Date: 10/02/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Debate on State of the Nation Address, NA
MINISTER OF HEALTH, MANTO TSHABALALA-MSIMANG DURING THE DEBATE ON THE STATE OF THE NATION ADDRESS, 10 February 2004
Madame Speaker
Mr President
Honourable Members.
The tenth anniversary of freedom invites us to reflect on dreams and plans we had for our country as we entered the unfamiliar territory of government. It also compels us to consider how far we have moved towards achieving the goals we held to be most precious.
In his State of the Nation Address, President Mbeki reminded us that South Africans have enjoyed a decade of "peace and progress". The notion of progress resonates in the field of health care where we have faced massive challenges - challenges that are linked to the apartheid legacy and challenges that arise from global health trends.
Our direction was determined from the outset by the simple principle that South Africa belongs to all who live in it and every citizen deserves access to essential health care at the time of need. In time, this principle became our constitutional duty, a duty that we have taken seriously at all times.
It is a responsibility that has demanded quite fundamental changes in the health system and the introduction of laws that have not always been popular. We are quite clear that we would need to take positive action to affirm the rights of the poor and the vulnerable.
One of the first requirements of our "health care for all" mandate was to establish the infrastructure for the effective delivery of primary health care services. We have substantially achieved this.
In ten years we introduced free health care for children and pregnant women. In 1996, free health care was extended to everybody at primary care level. Last year we included disabled persons in this package, including hospital care. This is a contribution towards poverty alleviation.
Fee for service has been a barrier to basic health care for those who needed it the most. We have proved our critics wrong who said that free health care was a pipe dream. Sure it costs money, but we managed this leap because of the political commitment of the African National Congress (ANC).
It must be said, however, that we claim progress - not perfection - in primary health care, precisely because there is still an unacceptable variation in the standard of primary care that is being offered across the country, and this is linked largely to resources.
The tragedy is that poorest among us, who are most in need of good public health care, all too often have the weakest services. To illustrate this point, the expenditure on primary health care per person per year among provinces ranges from R50 to R300.
Honourable Members, equity in service provision is the critical measure that determines who lives and who dies; who suffers permanent harm and who is restored to good health. Let us never forget this reality as we rededicate ourselves to service in the second decade of freedom.
The second major area of transformation in health care was the hospital sector, where physical revitalisation, rational planning and better management were the key objectives.
The investment in capital projects has steadily gained ground. In the year ahead, about R2 billion will be spent on infrastructure and the building of new hospitals. R911 million will be spent on 27 major hospital projects - including the building of 18 new hospitals. In building new hospitals, we have tried to overturn the apartheid legacy and create an effective referral network.
The Hospital Revitalisation Programme deals with organisational development - proper human resource planning and management systems, ensuring that hospitals have adequate medical equipment and simultaneously improving quality of care.
Far from neglecting tertiary level care, we have built three new academic hospitals in the last decade - the Chief Albert Luthuli Hospital in Durban, which replaces the old King Edward VIII Hospital, the Nelson Mandela Hospital in which replaces the old Umtata Hospital, and the Pretoria Academic Hospital Complex.
An increasing number of public hospitals offer the quality of service that attracts full-fee and medical aid patients - but never at the expense of patients who are 100% dependent on public sector care. These include Mankweng, Kimberly, Witbank, Folateng and Pelonomi Hospitals.
The social contract therefore demands that we participate in the governance of these facilities through hospital and clinic boards and protect and safeguard our health facilities from crime and vandalism.
The third major area of innovation was the expansion of programmes for disease control and prevention and the establishment of new programmes.
We have expanded the child immunisation programme in line with the World Health Organisation (WHO) guidelines and introduced additional vaccines against Hepatitis B and Haemophilus influenza and made immunisation part of our every day clinic operations. The results have been the eradication of polio and the sharp drop in measles.
Therefore, as part of our social contract, I am appealing to fathers and mothers to bring their children to our clinics to be immunised against preventable diseases.
We have seen a drop in the number of deaths due to diarrhoeal disease - due to a combination of factors including improved access to clean water, sanitation, promotion of breast-feeding, and prompt treatment of diarrhoea and education of the public.
We tackled the long-standing problem of tuberculosis (TB) by introducing the community-based treatment programme. This improved our ability to identify TB patients, to test them and to supply them with the correct drugs - all free of charge. TB remains a major challenge and it is further complicated by development of multi-drug resistance strain. We therefore need to re-double our efforts against TB. There is no room for complacency.
