Issued by Department of Health
18 November 2001
Programme Director and
Delegates to the Health Summit
It is my great pleasure, as host of the Health Summit, to welcome you here today. I hope you will quickly settle in and feel comfortable and, in particular, that every individual here will feel free to contribute fully and honestly to the deliberations of the next few days.
We are honoured to have with us the Health Minister of Swaziland, Minister Dlamini and several representatives from the SADC Health Sector, including the Nurses' AIDS Network. We are happy to have you join us at this significant meeting.
A special welcome to representatives of the media who are invited to attend all discussions at this Summit. We trust that you will make full use of this transparency and ensure that the public has the benefit of truly representative reporting of the debates that take place here.
Anyone glancing at the programme for the Summit would draw the conclusion that this event is in the hands of all the participants -- not in the hands of a few performers standing under bright lights on a platform. In organising a Summit on this scale, the Department of Health was driven by a strong impulse to consult -- a sense that those of us who make decisions of national consequence need to be guided by the thinking of colleagues working closer to the rock face of health service delivery.
In this assembly, therefore, ideas and opinions are all equally valued. Their importance does not derive from the rank of their owners or the field of their experience. And there are no holy cows, no areas of intellectual terrain that cannot be crossed. No debates that are closed off by signs that say: Beware -- Do not enter -- We have made up our minds!
In this open engagement, I believe, the central project of transforming our society will point us in a single direction and will ensure coherence in our deliberations. For this reason, I would like to spend a few minutes reviewing the course of transformation thus far in the health sector.
Let me take you back to the publication of our White Paper on Transformation of the Health System in 1997. The mission that we then set ourselves, as Government, was "to provide leadership and guidance to the National Health System in its efforts to promote and monitor the health of all people in South Africa and to provide caring and effective services through a primary health care approach".
There were seven goals that marked this road.
These then were the core concepts of transformation: a unified system; equity and access; appropriate services; health promotion, development of human resources; community participation; and planning and monitoring.
In 1999, the Department conducted a review of the public health system with the intention of reflecting on the impact of interventions undertaken in the five years since the landmark election of 1994. In many ways, this review highlighted the successes and shortcomings of our transformation initiatives.
At the risk of over-simplifying, the review pointed to substantial achievement in terms redesigning the health system and putting new structures on the ground; in terms of increasing access to services for the poorest in our communities and in the worst served localities; and in putting bold progressive laws on the statute books - laws such as:
However, the five-year review presented a less positive picture when we looked beyond the structural and institutional changes. Concerns about the quality of care remain real and persistent. Anecdotal evidence of professional behaviour that goes beyond neglect into the realm of outright abuse crops up too frequently for us to dismiss it as unusual. By this I do not mean to suggest that sub-standard practice is the norm - that is certainly not the case. But it occurs too often for us to be complacent.
It also tends to overshadow the truly outstanding work and singular commitment of some of our health workers. Last night I had the pleasure of attending the Denosa function to honour distinguished members of the nursing profession. Just a week ago, in Kimberley health workers across the board were recognised for their commitment to service and in October the third Khanyisa Awards ceremony of the Gauteng Health Department signalled a deepening concern with quality of care. In contrast to this, various studies have produced a finding that many health workers feel exploited, abandoned and unable to work in the idealistic spirit in which they entered their respective professions. This situation raises a host of questions about the effectiveness of management and communication particularly in the public health sector.
These and other insights gained from the review were put to use in developing the Health Sector Strategic Framework for 1999 - 2004. The document was jointly produced and agreed by national and provincial leadership in the public health sector. It was discussed with the health committees of legislatures across the country and members strongly endorsed the strategic direction the document outlined.
Each of you has a copy of the Strategic Framework in your Summit folder. You will realise that there is strong continuity with the White Paper but that there are also new emphases.
You might be finding it difficult to keep this checklist of strategic goals in focus. But I'm sure you will have got the message that, after five years in Government, we had come to appreciate the complexity of transformation. In addition, we had begun to pose the questions not only in terms of "what is to be done" but also in terms of "how do we get it done".
Of course, this shift in focus was consistent with the whole approach of the African National Congress to its second term in office where the question of improved delivery of services to the people of our country was one of three overriding concerns.
As we moved beyond the first five years of democratic government, analysts in independent think tanks began to take the view that the policies of the ANC were sound -- the real difficulties lay in the ability of government departments and agencies to implement these policies.
Over the next two days we want to hear your views about how we can take forward our mission of building a health system that truly answers to the needs of all our people.
From the point of view of both government and those who elected us it is an appropriate time to pause and take stock. We are mid-way through this second term of the democratic dispensation and it seems fitting to elicit the recommendations of our stakeholders. Clearly, some important constituencies in the health sector have felt a similar need for collective stocktaking -- earlier this year we had the SA Medical Association's Summit on the Future of Medicine and the Nursing Summit. Fairly recently the ANC held a major consultation of health. The work done at these important meetings will certainly contribute to a clearer analysis of problems and a bolder formulation of potential solutions at the present gathering.
We expect more than 600 delegates to take their seats and raise their voices within this convention centre. We do not expect that you will sing one song -- or even that you will all sing in tune. We are committed to consultation and we fully accept that dissent and criticism are part of the deal.
But we do expect that every delegate will approach our joint undertaking with seriousness, with a feeling of joint responsibility for a constructive outcome and with an appreciation that health care delivery is critical both to the development of our country and to the consolidation of democracy.
