Date: 19/07/2007
Source: Department of Health
Title: SA: Tshabalala-Msimang: National Consultative Health Forum

Speech by the Minister of Health M Tshabalala-Msimang to the National Consultative Health Forum

Programme Director
Colleagues from the provincial Departments of Health
Representatives of civil society
Ladies and gentlemen

It gives me great pleasure to be standing in front of you to officially open the 2007 National Consultative Health Forum. Firstly, let me thank you all for taking time to be with us for this important dialogue on the progress and challenges towards the attainment of the Millennium Development Goals (MDGs). We chose to dedicate this year's National Consultative Health Forum to the MDGs for a very obvious and yet important reason. As you know, July 2007 marks the midpoint between 2000 when the Millennium Declaration was signed and 2015 which is the target year for all of the targets set out in the declaration.

To provide a short factual context to the Millennium Declaration, delegates will recall that the six key values that underpin the declaration. These are: freedom, equality, solidarity, tolerance, respect for nature and shared responsibility. With respect to equality the declaration states: "No individual and no nation must be denied the opportunity to benefit from development. The equal rights and opportunities of women and men must be assured."

And on the value of solidarity: "Those who suffer or who benefit the least deserve help from those who benefit most." I am sure you will agree with me that in many respects, these values are incontrovertible. The challenge of course is to practice them. The declaration also lists a number of resolutions on a range of matters, including peace and security, development and poverty eradication, protection of the environment, human rights and democracy, protecting the vulnerable, meeting the special needs of Africa, and so on.

It is within the resolutions on development and poverty eradication that the health and health related MDGs are listed. Clearly, the Millennium Declaration recognised the link between health and development. A healthy nation is central to development. Of course development provided that the benefits are shared and that the poorest of the poor benefit also contributes to a healthy nation.

We must remember though that development, if it is measured in increased income for example, can also lead to poor health outcomes. There are developed countries that spend more than 15% of their Gross Domestic Product (GDP) on health but still have a serious obesity problem as well as other 'diseases of excesses.' This illustrates the need for societies to challenge practices that generate both diseases of poverty and diseases of excesses.

Let me again quote the Millennium Declaration: "We will spare no effort to free our fellow men, women and children from abject and dehumanising conditions of extreme poverty, to which more than a billion of them are currently subjected. We are committed to making the right to development a reality for everyone and to freeing the entire human race from want." This is a very noble goal, to which I am sure we all subscribe.

For us as the health family gathered here, the question is how do we contribute to this noble goal? Recently, many public sector workers, including some in the public health sector, went on strike action. Now, it is clearly the right of workers to withdraw their labour should this be felt necessary to support the demand for wage increases. However, health is an essential service which means that health workers cannot by law abandon health service delivery and go out on strike.

What was even more disturbing is the level of intimidation and acts of violation of patients' rights shown by some of the striking workers. It is true to say that their lack of concern for their professional values did impact negatively on patient's lives and patient care. We need to all put our heads together to think about how this can be prevented in future.

In addition, we need to think about how the post strike environment can be managed in ways that build new values in the workplace. These are values that will ensure that better quality of care is provided to our people, especially the poorest of the poor.

It might be argued that the employer also needs to review what else can be done to improve labour relations in general and the working environment of our health workers in particular. By employer, I am referring specifically to the public health sector but it can be argued that this applies also to the private health sector as well.

As you know the Department of Health has a number of measures in place to do just this. Perhaps the pace of implementation of these interventions is not fast enough for all of us. Soon after the 1994 democratic elections, we commenced with a clinic building and upgrading programme, more than 1 500 clinics have been built or upgraded thus far.

In 1999 we started with a hospital refurbishment programme, which was later renamed the hospital revitalisation programme. This programme seeks to completely revitalise our hospital stock within a 15 year time horizon, guided of course by the availability of resources. The programme focuses on new buildings, new equipment, strengthened management and improved quality of care among others.

We already have state-of-the art tertiary hospitals in the form of Inkosi Albert Luthuli, Nelson Mandela and Pretoria Academic Hospitals and ten other hospitals have been completed in the past three financial years. 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.

Programme Director, ladies and gentlemen, allow me to draw your attention to another area of healthcare delivery that is equally important. I am referring here to the issue of human resources development. I am confident that most of you have been following developments around our efforts to increase the human resources for health in order to enhance health care delivery.

Amongst other things, we introduced community service, starting with doctors. In January 2008 the first group of nurses who graduate at the end of this year from the four-year programme will begin community service. We also introduced a number of new mid-level categories like the pharmacy assistants. With respect to remuneration we introduced the rural and scarce skills allowance a few years ago.

However, we have reconsidered this strategy based on experiences and interaction with all of the stakeholders in the process. Instead we have decided on occupation specific remuneration systems, starting this year as I announced last Friday in my meeting with CEOs of hospitals from across the country. As you would have heard in subsequent reports, the recipients of this occupation specific dispensation will be those in the nursing profession.

