National Council of Provinces - 12 June 2001
TUESDAY, 12 JUNE 2001 __
PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
____
The Council met at 14:04.
The Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS see col - 000.
The CHAIRPERSON OF THE NCOP: Order! Judging from the fact that the usher announced ``Madam Speaker’’, the staff are clearly in very urgent need of serious self-motivation and reflection, since they are cooing me out of my job. [Laughter.] I am not sure whether it is recent events that encourage this approach, but I must say I got a bit of a shock. It could be a Freudian slip.
NOTICE OF MOTION
Mrs J N VILAKAZI: Chairperson, I give notice that I shall move at the next sitting of the Council:
That the Council -
(1) commends the Department of Correctional Services for their prompt handling of the outbreak of cholera in the Durban Central Prison;
(2) acknowledges the fact that cholera is a stubborn communicable waterborne disease which is not easily controlled; and
(3) appreciates the work done by the department with other stakeholders who were involved in combating this dreadful infection in the prison.
CONGRATULATIONS TO SANDRA BOTHA ON HER ROLE IN UN CONFERENCE
(Draft Resolution)
Mr L G LEVER: Chairperson, I move without notice:
That the Council -
(1) congratulates Sandra Botha on being invited to deliver a paper at the United Nations Expert Group Meeting on the Situation of Rural Women in the Context of Globalisation, held in Ulaanbaatar, Mongolia; and
(2) further congratulates Sandra Botha on being elected as chairperson of the conference.
[Applause.]
The CHAIRPERSON OF THE NCOP: Order! We congratulate Ms Botha and wish her well in this responsibility.
Motion agreed to in accordance with section 65 of the Constitution.
ALLEGATIONS AGAINST MAYOR PETER MARAIS
(Draft Resolution)
Mr P D N MALOYI: Chairperson, I move without notice: That the Council -
(1) notes with concern the latest allegations against Mr Peter Marais, the Democratic Alliance mayor of Cape Town, who is alleged to have presided over a vote-rigging exercise to have two prominent streets named after former presidents Nelson Mandela and FW de Klerk;
(2) further notes that the ANC has brought to the attention of this Council a string of other allegations against Mr Marais prior to this one, including -
(a) his sexist remarks against a female colleague;
(b) the preferential treatment of his family members in obtaining
accommodation in state housing complexes while they have homes
of their own; and
(c) his call on people to ignore the Constitution of this country if
it conflicts with their own views;
(3) believes these errors of judgment place a serious question mark over the continued suitability and competence of Mr Marais to occupy the important position of mayor; and
(4) further believes that failure of the DA to keep his despotic tendencies in check will lead to the inescapable conclusion that they condone his actions.
The CHAIRPERSON OF THE NCOP: Order! Is there any objection to the motion? [Interjections.] There is objection. The motion therefore becomes notice of a motion.
SIGNING OF MALOTI-DRAKENSBERG TRANSFRONTIER CONSERVATION AREA AGREEMENT
(Draft Resolution)
Mrs E N LUBIDLA: Chairperson, I move without notice:
That the Council -
(1) welcomes the signing of the historic Maloti-Drakensberg Transfrontier Conservation Area agreement between South Africa and Lesotho;
(2) notes that this mountain range -
(a) is rich in biodiversity;
(b) has unique vegetation;
(c) is known as the water basin of Southern Africa; and
(d) has one of the world's greatest collections of rock art;
(3) further notes that most of the people living in this area are poor;
(4) believes that the signing of this agreement has opened a door of opportunity for the poverty-stricken people in the area to create job opportunities through tourism; and
(5) recognises the role of the Peace Parks Foundation in facilitating the creation of the conservation area.
The CHAIRPERSON OF THE NCOP: Order! Is there any objection to the motion?
Mr K D S DURR: Chairperson, I move as an amendment: That the following paragraph be added after paragraph (4):
(5) recognises the role of the Peace Parks Foundation in facilitating the creation of the conservation area.
The CHAIRPERSON OF THE NCOP: Order! There is a proposed amendment to the motion. Mrs Lubidla, do you accept that amendment, recognising the role of the Peace Parks Foundation?
Mrs E N LUBIDLA: Yes, Chairperson.
Amendment agreed to in accordance with section 65 of the Constitution.
Motion, as amended, agreed to in accordance with section 65 of the Constitution, namely:
That the Council - (1) welcomes the signing of the historic Maloti-Drakensberg Transfrontier Conservation Area agreement between South Africa and Lesotho;
(2) notes that this mountain range -
(a) is rich in bio-diversity;
(b) has unique vegetation;
(c) known as the water basin of Southern Africa; and
(d) one of the world's greatest collections of rock art;
(3) further notes that most of the people living in this area are poor;
(4) believes that the signing of this agreement has opened a door of opportunity for the poverty-stricken people in the area to create job opportunities through tourism; and
(5) recognises the Peace Parks Foundation in facilitating the creation of the conservation area.
DEATH OF ABE WILLIAMS'S DAUGHTER AND OTHERS IN MOTOR VEHICLE ACCIDENT
(Draft Resolution)
Mnr A E VAN NIEKERK: Voorsitter, ek stel voor sonder kennisgewing:
Dat die Raad -
(1) met skok kennis geneem het van die motorongeluk wat verlede Vrydag hier in die Kaap plaasgevind het;
(2) sy medelye uitspreek teenoor die ouers en naasbestaandes van die volgende jongmense wat in die ongeluk gesterf het;
(a) Yolandi Williams;
(b) Henry Africa;
(c) Shaun Moses;
(d) Gail Williams; and
(e) Vernora Pieterse;
(3) veral dink aan oud-kollega mnr Abe Williams van die Wes-Kaapse Wetgewer en spesiale afgevaardigde na die Raad, wat verlede Vrydag uit die Raad geroep is om te verneem van die afsterwe van sy dogter; en
(4) se gedagtes en gebede met hulle almal gaan, in die hoop dat hulle vertroosting sal vind by die Enigste werklike Bron daarvoor.
[Mr A E VAN NIEKERK: Chairperson, I move without notice:
That the Council -
(1) notes with shock the motor vehicle accident which took place in Cape Town last Friday;
(2) expresses its condolences to the next-of-kin of the following young people who died in the accident:
(a) Yolandi Williams;
(b) Henry Africa;
(c) Shaun Moses;
(d) Gail Williams; and
(e) Vernora Pieterse; (3) thinks in particular of former colleague Mr Abe Williams, member of
the Western Cape legislature and special delegate to the Council, who
was called from the Council last Friday to learn of the death of his
daughter; and
(4) extends its thoughts and prayers to all of them, in the hope that they will find comfort in the Only true Source thereof.]
Motion agreed to in accordance with section 65 of the Constitution.
RETRACTION OF STATEMENT BY NOSEWEEK EDITOR
(Draft Resolution)
Prince B Z ZULU: Chairperson, I move without notice:
That the Council -
(1) notes with concern the recent report in the news about the Noseweek editor, Mr Welz, who had to retract the lies he reported about the meeting between the NA Chief Whip and the organs of state entrusted with the duty of investigating the arms deal;
(2) believes that such lies would potentially destroy the image of our legitimate organs of state;
(3) further believes that this withdrawal and the incident in KwaZulu- Natal confirms what we have always been saying about certain individuals in the media who are intent on destabilising the Government’s efforts towards reconciliation and nation-building; and
(4) calls upon those politicians who made press statements on the issue and in support of Mr Welz also to withdraw their statements.
The CHAIRPERSON OF THE NCOP: Order! Is there any objection to the motion? [Interjections.] There is an objection. The motion therefore becomes notice of a motion.
INTERVENTION OF PRESIDENT AND MINISTER OF MINERALS AND ENERGY IN IMPASSE SURROUNDING MINERALS DEVELOPMENT BILL (Draft Resolution)
Mr D M KGWARE: Chairperson, I move without notice: That the Council -
(1) calls upon its members to show appreciation for and applaud the successful interventions by the President and the Minister of Minerals and Energy in the impasse over the Minerals Development Bill since last year, November 2000;
(2) believes that through ongoing negotiations with all relevant stakeholders this country will achieve its transformation objectives;
(3) believes that the Government’s intervention was a step in the same direction and an indication of how best it would deal with contentious issues of this country; and
(4) calls upon all those South Africans who are still uncertain about the future of this country to join our Government in its quest to unite all South Africans for change. Motion agreed to in accordance with section 65 of the Constitution.
PRIORITY DEVELOPMENT PROJECTS LAUNCHED IN VARIOUS PROVINCES
(Draft Resolution)
Mr G A LUCAS: Chairperson, I move without notice:
That the Council -
(1) notes that President Thabo Mbeki identified a number of provinces in this state-of-the-nation address in February that would be prioritised for development;
(2) further notes that since then the Government has -
(a) launched the R1,5 billion Alexandra Renewal Project in Gauteng
which will improve sanitation, schools, roads and clinics, will
involve the building of 56 000 more houses in the area and will
generally provide an environment where the people of Alex can
find jobs and look after their families;
(b) set aside R18 million for the establishment of water projects in
the Bushbuckridge area in the Northern Province as part of the
Integrated Sustainable Rural Development Strategy which is
scheduled to start in the province at the beginning of July
2001; and
(c) visited Sekhukhune, which borders Mpumalanga and the Northern
Province, to assess the readiness of municipalities in the
district to receive funds for the Integrated Sustainable Rural
Development Strategy which is due to start within the next two
months;
(3) acknowledges the important contribution these projects will make in promoting economic development, job creation, social development and capacity-building in those provinces; and
(4) believes that these projects once again confirm the commitment of the Government to speed up the delivery of services and to eradicate poverty.
Motion agreed to in accordance with section 65 of the Constitution.
REDUCTION IN NUMBER OF PRISON ESCAPES
(Draft Resolution)
Mrs J N VILAKAZI: Chairperson, I move without notice:
That the Council -
(1) notes that the Department of Correctional Services has managed to decrease the number of prison escapes by 46%;
(2) further notes that the number of prisoners who escaped from custody were 1 244 in 1996, 989 in 1997, 498 in 1998, 459 in 1999 and 250 in 2000; and
(3) highly applauds the security enforcement implemented to bring down the number of prison escapes.
Motion agreed to in accordance with section 65 of the Constitution. INVESTIGATION BY SOUTH AFRICAN HUMAN RIGHTS COMMISSION INTO LIVING CONDITIONS OF FARM WORKERS
(Draft Resolution) Chief M L MOKOENA: Chairperson, I move without notice:
That the Council -
(1) notes that since 1994 the South African Government has initiated a number of legislative and other interventions to improve the living conditions of farm workers;
(2) also notes that these included the establishment of the Land Claims Court, the extension of security of tenure to farm workers, the prevention of unlawful eviction of farm workers and the provision of agricultural land to farm workers;
(3) expresses its concern that, despite these interventions, farm workers are still subjected to brutality at the hands of their employers, shocking employment and living conditions, child labour and other violations of their basic human rights; (4) believes that farm workers are entitled to the same enjoyment of their basic human rights as all other sectors of our society; and
(5) therefore welcomes the decision by the South African Human Rights Commission to launch an investigation into the living conditions of farm workers.
The CHAIRPERSON OF THE NCOP: Order! Is there any objection to the motion?
Mr P A MATTHEE: Chairperson, I move as an amendment:
That, in paragraph (3), before their employers'', be inserteda small
minority of’’. [Interjections.]
Chief M L MOKOENA: Chairperson, unfortunately I do not accept that proposal.
The CHAIRPERSON OF THE NCOP: Order! The amendment has not been accepted.
Amendment negatived.
The CHIEF WHIP OF THE COUNCIL: Chairperson, I think a reasonable amendment would be:
That, in paragraph (3), before their employers'', be insertedsome
of’’.
We do not want to generalise.
The CHAIRPERSON OF THE NCOP: Order! Mr Matthee, it has been proposed that
your amendment be amended further, not to small minority'' but tosome
of’’. Could you think of that while I hear Mrs Versfeld?
Mrs A M VERSFELD: Chairperson, I move as a further amendment:
That, where the motion says farmworkers'',and people in the fishing
industry’’ be included.
[Interjections.]
The CHAIRPERSON OF THE NCOP: Order! Mrs Versfeld, I am not sure that that particular amendment falls within the spirit of the motion as set out. Mr Matthee? Mr P A MATTHEE: Yes, I agree with the amendment, Chairperson.
The CHAIRPERSON OF THE NCOP: Order! Mr Mokoena, do you accept that amendment?
Chief M L MOKOENA: Yes, Chairperson.
Amendment agreed to in accordance with section 65 of the Constitution.
Motion, as amended, agreed to in accordance with section 65 of the Constitution, namely:
That the Council -
(1) notes that since 1994 the South African Government has initiated
a number of legislative and other interventions to improve the
living conditions of farm-workers;
(2) also notes that these included the establishment of the Land
Claims Court, the extension of security of tenure to farm workers,
the prevention of unlawful eviction of farm workers and the
provision of agricultural land to farm workers;
(3) expresses its concern that, despite these interventions, farm
workers are still subjected to brutality at the hands of their
employers, shocking employment and living conditions, child labour
and other violations of their basic human rights;
(4) believes that farm workers are entitled to the same enjoyment of
their basic human rights as all other sectors of our society; and
(5) therefore welcomes the decision by the South African Human
Rights Commission to launch an investigation into the living
conditions of farm workers.
APPROPRIATION BILL
(Policy debate)
Vote No 15 - Health:
The CHAIRPERSON OF THE NCOP: Order! It is a great pleasure to welcome the Minister of Health, Dr Tshabalala-Msimang. I understand a number of journalists in the United Kingdom are wondering why you are not there. I wish we could tell them you are in the National Council of Provinces.
The MINISTER OF HEALTH: Chairperson, I shall do so. There is before hon members the national health budget amounting to R6,61 billion for their consideration. Given the special character of this House, I expect that we will not view this budget in isolation but we will assess how it interacts with and adds value to the provincial health budgets, which exceed R28 billion in total.
About 90% of the national health budget is directly allocated to provinces in the form of conditional grants to run central hospitals for high-level care, to fund the training of health professionals, to develop HIV/Aids and STD programmes, to develop poverty relief and nutrition programmes, to build tertiary services outside central hospitals, to develop health systems management and to undertake capital projects.
In considering this budget we need to ask whether these conditional grants are contributing to our goals for health system development and transformation. Are we increasing access to health care for the people of our country? Are we increasing their chances of attaining an optimal state of health? Are we building social justice by promoting equity in our services? Are we exercising good stewardship, which includes preserving and maintaining the assets that we have? Are we gearing up for the large additional burden of emerging and re-emerging infectious diseases like HIV/Aids, tuberculosis and malaria, and other infectious diseases?
I believe that we can confidently claim we are making steady progress towards fulfilling most of these goals. Our clearest gains have been in the areas of expanding access to basic health services and in introducing preventive programmes that have been tried and tested and proven effective in other countries.
In addition, in most provinces long-standing patterns of overexpenditure on budgets have been reversed. This is certainly evidence of improved financial management at all levels in the provincial health services. However, against this progressive trend there are a couple of features that contradict our transformation agenda. The one is the familiar issue of quality of care in our health services, a matter that I addressed at length in the National Assembly last week.
We are striving to make the Patients’ Rights Charter a living reality in our services, but we are still far from reaching this. I believe we should not be deterred by this factor. The problems that undermine quality of care are complex and are not amenable to instant solutions. But we also need to recognise that we will not succeed unless we provide powerful leadership to quality initiatives and infuse a measure of discipline that has been sadly lacking in recent times.
The other matter of concern is the disturbing retreat from our goal of establishing equity across provinces. We made significant gains between 1994 and 1997 in narrowing the gap in per capita health spending between urban and rural provinces, but this progress has not been sustained in recent years. With the introduction of fiscal federalism, competing provincial priorities have eroded gains in health spending, particularly in the less developed provinces, and equity has suffered in the process. I want to flag this trend in this Chamber and appeal to the members of this Council to consider its implications in terms of addressing the basic needs of our most disadvantaged people and breaking the cycle of poverty.
The proportion of the national health allocation that is retained for the national department’s own work is small, but it inevitably has a wide impact. In essence it is spent on drafting laws and policies, setting norms and standards and undertaking research and surveillance. New policies and programmes depend largely on provincial resources for their implementation. Alignment between the two spheres of government is therefore critical for effective delivery. It is important to note that our intergovernmental structure, the health Minmec, plays a central role in achieving this alignment.
The Minmec carefully scrutinises national health plans and subjects them to reality checks so that they take account of resource constraints. This process allows various elements of the health system to move largely in unison, thereby giving expression to our basic constitutional character as a unitary state. At the same time the Minmec also recognises that provinces face different conditions and the implementation strategies may vary.
The concurrent exercise of powers by different spheres of government would be unworkable without a clear sense of priorities and shared direction among the leadership. I used the opportunity of my budget speech in the National Assembly last week to outline some of these priorities and would like to continue the process this afternoon, focusing on different areas of intervention. Unfortunately, time does not allow for a comprehensive review and I hope members will read my remarks in the National Assembly in conjunction with today’s comments.
This afternoon I would like to focus on developing the district health system, human resource planning, gearing the health system to cope with emerging and re-emerging communicable diseases, namely HIV/Aids, TB and Malaria, emergency medical services, and hospital revitalisation, including quality of care.
