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6 June 2006

Madam Speaker,
Honourable members,
Invited guests,

Members would have noticed the screening programme outside this Chamber and I hope most members have taken the opportunity to be screened for body mass, hypertension and diabetes. These screenings, together with skipping ropes and pedometers on your desks are part of our interventions to promote healthy lifestyles and I hope you will use them.

Allow me to especially welcome the health workers who made a special effort to be in the House this afternoon.

Madam Speaker, in January this year the National Health Council (NHC) decided on five priorities for health for 2006/07 in the context of our five-year strategic plan. These priorities are:
* service transformation plans which should be completed by each province
* human resources plan for health
* quality of care
* physical infrastructure for primary health care and hospitals
* priority health programmes with specific reference to the promotion of healthy lifestyles, tuberculosis (TB) control and prevention of HIV.

Through a resolution sponsored by South Africa in 2005, the World Health Assembly resolved that 2006 should be dedicated to human resources for Health. This is in recognition of the hard work that health workers in all categories put into ensuring that we promote healthy lifestyles and when we are ill, we receive the best possible care that our country can afford.

South Africa led this process because we understand that the planning and development of human resources for health is a major undertaking that requires both national and global interventions.

I wish to take this opportunity to salute the contribution of each and every health worker who contributes to the effective functioning of our health system.

In line with the importance that we have attached to the matter of human resources for health, we made considerable efforts to finalise the human resources plan for health for South Africa. Part of the process included extensive consultation with stakeholders. I am happy to announce that we completed and launched this plan on World Health Day, 7 April 2006.

During our consultations, health workers raised many issues as challenges affecting them. There are issues of inadequate remuneration, poor working conditions in some areas, lack of suitable accommodation and other supportive amenities particularly in rural areas.

The health system is challenged by the migration of health workers from rural to urban areas from public to private health sector and from South Africa to developed countries. One of the factors is a desire by some health workers to gain international exposure and experience by working in different health environments as part of their career development.

Madam Speaker, permit me to provide just a few examples of the activities of the Department of Health that are beginning to address these push and pull factors.

On the issue of remuneration, we accept that over the past few years the remuneration of public health workers has lagged behind other public sectors workers.

We have been working closely with the Department of Public Service and Administration and National Treasury on developing a revised remuneration structure for health workers and I am informed that this should be ready for implementation in the next financial year.

On the issue of improved conditions of our health facilities, members will recall that we initiated the revitalisation of hospitals programme three years ago. Currently, we have 42 projects enrolled into the programme and we hope to complete another four hospitals in the 2006/07 financial year. These are George Hospital in the Western Cape which will be officially opened on 30 June; Jane Furse Hospital and Lebowakgomo Hospital in Limpopo and Mary Therese Hospital in the Eastern Cape. The other three hospitals will also be officially opened during this financial year.

In addition, every hospital has been requested to develop a hospital improvement plan that includes basic activities such as repairing of broken windows or leaking taps to clinical audits to improve the quality of care that we provide in all public hospitals.

To demonstrate the effect of the changes we making through revitalisation of public hospitals, I would like to quote two health workers and a journalist on their experiences and perceptions of these new facilities.

A nursing sister working at the newly opened Manne Depico Hospital in Colesberg said; “Our patients feel safe and comfortable in this beautiful hospital. It is fantastic to work here, we have all the equipment we need and the Karoo summer heat cannot reach us or our patients, thanks to the air-conditioning. In my 20 years of experience I have never felt more comfortable and confident to provide our people with the care they need.”

The Head of the newly completed Trauma Unit at Pelonomi Hospital in Bloemfontein said; “This is going to the best trauma centre in the country. We will be able to handle all accidents and emergencies.”

A reporter who went to write a story about the same Trauma Unit said; “The trauma unit is so well equipped that I would not mind being treated here, should I be involved in an accident.”

These comments from health workers and users of our service bear testimony to the results that are beginning to filter through. We must however, accelerate our programme to ensure that within at least a 15-year period all our health facilities are completely revitalised. Off course, in the meantime we shall be embarking on maintenance work to ensure that the facilities we have not covered are properly maintained.

In this regard I wish to quote from a letter that I received recently from Mr Prinsloo about treatment received at the Dr George Mukhari Hospital in Gauteng by his friend who had sustained gunshot wounds. This is the same hospital that I visited last year and found its mental health section to be in urgent need of upgrading which I am pleased to report has taken place.

