Policy debate speech on the Health budget vote delivered by the Minister of Health, Dr Aaron Motsoaledi at the National Council of Provinces (NCOP)
Honourable Chairperson
My Colleague Deputy Minister of Health, Dr Joe Phaahla
My Colleagues Ministers and Deputy Ministers present
Chairperson of the Select Committee on Social Services, Honourable Dlamini
Honourable Members of the Select Committee on Social Services
My Colleagues MECs from various Provinces
Honourable Members of the House
Distinguished guests
Good afternoon!
Honourable Chairperson, I am presenting this Budget Speech at the time when the world, through the United Nations General Assembly, is on the verge of ushering a new and promising era in healthcare. The end of this year signals the end period of the eight (8) Millennium Development Goals (MDGs) declared by the United Nations in the year 2000.
A new set of goals, called Sustainable Development Goals, or SDGs will be declared. It is generally believed that MDGs 4, 5 and 6 are unfinished business and need to continue and become part of the SDGs.
As you know, MDG 4 is about reducing child mortality, MDG 5 is about reducing maternal mortality and MDG 6 is about reducing HIV and AIDS, TB and Malaria. As South Africa, we have spoken a lot and dished out a lot of data and outlined programmes related to MDGs 4 and 5. On MDG 6, we have also engaged a lot on issues of HIV and AIDS and Malaria.
Today, I want to engage on issues pertaining to TB. When the President presented his State of the Nation Address (SoNA) early this year, he gave instructions in this regard.
Let me remind you of these instructions by quoting directly from SoNA:
“Over the past five years, Government has scored significant gains in healthcare. This year, we are going to launch a massive programme to turn the tide against Tuberculosis (TB), with special focus on three vulnerable communities, offenders at Correctional Services facilities, Mineworkers and communities in mining towns.”
Just how big is this problem of TB in our country?
StatsSA has reported that TB is number one underlying cause of death in South Africa. Of course we know that 80% of deaths of HIV positive people are attributable to TB.
As is now common knowledge, Ebola is now regarded as the biggest scourge health systems around the world have had to contend with in recent times. We all know that West Africa was the hardest hit.
Everybody was scared and deeply fearful of what would happen to them and their families. At the height of this fear last year, I shared a platform on National TV with Prof Shabir Mahdi, the Director of the NICD (the National Institute of Communicable Diseases).
He advised South Africans not to be unduly scared of Ebola because the likelihood of contracting it are very slim. He said however if you are a South African, be more scared of TB because you are very much likely to contract it. The public’s response to him on TV through social media was swift and brutal. They accused him of misleading the Nation. Some even ventured that he is trying to fool them because he believe that they know nothing because they are not professors. Such was the public’s response to his advice.
Who had it right? Well, a year after Prof Mahdi gave that advice, nobody in South Africa died of Ebola, but 40 000 people died of TB. But I am afraid this still does not ring a bell in many people’s mind.
Honourable Chairperson, the figure of 40 000 is actually a massive improvement from a figure of 70 000 of people who died of TB back in 2009. So there has been a massive drop of TB deaths by as much as 43%.
Regardless of this massive improvement and progress, TB is still very much the biggestkiller. This is not only in South Africa. We share this problem with 21 other Nations around the world. Together with these Nations, we make up 80% of the total TB of the world.
The five (5) BRICS countries alone constitute 56% of the TB of the world and 60% of MDR-TB (Multi-Drug Resistant TB).
Honourable Chairperson, in July 2013 I was elected the Chairperson of the International Board of Stop TB Partnership during a Board meeting held in Canada. Our offices are in Geneva, Switzerland.
Our job as a Board is to devise strategies to combat TB, under the auspices of the WHO (World Health Organisation).
Since “charity begins at home”, I thought that I must lead the Board by example and make sure that South Africa is ahead of the pack in implementing programmes to combat and stop TB.
Honourable Chairperson, I wish then to dedicate my speech today, to the fight against TB in order to free our country of this scourge.
We have analysed the situation very well and we hence understand the task at hand.
Our analysis shows that there are three (3) groups who are typically vulnerable to TB:
- Inmates in Correctional Services facilities – 160 000 of them;
- Mine workers, especially those working in Gold mines – 500 000 of them; and
- People who stay in peri-mining communities – about 600 000 of them in six (6) districts with intense mining activities.
Hence we wanted to know, which districts have a very high prevalence of TB based on those three known groups of vulnerable people.
Our analysis and figures further show that the first district, i.e the worst affected is:
- Lejweleputswa in the Free State, i.e around Welkom – Virginia;
- The second worst is Kenneth Kaunda district in North West, i.e around Orkney – Klerksdorp area;
- The third is Waterberg in Limpopo, i.e around Lephalale;
- The fourth is Westrand in Gauteng, i.e around Carletonville;
- The fifth is Bojanala district, also in North West, i.e around Rustenburg;
- The sixth district is Sekhukhune in Limpopo, i.e around Burgersfort.
