laid upon the Table:

Mr Chairman, at the outset you will allow me welcome the hon the Deputy Minister of Population Development here in the Committee.

Hear, hear!

I should also like to avail myself of this opportunity to thank the Director-General of this department, Dr Retief, very sincerely for his activities, not only during the past few years, but in fact over a long period in this department. I also want to congratulate him on his appointment as rector of the University of Orange Free State as from 1 January 1988.

Hear, hear!

I think I am speaking on behalf of all hon members when I wish him the best of luck and everything of the best in this important task at one of the foremost universities in South Africa. Dr Retief will assume the post of rector with effect from 1 January 1988, and this is consequently the last time he will be lending active assistance here in the discussion of the National Health and Population Development Vote. I thank him cordially for his sincere and dedicated service during the past few years.

When I thank members of the department, I also include the Deputy Directors-General, Mr Marais, Dr Watermeyer and also the Chief Directors. But what I especially want to do this afternoon is first of all to thank the large number of medical practitioners, dentists, nurses, pharmacists, psychologists and others, including those in the paramedical professions and in the supplementary health service professions, for the 24 hours of service that are being rendered every day of the year throughout this entire country of ours, not only for the sake of preventing illness, but also in order to cure it. I think that we in South Africa are privileged to have a health service which is comparable to the best in the world.

You will allow me, Mr Chairman, to take this opportunity of thanking Sister Van Coller and her staff for the way in which they do their work in this Parliament. They work long hours, and I am aware that it is an essential service for Parliamentarians, officials and other workers in Parliament. I believe that all hon members will agree with me when I thank her cordially in this way for the work she is doing.

Hear, hear!

When it comes to expressing thanks, I should also like to thank the Joint Parliamentary Committee on Pension Benefits—the Meiring Committee. I am pleased that the hon the Deputy Minister, who was chairman of this parliamentary committee on pension benefits is here this afternoon. I want to thank the hon the Deputy Minister of Foreign Affairs very cordially for the way in which he directed this committee and contended with very difficult and drastic problems. I want to thank him because it was owing to his guidance that such a good spirit and such a good report resulted from its activities.

Since we are looking forward with expectation to final recommendations of the committee in connection with the establishment of a system of pension provision for the entire community, I fully appreciate the reasons why this committee is still not able at this stage to make final recommendations. As the committee correctly pointed out, this is a sensitive matter owing to the particular structure of our society, and the attainment of the greatest measure of consensus by all interested parties is a prerequisite for a system of pension provision which can be implemented for the entire population.

It goes without saying that the Government places a high premium on labour peace, and nothing must be done to jeopardise it at this stage. Similarly it will be realised that the maximum degree of economic growth and provision of employment ought to be accommodated in any compulsory system of pension provision. Under these circumstances I agree wholeheartedly with the committee that the entire matter should be investigated further by a representative committee, as they proposed in their report. I want to thank the committee for the important spadework it has done and also for their long-term objectives in respect of a pension system for South Africa which it so clearly indicated and which comprises the most important part of its report.

This will undoubtedly facilitate to a great extent the task of the representative committee in respect of creating a climate for the attainment of consensus among the parties concerned. As far as the composition of the representative committee is concerned, it appears that the further investigation will spill over into the areas of various other Government departments. In addition, control over pension funds is the responsibility of the Department of Finance in terms of the Pension Funds Act, Act 24 of 1956. The appointment of the representative committee is therefore being dealt with at present by the hon the Minister of Finance. With this short statement I once again want to convey my thanks not only to the chairman but to every member of that committee.

I now want to deal with a matter which received a good deal of attention in the media. Recently there has been considerable comment on the report of the actuary who investigated the Government Service Pension Fund last year. Up to now we have considered that the report was intended for internal consumption and apart from the fact that we made the most important findings known to the media, the report in its entirety has not been released. This has probably led to some people commenting on the report without really knowing what was stated in it. I have consequently decided to release the report, and any person who is interested in it can request it from my department.

Right now!

That would be a good thing. You would not understand it in any case.

Therefore I want to express the hope that no one, and that also applies to hon members of this House, will in future comment in any way on this report before he or she has made a proper study of it. It is now available.

In the meantime, however, I can announce that the following positive steps have already been taken in connection with the findings of the actuary.

In the first place, the formula in terms of which service can be purchased, is going to be changed soon in accordance with the actuary’s recommendation. The result of this will be that in every service purchase transaction the fund will be fully compensated for the benefit which the member will ultimately receive from the fund.

†Secondly, an interdepartmental committee of experts has been appointed to investigate, inter alia, the feasibility of investing the capital or a portion thereof in such a manner that the fund could receive a much higher return. The possibility exists that the income of the fund could be increased considerably.

Thirdly, various other avenues of increasing the fund’s income are being explored without the Exchequer having to be addressed. The aforementioned interdepartmental committee of experts will assist in this regard.

Fourthly, probably the most important step already taken, is that I have laid down the policy that any proposals for the granting or improvement of benefits will only be considered by me if the expenditure involved has been determined by the actuary and am completely satisfied that the fund will be fully compensated therefore.

Fifthly, in order to ensure that the steps taken will have the desired effect, I have instructed that henceforth the fund be actuarially assessed every three years.

The position will thus be monitored continuously in the light of expert advice, and I will be able to determine whether or not satisfactory progress has been made and decide on any action to be taken.

*In the meantime I want to reassure pensioners as well as members of the fund, who are still in service, that the income of the fund is far in excess of its expenditure. During the past financial year the expenditure was only 31,6% of the income.

[Inaudible.]

A reassuring fact is that the interest alone which is earned annually on the investments of the fund—at present it is only about 10%—is more than sufficient to cover the current expenses of the fund.

I want to mention a few facts in this connection. The interest earned during the 1986-87 financial year was R1,363 billion. The total expenditure for the same period was R1,206 billion, and members’ contributions were not even touched. Consequently the interest on the fund was more than sufficient. [Interjections.] The Auditor-General’s report demonstrated this.

You are misleading the public with what you are saying.

I want to repeat this to the hon member. The interest of the fund was R1.363 billion. [Interjections.] The expenditure for the same period was only R1,206 billion.

I think you should read it.

That is to say, members’ contributions are not even being touched.

Have you read that report?

The income, expenditure and capital have appreciated as follows since the assessment on 1 April 1985…

Mr Chairman, may I ask the hon the Minister whether he referred to R1 000 billion?

I referred to R1,206 billion. [Interjections.]

No, it cannot be.

They have forgotten to insert a comma.

Did the hon the Minister actually mean “million”? A billion is equal to a thousand million.

The figure is R1,206 million. [Interjections.]

The fact of the matter—the hon the Leader of the Official Opposition will concede this point—is that the expenditure is less than the income. [Interjections.] That is the important point. I want to thank the hon the Leader of the Official Opposition for the very valid point he made. If I understood him correctly, he emphasised the fact that the expenditure was less than the income. [Interjections.] I think this is a wonderful example of how the hon the Leader of the Official Opposition should act in such a situation. [Interjections.]

You have a powerful imagination.

With effect from 1 April 1985 the revenue rose by 65%, the expenditure by 3,3% and the capital by 59%. In my opinion these are important figures. It follows that as far as the foreseeable future is concerned, there is nothing to worry about. In the long term, all the members of the fund and the pensioners may also rest assured that, as I explained, we are going to monitor the position carefully and that the Government will not allow the position of the fund to be endangered.

Mr Chairman, would the hon the Minister please tell us by how much per year the interest on the accumulated actuarial deficit is actually increasing, because if he takes that into account his whole story of the expenditure being less than the income, will fall to the ground.

I am sure that I shall be able to give the hon member a very accurate answer at the end of this debate. [Interjections.]

*I shall now proceed to discuss a very important disease which in the sphere of health is probably considered to be the most significant contagious disease in the world. Today we are experiencing an Aids pandemic in the world.

†There is no doubt about the fact that Aids has assumed pandemic proportions over the whole world today. In South Africa we have had 55 deaths so far. Of these victims 48 were homo/bisexuals and two heterosexuals; two died before blood-testing was done and three were haemophiliacs.

I would like to pay tribute to the Advisory Group on Aids under the chairmanship of the Deputy Director-General, Dr Watermeyer. I would like to pay tribute to the way they have continuously given excellent service and advice to the Government since 1985. I would like to express my approval for the new facility which will be started in the Institute for Medical Research shortly where education and training will be given to those people who work with Aids patients.

Hon members are undoubtedly aware that the Institute for Bio-virology initiated research on the Aids virus, the HIV virus.

Some disturbing aspects we have to deal with include the fact that when we look at carriers of this disease in South Africa, we find there are thus far 1 140 of them among the White population, 31 in the Coloured population, three Indians and 1 093 among the Black population. At present more than 1 000 of them are workers from outside the borders of our country.

*If people’s blood tests are positive it proves that they are carrying the virus. If a person is carrying the virus one can transmit it to another person. This virus is not destroyed by the body. It remains in a person’s body. Those who are dying now, contracted the virus in 1979-80.

South Africa has a relatively low death rate in comparison with the rest of the world. In the USA there are 1,5 million people who are carriers of this virus. The highest incidence at present is in Central Africa. In cases that were tested for blood transfusion purposes, it varied between 10% and 20% of the population. Among the Malawian mineworkers in South Africa the figure was almost 5%. It is for that reason that I am at this stage making this statement in the Committee.

The danger that AIDS presents to mankind is alarming. Consequently the combating of the spread of this disease is being accorded a very high priority on Government level. It is also known that contagion is assuming alarming proportions in most of the countries of Central Africa and that the entry into the RSA of workers from these high-risk areas who are suffering from AIDS, or who are contaminated with the HIV virus, requires special attention. The matter has already been discussed with other departments and organisations that are affected, including the Chamber of Mines.

The Department of National Health and Population Development has already prepared draft regulations in terms of the Health Act in which provision is being made for the identification of any transmittable disease, which by statutory definition includes AIDS or HIV contamination, as well as isolation for treatment in special units in South Africa and entails compulsory medical treatment of such sufferers or carriers. Consultations have also been held with the Department of Home Affairs to take suitable steps now, in terms of its aliens control legislation and regulations, to remove such persons from the Republic of South Africa.

Since most of these workers come from Central Africa, and in this connection most of them from Malawi, my department has already sent two delegations to Malawi to negotiate with Government officials there, and we are available to help them with an epidemiological study, to help them with their guidance and to help them to combat that situation in that country.

It is very clear, however that these people form a reservoir in South Africa which not only makes the spread of this virus in South Africa possible but in addition makes it a real threat. For that reason it is essential that we deal with it in the manner I have just mentioned. So that there may be no uncertainty, I want to say it does not mean that visitors to South Africa must be tested before their arrival here, but it does mean that labourers recruited elsewhere will first be tested before they enter the country.

In conclusion I can mention that the studies we have made on workers from Mozambique, Lesotho and Botswana have indicated that the rate of incidence is less than 1%. Consequently it is not a problem. I believe that with this measure the Republic of South Africa may rest assured that we are doing everything in our power to spare South Africa from this disease, which has 100% mortality rate.

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

Allow me to begin by congratulating Dr Retief on behalf of this side of the Committee on his appointment as Rector of the University of the Orange Free State. We want to wish him every success in this new chapter in his life. We also want to thank him for the valuable work he has done in this department in his present position.

The hon the Minister made a few very important statements. Incidentally, Sir, allow me to join him in thanking our nursing staff at Parliament, Sister Van Coller and her colleagues. During the past week we experienced the friendliness and helpfulness of the nursing staff when an hon member had a little accident. [Interjections.]

The hon the Minister made some announcements with regard to the pension committee, the Meiring Committee, which is going to be investigated further. That touches on a very important aspect of pension matters in South Africa. We must not lose sight of the fact that a dwindling group of economically active people will have to provide pension money for an increasing and ageing community, especially since we are, in terms of the policy of the Government, going to have to be accommodated in a unitary state in future. That is an aspect that we shall have to consider well beforehand in order to ensure that this thing does not collapse in the end.

The hon the Minister also made a statement with regard to speculation in the Press about the State pension schemes. I am glad that that was done, but one wonders why the hon the Minister waited so long to release the actuary’s report. That could perhaps have contributed to preventing much of the speculation about this fund. We are also glad to note that an actuarial report on this fund will be submitted every three years.

There was also the important announcement in connection with Aids and the testing of mineworkers for the HIV virus. The hon the Minister also said that the regulations in respect of aliens would be amended so that these people could even be removed from South Africa. I should just want to ask the hon the Minister whether the matter has not become so urgent that one should also examine visitors to South Africa. Other countries have already taken such steps to contend with this great danger.

When we look at the health situation in South Africa, we see that there are three problems which weigh heavily upon the man in the street. In the first place, there is the cost of medical services and especially of medicines, which have escalated dramatically over the past years and are continuing to do so. They are threatening to move completely out of the reach of the man in the street, especially those who do not belong to a medical aid scheme or who do not qualify for an old-age pension.

The second cause for concern is the standard of the medical services rendered in South Africa, which is closely linked to the professions in the front line of health care, namely the general practitioner, the nurse and the pharmacist. There is concern about the welfare of and the situation in these professions, and this cannot be ignored.

The third matter which deserves attention is the question of the thousands of pensioners and prospective pensioners in the Government sector who were very worried. They received certain assurances from the hon the Minister today. I must say, however, that assurances from the Government must sometimes be taken with a pinch of salt. [Interjections.]

I should like to confine myself to these three matters in the rest of my speech. I want to begin with the cost of medicines and medical services. This is a disturbing situation that is threatening to get out of control, as I have just said. I should like to cite one example to hon members.

In the SA Medical Journal of 18 July, the editor, Dr Lee, described a case in a private hospital with reference to his misgivings about the privatisation of hospitals. I quote:

He went on to describe the different expense items. These included:

And various other additional items.

He went further and said:

He then described the different items and what they cost, and he wrote at the end:

When we compare this with the new tariffs that were announced in the Transvaal, we see something very interesting, and I want to ask the hon the Minister how this can be possible. The Transvaal hospitals announced the following tariffs with effect from 1 July: Private patients, the so-called P2-patients, have to pay R82,50 per day; a visit to the casualty or out-patients unit costs R20, with an additional 50%—making it a total of R30—if the visit takes place after hours. If the patient has to go to the theatre for 60 minutes, it costs R160,50, plus 50% if it is after hours.

Let us make a little calculation and use the example of someone who is involved in a car accident one night. Let us suppose this person has to spend three hours in the theatre and 10 days in hospital. If my calculations are correct, his expenses would amount to R1 529,25 in a provincial hospital that I regard as the important point in this case is that there is such a big difference between the Cape provincial hospital and a hospital in the Transvaal, if one is to judge by this article and the tariffs that have just been announced. I calculated that the expenses in this particular case the editor described would amount to R325,50 in the Transvaal as opposed to R121 in the Cape Province. That is almost unbelievable.

