Date: 05/09/2003
Source: Ministry of Health
Title: Tshabalala-Msimang: National Health Bill, NA
SPEECH BY THE MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, ON THE NATIONAL HEALTH BILL, 5 September 2003
Madame Speaker and Honourable Members, it is my pleasure to be presenting to you one of the most important pieces of legislation in the health sector.
1. I believe that in the history of the health sector in this country, this Bill is the most important legislation we will pass regarding the framework for health service delivery in South Africa.
2. I am sure you will all agree that, given the divisions of the past, the values of equity, justice and human dignity are essential to the establishment of a fair, just and credible health system that cares for all.
3. This Bill deals with health matters that require uniformity across the nation, and provides norms and standards and framework for health service delivery, and implementation of national health policy.
What is the Bill about?
4. A key feature of the Bill is that it is embedded in the Constitution. The Bill sets the patient at the centre of the national health system. It creates a National Health System that sets out governance structures across all spheres of government. It reinforces the primary health care approach to health service delivery. It creates a framework for both the public and private health sectors to work closely together to achieve the common vision of a National Health System, and most importantly, it lays the foundation for equity in the health sector.
5. One of the primary concerns, and a theme that runs throughout the Bill is the issue of quality. In the context of health services, quality is not just something that is nice to have - it must be integral to the system. A health care system that does not meet certain minimum standards of quality in service is simply not health care.
How the Bill will be discussed?
6. Madam Speaker, since the Bill is quite long I am not going to discuss each chapter in detail because the Portfolio Committee did this work. Rather, I will point you to key principles within the chapters.
7. First let me say that each of the chapters covers a critical area for successful health service delivery - notably: the rights and duties of users and providers of health care services; the national, provincial and municipal structures that must ensure the provision of such services; health establishments; human resources; the control and use of various types of human tissue; health research, evaluation and monitoring; and mechanisms to ensure compliance with its provisions.
8. The first chapter acknowledges and elaborates upon the broad objects of the Bill and the constitutional obligations of the government to protect, respect, promote and fulfil the constitutional rights that involve access to health services.
9. It sets out the roles and responsibilities of the three different spheres of government to ensure the provision of health services and allows for the Minister of Health to prescribe conditions under which categories of persons are eligible for certain free health services.
10. The 2nd chapter deals with the rights of users and providers. Users' rights to have full knowledge of their health status and treatment and to consent to or refuse treatment are acknowledged and emphasised in the Bill, including the right not to be refused emergency medical treatment.
11. Chapter 2 seeks to protect users concerning health information and health records and to ensure that no one has unauthorised access to sensitive health information. Health information is personal to all of us and it is important that there are safeguards in place to prevent its abuse. The chapter further seeks to empower users to themselves promote the quality and standard of health services by making provision for a system for the laying of complaints.
12. We have also frequently heard of our health care professionals, who work so hard and sacrifice so much, who have been abused and mistreated by patients and families. This chapter entrenches the rights of providers to be treated with dignity and respect.
13. Chapters 3 and 4 set out the functions of the national and provincial departments of health respectively and the structures that must be in place to ensure the delivery of health care.
14. Both chapters balance the constitutional requirements of co-operative government on the one hand and the distinct and separate identities of the three different spheres of government on the other. For this reason the National and Provincial Health Councils established by the Bill are advisory bodies only. It is the responsibility of the Minister at national level and the MECs at provincial level to make health policy.
15. Provision is also made in these two chapters for consultative forums to meet at both national and provincial level at least once a year so as to ensure that there is significant interaction with relevant stakeholders on issues that affect them.
16. The preparation of national and provincial health plans covering strategic, medium term and human resources matters is mandated. Our health plan has been based on the PHC approach that has been endorsed by the World Health Organisation and adopted by many countries.
17. We recently had a very successful conference celebrating 25 years of the Alma Ata Declaration on Primary Health Care. It is therefore fitting that at this time in the history of the health sector that Chapter 5 establishes a district health system as the foundation for PHC.
18. Although many municipalities are still finding their feet and there is still work to be done with regard to the building of capacity and funding of the different roles of different types of municipalities, the Bill envisages an end point where most municipalities will be providing primary health care services in accordance with national health policy.
19. Let me now turn to the process of planning and development in the health sector. Prior to 1994, the process of planning in the health sector was virtually non-existent or at least it was geared towards planning first class health services for a privileged few only, thus maintaining the apartheid policy of the previous government. This resulted in fragmentation and unnecessary duplication of services. This irrational planning process has not only had an impact on the users, but the providers as well.
