as Chairman, presented the Tenth Report of the Standing Select Committee on Trade and Industry, relative to the Share Blocks Control Amendment Bill [No 79—85 (GA)], as follows:

J H HEYNS,

Chairman.

Committee Rooms

Parliament

10 May 1985.

Bill to be read a second time.

Mr Chairman, you will allow me, at the outset, to announce the arrangements for the debate. Actually, this debate will be dealt with by the acting Minister of Health and Welfare. Owing to unavoidable circumstances, he was unable to be here now, but he will join us later this afternoon. I shall deal with the own affairs debate.

I should like to make an announcement in connection with benefits granted for compensateable disease contracted as a result of risk work in mines and works. This form of compensation is paid by way of pensions from State funds in the case of persons who qualified for such pensions prior to 1 October 1973, and lump sum benefits in the case of certifications after this date. All benefits payable in terms of the Occupational Diseases in Mines and Works Act, 1973, ie both pensions and lump sum benefits, will as from 1 October 1985 be increased by 12,5% in the case of Whites, 20% in the case of Coloureds and 25% in the case of Blacks.

The differentiated increases should be seen as an interim measure until a new system of compensation can be developed. Hon members will recall that the Nieuwenhuizen commission of enquiry made certain recommendations in connection with this form of compensation. An interdepartmental committee under the chairmanship of an official of the Department of Health and Welfare is engaged on a further enquiry into the implementation of the recommendations that were accepted by the Government, and the committee’s recommendations will be submitted to the Cabinet soon. The Government is aware that the present system of compensation is based on historic levels of remuneration for employees from the various population groups, something which is possibly no longer relevant. The new system will be devised in such a way that provision will be made for compensation on an equitable basis linked to income and not based on the population group of the beneficiary.

†As far as military pensions are concerned, the hon the Minister of Finance has announced a 15% increase in military pensions with effect from 1 October 1985. These pensions have also been based on historical levels of earnings of the various population groups in the past. The present system has become outdated and the Department of Health and Welfare is investigating the introduction of a revised system which will be based on earnings. This investigation will be completed shortly.

Mr Chairman, may I ask you for the privilege of the half-hour? [Interjections.]

It is with regret that we note the absence of the hon the Acting Minister of Health and Welfare, but we understand that he had other matters to attend to, and we accept that. I was very keen for him to be here because he was here before. He was posted away for a while but seems to have been posted back again. One wonders what his future will be.

We welcome the announcements by the hon the Deputy Minister concerning military pensions and allowances and pensions to people suffering from occupational disease. I think it is welcome in these financial times and the hon the Deputy Minister can be sure of our support. I should also like to thank the officials of the department for their kindness and attention during the year.

I should also like to refer to the annual report. It is a bulky document containing many interesting facts. I also found a lot of omissions interesting. Unfortunately time will not allow us to discuss this in detail. As usual the annual report starts with what the department regards as matters of prominence. There is one matter of prominence which I do not find discussed here. However, if one turns back to chapter 5, page 20, one reads about medical care and especially district surgeon services. It says here:

These district surgeons also have the very important task and duty to look after prisoners and detainees. Therefore I consider it a matter of prominence to read in the Cape Times of 11 May 1985: “Second man dies after questioning. Raditsela had brain damage.”

I have repeatedly in this House asked the hon the Minister questions concerning the inspection of health facilities in prisons and the examination of detainees and others. At all times I have been assured that the department is satisfied that these prisoners are well cared for and that the district surgeons whose task it is to look after them, are taking good care of them. At no time have I ever noticed—the hon the Deputy Minister can correct me—that there has been any action taken, following evidence of assault on detainees and prisoners.

Order! I want to request the hon member to confine himself strictly to the health aspect. [Interjections.]

That is what I was doing, Sir. I am talking about district surgeons.

At all times I have been assured that these people are carefully looked after and that they are visited regularly by district surgeons. The hon the Deputy Minister must tell me in case I have perhaps missed it—of any report by a district surgeon on an injury sustained in prison as a result of police action, and whether any policeman has ever been brought before an enquiry because of this. [Interjections.] I should like to tell him not to get excited. His turn will come because, unfortunately he also has to speak in this debate. When one looks at these reports one sees, first of all, that Raditsela had brain damage. That means he died as a result of some bleeding on his brain. Secondly, one reads that the other gentleman, Mr Sipho Mutsi, had epileptic fits. This information was given afterwards by his mother. Nobody knew about it until after his death. Conveniently, while he was being interrogated, this man who must have had epilepsy for quite a while, had a fit in his chair, fell backwards and obviously as a result of this, suffered a brain haemorrhage and died. It might happen, but I find it very difficult to believe that this man who went to work and most likely cycled and walked in the streets, had his fatal fit just at that moment.

The other problem I have is that once there is a post-mortem, we hear that a private pathologist is allowed to see the deceased. [Interjections.]

Order!

Once the prisoner is dead, a private pathologist is allowed to see the body. By that time the unfortunate happening has already occurred. In this House we debated the fact that these detainees or prisoners should be seen by private doctors. However, this has not been allowed. Why do we wait…

Order! The hon member must confine himself to the health aspect. He cannot debate the merits or demerits of not allowing prisoners to be seen by medical practitioners under this Vote.

Mr Chairman, on a point of order.

Order! While I am addressing the hon member for Parktown the hon member for Yeoville must contain himself.

Mr Chairman, you cannot give a ruling on what you have not heard.

Order! I have heard what the hon member for Parktown has said. He has argued that prisoners are not allowed to see medical practitioners, and that is not a matter for this Committee to consider under this Vote. That matter falls under the Prisons Vote. The hon member for Yeoville may address the Chair now.

Mr Chairman, the hon member for Parktown is addressing you on the functions of district surgeons, on the functions of medical men in relation to an injury or a potential injury which has been or may be sustained. I do not know, Sir, if anything can be more relevant to the Health Vote. With great respect, I believe that when you say it is a matter relating to Prisons, it is not because the district surgeons do not fall under the Department of Prisons. They fall under this department and therefore, with great respect, I submit you are making a mistake and I ask you to reconsider it.

Order! Obviously the hon member for Yeoville has not been following the hon member for Parktown’s argument as well as I have. I allowed the hon member to address the Committee on the aspect of the matter to which the hon member for Yeoville has now referred. I did not call him to order then. However, when he started discussing of whether or not prisoners should be allowed to see medical practitioners, I interrupted him because that is a matter for discussion under the Prisons Vote.

Mr Chairman, with great respect, may I again address you in this regard? The question of the functions of a medical practitioner—and that is why I dealt with it in two sections—falls under this Vote. If it does not fall under this Vote, it falls under no other Vote of Parliament. This aspect does not fall under the Prisons Vote. The whole point under discussion is the functions of a medical practitioner and the right of a man to receive medical attention. We are dealing here with the right of a private doctor and the right of the individual concerned. All these are matters which fall under this Ministry. They have nothing to do with the Department of Prisons. It simply happens to be the case that the man concerned is in prison. However, that does not fall under the Vote of Prisons. If we were dealing with prisons now, Sir, you would rule it out of order and say it is related to health matters. It is simply not possible to discuss this matter under any other Vote.

Order! My ruling is that access to medical care as far as prisoners are concerned is a matter which is dealt with under the Prisons Vote. The actual medical care that is administered to prisoners is a matter to be discussed under this Vote. As long as the hon member for Parktown confines himself to that aspect, I shall allow him to continue. However, I am not going to allow him to discuss the question of access by prisoners to medical care. The hon member for Parktown may continue.

Sir, I want to conclude this argument by stating that the practice of allowing a private practitioner only to attend the post-mortem of a prisoner is destroying the good name of South African medicine not only here but also overseas. I want to warn the hon the Deputy Minister that the South African Medical Association has already been banned from the World Medical Association following the Biko affair. If anything is going to harm the good name of the South African Medical Association with the world body again, we will hold this Government and the Department of Health responsible. The Government must not then accuse the PFP and other organizations of being responsible.

Another matter of prominence in this annual report concerns the Commission of Inquiry into Health Services. This commission of inquiry is now in its fifth year. A previous hon Minister said that this was a matter of great importance, but five years and R350 000 later, we now have the problem that we are still waiting for this commission’s final report. I would like the hon Deputy-Minister to give us some indication, because at present the Department of Health seems to be ruled by ad hoc measures, legislation and regulations. This is of deep concern to the South African medical profession.

Throughout the world, countries are looking for better systems of providing health services for the whole population. This is not only true for developing countries but also for countries with highly sophisticated medical services eg the USA and West Germany.

This is not easy, for not one system will be applicable universally. Different circumstances in different countries require diverse solutions. Developing countries must surely have a different approach to those of the so-called developed countries.

In South Africa we have not escaped this problem, and medicine in South Africa is today at the crossroads. There are many matters which I would like to discuss to prove this but unfortunately time will not allow me to do so.

I just want to refer the hon the Minister to the problems the Nursing Association and nurses have with the department in connection with overtime work and salaries. I would like to refer the hon the Minister to the conflict situation between pharmacists and doctors over the right of dispensing. I have received letters from all departments, from porters, from doctors talking about the crisis of long working hours. If the time allows me, I will come back to some of these aspects.

The future of overall health services in this country has not been adequately defined and is endangered in the face of a frightening population growth. In spite of commissions, plans, programmes and committees there does not appear to be a national health policy to meet the demands of the future, and certainly no evidence of adequate financial backing. It is important that we as the legislators, the medical profession, the private sector and the public must be aware of the problem. We must all join to find a solution and implement it.

We in this country are in an unusual position in that we are both a developed and a developing country in the medical context. This diversity has in the past been the cause of our medical success and it will in future continue to be the cause of our medical failure.

The health demands of developed South Africa resulted in the training of medical personnel and the provision of hospitals and facilities to a standard equal to the best in the Western World. I am very proud to say that our medical standards are equal to the best in the world. The result was that medical facilities and personnel were concentrated and made available where developed South Africa worked and lived.

We trained our doctors to practise in America. Failing to get a visa, they specialize and practise in our cities. The teaching hospitals were built within walking distance of the wealthy but the poor struggled to get to these hospitals. Due to a demand for sophisticated medicine private hospitals mushroomed.

The result was that the developed had an oversupply of doctors—1 to 300 in some areas or 1 to 600—and the best hospitals and medical standards available. If one takes infant mortality as a guide, one finds that it is 12 per 1 000.

This has resulted in the failure of our medical system. Underdeveloped South Africa had to be satisfied with the medical left-overs. There are fewer doctors—from 1 for every 5 000 people to 1 for every 20 000—and fewer hospitals that are further away from where they live. These hospitals were also much more poorly equipped. This has resulted in a much lower standard of medical care that is less easily available. The infant mortality can at its best be described as 80 per 1 000 and in some areas it went up to as high as 150 to 200 per 1 000.

Let us be honest. The Department of Health and Welfare has recognized the problems. That much I will concede. The future of South Africa will be very much influenced by our sincerity and our dedication to the task that awaits us to turn failure into success. In this the Department of Health and Welfare plays a very important role.

The Department of Health and Welfare recognizes these inadequacies. To give an example, a policy has been adopted whereby expenditure on preventive medicine—2% of all money spent on health care in 1976—will gradually be increased to 15% by the year 2000. I should like to ask the hon the Minister whether this plan has been successful and, if so, what sort of progress has been made with it. This policy is laudable but I must point out that the fact that the decision to spend an increasing percentage of health care funds on preventive medicine and primary health services, which we all recognize to be so important, has been taken against the background of a diminishing overall financial allocation in respect of health care in South Africa. The report and the explanatory memorandum both indicate that the increase this year has been basically in respect of increased salaries and not basic health needs. The amount budgeted for in this regard has not been increased overly much in respect of previous years.

It is therefore important to note that in countries like the United States of America, the United Kingdom and most European countries, there has been a progressive increase in the percentage of the GDP allocated for this purpose Over the past decade to between 7% and 11%. In South Africa, the percentage of the GDP allocated to this purpose of 4,2% in 1976 is now just under 3%. I think this is a very important factor. When we look, for example, at the population development programme project, we are beginning to ask ourselves whether this project will be successful. Where will the money come from to pay for what I believe is a very laudable but very expensive project?

When we look at program 6 under the Health Vote, we notice that of the planned amount of R37 million budgeted for family planning, R22 million is for clinical services, R11 million for education and approximately R3 million for community development. I realize that the total plan is interdepartmental but I find the total amount allocated for such an important plan to be inadequate and the amount of R3 million for community development laughable. It makes one wonder whether the Government is really so sincere as far as its intentions in this regard are concerned.