Firstly, let us look at developing the district health system. There is a firm view held across the public health system that primary health care services should be administered and controlled at a local level. Partly this has to do with ensuring that communities can engage the authorities directly about their service needs, but it also relates to the fact that health is an intersectoral endeavour and co-operation among these various sectors works best when it is focused. The division of local health districts provides precisely such a focus and creates the conditions for good co-ordination among role-players.
When the restructuring of local government took place last year, health district boundaries were redrawn to coincide with municipal boundaries. Soon after this the Minmec took a policy decision that primary health care services should be delivered by local government wherever this option is viable and acceptable to both the province and the municipality in question. I would like to emphasise that the shift of primary health care services to local authorities will be an incremental process. In each locality the shift will only take place if and when both the province and the local authority agree to it, and if and when the municipality is capable of maintaining services at the required standard.
A service agreement between the province and the municipality will spell out the terms of transfer of primary health care services. The agreement will specify the services to be delivered by the municipality and it will set out the financial, human and other resources to be contributed by the province.
We welcome and support the initiatives by the Minister for the Public Service and Administration to incorporate local government personnel into the Public Service. This would certainly facilitate the personnel transfers that are critical for the building of our new health districts. It goes without saying that labour law provisions will be observed at all times in creating the new districts and that appropriate talks will be held with the trade unions.
Decentralisation has many obvious benefits, but unless managed carefully, it also has the potential to create or increase inequalities. Our strongest defence against this danger is the very thorough work that we have done to create a standard service package for primary health care in clinics and community health centres. This not only specifies the range of services to be delivered but also itemises the mixture of staff, equipment and drug supplies needed.
The package of services represents a realistic norm for primary care delivery. We believe that the vast majority of clinics and community health centres will be able to achieve this norm by the year 2004. During the course of this year we will be conducting an audit of the services and resources in all health districts so that we actually know the size of the gap between what exists at present and the standards we want to achieve.
I want to make a commitment to the members of this House that the transfer of primary care services to local authorities will be an exercise in development and not a dumping of responsibility. We are proud of the advances that we have made in primary care - our expansion of immunisation, improved sexually transmitted diseases management, strengthening of TB treatment and increased access to maternity care, to name but a few achievements. We will guard these gains jealously throughout the process of restructuring.
Obviously, as local councils become major role-players in the public health sector, it becomes necessary to create structures to give effect to co- operative government between provinces and local authorities. These provincial health authorities would play a similar role to the one currently played by Health Minmec.
The national health Bill will be tabled later this year and will provide a firm basis for the division of responsibility among spheres of government and for the consultative process that will ensure that all elements combine to form a single national health system.
Turning to our second focus area of human resources, I would like to say that there is more than a little truth in the commonly held view that there is a shortage of health personnel in the public sector, that the rural areas are worse off and that the brain drain is hurting public health care. But, of course, the picture is a lot more complex than this, and I can only give hon members a flavour of the issues relating to the recruitment, redistribution and retention of personnel.
Firstly, regarding recruitment and the related matter of training, at the time of last year’s Budget Vote, the department had just produced a major strategy document entitled Human Resources for Health. This strategy spans the private and public health sectors. It examines future demands for various health professions and sets training targets in accordance with this demand. The report concludes that there is no overall need to produce a great number of doctors, dentists and pharmacists, but that there is a need to create increased training opportunities for clinical psychologists and mid-level workers, especially enrolled nurses who do a two-year course. It identifies a need to redefine the scope of practice of various professions to meet the requirements of primary health care, and sets out in great detail the nature of changes that are required. It asserts the need to promote representivity amongst students and teaching staff in health disciplines and proposes changes to admission criteria at universities and colleges.
Two further human resource audits have been undertaken during the past year. One was an audit of primary health care personnel to determine where we stand in terms of our ability to implement the primary care package. The data is currently being analysed.
The other audit focused on postgraduate medical training. It uncovered the fact that we are overproducing certain kinds of specialists and underproducing others. Underproduction is especially critical in the disciplines of forensic pathology and public health.
The recent cholera epidemic emphasised just how serious our shortage of public health specialists is. In a country where cutting-edge heart surgery is performed, we were forced to import WHO experts from abroad to advise us on the management of the cholera outbreak.
The evidence on recruitment and training points to one simple fact - Government and the institutions that train our health professionals are badly out of step. Few university medical faculties can show real results in terms of the diversity of their student bodies. A minority of clinical departments in medical schools have embraced the goals of health sector transformation. I believe that the situation demands urgent remedial action.
Our medical schools represent a considerable public investment and their potential to contribute to the development of our country is enormous. But we will not reap this benefit if we do not engage each other fully and honestly. I am therefore inviting the relevant university administrations to get together with government, that is, with the Departments of Education and Health, so that we can jointly hammer out an accord on the transformation of training in health sciences. I believe that we should commit ourselves to achieving this accord before the end of this year.
As the Human Resources for Health report suggests, the so-called shortage of health professionals could often be more accurately described as an extremely uneven distribution of health professionals.
Our provincial health departments vary in the extent to which they experience serious shortages of health professionals. Provinces that are mainly rural are hit by these shortages in almost all professional categories while the more urbanised provinces only experience problems in filling posts in a few occupations where the private sector has greater pulling power. A compelling need to introduce doctors and other professionals into distant dispossessed communities has driven our community service programmes as well as various country-to-country agreements to opt for the deployment of foreign doctors.
In the Northern Cape, for instance, there were only 20 full-time doctors in the province in 1994. As a result of community service and the employment of Cuban doctors, the number of full-time doctors employed in 2000 was 111
- a fivefold increase. In the Eastern Cape, community service has put pharmacists into hospitals that have been without a single pharmacist for some years.
Critics of community service refer to it disparagingly as a stopgap measure, with low retention of professionals beyond the compulsory year. For instance, in the Northern Province last year, just 20 out of 137 community service doctors stayed on after completing community service. The chances are that far fewer than 20 South African trained doctors would have been recruited to the Northern Province without introducing them through community service. And, although the yearly turnover is not ideal, I have no doubt that any patient in pain and distress would rather have a ``stopgap’’ doctor than no doctor at all.
Perhaps surprisingly, a recent feature article in the Afrikaans Sunday paper Rapport portrayed the community service initiative in a really positive light. The young professionals who were interviewed confirmed that being sent from the world of plenty and privilege to serve in an environment of need and destitution is a life-altering experience. It is an experience that they will carry with them forever, and that will continue to influence our professional practice.
I would like to pay tribute to the young doctors, dentists, pharmacists and allied health professionals who have performed their community service with commitment, often in conditions that are far from easy. For me, if we talk of patriotism, this is the genuine article - a real contribution of service to our country at a critical time in our history. [Applause.]
Finally, in the area of human resource planning, there is the challenge of retaining skilled professionals in the public health sector and, indeed, in South Africa. When it comes to the foreign brain drain, we recognise that higher salaries in developed countries, together with exchange rates that favour their countries, are inevitably going to attract a certain number of our health workers.
We may regret this, but freedom of movement and freedom to sell one’s labour are basic rights on which we have built our democracy and we cannot restrict these rights. However, any responsible government will take steps to protect its assets, and we certainly need to devise strategies that will conserve the public investment in human resources for health.
We need to recognise that many health workers leave this country temporarily, for instance to gain experience abroad or to boost their earnings to repay student loans. Such international exposure, generally, leads to personal development and enriched knowledge. Therefore, we should make it easy and attractive for returning professionals to reintegrate into the public sector.
It may very well be in our interests to facilitate short-term foreign contacts for public-sector health workers and to offer options for continuity of pension and other service benefits. We will be exploring ways of doing this within the context of South-South co-operation and, more specifically, to benefit our neighbouring countries in the SADC region.
We want to state quite clearly, though, that although we recognise migration as a normal phenomenon in any free country, we will continue to object vigorously whenever developed countries plunder the meagre skills resources of developing countries in organised recruitment raids. Countries that systematically underproduce skilled workers because it is cheaper to poach them from poorer countries are guilty of exploitation. This is simply colonialism in a new guise. And, in the context of knowledge-based economies, it is as destructive to our national interests as the rape of our national resources was in the past.
As South Africans, we are proud of our decision not to meet our short-term human resource needs by bleeding the health systems of our neighbouring countries. The outflow of health professionals to the private sector probably represents a greater drain on public health services than foreign migration does. I am not arguing in any way for the demise of the private health sector, but I do believe that it should be aligned with the overall public health goals of the country. When the private sector operates in a way that undermines national health objectives, for instance through wasteful and irrational practices that create artificial markets, then Government is compelled to intervene.
We have already done so through a number of laws that are designed to reduce health costs in the private sector. The Medicines and Related Substances Control Amendment Act, for instance, outlaws kickbacks which artificially increase demand, and compels pharmacists to offer the cheapest versions of prescribed drugs. The Pharmacy Act opens up ownership of pharmacies and therefore increases competition. The Medical Schemes Act strengthens the hand of members in relation to the schemes and the schemes in relation to service providers.
We acknowledge that conditions in the public sector are also a significant factor when it comes to the loss of professional personnel. There are many aspects of the working environment, over and above salaries, that are unattractive. Poor management systems, in particular, impose additional burdens on busy professionals. We need to work constantly at improving the working environment and injecting attractive features into public health settings.
We also need to ensure that there is representivity in all sectors of the health profession. To this end, a group of pharmaceutical companies and private health care institutions have initiated a bursary in my name to provide financial assistance to deserving students in a variety of fields.
In concluding my review of human resource planning, I would like to mention that the department is finalising a comprehensive gender policy and that we aim to launch this publicly before the end of this year.
Of course, the policy extends beyond issues of human resource development. However, gender issues are of direct concern to a huge number of our health workers and this seemed an appropriate point to share our plans. The policy deals with issues of women’s health in a comprehensive way and includes policy perspectives on violence against women and girls, safe pregnancy and motherhood, female cancers, women’s mental health, tobacco control and health promotion issues, as well as ways of making the health system more responsive to women’s needs.
The next area of focus is planning for the impact of HIV/Aids, tuberculosis, malaria and other infectious diseases. The specific allocation for HIV/Aids programmes in the budget before us is R207 million. However, that represents only a fraction of the amount actually spent on HIV/Aids in the health sector. The bulk of spending on treatment for Aids- related illnesses is indistinguishable from general hospital and clinic spending in all provinces. The challenges of meeting the demand for HIV/Aids treatment and care were at the heart of the meeting that was held in Pretoria last week between health Ministers of the SADC regions and representatives of seven of the world’s largest pharmaceutical companies.
All of the countries represented at that meeting reported that the sheer size of the HIV/Aids epidemic makes it extremely difficult to deal effectively with the adequate nutrition of people living with HIV/Aids and the treatment of opportunistic infections, let alone expand health infrastructure to the point where antiretroviral therapy can be done in a safe and responsible way. Furthermore, in the SADC region we have embraced the view, taken at the Abuja conference last month, that there is no justification for dealing with HIV/Aids in an isolated and elevated way when other diseases like TB and Malaria are having a devastating impact on our countries. These emerging and re-emerging diseases have common roots in poverty and underdevelopment. To some extent, they have common solutions in poverty relief, development and the general strengthening of health systems. Therefore, they demand a response that is co-ordinated and comprehensive.
SADC health Ministers asserted the position that, given the incurable nature of HIV/Aids, prevention programmes must remain the first line of attack and should not be reduced in scope, no matter how urgent the need for expanded treatment infrastructure. The drug company executives concurred with this view.
UNAids executive director Peter Piot drew the obvious conclusion that the HIV/Aids epidemic will not be tackled effectively on the resources of the affected countries alone. A massive and sustained contribution of resources is required from the countries of the northern hemisphere. This, of course, is what the Global Fund for HIV/Aids and Health, initiated by UN secretary- general Mr Kofi Annan, is all about. Like other developing countries, South Africa has a vital interest in the success of this fund.
However, the possibility that demand for treating HIV/Aids-related conditions could overwhelm our health service has been apparent for some time. We have never believed that we can sit back and wait for an outside benefactor to solve the problem.
Last year the Government commissioned a study on the likely impact of HIV/Aids on health services. The study was completed late last year. It was, essentially, a modelling exercise in which existing research was utilised to produce various scenarios.
The value of the impact study lies not in the exact figures produced. In fact, there are some methodological problems that have to be sorted out, and this will alter the figures.
The true value of the study lies, firstly, in the inescapable conclusion that the demand for Aids care will far outstrip the capacity of our health system to deliver, unless we take decisive action to strengthen our health system.
Secondly, and equally important, the study suggests areas where we could intervene most fruitfully to reduce the gap between the demand and the supply of health care.
The top treatment priority that emerges from the impact study is more effective control of tuberculosis. Experience on the ground in provinces confirms the finding that effective control of TB will be the key to containing the burden of opportunistic infections. Every province has taken steps in the past year to improve TB management and are all targeting it as a priority for the year ahead.
TB cure rates have improved to about 65% in recent years, and that is thanks to widespread implementation of the Dots community-based treatment strategy. Pilot schemes for integrating TB and HIV management have yielded promising results and will be scaled up. At the integrated sites, many HIV- positive patients can be given medication to prevent them developing active TB.
National and provincial departments have set in motion a forensic audit of Santa, which is contracted to provide hospital care for a large number of public-sector TB patients. Members of this Chamber might have seen the tender for the audit advertised this week. This move follows a review of TB hospitals run by Santa and Lifecare that uncovered some serious problems in the management of the institutions.
The HIV/Aids impact study also highlighted the need to build alternatives to hospital care. Our main alternative form of care is home-based and community-based care, which is still at an extremely early stage. This year we will focus on providing additional funding to existing projects so that they can consolidate their services. Some provinces are funding NGO-run hospice beds, and in Gauteng and the Northern Cape health departments have created the first step-down facilities within public hospitals.
When we talk of strengthening the health system, we are referring to improving its overall efficiency, for instance by managing length of stay, ensuring that care is delivered at the most appropriate level of service and pursuing the lowest possible drug prices.
The use of nevirapine to prevent mother-to-child transmission, or MTCT, of HIV may substantially reduce pressure on paediatric HIV care. It will only do so, however, if we can ensure that the majority of babies that are protected by nevirapine at birth are not exposed later on to the risks of infection. A total of 18 research sites for the prevention of MTCT have been designated in order to enhance understanding of the demands for a successful programme.
One of the aims of the programme is to sustain the mother in good health through nutritional supplements, prompt treatment of opportunistic infections and supportive counselling. Some of the sites will also research the nature of drug resistance in mother-to-child transmission programmes. Five research sites in three provinces are already operational and others will follow soon.
We are also prioritising the promotion of voluntary counselling and testing because knowledge of an individual’s HIV status is the precondition for various prophylactic and therapeutic measures. Provinces have taken up the challenge of expanding the number of facilities where this service is on offer. For instance in the North West, the number of sites offering voluntary counselling and testing has been increased to 78, and 350 nurses have been trained in the use of rapid test kits for HIV.
There has been considerable progress in certain provinces in establishing Aids directorates where these did not exist and staffing them appropriately.
When it comes to emergency medical services, we need to remind ourselves that emergency medical services are the single area of health care where the Constitution confirms an outright guarantee of service provision. Emergency medical services are also an exclusive function of the provinces. Although they are not specifically funded by a conditional grant, I would like to spend some time reporting on this area, because it has been the focus of public debate and there have been considerable changes during the year.
Until recently most provinces depended on local authorities to deliver noninstitutional emergency services on their behalf - in other words, to staff and run their fleets of ambulances. The arrangement worked with varying degrees of success, but overall it was unsatisfactory.
During the past year eight provinces have resumed direct responsibility for the operation of ambulance services. Emergency medical services have been separated from other emergency services such as fire services and now have a dedicated staff. All provinces will soon have their own training facilities for emergency services personnel. Several provinces, including the Free State, KwaZulu-Natal, the Western Cape and the Northern Cape are investing substantial amounts in renewing their ambulance fleets. The Free State is perhaps at the top of this list with the recent acquisition of 62 new ambulances, 32 commuter transport vehicles and 19 emergency response vehicles. It is committed to eradicating backlogs by purchasing 20 new ambulances every year. [Interjections.] National norms are being developed for the emergency medical services.
The final significant item on the list for debating this afternoon is hospital revitalisation. We have identified better management systems and skilled managers as critical factors in the programme of hospital revitalisation, impacting both on the dimension of the quality of care and on capital works projects. All provinces confirm that they have taken this priority on board.
Wherever provinces are reducing or eliminating overspending, better financial management, particularly by hospital managers, has been a critical factor. Funding is available from Treasury for the further development of management skills in the course of this year. Amounts totalling more than R3,5 billion have been allocated for a three-year programme to restore and replace hospital facilities. In all, 242 hospitals will benefit from this programme. To date 331 individual building projects have been completed at 86 hospitals.
