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SA: Gwen Ramokgopa: Address by the Deputy Minister of Health, during the delivery of the Health Department Budget Vote 2013/14 , Parliament, Cape Town (15/05/2013)

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SA: Gwen Ramokgopa: Address by the Deputy Minister of Health, during the delivery of the Health Department Budget Vote 2013/14 , Parliament, Cape Town (15/05/2013)

15th May 2013

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Honourable Chairperson,
Honourable Minister of Health, Dr Aaron Motsoaledi,
Honorable Ministers and Deputy Ministers present here today,
Honourable Chairperson of the Portfolio Committee on Health, Dr Bevan Goqwana
Honourable Members,
Distinguished guests,
Ladies and gentlemen,

Non-Communicable diseases

NCDs are the number one killer in the world, with more than 63% of all global deaths due to cardiovascular and chronic lung diseases, cancers and diabetes.
Globally, 90% of preventable, premature deaths due to NCDs occur in low-and middle-income countries. In two-days time, this trend can be reversed with political will and sound action.

Over the past few years scientists have been highlighting the quadrupple burden of disease and alerting South Africans of what Professor Mayosi et al in the Lancet Medical Journal refer  to as a cocktail of four colliding epidemics.

In asking this august house to support the Health Budget Vote 2013/14 as an enable to tackle these major challenges, we also say to you and our people that we bring good news. Good News that our children and young people are living longer ! Good news that our working  population is more productive and alive and to nurture their children and our elderly are not burying their children and grand children at a rate of yesteryear.

An increase in life expectancy of any nation by 4 years over a short period of time as happened in our country is by no means a small occurance, it is profound and demonstrates the fortuitous and tenacious resolve by a people to survive. This occurance has left the global community and scientist in awe , refered ro this success as of this success refered ( Slim Karim)  .................

Our vision of a long and healthy life of South Africans is in the making, in our lifetime under the leadership of the ANC government through our collective effort as a nation! Six important success factors have been the love for our people, dicisive leadership, social cohesion, evidence based medicine, a dedicated health workforce and the appreciation that this high burden of disease not only threatens our development agenda but also mocks the democracy our people fought. As we enter the second decade of our democracy the ANC is not only celebrating with our people her legacy as a liberation movement against political bondage but also a liberation movement against illhealth, suffering and  threaths to our democracy and prosperity.

Tor Lancet  article further warns however that we should not be complacent with the progress we have made to date as major challenges still exist relating to:-

  • the adverse social determinants of health and persisting racial disparities
  • the need to Intergrate and coordinate the Health system
  • the need to improve surveillance and information systems
  • the scaling up of innovative interventions for the benefit of the whole system

The budget we present today aims to consolidate our efforts, respond to the remaining challenges and to rally our nation to respond successfully the the NDP which calls amongst others for the increase of life expectancy from the current 60 to 70 years. Through strengthening evidence based approach and stakeholder involvement in our work we are well positioned to succeed.

Since the Declaration of the National Summit on Non Communicable Diseases identified the 10 priorities, the NHC has approved a strategic implementation plan, the Ministerial Advisory Committee on Cancer has begun its work. The introduction of HPV vaccine will go a long way in reducing cancer of the cervix which is the leading cancer amongst women. Cervical Cancer presents a good example of the co- morbidity of infectious and non communicable diseases.

Patients who are also HIV positive are also more vulnerable to having this cancer and on the other hand smoking increases the risk.

Already there is emerging evidence from the 3 pilot sites in the country that the Intergrated Management of Chronic Diseases is an ideal, practical and patient centred effective manner to manage the double burden of HIV and NCD's. This year we will roll out the model to the NHI sites. Silent killers especially,  but not limited to, amongst the poor and rural communities. Breast cancer, cervical cancer, diabetes and hypertension. This model will assist to pick up risk factors and early signs of disease to prevent complications such as amputations, strokes, kidney failure and blindness. Screening and early detection will also save costs in treating advanced disease, absenteeism, loss of income and the burden on the family to provide care.

The media platform the Minister has announced will certainly go a long way in ensuring an intergrated and effective approach to public awareness and health promotion campaigns.

We will also leverage the various other programs such as the Intergrated School Health and the Ward Based Programs as we strengthen PHC approach. We have begun to pilot the Intergrated Management of Chronic Diseases Model to ensure a patient Centred approach. As we honor and salute our health workers for their role in halting the HIV and AIDS epidemic and saving our children, we call on them to be at the forefront to consolidate our gains and decisively tackle maternal mortality, NCD's as well as injuries in an Intergrated manner. There should not be a missed opportunity to reverse all quadruple epidemic onslaught.

We will fastrack the process of establishing a National Health Commission  as a multisectoral partnership forum to strengthen our capacity to make Health a Societal Priority in tackling the socio-economic determinants of illhealth. We should remember that globally as well as in South Africa the major NCD's are cardiovacsular diseases like hypertension and stokes, metabolic diseases like diabetes, cancers, chronic respiratory illnesses like asthma and mental illnesses like depression and anxiety disorders.

