Madam Speaker, honorable members and guests
This year marks the 50th anniversary of the Freedom Charter, a guiding
document in our struggle to create a better life for all our citizens. As we
observe this historic moment, our movement through the January 08 statement of
the African National Congress has highlighted some of the key areas we have to
focus on this year within the social sector cluster of government to ensure that
we indeed realize one of the critical goals of the Freedom Charter - that there
shall be houses, security and comfort.
High on the Programme of Action of our movement is the need to intensify our
campaign to promote healthy lifestyles within our communities. This public
health awareness campaign was also emphasized by our President in the State of
Nation Address and is supported by an increase in the allocation of resources
for the social sector.
Healthy Lifestyles
Madam Speaker, Honorable members, the healthy lifestyle campaign is central
to our response to the causes of mortality and morbidity in the country as it
aims to reduce communicable and non- communicable diseases including non-natural
causes of death.
It highlights the need for a paradigm shift in the way we approach the health
of our population. We often spend the first part of our lives undermining our
own health through the way we eat, drink, drive and by smoking and engaging in
unsafe sex. We thereafter spend the second part of our lives trying to manage
the negative health consequences of our behavior through costly and complex
interventions. We cannot continue on this trajectory of destroy and repair,
destroy and repair. We need to make the right choices about our lives right from
the start, as life does not usually give us second chances.
This morning we witnessed a march by people from many walks of life in
support of this key theme of work of the Department of Health. Unlike other
demonstrations to this important institution of our democracy which focus on
demanding certain things from government, today's march highlights the critical
role of choices made by individual communities in determining their own health
status. It begins to mobilize our communities and other partners to work
together with government in promoting good health. This partnership in promoting
public health awareness is what we meant when we called for a people's contract
to fight poverty and diseases and ensure better health for all.
Chronic Diseases of lifestyle
Together with various stakeholders in the private and non-governmental sectors,
we have conducted health screening mainly for hypertension, diabetes and Body
Mass Index at selected sites in some of our provinces. From the results of
the screening done to date, it is clear to us that chronic diseases of lifestyle
are a major problem in our communities. We are concerned about the levels of
obesity and number of people who are overweight particularly because of lack of
physical activity and over consumption of food high in fats and sugar. We
are also worried about high sugar and blood pressure levels that are detected
amongst many of our people. That is why we are promoting physical activity of
any kind by everyone, young and old starting with the Members of this House.
I urge honorable Members and our guests to also utilize the screening
services that we have made available in this building today. Let's all commit
ourselves to lead by examples and live healthy lives.
May 2005 is physical activity month and we are planning a range of activities
in the country for both young and old. In particular, the 10th of May 2005 is
World Physical Activity Day. I therefore encourage all sectors of our
population to participate in physical activities and MOVE FOR YOUR HEALTH.
Tobacco Control
Madam speaker, we are sustaining our efforts against the use of tobacco which
contributes significantly to ill-health for both smokers and those exposed to
secondary smoke. Recently this House was requested to consider and ratify the
Framework Convention on Tobacco Control. We appreciate your speedy finalization
of this matter which once again puts South Africa at the forefront of the
world's efforts in tobacco control. Our policies on tobacco control make South
Africa to be one of the leaders in the world - a country to which many others
turn to for advice on tobacco control.
Alcohol
As I promised in this House, we have published for public comment a set of draft
regulations with regard to the labeling of alcohol beverages. These regulations
aim to introduce warnings on the negative health and social effects of abuse of
alcohol that should accompany all promotional material for alcohol products. We
will also be focusing on discouraging pregnant women from drinking to reduce the
rate of foetal alcohol syndrome. As you may know, high levels of alcohol intake
also contribute significantly to injuries that lead to non-natural deaths,
violence, various forms abuse and other social ills.
Mental Health Act
Also critical to the overall well-being of our people is the need to strengthen
our mental health services including addressing the challenges that have been
reported in some of our mental health facilities. We will be intensifying the
implementation of the Mental Health Care Act beginning with the establishment of
Mental Health Review Boards for mental health hospitals as required by the law.
Provinces are at different stages of setting up these boards and we urge the
public to participate in the process and in the provision of mental services in
general. The Mental Health Care Act enforces the culture of human rights within
the mental health services and ensures that mental health patients are treated
with respect and dignity.
