Date: 10/06/2003
Source: Ministry of Health
Title: R Schoeman: Health Dept Budget Vote 2003/2004, NCOP
SPEECH BY RENIER SCHOEMAN, MP, DEPUTY MINISTER OF HEALTH, HEALTH BUDGET DEBATE, National Council of Provinces, 10 June 2003
Honourable Chair
Hon. Minister
Hon. Provincial Ministers of the NCOP
When I was appointed as Deputy Minister of Health on 4 November 2002, I said that I saw my appointment not only as a challenge but also as a great opportunity to serve my country and this view has been reinforced by all my experiences since my appointment.
I have also made a point of repeating as often as I can that I believe that there is a new positive political dynamic of putting South Africa's interest first gaining momentum. I hold this view because there is an increasing acceptance that the problems of South Africa are shared problems which call for a shared commitment to resolve. I will continue to play a positive role in this regard to the best of my ability and in the knowledge that by serving the common good, the interests of all are best served.
I also wish to record, in this House, my appreciation for the warm welcome I have been accorded in the National Ministry and Department of Health, from the Provincial Health Ministers and their Departments, from the Chairs and members of the portfolio committees dealing with health in the National Assembly as well as the National Council of Provinces, and from the health private sector. As a functionary in the National Ministry I have been impressed by the excellent and valued co-operation in MINMEC chaired and led by the Hon. The Minister of Health. It is a good example of excellent tem work and the collective effort in a spirit of common purpose.
Dit is vir my 'n voorreg om deel te wees van hierdie groot en toegewyde span wat oor die lengte en breedte van ons land strewe vir gesondheid en gehalte mediese dienste vir al ons mense.
SPECIAL ROLE OF NCOP
In supporting the budget vote for health in this chamber today, I would like to recognise the special and valuable role played by members of the National Council of Provinces especially in portfolios where the Constitution assigns concurrent functions to national and provincial spheres of Government.
The role of this Council in terms of the processing of legislation is well understood but its value in terms of ensuring accountability is perhaps underestimated and not always given adequate recognition. In portfolios such as Health the greater part of the "national" budget is effectively spent by provinces. The Select Committee on Social Services under the able leadership of the Hon. Loretta Jacobus promotes significant interaction with provinces, which assists not only in monitoring expenditure but also in understanding the particular successes and challenges of individual provinces and I would like to acknowledge this specifically today.
The combination of provincial visits by members of the NCOP, reports to NCOP hearings and the active participation of Health MECs in the debates of the NCOP contributes in a unique way to the vital interactive role which the NCOP plays in health administration in South Africa.
ROLE OF AND NATIONAL HEALTH LABORATORY SERVICE AND ITS SUPPORT FOR PROVINCES
A critical factor in the quality of provincial health services is access to support services, such as laboratories, blood supplies, etc. Both of these services have been restructured in recent years to form national entities that strive to serve all of South Africa on an equal footing. The restructuring was perhaps more fundamental in relation to the laboratory services where a large number of provincial laboratories were drawn together with national research organisations to form the National Health Laboratory Service.
The NHLS was born as a public entity in October 2001 and is sole provider of laboratory services to the provincial health departments. It has almost 300 laboratories around the country and its budget presently runs close to R970-million - most of which is funded by fees for service.
A high-profile component of the NHLS is the National Institute for Communicable Diseases which has a well deserved reputation in the international arena for research and for specialised support to the continent of Africa in relation to outbreak control. But ultimately the success of the NHLS will depend on its less high profile elements - the laboratories, large and small, in all parts of the country that support clinicians in thousands of public hospitals and clinics in the provinces, on a daily basis.
I therefore say that the NHLS has a critical role to play in building the health infrastructure of this country also in provinces and also enabling rural hospitals, in particular, to function at a more effective level.
