Budget speech of Honourable Dr A Motsoaledi, MP, Minister of Health, delivered to the National Assembly, Parliament of the Republic of South Africa
13 April 2010
Ladies and gentlemen
I am honoured to present to this esteemed House the national Department of Health’s policy priorities and budget for 2010/11 for your consideration.
Tribute to the late Deputy Minister of Health, Dr Molefi Sefularo
I wish to start by paying tribute to a gallant son of the soil, who was also a member of this house, Honourable Dr Molefi Sefularo, Deputy Minister of Health, who passed away on 5 April 2010.
I have personally known the Honourable Sefularo for over 30 years, as a comrade in the struggle for the emancipation of the people of South Africa, as well as a colleague, friend and a fellow student and subsequently medical practitioner. He was a highly talented, gifted and astute person, who was always humble and easy to work with.
Testimony to these characteristics were the many people who paid similar tributes to his life and work during the official memorial ceremony held in Pretoria on 8 April and again during the funeral service held at the University of Limpopo’s medical campus on Saturday, 10 April. It was indeed appropriate that Dr Sefularo’s funeral service was held on the campus that he transformed as a student leader and at which he studied and graduated as a medical doctor.
The late Dr Sefularo was a stalwart in the mammoth task of liberating this country from the bondage of oppression and inequality, as well as in the transformation of the health sector to an accessible, equitable system, providing quality services to all South Africans. As we all know, he was passionate about communities and their welfare and was particularly interested in ensuring that we strengthen primary health care in our country.
Amongst many other projects, the late Deputy Minister of Health worked tirelessly to ensure the health sector’s readiness for the FIFA World Cup in 2010. Our health services are ready to provide comprehensive health services to hundreds of thousands of football fans from the 31 nations that will visit our shores in June 2010, as well as fans from our own country. Dr Sefularo dedicated his time and energy to visiting all our health facilities in the cities where World Cup games will be held to ensure that we were indeed ready.
He has fought a good fight; he has finished the race and he has kept his faith. What is left is for us to honour him by dedicating ourselves to completing the work. I therefore wish to dedicate this budget speech to the memory of Dr Sefularo. I request members of this house to join me in conveying our deepest condolences to Mrs Kgomotso Sefularo, the children and the extended family.
The year 2010/11 in perspective
Mister Speaker, this year is historic in many respects. Apart from the FIFA Soccer World Cup, which will be held for the first time on African soil, this year also marks the 20th anniversary of the release from prison of our icon, former President Nelson Mandela.
Madiba dedicated 66 years of his life to the struggle for emancipation. He sacrificed his own freedom for almost three decades to secure the liberty that all South Africans enjoy today. No tribute to Madiba can ever be adequate or commensurate with his contribution to the attainment of our freedom. The least that we can do is to strive to perpetuate his legacy in our lifetimes.
The 10 point plan of the health sector 2009 to 2014
Honourable members, this year marks the second year of implementation of our 10 point programme for transforming the health sector into a well functioning health system capable of producing improved health outcomes.
To refresh the memories of Honourable members, the 10 point programme consists of the following priorities:
* Provision of Strategic leadership and creation of a social compact for better health outcomes
* Implementation of National Health Insurance (NHI)
* Improving quality of health services
* Overhauling the health care system and improving its management
* Improved human resources planning, development and management
* Revitalisation of infrastructure
* Accelerated implementation of the HIV and AIDS and Sexually Transmitted Infections (STI) national strategic plan 2007 to 2011 and increased focus on TB and other communicable diseases
* Mass mobilisation for better health for the population
* Review of the drug policy
* Strengthen research and development.
Since the last budget speech that I delivered to this house on 30 June 2009, a solid foundation has been laid for the attainment of the goals we have set ourselves in the 10 point programme. Our 10 point programme has been endorsed by a wide range of key stakeholders in health sector, including trade unions; medical associations; nursing organisations; most of the private health sector, and indeed non-governmental organisation (NGOs) and civil society. The 10 point programme also received support at the Public Service Summit held from 10 to 12 March 2010. We wish to thank all our partners for endorsing this programme. This means that they will all support us in its implementation.