Only three years ago—that was also during the discussion of this Vote—I quoted with amazement what the tariffs would have been at the time. I quoted from a report in The Citizen of 22 March 1984, and I quote it again:

The report went on to read:

It is in excess of R80 now:

The R7 of barely three years ago has already become R20, Sir. If the expenses continue to escalate at this rate, they will assume quite catastrophic dimensions within the next three years. I should like to know what the hon the Minister’s comments are in this regard.

Then, of course, there is also the cost of the medicines themselves, which remains the highest single cost factor of medical schemes. We see in annexure 14 of the department’s annual report that the total medicine cost benefits paid out by medical schemes amounted to 33,6% of their total disbursements. Hospitals come in second, with 19,7%. There are other medical funds, of which I am personally aware, in respect of which this figure is even higher than the 33,6% to which I referred. The Browne Commission and the Competition Board have made various recommendations in this regard. According to what the hon the Minister said in the House of Delegates last week, these recommendations are still being considered. They include, for example, the recommendation by the Competition Board that all pharmacists and dispensing doctors—those doctors who supply medicines themselves—be prohibited from making a profit on prescribed medicines and that pharmacists be allowed to advertise without restriction. Another of the recommendations is that pharmacists be allowed to sell medicines that are cheaper but therapeutically equivalent to those that the doctor prescribes, or that the Medicine Control Board should consider rescheduling certain schedule 3 and 4 medicines from schedule 3 and 4 to schedule 1 and 2. A further recommendation is that medical funds should investigate the possibility of allowing members to submit claims for certain medicines that were recommended and supplied by a pharmacist.

Various other recommendations are contained in this report, including recommendations in connection with the State tender system, which some people consider to be the real inflationary measure with regard to the private supply of medicines. There are other recommendations as well. In its White Paper, however, the Government referred all these recommendations to different professional associations, inter alia, the Competition Board, the Medicine Control Board, and even the Medical Council. I should like to know, therefore, whether the Government has set a cut-off point and whether it has already received some of the expected reports. I should also like to know when we can expect to be further enlightened with regard to the relevant decisions.

In the second place I should like to turn to the question of general practice, and other medical disciplines as well. That concerns the statutory tariff fixing, as provided by section 29 of the Medical Schemes Act. When we amended this section in 1984, I said the following here in the House (Hansard, 28 March 1984, col 3953):

That was precisely what I predicted, Mr Chairman; and that is precisely what has happened. It is a fact that a visit to a general practitioner, in accordance with the scale of benefits and the guidelines of the Medical Association, can cost exactly double in one case what it costs in another. With regard to other matters, visits to specialists for example, the costs are double; and if the doctor’s tariff was in accordance with the guideline, this would amount to the patient’s having to pay exactly double the amount his medical fund would pay.

The fact that 80% of the medical practitioners adhere to the scale of benefits can probably be largely ascribed to the depressed state of the economy in our country. That is a fact. Nonetheless it is an unhealthy state of affairs. I should therefore like to put a serious question to the hon the Minister. In view of the fact that a general practitioner’s overheads amount to approximately 64%, I believe it is unfair to expect those people to continue in that way. I should therefore like to know whether the hon the Minister perhaps intends amending section 29 as far as this pressing problem is concerned.

Years ago one had a right of appeal to the SA Medical and Dental Council’s disciplinary committee, but this right has been removed from the existing legislation. I consider this to be a serious matter for the members of the profession. After all, it is their livelihood that is at stake here. I sincerely believe that it is only reasonable and proper that a method of appeal be incorporated in the Act once again so that these people can at least be treated fairly as far as this extremely important matter is concerned.

As far as pharmacists are concerned, for example, the Browne Commission made extensive recommendations in the chapter on pharmacists in the private sector. Now it seems the pharmacy profession is still in a depressed state with regard to district surgeons’ prescriptions. We have already raised this question of dispensing doctors and the State tender system in the discussion of the own affairs Vote.

The pharmacist would be quite justified if he questioned whether he still had the right to exist, whether he still played a part and whether the Government still wanted him to be trained, at great cost, to render a service. I should like to know how the hon the Minister perceives the role of the pharmacist in the new health dispensation.

Finally I want to say something about pensions. Apart from those people who have perhaps been partially reassured by the hon the Minister, there is still that fervent appeal of the pensioners, especially the civil pensioners, that was articulated in a document I received from the Civil Pensioners’ Association of South Africa. This association has been making urgent representations in respect of widows’ pensions. They are asking for widows’ pensions to be increased as expeditiously as possible to 75% of the husband pensions.

We cannot really expect the cost of renting a flat, and the electricity and telephone accounts to be reduced by exactly half when the husband passes away. Why must we leave these people in poorer financial circumstances than those experienced before the death of the husband? The hon the Minister’s department has made many promises in this regard, and I believe the time has come for us to pay very serious attention to this matter.

As far as the elderly are concerned, there are government officials receiving a pension that is scarcely more than the means limit of old-age or social pensions. They are actually being penalised for having made provision for their old age. I feel that we should look into that as well.

Thirdly, it is necessary that adjustments come into effect from 1 April in future, and not later in the year. The same reasons apply in respect of social pensions.

We in this House, as well as the Government, have a duty towards these people, because they were in the service of the Government before we were, and the least we owe them is a peaceful retirement without unnecessary financial worries. I am really making an earnest appeal to the hon the Minister to attend to this matter so that we can create peace of mind, not only for our present civil pensioners, but also for those who are going to become State pensioners in future.

Mr Chairman, I am indeed extremely honoured to participate today for the first time in the debate on this Vote as the main speaker and chairman of the Health Study Group from this side of the House.

Under the circumstances, the hon member for Pietersburg will therefore pardon me for not reacting too much to what he had to say. He touched on very important matters in quite a reasonable and well-balanced manner, and I am sure the hon the Minister will reply to him in that regard.

I could also just say that the cost of medical care gives cause for a great deal of concern—to use that terminology—and we are in fact addressing this very seriously on a very broad level. We certainly cannot view this matter on its own; we must also ask, for example, what a motor car costs today. What are the input costs in agriculture today? What does bread cost today? We must therefore see this matter as a whole, but I am sure the hon the Minister will react to this further.

I should also just like to convey my thanks the hon the Minister, as well as to the officials. I do not want to expand on this today, as I have done on other occasions. All I can say is that apparently this is always the problem with the Public Service; as soon as it has a man of the calibre of Dr Retief, for example, the man is so bright that the other people come and snatch him away and another plan has to be made. I congratulate him most sincerely on his promotion.

Today I also take great pleasure in thanking the hon the Deputy Minister of Population Development, the hon member for Mitchells Plain, for the very good work and service he renders, specifically in the very important field of population development, a field which is of the utmost importance to all of us in this country. The hon the Deputy Minister of Population Development finds himself in a somewhat unusual position. He is not a member of the NP and conducts his politics in another caucus. However, he is just as genuine a patriotic South African as any of us in this House. Unlike most of us in this House, he has physically felt the hand-grenade shrapnel from a terrorist attack. Consequently, I say that party politics is irrelevant now, and although I would wrestle with the hon the Deputy Minister in other spheres, I shall not do so now.

What is relevant, however, is the service the hon the Deputy Minister is rendering in the field of population development. This is a matter which intensely affects all of us in South Africa, and our children and their children in particular. Everyone in South Africa, irrespective of colour, gender, religion or political party, must work at population development, since we shall succeed or fail in this together. It is not possible for one group to succeed and another to fail. We are in fact on the same sea, in the same storm, on the same boat, called the SAS South Africa. I therefore want to thank the hon the Deputy Minister, as one of the helmsmen of this boat, for the task he is performing, and express the appreciation of this side.

I do not wish to go into population development any further, except to refer briefly to the policy of the CP. Supposing the CP were to come to power and they succeed with their policy of partition in establishing a White majority somewhere in their Southern Land. The White majority would probably not be more than 2 000 or 3 000. What would the position be then? The position would be that the Whites would have to remain in the majority. After all, we know that the population growth of the other groups is much greater than that of the Whites. The Whites will therefore really have to breed like anything in order to keep up—to put it that way in this debate on health. Possibly the CP will need a slogan about population development like the following:

It does not work like that, however. The policy of partition, whether it be full partition or partial partition, does not provide a solution. We must all work hard together to cause the population development plan to succeed.

On my first occasion as main speaker on this side, it is of course obvious that I want to raise as many important matters as possible. For example, like the hon the Minister, I have a real desire to express tremendous gratitude and appreciation to the nursing profession in South Africa. For example, if one looks at Nursing News of September 1987, and reads how bravely a nurse acted on the occasion of the bomb explosion in Johannesburg, this is symbolic of the South African nurse. Unfortunately, I am unable to go into detail about this in the eight minutes I have at my disposal, but on behalf of this side of the House I want to express our appreciation and admiration for the nurses of South Africa. This also applies to the other paramedical professions, which I unfortunately do not have the time to deal with now.

Another matter which deserves special attention, is the so-called Aids problem, to which the hon the Minister also referred. One of our other speakers will deal with that, but I just want to make one or two remarks. The lie that is purportedly told the most in the world is that of the “your cheque is in the post”. After a little research on Aids, however, it has been established that the lie that is told the most is, “I just want to lie with you a little”. Aids is only spread in three ways: Sexually, from mother to child during pregnancy and through contact with blood products. We learnt the solution to the Aids problem at our mother’s knee and in the Bible. That is a clean moral and ethical life. That is all.

The question of spreading it through blood can be dealt with scientifically. This is being done very well. The question of transferring it from mother to child is also being dealt with very effectively. As regards the only remaining way, no matter how much information we provide, and no matter what we do, one cannot control people’s sexual behaviour. They will have to do so themselves. This is what we have to make our people and everyone understand.

In conclusion, I want to address another extremely important question, and that is the treatment of detainees. I am not merely reading from a piece of paper here; I was district surgeon for a long time, and then I was acting district surgeon for a long period. Afterwards I very often visited prisoners, mostly in the company of hon members of the former and present Official Opposition. The hon members for Parktown, Houghton and Johannesburg North will recall, for example, when we arrived at one prison and the hon member for Parktown did his best to try and ascertain whether there were any complaints. All they said was that they did not want to speak to the PFP; they wanted to speak to the NP. That was the only complaint, they did not want to see him. [Interjections.] Those hon members will recall that time and again the prisoners told us in front of everyone that they were satisfied with the medical service. There was one person who said that it had taken a bit long to diagnose that there was a bullet in his buttock.

In general, and in all the years we visited the prisons, the prisoners themselves were satisfied with the medical treatment they received. I am not speaking about other treatment; that could form part of another discussion.

In case my time expires. I just want to say at this stage on behalf of this side of the Committee that we convey our heartfelt gratitude and appreciation to the district surgeons, full time and part time, the nursing staff and all these people who, in our opinion, are doing a highly valuable, but according to others, often degrading, job. Not enough appreciation and gratitude is expressed for the task they are performing.

Of course one can divide prisoners into sentenced and unsentenced prisoners. The unsentenced prisoners, again, can be divided into those awaiting trial in connection with criminal cases, and of course also detainees in terms of regulations issued in terms of the Public Safety Act, the Internal Security Act, and so on.

Unfortunately I do not have time to go into that, but I have the relevant UNO regulations before me, the Standard Minimum Rules for the Treatment of Prisoners and Procedures for the Effective Implementation of Rules. [Time expired.]

Mr Chairman, in the course of my speech I will refer to some of the subjects discussed by the hon member for Langlaagte. It is a pity that he tried to introduce politics into this debate. He knows he told untruths here, and he must live with his own conscience.

I should like to refer to the hon the Minister’s statement about foreign workers infected with Aids. It is right that the hon the Minister and this Committee should remind the public of the seriousness of Aids. We all know how it is transmitted, what it does to human beings and the 100% mortality rate of those diagnosed to be suffering from the disease. Its seriousness is therefore appreciated by us on this side.

Secondly, we cannot fault the hon the Minister’s statement regarding the regulations for the isolation and treatment of Aids carriers and patients. We support the hon the Minister there. Unfortunately, once a person has the disease the treatment is no longer really of much relevance, but isolation is very important, and I am pleased that this has been dealt with.

The second part of the statement of the hon the Minister actually means that these workers will be deported to their countries of origin; that is what it amounts to. Looking at the seriousness of this disease as a doctor, I am initially inclined to support the hon the Minister. I am also pleased to read that the hon the Minister has consulted the Chamber of Mines and other responsible people in this regard. As a human being, therefore, I would like the hon the Minister and the Chamber of Mines to treat these unfortunate people—they came to this country because they needed the income, and we paid for their labour because we needed it—as human beings. I think that is very important. [Interjections.]

Before we give our unqualified support to the hon the Minister, therefore, I would like to know more about the way in which these people are going to be deported. Are they going to have their contracts fulfilled? Are they going to be paid compensation? We have lost millions of rand because of the strike, and I think it would be good for our relations with the rest of the world and for our labour relations if we could show that the mines and the South African people have compassion and will treat these unfortunate people in a way that is humane and a credit to our medical profession of South Africa. Only then can we give him our full support.

Nonsense! [Interjections.]

I am sure the hon the Minister will respond responsibly to my questions, and I will ignore hon members who obviously have no knowledge of what I am talking about. I will not be tempted to sink to their level.

There is another subject mentioned by the hon member for Langlaagte which I would like to refer to, namely the medical treatment of detainees. The hon the Minister might not remember this, but during the debate on the security legislation we on this side of the House moved an amendment to allow detainees to ask for their own private medical doctors to attend them. At that stage, the hon the Minister refused.

I believe he subsequently received representations from other people, and the right of a detainee to call a private practitioner was eventually acceded to, for which we were very grateful. The Medical Association of South Africa claimed responsibility for this, and we are happy for them if they believe it was due to them. I will not argue about that.

However, I asked two questions in Parliament concerning the right of the detainee to ask for a private practitioner.

I am rather concerned about the answers. Although I tried, I could not find out the names of this panel of doctors appointed by the Medical Association, but perhaps I can understand that.

In my last question to the hon the Minister I asked when and by whom detainees were informed that the services of a panel of private doctors were available to them and how many detainees or their parents had requested this. The answer was that the detainee himself must request a second opinion and that the district surgeon will tell him the name of a doctor on the panel. When I asked how many detainees had used this facility, the answer I was given was “unknown”.

I do not believe that this is satisfactory. I believe the Medical Association of South Africa should take note of this. If detainees are allowed private doctors we should be informed how this is done and how many times it has been done. The Medical Association was desperate to have this very important measure because of threats of overseas interference. For the benefit of that hon the Minister, this is one thing that Namda worked very hard on. It is one of the sticks used that he has complained about so often. [Interjections.]

I would like to ask the hon the Minister to give us more information about the availability of private doctors and how many times these examinations have been allowed since they were started. I believe that is very important.

It is allowed every time people ask for it.

I accept the hon member’s word, but I would like definite proof from the hon the Minister that this does happen. I also want to know how often it has been requested, who saw these patients and what the final decision was. I think it is only right that it should be made public. As hon members know, we doctors do not hide it when we do good work, but perhaps we hide it when we do not do good work.