Mr Prinsloo writes, “A very dear friend of mine, Kobus Cronje (was shot) in the head on 21 April 2006 in his house at 02h00 in the morning. He was rushed to the Montana Private Hospital and the doctors there stabilised him for which I am very thankful. Because he did not have a medical fund and because the family could not secure R500 000, the functionaries of the said hospital dumped him at the Dr George Mukhari Hospital on the same date at 08h00 in the morning.

“One must understand that the Intensive Care Unit (ICU) of the George Mukhari Hospital was full but the doctors made a plan. I witnessed the doctors, sisters, nurses and other staff rendering but only the best possible services to my friend. Apart from the absolute professional services the hospital, although old, was very clean. Another fact is that the doctors worked for more than 18 consecutive hours in order to do good to the patients. The aforesaid is not hearsay, I saw it with my own eyes, as I was at the hospital myself for more than 24 consecutive hours.

“For example Dr Monana an ear nose and throat specialist who attended to my friend in the morning came back at 21h00 that night and worked on him until 02h30 the [following] morning. Dr Monana was not the only doctor, a number of others also worked on him.

“The only thing I can do is to thank you for rescuing my friend through your hospital and wonderful staff at Dr George Makhari Hospital. If possible kindly convey to the staff our sincere appreciation. From now on I will be your and your department’s biggest supporter.”

I am delighted that Mr Prinsloo and Dr Monana were able to be here with us today so that we can show them our appreciation. I am however saddened to learn that despite their best efforts Mr Cronje passed on. I wish to take this opportunity to express my sincere condolences to the Cronje family for their loss.

Can I ask both Mr Prinsloo and Dr Monana to stand please so that we can thank both of them for their efforts in helping South Africans in their time of need?

There are many Dr Monana’s out there. They work very hard everyday, saving lives, providing comfort and improving health. Their skills have made them to be valuable assets in the global market. Those who, because of today’s world realities happen to have much stronger economies than ours would like to steal our Dr Monana’s away from us.

In search of professional excellence, our health professionals may want to compare his competencies with those of his peers in developed countries. We cannot stop our health professionals from gaining experience outside the country. However, we have sought to work with other countries to manage this movement so that it does not impact negatively on our health system.

For example we have an agreement with the United Kingdom (UK) through which health workers can work in UK hospitals and return to the public sector without loss of employment or status.

There have been major achievements as a result of this agreement. Since we signed the agreement in 2003, the number of South African nurses registered with the Nursing and Midwifery Council in UK has decreased by more than 55 percent from 2114 in 2002 to 933 in 2005.

We are exploring similar agreements with other countries which host a significant number of South African trained professionals such as Canada.

Finally, with respect to human resources for health I am pleased to announce that the Universities of Pretoria, Walter Sisulu and Witwatersrand will amongst them admit 100 students to commence training as clinical associates in January 2007. This new cadre of health workers will complete a three year degree programme with significant on site training in district learning centres. Upon graduation, they will work under the supervision of medical officers in district hospitals and primary health care level. The scope of practice will include diagnosis and treatment including performing minor surgery.

Madam Speaker, we have made progress in other areas of the health sector as well. The implementation of the integrated management of childhood illness strategy has been strengthened in the past year and will continue to be improved through training of additional health workers who work with children.

Our immunisation programme is generally good with a national coverage rate of more than 80 percent. However, there are districts and sub districts with coverage of less than 70 percent that we will be paying a special attention to during 2006/07. Through our joint initiative with Biovac, a public private partnership for local vaccine production and distribution South Africa has been able to become self reliant with regard to the production of a range of vaccines and is currently building capacity required to export vaccines to other countries in the region.

We need to double our efforts to decrease the burden of non-communicable diseases on our population.

As you know there are many risk factors for non-communicable diseases which include high blood pressure, tobacco use, excessive alcohol use, diabetes mellitus, artery diseases, physical inactivity and obesity these are things which we can do something about as part of a healthy lifestyles programme.

On tobacco use in particular, we appreciate the support that we are receiving from ordinary South Africans in terms of intensifying our tobacco control measures. We hope we will get similar support from this House with regard to the amendments to the Tobacco Control Act.