I am therefore pleased to note that the NHLS has experienced a more stable period in the last nine months, after a difficult year which culminated in the resignation of the first chief executive officer. We have had a caretaker CEO in place since October last year - in the person of Dr Nicholas Crisp and under his guidance and dynamic leadership and that of the chairperson, Ms Sesi Baloyi, the organisation has stabilised and its services are improving steadily. We wish to thank both Dr Crisp and Ms Baloyi for the effort they have invested to get the service back on a firm and effective footing.
It is against this background that a new CEO, Mr John Robertson, has recently been appointed. I am confident that he has the necessary insight and experience to continue to take the NHLS forward, paying close attention to the needs of provinces where the service is least developed, and the needs are greatest.
MEDICOLEGAL MORTUARIES
Another area in which restructuring has been long-awaited is the medico-legal mortuaries. This year we expect to see further movement n terms of the transfer of these mortuaries from the police service to the provincial health departments.
Members of the NCOP will appreciate that it is in the interests of justice that the medico-legal services are run by skilled professionals, with well trained assistants, whose independence in providing evidence to the courts is beyond question. The current arrangement, whereby mortuaries are run by the police service and mortuary assistants are police personnel, does therefore need to be adapted so that that the service in its entirety will eventually vest in the health sector, where it belongs.
Treasury has allocated funding for the capital works that need to be carried out at mortuaries to create facilities conducive to high quality work. We are discussing with Treasury the flexible utilisation of such finance over two or three financial years. The Police Service has confirmed that funding for all medico-legal posts will be transferred to provincial health departments.
All provinces are giving their full co-operation and four provinces have already indicated that they would be in a position to begin the transfer of medico-legal mortuaries within 12 months of receiving funding for the renovations contemplated. From the side of the national Department we will continue to approach the matter with a sense of urgency.
PHARMACEUTICAL FRAUD
Another area where collaboration with the criminal justice system has become critical - and increasingly successful - is that of pharmaceutical fraud. I am informed that a number of provinces have in the past year made significant breakthroughs in unmasking criminal syndicates at work selling state drugs to the private sector.
But criminals are notorious for their inventiveness - and the Internet is increasingly becoming a vehicle for illicit trafficking in pharmaceutical products. The illegality of the practice lies in the cross-border nature of the operation, the fraudulent issuing of prescriptions to support Internet mail orders and the fact that the drugs are often unregistered and of dubious quality.
Fortunately these operations are not immune to police investigation and just last month one such operation was uncovered in Cape Town. The "pharmacy" to which foreign clients were sending their electronic orders was nothing more than a suburban home. The prescriptions needed to dispense the schedule 5 drugs on offer were issued by Cape Town doctors who had never seen their so-called patients.
The public needs to be made aware of how dangerous such operations are and that so called "virtual pharmacies" are no substitute for the real thing. Fortunately for the public, the medicines industry is a competitive field and there are thousands of legitimate operators who are on the side of the law and who have also proved to be valuable sources of intelligence about illicit operations for which we must thank them.
HIV/AIDS AND ANTI-RETROVIRALS
In my participation in the Health Vote in the National Assembly a few weeks ago I made the point, that the view sometimes expressed from outside the system, that the major challenges of HIV/AIDS and TB are not taken seriously enough from the side of Government, does simply not accord with the commitment I have seen within the public health sector to strengthening our ability to face up to the twin scourges of HIV/AIDS and TB.
The fact that at this very moment serious consideration is being given by Government, inter alia, to the matter of the extent of anti-retroviral treatment further underlines the seriousness with which the challenge of HIV/AIDS is being approached.
Maar dit is ook nodig om weer op rekord te plaas dat die NNP wel deurlopend konsekwent sy standpunt handhaaf oor 'n belangrike aspek van die hantering van die MIV/Vigs probleem en dit gaan spesifiek oor die kwessie van beskikbaar- heid van anti-retrovirale middels.