Sexual behavior
Madam speaker, we are encouraged by the recent commitment expressed by
faith-based organizations and other groups to work with us in increasing the
impact of campaigns against alcohol and substance abuse, smoking, unsafe sexual behavior
and other health risky behaviors. At a meeting with religious leaders in
February this year we agreed that we should work together particularly in
promoting abstinence and being faithful to one partner. These two elements of
the ABC Campaign are also an important contribution to moral regeneration and
building of strong family structures based on gender equality and respect for
the right of children to grow up in a safe environment.
Also important in our efforts to prevent sexually transmitted infections and
unwanted pregnancies, is the need to ensure the availability of condoms. The
distribution of male condoms has increased from 302 million in 2003 to 346
million in 2004. A total of 1.2 million female condoms were distributed
through 203 sites nation-wide in 2004. The favorable exchange rate for the past
few months has enabled the Department to purchase additional female condoms,
which increases our stock for distribution during the course of this year.
World Health Day
Madam speaker, we are presenting this budget a day after South Africa joined the
rest of the world in celebrating the World Health Day with a theme: make
every mother and child count. We observed this day with the community of
Steiloop in Limpopo where we highlighted the need to change today's world
reality where many women die during pregnancy or as a result of delivery each
year and where millions of children die before celebrating their fifth birthday.
Through our healthy lifestyle programme, we want to ensure that every
pregnancy and delivery is a happy and safe experience. We are emphasizing the
need to care for the health of babies before and after birth to ensure that they
have a healthy start to life.
Millennium Development Goals
The health of women and children is also an important indicator in the
world's effort to meet the Millennium Development Goals relating to health.
These goals include addressing the challenges of hunger and lack of access to
safe water, reducing maternal and child mortality and begin to reverse the
incidence of infectious diseases like HIV and AIDS, Tuberculosis and Malaria by
2015.The United Nations will report later this year on the progress being made
towards meeting these goals. However, as a country we conducted the second South
African Demographic and Health Survey in 2003 and we are working with Stats SA
to assess the progress we are making in this regard particularly on maternal and
child health.
Child and maternal health
In 1998 the infant mortality rate was measured to be 45.4/1000 live births. This
has decreased in 2003 to 42.5/1000 live births. Mortality of children under five
years has also decreased from 59.4/1000 live births in 1998 to 57.6/1000 in
2003. The proportion of births that were attended to by either a nurse or doctor
has increased from 84% in 1998 to 92% in 2003. This can be attributed to the
increased access to health services both in terms of availability of health
facilities in various communities and free health services for pregnant and
lactating women as well as children under the age of six years. We are verifying data with regard to the maternal mortality ratio and the initial indications are that we have indeed significantly reduced this major cause of death amongst women. The maternal mortality ratio for the country will
be announced soon.
The positive developments around maternal and child mortality indicates that
we are on the correct path and we need to sustain our efforts to further improve
the lives of women and children. We will also be intensifying the implementation
of the School Health Policy to ensure that we cater for the health needs of
learners in particular. To respond to the cases of measles being reported
sporadically in some of the provinces, we will be strengthening cold chain to
ensure sustainable and safe supply of vaccines and intensify our Expanded
Programme on Immunization with campaigns aimed at increasing immunization
coverage amongst our communities.
Cholera
The programmes of government to improve access to basic services like clean
water and proper sanitation are contributing positively to the health efforts to
prevent water borne diseases which impact heavily on women and children. Because
of sustained health education and proper coordination through outbreak response
teams at national and provincial levels, we have not had outbreaks of cholera
over the past year. This is a significant achievement noting the prevalence in
various parts of the country of conditions that are conducive to outbreaks of
water borne diseases such as long droughts and heavy floods.
Malaria
Madam Speaker, malaria still poses a major challenge for women, children and the
rest of our populations in Africa. However we have made significant progress in
addressing this challenge. The success of our malaria control programme has not
been limited to the affected areas in South Africa but extended to other
countries in the SADC region where we initiated joint efforts in malaria control
with our neighbors. The prevalence of malaria in South Africa has dropped from
120 per 100 000 in 1999 to 28 per 100 000 in 2003. The case fatality rate has
respectively declined from 0.8 to 0.6%.