Background to the outcome-based approach and the selection of health priorities
Honourable Speaker, having successfully popularised the 10 point plan, we wish to draw the attention of the house to the outcome-based approach for improving service delivery, which was announced by the President of the Republic in his State of the Nation Address earlier this year. In his State of the Nation Address, the Honourable President also emphasised the need to fundamentally transform the health system and listed health as one of five key priorities of government.
I wish to remind this house of the health situation in the country that requires our collective and sustained attention:
* Life expectancy in South Africa has declined. For the period 1985-1994, Statistics South Africa estimated life expectancy at birth at about 54,12 years for males and 64,38 years for females. In 2009, Statistics South Africa estimated life expectancy at 53.5 years for males and 57.2 years for females
* Maternal mortality and child mortality rates are unacceptably high
* South Africa carries a significant burden of disease from HIV and AIDS and TB
* South Africa has a predominantly curative health system that places less emphasis on disease prevention and health promotion. Over the last 10 years, there was an inadvertent shift of emphasis from primary health care, which was adopted by the first democratic government as the foundation of our health service delivery system, towards a predominantly curative health system
* Ineffectiveness of the health system and provision of poor quality of health services. This has led to many people wrongly but increasingly believing that private health care is the only way possible towards meeting the health care needs of our country.
A prominent health expert, who has contributed significantly to strengthening the National Health Service in the United Kingdom, recently remarked to me that South Africa’s health care system has a larger private health care sector than the United Kingdom (UK)! He also remarked on how little preventive and promotive care we provide in our health system compared to curative care.
Clearly decisive, systematic and quantifiable interventions must be implemented to address these adverse trends. In response to this, the Cabinet agreed in January 2010 on a set of concrete outcomes that must emerge from our interventions to transform the health sector over the next four years.
These can be classified into four broad categories namely:
* Increasing life expectancy
* Combating HIV and AIDS
* Decreasing the burden of diseases from (TB) Tuberculosis
* Improving health systems effectiveness, by strengthening Primary Health Care and reducing the costs of health care.
Based on these four broad categories, the health sector needs to, during the period 2010 to 2014, produce the following 20 outcomes:
* Increased life expectancy at birth
* Reduced child mortality
* Decreased maternal mortality
* Managing HIV prevalence and improving the quality of life of people living with HIV and AIDS
* Reduction of new HIV infections
* Expanding access to the Prevention of Mother to Child Transmission programme
* Improved TB case finding
* Improved TB treatment outcomes
* Improved access to antiretroviral treatment for HIV-TB co-infected patients
* Decreased prevalence of drug resistant TB
* Revitalisation of primary health care
* Improved physical infrastructure for healthcare delivery
* Improved patient care and satisfaction
* Accreditation of health facilities for quality
* Enhanced operational management of health facilities
* Improved access to human resources for health
* Improved health care financing
* Strengthened health information systems (HIS), including strengthening information, communication and technology (ICT)
* Improved health services for the Youth
* Expanded access to home based care and community health workers.
These 20 deliverables provide additional specificity to the 10 point programme of the health sector 2010 to 2014. The prioritisation of these outcomes does not imply that we will not do everything else that needs to be done these priorities however do reflect things we must do with added urgency.
Key policy priorities for the health sector for 2010/11 to 2012/13
Honourable Members, the key policy priorities for the health sector for 2010/11 to 2012/13 will strengthen our ability to meet the health related Millennium Development Goals (MDGs).
Our Maternal Mortality Ratio (MMR) must decrease from the estimated 400-625 per 100,000 to 100 or less per 100,000 live births over the next four years. We will implement a number of interventions to achieve this, including:
* Increasing access to health care facilities, including possibly the provision of waiting mothers homes
* Increasing the percentage of pregnant women who book for antenatal care before 20 weeks gestation
* Increasing the percentage of maternity care facilities which review maternal and perinatal deaths and address identified deficiencies
* Enhancing the clinical skills of health workers and improving the use of clinical guidelines and protocols.
