Budget Speech for the Minister of Health, National Council of Provinces (NCOP)

Honourable Chairperson
Honourable members
My colleagues, the MECs for Health
Distinguished guests
Ladies and gentlemen

Good morning!

Before I present the Department of Health Budget speech, allow me, on a personal note, to thank the President and the Deputy President for their support during my recent illness. I wish to also thank honourable Members for your concern, support and good wishes during my recent illness. This has been a really trying period for me, my family and friends as well as for the Department of Health. I also wish to thank Minister Jeff Radebe for standing in as acting Minister. He did a wonderful job.

As I said last week during the Department's Budget Vote in the National Assembly, I wish to thank all those health workers that remained true to their calling and did not go on strike or intimidate others who did want to work. Whilst we would like our health workers to earn a decent living, it is important that they respect the needs of patients. Health is an essential service. This is well known to all health workers. In addition, there is an ethical responsibility on all health workers to ensure that we put the interests of our patients before our own. I wish to call on all health workers to return to work immediately so that our people who need health services can again access it.

We are grateful to the South African Military Health Services, the South African National Defence Force (SANDF), the private health sector as well as retired nurses who are assisting to ensure that health facilities are open and are able to deliver a service.

June is Youth Month. To celebrate Youth Month, the department will be hosting a Youth Indaba in Kimberly, to which I invite all members.

Honourable Chairperson, the Department of Health has made significant progress in the past year. I wish to note the following in particular which were highlighted in some of the provincial budget speeches by the MECs for health. I thought that it was important to include these given that Honourable Members need to get a national picture of how some of the provinces are doing. Given time limitations I cannot speak about all provinces but I am sure that the MECs who are here will provide significantly more information about their provinces.

To expand health services to rural and remote areas, the North West province has provincialised and extended services provided by health posts. At these health posts preventive and promotive services are provided by nursing auxiliaries and it is where the mobile services stop to provide curative care. Also in the North West province a successful pilot project on removal and treatment of healthcare waste was conducted in the Central District between the Department of Health and the Department of Environmental Affairs and Tourism.

The Free State has done really well in improving Tuberculosis (TB) cure rates as well as decreasing stillbirths and perinatal mortality. They have also achieved 90% immunisation coverage. The Free State is also doing well in implementing the Mental Health Care Act, in particular in the establishment of Mental Health Review Boards.

Limpopo province has graduated more than 300 auxiliary nurses in March this year. Students were recruited largely from poor families and this is the contribution that the Department of Health is making to the Accelerated and Shared Growth Initiative for South Africa (AsgiSA) as well as the Joint Initiative for Priority Skills Acquisition (Jipsa). In his budget speech to the provincial legislature MEC Sekoati told the story of one of the students who passed with distinction and I am sure that he won't mind that I quote him: "Emmanuel Maluleke is an orphan who lost his mother when he was 18 months and his father when he was in Standard 3. His grandmother who is a pensioner took responsibility for his education until he passed matric in 1999. Until he was offered an opportunity to study, to become an auxiliary nurse by the Department of Health, Emmanuel had no prospect of employment. Now he has."

Honourable Members, next year we shall commemorate the 30th anniversary of Alma Ata Declaration at which the primary healthcare approach was born. The key principles of this approach are: equity in access to services and allocation of resources; community participation and involvement; intersectoral action; and decentralised management.

The MEC for Health in KwaZulu-Natal reminded the provincial legislature that this approach really started in Pholela where the first primary healthcare centre was developed in the 1940s! It is therefore very important that KwaZulu-Natal and indeed the rest of the country remain the pioneers in health system development and showcase to the rest of the world next year the achievements we have made since the dawn of democracy in 1994.

The 7th of July this year marks the midpoint of the 15 year period that the international community led by the United Nations in 2000 set a number of goals and targets in what has been called the Millennium Development Goals (MDGs). We will use the next National Consultative Health Forum planned for July to review South Africa's achievements and next steps in achieving these goals. We shall, of course, invite Honourable Members to attend this event as well as our other key stakeholders both in government and in civil society.