Tuberculosis
As we marked the World TB Day last month, we acknowledged the challenges facing
our TB control programme particularly in increasing our cure rate and reducing
the interruption rates. However, we appreciate the significant media attention
that this year's World TB Day received and we hope that we will continue to work
with the media in raising public awareness about this major challenge.
The role of community health workers in particular is critical in providing
support to enable TB patients complete their treatment. Hence we will be
strengthening the community health worker programme and ensure that these
workers are able to identify the health care needs of communities, refer people
to relevant health and other government services and support those who are on
treatment for TB, HIV and AIDS and other debilitating conditions.
We are continuing to provide nutritional support for patients with TB or HIV
and AIDS and are either food insecure or have depleted micronutrients.
Supplementary meals and multivitamin syrup or tablets are being provided to
about 153 000 people as part of the nutritional care and support package.
HIV and AIDS
In line with the President's directive in the State of the Nation address and utilizing
the significantly increased budget for HIV and AIDS for this year, we are
implementing our Comprehensive Plan for Management, Care and Treatment of HIV
and AIDS in its totality with much vigor. This Comprehensive Plan is centred
around preventing the spread of HIV infection and improving the health system to
enable us to provide a series of interventions aimed at improving the lives of
those infected and affected by HIV and AIDS. Over the past year, we embarked on a process of accrediting sites at which these services will be provided. This process was aimed at strengthening the
health system by evaluating the capacity of health facilities to provide quality
health services including effective screening, treatment and monitoring of the
safety of people living with HIV and AIDS. This approach was necessary because
of the complexity of the programme to safely administer in particular
antiretroviral drugs. We also have three pharmacovigilance centres to monitor
and investigate adverse drug reaction.
I am pleased to report that we have been able to meet our target of
establishing at least one service point in all of the 53 districts in the
country by the end of March 2005. Some districts already have more than one
facility providing HIV and AIDS related care and treatment within their
boundaries. Our goal now is to increase the number of health facilities
accredited to provide treatment and ensure that these facilities are available
in every local municipality in the country. We have appointed seven companies to provide sustainable supplies of antiretroviral drugs through a tender valued at R3, 4 billion over the next
three years. We are continuing with research on traditional medicines to ensure
that all the medicines that have proven to have an impact in alleviating
conditions associated with AIDS get the necessary scientific endorsement.
Treatment of opportunistic infections also remains an important component of our
programme as most of these diseases can be treated even in the presence of HIV
and AIDS.
The challenges on the ground are enormous including the need to attract
necessary staff to underserved areas, improving the turn around times for
laboratories as well ensuring compliance with treatment regimens.
Affordable and quality medicine
Last on the list of Millennium Development Goals relating to health is the need
to improve access to essential medicine. The President also directed us to
continue with the battle for access to affordable and quality medicine through
the implementation of the Medicine Control Act adopted by this House. As members
will know, we have implemented a range of measures to improve the quality of
medicines, reduce their prices and ensure availability at public health
facilities. Members will also know that our attempts to achieve this goal have
been met with resistance from those who are determined to put their narrow
interests above the right of our citizens to access this essential commodity.
We are encouraged by the outcome of the Constitutional Court case on
dispensing of medicine which endorsed the right of Government to implement
regulations to ensure that dispensing health professionals have the necessary
competencies to handle and dispense medicine and that these medicines are stores
in an environment that promotes safety, quality and efficacy. This judgment also
reaffirms the right of Government to regulate where professionals can practice. Another encouraging development is the decision by the pharmaceutical manufacturers not only to comply but also to defend, through a submission to the Constitutional court, the medicine pricing regulations particularly with reference to the single exit price. A responsible view is also emerging amongst
community pharmacists that a concern over a single technical issue of the
quantum of the dispensing fee does not justify a legal action aimed at setting
aside the entire body of the regulations. Pending the ruling of the
Constitutional Court on the matter, the Department of Health is engaged in
discussions with these pharmacists as both parties believe that the issue of a
dispensing fee can be resolved within the current framework of the Medicine Act
and the pricing regulations.
We hope that the Constitutional court will assist us in resolving contested
issues around the medicine pricing regulations and give a ruling that should
ensure that South Africans ultimately realize their right of access to
affordable, safe and quality medicine.