Having pointed out some of the mistakes in the past and criticized some of the mistakes of the present, what does the PFP offer as a solution for the future? I think the hon the Deputy Minister will agree with me that the Government’s plans for the future in this regard must be governed by the total health needs of all South Africans. We therefore have to consider the training of health personnel to look after the health requirements of all of our people, as well as the availability of health facilities to all. We also have to ensure that the necessary finance is made available to ensure success.

We in the PFP believe that a primary principle of any future health policy must be total health care for all within their means. This is different to a system of socialized medicine. Once we start talking about this sort of thing we also believe that surveys must be made in respect of the total health needs of all South Africans. I cannot deal with all the aspects involved in this regard but this must include the incidence and pattern of disease among all race groups in all parts of the country, and the re-allocation of resources in terms of those needs. When I speak of resources I am referring not only to financial resources but also manpower resources. We have discovered that we have sufficient doctors in South Africa but they are in the wrong places. Therefore, any plan to establish these health needs will also have to ascertain where those needs are greatest and how the available money and personnel should be allocated.

Who will be the people who will take care of these needs and where will they be situated? Let us take the question of training. Our entire training pattern will have to be changed. If we are going to opt for community health services, we will not only have to train more doctors but vast numbers of other people interested in other aspects of health training as well so that there will be adequate numbers of them at the places where they are needed to look after the health needs of our people. We have to give attention to the number of hospital beds for the acutely and chronically ill in each region. The same applies in the case of geriatric patients. It is definitely true that for the chronically ill one needs less sophisticated beds and equipment and fewer trained staff than for the acutely ill. Therefore there should be a clear dividing line among acutely ill, chronically ill and geriatric patients. Very important too, I believe, is the need for the establishment of health-care centres—both rural and urban. That is very important indeed, I submit. What I want to advocate here amounts in other words to a triple-level medical care programme—academic hospitals responsible for research, training and specialized treatment; regional hospitals catering for the health needs of specific regions, and, thirdly, health centres.

The greatest need of course, I believe, is the need for health centres. The creation of health centres will reduce the need for more hospitals and also for specialized personnel because health centres can be staffed by primary health care professionals. These personnel will be trained to look after the primary health care of the community and their functions will include the prevention of diseases, educating the people and the performing of curative services. No longer, I believe, do we need the separation of these three important functions—the preventive, the educative and the curative. Also not to be separated from these functions any longer is of course the important one of rehabilitation. All these functions should be treated and looked upon as one because the patient is most certainly not divided into all these different parts, and nor is the disease affecting the patient.

The three-tier medical profession can then function satisfactorily in a proportion of—and I base my figures on what I have been told—36 primary health-care professionals, six general practitioners and one specialist. Do hon members know that for every five primary health-care professionals one needs to train one doctor less in South Africa. Moreover these primary health-care professionals will also be better trained to perform their duties in those areas in which they are most needed. It will be easier to use their skills at the primary health centres in the rural areas—and in some cases even in urban areas—than it would be to make use of the services of trained general practitioners in all these instances.

Furthermore I should add that we in this party believe in the principle of non-fragmentation of medical departments. The system headed by one Minister, with further divisions into health departments for all the separate population groups—based on race and colour of course—and finally health departments catering for the different national states and non-independent homelands, we believe, is totally unacceptably and should not be allowed to continue to function in its present form. We believe it to be a racist system. We believe too that this system does not even function well.

We also need a re-assessment of conditions of service for medical personnel. We need to look at the question of housing in this field, for example. Attention should be given to home-ownership schemes and to adequate security for retired medical staff in their old age or in case of illness which renders them incapable to continue to work. Ways and means should be devised to get medical and health-care staff to remain in this profession and not to opt for other occupations. We also need involvement by the private sector in all aspects of medical care. Instead of fighting each other and becoming involved in all sorts of rivalry all the different branches of the health care professions in South Africa should unite their strength and powers and should pursue one common goal—the health of all our people. That is why I believe that the different branches of our health service professions should no longer be treated separately, nor should they be allowed to continue to function in isolation from one another. Not only the public sector, but also the private sector must be held responsible for the training of medical personnel. In South Africa there are numerous private hospitals with thousands of beds, yet these hospitals do not provide any training for nurses or for any medical personnel. What a waste of time, of equipment and of opportunities!

We must furthermore establish facilities for the ill—I think for instance of the concept of subsidizing individuals. We cannot expect the State build all those hospitals, to pay for them and to carry the total cost of all medical care and training. It will be better, I believe, to have private institutions that will allow individuals subsidized by the State.

I also believe we must have a very close look again at the financing of our health services. Medical aid schemes should either be amended or individuals must be permitted to join private schemes.

Next I come to an aspect which is of paramount importance to us in this party. We believe there must be no discrimination whatsoever in the field of health care. We stand for the principle of equal pay for equal work. We believe that doctors, nurses and all other medical personnel should be allowed to work wherever they are needed irrespective of their race or colour. Separate hospitals, wards, services and amenities for the races is something we can no longer tolerate. Particularly in terms of our new constitutional dispensation, which is said to be one of consensus, I find that sort of thing totally unacceptable. Therefore all health facilities should be made available to all patients irrespective of their colour or race. This is what we believe in—equal health care for all our people!

The removal of racial discrimination from all spheres of health care will, I believe, result immediately in a better utilization of manpower and facilities. The hon the Deputy Minister knows that many beds in the Johannesburg General Hospital are empty and that half of the provincial hospitals in the southern and eastern suburbs hardly have any patients any more. There we have hospital facilities under-utilized while at Baragwanath patients have to sleep under the beds. What nonsense! In such circumstances one can speak of ill health rather than health. In addition, the financial aspects would be improved. What a lot of money could be saved if one did not need to duplicate x-ray machines for White, Brown and Blue. One buys an x-ray machine because it is needed for sick people.

Sir, I wish I had more time to discuss all these problems. There are a few other problems I should like to raise with the hon the Deputy Minister. I have heard recently of something affecting the teaching hospitals in Johannesburg. That is causing great concern. I know that this is a provincial matter, but the standard of health care is also affected by it. I will not be allowed to talk about the way in which the workload of various clinical departments at provincial hospitals, including teaching hospitals, is determined by means of an established formula. I would, however, like the Committee just to accept that there is such a formula. This system is used to determine the number of posts in such departments.

Very recently the superintendents of teaching hospitals were telephoned and told that the system is now being changed. The calculation is now to be based on 10% of the basic workload and no longer 33%. In addition, no consideration whatsoever is to be given to senior house officers. So that is to be taken away. What is the effect of all this? It will result in a staff reduction of at least 20%. These new quotas are to be implemented as soon as possible. To reduce the staff, which is already working overtime, by 20% is asking for trouble. From what I can gather—I made some telephone calls—the new formula was not discussed with the dean of the Medical School nor with the vice-principal of the University of Witwatersrand. It is arbitrary and appears to apply only to the Transvaal Department of Health Services, to the hospitals of the University of Witwatersrand. I should like the hon the Deputy Minister to think about that. It can only be concluded that the new formula is a pernicious attempt to destroy the teaching and seriously to interfere with the clinical practice at the hospitals concerned to the detriment of the staff, the patients and students. In the circumstances it would be most surprising if it is introduced, even with the knowledge of the Department of Health and Welfare, not to speak of its approval.

We have often heard Martin Luther King’s words “I have a dream” quoted. As a man who has been a medical practitioner for 35 years, who has been a general practitioner and a specialist and who has already practised in three continents and in about seven countries, I also have a dream. I dream that we in South Africa could have a health system that would meet the health needs of the country. When I speak of “health”, I am thinking not only of sickness but of health in body and in mind. I think also of social security, housing, water and education. That is my dream and I pray that it will be realized in the near future.

Mr Chairman, I should like to add this Committee’s tribute to the many tributes expressed in this House and in public on the death of our beloved friend, Dr Nak van der Merwe. If we ask ourselves why he was an esteemed person in the House, the answer is surely not that it was because he put himself on a pedestal and saw himself as a particularly capable man. He was an esteemed person because he had his feet firmly on the ground—truly an example for each of us. Everyone whose path crossed his, was truly lucky. We are the poorer for his death, but South Africa is much richer as a result of his legacy. We want to express this Committee’s sincere sympathy towards his wife and family.

I also want to excuse the hon member for Brits, the main spokesman on this side, who, as hon members know, underwent an operation a short while ago. We are pleased to hear that he is making good progress and is improving daily.

I have a sincere desire to associate myself with something said by the hon member while he was lying in hospital. It concerns the decision made by the Treasury some time ago in respect of the recovery of costs incurred by doctors when they go overseas to attend congresses. The decision was made not to make those costs deductible in particular for the income tax purposes any longer. I believe we shall really have to reconsider this matter, because when one moves through the hospital wards and looks at the enormous arsenal of expertise built up in this country and which in part is the reason we provide a medical service of outstanding quality here, one realizes we cannot block off the way to those who want to add to their knowledge abroad in order to build up that arsenal for us even further.

Like the hon member for Parktown I want to refer to the department’s annual report. Of course the hon member discussed nothing in the report; he discussed what is not in the report. He is running over with negativism, and there is no mention of the positive and fine things he could find in the report.

I not only want to congratulate everyone who had anything to do with the composition of this annual report, but also to convey my thanks for an extremely illuminating document and the amount of information available in it if only one wants to take the trouble to read it.

I am also grateful for the announcements initially made by the hon the Deputy Minister at the beginning of the debate. What also pleases me, is that there is talk of giving attention to the Nieuwenhuizen report. We hope that we shall hear more about that in the near future.

The hon member for Parktown is not worried about the district surgeons. He does not talk about those people in the sense of showing an understanding for the difficult work of the district surgeons. Oh no, that hon member made the point in question for one reason only, and that is to launch an attack on the Police. There is no other reason …

You know nothing about health …

Order!

He showed no understanding at all for the work of the district surgeon. We know, after all, that the district surgeons have a difficult task. To assert here by implication that they do not do good work because they do not even take down the history well—that is what the hon member said, after all… [Interjections.]

Order!

The hon member said they were not even aware of the fact that a certain patient suffered from epilepsy and only realized it later. Surely the hon member knows how the history is taken down when one is dealing with a patient. This creates the situation now and again that these things can slip through. I will not be told that every time the hon member for Parktown takes down a patient’s history and eventually has come to his differential diagnosis, he has taken every possible contributory factor or every possible fact concerning his history into account or has known about it. [Interjections.]

The hon member for Parktown talks about medicine being at the crossroads. What is the hon member really saying when he makes that statement? He talks about nurses who have to sacrifice one third of their service bonus and of the time which is now going to be added to their normal working week. He also talks about the argument which is in progress amongst pharmacists and doctors at present. This is the crossroads of which he is speaking. He does not know what crossroads are.

In addition he makes the amazing statement “There is no national plan”, when he talks about population development programmes. Did the hon member not take note of the Population Development Programme as worked out under the leadership of Dr Schoeman and others? I think the hon member was present at a meeting where that excellent plan, which is being applied over a wide front, was presented to us. He says, however, there is no national plan.

For health.

But that is part of the whole process. The hon member himself said we could not see these things in a fragmentary way, that we had to see preventive medicine together with healing medicine. Does the hon member now want to see the Population Development Programme separately and not as part of the whole? Worst of all is that the hon member talks of the doctors and nurses and other people who furnish their services in remote places as “medical left-overs”.

You are talking nonsense.

That is what he calls them. We can look at his Hansard.

The hon member also emerged with a “future plan” and said we had to determine the total need. If one merely looks at what preceded the population development programme, what did we do but determine the need as a result of the demographic study done by the President’s Council? The hon member says money should be available for that and I agree with him. If, in his opinion, sufficient money has not been voted for this by the House, he should tell the people in Parktown to make money available so that the private sector can contribute its part to making a success of this.

The last point made by the hon member—I do not want to spend too much time on him—is that the method of consensus in seeking solutions is quite unacceptable. How does the hon member think his party will be able to govern in future if he does not handle matters by way of consensus? I leave the hon member there.

Order! I am sorry, but the hon member’s time has expired.

Mr Chairman, I rise to allow the hon member for Rustenburg to continue his speech.

Mr Chairman, I thank the hon Whip for the opportunity.

If I devote the rest of my speech to the Population Development Programme, I do so in the knowledge that the whole health team is evaluating its role and indeed will do its part. We are all aware of the demographic tendencies in the RSA as spelled out in a President’s Council report and each of us knows what the catastrophic results would be not only here, but also far outside our borders, if the tendency of population growth in the RSA were to continue in this way. The condition has not improved since the report appeared. Perhaps this has happened in certain places and in certain regions, but generally the condition has not improved; indeed, it has become worse. The question is whether or not people outside the House know this. If the message remains between the walls of this House or between the walls of the offices where this neat plan is to be worked out, we have lost. The addressing of the problem is not a one man or one department effort, but should be a national effort which is addressed multi-nationally.

