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Date : 22/06/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Health Dept Budget Vote debate, NCOP


BUDGET SPEECH BY THE MINISTER OF HEALTH, DR M TSHABALALA-MSIMANG, NCOP, 22 June 2004

Chairperson,
Minister of Social Development,
Deputy Ministers of Health and Social Development,
MECs present,
Honourable members of the NCOP

I wish to dedicate this speech to Aggrey Klaaste, the former editor of the Sowetan. The late Mr Klaaste's life and dedication to nation building should be an inspiration to all of us. I wish to convey my sincere condolences to his family and friends.

It is a pleasure for me to address this House on my Budget Vote today. It is a pleasure because the electorate has demonstrated its confidence in the policies and programmes of two successive African National Congress led governments by re-electing the African National Congress with such a great majority.

It is a pleasure because we can collectively take credit for our achievements in the first ten years of our democracy.

We are sharing this budget vote with my colleague Minister Skweyiya that illustrates in concrete terms the extent of integration in government functioning.

Despite many obstacles we are well on our way to transforming the delivery of social services in this country.

When travel to many provinces, people express their appreciation of the services provided by this government.

One also realises that the policies that we have adopted are making a difference to the poorest of our people. If this were not so, people would not have voted for the ANC in such overwhelmingly large numbers.

Off course those parts of our society that were reaping extra-ordinary profits at the expense of the poor are beginning to feel the pinch. If we want to broaden access to social services, to make health services more affordable, equitable and sustainable - we have no choice but to regulate those activities that impact negatively on the provision of equitable, affordable and high quality services.

This is not to say that we are in the process of throwing the baby out with the bath water. We have a coherent plan and an internationally benchmarked and respected set of policies. What we do need is your active support to ensure successful implementation.

Before I speak about the budget and what we hope to focus on in the next year permit me chairperson to focus on some of our key achievements in the past year or so.

We have improved child health in our country. Our immunisation coverage has improved to 74%, with no deaths of children from measles since 1999. We are confident that we will be certified polio free by the WHO next year. In order to increase our immunisation coverage we will embark on a national immunisation with our compatriots in SADC next month. We hope that such collaboration will enhance our collective efforts to prevent disease and promote health.

We have developed and are phasing in the implementation of a school health policy. Our tobacco control policies combined with our health promotion activities have resulted in fewer youth taking up smoking.

On the issue of malaria, in collaboration with our neighbours, Mozambique and Swaziland we have enhanced our malaria control programme, which has resulted in a steady decrease in the number of case each year as well as significantly fewer deaths. I am proud to announce that we have succeeded in lowering the death rate to below the target set by the World Health Organisation.

On the issue of HIV and AIDS, we have expanded our prevention and care and support programmes in all provinces. This has been accompanied by significant increases in resources that this government has made available to provinces and non-governmental organisations. I shall return to this issue when I deal with the budget. We are working with other government departments to ensure that we all have policies and programmes that complement each other in our fight against the pandemic.

On tuberculosis, we have expanded the DOTs programme in an effort to ensure that every TB patient has a supporter who ensures that the patient takes medication and completes the course but our cure rates are still well short of our target. We need greater commitment from patients and communities, including community leaders to ensure that this programme delivers the results that we want. I therefore urge honourable members to take this message to your constituencies and work tirelessly to convince communities and local leaders to work with the health personnel to strengthen the TB control programme in each health district.

Chairperson, the provision of health services is labour intensive. This is positive in the sense that the provision of health services creates work. However, it also requires that we are able to manage our human resources very effectively by providing appropriate training, the right mix of incentives to recruit, and retain health professionals in all parts of the country - but especially the rural areas.

As part of our contribution to work creation we will expand the community health worker programme that already exists in the country. This cadre will be the interface between communities and the formal health sector. They will assist communities to take some of the burden off families who have to cope with caring for family members who are ill. They will also assist communities to remain healthy by spreading health promotion messages.

In addition to expanding the community health worker programme we have initiated a range of other measures to strengthen and support our health personnel. These include: implementation of a mid level cadre for a range of health professions; the provision of scarce and rural allowances as of 1 July 2003; and strengthening community service for health professionals.

We also need to ensure that the health services provided in the public and private sectors are affordable. We have known for some time - this is reflected in the National Drug Policy that we adopted in the first 5 years of our democracy - that there are a range of perverse incentives like discounts and rebates in the health market. In order to address this issue we have introduced legislation that will provide for a single exit price for medicines. On the issue of quality we have introduced legislation that will require all those health professionals who wish to dispense to complete a dispensing course and to obtain a dispensing licence from the Department.

Let me reiterate, the first measure is to reduce the price of medicines and the second is to improve the quality of dispensing of these medicines.

There have been suggestions that this government wants to destroy the private health sector. Nothing can be further from the truth. However, we are committed to ensuring that the private and public health sectors work in synergy to provide the most affordable and best quality care for all the people of this country. Given our values we cannot be complacent when the public health sector spends about R800 per person whilst the private sector spends more than R6000 per person. Honourable members, I am sure you will agree with me that this is totally unacceptable.

Given that I have begun to touch on health financing issues, let me turn to the budget for 2004/05 and then I will close with a few paragraphs on our priorities for 2004/05.

Of the R8.7 billion that the Department received in the 2004/05 financial year, R7,7 billion or 88.5% is in the form of conditional grants, which are largely allocated to the nine provinces. Conditional grants are for: the integrated nutrition programme; the HIV and AIDS programme; the transfer of South African Police Services mortuaries to the provincial Departments of Health; the national tertiary services grant; the health professional training and research; the hospital revitalisation programme; and the hospital management grant.