Honourable Chairperson, I already provided some examples of what the department has achieved during 2006/07. Permit me to provide a few more examples before I inform members of the challenges and some of our priorities for 2007/08.

We made some advances with respect to preventive illness especially those that affect children. These advances are reflected in our infant mortality rate for example. In 1998 according to the South African Demographic and Health Survey the infant mortality rate was 45/1 000 live births. In 2003, we conducted our second Demographic and Health Survey and found the infant mortality rate to be lower at 43/1 000 live births.

Honourable members will know that in 2002, the Department adopted the Integrated Management of Childhood Illnesses strategy. This strategy tries to integrate all interventions relating to children to ensure that a package of care is offered to each child. Sixty percent of health facilities that attend to children now have at least one health professional who has been trained in the Integrated Management of Childhood Illness (IMCI) strategy. One outcome of the implementation of this strategy is that our facility surveys show that our health professionals now use antibiotics more carefully � this is important as injudicious use of antibiotics leads to the development of resistance to these drugs.

I am happy to inform Members that South Africa has been declared polio free. We need to work on strengthening our surveillance as well as to support our neighbours to ensure that we retain this status. As I mentioned earlier, our national immunisation coverage has also improved � it now stands at 83%. However, there are health districts in some provinces where the coverage is still low. We hope that the immunisation campaigns that commenced a few weeks ago as well as the implementation of the Reach Every District Strategy (REDS) will assist these districts to improve on their levels of coverage. Honourable Members, you too can assist by taking this message to your constituencies � all children should be fully immunised. Primary healthcare is free in all public health clinics, our nurses are well trained and the vaccine is available.

It is true, and this is part of the primary healthcare approach, that investment in health is an investment in development. What is also true is that healthy people are a product of many factors � many of which are outside of the direct control of the healthcare system. Honourable Members, this means that integrated service delivery and individual responsibility are key to good health. We need to ensure that there is full integration of services at community level. One way to achieve this is to train and deploy community care givers that are trained to help on a number of levels. If a community care giver visits a family and finds a bedridden gogo, she should be able to assist. If a community care giver comes across a child who does not have access to a social grant and is eligible for one, she should be able to assist. If a community care giver comes across a family with no food she should be able to assist. This does not mean that we are expecting a community care giver to be superhuman but she or he should be able to link these vulnerable people to resources. This is also true of health workers, regardless of where in the system they work � we must ensure that health service delivery becomes more holistic. This is the true measure of a well functioning health system.

As we heard at last year's International Diabetes Conference held here in Cape Town, non-communicable diseases like diabetes, hypertension and cardio-vascular diseases are increasing at an alarming rate in Africa and in South Africa as well. We can prevent many illnesses by doing simple things like eating right, taking part in physical activity and being responsible with respect to our sexual practices, not using tobacco products and using alcohol responsibly. Again, Honourable Members, as leaders in our communities we need to take these messages to our people and I urge you to assist us in doing this. Let us know if you require assistance and I am sure that the MECs will be more than happy to oblige.

Good nutrition is vital for good health. The Department of Health has established a number of clinic, school and community gardens to assist in developing food security. We will be expanding our efforts in this regard. In addition, most infants and a large percentage of their mothers who deliver at public health facilities receive vitamin A supplementation. More than 490 000 patients with debilitating illness received food supplementation last year.

We also have a growing problem with injuries and trauma. We have worked with the Departments of Transport, Social Development and Education in particular within the Social Cluster to develop a programme to target road traffic accidents, alcohol abuse, drowning and suicides in particular. These focused on the December and Easter periods but need to be sustained throughout the year. Over weekends and during vacation periods the casualty departments of our hospitals are often unable to cope with the victims of injuries and trauma. Besides the pain and suffering, the cost to the health system and the economy is large. We must work together to reduce the incidence of these avoidable injuries and trauma. In this regard, it is very important for members of this House to actively participate in this effort.