I can think of no better and more important co-operative project than the very Population Development Programme of Southern Africa. If handled correctly, the result will be a better life potential for everyone in Southern Africa. It is an indisputable fact that disparity is a characteristic of the world community and there are signs of the gap between the rich and the poor becoming progressively greater. Experts contend that unequal health levels and disparity in medical care aggravate this situation and I want to assert that ignorance plays a large part in this connection and that active training, instruction and guidance can narrow that gap. If we create the structures to make co-operation possible, we are accelerating this equalization process.

If the message that the socio-economic elevation of people makes up an extremely large part of the answer to the problem we are discussing finds acceptance, we are on the way to victory. One gets the impression that it does capture the imagination of those people who should know. In the television programme last night President Nyerere said very clearly: “We must deal with the basic problems.” He also spoke about the standard of living which has to be raised and of education as part of the answer to the problem we are dealing with. If education simply means, however, that people have to sit on school benches and learn to read, count and write, we cannot win. That part of people’s education must also mean that they will learn that the norms and standards as we know them here, should mean something to people and that one should work at improving this.

The Western World cannot save us. This effort we have to make is an indigenous effort. I am afraid the imagination of the man on the street whose interests are the real concern, has not yet been captured. In the Dutch weekly magazine Medisch Contact a man by the name of Wolffers writes that the importing of a Western medical science into the Third World has had a detrimental affect on the latter and has increased the gap between rich and poor. He contends that the imported doctors have not really helped those in need of aid. He says:

I quote from another article in the same magazine which deals with institutions in the Third World:

These quotations make one think. Let us see what our position is, for we do not want to increase this gap. After all, we have the Albert Schweitzers and the Florence Nightingales. We can communicate with one another across dividing lines in some or other language. We have television and radio at our disposal which can carry the message into the houses of thousands of people. An infrastructure has been created and medical aids have been made available across the whole of Southern Africa and we are still extending these. We admit that there are parts where these services are not provided as one would wish, but we have committed ourselves inextricably to the socio-economic elevation of all people. We have gone further and created the negotiation structures with the regional liaison committees on RDCA level, as well as by means of the multi-lateral Technical Committees for Health and Welfare in order to promote the Population Development Programme bilaterally in the TBVC countries. We have gone further and also provide medical assistance further north. My information is that Bophuthatswana in particular is showing involvement and that everyone understands that urgent action is necessary in every country in respect of the following: Health, welfare, agriculture, housing, economic growth and rural and urban development. Co-operation does already exist, therefore. If we have said all this, however, it remains true that the success of the effort will depend on whether or not the various communities are truly involved, and whether or not the funds are available. If that happens, if we can get the community involved and we can get hold of the funds through the involvement of the private sector, we have a chance of winning.

I want to pay tribute to each one of these nurses, social workers and willing workers who are committed to motivating their people in difficult circumstances outside in the field to become part of this action programme so that this Population Development Programme can be a success. We want to express the hope that that effort will be strengthened from various sides by outside intervention.

We have a choice: If we make every effort, we can survive. There is a condition, however, viz that it requires a mass effort, and every possible aid such as television, the radio and the newspapers will have to be better utilized as bearers of this message. I am of the opinion that we often miss those contributions in our national effort. May we also experience assistance from that side soon and to an ever greater extent.

Mr Chairman, to begin with I want to identify myself wholeheartedly with the tribute by the hon member for Rustenburg in respect of the death of Dr Nak van der Merwe. This side of the Committee identifies itself wholeheartedly with it. Then I also want to associate myself with his good wishes for the recovery of the hon member for Brits.

Mr Chairman, in the limited time at my disposal I should like to draw two matters pertinently to the attention of the hon the Minister. Firstly, also prompted by the announcement made by the hon the Deputy Minister this afternoon, I want to say that a certain deficiency exists in respect of the regulations of the Occupational Diseases in Mines and Works Act, 1973. It is an Act which has been administered by the Department of Health and Welfare since April last year. There is a category of workers who are exposed to all the risks of a mining industry, but who are excluded from the benefits by the hon the Minister in terms of this Act at present.

In respect of the announcement made by the hon the Deputy Minister, I merely want to make this remark: The compensation to Whites for occupational diseases is being increased by 12,5%. In reality that is still below the inflation rate, and it is indeed true that these people are therefore worse off with the available funds than they were a year ago. In respect of Coloureds the hon the Deputy Minister has announced an increase of 20%, whereas Blacks receive an increase of 25%. Since it is the Government’s policy to co-ordinate, I merely want to make this remark: We must also, since the hon the Deputy Minister announced the increase and explained the historical background, take into account that other expenses from the Government’s side such as subsidizing of housing and subsidizing of health services also differ in respect of the various population groups, and that if there is to be a coordination, the measure of subsidizing of for example housing and transport should also be considered, and that one should not disregard this when one wants to institute parity in this respect.

In looking at a single paragraph on this matter in chapter 10 of the department’s annual report for 1984, hon members will agree with me that it was honestly not the intention of the legislation to exclude anyone who was doing a risk work. In chapter 10 we read this paragraph:

It is very clear therefore that the intention is to compensate everyone who was attached to these risk industries in any way. The definition of a mine according to the Mines and Works Act, No 27 of 1956, determines, however, that a building is only part of a mine if it is used by the owner of the mine for any of the following purposes:

1. (a) Searching for or winning a mineral;
2. (b) crushing, reducing, dressing, concentrating or smelting a mineral;
3. (c) producing a product of commercial value, other than a clay or earthenware product or cement, from a mineral; or
4. (e) extracting, concentrating or refining any constituent of a mineral.

In addition, section 13(6) of the Occupational Diseases in Mines and Works Act, No 78 of 1973, says:

Now, however, I have a problem. I have knowledge of people, in the asbestos mining industry for example, in the Northern and North-Eastern Transvaal, the Northern Cape and other areas, who have been involved in the handling of asbestos at a storage place and with the railage of the products in a place away from certain mines, and who are being kept from receiving compensation purely for technical legal reasons after they have contracted proven asbestosis or even the deadly mesothelioma, because in terms of the Act they were not working at the mine. These are people, therefore, who worked in an industry which involved mortal danger of which the true extent was only realized in later years. They lost their health, and even their lives, without any compensation as determined in the relevant Act.

I want to suggest that in the meantime the hon the Minister regards these people as having worked at a mine in terms of the authority he has according to section 13(6). Surely the storage and rail age are another part of the mining activities, on the mine’s property. If not, even if such a store were not the property of the mine, possibly we can amend the Act concerned in such a way in future that there is no doubt that it also has to include these people. I want to plead seriously with the hon the Minister for this, for there cannot be many cases of this nature. According to my judgment they should really have been included, according to the spirit of the report.

Many of these mines have closed and no longer exist. There is a regulation in the Act which makes provision for this. Section 13(5) of the Occupational Diseases in Mines and Works Act reads as follows:

There are many such cases and I want to plead with the hon the Minister that one should not hide behind a technical rule to exclude from such benefits certain cases which, according to my judgement, definitely qualify for benefits in terms of this Act.

A second matter I want to broach, is the whole question of the provision of medicines and dispensing by doctors and the amending of an ethical rule to allow the dispensing of generic equivalents by pharmacists in order to force the costs of medicines to decrease. This is not a simple problem. It is a complex problem which has surely been investigated to a great extent by the Browne Commission whose report we are still awaiting anxiously. I want to ask the hon the Minister for the umpteenth time when this report of the Browne Commission is to be tabled.

What I cannot understand, is that the Government finds it necessary to move amendments at this stage, for example the Pharmacy Amendment Bill and even the Health Amendment Bill. This legislation is now being proposed and involves certain changes of principle which the Browne Commission will probably have to report on. Possibly the Browne Commission will deal with those principles in their report. I cannot understand, therefore, what the hurry is. It cannot be so urgent that those amendments have to be made now, for this merely leads to ad hoc amendments which may have to be amended again soon. [Time expired.]

Mr Chairman, it is a pleasure for me to speak after the hon member for Pietersburg because he has revealed a reasonably balanced approach to matters in his speech today. In the first place he referred to the Nieuwenhuizen Report. This report is very important in the sense that it deals with matters that affect people most closely in the mining industry. That is why the proposals contained in this report are of particular interest to the workers in the mining industry.

The hon member for Pietersburg spoke about the percentage improvement in compensation announced by the hon the Deputy Minister. In the first place I want to say I think we are all happy to take cognizance of the fact that those people who suffer harm in the mining industry are being kept in mind and that improvements are being made for them. These people do a special kind of work. All too often they work in particularly difficult circumstances and that is why it is only right that the State should take care of these workers in our mines and industries. If one takes into account how much this country benefits from the development of precious metals and other elements which are mined in this country, one realizes the value of the services provided by those people.

The hon member for Pietersburg also spoke about the respective percentage increases for the various population groups. It is regrettable, but one of the points of departure of the hon member’s party is to place every adjustment or whatever is done under a microscope and to see how it affects the various population groups. We accept that it is a matter which they set great store by and regard as very important in all respects. Certain arguments advanced by the hon member are valid, but I also think the various socioeconomic aspects and other facets involved in the matter are considered when this adjustment is made. He referred inter alia in this connection to other advantages that certain population groups have, for example in respect of housing and other subsidies they receive, and said these should be taken into account. I do not think the argument is without logic, but in my opinion this is taken thoroughly into account.

The hon member also spoke of certain people who can be detrimentally affected, although strictly speaking they do not really work in mines. These are people who work in asbestos factories for example, and who can contract similar occupational diseases. I think the hon member could make out a case for that, but I am convinced that it will also be taken into account in the expected legislation, resulting from the Nieuwenhuizen Report. It is only right for the people who are subjected to the detrimental effects of the handling of that element with which they are working, to receive the benefits.

May I say briefly that as far as the Nieuwenhuizen Report is concerned, we know that the medical bureau, which has to determine the degree of illness, has been placed under the Department of Health and Welfare. The compensation commissioner in this connection will also fall under this department. Certain institutions which are involved in this matter feel that it would be preferable if the compensation commissioner fell under the Department of Manpower. Various reasons are given for this. The Department of Manpower has been involved with this matter for many years, for example, and there are assertions that there would be resulting benefits if the compensation component could rather be in this department. I am convinced that the interdepartmental committee which is handling this affair, will consider the whole matter in a capable way, and that the decision which will follow their discussions and investigations will be such that it will be in the interests of the workers in those industries. As I said originally, it is important to take care of those people, and to deal with the detrimental effects in respect of their health, as a result of the handling of certain elements—since they are working in those very important industries—in such a way that it will be in their best interests, so that they will be happy and satisfied that the manner in which diagnostic tests are carried out to determine to what extent they are suffering from occupational diseases, will be reliable. When the question of the compensation package for damage incurred comes under discussion, it too must attest to discretion, and it should be clear that the interests of the worker are receiving priority.

A measure of distrust has existed amongst miners for a long time in respect of certain institutions which, in their opinion, have acted in such a way that they have limited their expense in respect of compensation. The result is that the workers have not always received what they thought was their due. Whatever the case may be, I want to express the confidence that the new constitution will be such that those workers will have full confidence in the institutions that have to supervise them and have to take care, especially as far as the diagnostic aspects are concerned, that justice is done.

After responding briefly to what the hon member for Pietersburg said, I want to raise another matter. Once again I want to make representations in respect of the important task of the department, a task which is also performed by local authorities and other institutions. I am referring to those services performed by health officials on local government level and also by this department.

I think it is the State’s endeavour to utilize manpower in such a way that we can attain the optimum effectiveness in the provision of those services as far as possible.

As we too are now moving in the direction of a regional services basis as far as certain legislation considered in this House is concerned, I think the time has come for the absolute separation between the sphere of the health inspector in service of the local authority—seven-eights of his salary is subsidized in any case—and that of the State’s health inspector, to be lifted. Many man-hours and expenses can be saved if interaction takes place. [Time expired.]

Mr Chairman, on a previous occasion we paid tribute to the late Dr Nak van der Merwe as a person. Where we are dealing today with the portfolio he held, I would like to say that those of us on the outside who watched the administration of his department always regarded him as a man who knew his job. He did not seek the spotlight and he did not wave his arms about, but he was a man who showed he knew what he was doing. Now as a layman thrown in at the deep end, as it were, having to find my way around the inside ways and alleys of the department, I have added to that feeling a respect for the courage which Dr Nak van der Merwe showed in grasping some of the nettles in his department. Supported by the Director-General and officials of the department I believe he saw the problems clearly and was prepared to tackle them. I have certainly learnt in a very short time what these nettles are that have been and are still lying around.

