Date: 01/06/2005
Source: Ministry of Health
TItle: Tshabalala-Msimang: Health Dept Budget Vote debate, NCOP
Manto Tshabalala-Msimang, Minister of Health’s Budget speech to the NCOP
Madam Speaker
Members of the NCOP
MECs for Health
Ladies and Gentlemen
We observed two health days this week.
On Monday we held functions nation-wide to promote physical exercise. The main event to launch the Move for Health Campaign was in Alexandra township, an area designated for Urban Renewal Programme.
We are encouraging all South Africans to engage in some form of physical exercise to maintain optimal health and prevent various chronic diseases of lifestyle, like diabetes, heart and cardiovascular diseases.
Yesterday, we marked the World No Tobacco Day in Free State where we encouraged South Africans to keep the positive trend of reducing the number people who are smoking in our country.
Both physical exercise and tobacco control are critical elements of our Healthy Lifestyles Programme which also encourages good nutrition, responsible use of alcohol and safe sexual behaviour.
I call on all the members of this House to mobilise their constituencies around these key elements of the Healthy Lifestyles programme and contribute towards reducing the spread of infectious diseases, high levels of non-communicable diseases and the prevalence of violence and trauma within our society.
As you know, the role of the national Department and myself, as the Minister of Health, is to provide stewardship over the national health system as a whole.
Let me remind this House again that the National Health System consists of both the public and private health care sectors.
Our stewardship role includes the responsibility of the national Department of Health to set national policy and to prepare national legislation. In this regard, we wish to announce that the President has proclaimed into law much of the National Health Act which was passed in this House. The National Health Act no 61 of 2003 came into effect on 2 May 2005 with the exception of some clauses. This is a major victory for the National Health System, which up to 2 May 2005 was governed by the Health Act of 1977.
The national Department also plays a role in supporting provinces and monitoring the implementation of national policies. To this end, the National Department and I have visited all the provinces through various initiatives during the 2004/5 financial year.
In the past few months, the Health MINMEC visited facilities in two provinces, namely Northern Cape and Free State. In addition, I have held izimbizo in Limpopo, KwaZulu-Natal, Mpumalanga and the Western Cape.
In general, we found that most health workers are dedicated to their work and provide a good service, sometimes under difficult circumstances. We also found that good management results in a motivated workforce. This was true in newly built hospitals in the Northern Cape and in facilities like the Kimberley Hospital as well as various clinics in the Free State.
I therefore wish to take this opportunity to salute all health workers and managers around the country for the good work they are doing.
Chairperson, we also found a range of challenges faced by both communities and health workers. Communities and patients complained of long waiting times and overcrowding in both hospitals and clinics.
Lack of shelter for those who arrive early and have to wait for a service, insufficient health facilities (hospitals or clinics are too far from their homes), shortage of ambulances and negative attitude of some of the health workers were part of the complaints given by communities.
For their part, health providers in some facilities complained of insufficient personnel and heavy workload.
There were also specific cases that we attended outside of this long-term programme to visit our facilities and interact with communities.
We visited two mental health facilities in KwaZulu-Natal, Townhill and Fort Napier Hospitals, to address the reported cases of inappropriate treatment of mental health patients. A commission of enquiry we established to investigate these issues has provided a report and we are implementing its recommendations. This was in line with our efforts to implement the Mental Health Care Act, which emphasises human rights and treatment of mental health patients with respect.
We also visited St Barnabas Hospital in OR Tambo district of the Eastern Cape where there was an outbreak of neurocysticercosis – a parasitic brain infection caused by a tapeworm that infects pigs.
Efforts were made to provide safe water and educate the community about how to avoid the infection. An immunisation campaign has also been intensified following reported cases of measles in this district. I will come back to this issue of measles later on.
I also visited the farming areas around Utretch and spoke to farm workers who reported many instances of abuse. They complained about the lack of access to safe water and sanitation, health services, land and housing. In one case, a farmer had dumped the carcass of cow into the only source of drinking water for the community. I want to assure everyone in this House that this government is committed to ensure equity in access to basic services and will strive to meet the challenges presented by communities like the one I met in Utretch. We will be revisiting this area later this month to address some of the challenges they have raised.
I now return to what will be done this year to address the priorities as contained in the Strategic Plan for 2004 to 2009.