20. Chapter 6, therefore, is a very important chapter as it seeks to ensure and promote improved access to health services. It does this through a certificate of need process which is a rational planning tool that is designed to promote good organisation, efficiency, and effectiveness, and prevent unnecessary duplication of health care facilities and services. It will guide the establishment of health facilities and health services which best serve public needs.
21. Our objective is to provide health services of the same standard and quality to all. I need to stress that the certificate of need process not only protects the users, but it protects the providers as well. Multiple providers cannot survive in a saturated market; hence a rational planning tool such as the certificate of need will ensure that services are delivered according to need. Similar systems operate successfully in the US and Italy, to name but a few countries. The very great and disparate health needs in South Africa dictate that we cannot afford to permit an oversupply of resources in some areas at the expense of others.
22. There is general agreement that human resources are one of the most critically important areas in the health sector. This is an issue that countries throughout the world are grappling with. This was highlighted in the World Health Conference of the AFRO region that we currently are hosting. Chapter 7 covers the critically important areas of human resources for the health sector.
23. Provision is made in this chapter for many different kinds of regulations that can be written to address the many and varying aspects of health human resources that we encounter every day. These aspects include retention, education and training, of health care personnel, strategies for recruitment, and the identification of shortages of key skills, expertise and competencies within the national health system so that we can work together with the educational sector to address these.
24. The chapter also allows the Minister of Health, in consultation with the Minister of Education, to establish academic health complexes at various levels of the health system for training and research purposes.
25. An important policy principle addressed in this chapter is the establishment of the Forum of Statutory Health Councils as a statutory body. There already is such a Forum but it was important to give it formal recognition in this Bill in order for it to play a more meaningful role. It has been beefed up with community, departmental and educational representatives.
26. The Forum has been given statutory powers so that it can be a force to be reckoned with in calling the statutory health councils to account for their performance as public authorities. Its work includes the monitoring and setting of performance improvement targets, protecting the interests of the public and users, acting as an ombudsperson for complaints about particular councils and advising me on matters that cut across two or more of the statutory health professions.
27. Chapter 8 is the replacement of the Human Tissue Act of 1985. It regulates who may acquire, use, supply and store human tissue, including blood, organs and gametes and for what purposes.
28. The World Health Organisation has stated that it is very important that countries have a single national blood transfusion service for a number of different reasons. In these days of lethal blood borne diseases such as HIV/AIDS and the haemorrhagic fevers it is critical that we ensure the integrity and safety of the nation's blood supply. A single supplier is more easily monitored and regulated especially concerning quality and the observation of prescribed standards and procedures.
29. A fragmented service increases the possibility of service gaps where people in outlying areas can be underserved because it is uneconomical, from a business perspective, to operate there. It is important to ensure that there is no competition between blood suppliers as this compromises blood safety and that economies of scale in this area are optimised.
30. This chapter also covers the very controversial aspect of human cloning. It distinguishes between cloning for two different purposes. Cloning for reproductive purposes is prohibited for a number of reasons that are internationally recognized.
31. The right to human dignity is inextricably bound up in who we are - including our physical makeup. Reproductive cloning strikes at the heart of our physical identity and our value as individual human beings. Cloning for therapeutic purposes can be permitted in terms of the chapter but only in restricted circumstances.
32. We do not want to create a market for human tissue in this country. It has always been reprehensible to us as a society that people should be able to trade in human tissue as though it was just another scarce commodity. It is a matter of recognising the fundamental value of a human being and human life. The potential for exploitation of the poor, for unethical and morally unacceptable practices involving human embryos and for profiteering in human tissue markets is significant. Therapeutic cloning must therefore, of necessity, be carefully regulated.
33. Chapter 9 deals with national health research, monitoring and evaluation. As government, we cannot make meaningful policy decisions concerning health services if we do not have sound information upon which to base these decisions. It is important, in order to effectively and efficiently address the health needs of our people, that we identify national health research priorities so that scarce funds are spent in areas where people can derive the greatest benefit.
34. It is also important to protect people who are used as subjects in health research given the potential for their exploitation and the importance of human dignity within our legal system. It is especially important to protect our children in this area. It is a serious indictment of South African society that they are one of the most abused and exploited sectors of our population and we cannot allow them to become just another commodity in the health research setting.
35. The chapter establishes a National Health Research Ethics Committee whose job is to identify and prioritise areas of public health research and ensures the focus on priority health problems.
36. A National Health Research Ethics Council is established to ensure that all health research conduct in South Africa is of an acceptable ethical standard and to act against those who do not have sufficient respect for established ethical norms, standards and guidelines in health research.
37. Provision is made in this chapter for a national health information system, which is based on information coming from provincial and district health level.