I would have liked to have dealt with the allocation and redistribution of responsibilities to own affairs, but I have to leave that aside because I have only ten minutes. In that time I want to deal with certain problems.

In my quick initiation it is clear that there are simmering undercurrents which are on the verge of breaking out into open warfare within the responsibility of this department. War could break out on two separate fronts. One of these is the war between the doctors and the pharmacists to which the hon member for Parktown referred. Sniping from the sidelines are the irregular forces of the Chemical Manufacturers—perhaps we could call them the partisans—and they are sniping at both sides. The other warfront is that be tween the doctors and the chiropractors and homeopaths.

Both of these are age-old conflicts stretching back into the last century and I do not think one can ever end them.

At the very best, I believe, one can aim at a controlled and balanced armistice—even perhaps an armed cease-fire; a non-violent armistice however. Both these fights are based on the professional level. The professional troops fighting the battles are fighting them on questions of ethics and of standards. However, human nature being what it is, I am afraid we have to accept that there are also less professional influences involved in these battles—those of private enterprise and of profit.

This Parliament happens to be the referee. Ultimately we are going to have to arbitrate on both these disputes that are raging at the moment because Parliament is the guardian of the public interest, the guardian of all the people of South Africa. This Parliament must ensure three things in the field of health care. Firstly we must ensure that the quality and standards of the services are maintained. Secondly we must ensure that services are available to meet the needs of the people. Thirdly we must ensure that those services are available at a cost which is not beyond the reach of the people themselves.

I believe that it is everyone’s right to lobby. Masa is the strongest trade union in South Africa. They have the right to lobby, as have the homeopaths, the chiropractors, the pharmacists, the PCMA and the nurses. They are all entitled to lobby for a better deal. I respect that right, and it is our duty as a Parliament to listen to that lobby of each respective group and to evaluate their submissions and to establish the real facts of the case. However, we in this Parliament must never become the instrument or the voice of any one of those lobbies. We must never become the voice of any influence group, any pressure group that believes it is superior to others, and therefore listen to what it has to say to the exclusion of any other group.

Mr Chairman, we must also not allow ourselves to be blackmailed or threatened when we have to fulfil our role as arbitrator. We cannot allow pseudo-blackmail by those who threaten to withdraw services or to do anything else to the detriment of health care in South Africa. No sphere in the field of medical care belongs exclusively to one group only. Our job is to take note of all the facts and to ensure in the first instance—as I have already said—that the standards are protected but that no one is denied the right to treatment, provided it does not constitute a danger or a threat to their health or to the public welfare.

The second thing we have to see to is that in the provision of health services prices are not manipulated to the detriment of the public. In this respect I should like to refer to a newspaper report headed “Dokters kry medisyne spotgoedkoop”. When one looks at the prices that are quoted in this particular report it is clear that there is something wrong somewhere, Mr Chairman, and it is the duty of this Parliament to look at what is wrong and try to put it right. These are issues which we are going to have to face.

I want to make one suggestion, Mr Chairman, and to sound one warning as well. I believe that the State President, when he replaces the late Dr Nak van der Merwe, should appoint as Minister of Health and Welfare a person who is not a medical doctor or in any way associated with the medical profession. I believe we need a neutral person in that post, a neutral arbitrator who will have his professional advisers, an excellent department and specialists to guide and to advise him in respect of technical and professional matters. We do, however, need someone strong enough to withstand and to resist the pressures and the lobbying which we are going to face during the next year or two.

Someone like you, Vause!

Yes, I think I could do it quite well! When I was a Justice spokesman, I had to compete with members of the bar and the side bar. So, I shall manage somehow. [Interjections.] I believe that this would make it easier for the Minister not to see himself as representing a particular profession or a particular point of view. If one is a member of a profession, it is very hard to listen to their views and then to say: “No, I am sorry, I am going to go against you.” So, that is my positive suggestion.

The warning is that if the cost of medical care and medicines rise beyond the financial reach of the public, the public will put pressure on the State to supply health services itself. That would be a sad day for South Africa. It would be a sad day if we had to have imposed on this country a national health scheme such as Britain had. If one asks members of the old Railways Pension Fund, the members limited to their panels, what they thought of it and if one asks the doctors who provided that service how it worked out for them, one will find that both will say that it just did not work at all. That is not what we want. Therefore we must allow private enterprise and competition full play. However, the warning to them is not to price themselves beyond the reach of the public so that the State is left with no option but to interfere to ensure that the public can receive treatment. [Time expired.]

Mr Chairman, I identify myself with many of the things said by the hon member for Durban Point, except that I believe it to be the State President’s duty to appoint the next Minister of Health and Welfare. I leave it to him to do so.

I think one can say without fear of contradiction that it is the desire of this House and indeed its duty to ensure that in its composition and functioning, the South African health services, the so-called health family, will be sincere and unimpeachable. Health is man’s most desirable and most valuable treasure, something one does not play around with. One is filled with aversion when the services that revolve around health display the slightest defects. That is why I say it is a pity that the differences between the pharmacists and the doctors create the image that sick people, patients, are being exploited to the financial benefit of what in my opinion are valued members of the health family, viz doctors and pharmacists. One can only hope that a speedy solution will be found and that it will result in more reasonable prices for medicine.

In the case of the associated health service professions such as those of chiropractors and homeopaths, it is encouraging to know that legislation which will open the closed registers of these professions, thus ensuring that in future these professions will be practised in a purified form in South Africa, is on its way. Quackery in the name of chiropractic was the reason for an antipathy existing in certain circles against the continuation of the profession. One thinks of the days when every Tom, Dick and Harry could heal all ailments by so-called methods of manipulation.

Mindful of the desire that all members of the health family should make worthy, sincere and effective contributions, it is interesting to note the procedure used to attain this purpose in the case of chiropractors. We find that a commission was appointed in 1962 to investigate the effectiveness of chiropractors. The commission’s report was so damning for the profession that it was never published. That was also in the days when quacks asserted in the name of chiropractic that they could even heal measles by means of manipulation.

In 1971, 11 years later, an effort to remove chiropractic from the South African health family was thwarted by Act 76 of 1971 which granted recognition to the profession, but the profession’s register was closed and the profession was commanded to get its house in order. They had to obtain ethnical control. They had to refute the 1962 commission’s report. They had to recover the ground lost by the profession since 1962. They had to settle their disputes and speak as one. In those days there were two organizations which often contradicted each other.

The chiropractors accepted that legislation. They accepted it because there were three important reasons for doing so. In the first place they could check the qualifications of persons who professed to be chiropractors, and make sure that qualified people performed the task. In this process they removed 70 persons from the roll and purified their profession. In the second place it was beneficial for them because registration would recognize and legalize their profession. In the third place it was beneficial because during the negotiations with the Minister at the time, they were brought under the impression that if their affairs were in order, the opening of their register would be reconsidered.

In 1981 the then serving Minister recommended to the SA Medical Council that chiropractors be included in the Medical Council, but this proposal was rejected by the Medical Council by 17 votes to 16.

In 1982 they got their own statutory council to exert control over chiropractic and homeopathic professions.

In 1984—now things went more quickly—this new council had handed a few memoranda to the Minister and the Medical Council, inter alia one in which they proposed a curriculum for the training of future chiropractors in South Africa with the purpose of getting a chair in South Africa for the training of its own chiropractors. They also went to the trouble of visiting training institutions abroad to determine the standards they could accept to put chiropractors on the register in South Africa.

The proposed curriculum was referred to the Medical Council for commentary by the Minister, and that commentary is very unfavourable.

The HSRC also launched an investigation which points to the fact that the public makes full use of chiropractors’ services and that the public benefits from the services.

After 14 years had elapsed since 1970 in which the chiropractic profession reacted conscientiously to the tasks set them and succeeded in getting its house in order, their register is still closed and their profession is declining as far as numbers are concerned. Even worse: The same Act that enabled them to get rid of their quacks to purify their profession in order to ensure that their profession also provided a real health service to sick people in South Africa, is forcing them today to prosecute their qualified people, people who have qualified in the meantime, but have not yet been taken up in the register, because they are practising in South Africa illegally. It is ironic that a profession accepts its register being closed to enable it to apply the necessary purification processes and that later the same legislation forces it to have qualified people prosecuted because they cannot get their names on the register.

One wonders what will happen if the legislation is not passed, the status quo is maintained and all chiropractors have left South Africa. It will create a condition like the one that reigned before we began with the practice. Once again there will be illegal chiropractic practices in South Africa which will be run by quacks and people who have not been trained to do the work. I request, therefore, that after 14 years we should not apply additional delaying tactics. [Time expired.]

Mr Chairman, because we are probably going to discuss the Bill to which the hon member for Swellendam referred soon, I do not intend to go into his speech in detail, except perhaps to place on record my personal view, namely that I am of the opinion that both chiropractors and homeopaths do have a rightful place in our overall health family, if I may call it that. Because the matter will be discussed again, I do not wish to take it any further now.

Just tell that to Marius as well.

I want to react briefly to a few statements which the hon member for Rustenburg made. He tried to react to the speech made by the hon member for Parktown. How does one deal with the problem if, in the urban areas, there is an overpopulation of medical practitioners and facilities while in the underdeveloped areas there is a tremendous demand for and shortage of such people and facilities. The hon member for Rustenburg suggested that the problem be addressed by means of the population development plan, which would solve the problems.

†The population development plan, as I understand it, does not specifically deal with this problem area, namely how to persuade the medical practitioner and associated medical services which are operating under the private enterprise system to go to those underdeveloped areas where the profits are not that healthy, where the city lights are not available and where other comforts are not available. The hon member for Parktown poses the question what the department is doing to resolve this problem. The hon member for Durban Point made the point that it will be a sad day when a national health services plan has to be implemented. I do not believe that we have to go that far but I want to suggest that unless the State steps in to create some sort of balance in the existing situation, the problem is not going to be resolved. If one expects the free market system to look after the underdeveloped areas, I do not believe one has a chance. The hon member for Parktown asked how we were going to address this problem and how we were going to persuade medical practitioners to operate in underdeveloped areas. This question needs to be answered by the Government. Free enterprise on its own is not going to do it. The department has to investigate, study and make suggestions as to how medical practitioners and others can be attracted to those areas.

One aspect on which I want to compliment the department relates to the South African code of ethics for the marketing of breast milk substitutes which at this stage is in its final draft form. The hon the Minister may recall that some three years ago, this aspect was raised, and I think the department has done well in producing a draft code which almost entirely reflects the world health organization code dealing with the promotion of breastfeeding for infants. Breastfeeding and the control of substitutes for breast milk is in my view an essential element of primary health care in this country. Although there was an initial reluctance on the part of the department—I am talking about 3 or 4 years ago—to follow the standards set by the World Health Organization it seems as though at this stage there is a determination to achieve the standards laid down.

May I just pose a question or two in respect of this code. Why does the draft code totally omit the monitoring provisions which should apply to the code? A code can only be as effective as the respect that it has in the public eye and, unless there are monitoring clauses in this code, it is not going to enjoy the necessary respect of the various instances who need to be guided by the code.

A second question is: Why does the draft code omit all references to the Government’s responsibility in upholding this code? The code should make it clear to everyone that the Government regards itself as the responsible party to uphold this code, even though there is no criminal sanction or any other kind of sanction which can be applied. The Government’s weight and its authority should be reflected in the code.

May I conclude by telling the hon the Minister that we look forward to the actual signing of this code. He will find that from this side we will try to monitor it as effecttively as possible to ensure that the parties, specifically the manufacturers of those products, abide by the standards.

Mr Chairman, I hope the hon member will excuse me for not following up his address directly although I appreciate the point he made as regards the importance of breast feeding. I should like to support him on this.

The hon member for Durban Point as well as the hon member who has just resumed his seat referred to the population development programme this afternoon. The question was raised how one could encourage people to go and provide medical services in certain areas. The total population of the RSA and the TBVC countries was put at 31 million in 1983. According to the latest estimate of the Bureau for Market Research of Unisa, 72,8% of the 31,3 million represents Blacks, 15,4% Whites, 9,0% Coloureds and 2,8% Asians. In mentioning these figures, I wish to say the time has come for us to encourage other groups as well to qualify themselves to furnish a service to their own people. The bureau puts the RSA population figure at 26,2 million, of which 67,2% are Blacks, 18,4% Whites, 10,6% Coloureds and 3,3% Asians. The Transvaal accommodates more than half, namely 53,6% of all the Whites in the RSA and also in the TBVC countries. The Cape Province accommodates 84,1% of all Coloureds, whereas 80,7% of all Asians reside in Natal. Black people with permanent residence in the national states and in the TBVC countries comprise 52,6% of the total Black population of the RSA and the TBVC countries. In the years 1980-83 the total population of the RSA and the TBVC countries increased by 2,5% per annum. The White population increased by 1,5% per annum, from 4,6 million in 1980 to 4,8 million in 1983. From 1980 to 1983 the population increase of Coloureds and Indians was 1,9% per annum.