We have strengthened our healthy lifestyles programmes through a range of activities including the establishment of food gardens, the initiation of the move for health campaign to encourage increased physical activity, screening for diabetes, hypertension and cervical cancer, strengthening the health promoting schools programme as well as the school health service. In this regard South Africa was able to showcase together with Brazil and Spain our efforts to implement a healthy lifestyles programme at the World Health Assembly and I must say our input was appreciated by the audience from many countries who I have no doubt will be emulating us in the months ahead.

Those members who joined us before lunch would have seen concrete evidence of our attempts to increase the levels of physical activity amongst our people. I urge you to work with your constituencies to broaden this movement which is called “Vuka South Africa, Move for your Health.”

On communicable diseases, we have worked with other government departments and the private sector to develop an avian flu preparedness plan which has been approved by Cabinet. The control of avian flu outbreaks requires monitoring of poultry and birds, especially migratory birds. This is being done by the Department of Agriculture and South Africa has been declared free of avian flu.

The Department of Health has taken primary responsibility to prevent humans from contracting human influenza. Let me assure this House that we are prepared. We shall use the World Health Organisation (WHO) guidelines on the management of patients with influenza and we have fast tracked the registration of antivirals that may assist in the management of patients and may be useful as prophylaxis. The recommendation from the WHO is that these drugs should be stockpiled in quantities that are adequate for management frontline workers who may have extended exposure to possible infection in the line of their duty.

As you may be aware we launched a national TB crisis management plan in March this year to strengthen the TB control programme in those districts with a significant number of TB cases and unsatisfactory cure rates. These districts are the Nelson Mandela Metro and Amatole District in Eastern Cape, Ethekweni Metro in KwaZulu-Natal (KZN) and the Johannesburg metro in Gauteng.

On HIV and AIDS, our emphasis on prevention of new infections and tackling the link with poor nutrition has finally been endorsed by the international community in various forums. The WHO Africa region declared 2006 as the year of accelerated prevention because of the understanding of the central role of preventing new infections in responding to this major challenge.

We will be implementing an accelerated HIV prevention strategy which includes an increase in budget allocation for communication and social mobilisation campaign to R200 million for the next two years. The campaign will improve the abstinence component of prevention, support the distribution of female condoms and seek to sustain the very impressive condom distribution rate which currently averages 350 million free male condoms per year.

A report tabled by the World Health Organisation (WHO) to the World Health Assembly two weeks ago urged member states to integrate nutrition in their response plan. The Global Fund to Fight AIDS, TB and malaria has urged that proposals for funding on HIV and AIDS should include a nutrition component. We are honoured as South Africans to have led the way in this regard through our comprehensive plan for management, care and treatment of HIV and AIDS.

We are conscious of the need to strengthen the implementation of the comprehensive plan in its totality including:
* strengthening the health system
* social mobilisation and public awareness
* increasing access to voluntary counselling and testing
* prevention of mother to child transmission of HIV
* promoting human rights and access to care and support services
* promotion of good nutrition
* research and development of African traditional medicines
* and safe administration and monitoring of antiretroviral therapy.

Our determination to rigorously implement this programme comprehensively is reflected in the constantly increasing budgetary allocation for our response to HIV and AIDS.

The hosting of the Soccer World Cup in South Africa in 2010 provides us with both challenges and opportunities. The Department will be ready with regard to the preparedness of the health system. We will be training and deploying significant numbers of emergency medical services practitioners, purchasing additional ambulances as well as upgrading the casualty sections of designated hospitals as a matter of urgency. These improvements to the health system will be one of the concrete legacies of the 2010 World Cup.

Madam Speaker, let me now turn to our interaction with the private health sector. The Department has been engaging with various health stakeholders in our effort to finalise a Charter for the Health Sector. The Charter is our attempt to provide a coherent framework for engagement between the public and private health sectors. It is an effort to deal with the inequities between the two sectors as well as the transformation of the private health sector. We have started the process of negotiating targets with respect to equity ownership within the context of broad-based black economic empowerment (BBBEE).

Equally important is the need for sharing of resources, experiences and competencies between the two sectors in the manner that strengthens the entire health system. We are confident that we will be able to negotiate a Charter that stakeholders will feel comfortable to sign, noting that this is voluntary within the next month.

