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28 June 2005

In this report, the Social Sector Cluster will outline progress achieved since the briefing we made on 5 May 2005.

1. Comprehensive Social Security

The extension of the Child Support Grant is well on target with close to 2.3 million children of ages 7 to 14 already benefiting from the grants. These are in addition to the 0 to 6 year olds that were initial beneficiaries of the Child Support Grant before the Cabinet decision to extend the age of eligibility to 14.

Parallel to the extension of the Child Support Grant the Cluster has put in place mechanisms of addressing inefficiencies and unintended consequences of social protection as directed by Cabinet. A research report on fertility rate in South Africa has been completed and nothing in the analysis of the report indicates that more teenagers are getting pregnant. To advance the research work is ongoing is assessing potential perverse incentives, including teenage pregnancies.

It is also the intention of government to encourage income generation amongst those beneficiaries of social grants that can be able to earn an income. In this regard, we continue to roll out public works programmes and are pursuing various models of cooperation with civil society, including faith based organisations. We also continue to review the potential number of beneficiaries against available budgets and to improve the efficiency of the grant system and the targeting mechanisms. Since the adoption of a common definition of disability last month by Cabinet, we are now in the process of implementing simplified administrative procedures that have to be followed to check eligibility amongst beneficiaries.

The National Social Security Agency launched early this year, will result in the implementation of a new model of grants administration that will be piloted towards the end of this year. Discussions are already under way with banks on the role that they will play in the efficient delivery of the grants, especially in reaching rural beneficiaries that did not have access to the formal banking services.

Basic Services

With regard to basic services, the Cluster is expected to deal with the remaining challenges in sanitation and refuse removal, especially in rural communities and areas of human settlement – which is an ongoing programme. In May, we announced that a budget of R1.2 billion had been allocated to the eradication of bucket system over three years. It is expected that the budget will cover the replacement of 233 000 buckets during the three-year period. Work in this area is ongoing.

The indigent policy has been approved and a registration pilot has been started this month in selected rural nodes and metros. The intention is to address the challenges relating to targeting in the provision of free basic services to those that are eligible, deal with the culture of non-payment and improving the billing systems.

2. Promotion of National Identity and Social Cohesion

The main intention of the Cluster’s programme on the promotion of national identity and social cohesion related to the review of the impact of socio-economic transformation on social cohesion in communities and across society, including issues like non-racialism and non-sexism as well as the role of the family, value systems, identity and moral regeneration.

The focus of the review was on the changes in the material conditions and the structure of society in South Africa in the past decade, and the trends in the organisation of social life; trends in households and families, community organisation and economic relations as well as an analysis on how the diverse and overarching identities and value systems affect the self-worth and aspirations of South Africans.

The Cluster is currently finalising a document on the policy implications of the findings of that macro social analysis for discussion at the July Lekgotla. The public will be informed of the outcomes in due course.

Parallel to that is the ongoing work of the enhancing integration between the Security and Social Clusters to deal with roots of many crimes that occur in communities, with a special focus on areas identified as hot spots.

3. Comprehensive Health Care

In promoting healthy lifestyles, the Cluster is working in collaboration with the private sector and civil society in the provinces in educating communities about risky behaviour and importance of healthy living in the reduction of the diseases of lifestyles such as hypertension and diabetes. The move for Health campaign slogan: Vuka South Africa, Move for your Health was launched on 30May 2005 in collaboration with the Departments of Education, Sports & Recreation and private sector partners. The key messages promote good nutrition and physical activity and thousands of people were screened at various Izimbizo for diabetes, hypertension and eyesight amongst others.

HIV and AIDS

We continue our work in dealing comprehensively with the challenge of HIV and AIDS. Our strategy operates at two levels. The first level relates to a comprehensive strategic response to HIV and AIDS as outlined in our HIV and AIDS/ STIs Strategic Plan for South Africa. In this regard we are pleased to report that our prevention strategies continue to form the backbone of our response to HIV and AIDS. We have been pleased with efforts by all actors to begin to put visibility into our abstinence message as recently demonstrated by the abstinence marches in KwaZulu-Natal, which culminated in a massive gathering at kwaNongoma recently. We continue to discuss ways of intensifying this focus on abstinence with the Religious Leaders Forum. Our condom distribution has also grown to higher levels and the incidence of STIs has actually gone down.

Another element of prevention is the prevention of mother-to-child transmission. In this regard we had requested three different structures to look into the matter of the efficacy of moving to dual or triple therapy in the context of our country, the Medicines Control Council (MCC), The Medical Research Council (MRC) and the EDL Committee. While we have received reports and suggestions from the three institutions, we have not found conclusive support for a change of our current policy in this regard. The Department of Health has therefore been asked to do more work in this regard, in preparation for a report and a proposal to Cabinet soon.

Other elements of the broad strategic response to HIV and AIDS include research, monitoring and surveillance, and human rights issues. The Strategic Plan is due for review this year, as it was meant to last for five years, from 2000 –2005.

The second level relates to the Comprehensive Plan for Treatment Care and Support. Again in this regard we are pleased to report that the implementation of the plan is going very well, although we still face a number of challenges. Voluntary Counselling and Testing sites continue to see more people than before, while through the Khomanani social mobilisation campaign we intensified efforts to spread messages around voluntary testing and counselling as well as abstinence. With regard to care and support for people who have tested positive and those who are living with the virus, messages around positive living and healthy lifestyles have also been intensified, including the role of physical exercise and good nutrition in delaying the development of Aids defining conditions.