You bury your bad work.

Yes, it is amazing that that hon member has not been buried yet! [Interjections.]

I would like to follow up some of the statements made by the hon member for Pietersburg. He made a very good speech about the problems we have in the South African health care field.

It is very interesting to hear that everybody now has the solution to the problems of the so-called increasing costs of health care, medicines etc in South Africa. I have attended a joint standing committee where there was some representation. An interesting article called “Privatisation and Deregulation of Health Services in South Africa”, was given to us by the pharmaceutical forum. I believe that some of the statements made in that article should be considered here.

Firstly, they say that the individual is responsible for his or her own health. I think this is partly true, but I also feel it is the Government’s responsibility to make it possible and to encourage individuals to take responsibility for their own health. I think that is really important.

Secondly, they say that access to unlimited free health care is a privilege and not a right. I think that is a very wrong statement to make. I think they should say, access to health care is a privilege, because we have discovered that this access to unlimited health care, while that health care is very expensive, causes people simply to rush to doctors, and there is simply no way of making them realise how expensive that health care is.

However, if the public of South Africa want First World medical care, they cannot expect to pay Third World prices for it. That is a fact. South African medical care and the standard that the medical profession of South Africa maintains are among the cheapest and best in comparison with the medical treatment available in First World countries. Compared to other countries, South Africans get their medicine free. It is easy to say that it is so expensive, but what do people expect if they enjoy modern technology, medical care using the most expensive equipment, and people demand that kind of treatment?

Let me tell hon members: This medical care is cheap. When the hon the Minister and I started out as doctors, when a patient went to hospital with angina, he was given a couple of sublingual TNT—this is a pill to be placed underneath the tongue—as well as a few other pills. He stayed in hospital for a few days or a few weeks, was sent home, he could not work, he had a heart attack and came back to hospital etc. Today we operate on him. It costs him R16 000, but within a month he is back at work. He is again able to deliver some input into society. [Interjections.]

For that reason we must not say that in that sense our health care is expensive. Health care is expensive—of course it is expensive—but that is because we maintain a health treatment system that is cheap in the sense that the patient is able to return to and be an active member of society much more quickly. If one looks at the situation from that point of view, one will find that health care is now much cheaper than it was 20 or 30 years ago.

I am going to speak on this matter again, but I want to point out that this does not give the public of South Africa a licence simply to carry on demanding health care at all times. It is well known that 18% of the South African population are responsible for 50% of the cost of health care. [Time expired.]

Mr Chairman, the hon member for Parktown will pardon me if I do not follow his argument, particularly since he is going to speak again.

I should just like to address myself to the hon the Minister. I should like to consider the problems that have developed over the years in regard to the provision of medicine to the general public of South Africa and to State patients. This very contentious matter and the problems in this regard have recently been aggravated by the tremendous financial pressure experienced by the Department of National Health and Population Development.

However, before I deal with this matter, permit me just to take this opportunity to extend my cordial thanks to the hon the Minister for the friendly way in which he has treated me and has made available to me all the information I needed, and even some I did not ask for. I am very grateful for that because it has enabled me to make certain statements here today.

The reason I am discussing this matter today is not that I am a member of the pharmacist pressure group; on the contrary, I even refused to attend their savoury meal, because I did not wish to be associated with a pressure group.

The single biggest problem in my constituency at present is the impossibly high price of medicine in the case of people who are not well off but are nevertheless not entitled to State aid. These people, whose income is less than that of the wealthy but more than that of people who are assisted by the State, are at present under tremendous pressure as far as medical care is concerned.

When one discusses so contentious a matter the things one says can very easily be misinterpreted. Therefore I want to say in advance that I have a very high opinion of the medical and the pharmaceutical professions and that my standpoint is that in general, their ethical norms are probably considerably higher than those of the ordinary person.

I deem it advisable to begin by describing the origin of the problem. In the past pharmacists were responsible for dispensing medicine to the general public as well as much of the dispensing to State patients. Particularly in the rural areas, this dispensing for State patients comprised a very major part of the total dispensing by pharmacists. The figure mentioned is that between 30% and 90% of the dispensing done by the private pharmacist was in respect of the State patient. The medical requirements of the State patient were provided by the health administrations and other semi-State institutions that bought medicines on a consignment basis on direct tender from the large pharmaceutical firms and supplied them directly to their patients through their own pharmacy outlets.

The cost per medical prescription, according to Dr Kruger of the Free State Administration, was R35 per prescription when provided through the Administration, whereas when it was done through the private pharmacist the cost amounted to R64. Provided through hospitals, the cost was also R35. One could infer from this that dispensing through private pharmacists increased the cost of medicines to the State by 82%.

It was for this reason that the department decided to try and do all its own dispensing as far as possible and in this way put an end to the tremendous financial deficits they were experiencing.

At first glance it might appear that the department was in the right in adopting the standpoint that medicines dispensed by the private sector were far more expensive than the medicine dispensed by the State. However, we all know from experience that never in history have the State, State institutions or semi-State institutions been able to provide a service as effectively as the private sector. The OFS Administration went so far as to provide the district surgeons with inexpensive medicine purchased in terms of the tender system at cost price. The district surgeon would then treat the State patient and would receive a 50%—that was the figure mentioned—bonus on the price of the medicine if he dispensed it; if not, he would be paid R35 per examination if he supplied the medicine.

This benefit accorded doctors was not passed on to the pharmacists—I received that confirmation this morning—despite the fact that the hon the Minister was assured by officials of the OFS Administration that this would in fact be the case.

I am convinced that this dispensing procedure is not to the benefit of the broad South African public and in the long term it is not to the benefit of the State either. I say this despite the fact that there is such a considerable difference in the price of the same medicine in respect of these two channels.

I say this firstly because this cheaper price for a State patient may appear to be better than it really is, and secondly because we must take into account how it arose. When the State tenders, it can apply substitution. Substitution of brands and substitution of generic remedies may be applied, whereas the pharmacist has no right to apply substitution. He cannot replace one brand name with another, nor can he apply generic substitution; on the contrary, he is specifically restricted from effecting any substitution. The whole problem in regard to this cost increase for the pharmacist can therefore be ascribed to the fact that he is not permitted to apply substitution. This means, therefore, that he is not permitted to utilise the market forces of free enterprise so that the price can be brought down. Let me mention examples to demonstrate this.

For the State and semi-State institutions that are permitted to apply substitution, the price of Furosomide—that is a generic remedy—dropped by 30% between 1983 and 1986. During the same period the tender price of the brand Angiset—a therapeutic equivalent—increased by 281%. Nevertheless the price of Lasix, which is therapeutically equivalent and is widely prescribed for private patients by doctors, increased by 187%. However the clearest illustration of how deplorable the situation is, is the following: In 1983 the price paid by the pharmacist for Lasix was 1 747% higher than the price paid by the Administration for its generic equivalent. By 1987 this difference in price had increased to 6 300%! Therefore the pharmacist had to pay 6 300% more than the State for the same remedy.

The fact that the pharmacist may neither prescribe nor substitute means that the pharmaceutical companies can simply ask any price and he has to accept it. That is the essence of the problem. Therefore it is easy to understand why the pharmacist’s price for a prescription will always be higher than that of the Government institutions or semi-State institutions. If the pharmacist can practice substitution the problem will largely be solved.

Let me mention another point. According to the latest figures at my disposal—it is true that they differ to some extent from those of the hon member for Parktown, but they are the most recent figures I was able to obtain from the Pharmaceutical Association—the State buys 65% of the pharmaceutical remedies in the country and pays 34% of the income of the pharmaceutical companies, while the pharmacists, with the 35% that they purchase, carry 64% of the cost. What this amounts to is that I as a private patient am paying approximately 265% more than the State patient for the same medicine. I can still understand this if I have to pay it, because I had an increase recently. The people on the farm say that I am a “fat cat”; I sit here in Parliament and do nothing, and all I get is a fat salary increase.

In your case it is true! [Interjections.]

I want to tell hon members that the ordinary salary-earner has a tremendous problem, because what this amounts to is that every time he falls ill, he is indirectly subsidising the State patient. [Time expired.]

Mr Chairman, I need not refer again to the problems caused by the excessive growth of the population of a country. I think we are all too familiar with that, and this has already been referred to by the hon member for Langlaagte.

Unfortunately, this is a problem which could very easily be politicised. It is therefore essential that when we address this problem, we place particular emphasis on the improvement of the quality of life. We must therefore go and look at the development of people and what this brings with it, viz work, peace and stability. Consequently, we must make a real effort in this way, and in so doing we will find that we will be able to defuse the whole problem with regard to the population explosion.

It has also been said that we are all in the same boat. Therefore, as Whites, Coloureds, Indians or Blacks we cannot dissociate ourselves from the fact that whatever happens in the future will determine what quality of life we and our descendants will be able to gain from South Africa’s economy.

There is a very small group of privileged Whites and people of Colour in this country who in reality have to accept responsibility at this stage for extending a helping hand when it comes to the development of the underprivileged. At the same time it is necessary that those receiving help must accept co-responsibility, and must be given the opportunity to become jointly involved.

Development brings with it the opportunity to experience the dignity of job satisfaction. At the end of this century we shall have to be able to provide work for at least 8 million people in South Africa—in the small business and informal sector of the economy—otherwise we will go under altogether. There is a great deal of appreciation for what is already being done by the hon Deputy Minister concerned, as well as the officials in the Department of National Health and Population Development.

I now come to the point I really want to emphasise. I wonder whether we are sometimes not addressing the wrong group. Since this concerns the population development programme, I want to make a plea here that we focus our attention very strongly on the role of the woman. [Interjections.] The woman is really the key to every family. Today I want to appeal to the women of our country, irrespective of the group to which they belong, to come forward and to tackle the responsibility of population development on a very large scale.

One group simply teaching another skills in order to create employment opportunities in home industries, could have a tremendous ripple effect. When a woman from a less affluent community can learn to make her children’s clothes herself and eventually to start a small undertaking at her home, where she not only has the opportunity to keep in contact with her children in the afternoons when they get home, but perhaps even to involve them in the undertaking, thereby keeping them off the streets, we have already achieved a great deal. At the same time the economic improvement of that family situation immediately comes into the picture, and that family develops a pride in what they are achieving.

In the USA it was found that the largest group of entrepreneurs entering the field at present, are all women. I believe that particularly in South Africa our women have this ability to an even greater extent than in any other country. It would also immediately create better relations when we work together and understand one another’s problems. We have already proved this to a certain extent in a small group in Kempton Park.

I now want to refer to a pronouncement of Mrs Alathea Jansen of the South African Union of Homemakers’ Clubs. By the way, this is a club which was started due to the initiative of the WAA, with Mrs Wynnie Schumann at the head, to initiate development amongst Coloured women. Mrs Jansen said:

I want to appeal to the women of our country: Come forward, let us join hands, and do something about this.

However, I now want to appeal to the men as well, Sir. As long as the status of the woman does not receive the necessary recognition it should receive in this country, we cannot expect the women to do the full share expected of them.

We will do our share! [Interjections.]

Yes, Sir, it depends on what share one is talking about! [Interjections.]

At this stage I want us to take another look at a certain well-known saying:

I think it is very important to begin concentrating more on involving women and developing their potential, since ultimately they are the people who can drastically influence the quality of life of a family. At this stage I want to say to the woman that she must not allow this to be said of us:

[Interjections.]

However, at the same time I want to say to hon members that they must give women a chance. A woman is like a tea bag; when one immerses her in hot water, all her strength appears. [Interjections.] Our women will then prove what we can do with regard to the population development programme. Too little attention is given to women and their contribution.

Mr Chairman, I trust the hon member for Kempton Park will not mind if I do not follow her somewhat humorous speech because there are more important issues I want to discuss. [Interjections.] For many years there has been an ongoing debate with regard to the conditions of the service offered in certain hospitals in South Africa—particularly with regard to hospitals in the Black community. The PFP has always made it very clear what its policy is with regard to apartheid in health and hospital services and we have also made it very clear over the years—the past few in particular—that health own affairs is totally unacceptable to us and we know for a fact that the vast majority of people in this country support this point of view.

We realise too that the Government is totally committed to separate health and hospital services and consequently we find the shocking inequalities that exist among the hospital services for the various population groups in this country.

I want to draw the attention of the hon the Minister today to something I am sure he would prefer to avoid—in fact newspapers over the past few months have indicated that he tries very hard to avoid this particular issue—namely the King Edward VIII Hospital which obviously is regarded as the busiest hospital in South Africa, treating more than 105 000 in-patients and 750 000 out-patients annually. I think this hospital must be causing the Government quite acute embarrassment, despite the fact that it is particularly well-equipped and has a particularly well-trained staff.

These people work under absolutely impossible conditions. In fact, I believe the conditions which exist in this hospital make it virtually impossible for this hospital to render a proper service. I would like to pay tribute to the doctors, surgeons and nurses and the administrative staff at this particular hospital for the outstanding service that they do in fact render, despite the fact that they work—as I have indicated—under extremely difficult circumstances.

For many years, experts in many fields have warned that this hospital was becoming totally inadequate for the vast number of people who would need to use its services. Many people have for years also indicated the importance of planning for the future, and the consequent need for more hospitals and for more staff. There is a critical shortage of adequate facilities in the Durban area, as there is in other parts of the country, and this has now led to the unacceptable conditions which now prevail.

There was an outstanding article in the Sunday Tribune of 16 August—just two weeks ago—which laid bare many of the facts which I think many of us in Durban who have visited the hospital before and may know people who work in the hospital, have known for a long time. This article in the Sunday Tribune laid bare a number of facts which I think make interesting albeit quite shocking reading. I have no doubt that the disclosure in this newspaper must have caused the hon the Minister some acute embarrassment as well, for it pointed out many of the serious shortcomings in the services provided in this hospital. Among these, if I may list them, are:

What are the conditions in Dakar?

You do not live there; you live in South Africa!

Why do you not go and stay in Dakar, man?

Taking into account that that hon member is a doctor, I find his comment most extraordinary. [Interjections.]

We find cases in this hospital where a child with a malignant tumour shares a room with a child who has typhoid; we have patients with severe injuries having to wait up to six hours for attention.

There are many other points raised in this newspaper that reveal shocking overcrowding in all service areas of the hospital. According to many of the senior staff, it is absolutely impossible to provide the proper care and attention for patients; often the service rendered is grossly inadequate for the patients’ needs.

The situation is now so serious that one has to look for both short- and long-term solutions. Before we look at them, however, I should like to stress that the Government must be severely criticised for having allowed this and similar situations in the country to develop. For example, at Baragwanath Hospital today, 30-bed wards are now overoccupied to the extent that the beds are all full, 30 additional patients occupy chairs, and under all the beds more patients are accommodated on mattresses. In other words, a ward that is designed to accommodate 30 patients now accommodates as many as 90.