Addressing poverty
Madam speaker, we will continue to provide a social safety net for the poor in
this country. We are committed to contribute to the alleviation of poverty by
adopting more labor intensive construction methods in our capital projects and
strengthening the community health worker programme.
We made an undertaking in this House to implement the decision to provide
free health care for people with disabilities. While addressing all the health
needs of this section of our society, over the last financial year we focused on
eliminating the backlog in the provision of assistive devices which are critical
in enabling people with disabilities to actively participate in everyday life.
In the last financial year, the national Department of Health supplied 10
407wheelchairs and buggies, 1131 pressure care cushions and 4547 hearing
aids. These are in addition to the devices procured and distributed by
provinces.
Budget of the national Department of Health
Madam speaker, the only way we can achieve the health goals we have set for
ourselves is through equitable distribution and effective utilization of the
resources available within the health sector. Hence we are presenting this
budget for the national Department of Health before this house today. The total amount budgeted for 2005/06 is R 9, 825 billion. This is an increase of 11,4% compared to the last financial year. This allocation is projected to rise to R10, 658 billion in 2006/07 and to R11, 184 billion in
2007/08.
Conditional Grants
A significant potion of this budget is spent through three conditional grants
that will be transferred to provinces.
The hospital revitalization grant increases by 12,7% from R911 million in the
last financial year to R1,027 billion this year. We completed the revitalization
of 2 hospitals last year with another 37 in various stages of completion. As
mentioned, we will ensure that the revitalization projects adopt labor intensive
methods of construction to ensure that they also contribute in creating work for
communities in addition to improving infrastructure and the quality of care in
the revitalized facilities. We also have the conditional grant for the funding of Tertiary Services and
the activities, which form part of the training of health professionals. The third conditional grant is aimed at assisting provinces to implement the Comprehensive Plan for HIV and AIDS. Because of our commitment to curb the spread of HIV infection and reduce the impact of AIDS, we are increasing this
conditional grant by 45% from R782 million in 2004/05 to R1.135 billion this year. This substantial increase in budget allocation will assist us in vigorously implementing the Comprehensive Plan on HIV and AIDS which I have already outlined.
We have increased the budgets of the units that handle these grants to
improve the capacity and expenditure of these resources with greater
accountability. We are also strengthening our control systems to ensure that resources are
not lost to corruption and are fully utilized for service delivery. The
Compensation Commission for Occupational Diseases (CCOD) as a public entity
under the auspices of the National Department of Health will table its audit
report for 2003/04 shortly, which is bad to put it very frankly. The Department
has taken steps to address the challenges within the CCOD particularly in
dealing with fraud within this entity. The National Department of Health and the
forensic auditors are working closely with the South African Police Service to
resolve the matter and I can report that one individual has already been
arrested.
Madam speaker, the President has said that government needs to massively
improve the management, organizational, technical and other capacities of
government so that it meets its objectives. The budget for the Public Health
Sector in general increases from R42.8 billion to R48.1 billion which translates
to a 12,2% increase. The allocation brings the Public Health Sector budget to
12.6% of the total national allocated expenditure for the current financial year
which should improve our ability to deliver health services.
Human resources for health
However, we are of the view that the single most critical resource in our
ability to deliver on our health objectives is the availability and capacity of
health personnel. Various interventions are being made to address
particularly the supply and distribution of health personnel in the country and
mitigate the impact of outwards migration of health skills. Earlier this year I promised that by the end of March 2005 a draft National Human Resource Plan would be ready for discussion. A strategic framework on human resources for health is being finalized and I call upon all relevant organizations
and institutions including the private health sector to engage with this
process. I hope that through this effort, South Africa will find a strategy to
successfully address the human resource challenges faced by our country. We will be bringing before this House, the Nursing Bill which brings the
current Nursing Act up to date with developments in nursing education and
classification of nurses into different categories. This Bill will also assist
us in introducing the nursing profession into community service programme which
already covers all other categories of health professionals.
We are making progress in defining the scope of practice and developing the
curriculum for medical assistants. Working together with other relevant
structures, we want to ensure that this process is finalized as soon as possible
so that we can begin to recruit students into this category of health practice. The implementation of the National Community Health Worker policy framework
has started. The Qualifications and skills programmes for the policy framework
have been identified. Learning materials and curriculum framework are being
developed and the first intake of learners should commence later this year. The Traditional Health Practitioners Act was promulgated by the President
earlier this year and the Department is finalizing the regulations for the
implementation of this Act. We will be consulting with traditional health
practitioners to ensure that a Council for Traditional Health Practitioners is
established during the course of this year.