National Health Act
We are implementing the provisions of the National Health Act.
We have established and held the first meeting of the National Health Council (which has replaced the MINMEC) in May 2005.
The Act requires that MECs for Health convene Provincial Health Councils within 90 days of the commencement of the Act – which means that this should be done by the end of July 2005.
The Act also requires the MECs to establish District Health Councils. These structures will strengthen the governance of the health system and provide avenues to improve the quality of care.
Policy and Planning
The National Health Act requires all levels of government responsible for health delivery to develop strategic plans.
We have developed templates for these plans and will require provinces and health districts to develop coherent strategic and operational plans for the 2006/07 to 2008/09 MTEF period that take into account national priorities.
Information Systems
The Act mandates the creation of a national health information system and the establishment of provincial health information committees by 1 July 2005.
The role of these structures is to strengthen the collection, analysis and use of health information for planning and monitoring of service provision. Human Resources
The Department has been working with stakeholders to develop a Human Resources for Health Strategic Framework which is now ready for consultation and finalisation.
Some of the interventions that are currently being made in addressing the challenges around human resources include:
* Expanding the community health worker programme
* Provision of rural and scarce skills allowance
* And a well established community service programme covering most categories of health professionals.
We will be phasing in community services for nurses once the Nursing Bill has been passed by Parliament.
In addition, we initiated a programme to train mid-level workers – such as the pharmacy assistants - and we envisage commencing with the training of medical assistants early next year. The mid-level health worker programme will enable us to staff our facilities with skilled personnel.
We are also going to address the problem of fly-by-night nursing schools that exploit young people who are wishing to enter into the nursing profession.
Hospital Revitalisation
In the 2004/05 financial year we had 26 hospitals in the Hospital Revitalisation Programme, which is meant to refurbish the infrastructure, strengthen management and improve quality of care.
I am pleased to announce that as part of this programme we completed four new hospitals in the last financial year.
These are:
* Piet Retief Hospital in Mpumalanga;
* Swartruggens Hospitals in the North West Province;
* Mannie Dipico Hospital in Colesberg;
* And the Abraham Esau Hospital in Calvinia in the Northern Cape.
During this financial year, we will enroll 16 extra hospitals into the revitalisation programme and we hope to complete the revitalisation of four hospitals that are currently under this programme.
These hospitals are:
* Vredenburg and George Hospitals in the Western Cape
* As well as Lebowakgomo and Jane Furse Hospitals in Limpopo.
Immunisation
Chairperson, we are concerned about measles cases and deaths reported in Gauteng, KwaZulu-Natal and the Eastern Cape.
These cases continued despite a successful mass immunisation campaign conducted late last year. We have therefore asked for the assistance of the World Health Organisation to understand this problem. As soon as we obtain the final report from the team of experts that is examining this problem we shall announce the steps that will be taken to address this matter.
In the meantime, it is important to continue encouraging every parent to bring each and every child to our facilities for immunisation.
It is critical, Chairperson, that we sustain our interventions aimed at improving the health of women and children highlighted by the theme for this year’s World Health Day which was: Making every mother and child count.
We are encouraged by the positive trends in Maternal Mortality Rate, which decreased from 150 in 1998 to 123 per 100 000 live births in 2002 while infant mortality came down from 45.4 in 1998 to 42.5 per 1000 live births in 2002. Tuberculosis (TB)
Chairperson, we are strengthening the TB Control Programme by amongst other things:
* Appointing TB co-ordinators in each health district;
* Strengthening the laboratory system;
* Strengthening the implementation of Directly Observed Treatment Strategy;
* And mobilising communities to ensure that patients complete their treatment.
The challenges posed by TB emphasises the need to address the weaknesses that still exist in our national health system and the importance of a comprehensive approach to the management of diseases in the country.
Comprehensive Plan
We are implementing the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS in its entirety with much more vigour and we are indeed achieving results.
In line with our stated goals, we have been able to establish a minimum of one service point in every district in the country before the end of the last financial year.
Our effort in the coming years is to ensure that these services are made available in every local municipality to increase accessibility and uptake. However, it is important to emphasise in this House, Honourable Chairperson, that extension of services as contained in the Comprehensive Plan requires the strengthening of the national health system to ensure that we provide good quality health services.