This is to a large extent the result of the apartheid system which has led to much inequality of medical facilities and services among the various race groups. There has been a lack of proper planning for hospital and health services for Blacks over the years. If King Edward is overcrowded now, imagine what the situation will be in two, three, five or ten years’ time, with Durban’s population expanding at its present critical rate. As we all know, Durban’s population is expanding terribly fast.

We find now that elaborate plans are being prepared to build a new multi-million rand teaching hospital at Cato Manor in Durban. While obviously this will alleviate the problem to a large extent, the sad part of this decision is that it will take ten years to complete—and the plans are now only at the drawing stage! In point of fact that new hospital is desperately required now, while a second new hospital will be required in the very near future. One new hospital in ten years’ time will prove grossly inadequate if the population explosion in the Durban area continues at the same rapid rate as it is now. Short-term solutions are desperately needed to help alleviate the situation as it exists at present. One solution would be to ensure that hospitals in the rural areas are far better equipped and have more trained staff allocated to them in order to make them capable of coping with the many minor surgery cases which are at present, through necessity, being passed on to King Edward. The Government has to be prepared to spend more money on hospital services in the rural areas.

More important, perhaps, is that it must be asked yet again how the Government justifies the fact that there are wards in White hospitals—for example Addington Hospital—which are closed because of underutilisation, when there are people desperately in need of urgent attention at the King Edward VIII Hospital.

And Johannesburg.

This is in fact a point that applies to hospitals throughout the country.

On moral grounds, how does the hon the Minister justify the situation of having empty beds and empty wards in some hospitals, while other hospitals are so overcrowded to the detriment of the health of many patients? I hope that the hon the Minister will answer this question.

Mr Chairman, the hon member for Durban North asked the hon the Minister certain questions, and I feel sure he will receive adequate answers to them in due course.

If I may just digress from the subject of overcrowded hospitals for a while, Mr Chairman, I should like to place the spotlight on that division of the Department of National Health and Population Development which deals with control of the environment in so far as it may influence the health of the population. Under the auspices of the Directorate: Environmental Control, this function is performed by the Deputy Director-General, Dr Watermeyer, and his staff, who look after the health of the population with regard to air pollution, water pollution and radiation—a function which is often lost sight of but which is nevertheless of paramount importance in a country such as South Africa, which is becoming more and more urbanised and industrialised. In order to comply with certain minimum health standards, it is of cardinal importance that close attention be paid to the problem of pollution. Minimum guidelines should be laid down, in accordance with which the situation may be monitored regularly. Moreover, it is also the task of this directorate to perform precisely this function, in conjunction with other bodies.

In comparison to international standards, however, the matter is not quite such a simple one because there is a world of difference between conditions here and those in America and Europe, for example. Therefore, standards of water purity in our situation cannot be set at the same level as those in the developed countries, since we do not possess unlimited water resources. In the South African situation, therefore, we must have guidelines which are adaptable. If we were to adopt too rigid an approach towards our standards, we could remain saddled with an inadequate water supply.

We are faced with a similar situation in the case of atmospheric pollution. Height above sea level plays an important role in this regard. We do not have much information with regard to the aspect of climatic conditions on the Transvaal Highveld—for example, the influence of inversion conditions on the dispersion of dust particles or other particles, which gives rise to an abnormally high concentration of air pollution. We are experiencing this problem in the Witbank area, for example, where we find that smog is giving rise to complaints from the public of irritation of the eyes and respiratory tract. However, this need not necessarily pose a health hazard to the community. In other words, there could be a problem in distinguishing between the real health hazards and those hazards which simply have a nuisance value.

In applying the Atmospheric Pollution Prevention Act, the principle of the best available method is being employed with a view to restricting atmospheric pollution to a level which does not pose a health hazard. For example, use is being made of high smoke towers in order to release soot and other particles into the atmosphere above the so-called inversion layer. The standards that are set must, however, be of such a nature that their financial impact on our industries is restricted to a minimum. The co-operation that is being received from industrialists in the fight against pollution is extremely good and is commendable. Since the Act came into operation in 1965, better progress has been made than was originally expected. It has been found that the pollution levels in all our larger cities have decreased by more than 50% over the past 15 years, notwithstanding the increase in population size and industrial activity. Large sums of money have been spent by various industries in this regard with great success. Certain industrial problems still exist, however, and we must, in fact, devote our attention to these.

Thus, for example, R20 million is being spent on solving an existing pollution problem at the ferro-alloy plant at Meyerton. Eskom is engaged in a R25 million programme to combat dust emissions at power stations, and steel industries in the Transvaal, and even here in Cape Town, are working on improved emission control—also at great expense.

Smoke pollution, particularly in our Black townships, is probably one of our thorniest problems. This is, of course, because it is socio-economic by nature. Coal is far and away our cheapest source of energy on the Transvaal Highveld, and is used on a large scale in the Black townships. Smoke pollution levels, particularly during the winter months, are therefore tremendously high. They are so severe that they often exceed the safe limits. A minimum smoke stove has already been developed and is currently being marketed. By raising living standards and communicating the necessary information, electricity could offer a solution in the longer term.

It is an acknowledged fact that acid rain is having a detrimental effect on the ecosystem in certain parts of America, Western Europe and West Germany, particularly in forests and nature reserves. The large concentrations of sulphur dioxide and nitrous oxide being released by the power stations in the Eastern Transvaal could also have a detrimental effect on plant growth and on the agricultural products of those regions. A research and measurement programme has already been implemented and, fortunately, no detrimental effects have been observed thus far.

As far as motor vehicle emissions are concerned, readings taken in our cities have not as yet produced any evidence of harmful photochemical smog problems. As our cities expand, however, we can expect problems in this regard as well.

Asbestos pollution from asbestos dumps is another very sensitive matter which is receiving urgent attention.

The management of water and refuse is, of course, another very important aspect. It is a very extensive, multi-disciplinary activity and various authorities and other bodies are involved in it. The department also has certain specific responsibilities in this regard and is extensively involved in the health aspects of water and refuse management. Unfortunately, time does not permit me to elaborate on those aspects.

In conclusion, I just want to issue a few words of warning regarding the dangers of radiation to man. We are living in the age of the microwave oven. According to the available evidence, unlimited radiation from micro-wave ovens could be dangerous to humans. When one uses such appliances, it is essential that they be manufactured and operated correctly. In co-operation with bodies such as the CSIR, the department is paying continuous attention to this matter. It has come to the department’s attention that some fast food outlets are removing the doors from their ovens in order to work more quickly, and the ovens are being used in this state. Of course this is extremely dangerous to the human body. Certain action has already been taken in this regard and further action is being contemplated.

It is very clear from the aforementioned facts that the environmental control division of the Department of Health performs an extremely important function by acting as a general watchdog in so far as the pollution of our environment is concerned. We want to wish that division of the department every success in its work in the future.

Mr Chairman, in voicing my support for this health Vote I am motivated by the ghastly sights that have greeted me in the past. I refer in particular to what a gun can do in the hands of a suicidal, homicidal maniac who wipes out his family and then himself. Reviewing the need for a register of the potentially dangerous is becoming increasingly apparent.

Thanks to our hon Minister we are entering a new and significant phase in South Africa in which the State and the private sector are partners complementing each other in the provision of a service attuned to the new needs of the public which will enable those in the helping professions to fill the gaps with the greatest degree of flexibility. The rationalization of health services will not mean that anyone will be denied the benefit of health services, neither will it mean the lowering of standards. It will also not lead to the enforced integration of hospital services but will allow people and communities the choice of retaining their own hospital services. Health services extend far beyond the hospital. They influence the health and the safety of all citizens. It is this safety that is assured by adequate mental health measures to safeguard our citizens.

One very important facet of mental health care is the ability to prevent the actions of emotionally unstable and immature or otherwise dangerous persons. More often that not the death and destruction that I witnessed was the direct result of the actions of an emotionally unstable person who had gained easy access to a firearm. The problem is caused by those unfit to possess arms and who constitute a danger to themselves and others or to their society. Family murder has become an everyday occurrence and all too often, unfortunately, sensational coverage is given to these tragedies by the media thus planting the seed of suggestion in other unstable minds.

Recently several schoolchildren committed suicide by shooting themselves. In another case, a whole family was wiped out by a cross-bow, and so the list goes on.

I believe cross-bows should be classed as dangerous weapons and should be licensed. The Arms and Ammunition Act must be amended. Guns cause more unhappiness than anything else. Most of these tragedies are preventable, predictable and recognisable.

Is it perhaps not true to say that many a suicide would not have taken place and taken that final route had a licence been refused to him or her right at the start? Many an innocent member of the public would not have died had it not been for the carelessness of individuals who failed to keep their fire-arms in a safe place and thus made it easier for burglars to steal them. Many a child would probably have been alive today if their parents had not left fire-arms lying around in open cupboards where inquisitive hands could easily get at them. Many a family and individual would have been alive today had proper licensing procedures been adopted long ago to prevent the emotionally immature and unstable persons getting their hands on a gun and wiping out their families and themselves.

While it is unfortunately true that one cannot legislate against human nature per se we can and must enact strict measures which will prevent people from posing a danger to themselves and to others. Heretofore we have only been licensing fire-arms. I believe the time has come for us specifically to start licensing the people who carry those firearms. There is an appalling tendency to run off to the nearest gunsmith and go to the Police and pay R2 for a licence for a gun from R1 000 upwards and, hey presto!, we have an instant fire-arm owner. The person has had no training, no psychological testing and has undergone no rigorous procedure to ensure that he will not be a danger to himself and to others.

I believe that the time has come for the establishment of a permanent fire-arm licensing commission to deal with the present and set the pace for the future. We need to make guns more difficult to obtain for both the criminal element and those who are psychologically totally unfit to possess a fire-arm. Not only that, but I believe that the commission should have the power to appoint or commission a credible psychological assessor to screen any applicant for a fire-arm licence.

It is abundantly clear that we are asking for trouble if we grant licences to people with a history of emotional instability, personality disorders, suicidal tendencies, low intelligence, drug taking or alcoholism. I believe that each applicant should be made to sit for a psychological test conducted by a properly appointed clinical psychologist under the aegis of the commission.

Over and above this I believe that the most important thing is practical shooting experience. The commission should in consultation with reputable shooting ranges and galleries set a certain proficiency test for applicants to be conducted by professionals at these galleries or shooting ranges.

In addition I believe that the SABS, in conjunction with Armscor, should lay down strict standards for fire-arms. I also believe that the fee for a fire-arm licence should be raised to R100 or more. The current low fee is too counter-productive and unrealistic.

At the same time the Police should be granted the power to establish whether or not there is a safe where a gun or other fire-arms are to be kept. As part of any future licensing process certain minimum standards should be set for the safe deposit of fire-arms. The commission should have the power to ask the SABS to determine minimum standards for such safes. Any gun owner not possessing such a safe could and should be deprived of his or her licence.

Our country cannot afford a horde of trigger-happy people. There are enough weapons in the hands of the security forces and other properly licensed security outfits to provide for the security needs of most.

One thing is quite clear. Action has to be taken immediately. We do not want to enter the 21st century in 14 years’ time with citizens armed to the teeth in a one man, one gun situation.

This leads me to my final point. Why should people be allowed to possess a veritable armoury of up to 12 fire-arms? Just how many weapons can one fire simultaneously?

Unless people are collectors of antiques and have only properly spiked weapons, I see no need for a gun shop in a living room, whether in a city or on a farm.

Guns and bullets themselves are not dangerous; it is the mentally unstable people who misuse them who pose the greatest danger.

Allow me to conclude by quoting from an American police manual:

Mr Chairman, I do not wish to react to the speech of the hon member for Bezuidenhout on this occasion. This matter was in fact raised yesterday evening during the discussion of the Vote of the hon the Minister of Law and Order, and I think it should preferably be dealt with there.

In the annual report of the department which is being discussed here at present, the following data are provided in respect of legal abortions in 1986. Out of a total of 770 cases, there were 112 in which continued pregnancy would endanger the life of the woman concerned, or would pose a serious threat to her physical health; 210 which posed a serious threat that the child to be born would suffer from a physical or mental abnormality; 27 in which fertilisation allegedly took place as a result of rape or incest; and 416 in which continued pregnancy posed a serious threat to the mental health of the woman.

In analysing these data we find the following. Out of the 770 cases of legal abortions, 609 were carried out on White women; that is almost 80%, while the White population constitutes only a small percentage of the total population that was relevant to this report. We also find that the reason which gave rise to the most legal abortions in terms of the Abortion and Sterilisation Act, was that contained in section 3 (1) (b), viz that the continued pregnancy of the woman would pose a serious threat to her mental health.

This is significant, since this is the one reason which is the least verifiable. In fact, this is the one reason which lends itself easiest to fraud, so much so that some hospitals in the USA no longer accept it as a valid reason for abortion.

What is also illuminating, is that percentagewise these grounds for abortion differ tremendously amongst the various population groups. Among Black women this was the reason for only 13% of all abortions; among Coloureds, 28%; among Asians, 37%; and among Whites, no less than 60%. One can rightly ask whether White women are really more prone to mental illness during pregnancy than women from other population groups. Are the chances of White women of developing mental health problems during pregnancy really so much greater than those of other women? I cannot accept this as a fact, and I am of the opinion these grounds for legal abortion must be serious reconsidered.

Approximately two weeks ago the hon member for Houghton made a plea for the liberalisation of our legislation on abortion.

[Inaudible.]

She and other proabortionists have a few arguments they put forward in favour of their standpoint. One of the most important arguments is that abortion should be used as a method of promoting family planning.

That is not…

Of course family planning is a subject on its own. [Interjections.] In that regard I just want to say that in a country like South Africa, where one accommodates a First World as well as a Third World population, one cannot pursue the same policy for the entire population. The Dutch Reformed Church even conceded this point at last year’s synod.

Abortion is not a responsible way of letting family planning come into its own.

Nobody ever said it was.

Abortion is the destruction of human life. If we were to use that method to control population growth, we would in principle be committing the same crime as if we were to decide to end the lives of the elderly over a certain age. In principle there is no difference between destroying a life before birth and destroying it after birth.

The fundamental question still remains: When does human life begin? The proabortionists deny that one is a true human being from fertilisation. According to them, life only begins thereafter. What are the scientific facts, however? After fertilisation a new, unique entity is created, and whatever happens to that new entity in the next 60 or 80 years, the fertilised egg cell is complete from the moment of fertilisation, and it carries within it the mark of a unique individuality.

What follows, viz the process of cell division and the further development of the embryo and foetus until birth cannot change this primary fact in any way. At no stage does anything have to be added to make it essentially or qualitatively different from what it was at the time of fertilisation. The only logical starting point for human life is the process of fertilisation. Whoever accepts this, must admit that abortion after fertilisation entails the destruction of human life.

There is another argument that is advanced for abortion, and that is that many backstreet abortions are carried out in any case. I do not deny that; in fact, it is true. However, this is no reason to legalise abortion on request. Who would think of legalising murder just because there are people who commit murder? In any case, it has been found that in countries where abortion has been legalised or made more easily obtainable, backstreet abortions have not decreased dramatically.