Provinces have also shown results in relation to improving the mobilisation of resources. Revenue recovery is increasing with a new patient billing system. Private-sector usage of hospitals is being actively negotiated in a number of provinces. Donor funding has been secured, for instance to take forward the expansion of primary care facilities. It is encouraging to see that even where donor funding is not available, several provinces have budgeted to expand their clinic networks in the year ahead or to upgrade existing facilities. I am pleased to see that provinces have defined quality of care as a multidimensional issue that is critically influenced by the effectiveness of management systems. The factors that provincial departments believe have made a real difference to quality of care include the following: ensuring that there is unbroken availability of essential drugs, acting on information produced by maternal death monitoring to remedy deficiencies in professional knowledge and skill, promoting a patient rights culture and monitoring compliance with the Patient Rights Charter. I spoke at length in the National Assembly about the quality of care. I believe that it is the responsibility of every health worker to contribute directly and on a daily basis to better health care. It is a responsibility that should not have to be imposed from above, but should be enacted simply as part of our professional commitment and our undertaking as public servants. The Batho Pele ethos is non-negotiable.
I also indicated in the National Assembly that I believe that there should be far more serious consequences for health workers who fail in their responsibility to deliver quality care. I would like to see cases of gross negligence, fraudulent behaviour and outright abuse of patients pursued much more vigorously by the various professional councils that are charged with defending the public interest.
It is disturbing that it has taken years for anybody to lodge a complaint against Wouter Basson and to ask whether his behaviour renders him unfit to remain in the ranks of the medical profession.
It seems that our moral and ethical senses have been anaesthetised, and that we are in need of a real shaking up. I would like to repeat my intention to appoint a task team to look into the ability of the professional councils to deal decisively and fairly with cases of professional misconduct and malpractice. The task team will be asked to consider in particular whether we need to review the legislation that governs the councils.
Before taking my seat, I would like to thank a range of individuals for the constructive role they have played during the course of the last year. Members of the Select Committee on Social Services and the Portfolio Committee on Health have continued to play a significant role in guiding our work. We thank all of them, and in particular their respective chairpersons.
I started out this speech with a reference to co-operative government and I want to acknowledge the contribution of all the MECs for health and their departmental heads in making this concept a living reality. The President, the Deputy President and colleagues in the Cabinet have taken the challenges of health care to heart, and I thank them for their interest and collegial support.
Finally, my thanks go to those whose daily and unremitting task is the improvement of our health system: the thousands of health professionals, health support staff and health service managers across the country. We are profoundly indebted to those who do their work with compassion and understanding, guided by their deepest personal values. I include in this group officials and managers of the Department of Health, and especially the Director-General of the Department of Health, whose leadership remains constant in challenging times.
I am deeply appreciative of my personal staff and particularly the support staff: Mr Lucky Motaung, Mr Patrick Mahlangu, Mr Jaco Theron and Chris Kondowe, who work extremely long hours and respond to many unexpected demands with great resilience and goodwill.
I thank hon members for this opportunity to address them and look forward to their responses. [Applause.]
Ms L JACOBUS: Hon Chair, Minister, MECs, special delegates and members, at the beginning of this year, the Department of Health presented to the select committee an outline of its priorities for 2001. Amongst these priorities were: firstly, reducing morbidity and mortality rates through a number of health promotion campaigns; secondly, the revitalisation of hospital services; thirdly, improving human resource development; fourthly, improving communication and consultation; and lastly, the reorganisation of support services.
For purposes of this debate we have narrowed it down to four themes, linked to these priorities, namely: the transformation of the department, access to health services, service delivery and HIV and Aids.
As I said last week during our Social Development debate, I hope that MECs and special delegates from the provinces will use this platform not only to highlight their successes, but also to pinpoint the challenges facing them as they work towards the goal of providing quality health care to our people, a constitutionally enshrined right of every citizen.
Regarding transformation, I want to begin with a quote from a book called Transformation in Action: Budgeting for Health Service Delivery:
Health spending is currently inefficient and ineffective. South Africa spends a large proportion of its GDP on health … yet it has a poorer health status than countries which spend considerably less on health.
While some members of this House might jump up in support of this statement and others in rejection of it, I think we need to reflect on it in the broader context of the socioeconomic status of our population. We need to ask ourselves the question: What generally determines a person’s physical and/or mental health status?
It is my view that one’s health status is determined by, amongst other factors, whether a person is employed or unemployed, whether a person has proper housing or not, the level of education of an individual, access to a daily balanced diet, clean drinking water and sanitation and exercise. If we are honest with ourselves, we will all acknowledge that a large chunk of our population is not healthy, simply because they do not have access to the goods and services I have just outlined.
I am sure we are all aware that Cabinet cluster committees have been established. One of these is the social cluster committee. It is on the initiative of the hon the Minister of Health and Minister Skweyiya that this cluster has on its agenda matters like water, sanitation, food security, nutrition, HIV/Aids, integrated sustainable rural development and housing.
This shows that Government has already acknowledged that we need a comprehensive, integrated response to the socioeconomic challenges facing us as a nation. We know that this cluster has developed action plans for these specific areas of intervention, with clear objectives and deliverables. We will, within the next term, call upon this cluster to present these objectives and deliverables to our committee, so that we can assist the Minister in monitoring and achieving our broad objective, and that is to create a healthy nation.
At this point I want to congratulate the Minister, and Government as a whole, on the victorious outcome of the court case against some of the giants in the pharmaceutical industry a few months ago. This victory symbolised the triumph of united action by progressive forces, both here and abroad, over capital. This victory has cleared the way for us to begin to systematically provide our people with much-needed drugs at a fraction of their present price. I want to emphasise here that this means cheaper drugs across the board, not just anti-Aids drugs.
I do not think it would be out of order if I also thanked those organisations and individuals that rallied to support us, as Government, in this crucial matter. It was morally and politically incorrect and unacceptable for these pharmaceutical companies to challenge a country’s head of state and, by implication, its constitution, for their own profit, at the expense of the lives of fellow human beings. This victory allows us to finally implement our commitment to ensuring the availability of affordable medicines, in line with our national drugs policy.
The hospital rehabilitation and reconstruction programme also needs to be commended. Although funding has been set aside for this programme, institutions in rural areas must be prioritised. Our visits to rural KwaZulu-Natal and the Eastern Cape highlighted the level of dilapidation and neglect these buildings are in. They are health hazards themselves! This illustrates that access to health services goes beyond mere access to drugs. Patients must also have access to safe, healthy, well-equipped, adequately staffed health facilities.
Every time we visit health institutions throughout the country, we are confronted with complaints of staff shortages and theft of drugs, hospital equipment and other provisions. These thefts cost both public and private health institutions an estimated R1 billion, according to a study done in
- Unfortunately this stock theft has continued, at a tremendous cost to the state. We propose that medicines and equipment be clearly marked to identify them as Government property, and anyone found in possession of such stock and equipment should be held liable for prosecution. Stealing Government property is no different from stealing Government money. This is theft and corruption, and the perpetrators must be found and brought to book.
While we have made considerable strides towards allocating a more equitable share of the budget to the provinces, we also need to ensure that this equity in terms of input translates into improved access to health care for our people. Equity in output needs to be measured and monitored, and we need to find a way of doing it. Only then can we say with confidence that our budget speaks to our priority of ensuring access to health care.
Regarding service delivery we want to emphasise that spending does not necessarily mean delivery. Again I want to quote from this book called Transformation in Action: Budgeting for Health Service Delivery:
Financial planning and budgeting is how the organisation, in this instance Government, allocates money and other resources to realise its aims and objectives. An effective system for financial planning, budgeting and financial management is therefore essential for an effective and efficient service delivery system.
One of the weaknesses identified in service delivery is the lack of financial management and accountability of our limited resources in some provinces. This poses a challenge to our leadership at the national level to develop capacity at the provincial level in order to decentralise responsibility and accountability. Let me commend the department on the appointment of CEOs in hospitals. It certainly goes a long way in addressing the problem of the management, particularly financial management, of these institutions.
Because the health portfolio, in many instances, has to budget on projections, it becomes increasingly important that we develop the ability to budget for new objectives and challenges and monitor delivery in relation to expenditure and outcome, which means the improvement of health and health care.
Mismanagement of the budget manifests itself in areas such as the school nutrition programme. Some provinces have reported underspending and even acts of corruption in this area.
How are we supposed to justify the fact that a child faints at school because he or she has not eaten for the day, and yet Government has set aside money to feed this child at least once a day at school?
A case in point is the incident reported on e-news on Saturday evening, which took place at Silversands Primary School here in the Western Cape, where kids went scavenging on a nearby rubbish dump in search of food because they were hungry. A number of them ended up in hospital with food poisoning and sores around the mouth, after eating rotten apples and contaminated food products.
The company contracted to deliver bread to the school only delivered 60 loaves a day, which only fed half of the pupils. The other half obviously had to look for food elsewhere, in the nearby rubbish dump. These corrupt practices amount to stealing food out of the mouths of our children, and they need to stop.
The hon the Minister may need to tighten the screws on these crooks, whoever they might be, and task school-governing bodies with playing a more active role in awarding, monitoring and reviewing tenders to provide this nutrition service to our children.
Service delivery is not just the administration of a Panado to a person with a headache, or giving a slice of bread to a hungry child; it goes way beyond that. It includes the principle of Batho Pele, people first - the Minister has referred to that as well - according to which every human being has the right to be treated with dignity and respect.
Batho Pele costs nothing. It merely requires a change in attitude within our Public Service, especially among those in the front line of service delivery, our hospital and clinic staff. As we have introduced the Patients’ Rights Charter, we might want to think about outlining the duties and responsibilities of our public servants, based on the Batho Pele principles. In the words of the hon the Minister, and I quote: ``The Batho Pele principle is non-negotiable.’’
The department also needs to be commended for establishing hospital boards, which have assisted in improving the management of hospitals and clinics, through community participation. They also serve as an effective monitoring mechanism for service delivery. However, clinic committees seem to be either poorly developed or nonexistent. I see it as our responsibility to encourage the establishment of these committees in our various constituencies, rural areas in particular.
This brings me to the last theme, which is HIV/Aids. Government deserves a pat on the back for establishing the SA National Aids Council, which replaced the Interministerial Committee on Aids and serves as an advisory body to Government. The establishment of Sanac has brought together a much broader range of role-players than just Government.
This is an acknowledgement that HIV/Aids requires a much broader response than just that of Government. Sanac members include traditional healers, the youth, women, the hospitality and entertainment industries, the media, faith-based organisations, the disabled and people living with Aids. Future projections of HIV infections are frightening, to say the least. Focusing on vulnerable groups, I think that women, especially married ones, are probably one of the most vulnerable groupings when it comes to HIV infection. They find it difficult to negotiate condom use with their partners or husbands. I therefore want to suggest that the department embark on a much more vigorous campaign to empower women to take control of their own health. This might mean broadening the pilots of female condom distribution points.
People using hospital services for the treatment of opportunistic diseases already place a tremendous strain on the health budget. Therefore, the implementation of the home or community-based care programme, in collaboration with the Department of Social Development, should be welcomed.
As I said last week, I also want to encourage the Department of Health to forge stronger links with NGOs, CBOs and FBOs in the implementation of this programme, so as to relieve the financial and human resource burden on the department.
In conclusion, we need to acknowledge the following, in the words of my premier at his opening address to the legislature, and I quote:
Our country’s foundation was built on systematically enforced racial divisions in every sphere of our society. Towns and cities were divided into black townships and white suburbs, the one without basic infrastructure and the other very well resourced. While a lot still needs to be done to improve the lives of our people, tremendous progress has been made since 1994. While seven years is too short a time, to undo the ills of decades of systematic oppression, we are proud of our achievements to date.
Let me also take this opportunity to thank the Minister and her department for their continuous support and assistance to the select committee when we request information and briefings, sometimes at very short notice. We appreciate the very good work that they are doing and hope that the comments, suggestions and recommendations we put forward today during this debate are taken in the spirit of co-operation, in which the various arms of Government work together towards a common goal, that of creating a better life for all our people. [Applause.]
Dr P J C NEL: Chairperson, hon Minister, hon MEC from the Free State, all other MECs, hon members, in an interview with the Mail & Guardian recently, Mr Mandela called for an open debate on political differences within the ruling party. Regarding criticism voiced by the DA and other opposition groups voiced, Mr Mandela said, and I quote from article in the Mail & Guardian of 2 March this year:
I dare to say that even the opposition, the DA, is proud of South Africa. They are criticising because they regard this as their country. They are not prepared just to leave the country and go abroad. That is pride.
I challenge the hon the Minister, or any member of the ANC in this House, for that matter, to contradict this statement made by our ex-president. [Interjections.]
When the DA says that the underfunding of health services, the poor management of funds and the ineffective usage of health resources have given rise to almost total collapse in the delivery of health services in some of our state hospitals and clinics, we criticise because we are really concerned. The World Health Report 2000 of the WHO, which measures how effectively countries are using their health resources, rated South Africa only 175th out of 191 countries. Only 16 countries did worse than South Africa.
The lack of funds also results in poor working conditions and low salaries, forcing our doctors, like Dr Nzo, nurses and other health workers to leave our country. According to the SA Nursing Council, approximately 300 nurses a month are leaving South Africa without being replaced, putting greater pressure on the remaining staff.
The ever-increasing admission of patients with HIV and Aids- related diseases is also putting an increasing burden on the health care facilities and funds. In many hospital 80% of beds are already filled with Aids patients. The fact that the national department failed to spend R31,9 million, 29% of its allocation for HIV/Aids is unacceptable and shocking.
The lack of funds also results in the deterioration of our health infrastructure. The Department of Public Works, in a submission to the Department of Finance as far back as 1999, already stated that 30% of the existing infrastructure would soon be beyond repair, and that R8 billion would soon have to be spent to address the backlog.
To my amazement, I read the following in the report of the Select Committee on Finance tabled in this House on 26 March this year, and I quote:
The committee has observed that serious underspending is being recorded in respect of the Hospital Rehabilitation Grant …
How can one justify that?
The other factor contributing to the lack of funds is that many state hospitals are owed large amounts of money by patients who can pay, but neglect to do so. The amount of money owed by the state itself to state hospitals is quite substantial. The Compensation Commissioner alone owes the state hospitals more than R9 million, let alone the RAF, which is at the moment operating with a deficit of more than R10 billion.
I request the hon the Minister to talk to her colleagues, the Ministers of Labour and of Transport, and urge them to pay their debts.
‘n Ander belangrike aspek wat fondse in die gesondheidstelsel erodeer is diefstal van medisyne, toerusting en ander artikels uit hospitale. Volgens die departement is in die jaar 2000 artikels ten bedrae van R6,2 miljoen gesteel. Ek het egter groot waardering vir die sterk standpunt wat die agb Minister in dié verband inneem. (Translation of Afrikaans paragraph follows.)
[Another important aspect that is eroding funds in the health system is the theft of medicines, equipment and other articles from hospitals. According to the department, articles amounting to R6,2 million were stolen in the year 2000. I do, however, have great appreciation for the strong standpoint the hon the Minister is adopting in this regard.]
HIV/Aids makes all the other problems that I have mentioned seem trivial. There has never been an epidemic like this in human history. It is even worse than the black plague that wiped out one third of the European society. However, that plague came and went. HIV/Aids came to us 20 years ago. It is still with us and will be with us for many years. Many people have become more or less accustomed to the shocking statistics published daily in our media and press. They do not really take notice of them, nor do they want to hear and read the statistics, which I do not want to repeat today. However, whether people want to hear or not, this is the reality. Aids is everybody’s baby. Hon members should listen.
The fact that South Africa is struggling to get to grips with the Aids crisis can mainly be attributed to the lack of leadership and the apathy of people at large. [Time expired.]
Mr M D QWASE (Eastern Cape): Chairperson, hon members, MECs, distinguished guests and the representatives of the media, firstly, I would like to tender an apology for the MEC for health of the Eastern Cape who is tied up in other programmes in the province.
The Eastern Cape department of health has been allocated R3,8 billion for the financial year 2001-02 to fulfil its constitutional obligations. We are confident that with these resources at our disposal we will be able to deliver quality and equitable health care services to all our people in the province.
We are proud to announce that the Eastern Cape department of health has never been better positioned than it is today to take the decisive steps towards contributing to a better quality of life for all the people of the province, especially those communities that have never seen a health worker in their lives.
There are a number of concrete achievements we have attained in the past financial year. Amongst those achievements I can cite the completion of projects that are related to the rehabilitation of hospitals - that is, 15 projects and nine clinics - the installation of solar energy in 46 clinics, the connection to the Eskom grid in 61 clinics, the installation of refrigerators and 94 two-way radios in our clinics and also other achievements in respect of infrastructure.
The hospital transformation process is being finalised. The rationalisation of three complexes, that is, East London, Port Elizabeth and Umtata, has also commenced. Other achievements include the successful implementation of Dots which has resulted in the closure of TB wards, for example in Tsolo and Qumbu.
We have also had successes in terms of the availability of drugs, which has increased by 90% for TB cases and 30% for cases of sexually transmitted diseases. There are a number of other achievements. These major indicators point to the excellent work that has been done to place our province on the path to achieving a better quality of life for all.
Despite all these successes, we are still faced with many challenges, and we are hopeful they will soon become history if we commit ourselves to acting in unity and with a passion for development. We have to deliver under circumstances not of our creation. The problems and challenges that we feel include, firstly, the economic status of the province, where 80% of the population depend on public health care services. The situation becomes worse when we have to accommodate economically inept migrant labourers from other provinces. The province is very rural with certain areas being inaccessible by modern transport. All the same, we have to reach to those communities. Thirdly, the rural nature of the province has made it not attractive to both nurses and doctors, especially in the rural areas. This hampers the effective delivery of services in these disadvantaged areas.
