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Polity
Published: 06 Jun 2008
SA: Tshabalala-Msimang: Health Dept Budget Vote debate 2008/09, NCOP (06/06/2008)
Date: 06/06/2008
Source: Department of Health
Title: SA: Tshabalala-Msimang: Health Dept Budget Vote debate 2008/09, NCOP
Budget Speech of the Minister of Health, National Council of Provinces

Chairperson
MECs for Health
Honourable Members
Ladies and Gentlemen

Good morning!

It gives me a great pleasure for me to present the National Department of Health's budget to this House. Whilst this budget largely provides for the operations of the national Department of Health, it also provides for a number of conditional grants which are used by provincial Departments of Health.

In addition, I would like to highlight a few critical issues that apply to specific provinces as the business of this House relates to the performance of provinces as much as to the role that the national department in supporting provinces.

Over the past few weeks, the national and affected provincial governments have been working tirelessly to respond to the incidents of attacks on non-South Africans. I wish to condemn in the strongest possible terms these acts of violence and convey our sympathies and condolences to those affected.

In addition to handling injury cases, the Department of Health has been part of the inter-sectoral collaboration to address the challenges relating to displacement and relocation of those affected.

The national Department of Health has issued clear guidelines to assist provinces to prevent transmission of infectious diseases in the temporary shelters that have been provided. The guidelines require that we ensure access to Primary Healthcare (PHC) for people accommodated in these shelters and patient transport is provided for referrals.

Our interventions focus on health promotion which covers prevention methods, signs and symptoms of common infectious diseases and personal hygiene. The guidelines also cover the prevention of water- and food-borne diseases, providing advice on appropriate handling of food and prevention of contamination of water sources.

We are verifying the immunisation status of children. Where there is no proof of immunisation history, immunisation against polio is provided for children up to five years of age and against measles for children between six months and 15 years of age.

Surveillance for infectious and vaccine preventable diseases are being upscaled to detect cases of cholera, polio, measles, meningococcal disease and other diseases that could cause serious outbreaks. Health workers have been advised to report immediately suspected cases of any infectious disease.

What I need to mention is that these are equally important measures to take for all the people of our country. If you know of children that have not been immunised, please encourage caregivers to take them to our clinics for vaccination.

Chairperson, this year we commemorate the 30th anniversary of the adoption of the Alma Ata Declaration on primary health care. The policies and legislation that we have adopted as the foundation of our health system is based on the primary health care approach. Key principles that underpin this approach which we have included in the National Health Act are: equity; solidarity; community participation; inter-sectoral collaboration and decentralisation.

The inter-sectoral collaboration in particular is critical to the achievement of good health outcomes. Health outcomes are determined by a range of factors, many of which are outside the direct control of the Department of Health. These include:
* access to clean water and proper sanitation,
* food security and good nutrition,
* access to educational opportunities, especially for women,
* access to sustainable livelihoods and other factors generally known as the social determinants of health.

Significant achievements have been recorded in a number of areas in line with our strategic plan for 2007/08 and I shall highlight a few of them.

Achieving the Millennium Development Goals (MDGs) with respect to child health requires for example that we improve our immunisation coverage. We have increased our coverage of fully immunised under one year olds to 84 percent in 2007/08. In fact, provinces such as Gauteng, Free State, Northern Cape and Western Cape have already exceeded the national and global target by achieving immunisation coverage rates of above 90 percent. Going forward we will strive to reach our overall national target of 90 percent coverage in all of our 52 health districts.

We have also increased provision of vitamin A to infants and mothers; this together with fortification of staple foods and the establishment of food gardens contribute to improvements in the nutritional status of South Africans. 100 percent of children aged six to twelve months and 61 percent of their mothers received vitamin A supplementation. However, we must increase the percentage of mothers that receive vitamin A to 100 percent this year.

As honourable members know, I have been an advocate of food gardens as these assist in ensuring food security and better nutritional status. It is therefore pleasing to note that KwaZulu-Natal for example has established 327 food gardens over the past few years. It is important that we also monitor the impact that these food gardens have on the nutritional status of our people. We can provide food parcels when there are emergencies but we also need to focus on food security.

You may well say, yes this is very good progress but why is the media reporting deaths of children in the Eastern Cape? In addition to investigation by the National Outbreak Response Team (NORT) and the committee on the mortality of children under five years of age, I personally visited the district with a team of officials last week and this is what we found.

This is a deep rural district with a population of over 350 000. It is has a poverty rate of 77 percent which is why it was designated as one of the rural nodes in the Integrated Sustainable Rural Development Programme (ISRDP).

There are significant challenges with respect to access to safe water and proper sanitation. To compound this situation the piped water that is available is not always adequately chlorinated.

