to the vast majority of the White voters in South Africa.

I want now to return to the annual report. Chapter 7 deals with family planning. I must congratulate the department on the progress that has been made. The hon. member for Parktown gave the figures. Progress has been slow, but there has been progress. However, I want to ask the hon. the Minister what the birth figure of the White population is at present. Has this figure not already dropped to below the replacement figure or very close to it? I should like to know from the hon. the Minister what the official growth figure of the White population is. I should like to know whether the Government intends to do anything about this dangerous… [Interjections.] The hon. member for Brits referred to danger signals. I want to tell you this trend is even more dangerous. It is just as much of an imbalance as far as sound population growth is concerned. An important cause is probably socio-economic, namely the increasing love of ease and the materialism and so forth of our people. This is a fact. However, a very important factor is the increasingly fatalistic attitude of our young people in connection with the expectations for the future a nation can hold out to its children. If we in this country are going to find ourselves in a protracted power struggle situation in which a constitution with power-sharing and mixed government is going to be carried through in all its consequences, I predict that that low birth figure is going to drop even further. There is a danger that White civilization at the southern tip of Africa will die out because a nation that no longer sees a future for its children has become passive and no longer has the desire to survive. The CP’s attitude in this regard is quite clear. The party says that sound and balanced family growth should be actively promoted. This means that when there is an unhealthy and excessive population growth among population groups at present still under our control, they must be assisted, inter alia, by means of family planning to uplift themselves and thus assure their children of a decent existence. However, this also means that where there is an unhealthily low population growth, such is at present the case among the White population, the necessary corrective measures must be introduced. A very important measure is to give the children of your nation a vision for the future once again. That is the vision of freedom and a fatherland of their own with full authority and control over themselves. It is also necessary for us to consult the excellent table—I am glad the department drew it up—in Schedule 14 which sets out very clearly the situation in respect of abortions. [Time expired.]

Mr. Chairman, I should like to associate myself with previous hon. speakers in congratulating the hon. the Minister and the Director-General. I have pleasure in doing so particularly in view of the circumstances and in the light of where they come from. This is also a strong recommendation that they will be very successful in this undertaking as well. I am sorry that time is so limited that I cannot follow the hon. member for Pietersburg because I shall then not be able to put the case I should like to put. May I, however, say in just a few words that I think the hon. member for Pietersburg and his colleagues are being very successful in creating a feeling of pessimism and defeatism and creating a miserable future for the Whites of South Africa. They are creating a feeling of depression, of despondency… [Interjections.] In this process they are not doing their fellow Whites in South Africa a favour. On the contrary, these embittered and frustrated people are unfortunately no longer thinking rationally. This is the tragedy we are facing today in this country. They do not care what harm they cause in the process. You heard the hon. member start with health matters and then he went on to family planning and the like. He is aware of what is being done in this country as far as family planning is concerned. He is not ignorant of this. Now he wants to create the impression that this Government has absolutely no interest in family planning. How much money is not already being spend in this regard? We have to accept one thing: We can only expect a negative approach to any subject from the CP. This is unfortunately the case. It is tragic because they are our own people. What they helped to build up over the years they are now breaking down again just as quickly. I hope they will come to their senses in time because they are harming their fatherland and their own people. [Interjections.] Unfortunately I cannot spent any more time on this negative process.

I should like to discuss another matter briefly. The service rendered by the hon. the Minister and his Department is indispensable to this country. It is a service to the country in which every person in this country has an interest. [Interjections.] I hope the hon. member for Rissik is now going to relax a little. He becomes over-excited these days and it will not do his health any good. I want him to relax a little now so that I can finish. The Department’s whole programme and setup is aimed at promoting public welfare. I feel therefore that the Department merits the thanks and appreciation of all of us for the sustained way in which it carries out its task. As has already been pointed out, this is an expensive service. This is also reflected in the budget in the amounts provided for this service. I want to refer briefly to preventive health services. In my opinion this is one of the most important tasks of the Department. For that reason I want to single out certain aspects in this connection and bring them to the hon. the Minister’s attention. We know that he is a practical man and he will also understand the matters that are troubling me. The medical practitioners and health inspectors rendering this important service are attached to the Department of Health, as well as the local government bodies, the municipalities, of this country. Seven-eighths of the salaries of local government officials are subsidized by the department. At present there are 1 344 posts under the municipalities and the department has 181 posts for health officers. There are other State Departments and private undertakings that employ limited numbers of these officers, such as SATS, the mines and others. The services of these people cover a wide field but unfortunately time does not permit me to go into detail. What it amounts to basically, however, is that their task is aimed at preventing conditions arising that can lead to the spreading of disease. They ensure that food such as meat and milk is handled hygienically. This also applies to water supplied to towns and cities. They are also involved in immunization campaigns when epidemics break out. They also have many other duties which I do not have time to mention. I should like to point that the utilization of the services of these officers can definitely be improved by better co-ordination. If this can be done it will result in more manpower being saved in this process and the buildings, offices and clinics being used for this purpose being better utilized. The services of municipal officers are restricted to the areas of jurisdiction of those municipalities, and the officers of the State again function outside municipal areas. It frequently happens that a State inspector has to make an inspection for either a trading licence, a dairy or whatever it may be, and has sometimes to travel long distances to carry out such inspections. A great deal of time is occupied in travelling whereas his counterpart in the service of the local authority may be performing a similar service a few kilometres away. If the duties of the officers of these two bodies were coordinated, a great deal of manpower could be saved. I think it will be possible to do this if the necessary effort is made. I would even go as far as to say that if this could not be implemented successfully, the hon. the Minister could consider placing these officials under the control of one of these bodies, whether it be the Department of Health and Welfare or the local government body. However, I do not think that this dual system is in the interests of the country.

We are also all aware that in a region like the Free State in particular, the smaller town, which is where I come from, simply cannot obtain the services of a health inspector because it cannot afford to pay his salary. If therefore the services are rendered on a regional basis within a magisterial district, it will have the advantage that these smaller towns will also benefit from that system because those officers can then also serve them. The impression may perhaps be created that this is a more practical service which as such is not linked as intimately with the health of people, but I feel that if those health officers were not available we would probably be living under very unhealthy conditions in this country. That is why the task they perform is of great importance and I trust that the hon. the Minister and his department will go into this problem as well. We are living in a time of rationalization and the greater utilization of manpower and I feel that great progress can also be made in this way. [Time expired.]

Mr. Chairman, I see that the war is still on and I wonder whether I am safe in taking my tin hat off for now. At the outset I should like to congratulate the hon. Minister and the hon. Deputy Minister on their appointment and I should also like to congratulate Dr. Retief and just wish them a successful term of office, because I believe that if they are successful, they will make us all happy. To the officials in the department I should like to say how much I appreciate being received in the courteous way that they do receive me when I go and see them from time to time with various problems affecting my constituency. Then I should also like to thank them for their 1982 report which I believe is a very comprehensive one which has a tremendous amount of information.

Arising from this report are some questions I should like answered as well as clarity on certain other points. Firstly, I want to deal with Additional Investigations, and I quote from the Annual Report (page 5)—

There are three questions that I should like to ask in this regard. Firstly, has the investigation been completed? If not, when is it anticipated that it will be completed? Thirdly, will we have access to this report?

Under the heading Staff Administration it is said that recruitment has come to a standstill because of salaries. I also note in the explanatory memorandum there is a net amount of R52,5 million being allocated for salary improvements, including occupational differentiation. I should like to ask whether this really is going to ease the position. If one goes a little further through the Report, the position of staff is again highlighted on page 39, under the heading Inspection Services. I quote—

It goes on to say, and I further quote—

I believe this is a highly unsatisfactory state of affairs, because the health of the nation is involved. Surely Treasury must be made to see the serious implications of allowing this state of affairs to continue. Even if cuts are to be implemented in other areas, it is essential that health must be seen as a very high priority.

On page 16 reference is made to the typhoid outbreak at Weskoppies Hospital which resulted in the death of eight patients. I should like an explanation in this regard as to what were the circumstances of this outbreak and what were the direct consequences. Was there a dereliction of duty by anybody, because it seems strange that there is an outbreak like this in a hospital? Under the heading Air Pollution on page 33, reference is made to smoke pollution resulting from Black urbanization. This is rather alarming when one looks at this and one sees the implications. It says basically that the Black householders still prefer the old type of coal stove, because it acts as a heater in the winter months. However, it goes on to say, and I quote—

We have here a classic case of exploitation by certain business interests. Again we see the greed factor overriding all other considerations, including pollution and health. This is a situation which should not be allowed to continue and the Department of Trade and Commerce should be made aware of the situation and should act against these traders who are involved in the exploitation of those who are a little less privileged than ourselves. I would go further and suggest to the Press, who are the great protectors of the underprivileged, to seek out these traders and expose them for what they are: money grubbers, riding on the back of those who can ill afford it. No more, no less.

The additional allowance budgeted for the raising of income limits is to be welcomed. The raising of the income limit from R200 to R300 per person for the purpose of subsidy payments in respect of inmates of old age homes will greatly assist the homes, because they too are feeling the ravages of inflation just the same as everyone else.

I now come to the report that the Human Sciences Research Council is investigating. This deals with the placement in school hostels of children who are presumed to be in need of care. I quote—

I trust that these findings will be made available to us. It is quite clear that there is a definite resistance by certain rural parents to use the school hostels in that area for the simple reason that it is felt by parents and teachers, rightly or wrongly, that this practice has a detrimental effect on the rural child because of the environment in which the urban child is being brought up. Now he or she comes down to the rural areas. The same applies when the rural child goes to the urban hostel. This is very rife in my particular area. We have rural schools and we find that there are a lot of children coming from the urban areas, children who are supposed to have problems. I say that it is not the children who have the problems, but the parents. However, these children are nevertheless put into these hostels and this has created a certain amount of resentment among some of the people living in rural areas.