The total number of doctors in the RSA in 1983—that is to say doctors registered with the South African Medical and Dental Council—was as follows: 15 251 White doctors as against 60 Coloured doctors, 1 255 Asian doctors and only 249 Black medical practitioners. Having said that, I wish to emphasize the following fact: The time has come for other groups to qualify themselves; it is humanly impossible for those small groups of medical doctors to accomplish the task currently expected of them. The total population is 26 749 000 while there are 18 109 medical doctors which comes down to a proportion of one doctor to every 1 477 inhabitants of the country.

I know the argument may be used that these figures compare very favourably with those of developing countries of the world. Nevertheless we should do something about the situation at this early stage as we are dealing with a Vote this afternoon which is actually of common concern and which therefore affects the other groups too. I can do no other but stress this point this afternoon.

The total number of pharmacists if 7 200 of which 6 726 are Whites, 279 Asians, 71 Coloureds, 84 Blacks and only 40 Chinese. In indicating this, it is very clear to me that the point I am raising this afternoon should be regarded in a very serious light. There is a total of 3 100 pharmacies whereas there are 2 470 retail chemists. Achievements in the medical field—in South Africa as well—have made headlines over the past year. The birth of test-tube babies and, naturally, organ transplants confirmed that there was actually no limit to progress in the field of curative medicine.

On the other hand the application of labour forces within the medical profession should be examined as well as making the necessary means available. It is important that everything possible should be done to bring medical services, as well as medicine, within the reach of our patients. I wish to appeal to the hon the Minister to provide the necessary protection by means of legislation to everyone who has to make use of medical services in South Africa. I also wish to appeal to the South African Medical and Dental Council, the Pharmacy Board and the manufacturing industry to set aside their problems and to attempt to reach an agreement in this regard because what is in progress at the moment definitely does not benefit the community. There are various reports to which I can refer: “Aptekers pak die dokters!” “Aptekers moet hand in eie boesem steek.” “Dokters kry medisyne spotgoedkoop.” “Veertig apteke aan die Oos Rand word bedreig.” “Spesialis sê dis logies.” These are only a few of the newspaper headlines in this respect. In this way our people become involved in the discussion.

The hon member for Durban Point also referred to the fact this afternoon that it is now expected of the Standing Committee on Health and Welfare to act as an arbitrator between these people. I do not think this can be expected of us; these people should attempt dealing with their problems themselves.

I wish to request the hon the Minister this afternoon that we, as the State and the Government, should be prepared to examine our consciences to see where our problem lies and where to find the solution to the problem in connection with medicine. I wish to mention a few examples to hon members this afternoon. If a patient using medicine were aware of these facts, he could justifiably ask himself how this could be possible. I should like to mention certain examples.

If I go to a Transmed pharmacy and I am a member of that group, I can purchase a bottle of cough syrup, Benelyn, for 85 cents, whereas people who have to go to pharmacies in the trade pay R6,25 for that same bottle of cough syrup. Thirty Ativan tablets cost R4,73 from Transmed and R13,84 in the trade. I can continue in this vein. One pays Transmed R8,72 for 100 Sotazide tablets as against R24,52 charged for the same medicine in the trade. Surely there is something wrong somewhere.

If we examine the price of medicine in South Africa and compare it with that of the same product in the United Kingdom, we find a great difference. Time does not permit me to go into full details but I shall mention only a few products. I am quoting prices from the MIMS price list which is used in the United Kingdom as well as in South Africa. In South Africa Ativan costs R12,54 and R4,30 in the United Kingdom for the same product and the same quantity. Valium costs R19,19 in South Africa against R3,80 in the United Kingdom. Tegretol costs R44,00 in South Africa and R12,38 in the United Kingdom. Amesec costs R25,30 in the United Kingdom against R89,30 in South Africa.

As regards medicines, the consumer can justifiably lay claim to the best products and the best services when he is in trouble; he is entitled to obtain only the best. That is why I wish to appeal to the hon the Minister this afternoon that we as the Government should become involved in accomplishing this ideal of bringing medicine and medical services within the financial reach of all the inhabitants of the RSA. [Time expired.]

Mr Chairman, it is always a pleasure and a privilege to listen to the hon member for Witbank especially as one could see he had made an exhaustive study of the subject on which he spoke this afternoon.

I wish to return for a moment to the speech of the hon member for Durban Point. He touched upon a very important facet here, namely the problem situation between pharmacists and medical practitioners. I wish to appeal here today that doctors should not harm our pharmaceutical profession. It is easy for them to say they want to prescribe and hand medicine to patients themselves but our pharmacists provide a very valuable service, especially after office hours. I want to say today that, if one has to contact medical practitioners after consulting hours to obtain a prescription for medicine, it can create a problem whereas our pharmacists furnish that type of service. At present they already have to stock many other items in their pharmacies to remain a profitable concern.

What I find incomprehensible is that doctors within the same building complex as a pharmacy prescribe and supply their medicine to patients. That does not make sense to me. That type of conduct will eventually cause us to be unable to obtain people to take up the study of pharmacy any longer. They do it for one reason only which is to make a living from it. If there is no pharmacy near the patient—let us say within about ten kilometres—I can understand the doctor’s furnishing that service but where he pertinently provides that service in strong competition with a pharmacist, I think the Medical Council ought to investigate this situation.

I should like to associate myself with the hon member for Witbank and turn to a problem which in itself carries the destruction of orderly survival in Southern Africa, namely that of overpopulation. Statistics recently released by an organization indicate an estimated population of 80 million in South Africa by the year 2020, in other words our population will have increased by approximately 50 million in 35 years’ time. If I juggle with figures a little now—it is pleasant doing this—and I assume 45 of the 50 million people are going to be Black and that only five million will be Whites, Coloureds and Asians, we come up against the following facts: If the average Black family living together in a housing unit numbers eight people per unit, it means we shall have to erect approximately 5 625 000 housing units within the next 35 years. In making that statement, I assume agriculture will not be able to absorb much more of the population growth. If I allow only R3 000 per housing unit, in current money values, it means we shall have to spend R16,875 billion which is approximately R500 million per annum calculated at prevailing money values. If we accept that the remaining five million people are going to require approximately an additional one million houses, it will require almost 30 000 units per annum to fulfil their requirements. That means we shall have to make approximately R900 million available per annum to supply the housing needs of those five million people. I am not even thinking of education, schools and health services—that concerns only the housing facet. If one takes all these other things into consideration, the picture becomes far more alarming.

I wish to predict today that, if the present growth figure of 2,5% is maintained, we shall not require any war to force our country to its knees—we are going to do it ourselves. We should not underestimate the work currently being done by the Department of Health and Welfare; I think it accomplishes an enormous task with the slender resources at its disposal. One can almost say it has to accomplish a superhuman task as regards family planning; I think there is still insufficient being done about this unfortunately. We shall simply have to make more funds available to carry out the message of family planning in an effort to curb this massive population increase. We have to carry out the message and also make facilities available to offer everyone the opportunity of planning and limiting his family. Let us call a spade a spade: It involves planning and limiting but where do we begin?

In the primary school we make a start on assuring a child’s future as regards culture, the standard of education, scholastic capabilities, etc. Why can we not also begin as early as at primary school level to assure the standard of living of the child’s own future family? That child is a prospective parent and head of a family. Can there really be any reason in the present era to prevent our starting to influence children positively as early as at the primary school level? It is estimated that there is a very high incidence of undesired pregnancies in the RSA; some people put the figure as high as 500 000—which I think is slightly exaggerated. If a teenager is physically capable of producing a child, I think he or she is ready to be told about the social evils of overpopulation and undesired pregnancies. I do not believe we should keep this from children merely because we will then supposedly be telling them everything and leaving them nothing to discover in the future.

I think we should begin conveying this message in our schools now; we should simply involve our teachers in the matter. It is a fact that we tell pupils of the dangers attached to drugs long before they begin experimenting with them. I feel we should spell out the dangers of overpopulation to them long before they are ready to start families. It should be done at school. We should undoubtedly plead the cause that not only one preparedness period a year should be devoted to family planning—the limiting of numbers in our country. It ought to be done more frequently—at least half a period a month ought to be devoted to family planning and the matter of undesired pregnancies. This message simply has to be brought home to our youth.

Nevertheless this matter should not be brought to the youth alone; adults should also be involved. But how do we set about it? At present there are advertisements on radio, television, in daily papers and so forth bringing to people’s attention that there are programmes available under which they can limit their families. In this respect, however, we should not only attempt making families aware of the programmes and the means of assistance they offer. We should also attempt it the other way around which is to involve families in the programmes. If we could combine these two matters, I believe we could make a success of family planning.

A further matter we could consider would be to tell couples getting married in the future—for example from 1986 onwards—that instead of receiving higher tax concessions for larger families, we would begin granting large deductions for one or two children and then progressively reduce the deduction. At present we are playing into the hands of those with larger families with our current tax system.

Something else which concerns me is that, if we proceed at the present tempo of increase of 2,5%, we shall have no alternative—no matter how difficult this may sound—but to start applying compulsory sterilization after a family has a certain number of children. These are hard words to utter and I know people will perhaps rain coals of fire on my head but, if we think of the survival of our country and our total people, we have no choice but to begin thinking of compulsory sterilization if we cannot limit birth figures effectively.

There are naturally other solutions we may put forward as well. If we do not take positive steps now to ensure the survival of our descendants and limit our population to between 68 and 72 million, we shall have problems. If we do not do something drastic about it, we are going to perish of hunger, thirst and poverty—especially if we consider that our water and food resources simply cannot provide for a population in excess of approximately 68 to 72 million at optimum times. [Time expired.]

Mr Chairman, at the beginning of his speech the hon member for Stilfontein referred to the battle between medical practitioners and pharmacists and then made the staggering accusation that the pharmacist is sometimes the only person available after hours. I am not acquainted with circumstances in the hon member’s area but in our country districts the doctor is the one person available throughout the night to see to health care. The hon member also said a problem arose where doctors practised in a building which also housed pharmacies. I shall shortly indicate to the hon member how we solve this problem most amicably among doctors and pharmacists in country districts.

Toward the end of his speech the hon member spoke about population development. I wish to point out that at the moment the figure of increase among the White population in South Africa is 1,08% whereas the replacement figure is 2,1% and that we should therefore speak of compulsory sterilization with great prudence when we reach this subject. I shall leave my response to the hon member’s speech at that, however.

I wish to refer to the hon member for Durban Point who also spoke about the battle between doctors and chiropractors as well as between doctors and pharmacists. The hon member then pointed out three important factors which should be examined. The first was the quality of medical service rendered, the second the availability of services and the third the cost aspect of medicine and the provision of medical services. I think all three these aspects can only be regulated well enough by one controlling body. Such a body exists in South Africa and it is the South African Medical and Dental Council. Let me add immediately that it is not composed only of doctors but of a wide spectrum of people involved in health services. This ought to be the body under which the provision of all medical services falls.

Now I wish to return to the hon member for Swellendam; I think I have heard the speech concerned previously in the House. I want to point out to the hon member that the relevant legislation about which he spoke is actually still coming; only today did we listen to the Second Reading speech on it. We shall deal with this matter further when that Bill is discussed.

The hon member for Witbank became very excited about the prices of medicine and referred to the products Ativan and Valium. I wonder if the hon member knows precisely what one uses them for; I should say the hon member perhaps required some of them in his excitement about this aspect. [Interjections.] The hon member quoted British prices here but he should take into account that the British health service is entirely socialized. Even medicine is largely subsidized by the State; it is a totally different system from that in South Africa and one cannot compare the two in a trice. [Interjections.]

I wish to return to the controversy which has arisen on the position of a dispensing medical practitioner. This can seriously damage the good relationship which has existed for many years between doctors and pharmacists. I do not think this has already damaged it because the problem to my mind appears in isolation in some parts of our country.

The price of medicine—the hon member did not get to this—is very closely related to the State tender system. At a conference of pharmacists held by the Afrikaanse Handels institute in Pretoria it came to light that the public in some cases has to pay up to 400% more for medicine than the public sector and in some cases up to 1 400% more. This means, in fact, that the private sector is subsidizing the State in this sphere.