The consistent view of the NNP on the highly topical issue of provision of ANTI-RETROVIRALS is a matter of clear public record and was articulated again recently, as, follows by the National Leader of the NNP when he said and I quote:
"We say South Africa has a moral duty to assist the millions of our fellow citizens who are infected with HIV/AIDS. We must intensify our war against the pandemic. In this war we must stop at nothing to win. The NNP therefore calls on Government to urgently spell out its road map for comprehensively treating the millions of South Africans already infected - especially with regard to rolling-out the use of anti-retroviral (ARV) treatment.
The additional R3.3 billion in this year's budget for fighting Aids is great news. Combined with the massive awareness campaigns, home-based care initiatives voluntary testing and counselling and a range of other measures, it shows that Government is serious about this battle - but the critical element which is still missing at this stage is a plan for harnessing ARV drugs as part of the national treatment strategy.
We believe that for the millions of people who are living with HIV, a clear, unequivocal commitment from Government will provide great hope for those who need it most and this needs to happen as soon as possible".
However, apart from this issue, I have said before and say so again that I have come to appreciate the sense of purpose that lies behind a clear programme of action that is unfolding in accordance with the Department's five-year national strategy, and any claim that there is currently no plan for HIV and Aids is simply not true.
PUBLIC PRIVATE PARTNERSHIPS
Among the more interesting developments of the past two years is the birth of various partnerships between the public health care sector and private enterprise. Most of these PPP initiatives are young and experimental and they are quite diverse in nature.
They range from enterprises where the shares are divided between government and the private sector, to differentiated facilities within public hospitals, to Government funding of non-profit organisations and private sector sponsorship of public health campaigns.
A new entity for vaccine production has been brought into existence as a result of a partnership between the Department of Health and the Biovac Consortium. The purpose of this partnership is to revive South Africa's vaccine production capability through an infusion of private investment.
Hospitals in a range of provinces have accommodated private patients or private sector initiatives within their premises.
* Among these is the Johannesburg Hospital that experienced immediate success with the provision of amenities for private patients - to the extent that it had to expand its capacity within just a few months of the launch last year
* Universitas and Pelonomi Hospitals in Bloemfontein have similarly used excess ward space to provide private facilities and to generate income for the renovation of both hospitals.
In KwaZulu-Natal the flagship PPP is the new Inkosi Albert Luthuli Hospital where a range of non-clinical functions has been outsourced. The underlying objective is to achieve better service especially in fields where the public sector has not been particularly effective. These include the provision and maintenance of medical technology and information technology.
When it comes to partnerships with non-profit organisations, the Department has recognised the potential of loveLife to add value to public health programmes. The Department has entered into a three-way partnership with loveLife and the Kaiser Family Foundation to enhance health services for young people. At the heart of this programme is the process of creating "youth friendly" services within primary health care clinics. The aim by the end of 2003 is to have 150 youth friendly clinics up and running. Thereafter the pace of roll out should increase to reach 3 000 clinics in three to five years. The partnership also sponsors the loveLife Games, which are sporting events arranged in accordance with the normal school sporting calendar but which offer participants opportunities to develop life skills and improve their knowledge of sexual health.
The recent multi-country Racing against Malaria initiative could not have been achieved without the generous sponsorship of a whole number of private sector companies. The 4X4 vehicles for the rally as well as many other costs were covered by donation. And - as in all the above examples - the real beneficiaries have been the millions of people who depend on the public health sector.
CONCLUSION
Since taking up my position as Deputy Minister, I have come to appreciate the special and useful co-operation that exists between the health ministers of the SADC countries. I have also become aware of the extent to which Minister Tshabalala-Msimang plays a significant role in promoting and nurturing this co-operation. For example her presence at every major event along the route, of the recent malaria rally, really demonstrates the kind of time, energy, and commitment she devotes to regional co-operation to the benefit of the entire region.
Chairperson and members, I propose that the budget vote for health be supported. The programmes that are funded are appropriate. They are central both to the continuing improvement of the health sector and to providing ongoing support to provincial health departments in their delivery of services to the people of this country.
Ek steun graag hierdie begrotingspos en doen dit met vrymoedigheid.