Medicines
Government’s efforts to reduce the price of medicines through the implementation of the Medicine Control Act have paid dividends.
The removal of perverse incentives and the introduction of the single exit price for medicine have resulted in a 19% reduction in prices of medicines. This translates to a saving of approximately R2.3 billion in the private sector.
However, the impact of this reduction in the overall cost of medicines to the consumer has been limited due to lack of cooperation at a retail pharmacy level including the introduction of unnecessary administration fees and levies.
We hope that the Constitutional Court will rule in our favour so that consumers can fully enjoy the benefits of the reduction in the prices of medicines.
Honourable members, now let me turn to the budget that has been allocated to the national Department of Health. This budget increased by 11.4 % from 2004/2005 to 2005/06.
The conditional grants which flow via the national Department of Health to provinces grew by 13.2%.
The budget for HIV and AIDS grows by a staggering 45% from R781 million in 2004/5 to R1,135 billion in 2005/6 financial year.
The Hospital Revitalisation grant increases from R912 million to R1,027 million – which is a 12.6% increase.
Early figures indicate that, in total, the nine provincial Health Departments spent 98.6% of their 2004/05 budgets. Further good news is that their 2004/05 expenditures grew by 7.5% from 2003/04. Budgets allocated for the provincial Health Departments for 2005/06 are on average 9.4% higher than the previous year.
Madam speaker, I sincerely hope that we have demonstrated to this house that the African National Congress government has the capacity and a committed cadre of health workers and managers to achieve our strategic goals and targets for 2005/6.
We are determined to ensure that we deliver quality health services to all our people within the limited resources that we have.
We will do this in collaboration with other government departments, the private sector as well as organs of civil society, to ensure that we attain the targets set, particularly in the Millennium Development Goals which we are party to as a member of the international community of nations.
International Role We have continued to play our international role including our active participation in the World Health Assembly held in Geneva last month.
During this assembly, we successfully mobilised member-states to support our effort to ensure that the World Health Organisation implement the resolutions aimed at addressing the challenge of international recruitment and migration of health personnel.
Human resources for health are expected to be the main subject for the World Health Report to be released by the WHO early next year and will be the theme for next years' World Health Day.
The focus on human resource should create an opportunity for African countries in particular to highlight the severe impact of migration on our national health systems in the continent.
During the Assembly I had an opportunity to meet with the Ministers of Health of India and Brazil where we discussed the ways in which we can strengthen health co-operation among our three countries within the context of South-South cooperation. We will be meeting soon as IBSA (India, Brazil and South Africa) to approve an action plan for cooperation between the three countries
Within the continent, we hosted representatives from Sudan and shared with them some of the experiences we have had in rebuilding our own health system.
We are also working closely with the Department of Health in Nigeria in sharing experiences on the development of our National Health Act. We will be studying their efforts and that of other countries in establishing a social health insurance.
During the Assembly, I had meetings with the Ministers of Health of Mozambique and Senegal to discuss bilateral cooperation. We are looking forward to signing a co-operation agreement with Mozambique focusing, amongst other things, on malaria control around the Lubombo Spatial Development Initiative and the Sasol gas pipeline. The agreement should also deal with the provision of health services to communities along the border of Mozambique and Mpumalanga province.
Recently we hosted the WHO Commission on Intellectual Property Rights that is dealing with the major issue of balancing patent protection for investment on development of new medicines against the dire need for access to affordable medicines.
The Commission was here to brief us on the progress in this area and ascertain our position on these issues. As the members of this House are aware, this country is determined to improve access to affordable, quality medicine.
Conclusion
Chairperson and Honourable members may be aware that the Chairperson of the Health Portfolio Committee, Mr James Ngculu, was admitted to hospital. On behalf of the Ministry and the Department of Health, we wish him a speedy recovery.
Finally, I wish to express my sincere appreciation to the Chairperson and the members of the Select Committee on Social Services for your support.
To the Deputy Minister of Health, the MECs for Health and national and provincial employees of the Department of Health, may I say, without your commitment and dedication, we will not achieve our goals.
It is only through your dedicated service that we will be able to achieve a better life for all
Chairperson, with these not so few words, I ask this house to pass the Budget of the National Department of Health.
I thank you!