I quote from an article in the March edition of Volkshandel under the caption “Duur Medisyne”:

I should say that action is incumbent upon the State.

According to an article in Die Transvaler of 16 April the Director-General of Health expressed himself as follows on the problem:

The Director-General then suggested that the State should examine the matter.

I now want to ask the hon the Minister what his opinion of the question is. What does he intend doing in the interest of medical practitioners, pharmacists, the manufacturing industry and in the last, but most important instance, the public of South Africa? Is this a general, countrywide problem or is it limited only to certain areas, for example the East Rand? We have read about this already in the Press. In quite a number of rural areas, for example Pietersburg and elsewhere—and that also brings me back to the hon member for Stilfontein—there are no problems whatsoever between doctors and pharmacists. There one finds for example that doctors and pharmacists practise in one and the same building and that doctors actually dispense—and by this time must also have their names on the register which authorizes them to dispense—but that the pharmacists have no objection to this because the category of patient to whom the doctor renders an umbrella service is in any case not a client of the pharmacist practising privately. That patient cannot afford to take a prescription to the pharmacy for dispensing.

We on this side of the House last year indicated our opposition to a register being instituted for dispensing doctors. Now it appears to me—now, after the register has been instituted—that in its institution it has had precisely the opposite effect to what was originally intended. Now one sees for example that more than 3 300 dispensing doctors are registered. Let me say immediately that I refuse to accept that a high percentage of those doctors are acting improperly in this respect. I should actually very much like to see proper application of the new legislation as regards dispensing doctors—hon members opposite contend this legislation now has teeth—so that we may establish how many of those doctors have really made themselves guilty of transgressions in this respect. I believe it will be a very small percentage of our medical practitioners in South Africa.

At present a great deal of feeling is being stirred up in the Press especially against doctors; they are perpetually being presented in a bad light. Other hon members have referred to this already. Reference has also been made to the article in Rapport of 5 May of this year under the caption “Dokters kry medisyne spotgoedkoop”. There is reference in that article inter alia to manufacturers and manufacturing companies selling medicine excessively cheaply to doctors. According to this article certain manufacturers also make special offers to doctors ranging from free medicine to huge discounts on purchases of medicine. In addition dreadful allegations are made, amongst others that some doctors purchase large quantities of medicine after its expiry date. They supposedly obtain this medicine very cheaply but dispose of it equally rapidly. It is said further—in another article—that various pharmacies in Alberton and Benoni have already closed because they cannot compete with doctors who have a turnover of up to R500 000 per annum from the sale of medicine. [Time expired.]

Mr Chairman, I wish to refer very briefly to the hon member for Pietersburg’s speech. I believe he started with an incorrect figure as regards population growth to which he referred; I want to request him to check that figure again. It is true the White growth figure is somewhat negative at the moment but it is not as bad as the hon member wished to imply.

Further I should not like to comment on the battle between the doctors, pharmacists and who knows who else. Viewed from the outside I must say the battle is not very elevating here and there. I should very much like to agree with the hon member for Witbank in his saying the standing committee cannot find decisively as regards that battle; the standing committee cannot act as an arbitrator. I believe the warring parties should set their own house to rights just as the chiropractors did.

I should like to make a few comments in connection with the accomplishment of rural community development. In previous debates reference was made to what is known in brief as the Rural Foundation. In the past, emphasis was laid especially on the objectives and ideals of that foundation. In attempting to summarize those ideals, it could be said the foundation was established with a view to involving organized agriculture, the private and the public sectors in and to organize them for the promotion of rural community development. Stated briefly in language farmers understand this means an effort is being made to involve the entire community in the upliftment of rural communities; or even more briefly it means increasing the quality of life of people in country districts.

The hon member for Rustenburg referred very strikingly to population development. I wish to put it that this organization forms an exceptionally important part of this population development. We have to be honest and say that people viewed the inception of this undertaking with trepidation because such a scheme costs money and also sustained financial support.

In this belief and with these lofty ideals the foundation was established on 23 December 1982 as a non-profitmaking utility company on a non-political and non-racial basis. The directorate consists firstly of Mr Frans Malan as the chairman. He is the Vice President of the Western Cape Agricultural Union. Mr Jan Boland Coetzee, the exSpringbok, is the deputy chairman. Together with Mr Malan, Mr Nico Kotze represents agriculture. As hon members know, Mr Kotze is the Vice President of the SA Agricultural Union and also the President of the Transvaal Agricultural Union. In addition there is Dr Jannie Rossouw representing the department and Mr Jan Boland Coetzee representing the private sector. Mr Ockie Bosman is the general manager.

The Rural Foundation confines itself to the agricultural sector throughout the country, starting initially in the Western Cape and concentrating on that area. Initially the tempo of expansion was estimated at 20 projects a year for the first three years.

So far everything has been merely dreams and ideals. What has been accomplished in reality after these three years? It is pleasant actually to be able to report on staggering results. During the first year of the existence of this foundation 18 community developers were appointed in 15 areas. At present 38 areas have already been affiliated with the foundation with a total roll of approximately 60 000 people. Eight hundred farmers are involved and 10 000 families are served throughout our country. Negotiations and enquiries in respect of a further 20 areas are on hand already and receiving attention.

As has already been said, the initial interest was in the Western Cape which is why most activities take place here. Nevertheless interest expanded considerably within two years. I can mention a few districts where action is already being taken: Warmbaths, Lichtenburg, Ventersdorp, Mossel Bay, Tsitsikamma and Langkloof. The foundation is operative among these people. Areas already affiliated are Humansdorp, the Upper Gamtoos and a place named Mookamedi in the vicinity of Reitz.

In speaking of areas where negotiations are already in progress, names too numerous to mention come to mind. Suffice it to say that 10 out of the 30 areas are in other provinces while enquiries are pouring in from district agricultural unions and farmers’ associations throughout the country. That is why it is truly pleasant to be able to put it that within two years this action has fanned out nationwide because our farmers realize the value of upliftment.

I believe these events are truly something on which we may congratulate the farmers of our country. What has been achieved totally contradicts the statement by the hon member for Parktown that almost nothing was taking place in the sphere of population development. Similarly the hon member for Durban Central said private initiative on its own could not eliminate shortcomings in the sphere of development. If I understood him correctly, he stated that it was only the task of the Government. I cannot agree with him because the Government cannot tackle this alone. The project I am speaking about is precisely the proof that private initiative together with the State can and should tackle these things. I find it a fine development that the farmers of South Africa in particular are teaching other members of the private sector a lesson.

There are many people and institutions contributing to the success of this undertaking. I have referred to organized agriculture with its initiatives and funds; we have spoken of contributions from the private sector and the department’s assistance in word and deed.

The late Dr Nak van der Merwe said we could come with constitutions and dispensations, we could do and think whatever we liked, but if we were going to neglect to uplift our population in this country and provide them with a quality of life worth striving for, everything would fail.

Here something is growing and expanding in a modest way to the benefit of our entire country. Because this project does not include matters of life and death, it will naturally never make a front page. That is why I wish to take the liberty today of thanking all involved and in particular the department.

This movement also acts in other fields. We are daily expecting the first results of research which is being carried out; a second matter which has been started is child-care projects; a third aspect is that 116 projects are already in progress in which farmers provide even teachers, food and housing to launch these projects. It is important to note that the State could not finance and institute these schemes at such low cost anywhere. What is of particular importance to us in rural areas is that children cared for in such a way without exception perform better at school than the rest. As regards social work, it is also true the State could not manage this task at these costs.

Other projects which have received attention are for example a provident fund for farm labourers; there was participation in television programmes for overseas distribution; a group funeral scheme was instituted and it was negotiated by this foundation at 73 cents per family per month against the normal rate nowadays of approximately R7 per family per month.

I believe we all take note of all this with profound gratitude. Once again I wish to take the liberty of expressing my thanks to these people who have shouldered this enormously great task. They are people who carry it out with enthusiasm, dedication and perseverance. That is why we expect many good and many fine results in future from this Rural Foundation and we wish these people every success in what they are yet to do for us in future.

Mr Chairman, since the end of the Second World War man’s interest in his environment has increased enormously. In speaking on pollution this afternoon, I should like to express my appreciation of the fact that as regards conservation of the environment—which naturally also includes the matter of air pollution—there will be an Environment Day on 5 June this year in Pretoria during which the environment will be discussed. On that occasion the focus will fall anew on air pollution in South Africa.

From 1946 to the present may be termed the period of environmental awareness. Although pollution in its various forms existed long before this time, it has only been since 1968 that something concrete has been done about pollution, whether of the atmosphere, water or whatever form it assumes.

In our country the industrial sector is usually regarded as the greatest sinner in connection with pollution. A short while ago a survey indicated that power stations emitted approximately a million tons of fly ash into the atmosphere annually. In the electoral division I represent on the Transvaal Highveld there is the greatest concentration of power stations in the world. In addition approximately a million tons of sulphur dioxide are emitted annually by power stations, refineries and industries operating sulphide ore foundries. About 10 000 tons of iron oxide coming from iron and steel works are also released into the atmosphere annually. Fortunately most of these pollutants are released from high chimneys so that they normally reach the surface of the earth in low concentrations because of dilution.

The smaller fuel-burning appliances in our cities are an important source of pollution at ground level, however. Here I am thinking particularly of coal stoves, an aspect to which I shall return later, and boilers in factories, hospitals and also blocks of flats. It is estimated that approximately 50 000 tons of sulphur dioxide are released into the atmosphere by these appliances annually, most of it close to the ground in our residential areas. In addition about 250 000 tons of hydrocarbons issue annually from the same source of pollution near the ground and for example from motor vehicles.

Another source of pollution is that caused by motor vehicles and diesel trucks. It has been established that pollution caused by petrol-driven vehicles in South Africa is at present much lower than that measured in cities such as New York, Tokyo and Los Angeles. The concentrations of carbon monoxide, hydrocarbons, nitrogen oxides and lead issuing from approximately four million motor vehicles in South Africa are measured regularly by the CSIR in cities such as Johannesburg, Durban, Pretoria, Cape Town and Port Elizabeth. The concentration of air-borne lead in our large cities is still considerably below the two microgrammes per m3 of atmosphere which is currently accepted by most countries as the ambient air quality standard. Research continues, however, to decrease the concentration of this undesirable material still further. In Die Vaderland of Wednesday 24 April an article appeared under the caption “Suurreën nie so erg in die Goudstad”, in which the medical officer of health of Johannesburg referred in particular to the lead content of the atmosphere. According to Dr Richards, lead levels in the atmosphere of the Golden City are not very high. Arising from tests applied to 100 children in Johannesburg, the highest incidence of lead was 33 microgrammes per 100 millilitres which occurred in the case of one child, 25,5 microgrammes in the case of two children whereas the rest all fell below 25 microgrammes per 100 millitres.

Up to the present considerable progress has been made in this field. More then 95% of our industries handling lead have already been equipped with suitable filters. Large industries such as Sasol, Iscor and Escom have spent large amounts on antipollutant equipment such as electrostatic precipitators. Today the accent is decidedly on the combating of atmospheric pollution. As an example it may be mentioned that AECI has brought an ammonia plant to the value of R65 million based on coal and capable of producing 1 000 tons of ammonia a day into production. An amount of R3 million was spent on combating pollution in this case. The designers of this plant were so pollution-conscious that, instead of sulphuretted hydrogen being released into the atmosphere, it is conducted by eight kilometres of pipeline to a sulphuric acid plant where the offensive and harmful gas is used in the manufacture of sulphuric acid. The programme for the asbestos cement industry is almost 95% complete whereas iron and steel works have almost all been equipped with air filters. As an example the Highveld group at Witbank spent R44 million in cleaning up their works while Dunswart at Benoni spent more than R3 million in ensuring that the air was purified.

The presence of offensive, noxious and harmful gases in the atmosphere we breathe has not only been the subject of public and political interest for a considerable time but also of scientific research. Although the public and the worldwide scientific and engineering fraternity are only too aware of the problem, progress is slow. In some parts of the world air pollution is increasing even faster than it can be combated.

In speaking of air pollution this afternoon I wish to stress that our people have the right to inhale pure air. In referring to an article which appeared in Beeld of 30 March 1985, I do not wish to refer to the person’s name but in the article it was said that this person feared she would be drawing her last breath each day. This person suffers from a type of lung cancer which is aggravated by asbestos dust. I do not believe we should become totally hysterical when we speak about asbestos pollution but it is a matter which should be scrutinized thoroughly. The article continues by mentioning a clever scientist with a B Sc degree in botany and microbiology who grew up on an asbestos mine near Prieska in the North-Western Cape and for whom the curtain is gradually coming down. In discussing atmospheric pollution, each of us in the Republic of South Africa should take this matter very seriously.