Issued by Ministry of Health
10 Jun 2003
Source: Ministry of Health
Title: R Schoeman: Health Dept Budget Vote 2003/2004, NCOP
SPEECH BY RENIER SCHOEMAN, MP, DEPUTY MINISTER OF HEALTH, HEALTH BUDGET DEBATE, National Council of Provinces, 10 June 2003
Honourable Chair
Hon. Minister
Hon. Provincial Ministers of the NCOP
When I was appointed as Deputy Minister of Health on 4 November 2002, I said that I saw my appointment not only as a challenge but also as a great opportunity to serve my country and this view has been reinforced by all my experiences since my appointment.
I have also made a point of repeating as often as I can that I believe that there is a new positive political dynamic of putting South Africa's interest first gaining momentum. I hold this view because there is an increasing acceptance that the problems of South Africa are shared problems which call for a shared commitment to resolve. I will continue to play a positive role in this regard to the best of my ability and in the knowledge that by serving the common good, the interests of all are best served.
I also wish to record, in this House, my appreciation for the warm welcome I have been accorded in the National Ministry and Department of Health, from the Provincial Health Ministers and their Departments, from the Chairs and members of the portfolio committees dealing with health in the National Assembly as well as the National Council of Provinces, and from the health private sector. As a functionary in the National Ministry I have been impressed by the excellent and valued co-operation in MINMEC chaired and led by the Hon. The Minister of Health. It is a good example of excellent tem work and the collective effort in a spirit of common purpose.
Dit is vir my 'n voorreg om deel te wees van hierdie groot en toegewyde span wat oor die lengte en breedte van ons land strewe vir gesondheid en gehalte mediese dienste vir al ons mense.
SPECIAL ROLE OF NCOP
In supporting the budget vote for health in this chamber today, I would like to recognise the special and valuable role played by members of the National Council of Provinces especially in portfolios where the Constitution assigns concurrent functions to national and provincial spheres of Government.
The role of this Council in terms of the processing of legislation is well understood but its value in terms of ensuring accountability is perhaps underestimated and not always given adequate recognition. In portfolios such as Health the greater part of the "national" budget is effectively spent by provinces. The Select Committee on Social Services under the able leadership of the Hon. Loretta Jacobus promotes significant interaction with provinces, which assists not only in monitoring expenditure but also in understanding the particular successes and challenges of individual provinces and I would like to acknowledge this specifically today.
The combination of provincial visits by members of the NCOP, reports to NCOP hearings and the active participation of Health MECs in the debates of the NCOP contributes in a unique way to the vital interactive role which the NCOP plays in health administration in South Africa.
ROLE OF AND NATIONAL HEALTH LABORATORY SERVICE AND ITS SUPPORT FOR PROVINCES
A critical factor in the quality of provincial health services is access to support services, such as laboratories, blood supplies, etc. Both of these services have been restructured in recent years to form national entities that strive to serve all of South Africa on an equal footing. The restructuring was perhaps more fundamental in relation to the laboratory services where a large number of provincial laboratories were drawn together with national research organisations to form the National Health Laboratory Service.
The NHLS was born as a public entity in October 2001 and is sole provider of laboratory services to the provincial health departments. It has almost 300 laboratories around the country and its budget presently runs close to R970-million - most of which is funded by fees for service.
A high-profile component of the NHLS is the National Institute for Communicable Diseases which has a well deserved reputation in the international arena for research and for specialised support to the continent of Africa in relation to outbreak control. But ultimately the success of the NHLS will depend on its less high profile elements - the laboratories, large and small, in all parts of the country that support clinicians in thousands of public hospitals and clinics in the provinces, on a daily basis.
I therefore say that the NHLS has a critical role to play in building the health infrastructure of this country also in provinces and also enabling rural hospitals, in particular, to function at a more effective level.