There is a degree of hypocrisy in the commentary about why democracy often falters and fails in developing countries. Little is said about how poverty erodes the goodwill between government and the governed as the state struggles to deliver the basics of a decent life to its people. But we know that to be true and we need to be aware how fragile democracy can be and how we need to protect it. The development of a caring, effective health care system is one way to safeguard the democratic society that the people of our country won through tremendous sacrifice and suffering.
I feel absolutely confident that a commitment to preserving our young democracy is something we all share and that we will express this through our honest engagement here and our determination to contribute to solutions.
Many of us will also readily acknowledge how difficult the transformation of this society is, scarred as it is by racism and exclusion. The agenda for change is huge, the pressure of legitimate expectations is intense and the economic climate is tough. Although there are some indicators of general direction, in many ways we are traversing uncharted waters.
Most of us who arrived without too much warning in positions of leadership and responsibility carried very personal memories of dispossession and discrimination. The imperatives of equity and redistribution of resources were not simply principles of administrative justice, they were demands that burned inside of us -- and yet they have not proved easy to achieve.
We would be the first to acknowledge that we have made mistakes in our attempts to rebuild the health care system. At times we have not been sufficiently sensitive to the pressures our decisions have placed on those responsible for implementing them in our hospitals and clinics. Not all of our interventions have had the beneficial impact we intended and sometimes there have been unintended consequences.
However, it is not in the interests of our country for any interest group to celebrate these shortcomings or to withdraw and sulk about them. The challenge is to recognise the problem, to learn from mistakes and to have the courage to change course when this is necessary. It is important to distinguish whether the policies themselves are correct or whether we have chosen inappropriate methods to achieve them or whether both the goals and strategies are entirely valid and well matched - but perhaps we don't have the means to carry them through successfully.
It is not necessarily the radical overhaul of policies that will make the biggest differences. Sometimes it is the practical genius of being able to achieve seemingly small changes that adds enormous value for the service user. It takes no great intellectual ability to recognise that you cannot have quality health care without clean linen on the beds, reliable stocks of drugs; and personnel who treat patients with compassion and respect. But managing our services in a way that ensures precisely these results demands an approach that often eludes us.
Four broad theme areas have been defined for you to apply your collective experience and wisdom to. They are:
The themes have been selected because of their significance to the overall performance of our health system and because there exists within each of them a bundle of unresolved issues or problems that have not yielded to existing solutions.
Discussion papers were developed not to restrict debate, but to ensure that we address the most critical questions in each theme area. The authors have not hesitated to place contested issues on the table in the hope that we may forge a new consensus here or, through collaboration, produce solutions that could not exist through unilateral action.
No health gathering of this significance on the African continent could fail to address the challenges that are presented by emerging and re-emerging diseases, particularly HIV/AIDS, tuberculosis and malaria. I need hardly remind you that we rank among 22 nations worldwide with the most serious tuberculosis problem and that the malaria threat along our northeastern border has demanded a concerted tri-nation strategy.
HIV/AIDS has without any question become the most contested area of health care and it has a significance that is felt way beyond our sector. Given the numbers of our people who are affected and given the particular impact on young people, it was perhaps inevitable that HIV/AIDS would become a focus for social action and not be regarded simply as an infection or illness.
I would like to say quite simply that this Government is committed to meeting the challenges of HIV/AIDS. We will continue to strengthen and expand our programmes across the country and we will participate vigorously in international initiatives - such as the Global Fund for Health - to obtain maximum benefit for our people.
At this Summit, consultation on HIV/AIDS responses will be as open and as serious in the quest for solutions as any other. The discussion paper does not shrink from the tough questions and we feel sure that there is much to be gained from pursuing them with an unusually broad group of health stakeholders.
In all the theme areas we are searching for proposals that will result in improved health service delivery to the people of this country. It is left to the critical judgment of the discussion groups whether their recommendations are in the area of fundamental policy changes or creative implementation strategies. My guess is that we will see a mixture of the two, but given my remarks earlier in this address about the relative strengths of our policies and our capacity to deliver, it seems clear that the greatest challenge will lie in the latter area.
The question of creating a suitable mechanism to carry forward the range of proposals made by participants will be addressed on the last day of the Summit. I would like to say unequivocally that we view the Summit as part of a process, in which periodic consultation and accountability become more pronounced features of our relationship with stakeholders.
In addition to the four theme areas, we have three panel discussions which:
The panel discussions are really there to round-out the programme and to remind us that there is significant life outside the four theme areas. We are not asking you to apply the same problem-solving energy to the subjects for panel discussion, but we are encouraging a critical awareness of the issues involved.
It remains for me to thank you for being here and treating the challenge of continued transformation of the health system with the dedication it demands. We all approach this Summit carrying a wealth of experience. Sometimes it feels more like a burden of experience, so heavy with frustration and fatigue that we are tempted to dump it. To do so would not only be to betray ourselves but to betray the vision of a free society. Our liberation struggle will not truly be won until we have built a nation where every person lives in conditions that are consistent with human dignity. Social transformation is simply another phase of struggle and we can no more abandon it than we could submit to the insult of apartheid.
If we need inspiration we need only look to the outstanding leaders of the freedom movement - leaders like Nelson Mandela, Albertina and Walter Sisulu, Govan Mbeki, Solomon Mahlangu, Lilian Ngoyi and Joe Slovo. For all of them, life has been an unremitting quest for a more humane world, a quest that continues until time or strength runs out. May this spirit of perseverance, generosity and selflessness be the hallmark of this Health Summit and may South Africa reap the benefit of our collective effort.
Dr Manto Tshabalala Msimang
Minister of Health