As you know the Department has over the past few years taken legislative and other measures to strengthen the financial situation of schemes, I reported previously that this has been achieved medical schemes are now financially stable and the council for medical schemes has put in place strategies for early identification of potential problems which they then deal with. I also reported on the decision to implement a risk equalisation fund previously. We are in the process of finalising legislation to give effect to this policy and hope to send to this House draft legislation in this regard during this parliamentary session.

As a result of the Constitutional Court ruling which upheld the right of government to regulate medicine prices, we are continuing with our efforts to reduce the prices of medicines in the country. Interested parties have provided input to the draft dispensing fee structure published in March and these inputs are being considered in the finalisation of the new dispensing fee structure which should be finalised soon.

The pricing committee is also developing a methodology for international benchmarking which will bring medicine prices in South Africa in line with those of other countries. The draft methodology should also be available for public input within the next few months with the intention to implement it before the end of this year. Patients can expect further cost savings when this methodology is implemented.

On African traditional medicines, the Department will focus on the following during this financial year:

* establishment of the Traditional Health Practitioners Council as provided for in the Traditional Health Practitioners Act
* we will be hosting an international workshop on traditional medicine on 9 and 10 June.

These initiatives will assist us to better understand the value and the use of traditional medicine and support the research and development of this important component of health.

In the development of critical policies that I have highlighted this afternoon, Madam Speaker, you will notice that we have gone an extra mile in ensuring that most stakeholders had ample opportunity to make input and influence these major policy undertakings.

In addition to consulting on specific issues, last month we inaugurated the National Consultative Health Forum (NCHF) whose purpose is to act as a platform for consultation with national stakeholders. Similar structures have been established at provincial level and will be extended to district level as provided for in the National Health Act.

Finally, let me turn to the budget that we have been allocated to fulfil our mandate.

The allocation to the national Department of Health for 2006/07 was R11 269 996 000 (in 2005/06 this figure stood at R10 039 399, 000). Of this amount R1 236 630 000 (R1 132 544 000 in 2005/06) was for use by the national Department whilst the remainder of R10 033 366 000 in 2006/07 (R8 906 855 000 in 2005/06) formed the conditional grants that are routed through the national Department for use by provincial departments of health.

The increased allocation received by the national Department of Health for its own use was limited to R15 million for project management of certain projects in the provinces and also the risk management to be implemented by the council for medical schemes.

With respect to conditional grants the Department received the following increased allocations for 2006/07:
* R100 million for the Hospital Revitalisation Programme
* R525 million to fund improvements in the Forensic Pathology Services which we took over from the South African police Service (SAPS) on 1 April this year
* R32 million for the Medical Research Council (MRC) to accommodate the new Vat laws without decreasing its operating budget.

In order to strengthen the national Department of Health I approved a new organogram for implementation in 2006/07. This will see the number of Deputy Directors-General increasing from the current three to six. There will also be an increase in the number of managers at other levels to strengthen the senior management team. This expansion will require an additional R30 million for personnel.

In the past, the cost of accommodation occupied by the national Department of Health was budgeted for by Department of Public Works. These funds have now been transferred and are included in the budget of the national Department of Health amounting to R35 million for 2006/07.

As I noted earlier I attended together with the MECs for Health of KwaZulu-Natal and the North West province the annual World Health Assembly meeting of the WHO. I am pleased to report that the South African delegation made significant contributions to several areas of debate and to strengthening of resolutions on a wide range of issues. I shall mention just two to provide, honourable members, with a flavour of the issues.

The first is whether all countries should destroy the smallpox virus that some countries still hold even though small pox has been eradicated. The key issue here is the risk posed to all nations should the virus get into the wrong hands. Progress was made in this regard through the broadening of the advisory committee that will address this matter.

The second issue revolves around international property rights as it affects health. Again tough discussions were needed to protect the interests of developing countries which we championed. In the context of a globalised health service, it is very important that South Africa is able to speak for itself and on behalf of other developing countries especially those in Africa and ally ourselves with progressive forces in Africa and other parts of the developing world. Unless we are able to do this, nation states in the developing world will be less likely to make and implement health policies that are in their best interests.

In conclusion, Madam Speaker, may I thank our health workers once again for the sterling work that they are doing. In addition, I wish to thank the Deputy Minister, the MECs for Health, the Chairperson and members of the Portfolio Committee for Health, the Director-General and officials of the Department of Health at national and provincial level for their contributions to this transformation agenda.

I request this House to pass the Health Budget Vote.

I thank you!

Issued by: Department of Health
6 June 2006