Our greatest challenge is to recruit and retain professional staff in the rural areas.
We have a duty to realign current health districts with the newly demarcated municipal areas to ensure that the process of devolving certain health services to local government, in line with the national district health systems policy, is enhanced. Another challenge is around mental health. For many years mental health has never been given priority. The Eastern Cape has since prioritised this aspect.
On transformation strategies to improve service delivery, the department of health has undertaken a series of strategic work sessions to restructure and reorganise and provide efficient, effective, appropriate and equitable services. Our efforts are not directed only at organisational structure, but also at producing a health cadre that is technically skilled and fully committed and that has the values to ensure a caring ethos when delivering our services.
The following are the critical areas of intervention that we have identified. The first is the reorganisation of the department of health. An amount of R7 million has been set aside to build management capacity in the provincial office, so that it is capable of strategically steering the organisation to achieve its vision and objectives. In line with the resolution of the executive council, the department has replaced regional offices with revamped health districts to deliver cost-effective health services.
The second is the targeting of 10 institutions as pilot interventions in the year 2001-02. The department has targeted three complexes; Umtata, Port Elizabeth and East London, for the rationalisation of services. The department has commenced the process of recruiting the CEOs to manage these complexes. They are also in the process of recruiting senior executive officers and executive officers to manage other smaller institutions. This process will be finalised by August 2001.
Issues that impeded appropriate spending on conditional grants have also been resolved. The new financial year should realise the correct planning and implementation of these programmes. The business plans to access the conditional grants for the ensuing years would, in line with the provisions of the Division of Revenue Act, be finalised before the end of June 2001.
On district development, the ushering in of the last phase of local government transformation on 5 December 2000 will enhance our relationship with local government and ensure that the delivery of services is strengthened.
The department is restructuring its delivery units to be in line with the newly demarcated district municipalities to ensure meaningful co-ordination and political accountability. The department will take responsibility for co-ordinating services in those areas where devolution to local government has not taken place.
We are working within the integrated provincial support programme of district development. The department will contribute its part in the delivery of the above and other programmes within the social services cluster. Each district will develop service plans which will cover at least all the essential services that the department is required to provide.
The Government structures, like boards and community health committees, are being established to meaningfully provide participatory democracy at community level.
The Integrated Sustainable Rural Developments strategy implores us to plan and deliver as departments in unison. It is our unwavering commitment to work as a department within this strategic framework of the province.
The quality of care, as indicated above, will be one of our priority areas. The Patients Rights Charter, which has been officially launched in the Eastern Cape with the support of the hon the national Minister of Health, will be rolled out. Each and every institutional or district manager will be required to sign a pledge to ensure that the charter is communicated, internalised by the staff, and fully implemented in all our facilities. Representative boards will be established for all hospitals and the department will ensure that the regulatory framework is provided.
Regarding HIV/Aids, as indicated, the province committed R50 million to develop programmes for implementation in different departments. The Department of Health is responsible for R38 million of that whole amount. We promise to undertake the task of co-ordinating this responsibility without failing.
On drugs supply and management, the department has recognised drugs and pharmaceutical products as one of our cost drivers and priority areas. We are currently finalising the process of outsourcing the distribution of drugs and the bar-coding of bulk supplies. An amount of R5 million has been set aside to improve management in our depots, to prevent pilferage and also to develop drug management systems. Clinic drugs budgets will be de- linked from the hospital supply.
The establishment of pharmaceutical and therapy committees in all institutions and districts is also our priority. We will also develop computerised stock and formulatory management systems.
On primary health care programmes, in addition to HIV/Aids strategy, the department will focus on TB programmes by purchasing transport to improve sputum results and the Dots system. The focus will also be on the developing of an alternative delivery strategy in the school feeding nutritional programme.
On management issues, the department of health will focus on training and development consultation management systems. It will also continue and finalise the process of rationalising nursing colleges. This does not only ensure the cost-effective delivery of training services, but is also in line with the broad transformation agenda.
We are gravely concerned about debt control regarding the department’s assets, and we are committed to developing asset and fleet management systems. [Time expired.]
Mr H T SOGONI: Chairperson, hon Minister and members, providing health care services to the nation is the department’s greatest challenge. The vision of the department to afford all South Africans good quality health care requires the extension of its delivery system to reach the remotest and poorest of our communities.
The Minister in her presentation to the committee on social services on 27 February 2001, correctly referred to the report in the SA Demographic and Health Survey, indicating vast inequities in the health status of South Africans based on race and geography.
Therefore, the Budget Vote before us represents one of the central pillars of service delivery, the provision of the Constitutionally guaranteed right to health for all. It stands central among the needs to those who were previously disadvantaged. The budget is therefore appropriated to translate the policies and programmes of the department into the outcomes desired to reverse the imbalances.
The department has identified its priorities for 2001-02 within the health sector strategic framework, which constitutes the main objectives of the department for the remaining term of the Government. We also note the argument of the department that the negative real growth in the national budget over the next three years must be seen in the context of the completion of a few large infrastructure projects and the location of the bulk of resources by the department.
In spite of huge amounts allocated to the construction and maintenance of clinics and hospitals, the need remains severe, especially in rural areas. Constituency visits to the rural areas provide a stark reminder of the dire need for proper and accessible health care. Many thousands of people have yet to experience the fruits of the new Constitution when it comes to health care.
This, linked with high levels of poverty and the disintegration of the social fabric in rural areas, leads to immense suffering and unnecessary but avoidable low standards of living and loss of life. The intervention strategies of the department, therefore, to decrease the morbidity and mortality rates are most welcome. Perhaps the observation by Solani Khosa of the Health Systems Trust, in an article published in Idasa’s Budget Watch, is relevant to this debate. He indicates, among other things, that, poor provinces still receive relatively small or no increments for health care.
Historically disadvantaged provinces should be favoured even more.
Such provinces could then secure a fair share of the allocated funds in order to provide additional resources for health care. To me, this makes good sense. I consider it to be a statement that proposes a genuine approach to be followed in order to fulfil the objectives of the department.
Finally, no discussion on health in South Africa today would be complete if it did not recognise the pandemic of HIV/Aids that we are faced with. It has also unfortunately become one of the most politicised and controversial subjects in South Africa. We remain concerned about this and believe that the department should approach the matter from the correct policy perspective.
As long as HIV/Aids remains a controversial issue, millions of rands budgeted towards this vital cause will make little or no impact, especially in the light of Government winning the court case against pharmaceutical companies. It is time to act decisively. Having said this, the UDM supports the Budget Vote. [Applause.]
Ms M A TSOPO (Free State): Hon Chairperson, hon Minister of Health, hon members, colleagues, ladies and gentlemen, there is no question about the fact that the historical challenges before us are major.
As I stand before this House today, I am well aware of the historical backlogs we are still faced with, particularly with regard to health service delivery. Our goal is not just health service delivery to the masses of our people, but quality service delivery. This process must take into account a number of factors as contained within Batho Pele and the Patients Rights Charter.
These historical challenges can be placed in broad categories such as service delivery HIV/Aids and, access and transformation. Although these categories are closely intertwined, I would like to address the challenges in the context of these categories, with special attention to the Free State’s department of health.
We have developed a human resources plan whose objective is to ensure that we have the optimum staffing levels in our institutions, and that our personnel is well trained. Most of our critical posts have been and are continuously being filled. A proportion of 1,1% of our personnel expenditure has been budgeted for training. An amount of R9,8 million has been earmarked for bursaries and for the training of under-graduate and post-graduates health professionals, including students from disadvantaged backgrounds, who are always targeted through this particular bursary scheme. For example, this year, 18 students were targeted for the MBChB degree out of the six fields we are currently supporting.
Abet and the interactive distant education and learning programmes are utilised as tools for the attainment of quality personnel. Through Abet, we have already covered 825 personnel.
The department of health has very successfully integrated all primary health care services into district health services. The latter have been organised to coincide with the five districts in the Free State. Outlined below are the challenges faced by the primary health care services. The first is the establishment of district health authorities and the transfer of the provincial primary health services to the district health authorities over the next two years. The second is the improvement in the quality of care rendered.
Here, several projects are being implemented to help improve the quality of care. Last year equipment worth R9 million was purchased for primary health care facilities, including district hospitals.
The accreditation programme of the Council for Health Accreditation Southern Africa, will be implemented in several districts in the Free State this year, and it will be rolled out to include all district hospitals over the next four years. An interactive distant learning system is being implemented in the Free State at a cost of R11 million. The system is based upon television broadcasting and electronic feedback and uses the networks of the Department of Health and Telkom networks. The department is in the process of hiring a 24-hour satellite channel. This system will enable the department to train people online and 600 staff members at a time.
The conditional grants of R16 million for hospital reconstruction and rehabilitation and the R6 million for the maintenance of infrastructure should go a long way in ensuring that our facilities are of world class. We have indeed moved with speed in the direction of restructuring emergency medical services in the province. The service has been provincialised in accordance with the Health Act, Act 63 of 1977, and Schedule 5 to our Constitution. We have now taken the service from local authorities who previously ran it on an agency basis.
Following this provincialisation, we have put strategies in place according to which we plan to purchase 20 ambulances per annum so as to address the backlog around ambulance vehicles. Sixty-two ambulances, 35 commuter transport vehicles and 19 emergency response vehicles were purchased at the end of the 2000-01 financial year. There is a possibility of going beyond the annual purchasing target of ambulances.
Ambulance emergency and commuter services will now be provided on a regional basis, with the central co-ordinating control rooms situated in Bethlehem and Bloemfontein. This will enable the department to provide more effective and efficient medical services.
Regarding quality care, factors that contribute to this goal include personnel, pharmaceutical services and equipment. In terms of personnel, we have managed to fill most of the posts which are essential in the delivery of health services. We have developed a human resource plan, the objective of which is to ensure that we have the optimum staffing level in our institution.
The state of equipment is something that will require urgent attention. Most of our equipment is not in good shape, and requires repair, if not total replacement. However, we believe that we are not at a crisis point as we have effectively developed a three-year strategic plan.
The situation as regards pharmaceutical and medical consumables has improved a great deal. To address the availability of essential drugs, the department has put in place a three-month stock level strategy. Strategies and programmes have also been put in place to alleviate the problem of theft of pharmaceutical and medical consumables.
There are major challenges that we have to address in our country as regards HIV/Aids. We are, nonetheless, moving with dramatic speed in terms of our interventions and strategies against HIV/Aids. Comprehensive home- based care is being rendered in the province and a strategy was approved during the workshop held on 21 March 2000 to extend the service throughout the province. Ireland Aid is considering a proposal that we have made to fund the Department of Health with an amount of R2,5 million over the next three years with the aim of developing NGOs working with the Department of Health’s financial and personnel management capabilities.
We are also refining strategies in order to implement research and training sites for nevirapine in Virginia and Frankfort by the end of July 2001. The department is also dispensing fluconazole in three of our hospitals, which are Universitas, Pelonomi and Goldfields, and this process will be extended to Bethlehem, Manapo and Boitumelo in due course.
We have also upgraded the HIV/Aids sub-directorate into a directorate as from 1 April 2001. The Free State established a provincial Aids council in February 2000 and will be establishing district Aids councils in each of the five districts by the end of June 2001.
To make services accessible for people with disabilities, the department has ring-fenced money in the department for assistive devices as well as prosthetic and orthotic services from the last financial year. We have established structures where NGOs are fully represented, namely assistive devices and rehabilitation committees. We have opened a third orthotic and prosthetic workshop in Bloemfontein.
In relation to TB, since the change-over to the new drug, no shortage has been experienced as regards TB drugs in the province. Currently, we are managing our MDR patients through the Santa Sandtoord Hospital in Thaba- Nchu, but we will be taking over the MDR unit at Moroka state hospital, which will be functional by the end of March 2002.
On 19 March 2001, a new joint agreement between the Department of Health and the University of the Free State was signed after 31 years. This agreement gives effect to the principles in the co-operative framework; promotes the provision of high quality education, training, research and health services by the school of medicine; and establishes a commitment to a long-term, sustainable and quality faculty of health sciences leading to excellent management, adequate funding and high standards.
We have recently been blessed with the arrival of two Tunisian doctors at the Goldfields regional hospital in Welkom to assist with cataract surgery from 4 to 15 June 2001. To date, 514 cases of cataracts have been operated in the province. In terms of oral health, we have procured three mobile dental clinics and 13 set of equipment for new dental clinics in the province to make the dental services accessible to rural areas.
Regarding public-private partnership, further impetus to quality service delivery will be provided by the public-private partnership that we will be entering into at the Pelonomi and Universitas hospitals around underutilised beds at these institutions. This partnership will be operational before the end of this financial year. It will bring along an injection of additional funds. The process will establish a very necessary working relationship between the public and private sectors and will ensure that the Free State gets maximal benefits from the available resources.
I want to thank the Development Bank of South Africa for financing the appointment of transaction advisers to manage the project as well as the unit for public-private partnership of the National Treasury for its valuable assistance in this regard.
The actions that we have taken as a province, as I have just outlined to the hon members, are the end of the beginning and not the beginning of the end. As we travel on this path of quality health service delivery, we are conquering milestones in terms of access, transformation and service delivery. All the milestones that we have conquered as the Free State give us hope that we have finally reached the end of this tunnel.
In conclusion, I would like to express my gratitude for the leadership of our hon Minister, Dr Manto Tshabalala-Msimang, because hon members must also understand that as various members who are leading various portfolios in provinces, we are not health activists, but through the leadership of the Minister we are really tackling challenges head-on in our particular provinces. [Applause.]
Mr B WILLEM: Chairperson, hon Minister, esteemed MECs, special delegates and hon members of the House, first and foremost I would like to deal with something that has been pronounced upon many a time, namely the question of service delivery. A famous British politician once said, ``A week is a long time in politics.’’
In the face of the challenges which confronted us when we swept away the old order in 1994 and ventured into the cobwebbed corridors of power bequeathed to us by the apartheid order, the past seven years have been short indeed. They have been short if we examine this period against the herculean efforts that we had to make to dismantle a system nurtured for over three decades.
I suppose that from this point of view, our understanding of power, its possibilities and limits imposes a greater sense of reality. The ANC-led Government is always concerned about access to health care facilities for all of our people. We know that in our areas there were insufficient and ineffective health services to deal with the inequities of the past. However, with our focal point being access to facilities to meet the demands of the people, we overlooked quality.
When the people in our constituencies started complaining about attitudes of staff, the long queue and the lack of medicine, we knew that we should shift our focus to improving the quality of care in all our health care facilities. With this in mind, the Minister and her department put their minds together and came up with the 1999-2004 strategic framework. This focus concentrates on accelerating the quality of service delivery in 10 key areas.
They describe this attention as a way of strengthening the implementation of efficient, effective and high-quality health services. The plan has very high goals and is very ambitious. With the co-operation of all the role- players, it is possible for us to fulfil the guidelines provided by the plan.
Over and above ensuring that certain crucial aspects like the cost of medicine - the second highest expenditure in the Department of Health - is kept at a cost-effective level, both the Ministry and the ANC members of Parliament are tasked with the responsibility of monitoring health facilities in their provinces.
We know that our Minister and her department are also dedicated to experiencing first-hand the challenges facing all nine provinces and to giving them the necessary support for the work they are doing to provide quality health care services, often under challenging circumstances. An example of this pledge to improve the service delivery of health care is the visit the Minister made to my province, the famous Eastern Cape, in October 2000. It was about time, as my province was threatened by the crisis of a depleting budget and increasing demand.
My Minister met with the premier and senior management in both the departments. As a result of this visit, the Eastern Cape drafted a short- term action plan, which they forwarded to the Minister. The director- general and a team of managers followed up the Minister’s visit to concretise the action plan and to offer support from the national department.
My colleague referred to our achievements as a province, which I will not touch on. The problems in health are highlighted, and the impression is left that health care has gone to the dogs. What we find in reality is that we do not have sufficient resources in the provinces to deal with the large needs, a large legacy of the past. At the same time, now that we have identified that there is a problem, I think the public representatives will have to work on a programme to ensure that our provinces are on track.
It is this kind of vigilance that allows us to rise to the challenges of rectifying and strengthening those areas in need. If we were an uncaring Government, we would have left the Eastern Cape in the mess we inherited from the Bantustan apartheid era, in which corruption was rife and little attention was given to the majority of our people.
Our policies allow for checks and balances, so that a problem can be nipped in the bud. Even this annual budget debate allows us to refocus on our spending patterns in terms of where we are going off track.
I know from experience the enormous task that the department has before it. As the ANC, which masterminded the services of delivery policies, we want to thank the Minister for her advances in a very difficult and often underresourced portfolio. We value the cheaper medicines, the foreign doctors, improved health facilities and all other help that the new Government has brought to our province. [Applause.]
Mrs B S MOHLAKA (KwaZulu-Natal): Chairperson, transformation is a buzz word and it is necessary. I feel privileged to participate in today’s debate. I will therefore talk about medicolegal mortuaries. Perhaps to define medicolegal mortuaries, these are mortuaries which handle mainly police cases. Let me go further by saying that deaths resulting from accidents of any nature - patients dying before arrival at hospital - are regarded as police cases and are therefore transferred to the medicolegal mortuaries which fall under SAPS management.
