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18 February 2005

During the State of the Nation Address, the President reported on the progress made in implementing government programme last year and outlined the programme of action for government for this year.

This presentation will therefore cover both the progress report in terms of health sector activities as outline in last year’s State of the Nation Address and we will seek to elaborate on the priorities for this sector as outlined by the President in this year’s State of the Nation Address.

Our health interventions continue to be directed by the vision for health care as envisaged in the Freedom Charter. We have a responsibility to improve the quality of health care in line with the Batho Pele principles and the Patient’s Rights Charter.

We will continue our strides in the provision of free health care services for children under six, pregnant women and people with disabilities and pay special attention to other vulnerable sections of our society including the children in need of care and the aged.

As you will recall that, the President announced that government would provide free health services for people with disabilities. We have made progress in reaching consensus on the definition of disability. The Department of Health made a commitment to eradicate the backlog in terms of provision of assistive devices for people with disabilities. In this regard, we distributed a total of 4770 wheelchairs and 4674 hearing aids during the last financial year. In the current financial year, we are spending about R17 million to eliminate the backlog.

Maternal and Child Health

In line will addressing the needs of women and children, this year we will be focusing more on issues around maternal and child health this year as we build towards the World Health Day with a theme: Make Every Mother and Child Count. The indications are that there is improvement in addressing the challenge of maternal mortality rate and we will be able to release more information as part of the outcomes of the Demographic and Health Survey.

Of critical importance to child health is the need to ensure that all our children are protected from immunisation-preventable diseases. The recent challenges posed by measles require that we intensify the implementation of the Expanded Programme on Immunisation (EPI). The success of this programme is even more critical this year as we seek to be declared Polio free by the end of 2005.

We will also improve the implementation of our school health policy to promote health and healthy environment amongst young people and ensure that health challenges facing learners are addressed proactively.
Developing the National Health System

National Health Act

We are working with the Presidency to ensure the promulgation of the National Health Act. The Department is already developing the regulations that should bring into effect certain sections of this Act once promulgated. The National Health Act should bring about a single health system for the country that is characterised by a respect for the rights and responsibilities of patients and health providers.

The Act provides a legislative framework for proper organisation of health services from a local facility up to the national level where health policy is formulated. It encourages community and stakeholder participation at all levels of the health system. We will regularly brief the media on the implementation of this Act as it unfolds after its promulgation.

Human resources

The capacity of the public service to deliver on the government’s mandate has been a subject of an extensive debate since the State of the Nation Address. There are a number of programmes we have already put in place to address issues of capacity – especially in areas where there is a greater need.

The Department of Health provides rural and scarce skills allowances to ensure that we attract and retain health professionals in the public health sector in general and rural areas in particular. While we still have to evaluate the real impact of this component of the recruitment and retention strategy, there are already success stories, where young health professionals are settling in rural areas after completing their community service. This is happening particularly in areas where we have catered for the basic necessities of the staff like accommodation and recreational facilities within the building or revitalisation of our hospitals or clinics.

We are also addressing the issue of distribution of health personnel at a global level through interaction with countries like Britain in managing the migration of health workers. We signed an agreement with the government of Iran to recruit doctors who will be placed in areas that experience the most difficulties in recruiting health professionals.

We are currently finalising the work contracts with the Iranian government for about 136 doctors that will be deployed in Limpopo, North West and Mpumalanga. We will also ensure that the negative effects of migration of health workers on the health systems of developing countries particularly in Africa remains high on the international health agenda.

To further advance government’s campaign to provide quality health care to our people in all settings, especially in rural areas, we are currently working towards developing a new cadre of health workers – midlevel workers. These medical and pharmacist assistants should assist in relieving pressure on our doctors and pharmacists and contribute in improving health care delivery.

This year, we plan to have a conference which will bring community health workers together and ensure that we have a common understanding and agenda when it comes to the delivery of health care to our people.

As we make all these interventions, we are also finalising the human resource framework that should provide a long-term strategy to ensure that the health system is adequately resourced with appropriately skilled health care professionals. The basic tenets of the framework include:

* Striking a balance between supply and demand of health professionals;
* Equitable distribution of available skills;
* And overall management of human resources in the health sector

Health infrastructure

In intensifying the implementation of the hospital revitalisation programme, we will secure the necessary capacity to ensure that all the funds allocated to this programme are used to achieve the desired results. We noted the President’s concerns about the slower pace of building essential infrastructure, particularly with regard to the management and coordination processes in the three spheres of government. We are undertaking to work with our colleagues to accelerate implementation.

Currently, there are 30 hospitals in the hospital revitalisation programme. By the end of the next financial year we expect to expand the programme to include 15 more hospitals. A total of 41 hospital revitalisation projects would have been completed by the end of 2005/6. The level of resources that government invests in these projects requires that we leverage the Expanded Public Works Programme model and use labour intensive methods of construction.

Blood Transfusion Services

One of the challenges that have recently faced us in our endeavour to bring dignity to our people through quality health care, were the reports that the South African National Blood Service was using race as the main indicator in its risk rating model for blood donations. The recent agreement we reached with the SANBS in establishing a new non-discriminatory risk-rating model is a significant achievement in our effort to protect the dignity of all citizens of this country and to rid the health care system of any traces of discrimination. We expect the new risk rating model to further improve the safety of blood supplied through the SANBS.

Hospital Infections

Other concerning reports have been around the issue of hospital acquired infections. This is an international problem facing many health facilities even in most developed settings. We are going to emphasise the “back to basics” approach around hygiene in hospitals. We have also requested the Medical Research Council to provide us with an evidence-based understanding of the challenges, so that we can make necessary intervention.

