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17 September 2008

Introduction

As most of us would recall, during the course of last month Health Minister Dr Manto Tshabalala-Msimang in her capacity as chair of the Social Cluster hosted a briefing from the Union Buildings in Pretoria updating the media about progress on the implementation of government Programme of Action (POA).

In this briefing therefore, we are not going to repeat what was said then. Rather, as Director-General of the Department of Health and co-chair of the Cluster, I will concentrate on a few issues that relate or affect the Department and paint a picture of the progress that we are making. Obviously, these issues will in a way or another relate in specific or general terms to government POA.
The issues that I wish to focus on this afternoon are: 2007 antenatal survey, interventions on child-mortality, poverty alleviation and nutrition and conclude with broad remarks on general issues that have been in the media recently.

HIV and AIDS

On the weekend of 29 August this year we placed (as Department of Health) on our website the report on the results of the 2007 National HIV and Syphilis Antenatal Prevalence Survey conducted a little under a year ago.

In our view the 2007 report shows South Africa may be making some real progress in its response to the HIV epidemic. These are the first results to show a comparison of the impact of HIV infection between districts over two consecutive years. The epidemic is progressing at a different pace in the different provinces. The findings suggest that the South African HIV epidemic is on a downward trend. Another important observation in the 2007 survey is that HIV prevalence among younger women (15 to 24 years) continues to show a significant decline.

A decline in this age group in our view is suggestive of a decline in HIV incidence and is a good indicator of the impact of intervention programmes. More concerted efforts in prevention strategies are needed in the older age groups where declines have not been observed.

We were worried about the recent media reports that sought to suggest or insinuate that there was some tampering with the methodology in conducting the survey with a view to influencing the results in our favour. As some of you would know, these media reports were based on an article by two researchers published in the current edition of the South African Medical Journal, which did not accord us an opportunity to put our view, something we have always assumed was standard.

We are working on organising a meeting of researchers and experts in this area, including agencies such as the United Nations Programme on AIDS (UNAIDS) to take a collective look at the survey and its results, using a comparative method, with a view to determine the validity of this suggestion that there was some unethical or unprofessional conduct on our part in conducting the survey.

Generally, we are continuing with all our HIV and AIDS and tuberculosis (TB) programmes and remain a committed partner at South African National AIDS Council (SANAC).

Interventions around child-mortality

As has been widely reported in the media, this month we are marking the 30th anniversary of the Alma Ata Declaration which places particular emphasis on primary healthcare and issues of solidarity amongst others. As part of this commemoration, but also in line with our own Constitutional obligations as part of our work we have been focusing recently on the health of children under five pushing campaigns such as the Vitamin A supplementation that was launched by Minister early last week. Through this campaign our aim is to address the apparently increasing challenge of Vitamin A deficiency among the children, which leads to health difficulties such as blindness, measles but also generally makes the body to be unable to fend off infections.

Late last week we were in the Ukhahlamba district in the Eastern Cape to introduce for the very first time in our country two new vaccines, pneumococcus conjugate and rotavirus as part of our interventions around infant and child-mortality. As was indicated by Minister at the launch, our plan is to roll out district by district in the Eastern Cape and ultimately nationally. The introduction of these two vaccines will assist us in addressing the challenges of pneumonia, meningitis and diarrhoea among the under fives, factors which are commonly associated with death in this age group.

Let me, however, take this opportunity to draw everyone's attention to those factors that lie beyond the actual mandate of Departments of health world-over, the so-called social determinants of health. I am referring here to life and health-enhancing factors such as water and sanitation, nutrition and general social infrastructure factors such as transport which have a bearing on the health of citizens but also assist or hinder the delivery of quality health services by the relevant departments.

These are exactly the factors that we always take into account when we deliver health services in our country. When news broke of the unusual deaths of children in Ukhahlamba for instance, we assembled a team comprising other Departments other than health because of the nature and complexity of the challenges in the area, which include these same factors.

Nutrition and poverty alleviation

As we have consistently pointed out, nutrition forms a critical component of our delivery strategy as the Department of Health. To this end, we are working closely together with other government departments such as Education and Social Development in implementing programmes that would assist us in alleviating poverty among our citizens.

Every time we take service-delivery to communities we always aim to leave behind a legacy through establishing food gardens that will assist communities, including schools and clinics, to produce their own food and thus address poverty but also address the whole issue of food security. All of us are badly affected by the recent sky-rocketing oil and food prices, a factor that complicates the plight of millions of people, especially those already trapped in poverty.

Since 2004 when we aggressively pushed our healthy life-styles programme we have helped establish 200 community gardens, making garden implements such as forks and rakes as part of enabling communities to sustain themselves. We are also collaborating with our sister departments in rolling out other poverty alleviating interventions through legislative and policy changes so that we remain as much obstacles in the system as possible.

General issues in the media

Service-delivery in public hospitals continues to be the one issue that always catch the attention of the media, and rightly so. However, one sometimes gets a sense that the way in which the story is related seems to create an impression that nothing is working in the public health system, a myth we always dispel. We are on record as admitting that the system is not working as well as we would want to, but there are concrete and progressive interventions that are underway aimed at improving the system. We are working on improving the human resource (HR) situation, the hospital revitalisation is proceeding well, facilities are being refurbished and new ones constructed as part of improving the functioning of the sector.

Recently we launched our facility improvement plan targeting about 27 facilities for rapid improvement. The process has already begun to yield some very positive results and the Minister will make an announcement soon in this regard.
Legislative work regarding our Bills is also proceeding well and as most of you would know the Tobacco Products Control Amendment Bill is now before the National Council of Provinces (NCOP) and we remain hopeful as to the outcomes there.

Conclusion

As the department we are happy with the way in which we are carrying out our mandate as far as healthcare delivery is concerned. Recently, we appointed two new Deputy Directors-General as part of our strategy to function in a much more focused and accelerated way and we are beginning to see the results.

Enquiries:
Fidel Hadebe
Cell: 079 517 3333

Issued by: Department of Health
17 September 2008