Date: 17/06/2004
Source: Ministry of Health
Title: N Madlala-Routledge: Health Dept Budget Vote 2004/2005
BUDGET SPEECH BY DEPUTY MINISTER OF HEALTH, NOZIZWE MADLALA-ROUTLEDGE, 17 June 2004
Madam Speaker,
Honourable members,
INTRODUCTION
In supporting the budget speech of the Minister of Health, I am mindful that June is dedicated to youth development this year. I therefore wish to dedicate my first Health Budget Speech to the youth of our country. I wish to say to our youth that we do care. I call on them to support our national programme of making health care accessible and affordable.
MENTAL HEALTH
When a young man commits suicide after taking an HIV test, when a woman straps her baby on her back and lies on rail tracks waiting for the train to end her misery, when a young musician gives in to illicit drugs and when a loving man takes a gun and wipes out his entire family before turning the gun on himself, then it is time for us to listen, it is time for us to take action.
Honourable members, the problems of depression and suicide are real. Issues around the modern lifestyle, unemployment, poverty, illness and unnatural early deaths are causing mental stress.
A year ago, we passed the Mental Health Care Act. The regulations will be published in two months. This progressive law takes mental health services out of the rigid custodial care into the light of community integration.
There will be an increasing demand on our clinics and hospitals to provide treatment and on NGO's to expand services. There has been progress in developing community capacity to care for mentally ill people, but there are still many individuals who are slipping through the cracks between hospital and community care. We know that discharge from a psychiatric hospital can result in a breakdown in treatment or even homelessness and a life on the streets.
We need families of people with mental illnesses to accept them and assume responsibility for their daily care. We need community organisations to support families in this role, through services such as day care centres and employment projects. We need to put more resources into mental health care. As members of parliament we must lead by example and acknowledge and affirm those who are mentally ill or challenged in our communities.
We will work together in a people's contract, to build a healthy and caring nation. We will work with employers to ensure that the workplace is a happy and safe place, where workers feel valued and supported. We will work with schools to create a conducive, supportive and safe environment for learning and teaching to take place. We will work with communities to create a network of care.
We will work with the Department of Sport and Recreation to ensure communities have access to sporting and recreational facilities. As the saying goes, a healthy mind needs a healthy body. We will work with youth organisations to create opportunities for them to discuss their issues in an environment of support and confidentiality.
Post-traumatic stress disorder has been identified as a key cause of people "snapping" and behaving irrationally and violently. It has been cited in some cases of domestic violence, woman and child abuse, as well as suicide and homicide. This is compounded by alcohol and drug abuse. It therefore follows that attending to post traumatic stress disorder and other forms of mental illness will benefit the campaign to end domestic violence and child abuse. This will require that we pay special attention to the training of health care personnel.
HUMAN SECURITY
Tackling these issues and meeting the challenge they pose to human security will require new approaches and new thinking about how we do things.
As so clearly articulated in the UN Commission's Report on Human Security, published in 2003 and presented to President Mbeki, human security naturally connects several kinds of freedom - such as freedom from hunger, fear and ill-health as well as freedom to take action on one's own behalf. People protected can exercise many choices. And people empowered can avoid some risks and demand improvements in the system of protection.
Human security underpins South Africa's transformation agenda, which seeks to achieve social justice and equity. Equity is a cornerstone of our health care system and is a dominant thread running though the RDP and our Constitution.
The Bill of Rights has made access to affordable health care a basic human right, together with housing, food, water, social security and education.
Health is a key ministry in Government's commitment to achieving human security and dignity for all. Because of that, and the fact that health affects individuals directly, as well as the threat posed by HIV and Aids, it is the focus of much press attention. This is correct when the media focuses on facts and does not sensationalise the issues.
RURAL PRIMARY HEALTH CARE
Progress towards equity in access to health care has gone beyond simply removing racial discrimination. In 1996 free care was extended to all those attending government Primary Health Care facilities, and in 2003 free health care was extended to those with disabilities. Women too have benefited from the new health dispensation. They now enjoy free primary health care, free antenatal and postnatal care and safe termination of unwanted pregnancies.