We have also developed strategies to enhance our Prevention of Mother to Child Transmission (PMTCT) programme, to ensure that by 2014/15, less than five percent of babies born to HIV positive mothers are HIV positive. These include the integration of antenatal care and HIV and AIDS services, so that our people do not have to travel from one health facility to another to access each of these services. In fact, the Executive Director of United Nations Programme on HIV and AIDS (UNAIDS), Michel Sidibe has asked all countries to implement plans to “virtually eliminate mother to child transmission of HIV”. We are determined to achieve this no child should be born HIV positive.
Our child mortality must decrease from the current 69 deaths per 1,000 live births to not more than 30 to 45 deaths per 1,000 live births. The health sector will continue to ensure that children less than one year of age are fully vaccinated against pneumococcal infection and rotavirus. International evidence has shown this to be an effective intervention in ensuring child survival, together with other key strategies.
Other key interventions to improve child health will include:
* Increasing the percentage of eligible infants receiving treatment for HIV and AIDS
* Increasing the percentage of mothers and babies who receive post-natal care within six days of delivery
* Increasing the proportion of nurse training institutions who teach the Integrated Management of Childhood Illnesses (IMCI) so that we have more nurses able to implement IMCI in our primary health care facilities;
* Increasing the proportion of schools which are visited by a School Health Nurse
* Conducting health screening of learners in Grade 1 in poor schools.
We need to prepare to deal with H1N1 influenza as we are entering the winter season. Unlike last year when we did not have a vaccine, the good news is that we have been able to secure vaccines this year but regrettably not sufficient for everybody within our Country. Following advice from the World Health Organisation and our own experts, between 05 and 30 April 2010 we will prioritise for vaccination against H1N1 the following:
* 80,000 children under 15 years of age who are living with HIV and AIDS
* 10,000 officials at our ports of entry
* 700,000 pregnant women
* 1 million adults with HIV and AIDS who receive treatment at our ART clinics
* 900,000 people with chronic heart and lung diseases.
During this month we will also have a national Measles and Polio Vaccination Campaign. I officially launched this campaign at the Benoni West Primary school yesterday. It will end on the 28 May 2010. Our target is to vaccinate 15 million children between the ages of six months and 15 years against measles and to vaccinate 5 million children under five against polio. Honourable Members are requested to assist the Department of Health by speaking to our constituencies about the importance of immunization against these diseases. We have the means to eliminate measles and polio this means having a fully immunised community now and in the future.
Honourable Members, in keeping with the targets in our outcome-based approach we must increase our TB cure rate from the current 64 percent to 85 percent by 2014/15. Based on a review of TB control programme led by the World Health Organisation, we have developed concrete and clear strategies, in each province, to strengthen this programme.
During this financial year, we will train 3,000 health workers in the management of TB. We will also expand our TB DOTS programme and train 2,500 community health workers as DOTS supporters. This will assist in reducing the defaulter rate of TB patients from the current 8,5 percent to less than 5,5 percent by 2012/13.
A key strategy to strengthen TB control is social mobilisation. Working together with the Desmond Tutu TB centre and other development partners we have developed a social mobilisation campaign called ‘Kick TB 2010’. This campaign builds on the excitement generated by the 2010 FIFA World Cup and aims to help to combat TB and the stigma associated with it, by linking it with soccer.
The campaign will target approximately 250,000 learners who will be drawn from diverse schools and backgrounds, across all nine provinces, to be ‘agents’ for TB control and management. Each participating learner will receive a specially designed soccer ball with TB appropriate messages that will educate and inform the community about TB, its symptoms and treatment.
As mentioned earlier, the largest public health problem that faces South Africa today, and which drives many of the other pandemics and significantly reduces our life expectancy, is HIV and AIDS. The most important task that faces us is to reduce by 50 percent the number of new HIV infections by 2011/12, and to initiate on Antiretroviral Treatment (ART) 80 percent of eligible people living with HIV and AIDS.
