Budget Vote speech by the Minister of Health, Dr Manto Tshabalala-Msimang, for 2007/08 financial year, National Assembly

Madam Speaker
Honourable members
Distinguished guests
Ladies and gentlemen

It gives me a great pleasure to present the national Department of Health 2007/08 budget to this House for consideration and approval. I would like to alert honourable members that the full version of my address has been printed and is available to honourable members.

Before I speak to the achievements, priorities and budget of the Department of Health, permit me to speak about a personal matter for a few minutes. As is known I have been ill for a few months and have been a beneficiary of a transplant. During this trying time I was sustained by the love, concern and support of my family, friends and comrades many of whom are in the House today. I wish to thank the President and the Deputy President of our country for support rendered to me during this period. I also wish to take this opportunity to thank all those who privately and publicly expressed their wish for my speedy recovery.

My sincere gratitude goes particularly to the health workers at the Johannesburg General Hospital and Donald Gordon Medical Centre. I am really proud of their caring attitude as well as their clinical skills. I am now well, re-energised and committed to ensuring that we proceed with the reforms in the health sector that we started.

Madam Speaker, I wish to read some extracts from a letter written by Dr Yesuf Taha of the Department of Gastroenterology at Karolinska University Hospital in Stockholm, Sweden to our President. Dr Taha who is originally from Ethiopia brought his son to the George Mukhari Hospital for treatment of a rare eye disease known as "infantile glaucoma". This is what Dr Taha says in his letter:
"During my three-week stay in South Africa I had been going to Dr George Mukhari Hospital almost daily and I have observed that the doctors at the eye clinic are providing one of the best ophthalmologic treatments in the world with meagre resources. There are top grade professionals with lots of knowledge and very valuable experience in this eye clinic which must be assisted to remain in Africa and to continue to grow and flourish." End quote.

This letter highlights a number of issues. Firstly, the public health sector can and does provide good quality care. Secondly, most of our health workers are skilled and dedicated. Thirdly, even with few resources we can produce good health outcomes but clearly the public health sector needs additional resources to fulfil its enormous potential. Investing in health will also ensure that our communities can reach their potential and contribute maximally to the development of our country.

The 2006/07 financial year has indeed been a busy year for the Department of Health.

Last year, South Africa hosted the International Diabetes Conference in Cape Town. The conference highlighted the need to recognise that the incidence of non-communicable diseases have significantly increased in developing countries, thus contributing to the burden of disease. It also provided an opportunity for African researchers and decision makers to share information around the burden of diabetes and best practices.

We need to highlight the need to address diseases of lifestyle in South Africa because of their growing contribution to the burden of disease. These diseases include various types of cancer, cardiovascular diseases inclusive of hypertension and respiratory diseases.

The Department undertook the following activities to reduce the burden of disease from non-communicable diseases during 2006/07 including:
* a number of health screening activities
* the 'Move for Health' programme to encourages physical activity
* nutrition programmes including the provision of vitamins and the establishment of food gardens
* programmes to reduce risky behaviour such as smoking, alcohol and drug abuse.

Madam Speaker, in April this year South Africa had the honour of hosting the third Ordinary Session of African Union Conference of Ministers of Health. At this meeting the Minister of Health of South Africa was elected Chairperson of the meeting and will serve as chair of the Bureau for a two-year period. This means that together with the African Union (AU) Commissioner for Social Affairs, we shall be responsible for providing the leadership on health in the continent.

The highlight of the meeting was the approval of the African Health Strategy that updates the New Partnership for Africa's Development (Nepad) Health Strategy and is therefore the platform for strengthening health systems in Africa. This document will also be used to advocate for resources for health and signals to our partners in the international community what Africa's health priorities are and what we wish to achieve by 2015.

The target of 2015 for the achievement of the goals in the African Health Strategy is not accidental but relates to the target date for achieving the goals set out in the Millennium Development Goals (MDGs). In this regard I wish to remind honourable members that 7 July this year marks the midpoint of the 15-year period set in 2000 when our President together with other Heads of State signed the United Nations (UN) Millennium Declaration.

All eight MDGs contribute either directly or indirectly to improving the health status of individuals and communities. This means that government as a whole as well as its partners needs to place the attainment of the MDGs at the heart of our plans and to prioritise the achievement of the targets in the way in which we allocate resources.

The Department of Health will host a National Consultative Health Forum in July which will focus on the attainment of the MDGs. Given the inter-sectoral nature of health and the MDGs, we shall invite departments in the social cluster as well as our stakeholders in civil society.

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 (the first conducted in 1998 and the next in 2003) suggest that with respect to child health, our infant mortality rates are around 45/1 000 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, I am proud to announce that 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 six 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 to 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.

As honourable members know the Department established a confidential inquiries into Maternal Deaths Committee to investigate every maternal death in public hospitals. The Department is implementing the recommendations in 85% of public health facilities that have maternity units. The Department will also intensify programmes on women's health including increasing access to cervical cancer screening to prevent invasive cervical cancer.

With respect to HIV and AIDS, I am happy to announce 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.