In the face of a huge escalation in malaria, we took the bold step of re-introducing residual indoor spraying with DDT - and we did this with the consent of the international community. By taking this step - and working closely with Swaziland, Mozambique, soon to be followed by Zimbabwe, the Democratic Republic of the Congo and Angola - we effectively turned the tide of malaria infection in the year 2000.
HIV infection and the impact of AIDS had begun to emerge as a serious public health threat by 1994, but there was no national programme to speak of as freedom dawned.
In the past decade, enormous resources have been committed to HIV and AIDS and South Africa has indeed followed international best practice in its national strategy. Few countries would be able to claim an increase of 2000% in AIDS spending in less than ten years from R22 million in 1994 to R660 million (in the national department alone).
Few would be able to point to greater investment in prevention strategies and few could claim such widespread mobilisation across sectors. The South African National AIDS Campaign is an achievement. We should not allow our progress to be overshadowed by the sheer scale of HIV infection. We should take the magnitude of the problem as a challenge, not a defeat.
I would be the first one to concede that it is not sufficient to have stabilised our HIV infection rates - we need to put them into reverse gear. Therefore, we are committed to strengthening the national response to HIV and AIDS through the Comprehensive Plan adopted by Cabinet in November 2003, as this brings to completion our Five-Year Strategic Plan on HIV and AIDS, which is itself due for review during the next ten-year period.
In the 12 weeks since the Plan was adopted, there has been intense preparatory work and our implementation plan is at an advanced stage. The Plan requires simultaneous action on many fronts across the health sector. Madam Speaker, I can assure Parliament that we are committed to making this Plan a reality - to achieving the target of a service point in all 53 district and metropolitan councils within one year. Let me assure you that we are determined to offer every citizen quality treatment, management and care for HIV and AIDS and not shoddy programme that some in this house want to hurry us into.
Madame Speaker, let me clarify that, as the Minister of Health, the President has delegated to me the responsibility to account in detail for what this government is doing in the fight HIV and AIDS, and not the President. South Africa is a member of the board of the Global Fund to Fight AIDS, TB and Malaria where it represents the Southern and Eastern Africa Region.
We also chair the Afro Regional Committee of WHO.
Through far-sighted Tobacco Control Legislation and tax policies, government has reduced the size of the smoking population. Given the relationship between tobacco use and various cancers and cardio-vascular disorders, the population is likely to reap the benefit of this decisive move by government in years to come.
Madam Speaker, a critical factor in our ability to ensure universal access to health care is equity in the distribution of resources. More bluntly put, it is our ability to overturn the huge imbalance in resources between the private and public sectors, on the one hand, and between urban and rural areas on the other.
We have tackled this in two ways, firstly by redistributing financial and human resources in the public health sector and secondly, by legislation that encourages more efficient use of health resources in the private sector. The impact of initiatives for redistribution in the public sector is visible:
* Most of the 900 new clinics we have built are in rural areas
* There is a narrowing in gap between the health spending of best-resourced provinces -- Gauteng and Western Cape - and that of the least developed rural provinces
* Through community service and government-to-government agreements, we have improved the professional staffing of rural facilities quite dramatically. This year alone, more than 3 000 young graduates are doing community services - and the proportion in rural areas is the highest yet. And just a week ago we announced a unique system of allowances for 33 000 health professionals in rural areas and 66 000 professionals who have skills that are in scarce supply.
Despite all these measures, Madame Speaker, the health gap between the major cities and rural towns remains unacceptably high. We need to boost the rural areas further - and we cannot do this simply by siphoning grants from the urban areas.
We would seriously urge Parliament to look more closely at the size of the health pie and at the relatively low priority that certain provinces attach to health care as a percentage of global social spending.
We seriously need to consider whether we can achieve peace, progress, social justice and better quality of health care on the current spending levels. Various laws have been passed to safeguard private sector health consumers and promote better value for money in that sector.
These include the Medical Schemes Act and the Medicines and Related Substances Control Amendment Act of 1997, which advance the cause of more affordable and quality medicine.
The National Health Bill replaces the old Health Act of 1977 and ensures that the health sector is in line with the Constitution. This Bill lays the foundation for rational health planning and the proper co-ordination of all the elements of the public and private health sector, and from this perspective of national interest, it requires that all health establishments be certified to provide health services.
