Debate on the State of the Nation Address Minister of Health, Dr Aaron Motsoaledi
Honourable Speaker
Honourable Chairperson of the NCOP
Honourable President
Honourable Deputy President
Honourable Members of the House
Ladies and Gentlemen
Two years ago, Ministers of Finance of the Developing Nations around the globe were invited to Harvard University to debate the NHI. Yes, I said Ministers of Finance – Not of Health. And yes the topic was National Health Insurance or Universal Health Coverage as the World Health Organisation call it.
They were asked a very important question: What are the core functions of Ministers of Finance?
Of course they all rattled about facilitating economic growth of their countries to a higher percentage through macro-economic stabilization and all the other financial wizardry that Ministers of Finance engage in every day.
They were then asked to name a country that has been able to grow their economy with a sick workforce or a sick population.
Harvard was trying to show them that stabilizing health care system is a vital cork in the development of economies of the World.
It was hence pleasing Mr President that when you outlined the packages of State intervention in the mining sector, you appointed in the Inter-Ministerial Committee, among others, health.
I wish to assure you and the House that Health is ready to take up the challenge. It will then be important to outline the magnitude of the challenge to this House.
Mining has been a backbone of the South African economy for centuries and it will still be for many more decades to come.
Yet some of the major problems the sector has been experiencing have been persistent over a long period of long time. One of them is the very high – unacceptably high prevalence of TB in the mines.
Mr President, we now know that TB is the biggest killer in the country because 80% of the people who are HIV positive are actually killed by TB.
We have identified three (3) populations that are vulnerable to TB in South Africa.
Number one i.e. the most vulnerable of them all are the 150 000 inmates in the 242 Correctional Services facilities around the country.
The second most vulnerable group are the 500 000 mine workers who are sustaining our mining industry.
The third most vulnerable group are communities who stay around or next to mining operations – these are called peri-mining communities by the World Health Organisation. We estimate them to be 600 000 people around South African mines.
We have a very well executed plan which was launched last year at Polsmoor Prison by former Deputy President, Kgalema Motlanthe. I may like to talk about it some other day.
Today, let me concentrate on the mines because 70% of SONA has about the economy – appropriately so.
Mr President here is the big challenge:
There are 41 810 cases of active TB in South Africa mines every year.
It is 8% of the National total or 1% of the population.
It is the highest incidence of TB in any other working population in the world.
- 500 mine workers, plus 230 000 partners and 700 000 children are directly affected
- 20% of these partners and children are in Lesotho, Mozambique and Swaziland
- 59 400 orphans are currently in care as a result of TB related deaths in the mining sector
- 9.6 million work days are lost each year to TB
If you talk to any union leader about some of the hazards mine workers are faced with on a daily basis, he/she will immediately cite mining accidents.
Yes, mining accidents are very very emotive and evoke a lot of anger. After each accident, because many of them are so unnecessary and preventable we all explode in anger – and appropriately so.
But I wish to show the House the other side of the coin – I have already addressed mining union leaders and showed them this other side of the coin.
Let us take the year 2009.
In that year, 167 fatalities occurred in the mining sector due to mining accidents. But in the same year, there were 24 590 cases of TB in the mining sector which led 1 598 TB fatalities.
The gold mines are the most affected. In the gold mining industry in the same year, there were 80 fatalities due to mining accidents.
But the TB cases were 17 591 in this sector alone and it led to 1 143 deaths. Hence, for every death of a miner due to accidents, there are 9 deaths due to TB.
You can see Mr President, no way can we stabilize the mining sector without dealing with this scourge of TB.
But because we have been preparing for action the whole of the past year, we are combat really to face this challenge and halt this scourge.
Here is our plan Mr President:
Firstly, we have sent a bid to - a World-Cup like bid to the Global Fund to secure funding. Our plan was passed as workable and we were granted half – a – billion rand (R500 000 000).=
This money will be utilized to combat TB in the vulnerable groups I have mentioned, plus deal with the problem of MDR in the whole country.
Secondly, having received the money, we have identified six (6) districts in the country, that have a very high concentration of mining activity. These are: West Rand (Gauteng), Bojanala and Dr K.K. Kaunda (North West),
Waterberg and Sekhukhune (Limpopo) and Lejweleputswa (Free State).\The 600 000 peri-mining communities that I have earlier mentioned as part of the three identified vulnerable groups, reside in these 6 districts.
The third thing we have done was to massively deploy the newest technology for the diagnosis of TB. This is the GeneXpert technology. Mr President, the last time a diagnostic tool for TB was invented was 50 years ago. Hence for
he first time in 50 years, we have got a new technology that has revolutionalised the diagnosis of TB, by reducing the period of the diagnostic process from a week to only 2 hours.
Let me take this opportunity to report Mr President, that South Africa has deployed this GeneXpert technology more than any country on this planet.
Last year when I spoke to you, we had covered 80% of all public health laboratories in our country. Today I am happy to announce that we have now covered 100%.
Up to the end of December last year, 5.8 million tests using the GeneXpert technology were done globally. And 3.8 million of them were done in one country, that is South Africa.