As announced by President Zuma on World AIDS Day in December 2009, we started on 1 April 2010 to provide Antiretroviral Treatment to pregnant women at CD4 count of 350 or less, to enhance maternal survival. ART is also being provided to people co-infected with TB and HIV at a CD4 count of 350 or less. This will contribute significantly to reducing morbidity, disease progression and mortality associated with TB and HIV and AIDS.
In addition, HIV positive pregnant women are now receiving dual therapy from 14 weeks of pregnancy (not 28 weeks as was previously the case) until post delivery. Most importantly, HIV and AIDS and TB are being integrated, and will be treated under one roof. This means that all public health facilities that provide TB treatment must over this financial year be strengthened to also provide treatment for HIV and AIDS.
By the end of March 2010, only 496 public health facilities accredited were providing antiretroviral therapy. We have decided that all 4,333 public health facilities should over time provide ARVs. I am happy to report that we have prepared an additional 519 public health facilities and they have started to provide ARVs since 1 April 2010 that is 13 days ago. This means that as we speak more than 1000 public health facilities are initiating eligible patients on treatment.
Some people were sceptical about our resolve to implement the new treatment guidelines and increase access to treatment. I wish to assure the house that we are very determined!
This does not mean that we are not experiencing a few teething problems in the implementation of these new policies and strategies, such as our human resource capacity and supply and logistical problems in some facilities. However, these are not insurmountable and are being addressed.
Honourable Speaker, I mentioned possibly as early as last year that the prices that South Africa pays for ARVs are significantly higher than all other countries. This has been confirmed by our international development partners and has been said publicly by the executive director of UNAIDS during his speech at the World AIDS Day event last year when he shared a platform with the President. This is despite the fact that South Africa has the largest ARV programme in the world. This just does not make sense. We must be able to purchase ARVs at the lowest prices as we are the largest consumers of ARV in the world and must benefit from economies of scale. If we continue doing what we have been doing the fiscus will be overburdened.
Honourable Members let me put it once and for all. There is no choice. We must purchase ARVs at the lowest possible cost from whatever source that can guarantee us the lowest prices, whether inside or outside the country!!!
I have to inform this House that this position has already generated some opposition from some of our local pharmaceutical manufacturers. They have claimed that this approach will result in some job losses. I believe this to be some sort of blackmail but I will never bow down to it!!! We need to understand that unless we take decisive action we will not overcome the challenge that HIV presents. This is why the new ARV tender specifications will be prepared in a way that opens the way for us to purchase ARVs at the lowest possible price. I will not comprise on this. Let me say however, that this policy position applies to Antiretroviral only and not to all other pharmaceuticals products.
Honourable Speaker, many people, especially the media focussed on one aspect of President Zuma’s speech on 1 December last year. In his speech he focussed on both treatment and the importance of prevention. As already mentioned we have commenced implementation of the new treatment guidelines. However the mainstay of our approach must remain prevention!!! As you have already heard South Africa will initiate the largest HIV counselling and testing campaign ever undertaken. The Cabinet has taken a decision on 10 March 2010 that the campaign is launched on 15 April with the President and Deputy President leading the campaign and being the first to test.
They have subsequently requested that the date be reviewed as they both would be out of the country on the 15th April. We have accordingly postponed the launch, both national and provincial, to a later date to be announced as soon as the Presidency is available.
This ambitious Campaign seeks to mobilise the majority of South Africans to get tested for HIV and AIDS. We aim to provide HIV counselling and testing to 15 million South Africans by the end of June 2011. I have been crisscrossing the country in recent weeks speaking to various constituencies to get them onboard. I can inform this house that all 17 sectors represented in South African National AIDS Council (SANAC) have thrown their weight behind this campaign. Several private sector service providers have also come on board to support us. These include: Pharmacy groups; medical aid schemes; hospital associations; groups of medical practitioners etc.