Health care cannot be left to the whims of the market. Government has stewardship to ensure that every citizen has equal access to quality health services. The health agenda in the first decade of democracy has, necessarily, asserted the health rights of the poor and of vulnerable groups.
In order to fulfil our Constitutional mandate of access to health care for all, we have at times challenged the established practices of powerful interest groups. This action has not been malicious. It has been intended to serve the greater good.
During the next decade, we will focus on the following priority areas:
* We will improve our understanding of the causes of deaths in South Africa in order to ensure proper planning and appropriate allocation of resources
* We will accelerate the revitalisation of health facilities to reverse apartheid planning
* We will improve human resource planning and training to deal aggressively with the shortages and fair distribution of health workers throughout the National Health System
* We will implement a comprehensive school health programme as this will lay the foundation for health promotion among the youth
* We will accelerate the programme of making sure that medicines are available to all South Africans at an affordable price
* The goal of achieving equity between rich and poor, between urban and rural, between provinces and within provinces, will continue to drive our health sector reform programme
* We will increase the pool of those who have medical aid and protect them against unscrupulous schemes
* We will promote solidarity in health by ensuring those who can afford contribute to the health of the poor and indigent.
This year we will eliminate the backlog in assistive devices such as wheelchairs, hearing and walking aids and intensify our programmes on the non-communicable diseases such as diabetes, hypertension, heart disease, including obesity, by amongst others, stepping up our health promotion programme.
Madame Speaker, I have observed that the promise of free treatment for HIV and AIDS is fast becoming the popular slogan of the opposition parties in this house.
I think they need to wake up and stop daydreaming because we have already approved a programme to treat comprehensively those who are infected with HIV and are affected by AIDS, to manage them compassionately and to provide them with quality care. In the public sector these services are provided free of charge.
As we approach the tenth anniversary of freedom and democracy, I would urge sober reflection across society on the meaning and value of a just and equitable health care system to a nation that is still divided in many ways.
When we act to uphold the right to health and life of each South African, we truly begin to bridge these divisions.
The new decade is a new opportunity!
Issued by: Ministry of Health
10 February 2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Debate on State of the Nation Address, NA
MINISTER OF HEALTH, MANTO TSHABALALA-MSIMANG DURING THE DEBATE ON THE STATE OF THE NATION ADDRESS, 10 February 2004
Madame Speaker
Mr President
Honourable Members.
The tenth anniversary of freedom invites us to reflect on dreams and plans we had for our country as we entered the unfamiliar territory of government. It also compels us to consider how far we have moved towards achieving the goals we held to be most precious.
In his State of the Nation Address, President Mbeki reminded us that South Africans have enjoyed a decade of "peace and progress". The notion of progress resonates in the field of health care where we have faced massive challenges - challenges that are linked to the apartheid legacy and challenges that arise from global health trends.
Our direction was determined from the outset by the simple principle that South Africa belongs to all who live in it and every citizen deserves access to essential health care at the time of need. In time, this principle became our constitutional duty, a duty that we have taken seriously at all times.
It is a responsibility that has demanded quite fundamental changes in the health system and the introduction of laws that have not always been popular. We are quite clear that we would need to take positive action to affirm the rights of the poor and the vulnerable.
One of the first requirements of our "health care for all" mandate was to establish the infrastructure for the effective delivery of primary health care services. We have substantially achieved this.
In ten years we introduced free health care for children and pregnant women. In 1996, free health care was extended to everybody at primary care level. Last year we included disabled persons in this package, including hospital care. This is a contribution towards poverty alleviation.
Fee for service has been a barrier to basic health care for those who needed it the most. We have proved our critics wrong who said that free health care was a pipe dream. Sure it costs money, but we managed this leap because of the political commitment of the African National Congress (ANC).
It must be said, however, that we claim progress - not perfection - in primary health care, precisely because there is still an unacceptable variation in the standard of primary care that is being offered across the country, and this is linked largely to resources.
The tragedy is that poorest among us, who are most in need of good public health care, all too often have the weakest services. To illustrate this point, the expenditure on primary health care per person per year among provinces ranges from R50 to R300.
Honourable Members, equity in service provision is the critical measure that determines who lives and who dies; who suffers permanent harm and who is restored to good health. Let us never forget this reality as we rededicate ourselves to service in the second decade of freedom.