In summary, we need to deal decisively with non-communicable diseases and injuries. Honourable members therefore are requested to assist the department and more broadly the Social Cluster to mobilise communities around the need for healthy lifestyles, including: eating nutritious meals; increasing physical activity through the Vuka South Africa, Move for your Health; responsible sexual behaviour; stopping the use of tobacco products; and responsible use of alcohol.

With respect to communicable diseases we continue to battle against a large burden of disease from this source. With respect to HIV and AIDS, the good news is that the prevalence of HIV amongst pregnant women who attend public health facilities is on the decrease. For the first time we are seeing a percentage point decrease in prevalence amongst this group. This means that our prevention programmes are beginning to show an effect. Clearly, we need to sustain and increase this effort and at the same time continue to expand access to care and support as well.

The good news is malaria. For the first quarter this year, compared to the same period last year we are seeing a decrease in both the number of cases as well the number of deaths from malaria. This is the result of in-door residual spraying, with DDT, in the three provinces in which malaria is endemic as well as early diagnosis and treatment and our efforts to work with our neighbours, Mozambique, Swaziland and Zimbabwe.

With some exceptions, TB control remains a challenge. We have health districts that are doing well in terms of the percentage of people with TB that are cured. However, the national average is less than 60% with about a 10% default rate. This is cause for concern as it results in both multiple and extensively drug resistant TB. I wish to reassure Honourable Members that the department with the assistance of the World Health Organisation (WHO) has a plan to address this challenge, with the assistance of Honourable Members, as well as community members.

Whilst we have a large network of clinics and hospitals the key challenge is to improve the quality of care provided at our facilities. We have increased the number of clinics since 1994 and instituted a hospital revitalisation programme to improve the infrastructure, the equipment and the management of our hospitals.

Some of detractors have suggested that we are neglecting our tertiary services. This is not true. We have two state of the art tertiary hospitals in the form of Inkosi Albert Luthuli, Nelson Mandela and Pretoria Academic Hospitals.

In 2004/05 we completed three hospitals � Calvinia and Colesberg in the Northern Cape and Piet Retief in Mpumalanga. In 2005/06 we completed five hospitals � Lebowakgomo and Jane Furse in Limpopo, Mary Theresa in the Eastern Cape, Swartruggens in the North West and George in the Western Cape. Last year two hospitals were completed. These are: Dikolong and Nkhatsani Hospitals in Limpopo.

We currently have 46 revitalisation projects with 30 already on site and 16 in the planning stages. We hope to complete the following hospitals during this financial year: Mamelodi Hospital in Gauteng; Worcester Hospital in the Western Cape; Rietvlei Hospital in KwaZulu-Natal; and Barkley West in Northern Cape.

Whilst good progress is being made, we need to accelerate this programme if we wish to complete the revitalisation of all our public hospitals within the 15 year timeframe that we set ourselves. We need to ensure that this programme is fully funded in the remaining timeframe.

Together with improving the staffing of the health sector, these are our major challenges to improving quality of care. These issues were emphasised during the hearings held recently by the South African Human Rights Commission. Any incident of poor quality of care is regrettable. The department will continue to take all steps necessary to improve the quality of care that our people receive in both the public and private health sectors.

We have been able to reduce the cost of drugs over time but the cost, and therefore access to the private sector is still a challenge. We hope that the Health Charter, which we hope will be signed by all parties before the end of this year, will provide the platform for a more equitable health care system as well as a more affordable private health care sector.

One of the key challenges that is receiving priority attention is human resources for health. We need skilled and motivated health providers in adequate numbers in the public health sector. We hope that the new dispensation for health workers, once agreed to in the Public Sector Bargaining Council will provide the necessary motivation for health workers to return to work, to provide quality care and to remain in the public health sector. In addition to remuneration, the hospital revitalisation programme as well as further training and management support will be provided to incentivise health workers to remain in the public health sector. A further boost to the number of nurses working in the public health sector will be the commencement of community service for nurses in July this year as well as the soon to be implemented clinical associate programme by our universities.