One often wonders whether present staff, excluding district surgeons, receive any form of training on the last offices, inter alia, setting the features of the corpses. It is gratifying that at last these types of mortuaries are going to fall under the Department of Health.
In KwaZulu-Natal the transfer of medicolegal mortuaries from the SAPS to the Department of Health is going to take place soon. Phase 1 will commence in August 2001. However, KwaZulu-Natal still needs a lot of funding as building costs have escalated over the past few years.
Recruitment and training of personnel, who will be responsible and who will be employed to work in these medicolegal mortuaries, should commence soon. In preparation for this big task, we hope that personnel involved in the handling of the dead will do their work in a more professional way, which must also include counselling the relatives.
We are all aware that the conditions of service of health workers, particularly doctors, nurses and other paramedics, must be revisited. HIV is sweeping the country. One gets very concerned at how infection control in these medicolegal mortuaries is going to be handled by untrained mortuary attendants. I have become very concerned that these handlers should not become infected with HIV/Aids. Therefore, a policy on mortuary attendants will have to be developed.
Mortuaries are not places to conduct mischievous practices such as hiding liquor, the illegal dissection of tissues from bodies for selling for financial gain, and even the mixing up of corpses. In most cases, suturing corpses remains and becomes the duty of police who assist during the postmortem. In fact, in that case, such fine procedures should form part of the training of medicolegal mortuary attendants.
In conclusion, let me sound a word of warning: The nursing fraternity must not be utilised at all in procedures carried out in medicolegal mortuaries.
I also request that regular inspections of these medicolegal mortuaries be carried out regularly, since they will be falling under the Department of Health.
I want to thank the hon the Minister for a very informative speech in this debate on Vote 15. [Applause.]
Dr R A M SALOOJEE (Gauteng): Chairperson, in the absence of our MEC for health, I would like to focus on some aspects of our successes, the challenges we face and the risks we are exposed to. The strategic priorities of the Gauteng department of health and, of course, the government, are to improve the health of the people of Gauteng, provide better health care services, and secure better value for money and effective organisation. There is a move away from incremental budgeting through a phase of budgeting for output towards the phase of output budgeting as required and defined in the Public Finance Management Act for better accountability. The Gauteng department of health’s expenditure framework for 2001-02 is consistent with these defined objectives of achieving equity through better utilisation of the resources and efficient delivery of services made available to the most vulnerable and needy groups in the Gauteng province. We know that there are constraints of budgetary allocations, but we must also be aware of the inefficiencies in structural and organisational sectors which do not need more money, but are willing to improve care, motivate, be compassionate and refocus on discipline and commit to delivering excellence.
The complex nature of the inherited problems of our health system and the chronic nature of all expenditure in the past appear to have stabilised. The department has to be complimented for moving into a phase of budgeting for output and continuous movement away from public administration to public management.
The sum of R32 million for financial management capacitation in central hospitals, the establishment of cost structures and the appointment of financial managers, internal audits and a shared service centre will enhance development towards output budgeting, as envisaged in the Medium- Term Expenditure Framework process, so as to achieve the defined goals of the Public Finance Management Act, thus favourably filling the gaps caused by the middle management shortage and lack of financial skills and thereby improving management systems at all levels of the provincial health structures.
One of our foremost priorities, of course, for the ensuing MTEF period should be the control and reduction of the virulent spreading of HIV/Aids. It is time to put to rest the confusing debates that have coloured the issues surrounding the epidemic. Whilst the fundamentals of our strategy to curb the epidemic are sound, we cannot remain complacent. Recent statistics show that in Gauteng there is an increase of 4% in the number of new infections.
We note that in the 2001-02 budget, additional funds have been made available, but the financial resources needed to counteract the spread will need more, much more, than the allocated funds and a greater willingness to review our present pace of action if we are to make meaningful inroads.
In Gauteng we support the establishment of home-based care, step-down and hospice beds, but our progress doing so is too minimal to be effective in the short term. As the availability of a vaccine is still years in the future - it may be three years or six years; we do not know how long it takes to develop a vaccine and what kind of duplication and replication of the virus may occur - certain aspects such as mother-to-child transmission and antisocial factors such as the alleviation of poverty, the abuse of alcohol, drugs and sexual violence, must receive aggressive attention.
When affordable drugs become available, the need for active antiretroviral treatment in certain appropriate circumstances must be seriously considered and, if necessary, implemented.
From statistics it is clear that there are significant shifts of patient attendance to primary health care clinics from hospital OPDs, from 41% to 67%, in the last three years. Furthermore, the rate of accessibility to health services has significantly increased in the last three years from 8,4 million to 12,8 million, an increase of 51%.
Never in the history of humankind has any nation or continent faced such a pestilent future. Those of us free from the contagion of HIV/Aids can never feel the pain and torment of those afflicted. We must place life above costs and profit. This is the least we can do to bring comfort and offer hope to the hundreds of thousands who will no doubt die, and the others who will be orphaned.
If we do not act appropriately and with a moral conscience, the consequences will be ghoulish and incomprehensible. This is merely a warning that all of us should take very seriously. We cannot, and must not, be duped by the change that has come as a result of the question of affordable drugs that is now in front of us, because that is merely a small issue in the greater context of the epidemic that we face.
The question we need to ask, especially when we look at the shift towards PHC as opposed to the central hospital, is: If we have a constrained number of personnel, which we currently have, over this period of increased accessibility, are we going to be able to provide equitable and comprehensive care and attention? Will the targets set by the health departments be realisable? Will the quality of care be sustained, especially in the light of the accelerated rate of the brain drain which is reaching serious proportions? This will have future critical consequences for continued adequate care for all in all the provinces that we are running, without doubt.
The answer is given by our own department. There are shortages in the following categories of nurses: operating theatre nurses, intensive care unit nurses, primary health care nurses, trauma nurses, and personnel providing palliative, neonatal and paediatric care. Thus the lack of nurses from level 6 to level 8, with post-basic clinical skills, poses a serious threat to patient care at all levels, leading to poor staff morale, and encourages moonlighting, which is a very prominent feature of health services in Gauteng, especially with the private sector being so well endowed.
We have a shortage of medical specialists in public health and family medicine, radiology, radiation therapy skills, neurosurgery, nephrology, oncology, cardiothoracic surgery, etc. There is a vast array of shortages that we need to fill. There is also a lack of allied health professionals in speech and audiology therapy, physiotherapy, occupational therapy and pharmacy.
We are aware that a number of steps are being taken in training nurses, with contractual measures being introduced. A skills audit is being instituted. Differentiated remunerative packages are being planned and incentives explored, but the rate of loss demands speed of action and forward planning.
For Gauteng, with the largest number of central hospitals and academic training facilities, the above deficiencies have serious implications. We believe this matter is very urgent. Academic institutions and health departments, both national and provincial, need to develop a sustainable strategy. Closer partnerships must be forged. There is such a big divide.
We held a workshop in the standing committee to bring together the three or four stakeholders to see where the differences lie. I can assure hon members that the chasm is so great that I think our Minister will have to pay greater attention to trying to create that partnership and to develop that infrastructure so that our health systems will not collapse in future as a result of the deficiencies that I have noted above.
Following on the above, our country should revisit the whole issue of allowing freer access to professional health skills from other countries, of course not from the deprived and the lower socioeconomic countries, be they nursing, medical or allied health professionals. I think I saw in the press today that there are more than 100 or 200 doctors waiting to be registered in this country. We cannot afford this kind of procrastination, which undermines our health system.
Last year we terminated limited private practice, because of its negative connotations, and introduced remuneration outside provincial services. This change seems not to have been applied or followed uniformly. As a matter of fact, it seems that many of those doctors are still functioning under the same limited private practice system as in the past. Assessment of the situation and the present level of implementation at various facilities is desirable.
We should all be glad to see the deployment of community service doctors. It has helped to alleviate the dearth of medical personnel at many of our institutions, but there appears to be serious dissatisfaction with interns who are being deployed under similar criteria. Many interns have to labour without outreach support and supervisory monitoring. They have to take decisions which they are not yet competent to exercise, and nonteaching clinical supervisory support does not exist, or is lacking, whilst others are better off … [Time expired.] [Applause.]
Ms L JOHNSON (KwaZulu-Natal): Mr Chairman, firstly I would like to thank the Minister for the comprehensive and well-thought-out speech she delivered this afternoon. I wish to express our profound appreciation for the support received from the Department of Health and the hon the Minister, Dr Manto Tshabalala-Msimang, when our province, KwaZulu-Natal, was struck by malaria and cholera.
I also want to address a special word of gratitude to provinces that sent retired staff to give us a helping hand. Their contribution helped us to contain the spread of cholera. Their support reminded us that South Africa is one country, and we are one people and one nation. During our struggle the labour slogan went: ``An injury to one is an injury to all.’’ KwaZulu-Natal is known as a province of outbreaks. First it was malaria, then foot-and-mouth disease and lastly cholera. The good news is that these outbreaks were well managed. The success story is attributed to the intersectorial collaboration, teamwork and community participation. The World Health Organisation team commended the KwaZulu-Natal department of health for the management and control of the spread of cholera, and keeping the mortality rate low.
Allow me to take a few steps backwards. Apartheid was indeed an expensive and wasteful system. Services were fragmented and duplicated. The present Government is grappling with the legacy of apartheid. It is unfair to expect the Government to undo the apartheid mess in seven years. Apartheid was nurtured over more than 40 years, and a lot of resources were used to maintain it. The present Government will equally need more resources to transform and restructure the apartheid structures. Despite all these constraints, the Government has achieved a lot in a short space of time.
Coming back to my province, KwaZulu-Natal, it is known as having a large rural population, and it is also one of the poorest provinces in the country. The vision and mission of the department of health is as follows: The vision is to achieve the optimal health status for all persons in the province of KwaZulu-Natal. The mission is to develop a sustainable, co- ordinated, integrated and comprehensive health system at all levels, based on a primary health care approach through the district health system. I must say the department is faring fairly well on this issue. We have already aligned the health regions with the new local government boundaries.
The topical area of concern is the shortage of professional staff due to emigration. Even this afternoon it is an issue that has been raised. It is also dominating our agenda as we keep on discussing the issues around service delivery. If this issue is not adequately addressed, it will paralyse the health services. I am glad to have heard this afternoon that the Minister has actually covered this area on human resource development very comprehensively. It indicates a commitment to addressing the issue of staff shortages. It is indeed encouraging.
In KwaZulu-Natal, the department of health is currently working on recruiting retired nurses back to the service, and the response is quite encouraging. We are also looking at increasing the intake of nurses, opening some of the colleges to train more nurses, and also improving the working conditions in some of our institutions.
With the opening of Inkosi Albert Luthuli Hospital very soon, there is also a concern that some of the staff will be moved from other institutions to that hospital, and that also will worsen the situation.
I will also briefly also touch on the issue of HIV/Aids. Again it remains a serious concern. The recent national study revealed that the infection is on the increase in KwaZulu-Natal. We support the integrated approach in the fight against the infection. [Time expired.] [Applause.]
Mr K D S DURR: Chairman, my congratulations to Dr Saloojee for a really honest, patriotic and excellent speech. [Interjections.] For a time, we in South Africa felt that we were going to kick disease and prolong healthy life. People were living longer and longer. Heart transplants and organ transplants gave hope of things to come. We were in the forefront against disease. Malaria had been banished from our country. It was something rarely found. I can recall debates, in which I was involved myself, about closing down certain TB hospitals, because of diminishing cases.
Great cathedrals to modern medicine like Groote Schuur and Tygerberg were built. Here great medical men did great things. My father was a doctor. He worked amongst the poor communities all his life. I know that the best medical attention was found in public hospitals for nothing, not in the fee- paying private hospitals. People from all over the world came to us to learn.
The hope was that when we had the great transformation and reform in our society in 1994, of which we are all proud, it would allow us to improve things further for everyone, and to take our society to new heights. But what has happened? The test is: Are people living longer, or are they living for a shorter time? That is the test of this department. The fact is that life expectancy is dropping in South Africa for the first time in 100 years.
It seems that our country is in the grip of one scourge after the other. HIV/Aids is a pandemic, TB is rampant, malaria and tropical diseases are now being reported in our major cities. Diseases like cholera, which were exceptional, have become commonplace. Medical aids, hospitals and health budgets are under stress. I visit the clinics in my constituency every time we have a constituency week. Everywhere I go the ambulances are not working, there are staff shortages, or there are shortages of medication of one kind or another. [Interjections.]
We are losing some of our best doctors to emigration, people like Dr Ike Nzo, and replacing them with third world Cubans. [Interjections.] That is a reality. In the bad old days we used to say that one cannot practice normal sport in an abnormal environment. I agreed with that. But in the same way one cannot practice health in an unhealthy moral environment, devoid of a value system. Respect for the sanctity of life should be paramount.
The scourge of Aids and related diseases is as much a problem of values as it is a medical challenge, and there are too many mixed signals coming from the Government. It is no good taking a tough line on smoking - saying that people cannot smoke in certain places and children cannot smoke, but at the same time condoning sexual deviation, pornography, promiscuity and prostitution as being acceptable practices, and then being surprised at the escalating level of sexually transmitted disease which comes as a consequence.
In our society, abortion has become less hazardous than going to have a tooth extracted.
Unless the Minister and the Government begin to roll back this humanist legislative assault upon South Africa’s value systems, family values and basic morality, the health of this country will go nowhere.
Just as the abolition of slavery and apartheid, representative government and labour reform were the products of the value system of the society that gave birth to these great notions, so it is with public health. A healthy society will underpin good public health services, and we do not have that in our country. Therefore my party opposes this budget. [Applause.]
Mr C R REDCLIFFE (Western Cape): Chairperson, I am honoured to be back here in this House, where I spent some time as a senator, and look forward to taking part part in this very important budget debate. We count ourselves fortunate in this province to have a well-developed health care infrastructure, from primary health care to a full range of available services and a strong academic and a research base. It has taken hard work over the past seven years to deal with transformation, downsizing and consolidation, and still to remain a respected international player which can attract top candidates to fill vacancies.
Thanks to some astute long-range planning, consolidation can now be rounded off within budgetary parameters in this budget year, and in the following one, too. In short, the Western Cape health department can be commended on the job that it is doing, not least for its willingness to help health care staff and patients from other provinces.
I foresee the interdependence of provinces growing in importance, and not least in two of the three major fields of health care in Africa, considering the following from the last week’s edition of the respected journal The Economist. Referring to the UN’s mooted worldwide fund to contain TB, malaria and HIV/Aids, The Economist noted that $7 billion to $10 billion a year will be required, yet a rather modest United States offer of $200 million dollars has been the only one forthcoming.
Sadly but clearly, we could still be waiting for doomsday if we depend only or mainly on outside help. Our voice must go out from this Council of Provinces for stronger interprovincial and international co-operative ventures, particularly in the face of malaria, HIV/Aids and tuberculosis.
Our programme against Aids takes cognisance of the strong synergy between HIV/Aids and TB, which is still rife in our province. The big difference between TB and HIV/Aids, apart from the mechanism by which they are contracted, is that the one can be cured and the other cannot.
TB is the single most prevalent communicable disease, and it was declared an emergency in the province in December 1996. There are many factors that drive these two diseases together. When there is a confluence, they conspire to bring about rapid death.
Prof Gary Maartens of the University of Cape Town has pointed to the dramatic increase in TB once the HIV/Aids prevalence is high. He has stressed that preventative therapy works best where a control programme is firmly established.
The reality of this decade is that the incidence of HIV/Aids is increasing. Despite the enormously negative impact of HIV, a well-run TB treatment programme based on the directly observed therapy strategy, Dots, remains an important response to the TB epidemic. A partnership involving the patient, health authority and community can help limit the effects of TB.
In March last year, we adopted the World Health Organisation’s Dots strategy in its entirety. Since then it has been supported, refined and successfully implemented. We have seen a sharp increase in the number of Dots workers in the past year. Without this, the situation would have been far worse. We owe them a deep debt of gratitude.
As the confluence of HIV and TB increases, we are going to need more people trained in Dots. Too many people are still leaving their jobs or getting fired if they contract tuberculosis. Researchers have stressed the need to go to the workplace if we are to improve our success rate. The employers must be encouraged to allow their employees who have contracted TB to keep working. Supportive employers could assist by becoming part of the Dots programme, and perhaps by working with the patient’s family. Fellow employees must be counselled, and asked to support their colleagues until they can be fully reintegrated, which often takes a few weeks.
In South Africa there are two further imperatives that drive this scenario. Labour legislation is being tightened on every front in order to address historically skewed patterns of employment. Labour unions are acutely aware of the move to replace personnel in jobs with contracts. Employers must be alerted to possible long-term advantages, and where they find that it is cheaper to treat a worker with TB than to train a new one, the experience must be shared with the business community. Health education plays a very important part in strengthening these ties.
In the end, life comes down to family. It is up to the patient who has contracted TB and his or her family to go to the clinic immediately, and, in addition to be aware of the issues around acquiring the HIV. The stigma still attached to TB must be addressed in every community and throughout every province. The true nature of the link between HIV/Aids and TB must be explained repeatedly. It is imperative to destigmatise both these conditions, if we are to make inroads into either HIV/Aids or tuberculosis.
