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Chairperson and delegates

Our final responsibility at this historic and exciting consultation is to agree on a process to take us forward and turn our ideas into reality

The sense I get from the discussions and debates is that the strategic direction that government adopted more than two years back is still appropriate and already embraces most of the approaches endorsed here. The real challenges lie in our ability to mobilise and focus our efforts to achieve our common goals.

It is of great importance that we all leave the Summit confident of the tremendous work done and the energy expended - and of course the resources - will result in some critical actions to improve the delivery of health care.

It is equally important that we all continue to feel a connection with the ideas and the strategies we have generated - and a moral obligation to putting them into practice. Perhaps the most basic truth we have spoken over the past few days is that health for all will only be achieved through the sustained action and focused action of every organisation with an interest in health and if we draw on the energy of the communities we serve.

It is largely my responsibility and that of my colleagues, the provincial MECs for Health, to ensure that the Summit translates into action. But the production of a practical - yet creative - plan of action, that pulls together the major recommendations of this Summit, must surely be placed in the hands of people like yourselves.

In the light of this I would like to put a proposal to you on how we proceed from here.

In essence, I propose to mandate the Director-General of Health to convene an Action Team based on the group of individuals who developed the Summit Programme. This group, as you are probably aware, has a core of national and provincial health department participants, but also includes representatives from the trade unions, professional associations, private health sector, academic institutions, statutory bodies and research institutions.

It would be the task of this group to develop an Action and Tracking Plan.

This morning's brief "tour" of the main features of various discussions made it plain that Government's performance remains key to improving health care, but that complementary and co-ordinated actions by many other stakeholders are absolutely critical.

In terms of Government's own commitment to moving forward on the critical priorities endorsed by this Summit, the Health Minmec will give speedy attention to the proposed action plan and especially to the policy questions raised in it.

Communication and consultation cropped up repeatedly in the recommendations of the various groups and reflecting on our past track record and the shortcomings in the National Health Consultative Forum, it is clear we need to apply our minds to developing a more robust consultation mechanism. The Summit has enhanced the prospects of success by defining a common agenda for future engagement.

Without in any way detracting from the process outlined above, I would like to suggest that there are some actions suggested by the various theme discussions that are quite simple, quite clear and quite easy to move ahead on. I would propose that we do so immediately to maintain the momentum of the Summit.

There are many sound proposals that have come out of this consultation process. Definitely we need to consider these proposals and look at how we take them forward.

However there are issues that are concrete enough for us to move to implementation. Clearly the issue of representativity in the health sector is one of the crucial issues we need to attend to. Therefore, I would like to make a commitment here that we are going to facilitate the meeting between the deans of health sciences faculties and the departments of health and education as proposed in this Summit.

This meeting will also discuss other issues that are important for us to achieve human resource goals that we have set for ourselves.

Discussion on human resources have been very interesting. While there were a number of issues that were discussed on this matter, the issue of mid-level workers is critical and it needs to be attended to in more detail. We will facilitate a consultation amongst relevant stakeholders on this before the end of March. Such a consultation will have to come out with a coherent strategy on issues such as the categories, scopes of practice and career paths for these workers.

This Summit has made a number of proposals on what can be done to encourage public-private initiatives. There were some points of agreement on the direction these initiatives need to take including the vision and principles. The use of these principles in building partnership between the two sectors could play a role in achieving equity in the allocation of resources

The discussions in this area have indicated that government has a major role of providing leadership and clarity on this issue. There is an urgent need for us to develop the capacity to determine which PPIs are in the best interest of the South African public. The creation of a forum to facilitate the partnership between the two sectors and the need to exchange information was emphasised. I would make a commitment to this summit that the creation of Private-Public Initiative forum will be attended to quite soon.

I hope that the work of this forum will impact in some way in our effort to attain equitable utilisation of health resources in the country. Clearly, the issue of equity stood out as the most important area that we need to attend to. Out of the delegates at the Summit who filled in the equity questionnaire, 92% identified equity as a major priority and raised the need to direct resources to particularly vulnerable groups.

We have made some progress towards promoting equitable access to health service, particularly through the distribution of health facilities and staff as well as removal of fees for primary care services. However, the extent of inequalities inherited from our past dictates that we increase the pace of redressing these disparities. The most glaring challenge facing our health system is the disparity in the resources available to public and private sector relative to the population each sector serves. Government cannot tackle this challenge alone. It requires that the two sectors work hand in hand to use the combined resources to meet the health needs of all South Africans in a more equitable and efficient manner.

In my view quality of care cannot be achieved by measures imposed by government without active participation of all the stakeholders. However, there are initiative that we as government are prepared to move on as a matter of urgency. I am glad to report to this forum that as part of our efforts to improve quality of care, as from next year we will be launching the national awards for outstanding service for different categories of health workers and professionals. One of the elements of this will be the Cecilia Makiwane awards for nurses.

In the area of communicable diseases, the practical first steps might indeed be to initiate a mapping in every district across the country of available services and resources related in particular to HIV/AIDS, STIs and TB. This would lay the objective foundation for effective intervention consistent with the continuum of care. Such an exercise would enable us to simultaneously identify service gaps specific to these conditions and more general weaknesses in our system, such as inadequate drug supplies, weak laboratory support and deficient referral systems.

Although the Summit has produced less explicit direction on the areas of non-communicable diseases and trauma, many of the recommendations in relation to human resources, quality of care and the strengthening of primary health care services are equally applicable to these.

In conclusion programme director, I view this Summit as a landmark in the fulfilment of our strategic vision which includes, as a major goal, better communication and consultation with stakeholders. We believe that this event has set the tone for closer engagement in the future.

Thank you

Dr Manto Tshabalala-Msimang

Issued by the Ministry of Health, 20 November 2001