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Date : 09/02/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Parliamentary Media Briefing, February 2004


STATEMENT BY THE MINISTER OF HEALTH, MANTO TSHABALALA-MSIMANG, AT THE GCIS PARLIAMENTARY MEDIA BRIEFINGS 2004: FIRST SOCIAL CLUSTER BRIEFING, 9 February 2004

Representatives of the media and guests

Together with my colleagues - Minister Stella Sigcau and Minister Zola Skweyiya - I would like to welcome you to the first media briefing by the Social Cluster.

You will be aware that this is the first of three social cluster briefings - with the other two focusing on rural development and issues related to education and human resource development.

I propose, in introduction, to give a brief overview of the work of the cluster during 2003/4. And then to look a bit more closely at the three issues selected for the Ministries present at this briefing, namely:

* The Expanded Public Works Programme
* Comprehensive social security
* Access to affordable health care

Many activities of the Social Cluster relate to the challenges of poverty. In examining the roles of different departments in relation to poverty alleviation, we have come to recognise that:
* There are departments whose job it is to challenge poverty by providing access to a regular income for poor families. These would include the departments headed by my colleagues here today
* There are those that tackle the relationship between household assets and poverty. The departments of Land and Housing come most readily to mind
* There are those that relieve poverty by providing access to services that meet the basic needs of households. These services range from health and education, to water and electricity.

Overview of Social Cluster Activities

1. Integrated Nutrition Programme and food security

The Food Emergency Programme, involving a special allocation of R400 million for food parcel distribution and for contribution to the World Food Programme, is nearing completion. It is envisaged that food parcels will in future be dealt with in terms of disaster management and that food insecure families will be captured by the social security net or afforded productive options through the Agricultural Starter Pack Scheme.

In addition, the feasibility of introducing foods stamps as part of Comprehensive Social Security is being investigated.

A smooth hand over of the School Nutrition Programme from the Department of Health to the Department of Education is expected in April. Dual systems have been in place for several months. About 4,5 million children have benefited each year for a decade.

Mandatory fortification of all bread and maize meal with specified minerals and vitamins came into effect in October with full support of the Chambers of Milling and Baking.

The emergency response to the drought will be dealt with by the Ministry of Provincial and Local Government's briefing later this week.

2. Integrated Sustainable Rural Development and Urban Renewal Programme

The critical elements of the Integrated Sustainable Rural Development Programme (ISRDP) are the framework for community development workers and the nodes. Cabinet approved the funding and institutionalisation of community development workers as part of the public service. Learnership, as the first focus area will initially begin in Eastern Cape, Gauteng, Limpopo and North West.

While there is some progress in building staff capacity through training, attracting management capacity to the nodal areas is still a challenge. Much progress is being made within both the ISRDP and the Urban Renewal Programme (URP) as a result of their integration into city/district operations, enhanced local leadership and community involvement. A detailed presentation will be made here tomorrow on these two critical programmes.

3. Social cohesion and social justice

We have agreed that a national strategy on social cohesion be developed, which will amongst other things:
* Encourage a culture of volunteerism
* Mobilise community-based care for the vulnerable
* Mobilise schools to contribute to the reduction of illiteracy amongst the communities they serve
* Encourage food gardening in support of government food security programmes

All government departments will have to integrate social cohesion and justice as part of their nation-building programme.

4. Comprehensive Social Security

Social grants

The numbers of beneficiaries and expenditure on grants, especially the child support grant, the foster care grant, the care dependency grant and the disability grant have shown a significant increase over the past three years. Between April 2000 and the end of November 2004, the number of social grant beneficiaries has increased from 3,2 million to no less than 7,5 million, that is an increase of 128% over the last four years with a budget of R34 billion per annum.

Under the banner of putting children first, we have been able to increase the number of children in payment from 349 000 in 2000 to about 3,9 million children at the end of November 2003. Children ten and eleven years of age will qualify in the 2004/5 financial year starting in April this year and children between the ages of 12 and 14 years will be able to register for the child support grant in the 2005/6 financial year.

The number of beneficiaries for old age pension increased from 1,8 million recipients in April 2000 to more than 2 million in 2003 (a 7,7% over three years).