In support of primary health care, 53 health districts have been established in line with the new metropolitan and district municipal boundaries. As a result of the expansion of facilities, the wider range of services on offer and the free primary health care policy, the number of primary health care visits per person increased from an estimated 1,8 per year in 1992 to an estimated 2,3 per year in 2001 and in some provinces to 3,5 visits in 2003.
Our effort to shift resources from better-served areas to the most impoverished ones will be stepped up in this financial year. We have been able to reduce the expenditure ratio between best and worst served provinces from 3,9 to 1,9 in the seven years from 1995 to 2002. Apart from Cuba, we know of no other country that has managed to reduce inequity in resource allocation this rapidly.
As a direct contribution of our people to the delivery of quality health care to all, we will be asking honourable members to help form district health committees, hospital boards and clinic committees. Like water committees, community policing forums and school governing bodies, these health committees will bring community representatives together with health care providers and government representatives to ensure quality health care and communicate and support health campaigns.
Through these committees, communities will play a direct role in making sure that clinics and other health services are being provided. They will make sure that in the spirit of "batho pele", health personnel are putting people first. We expect the youth to play an active part in these structures to ensure that health services are youth friendly.
To plan properly and to develop a good health system we need reliable and accurate health information. We need to pay attention to keeping good records, which can be accessed easily throughout our system in order to ensure that our patients do not fall through the cracks as they move from one area to another.
This is particularly important in the case of patients being treated for communicable diseases and those diseases that develop resistance to drugs as a result of interruption of treatment, like TB and HIV and AIDS.
To strengthen health services in rural and under-served areas we will ensure that they benefit from interventions like the scarce skills allowances that the Minister of Health referred to. The expanded community service system, which now includes new graduates in ten health professions, will include newly qualified nurses in 2005 to enhance health service delivery to rural areas.
Our national laboratories are in the process of being upgraded as part of the national comprehensive treatment plan for HIV and AIDS. This we will seek to decentralise the laboratory services in order to facilitate quick diagnosis and monitoring of disease.
I am acutely aware of the conditions under which many of our health workers work. I want to use this opportunity to express my appreciation for the work done by our front line health workers.
MEDICO-LEGAL
Working with the Criminal Justice Cluster, we will pay special attention to the area of medico-legal investigations. This is the area of autopsies and forensic studies. The forensic pathologist or medical examiner plays a critical role in the justice process as an independent expert witness.
We will be transferring the mortuaries from the South African Police Service and locating them under the roof of the provincial health departments, along with the forensic laboratories. Detailed plans are being drawn up for each of our provinces and a project manager has been appointed. It is expected that the process will be completed in a year.
ENVIRONMENTAL HEALTH
Government has taken measures to reduce environmental health risks. Already the measures to create an environment of clean air are beginning to pay off. Our airports, restaurants and places of work have become non-smoking areas. We will strengthen the anti-tobacco legislation this year. We will work with the Departments of Environmental Affairs, Agriculture and Labour to ensure that harmful emissions and chemicals that pollute our water, air, and soil are eliminated. We will work with non-governmental and community organisations, to ensure success.
As part of implementing the NEPAD agenda, we will make sure that poor countries do not continue to be the dumping ground for harmful products that put lives and the environment at risk. We will raise our voices at the World Health Assembly, to make sure that these issues are put high on the agenda. Raising consumer awareness about the harmful additives to foodstuff and related issues will form part of this campaign.
In terms of the New Health Bill, environmental health services will be vested with local government. This shifts responsibility for rendering environmental health to metropolitan and district councils as from 1 July this year. In discussion with the Minister for Provincial and Local Government, we have decided that the municipal health services, which are mandated as a local government competence in the Constitution, should be defined as a list of environmental health services, as do other major mandates such as development planning and provision of basic services. In some cases the change will entail very little in terms of need for new funds and the transfer of human resources. In others, the impact will be greater.
We are working hard to ensure that the services to the public will be maintained as the handover takes place and that the spirit of co-operative governance prevails as we iron out the details of restructuring. The district councils must ensure that appropriate transitional arrangements are in place for a smooth continuation of these services.