Approximately 85% of our total emission of sulphur dioxide and nitrogen oxide on the Highveld and in the Eastern Transvaal and Northern Free State is caused by the approximately 15 power stations and Sasols I, II and III together with the other heavy industries in the area. The estimated total annual emission of sulphur dioxide and nitrogen oxide is approximately 1 million tons and 0,5 million tons respectively. I should like to appeal to the hon the Minister this afternoon to adopt a very firm stand from a health point of view against the erection of any further coal-burning power stations in South Africa. We have to move to the erection of atomic power stations because they are more sympathetic toward the atmosphere of South Africa which is so essential in permitting our people to live a healthy life. [Time expired.]

Mr Chairman, I am rising just to make a few brief remarks. I want to apologize right at the outset to the hon members who have been speaking. Unfortunately I was on another mission. My Department of Posts and Telecommunications also makes a demand on my time and I opened a post office this morning in a small place called Stutterheim and left at only quarter past one. I want to express my thanks and appreciation to my efficient Deputy Minister Dr Morrison. I am sure that when we give our final reply to the debate tomorrow hon members will receive full replies or reasons for our not giving full replies.

I am really rising as Acting Minister to pay a brief tribute on behalf of the department to my predecessor, the late Dr Nak van der Merwe. Parliament has already paid tribute to him. I can only say that it was a terrible experience when I turned in to the 06h45 news in my hotel room in Pretoria on the 16th of April to hear that my good friend had passed away.

The late Dr Nak were associates for a long time. When the Afrikaanse Studentebond was founded in Bloemfontein in 1948 we attended that congress together. He was eventually elected chairman of the first reconstituted Afrikaanse Studentebond. My friend, the Deputy Minister Dr Morrison, was the secretary and it was my privilege to be one of the 10 chief executive members. In this way we got to know each other over a long period of time. As a student he made his contribution to the youth. He made his contribution as a teacher and a doctor as well as an MP and deputy chairman of this House, as Administrator, Minister of Water Affairs and later hon Minister of Health and Welfare and even later as chairman of the Ministers’ Council and the Minister of Health Services and Welfare of own affairs. He very soon left his mark on this department. He was known for his firm, yet reasonable and friendly approach. His decisions left their stamp on our health services in this country. He took certain decisions, and from indications I have had in the last short while it is evident with reference to interviews that he held it is clear that the people with whom he conducted the interviews had the greatest esteem and respect for him. They knew that his courageous pronouncements were really made with the utmost integrity.

I am really sorry that at this stage of the new dispensation, while a lot is still happening and he could have made a contribution precisely because of his courageous pronouncements, his integrity, his knowledge and his ability to work with people and to persuade them, he was not given the opportunity by the Creator to make such a contribution.

Dr Nak van der Merwe was an example of a fine and honest politician who, due to his contribution to the Department of Health and Welfare, will be remembered for a long time by the inhabitants of our country. Apart from this it is true that these characteristics observed by the inhabitants of this country were experienced by the department. I speak on behalf of all the officials when I pay this tribute here and place on record that, long after the public no longer recalls who the Minister of Health and Welfare was, he will be remembered by the officials in the Department of Health and Welfare, from the Director-General to the most junior official, as well as the office bearers in health and welfare services and also the officials of the Ministers’ Council. We as a department should also like to convey our sympathy at this stage to Mrs Van der Merwe and their children. I think it is fitting to do so in the discussion of this Vote because if it were not for this sad occurrence he himself would have been standing here where I am now standing today.

Mr Chairman, I would like to associate myself and my party with the words that the hon the Acting Minister has expressed concerning the late Dr Nak van der Merwe. I did not have the opportunity to get to know Dr Van der Merwe particularly well because he was, relatively new in this particular portfolio. During the period that he held the portfolio, however, he took one very important decision. That was to establish the select committee to look into the provision of pension benefits. That was when we were still the White House, and that committee has subsequently been extended. To my mind it is regrettable that he will not in fact be able to see the results achieved by those committees he appointed because they deal with particularly important subjects. It is therefore regrettable that he will not be here when we actually report. We would also like to extend our sympathies to his wife and his children.

Mr Chairman, I would like to come to the question of welfare. I think the key question that we should be debating at the present moment is what sort of welfare system is appropriate to a country that has a mixture of a First and a Third World economy. For so long the answer seemed simple. If one had asked that question five or 10 years ago, we would have said that we should take the benefits that are applicable to the Whites in South Africa and extend those benefits to the non-White population groups. In other words, we were going to take the benefits applicable in the First World and extend those benefits to the Third World. For a long period of time it seemed as if it was in fact possible to achieve that.

One can go back to a report that was drawn up under the auspices of Mercabank Ltd by the Bureau for Economic Policy and Analysis of the University of Pretoria. They pointed out that at a growth rate of 4,5% per annum it would be possible to do all these things. We could provide the education, we could provide the housing, and we could provide the health and welfare benefits. We have not, however, grown at a real rate of 4,5% per annum. When we look at the figures for the past 10 years we see that we have grown at a real rate of 2,3% per annum. If we are realistic we must assume that until the year 2000 we are going to continue to grow at a real rate of 2,5% to 3% per annum. In fact, even if our welfare system had continued merely to service the First World of this country, it is doubtful whether we could in fact have afforded it. If we go back only 10 years, to 1973, we find that we paid out R96 million for 472 000-odd social old age pensions. If we compare that with the figures for this tax year, and one includes also the dependent states, then it seems as if we are going to spend something like R850 million. We should bear in mind that 12 years ago we were talking of R96 million, and now we are going to spend something like R850 million to look after three-quarters of a million people.

If one projects those figures, one finds that in 15 years’ time the minimum figure we will be spending on social old age pensions and welfare benefits will be, I think, R8 billion. I think a more realistic figure is somewhere in the neighbourhood of R14 billion.

One can see the impact of this. In 10 years the proportion that social old age pensions has been of the gross domestic product has trebled from 0,5% to 1,5%—we are not talking about big figures, but that is a fairly significant increase.

If one considers what we are paying to some of the State Pension Funds—I keep asking questions about the State’s contribution to certain pension funds—one finds that in respect of the contribution to five such civil pension funds the latest figures, those for 1983-84, are in excess of a billion rand. That figure was in the neighbourhood of about half a billion rand about three or four years ago. There are places like Los Angeles and New York City that actually went bankrupt because of their pension schemes, and it would be interesting to know whether they were growing faster or slower than the increase in our costs.

The position is going to get worse, not better. The reason for this lies simply in the fact that life expectancy has improved. In the case of Whites the life expectancy has not increased so dramatically since 1945. A White male’s life expectancy has increased by something like three years, while a White female’s life expectancy has increased by six years. However, when one considers the life expectancy of the non-White population, one finds an interesting fact. For example, in 1945 an Asian female had a life expectancy of 50 years. Today she can anticipate reaching the age of 67,5 years. In 1945 a Coloured female had a life expectancy of 44 years. Today, it is 61 years. These figures are very significant. It means that large segments of the Third World population of South Africa never claimed social old age pensions before, because they were not living long enough. Now, however, they are reaching that age group, with the result that we are going to have a tremendous increase in the number of aged people. Figures provided by the Human Sciences Research Council show that between 1980 and the year 2000 the number of people in that age category will nearly double, and between the year 2000 and the year 2020 it will double again.

That is the first thing I wanted to mention. Not only is there going to be a tremendous escalation in the number of aged people, but the proportion of aged people in the population is increasing. It will not be too long before one person out of every six White South Africans is going to be over the age of 65 years.

We also know that urbanization is going to increase at a rapid rate. This has particular significance for the provision of welfare benefits. It was estimated by Kok that in 1980 there would be an urban population of 14 million people, which would increase to approximately 36 million in the year 2000. The importance of that is that, as people become urbanized, the extended family unit begins to break down, and what happens is that, instead of families and society looking after the aged, the aged are put into old age homes and we do not use them in the economic system. It is very interesting that White South Africa must have the worst record in this regard compared to any other country that I know. We put our aged into old age homes as fast as we can. The hon the Minister might find it interesting that in 1980 it was estimated that 70% of the aged in Japan were still living with their families.

We have another problem of which the hon the Acting Minister will be aware because we have debated it between ourselves, and that is the question of the equalization of pensions. The cost of equalization is going to be substantial, but I believe there is nothing that we can do about it. It is a cost that we are going to have to accept, and we on these benches support the fact. It is a fact, however, that it is going to increase fairly rapidly the cost of providing for the aged.

I have said that we are a mixture of a First and a Third World social system. In fact, this aggravates the problem in South Africa. I should like to deal with this to some extent. We are like a candle which is actually being burnt at both ends. In the First World economic system one has the proportion of aged increasing and in the Third World section of our country the proportion of young people is increasing at a dramatic rate. If one looks, for example, at the demographic figures, one sees that 41% of our Black population, 39% of our Coloured population and 37% of our Asian population fall in the age group 0 to 14 years. From an economic point of view…

Order! I regret that the hon member’s time has expired.

Mr Chairman, I merely rise to give the hon member time to complete his speech.

I thank the hon Whip for the opportunity to complete my speech.

†As I have said, one has this large proportion of people in the aged category and in the young category who, from an economic and a tax point of view, are in fact unproductive. This can have a devastating impact on the economy, and one just has to look at the rural areas of South Africa to see this. I have seen an article in the Press—and I do not know whether it is correct or not—in which the figure was given that in the dependent and independent Black states of South Africa, with a total resident population of approximately 3 million people, there were only 12 homes for the aged which catered for approximately 1 000 residents.

From a welfare point of view, let us have a look at what is actually happening in these rural areas. The figures might be slightly different, but it is the proportions that interest me. We have a de jure population of approximately 12 million people in the dependent and independent Black states of South Africa. About 1,3 million of those are migrant workers. That leaves a population of 10,7 million. About one million of those fall in the aged category—just slightly less than 10%. This is significant, because if one looks at the other Third World countries which have a similar sort of population distribution, one finds that there only 2% or 3% of the population falls in the aged category. That is the same figure for South Africa seen as a whole. However, because one has the migrant workers, the proportion of aged unproductive people in those rural areas is very high. What is equally significant if one looks at those figures, is that approximately 5 million of those people are going to be in the age group 0 to 14 years that I was talking about. So, of a de jure population of 12 million, 7,3 million people are either not working there or are unproductive from an economic and a tax point of view. So one has a very small proportion of people who have to provide the welfare benefits for a large segment of the population. It is hardly surprising that the rural areas of South Africa are in fact beginning to decay.

I maintained that we were a mixture of a First and Third World country and that for a long time the solutions to our problems seemed simple. We were merely going to take the benefits of the First World and apply them to the Third World, but I question the fact of whether it is actually possible to do that because when one looks at what is happening to the rest of the First World economies, one notes that they are in as much difficulty as we are. One just has to look at the findings of a Senate commission which was established in the USA in 1972. The commission pointed out that roughly one third of the aged were living in dilapidated and decaying buildings in the United States in 1972. In fact, they were paying in excess of 30% of their income to provide for that dilapidated and decaying accommodation. Today that system pays out R24 million more than it is getting in.

There is a very significant point to bear in mind—I am glad that the hon the Minister of the Budget is here—and that is that when we talk about the Western European system, we must not forget that those countries take a contribution from both employer and employee to pay for social benefits. In South Africa we just rely on the tax system. When one looks at the latest American budget figures, it is very interesting to note that social security payments account for 35% of the total income collected by the Federal Government. Everybody knows, however, that the figure of 6,65% from employer and employee each, which goes towards social security is not going to be sufficient. They are now doing projections some of which suggest that 30 to 40 years down the line the combined contribution could be as high as 45% if they continue with the present system.

In a Western country like Sweden which is renowned for its welfare system, 52% of its national income goes to pay for welfare and pension benefits. Japan probably has the greatest problem of all those countries because in about 45 years’ time one out of four Japanese is going to be over the age of 65. Their specialists have estimated that in the next 45 years the cost of medical expenses and health services will increase seventyfold. This will happen mainly as a result of the need to provide for geriatric medical facilities. When looking at their pension benefits, they say that those are going to have to treble in the next 45 years.

The reason is not hard to find. The proportion of the aged group in the Western World is increasing rapidly, and that means that there are fewer and fewer people to bear that burden. When the United States established their contributory system there were 12 contributors for every person who was drawing a benefit. The ratio is now roughly 3:1.

