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7 June 2007

Co-operating to improve healthcare in South Africa

Madam Speaker
Minister of Health
Acting Minister of Health
Members of Parliament
Invited guests

I would like to congratulate the Minister of Health and her medical team on her speedy recovery, welcome her back and wish her well in her continuing recovery. I also want to thank the President for appointing Minister Jeff Radebe to act while our Minister of Health was on sick leave. Minister Radebe led the Department with diligence and in the short time that he was there he played a significant leadership role in the Department's response to tuberculosis (TB).

Our most crucial task presently is that of strengthening the national health system so that it can respond effectively and improve the quality of healthcare delivery. Building on the good plans and policies, we must ensure proper implementation in order to improve health outcomes and indicators which presently are far from what they should be.

The growing burden of disease demands that we strengthen co-operation and dialogue between government and research, the public and private health sectors as well as between the public and the complementary/traditional health systems so that they can work together to provide optimal health to the nation. This dialogue and co-operation is based on respect, deliberation, reaching consensus and evidence based interventions. All South Africans need to take responsibility so that threats to their health are prevented, detected and treated early and there is adherence to treatment.

Health systems worldwide are at a crossroads. Between the healthcares we have and the care we could have lies not just a gap, but a chasm. With limited resources we must do everything we can to maximise the effectiveness and quality of healthcare we give and minimise waste. We need to develop strategies for bridging the gap between what we have and what we would like to have.

"Knowing is not enough, we must apply.
Willing is not enough, we must do," Goethe.

The quality of healthcare service delivery is of concern to all South Africans, particularly the majority who cannot afford private healthcare. This has been communicated through the public media and was stated strongly in the public hearings organised by the South African Human Rights Commission (SAHRC), held from 29 May to 1 June 2007. Government appreciates the role of civil society in advocating for their constituencies, pointing out our blind spots and contributing significantly to the delivery of healthcare.

Healthcare financing careful deployment of our resources and good governance are key functional areas for improving the performance of the health system. Monitoring and evaluation of implementation is crucial in giving feedback on how we are performing.

This was echoed in the presentation made to the SAHRC by Professor Bongani Mayosi, Head of the Department of Medicine at Groote Schuur Hospital, University of Cape Town. Professor Mayosi acknowledged that the government's desire to take healthcare services closer to the people can only be achieved if the secondary and tertiary levels of care are strengthened to provide a good referral system and continuum of care in a seamless health service.

Bongani Mayosi is a humble man. Born in Nqamakwe, near Butterworth, he spent his formative years herding cattle in the hills surrounding his village and excelling at school. He entered the then University of Natal's Black Section at the age of 16. His academic excellence earned him a full research scholarship to Oxford University where his area of specialty became heart diseases related to poverty. Since joining the University of Cape Town in 1992 his achievements in cardiology and genetics have culminated in his attaining full professorship in 2006.

He continues to excel as a specialist clinician, focusing on heart disease induced by childhood rheumatic fever amongst the poor. In his present capacity as Professor of Medicine at University of Cape Town Professor Mayosi is called upon to lead the Faculty of Health Sciences in its quest to remain a centre of excellence for academic endeavour and high-end treatment of diseases.

It is this that drives the campaign he has bravely led, calling for rationality in how we allocate health resources. Like many of the honourable members of this House who have a history of struggle and activism for justice, Professor Mayosi is deeply concerned about the poor.

The solution for the financing of tertiary healthcare in a way that strengthens primary and secondary healthcare already exists. The Department of Health led an extensive consultation process which resulted in the Modernisation of Tertiary Services Programme. National Treasury has expressed support for the modernisation of our tertiary health services. As a start, an allocation for diagnostic tools has been made in this year's budget. The programme involves improving health infrastructure and recruiting skilled staff. Implementation of this programme has the potential to greatly improve the quality of care and strengthen all the levels of healthcare.

One of the main contributory factors for South Africa's poor health outcomes is the inequity and inefficiency associated with the segmentation between the public and private health sectors. The financial disparity in health spending between the two sectors has widened, with the private sector spending approximately seven times more per capita than the public sector on less than 20% of the population. It has been pointed out that the public sector serves 84% of the population, mainly the uninsured and poor.

Collaboration between the different health sectors should include sharing of resources and expertise. The increased demand for healthcare services as a result of the free primary healthcare (PHC) policy and the increased burden of disease have caused strain on the availability of human resources for health. The loss of health personnel affects both the public and private sectors and adds to the urgent need for greater public private co-operation.

A functional health management information system is essential for the planning and management of effective health services, as well as for monitoring and evaluation. South Africa has made considerable progress in strengthening its health management information systems. The District Health Information System has successfully standardised routine PHC information. The challenge remains of training our managers to optimally use this information for purposes of planning, monitoring and corrective action.

Health technology is a critical component of the health system. We will ensure that health technology regulations are finalised in this budget year, so that we can achieve standardisation of our health technology and medical device service platform. Much work has already been done to build consensus with role players in the health technology industry and professions. Part of this consultation has resulted in agreement on the registration of health technologists and engineers.

Co-operation with the Department of Science and Technology in health research and technology is growing and yielding very good results. This includes research to understand the social impact of disease, creating an environment and technologies to reduce the effect of poverty on the spread of disease, developing innovative prevention, treatment and care strategies and developing therapeutic and preventive regimes in the utilisation of indigenous knowledge and the development of HIV and AIDS vaccines including research into microbicides. South Africa has a world-class research capacity. Currently, as an example, South Africa is reported as the world's largest HIV clinical research site with more than R3 billion being spent each year.

The advances in the development of appropriate forms of telemedicine have shown great potential for improving access to quality healthcare and serving remote populations. I visited the Grabouw Community Health Centre with the honourable Derek Hanekom, Deputy Minister of Science and Technology, to observe the use of tele-medicine which the Medical Research Council (MRC) is piloting in partnership with Stellenbosch University. We were very pleased to see how technology can be put to effective use, to link up our PHC facilities with specialist care, thus servicing remote areas cost effectively and efficiently. Tele-medicine is being applied in KwaZulu-Natal for both clinical and training purposes. We are exploring ways to integrate tele-medicine and other technologies to improve care and respond to staff shortage of specialist skills in partnership with the private health sector and industry.

Improved performance will depend on new system designs that help us provide care that is safe, effective, patient centred, timely, efficient and equitable. Such systems must ensure that patients retain control and participate in care delivered whenever possible. Such systems must facilitate the application of scientific knowledge to practice and provide clinicians with the tools and supports necessary to deliver evidence based care consistently and safely.

The National Strategic Plan on AIDS is a groundbreaking consensus document that bears the Minister's imprint throughout. While she was recovering she kept in touch giving guidance. Each sentence was carefully considered and contested by the stakeholders until satisfied. What we have is a document that unites us all in the struggle to overcome HIV and AIDS. Among the guiding principles are supportive leadership driven by political leaders with the support of leaders of all sectors, leadership by government in resource allocation, co-ordination and policy development, effective communication and effective partnership. I wish the Minister every success as takes up the leadership again and wish to assure her of my full support in the challenges ahead.

I thank you!

Issued by: Department of Health
7 June 2007