Honourable Chairperson
Honourable Minister of Health Dr Aaron Motsoaledi
Honourable Ministers and Deputy Ministers Present
Chairperson of Portfolio Committee for Health Honourable Dunjwa and Honourable Members of the Committee
Honourable members of the National Assembly
Distinguished guests.
A very good afternoon!
I am honoured to be here today to participate in the 2015/2016 budget vote for the Department of Health. Our budget vote debate takes place just over six weeks before we celebrate the 60th anniversary of the adoption of the Freedom Charter by our forebears at the historic Kliptown on 26 June 1955. The Freedom Charter became a beacon which guided us over decades of struggle for freedom and today is the anchoring vision of our country embedded in our constitution. This vision of the masses of our people is today the central foundation of the National Development Plan which in turn is the central directive in our Strategic Plans, Annual Performance Plans and our programmes.
Guided by the key policies already mentioned , in the remaining four years of this administration we will be focusing amongst our Key priorities on :-
i) Promotion of health and prevention of disease and thereby reduction of the burden of disease in our country.
ii) Accelerate progress towards Universal Health Coverage as we put in place the building blocks of the National Health Insurance and improve the readiness of our health facilities for its implementation.
iii) Re-engineering primary healthcare by amongst others increasing the number of ward based outreach teams , contracting of health practitioners, expanding district specialist teams and extending school health services.
iv) Improving health facility planning by implementing norms and standards.
v) Improving management capacity at all levels with a focus on human resources management, financial management, supply chain management and infrastructure development and maintenance.
Honourable Chairperson let me again remind this house that while South Africa, Africa and the world remain challenged by a wide range of infectious communicable diseases causing major epidemics these are not the only challenges. The epidemics grasp our attention and imagination because their threat to us is immediate as in haemorrhagic fevers like Ebola , various strains of Influenza such H1N1 and then the slow viruses such as HIV and AIDS. While these remain huge challenges which we must tackle I wish to remind us again of silent killers, collectively referred to as non-communicable disease. The reality we still face is that these category of diseases which to differing extends can be prevented or effectively managed through change of Lifestyle remain a major drain on our economy and health resources. Our principal strategy remains that of promoting prevention and in case disease has already set in expediting early detection and education on how to reduce the impact.
The non-communicable diseases can be broadly grouped into five categories:-
i) Hypertension and cardiovascular diseases.
ii) Chronic Kidney diseases
iii) Diabetese Mellitus
iv) Cancer
v) Mental disease
While the causative or contributing factors vary in some of them it is scientifically undisputed that common factors are:-
a) Poor diet
b) Use of tobacco in smoking or other form of usage.
c) Excessive use and abuse of alcohol which at times leads to use of prohibited harmful drugs.
d) Lack of adequate physical exercise.
The tools available to us as government in helping our population avoid or reduce the dangers of these disease are:-
a) Education and mobilisation
Over the past year we continued to build on previously laid foundation to educate the public often working with organisations of civil society and those specifically focused on awareness either broadly or focused on specific diseases .We want to take this opportunity to thank all those who have played an active role in the promotion of healthy lifestyles. Amongst personalities and organisations we worked with and hope to continue in this financial year is Pink Drive whose main focus is on cancers especially those affecting woman e.g. breast cancer and cancer of cervix and of late also focusing on prostate cancer. I want to take this opportunity to thank cricket South Africa and the Proteas National Team for dedicating one of their one day series games against the West Indies at the Wanderes Stadium on the 18th January 2015 to Pink Drive and Cancer awareness. We say to them even though you did not win the World Cup you remain our heroes and stars because of your social conscience.
I also wish to single out First Lady Mangema-Zuma for her championing of awareness on Diabetes Mellitus prevention and Management and first Lady Tobeka Madiba-Zuma for her championing of awareness of cancers especially those afflicting women. I must also thank and congratulate President Zuma himself for supporting the launch of the first annual '' Warriors walking for cancer ''. on the 28th February this year where he finished 5 km walk with no sign of sweat or effort.
There are many other big and small organisations which work with us in promoting healthy lifestyle in all respects of the contributing factors and we are going to continue working with them , including businesses who are ploughing back some of their profits into health promotion. We want to call upon businesses especially those in the health , food, hospitality and sport and leisure to come on board.
The next area of involvement is :-
b) Legislation and regulations
A lot of progress has been made in providing the necessary legislative and regulatory framework to protect the public from unscrupulous traders in the area of tobacco controls , salt reduction , control of trans fatty acids but a lot still need to be done including with respect to excessive consumption of sugar. With respect to tobacco a lot of gains have been achieved over the last years 20 years with the HRSC finding that adult smoking went down by 50% between 1993 and 2012. However research shows that there are still some loopholes in the current act but we are working on plucking them through amendment.