I now want to support the argument of the hon. member for Brits. I wish to address myself to the concern that has been expressed from many quarters in respect of the growing development in State health care which reflects a process of socialization. If allowed to continue it will in effect diminish the contribution made by the private sector when we should in fact be looking for a greater contribution from this area. At present the position is that 75% of all nurses, 54% of all medical practitioners, 10% of all dentists and 10% of all pharmacists are in the employ of the State. This current position, whether one admits it or not, is placing a tremendous financial burden on the State as well as aggravating the shortage of health personnel which in some areas is critical. If one looks at the tender system, 60% of the volume of medicines is dispensed by the State. It is a pretty large percentage. This without doubt erodes the viability of the pharmaceutical industry and what is more, puts the profession of the private pharmacy into jeopardy.

People in general seem to have a fixation that health is a human right. My belief is that this is a misconception, but because of the belief this is leading to socialization. I think it is about time people realized that health is an individual responsibility. This is a responsibility that we must start learning to accept, because if we do not, it is going to lead us to an ever increasing provision of health care through subsidized State institutions to an even larger number of people who are perfectly able to make adequate provision for themselves within the private sector system. However, having said that, let me hasten to say that there is a large percentage of our population who are at present unable to make these provisions. There are many who believe that the shift of State subsidy from institutions to indigent individuals would be a more cheaper and a more effective approach to solving the situation. [Time expired.]

Mr. Chairman, I am merely rising to afford the hon. member the opportunity to complete his speech.

I should like to thank the hon. member for his kindness. Nobody will argue that there is more merit in the attempt to decrease the number of indigents through economic development and job creation than to erode the incentive for individual advancement by subsidized provisions of services. One just has to look at America, West Germany and the Netherlands to see what socialization has cost them and what it has done to their budgets. I quote from Time Magazine of 22 November 1982 (page 55)—

It goes on to say—

I further quote—

Financially I believe that the Republic cannot continue to go along the road that we are going at the moment as far as socialization is concerned. In no ways can we afford it. We have to find alternates or else the whole system will face collapse, purely on economic factors. Nothing else. One only has to look at the consequence of population growths, modernization, future industrialization, rapid urbanization, reform in the fields of labour, education and constitutional dispensations. Taking all these factors into account, the projected demand for health services will grow threefold in the next 10 years and sevenfold in the next 20 years. Those are the demands. When one looks at the other demand areas such as housing, education, defence and transport, just to name a few, which are already placing strains on the fiscus and ultimately, as a result, curtail finance in other areas, which includes health care, it proves my point. I have just referred to the report, and that confirms it.

I ask the question whether the State can be expected to meet the demand explosion which is taking place. I believe it cannot. I utter a note of warning, because if we continue on our present course the position will be aggravated and we can then expect social and political repercussions, something which we can ill afford in this country at the moment, something I do not think anybody wishes to see. The private sector must realize that it must play its part. It has an important contribution to make in the rising demand for health care. Housing, employment, provision of safe drinking water, education and sanitation are vital areas where they can make a contribution. The industrial and commercial sectors are great on making money. That is the name of the game, increasing profits. I therefore believe that it is incumbent on them, in fact it is their responsibility, to invest in the future and to play their role in this regard. Taking into account future demands under prevailing circumstances we must ask ourselves what is going to be the more competitive: State health provision or that provided for by the private sector. One cannot ignore the economic facts of life. International evidence points to the fact that health provision provided for by the State is more expensive per unit of output and this only takes into account direct costs via State health budgets and it excludes other costs incurred by other departments at other levels of government. I want to make it quite clear that I am not criticizing the department. On the contrary, I have the highest regard for what they are doing and what they are achieving. However, I am looking at it purely from a factual economic position.

How are we to remedy the status quo? What are the solutions? I would venture to say that there are no easy solutions, but I should just like to offer one or two. I believe that the public sector and the private sector must be pulled together in a new spirit of cooperation to find an equitable solution based on the free market principle. Here I support the hon. the Member for Brits, because I think he was saying exactly the same thing. In my opinion we have to have a look at medical care or medical insurance cover for everybody. Once that is done, I believe that a shift can take place from the institution to the individual. The pharmacy should become a place where a pharmacist derives his income from professional services for which they were trained. They are highly trained people. It should not be conducted as a straight trading concern. I should like to go into this more fully, but time precludes me. I am running out of time.

The last point I should like to raise with the hon. Minister is Black hospitalization in Natal. I should like to take this opportunity of thanking the hon. the Minister for announcing that at long last we have the green light for the teaching hospital in Natal at a cost of approximately R90 million. However, I should like to ask him when this will be put on the estimates. When is it envisaged that it will be finished? Lastly, I want to ask him just to realize that we in Natal would also like facilities for training Whites as well as non-Whites. The other point which I should like to draw to the hon. the Minister’s attention is the position of foreign and homeland Blacks being treated in the Natal hospitals. It is not necessary for me to discuss the King Edward VIII hospital. The hon. the Minister is, I am sure, fully aware of the position there. However, I should just like to bring a few figures to his attention, arising from the treatment of foreign and homeland Blacks. In 1982 King Edward VIII Hospital had a bed occupancy of 93,3%. I think that 75% to 80% is considered reasonably good. The total number of admitted patients was 78 400 of which 49 500 were homeland Blacks, which is 63%. The number of outpatients treated was 765 000 of which 442 000 were homeland Blacks, which is 57,7%. All I am saying is that according to my figures the cost of servicing those foreign and homeland Blacks is approximately R45 million. The estimated advance from Treasury is as follows: Full cost of foreign Blacks in teaching hospitals, R28 million; allowances for patients ex-Transkei, R1,24 million; allowance for patients ex-kwaZulu, R9,62 million. This makes a total of R38,8 million leaving a shortfall of R6 million approximately which the province has to fund from the budget it receives from the State. My appeal to the hon. the Minister is to consult with Treasury in order to assist the Province with a larger grant to enable them to continue to provide treatment for our neighbours. I am not complaining and the Province is not complaining about having to provide that service. They do it willingly and they do it with dedication. However, it costs money and I am appealing to the hon. the Minister to see if he can allocate a little more funds to allow Natal to provide this very necessary service for our neighbours in the adjoining state.

Mr. Chairman, I find it strange that someone like the hon. member for Parktown has such a short memory. It seems to me he has completely forgotten the beating he was given by the previous hon. Minister of Health last year.

I did not forget because I did not get it.

Now he comes along with the same nonsense and he will get a beating from this hon. Minister as well in the course of this debate. I do not actually feel like reacting to the hon. member for Pietersburg. In any case the hon. member has left. The hon. member for Rissik need not worry; we know what the rules of the House are. However, this was a clear example of what we saw in Waterberg. They start sanctimoniously and then they proceed with their smear tactics. Then they walk out.

They learnt it from you! [Interjections.]

Tomorrow hon. members can read what he said in the Assembly where he will probably participate in the debate on the Defence Vote. However, I have nothing further to say about him. The hon. the Minister will also make short work of him.

I should like this afternoon to raise a matter in this Committee in connection with something which troubles me greatly and which far too regularly leads to an unpleasant debate, particularly in the media. This happens almost as regularly as Northern Transvaal snatches the Currie Cup from under Western Province’s nose. [Interjections.] The matter I want to touch on concerns reporting on medical matters in general and medical and dental tariffs in particular. The second point is one I want to make to the hon. the Minister, namely the fixing of tariffs for medical and dental services.

In the first place I want to ask whether it is necessary and whether there is a good reason for the media to descend on the medical profession with such bloodthirsty delight when something happens in its ranks. If it is right and proper, they are entitled to report specifically on it, but there should not be any suggestion of something supposedly being wrong. Then they seize on this and blow it up. If it deals with members of the medical profession who are exploiters or who are guilty of improper practices, the media are entitled to write them out of the profession. However, there are a few points I want to make to put this matter in perspective. We realize that medical care is very expensive and that we also have to accept that it will become increasingly more expensive in the future. The second point I want to make is that the workload on the shoulders of the doctor is enormous. There are many people who need help and there is no substitute for a doctor. He is not like an architect, for example, who can tell the draughtsman to carry on with the work on the drawing board while he is out of the office. In addition to being a comforter of the sick, he is frequently also a peacemaker and marriage counsellor, a spiritual comforter and much more besides. I also want to make the point that I am very satisfied with the ethical standards of the medical profession and also obviously, as the outside world acknowledges, with the standard of the medical services rendered which is of world quality. However, there is one point I feel everyone who wants to comment on medical matters should bear in mind. A doctor is also a human being with his own interests and family interests. However, there are people who think that a doctor is a national possession and, as such, is there for their benefit only. I think it is important to remember that a doctor also has his own interests and his family interests to see to.

The last point I want to make is that in a report which was published not very long ago the HSRC pointed out that the profitability of the medical profession is judged completely incorrectly. Having said these things, I want to ask the hon. the Minister why the medical and dental professions are singled out when tariffs are to be determined for services rendered and are treated differently to other professions in that those specific professions decide for themselves upon the tariffs and fees they are to levy. Why this anomaly? I think that with the advent of medical funds, the picture changed radically as far as the medical profession was concerned. At that stage good reasons were given for the establishment of a remuneration commission under the chairmanship of a judge which had to make certain rulings in connection with tariffs and also approve them. In 1978 those functions were transferred to the South African Medical and Dental Council, and in 1980 an amendment was effected that the recommended tariffs of fees had to be approved by the hon. the Minister.