Our distinguished visitors may have noticed that we have been bold and alone in introducing two of our interventions. I would like to explain our rationale for our campaign to prevent mother-to-child transmission of HIV/Aids, and our announcement this week on extending antiretroviral treatment for rape victims.
Each of the five points in the programme that the Western Cape has adopted against HIV/Aids has, in specific ways, been taken further than usual, for example by means of voluntary counselling and testing for HIV.
What will persuade people to act in a way that will protect their status? Facing the reality of the status will influence the action. If one is HIV- positive, one focuses on preparing for the future and not infecting others. If one is not, while having undergone the trauma of testing, then one can often be persuaded to behave in a different way. In voluntary testing and counselling the results are kept private, to minimise the threat that testing poses for some.
What is it that will persuade people to come forward and know their status? There must be something for the individual, and the answer is treatment. That is the basis of the programme to prevent mother-to-child transmission of HIV/Aids - that is, treatment, so that the unborn baby can have a chance.
Our core health programmes are, firstly, the treatment of sexually transmitted infections; secondly, the prevention of mother-to-child transmission; thirdly, voluntary counselling and testing services; fourthly, treatment of opportunistic infections; and, lastly, home-based care.
As far as STDs are concerned, we have a prevalence of 5% to 8%. Effective treatment of STDs leads to a reduction in HIV transmission of up to 40%. A new syndromic management approach is required. The public sector treats 125 000 STDs every year in provincial and local authority facilities in the Western Cape. The private sector treats about 60% of STDs. In the Western Cape 170 GPs have received further training, and we will provide free syndromic drugs to them to treat STDs.
Our programme to prevent mother-to-child transmission of HIV/Aids is recognised internationally. Of the 70 000 deliveries per year, 8,7% are HIV- positive. In Khayelitsha we have had the AZT programme in place since January 1999.
Between that date and December 2000, there have been 14 000 antenatal attenders and 71% accepted voluntary counselling and testing; 18% are HIV positive, and 1 700 HIV positive women were treated. Of the 538 babies tested at birth, 90% are HIV negative and the programme is continuing in a very successful way.
The national Minister announced in August last year that there would be two test sites using nevirapine in each of the nine provinces. We were eager to change to nevirapine as the legimen preferred by the World Health Organisation. We started with nevirapine in Guguletu on 4 January 2001. In Vanguard, Paarl and George we started in May, and we will be commencing soon in Worcester as well.
Altogether, mother-to-child treatment will be offered to 23 000 women at these sites at more than 50 antenatal and child health clinics already covering approximately 50% of HIV pregnancies. [Time expired.]
Mr S MOLOTO (Northern Province): Chairperson, Minister, and hon members, we wish to seize this opportunity afforded to us by this House to highlight our views on the policy debate in respect of the Health budget. We would also like to add our voice of appreciation to the good leadership that the Minister continues to provide to the health sector.
Perhaps it would be proper to sketch out the Northern Province scenario to the House. The province remains one of the poorest, with a total population of about 5 million, the majority of whom are the youth and the elderly. The province is 90% rural, with an unemployment rate of more than 46% and about 40% of the adults being functionally illiterate.
The province is also characterised by problems of infrastructural backlogs, such as a lack of clean water and sanitation facilities, and poor road networks. All these factors continue to have a bearing on our capacity to discharge our constitutional mandate of delivering quality health services to our people.
During the past seven years, our department has succeeded in fast-tracking the delivery of health care services to the communities through the implementation of primary health care policy. Our roll-out programme for hospital rehabilitation and clinic building has made a positive impact in the lives of our people. We have succeeded in increasing the number of clinics built in from 312 in 1994 to 474 in 2001. At least 164 of these clinics are now rendering 24 hour services. Mobile outreach programmes are in place for villages that are not within walking distance from the nearest health facility.
Due to the improved access to the health services, we are able to reduce the morbidity and the mortality rates for priority diseases such as polio, measles and TB. The infant mortality rate in the province has dropped from 57 in 1 000 live births in 1994 to 37,2 per 1 000 in 2000. Immunisation coverage currently stands at 90% for polio and 100% for measles. The TB cure rate has been improved to about 75%.
The Northern Province, like KwaZulu-Natal, has been severely affected by the sudden outbreak of the cholera pandemic. Our swift and hands-on actions in terms of the multidisciplinary approach and intensive health awareness campaign have succeeded in curbing the spread and fatal effects of this pandemic. It is expected that if further measures are not taken for the provision of potable water and adequate sanitation facilities, this pandemic will still pose a serious threat during the coming summer seasons.
In the last malaria season, we saw a drop in the malaria fatality rate from 0,76% to 0,68%. We are grateful for the support of the national grant of R16 million, through which we have employed sufficient seasonal sprayers and sprayed more than 700 000 houses for this season.
Our administrative records on the pharmaceutical distributions suggest a marked improvement in the supply of medicines to our health institutions. Whilst this is the case, we are continuously receiving complaints from communities about the shortage of medicines in our hospitals and clinics.
Our primary school nutrition programme is going relatively well, with a total number of 1,3 million learners being fed for 196 school days a year. We are still exploring better ways of improving primary school nutrition programmes through a broader community involvement. Our view is that this programme should be linked with other Government poverty alleviation interventions.
The department is making significant progress in realigning health districts with the new municipal boundaries. We do, however, remain conscious that it is going to take some time before most municipalities are able to carry out their health delivery responsibilities.
In our last interaction with the municipalities, it was mutually agreed that the process of devolving such responsibilities should be finalised by 31 December 2002. Furthermore, we have put in place three distinct levels of care with a clear chain of referrals from primary health care centres through to district hospitals and to secondary and tertiary services.
We have also witnessed an improvement in the patient-doctor ratio since the introduction of the community services. The department is faced with the challenge of recruiting and retaining enough doctors in the province, with the retention rate consistently remaining at about 14% despite all the incentives that we have put in place to encourage them to remain in the Public Service. In fact, our doctor population is dominated by foreign doctors who continue to experience problems of cultural and language barriers. Over and above these social obstacles, they also experience problems regarding issues of work permits and approval for permanent residence which often turn out to be demoralising factors.
The health sector has been experiencing incidents of dropping service delivery standards. This has been characterised by acts of misconduct and negligence among our personnel. The department is doing everything possible to deal with the problems. Over and above the stern measures that we are instituting against the perpetrators of these acts, we are also embarking on service delivery improvement workshops in order to sensitise our personnel about the need to adhere to the Batho Pele principles.
Our department is continuing to experience problems with the shortage of personnel, which leads to general demoralisation and burn-out. Of the total staff complement of 37 909 that the department requires to render health services fully, only 23 415 posts are filled, thus leaving a shortfall of 14 494 vacancies. Worse still, our budget can only accommodate 1000 vacancies in this current financial year.
As has been stated in the previous policy debates of this House, the Northern Province health sector continues to be underfunded. Funding for health in the Northern Province stands at about 17%, whilst the national average is about 24,8% per capita expenditure. This explains why we are still unable to fill these vacant posts, and equally unable to fund other cost pressures like rank-and-leg promotions as well as second and third notches.
Arrears in respect of rank promotions require additional funding of R32 million. We have since negotiated with the unions for this payment to be spread over a period of three years. Equally, there is a shortfall of about R21 million on payments of second and third notch promotions.
We are equally faced with the challenge of improving our emergency services. We have always argued about whether it is appropriate to fight for allocation to purchase a new fleet of ambulances, which will be awaiting attention in the Government Garage within a short period of time due to poor road infrastructure, or put the money aside in order to improve infrastructure. Besides these arguments, there are still no adequate allocations for the replacement of our ambulance fleet.
The HIV/Aids epidemic remains a serious challenge to the Northern Province as much as it is to the rest of the country. The rate of prevalence in the province stands at about 13,2%, being the third lowest in the country. We have vigorously stepped up awareness campaigns which culminated in the launch of a provincial Aids council representative of all the sectors in the province. As part of the national programme, the province has also identified two research sites for mother-to-child transmission at Mankweng and Silom Hospitals.
Preparations are at an advanced stage for the actual implementation of the programme. The department has also embarked on a programme of voluntary counselling and testing in most of the health institutions in the province. More than 400 people throughout the province have already been trained for this purpose. An integrated home-based care programme is being planned, with four sites already identified. We are hoping to expand this programme with an additional six new sites before the end of this financial year.
Through the provincial Aids council and other forums, we continue to intensify our awareness campaigns and social mobilisation. We have already established contacts and conducted health education in places like taverns, shebeens and truck stops throughout the province.
All these challenges and highlights should serve to draw the attention of the House to the fact that provision of health services in the Northern Province has not been without impediments. However, it should be noted that we will continue to be equal to the task and match the challenges. [Applause.]
Mr B J MKHALIPHI: Chairperson, hon MECs present here, hon Minister and members of the National Council of Provinces, I arise to tender an apology for our hon MEC, who could not make it to this sitting due to some emergencies in the province. Our vision in the province remains that of achieving the optimal wellbeing of all inhabitants of the province. We want to achieve this by ensuring the provision and promotion of transparent health services that address the basic needs of the inhabitants through a decentralised, holistic primary care approach in a caring and a gender-sensitive manner in order to develop self-reliance in a safe environment.
In an attempt to achieve these broad goals and objectives, the following are prioritised: tackling HIV/Aids, improving child and adolescent health, improving women’s health, managing chronic conditions and improving mental health. Of course, the other priorities are as follows: reducing infectious and parasitic diseases, improving primary care services, endorsing and promoting the Patients’ Rights Charter, improving medical emergency services, developing the workforce, improving hospital services and also improving pharmaceutical services. All these priorities form the backbone of service delivery.
The biggest threat to Africa’s economic development and growth is HIV/Aids. The Mpumalanga province is largely rural and rates the highest in terms of the prevalence of HIV/Aids in our population. Of course, we are not proud of this situation. The prevalence of HIV has slightly increased from 27,3% in 1999 to 29,5% in 2000. However, it has been observed that the prevalence is decreasing. The highest HIV prevalence continues to be in the 25 to 29 - year age group, rated at 38,77%. The prevalence rate among the 20 to 24- year-olds has risen to 36%. Of the three districts in our province, Enkangala continues to have the lowest prevalence of HIV at 20%, while the Ehlanzeni and East Vaal districts stand at 34% and 35% respectively.
Given the above-mentioned scenario we cannot just fold our hands. The department will continue to enhance the development of social awareness and mobilisation initiatives. To date approximately 40 master trainers on voluntary counselling and testing have been trained. Training on rapid testing has also been conducted. It is encouraging to note that awareness levels and the demand for condoms have increased. Condom distribution sites have increased by almost 40% in the province, with government departments now having their own condom sites for distribution.
The impact of condom distribution and appropriate management has already reduced sexually transmitted diseases such as syphilis and gonorrhoea. We believe this strategy will have a positive impact on reducing the spread of HIV. The plan for the project to prevent mother-to-child transmission of HIV is at an advanced stage. This is being implemented at two research sites, one urban and one rural. The urban one is in Evander and the rural one is Eshongwe Hospital. The site committees and pharmacists are finalising logistical issues relating to training and pharmaceutical supplies. Interviews for the post of chief community liaison officer have been held.
The launch of the Mpumalanga Aids Council, which was held in March 2001, will strengthen the partnership between government and civil society in our fight against the spread of HIV/Aids. Plans are also in place to launch the district and local Aids councils with the Enkangala District Aids Council due to be launched on 15 June 2001.
The Demarcation Board has come up with far-reaching recommendations which our province needs to adjust to. Our department has already made a policy decision to have three health districts in line with newly demarcated districts. The new health districts are already integrating the old districts in line with the new developments.
Our emphasis is on continuing to sustain a primary health care approach, which is the effective means of providing an essential primary health care package, by ensuring access to water, sanitation, nutrition and basic health services based on prevention, health promotion and education. Our aim is to ensure that we bring health services closer to the people, especially the rural poor. We can only achieve this by building clinics and availing the necessary resources for the functioning of these clinics.
There has been a reasonable increase in the people who have visited our clinics between 1999 and 2000. In 1999, 4 930 million people visited our clinics while in 2000, 4 949 have visited our clinics. This indicates an increase of patients of about 19 000. This clearly indicates an increase in the number of people who receive primary health care services.
It is also encouraging to note that there has been a decrease in cases of severe malnutrition, with an indication of about 15 926 in 1999 which decreased to about 15 305 in 2000.
Intervention measures have been also put in place to improve the state of our emergency medical services. One hundred and fifty posts were advertised and filled in that section. Thirty ambulances were purchased and the first consignment was delivered in April 2001.
The majority of these ambulances were allocated to the rural areas. This contributes positively to service delivery.
The introduction of 35 community pharmacists has also had a positive impact. We also believe that the introduction of the basic accounting system, the BAS, and the decentralisation of bank accounts will improve the pharmaceutical services. Our main goal remains that of transforming service delivery. We will attain this by providing impartial, fair and equitable public services.
Implementing the Batho Pele principle should be a dynamic process which aims at reforming public services based on the needs of the customers, either internal or external, and developing a relationship between public servants and their individual clients. The launch of the service standards has not yet yielded the desired results, and we have taken a calculated decision to relaunch them. A process has already been started in this regard.
In conclusion, I would like to request the House to acknowledge and be part of Youth Month. As we do this, we will be honouring the martyrs of our struggle: the Solomon Mahlangus, the Tsietsi Mashininis and others. [Applause.]
Mrs M KHUNWANA (North West): Chairperson, allow me to greet the hon the Minister, MECs present here, colleagues, ladies and gentlemen. Allow me to apologise for my MEC, who was unable to come because he had to launch SMMEs in Taung.
With regard to emergency medical services, I wish to confirm that the transformation process is firmly on track. In terms of the South African Constitution, ambulance services are the competency of the provincial government. We have no doubt that the result of our transformation process will be a uniform, quality and equitable provision of services across the province. When our work is done, every village or health centre should have an ambulance. Our fundamental objective is to establish a fully fledged emergency service with a capacity to deliver an adequate and effective service. We will also ensure that we have an adequate number of well-equipped emergency vehicles. We are in the process of appointing 324 people, half of whom will be women. All administrative posts will be reserved for people with disabilities.
Towards the end of last year, a total of 25 ambulances was purchased and distributed equitably across the province. We expect to procure 32 more ambulances in the next few weeks. We are satisfied that these measures will contribute towards creating an emergency service that will respond adequately to the needs of all our people in the province.
Regarding the historically disadvantaged students, our largest contribution in the admission of students is nurse training. We do this through the provision of funded posts for the Universities of Potchefstroom and North West, and the Excelsius and Mmabatho colleges of nursing. Eighty per cent of these students are from rural backgrounds.
Our greatest challenge in terms of empowering students from historically disadvantaged backgrounds is in respect of the largely skewed profile of students at the University of Potchefstroom. However, we are in negotiations with the university with a view to reversing this trend. We need to enforce, without fear, the requirement that institutions of learning such as this university become more representative and overcome the historical racial imbalances.
The equity criteria which characterise selection for Cuban medical training cannot be overemphasised. In particular, a large intake of this programme has been young women from rural backgrounds.
District surgeons in the North West have been given letters informing them that their contracts will be terminated. This decision is consistent with the statement made by the MEC of health, Dr Molefi Sefularo, in his previous budget speech in April 2000.
Dr Sefularo has in the past made the following observations about district surgeons, and I quote:
… many district surgeons have not returned our gesture of reconciliation and co-operation. We continue to see separate consulting rooms for blacks and whites. Many district surgeons still reject the values of our new society. They are using every ounce of their energy to undermine all efforts aimed at reconciliation and transformation of services. Our patience has been stretched to the limit.
Those who wished to remain were given the option of doing so on different terms, terms that define them as a secondary level of care for indigent people and part of the Public Service. Among other things, they will be expected to work fixed hours and provide services at public facilities like clinics, community health centres and hospitals. Their contracts will be renewable upon satisfactory performance.
A separate group of doctors, led by regional specialists, has been appointed to look after our medicolegal and forensic services. This, we believe, will improve our health service, our human rights record and our services to the courts in cases of criminal offences like rape, drunken driving and violent crimes.
The department wishes to stress that full-time medical officers have been trained to perform forensic medical services as part of their normal duties. Currently, there are 32 full-time officials trained to perform these services in the North West.
As is the case with other rural provinces, the North West continues to find it hard to attract and retain medical professionals, especially specialists. The community health service programme for doctors, dentists and pharmacists remains one of the central pillars of our strategy to alleviate the critical shortage of doctors. The other strategies are the Cuban programme and the telemedicine project.
Areas where a serious shortage of doctors is being experienced include Brits, Ganyesa, Kuruman and rural Moretele. Potchefstroom and Klerksdorp are urban areas with the worst indicators for primary health care services. We will therefore be shifting resources to these areas of great need.
Regarding the speeding up of integrated primary health care services through district health services, we have 18 well-functioning health districts with fully fledged district management teams. The districts provide comprehensive primary health services: that is, clinical primary health care programmes through provincial clinics, community health centres and district hospitals and nonclinical services through district offices and their primary health care programmes, for example environmental health care.