There are challenges of food insecurity and the majority of children that died were malnourished. Babies are going hungry because they do not get the benefits of breast milk as many live with grandparents. To make the baby milk formula go as far as possible it is it is often over-diluted to the point of being nutritionally inadequate.

Given the high level of poverty there is a need for easy access to social grants. A challenge is that the local office of the Department of Home Affairs is a long distance from most parts of the district. The need for a mobile office has been identified to address this challenge.

These conditions contributed to the significant increase in the number of children who died between 2007 and 2008.

Let me now turn to the health system's responses to these deaths. Most of the children that presented at the district hospital were already in a critical condition. Also, because the children presented from a number of villages, it took a while for the district to realise that cumulatively this was a large increase in the number of deaths. This means that the surveillance system and clinical auditing systems need to be strengthened at facility and district levels.

So what have we done to address the challenges that exist in the district? Briefly, using community health workers and retired nurses we have strengthened our health promotion activities which now include door-to-door visits during which issues like correct feeding practices, including the importance of breast feeding, basic hygiene, the need to start food gardens etc are explained. In addition, we have strengthened the knowledge and skills of health professionals in the area of integrated management of childhood illnesses.

Within the next three months, we will be introducing two new vaccines into our expanded immunisation programme. These will assist us to prevent deaths from pneumonias and diarrhoea. We plan to formally launch this initiative in this district. I must emphasise that even with vaccination we must ensure that we provide safe water and proper sanitation and improve hygiene practices.

In addition, we have requested the World Health Organisation (WHO) provide us with technical assistance in the form of technical experts from both WHO/AFRO and WHO headquarters in Geneva. These experts will assist us in consolidating our findings and recommendations as well as assist with building capacity for surveillance and early detection.

I have established expert ministerial committees to investigate and report on neonatal, child and maternal health. I have asked these committees to ensure that I get regular reports so that speedy remedial action can be taken to prevent avoidable deaths.

The Committee on Confidential Inquiry into Maternal Deaths (NCCEMD) is ten years old and 85 percent of public hospitals are currently implementing the ten recommendations contained in the third report on Confidential Enquiries into Maternal Deaths.

Our prevention programmes with respect to HIV are showing signs of sustained success. Last year I reported a one percent decline in HIV prevalence in women attending antenatal clinics in the public health sector. The results of the 2007 HIV antenatal survey show a similar reduction. The findings of the 2007 survey show that HIV prevalence was at 28,0 percent in 2007 compared to 29,2 percent in 2006. HIV prevalence in the 15 to 19 year age group dropped from 13,7 percent in 2006 to 12,9 percent in 2007; as well a decrease was observed in the 25 to 29 year age group from 38,7 percent in 2006 to 37,9 percent in 2007. The rate in the 20 to 24 year group was stable between 2006/07. Taken together, these figures do indeed suggest that we have a trend of decreasing prevalence overall and in the younger age cohort in particular.

We are achieving these encouraging trends because of our intensive prevention campaigns which we believe are starting to make a difference.

I must commend the three provinces in which malaria is endemic - KwaZulu-Natal, Limpopo and Mpumalanga. By strengthening their programmes through training, in-door residual spraying and use of new combination drugs, as well as collaborating with our neighbours, Mozambique, Swaziland and Zimbabwe they have succeeded in reducing the number of malaria cases by 57 percent between 2006 and 2007. The next step is to ensure that we further decrease the case fatality by working closely with communities to ensure that anyone with malaria symptoms is diagnosed and gets treatment as early as possible.

Whilst some progress has been made in increasing the tuberculosis (TB) cure rate and decreasing the defaulter rate, we need to accelerate progress to ensure that we decrease drug resistant TB. To address the challenge of drug resistant TB challenges we provided provinces with R400 million last year. These funds are largely used to pay for the additional drug costs and to provide additional beds to isolate patients who were drug resistant.

We have patients that are isolated because of the danger they pose to others. Understandably, some of them are unhappy will the extended hospital admission. We are doing all we can to make their stay in our facilities as comfortable as possible.

The key to addressing drug resistant tuberculosis (XDR-TB) is to turn off the tap - that is to cure patients the first time that they contract TB. In this regard the national department, with support from the European Union (EU) has trained and deployed 72 tracer teams to find defaulters and ensure that they are put back on treatment. We are confident that we will meet the target of decreasing the defaulter rate to less than seven percent as indicated in the President's State of the Nation address earlier this year.

We have signed an agreement with the Chamber of Mines and the National Union of Mineworkers (NUM) to strengthen our ability to do benefit examination of miners and ex-miners who present with occupational health problems. This will also increase access to occupational health benefits for qualifying miners.

The world is slowly waking up to the increasing incidence of non-communicable diseases. This was one of the major issues discussed at this year's World Health Assembly in Geneva. We recognised this several years ago and hence our focus on healthy lifestyles. Our Healthy Lifestyles programme is now three years old and it continues to focus on physical activity, proper nutrition, responsible sexual behaviour, control of tobacco use, and responsible alcohol use. The last Friday of February each year is now declared a Health Lifestyles Day for both our country and our continent.