The second major area of transformation in health care was the hospital sector, where physical revitalisation, rational planning and better management were the key objectives.
The investment in capital projects has steadily gained ground. In the year ahead, about R2 billion will be spent on infrastructure and the building of new hospitals. R911 million will be spent on 27 major hospital projects - including the building of 18 new hospitals. In building new hospitals, we have tried to overturn the apartheid legacy and create an effective referral network.
The Hospital Revitalisation Programme deals with organisational development - proper human resource planning and management systems, ensuring that hospitals have adequate medical equipment and simultaneously improving quality of care.
Far from neglecting tertiary level care, we have built three new academic hospitals in the last decade - the Chief Albert Luthuli Hospital in Durban, which replaces the old King Edward VIII Hospital, the Nelson Mandela Hospital in which replaces the old Umtata Hospital, and the Pretoria Academic Hospital Complex.
An increasing number of public hospitals offer the quality of service that attracts full-fee and medical aid patients - but never at the expense of patients who are 100% dependent on public sector care. These include Mankweng, Kimberly, Witbank, Folateng and Pelonomi Hospitals.
The social contract therefore demands that we participate in the governance of these facilities through hospital and clinic boards and protect and safeguard our health facilities from crime and vandalism.
The third major area of innovation was the expansion of programmes for disease control and prevention and the establishment of new programmes.
We have expanded the child immunisation programme in line with the World Health Organisation (WHO) guidelines and introduced additional vaccines against Hepatitis B and Haemophilus influenza and made immunisation part of our every day clinic operations. The results have been the eradication of polio and the sharp drop in measles.
Therefore, as part of our social contract, I am appealing to fathers and mothers to bring their children to our clinics to be immunised against preventable diseases.
We have seen a drop in the number of deaths due to diarrhoeal disease - due to a combination of factors including improved access to clean water, sanitation, promotion of breast-feeding, and prompt treatment of diarrhoea and education of the public.
We tackled the long-standing problem of tuberculosis (TB) by introducing the community-based treatment programme. This improved our ability to identify TB patients, to test them and to supply them with the correct drugs - all free of charge. TB remains a major challenge and it is further complicated by development of multi-drug resistance strain. We therefore need to re-double our efforts against TB. There is no room for complacency.
In the face of a huge escalation in malaria, we took the bold step of re-introducing residual indoor spraying with DDT - and we did this with the consent of the international community. By taking this step - and working closely with Swaziland, Mozambique, soon to be followed by Zimbabwe, the Democratic Republic of the Congo and Angola - we effectively turned the tide of malaria infection in the year 2000.
HIV infection and the impact of AIDS had begun to emerge as a serious public health threat by 1994, but there was no national programme to speak of as freedom dawned.
In the past decade, enormous resources have been committed to HIV and AIDS and South Africa has indeed followed international best practice in its national strategy. Few countries would be able to claim an increase of 2000% in AIDS spending in less than ten years from R22 million in 1994 to R660 million (in the national department alone).
Few would be able to point to greater investment in prevention strategies and few could claim such widespread mobilisation across sectors. The South African National AIDS Campaign is an achievement. We should not allow our progress to be overshadowed by the sheer scale of HIV infection. We should take the magnitude of the problem as a challenge, not a defeat.
I would be the first one to concede that it is not sufficient to have stabilised our HIV infection rates - we need to put them into reverse gear. Therefore, we are committed to strengthening the national response to HIV and AIDS through the Comprehensive Plan adopted by Cabinet in November 2003, as this brings to completion our Five-Year Strategic Plan on HIV and AIDS, which is itself due for review during the next ten-year period.
In the 12 weeks since the Plan was adopted, there has been intense preparatory work and our implementation plan is at an advanced stage. The Plan requires simultaneous action on many fronts across the health sector. Madam Speaker, I can assure Parliament that we are committed to making this Plan a reality - to achieving the target of a service point in all 53 district and metropolitan councils within one year. Let me assure you that we are determined to offer every citizen quality treatment, management and care for HIV and AIDS and not shoddy programme that some in this house want to hurry us into.
Madame Speaker, let me clarify that, as the Minister of Health, the President has delegated to me the responsibility to account in detail for what this government is doing in the fight HIV and AIDS, and not the President. South Africa is a member of the board of the Global Fund to Fight AIDS, TB and Malaria where it represents the Southern and Eastern Africa Region.
