Date: 10/04/2003
Source: Department of Health
Title: Tshabalala-Msimang: Chris Hani Memorial Lecture


ADDRESS BY THE MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, TO THE ANNUAL CHRIS HANI MEMORIAL LECTURE ON HEALTH, 10 April 2003

The MEC for Health in Gauteng
Comrades and colleagues
Our long walk to freedom has been a true test of the capacity of ordinary human beings to overcome adversity and rise to the challenge of times. We have traversed many treacherous paths! Many have had to walk in the valley of death. There have been many casualties - most in the course of this noble duty.

But today we have gathered to celebrate the life and memory of a truly remarkable leader, an outstanding revolutionary and internationalist, a brave people's soldier and a finest cadre of our movement.

Martin Thembisile Hani - popularly known as "Chris" will forever remain an inspiration to us in our forward march. We dip our revolutionary banner in memory of his selfless sacrifice which has made it possible for us today to be what we are - a free people with an opportunity to truly reconstruct our country in the interests of all its citizens.

Chris walked with giants of our liberation struggle. Amongst these are Moses Kotane, JB Marks, Yusuf Dadoo and Oliver Tambo. We salute all of them and thank them for having inspired Chris.

As we all know, OR died soon after Chris's assassination. Today, we pay tribute to him too.

I have known Chris for many years. In our student days at the University of Fort Hare - at some stage we shared the same desk. We once more had opportunity to see each other's growth during the many years in exile.

As Chris grew, he remained strikingly the same. Humble, full of life, sensitive wand caring and always ready to help.

Chris was born on 28 June 1942 in Cofimvaba in what was then the Transkei. Three of his siblings died in infancy. His mother was illiterate and his father semi-literate. His father was a migrant worker - working on the mines in the former Transvaal and subsequently as an unskilled worker in the building industry. He was a revolutionary having joined the ANC in 1956 and the SACP in 1961. He was a commissar and commander of Umkhonto weSizwe and in 1987 was its Chief of Staff. Soon after the unbanning of the SACP he became its secretary general.

Chris understood the need for freedom, democracy and equality between men and women as well equity between the rich and the poor.

In honour of this internationalist, we have to analyse the challenges we are facing within a broader context of the current world order. Let us look at some very graphic examples of the kinds of inequities that exist today, as a backdrop to the many challenges confronting our nation as we honour this fallen hero.

* The world spends $780 billion each year on the military and war - that is $2 billion a day, whilst the cost to cut world poverty by half by 2015 would cost between $50 and $100 billion. This example is particularly apt in view of the current war in Iraq
* A European cow receives twice as much in subsidies as a farmer in developing countries makes in a year
* If Africa, south Asia and South America each increased their share of world exports by just 1%, 128 million people in these continents can be lifted out of poverty. Yet all sorts of barriers for exports from the South are created by the same who would wish us believe that they care!

The under-development in Africa and other continents is thus closely related to the high levels of development in the north. The same is true of health status.

If you had the good fortune to have been born in Japan, your disability-adjusted life expectancy at birth would be 74,5 years. However, if you were born in any of three African countries - Malawi, Niger or Sierra Leone - it would be below 30 years. The Disability Adjusted Life Years of twenty-one countries is half that of Japan AND all of these countries are in Africa.

In the build up to the World Summit on Sustainable Development, I had an opportunity to address the Health Ministers' meeting on Health and Sustainable Development. At that meeting I said that we have come to recognise more than ever before that the relationship between development and health is not a one-way street. Just as the state of development of a nation influences the health status of its people, the disease burden of any country has a critical impact on its development path. Furthermore, it has been shown that effective health systems can make an enormous difference to the size and nature of a nation's disease burden - and therefore to the course of national development.

Let us look at our country. How are we doing in terms of poverty and development? Just this Monday, we held our national celebration of the World Health Day at Qhumanco just outside Chris Hani's hometown of Cofimvaba. The theme for this year is Healthy Environments for Children.

During our discussion with the community, we all acknowledged that there are still enormous challenges in creating a healthy environment for our children and ultimately a better environment for all of us.

However, there is clear recognition amongst our people that much progress is being made in improving the social conditions of the majority of the poor - pursuing what Chris Hani defined as his ideals.

With a clear understanding of the critical need for development and its relationship with the well-being our people, Chris once told us that and I quote:

"Socialism is not about big concepts and heavy theory. Socialism is about decent shelter for those who are homeless. It is about water for those who have no safe drinking water. It is about health care, it is about a life of dignity for the old. It is about overcoming the huge divide between urban and rural areas. It is about education for all our people. Socialism is about rolling back the tyranny of the market." Unquote.

Without theoretical grandstanding, the ANC-led government has been in many respects faithful to Chris Hani's ideals in our programme to create a better life for all.

Since 1994 access to social services has widened. Amongst other things:

* Clean water has reached more than 8 million people and more investment is being made in addressing this major apartheid backlog
* Light has come to millions of homes through more than 3,8m electricity connections
* 1,4 million subsidised homes have been built or are under construction
* The Child Support Grant was reaching 2,5-million children by December last year.