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. This strategic plan was officially launched by our Deputy President in Durban on Tuesday at the official opening of the South African AIDS Conference. I wish the AIDS Conference in Durban successful deliberations, discussions and outcomes.

Madam Speaker, we will do everything within our power as the Department of Health to contribute to the successful implementation of the National Strategic Plan.

We have re-launched the Government HIV and AIDS Communication Programme, Khomanani which has been allocated R190 million for a two-year period. This communication programme encourages responsible sexual behaviour and mobilise access to treatment, care and support services for those who are infected and affected.

During the last financial year more than 439 million male and more than three million female condoms were distributed. We supported home and community based programmes in 60% of sub-districts and more than 493 000 patients with debilitating conditions received nutritional support. Since the inception of the antiretroviral treatment component of the Comprehensive Plan, more than 282 836 patients have been initiated on antiretroviral (ARVs) in the 335 accredited facilities by the end of March 2007.

Tuberculosis (TB) control remains a major challenge but some advances are being made in this regard. Case finding is relatively good, 89% of patients diagnosed with Pulmonary TB are started on treatment and large numbers are placed on direct observed treatment. A few districts are doing well and we wish to congratulate them and urge them to keep up the good work.

I am pleased to inform honourable members that our efforts to control malaria continue to pay dividends. A total of 4 404 malaria cases were reported between June 2006 and April 2007 as compared to 11 246 cases reported for the June 2005 to April 2006. During the same reporting period, the number of deaths decreased from 88 to 31. The main reasons for this decline include indoor residual spraying using DDT which has now been accepted by World Health Organisation (WHO) as the significant tool in malaria control after many years of South Africa's engagement on this issue.

Madam Speaker, primary healthcare continues to be the foundation of the National Health System. In this regard I wish to remind honourable members that next year, we shall celebrate the 30th anniversary of the Alma Ata Declaration and the adoption by the WHO of the primary healthcare (PHC) approach. This approach focuses on the following key principles:
* equity in access to services and allocation of resources
* community participation and involvement
* inter-sectoral action
* and decentralised management, so that services can be tailored to the needs of communities.

I urge honourable members to adopt the Alma Ata principles and work in their constituencies to ensure that communities participate in improving their health.

In commemorating this event, the Department of Health will host a conference aimed at reviewing progress in implementing the PHC approach as well as to chart the way forward.

We have made significant gains with respect to the hospital revitalisation programme. We already have state of the art tertiary hospitals in the form of Inkosi Albert Luthuli and Pretoria Academic Hospitals and 10 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.

Whilst good progress is being made, we need to ensure that this programme is fully funded if we wish to complete the revitalisation of all our public hospitals within the 15-year timeframe that we set ourselves. We actually need to shorten this period and also ensure good maintenance of health facilities.

Besides the Hospital Revitalisation Programme, provinces have delegated functions to hospital chief executive officers (CEOs) as directed by the President in his 2006 State of the Nation address (SONA). We will continue to strengthen the ability of hospital managers to use their delegated authority by improving training and strengthening administrative systems.

A key link between PHC facilities and hospitals are our emergency medical services. We will continue to increase the level of air transportation as well as the number of ambulances that we purchased. This is important to ensure that our people have access to Emergency Medical Services (EMS) in times of need.

We have developed a national EMS Plan for 2010 and we are confident that with the right levels of investment in EMS as well as in hospitals in the host cities, we will be ready for any eventuality that may occur during the 2010 FIFA Soccer World Cup.

Madam Speaker, the South African Human Rights Commission recently held hearings on access to health services in South Africa. The preliminary report reflects both on the achievements of the sector as well as the continuing challenges.

The hearings in particular, highlighted the urgent need to address inequities between the public and private sector. The private sector spends about R66 billion to service about seven million while the rest of our population depends on R59 billion spent through the public health sector.

The Department has a number of strategies to reduce these inequities as well as to reduce the cost of healthcare in South Africa. As part of improving health financing, we are going to present to this House amendments to the Medical Schemes Act which will enable us to establish the Risk Equalisation Fund. The Risk Equalisation Fund is one of the crucial elements in the establishment of a social health insurance which is a step towards a national health insurance.

The Department has been engaged over the past 18 months with business, labour and representatives of civil society to draft a Health Charter. The Charter aims to create a platform for engagement between these sectors to address issues of access, equity and quality of health services as well as issues of broad based black economic empowerment (BBBEE) and employment equity.

We thought that we were close to agreement on a draft Charter only to be informed by representatives of labour and civil society that they wish to reopen matters of principle. We call on representatives of all three sectors to work harder to reach agreement so that the Health Charter can be adopted and implemented.

Madam Speaker, the Department has made significant gains in reducing the cost of medicines in South Africa. These were achieved by introducing the single exit price system as well as setting a dispensing fee for pharmacists. Unfortunately the latter issue has resulted in a legal challenge by some members of the pharmacy profession.

We gazetted the methodology by which we propose to benchmark the prices of medicines in South Africa against a comparable basket of medicines in other countries. We have received numerous submissions in response to the gazette and are in the process of evaluating these submissions before moving forward with the benchmarking exercise.