OCCUPATIONAL HEALTH
I believe occupational health is an area where we have yet to maximise potential and where we followed a rather restricted agenda. The threat HIV and AIDS posed to the economy, to particular industries and individual corporations, compelled employers and unions to consider occupational health in a new light. Many work-places became sites for the prevention and treatment of HIV and AIDS. We hope this preventative emphasis will be applied to other relevant areas of health in the workplace.
In the Demographic and Health Survey done five years ago, 13% of respondents reported that their health was affected by work. In 1996 researchers calculated that the direct cost of occupational injuries and disease was R17 billion or 3,5% of GDP.
We need to be more forward looking, taking a more pro-active and comprehensive approach to occupational health and safety. This will demand closer collaboration between the Departments of Labour and Health because they deal with different aspects of this challenge. Through Nedlac, we will engage our social partners about health issues.
CONCLUSION
As part of the team, I will help make sure that we turn the negative publicity around and get the media to report the good news and achievements of our department. We have prioritised communication as part of our strategic plan. We will ensure that the voices of the millions of people who benefit from our programmes are heard.
Health is a key delivery area and a key indicator of our success or failure. In the State of the Nation Address last month, President Mbeki made over 100 promises that are concrete and measurable. Many of these, though not the responsibility of the Department of Health, affect the health of the nation. These include the elimination of poverty and unemployment, the provision of basic services such as water, sanitation and electricity, the provision of social services and housing.
Honourable members, we are challenged by this. The people have great expectations of the people they elect. But, working together with other state departments, provincial and local government, parliament and our social partners, we will deliver on these promises and the popular mandate.
It will require that we ensure that we prepare ourselves physically and mentally to perform our tasks, given to us by the electorate. Long hours, travel, hectic schedules, poor diet, and lack of exercise - all contribute to poor health. We need to ensure that we identify ways that as public representatives and government officials we can be in good health so that we can do our job effectively as well as enjoy life.
There are two gyms in parliament. Are we using them? I invite you to join me in a campaign to get physically fit - FIT TO GOVERN.
Issued by: Ministry of Health
17 June 2004
Source: Ministry of Health
Title: N Madlala-Routledge: Health Dept Budget Vote 2004/2005
BUDGET SPEECH BY DEPUTY MINISTER OF HEALTH, NOZIZWE MADLALA-ROUTLEDGE, 17 June 2004
Madam Speaker,
Honourable members,
INTRODUCTION
In supporting the budget speech of the Minister of Health, I am mindful that June is dedicated to youth development this year. I therefore wish to dedicate my first Health Budget Speech to the youth of our country. I wish to say to our youth that we do care. I call on them to support our national programme of making health care accessible and affordable.
MENTAL HEALTH
When a young man commits suicide after taking an HIV test, when a woman straps her baby on her back and lies on rail tracks waiting for the train to end her misery, when a young musician gives in to illicit drugs and when a loving man takes a gun and wipes out his entire family before turning the gun on himself, then it is time for us to listen, it is time for us to take action.
Honourable members, the problems of depression and suicide are real. Issues around the modern lifestyle, unemployment, poverty, illness and unnatural early deaths are causing mental stress.
A year ago, we passed the Mental Health Care Act. The regulations will be published in two months. This progressive law takes mental health services out of the rigid custodial care into the light of community integration.
There will be an increasing demand on our clinics and hospitals to provide treatment and on NGO's to expand services. There has been progress in developing community capacity to care for mentally ill people, but there are still many individuals who are slipping through the cracks between hospital and community care. We know that discharge from a psychiatric hospital can result in a breakdown in treatment or even homelessness and a life on the streets.
We need families of people with mental illnesses to accept them and assume responsibility for their daily care. We need community organisations to support families in this role, through services such as day care centres and employment projects. We need to put more resources into mental health care. As members of parliament we must lead by example and acknowledge and affirm those who are mentally ill or challenged in our communities.
We will work together in a people's contract, to build a healthy and caring nation. We will work with employers to ensure that the workplace is a happy and safe place, where workers feel valued and supported. We will work with schools to create a conducive, supportive and safe environment for learning and teaching to take place. We will work with communities to create a network of care.