The primary health care services are delivered in an integrated function. This is further enhanced by the advanced development of the biggest allocation through the creation of functioning cost centres and units. Each individual district is allocated a budget which is subdivided to all programmes according to cost units and monitored by programme managers.
The department intends to improve the working and living conditions of our dedicated personnel.
Concerning youth and school health, through partnership with the Department of Education, 15 health-promoting school projects have been conducted in the year 2000.
Twelve schools have participated in the Breast Cancer SA competition. This project was aimed at educating young women on how to prevent and how to detect early breast cancer. The province has launched five new adolescent and youth centres. Including the old one in the Winterveldt, six centres are currently fully operational. This has been done with the aim of encouraging youth to have free access to health facilities without being labelled or ill-treated by health personnel.
Regarding hospital services, the visible chant in our hospitals is for an improved quality of service. The focus in all our hospitals is on quality patient care and sound hospital management. The appointment of hospital general managers is having a positive effect on the performance of hospitals based on the key hospital performance indicators. This has resulted in a decline in hospital stays and a decrease in outpatients. This is mainly due to the Cuban programme and community service doctors and dentists.
From 1 April 2000 we decentralised the primary school nutrition programme. The initiative was first implemented in the Bopherema region, followed by the Klerksdorp region or the southern district, Mafikeng, the central district and, finally, Bojanala.
At all times, we prefer some form of co-operative instead of individual operators. [Time expired.] [Applause.]
Mrs A M VERSFELD: Chairperson, I am delivering this speech on behalf of Mrs Embré Gouws, who is currently in Korea. We believe that health services must be accessible, equitable and efficient. Currently, state hospitals are overcrowded, undermaintained and underresourced. In a submission to the Department of Finance contained in the 1999 budget of this report, the Department of Public Works said that unless R8 billion was spent on rehabilitating existing health facilities, 30% of existing infrastructure would soon be beyond repair.
Despite this, there has been a per capita decline in public-sector health care spending since 1996. The virtual collapse of public health care means that effective treatment for life-threatening diseases like cancer, Aids and tuberculosis is surely undermined.
Poor working conditions and pay have forced a steady stream of doctors and nurses out of the public sector. These posts are generally frozen, putting greater pressure on remaining staff and risking patients’ lives. According to the SA Nursing Council, 300 nurses a month are leaving South Africa without being replaced. What is the Minister going to do about the brain drain of doctors, nurses and other health care professionals?
Provinces do not have affordable retrenchment or redeployment tools, so they cannot remove nonperforming staff. The extent of the collapse is so bad that patients must sometimes supply their own food and bedding. Hospitals and clinics do not have all the necessary drugs and are forced to treat seriously ill patients with inferior medicine.
The World Health Report 2000, a World Health Organisation report which measures how effectively countries use their health resources, rated South Africa 175th out of 192 countries in the year 2000.
The Government’s priority has been to change the focus from secondary to primary health care. This change has been implemented too fast. In 1997, at an international health conference in Durban, a petition was drawn up and handed to the then Minister, which dealt with the issue of recruiting and training health care workers, doctors and nurses in rural areas. This was done so that the problems in clinics, especially in the rural areas, could be addressed and overcome. The then ANC Minister never responded.
There are so many unresolved health issues in this country. Rural health is one of the important areas in which the Government has claimed success, but that is not true. We have the Aids issue, the TB issue, which is also one of the highest in the world, and then the bad management, on the Minister’s part, of merger … Six minutes? [Interjections.]
The DEPUTY CHAIRPERSON OF THE NCOP (Mr M L Mushwana): Order! Will you please take your seat, hon member? What is your point of order, Mr Lucas?
Mr G A LUCAS: Chairperson, I just want to find out if the hon member is prepared to take a question. [Interjections.]
Mrs A M VERSFELD: Chairperson, Yes, I am prepared to take a question.
The DEPUTY CHAIRPERSON OF THE NCOP (Mr M L Mushwana): She is prepared to take a question, hon member. Mr G A LUCAS: I just want to find out where she gets her statistics about the issues related to rural health and so forth. Who gave her those statistics?
Mrs A M VERSFELD: Chairperson, I said right at the beginning I was delivering the speech on behalf of Mrs Embré Gouws and not on behalf of myself. [Interjections.]
The DEPUTY CHAIRPERSON OF THE NCOP (Mr M L Mushwana): Order! Continue, hon member.
Mrs A M VERSFELD: Chairperson, we have the HIV/Aids issue and the TB issue, which is also one of the highest in the world, and then the bad management, on the part of the Minister, of the merger of Fedsure Health and Northern Medical Aids. It now appears, according to auditing firm KPMG, that the merger should never have taken place. There are thousands of people at risk, yet nothing is done by the Ministry of Health.
The DA policy focuses on decentralising services by creating independent management units and reviewing the tangle of bureaucracy governing public health. This will allow for closer control and more direct accountability. The people are suffering, the people are dying. The Minister must please take action.
Samuel Johnson, a writer and a philosopher, said:
Health is, indeed, so necessary to all the duties, as well as the pleasures of life, that the crime of squandering it is equal to the folly.
Mrs E N LUBIDLA: Chairperson, I say to Mrs Versfeld: ``Walala wasala.’’ [You snooze, you lose.] [Interjections.] [Laughter.] Hon Chairperson, hon Minister, hon members, firstly, I want to render an apology on behalf of MEC Peters to the House for her absence from these proceedings. I am informed that owing to other urgent commitments, which were unforeseen, Mrs Peters could not be present though she would have wanted to. It is therefore indeed an honour and privilege for me to represent the Ministry and the department on the sterling work and performance of the Northern Cape health department.
We are satisfied that our people have witnessed our practical commitment to quality health care. However, we still believe that a lot needs to be done to improve and better the daring efforts of our health professionals, managers and personnel in general.
The local government elections in December 2000 represented a critical moment with far-reaching implications for health service delivery. The new dispensation ushered in a new window of opportunity for our department to accelerate the decentralisation and devolution of health services to the local authorities. The department’s districts have been aligned to the new district municipality boundaries.
Pursuant to our decision to devolve district health services to local authorities, a task team was constituted by the MECs of health and local government and housing to give effect to this decision.
The task team is representative of all role-players, including representatives from labour, local authorities and the two departments. The team works in close collaboration with the national district health committee. The task team will report on its work by September 2001, which report will then be submitted to the MECs for their consideration and finalisation.
It is anticipated that the devolution of services will take effect in July
- The department is gradually moving towards its target of achieving employment equity and representivity in terms of demographics, skills and gender.
Currently the department reflects a female gender dominance because the core of our workers is female nursing professionals. It is anticipated that in this financial year, we will increase the component of male nurses by 10%. While there is female dominancy at the level of professional caregivers, at management level there is an overdominance by males. This situation will be corrected.
Some 60% of our staff are health professionals. We strive for representivity of the disabled. The health faculties from which we draw our labour force are not producing graduates from this sector of our society. Thus we could not meet our target of 2% of our workforce being from the disabled community. However, we are engaged in talks with the office for the status of people with disabilities and the office of the premier to find a common strategy on how best to address this shortcoming.
We continue to adhere to the prescripts of the Skills Development Act. Currently 18 porters are being trained as nursing assistants. The staff nurse post is being done away with and all staff nurses are being retrained to qualify as full professional nurses. Others are being trained in the discipline of midwifery and related fields. This training runs over a two- year period. With a cadre of 140 staff nurses already trained, we can see the difference.
Services are being improved through the introduction of a core package of primary care services. A major constraint is the extensive distances and the low population density in the province. These limit our ability to ensure optimal access to certain services, irrespective of the major strides that are being made in improving access to services. Community service doctors are being deployed in remote areas with supervision being provided by large hospitals and private, sessional doctors.
Community service doctors also rotate through hospitals such as the Kimberley and Gordonia Hospitals. Cuban specialists at Gordonia Hospital in Upington have significantly increased access to these services for the western half of the province. Cuban family physicians are also deployed in remote areas. Five community pharmacists have been deployed since January, and this has improved our medicine management, giving better access to medicines. In July 2000, eight community dentists were deployed. This number was increased to 11 in January and by July 2001 we will have a total of 13 community dentists.
Access to oral health services has significantly increased. We foresee greater improvement in all oral health services through the integration of oral health promotion in primary health care programmes. R2 million was spent on dental equipment to ensure the maximum utilisation of these dentists.
The 24-hour services which were available at hospitals are being extended to other nurse-driven primary care centres. The implementation of this process will be achieved over the next two-year period. The challenge for the coming years is to ensure the availability of at least two professional nurses at 50% of these facilities. As with the decision for a 24-hour service, the implementation of this policy position is anticipated over a two-year period. In 2003 this will greatly enhance the capacity of these health care centres to, on the one hand, handle more patients, whilst, on the other, improving the levels of care and service at these centres.
Also in line with our decision to create a user-friendly environment for our clientele, access for physically disabled people is being attended to. This involves improvement to the physical structures such as erecting ramps at entrances and ablution facilities that are comparable to the required standards for disabled persons. A new clinic for the Green Point community has been completed and is fully operational. New clinics will also be built at Sanddrift, Strydenburg and Kujasa in Colesberg. Providing primary care facilities at Schmidtsdrift and Platfontein for the Batlaping and the KhoiSan communities will receive our primary attention.
The department has committed itself to improving the standards of care by upholding the Patients’ Rights Charter, which was launched in March 2000. In addition, we continue to emphasise the effective implementation and observance of the Batho Pele principles.
Since the launch of the Patients’ Rights Charter, reports of rude and unprofessional behaviour by our staff members have dramatically declined. As a department we are of the view that such behaviour constitutes a gross violation of our people’s rights to dignity and health.
The department has constantly stated its position that action will be taken without any hesitation against any employee whose action or behaviour has the effect of undermining our public commitment to the principles of Batho Pele and the provision of the Patients’ Rights Charter. [Time expired.] [Applause.]
The CHAIRPERSON OF THE NCOP: I must commend the hon Mrs Lubidla on her very valiant attempt.
Mrs J N VILAKAZI: Chairperson, hon Minister of Health, Dr M Tshabalala- Msimang, hon members, on behalf of the IFP I congratulate the hon the Minister and her department on the great task she and her department have performed up to now.
I would also be failing in my duty if I did not also congratulate the chairperson of the portfolio committee, the hon Ms L Jacobus, and the committee members for all their contributions towards the proper functioning of this committee.
The Department of Health is very complex in nature, heavily laden with work and heavily challenged by various health and social problems. One of the challenges facing the Government and the department in particular is rural health. Health conditions are still very bad in rural areas where people have lived for many years without health facilities.
This situation makes it difficult for the Government’s labours to bear any visible fruits at this point in time. After all, this is the legacy of the previous apartheid system.
The HIV/Aids pandemic is the worst health hazard confronting this department in my province, KwaZulu-Natal. The sting of this health hazard is experienced by a broad spectrum of society.
Besides the killer disease HIV/Aids, tuberculosis is still claiming more lives, and so is malaria and the cholera epidemic, although it is now declining. I can name quite a lot of diseases. KwaZulu-Natal is still hard hit by life-threatening conditions.
Besides the contemporary health hazards I have just mentioned, the health sector is highly affected by the heavy workload experienced by health care givers. The heavy workload is worsened by shortages as a result of absenteeism, because the care givers are also not immune to the hazards I have just mentioned. Then there is the brain drain of highly skilled personnel who leave the country for greener pastures abroad.
Staff members are overworked as they stay long hours on duty in overcrowded wards. The situation is really unbearable in clinical areas. Overcrowding, besides draining care givers’ strength and energy, also drains medicine supplies and other essential resources. The budget is placed under stress and this leads to a failure to accomplish certain goals. In other words, quality care to patients becomes lip service.
Thina be-IFP sisibona singengcono neze isimo kwezempilo. Angisho ukuthi ngisola uNgqonqqoshe noMnyango wakhe - uthwele kanzima. UNgqongqoshe wezeMpilo uphathe esimeni esibukhuni sokuhlaselwa yizifo ezinhlobonhlobo. Mina nje, isifundazwe sami saKwazulu-Natali sesiphelile ubhubhane lweNgculazi. Singcwaba masonto onke izinqwaba zabantu. Nansi i-TB nayo ayizibekile phansi. Nayo iyaqotha futhi ithi uma isihlangene neNgulazi sibondwe sibe sinye. Kuyosala bani? Nangu nomalaleveva naye akazibekile phansi. Kukhona nesifo sohudo naso esihlasele sacoboshisa KwaZulu-Natali. Yingakho ngithi uNgqongqoshe walo Mnyango uthwele kanzima.
Sinethemba lokuthi uMnyango wezeMpilo uzobhincela nxanye uzame amakhambi okuthiba lezi zifo. Sizwile ukuthi ukuze igciwane lingaweleli emntwaneni, sekuyaqalwa ukuthi kusetshenziswe ikhambi lokuvimbela lokho ko-King Edward VIII Hospital, Prince Mshiyeni Hospital nakwezinye izindawo. Kodwa thina be- IFP siyakubona lokho futhi sihambisana naye uNgqongqoshe. Sengathi angalwandisa uhlelo lwezempilo lwe-primary health care engizwe ethi uzolubuyisela ezandleni zomasipala. Sengathi kungaba njalo nabo baphathe kahle futhi baqhubekele phambili nomsebenzi. Indima yinde kakhulu. [Ihlombe.] (Translation of Zulu paragraphs follows.)
[We in the IFP feel that the health situation is not improving. I am not blaming the hon the Minister of Health, I know she has a lot of things going on in her department. She took this position at a difficult time, when people are suffering from different diseases. Now, my province, KwaZulu-Natal, is greatly suffering from Aids. Every weekend we bury many people. TB is also spreading. It is killing people and it becomes worse when it affects an HIV positive person. Who will survive? Malaria is also spreading. Cholera has also killed many people in KwaZulu-Natal. That is why I am saying that the Minister and her department are heavily burdened.
We hope that the Ministry of Health will work hard in trying to find medications to fight these diseases. We have heard that in the King Edward, Prince Mshiyeni and other hospitals, they have started the process of preventing the transferring of HIV from a mother to a baby. The IFP acknowledges this and also supports the Minister. We wish her to extend the primary health care, which I heard her say she would entrust to municipalities. We wish this to be so and also wish them to manage it well and improve the work. There is still a long way to go. [Applause.]]
Mr M I MAKOELA: Chairperson, hon Minister, MECs present and colleagues, the usual prophecy of doom and gloom is what we heard from the hon, but poorly disposed, Dr Nel, who together with Mrs Gouws, in absentia … [Laughter.] … and Mrs Versfeld, together with their group of lost sheep, whose name I will not mention, because I do not want to enhance its credibility, suffer from a very debilitating syndrome, injected into their minds long ago. This syndrome will plague them for the rest of their lives, and get worse with every sunrise. [Laughter.]
Some of them, like Dr Nel, are fond of quoting the hon Dr Mandela when it suits them. As for Mr Durr, he and his ilk, during their time, when they talked of South Africa, and he fails to mention it, excluded almost two thirds of the country, and called it ``homelands’’, with the poor and marginalised majority of the people excluded. Maybe he is not in touch with the geographically changed South Africa, because he spent most of his time in foreign countries selling apartheid policies. [Interjections.] [Laughter.]
The state of the wellness of our nation is always uppermost in the minds of the ANC. When we first came to power in 1994, it was one of the key areas earmarked for transformation. We needed to ensure that the fragmented, inequitable, racially and ethnically divided system which was in existence then was replaced with a democratic, transparent, equitable and integrated system, using, as its basis, primary health care.
This policy direction was clearly stipulated in our Reconstruction and Development Programme. One of the first transformative documents to come out of the meeting of minds on health matters was the White Paper on the Transformation of the Health System in South Africa.
In our country the costs of drugs used in the public hospitals and clinics, etc, are second only to personnel costs. We, as the ANC, know very well how contentious the issue of the cost of drugs is, but we did not shy away from the struggle for cheaper drugs. We refused to be bullied by those forces that insisted that our course of action was illegitimate and that we would have to face the consequences of legal action. We were prepared to take on the biggest and best of the pharmaceutical giants so that our people would be able to access affordable drugs.
As an example of how outrageous the cost of drugs in the global free trade arena was becoming, I would like to cite the Hospital Association of South Africa, and the comparative study that they did on drug pricing. They found that a basket of 1 000 drugs increased substantially in price between January 1997 and May 2000. In fact, all products in the basket reached the 145,9% mark. Part of the reason for these outrageous figures is the fact that one company may dominate the sales in, for instance, cardiovascular drugs, or in HIV/Aids drugs, and would therefore be able to manipulate the prices at whim, leaving those in need of drugs at their mercy. In South Africa four companies account for 92% of local company sales in the private pharmacy market.
Another problem contributing to high drug prices was the high profits made by pharmaceutical companies. In the last 10 years the pharmaceutical companies have been the most profitable companies in, for instance, America, with their chief executive officers in top firms averaging about $10 million each in salaries in 1999.
Clearly, with this kind of blatant manipulation of prices, which had little to do with the needs of patients or with manufacturing and development costs, and more to do with profit margins, South Africa, through our Minister, had no other option but to stop the abuse, court case or no court case.
The battle for transformation in medicines has been won here, and we would like to tell the Minister that we are extremely proud of the victory. However, we achieved even more. Our efforts have had positive implications around the globe. Other developing countries faced with similar challenges have now begun to use South Africa’s precedent as a springboard to make the necessary changes to their legislation.
