Title: Tshabalala-Msimang: Parliamentary Media Briefing, February 2003
SOCIAL SECTOR CLUSTER PARLIAMENTARY MEDIA BRIEFING BY MINISTER OF HEALTH, MINISTER OF SOCIAL DEVELOPMENT, MINISTER OF WATER AFFAIRS AND FORESTRY, WITH INPUT FROM THE MINISTRY OF HOME AFFAIRS - PRESENTED BY MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, 19 February 2003
This briefing focuses on the priorities for 2003 that Cabinet has determined for the Social Cluster - and particularly the Ministries represented here today.
I think you will sense, when you view the priorities collectively, that we have a continuing concern with mounting an effective assault on poverty and the effects of poverty.
Our focus today is on areas of common ground for our Ministries - rather than the unique field covered by each. The briefing will, therefore, not provide an overview of the core business of our respective departments.
You will also appreciate that Cabinet has in many cases pinpointed critical factors that add value to existing programmes. In addition to the Cabinet decision, I will try to provide a bit of relevant background so that you can place the initiative in context. But I hope you will feel free - afterwards - to ask for further details from the relevant Minister.
Summary of priorities
The Social Cluster priorities for 2003 are grouped under five headings, namely:
* Comprehensive Social Security
* Basic Services
* Nutrition and Health
* Social Justice and Social Cohesion
* Integrated development in rural and urban areas.
Cabinet has designated a number of specific initiatives in the year ahead.
Comprehensive Social Security
In this area of work, there is a continued focus on increasing access to social security measures - both by means of improved administration of existing grants and by reviewing policy to extend provisions.
Extending the Child Support Grant
In relation to the latter, as the President announced last week, the upper age limit for the Child Support Grant will be gradually increased from the present limit of six years to 14 years.
In 2003, children turning seven will continue to receive their grants and no child presently benefiting from the Child Support Grant will be disqualified by reason of age until he or she turns 14 years.
* By 2004, the grant should cover children up to and including eight years of age.
* By 2005, nine and 10 year-olds will become eligible.
* And in 2006, the upper age limit will be 14 years - that is, children 11 to 13 years will be included.
By December 2002, 2,5 million children were receiving the Child Support Grant. This is a remarkable increase from 1999 - when there were only 60 000 beneficiaries - and it is testimony to the success of the campaign to identify and register eligible children. Partners from faith-based organisations, non-governmental organizations, business and labour have assisted the Department of Social Development in this critical initiative to combat poverty.
The process was underpinned by an equally focused effort to eliminate backlogs in birth registration. In just 10 months - December 2001 to October 2002 - more than 2,7 million births of children under the age of 15 years were registered. A comparison with 1996 - when just 800 000 births were registered - gives you a sense of the improvement the Department of Home Affairs has achieved.
The total number of people receiving social grants is now about 5, 5 million. Over 95% of the older persons who are eligible are now receiving their grants and efforts to register the remaining 5% will be intensified.
Introducing free health care for people with disabilities
People with disabilities who are dependent on public health care provision will soon receive all health services free of charge. The Department of Health and the Presidency will produce a clear statement defining the eligibility for this free service so that the policy is uniformly applied by public health facilities countrywide.
The move recognises the frequent need for treatment that many disabled people experience and it links with health sector reparations for those disabled as a result of human rights abuses under apartheid. The decision emphasises the need to address backlogs with regard to cataract operations, provision of wheelchairs and other assistive devices for people with disabilities.
Establishing a Social Security Agency
Cabinet has endorsed the concept of a Social Security Agency that would serve to improve management of social grants, eliminating opportunities for fraud due to "double dipping" and enhancing the quality of the service. Firm time frames for implementation have now been set, targeting 2004.
Finalising proposals on a Comprehensive Security System
Cabinet has requested a clear policy proposal on further developing our social security system, including the possibility of a system of social health insurance. A concrete proposal should be finalised by the end of 2003.
The Department of Health believes that it is necessary for all working South Africans to make some contribution to the cost of health care and that a system must be developed to facilitate prepayment.
The introduction of such insurance should strengthen the public sector for all users. It should have a progressive impact and promote cross-subsidisation:
* From the wealthier to the poorer
* From the young to the old
* From the healthy to the sickly.
It should also address equity issues in terms of the relative size of the state's contribution to private health cover (presently effected through tax rebates on medical aid contributions) and public provision (presently channelled through direct funding of services).