With respect to control of tobacco use, South Africa will in November this year host the third session of the Conference of Parties to the Framework Convention on Tobacco Control (FCTC). This meeting will deliberate on practical steps that need to be taken to reduce tobacco use and its harm to human health, the economy and the environment. The Conference of the Parties is a body that monitors progress in the implementation of the Framework Convention on Tobacco Control, which was ratified by our parliament in April 2005.

Honourable members will know that prevention is better than cure. Unfortunately, the world over, health facilities have been designed for the sick. However, we need to also make sure that they focus on keeping people well. One way to do this is to establish wellness centres in all our facilities. These centres can advocate for a wellness approach in all parts of our facilities especially for our health workers. I shall work with the MECs to find ways of ensuring that we start the process of establishing these centres in earnest during this financial year.

It is important to alert this House to the resolution of the World Health Assembly last month to include non-communicable diseases on the list of indicators monitored in addition to the Millennium Development Goals (MDGs). The world is increasingly becoming aware of the increasing challenge of non-communicable diseases - something we have been highlighting for a long time as South Africa.

Besides the emphasis on non-communicable diseases, the delegates to the World Health Assembly also reiterated, in the context of the Millennium Development Goals amongst others, the need to strengthen health systems. We cannot only focus on priority health programmes. For sustainability and long term success, we must focus on the health system as a whole.

To further expand our primary health care system, a number of provinces commissioned new clinics in 2007/08. The North West province for example completed nine clinics, built two new community health centres and upgraded two others and they are on track to complete another six community health centres in 2008. The Free State upgraded two clinics and one community health centre last year at a cost of R11 million and upgraded the emergency unit which I had a pleasure to visit. These are just a few examples. I am sure that the MECs who shall take the floor will provide additional details.

Similarly, we have made progress with the hospital revitalisation programme as we need hospitals to support primary health care and provide quality health care as well as healthy working environment for our staff.

During the last two financial years, three new hospitals were opened bringing to eight the number of new hospitals. These are George Hospital in Western Cape; Madikana ka Zulu Memorial Hospital in Eastern Cape and Lebowakgomo Hospital in Limpopo. An additional three hospitals will be completed by the end of this financial year. These are Dilokong and Nkhensani Hospitals in Limpopo and Barkley West Hospital in the Northern Cape.

New buildings contribute to better working environments for our health workers and in turn to improvements in quality of care. However, quality of care at all public health facilities remains a challenge and we have taken additional steps to improve the quality of care we provide. The Department of Health has established a set of core national standards reflecting the degree of excellence we wish to attain in delivering acceptable and quality health services.

These standards cover a broad range of performance areas. For instance with respect to safety, we will look at safe handling (and storage) of medicines, patient safety systems and infection prevention and control.

A total of 27 hospitals and four community health centres have been identified as initial focus points for appraisals based on these core-standards covering all provinces and all levels of care and the first report is expected in July.

Chairperson, 31 August each year is Africa Traditional Medicine Day. This year we will celebrate progress made in finalising our policy on African Traditional Medicine and intensify the implementation. In preparation for implementation we shall be hosting a colloquium on African traditional medicine, launch the national institute of African traditional medicine and also participating in a continent-wide review of progress during this African Decade of Traditional Medicine. The continental review will take place under the chairpersonship of the Minister of Health of South Africa, who is the current chair of the bureau of African Ministers of Health in Yaounde in the Cameroon on 30 August this year.

Key to achieving all these has been and will continue to be a strong cadre of health workers.

We are proud of our health workers, many of whom work under difficult conditions. We know that by and large they are dedicated to providing the best possible service. Like many other countries with the growing burden of disease and migration of health workers, the strain felt by the health system is significant. Hence we have implemented a number of strategies to increase and stabilise our health workforce.

These include: community service- community service for nurses commenced in this year. There are government-to-government recruitment agreements especially of doctors with the most recent being with Tunisia. We were the first department to implement a new approach to remuneration adjustment called the occupation specific dispensation.

In January this year, the first cohort of 23 students started training at the Walter Sisulu University. Walter Sisulu University will have a further intake into this programme in July this year. The University of Pretoria (UP) will enrol 40 students in June this year and will have a further intake in January 2009. The University of Witwatersrand will start in January 2009 with an intake of 24 students. The University of Limpopo is working towards commencing this programme in January 2009 as well.

The clinical associate programme is a three programme that will produce a cadre of health professional who will work mainly in community health centres and district hospitals. Upon qualification, they will be registered with the Health Professions Council of SA (HPCSA) with a defined scope of practice. They will be able assess patients, make a diagnosis, treat and prescribe appropriate therapy and undertake minor surgical procedures under the supervision of medical officers.