38. Madam Speaker, let me now turn to the important issue of compliance, monitoring and evaluation. Too often we see good pieces of legislation been rendered ineffectual because of lack of capacity to enforce compliance.
39. Chapter 10 of the Bill gives it teeth. It creates structures at provincial and national level to ensure compliance with the provisions of the Bill.
40. The Director-General must establish the Office of Standards Compliance within the national health department. It plays an important role not only in ensuring compliance with the certificate of need provisions and conditions, but also in monitoring, evaluating and promoting the quality of health services throughout the country.
41. Every province must have an inspectorate for health establishments that must monitor and evaluate compliance by health establishments and health agencies within the province. It is the intention that these inspectorates will work in cooperation with the National Office of Standards Compliance on areas of common interest to ensure a national health system that is safe, effective and accessible to all.
42. Chapter 11 provides for regulations to be made in many important areas involving health services.
43. The regulation of the health sector is a complex and intricate business because the health sector itself is a dynamic and developing environment. For this reason, it is neither advisable nor appropriate to make provision for every matter in the Bill itself. Hence, the Minister may, in terms of chapter 11 make regulations on communicable diseases, health research, health technology, emergency medical services, rehabilitation, human resource development and other matters.
44. Chapter 12 is the final chapter of the Bill. It allows the Minister to appoint advisory and technical committees that are necessary to achieve the objects of the Bill. It also allows for the assignment of duties and delegation of powers by the Director-General and myself to other persons.
45. The legislation that will be repealed by the Bill is listed in the Schedule. The main laws that will be repealed are the Health Act of 1977, the Human Tissue Act of 1983, the National Policy for Health Act of 1990 and the Academic Health Centres Act, 1993.
46. Honourable members, we have taken a long time to present this Bill before you today. As you can see, the Bill is complex. I believe that there are benefits in taking the time to do a thing properly. I can assure you that, in the true spirit of the ANC, consultation on this Bill has been extensive. We did our best to accommodate the concerns of many stakeholders, even though there were sometimes conflicting interests.
47. In conclusion, I would like to thank the portfolio committee for their active participation in strengthening this Bill. In particular, I would like to thank Comrade James Ngculu, the Chairperson, for his able leadership during the deliberations, and of course the African National Congress for its progressive health policies whose aim is to provide a better life for all South Africans.
I thank you.
Issued by Ministry of Health
5 September 2003
Source: Ministry of Health
Title: Tshabalala-Msimang: National Health Bill, NA
SPEECH BY THE MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, ON THE NATIONAL HEALTH BILL, 5 September 2003
Madame Speaker and Honourable Members, it is my pleasure to be presenting to you one of the most important pieces of legislation in the health sector.
1. I believe that in the history of the health sector in this country, this Bill is the most important legislation we will pass regarding the framework for health service delivery in South Africa.
2. I am sure you will all agree that, given the divisions of the past, the values of equity, justice and human dignity are essential to the establishment of a fair, just and credible health system that cares for all.
3. This Bill deals with health matters that require uniformity across the nation, and provides norms and standards and framework for health service delivery, and implementation of national health policy.
What is the Bill about?
4. A key feature of the Bill is that it is embedded in the Constitution. The Bill sets the patient at the centre of the national health system. It creates a National Health System that sets out governance structures across all spheres of government. It reinforces the primary health care approach to health service delivery. It creates a framework for both the public and private health sectors to work closely together to achieve the common vision of a National Health System, and most importantly, it lays the foundation for equity in the health sector.
5. One of the primary concerns, and a theme that runs throughout the Bill is the issue of quality. In the context of health services, quality is not just something that is nice to have - it must be integral to the system. A health care system that does not meet certain minimum standards of quality in service is simply not health care.
How the Bill will be discussed?
6. Madam Speaker, since the Bill is quite long I am not going to discuss each chapter in detail because the Portfolio Committee did this work. Rather, I will point you to key principles within the chapters.
7. First let me say that each of the chapters covers a critical area for successful health service delivery - notably: the rights and duties of users and providers of health care services; the national, provincial and municipal structures that must ensure the provision of such services; health establishments; human resources; the control and use of various types of human tissue; health research, evaluation and monitoring; and mechanisms to ensure compliance with its provisions.
8. The first chapter acknowledges and elaborates upon the broad objects of the Bill and the constitutional obligations of the government to protect, respect, promote and fulfil the constitutional rights that involve access to health services.
9. It sets out the roles and responsibilities of the three different spheres of government to ensure the provision of health services and allows for the Minister of Health to prescribe conditions under which categories of persons are eligible for certain free health services.