We have noted the gaps with regard to the provision of social assistance due to age and other factors affecting a large number of people. In essence, the process of developing a comprehensive social security system that builds on existing contributory and non-contributory schemes and prioritises the most vulnerable households is under way. In this regard various poverty relief programmes are being integrated. The strengthening of partnerships is critical, thus our efforts to strengthen institutions such as the National Development Agency, whose mandate remains the strengthening of civil society.

Social health insurance

The recent Cabinet Lekgotla directed the Department of Health and the Treasury to finalise a recommendation on social health insurance (SHI) by the end of March. SHI will ensure that families of all people in formal employment have access to contributory health cover. SHI will embrace three major principles:
* Risk related cross subsidies
* Income-related cross subsidies
* Mandatory cover.

Important groundwork for SHI was done in 2003 through a consultative process on risk pooling and cross-subsidisation. The work done by two task teams was subjected to the scrutiny of international experts recently at a workshop here in Cape Town and this will inform the way forward.

Expanded public works programme

Public works programmes are intended to benefit the section of the population that is excluded from the formal economy, but is not eligible for any social grant. It has enormous potential to alleviate poverty in both rural and urban settings.

Since 1999, the Department of Public Works has invested more than R1,7 billion and created close to 124 000 jobs in impoverished rural areas in six provinces.

The strategy of public works is due to be taken to a new level with the launch of the Expanded Public Works Programme (EPWP) in April 2004. This programme will focus on job creation in the areas of infrastructure provision, social services and environmental protection.

In the infrastructure sector a Labour Intensive Contractor Learnership Programme has been established, with support from three national banks. Training and skills development will form a major part of this programme.

In the social sector, the public works programme will focus on expanding home and community-based care programmes and early childhood development programmes. Not only do these programmes address critical community needs, they are also labour intensive.

The environmental element of the programme will seek to build on the current programmes: Working for Water, Land Care and Coastal Care.

5. Access to essential services

The Social Cluster deals with access to a range of essential services, namely:
* Water provision and sanitation
* Education
* Population registration
* Housing
* Health services.

Progress has been recorded in all these areas and details will be given in the respective briefing sessions. The only area that falls squarely in this briefing is health care, which I will deal with briefly.

Access to affordable health care

Access to health care is affected by available infrastructure and human resources as well as by user costs.

It is also critically affected by the policy framework and, in this regard it should be noted that we are still operating under the Health Act of 1977. This is due to be replaced shortly by the National Health Bill, which has been specifically designed to give effect to government's constitutional duty to ensure progressive access to essential health services for all our people.

The Bill is a wide-ranging, framework law that deals with patient's rights, with the structure of the public health system, with human resources issues, with the setting of standards - and with the certification of all health establishments.

The certificate of need, which will in time to come, be a requirement for all health establishments is intended to promote efficiency, prevent unnecessary duplication of services and ensure that our resources are put to best use in the service of the country.

Infrastructure for better access

The location, type and condition of our health facilities have been a major challenge.

We are constantly strengthening the platform for delivery of primary care services through the building of clinics. The process began under national government in 1994 and continues with provincial funding. By the end of 2003, more than 900 clinics had been built or had major upgrading since 1994.

Renewal of our hospital stock focused initially on renovation and maintenance, but has progressed to major rebuilding under the Hospital Revitalisation Programme in the last two years. Capital budgets are currently at their highest since 1994. The hospital revitalisation process will use R911 million in 2004, as part of a total budget of about R2 billion for improving health service infrastructure.

This year we will be opening the Nelson Mandela Hospital in Umtata, one of the three state-of-the-art tertiary care hospitals we have commissioned. The others are Inkosi Albert Luthuli, which is already functioning in Durban, and the soon-to-be completed Pretoria Academic Hospital.

Free health care

Free health was introduced for pregnant women and children under six in 1994. Paediatric cases have increased by more than 100% since then.

In 1996, user fees as clinic level were abolished. Once again, we can document the increase in usage - up from an average of 1,8 visits per person per year in 1992 to 2,3 visits in 2001.

Last year we added free health care for people with permanent disabilities. This includes frail elderly people and people with psychiatric conditions that seriously impede daily functioning.