I maintain that during that time something happened. Something happened to the medical profession. It was that the position of trust between doctor and patient suffered because part of that position was that they could negotiate the fee for the specific service to be rendered in the consulting room. The patient trusted the doctor to give him the best service. The doctor trusted the patient to pay him his fee. People are asking what has become of the family doctor of old. I do not think he disappeared from the family scene because he priced himself out of the market. I do not believe that there is no longer such a person as a family doctor and that he has disappeared because patients no longer feel the need for such a service in the community. I repeat, and I do so very responsibly, that as a result of reports in the media in this connection, matters have been blown up out of all proportion and some of these family doctors have been written out of that career or profession or idea. I appeal to the media to report fairly about matters affecting doctors and to understand the position of the doctor. I ask the hon. the Minister that we reconsider the policy in respect of the determining of tariffs. Cannot we reconsider the possibility of allowing the doctor, through his representative body, to handle once again the determination and fixing and eventual approval of his own tariffs, and then to negotiate with the medical aid funds without the intervention of the hon. the Minister? The Government has to protect its citizens, and here I am thinking of the patients, but the Government can also trust its citizens, and now I am referring to the doctors. I believe that the members of the medical profession are responsible enough and have sufficient integrity when they determine fees for services rendered to make a reasonable request. After all, if there is a dispute, there are ways of settling it. It can be submitted to the Medical Council in the form of a complaint or, if necessary, an appeal may be made to the hon. the Minister. With these few remarks I want to put in a good word for the doctor and ask the hon. the Minister kindly to reply.

Mr. Chairman, the hon. members on this side of the House will agree with many of the sentiments expressed by the hon. member for Rustenburg relating to action that has to be taken to see to it that the medical profession is restored to the status which it deserves in order to provide the service which the country needs from it.

I would like to deal with a matter which was touched on by the hon. member for Park-town and that is the very urgent problem facing South Africa with regard to the uncontrolled population explosion and the consequences of that phenomenon for our society. The other day I listened to a low-key news item. The news-reader said that by November, unless rains fall in the catchment area of the Vaal Dam, that dam would run dry. He left it at that. If one looks at the consequences of such a situation it would mean the collapse of the economy and the social fabric of the biggest metropolitan area in South Africa and one of the biggest in the world. It would mean that overnight the hub of South Africa’s industry and commerce would grind to a halt. One million people would suddenly find themselves without employment and without income and over three million people would overnight be without water, without food, without light, without any hope whatsoever. The consequences of that would be absolutely disastrous. It would be a catastrophe of tremendous proportions. That is just one of the signals of danger which I believe our planners should take into consideration in respect of a number of fields but also in respect of the field of population control in South Africa. It points to a lack of appreciation of the compelling realities of our country. A lack of timeous intelligent planning and also a lack of effective action which should be taken not only by the authorities, but primarily by the authorities and all other associated bodies. I would like to mention a few factors which have been brought to the fore recently.

The hon. the Minister of Finance very recently said, when he spoke before a prestige audience of businessmen, that by the year 2000 an additional 20 million Black people would join the urban population from the rural areas and from the homelands. The President’s Council in their scientific report said that from 1980 to the year 2050 the urban population of South Africa would increase from 14 million people to between 70 million and 109 million people, depending on whether one takes the pessimistic or the optimistic prediction. I think that in view of the figures that have been published the Government is called upon to make an urgent reassessment of the ability of our country with its existing resources to accommodate such a population. I think that when we said that it is possible to accommodate that population we said so at a time when we did not fully understand the constraints which exist with regard to South Africa’s resources. I do not think that the country has looked realistically at the constraints on our resources, the limits of our resources. I believe that the present crises which are bearing down upon us and which are of a twofold nature—the uncontrolled explosion of our population on the one hand and the tremendous strain which they are placing on our resources of water, food, housing and education on the other hand—need to be restudied. We need to re-establish whether we, in fact, are going to be able to accommodate the situation or whether we are heading for an unbelievable catastrophe.

Let us have a look at water. According to the latest report our available water resources will not be able to support a population of more than approximately 80 million. I wonder whether that figure is not far too high. I wonder whether with that figure the sort of crises which are brought about by droughts such as we are experiencing at the moment is taken into consideration. If one looks at the situation in South Africa with a population of 28 million under drought conditions—and nobody can say that we will not experience similar conditions in the future—South Africa is severely stretched to be able to meet the requirements of our 28 million people in terms of the water resources that exist in 1983 under these conditions. Yet our planners believe that we can accommodate 80 million people. I wonder whether that is a realistic figure and whether we should not look at it from two points of view. Is it correct and should not drastic action be taken in terms of population control?

If one looks in terms of land one sees that only 12% of South Africa’s total land area of 122 111 million hectares is arable. We have a small percentage of arable land compared to for example the European countries. The total area of towns, cities, roads, railroads, airports and nature reserves in South Africa is 34,316 million hectares which is three times the total area of arable land in South Africa of 10,607 million hectares. It is an alarming figure. It is alarming that our cities, roads and railroads, our infrastructure, in fact, already occupy three times as much land as the arable land of our country. Arable land is the land which feeds your nation. If one does not have the necessary arable land and the water required, one cannot feed a greater number of people. We can become a country which has to import food and we, in fact, then join virtually all the other countries in the world, with the exception of seven of which South Africa is at the moment one, which can feed themselves.

Then there is the economy. Mr. McNamara, President of the World Bank, said that the greatest single obstacle to growth in the developing world is their uncontrolled population explosion. Every single effort, based on the pumping in of vast quantities of money in the form of aid, is undermined and destroyed, because no sooner has the standard of living of a community been improved by the creation of jobs, by the improvement of the infrastructure, than the per capita availability of income is undermined by the increase of the population. This has resulted in socio-economic catastrophe staring the people of the Third World in the face.

I would like to mention a few other facts. In South Africa, if you take 1981 costs, and compare the years 2020 to 2050: Education will cost R2 000 million per annum in 2020 and R8 470 million per annum in the year 2050. The cost of health will increase from R670 million per annum to R2 800 million per annum and the cost of housing will increase from R780 million per annum to R1 960 million per annum. Can South Africa afford those expenditures in terms of the increasing population in our country? Is it not absolutely essential that, in order to give a better standard of living, a better quality of life, better education, better housing, and to have healthier and happier people, steps are taken to see to it that there are fewer people? As far as jobs are concerned, we will have to provide jobs for 290 000 people per annum between 1981 and 1985. It cannot be done even if we can achieve a growth rate of 4,5% per annum; it is not possible.

I do not have the time to expand on what has to be done. I simply want to say that all of us, the Government and the entire society, should recognize this as an extremely serious problem facing us which can destroy all prospects of peace, stability and progress for our country and our nation. All of us are called upon to approach this problem as a matter of the highest priority and to contribute to the solution of the problem all the talent and effort that we can possibly muster. I would like to call upon the Government to immediately set about formulating a national population programme and forming the Population Planning Council which was recommended recently by the President’s Council to handle this matter.

Mr. Chairman, this afternoon I was dumbfounded to hear the hon. member for Bryanston making such a constructive contribution. I do not think this side of the House, or anyone in this Committee, disagrees about any single matter he mentioned. He called upon the Government to take drastic steps to combat this very real problem of a too rapid population growth. In South Africa, however, the Government actually has a problem. This question of population growth is a very delicate one because of the fact that in South Africa this whole matter has already been politicized. When the Government—and a certain connotation attaches to the Government of the day, particularly amongst the Black people—takes steps to initiate a positive family planning programme, it is suspected of actually playing a finely orchestrated political game. I think the Black population groups harbour such ideas because certain political parties, of which the hon. member for Bryanston is also a member, consistently proclaim, day in and day out, that there are actually injustices being committed against the Black people. That is why they are sceptical about any efforts made by the Government. My plea is that when this subject comes up for discussion, it should not be politicized. I want to give you an example of politicizing. Towards the end of last year an article appeared in The African Communist under the following headline: “Family Planning in South Africa—a Kind of Genocide”. The article reads as follows—

I am just mentioning this as an example of how, in those circles, efforts are being made to wreck this programme which the Government has initiated. I do not think that we in South Africa should adopt the course they have adopted.

I want to link up with the subject raised by the hon. member for Bryanston. South Africa is a country of complex problems, yet also a country presenting great challenges. I think that one of the reasons for the complexity of these problems is specifically the fact that two worlds meet in South Africa, the First World and the Third World. It is an unfortunate fact that the First World is faced with its own unique problems demanding unique solutions, whilst the Third World is faced with other problems demanding other solutions. Any effort at offering similar solutions is not, as far as I am concerned, a viable proposition in the South African context. An example of what I have just said is, I think, this question of population growth on the one hand and the reduction in the population growth on the other.

First World countries, of which the White section of the South African nation is chiefly an extension are, on a world-wide scale, wrestling with the problem of a reduction in population growth. A sharply declining birthrate in Western Europe is a cause for concern amongst social planners and political leaders. Countries such as West Germany, Belguim, Sweden and Britain are concerned at the dwindling domestic market for their industrial products. Allow me to quote a few figures. In the year 1800 Europe accounted for 20% of the world’s population. At present the figure is 9% and it is estimated that in the year 2075 the figure will be 4%. In this connection a Belgian professor remarked that a decrease in population was a sign of a declining civilization. I am strongly reminded of Oswald Spengler’s prediction, at the beginning of this century, about “Der Untergang des Abendlandes”. It is therefore obvious—and I think the obligation lies with these countries of Western Europe and of the First World—to at least attempt to keep their birth rate or population growth figure at 2,1 per family, the intention being to counterbalance those in the population who are dying off. I think the obligation lies with the country’s of the First World. In one and the same breath I want to say—and I said initially that this matter should not be politicized—that I think it is the duty of the Whites in South Africa to endeavour to achieve a population growth rate of 2,1 in order to offset the figure of those in the population who are dying off. I do not think anyone needs to argue that point. I think we must also meet our responsibilities in this connection.