10. The 2nd chapter deals with the rights of users and providers. Users' rights to have full knowledge of their health status and treatment and to consent to or refuse treatment are acknowledged and emphasised in the Bill, including the right not to be refused emergency medical treatment.
11. Chapter 2 seeks to protect users concerning health information and health records and to ensure that no one has unauthorised access to sensitive health information. Health information is personal to all of us and it is important that there are safeguards in place to prevent its abuse. The chapter further seeks to empower users to themselves promote the quality and standard of health services by making provision for a system for the laying of complaints.
12. We have also frequently heard of our health care professionals, who work so hard and sacrifice so much, who have been abused and mistreated by patients and families. This chapter entrenches the rights of providers to be treated with dignity and respect.
13. Chapters 3 and 4 set out the functions of the national and provincial departments of health respectively and the structures that must be in place to ensure the delivery of health care.
14. Both chapters balance the constitutional requirements of co-operative government on the one hand and the distinct and separate identities of the three different spheres of government on the other. For this reason the National and Provincial Health Councils established by the Bill are advisory bodies only. It is the responsibility of the Minister at national level and the MECs at provincial level to make health policy.
15. Provision is also made in these two chapters for consultative forums to meet at both national and provincial level at least once a year so as to ensure that there is significant interaction with relevant stakeholders on issues that affect them.
16. The preparation of national and provincial health plans covering strategic, medium term and human resources matters is mandated. Our health plan has been based on the PHC approach that has been endorsed by the World Health Organisation and adopted by many countries.
17. We recently had a very successful conference celebrating 25 years of the Alma Ata Declaration on Primary Health Care. It is therefore fitting that at this time in the history of the health sector that Chapter 5 establishes a district health system as the foundation for PHC.
18. Although many municipalities are still finding their feet and there is still work to be done with regard to the building of capacity and funding of the different roles of different types of municipalities, the Bill envisages an end point where most municipalities will be providing primary health care services in accordance with national health policy.
19. Let me now turn to the process of planning and development in the health sector. Prior to 1994, the process of planning in the health sector was virtually non-existent or at least it was geared towards planning first class health services for a privileged few only, thus maintaining the apartheid policy of the previous government. This resulted in fragmentation and unnecessary duplication of services. This irrational planning process has not only had an impact on the users, but the providers as well.
20. Chapter 6, therefore, is a very important chapter as it seeks to ensure and promote improved access to health services. It does this through a certificate of need process which is a rational planning tool that is designed to promote good organisation, efficiency, and effectiveness, and prevent unnecessary duplication of health care facilities and services. It will guide the establishment of health facilities and health services which best serve public needs.
21. Our objective is to provide health services of the same standard and quality to all. I need to stress that the certificate of need process not only protects the users, but it protects the providers as well. Multiple providers cannot survive in a saturated market; hence a rational planning tool such as the certificate of need will ensure that services are delivered according to need. Similar systems operate successfully in the US and Italy, to name but a few countries. The very great and disparate health needs in South Africa dictate that we cannot afford to permit an oversupply of resources in some areas at the expense of others.
22. There is general agreement that human resources are one of the most critically important areas in the health sector. This is an issue that countries throughout the world are grappling with. This was highlighted in the World Health Conference of the AFRO region that we currently are hosting. Chapter 7 covers the critically important areas of human resources for the health sector.
23. Provision is made in this chapter for many different kinds of regulations that can be written to address the many and varying aspects of health human resources that we encounter every day. These aspects include retention, education and training, of health care personnel, strategies for recruitment, and the identification of shortages of key skills, expertise and competencies within the national health system so that we can work together with the educational sector to address these.
24. The chapter also allows the Minister of Health, in consultation with the Minister of Education, to establish academic health complexes at various levels of the health system for training and research purposes.
25. An important policy principle addressed in this chapter is the establishment of the Forum of Statutory Health Councils as a statutory body. There already is such a Forum but it was important to give it formal recognition in this Bill in order for it to play a more meaningful role. It has been beefed up with community, departmental and educational representatives.
26. The Forum has been given statutory powers so that it can be a force to be reckoned with in calling the statutory health councils to account for their performance as public authorities. Its work includes the monitoring and setting of performance improvement targets, protecting the interests of the public and users, acting as an ombudsperson for complaints about particular councils and advising me on matters that cut across two or more of the statutory health professions.
27. Chapter 8 is the replacement of the Human Tissue Act of 1985. It regulates who may acquire, use, supply and store human tissue, including blood, organs and gametes and for what purposes.
28. The World Health Organisation has stated that it is very important that countries have a single national blood transfusion service for a number of different reasons. In these days of lethal blood borne diseases such as HIV/AIDS and the haemorrhagic fevers it is critical that we ensure the integrity and safety of the nation's blood supply. A single supplier is more easily monitored and regulated especially concerning quality and the observation of prescribed standards and procedures.