Issued by: Ministry of Health
1 June 2005
Source: Ministry of Health
TItle: Tshabalala-Msimang: Health Dept Budget Vote debate, NCOP
Manto Tshabalala-Msimang, Minister of Health’s Budget speech to the NCOP
Madam Speaker
Members of the NCOP
MECs for Health
Ladies and Gentlemen
We observed two health days this week.
On Monday we held functions nation-wide to promote physical exercise. The main event to launch the Move for Health Campaign was in Alexandra township, an area designated for Urban Renewal Programme.
We are encouraging all South Africans to engage in some form of physical exercise to maintain optimal health and prevent various chronic diseases of lifestyle, like diabetes, heart and cardiovascular diseases.
Yesterday, we marked the World No Tobacco Day in Free State where we encouraged South Africans to keep the positive trend of reducing the number people who are smoking in our country.
Both physical exercise and tobacco control are critical elements of our Healthy Lifestyles Programme which also encourages good nutrition, responsible use of alcohol and safe sexual behaviour.
I call on all the members of this House to mobilise their constituencies around these key elements of the Healthy Lifestyles programme and contribute towards reducing the spread of infectious diseases, high levels of non-communicable diseases and the prevalence of violence and trauma within our society.
As you know, the role of the national Department and myself, as the Minister of Health, is to provide stewardship over the national health system as a whole.
Let me remind this House again that the National Health System consists of both the public and private health care sectors.
Our stewardship role includes the responsibility of the national Department of Health to set national policy and to prepare national legislation. In this regard, we wish to announce that the President has proclaimed into law much of the National Health Act which was passed in this House. The National Health Act no 61 of 2003 came into effect on 2 May 2005 with the exception of some clauses. This is a major victory for the National Health System, which up to 2 May 2005 was governed by the Health Act of 1977.
The national Department also plays a role in supporting provinces and monitoring the implementation of national policies. To this end, the National Department and I have visited all the provinces through various initiatives during the 2004/5 financial year.
In the past few months, the Health MINMEC visited facilities in two provinces, namely Northern Cape and Free State. In addition, I have held izimbizo in Limpopo, KwaZulu-Natal, Mpumalanga and the Western Cape.
In general, we found that most health workers are dedicated to their work and provide a good service, sometimes under difficult circumstances. We also found that good management results in a motivated workforce. This was true in newly built hospitals in the Northern Cape and in facilities like the Kimberley Hospital as well as various clinics in the Free State.
I therefore wish to take this opportunity to salute all health workers and managers around the country for the good work they are doing.
Chairperson, we also found a range of challenges faced by both communities and health workers. Communities and patients complained of long waiting times and overcrowding in both hospitals and clinics.
Lack of shelter for those who arrive early and have to wait for a service, insufficient health facilities (hospitals or clinics are too far from their homes), shortage of ambulances and negative attitude of some of the health workers were part of the complaints given by communities.
For their part, health providers in some facilities complained of insufficient personnel and heavy workload.
There were also specific cases that we attended outside of this long-term programme to visit our facilities and interact with communities.
We visited two mental health facilities in KwaZulu-Natal, Townhill and Fort Napier Hospitals, to address the reported cases of inappropriate treatment of mental health patients. A commission of enquiry we established to investigate these issues has provided a report and we are implementing its recommendations. This was in line with our efforts to implement the Mental Health Care Act, which emphasises human rights and treatment of mental health patients with respect.
We also visited St Barnabas Hospital in OR Tambo district of the Eastern Cape where there was an outbreak of neurocysticercosis – a parasitic brain infection caused by a tapeworm that infects pigs.
Efforts were made to provide safe water and educate the community about how to avoid the infection. An immunisation campaign has also been intensified following reported cases of measles in this district. I will come back to this issue of measles later on.
I also visited the farming areas around Utretch and spoke to farm workers who reported many instances of abuse. They complained about the lack of access to safe water and sanitation, health services, land and housing. In one case, a farmer had dumped the carcass of cow into the only source of drinking water for the community. I want to assure everyone in this House that this government is committed to ensure equity in access to basic services and will strive to meet the challenges presented by communities like the one I met in Utretch. We will be revisiting this area later this month to address some of the challenges they have raised.
I now return to what will be done this year to address the priorities as contained in the Strategic Plan for 2004 to 2009.