This means that 65% of all global tests on the GeneXpert are conducted in South Africa.
The fourth thing we are doing, is a strategy to deal with all the other peri-mining communities but outside the high density mining activity which are found in the six (6) districts mentioned.
In each municipal ward, we are deploying outreach teams made up of a nurse and 6-8 community health workers. These teams are performing multiplicity of Primary Health tasks. These tasks include a lot of work on combating TB.
As of May 2014, we have deployed 1 634 outreach teams. In March this year, we tested the usefulness of this approach in the mining communities around Carltonville.
We reached 25 000 members of the community and piloted Screening of TB there. Out of this 25 000, 1110 were suspected and 883 were subjected to GeneXpert.
8% were confirmed to be having TB – they knew nothing about their TB status before this screening exercise.This Mr President proved the correctness of our approach, considering the fact that in the general population, prevalence of TB is 0,76% but as you can see, around this mining community of Carltonville, the prevalence is 8%.
The fifth activity we did was to integrate our plans in SADC. In March this year, under the leadership of Former Deputy President Kgalema Motlanthe, we invited Four (4) Ministers from each SADC country – Health, Mining or Minerals, Labour and Finance.
These Ministers came together in Sandton for a Summit about integrating TB in the mines around SADC because as I said at the beginning, mine workers in South Africa are from Mozambique, Lesotho, Swaziland and most of SADC countries.
Our aim President was to agree in three issues:
The first was that we need a common database of all mine workers with TB around the whole of SADC.
The second was that we need a common treatment protocol for all mine workers around SADC.
The third was that we needed to agree on referral systems of mine workers with TB, between the mining houses, the public health care system within other SADC countries and the South Africa Public Health System.
Apart from dealing with ordinary TB in the Correctional Services facilities, the mining sector, peri-mining communities and within SADC, we do have a problem of MDR or XDR. That is multi-drug resistant TB or extreme-drug resistant TB.
Around the World, the problem of MDR is huge within BRICS. It accounts for 60% of the global problem, and as you know, we are part of BRICS.
The problem of MDR has huge economic impact to any country, just by the sheer amount of resources needed to deal with it.
We have established 9 MDR facilities in the country, where infected people have to spend 18 months staying in that facility.
But this method of institutionalising MDR patients is not going to help us win the battle. We need a game changer. The same game changer that we deployed to deal with the scourge of HIV/AIDS.
You will remember that to put 2.4 million patients on ARVs, we had to train 23 000 nurses within a short space of time. This programme is called NIMART (Nurse-initiated management of antiretroviral therapy).
We need a “TB NIMART” whereby nurses will also have to be extensively trained so that we decentralise management of MDR into communities rather than in facilities. This decentralisation will be done at the level of our municipality wards. At the moment we only have 100 of such sites in various wards, and the intention is to increase to 2 500 ward level sites by 2016.
We wish to invite members of this House to help mobilize communities within their constituencies for this major task of reclaiming our mining communities from the jaws of TB.
Let me Mr President move to the other activity we are engaged in within the mining sector. If you go to the Labour sending areas like O.R. Tambo district in Eastern Cape, you will find a lot of former mine workers who have been sent home to die.
Many will have silicosis which they acquired in the mines but it only emerges 20 years after they have left the mine. Silicosis will predispose them to TB. In some the silicosis may develop into mesothelioma – a type of cancer of the covering of the lung which as we this House will know, has deadly affected one of our Honourable Members in this very House, even though of course he never worked in any mine. The point is that this type of cancer is more prevalent among mine workers who were exposed to silicosis.
To deal with this decades-long problem, we have decided to establish what we call 1 Stop Service Centres. These are highly specialised facilities which have three sections:
- one section is for the miner or ex-miner to receive advice about pensions, compensation and their welfare and welfare of their families. Some are unable to access these services because apart from remembering which mine they worked for for 20 to 30 years previously, they don’t have any other information at all.
- The second section of the 1 Stop Centre have high tech equipment like X-Rays, Spirometors to measure lung function because of the high levels of dust within the mines, and audiometors to measure hearing loss due to high levels of noise in the mining sector. These assessments are done by doctors and nurses specially trained in Occupational medicine.
- The third section will deals with rehabilitation of diseased and injured mine workers.
Some have lost their limbs and parts of their bodies have been left back in the mines where they worked some decades ago.
South Africa have only 40 (four zero) Occupational Health Specialists for working population of about 17 million people, which of course include this half a million mine workers.
Hence, it is very difficult for a mine worker to get specialist services anywhere and hence we believe that the 1 Stop Centres will provide this much needed care and support.
The 1 Stop Service Centres were established by joint teams from Health, Labour and Mineral Resources under the leadership of the former Deputy President Motlanthe.
We have selected four (4) key districts where this centres are to be launched:
- Mthatha in OR Tambo District – Eastern Cape
- Carltonville – Gauteng
- Kuruman – Northern Cape
- Burgersfort – Limpopo
The Mthatha and Carltonville 1stop centres have been launched in April this year.
We are busy with Kuruman and Burgersfort.