Honourable Speaker, in embarking on this massive HIV Counselling and Testing Campaign, we did not do it in a vacuum. We reflected on the findings of the special series of the prestigious medical journal, the Lancet of August 2009, which indicated that South Africa is facing a quadruple burden of disease consisting of:
* HIV and AIDS and TB
* High maternal and child mortality
* Non-communicable diseases
* Violence and injuries.
Taking the above into account, we decided to include in the campaign a focus on non-communicable diseases and diseases of lifestyles. Many of you here in this House are either faced with or will very soon be victims of these afflictions.
Apart from HIV Counselling and Testing, we will also screen for:
* Blood pressure
* Blood sugar
This means that by June next year we will know the status on all of these measures of 15 million South Africans. This will enable them to take better care of themselves, and enable the health system to better respond to their health care needs.
Leaders in all sectors are strongly urged to provide leadership during the HIV Counselling and Testing Campaign. Province-specific launches of the campaigns will take place following the national launch. Premiers have been urged and have agreed to take the lead in testing. Principals of universities have been requested to take the lead in testing in their respective institutions and they have agreed. All heads of department will provide leadership to their departments. Chief Executive Officers of hospitals have been requested to do the same in their hospitals. In churches, ministers of religion have been asked to lead their congregations in taking the tests. Traditional leaders and traditional healers have been requested to do the same in their communities. We also expect business people and captains of industry to take the lead in their respective businesses. Similarly, mine bosses and union leaders should lead this campaign.
In Parliament, we believe that the Honourable Speaker and the leaders and Whips of the different political parties will be the first to test and to lead this campaign and Honourable members are requested to do the same in their constituencies. I am sure that during this debate we will get all political parties pledging their support for the campaign.
Primary prevention will remain the mainstay of all efforts to combat HIV and AIDS. There are a number of interventions that we have to strengthen to ensure the success of our prevention programme. These include:
* The PMTCT programme that I mentioned previously
* Syndromic treatment of sexually transmitted diseases
* Massively increasing the number of male and female condoms that are distributed which must be used during each sexual encounter
* Medical male circumcision which was launched by his Majesty the King in KwaZulu-Natal this past weekend
* Decreasing alcohol abuse which increases risky sexual behaviour
* Behaviour change, including decreasing multiple and concurrent sexual partners.
To massively expand condom distribution has major costs implications, which extend beyond our resources. We therefore appeal to the Private Sector to assist in this regard.
Honourable members, one of the huge outcomes that must be achieved by the health sector is to improve the effectiveness of the health system. Our interventions in this regard will include:
* Revitalisation of infrastructure
* Improving quality of care
* Overhauling the health system
* Reducing the ever escalating costs of providing health care, both in the public and private health sectors.
With regard to the issue of Health Infrastructure, the department will implement a three-pronged strategy to accelerate infrastructure delivery. The first entails accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) especially for the construction of the Tertiary Hospitals. Construction or refurbishment of five tertiary hospitals will commence in 2010/11 and be completed in 2014/15. These are: Nelson Mandela Academic Hospital in the Eastern Cape; Dr George Mukhari and Chris Hani Baragwanath Hospitals in Gauteng; King George VIII Hospital in KwaZulu-Natal and the Limpopo Academic Hospital.
The second element of the strategy entails improving our primary health facilities. This process will be informed by the outcomes of the audit of primary health care infrastructure and services that will be carried out during 2010/11. The third consists of enhancing health technology and information communication technology infrastructure. The department will conduct an audit of essential equipment in all nine provinces, which will inform the finalisation of the national health technology strategy. Health technology maintenance, as a means to ensure safety will be prioritised. An information communication technology strategy will also be finalised and implemented.
In terms of quality of care, we will build on the milestones achieved in 2009, and implement various measures to enhance our people’s experience of our health services. We will support all health facilities to produce quality improvement plans, which will focus on turning around six key areas namely:
* Patient safety
* Infection prevention and control
* Availability of medicines
* Waiting times
* Positive and caring attitudes.
The national core standards for assessing the performance of health facilities have been revised extensively, and will be used to assess another cohort of facilities. We will also audit 25 percent of health establishments annually to assess if they comply with core standards for quality. This will be done with a view to accrediting those that meet the standards. Our health facilities will also conduct standardised surveys to measure the level of satisfaction of users of our services.