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The Commission will also help in focussing our society to find lasting solutions in tackling the four risk factors namely poor diet , physical inactivity, tobacco use and harmful use of alcohol.

  • The process of legislation to prohibit alcohol advertising is at an advanced stage and regulations on warning labels on alcohol containers will be revised.
  • Regulations will be enhanced to further reduce passive smoking at the workplace and other public places and to educate the public effectively about the health dangers of smoking through graphic warnings.
  • A Health Promotion Strategy incorporating the promotion of physical activity and nutrition will be finalised this year. 
  • Working with industry we will ensure that preparations to meet the the 2016 deadline for the reduction of salt and  for fatty acids in food are met and together we will also launch a public awareness campaign. 60% of intake of salt in South Africa is through industrial supplies and in line with WHO recommendations we call on our people lets limit salt intake to not more than 5 grams per day.

The effectiveness and efficiency of the Health System remains a top priority.

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In endorsing World Health Organisation and the International Telecommunications Union (ITU) on eHealth being at the core of responsive health systems and that expectations are that the health sector must inevitably integrate technology into its way of doing business, last year we finalised the eHealth Strategy and have completed a Normative Standards Framework, in partnership with the MRC and the Council for Scientific and Industrial Research (CSIR). In 2013, we will apply this framework to mitigate against the current 42 health information systems in the public sector many of which are not interoperable. 

Honoured members, the National Development Plan 2030 indicates that ' given the escalating costs of services in both the public and private sectors and the high proportion of the GDP that goes to health service funding, it is essential to create a culture of using evidence to inform planning, resource allocation and clinical practice.' To achieve this goal and in implementing the National Health Research Summit of 2011 the National Health Scholars Programme has been established with an aim to produce 1 000 PhD graduates over the next 10 years. Already  13 PhD scholars have been funded for this financial year. In the near future, these PhD Scholars will become the new generation of health researchers, and also contribute to clinical teaching and training and health service delivery.

The National Health Surveillance System is assisting the Department to swiftly contain infectious disease outbreaks. This year we will finalise the Intergrated National Plan on Disease Surveillance with the aim of aligning to the quadruple burden of disease, to strengthen monitoring and to measure the impact of our interventions on a continuous systemating basis.

Chairperson, the billions of rands saved through a more efficient  drug procurement system has enable more patients to access medication. The National Essential Medicine List Committee periodically reviews the Treatment Guidelines and updates the Essential Drug List. A national monitoring system has been designed and implemented for the early detection of facility stock outs. With the inefficiencies, losses and expiry of medicines experienced through the Medical Depot System, we are encouraged that a number of provinces have begun a model of Direct Deliveries to Point Care in health facilities. The National Central Procurement Unit will be assisting provinces to move with greater speed.

In partnership with the World Health Organisation, the Tshwane University of Technology as well as the Japanese International Cooperation respectively training in Health Technology Audit and Maintainance has already benefitted more that 50 Clinical Engineering Technicians from six provinces. This program augments the capacity of facilities in various districts to be compliant to the Essential Equipment List approved by the NHC.

Chairperson, later this year in KZN we will officially open the National Forensic Chemistry Laboratory in Durban and had started functioning with the first 15 employees from 2 April 2013. This laboratory will be performing post-mortem and ante-mortem blood alcohol analysis for KwaZulu-Natal and some parts of the Eastern Cape – the borders of which will still be announced. It is envisioned that the first samples would be received for analysis in July 2013, and the procurement of analytical equipment is currently in the final stages. 

This would enable us to decrease the current blood alcohol backlogs more effectively. The department made funding available for the building of a brand new Forensic Chemistry Laboratory in Phoenix, in the KZN province as well. This facility will be responsible for post-mortem and ante-mortem blood alcohol analysis, toxicology analysis in cases of unnatural death, as well as food analysis in terms of the Foodstuffs Act. Furthermore, 70 Forensic Interns have been enrolled for the Forensic Toxicology Certificate at Continuous Education at the University of Pretoria in April 2012. These interns successfully completed the course and have been absorbed within the four Forensic Chemistry Laboratories, namely 13 in Cape Town, 12 in Durban, 30 in Johannesburg and 15 in Pretoria. 

This significant increase in human resources will also contribute to the Directorate’s strategy of decreasing toxicology backlogs and to decrease the turn-around time of toxicology analysis in cases of unnatural death.

In this financial year the National policy on Emergency Medical Services Training and the Regulations governing the provision of Emergency Medical services will be published for comment and approved. With the Framework on the management of EMS data finalised training provided by Health Information System to provinces. The introduction of Obstertrics Ambulances will help to further halt the increase in maternal morbidity and mortality, Western Cape. The number of community members trained in first AID in partnership with Red Cross.

Chairperson and the house, please allow me to thank the Minister for his goal orientated leadership, Colleagues MECs for Health, the Director-General and staff throughout the health system, especially our management, professionals and support staff for placing the health of our people as their occupation. Working with our people and partners, focused on excellence, equity and effectiveness we are well poised to halt and reverse the cocktail of the four colliding epidemics.

I thank you all. 

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