Compared with this, Third World countries have a completely different problem. They are faced with rapid population growth or a population explosion. 70% of the present world population, about 2 800 million people, are found in the Third World. This 70% are responsible for 85% of the population growth. This applies equally to the population groups in Southern Africa. In 1980 the population figure for the Black peoples was 21 million. It is calculated that in the 22nd century the population will be 4 554 million. This is more than the present total world population. We know what the consequences are—starvation, slums, disease and illiteracy. It is a fact, too, that in Third World countries the number of slums doubles every five to seven years, and we in South Africa see this each and every day. I think that the extensions of the Third World in Southern Africa also have a responsibility in regard to this matter. In the first place these countries will greatly have to improve their environmental infrastructure so as to be able to accommodate their people. The population explosion can also be counteracted by drastically improving the socioeconomic position of these people. I think the Government is doing so. The problem, however, is that whenever attempts are made to improve the socio-economic conditions of Black people, there are people from other political parties who accuse the Government of summarily giving away everything to the Black people. I think that in this matter we have an obligation towards all the population groups in Southern Africa. I think that another solution would be for all these leaders to take the initiative and see the figure of 2,1 as a realistic figure for population growth. I want to reiterate that this is not a question of politics, but here a party such as the PFP can also play a leading role in conveying this message to Black community leaders.

Stop discriminating!

Mr. Chairman, this is not a question of discrimination. This is a problem affecting everyone. [Time expired.]

Mr. Chairman, I listened with much interest to what the hon. member for Randfontein had to say and I certainly agree with one thing that he said, namely that the only real way in which one will be able to reduce the increase in the Black population is to raise the standard of living of those people. Socio-economic methods have been shown throughout the world to be the main way in which to regulate the population growth of different races. But it is no good for him to tell us that we must not make this a political issue when he straightaway does it himself. The very fact that he appeals to Whites to raise the annual increase in population to 2,1 and then tells us that we must go out and tell the leaders of the Black people that they must reduce their increase in population, immediately puts it on a racist basis. A far better way of doing it would be to say that the whole population of South Africa, irrespective of race, should attempt to keep down population growth and leave it at that. [Interjections.] No, but the hon. member did not say that. He appeals to Whites to raise the increase in population and to Blacks to lower the growth in population. He will never get a response from Blacks in that way. It immediately politicizes the whole question. We must talk about it entirely in the way in which the hon. member for Randburg did and that is that one has to match population growth with economic growth and the ability of one’s country to feed itself; otherwise one will get nowhere.

Now, I want to talk about another question which is related to population growth and I want to make it quite clear that I am not advancing this as an alternative to family planning. I wish to discuss the question of abortion. I have raised this several times before in the House and I want again to make it clear that I do this on my own behalf. There is no party policy on this issue. This is a matter which is left to the free vote of our party and to everybody’s individual conscience because it is very much a religious and social affair. The hon. the Minister, it so happens, was the Minister of Health and Welfare when I raised this in the House last year when we had an amendment to the Abortion and Sterilization Act and when I tried to move an instruction in the House and failed. I have since then been putting questions to the hon. the Minister in order to be able to elicit his response to the request by numerous women’s organizations for a commission of inquiry into the workings of the Abortion and Sterilization Act of 1975. That Act was passed eight years ago. We have now had ample opportunity to study the statistics that have emerged as a result of the working of the Act and I think the hon. the Minister should now really give consideration to the appointment of such a commission, an independent commission, headed by a judge and containing amongst its members women—unlike the first commission of inquiry into abortion in this country which did not have a single woman on it—of all races, because this is a matter which affects all races in South Africa. I was upset to see that on the 20th April this year, in reply to a question, the hon. the Minister told us that he had indeed had further requests from organizations over and above the ones that he had received from women’s organizations in 1981. He had received requests from the South African Association of University Women, Durban Branch; Professor Shaw of the Department of Social Studies, University of Natal; Seroptimists; the Garment Worker’s Union; Stanger and Indian Child Welfare Society; the Federation of Women’s Institutes, Pietermaritzburg; and the Afrikaanse Christelike Vrouevereniging. All those organizations have added their plea to the existing ones that the hon. the Minister has had. They included the Women’s Legal Status Committee, the National Council of Women, the Abortion Reform League, and the South African Association of University Women. All of these organizations have asked in the past for a commission of inquiry. I cannot see what the hon. the Minister has against that. He says that they have not motivated their reasons. All of them have sent in memoranda. All gave reasons for their requesting a commission. He said that the Department is not aware of any problems that necessitate such an investigation. I would like to give the hon. the Minister some figures which, perhaps, may change his mind and that of officials of the Department. The figures from the reports of the Department reveal that there were 347 legal abortions in 1980, 381 legal abortions in 1981 and 464 legal abortions in 1982. As far as incomplete and septic miscarriages are concerned, I think the doctors in this House will admit that a high percentage of incomplete and septic miscarriages are either as a result of self-induced abortions or illegal or back street abortions…

Not necessarily.

Not necessarily, but a high proportion of them are. There were 30 000 in 1980, just about 33 000 in 1981 and this year’s report reveals that there were 33 421 incomplete and septic miscarriages in 1982. Those miscarriages can result in a serious and permanent damage to the health of the women concerned. And it can also result in death. I believe that backstreet abortionists are doing a roaring trade in South Africa as a result of the stringent provisions of the Act of 1975, which makes it so difficult to get legal abortions in this country. It is very interesting to note what is said in a document that I have which is from the Office of Population Census and Surveys of the United Kingdom’s Government Statistical Service. It says—

In other words, there were more women from South Africa obtaining legal abortions in the United Kingdom than there were South African women able to obtain legal abortions in this country. What does this mean? It means that rich women, who want abortions, can fly overseas and have abortions without any difficulty whatsoever. However, poorer women have to go either to backstreet abortionists or they induce abortions themselves, with the grave consequences that follow.

Mr. Chairman, we need an inquiry as to why we should have such a stringent provision. This provision includes the phrase saying that a continued pregnancy would do permanent damage to the women’s mental health. It is very difficult to get a doctor to sign such a certificate. One of the two doctors has to be a psychiatrist in government employ. It is very difficult. However, it is interesting to note that the official Annual Report makes no mention about “permanent damage”. Section 3(l)(b) in Annexure 14 simply says—

I would be very happy if that were left as one of the stipulations for obtaining a legal abortion—just “a serious threat to the mental health”, instead of “permanent damage”, because that is the operative phrase that stops it.

I want special consideration to be given to women over the age of 40 and to those who have already had a large number of children and do not want any more, as well as to girls under the age of 16. I have asked for this over and over again. And of course, I want more sympathetic treatment of the victims of rape cases who become pregnant. I know that it is possible to get an abortion if the pregnancy is a result of rape, but it is such a long drawn-out and difficult procedure that generally by the time these young women—I have the figures here—have gone through all this, it is too late for them to have an abortion and then they have to go through with the pregnancy. I think that requires revision and the only way we can do this, as this is a conservative country with conservative views, is at least to have an inquiry which will lend respectability to the whole question of changing the abortion laws.

Mr. Chairman, while I am talking of rape, it is interesting to note that 15 000 women report every year that they have been raped. Heaven only knows how many thousands more do not report it, because there are very humiliating procedures which have to be carried out. I know that these are now being examined by the Law Commission and I am very glad of that, more particularly because an excellent woman has been put on the Law Commission for that purpose. She is Professor June Sinclair, the professor of Family Law at the Witwatersrand University. Although 15 000 women did report rape, only 35, 27 and 24 legal abortions were performed on the grounds of rape or incest in 1979, 1980 and 1981 respectively. Something is wrong somewhere and I think we need an inquiry into this as well. [Time expired.]

Mr. Chairman, thank you very much for the opportunity. I should like to begin with the hon. member for Houghton, who has just resumed her seat. I have a great deal of sympathy for that hon. member because I know that she is fighting a lone battle on this matter in this House. [Interjections.]

No, I support her entirely.

All right, but she started off by saying that that was her personal opinion and that she was not talking on behalf of her Party. Therefore, I am entitled to gather from that that she is alone. [Interjections.] All right, let us just leave it at that. Let us not argue, but that is not an unnecessary argument.

You are on the wrong premise.

All right, that is an unnecessary argument.

Irrelevant.

All right, irrelevant.

Well, then drop it.

Mr. Chairman, the position is this: That hon. member is not talking to an unenlightened person. I had the privilege of being the chairman of the commission that brought this piece of legislation before Parliament. We had discussions, we invited evidence from all over South Africa, from everybody that wanted to give evidence, and there were very, very few organizations asking that abortions be liberalized. Most of the evidence that was given before this commission, asked for much more stringent legislation on abortions than what we have here.

How about humanizing it?

You can humanize it. This is what South Africans want. I can say to the hon. member for Parktown that this proposed legislation was brought before Parliament almost exactly in the terms that the Gynaecological Society of South Africa wanted it.

They have changed their minds.

They are mostly men.

It does not matter. They are the people who are most intimately involved with these things.

That was eight years ago.

All right, it was eight years ago, but I have not received any report from them.