We also chair the Afro Regional Committee of WHO.
Through far-sighted Tobacco Control Legislation and tax policies, government has reduced the size of the smoking population. Given the relationship between tobacco use and various cancers and cardio-vascular disorders, the population is likely to reap the benefit of this decisive move by government in years to come.
Madam Speaker, a critical factor in our ability to ensure universal access to health care is equity in the distribution of resources. More bluntly put, it is our ability to overturn the huge imbalance in resources between the private and public sectors, on the one hand, and between urban and rural areas on the other.
We have tackled this in two ways, firstly by redistributing financial and human resources in the public health sector and secondly, by legislation that encourages more efficient use of health resources in the private sector. The impact of initiatives for redistribution in the public sector is visible:
* Most of the 900 new clinics we have built are in rural areas
* There is a narrowing in gap between the health spending of best-resourced provinces -- Gauteng and Western Cape - and that of the least developed rural provinces
* Through community service and government-to-government agreements, we have improved the professional staffing of rural facilities quite dramatically. This year alone, more than 3 000 young graduates are doing community services - and the proportion in rural areas is the highest yet. And just a week ago we announced a unique system of allowances for 33 000 health professionals in rural areas and 66 000 professionals who have skills that are in scarce supply.
Despite all these measures, Madame Speaker, the health gap between the major cities and rural towns remains unacceptably high. We need to boost the rural areas further - and we cannot do this simply by siphoning grants from the urban areas.
We would seriously urge Parliament to look more closely at the size of the health pie and at the relatively low priority that certain provinces attach to health care as a percentage of global social spending.
We seriously need to consider whether we can achieve peace, progress, social justice and better quality of health care on the current spending levels. Various laws have been passed to safeguard private sector health consumers and promote better value for money in that sector.
These include the Medical Schemes Act and the Medicines and Related Substances Control Amendment Act of 1997, which advance the cause of more affordable and quality medicine.
The National Health Bill replaces the old Health Act of 1977 and ensures that the health sector is in line with the Constitution. This Bill lays the foundation for rational health planning and the proper co-ordination of all the elements of the public and private health sector, and from this perspective of national interest, it requires that all health establishments be certified to provide health services.
Health care cannot be left to the whims of the market. Government has stewardship to ensure that every citizen has equal access to quality health services. The health agenda in the first decade of democracy has, necessarily, asserted the health rights of the poor and of vulnerable groups.
In order to fulfil our Constitutional mandate of access to health care for all, we have at times challenged the established practices of powerful interest groups. This action has not been malicious. It has been intended to serve the greater good.
During the next decade, we will focus on the following priority areas:
* We will improve our understanding of the causes of deaths in South Africa in order to ensure proper planning and appropriate allocation of resources
* We will accelerate the revitalisation of health facilities to reverse apartheid planning
* We will improve human resource planning and training to deal aggressively with the shortages and fair distribution of health workers throughout the National Health System
* We will implement a comprehensive school health programme as this will lay the foundation for health promotion among the youth
* We will accelerate the programme of making sure that medicines are available to all South Africans at an affordable price
* The goal of achieving equity between rich and poor, between urban and rural, between provinces and within provinces, will continue to drive our health sector reform programme
* We will increase the pool of those who have medical aid and protect them against unscrupulous schemes
* We will promote solidarity in health by ensuring those who can afford contribute to the health of the poor and indigent.
This year we will eliminate the backlog in assistive devices such as wheelchairs, hearing and walking aids and intensify our programmes on the non-communicable diseases such as diabetes, hypertension, heart disease, including obesity, by amongst others, stepping up our health promotion programme.
Madame Speaker, I have observed that the promise of free treatment for HIV and AIDS is fast becoming the popular slogan of the opposition parties in this house.
I think they need to wake up and stop daydreaming because we have already approved a programme to treat comprehensively those who are infected with HIV and are affected by AIDS, to manage them compassionately and to provide them with quality care. In the public sector these services are provided free of charge.
As we approach the tenth anniversary of freedom and democracy, I would urge sober reflection across society on the meaning and value of a just and equitable health care system to a nation that is still divided in many ways.
When we act to uphold the right to health and life of each South African, we truly begin to bridge these divisions.
The new decade is a new opportunity!
Issued by: Ministry of Health
10 February 2004
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