I wish to thank the Deputy Minister of Minerals Mr Godfrey Oliphant and former Deputy Minister of Health, Dr Gwen Ramokgopha for having been champions of this very useful 1 stop centres.
Mr President, you have also declared that the campaign to reduce Child and Maternal Mortality is to continue.
The NDP also concludes that we must provide quality pre-birth and post-natal services through a Primary Health Care approach.
As I have said earlier when dealing with TB in the mines, we are busy building and deploying teams of community health care workers in our municipal wards. They are already busy actively reporting data that they gather into the District Health Information Systems (which is used to monitor activities and plan health services).
There are teams in 43 of South Africa’s 52 districts. Of the 1 634 teams already deployed, the OR Tambo District in the Eastern Cape alone accounts for 680 teams. This is for obvious reasons which I do not need to repeat here.
Among the many services these teams will provide, will be to provide support to household mothers and children, including antenatal and post natal care.
This house already know the overwhelming success we have Achieved in reducing mother-to-child transmission of HIV and AIDS and our aim to move towards zero or at least to below 1% by 2015.
These teams are busy visiting households. In the 2013 Calendar year, they have visited 569 207 households in which there are approximately 2 million of the most deprived of our citizens.
In the first three months, this year, they had already visited 162 719 households. In this process they had encountered 47 461 pregnant women who they have referred to the clinics.
They also encountered 430 616 children under 5 years and dealt with advice regarding their health.
Mr President, in less than two weeks’ time, i.e. on the 30 June and 1st of July the government will be co-hosting an international forum called The Partnership for Maternal, Newborn and Child Health (PMNCH), with the World Health Organisation and other partners. This forum is chaired by our Mother, our own Mrs Graca Machel.
This global event will launch 3 plans:
- • Every Newborn Action Plan
- • Countdown to 2015 MDG report
- • State of the World’s midwifery (2014 report for the Africa Region)
A wide range of Organisations will put forward action plans to Reduce Maternal, Newborn and Child Mortality and will see Governments and civil society working together to achieve these very important goals.
South Africa will launch its own “countdown to 2015” in the woman’s month – August. During the launch, we will outline every step to be undertaken to reduce Maternal and Child Mortality in our country!
But for now, I can report that we are far advanced in our preparation to launch the MomConnect service. This will be a service whereby all pregnant women – there are 1 million of them every year in South Africa, in the public service alone. If we include the private sector, the figure moves to 1.5 million. This service will enable us to send sms messages to every registered pregnant woman. These messages will be sent at intervals of at least 2 weeks during pregnancy, and will continue for at least 1 year after the child was born.
The messages will be appropriate to their stage of pregnancy and will advise them on what to do at that stage. It will also advise them on how to take care of their newborn for that period of 1 year. This will be messages on growth monitoring, oral rehydration, breastfeeding, immunisation, food supplementation, and family planning.
We will attempt to make sure that all the messages are in all our 11 official languages. But at the launch this year, we will at least cover 6 languages.
Apart from us sending messages to them, they will also be able to send us sms messages about the problems they encounter when they try to access health services. They may also call to compliment the health facility if they think the service they received was good.
The Office of Health Standards Compliance (OHSC) has been established in January this year, after the Act was passed by Parliament late last year. This Office as you remember, will send inspectors to all health facilities without any notification, to inspect for cleanliness, attitude of staff, waiting times, safety and security of staff and patients, availability of medicines, and infection control.
The inspectors will then compile a report. All inspected health facilities will be graded into grades A, B, C up to F. The CEO or manager of such a facility, together with the Chairperson of the Hospital Board or Clinic Committee, will then have to call a public meeting and release the report to the members of the communities they serve. This will enforce accountability on the management of our health facilities.
The OHSC will also have an Ombudsperson, to whom complaints will be lodged by members of the community, if they believe they received a raw deal while accessing health services. This will also place responsibility on the shoulders of the managers of the facilities. Because the OHSC is still in its infancy stage, it is still laying down structures to perform this very difficult task.
Another programme that we are working on very keenly, is the Chronic Medication programme. Mr President, our health care facilities have started experiencing a high burden they are unable to carry. This high burden has resulted in very long waiting times at our health facilities. Some people blame nurses for laziness for these long waiting times.
Many members might have come across this problem during their election campaigns. I think it is very important for me to outline its root causes.
If you go back to 2004, we only had 400 000 people on ARVs. In 2009, the number more than doubled to 923 000. And today the figure is 2.4 million. This figure is 30% of the global figure. This means that 30% of all the World people on ARVs are receiving them from health facilities in only one country – and that is our country.
As you will have seen from the manifesto of the ruling party, this figure of people on treatment will move to 4.6 million in the next 24 months.
Add to these, the exploding number of people suffering from non-communicable diseases like hypertension, diabetes mellitus, cancer, and chronic lung diseases.
There is no way the number of health facilities, as well as nurses and doctors can ever grow at such a rapid rate.
Our solution is the Chronic medication programme, whereby patients who are not very ill, who do not have to be seen by a doctor or a nurse, will choose a doctor in a private practice, a community pharmacy, or a departmental store with pharmacy facilities, where they will receive their medication, and the government will supply it there.
I thank you