There was a conference on this which was held at Stellenbosch about two years ago. Did the hon. the Minister not see the results of this conference? There is a completely new attitude.

We have not been approached by the Gynaecological Society or any gynaecologists to amend the Act. Not at all.

I shall send you the report.

Yes, you can send me their report. As far as we are concerned, it works very well. That hon. member said in her summary that so many rape cases were reported, but only a few legal abortions were done. Not all women that are raped, become pregnant.

Of course not.

Of course not. So it is just impossible to make a comparison like that.

It is significant.

No, it is not significant. It is not comparable at all.

What about the other figures I have given?

We realize what those figures mean, but there is another point to this question as well. We prefer that women should decide what they want to do. What we are arguing about, is the time they should decide about it.

The hon. the Minister should not come with that argument again.

Yes. We are providing all the facilities.

It has been unsuccessful all over the world.

All right, it has been unsuccessful all over the world, but does that hon. member call the abortion laws of Britain successful? Does that hon. member, as a medical doctor, want to tell me that that is successful?

I would think so.

I think that hon. member should be ashamed of himself. [Interjections.]

Let the women decide.

Order!

How many septic cases were there in Britain?

I do not know and you do not know either. Of course it will be less.

That means that it is successful.

On the other hand, Britain does not have any Third World people. That is a very significant aspect as regards this.

I do not understand it. The hon. the Minister should explain himself.

That hon. member would not understand it.

*Mr. Chairman, if the people who read the Act now wish to point out to the doctors what the cause of septic abortions is, we shall simply have to look into the matter further. At the time, when I was Chairman of this commission, I received very serious representations from the Nursing Association of South Africa. Those hon. members will not be able to tell me that there was a more prominent group of women, who work with these things every day, who expressed an opinion on the matter. The Nursing Association is not in favour of the kind of proposals those hon. members are making here. No, I adhere to the reply I have given. I cannot see any reason at all why the department should at this stage appoint a further commission of inquiry into this Abortion and Sterilization Act.

A few amendments have been effected in respect of administrative matters. These we have rectified, but I think the principle is accepted by the medical practitioners of South Africa. It is accepted by the nurses of South Africa and it is accepted by most of the people in South Africa who are concerned about the morals of the entire South African population, and here I include all the various peoples and race groups.

Mr. Chairman, I want to go further and react to the speeches made by the hon. members for Parktown, Pietersburg, South Coast, Bryanston and Randfontein. These hon. members all spoke about the population explosion. The hon. members will allow me to speak in general about this matter, and not reply to each member individually. I want to give the hon. member for Bryanston some sound advice. I want to tell him that he is far more effective when he uses his intellect, instead of trying to be funny. He made a good speech, and I want to congratulate him on it. In addition I want to thank hon. members very much for the support I received. I shall try to deal with the points which they mentioned.

As far as the hon. member for Pietersburg is concerned—I see that he has left the Committee again—I just want to say this: The hon. member for Koedoespoort will know that he and I have ironed out our problems. We do not need the intervention of the hon. member for Pietersburg to bedevil them further. As for the rest of his speech, I want to say that I do not think it is necessary, in a debate on this Vote, to reply to that kind of drivel. I shall forget about it.

Mr. Chairman, I now wish to refer to the question of population planning, the population explosion and the dangers threatening us. The hon. member for Parktown began by saying that I had said in a previous debate that I considered this to be priority number one. I say again: Yes, this is a fact. To point out what a small amount of money we are spending on this aspect—approximately R31 million in comparison with R3 000 million—is not right. Priorities are not determined by the amount of money spent. The fact of this matter is that if we need more for this programme, we can get it. The problem is to find the people who have to work with it.

I should like to give the hon. members a few figures. The Department already has in the region of 2 000 workers—I am simply giving the round figures—at work on this programme. These are nurses, medical practitioners and other trained persons. A total of 26 000 service centres have already been established where people can be provided with advice, where they can receive help and the necessary preparations and treatment. This year we are trying to increase the figure to 27 000. In this process there are approximately 1 100 800 women of childbearing age who are being protected. This is approximately 41% of the fertile women of South Africa. The hon. members will agree with me that this figure is too low, but it is nevertheless a formidable number that have already been reached. There is no doubt that we have to expand and that we have to continue. I want to say this: I do not know of one hon. member who has sounded a discordant note in this connection, except for the despicable speech made by the hon. member for Pietersburg. Apart from him, I do not know of any other, and I am grateful for that. If there is one area in which we need one another’s help, it is this area.

†Mr. Chairman, we need one another’s help in every respect. I have no illusions. The hon. member for Houghton has influence with people which I do not have. The hon. member for Parktown has his influence and so have all the others.

*That is why it is necessary for us to support one another in this respect. I should like to show hon. members what the Department is trying to do. Mr. Chairman, hon. members will be astounded to see, inter alia, from what quarters we receive assistance. I cannot start mentioning names here. I should like to mention these names to the hon. member, but they will understand why I cannot do so. It is because I realize only to well the danger of this entire situation becoming politicized. That is why I agree with the warning which the hon. member for Houghton issued to the hon. member for Randfontein. However, I think that she simply misunderstood the hon. member for Randfontein. I think we are all pleading for a family figure of approximately 2,1 per family. Then we arrive at a manageable population figure.

It will not be interpreted like that.

Well, somebody has to say what figure we are aiming at. This is just a figure we are aiming at. We are not propagating that. We have appointed a very eminent public relations company to try and do this propaganda for us. I now invite hon. members, if they want to accompany me next Friday, to see what some of these films, that we have made, look like. They can have a look at some of our suggestions and how we intend propagating these things. We will let those hon. members know and we will let them have more information as soon as possible. I cannot give the time now, but hon. members must remember that it is Friday morning next week.

*Mr. Chairman, this is a very serious effort. I think the hon. member for Bryanston said that we must have a population policy. We have not publicized it, but we are working on it very earnestly. In fact, the hon. the Prime Minister instructed the Department of Health to co-ordinate this entire programme. We are in the process of forming a unit within the Department for the specific purpose of organizing this programme and co-ordinating it with all the other departments. That is why I say again—and I stand by every word I said in the previous debate—that I think there is only one way to do truly uplifting work among people and that is by using members of their own group for that purpose. One has to identify the leaders of every individual organization and then you have to persuade them to help to uplift and develop their own people. I know housing and other matters play a part, but that is not the whole answer. What we are dealing with here is self-upliftment, the identification of leadership qualities and the identification of potential educational qualities among those people, to help them to help themselves. Perhaps hon. members saw on television that we have succeeded, in conjunction with the South African Agricultural Union, in starting a rural development programme here in the Boland. A utility company was established in which most of the prominent farmers in the Boland serve and are actively engaged in launching a development programme to uplift their own farm labourers. These people realize that are economic benefits for them if they help to give their farm labourers a measure of training, upliftment and community life. I repeat: These are among the most prominent farmers in the area. The chairman of the company is Mr. Frans Malan of Simonsig. Then there is Jan-Boland Coetzee, Mr. Nico Coetzee, the President of the Transvaal Agricultural Union, and also someone from our Department, Dr. Jan Rossouw, who has been charged with family planning. These are the people who serve on the Board of Directors. During the course of next year they plan to establish another 20 similar associations among agriculturalists. We are inspiring the Vroue Landbou-unie. It is necessary for one to talk to those people. This is the only way in which this can be done. After having said all these things, I still maintain that we are not doing nearly enough. I have mentioned the figures. That is why I say that we need everyone’s help and for that reason I am making this very serious appeal to hon. members, and I also express my very sincere gratitude for the assistance I received here today. I hope we will be able to count on this in future as well.

Furthermore, Mr. Chairman, the hon. members spoke briefly about the rising costs of medical services in South Africa. Personally I am deeply concerned about this. Hon. members are correct when they say that we are gravely concerned about the way these costs are soaring. If projections in the USA continue their present trend, the health services in that country will swallow up the entire American budget by the year 2020. Hon. members will understand that in the meantime something has to give. Here in our own country we too are contending with a very serious problem. There is this agitation over the tremendously large hospitals which are being built. Let me mention one figure, because I want hon. members to be aware of it. Roughly speaking the annual running costs of a hospital are approximately a quarter of the buildings costs of a hospital. Therefore, even when a hospital has been built, one has not finished paying for it.

What does it cost per bed?

No, I do not know. It depends on what kind of hospital it is. Hon. members will understand that it costs far more in the case of an academic hospital than an ordinary hospital, yet they are both called hospitals. It is therefore impossible to say that it costs this amount or that amount per bed. I will be able to say that in this type of hospital it costs so much per bed, and in that type of hospital that much per bed. Hon. members should be able to work out for themselves that if the hospital cost R200 000 000, the running costs of that hospital will be approximately R50 000 000 per annum. Just think back a little further. The tender price of the Hendrik Verwoerd dam, which everyone had so much to say about, was approximately R60 000 000. I think it eventually cost in the region of R90 000 000. I am simply mentioning this by way of comparison. I am saying that to emphasize that somewhere along the line we shall have to adopt a different course. I think that one of the courses we should adopt is via the private sector. I accept that, but then in addition to that I also accept that the people who can be served by the private sector in its hospitals, will become ever fewer. They will become ever fewer because those costs are so much higher, because the running costs of the private hospital will not be much lower than those of the public hospitals, and the private hospital will have to derive all its funds from internal sources.

Consequently I wish to break a lance here for the medical practitioners, just as my colleague, the hon. member for Rustenburg also did. If the medical practitioner sends a person to a private hospital and it costs a great deal of money, then it is said that it is the doctors who are making so much money. However, one will quite probably find that the doctor’s fee is less than a quarter of the hospital fee.