We will continue overhauling the health system. Our twin strategies for achieving this include refocusing the health system on primary health care; and improving the functionality and management of the health system. The primary health care approach remains the mainstay of our health system. We will re-invigorate this approach throughout the health system, based on the principles of equity; quality; efficiency; integrated and comprehensive care; community involvement and inter-sectoral collaboration.
To enhance the governance of the health system based on the primary health care approach we will work with all spheres to ensure that we have a single unified national health system as envisaged in the National Health Act of 2003.
Later in 2010, we will return to this House to table the National Health Amendment Bill, which will provide for a review of the powers and functions of both the national and provincial Departments of Health; facilitate the establishment of an independent office of standards compliance; and enable the review of the current position on the licensing of blood transfusion services. We hope to table the bill in September 2010. We will also table the Health Laws Amendment Bill, which will cover all important amendments to all Acts administered by the national Department of Health, to ensure that existing legislation enable us to implement government’s priorities, where it is found to be inconsistent with these policies.
Our other key interventions to revitalise Primary Health Care will include:
* Producing a Primary Health Care (PHC)-oriented service delivery model for South Africa
* Establishing PHC teams in each district to improve access to health care
* Completing the audit of primary level services and infrastructure
* Establishing Governance structures for all health facilities
* Improving the resource allocation for primary level health services.
In February 2010, the National Health Council, which consists of the Minister and Deputy Minister of Health and the nine provincial MECs for Health, accepted the Project Plan of the Development Bank of Southern Africa (DBSA) for assessing the functionality, efficiency and appropriateness of the organisational structure of our hospitals. This work has commenced. Based on the outcome of the assessment we will implement interventions to create, sustain and enhance an enabling environment for improving hospital management.
Honourable members, most countries globally are searching for strategies to reduce the costs of health care delivery whilst improving access and quality. The establishment of a National Health Insurance (NHI) system will go a long way to ensure this. Through NHI, we will ensure universal access to good quality and affordable health services for all South Africans. Our major objective of pursuing an NHI is to put into place the necessary funding and health service delivery mechanisms that will enable the creation of an efficient, equitable and sustainable health system for all South Africa with the ever widening gap between the rich and the poor, a gap regarded to be one of the biggest in the world, we have no option morally, economically, socially or otherwise but to move in this direction. South African needs it more than any other country that you can think of.
The budget of the health sector for 2010/11 to 2012/13
I shall now turn to the budget of the national Department of Health for 2010/11. The budget of the department grows by 16 percent from R18 billion in 2009/10 to R21,5 billion in 2010/11. Policy areas that received additional funding include:
* HIV and AIDS conditional grant
* Hospital revitalisation conditional grant
* Mass immunisation campaign for measles
* Strengthening the office of standards compliance
* Establishment of a provincial finance and budget support unit
* Stabilisation of personnel expenditure
* Improvement of the conditions of service for employees in the department, including the National Health Laboratory Service and South African Medical Research Council.
The department has also received donor funding from our international development partners, to address other priorities that could not accommodated by the national ficus.
Honourable members, in concluding let me take this opportunity to thank the many people that I worked with during the last year for their significant contributions to the process of turning around our health system. I wish again to pay tribute to the late Deputy Minister. The MECs for Health have played an invaluable role in ensuring that national policies are implemented by provinces. I wish to also thank the Portfolio Committee on Health ably led by the Honourable Dr Goqwana. My thanks also go to the many managers and health professionals in our health system for their sterling work often under difficult circumstances. Last but not least I wish to thank my family for understanding why I spend so much of time away from home.
Finally Mister Speaker, we believe that we are on course towards improving the health profile of all South Africans. As we have done today, we will return to this House in future to report on the milestones that we are achieving, in partnership with the people of South Africa. I request this House to approve the budget of the Department of Health for 2010/11 to 2012/13.
I thank you!!!
Issued by: Department of Health
13 April 2010