I believe we must give as much attention to this problem as is being given in the rest of the Western World because—and I am sure the hon the Minister of the Budget will agree with me—we are reaching the limit of the threshold with regard to the rate at which we can increase tax. The hon the Minister will know that in 1980-81 we collected R2 090 million from individual taxpayers. This year we are going to take roughly R9 billion—a 4½ fold increase in the receipts from individual taxpayers in a relatively short period of time. Even the new taxes are not helping. The income from GST, for example, has increased over that period from about R1,6 billion to roughly R8 billion which we are going to take this year. However, Sir, we still cannot afford those benefits.

What are the solutions? I do not claim to know all the answers but I think we should start debating with one another over the possible solutions.

I think we should divide it into three segments. Firstly there are those who participate in the First World economic system and who make some sort of provision for pension benefits. There is an incredible wastage there. The wastage in 1980-81—by wastage I mean people who are paid out and do not use that money to provide for their retirement—was R364 million. In 1981 the total cost to South Africa, of our social old age pension scheme including the dependent states was R434 million. From these figures one can see the significance of that wastage. I find it interesting when one looks at our tremendous pension system that we only provide a pension for 333 000 people while we are paying out social old age pensions to three quarters of a million people.

The second group are those who work in what I classify as the First World economy but who do not belong to a pension scheme. Somehow we have to lock them in. The hon the Minister will know that we have walked this road once before. If we want to involve those people and get them on our side, I think there are two things that we have to do.

We have to follow an imaginative marketing programme. We have to involve the trade unions and particularly the Black trade unions in working out the solutions. If we do not do this, they are going to cripple the scheme again.

Hon members will remember that we had Decimal Dan. I think the time has now come for Prudent Pete. He should be the man who explains why it is necessary for one to provide for one’s own retirement because someday the State may not be able to provide for one.

Furthermore, if we are going to engage these people we have to improve the Unemployment Insurance Fund. The Black trade unions see a pension benefit as being an unemployment insurance fund instead of a long-term saving which is what it should be.

Order! I regret that the hon member’s time has expired.

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

I thank the hon Whip very much indeed. I appreciate the chance to finish my speech.

Somehow we have to engage the people who belong in the First World economy. When I think of the second group, namely those who do not belong to a pension scheme but who work in the First World economic system—they are a significant figure, approximately 50% of our work force—I think we should place the onus on the employer. I think we should in fact say that instead of all individuals belonging to a pension scheme, anybody who employs more than, say, five people should be compelled to provide a pension scheme for his workers. I think that would make a significant difference as it removes the emphasis from the labour relations field and puts it on the employer.

Whatever we do to provide for the aged, I think we have to re-evaluate the way we look at the aged group. In the past we retired people at 60 or 65 when their life expectancy was not much longer than that. Today, on average, a White man in South Africa will live for 15 years and White females for 19 years after the age of 65.

But he should also enjoy life!

Yes, he should also enjoy life, but he cannot do it now.

†In a country that has a shortage of skilled manpower and where that skilled manpower is needed in the Third World section of our economy, why do we still retire people because of age and not because of inability? I think we will have to reconsider this. What encouragement do we give people to continue working? The hon the Minister will tell us that we give them R13 per month if they defer taking their pension for five years. I think we should change our abatement system from giving abatement for being aged to actually giving the aged an abatement for trying to work and for trying to provide for themselves. Those people who are trying to provide for themselves should be encouraged. Let us tax only half of their income. I do not know what system one would like to use but let us give them some encouragement because while they work they are not dependent upon the taxpayer of South Africa.

We also need to re-examine our whole attitude towards the economic system for a mixture of a First and Third World economy. I do not have time to explore this any further. An economic and political system which does not take a holistic approach to South Africa and does not see South Africa as a single economic and political entity, whether it is a federal or a confederal entity, is going to lead to the eventual impoverishment of both Black and White in South Africa.

Mr Chairman, the fact that the hon member for Edenvale was twice accorded the opportunity to complete his speech in my view attests to the quality of his speech. He is an expert who, as usual, made a very good contribution. I agree with him that ability and not age should serve as a yardstick for retirement. The other day I read of a chap who at the age of 103 could manage 18 holes in 103. I think that chap could still make a very good contribution in the field of work.

I just want to make one remark with reference to an argument that the hon member put forward. He pointed out that we had too many elderly people in our old age homes. This problem, however, is as old as man himself. It is interesting that this specific problem provided the background to the situation that gave rise to the fifth commandment. The Israelites, who were nomadic, naturally trekked around, and when someone became too old to make a contribution to the family larder, they just left him on the spot and trekked on. To combat this problem the command was given: “Honour your father and your mother”. I just mention that in passing.

I should like to mention a few ideas on a completely different facet. On 27 March of this year, South Africa was numb with shock at the tragic death of 42 high school pupils in the Westdene bus disaster. Unfortunately it is also true that virtually the same number of White teenagers commit suicide every year. Let us take a look at the statistics available for 1983. We note that 41 teenagers in the age group 10 to 19 committed suicide. If the age group 10 to 24 is taken into account, we arrive at the figure of 120. This is approximately 9,29 per 100 000. As far as the Coloured population is concerned, 18 children between the ages 10 and 19 and 36 between the ages 10 and 24 committed suicide. The statistics in regard to Asians are as follows: 10 suicide cases in the age group 10 to 19 and 17 in the age group 10 to 24. If all the data are added up it appears that as far as these three population groups are concerned, 69 children in the age group 10 to 19 years and 173 young people in the age group 10 to 24 years committed suicide in that year.

It would therefore appear as if the incidence of teenage suicides is increasing more rapidly than in any other age group. Between 1967 and 1977 juvenile suicides in South Africa doubled. If the juvenile suicide statistics of South Africa are compared to those of the USA, we come off second best.

No country in the world can afford to allow such a state of affairs to continue. In my view it has become essential, particularly in South Africa, that this phenomenon of juvenile suicides receives urgent attention. It is necessary because it has also been alleged that 90% of the children who attempt suicide and are interviewed afterwards, admit that they had not really wanted to die.

It is also true that 95% of attempted teenage suicides could be prevented if timeous action is taken and the symptoms are responded to. Obviously the solution of this problem is related to its causes. Some experts contend that 90% of suicides amongst teenagers should be blamed on the parents. In most cases suicide is nothing but than a distress signal sent out by these children in an attempt to regain the attention of their parents.

During the 60’s Müller Scheve wrote a book called De Wereld Heeft Geen Vader Meer. He addressed the problem of the absentee father. If he had to write a book in the 80’s the title would be “De wereld heeft geen moeder meer”, because if the absentee father was a problem in the ‘sixties, I think the absentee mother is a greater problem in the ‘eighties. Numerous teenagers grow up in homes where the father and mother are permanently absent. Many fathers are compelled, due to the circumstances of their jobs, to work 18 hours a day—for months at a time—unfortunately this goes for State departments too. It is impossible for such a father to spend sufficient time on the problems of his child.

I do not think it is in keeping with the rules of labour ethics that employees are being obliged to work 18 hours per day because additional labour cannot be employed owing to recession conditions. I think employers should make it possible for parents to be present within the family context once again. I think it would help to reduce this worrying phenomenon of child suicides. In this regard I think we need a fairer labour set-up in the RSA.

A second aspect of child-rearing that could possibly be a cause of suicide is the fact that in cases where parents are at home the children lead an over-protected life. As a result they have insufficient resistance to be able to face up to problems, and consequently soon give up. They do not want to become part of the hard struggle of life. As a consequence they choose suicide as a temporary escape because very few of them appreciate the permanence of death.

Linked to this is also the fact that too much pressure is being exerted on children—in their school careers and also with a view to the future—to achieve success. We should take note of what a Japanese scholar said. He said the cause of teenage suicide lay in the fact that the lives of children were excessively organized at school and in the home. According to him children do not get the chance to develop in a natural way through relaxation and inter personal activities. He points out that children lead an unnatural, artificial life which is foisted on them by the education system and their parents. I think this Japanese scholar is right. I think it is in this area that it is necessary for parents to abandon this prestige syndrome in relation to their children; in the interest of those very children! That would certainly help to reduce the number of suicides.

I think a need exists for immediately available crisis aid services to combat this phenomenon. One appreciates the existing crisis clinics and the services that are provided. One thinks of the important work done by Suicides Anonymous under the leadership of Mr Sam Bloomberg and also the work that is done by Radio 702. The State, too, makes its contribution. Crisis clinics have been established at provincial hospitals, and at Groote Schuur in particular excellent work is also being done.

If one takes into account the guidelines to which crisis clinics have to conform, one of these guidelines is immediate availability. I think that for these crisis centres to be immediately accessible they should be attached to schools. This is already being done in West Germany. The state of California spent $300 000 on making expert assistance available to schools. I think something along the same lines should be done in South Africa. Such crisis clinics could be run by teachers who studied psychology as a subject or who are given in-service training for it. Use can also be made of additional professional assistance. I think it will combat this problem to a certain extent.

Mr Chairman, it is a pleasure to speak after the hon member for Randfontein has spoken and I am in complete agreement with the ideas that he raised here. I really hope it will be possible to do something about it.

I should like to associate myself with certain ideas raised by the hon member for Edenvale. One of the last things that the previous hon Minister of Health and Welfare, Dr Nak van der Merwe did, was to appoint this special joint committee to investigate the issue of pensions. This committee has met once and we are meeting again at the end of the month. There is a long history of what has been done over the years to find a possible solution for this problem, the problem of transferability of pensions on the one hand, and the issue of pensions for everyone in South Africa on the other. At this stage I just want to say that if this joint committee of all the Houses of Parliament could manage to come up with a worthwhile solution in this regard, those 23 members of the committee would be able to look back on a parliamentary career that was really worthwhile.

However, I should like to associate myself with an idea mentioned earlier by the hon member for Stilfontein, the issue of population development. Earlier this year we held a special debate on this subject and a lot has been said in this debate about population development and community development. The hon member for Stilfontein referred to the issue of housing, and the problem that R30 million allocated for the population development programme in the Budget was probably not enough to overcome this serious problem. I agree with that.

In the few minutes available to me, however, I should like to show how extremely essential it is that there should be interaction in this situation between the State, the private sector, the public and the medical profession. It will be of no avail at all for the Government to come up with a plan and then to attempt to put it into practice on its own. If we do not have healthy interaction between all the sectors that are involved in this situation I can say in advance that this effort is doomed to failure. The public will have to be involved in the establishment of local committees for community development and a wide range of interests of all the population groups will have to be represented in those committees. I was recently privileged to be present when the Director-General of the department officiated at the founding of such a committee in the Paarl community. I should like to affirm here that on that occasion an incredible amount of interest was shown by all the sectors of all the population groups. All the population groups; every possible association and organization was represented there. On that occasion a constitution for the community development committee was approved. I have it here with me and I should have liked to deal with it in detail but there is not enough time for it. If one just takes a look at the main aims of that community development committee, however, one sees that it augurs nothing but a lot of good.

However, it is of no use our merely talking about these things. This kind of community development committee will have to be established in every district of South Africa and should really get off the ground.

This, however, is only one side of the story. The other side of the story is that the medical profession must never be underestimated in this entire set-up because they play a role of the utmost importance. As far as I am concerned, urgent plans will have to be thought of to get the full co-operation of the medical profession for the programme of community development and its components, viz family planning, voluntary sterilization and everything that goes with it.

As coincidence would have it, there was also a second occasion in Paarl on which the Deputy Director, Dr Watermeyer, was present. It was concerned with an attempt that had been made by doctors to promote the whole idea of voluntary sterilization in this community. I have spoken about it in this House before. Eight hundred people attended this function and it was possible to convey the message to them. A film entitled, “A Question of Choice” was shown. This film tells the success story of voluntary sterilization in backward countries such as Bangladesh, El Salvador, the Philippines and Thailand. One thing emerged very clearly, ie that the need exists all over the world—all that has to be done is to improve the service. I was dumbfounded yesterday evening to hear Pres Nyerere of Tanzania saying on TV that family planning could only be applied if peoples’ standards of living were improved. He admitted that they had still not managed it in Tanzania. Here in South Africa and in many places in the world it has been proved that one can achieve exactly the opposite with voluntary sterilization.

One final thought. We have to do something drastic to increase interest in and assistance for this effort in South Africa. We shall have to think—-it is perhaps an extreme idea—of a form of remuneration for doctors to encourage them to help with this project, either in the form of cash or in the form of a tax rebate. We shall have to encourage companies to make contributions to help launch this effort. We shall have to think about making a film on the advantages of planned families and we shall have to continue seeing to it that the whole matter does not become politicized. I realize my time is up but I should like to lodge an appeal that it will be an effort made by all institutions in South Africa; the State, the private sector, the medical profession and everyone who is involved in it.

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.