It is a tenth.

I hear that hon. member saying that it is a tenth. I am mentioning this because I want to tell hon. members that there is a problem staring us in the face, and we have to solve it. How are we going to solve it?

The Department of Health and Welfare has a National Health Policy Committee, which consists of the Minister and the four MECs of the various provinces. After they had been provided with advice from all the health departments throughout the country, they lay down certain norms and announced a certain policy. They are all agreed on it. The premise of their policy, as some hon. members spelt out here, was that we should try to keep patients out of hospitals. In other words, we should be able to render a preventive instead of a curative service. That is the objective. For that we need health centres all over the country so that the patients there can receive assistance, advice, treatment for minor ailments, prenatal services and even so that confinements—where the patient spends only a day in the hospital and then goes home—can be catered for there. In other words, all the less serious things can be done there and the patients will only go to hospital for more serious illnesses. Consequently, in a place like Soweto—and I am only mentioning one example now—I foresee quite a number of these health centres being built throughout Soweto.

They were supposed to build six there long ago.

Yes, I know what was supposed to be, but this is all a question of money. [Interjections.] I agree, but I can only do something with the money that is provided to me. This is how I see the position and I think it is the cheapest to do it this way. I even foresee that private enterprise should start building some of these centres. Some members referred to pharmacies and I do not see why there should not be quite a number of pharmacies in this area. These community centres are being built all over the country and the hon. member for Houghton knows that. This system is well developed in the Cape Town area and works very well.

*When we establish those health centres, we will work together as a team there. We accept that there is a shortage of medical practitioners and the possibilities of training more in the immediate future are not very good. There are, however, other people whom we have to utilize. At these health centres we are using nurses on a large scale. They are rendering very valuable services. However, they can render even more services. We have pharmacists who receive highly scientific training for five years, but who count tablets after their training. We cannot waste scientific material in this way, and a place must be found for these people and they must be integrated into this health pattern. Only after we have integrated all these people into the health pattern and they are working together in a team, do we have a chance of bringing the costs down to a certain extent.

[Inaudible.]

No, Rome was not built in a day. We are making progress and these things do not happen overnight. People have to be trained, since trained persons are not picked up off the streets. It takes years and we are trying to train as many people as possible. There is still a shortage of nurses and of other trained staff as well. I see this as the course we should adopt, and I think that we can get somewhere with it. If we continue to build these “health palaces” however, we are heading for disaster—as surely as I am standing here this evening—for the simple reason that South Africa cannot afford them and who must pay for them?

What is more, they then compete with the private sector.

I do not want to elaborate on this competition now since it makes the situation even more complicated and difficult. The situation however, is that one must have a few of these hospitals because one has to train medical practitioners. There is nothing else for it. In addition they have to be trained in such a way that we remain abreast of developments in the medical world. We must also be realistic however, and this is basically how I see the health plan in future. I think I have replied to most of the questions asked by hon. members.

I also asked about malnutrition and the lack of food.

I shall reply to that at a later stage.

There is also the question of our being allowed to visit provincial and State hospitals.

You will understand that the hospitals of the Department of Health and Welfare are not ordinary hospitals where one has ordinary sick patient and where one can merely walk in the door and visit the patients. We do not differ with one another in that regard. I do not prohibit anyone from visiting these hospitals. I told the hon. member that he was welcome to visit the hospitals. All he has to do is tell me when he wishes to go, and I shall then ensure that he has a proper reception. Did I not say that?

Yes, you said that. What happens when I want to visit provincial hospitals?

As far as provincial hospitals are concerned, I think it is fair to say that any hon. member can visit a hospital in his constituency at any time if it is his task to do so. That is after all, what we people do among ourselves.

That cannot be correct.

You do not like the way we do it, but that is the way I prefer it.

Where do you draw the line? Does that mean you cannot go to a school or a provincial library in another constituency?

I did not say you cannot go. I just want you to make arrangements beforehand.

You said you thought it was not right.

I did not say that I wanted to prevent the hon. member from going, but said I would rather help him to go.

I an now referring to the MEC, Dr. Loubser.

The MEC has got nothing to do with you. After all, you did not ask the MEC whether you could go, you asked me.

The MEC told me that he did not think it was right that I should visit a provincial hospital.

It depends on what you are going to do in the provincial hospital.

I want to go and see what health facilities there are.

Surely one makes arrangements before one visits a hospital. After all, one does not walk into my department and ask in one office after another what is being done there. We have appointed a parliamentary officer who provides information in this regard. Further information may then be obtained from the Minister—surely that is fair. That means that no doctor can merely walk into any hospital whenever he feels like it.

You are not replying to the question. [Interjections.]

The hon. member for Welkom referred to health inspectors and said that there should be better co-ordination. I agree with his comments in this regard. We are going out of our way to ensure better co-ordination. There are provisions in the new Health Act which make provision for this co-ordination. Talks are held every now and again and in a week’s time there are more talks with provincial officials and municipal associations to ensure better coordination. There is nothing to prevent inspection services being applied on a reciprocal basis. In fact, it will be welcomed.

May I ask the hon. the Minister a question?

Let me first finish my speech.

†The hon. member for South Coast asked me about the outbreak of typhoid in the Weskoppies hospital. He has the knack of asking so many questions that one needs more or less an hour to answer them all. The typhoid epidemic was brought into the Weskoppies hospital by an infected patient. This infected patient was brought into the hospital and it is not very easy, in a mental hospital, to convince people that the real answer to an outbreak of typhoid is cleanliness. This is the reason why this happened.

*Reference was also made to smoke in Soweto. Smoke control in South Africa is an exceptional problem to us. The reason for that is to be found in our geography. There are only two countries in the world which, as we do, have industrial development in the interior. The other country is Mexico. The disadvantage we have is that for four or five months of the year there is no wind over the industrial area. Along the coast there are always wind currents. In other words, the smoke pall hangs over the industrial area for four or five months. We had hoped that the problem would be alleviated by the electrification of Soweto, but stoves are still being used for heating purposes. The hon. member also referred to the cost of these stoves. It is true, we have no control over this. A committee is giving serious consideration to this matter and will, if necessary, make a recommendation to the Minister of Industries to see whether he can exercise any control over that problem. This is one of the affects of the free market system we have to accept.

The hon. member asked further question, arising from the report, about errors which had occurred at pharmaceutical manufacturing companies. The errors which occurred there were mentioned in the report. If they had not been published there, no one would have known about them. The Department goes out of its way, but continuous monitoring of highly scientific production processes is a major problem. It is being done with a staff shortage, and you will realize that it has to be a scientifically trained staff, since ordinary people cannot do it. The Drugs Control Council is performing a wonderful task and I think they have better control in South Africa over the manufacture of drugs and medicines that we use than most other countries in the world have.

The hon. member for Rustenburg referred to tariffs and I have already referred to the determination of tariffs. I do not differ with him and I believe that a medical practitioner has the right to lay down his fees himself, because no one else is capable of doing so. I am in the process of negotiating with the Medical Association and there will be further negotiations next week. I have already held negotiations with the medical funds and I believe that we will be able to find a solution which will satisfy everyone. I do not wish to anticipate the situation now. To discuss this matter in detail now will take up too much time, and could possibly prejudice my negotiations with these people. I do wish to say, however, that there are aspects of this cost problem which worry me. For example if a person has to pay R950 to have his teeth filled and crowned—and this is what I myself paid—one cannot say it is too much, because one cannot ascertain how much the dentist’s work is worth and whether he is over-charging. What I do know is that there are now many people in South Africa who can pay R950 to have this done. I am opposed to the socialization of medicine, but my concern is “that there is a maximum price which the market-place can stand”.

That does not apply to lawyers. [Interjections.]

If you are afraid of lawyers, stay away from them, but if you have a toothache you have to see somebody and that is my trouble.

What is wrong with lawyers?

I am not worried about lawyers; the hon. member for Houghton is.

I will speak to her later.

What I am worried about is that the persons who cannot afford these services, come to the State for those services. I cannot see how the State can close its doors to these people. Consequently I believe that the practice of medicine should be a private enterprise and I also believe that the socialization of medicine, or otherwise, is also in private hands; it would depend on how it is dealt with. I believe that we will be able to solve the problem because I believe, as the hon. member said, that this is an honourable profession for which I have had only the highest respect in all these years.

Does the hon. the Minister not consider it necessary or appropriate for a member of Parliament to visit a provincial hospital?

If the hon. member wishes to visit a hospital, I have no objection to that, but if the hospital falls outside the hon. member’s constituency, I think it is only courteous to notify the person concerned of that intention. I think it is common courtesy and decency to ask the people who are in control: Can I go there?

Mr. Chairman, the hon. the Minister referred to preventative health services in Soweto. In the explanatory memorandum to the Vote of the Department it is stated that an amount of R210 000 has been voted for infectious, communicable and preventable diseases while for medical care an amount of R490 000 has been voted. While these seem good figures to show, in a place such as Soweto one under-estimates the population completely and it should most probably almost be at least double the official figure, and I think the hon. the Minister should vote more money for this next year.

The hon. member must not make the mistake of thinking that this Department is the only institution that renders these services in Soweto.

I should like to refer to pensions, particularly military pensions and the Military Pensions Act. No. 84 of 1976, because that affects military pensioners. The term “military pensions” is quite a misnomer; it should really have been called “The Military Compensation Act”, because these are payments for disability for something which took place either in barracks or in the field of battle. Therefore, just as we have workmen’s compensation resorting under the hon. the Minister of Manpower, I believe this does not belong under the Minister of Health and Welfare. I believe this should come under the hon. the Minister of Defence and I aim to bring it to the latter’s notice because I believe, with the growth of the Defence Force, this figure is likely to grow enormously in the next 10 to 15 years if what the hon. the Prime Minister says is correct.