The concept of district health care presupposes that there is a good district health system in place that will co-ordinate and facilitate primary health care, ensuring quality health care in the areas where people live. That would include incorporating local government in the delivery of health care. The fact that there is this discussion in health is already commendable, especially in this period of transition following the recent restructuring of local government.
The challenge is to integrate the services into a comprehensive service in each district or metropolitan council, so that under the co-ordination of the provincial department of health, various health authorities within the district or metropolitan council areas will provide the full complement of district health services. This provision, already outlined by the Minister, provides that the municipal health services will include personnel and nonpersonnel services performed, such as environmental and health services, the provision of clean water and sanitation, the provision of essential medication for primary health care, the treatment of minor injuries and diseases and the prevention of infectious or communicable diseases.
It is clear to us, in the ANC, that the Minister and her department are still clearly focused on transforming the health system to make it more accessible to all. We therefore would like to convey our congratulations to her and her team on bringing affordable health care to all. We will always endeavour to support her efforts in every way that we can. [Applause.]
The MINISTER OF HEALTH: Chairperson, thank you very much for the opportunity just to make brief remarks at the end of this debate. First of all, I would like to thank everybody who participated in this debate. I found it very enriching, educational and informative. Obviously, we have taken note of all the comments and recommendations, and certainly, the useful ones will continue to guide us in our work.
It is a pity Mr Durr is not here, so I will direct just one point to him. I do not think we actually, and in all honesty, require his solitary vote to support this Budget Vote. [Laughter.] It is quite negligible, so I am sure that is the reason he left, because even if he were to cast his vote or abstain, it would not affect the result.
Let me also just talk to Dr Nel, who has quoted figures here, some of them to the tune of R10 million. I tried to find out, but we all do not seem to know about this figure. It is really not proper to bring the claim up here when he himself has not investigated this matter thoroughly. Even the Compensation Commissioner has not completed or finalised his work, and it is not easy to actually count when they have not completed their work. Let me say therefore, that I have nothing to advise my colleagues concerning what and how much they should pay.
He also referred to an underspending of R29 million on HIV/Aids. I thought we had been explaining this over and over again. Honestly, I cannot help it if the hon member does not want to listen, because we have reported that this money had already been committed for the purchase of condoms. It is not as if it was not spent. The only issue that we were grappling with was to ensure that, indeed, we had quality condoms and that did take us some time. But the money was already committed, so I do not think it is correct for Dr Nel to say things that could mislead this House.
If I had been Mrs Versfeld of the DP, even though she was speaking on behalf of Ms Gouws, I think that after listening to several speeches, I would have withdrawn my name from the list because I do not think she added any value in terms of assisting us, in particular on what we should be doing this year. She talked about the rural areas, but she does not have a constituency there. I do not know where she got the mandate and information to come and talk about rural health. She probably has been speaking with Mr Mike Ellis and together they have decided that this is a new angle from which they can approach this matter. It is not going to help.
She talked about hospital buildings that are deteriorating. [Interjections.] The hon member was not here, I suppose. Since 1997 moneys have been allocated for the reconstruction and rehabilitation of hospitals, and that money has been increasing. My colleagues and I spoke at length about the hospital revitalisation programme. But the hon member still rattled on and on, saying that nothing was is being done, whereas she was here, right through from the beginning, listening to what all of us were contributing on this item during the debate.
I would like to talk to Mr Redcliffe right now, just to say to him that I was very pleased to listen to him talk about tuberculosis. As members know, the situation in the Western Cape has really been worrying us. At last, he has now understood. We shall, indeed, be supporting them to ensure that we improve on the cure rates of TB in this province, because it is of great concern to us.
When it came to mother-to-child transmission, he spoke about AZT and Khayelitsha. Honestly, I am still waiting to hear from him what the results of that programme are. Where are the mothers and babies? I hope that we will get a full report in this regard.
With regard to nevirapine, I visited the Paarl hospital this morning, where they have started the programme of nevirapine. Let me hasten to say that it is not correct to say that mother-to-child transmission or prevention thereof, using nevirapine, came from the WHO. This decision was taken by the health Minmec long before the WHO made the announcement. So it is not correct to say that it came from WHO. I think he needs to get his facts a little bit right.
But, as I was saying, I was at the Paarl hospital this morning. I express my thanks to Dr Cupido, who assisted me to move around, and, obviously, to some of the officials there, too, who welcomed me even though I had just dropped in to see what they were doing.
It also became very clear to me that the Western Cape did not want to move at a national pace, precisely because we have agreed that what we needed to do was to develop a national protocol. Considering what I saw today, I hope that they will also come back to us so that we can improve the deficient provincial protocol that they are using, and address some of the issues that we all agreed that we were going to address at these sites, and not do things differently, because I do not think that helps. I think we really must make sure that when we agree on certain things, we do them in the manner in which we had agreed.
He also spoke at length about the manner in which they are comprehensively responding to HIV/Aids. I need to congratulate them on that as well, simply because they are doing exactly what all of us have been saying we should do. It is not that anything new is being done by the Western Cape. All the components that he identified are contained in the strategic plan that all of us developed collectively. But I would like to congratulate them on the fact that they are now doing things in that particular way.
Bengicabanga ukuthi uNkk Vilakazi uzogcina ngokuthi athi uzongithandazela. [Uhleko.] Bengilindele ukuthi angagcini nje ngokuthi uyangesekela kodwa athi uzongithandazela. Kodwa-ke ngicabanga ukuthi, uma sekukhulunywa iqiniso, naye angavuma ukuthi izinto azisafani nakuqala KwaZulu-Natali. Azisafani ngempela, ikakhulukazi emakhaya. Cha, akusafani. Uma ekhuluma kanjalo, ukhuluma inkulumo efanayo nekaNk Gouws kepha ngiqinisekile ukuthi akavumelani naye mayelana nalolu daba.
Siyavuma ukuthi ziseziningi izinto okusafanele zenziwe. Bengithi mhlawumbe uzokhuluma nangabezempilo abasebenzela emiphakathini ababizwa ngama- community health workers futhi abaningi kangaka KwaZulu-Natali. Bayazama ukufinyelela le emakhaya ukuze benyuse izinga mayelana nezindlela esinakekela ngazo abantu ekhaya. Mhlawumbe kufanele sizixoxe kabanzi lezo zinto ukuze sibonisane mayelana nokuthi ngempela ngempela kuhanjwa ngayiphi indlela.
Ngicabanga ukuthi uma ngabe bebekhona lapha noDokt Mkhize bekungazwela kabuhlungu impela nakubona ngendlela elibeke ngayo leliya lungu. (Translation of Zulu paragraphs follows.)
[I thought Mrs Vilakazi would conclude by saying she will pray for me. [Laughter.] I was expecting her not only to say she supports me but also to pray for me. I think if we are to tell the truth, even Mrs Vilakazi can attest to this that things are not the same as they were before in KwaZulu- Natal. They are different now, especially in the rural areas. They have changed. If she speaks like that, she speaks like Mrs Gouws, but I am sure she does not agree with Mrs Gouws on this issue.
We agree that there is still a lot to be done. I thought she would talk about community health workers as they are in the majority in KwaZulu- Natal. They are trying to reach everybody in the rural areas so that they can uplift the level at which we care for the rural people. Maybe we should talk lengthily about these issues so that we can decide which route to take.
I think that if Dr Mkhize was here, he would have felt very badly about the way that hon member has spoken.]
We have had, as I said, a very robust debate this afternoon. We touched on quite a number of issues - on the quality of care, on HIV, TB, malaria, the hospital revitalisation programme, the human resources development programme, issues of telemedicine, developing district health systems, and, in part, on the medicolegal mortuaries. We identified successes, constraints and challenges. Once again, I would like to thank members for the debate. I thought that, maybe, before I sit down I should just use the time allocated to me now to say that with regard to the primary school nutrition programme, a lot of work has been done. Under the social sector cluster, we have reviewed the primary school nutrition programme because, indeed, we were very much concerned about its implementation.
As MEC Moloto indicated, we are focusing on strengthening community involvement and participation, and we would like to see this programme also being aligned to the other poverty alleviation programmes. Certainly, we are also going to rely on the members in this House to assist us in this regard, because it is one thing to say the Ministry is not doing this. But I think because all of us are elected representatives of our communities, we therefore must not just complain, but do something ourselves in order to ensure that the programmes that are meant to benefit our people are, actually, properly implemented.
With regard to nongovernmental organisations and community -based organisations, I can, with all confidence, say that we are involving NGOs and CBOs in all the programmes that we implement. I think, for example, around the issue of HIV/Aids, we have more than 80 NGOs, and I will tell the hon members what the problem that we are facing is. We give the NGOs resources, and when the time to account comes, they do not account.
It becomes very difficult, and I hope that we can interact with the NGOs in this regard. Obviously, we have not thrown them out through the window, because we must work with them. Civil society must be part of the implementation of all the programmes.
So we have had to incur additional costs to hire financial officers to go right around the country to audit their books, and that becomes very difficult. I just hope that we can also be assisted in this regard.
I would like to tell the hon Dr Nel that I am not even going to talk again about the WHO report. I think the patriotism in hon Dr Nel should have told him to look at all other countries, the least developed countries, countries in Southern Africa, countries in Africa. Can he honestly sit there and say we were correctly graded by the WHO report? I do not think so. We have repeatedly reported this and talked about methodological problems with this report.
The CHAIRPERSON OF THE NCOP: Order! I am afraid, Minister, that your time has expired.
The MINISTER: Chairperson, I have a piece of good news, and I thought it would be improper for me not to make this announcement. The Northern Cape has won the cataract surgery trophy for the year 2000. This is in recognition of their having achieved the highest cataract surgery rate in this country. [Applause.]
The second piece of good news is that more than 300 opthalmologists in this country have agreed to donate their services and perform 60 000 cataract operations. I think we need to applaud them too. [Applause.]
The last one is that we have Tunisian doctors who have just arrived. They will be in the Free State and Northern Province, and will be also doing cataract operations. [Applause.]
The CHAIRPERSON OF THE NCOP: Order! Minister, Mr Van Niekerk has asked me to inform you that they can now see very clearly, and they are grateful for that. [Laughter.]
Debate concluded.
The Council adjourned at 17:42. ____
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
MONDAY, 11 JUNE 2001
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- The Speaker and the Chairperson:
(1) The following Bill was introduced by the Minister of Trade and
Industry in the National Assembly on 11 June 2001 and referred to
the Joint Tagging Mechanism (JTM) for classification in terms of
Joint Rule 160:
(i) Industrial Development Amendment Bill [B 32 - 2001]
(National Assembly - sec 75) [Explanatory summary of Bill and
prior notice of its introduction published in Government
Gazette No 22249 of 24 April 2001.]
The Bill has also been referred to the Portfolio Committee on
Trade and Industry of the National Assembly.
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Finance:
(1) Government Notice No R.349 published in the Government Gazette
No 22219 dated 9 April 2001, Public Finance Management Act, 1999:
Treasury Regulations, made in terms of section 76 of the Public
Finance Management Act, 1999 (Act No 1 of 1999).
(2) Government Notice No R.357 published in the Government Gazette
No 22248 dated 20 April 2001, Designation of an institution of
which the activities do not fall within the meaning of "the
business of a bank" ("Ithala Development Finance Corporation
Limited" formerly known as "KwaZulu Finance and Investment
Corporation Limited").
(3) Government Notice No R.303 published in the Government Gazette
No 22234 dated 26 April 2001, Appointment of an authorised dealer
in foreign exchange, made in terms of Paragraph 3(a) of the
Government Notice No R.1112 of 1 December 1961.
COMMITTEE REPORTS:
National Assembly and National Council of Provinces:
-
Report of the Joint Subcommittee on Powers and Privileges of Parliament, dated 7 June 2001, in terms of the resolutions adopted by the National Assembly and the National Council of Provinces on 5 April 2001:
The Joint Subcommittee on Powers and Privileges of Parliament reports as its recommendations to transform the existing law and practice on parliamentary powers and privileges, as follows:
(1) Second Draft dated 4 April 2001 of the Powers and Immunities of Parliament Bill; and (2) Minutes of the meeting of the Joint Subcommittee on Powers and Privileges held on 4 April 2001. TUESDAY, 12 JUNE 2001
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- The Speaker and the Chairperson:
(1) The Joint Tagging Mechanism (JTM) on 12 June 2001 in terms of
Joint Rule 160(3), classified the following Bill as a section 75
Bill:
(i) Close Corporations Amendment Bill [B 31 - 2001] (National
Assembly - sec 75).
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Speaker and the Chairperson:
Report of the Auditor-General on the Council for Mineral Technology for
1999-2000 [RP 65-2001].
- The Minister of Finance:
(1) Specific Agreement between the Government of the Republic of
South Africa and the Government of Sweden on Children and Justice
Support 1 September 2000 - 30 September 2003, tabled in terms of
section 231(3) of the Constitution, 1996.
(2) Specific Agreement between the Government of the Republic of
South Africa and the Government of Sweden on the establishment of
a Technical Co-operation Facility, tabled in terms of section
231(3) of the Constitution, 1996.
(3) Specific Agreement between the Government of the Republic of
South Africa and the Government of Sweden on Revised Budget
Reporting Formats, tabled in terms of section 231(3) of the
Constitution, 1996.
(4) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning the Support
Programme to the Chief Directorate International Development Co-
operation IDC (IDC - NAO Office), tabled in terms of section
231(3) of the Constitution, 1996.
(5) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning Conference,
Workshop and Cultural Initiative Fund II, tabled in terms of
section 231(3) of the Constitution, 1996.
(6) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning the Technical and
Administrative Assistance Programme to the European Programme for
Reconstruction and Development in South Africa (EPRD), tabled in
terms of section 231(3) of the Constitution, 1996.
(7) Rider No 1 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning Support
for the SADC Finance and Investment Protocol (FISCU), tabled in
terms of section 231(3) of the Constitution, 1996.
(8) Amendment Number Two to the Development Co-operation Agreement
between the Government of the Republic of South Africa and the
Government of Sweden, tabled in terms of section 231(3) of the
Constitution, 1996.
(9) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning Regional Support
for an Expanded Multisectoral Response to HIV/AIDS in the SADC
Region, tabled in terms of section 231(3) of the Constitution,
1996.
(10) Rider No 3 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the
Public Health Sectoral Support Programme, tabled in terms of
section 231(3) of the Constitution, 1996.
(11) Rider No 4 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the
Public Health Sectoral Support Programme, tabled in terms of
section 231(3) of the Constitution, 1996.
(12) Rider No 2 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the
Assistance to Policing in the Eastern Cape, tabled in terms of
section 231(3) of the Constitution, 1996.
(13) Rider No 3 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the
Assistance to Policing in the Eastern Cape, tabled in terms of
section 231(3) of the Constitution, 1996.
(14) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning Support to the
Transformation of the Justice System: The e-Justice Programme,
tabled in terms of section 231(3) of the Constitution, 1996.
(15) Rider No 3 to Financing Agreement between the Government of the
Republic of South Africa and the European Commission concerning
Public Service Management Development Programme, tabled in terms
of section 231(3) of the Constitution, 1996.
(16) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning Water Services
Sector Support Programme, tabled in terms of section 231(3) of the
Constitution, 1996.
(17) Rider No 4 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the
Water Development Programme in the Eastern Cape, tabled in terms
of section 231(3) of the Constitution, 1996.
(18) Rider No 3 to Financing Agreement between the Government of the
Republic of South Africa and the European Commission concerning
the Education Sectoral Support Programme, tabled in terms of
section 231(3) of the Constitution, 1996.
(19) Rider No 1 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the
South African Qualifications Authority, tabled in terms of section
231(3) of the Constitution, 1996.
(20) Rider No 2 to Financing Agreement between the Government of the
Republic of South Africa and the European Commission concerning
the Education Sectoral Support Programme, tabled in terms of
section 231(3) of the Constitution, 1996.
(21) Financing Agreement between the Government of the Republic of
South Africa and the European Union concerning the Second EU Human
Rights Programme, tabled in terms of section 231(3) of the
Constitution, 1996.
(22) Rider No 3 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning the EU
Human Rights Programme, tabled in terms of section 231(3) of the
Constitution, 1996.
(23) Exchange of Letters between the Government of the Republic of
South Africa and the European Commission concerning Privileges and
Immunities of Technical Assistants, tabled in terms of section
231(3) of the Constitution, 1996.
(24) Financing Agreement between the Commission of the European
Communities and the SADC Member States concerning the EU-SADC
Investment Promotion (ESIP) Programme, tabled in terms of section
231(3) of the Constitution, 1996.
(25) Rider No 1 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning
Technology Support for SMMEs Pilot Programme, tabled in terms of
section 231(3) of the Constitution, 1996.
(26) Rider No 1 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning Labour
Market Skills Development Programme, tabled in terms of section
231(3) of the Constitution, 1996.
(27) Rider No 2 to Financing Agreement between the Government of the
Republic of South Africa and the European Union concerning Labour
Market Skills Development Programme, tabled in terms of section
231(3) of the Constitution, 1996.
- The Minister of Minerals and Energy:
Report of Mintek for 1999-2000.