In 1966 the medical association of England warned that backstreet abortions would not decrease if legislation made abortions more easily obtainable. Statistics have shown this medical association was correct in their prediction.

In Japan, a country where abortion on request has been legal for a few decades, approximately 50% of the women nevertheless have the so-called backstreet abortions.

I want to appeal to the hon the Minister in respect of this matter not to allow himself to be intimidated by the tremendous onslaught liberal-thinking people are launching against our present legislation on abortion. Abortion is not a solution to family planning.

No one said it was.

In any case, it hits those peoples who should have larger families the hardest. [Interjections.] In principle the destruction of life before birth remains the same as the destruction of life after birth.

I also want to ask the hon the Minister to take another look at section 3 (1) (b) of the Abortion and Sterilisation Act. The fact is that no abortion can cure a woman’s mental abnormality. In addition, there is no mental illness which cannot be treated just as well in a pregnant woman as in a woman who is not pregnant. What is true, is that after an abortion, women sometimes have mental problems for the rest of their lives. A scientifically-based investigation into this should be conducted. [Interjections.] We cannot get away from the fact that the mental health of the woman as a reason for abortion lends itself to abuse.

We have had a prime example of this in the USA. Before 1973, a law in California provided that a woman’s mental illness was no reason for abortion, and this was advanced as grounds for abortion in only 2% of the cases. In New York, on the other hand, it was a reason, and there it was given as grounds for abortion in 98% of the cases.

As far as the White population is concerned, we in South Africa are rapidly approaching 98% if we do not make a serious attempt to stop the abuse of this section in the Act.

In conclusion I just want to address a word to the media in this regard. The media, too, have a responsibility in this regard. Last year I read the following emotional headline in a newspaper regarding this matter:

Inter alia, this report states:

It is easy to bemoan the lot of the woman in these circumstances in an emotional way. However, it is also necessary to think of the unborn child in a responsible way. In these days of pleas for human rights, the rights of the unborn child should also be considered. If there is one right he may not be denied, it is the right to be allowed to live. Abortion denies him that right without his being given the opportunity to defend it.

Mr Chairman, the hon member who has just resumed his seat achieved one thing. He produced quite a reaction from the hon member for Houghton, and he put her in a difficult mood. He should be grateful that I have not given her the opportunity of speaking in my place, because she would have made a meal of him. [Interjections.]

Many words of congratulation have been addressed to Dr Retief on his appointment, and I wish to add mine. I should like to express the hope that the days ahead will be wonderful for him—I am sure that will be the case—and that he will be very happy in his new sphere of activity.

The hon members for Pietersburg and Parktown made very responsible speeches. I have always told the hon member for Parktown not to ask so many questions. For many years we have seen people trying to make speeches by asking questions. Today he did not ask any questions, and he began to talk sense. I think he made a good contribution.

I want to refer to the speech of the hon member for Humansdorp. We are all aware that the hon member knows everything there is to know about Jersey cattle. Apparently he farms with Jersey cattle, but it seems to me that he also knows a lot about pollution. If we want to know anything about pollution, I think we should ask that hon member. I congratulate him on a good speech. He certainly did his homework thoroughly.

In this regard I want to refer to what the hon member for Kempton Park said, namely that development brings peace, work and stability. Well, that is true. It is also true that one of the prices we have to pay for development is atmospheric pollution. Those two concepts go hand in hand. Ironically, it is, in truth, man and science who contribute to pollution. Fortunately it is also true that man can use science to combat pollution.

I can assure this Committee that the relevant subdirectorate has exceptionally competent people in the field to deal with the matter. Hon members can rest assured that we are doing our best, with the means at our disposal, to find an answer to this problem.

The hon member for Humansdorp referred to various causes of atmospheric pollution, including industry. There is genuine cooperation between the State and industry, and this is largely the reason why the adoption and application of the Atmospheric Pollution Prevention Act, 1965, have proceeded so successfully, in spite of the tremendous development taking place in this country. As the hon member for Humansdorp indicated, pollution levels are, in fact, much lower than is sometimes alleged. We are so inclined to say, when driving into cities, that the pollution has worsened. However, statistics prove the opposite.

This all boils down to the single fact that the measures introduced and the co-operation we have experienced from various quarters—industry in particular—have contributed greatly to combating this problem effectively.

Another factor is that the department has a very good modus operandi. They do not simply descend on industries or grab them by the scruff of the neck when there are signs of excessive pollution. Nor is the Act summarily and vigorously applied. It incorporates an element of fairness, and people are given time to attend to matters, because—the hon member for Humansdorp referred to this—many millions of rands are involved. He also mentioned certain figures, but I do not want to repeat them. I do want to say, however, that the anti-pollution devices and scientific methods which have to be employed in order to deal with this matter are part of a very expensive process.

The other matter to which the hon member referred, the smoke pollution from Black residential areas, is, of course, creating a problem of increasing magnitude for us. I can assure the Committee that that problem, too, is receiving very serious attention. The other day I was at Witbank, where many of the complaints have been voiced. Of course, one encounters atmospheric conditions there, as the hon member for Humansdorp pointed out, the effect of which is that, when one views the area from a higher level, the pollution level seems worse than it should be. However, what happened there was a striking example of how an answer can be found to these problems if there is co-operation. We heard and saw how the industrialists and businessmen, as well as the town council of Witbank and the local authorities of the Black residential areas in that vicinity, met round a conference table to deal with the matter. I hope the hon member for Witbank supports that kind of approach to a tremendous problem.

The burning of coal is one our big problems. Naturally it is at present the most important source of energy for heating homes and cooking food. In this regard, I want to refer to a statement by Eskom with the heading “Eskom to Boost Electrification of Developing Areas”. What is said in it is very significant:

†What are they actually saying? They are saying that they want to be part and parcel of the team that will be combating this problem and in the same process trying to improve the quality of life of the people involved.

*They have actual alternatives in mind, not merely ideas and an intention to try to combat this pollution, because they want to provide the Black residential areas with electricity more cheaply. In the statement they discuss the upgrading of 60 residential areas, in which approximately 3 million people are living, and say that it would cost about R700 million to supply electricity in the conventional manner while, according to the investigations they have carried out and by means of the new techniques they have proposed, they will be in a position to do so for R300 million. This is certainly a matter which warrants serious attention.

I merely want to add that Eskom has provided us with a very good example of how a fresh and unique approach to this problem should be adopted. One must not set one’s mind on conventional methods; science can be harnessed in new ways.

I now want to refer to a matter which came up in the other two Houses when this Vote was being dealt with. It was also raised here when questions were put in this regard. It concerns the report of the Nieuwenhuizen Commission and the legislation which must flow from it. The Government’s White Paper on the report was tabled on 28 June 1983, and I do not want to repeat what it said. However, the Government took a few clear decisions on that occasion. One of them was that the envisaged legislation should not:

to create a more favourable dispensation. We should have liked to see it in the draft legislation which is presently being prepared.

However, as we informed this House in reply to a question, a problem cropped up, namely how to give substance to that principle in draft legislation without deviating from the Cabinet decision. As I said, it created problems and eventually led to the Cabinet decision, as worded in the White Paper, having to be amended in order to make it possible for the interdepartmental working committee to submit new legislation.

The preparation of the legislation is virtually complete. It is being checked legally and technically and translated, and will then be published. Hon members and other interested parties will than have an opportunity to comment on it.

I can state with certainty, however, that the envisaged draft legislation provides that compensation may only be paid if there has been a functional deprivation of a permanent nature irrespective of whether the cardiorespiratory functions have been impaired or not, subject to the fact that no worker or former worker will qualify for compensation in respect of pneumoconiosis unless he is placed in at least category 1/1 of the International Labour Organisation’s Classification of Radiographs of Pneumoconiosis, 1980.

Secondly, compensation will correlate quantitavely with income, and the legislation will be “colourless”, that is to say a person’s earnings will be taken into account in the payment of compensation. Compensation will be paid according to that and the degree of certification. Furthermore, compensation will be payable monthly. I think we should rather try to move away from the concept of a pension, because this compensation can easily be confused with the social pension. It is actually compensation in respect of damage to a person’s health as a result of a compensable industrial disease contracted while working at a registered workplace, meaning any presently controlled mine or works as well as any other place which will have to register in terms of the new legislation. Provision will also be made for the payment of the monthly compensation in a lump sum in certain cases, for the reason that some of those workers whose health has been damaged go to the neighbouring states where we cannot locate them easily.

My time is up, Sir, and I shall stop at this point.

Mr Chairman, apropos the Meiring Committee and considering the statement of the hon the Minister, we are happy that he intends to pursue this matter further with a full investigation by a representative committee. We hope and trust that in this way labour peace will be achieved, more so than when the previous attempts were made.

I would like to turn to the Government Service Pension Fund. I am pleased that the hon the Minister made the actuarial report available. It is a pity that it is 17 months late and that the previous actuarial report was published 18 years ago. However, I am pleased that the hon the Minister has proceeded to a three-year cycle of actuarial assessment. Unfortunately this Government—which often boasts that it has been in power for 40 years—must not only accept that it has done some good things, because it has also done some very bad things. I am afraid the history of the Government Service Pension Fund and its shortfalls and the problems related to it must be blamed on this Government and on this Government alone.

I think I must warn the hon the Minister that while the statement he made today will probably be received with some approval by the population as a whole, he needs to be aware that in his recommendation that a change be brought about in the formula for buying back he gives no indication of a time scale of when this will be brought about. This hon the Minister is aware that before I entered Parliament I was the general secretary of a teachers’ association. As did my colleagues from all Government service staff associations, I recommended actively every day that our members should buy back. It was, is, and remains a financial investment of the greatest possible worth to State employees. If the hon the Minister is going to change the buy-back formula and he wants to signal to every public servant in the country to commence buying back tomorrow, he has just done that. Therefore, unless he starts changing the formula to take effect almost immediately he is going to create a flood of applicants and that will make the situation much worse.

I take note of the hon the Minister’s statement that he intends to appoint a committee of experts to look at the investment of the fund in the Government Service Pension Fund and, I assume, of the other pension funds. I wonder whether they will only be doing this or whether they will be advising of other aspects of the financial side of the Government Service Pension Fund. What is this group of experts looking at?

The hon the Minister has mentioned the figure of R7 600 million shortfall. That is what he said in the House of Delegates yesterday, although I see in his unrevised Hansard he is supposed to have said R7,6 million while it is actually R7,6 billion. That figure excludes the next clause in the actuarial report, which states:

It is that R17 000 million that we in these benches are very concerned about, not just the R7,6 billion. We understand that the proposal the hon the Minister has made will take care of the buying back. We believe that he will also have to review, as the report recommends, the whole situation of the formula for the gratuity and the annuity of public servants being based on their last salary. If the hon the Minister intends to do this I think he should give fair warning in this respect to State employees.

I also believe he needs to ensure two particular aspects to be reviewed which I know State employees have been discussing. The increase in the widow’s pension from 50% to 75% also needs to be actuarially assessed. There is also within the orbit of buying back a legitimate reason many people have for doing so early in their careers, namely to get sufficient service in order to gain a disability pension. I believe 10 years is required. It is once again an area of conditions of service that may well be out of this hon Minister’s field and in the hands of his colleague from the State President’s office. At this point I must reiterate what I said under last week’s Vote.

I believe that the pension funds in the Public Service should fall under the Commission for Administration.

I think we also need to accept the fact mentioned in the actuarial report that the Stabilization Account itself must be assessed very rapidly. The contribution of the State to the Stabilization Account is now well over R200 million. This figure is based on 7% of the 13th cheque of State employees plus what the State pays in, namely three times that and anything over that amount required for current pensioners whose benefits have been increased. I believe that the stabilization account has never been able to meet its payouts since it was created. The hon the Minister has to review the Stabilization Account drastically and most urgently.

Finally, I think nothing more need be said than what is stated in the last sentence in the actuarial report itself:

Sir, the hon the Minister’s statement itself says exactly that. Looking at the following statement, I think we must distinguish between two time periods:

It is the long term that we now need to be looking at.

Mr Chairman, I hope the hon member for Pinetown will not blame me if I do not follow him.

*Later on in the course of my very short speech I shall touch on one or two matters the hon member for Parktown raised.

The altercations here in Parliament during the past few days reminded me of Jan van der Merwe, who asked his friend whether he had been to the border that year yet. He said he had not, to which Jan replied that he should know his brother Koos well, because he had not been to the border that year either. [Interjections.]

Today some members of the public as well as medical practitioners are under the impression that the Government has not taken any positive steps to combat the terrible disease, Aids. I can understand that, because if the layman has to decide for himself today on the seriousness of this disease, merely by reading reports appearing in newspapers and magazines—particularly reports with captions such as “Aids, the African Horror”, “Ten people infected with Aids after Blood Transfusion, “Aids—a growing plague”—and when the spread of this disease is sometimes compared with the Black Death, which wiped out a quarter of Europe’s population in the fourteenth century, one cannot blame them. It is alarming.

Unfortunately the naked facts in themselves are also alarming, such as the fact that world-wide 55 000 people have already died from this dreaded disease. Another disturbing fact is that the disease is no longer restricted to homosexual men; it is now appearing in the heterosexual community as well. In the USA in April there were already almost 2 000 identified cases among women, and this figure is continuing to rise. In Africa from the outset this disease was not restricted to homosexual men. It is also spreading heterosexually, and this is of great danger to us in South Africa.

A further important fact is that the disease is spread by what one can call unavoidable things, such as sex, pregnancy, blood transfusions and drug addiction. As long as there are people, there will be sexual intercourse, women will fall pregnant, blood transfusions will be needed, and there will be drug addicts. The most alarming fact of all is that there is no treatment for this disease. That is because this virus is as wily as a fox. It is able to change its form and character inside the body 40 to 50 times. It is characterised by the fact that it attacks and destroys the cells in the blood of the human being which are responsible for forming anti-bodies against viruses, namely the T4 lymphocytes, hence the name Acquired Immunity Deficiency Syndrome.

It is therefore clear that the Government can never dare to underestimate the political, socio-economic and psychological impact which this deadly disease can have on the population. I want to give hon members the assurance that this Government is not underestimating it either. In his speech the hon the Minister very clearly spelled out his department’s responsibility towards and policy in connection with this matter. The announcement made by the hon the Minister with regard to Aids again proves how serious he is about the matter. The announcement is gratifying and in line with the tendency in the rest of the world.

I want to quote to hon members from a report from Washington, which appeared in Die Burger of 18 August:

I do not believe that the hon the Minister could have waited any longer, and in this regard I want to disagree with the hon member for Parktown, who alleged that this announcement could lead to inhumane action. I feel that this announcement was made for humanitarian reasons.

Since 1981 this department of the hon the Minister has been in close contact with the Centre for Disease Control in the USA. Dr Watermeyer, the Deputy Director-General of Health, inter alia, received his training in the combating of Aids there.