I am therefore pleased to note that the NHLS has experienced a more stable period in the last nine months, after a difficult year which culminated in the resignation of the first chief executive officer. We have had a caretaker CEO in place since October last year - in the person of Dr Nicholas Crisp and under his guidance and dynamic leadership and that of the chairperson, Ms Sesi Baloyi, the organisation has stabilised and its services are improving steadily. We wish to thank both Dr Crisp and Ms Baloyi for the effort they have invested to get the service back on a firm and effective footing.
It is against this background that a new CEO, Mr John Robertson, has recently been appointed. I am confident that he has the necessary insight and experience to continue to take the NHLS forward, paying close attention to the needs of provinces where the service is least developed, and the needs are greatest.
MEDICOLEGAL MORTUARIES
Another area in which restructuring has been long-awaited is the medico-legal mortuaries. This year we expect to see further movement n terms of the transfer of these mortuaries from the police service to the provincial health departments.
Members of the NCOP will appreciate that it is in the interests of justice that the medico-legal services are run by skilled professionals, with well trained assistants, whose independence in providing evidence to the courts is beyond question. The current arrangement, whereby mortuaries are run by the police service and mortuary assistants are police personnel, does therefore need to be adapted so that that the service in its entirety will eventually vest in the health sector, where it belongs.
Treasury has allocated funding for the capital works that need to be carried out at mortuaries to create facilities conducive to high quality work. We are discussing with Treasury the flexible utilisation of such finance over two or three financial years. The Police Service has confirmed that funding for all medico-legal posts will be transferred to provincial health departments.
All provinces are giving their full co-operation and four provinces have already indicated that they would be in a position to begin the transfer of medico-legal mortuaries within 12 months of receiving funding for the renovations contemplated. From the side of the national Department we will continue to approach the matter with a sense of urgency.
PHARMACEUTICAL FRAUD
Another area where collaboration with the criminal justice system has become critical - and increasingly successful - is that of pharmaceutical fraud. I am informed that a number of provinces have in the past year made significant breakthroughs in unmasking criminal syndicates at work selling state drugs to the private sector.
But criminals are notorious for their inventiveness - and the Internet is increasingly becoming a vehicle for illicit trafficking in pharmaceutical products. The illegality of the practice lies in the cross-border nature of the operation, the fraudulent issuing of prescriptions to support Internet mail orders and the fact that the drugs are often unregistered and of dubious quality.
Fortunately these operations are not immune to police investigation and just last month one such operation was uncovered in Cape Town. The "pharmacy" to which foreign clients were sending their electronic orders was nothing more than a suburban home. The prescriptions needed to dispense the schedule 5 drugs on offer were issued by Cape Town doctors who had never seen their so-called patients.
The public needs to be made aware of how dangerous such operations are and that so called "virtual pharmacies" are no substitute for the real thing. Fortunately for the public, the medicines industry is a competitive field and there are thousands of legitimate operators who are on the side of the law and who have also proved to be valuable sources of intelligence about illicit operations for which we must thank them.
HIV/AIDS AND ANTI-RETROVIRALS
In my participation in the Health Vote in the National Assembly a few weeks ago I made the point, that the view sometimes expressed from outside the system, that the major challenges of HIV/AIDS and TB are not taken seriously enough from the side of Government, does simply not accord with the commitment I have seen within the public health sector to strengthening our ability to face up to the twin scourges of HIV/AIDS and TB.
The fact that at this very moment serious consideration is being given by Government, inter alia, to the matter of the extent of anti-retroviral treatment further underlines the seriousness with which the challenge of HIV/AIDS is being approached.
Maar dit is ook nodig om weer op rekord te plaas dat die NNP wel deurlopend konsekwent sy standpunt handhaaf oor 'n belangrike aspek van die hantering van die MIV/Vigs probleem en dit gaan spesifiek oor die kwessie van beskikbaar- heid van anti-retrovirale middels.
