Honourable Minister and Deputy Minister,

 

Honourable Members,

 

Ladies and Gentlemen,

 

Today I have the honour of addressing this esteemed House for the first time. I was born not too far from here, in an old maternity hospital in District Six, and over the years have been given many opportunities for which I am grateful, including the chance to study medicine. 

 

More recently, during my experience as a registrar in community health in Gauteng, I had the privilege of working with those at the front-line of our health system, from community health workers to healthcare managers, and have been humbled by their dedication to their fellow citizens.

 

Honourable Chairperson, the 2015 deadline for the UN Millennium Development Goals is looming. As we look towards a post-2015 agenda, it has been proposed that Sustainable Development Goals should be established to carry us into the future. Accordingly, I would like to suggest that, in our own country, we consider the idea of a sustainable health system.

 

Now we must recognize the exemplary efforts of our hard-working Minister and DG. Indeed, the Health Sector NSDA, which aims to tackle our country’s quadruple burden of disease, includes a focus on health system strengthening. However, while there has been progress, we still face many challenges. 

 

An example of these difficulties can be found in Gauteng, where my constituency is currently based. 

 

In the 2012/2013 financial year, the Auditor-General found that the Provincial Department of Health had wasteful expenditure of R408 million. 

 

Now, in the fourth quarterly report presented in Gauteng just last week it was shown that the same department, with regards to its 2013/2014 budget, had an underspend of over R1.35 billion. This erratic spending, failure to invest in vital services and squandering of precious public resources is anything but sustainable. 

 

We, therefore, call upon the Honourable Minister to fast track the capacitation of healthcare managers, who are entrusted with much of these resources. 

 

While we acknowledge the recently established Academy for Leadership and Management in Health Care and the efforts to train hospital CEOs, what we urgently need is a rapid professionalization of health management, including formal registration and an adapted public service code for all healthcare managers, ensuring that they sufficiently skilled, political independent and publically accountable – with severe consequences for mismanagement and zero-tolerance for corruption.

 

The above notwithstanding, we still have many dedicated healthcare managers. But they are often frustrated by infrastructure that is not sustainable. 

 

While R16.3 billion has been earmarked for the Health Facility Revitalization Grant in the MTEF period, infrastructure around health facilities also needs to be maintained. Roads to and from hospitals that carry critical supplies have to be prioritized, and the provision of water and electricity to these facilities simply cannot be interrupted.  

 

We, therefore, call upon the Honourable Minister to develop a coordinated infrastructure strategy within the Inter-Ministerial Service Delivery Task Team to drive joined-up governance and planning in this area.

 

Honourable Chairperson, when health systems are unsustainable, they are at risk of failure – and when they fail, we are all under threat.  

 

As a sobering example, the 2013 Global Tuberculosis Report highlighted the danger of multi-and extensively drug-resistant TB in our country. Now the national department has, commendably, begun to implement a policy on the Management of Drug-Resistant Tuberculosis. 

 

However, even with this, if the health system building blocks are not firmly in place there will be holes in our safety net and a potential epidemic of drug-resistant TB, simmering just beneath the surface, could burst through, putting us all under threat.

 

It also true, that when health systems fail, those who are at the margins, whose voices are not often heard, are most under threat. 

 

We are reminded of the tragic case in 2011 where, in the North West province, the four starving children of Kedibone Mmupele, ages nine, seven, six and two, died trying to find their mother who herself was desperately trying to find food for them, 18 kilometers away. 

 

Now it can be asked – what does this terrible tragedy have to do with health systems? 

 

The answer is simple: a health system that is unresponsive to the relevant social conditions, called the social determinants of health, is, frankly, unsustainable. While the NDP emphasizes these determinants, they are only briefly discussed in the APP, with no clear commitment of resources in the budget. 

 

Furthermore, while there is a proposed National Health Commission, that body will focus on non-communicable diseases.

 

I, therefore, ask the Honourable Minister to establish, as a separate body, a South African Commission on Social Determinants of Health. 

 

In addition to the WHO commission, we have precedence for this in Brazil, where a national commission on social determinants of health was established to significant effect. A similar commission could help to transform the landscape of our country’s health system. That would be a true revolution.

 

In conclusion, Honourable Chairperson, the DA offers South Africa a compelling health policy aimed at affordable, accessible, high quality health for all. But what is our collective understanding of health? 

 

Here, the Alma-Ata Declaration offers us the profound definition of health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease.” 

 

Surely we can all strive for this goal despite our political differences. But we can only reach for this if we have a health system that is dependable, equitable and, ultimately, sustainable.

 

I thank you.