Date: 03/05/2007

Source: Department of Health

Title: Radebe: National Council of Provinces summit on Intergovernmental Relations and Co-Operative Governance

Speech delivered by the acting Minister of Health, Jeff Radebe at the National Council of Provinces summit on Intergovernmental Relations and Co-Operative Governance, Cape Town

Programme director
Cabinet colleagues
Honourable members of the NCOP and the Assembly
Distinguished guests
Ladies and gentlemen

It is indeed an honour for me to speak at this historic summit which celebrates 10 years of co-operative government in our country. My specific task is to speak on the role of the National Council of Provinces (NCOP) in social transformation with specific focus on education, health and social development.

As is well known, education, health and welfare services are concurrent functions in terms of Schedule four of the Constitution with some exceptions. The exceptions are, tertiary education which is the competence of national government, the provision of ambulance services which is the competence of provincial government and provision of municipal health services and child care facilities which are the responsibility of local government as set out in section 155(6)(a) and (7) of the Constitution.

In order to implement the provisions of the Constitution each national and all provincial departments have established MINMECs called by various names to advise the respective ministers on policy and legislative matters and to monitor progress with respect to implementation of policy and legislation. Whilst it is true that National Ministers are accountable to the National Assembly and the NCOP and that, MECs are accountable to provincial legislatures, it is important for us to operate as a single cohesive unit for we are one country, we serve all South Africans regardless of where they live. It is therefore very important that we design and implement what can be best described as 'seamless government' so that our people experience no barriers to access to services regardless of which sphere of government is responsible for providing these services.

It is true that not all provinces have similar strengths and that government departments within provinces also differ in their ability to render services. It is therefore vitally important for provinces and departments to assist each other as it is for national government to monitor implementation and provide support where necessary. The ability of provinces and the national departments to monitor progress on implementation relies on having at least the following:

* a functional information system, which includes the people necessary to collect and use data
* effective management at all levels of the system
* the necessary political support
* the involvement of our communities.

Without these key ingredients, we will not be able to strengthen service delivery, even if we have excellent policies and legislation.

Over the past few years, by agreement and in terms of the Constitution, the roles of national and provincial departments in particular have changed. In terms of social development services, we witnessed a few years ago a change in terminology, from welfare services (as used in the Constitution) to social development. In addition, we changed the way in which social grants are administered from it being a provincial function, to the current arrangement in which the South African Social Security Agency (SASSA) is responsible for distributing social grants. The policy around social grants remains with the Minister and Department of Social Development. In addition, the Department of Social Development also adopted a new service delivery model that is in keeping with the change in terminology from 'welfare' to 'social development'. This signals a move away from either creating or fostering dependency to one that focuses on development as the path out of poverty. These are changes that we adopted by the National Council of Provinces (NCOP) in the past few years.

As we celebrate the 10th anniversary of the NCOP we should record some of the achievements that this government has made with respect to the expansion of social services. Whilst they are too numerous to mention in the short time that I have been allocated, I will take this opportunity to mention just a few in the areas of social development, education and health.

Social grants to children in the form of the Child Support Grant have been significantly extended in terms of the number of beneficiaries. We had set a target of 3,2 million children as new beneficiaries last year and exceeded the target by mid year by 300 000. Government provides social assistance to more than seven million children today. In a study we found that social grants are indeed benefiting the poorest of the poor.

Clearly however, we need to ensure that our people are empowered to enjoy the benefits of employment. In this regard the government's Accelerated Shared Growth Initiative of South Africa (AsgiSA) programme, under the leadership of the Deputy President is well-known and fast gaining momentum. The social clusters of departments have and continue to make their contributions to the creation of work opportunities through in particular the extended public works programme. We have increased the number of community caregivers that receive a stipend for their contribution to the provision of home and community based care to more than 25 000 during the last financial year for example.

With respect to legislation, the NCOP has considered very important pieces of legislation on social development in the past few years. These include the Older Persons Bill (now an Act) and the Children's Bill. The Department of Social Development has also recently released a draft Drug and Substance Abuse Bill which after revision will be sent to Parliament.

With respect to the provision of education opportunities to our people, under the political guidance of the NCOP, provinces have been able to increase the intake of primary school children and we are extremely proud of the fact that this commitment from government has resulted in South Africa already meeting the Millennium Development Goals (MDG) with respect to enrolment of primary school children, in particular the girl child.

Payment of school fees cannot under this government be a barrier to access to schools. This government therefore took a decision to exempt, in a targeted fashion schools which enrol children whose parents cannot pay fees. In 2006, more than 7 600 schools were no fee schools benefiting more than 2,6 million learners. Whilst in school learners who come from poor communities are also provided with one nutritious meal per day as part of the school nutrition programme that was first introduced as the primary school nutrition programme administered by the Department of Health. At present the programme provides meals to 1,8 million primary school learners each school day at a cost of R30,1 million. In addition, 1 149 schools now have vegetable gardens which provides the school with fresh vegetables and also teaches learners and community members food production skills.