We will work with the Department of Sport and Recreation to ensure communities have access to sporting and recreational facilities. As the saying goes, a healthy mind needs a healthy body. We will work with youth organisations to create opportunities for them to discuss their issues in an environment of support and confidentiality.
Post-traumatic stress disorder has been identified as a key cause of people "snapping" and behaving irrationally and violently. It has been cited in some cases of domestic violence, woman and child abuse, as well as suicide and homicide. This is compounded by alcohol and drug abuse. It therefore follows that attending to post traumatic stress disorder and other forms of mental illness will benefit the campaign to end domestic violence and child abuse. This will require that we pay special attention to the training of health care personnel.
HUMAN SECURITY
Tackling these issues and meeting the challenge they pose to human security will require new approaches and new thinking about how we do things.
As so clearly articulated in the UN Commission's Report on Human Security, published in 2003 and presented to President Mbeki, human security naturally connects several kinds of freedom - such as freedom from hunger, fear and ill-health as well as freedom to take action on one's own behalf. People protected can exercise many choices. And people empowered can avoid some risks and demand improvements in the system of protection.
Human security underpins South Africa's transformation agenda, which seeks to achieve social justice and equity. Equity is a cornerstone of our health care system and is a dominant thread running though the RDP and our Constitution.
The Bill of Rights has made access to affordable health care a basic human right, together with housing, food, water, social security and education.
Health is a key ministry in Government's commitment to achieving human security and dignity for all. Because of that, and the fact that health affects individuals directly, as well as the threat posed by HIV and Aids, it is the focus of much press attention. This is correct when the media focuses on facts and does not sensationalise the issues.
RURAL PRIMARY HEALTH CARE
Progress towards equity in access to health care has gone beyond simply removing racial discrimination. In 1996 free care was extended to all those attending government Primary Health Care facilities, and in 2003 free health care was extended to those with disabilities. Women too have benefited from the new health dispensation. They now enjoy free primary health care, free antenatal and postnatal care and safe termination of unwanted pregnancies.
In support of primary health care, 53 health districts have been established in line with the new metropolitan and district municipal boundaries. As a result of the expansion of facilities, the wider range of services on offer and the free primary health care policy, the number of primary health care visits per person increased from an estimated 1,8 per year in 1992 to an estimated 2,3 per year in 2001 and in some provinces to 3,5 visits in 2003.
Our effort to shift resources from better-served areas to the most impoverished ones will be stepped up in this financial year. We have been able to reduce the expenditure ratio between best and worst served provinces from 3,9 to 1,9 in the seven years from 1995 to 2002. Apart from Cuba, we know of no other country that has managed to reduce inequity in resource allocation this rapidly.
As a direct contribution of our people to the delivery of quality health care to all, we will be asking honourable members to help form district health committees, hospital boards and clinic committees. Like water committees, community policing forums and school governing bodies, these health committees will bring community representatives together with health care providers and government representatives to ensure quality health care and communicate and support health campaigns.
Through these committees, communities will play a direct role in making sure that clinics and other health services are being provided. They will make sure that in the spirit of "batho pele", health personnel are putting people first. We expect the youth to play an active part in these structures to ensure that health services are youth friendly.
To plan properly and to develop a good health system we need reliable and accurate health information. We need to pay attention to keeping good records, which can be accessed easily throughout our system in order to ensure that our patients do not fall through the cracks as they move from one area to another.
This is particularly important in the case of patients being treated for communicable diseases and those diseases that develop resistance to drugs as a result of interruption of treatment, like TB and HIV and AIDS.
To strengthen health services in rural and under-served areas we will ensure that they benefit from interventions like the scarce skills allowances that the Minister of Health referred to. The expanded community service system, which now includes new graduates in ten health professions, will include newly qualified nurses in 2005 to enhance health service delivery to rural areas.
Our national laboratories are in the process of being upgraded as part of the national comprehensive treatment plan for HIV and AIDS. This we will seek to decentralise the laboratory services in order to facilitate quick diagnosis and monitoring of disease.
I am acutely aware of the conditions under which many of our health workers work. I want to use this opportunity to express my appreciation for the work done by our front line health workers.