The Medical Research Council, which is a Government institution through and through, established the Aids Virus Research Unit at the National Institute for Virology early in 1987, after thorough planning the previous year, at a cost of approximately R1 million. This research unit will be of great value to the whole of Southern Africa because it already has sophisticated technology for Aids research, and international contributions are already being made. I can assure hon members that this is being done by a team of highly qualified people.

The department also deemed it necessary to start an Aids prevention strategy at the end of 1984. They brought together all the experts to establish an Aids Advisory Committee, under the leadership of Dr Jak Mentz as chairman. All organisations involved in the combating of Aids are represented on this committee. The aim of this committee is to monitor the entire situation and to advise the department.

In addition, in August 1985 the department ordered that all blood products should be tested for Aids before they were used for blood transfusion purposes. As a result of this action Dr Cochrane could say the following:

As recently as three days ago an information and training service for Aids was established, with the aim of providing experts and interested groups with information as well as study methods and material to enable them to give proper information to smaller groups.

The information campaign by the authorities and the private sector on the prevention of Aids is considered by this department to be the most important single strategy in the fight against Aids.

Mr Chairman, with apologies to the hon member for Welkom, I intend devoting the few minutes at my disposal to the plight of the pharmacists. We have already had addresses on this subject from the hon members for Pietersburg and Heilbron, and I do not intend repeating what they have said. I think they have emphasised, quite rightly, that there are certain very serious problems with regard to the future of the pharmacist in this country.

I do not want to appear an alarmist, but I want to suggest that if the present threats to the pharmacist continue uncontrolled, then what we have known as the local chemist—the man on the corner—will disappear from the South African scene. I would go so far as to say that the pharmacist is in a most unfortunate position in that he is somewhat overshadowed in the field of health services by other powerful groupings. In this regard I am specifically referring to the State on the one side, and the very powerful medical profession on the other side. It is no coincidence that when we look around this House we see that virtually every person who is involved in the field of health services is a medical doctor by profession; we do not see pharmacists, nurses or any person in that category. I submit that there is a distinct bias towards the medical profession and I believe it is the duty of those of us in this House to see to it that the interests of minority groups such as the pharmacist are adequately protected.

The sources of danger which have been referred to are the Government on the one hand and the trading competition from the medical profession on the other hand. I submit that both these threats require some positive action and planning on the part of the hon the Minister. I believe that this should be looked at, particularly as there is going to be a very substantial growth in the demand for health services over the next two or three decades. It is estimated that in the next 30 years, while there will be a doubling of our population, the demand for health services could grow four to five times, because of a number of factors which are not necessarily directly related to population growth.

This clearly demands that we have a broadening of the avenues through which the services are funded, and—more importantly—the avenues through which they are delivered. We should not, at this stage, be encountering a situation where the existence of a very essential element of the provision of health services, namely the pharmacist, is being threatened. While we accept that Government is presently and for the foreseeable future going to remain responsible for both the funding and provision of health services—and here I say “provision” and not necessarily the delivery of health services, because quite clearly Government has to provide for the indigent and the aged—we will have to involve the private sector more and more in the future in both the funding and the provision and delivery of health services. This includes the private practitioner, private hospitals and, certainly not least, pharmacists. I submit that they will have to play an increasing role, not only in the provision and delivery, but—more importantly—the funding of health services. We cannot, with the growing demand that we will experience in the future, expect the taxpayer to pay for everybody’s needs in terms of health services. The only way that the private sector is going to become involved in funding, is in a situation where your private sector is also involved in the provision and delivery of health services.

I will not go into all the details of the extent to which the pharmacist is being threatened. In addition to a lot of work being taken away from him, there are further threats of work being taken away from him in the form of State patients by the Government. The Government must look at a practice that is gaining momentum and that is of the doctor going into dispensing and trading in competition with the pharmacist.

Mr Chairman, the hon member for Groote Schuur will understand if I do not follow up on what he said, since I want to deal with a different matter, namely population development.

*I therefore prefer to associate myself with the hon member for Kempton Park. I promised her that we men would make our contribution; I shall therefore try to prove this in the course of my speech. If by the end of my speech she is disappointed, I apologise in advance. [Interjections.]

In South Africa there is a school of thought, particularly among our Black population groups, that children represent wealth, that they will care for one in one’s old age and that they are actually a pension scheme. Fortunately urbanisation has led to the gradual disappearance of this school of thought. Those particular population groups have started to become refined and have started to realise that too many children actually drag one down socio-economically. They realise that another form of pension is certainly better than the one they have believed in over the centuries. May I just say in passing that as I was privileged to be a member of the Meiring Committee, I just want to ask that the recommendations of this committee be implemented as soon as possible.

Unfortunately these changes have not yet taken place in the rural areas of South Africa. A very large part of our population are unsophisticated people, who mostly live in poverty. I know that I may be exaggerating and oversimplifying, but the level of education, learning and all these things which are of essential value, is actually low. I personally believe that the socio-economic conditions of the Black man in the rural areas are of more importance to him than to have the vote.

If we are serious about doing something for these oppressed people in South Africa to wrench them out of this poverty culture, I believe we must really start taking positive action. One is grateful that so much has already been done and that the department is serious about doing something about this. We already have the Population Development Board; there are a large number of mobile clinics rendering valuable services in our country. The department supports the Rural Foundation financially on a large-scale, and fortunately the farmers are beginning to realise that upliftment is actually the farmer’s primary task.

I think it is quite right that at the beginning of such a programme one should place emphasis on the number of children in the family. Too many children in the family is actually the most important reason for the poverty culture in which the people find themselves. However, we should also endeavour to develop the entire person and not only concentrate on the number of children he has. For that reason one is also grateful that increasing attention is being given to literacy and that better schools and educational facilities are being created. One is also grateful that a tremendous education process is taking place in the schools themselves. One is also very glad to see that farmers are giving far more attention to the spiritual needs of their workers.

In my opinion the purpose of the entire process is not only to uplift the person for his own sake, but also for the sake of the entire community. One can easily reason that one can develop a better worker, but that is not all. One creates a person who has greater endeavours and ideals in life and who starts to develop himself. Eventually one has a person who not only means far more to himself and to his family, but also to his community and the entire country.

Let us admit that our rural population is lagging behind other parts of the population. We can even say that here and there we still have backward people. We do not know how many of them there are, but it can be approximately four or five million. We dare not close our eyes to them any longer. Although a great deal is already being done, we must work far more intensively at the human level. We can draft constitutions and negotiate reforms, but it is going to be of no avail to us if we cannot uplift these people in South Africa.

What is therefore required? In my opinion the department must work even more intensively. In plain language the department must acquire more money in order to be able to spend more on this entire task of upliftment. I also want to ask that the department should make more money available to the Rural Foundation, which is performing a huge task in a wonderful way.

More and better education must be introduced in the rural areas. We must all take an increasing interest in these people. We must take an interest in their spiritual care. We must take an interest in how they spend their free time. After all, the devil finds work for idle hands to do. We must take far more of an interest in adult education in the rural areas.

If the State does all this, I feel that we in the private sector must also make our contribution. In the private sector we also have our co-operatives, which are a large and powerful instrument in the rural areas. We must get interest and funds from that quarter. If we can do that, we will be creating an asset for our country and for that particular community. We will be creating an asset for ourselves and for that private sector, with a person one has uplifted in life with more ideals and a better ability to work. In this way one has a person who earns more money and can spend more. The private sector therefore also benefits from this in the long run.

Today I am therefore asking that we all stand together, that we all think together, that we all work together and that we in the Government and in our private capacity give particular attention to the upliftment of these people. We must develop them so that we can uplift them to be full-fledged people in South Africa, people who mean something to themselves and to their families and to our country.

I am asking that we do this, and that we find the money and the means to be able to do this.

Mr Chairman, the hon member for Wellington made statements I cannot disagree with. I support him in most of what he said.

I was very interested in the rather searching speech by my colleague the hon member for Durban North. I could not help but hear an interjection by the hon member for Langaagte when the hon member for Durban North spoke about the King Edward VIII Hospital. He said: “Hoe lyk dit in Dakar?”

Let us be quite honest. We are talking about the health services of South Africa and I would like the hon member to remember that when we talk here, we talk about a total health service to the total population in South Africa and that the King Edward is a teaching hospital. It is not just any hospital. It is a teaching hospital. I therefore think we should compare the King Edward Hospital with other teaching hospitals in South Africa which are for Whites whereas the King Edward is for non-Whites.

I would like to ask the hon the Minister or any other NP speaker who is going to speak after me—I believe the hon the Deputy Minister will also respond to me—to answer the following questions.

I would like to ask the hon the Deputy Minister or the hon the Minister what the nurse-patient and doctor-patient ratios at King Edward are as compared to other teaching hospitals. I would like to ask the hon the Minister how many intern posts there are in King Edward as compared to other teaching hospitals. What is the bed occupancy rate in King Edward Hospital as compared to other teaching hospitals in South Africa, or other hospitals in Natal, especially White hospitals? What is the maximum and average number of floor beds the King Edward Hospital has had during the past year? When will the new teaching hospital be built in Durban? What will be done to relieve the overcrowding at King Edward Hospital in the immediate future?

The hon the Minister has been to this hospital, and I have corresponded with him about the conditions there. He knows that we have both visited the hospital. I would like to ask the hon the Minister, who is himself a doctor, to try to justify having two children to a bed or cot at the King Edward Hospital when facilities at other hospitals like Addington, for instance, are not fully utilised.

I would like to tell the hon the Minister—I am interested in his replies—and I would also like the hon the Minister or any other Nationalist hon member…

National Party.

I beg the hon member’s pardon; I should have referred to the National Party. At least that is one thing he knows!

You are all Nationalists, anyway.

I would like the hon the Minister, his deputies or other hon members of the NP to come with me to the King Edward Hospital. Then they can tell me if we should judge that hospital in the light of health conditions in Dakar or those in South Africa. [Interjections.] It is a teaching hospital where students are meant to be taught about South African health standards. It must be a bad education for the students to have to be satisfied with standards and facilities like that. Secondly, it must be most demotivating for the doctors and staff working there. To have to treat children with gastro-enteritis on top of one another is, I believe, not acceptable anywhere, but especially not in a teaching hospital.

In my previous speech I spoke about the modern South African notion of privatisation, and I warned against the idea that the concept of access to unlimited free health care should be replaced by that of access to unlimited health care. When we contemplate nationalisation or privatisation, and the criticisms of nationalisation, many of which I share, I think we must be careful. I would like hon members to listen to a few facts about what happened to the privatised health service in America.

In the United States they spent 1 billion per month on health care in 1950 and 1 billion per day in 1986. Thirty per cent to 40% of United States hospital beds are unoccupied.

West Germany has the largest number of doctors per capita and the worst health statistics. Japan has the least number of doctors per capita and the best health statistics.

Dakar!

Big mouth!

Now there is another clucking hen sitting there in the corner.

They say there are 200 000 excess hospital beds in the United States and every year the number of doctors increases by 15 000. One can go on to mention many other factors. What I am trying to say, is that with modem medicine and facilities the patient…

Mr Chairman, on a point of order: Is an hon member allowed to refer to another hon member as a clucking hen?

Order! Which hon member referred to another hon member as a clucking hen?

The hon member for Durban Central called the hon member for Hillbrow a clucking hen.

Order! Did the hon member for Durban Central say that?

Mr Chairman, I thought he sounded just like a clucking hen, but I withdraw it.

Mr Chairman, on a point of order: Is it permissible for one hon member to refer scornfully to another hon member as “big mouth”?

Order! Which hon member said that?

Mr Chairman, I did and I withdraw it.

Order! The hon member for Parktown may continue.

I am trying to make the point that if we in South Africa only believe that the rising costs of health care should be controlled, we are going to make a big mistake. Modern methods of health care are available and the public demand them. In fact, one cannot refuse them that health care because it is too expensive. When a patient came to us with a pain in the chest in the olden days, we listened to his heart with a stethoscope and gave him a few pills. Today there are many additional tests like X-rays, ECGs and Echos that will cost him quite a lot of money.

What I am trying to say is that we should build in a disincentive.

*The patient should also dip into his own pocket to pay for his good health.

†There must be some disincentive. There must also be some incentive for the patient to make the necessary financial arrangements to pay for his own health care. If he demands this health care—I support him in the fact that he should have this health care—he should make the necessary arrangements.

It can be free under the Medical Schemes Act. I am afraid the doctors of South Africa want to practise national health care, but they want to have private patients’ care payment. One cannot have both and therefore we should encourage insurance companies and other groups to take part. We should free health care in our health supply system. We should free it and make it a part of the open market so that more bodies can make provision for people to make sure that they can afford their own health care.

I must repeat that if one does not give the modern patient adequate health care, he will sue. We know what has happened in America. He demands it and I believe if it is available he has a right to it. We must free the system so that the patient and the private sector can bear the financial burden. The Government will then have more money available to use for Third World health care in the rural areas where it is needed most and those who want the additional, fantastic health care must pay for it themselves.

Mr Chairman, the hon member for Parktown will forgive me if I do not react to the points he raised. I am sure the hon Minister will do so more than adequately.

Allow me first of all to thank the hon the Minister for his warm welcome. I should like to associate myself fully with the sentiments expressed by the hon the Minister pertaining to the Director-General and all the other officials of the department. In the short time that I have been in this particular position I have found the Director-General to be a man of honour and integrity. I congratulate him on his new appointment and wish him all that I would wish myself in the near future. I want to assure him that I am going to miss him.

Of necessity I must react to the points raised in certain hon members’ contributions to this particular debate which I believe is of vital importance to the people of South Africa.

First of all I would like to thank the hon member for Langlaagte for his kind words.

*The hon member said that everyone should work hard and co-operate to make a success of PDP. As far as that is concerned, I agree wholeheartedly with the hon member.

I want to congratulate the hon member for Kempton Park on an outstanding contribution. [Interjections.] The hon member said that the emphasis should be on the improvement of the quality of life of people, and that this would result in job opportunities, peace and stability. She is right.

†The hon member for Wellington, who is regarded as somewhat of an expert in regard to the situation of farm workers raised certain very pertinent points here.

*The hon member said that increasing attention should be given to the promotion of learning, and that more money should be made available for the rural areas, as well as the Rural Foundation. I wholeheartedly agree with the hon member on that score.

†We all know that South Africa is still, in the true sense of the word, a developing country. Financing requirements for development in a developing country with an exploding population are immense. To demonstrate this point, may I point out that as a result of the youthful structure of the population, South Africa will have approximately 1 652 000 more children at school by the year 2000 than any developed country in the world with the same number of people.

If parity in education is assumed South Africa will by the end of the century have to foot an education bill of R1,7 billion and this is in 1982 terms. This is more than the bill that has to be footed by a developed country of the same population size. Similarly, other demographic related situations have to be faced in the provision of services such as health services, housing—which to my mind has reached crisis proportions—and job creation, together with the implied infrastructures.