Of course all of these strategies need to be accompanied by at least two things: The first is a health professional who values her or his work and puts patient and the health of the community first. We need to apply our minds as to how we can produce and nurture this type of health professional.

Secondly, we need to strengthen our management practices and systems in the health sector, including our ability to manage our human resources. If 60-65% of our health expenditure is on human resources, clearly we need to be investing more in the management of this asset. There are simple things that we can and in fact must do to ensure that our facilities function optimally. For example, we have to ensure that ward rounds are done, detailed patient notes are kept and instructions are followed.

Doctors that are on call should not disappear and leaving junior staff to fend for themselves. The nurse in charge of the ward should account to the nursing service manager for what happens in the ward. Support staff should do their work and professional staff should not be doing porter and clerical work.

The clinical director of a facility has to ensure that clinical audits are done and that corrective measures are implemented. The heads of our institutions have to be delegated the authority and responsibility necessary for them to effectively and efficiently perform their work. The provincial Health departments have to provide support to these facilities and the national department should support provinces.

We need to ask the human resources working group to interrogate all of these things and develop recommendations for the National Health Council to consider.
Let me now turn to the health programmes. As a developmental state, we must invest in prevention of diseases and health promotion. This implies that we need to mobilise our communities and work more closely with other government departments whose activities contribute to health, such as Education, Water Affairs and Forestry, Social Development and Housing to name a few.
Equally we must also work with departments in the economics cluster to ensure that our economic policies generate the type of development that is conducive to promotion of good health.

We need to work hard at community level to generate greater social cohesion between individuals and groups. In many communities the social fabric appears to be coming apart and we see the consequences in increasing inter-personal violence, mental illnesses, abuse of women and children, alcoholism and use of illicit drugs. We need to work harder, outside the walls of the clinics and hospitals to ensure that we rebuild our communities thus strengthening our nation.

Without pre-empting the deliberations of this meeting, I am confident that South Africa is making reasonably good progress in reaching some of the MDG targets. Our best data from two demographic and health surveys (one conducted in 1998 and the other in 2003) suggest that with respect to child health, our infant mortality rates are around 45 to 1 000 live births. While this mortality is very low compared to other countries in the region, we feel that the death of any baby is one death too many.

In protecting our children, we have implemented several immunisation campaigns which have resulted in the overall immunisation coverage increasing to 83%.
In addition, our country has been declared as being polio free by the Africa Regional Certification Commission which is a sub-committee of the Global Certification Commission.

Another strategy to improve child health is to provide vitamin A supplementation. Currently 100% of infants between 6 and 11 months of age receive vitamin A supplementation. In addition, we extended the implementation of the community and household component of the Integrated Management of Childhood Illnesses strategy to 67% of health districts. Forty-two percent of public health facilities with maternity beds have been accredited as baby friendly. In addition, we have expanded the Prevention of Mother to Child Transmission Programme to 90% of public health facilities.

We have made progress in the area of child and adolescent health as well. Infants aged 12-59 months receive vitamin supplementation, more than 40% of our health districts implemented the Youth and Adolescent Health Policy guidelines, and 89% of health districts implemented phase one of school health services.

The department established a Confidential Inquiries into Maternal Deaths Committee to investigate every maternal death in public hospitals. We are in the process of implementing the recommendations in 85% of public health facilities that have maternity units. Equally, the department is intensifying programmes on women's health including increasing access to cervical cancer screening to prevent invasive cervical cancer.

With respect to HIV and AIDS, we have announced that the 2006 antenatal survey results show a statistically significant decrease in the prevalence of HIV amongst pregnant women who use public health facilities. This is mainly as a result of our continued focus on prevention as the mainstay of our response to combat HIV and lead to an HIV free society. The full report of Antenatal Survey, which will for the first time cover information of district, will be released at the end of this month.

We have developed the National Strategic Plan for HIV and AIDS for 2007/11 which builds on the gains of the Strategic Plan for 2000/05. We are doing everything within our power and means as the Department of Health to contribute to the successful implementation of the National Strategic Plan.

Programme Director, whilst the MDGs are a significant point around which all of us must rally and which as a country we must try to achieve, we have to be aware of the omissions in some of the targets. This relate particularly to the fact that that the MDGs are silent on non-communicable diseases and injuries and trauma and that many countries, especially those that may not reach the targets, do not have reliable baselines and health information. I will therefore encourage delegates to also consider these issues when you discuss in you commissions.

In conclusion, chairperson, while we engage in robust discussion around the many issues relating to the MDGs, we must also ensure that at the end of these discussions we distil out some key interventions that this forum would like to propose. For my part I shall take your proposals to the National Health Council, which meets on 23 to 24 August for further discussions and decisions.

I wish all of you fruitful deliberations

I thank you!

Issued by: Department of Health
19 July 2007