We have a large cadre of community health workers in the country doing a number of tasks. We have taken a decision to review the programme. We have to ensure that these workers are trained to provide a number of services - and they should work closely with the community caregivers employed by the Department of Social Development who also provide home and community based care.

However, I still believe we can do more to ensure better co-ordination, monitoring and support for this programme. We shall be assessing the situation and taking the steps necessary to strengthen the role that this cadre plays during this financial year. This will take into consideration the need to increase community participation and involvement in health.

We will continue to strengthen our relations with our international partners, especially in Africa and countries in the south. We hosted an African Union (AU) Workshop on Maternal, Newborn and Child Mortality Reviews which came up with proposals on interventions needed towards meeting MDGs four and five and beyond. The recommendations of this workshop have been adopted by AU Health Ministers and will be tabled for consideration by Heads of State and government at their summit later this year. The African Union Health Ministers have also given me the honour and responsibility to be the African Union Goodwill Ambassador and Champion for Women and Child Health.

South Africa will also assume the role of Chairing SADC Health Ministers in the second half of 2008. All of these responsibilities reflect the confidence and trust that our sister countries in Southern African Development Community (SADC) and Africa have in us. We will also be attending the global celebration of this declaration organised by the World Health Organization in October this year. We are also attending the United Nations General Assembly Special Session on HIV and AIDS in New York next week.

We have concluded a number of agreements with other African countries that will enable them to refer their citizens to our tertiary hospitals. We are assisting Namibia with setting up of a cardiac unit in that country and the unit is expected to conduct its first open heart surgery soon. We are also collaborating with Namibia on the management of drug resistant TB.

We will continue to play an active role in the development of a code of conduct for international recruitment of health personnel. This process is a result of efforts by Africa to highlight the negative effects of migration of health workers on our health systems. Our view is that all countries should make an effort to train for their own needs.

Let me turn to the budget of the National Department of Health. The budget that I am tabling today calls for the spending of R15,1 billion by the National Department of Health. For the first time the budget is provided in the new six budget programme format. This development arises from the restructuring of the department from the old four budget programme structure to the new six budget programme structure, which, will provide resources to strengthen the management structure of the department by the addition of two more Deputy Directors-General.

In terms of funding available for the operations of the National Department of Health I wish to highlight the following:
* The budget for the department grows by 14 percent between 2004/05 and 2010/11.
* R10,721 million is allocated for personnel over the MTEF (R2,278 million in 2008/09, R3,756 million in 2009/10 and R4,687 million in 2010/11).
* R21,746 million again over the MTEF for non-personnel components of the vote (R6,506 million in 2008/09, R6,974 million in 2009/10 and R8,266 million in 2010/11).
* In addition R10 million has been granted for 2008/09 to undertake research and to develop detailed implementation plans for the recapitalisation of nursing colleges including more detailed planning on the supply and demand for nurses within the national health system.
* An amount of R5,3 million has been budgeted for Medical Research Council to compensate for inflation over the MTEF (R1,6 million in 2008/09; R1,7 million in 2009/10; R2,0 million in 2010/11).

In addition a number of conditional grants are provided for. As Honourable Members know, these funds are transferred to provinces by the National Department of Health for their disbursement.
* Hospital Revitalisation Conditional Grant - (R600 million for 2008/09, R500 million for 2009/10 and R900 million for 2010/11).
* HIV and AIDS Conditional Grant - (R350 million for 2008/09, R600 million for 2009/10 and R1,150 billion for 2010/11).
* National Tertiary Services Grant (NTSG) - (R193 million for 2008/09, R247 million for 2009/10 and R639 million for 2010/11).

I want to clarify that these are not total figures for conditional grants for the MTEF 2008/09 to 2010/11. They are additions to the baselines.

Whilst provinces are responsible for expenditure on these conditional grants, the national department is expected to monitor expenditure to ensure that they are both within the provisions of the Division of Revenue Act and business plans. We will be working more closely with provinces during this financial year to ensure that expenditure on the conditional grants are carefully monitored and that rapid corrective steps are taken when needed.

Much has been achieved in 2007/08, which fortifies the cumulative milestones we have achieved since 1994, guided by the Primary Health Care philosophy. Our priorities and budget for 2008/09 reflects our commitment to improving health service delivery to all the people of South Africa.

I wish to thank the members of this House for their support to the health system, and in particular wish to pay tribute to the Chairperson and members of the Standing Committee on Social Services. Much of the success of the department rests with the leadership provided by my colleagues the MEC's for Health, some of whom are present today and I wish to thank them for their support.

In addition, I wish to thank the officials of my department ably led by the Director-General, Mr Thami Mseleku and the Heads of the Provincial Departments of Health for their support.

I thank you.

Issued by: Department of Health
6 June 2008