We are also gearing up for the implementation of the National Health Act once
promulgated. This is a critical piece of legislation that provides a framework
for a single health system for South Africa, highlighting the rights and
responsibilities of health providers and users as well as ensuring broader
community participation in the healthcare delivery from a health facility up to
national level. Amongst other things, the National Health Act will enable us to establish the
Office of Standard Compliance which will be responsible for enforcing compliance
with the prescribed quality standards in all health facilities, public and
private. This will include ensuring that all health facilities comply with
hygiene practices to prevent hospital-acquired infections. We are also working
together with the Medical Research Council to develop evidence-based
interventions against hospital-acquired infections which is a challenge facing
both developing and developed countries.
We have put systems in place to respond to the reported cases of Marburg
virus in Angola. There is no need for alarm. No confirmed case of Marburg has
been reported in South Africa. Isolation facilities for suspected cases
have been identified in all provinces. Health care providers and port
health officers have been put on alert and are aware on how to deal with
suspected cases. In addition, a special committee has been established at
national level to closely monitor the situation both locally and
internationally. Working together with the food industry, the Department is intensifying its
efforts to rid our food supply chain of the illegal food colorant - Sudan Red
and also ensure that all food products comply the legal requirements on the
levels of other colorants in food products. Our laboratories have been inundated
with samples from the local authorities and across the food industry for
analysis. A total of 15 products have been confirmed to contain low levels of
Sudan Red and these products have been removed from the market. We will update
the public of any more food products that may be found to contain Sudan Red. It
is important to emphasize that this illegal colorant could increase the risk of
cancer only if consumed over a long period and in large quantities.
Health Charter
Madam speaker, the provision of health services is complex. It is complex
because of the large number of actors, their behavior and the unpredictability
of ill-health. This means that we must work together as families, as communities
and as a nation to ensure that we can harness all the resources of this country
to make a difference. In this regard I shall soon be convening the third meeting
of health stakeholders to discuss the draft Health Charter which a team composed
of members from the various sectors has put together. I hope that the Charter
will provide the basis for a consensual approach to eliminating inequities both
in the allocation of resources and provision of health services in our country.
Community outreach
Honourable members will recall that I promised in this House last year that,
together with the MECs, we will be holding izimbizo in all the 53 health
districts over the next five years in order to communicate more effectively with
communities on health. I am glad to report that over the past year alone, I have
been able to attend 60 events and meetings with various constituencies and
communities in more than 28 districts. This excludes several community
activities related to my party, the ANC. We will continue with this drive to
reach out to our people and ensure that health services are adequately
responding to their needs.
Finally Madam speaker may I take this opportunity to thank the President and
Deputy President for their leadership, my cabinet colleagues for their support
and guidance. I would to express my appreciation to the members of MINMEC,
Health portfolio and select committees as well as councilors responsible for
health - without your support and co-operation we will not have a
functioning national health system.
Noting that this is the first Budget we are presenting to this House since we
appointed the Director General for the Department of Health, Mr Thami Mseleku,
we would like to take this opportunity to once again welcome him to the health
sector. I would also like to express my appreciation to the two Deputy Directors
General, Dr Kamy Chetty and Mrs Nthari Matsau for ensuring that our Department
functions effectively while they were acting in this post. The same goes to the
management and staff of the Department for their dedication in ensuring optimal
functioning of the Department. I would also like to thank all the organizations that made various forms of donations to make this day a success and enabled us to provide screening
services for various health conditions here today. Our intention is to
demonstrate to the honorable members and guests gathered here the type of
services we are offering to ensure optimal health for communities across the
country.
Most importantly may I salute the thousands of health workers in our country
who often work under difficult conditions to deliver health services to our
people. In partnership with our communities we can achieve our objective of a
healthy South African nation, free of poverty and diseases. We have resolved to
start the journey to achieving this goal by ensuring that we indeed make every
mother and child count.
I request this House to pass the budget of the Department of Health.
I thank you!
(Source: DOH website, April 8, 2005)
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