Republic of South Africa, by Deputy Minister Nozizwe Madlala-Routledge,
MP
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