Nevertheless, as long as this remains under the control of the hon. Minister, for Health and Welfare I think he must bear in mind two very important things which the South African Legion and all the ex-servicemen have been claiming and that is the amount of 100% disability which was fixed in 1976 at R300 per month and today that amount is only R450. In 1981 there was a 12% increase, in 1982 a 15% increase and in 1983 a 10% increase. What has really happened is that these disability allowances have gone up 50% in a period of time when inflation has increased by 100%. These people who have been militarily disabled, should also have been compensated for the rise in inflation and I make an earnest appeal to the hon. the Minister to do something about it. The South African Legion—and I have the minutes of their last meeting here—feel very strongly about this. The other problem is discrimination in the method of compensation. It is based on the formula of 6 for Whites, 4 for Coloureds and 2 for Blacks. I cannot see why, if a Black loses two legs in battle and is 100% disabled, he should be compensated less than a White who has been fighting for the same fatherland. I think something should be done to narrow the gap that exists in this regard. As far as the social pensions Act, Act No. 37 of 1973, is concerned, war veterans are very grateful for the fact that they have been given a bonus over and above the normal old-age pension. However, in World War 11 alone, and this will happen again, although 86 000 Blacks fought, only 1 400 receive a war veteran’s pension at this time. Something should be done so that those who are entitled to receive what they fought for when they fought for their country, receive their benefits. The amounts voted are relatively small. As far as Blacks are concerned, the figure for war veterans’ pensions is only some R756 000, Coloureds only R8 million, Indians R0,25 million and Whites R25 million. That total amount is very small indeed when one realizes the amount of injuries that were suffered by these servicemen in the defence of their country. With the present developments in the Defence Force and with the legislation which was introduced last year, every man between the age of 18 and 55 years can now be called up for service. The question of compensation is very important and consideration should be given to it because there will be more and more of it and it will place a greater burden on the country. It is the duty of the country to see to it that those who are injured in battle or on military duty are properly compensated.

I want to deal briefly with the report of the South African Medical Research Council. I would like it to be clearly understood that I speak as a layman as I am not a medical man at all. I have no political reason for the points I want to raise. However, looking at the composition of this board, I am surprised at the way it is composed. There are quite a number of persons from the various universities on this board, but when you see the number of projects which are done by the variuos universities it is surprising that one of them, in particular, has no representation on the Medical Research Council. The University of the Witwatersrand did 35 projects last year, but has no representation on the board. The University of Cape Town did 42 projects and has two representatives on the board. I realize that the Medical Research Council is centred at Stellenbosch so that it has more representatives, but it seems strange that a big university such as the University of the Witwatersrand has no representation on this council. I think it should have at least one representative.

There are some very important points which are raised in this particular report. The ones I would like to deal with in particular are those which deal with the nutritional side and the problems that we have read in the newspapers lately. I want to refer to the question of mycotoxins and aflatoxins in foodstuffs. There is no doubt that there is a relationship between aflatoxins and liver cancer and that the incidence of liver cancer, as far as I know, amongst Blacks in particular is quite serious. I believe there must be some connection between this and the whole question of the contamination of foodstuffs, particularly peanut meal and mealie meal. Blacks, in particular, have the problem of having aflatoxin infection and something should be done about this. Attention is devoted in the report to a discovery in respect of one popular breakfast food because aflatoxin was discovered in it. This is not the only case. There are large organizations which are using both peanut meal and mealie meal and I think the Department should devote much more time to its health investigations into this particular problem. The same applies to sorghum malt. Bantu beer is after all a product which is consumed in big quantities by the Blacks. In the report it says: “The major finding is that the levels of total fungal contamination, particularly in some of the smaller commercial malt-houses, are unacceptably high and pose a real danger to health. The larger commercial maltsters and the industrial maltsters generally produce a reasonably fungusfree product, but periodic fungal infections do occur.” I think some form of inspection should be instituted in order to ensure that this is controlled.

The other point which is very worrying—it was raised during the debate on the Vote of Mineral and Energy Affairs—is about the lead content in the air. An interesting piece of research was done by the dental epidemiological group into lead in teeth, which is very high in metropolitan areas.

Mr. Chairman, I do not want to react to what the hon. member for Bezuidenhout said. It seems to me as if, in this debate, everyone is getting to his own small problems as quickly as possible and asking for solutions.

Someone said that a person’s overall welfare depended on three elements, i.e. money, happiness, and health, but that health was the most important of the three, because a healthy person was a happy person who could make money. This year’s budget, to provide for the health needs of our people, totals R1 330 254 000. A person’s health depends on many factors, and this gives rise to a wide variety of health services. These services can chiefly be divided up into two categories, i.e. personal and non-personal health services.

Personal health services embody all services relating to the individual, i.e. medical services, preventive medical services, dental services and paramedical services such as therapeutic nursing services and radiological services, whilst non-personal health services chiefly relate to environmental health or health protection services, as they are called at present. This includes the prevention of illness by the combating of unhygienic conditions, the provision of good housing, the combating of food, air, water and milk pollution, as well as other forms of pollution, the tracing and control of carriers of contagious diseases and the prevention of the epidemic spreading of diseases.

Although personal health services normally hit the limelight—one only has to think of the first heart transplant operation, with all the glory that went hand in hand with that effort, and the many other successful operations and the successful cureing of the sick as a result of accurate diagnoses and the provision of the correct medicines—non-personal health services are no less important. The uninterrupted scientific research in connection with diseases and the spreading of diseases was what led to preventive measures continually being improved. Even though the concept of infection was a familiar one as far back as the sixteenth and seventeenth centuries, knowledge of the actual process involved only really gained a footing in about 1870, at the time of Pasteur and Koch and their disciples. The knowledge that some diseases could be transferred from one person to another gave rise to attempts at preventing this, which in turn gradually led to the health prevention services as we know them today. Over the years these services have chiefly been carried out by health inspectors, and today they are an important responsibility of each local authority in the Republic of South Africa.

The health inspector’s task embraces a wide field that requires a thorough three-year diploma course. It is proposed that in future this three-year course be extended to a four-year course. It has also been said that the health inspector’s diploma is one of the most comprehensive diplomas available in our country. The course comprises a whole series of subjects such as Building Science. Sanitary Science, Microbiology, Health Chemistry, Physics, Physiology, Epidemiology, Housing Management, Social Psychology…

What a long word.

Yes, almost as long as your knife. Then there are courses such as Social Psychology, Food Hygiene and Industrial Hygiene. There are four further third-year subjects. Judging by this, it is a course that equips people, who want to qualify themselves to furnish non-personal health services in a professional capacity, with a thorough knowledge of their field.

The salary scales of health inspectors were recently adjusted to their satisfaction. The health inspectors with whom I spoke were very grateful to the State for this. I want to quote from a newsletter of the Natal branch of the Health Inspectors’ Association of South Africa, under the heading “The New Government Dispensation for Health Inspectors”—

They then furnish details of new salary scales that have been accepted. The scales relate to ordinary health inspectors, a chief health inspector and then a “Director: Public Hygiene”, which is the top post carrying a maximum salary of more than R30 000 per year. Not all these salary scales are available to local authorities on a subsidy basis. Although it is perhaps impossible to make them available on a subsidy basis, health inspectors have requested that information on the salary scales should at least be circulated amongst local authorities so that the boards can see what the various categories of health inspector posts are and what they entail. A municipality does not necessarily only pay a health inspector a subsidized salary. In cases where people are indispensable, or where we are dealing with good officials for whom their boards grant this concession, they are paid higher salaries than the subsidized salary, with the subsidy only being paid up to the notch or salary scale that the State is prepared to subsidize. One can understand that this could lead to municipalities keeping good officials on a lower salary scale because the salary scale provided for by the State only extends to a certain limit. I want to ask the hon. the Minister very seriously to make information about these salary scales available to local authorities instead of keeping the information about what the State is not prepared to subsidize from these people. That is not a lot to ask.

Mr. Chairman, I have no quarrel with the remarks made by the hon. member for Swellendam. I think his main address dealt with preventive medicine and it is on that preventive sign that I wish to address this Committee today and want to direct the attention of the hon. the Minister to.

I can start off by quoting as my authority for preventive medicine an extract from Time Magazine of 8 March 1982. My authority is no less a person than the Surgeon-General of the United States of America, C. Everett Koop. He said—

We have a new Minister and a new Director-General as far as health matters are concerned.

Does he smoke?

I hope not. The hon. the Minister has asked for co-operation from this side of the House and now we ask for co-operation from his side of the House. The Minister had a problem just now as far as finance is concerned, but there is no finance involved in the issue I want to raise at all. I want to ask the hon. the Minister to tell us, on the advice of his Department, exactly what his policy is with regard to smoking. He is no doubt aware of the declared policy of his predecessors. We had a debate on this subject some time ago and I think I have had the opportunity to raise the matter on one or two occasions. In this regard I want to refer to the 1979 annual report of his Department in which the following was said—

That date has gone and passed. When this matter was discussed by the Standing Committee on Friday, 28 August 1981 (Hansard, Volume 96 column 179), the hon. the Minister after the one who made the previous statement, in other words the hon. the Minister’s immediate predecessor, said: “We have a verbal agreement as far as advertising goes.” With great respect, Sir, a verbal agreement is just not acceptable, just not good enough. What they did, was to put the nicotine and the tar content on the back of cigarette packets in such small print and in such a way that nobody ever sees it. This is of absolutely no help to anybody whatsoever and does not provide any warning. As the hon. the Minister probably knows, in the United States the warning went further than just plodding away at remedial action on smoking advertisements. The warning says that smoking may be hazardous to your health. It goes that far. In fact, in discussing the effects of smoking, the Surgeon-General said—

What is our position in South Africa? I know because I put a question on the Order Paper in this regard. From customs duty we get R22,7 million a year and from excise duty R351 million per year. Those are substantial amounts, but can one really measure that against the cost in human tragedy. The Medical Association of South Africa, in conjunction with the Council on Smoking and Health, state as follows—

That is a very high price to pay. I am sure that the Committee accepts that this is not a political matter. I do not want to steal the hon. the Minister’s thunder. All I want is a decent law. I asked the hon. the Minister a question in the House on 23 February 1983, as follows—

The reply of this hon. Minister was “No”. I therefore have to keep on pushing away at this matter. [Interjections.] I think that hon. member has to declare his interests.