29. A fragmented service increases the possibility of service gaps where people in outlying areas can be underserved because it is uneconomical, from a business perspective, to operate there. It is important to ensure that there is no competition between blood suppliers as this compromises blood safety and that economies of scale in this area are optimised.
30. This chapter also covers the very controversial aspect of human cloning. It distinguishes between cloning for two different purposes. Cloning for reproductive purposes is prohibited for a number of reasons that are internationally recognized.
31. The right to human dignity is inextricably bound up in who we are - including our physical makeup. Reproductive cloning strikes at the heart of our physical identity and our value as individual human beings. Cloning for therapeutic purposes can be permitted in terms of the chapter but only in restricted circumstances.
32. We do not want to create a market for human tissue in this country. It has always been reprehensible to us as a society that people should be able to trade in human tissue as though it was just another scarce commodity. It is a matter of recognising the fundamental value of a human being and human life. The potential for exploitation of the poor, for unethical and morally unacceptable practices involving human embryos and for profiteering in human tissue markets is significant. Therapeutic cloning must therefore, of necessity, be carefully regulated.
33. Chapter 9 deals with national health research, monitoring and evaluation. As government, we cannot make meaningful policy decisions concerning health services if we do not have sound information upon which to base these decisions. It is important, in order to effectively and efficiently address the health needs of our people, that we identify national health research priorities so that scarce funds are spent in areas where people can derive the greatest benefit.
34. It is also important to protect people who are used as subjects in health research given the potential for their exploitation and the importance of human dignity within our legal system. It is especially important to protect our children in this area. It is a serious indictment of South African society that they are one of the most abused and exploited sectors of our population and we cannot allow them to become just another commodity in the health research setting.
35. The chapter establishes a National Health Research Ethics Committee whose job is to identify and prioritise areas of public health research and ensures the focus on priority health problems.
36. A National Health Research Ethics Council is established to ensure that all health research conduct in South Africa is of an acceptable ethical standard and to act against those who do not have sufficient respect for established ethical norms, standards and guidelines in health research.
37. Provision is made in this chapter for a national health information system, which is based on information coming from provincial and district health level.
38. Madam Speaker, let me now turn to the important issue of compliance, monitoring and evaluation. Too often we see good pieces of legislation been rendered ineffectual because of lack of capacity to enforce compliance.
39. Chapter 10 of the Bill gives it teeth. It creates structures at provincial and national level to ensure compliance with the provisions of the Bill.
40. The Director-General must establish the Office of Standards Compliance within the national health department. It plays an important role not only in ensuring compliance with the certificate of need provisions and conditions, but also in monitoring, evaluating and promoting the quality of health services throughout the country.
41. Every province must have an inspectorate for health establishments that must monitor and evaluate compliance by health establishments and health agencies within the province. It is the intention that these inspectorates will work in cooperation with the National Office of Standards Compliance on areas of common interest to ensure a national health system that is safe, effective and accessible to all.
42. Chapter 11 provides for regulations to be made in many important areas involving health services.
43. The regulation of the health sector is a complex and intricate business because the health sector itself is a dynamic and developing environment. For this reason, it is neither advisable nor appropriate to make provision for every matter in the Bill itself. Hence, the Minister may, in terms of chapter 11 make regulations on communicable diseases, health research, health technology, emergency medical services, rehabilitation, human resource development and other matters.
44. Chapter 12 is the final chapter of the Bill. It allows the Minister to appoint advisory and technical committees that are necessary to achieve the objects of the Bill. It also allows for the assignment of duties and delegation of powers by the Director-General and myself to other persons.
45. The legislation that will be repealed by the Bill is listed in the Schedule. The main laws that will be repealed are the Health Act of 1977, the Human Tissue Act of 1983, the National Policy for Health Act of 1990 and the Academic Health Centres Act, 1993.
46. Honourable members, we have taken a long time to present this Bill before you today. As you can see, the Bill is complex. I believe that there are benefits in taking the time to do a thing properly. I can assure you that, in the true spirit of the ANC, consultation on this Bill has been extensive. We did our best to accommodate the concerns of many stakeholders, even though there were sometimes conflicting interests.
47. In conclusion, I would like to thank the portfolio committee for their active participation in strengthening this Bill. In particular, I would like to thank Comrade James Ngculu, the Chairperson, for his able leadership during the deliberations, and of course the African National Congress for its progressive health policies whose aim is to provide a better life for all South Africans.
I thank you.
Issued by Ministry of Health
5 September 2003
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