Addressing major causes of death

In the State of the Nation Address, the President committed government to strengthening its campaign to reduce non-communicable and communicable diseases as well as non-natural causes of death. The reduction of communicable and non-communicable diseases as well as addressing non-natural causes of death remains a key programme of the Social Cluster and a number of departments work in collaboration to address these issues.

Non-communicable diseases

As a country, we are faced with a major challenge of chronic and non-communicable diseases like various kinds of cancers, cardiovascular diseases, diabetes and hypertension. The major factors behind the high burden of these diseases are lack of exercise, poor diets and health risky behaviours such as smoking and alcohol abuse.

Healthy Lifestyles

This year, we will be scaling our interventions against these diseases. The strengthening of our health promotion campaigns with a particular focus on promoting public health awareness and encouraging health lifestyles is central to our response.

We are expanding our campaign to encourage our people to eat healthy and nutritious food and exercise regularly to prevent various diseases of lifestyle.

Tobacco Control

We are amending our tobacco control legislation to close any loopholes and discourage infringement through increased fines. We are also working towards ratifying the Framework Convention on Tobacco Control which we hope to achieve within the next two weeks.

Labelling of Alcoholic beverages

We have already published the draft regulations on the labelling of alcoholic beverages for public comment over the next three months. This is our first step towards ensuring responsible use of alcohol. Alcohol abuse is a major cause of intentional and non-intentional injuries that lead to non-natural deaths.

I know that some efforts have been made within the alcohol industry to look at the issue of alcohol abuse. I therefore hope the industry will understand our intentions and work together with the Department of Health in addressing the major health and social problems caused by alcohol.

Communicable diseases

The communicable diseases that pose major health challenges include HIV and AIDS, TB, Malaria and cholera.

Tuberculosis

While TB is curable, it is clear that monitoring of patients on the TB regimen remains a challenge. The TB programme will therefore be strengthened through improvements in the management of the programme in general and improvement in early detection and treatment in particular. The expansion of the integration of the TB and HIV and AIDS programme shall be a key component of the programme.

Malaria and Cholera

With regard to malaria, all indications are that we have done well in terms of decreasing cases of malaria. Since the introduction of DDT in 2000 we have seen a significant decrease in malaria cases. Cholera outbreaks have been managed effectively largely due to the vigilance of the outbreak response teams that have been established in provinces. The collaboration between the Departments of Health, Water Affairs as well as Provincial and Local Government is critical in ensuring that we prevent and adequately respond to cholera outbreaks.

Comprehensive Plan on HIV and AIDS

The implementation of the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS has seen significant achievements in the strengthening of health system and building capacity to address HIV and AIDS. A total of 51 of the 53 health districts have at least one health facility providing services in the context of this plan.

We continue with our prevention campaign by encouraging abstinence, being faithful and using condoms through Khomanani – Caring Together. The distribution of “choice condoms” rose from an average of 17 million a month to 36 million since we re-branded these condoms.

Most of public health clinics are offering VCT services and a number of people have received nutritional supplements by the end of November.

The inventory management and tracker system tender was advertised and is being evaluated. Antiretroviral drugs are available at the facilities accredited to provide antiretroviral therapy. The main tender for drug procurement should be awarded shortly since we have been able to resolve some technical obstacles around this matter.

It is critical that we are able to monitor the people using ARVs to minimise the risk of those who stop taking treatment. The consequences for stopping the regimen are dire.

Affordable and safe medicines

We will continue pursuing the transformation agenda for the health sector in our country. A key aspect of this agenda is ensuring that everyone has access to affordable, quality medicines. Although our efforts in this regard are subject to court action, we are pleased with the progress made since the promulgation of the Medicines Control Act – and the support that has been demonstrated by various players across the drug distribution chain is encouraging.

Dispensing health professionals

At least 8 370 health professionals have applied for dispensing licences and 5 483 licences have been issued. Most of the outstanding applications have not been finalised because the applicants have not submitted a proof of completion of the dispensing course.

Medicine Pricing Regulations

Many pharmacists have demonstrated the falseness of claims that the medicine pricing regulations will undermine the viability of the retail pharmacy industry. We have received more than 260 applications for licences to run retail pharmacies since August last year when we started implementing these regulations.

Many pharmacies are complying with the regulations including one of the main opponents of these regulations, New Clicks. Pharmacy groups such as Dis-chem, Pick 'n Pay Hypermarket Pharmacies, Shoprite Medi-rite Pharmacies, Van Heerden Pharmacies Group and other individually owned pharmacies have been complying for sometime. We have urged consumers to use these pharmacies because that is where they can get the best prices as regulated by government.

The other opponent of these regulations - United South African Pharmacies (USAP) - ran an advert in one of the newspapers listing about 59 pharmacies that have closed as a result of our regulations. Concerned about the alleged negative developments within this industry, we investigated this matter and established that at least 26 of these pharmacies were still in business. USAP has since conceded in the Business Day of Tuesday, February 15 that their advert had “errors”.

Government will not be distracted from pursuing its goal of improving access to affordable, quality medicines for all South Africans. We are also very much conscious of the fact that access to medicine is dependent on a viable manufacturing and retail pharmacy industry to deliver the medicine to our people.

Conclusion

I would like to end here and hope that we will be able to elaborate on some of these issues during the question and answer section of this session.

Thank you

Issued by: Ministry of Health
18 February 2005