Besides increasing access, the school environment must also be conducive to learning and teaching. To this end the Department of Education embarked on a process to audit all schools so that the precise infrastructure needs of each school can be known and measures put in place to ensure that they are maintained to the highest standards.

Health services must be experienced as seamless by our communities as it often requires a continuum of care which straddles both levels of service that may be required as well as types of health services. As with the other services referred to above, the national department's function is the crafting of national policies and legislation with provincial colleagues, but it is the provinces that implement health policies and legislation at health facilities and in communities. It is therefore very important for the NCOP to continue to monitor progress made nationally in the implementation of health policy. Besides increasing access to both primary care as well as hospitals, it is also very important for us to ensure that the quality of these services improves over time. Communities in particular have an important role to play in this regard through clinic committees as well as hospital boards but also through their parliamentary representatives.

In line with the Constitution the Department of Health decided to define municipal health services as environmental or non-personal health services which are now the full responsibility of metro and district municipalities with three exceptions namely; malaria control, control of hazardous substances and port health services which provinces retain. This also implies that provinces are now responsible for providing primary healthcare and are currently in the process of provincialising these services where they have been provided by municipalities.

The act that sets out these matters is the National Health Act of 2003 which was debated by the NCOP and passed by both Houses before accented to by the President. It is very important that honourable members of the NCOP monitor this process carefully to ensure that in the process of provincialisation of primary healthcare services, patients get a significantly superior service.

In 1994 President Mandela announced a policy of free healthcare to children under six and pregnant women. In 1996, a no fee policy for primary health was announced to further improve access to health services. Most recently people with disabilities were exempt from paying fees for health services. These measures have indeed increased access to healthcare services. Whereas access to primary healthcare services measured by headcounts was 67 million visits in 1998/99, this has increased to more than 102 million by 2006. This represents a 52% increase in eight years. This gives us some idea of the unmet need that this government has tried to meet in the past 10 years.

It is often said that hospitals are the face of the health service. The department has initiated a process of strengthening hospital services. As stated by the President is a previous State of the Nation Address, we have appointed and delegated a range of management functions to hospital chief executive officers (CEOs). Also, in order to empower them, many have enrolled into university-based hospital management programmes. In addition, the department started a hospital rehabilitation programme in the late 1990s after finding that about a third of our hospital stock needed rebuilding. A few years ago we realised that merely having new buildings would not translate to improved service delivery and we changed our approach and instituted a hospital revitalisation programme. Provinces chose which hospitals to revitalise and through a conditional grant we provide them with the resources to change the infrastructure, buy new equipment and strengthen the management and quality of care provided.

The Department of Health is trying to cope with what is called the triple burden of diseases. These are diseases from communicable diseases, non-communicable diseases as well as injuries and trauma. This places a large burden on the health system. It is important that note that government alone cannot meet these challenges and that communities, must play their role as well. We have recently finalised a National Strategic Plan for 2007 to 2011 to deal with the challenge of HIV and AIDS. It is very important to note that this process was collaboration between government and its civil society partners. The challenge now is to ensure that we all, government and our partners, put our shoulders to the wheel and deliver on the very ambitious targets that we have set ourselves in this Plan.

As I have noted, all three departments that I referred to have put in place co-operative governance structures and processes to ensure that national policies are implemented. This is not to say the challenges have not been experienced. Indeed, there have been challenges; however, most were amicably resolved without the need to get courts of law to arbitrate.

For our system of government to work, our experience is that we must have structures and processes within which to work, however, key is leadership from all sides, because without leadership, all the structures in the world will not assist us. In addition, clear roles and responsibilities together with accountability to both structures that we have established and communities that we serve are critical for successful implementation of national policies.

I wish to salute the leadership provided by the NCOP. By taking the NCOP to the people, you have increased access to our governance structures at the highest levels to members of communities throughout this beautiful country of ours. I am not sure if this happens anywhere else in the world but it builds on the idea of izimbiso or makgotla that we inherited from our forebears. It is important that as we build on the successes of our new democracy that we also extend the lessons of our traditional past. Taking Parliament to the people as has been done so successfully by the NCOP is an excellent example of this. Off course it also increases our accountably and makes us more aware of the needs and aspirations of our people.

I wish to complement the NCOP and its leadership on the role that it has played in the past 10 years. Together with the executive of this government, we have indeed made major gains in dismantling the structures of apartheid and some its social and economic consequences It is our wish that the NCOP continues to play its role in facilitating harmonious intergovernmental relations and ensuring a better life for all of our people, especially the poorest of the poor.

I thank you.

Issued by: Department of Health
3 May 2007