The consistent view of the NNP on the highly topical issue of provision of ANTI-RETROVIRALS is a matter of clear public record and was articulated again recently, as, follows by the National Leader of the NNP when he said and I quote:
"We say South Africa has a moral duty to assist the millions of our fellow citizens who are infected with HIV/AIDS. We must intensify our war against the pandemic. In this war we must stop at nothing to win. The NNP therefore calls on Government to urgently spell out its road map for comprehensively treating the millions of South Africans already infected - especially with regard to rolling-out the use of anti-retroviral (ARV) treatment.
The additional R3.3 billion in this year's budget for fighting Aids is great news. Combined with the massive awareness campaigns, home-based care initiatives voluntary testing and counselling and a range of other measures, it shows that Government is serious about this battle - but the critical element which is still missing at this stage is a plan for harnessing ARV drugs as part of the national treatment strategy.
We believe that for the millions of people who are living with HIV, a clear, unequivocal commitment from Government will provide great hope for those who need it most and this needs to happen as soon as possible".
However, apart from this issue, I have said before and say so again that I have come to appreciate the sense of purpose that lies behind a clear programme of action that is unfolding in accordance with the Department's five-year national strategy, and any claim that there is currently no plan for HIV and Aids is simply not true.
PUBLIC PRIVATE PARTNERSHIPS
Among the more interesting developments of the past two years is the birth of various partnerships between the public health care sector and private enterprise. Most of these PPP initiatives are young and experimental and they are quite diverse in nature.
They range from enterprises where the shares are divided between government and the private sector, to differentiated facilities within public hospitals, to Government funding of non-profit organisations and private sector sponsorship of public health campaigns.
A new entity for vaccine production has been brought into existence as a result of a partnership between the Department of Health and the Biovac Consortium. The purpose of this partnership is to revive South Africa's vaccine production capability through an infusion of private investment.
Hospitals in a range of provinces have accommodated private patients or private sector initiatives within their premises.
* Among these is the Johannesburg Hospital that experienced immediate success with the provision of amenities for private patients - to the extent that it had to expand its capacity within just a few months of the launch last year
* Universitas and Pelonomi Hospitals in Bloemfontein have similarly used excess ward space to provide private facilities and to generate income for the renovation of both hospitals.
In KwaZulu-Natal the flagship PPP is the new Inkosi Albert Luthuli Hospital where a range of non-clinical functions has been outsourced. The underlying objective is to achieve better service especially in fields where the public sector has not been particularly effective. These include the provision and maintenance of medical technology and information technology.
When it comes to partnerships with non-profit organisations, the Department has recognised the potential of loveLife to add value to public health programmes. The Department has entered into a three-way partnership with loveLife and the Kaiser Family Foundation to enhance health services for young people. At the heart of this programme is the process of creating "youth friendly" services within primary health care clinics. The aim by the end of 2003 is to have 150 youth friendly clinics up and running. Thereafter the pace of roll out should increase to reach 3 000 clinics in three to five years. The partnership also sponsors the loveLife Games, which are sporting events arranged in accordance with the normal school sporting calendar but which offer participants opportunities to develop life skills and improve their knowledge of sexual health.
The recent multi-country Racing against Malaria initiative could not have been achieved without the generous sponsorship of a whole number of private sector companies. The 4X4 vehicles for the rally as well as many other costs were covered by donation. And - as in all the above examples - the real beneficiaries have been the millions of people who depend on the public health sector.
CONCLUSION
Since taking up my position as Deputy Minister, I have come to appreciate the special and useful co-operation that exists between the health ministers of the SADC countries. I have also become aware of the extent to which Minister Tshabalala-Msimang plays a significant role in promoting and nurturing this co-operation. For example her presence at every major event along the route, of the recent malaria rally, really demonstrates the kind of time, energy, and commitment she devotes to regional co-operation to the benefit of the entire region.
Chairperson and members, I propose that the budget vote for health be supported. The programmes that are funded are appropriate. They are central both to the continuing improvement of the health sector and to providing ongoing support to provincial health departments in their delivery of services to the people of this country.
Ek steun graag hierdie begrotingspos en doen dit met vrymoedigheid.
Issued by Ministry of Health
10 Jun 2003
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