I wish to report that as of 1 April 2004 the Primary School Nutrition Programme has been transferred to the Department of Education. Hence the conditional grant for the Integrated Nutrition Programme has reduced from R808 million in 2003/04 to R112 million in 2004/05. We will utilise these funds to strengthen nutrition programmes both at health facility level and in communities.

A major increase in conditional grant funding for the HIV and AIDS programme has been provided for. Conditional grant funding increases from R333 million in 2003/04 to R781 million in 2004/05. These funds are to be used to finance the comprehensive HIV and AIDS Care, Management and Treatment Plan for South Africa. Let me emphasise however, that the implementation of the Plan must strengthen the health system as a whole.

Provinces obtain the bulk of their funds from the national fiscus. A block grant (which is called the equitable share) is given to each province. Provinces then divide up the funds for their different departments. There is a guideline which is provided to provinces about what percentage of the budget should be used for social services and what percentage should be allocated for each social service, namely education, health and social welfare. However, sadly what provinces are finding is that the percentage allocated to health is decreasing whilst that allocated for social welfare (largely for the grants) has been steadily increasing. Some provinces therefore are under-budgeting for health services.

In the 2003/04 financial year provinces collectively overspent on their budgets by 0.5%. However, three provinces overspent by a larger margin. These are Gauteng, North West and the Northern Cape. This, it may be argued, reflects the extent of under-budgeting.

When one compares the allocations to provinces for the 2004/05 financial year one finds that on average the budget increase is 8% compared to 2003/04.

The increase of 8% is about 2% better than inflation. However, the additional funds are largely earmarked for the comprehensive plan for HIV and AIDS. It is however, heartening to note that some provinces with the lowest per capita health budget, like Limpopo, the North West, and the Northern Cape will get increases that are higher than the national average of 8%.

National Treasury is currently reviewing the equitable share formula, which is used to allocated funds to provinces and I urge members of this House to participate in this review process.

Whilst the allocation of funding for HIV and AIDS have been growing we must not forget that South Africans suffer and die from a range of diseases and that we therefore must make suitable provision for non-communicable diseases like asthma, hypertension and diabetes and non natural causes of death like traffic accidents and suicides.

Let me turn now to the provision of selected services. As members know we embarked on an ambitious hospital revitalisation programme into which 27 hospitals are currently enrolled. This programme will over the next 20 years ensure the revitalisation of all public hospitals that need improvement including improvements in management and in quality of care. This programme also targets physical infrastructure, and equipment.

Provinces chose the hospitals that they wish to enrol into the Revitalisation Programme each year as funds are made available by National Treasury. However, members are urged to ensure that in each province psychiatric hospitals are included into the revitalisation programme. The state of psychiatric hospitals and mental health care in general leaves much to be desired and I wish to commit my Department to work more vigorously with provinces to ensure that we strengthen mental health care in all nine provinces during this term. In this context we will be exploring how we can strengthen our collaboration with the Ministries of Social Development and of Education in particular.

As I end, Chairperson, permit me to share with this House some of our priorities for this year and the term of office of this government.

We need to sharpen implementation of our policies. As you are aware implementation takes place within provinces and within municipalities. This implies that the three spheres of government, national, provincial and municipal must work together to ensure that social services reach those in great need.

Many of our people who are in greatest need live in rural areas and in informal housing in urban areas. We must be able to plan and deliver services so that these South Africans are reached. We shall do this by increasing resources allocated to these areas, by increasing the number of community health workers that provide preventive and promotive health services in these areas, by increasing the number of health workers that are allocated and clinics that are built in these areas. National and provincial government must work closely with local government to increase our ability to reach those most in need of these services.

By ensuring better collaboration between the various departments that provide social services we will improve both the quantity and the quality of services that the marginalised and the poor receive. This will be our collective contribution to restoring the dignity of our people.

Clearly, we will continue our efforts to reduce morbidity and mortality from malaria, cholera, TB and HIV and AIDS but we shall also focus on non-communicable diseases. We will therefore also focus our efforts on the promotion of healthy lifestyles and initiate a healthy lifestyle campaign, which we encourage all members to participate in. This campaign will also include interventions to emphasise responsible alcohol use and the reduction of tobacco use especially amongst the youth.

Research and our own assessment reveals that non-natural causes of death from inter-personal violence, traffic accidents and suicides - many related to substance abuse - are increasing at an alarming rate. Together with colleagues in the Social Cluster, like the Ministers for Education, Social Development, Transport, etc we will develop a comprehensive intervention strategy. However, government cannot work alone. I therefore implore members of this House, the private sector and communities to work with us to deal decisively with this issue.

Madam Speaker and honourable members we have much work to do. We will only succeed if government works as one cohesive unit at national level and with provincial government and local government. In addition to government working in synchrony, dealing with social problems requires social mobilisation and therefore the involvement of all sectors of society. We must therefore commit ourselves to working together to ensure a better life for all.

Chairperson permit me to thank my colleagues the MECs who were responsible for exercising stewardship of the national health system in the last five years and to welcome the newly appointed MECs. I am sure that we will work effectively together to ensure that our policies and programmes are implemented in ways that benefits all our people.

I also wish to place on record my personal thanks to the past chairperson of the Select Committee on Social Services Ms Loretta Jacobus and the members of the committee. I also wish to welcome the newly appointed chairperson Ms Rejoice Masilo and her new committee and pledge that the Department will work closely with you to ensure that the oversight that you provide sharpens implementation.

Finally, Madam Speaker I wish to thank the officials at local, provincial and national levels for the sterling work that they have done in the past 5 years and encourage them to rededicate themselves to serving the people of this great land.

I thank you!!!

Issued by: Ministry of Health
22 June 2004

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