We all agree in this House that if the present population growth of 2,3% per annum continues we will face difficult times. It is this population growth rather than any political upheaval that is likely to influence the future of South Africa and to determine how its political and socio-economic life develops. It is therefore of the utmost importance that we determine priorities for the future. We should concentrate much more on socio-economic development programmes affecting these demographic trends.

*I am convinced that in all our development programmes we shall have to begin to take demographic facts and objectives into account. It is simply no longer acceptable for us to undertake demographic projections for interest’s sake and then speculate about the consequences of rapid population growth. That will not help us deal with this rapidly growing problem in a practical way. We shall have to give in-depth consideration to ways in which we can further extend and strengthen the population development programme, which has already achieved considerable success.

It is the responsibility of each and every hon member of this Parliament to concern himself with this. We owe it to South Africa. We in this Parliament are the last generation who can still do something concrete about this problem. It is essential that we show the sense of urgency necessary to deal with this problem.

Hon members are already aware that on the basis of the framework of the population development programme we strongly support the promotion of the following programmes, particularly in the underdeveloped and developing areas…

What should individual members of Parliament do?

Order!

If the hon member does not wish to listen to me he is free to leave. [Interjections.]

*I shall proceed, Mr Chairman. The programmes are education, manpower training, primary health care, family planning, job creation programmes, housing programmes, the provision of basic needs such as fresh water and sanitation and the socio-economic upgrading of backward areas.

Here I want to associate myself with the hon member for Kempton Park, who spoke so well on the status of women. I wholeheartedly agree with her standpoint. We must have programmes which are geared to increasing the status of women. Finally, there are community development programmes.

There is also a clear link between urbanisation and population growth. In a more urban community people are more exposed to a psychosocial climate of modernisation, and basic services and infrastructures are more readily available. Population growth in an urban or town community is, in general, far lower than in rural areas. In the PWV region, where 4,4 million Black people live, the average number of children per Black woman is already 2,8, as against the average figure of 6,2 for Black women on White farms.

In the self-governing territories and the TBVC countries the average figure is 6,3. Therefore urbanisation is an important mechanism whereby to get population growth under control.

Subject to the various Acts?

I will deal with the hon member next year, during the Joint Sitting, with regard to that particular issue—man to man, as a politician. The hon member must just give me a chance today. [Interjections.]

*I consider that we shall have to promote the implementation of the urbanisation strategy as an urgent priority. The rate of population growth in the rural areas of the RSA is still excessively high.

Mr Chairman, may I ask the hon the Deputy Minister a question?

I am sorry, Sir, but my time is limited. [Interjections.]

Among the most import reasons for the high population growth rate is the relatively poor socio-economic position of the Coloureds and particularly the Black people in the Black rural areas, the self-governing territories and the TBVC countries. Another reason is the resistance among traditional Black leaders in particular to family planning. I am concerned, on the basis of the framework of the population development plan, that too much emphasis is being place on urban development. We would be wrong to think that urbanisation alone is the answer to our population growth problem.

From a population growth perspective, development region G—it is in the Northern Transvaal—is our first priority, followed by region E in Natal, region F in the Eastern Transvaal, Region D in the Eastern Cape and Region C in the Orange Free State. My request is that we be far more aware of the problems in the rural areas and that we make far more provision for that in our planning. If we do not succeed in bringing the population growth rate of the developing communities in the rural areas, the self-governing territories and the TBVC countries under control rapidly and purposefully, the consequences of the rapid population growth in these territories will neutralise the positive results of all our work, however well-planned. The success of the PDP will largely depend on the seriousness of our approach to, and our handling of, the rural areas. The monitoring of the PDP already indicates without any doubt that we are on the right path and that we are beginning to score successes, particularly in the urban areas. Over the past two years there has been a definite decline in the population growth rate. The number of children per Coloured woman, for example, has declined from 3,6 in 1984 to 3,3 in 1986. This is a drop of 21 %, which signifies progress in any language. As I have already mentioned, in the PWV area the number of children per Black woman has declined from three in 1984 to 2,8 in 1986. This drop is remarkable and compares favourably with some of the greatest successes achieved throughout the world.

From the middle of October 1987 the Department is launching a national advertising campaign to lend further momentum to the PDP. The advertising campaign is aimed at two target groups, namely the opinion formers of all population groups, and also all developing communities, in order to promote an awareness of the problem. It is also important that we have hon members’ continued support of this important programme. I know we can rely on that.

Mr Chairman, I want to tell the hon the Deputy Minister who has just spoken that if he thinks that the abolition of the Group Areas Act or the abolition of influx control is the answer to a lower growth rate among non-Whites, he will see that if he throws these areas open in the Cape, the Blacks will crowd his people out and there will no longer be work for his people. This is the problem facing them.

The hon member for Kempton Park said that 8 million employment opportunities had to be created in the next few years, otherwise we will go under. I just want to tell that hon member that if the unions go on like this, it will not be possible to create 8 million more employment opportunities, because they are putting people out of work through the tremendous demands they are making.

I also want to speak about two other subjects this afternoon. The hon the Minister in particular is aware that hospitals have two fine qualities. One quality is the efficiency with which the hospital staff take care of the patients. The second characteristic of hospital staff is the friendly manner in which they receive people. We all know that if one of those members of staff do not practise this, he would soon find that he does not belong on the staff of that hospital. Yet there is something that is not as it should be at the Witbank Hospital. Apparently other hospitals in the Eastern Transvaal do not have this problem, but the Witbank Hospital is one of the bigger hospitals in the Eastern Transvaal. It is so big that there are a number of specialists, not to mention the ordinary doctors living in that town.

Order! The conversations in the House are too loud. The hon member may proceed.

I am used to noise, but it has always come from children. It is just coming from grown-ups now; it is the same thing. [Interjections.]

Order! The hon member must not encourage the noise now. The hon member may proceed.

There are good facilities at the Witbank Hospital. For example, there are 200 beds for Whites, as well as a number for non-Whites. The latest figures show that the Witbank Hospital handles about three times more patients annually than the other hospitals in the immediate vicinity.

Yet things do not always flow smoothly in that hospital. There have been a number of objections and complaints from certain specialists and senior doctors. The staff of the Witbank Hospital are friendly and helpful. They are people who go out of their way to render a service to those in need.

I think this hospital’s problem is that there is no full-time superintendent. This post is filled on a part-time basis. Quite a number of smaller hospitals in the area have full-time superintendents, but not the Witbank Hospital. The man who is acting as superintendent is competent and hardworking. No one as anything against him as a person. However, it is the opinion of many of the inhabitants of Witbank that that man has too much hay on his fork. No one can carry on a private practice and still deal with all the interests of such a big hospital. The Witbank Hospital almost qualifies for a senior superintendent as well as an ordinary superintendent, but today they only have a superintendent in a part-time capacity.

Hon members must not say that no one can be found; there are people who could do that job. However, it seems to me that the problem at the Witbank Hospital is that politics entered the picture there. Sir, I do not think there is any room for politics in hospitals. [Interjections.] Not all doctors are in the NP any longer. There are many in the PFP, and even more in the CP. [Interjections.] It is not only the NP’s doctors who are competent so that only they can get that job as superintendent. [Interjections.] I can assure hon members this afternoon that if that post were to be advertised, competent people would come forward to apply. I personally know people who would apply. [Interjections.] Witbank Hospital—I know that hospital; I have been working with the people there intensively for 10 years—has a great need for a full-time person at the head of things. This afternoon I want to make a plea to the hon the Minister please to look at this hospital. I just want to tell hon members about one incident. It is quite funny. My colleague received a call to say that one of his members was ill in hospital. He went there, walked through the foyer and saw that the man’s name did not appear on the board on which patient’s names are recorded. Six weeks later the man asked him to go and visit him. When he looked properly, he saw that the man’s name appeared under the maternity section. He never thought he would land up there. [Interjections.]

I want to ask the hon the Minister please to rectify the situation at Witbank so that things can run smoothly. We have the human resources, we have the hospital, but we do not have a leader there.

There is another thought I want to bring to the attention of the hon the Minister. In Modderfontein, to the North East of Johannesburg, there is a beautiful little place called Springkell. It is a haven for the mineworkers who have contracted miner’s phthisis over the years. Tests for miner’s phthisis are also carried out there. About 5 000 miners go there annually for tests alone. The first piece of land was donated for this hospital in 1910, and the condition the Government attached to it at that time, was that it had to be for the treatment of people who had contracted some disease or other in the mines. The Chamber of Mines in fact built that hospital.

We have now heard that this haven for men who have devoted their lives to the mines and to building up the economy of our country, is going to be closed down at some stage. There is even talk of it being closed down at the end of 1987. Now some people say that the patients can go to the Cottesloe Hospital. However, the Cottesloe Hospital does not have the atmosphere Springkell has. Springkell has a few advantages over the other places. Springkell’s atmosphere is very peaceful. It is a pleasant place, where one can recover physically, and in comparison with other places which provide the same services, the cost is exceptionally low.

Now it is our elderly, in the latter years of their lives, who can wait here satisfied—some of them seriously ill—for the last few years on the road ahead. I want to state unequivocally this afternoon that I have reached the conclusion—I have also read this in the papers I have seen—that there is a financial giant that has, it seems, already mentioned that it is interested in purchasing this complex, apparently for other purposes.

Now the moneyed interests apparently want the place and the health of these people has to suffer. I am aware of a petition that has been drawn up to keep this place. I am also aware that a commission of enquiry has been requested. As far as I know, the hon the Minister has done nothing about it until now. I have also heard that an interview with the hon the Minister has been requested. As far as I know, that interview has not been granted to this day.

If Springkell has to be done away with, I think it will only be because the moneyed interests want that place. [Interjections.] There are things money cannot buy. Money cannot buy health. Money cannot buy happiness. Why then exchange the peace and happiness of people for money?

I conclude by saying to hon members on that side of the House in particular that they must keep Springkell the way it is.

Mr Chairman… [Interjections.]

Order!

Mr Chairman, I was almost in overdrive a moment ago! [Interjections.] The hon member for Witbank tried to land a surprise blow by asking the hon the Deputy Minister whether the scrapping of the Group Areas Act would help to further the population development programme. I, on the other hand, want to ask him whether he thinks partition will help to further the population development programme. That was an absolutely ludicrous question for him to put to the hon the Deputy Minister.

The hon member also said his uncle was in the maternity ward. [Interjections.] I want to tell him that I hope it was not for the same reason that his aunt was in the maternity ward. [Interjections.]

On a more serious note, Mr Chairman, I think this afternoon’s debate affords me an appropriate opportunity to say that we greatly appreciate the manner in which this hon Minister is managing his Vote.

Hear, hear!

We must congratulate him on his fine, compassionate approach to the Vote and to the problems that exist under this Vote. I want to tell him that we are all proud to be part of his health team.

Hon members made quite a number of references here today to the problems pharmacists are experiencing. I am the first to admit that the pharmacist plays an important role in our overall health dispensation. It is extremely unfortunate that the hon member is not here this afternoon, but I must also say that the best pharmacy in the world belongs to one of our hon members, Dr Rabie. [Interjections.] I must really pay tribute to his “chemist’s shop”.

Once again on a more serious note, there are at present 7 895 registered pharmacists in our country, 3 580 of whom are men, and the hon member for Kempton Park will be pleased to know that 2 599 women are actively involved in private pharmacies and in commerce. Therefore, there is virtually parity of numbers between the men and women. This is really and truly one of the professions in which women play a very important role, for which we naturally applaud them.

The pharmacist is probably one of the most important links in our total health programme. Among the roles he plays are those of adviser, business partner, personal friend and, of course, he is also the primary supplier of medicines. However, being a pharmacist has lost a great deal of its glamour over the past few years, particularly in the rural areas. Pharmacists have to an increasing extent had to expand their business activities in order to keep their heads above water. That is why pharmacies are beginning to look more and more like gift shops. We also find cosmetics, perfumes, photographic services and many other goods and services on offer in pharmacies. Naturally, we cannot blame the pharmacist for this. His overheads have also increased.

Of course, the problem of dispensing physicians has also manifested itself in the rural areas and this has created problems for the pharmacists there, to such an extent that some of them could not survive without those sidelines. Their real services as pharmacists are now occupying a position of secondary importance.

Moreover, concern has also been expressed at the decision by the provinces to allow district surgeons to dispense medicines, particularly in the rural areas. In this regard we are faced with a twofold problem. On the one hand we have people clamouring for the province to trim its overheads. However, the moment the province tries to do something about the situation, people start clamouring against it. To my mind, this matter has become a very emotional one. We realise that there are certain problems, but it is no good our approaching this matter in an emotional frame of mind. We shall only be able to salvage anything from this entire situation if we can persuade the parties to come together around a conference table, and I think we shall have to approach this entire problem sympathetically. I am convinced that if we adopt a balanced approach towards this matter and follow the golden mean, we shall indeed find a solution to the problem facing the pharmacists in the rural areas. We realise that we must lend a sympathetic ear to the problems the pharmacist is experiencing. The pharmacist is our friend, and we must preserve that friendship. He is more than that; he has become an institution, particularly in the rural areas, and we should really try to preserve that institution as far as possible.

Furthermore, pharmacy is also a career and it must remain a worthwhile career to the approximately 1 480 senior pharmacy students and the 474 people who are now completing their final year of training. If we do not ensure that this happens, we could well find ourselves facing the problem of fewer and fewer students entering the field of pharmacy.

Once again, we must take a balanced look at this situation. It is our duty as a society to ensure that we never give the pharmacist the impression that he is redundant or that he has become the poor relation of the health dispensation. Pharmacists are professional people and we must treat them all as professionals.

On the other hand, there are also some other factors of which we must take cognisance. What is required is a healthy, balanced approach and not an emotional one, and we could so easily fall prey to emotionality with regard to this problem which is facing the pharmacists in the rural areas.

Mr Chairman, I must say this has been a very pleasant and to my mind an excellent debate which has been conducted here this afternoon. I should very much like to thank the hon member for Stilfontein for his gracious comments, since I am following him now. I also wish to take the opportunity to congratulate the hon member on his birthday.

Hear, hear!

I wish him and his family many years of prosperity and blessings.

The chief spokesman of the CP on health, the hon member for Pietersburg, as befits a main speaker of the Official Opposition, broached important matters here this afternoon and I should like to comment on them. In my opinion he did this with prudence, and I think he addressed crucial problems.

The hon member said we could perhaps have published this actuarial report earlier. That is true and the hon member for Pinetown also had something to say about this. I knew it would form part of the Auditor-General’s report which was submitted to the Standing Committee on Public Accounts yesterday, as the hon member knows. That is why I decided to issue this immediately afterwards. That replies to the hon member for Pinetown too.

The hon member proposed that visitors to South Africa be tested for Aids and the hon member for Welkom also referred to this. We have looked into this but it is simply impossible for a number of reasons. One is that we are dealing with a virus, an RNA virus with a glycogen capsule, and, if the virus penetrates a person’s body today, one does not develop antibodies until three or four weeks later. Consequently that is the first problem, one may be sickening for the viral attack but not yet have any antibodies.