National Health Act
We are implementing the provisions of the National Health Act.
We have established and held the first meeting of the National Health Council (which has replaced the MINMEC) in May 2005.
The Act requires that MECs for Health convene Provincial Health Councils within 90 days of the commencement of the Act – which means that this should be done by the end of July 2005.
The Act also requires the MECs to establish District Health Councils. These structures will strengthen the governance of the health system and provide avenues to improve the quality of care.
Policy and Planning
The National Health Act requires all levels of government responsible for health delivery to develop strategic plans.
We have developed templates for these plans and will require provinces and health districts to develop coherent strategic and operational plans for the 2006/07 to 2008/09 MTEF period that take into account national priorities.
Information Systems
The Act mandates the creation of a national health information system and the establishment of provincial health information committees by 1 July 2005.
The role of these structures is to strengthen the collection, analysis and use of health information for planning and monitoring of service provision. Human Resources
The Department has been working with stakeholders to develop a Human Resources for Health Strategic Framework which is now ready for consultation and finalisation.
Some of the interventions that are currently being made in addressing the challenges around human resources include:
* Expanding the community health worker programme
* Provision of rural and scarce skills allowance
* And a well established community service programme covering most categories of health professionals.
We will be phasing in community services for nurses once the Nursing Bill has been passed by Parliament.
In addition, we initiated a programme to train mid-level workers – such as the pharmacy assistants - and we envisage commencing with the training of medical assistants early next year. The mid-level health worker programme will enable us to staff our facilities with skilled personnel.
We are also going to address the problem of fly-by-night nursing schools that exploit young people who are wishing to enter into the nursing profession.
Hospital Revitalisation
In the 2004/05 financial year we had 26 hospitals in the Hospital Revitalisation Programme, which is meant to refurbish the infrastructure, strengthen management and improve quality of care.
I am pleased to announce that as part of this programme we completed four new hospitals in the last financial year.
These are:
* Piet Retief Hospital in Mpumalanga;
* Swartruggens Hospitals in the North West Province;
* Mannie Dipico Hospital in Colesberg;
* And the Abraham Esau Hospital in Calvinia in the Northern Cape.
During this financial year, we will enroll 16 extra hospitals into the revitalisation programme and we hope to complete the revitalisation of four hospitals that are currently under this programme.
These hospitals are:
* Vredenburg and George Hospitals in the Western Cape
* As well as Lebowakgomo and Jane Furse Hospitals in Limpopo.
Immunisation
Chairperson, we are concerned about measles cases and deaths reported in Gauteng, KwaZulu-Natal and the Eastern Cape.
These cases continued despite a successful mass immunisation campaign conducted late last year. We have therefore asked for the assistance of the World Health Organisation to understand this problem. As soon as we obtain the final report from the team of experts that is examining this problem we shall announce the steps that will be taken to address this matter.
In the meantime, it is important to continue encouraging every parent to bring each and every child to our facilities for immunisation.
It is critical, Chairperson, that we sustain our interventions aimed at improving the health of women and children highlighted by the theme for this year’s World Health Day which was: Making every mother and child count.
We are encouraged by the positive trends in Maternal Mortality Rate, which decreased from 150 in 1998 to 123 per 100 000 live births in 2002 while infant mortality came down from 45.4 in 1998 to 42.5 per 1000 live births in 2002. Tuberculosis (TB)
Chairperson, we are strengthening the TB Control Programme by amongst other things:
* Appointing TB co-ordinators in each health district;
* Strengthening the laboratory system;
* Strengthening the implementation of Directly Observed Treatment Strategy;
* And mobilising communities to ensure that patients complete their treatment.
The challenges posed by TB emphasises the need to address the weaknesses that still exist in our national health system and the importance of a comprehensive approach to the management of diseases in the country.
Comprehensive Plan
We are implementing the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS in its entirety with much more vigour and we are indeed achieving results.
In line with our stated goals, we have been able to establish a minimum of one service point in every district in the country before the end of the last financial year.
Our effort in the coming years is to ensure that these services are made available in every local municipality to increase accessibility and uptake. However, it is important to emphasise in this House, Honourable Chairperson, that extension of services as contained in the Comprehensive Plan requires the strengthening of the national health system to ensure that we provide good quality health services.