In this area of delivery Cabinet highlighted the extension of water and sanitation programmes to combat cholera and other water-borne diseases. The recent outbreak of cholera in the Eastern Cape has once again highlighted this critical need.
Our Government's water supply delivery continues to be on target and we have delivered these services to approximately 9.3 million people. The Department of Water Affairs and Forestry's Community Water Supply Programme alone has provided for over 8 million rural people. In this past financial year ending March 2003, the Department would have provided some 1.2 million people with access to basic water infrastructure at an expenditure of R 930 million. Since 1994, the Community Water Supply programme has created some 494 000 temporary employment opportunities in rural communities.
Since 1994, approximately 3.5 million people have been given access to sanitation facilities. However, 16.2 million still need to be provided for. Government is committed to eradicating this backlog by 2010. This current financial year, the Department of Water Affairs and Forestry committed R 326 million to provide sanitation for an estimated 800 000 people and to date has created 14 318 temporary employment opportunities. My colleague, Minister Kasrils, can later elaborate on a R1200 grant to assist individual households with proper sanitation.
Delivery of a basket of services, including water and electricity, in all municipalities was set a priority by Cabinet. This will be more fully addressed in another briefing. However, it should be noted that Free Basic Water is currently being implemented by 71% of municipalities, bringing the total number of people benefiting from the policy to 26,4 million.
Despite our successes many rural communities are still to benefit. The Ministry of Water Affairs is striving to ensure that the equitable share of revenue for local government is calculated and applied to make free basic water accessible to all.
Building of school classrooms in accordance with the existing Register of School Needs. Cabinet requires a clear set of targets for a programme geared to eradicate the phenomenon of classes being conducted in the open air, under trees and in dilapidated classrooms not favourable to learning.
The Health Department has felt the benefit of government focus on capital investment in social infrastructure over the last five years. We have been able to build three new academic hospitals and our Hospital Revitalisation Programme will be boosted by almost R3 billion in the next three years.
Nutrition and health
We seek to implement a comprehensive response to the health challenges facing the country. Our priorities are the eradication of poverty and better nutrition, promoting healthy lifestyles and a culture of observing treatment particularly in relation to curable diseases.
Integrated Food Security and Nutrition
The actions that Cabinet required us to take this year should be seen within the context of a range of established interventions. These interventions include the following:
* In the area of food security, there is the household and commercial food production programme, a developmental initiative run by the Department of Agriculture
* There is also the emergency relief scheme announced in October last year, totalling R400 million and intended to address the crisis caused by escalating food prices within our country and famine in the Southern African region. The local programme is expected to provide temporary relief through the delivery of food parcels to 1,2 million of the country's poorest households. The strategy also links these households to more sustainable assistance programmes
* In the area of nutrition, we have the Primary School Nutrition Programme that has been in operation for about eight years and that benefits about 5 million children in 15 000 schools
* And there are firm plans to introduce mandatory fortification of bread and maize meal in the course of this year in order to overcome mineral and vitamin deficiencies that are widespread in our country, especially among the poorest.
Cabinet has particularly directed the Social Cluster to:
* Ensure that the transfer of the Primary School Nutrition Programme from the Department of Health to the Department of Education in no way undermines the smooth delivery of meals to learners. The departments will co-operate and put the childrens' interests first and Health will share its experiences fully with Education to help the latter avoid some of the pitfalls that Health learned about during the early years of the programme. The transfer brings about an excellent opportunity to refocus this programme on its other objective of economically empowering communities and encouraging participation of school governing bodies.
* Explore the use of nutritional supplements as part of the treatment plan of certain patients particularly those with TB. Cabinet has taken the view that Health Departments should begin to introduce such supplements in tuberculosis control programmes, initially on a limited scale.
Priority health programmes
Tuberculosis is a leading killer-disease in the country and we will therefore be scaling up the investment of resources and effort in addressing it. In particular, in line with Cabinet's directive, we will develop a stronger public awareness programme on TB.
Three factors argue for the scaling up of awareness about tuberculosis:
* The first is high burden of disease combined with our relatively low cure rate and relatively high treatment interruption rate
* The second is evidence from a recent MRC study that we are picking up cases at an advanced stage - which means we have a lot of active, uncontrolled TB in communities.