The second problem is that the tests are not 100% accurate and have to be repeated, so it is impracticable at this stage to test all people entering South Africa.

The hon member also alluded to the cost of medicine. There is no doubt that this is one of the most important problems in health care today. The hon member for Parktown also referred to this, as did the hon members for Heilbron and Langlaagte. At the beginning of last year I requested the SA Pharmacy Board to investigate the high cost of medicine and to submit a report to me. Time does not permit me to deal with this in full but, in conjunction with the Browne Commission Report, this report highlights the most important reasons.

†The factors which contribute to the present high cost of medicine can be summarised as the following: Firstly, transfer pricing; secondly, customs duty on raw materials, especially the active ingredients. I think that is a most important aspect. The 10% surcharge on raw materials is another one. General sales tax, the lack of control over price increases in the pharmaceutical industry and wasteful promotional practices are other factors. There are also institutional factors which influence the cost of medicine. The State tender system is undoubtedly one of them. I must remind hon members, however, that some State medicines on the State tender price also increased by 40%.

The supply of medicine by the State to private patients and members of medical schemes, the allocation of medicine, the legal restrictions on bulk dispensing and medical schemes are the important factors.

Notwithstanding the desirability of promoting a free-market system in South Africa—I think we should remind ourselves of this significant fact—after the abolition of price control on medicine in 1982, there was an escalation in the cost of medicine to the public out of all proportion to previous expenditure in this regard.

I believe the price control on medicine in the past was a stabilising factor and eliminated indiscriminate increases in medicine prices. Due to a lack of price control, the prices of medicine have on average increased more than the inflation rate over the past four years. The increase over the past two years was extremely high. Representations have been made by certain organisations to reinstate price control on medicine but to no avail. Representations were also made recently to the hon the Minister of Finance to abolish general sales tax on medicine, also to no avail.

Owing to the high price of medicine the medical schemes are, as hon members have noted, finding it very difficult to manage their financial resources. I should like to refer to some of the figures.

*If we take private consumer expenditure at constant 1980 prices, we see this was R428 million in 1980 and R481 million last year, which means an increase of approximately R50 million. In addition we have to bear in mind that inflation is a very important factor. The average price per prescription was R27,42 in 1983 and R47,46 in 1987 which represents an increase of R20 over the past five years.

I wish to tell the hon member for Pietersburg, however, that we shall analyse these facets together with the Browne Commission Report and the report of the Competition Board which, as the hon members for Pietersburg and Parktown themselves know, stated very clearly that the pharmacist or doctor ought not to make any profit on prescribed medicine but should merely be compensated for his cost factor.

I may say here this afternoon that the SA Medical and Dental Council, as well as the SA Pharmacy Board, has accepted these recommendations. I consider this a very important step in the right direction, also in connection with the unpleasantness between the prescribing medical practitioner on the one hand and the pharmacist on the other. The hon member for Pietersburg also discussed the standard of service furnished by general practitioners, nurses and the pharmacists. He is quite right that costs have escalated everywhere. Today we are faced with a salary problem too, a matter which I raised in the previous debate. Nevertheless I wish to mention here that the Health Administrator’s Council—that is the council chaired by the Minister of National Health and Population Development—and the MECs have already made a great deal of progress with the introduction of a single scale of tariffs in South Africa. The point made by the hon member is quite right; there are different tariffs in the various provinces.

I have already referred to the report of the Competition Board and I now wish to refer to section 29 of the Medical Schemes Act. It is a fact that when we held the conference on medical aid schemes in Pretoria earlier this year, all interested parties were represented there. There were not only representatives of the medical aid funds but also the Medical Association of South Africa, the Dental Association of South Africa, the Pharmaceutical Society of South Africa and all other professional associations. Insurance companies were also present. Consensus was reached between these groups—that means the medical association and the aid schemes—on the time factor between the benefit scale and the guideline amount. I therefore consider it unnecessary to address that matter.

It is very interesting that we are actually considering certain changes to the Act and are in the process of sending them to the various interested parties to enable us to amend the Act in Parliament next year. The point is therefore quite valid. The hon member for Parktown also made this request last year.

I wish to make an important statement to the hon member for Parktown that nothing prohibits any medical aid scheme from offering its members package insurance over and above the scheme.

I have discussed the right of appeal to the disciplinary committee with the president of the SAMDC. Hon members know the history of this matter and I do not wish to go into it. They are investigating an appeal procedure within the council itself.

I think the 75% in regard to widows’ pensions is justified within the actuarial report. The hon member for Pinetown said we should give the pension fund to the Commission for Administration. I did my best to give it away but nobody wanted, it so we are saddled with it and are working on it. It can only be improved and hon members will see that this will be the case next year. I think it is a good thing that widows should receive 75% of the pension. We have reached the last phase of dealing with this matter with employers and I hope we shall be able to make an announcement soon.

We are just as concerned about civil pensioners and that is why we have introduced a sliding scale of 10% to 20%, with a 1% increase per annum for the first time. This is precisely to make provision to counteract the effect of inflation on persons who have been receiving a pension for a long time but it all depends on the amount of funds available. I should very much like to have it increased to 30% or even 40% for long-standing pensioners but it all depends on the amount of funds at our disposal. We are examining this with great compassion. Hon members would have noted that it became operative from 1 July and not 1 October this year.

I think that covers most of the points raised by the hon member.

I wish to congratulate the hon member for Langlaagte on his appointment as the main speaker for the NP in this debate. I think his contribution was sound.

I wish to agree with him on the importance of the nursing profession. There is no doubt that it remains one of the cornerstones of health care in South Africa. I think the hon member also paid excellent and fitting tribute to the work of those district surgeons in connection with detainees in prisons; I thank him for this and associate myself with it.

†The hon member for Parktown agrees about the seriousness of Aids, and I thank him for that. He mentioned the possibility of isolating those concerned. I just wish to make it quite clear that what I meant by isolation was not institutionalisation in the sense of quarantine.

* Consequently this does not parallel the cases of leprosy in former days, which were all placed in one institution. The crux here is the place where he can be treated to eliminate the risk of infection and I believe the hon member appreciates this.

I wish to reiterate this very clearly so that the media do not think we intend placing them all in concentration camps here. The point at issue here is places where they will not contract other infections because they have no resistance to them and they die from other infections.

† The hon member also asked me whether we could not make known the names of the members of the panels that deal with the detainees.

I also asked about the deportation of Aids sufferers.

About the deportation? Yes, let me answer that question.

It will be done with great circumspection and compassion. The hon member will remember that I said that we had already sent two delegations to Malawi. That means that we are going to help them with their programme in handling these cases. These cases are already involved in a programme where they are being educated and supported. We have already identified various workers to be taken up in this programme. I can assure the hon member, and all hon members here, that this will of course be done with great compassion in the true tradition of medical services in South Africa.

Will the companies also go along with that?

That is a problem that I cannot address now because I do not know what the particular contracts of the companies entail.

*We shall obviously examine this. A question was asked in connection with medical panels. The Medical Association itself requested us not to disclose the names of members of these panels, but branches have the privilege of doing so if they wish.

The hon member also asked me how many people had made use of this concession up to 25 June and the answer is 13.

To tell the truth, I do want to say to the hon member for Parktown that he has just asked me a question to which I have already replied. It is question 236—written reply 236—if the hon member wishes to look it up. I gave the hon member replies to all those questions.

[Inaudible.]

No, look at question 236. The hon member looked at the wrong one.

† I think that covers what the hon member said in his speech, but let me also deal with King Edward Hospital.

*Hon members will be very interested in the situation as regards the King Edward Hospital. As the hon member said, I was in correspondence with him about King Edward but the hon member did not quote the positive points in my correspondence. I know the King Edward Hospital just as well as he does and perhaps even better because about 10 to 15 years ago I conducted examinations there for five consecutive years. In fact, I agree with him that the place is in a terrible condition, but the nurse-patient ratio is 1:1 and that is the best in Natal. The doctor-patient ratio is 1:4 and again this is the best in Natal.

One cannot renovate the place, however, while it holds patients, so what is to be done? Patients have to be moved somewhere else. I wrote to him informing him what we had done but he did not tell the House this. Nor did the hon member for Durban North inform the House that the Prince Mshiyeni Hospital was only 14 km from King Edward. This is a hospital of 1 000 beds but because this hospital belongs to KwaZulu they do not want to mention this. They do not even want to use the name Prince Mshiyeni. We gave that R4,1 million to Prince Mshiyeni. My colleague, the hon the Minister of Education and Development Aid, gave Prince Mshiyeni R5,5 million last year so that the work there could be completed quickly and the patients at King Edward moved there. The King Edward hospital can then be repaired and construction of the new academic hospital, which is already being planned, started. [Interjections.] They are already planning this.

Did the move…

Order! The hon member for Parktown cannot carry on like this. The hon the Minister may proceed.

He is conducting a dialogue, Sir.

I want to reply to the hon member for Pinetown. I have already dealt with the reason why I did not make this known earlier.

†As far as the hon member for Pinetown’s questions are concerned, regulations to amend the buying back of service formula will be published within the next month. Applications on hand will naturally be dealt with in accordance with the formula existing at present. The new formula will make it impossible to buy back service unless a period of five years’ actual service has been rendered. There will thus not suddenly be a flood of new applications. The findings of the actuary that the shortage amounts to R16,9 billion if provision is made for pension increases are not relevant to Government pension funds as such increases are funded, firstly, from available funds in the Stabilization Account, and secondly, from money voted by Parliament.

There is virtually nothing in the Stabilisation Fund. Have you looked at the Stabilisation Fund? [Interjections.]

If I may just finish, the formula by which gratuities, ie pensions, are calculated in accordance with members’ final salaries is a condition of service and I have no intention of interfering in the affairs of my hon colleague who is responsible for the Commission for Administration.

That is why the Commission for Administration should have it.

The hon the Minister just reads the notes they give him.

Does the hon member not think I should? [Interjections.] Of course I should! When this benefit was introduced all the members of the fund had their contributions increased, whereas the Government’s contribution was decreased. Members are, therefore, making a fair contribution for this privilege.

The envisaged increase in the widows’ pension rate I referred to was in fact referred to the actuary who made the necessary projections as to the cost involved and this will be taken into account.

The Stabilisation Fund was not actuarially assessed as it is not a fund but merely an account in which a portion of members’ service bonuses is preserved until it is used partially to fund the annual increases in pension. It is impossible for me to spell out exactly how the funding of the actuary will be dealt with in the long term. When the next actuarial evaluation takes place next year the actuary will be asked to make a projection of the cash flow of the fund over a long term for the future, from which it will be possible to lay down objectives and also to determine when those objectives should be met. They will have it on record.

You are completely bankrupt. [Interjections.]

The hon member for Heilbron made a very good speech on the position of the pharmacist. It is true that generic equivalents are important, but therapeutic equivalents are actually the most important. When pills have the same chemical content, it does not mean that they will have the same effect, so the Medicines Control Council is now going to draw up a list of therapeutic equivalents.

The hon member for Kempton Park has already been thanked and congratulated by the hon the Deputy Minister and I want to agree with him that she made a very good contribution.

†I come now to the hon member for Durban North. I think I have dealt with the King Edward VIII hospital’s problem.

No, you have not.

I have, there is no doubt about it. The hon member must go and read my letter to the hon member for Parktown. [Interjections.] If the hon member reads my letter to him dated 17 July, I think he will find everything explained. If the hon member does not mind, will he please also give it to his fellow member.

*The hon member for Humansdorp made an excellent speech on pollution, and I wish to congratulate him on this. The hon member for Bezuidenhout really spoke like an expert.

†I think what he said, is important. We should look at cross-bows and maybe they should be registered. If it is practical to do a psychological test on everyone who buys a gun—I have a small problem as far as that is concerned—we can discuss it.

*I have no problem with the hon member for Brits’s approach to abortion from a Christian-ethical point of view but I want to tell hon members that the point at issue here is those cases in which a reactive depression manifests itself. These are actually cases one does not wish to treat because it is merely a temporary condition. My experience has been that these cases are dealt with very well by the Tygerberg Hospital. A team examines them and two psychiatrists are used. I must say our statistics on the incidence of psychiatric causes were very low but I have no problem with the hon member’s basic standpoint and I want to tell him the Government also bases its standpoint on Christian-ethical norms.

I want to thank the hon the Deputy Minister of Health Services heartily for his contribution on the problematic aspects of pollution. In my opinion he did this with great expertise. I am very pleased to have him on the team; he does work of outstanding quality.

The hon member for Welkom spoke expertly on Aids and I am grateful for this. I think he made a very good contribution.

† The hon member for Groote Schuur referred to pharmacists and I should like to comment on that. Many hon members have referred to the fact that pharmacists in South Africa are going through very difficult times.

*The hon member for Groote Schuur and the hon member for Heilbron referred to this and I think it requires some investigation. From 1983 to 1986 576 pharmacies were opened of which 272 closed in the same five-year period. We therefore have a total of 304 new pharmacies opened in the period from 1983 to 1986. I think that is a reasonably good growth rate but I myself am concerned about pharmacists in rural areas. As hon members are aware, we have commenced discussions with the provinces about this problem.

I next wish to thank the hon member for Wellington. Without a doubt he is an expert on the situation surrounding the Rural Foundation.

I should like to thank the hon the Deputy Minister of Population Development; I think his presentation here today was excellent.

†It is quite clear to everyone in this House that he is fully au fait with the diverse aspects covered by the Population Development Programme in our country. I thank him for the contribution he is making as far as population development in our country is concerned. He is a valuable part of our team and I thank him very much for that.

*I shall discuss the hon member for Witbank’s problem concerning the superintendent with the Transvaal Provincial Administration. As regards Springkell, I want to tell him nobody has ever applied to me for an appointment. I should be pleased if he would tell them to do so and I shall see them with the greatest of pleasure and see whether I can help them.

I have already referred to the hon member for Stilfontein. In conclusion…

What about my question?

Oh yes, I shall reply to it. [Interjections.] I do have the reply here. I have here the hon member for Yeoville’s answer which will take me two minutes to read and I do have exactly two minutes left.

In reply to the hon member for Yeoville’s question I want to say that interest on the shortfall in the fund amounts to R910 million, while normal interest on capital amounts to R160 million. It is true therefore that normal interest does not pay for the interest on the shortfall. What is important, however, is that the growth in real expenditure is much less than the growth in capital.

Now that is official-speak if ever I have heard it! [Interjections.]

Now we can revert to health. I am very pleased we have rectified the matter of pensions. I want to tell hon members that this department has only one ideal it represents and that is health for all, the best service for all in South Africa. The lower the number of people in South Africa the better, and the better our pension fund will be. That is what we stand for. I thank all hon members who participated in the debate.

Vote agreed to.

Chairman directed to report progress and ask leave to sit again.

House Resumed:

Progress reported and leave granted to sit again.

Mr Chairman, I move:

Agreed to.