The Medical Schemes Council has found that in response to measures to reduce the cost of drugs, the private hospital sector, increased hospital charges. We will be working with the council to see what can be done in this regard.

We have also made some strides with respect to African Traditional Medicines. The President appointed a Presidential Task Team to look into all aspects of the promotion and regulation of African Traditional Medicines, including the development of a pharmacopoeia. We urge Parliament to assist us in speeding up the implementation of the Constitutional Court ruling on the Traditional Health Practitioners Bill which is crucial in our efforts to institutionalise this very important component of the health sector.

As I said in this House yesterday, we will continue to make efforts to ensure that clinical trials that are conducted in South Africa comply with the highest possible ethical standards.

We have particularly asked the National Health Research Ethics Council to look at particularly the microbicide trials that are currently underway in the country to ensure that they comply with the highest ethical standards, in particular with respect to informed consent. This follows the challenges that have arisen with regard to the study conducted amongst a group of 604 women in KwaZulu-Natal, to test the effectiveness of a vaginal microbicide, cellulose sulphate gel in preventing the sexual transmission of HIV.

As honourable members are well aware, the provision of health services is labour intensive. Without well-trained and motivated health providers, the provision of quality health services is impossible. We are focusing on the recruitment and the retention of our health workers through the Human Resource Plan. As part of building the mid level worker category of health professionals, we will next year commence with the clinical associate training programme.

Since the signing of the agreement with the United Kingdom (UK) in 2003, the number of South African nurses registered in UK has decreased by more than 55% (from more than 2 100 in 2002 to 930 in 2005). We are also pursuing a cooperation agreement with Canada.

Co-operation with Tunisia is going to enable us to recruit from a pool of 2 000 doctors available in that country for foreign recruitment. We already have doctors from Iran working in the country.

The dispute in the Public Sector Bargaining Council has posed a major challenge for the health sector. As the Department of Health, we fully agree on the need for health workers to be paid a decent and competitive wage. However, we condemn any industrial action that jeopardises the lives and well-being of patients. Health workers are part of essential services and they have an ethical and legal obligation to ensure that no patient's life is negatively affected by their actions.

I would therefore like to extend my gratitude to the majority of health workers in the country who have continued to provide services during this period. I would also like to thank the South African Military Health Services and the private health sector that have assisted us in dealing with disruptions caused by the strike. Our appreciation also goes to the retired nurses, trainee health professionals and members of the public that are assisting.

Madam Speaker, statutory councils governing various health professions plays a critical role in maintaining the highest possible professional standards and in protecting the interests of the public. As part of our efforts to transform these councils, a Bill amending the Health Professions Act of 1974 has already been considered by this House.

We are also making interventions to address the challenges within the South African Nursing Council of South Africa. We already have a report indicating that the council is facing many difficulties in fulfilling its mandate and we are acting on the recommendations made to remedy the situation.

Madam Speaker, the total Public Sector Health budget grows to R59,2 billion this year. This constitutes 3,05% of gross domestic product (GDP) and 11,08% of government expenses.

The bulk of the funding allocated to the national Department is conditional grants which are allocated to provinces. I shall focus on these given that they are large amounts of money.

The budget for National Tertiary Services is R5,3 billion which reflects an increase of R100 million.

The budget for the Health Professions Training and Development Grant remained static at R1,6 billion as has the Forensic Pathology Services Grant at R551 million.

The Hospital Revitalisation Grant received an additional R200 million increasing it to R1,9 billion.

The HIV and AIDS grant increases by R300 million and now stands at R1,9 billion.

Whilst these increases may appear to be substantial, it needs to be considered against the backdrop of a low baseline. This means that given the historic under funding of health services, increases over a short period of time will not be sufficient to deal with our backlogs. We need to have significant increases over a long period of time to erode the backlogs and cope with an increasing burden of disease and growing population.

In conclusion, Madam Speaker, since this year marks the 40th anniversary of the death of a Nobel Peace Prize Laureate Inkosi Albert Luthuli, an outstanding leader of the struggling masses of South Africa I would like us to remind this House of what this beacon of hope said when receiving the Nobel Peace Prize.

He said and I quote, "Though I speak of Africa as a single entity, it is divided in many ways by race, language, history and custom, by political, economic and ethnic frontiers. But in truth despite these multiple divisions Africa has a single common purpose, our goal is a united Africa in which the standards of life and liberty are constantly expanding in which the ancient legacy of illiteracy and disease is swept aside, in which the dignity of man (and woman) is rescued from beneath the heels of colonialism which have trampled it."

As we engage in the debate this afternoon let us remember the historical nature of the challenges facing us today, objectively assess the progress we have made since the dawn of our democratic in 1994 and commit to work together towards attainment of our collective goal, a better health for all.

I believe that this budget does take us towards the vision articulated by Inkosi Albert Luthuli more than 40 years ago.

I therefore request this House to pass the Health Budget Vote.

Thank you!

Issued by: Department of Health
7 June 2007