We have increased funding for our TB control programme in the year ahead - both from the budget allocation and from the Global Fund.
We will be scaling up our communication on TB, to ensure that the signs and symptoms of tuberculosis are widely known and to build confidence that TB is curable even in the presence of HIV. We are strengthening relations with various stakeholders including community-based caregivers that assist TB patients to complete their treatment.
While we continue with overall implementation of our comprehensive HIV, AIDS and STI Strategic Plan, Cabinet focused on the rollout of the programme to prevent mother-to-child transmission of HIV (PMTCT) and continued implementation of the Constitutional Court order.
This is already happening and will proceed at two levels:
* Increased access to the "full package" of services that we initiated in the provincial research sites. Apart from the provision of Nevirapine, this package includes formula feeding for babies, prophylactic antibiotics and nutritional supplements for mothers. Safe infant feeding remains the biggest challenge of this programme
* Secondly, the general expansion of services for voluntary counselling and testing (VCT). By expanding VCT, health departments enhance conditions for fulfilling the judgment of the Constitutional Court. The court ruled that the attending doctor at any public health facility, in consultation with the medical superintendent, could administer Nevirapine if he or she deemed it appropriate for the patient and if appropriate counselling and testing was available.
Cabinet has also emphasised that home-based care programmes need more substantial support. On the one hand, attention needs to be paid to the efficient management of these programmes.
Equally, however, questions of sustainability must be confronted - especially in very poor communities where resources may already be stretched to breaking point.
These particular priorities in the HIV and AIDS programme have been identified in a context of greatly increased funding for this programme and for TB control. Conditional Grants - which are earmarked for PMTCT, VCT, home-based care and prophylactic treatment for survivors of sexual assault - were scheduled (in terms of the existing MTEF) to increase by about 70% in the coming year. This added funding is intended to strengthen hospitals and clinics in the face of HIV, AIDS and TB. The discussions are underway with the deans of health science faculties on the establishment of Coordination and Training Centres for Management of HIV and AIDS.
As part of our intensive prevention campaign, some of you would have noticed that last week, which was Condom/STI Week, that we are putting much emphasis on prevention and treatment of sexually transmitted infection. Apart from the morbidity they cause, including infertility, abortions, ectopic pregnancies, stillbirths, prematurity and cervical cancer, they significantly increase the risk of HIV infection.
Malaria remains a challenge as it affects at least three of our provinces and is major killer-disease in Africa. Collaborative efforts with neighbouring countries have been successful and promote partnership within our continent. In sustaining this approach, events in KwaZulu-Natal, Limpopo and Mpumalanga are being organised as a build up to the race for malaria campaign that will end with a major SADC celebration of Africa Malaria Day in Dar es Salaam on 25 April.
Social justice and social cohesion
Cabinet regards a coordinated initiative to combat the abuse of alcohol other illicit drugs as a major challenge. Implementation of this programme cuts across several clusters.
The Department of Health, working within the Central Drug Authority, will contribute by spearheading action in relation to alcohol advertising.
* This year, intend acting on the long-anticipated regulations requiring mandatory health warnings to appear on the labels of containers of alcoholic drinks. Research has already been commissioned to establish which types of warnings elicit the desired response from the public
* We will also consult with stakeholders across the spectrum to formulate an effective strategy with regard to advertising of alcoholic drinks and sponsorship by the producers of alcoholic drinks. We will not necessarily follow exactly the same route that we adopted in relation to tobacco products. We will focus especially on protecting young people.
Other priorities in the area of social justice and social cohesion include the development of an extensive awareness campaign on substance abuse; the improvement of sporting facilities and increasing youth centres as well as the consolidation of prisoner rehabilitation programmes.
What informs our approach is determination to encourage healthy lifestyles and discourage use of harmful substances including tobacco products and illicit drugs. These interventions are part of a broader effort to encourage observance of legal and social norms and tightening the social fabric within especially those communities living in poverty.
In closing, I must emphasise that I have done no more than give you a wide angle picture of the matters Cabinet has lifted out for concerted attention. It is over to you to choose those aspects, which you would like further, developed in the course of questions and answers.
Dr Manto Tshabalala-Msimang
Minister of Health and Social Cluster Chair on behalf of: Minister Ronnie Kasrils (Water Affairs and Forestry) Minister Zola Skweyiya (Social Development)
Issued by GCIS
19 February 2003