The elephant in the room remains the rampant excessive consumption and abuse of alcohol in our society. A lot has been said about the negative impact this has on our society. Work is still going on to thrash out a legislative framework tool to stop the glamorising of alcohol in our media.
The third and the fourth areas of our interventions are with regard to early detection of this diseases and management whether through behaviour adjustment such as dietary changes and/medical interventions where necessary. Organised programmes of screening are available in our primary health facilities but those have to be completed by outreach interventions including campaigns. In order to minimise on our limited resources we are now also promoting one stop screening services approach in which outreach campaigns to screen for communicable diseases such as HIV/AIDS and TB will include also a detection of NCDS.
Once people have been initiated on treatment the challenge is to make sure that they do not default and the common disincentive to compliance on treatment is long queues at our facilities. The Minister has already alluded to intervention we are making to make sure that for those who are stable there should be no need to come too often to health facilities to collect medications .
A few weeks ago we hosted a summit on ''effective approach to chronic kidney disease'' where the challenges of treating patients in end-stage kidney failure was brought into sharp focus. Amongst the participants were specialist physicians as well patients on dialysis and recipients of kidney transplants. The summit was a sharp reminder that we must do everything possible to reduce the dangers of causative factors leading to kidney failure because we are very lean on intervening in terms of haemodialysis facilities and finding donors for transplants. A strong message was that as South African we must do everything to promote organ donation for those in dire need.
Honourable members the overriding message is that we must do everything in our power to prevent NCDS rather than wait for cure when diseases have set in.
Honourable chairperson, meeting the needs of our most vulnerable people, the disabled is our priority. We are finalising a framework and plan for provision of disability and rehabilitation services. We want to be able to make assessments for wheelchairs, learning aids and artificial limbs possible at clinics and district hospitals. Information from our district health information system shows that of the 38 000 applications for wheelchair received in 2014, just under 22 000 were actually issued, giving us a 57% performance which is not good enough.
Honourable chairperson we managed to progressively increase the number of designated high risk individuals protected through seasonal influenza vaccination . In 2014 a total of 818908 people were vaccinated as compared to 706374 in 2012 and we are targeting a million recipients of the vaccine in 2015.
Still on epidemics, the Ebola virus outbreak in West Africa has prompted us to improve the capacity of our outbreak response teams at all levels, through the training of more than five thousands health professionals. Surveillance at ports of entry has been strengthened. We were also able to coordinate humanitarian support over and above the medical support to the affected countries .
Malaria is a vector transmissible disease in which we are doing very well with our focus still on elimination. We have seen a decline with 13986 cases in 2014 and 175 deaths compared to 64622 cases and 459 deaths in year 2000. We continue to work with neighbouring countries especially Mozambique and also the Elimination 8 initiative involving 8 SADC countries to move towards a complete Malaria elimination. We are strengthening malaria surveillance systems, tracking drug and insecticides resistance, increasing community awareness and increasing human recourse capacity.
Honourable Chairperson, in line with what The Minister has stated as the resolution of African Ministers of Health focused on strengthening health services delivery systems we have developed a plan to improve quality of care in our central, tertiary, regional and specialised hospitals. While we are quite clear that the rock on which an effective health systems should be built is the primary health service we have no illusion about the importance of strengthening our hospital services as well.
In order to achieve a good quality hospital services we have a plan to radically reform central hospitals management and governance. Our intention is that at the level of central hospitals the boards and management should be given the maximum possible delegations, to manage the resources of the institutions. We envisage a situation where central hospitals will operate as Cost Centre or Business Units with the boards and management being held fully accountable for the use of resources and revenue collection. A model which will be compliant with our legal prescripts is being investigated in this regard.
All our hospitals from central, tertiary, regional and specialised should adhere to national core standards established by the Office of the Health Standards Compliance. Five central hospitals were targeted for measurement of compliance. The outcome was that three of the five central hospitals ie. Steve Biko Hospital at 96%, Inkosi Albert Luthuli at 89% and Groote Schuur at 88%, were fully compliant with the national core standards and only Steve Biko was adherent to extreme measures at 100% and vital measures at 96%.
We still face challenges at tertiary, regional and specialised hospitals of the centralisation of operational decisions and non-functional governance structures but now, the policy is addressing this challenges.
We have however made progress in that in 2014/2015 we had targeted two tertiary hospitals to have full packages of tertiary one services but we have been able to gazzette four instead. In the 2015/16 financial year we plan to have all ten central hospital with the full delegated authority, four additional tertiary hospitals, with full tertiary 1 package also to have more central and tertiary hospitals fully compliant with the national core standards.