Medicines
Government’s efforts to reduce the price of medicines through the implementation of the Medicine Control Act have paid dividends.
The removal of perverse incentives and the introduction of the single exit price for medicine have resulted in a 19% reduction in prices of medicines. This translates to a saving of approximately R2.3 billion in the private sector.
However, the impact of this reduction in the overall cost of medicines to the consumer has been limited due to lack of cooperation at a retail pharmacy level including the introduction of unnecessary administration fees and levies.
We hope that the Constitutional Court will rule in our favour so that consumers can fully enjoy the benefits of the reduction in the prices of medicines.
Honourable members, now let me turn to the budget that has been allocated to the national Department of Health. This budget increased by 11.4 % from 2004/2005 to 2005/06.
The conditional grants which flow via the national Department of Health to provinces grew by 13.2%.
The budget for HIV and AIDS grows by a staggering 45% from R781 million in 2004/5 to R1,135 billion in 2005/6 financial year.
The Hospital Revitalisation grant increases from R912 million to R1,027 million – which is a 12.6% increase.
Early figures indicate that, in total, the nine provincial Health Departments spent 98.6% of their 2004/05 budgets. Further good news is that their 2004/05 expenditures grew by 7.5% from 2003/04. Budgets allocated for the provincial Health Departments for 2005/06 are on average 9.4% higher than the previous year.
Madam speaker, I sincerely hope that we have demonstrated to this house that the African National Congress government has the capacity and a committed cadre of health workers and managers to achieve our strategic goals and targets for 2005/6.
We are determined to ensure that we deliver quality health services to all our people within the limited resources that we have.
We will do this in collaboration with other government departments, the private sector as well as organs of civil society, to ensure that we attain the targets set, particularly in the Millennium Development Goals which we are party to as a member of the international community of nations.
International Role We have continued to play our international role including our active participation in the World Health Assembly held in Geneva last month.
During this assembly, we successfully mobilised member-states to support our effort to ensure that the World Health Organisation implement the resolutions aimed at addressing the challenge of international recruitment and migration of health personnel.
Human resources for health are expected to be the main subject for the World Health Report to be released by the WHO early next year and will be the theme for next years' World Health Day.
The focus on human resource should create an opportunity for African countries in particular to highlight the severe impact of migration on our national health systems in the continent.
During the Assembly I had an opportunity to meet with the Ministers of Health of India and Brazil where we discussed the ways in which we can strengthen health co-operation among our three countries within the context of South-South cooperation. We will be meeting soon as IBSA (India, Brazil and South Africa) to approve an action plan for cooperation between the three countries
Within the continent, we hosted representatives from Sudan and shared with them some of the experiences we have had in rebuilding our own health system.
We are also working closely with the Department of Health in Nigeria in sharing experiences on the development of our National Health Act. We will be studying their efforts and that of other countries in establishing a social health insurance.
During the Assembly, I had meetings with the Ministers of Health of Mozambique and Senegal to discuss bilateral cooperation. We are looking forward to signing a co-operation agreement with Mozambique focusing, amongst other things, on malaria control around the Lubombo Spatial Development Initiative and the Sasol gas pipeline. The agreement should also deal with the provision of health services to communities along the border of Mozambique and Mpumalanga province.
Recently we hosted the WHO Commission on Intellectual Property Rights that is dealing with the major issue of balancing patent protection for investment on development of new medicines against the dire need for access to affordable medicines.
The Commission was here to brief us on the progress in this area and ascertain our position on these issues. As the members of this House are aware, this country is determined to improve access to affordable, quality medicine.
Conclusion
Chairperson and Honourable members may be aware that the Chairperson of the Health Portfolio Committee, Mr James Ngculu, was admitted to hospital. On behalf of the Ministry and the Department of Health, we wish him a speedy recovery.
Finally, I wish to express my sincere appreciation to the Chairperson and the members of the Select Committee on Social Services for your support.
To the Deputy Minister of Health, the MECs for Health and national and provincial employees of the Department of Health, may I say, without your commitment and dedication, we will not achieve our goals.
It is only through your dedicated service that we will be able to achieve a better life for all
Chairperson, with these not so few words, I ask this house to pass the Budget of the National Department of Health.
I thank you!
Issued by: Ministry of Health
1 June 2005
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