As Honourable members know, there are two important pieces of legislation that will be discussed by this House this year. These are the Traditional Health Practitioners Bill and the amendments to the Choice on Termination of Pregnancy Act. It is very important that we institutionalise African Traditional Medicine. In this regard the President has appointed a Presidential Task Team on African Traditional Medicine. In addition, I have been elected as the chairperson of the Bureau of the African Health Minister's meeting of the African Union charged with conducting a mid-term review of progress on the continent on the implementation of the African Decade of African Traditional Medicine which was adopted by AU Heads of State. This House can assist this process by passing the Traditional Health Practitioners Bill.

August is Women's month. This House can honour women by extending the choice on termination of services provided by the public sector by passing the amendment to the Choice on Termination of Pregnancy Act.

Honourable Chairperson, I wish to conclude by speaking about the total budget for 2007/08 as well as those areas in which we received an increase relative to the 2006/07 budget.

The budget of the national Department of Health consists largely of conditional grants, 88% of which we transfer to provincial health departments. The budget for the National Tertiary Services Grant increased by R100 million to fund the Modernisation of Tertiary Services Programme. These funds will be used to modernise radiation oncology equipment which will reduce the backlogs and improve the management of cancer patients. The grant will amount to R5,3 billion in 2007/08. The amount grows by R200 million and R250 million in the outer years. A further R200 million and R280 million in the outer years have been added to this grant to fund additional remuneration of health professionals at tertiary hospitals.

The budget for the Health Professions Training and Development Grant remained static in real terms for the year under review. This grant will be the subject of a review in order to bring funding in line with the requirements. This grant amounts to R1,6 billion in 2007/08.

The Hospital Revitalisation Grant received an additional R200 million. The new total for 2007/08 is R1,9 billion. This grant also received a further R300 million and R500 million in the outer years. This grant will grow to R2,6 billion in 2009/2010. The allocations seem large but it is still not enough to reduce the 15-year horizon to revitalise all the hospitals in the country. To give some idea of the shortfall this year, the department requested R1 billion additional but only received R200 million.

Funding for the Forensic Pathology Services Grant is static at R551 million in 2007/08. This grant is for the refurbishment of mortuary services that the provincial departments of health took over from the South African Police Service. It is envisaged that this grant will become part of the equitable share once the services have been established and have been institutionalised.

The HIV and AIDS Grant received R300 million in the year under review and further amounts of R500 million and R850 million in the outer years. The grant will amount to R1,9 billion in 2007/08 and will grow to R2,6 billion in 2009/2010. These funds will largely fund the continual growing demand for HIV and AIDS related services.

The department also received additional R30 million allocation earmarked for LoveLife. This amount grows to R50 million additional in 2009/10.

R10 million has been added to the budget of the national Department of Health to cover the cost of the Department's planned move back to the Civitas Building later this year.

Honourable Chairperson, the total public sector health budget grows to R59,2 billion in 2007/08. This constitutes 3,05% of Gross Domestic Product (GDP) and 11,08% of government expenses. However, I wish to bring to the notice of Honourable Members that the public health sector is under-funded and unless additional funds are provided the 15 year timeframe that we have set ourselves within which to revitalise our hospitals for example, will not be met.

In conclusion, Honourable Chairperson, may I also thank other Ministers appointed as acting Ministers of Health by the President during my illness as well as the Deputy Minister and the MECs for Health. We would not have been able to make the gains that we have without the efforts of the MECs and their staff. I also wish to thank the Chairperson and members of the Select Committee for Social Services. Your oversight role is critical to the achievement of a healthy nation. I also wish to thank the Director-General and staff in the national Department of Health for their support. Finally, I wish to thank my family for their love and support � without their concern, love and support I would not have been able to get well as soon as I have.

I thank you.

Issued by: Department of Health
12 June 2007