MEDICO-LEGAL
Working with the Criminal Justice Cluster, we will pay special attention to the area of medico-legal investigations. This is the area of autopsies and forensic studies. The forensic pathologist or medical examiner plays a critical role in the justice process as an independent expert witness.
We will be transferring the mortuaries from the South African Police Service and locating them under the roof of the provincial health departments, along with the forensic laboratories. Detailed plans are being drawn up for each of our provinces and a project manager has been appointed. It is expected that the process will be completed in a year.
ENVIRONMENTAL HEALTH
Government has taken measures to reduce environmental health risks. Already the measures to create an environment of clean air are beginning to pay off. Our airports, restaurants and places of work have become non-smoking areas. We will strengthen the anti-tobacco legislation this year. We will work with the Departments of Environmental Affairs, Agriculture and Labour to ensure that harmful emissions and chemicals that pollute our water, air, and soil are eliminated. We will work with non-governmental and community organisations, to ensure success.
As part of implementing the NEPAD agenda, we will make sure that poor countries do not continue to be the dumping ground for harmful products that put lives and the environment at risk. We will raise our voices at the World Health Assembly, to make sure that these issues are put high on the agenda. Raising consumer awareness about the harmful additives to foodstuff and related issues will form part of this campaign.
In terms of the New Health Bill, environmental health services will be vested with local government. This shifts responsibility for rendering environmental health to metropolitan and district councils as from 1 July this year. In discussion with the Minister for Provincial and Local Government, we have decided that the municipal health services, which are mandated as a local government competence in the Constitution, should be defined as a list of environmental health services, as do other major mandates such as development planning and provision of basic services. In some cases the change will entail very little in terms of need for new funds and the transfer of human resources. In others, the impact will be greater.
We are working hard to ensure that the services to the public will be maintained as the handover takes place and that the spirit of co-operative governance prevails as we iron out the details of restructuring. The district councils must ensure that appropriate transitional arrangements are in place for a smooth continuation of these services.
OCCUPATIONAL HEALTH
I believe occupational health is an area where we have yet to maximise potential and where we followed a rather restricted agenda. The threat HIV and AIDS posed to the economy, to particular industries and individual corporations, compelled employers and unions to consider occupational health in a new light. Many work-places became sites for the prevention and treatment of HIV and AIDS. We hope this preventative emphasis will be applied to other relevant areas of health in the workplace.
In the Demographic and Health Survey done five years ago, 13% of respondents reported that their health was affected by work. In 1996 researchers calculated that the direct cost of occupational injuries and disease was R17 billion or 3,5% of GDP.
We need to be more forward looking, taking a more pro-active and comprehensive approach to occupational health and safety. This will demand closer collaboration between the Departments of Labour and Health because they deal with different aspects of this challenge. Through Nedlac, we will engage our social partners about health issues.
CONCLUSION
As part of the team, I will help make sure that we turn the negative publicity around and get the media to report the good news and achievements of our department. We have prioritised communication as part of our strategic plan. We will ensure that the voices of the millions of people who benefit from our programmes are heard.
Health is a key delivery area and a key indicator of our success or failure. In the State of the Nation Address last month, President Mbeki made over 100 promises that are concrete and measurable. Many of these, though not the responsibility of the Department of Health, affect the health of the nation. These include the elimination of poverty and unemployment, the provision of basic services such as water, sanitation and electricity, the provision of social services and housing.
Honourable members, we are challenged by this. The people have great expectations of the people they elect. But, working together with other state departments, provincial and local government, parliament and our social partners, we will deliver on these promises and the popular mandate.
It will require that we ensure that we prepare ourselves physically and mentally to perform our tasks, given to us by the electorate. Long hours, travel, hectic schedules, poor diet, and lack of exercise - all contribute to poor health. We need to ensure that we identify ways that as public representatives and government officials we can be in good health so that we can do our job effectively as well as enjoy life.
There are two gyms in parliament. Are we using them? I invite you to join me in a campaign to get physically fit - FIT TO GOVERN.
Issued by: Ministry of Health
17 June 2004
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