Mr. Chairman, I want to direct the attention of the Committee to what the Medical Association of South Africa says—

The association believes that it should be made clear that attempts to dilute this scientific evidence by various interest groups verge on the immoral. The association makes positive suggestions which I want to put to the hon. the Minister.

It recommends a total ban on all cigarette advertising in all the media. All purchases should bear a clear health warning ensuring that the public is told that tobacco smoking is dangerous to health. It also recommends a ban an all cigarette vending machines and the removal of tobacco products from open display shelves in supermarkets. It also recommends the discontinuation of allowing the tax relief on any form of tobacco promotion. It also says that there should be a ban on the sale of cigarettes to minors and that this should be strictly enforced. The maximum permitted nicotine and tar yields should be established by law and enforced. An appeal should be made on doctors and health professions generally to assist and encourage education campaigns, prompted by various organizations, including the Department of Health, Welfare and Pensions. Patients should be actively discouraged from smoking and doctors should give up smoking themselves, where they have not done so, in order to set an example. The Department of Health and Welfare should set a target of reducing tobacco consumption by at least 3% per year. An appeal should be made to sportsmen and entertainers not to be advertised as great heroes smoking cigarettes, as well as to insurance companies to continue the trend towards offering reduced premiums for non-smokers on life insurance policies. An appeal should also be made to industry and commerce to actively promote anti-smoking campaigns in their establishments.

May I ask the hon. member a question? Who is financing the hon. member to deliver this speech?

I can assure the hon. member that I have no financial interest in this at all.

I want to direct the attention of the Committee to the inclusion of the word “nicotine” in section 1(11) of the Abuse of Dependence Producing Substances and Rehabilitation Centres Act, 1971, so that the subsection will read…

Mr. Chairman, on a point of order: Is an hon. member allowed to discuss something now which appears on the Order Paper for discussion on a later occasion? [Interjections.]

You cannot get out of it that easy. You are not going to get away with that. I appeal to the hon. the Minister to change the definition of “afhanklik-heidsvormende stowwe”, “afhanklikheids-vormende medisyne”, “alkoholiese drank” and “nikotien” accordingly. I also want to ask the hon. the Minister about the request for a campaign in South Africa, for what they call the “smoke out week” which is planned for the period 14 November to 18 November 1983. I should like to know whether the hon. the Minister and his Department are going to support smokeless day on 17 November and the campaign and whether they are going to throw their full weight behind that campaign. [Time expired.]

Mr. Chairman, it is always very interesting to listen to the hon. member for Hillbrow speaking on this subject. I believe in moderation and enjoy smoking one cigarette a week, but recently I was again made aware of the very interesting case of a friend of mine who smokes 100 cigarettes a day. I asked him whether he was not terribly worried about his health. He replied by saying that he had read of a recent case in England of a man who smoked 150 cigarettes a day. At a certain stage the man gave up smoking altogether and six months later was killed in a car accident. Because he was known to have smoked such a lot, they performed a postmortem on him and found his lungs to be clean as a whistle. On the strength of this my friend said that he would stop smoking six months before he died. I was worried that the hon. member for Hill-brow would get round to discussing the product of my constituency, but fortunately he did not.

I should like to come back to a subject which the hon. the Minister has actually replied to and about which quite a few hon. members have already spoken, i.e. the question of the population explosion and family planning. With the hon. the Minister’s permission I do want to come back to this aspect, because I feel that it is such an extremely important matter that one can certainly never say enough about it. I want to say immediately that I am very grateful for the fact that in this House and in the country at large the prevailing atmosphere is such that one feels free to talk about this subject. I think that until fairly recently we were all too afraid to talk about this subject which is such a very important one. I want to link up with the hon. the Minister in thanking hon. members for the positive way in which this important matter has been discussed.

There is no doubt about the fact that all of us seated here agree that South Africa is not capable of accommodating a very large population and that there is a limit to the size of population that South Africa can support. As hon. members have pointed out, one only has to look at the recent water situation to realize how serious the problem is. The hon. member for Bryanston referred to the report of the President’s Council. I do not want to dwell on that again, but I do just want to say that when I read the report of the discussions in the President’s Council, I gained the impression that there was a measure of hopelessness and frustration about how this situation should really be handled. I found it very interesting to read, in the newspapers, about people’s reactions to the discussion in the President’s Council, specifically the reaction of Black leaders in South Africa. If there is one thing that was very clear to me from the reaction, it was that there was general agreement about the fact that South Africa should be very careful not to fall into the same trap into which the Third World, in particular Africa, had fallen, i.e. the vicious circle of overpopulation that leads to poverty, poverty that leads to chronic undernourishment, to debilitated people who in turn produce debilitated offspring. That is a vicious circle that gets worse and worse.

An interesting reaction, as far as I was concerned, was that of Dr. Motlana, the chairman of the Soweto Committee of Ten. He said exactly what the hon. member for Randfontein said, i.e. that we should be very careful not to politicize this matter. What his warning amounted to was that perhaps politicians should stay out of it and that we should leave it to community leaders, particularly the doctors and nurses, to solve the problem. He said that we should do more and talk less about the problem. Here at the end of this debate I want to say that there is a great deal of gratitude for what the department, the central Government, the provincial hospitals and the clinics are doing about this at local government level. I agree that it would be a very good thing if we could spend much more money on this, but as the hon. the Minister has pointed out, it is also a question of available manpower. As far as I am concerned, there are three basic elements involved. We must mobilize the medical manpower that we do have in an endeavour to interest them in this important task. Our hospital infrastructure already makes provision for the various forms of family planning. The available modern technology must also be utilized in this context.

I should now like to deal with one specific form of family planning. Ten years ago it was unknown and unused, but today it is the most commonly encountered form of family planning. I am referring to voluntary sterilization. I should like to take an example from my own constituency. In the past ten years, in Paarl, outstanding work has been done on voluntary sterilization. Over the past 12 years, from 1971 to just four weeks ago, 4 962 sterilizations were performed. It stands to reason, of course, that they were all voluntary. They are done on the basis of absolute confidentiality between the doctor and nurses involved on the one hand and the people undergoing the operation on the other. There were an average of 500 cases per year over the past 10 years in Paarl. Everyone has come to accept this, even the less privileged such as farm labourers and handymen. It has often been said that one must first do the job of economic upliftment before people would be inclined to accept family planning and voluntary sterilization. In Paarl it has been proven that if one uses the right techniques of persuasion, people accept family planning and voluntary sterilization in advance of economic upliftment. They realize that if they were to have smaller families, their chances of assuring their children of a much better future would be so much better. In the Burger of last week there was an interesting article about what had been done in Paarl in this connection. Ten years ago the population explosion in Paarl was one of the largest in South Africa. In 1972 35% of the Brown community had children in any one year, but as a result of the efforts of people who really take an interest in the problem, this figure has now decreased to 5% per year. This is an amazing reduction. According to the Department of Obstetrics and Gynaecology at Paarl Hospital, the success is ascribed to the fact that pregnant women who, in impoverished circumstances, already have too many children, were persuaded, by faith and love, not to have any more children. Today it is no longer necessary to suggest sterilization to these people. They often ask for it themselves.

If one looks at sterilization figures throughout the world, one sees that in a country such as Thailand, with a population of 50 million, 200 000 sterilizations are performed annually. In a country such as Sri Lanka, with 15 million people, 100 000 sterilizations are performed annually. In South Africa, with a population of 28 million, at a birth rate of 1 million per year, it is my opinion that there ought to be at least 100 000, if not 200 000, sterilizations performed annually. If one compares this with the present 19 000 sterilizations performed annually, all I can say is that there is still tremendous potential in this sphere.

The whole idea of sterilization is something that has taken hold throughout the world in recent times. People have realized—and this is not only the case in South Africa—that individual poverty, and poverty in the community, increases as a result of populations that have grown too large. In the ’fifties the number of sterilizations worldwide were restricted to three figures, but in the ’seventies there are millions of them being performed throughout the world. If we approach this matter in a spirit of faith and love, really trying to persuade the people who need it, I think that we can set a wonderful example in South Africa. I should like to express the hope that the idea that has already taken root here, can be extended further. At the Tygerberg Hospital 9 000 sterilizations are performed annually, whilst in East London there is a doctor who devotes his life to this cause and performs 1 400 sterilizations annually. It has nothing to do with the question of race. The President’s Council said—and in this connection I agree with the hon. the Minister—that our ideal should be to set our population growth at a figure of 2 or 2,1 per thousand, regardless of what it is at present. Eventually, by the year 2000 we shall arrive at a total population of 80 million. That is a figure that South Africa can handle. [Time expired.]

In accordance with Standing Order No. 82J the Committee adjourned at 18h00.