Included in free health care for people with disabilities is the provision of assistive devices.

Human resources as a factor in access

One of the greatest challenges in the provision of equitable health services has been the uneven distribution of our human resources, between the public and private health sectors and between urban and rural areas.

The Health Department has concluded a vital agreement in the bargaining council to pay special allowances to professionals working in rural areas and those with skills that are in scarce supply in the public sector. The total allocation for these allowances is R500 million in the current year and will rise to R750 million in 2004/5.

Medical doctors and specialists, dentists, pharmacists, radiographers, various types of therapists and nurses specialising in the areas of operating theatre technique, critical or intensive care and oncology will receive scarce skills allowances ranging from 10 to 15% of the current salary. Rural allowances range from 8% to 22% of annual salary, depending on area and occupational category. All these allowances are will be back-paid from 1 July last year.

We have continued to expand the community service programme. This year about 3 000 young professionals are doing community service, and a much larger proportion are serving in predominantly rural provinces.

To address the challenge of international migration, we pressed for the adoption of the code of conduct for recruitment of health workers within the Commonwealth in May last year. The code seeks to ensure that recruitment is transparent and does not harm the health services of the source country. We have since held bilateral discussions on recruitment with various countries and in October 2003 we signed an agreement with Britain.

Affordable medicines

We are forging ahead with strategies to reduce the price of medicines. Draft regulations on medicine pricing have been published for comment. These focus on a single exit price for manufacturers and controlled fees for wholesalers and retailers. We envisage real interaction with stakeholders during the comment period, in addition to the usual written submissions. These regulations will be finalised and implemented by 2 May this year.

6. Emerging and re-emerging diseases

We continue to address major communicable diseases including HIV and AIDS, tuberculosis, malaria and cholera.

Tuberculosis (TB)

TB remains a major challenge and we need to strengthen efforts to reach the target cure rate of 85%. The number of TB cases is steadily increasing and the problem is exacerbated development of multi-drug resistant TB (MDR-TB), which has a high risk of transmission and is very costly to treat. During 2003 provinces developed dedicated services for treatment of MDR-TB.

The emphasis in 2004, in line with international developments, will be on:
* Developing partnerships around TB
* Managing the TB/HIV link more effectively.

HIV and AIDS

We are working hard to implement the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS, while expanding the prevention strategies that remain the mainstay of our response to HIV and AIDS.

Central to implementation is the identification of a service point in all the 53 districts of the country. A service point is not a stand-alone hospital but includes a network of facilities providing various elements of comprehensive care. Accreditation teams are on the ground assessing capacity in some 120 facilities around the country and have covered almost two third of those.

The procurement of necessary drugs at the best possible prices is also critical to the sustainability of the programme. The Drug Procurement Negotiating Team, that I appointed last month, has developed its work plan.

Notices will appear in major newspapers and the government bulletin from Friday, 13 February, inviting interested pharmaceutical suppliers to indicate their interest in supplying drugs for the programme. Their proposals will be evaluated and short-listed or qualified parties will be invited to tender for the contracts.

In addition to quality and good prices, our concern is to ensure a completely reliable supply of anti-retroviral drugs and other medicines required for the Comprehensive Plan.

Other preparatory work includes:
* Creation and advertising of technical and management posts at the national department to support implementation
* Preparation of clinical protocols covering various elements of the plan
* Customising training manuals for various health worker categories
* Creating a standard electronic patient record system to facilitate monitoring of patients and the programme as a whole
* Drafting and testing of information leaflets and research on radio and television adverts.

Cholera and Malaria

The current drought affecting many parts of the country is posing some health challenges particularly with the possible outbreak of water-borne diseases like cholera and shift of vector-borne diseases like malaria to new areas.

We have been able to contain some few cases of cholera that have been reported over the past year and we are also ensuring epidemic preparedness and response in all districts.

The fight against malaria in the Southern African Development Community (SADC) region is gaining momentum and has been boosted with the allocation of resources from the Global Fund to Fight AIDS, TB and Malaria to the Lebombo Spatial Development Initiative. Except for some increase in malaria cases in Limpopo in October last year, good progress is being made on this front.

Issued by: Ministry of Health
9 February 2004

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