Honourable Chairperson we have published regulations governing the promotion of emergency medical services in the 2014/15 financial year. This regulations will enhance the importance of EMS by setting norms and standards of key service provision elements. We will now start inspection of ambulances and assess competencies of personnel. We have finalised policy on emergency care and education to improve the skills of EMS personnel; so that they are competent to deal with pre-hospitalisation of the ill and injured. We will fast track the process of establishing a national dedicated toll free emergency services number for emergency.
Honourable Chairperson and members , in the area of forensic pathology services we have seen improvement in the turnaround time for performance of autopsies. We have appointed a national forensic pathology committee to ensure that services are up to acceptable standards. The new forensic laboratory in Durban is now functional and will eliminate the need for blood samples in KZN and the Eastern Cape to be transported over a long distance to Cape Town and Pretoria.
Honourable Chairperson and members, the Department of Health has oversight over a number of schedule 3 public entities which we will briefly reflect on:-
A) THE MEDICAL RESEARCH COUNCIL
The MRC launched the flagship projects during the 2013/14 financial year and funding was awarded to 12 universities and 5 intra-mural research units. This funding covers a wide range of disease areas including HIV and AIDS, TB, Malaria, Cardiovascular, metabolic diseases, alcohol and drug abuse, women's health and the burden of disease. It is anticipated that these projects will produce 154 peer reviewed publications over the Medium Term, as well as to fund 64 Masters students, 39 doctoral candidates and 28 postdoctoral fellows .
The national health scholars programme was developed as part of department's human resource for health strategy with the purpose of supporting the education and training of 1000 doctoral candidates in health sciences over 10 years. To date the MRC has enrolled 54 scholars at the cost of R36 million from the Public Health Enhancement Fund. A joint venture between the department of health and various private sector partners most of whom are doing bursaries in the health sector. By the end of last month we were at five successfully completed degrees including 4 PHD's and 1 MSC. The MRC is confident that by the end of 2015/16 financial year there will be an additional seven completed PHD's over and above the current five. I am pleased to announce that tomorrow I will participate on behalf of Ministry and the department at the official launch of this programme at the S.A.M.R.C conference centre here in Cape Town, I hope honourable members are invited.
Honourable Chairperson and members, regulations related to norms and standards and procedures for the functioning of the office of the health standards compliance and its board were published in February this year. An interim CEO has been appointed to serve from April 2014 - July 2015. The OHSC has therefore commenced separation and is also working on the establishment of the health Ombudsman , who will investigate complaints received through call centre and issue findings and recommendations.
The compliance inspectorate which is the OHSCI largest programme grow over the medium to increase capacity so that it can move from the 401 facilities inspected 2014/15 to at least 738 in 2017/18 financial year while also carrying out reinspection of week facilities.
The council for medical schemes is continuing to protect medical schemes members and beneficiaries through proactive intervention, enforcing legislation, ensuring compliance and encouraging proper governance practices and promoting a financially stable medical scheme industry .In this regard, unfortunately the council often has to appoint curators through court actions, manages insolvent schemes and institutes legal proceedings to protect beneficiaries at high cost. Let me assure honourable members that CMS is at the tail end of dealing with matter which has been a lot in the media involving the registrar, this has not affected its functionality.
The national health laboratory services is an important institution for providing diagnostic laboratory services to our health facilities. It also provides training, education and supports health research. In order to address financial challenges in the NHLS, the budget council has endorsed a reform which will now see the national institute for communicable diseases, national institute for occupational health and the teaching, training and research function receive funding through a transfer from the department from 2015/16 financial year. This will result in the shift of funds from the HIV/AIDS conditional grant and equitable share back to department of health for the transfer to the above mentioned entities of the NHLS directly.
To even out matters the tariff schedules will be reduced since these functions were previously cross -subsidised through laboratory tests. The NHLS is also taking various measures to improve efficiency, cut duplication, wastage and improved performance.
Amongst the six statutory health professional councils we can only mention that we are in the process of addressing governance and management challenges being experienced by the HPCSA. A ministerial task team chaired by Professor Mayosi of UCT is investigating various allegations and will report back to the Ministry in due course.
CUBAN STUDENTS PROGRAMME
The Mandela Castro Bilateral Agreement has ensured that South Africa has Cuban trained specialists in remote, rural and undeserved areas of our country. In many instances, in some of these areas, our hospitals were totally dependent on Cuban doctors.
Since the inception of this agreement, South Africa has had the benefit of over 600 doctors from Cuba serving in South Africa. There are currently 196 Cuban doctors in South Africa mostly in rural areas.
The Cuban student training programme has already delivered 415 doctors to our country, a further 26 will graduate next month. In total there are currently close to 3000 South African students studying to become doctors in Cuba
I thank you all.