Strong government's policies have allowed resources to be shifted towards the poor:
* Gradually extending the Child Support Grant up to 14 years and possible reaching another 3,2 million children by year 2005;
* Increased social grants and expanded unemployment insurance to workers such as domestic, seasonal and agricultural workers;
* Steps are being taken to speed up broad-based economic empowerment and expand human resource development;

Let me turn now to the health system in our country. We have made much progress since 1994. Our policies clearly show that we understand the relationship between health and development. Health is a key pillar in the reconstruction and development of our country.

We have adopted the primary health care approach and the district health system. We have recognised the importance of inter-sectoral collaboration at all levels - hence the cluster system of government. At national and provincial levels we have established the social cluster, which pulls together the efforts of various departments in an endeavour to improve the social conditions of our people including their health status and well-being.

We recognise that if we want to establish a healthy nation we must look at issues of nutrition. In this regard, we have introduced the primary school nutrition programme that is benefiting more than 4,5 m learners countrywide.

Last week we launched the Food Fortification Programme. We are compelling millers to add the necessary vitamins and minerals in maze meal and wheat flour in order to address the serious challenge of micronutrient deficiencies facing the majority of the poor, particularly children. These deficiencies compromise the health of our people and cause them to succumb to diseases quicker than well-nourished individuals.

We are not only emphasising good nutrition as part of health promotion but also as a critical component of our response to diseases affecting our people. Good nutrition is critical for the effectiveness of other interventions against diseases including medicinal therapies. To put it simple, our approach is that as we give people medicines to take before or after meal, it is our equally important duty to ensure that the meal is there and it is healthy.

We have invested significantly in the health of our children. Through such initiatives as our mass measles and polio campaigns, we have wiped out vaccine preventable diseases as major causes of the death of our children.

We have removed the indifference to the death of women during pregnancy and childbirth. Through the reporting of these deaths, we actively investigate the causes of these deaths and the findings inform the interventions we make to ensure that pregnancy and delivery is a safe process for both the mother and her baby.

This year, we announced the extension of Free Health Care to categories of people with disabilities. This is in addition to the Free Health Care for pregnant mothers and children under 6 years throughout the public health system as well as the Free PHC services for every South African through the public clinic system.

The media continuously points to the poor condition of the public health system and I do concede that we have a long way to go before we get a system that meets all our needs. But surveys also show that most people who use the public health system are largely satisfied with the service.

Let me give you one example. A recently completed national survey on patients' perception of health services in clinics revealed that 62% of patients reported that the overall quality of services was good and 30% thought that they were OK. About 8% felt that the services were poor and we need to improve on this. The point I am making is that 90% of patients were satisfied with the services rendered.

This is despite the fact that we know that more experienced health workers are leaving the service for the private sector and job opportunities overseas. We also know that with the emergent of HIV and AIDS, we have more sick people needing care and support, putting pressure on already strained health resources. We must therefore commend our health workers for the sterling work that they are doing - often under difficult conditions.

Nothing threatens to reverse our gains in health than the twin serious challenges of HIV, AIDS and TB. HIV infection and the impact of AIDS affect us all. No one is immune. We confront it as mothers, fathers, brothers and sisters. We confront it as employers and employees. We confront it as friends and partners. We confront it in the health system.

We are also acutely aware of the large and in some instances, increasing burden of TB. While it has been curable for more than 50 years, TB remains the major killer disease in this country. Many people are failing to complete their treatment and therefore raising the problem of multi drug resistant TB, which is extremely expensive to treat compared to a normal case of TB.

We are responding to both the challenge of HIV, AIDS and TB. We are implementing the Strategic Plan on HIV, AIDS and Sexually Transmitted Infections, which covers the areas of prevention, treatment, care and support, research and human rights. Government spending on HIV and AIDS is set to increase 10-fold from R342 million in 2001/02 to R3, 6 billion in 2005/06, to expand our efforts in prevention, treatment, care and support.

While this is a comprehensive multi-sectoral response to this major developmental challenge, some people have focussed on one aspect of our response. They have launched narrow campaigns aimed putting pressure on the government to make anti-retrovirals available in the public health sector immediately.

This caring Government is carefully examining all aspects of this issue and will make a decision. We recognise that this is a sensitive issue but as government we need to make very careful judgements. If there is one thing our struggle have taught us, it is the enduring nature of well thought out decisions. Definitely, some challenges require that we act with urgency but they equally require responses that are sustainable and provide maximum benefits within our conditions.

Our dreams can only be realised by consistently striking the appropriate balance between our mandate and desire to improve the conditions of our people and, on the other hand, finding strategies that are most effective within the resource constraint environment in which we operate.

In conclusion, let me say that we have a wonderful legacy in the life of comrade Chris Hani. We have a country, which brims with opportunities. We must work together to build a better life for all. We must exploit every opportunity to develop our families, communities, villages, cities and country. We cannot allow the next generation to say that we failed them. We must build on the legacy of comrade Chris.

My call to all health workers is to emulate Chris Hani and the other revolutionary grants of our movement and South Africa will stand as a beacon of hope for all the peoples of the world.

I thank you.

10 April 2003
Source: (http://www.doh.gov.za)