With regard to treatment, 143 sites in all the 53 districts have now been accredited to provide comprehensive HIV and AIDS services, including ART. This is in line with the targets that have been set for the programme. Reports from provinces suggest that a total of 50 009 patients have been started on antiretroviral treatment, in accordance with current policy guidelines. Efforts to improve our monitoring systems continue, to ensure that we can track these patients and their response to such treatment.

People continue to use alternative treatment provided by various other groups of healers, such as traditional healers, complementary medicine practitioners, etc, and the department of health continues to monitor developments in these areas, and to encourage research, especially around traditional medicines. A few of these are now at clinical trial phase.

The South African National Aids Council (SANAC) has also served as an effective forum for strengthening and integrating programmes within government, and also between government and other stakeholders.

Other Communicable diseases

The prevalence of malaria has been decreased significantly and substantially over the past 5 years from prevalence levels above 80% in some areas to current levels, which are below 10%. This can be attributed to the success of in-door residual spraying using DDT and the partnership with Mozambique and Swaziland. The total number of malaria cases reported from January to May 2005 is 4 539, which represents a 44.5% decrease from the 8 173 cases reported during the same period in 2004. During the same period, 35 deaths were reported compared to 55 in 2004, which represents a 36.4% decrease on deaths related to Malaria. This means that we are slowly winning the war against malaria. We are about to collaborate with Mozambique in the use of residual spraying in the Libombo corridor.

Tuberculosis

Last time we reported that we were facing some challenges with regard to TB, as we saw some difficulties in the reduction of cure rates as a result of non-adherence to treatment. We also reported that the Department is working with provinces to develop centres for multi drug resistance in an attempt to deal with the tendency towards increasing drug resistance to TB treatment. The Department will strengthen four components of the TB programme. These include strengthening the DOTS programme, improving laboratory services, fast tracking the appointment of TB district coordinators and strengthening community mobilisation. We are pleased to report that provinces continue to take further steps to improve our TB control programme, especially as it relates to the management and supervision of TB work.

Reduction of cost of medicines

The first phase of the Medicine Pricing Regulations has yielded a 19% reduction in the ex-manufacturer price of medicines when compared to the previous blue book price. Savings of between 15 and 30% have also been reported by medical schemes.

In summary, the Cluster’s programme on Comprehensive Health Care is on target.

4. Housing and Human Settlement

A comprehensive programme dealing with housing and human settlements is well under way. The target or the Cluster was to spend R14.2 billion in the next three years to ensure that the people of South Africa had access to basic shelter. That target has been exceeded with government’s approval for a R17.4 billion over the same period being allocated.

The National Treasury has also approved a budget of R50 million to be spent on consumer education, accreditation of local municipalities as well as training on all human settlement policies and guidelines for municipalities and provinces. The intention is to improve institutional capacity and governance so that provinces and municipalities are able to deal with rapid growth and urbanisation that increase the demand for housing and basic services.

5. Integrated Food Security and Nutrition

Since the start of the National Food Emergency Scheme in 2004 a total of 245 000 households have benefited from the programme. Agricultural Starter Packs to the value of R31 million have been delivered to some 18 575 households in all provinces as a measure of encouraging the development of sustainable food gardens.

Business plans and a financial model for financing the farmer support programme have been finalised and the Department of Agriculture is in the process of finalising a memorandum of agreement with key partner institutions in preparation for the implementation of the programme. The agricultural state and state-supported community schemes have seen a significant increase in the number of viable projects.

With regard to the National School Nutrition Programme and the social mobilisation for food gardens, the Departments of Education and Health have worked together in developing guidelines for quality assurance of food products intended for use by the National School Nutrition Programme. The programme is on track.

6. Expanded Public Works Programme

The Social Cluster is progressively implementing labour intensive methods in the delivery in the construction of housing, schools, clinics and other community centres. The Cluster is developing a clear resourcing strategy for expansion of social services such as Early Childhood Development and the Community Health Worker programme. With regard to the Community Health Worker Programme unit standards have been developed. The Department of Social Development as a coordinating department will create a dedicated unit that will take charge in driving the programme.

Government is also exploring various partnerships with key institutions such as the Development Bank of Southern Africa (DBSA), the Independent Development Trust (IDT), the Business Trust, Umsobomvu, civil society and religious leaders in various aspects of the EPWP programme which will obviate some of the implementation challenges that have been encountered.

7. ISRDP/URP

The Integrated Sustainable Rural Development Programme and the Urban Renewal Programme are well under way. One of the main issues that the Cluster had to address during the current cycle of the Programme of Action was to develop a financing protocol for the nodes to improve the effective coordination and financing of the ISRDP and URP programmes by the three spheres of government. The principles of the protocol are in place and the task is now at a stage where the National Treasury is considering the feasibility of budget allocation to line function departments to ensure that they are able to implement programmes in support of the ISRDP/URP in the nodes.

8. Conclusion

In conclusion, I would like to state that the Cluster is satisfied with the progress in general. Areas that we have identified for intensified efforts include the Expanded Public Works Programme and the strong partnerships with key stakeholders that we are establishing will assist in dealing with the blockages. A detailed progress report on the Social Health Insurance will be outlined in the next report of the Cluster.

Issued by: Department of Health
28 June 2005