On 24 March this year, on World TB Day, the Deputy President of the country, Mr Cyril Ramaphosa launched the biggest TB screening programme the country has ever seen. This launch took place in Orkney.
It is extremely important for people to be screened for TB and those found positive to be promptly treated if we are to defeat this pandemic.
I want you to understand as leaders how the screening is being conducted so that you should participate and lead communities by imparting information and directing people where to go.
In the six (6) districts I have mentioned, all the people in Correctional Service facilities are being screened in these facilities.
All the people in the mines are being screened inside the mines themselves. We have hired nine (9) inspectors who are moving from mine to mine to make sure that screening of miners is indeed taking place.
For the rest of the people, we have screening teams moving around these peri-mining communities. If you are not sure where to find the teams within the district, you may go to the nearest health facility – a clinic or a hospital.
The screening may be done orally by asking four (4) key questions, or done through the new GeneXpert technology or the new digital mobile XR equipment we have just acquired with money from the Global Fund.
I wish to inform this House that the new GeneXpert technology introduced to the world very recently has brought a new revolution in diagnosis of TB. For the past 50 years, we used to rely on sending sputum for microscopy to a laboratory and wait for the results for at least a week. Now with the GeneXpert, introduced in South Africa in March 2011, we wait for only 2 hours – no longer a week!!
For MDR-TB, we used to wait for three (3) months before we make the diagnosis, but with GeneXpert, there is no more three months waiting period, we wait for only two (2) hours!!
I am happy to announce that in terms of this GeneXpert testing, South Africa is numberone in the whole world with GeneXpert coverage.
By December 2014, out of 10,1 million tests conducted worldwide on the GeneXpert, 6 million were conducted in South Africa alone – i.e South Africa did 60% of the world’s tests!!
Up to so far Honourable Chairperson, in the peri-mining communities of the six (6) districts I have mentioned, we have screened 252 843 people. Our inspectors have found that 88% of the mines are now routinely screening miners for TB.
We know that the 252 Correctional Services facilities are clustered into 48 prisons management centres. A total of 90% of these centres are now routinely screening for TB.
We have deployed 164 councillors and 36 data capturers to these centres.
In each of the seven (7) biggest Correctional Services centres we have deployed a GeneXpert 16 which can test 16 inmates at the same time. These seven (7) make up 30% of the Correctional Services population – hence we targeted them.
These are Kgosi Mampuru, Barberton, Johannesburg, Groenpunt, Pollsmoor, St Albans and Durban-Westville.
The remaining are linked to GeneXpert machines in the National Health Laboratory Services.
We have also deployed three (3) mobile digital XR machines, each costing R1,5 million to screen inmates for TB.
Because of these efforts Honourable Chairperson, we have already screened 167 462 inmates – this was not routinely done before 2013.
We have tested 66 862 inmates on the GeneXpert whereas before 2013 we only did 6 000. Hence our screening increased more than 10 times in only two years.
Of the 66 000 tested, 3 887 inmates have TB and 176 have MDR-TB.
They have all been initiated on treatment!!
After completing screening in the 6 districts as mentioned, our next screening programme will go to all the 8 Metros.
From the Metros, it will go to the 4 Provinces that are responsible for 70% of the TB of the country. These are KZN, Western Cape, Eastern Cape and Gauteng.
Coming to the MDR- and XDR-TB Honourable Chairperson, these are new worries for the world and we take them very seriously.
I have already mentioned that 60% of this MDR-TB is in the 5 BRICS countries, with 25% in Europe especially Eastern Europe, with the remaining 15% scattered all over the world.
In South Africa, by 2014, we had 350 000 people with TB, out of which 11 000 had MDR-TB and 700 XDR-TB.
Our biggest worry is that every person with TB can infect 15 others in their lifetime. Even MDR- and XDR-TB can be spread in this direct manner.
Hence we take their eradication as an extremely serious and urgent matter.
In 2009, we used to have a total of nine (9) central sites in our country in which we were isolating and treating people with MDR- and XDR-TB. We have had to decentralise and manage MDR- and XDR-TB in communities.
Today, we now have 298 decentralised sites, with 272 satellite sites and 150 injection teams.
We have 135 nurses who have been trained and are able to initiate treatment for MDR-TB in these decentralised sites in the absence of a Doctor!!
Honourable Chairperson, these efforts have borne some fruits.
In 2009 our TB treatment success rate was only 76,6%. However, by 2014, I am happy to announce that we had reached a success rate of 82,5%. Of course the World Health Organisation’s target figure is 85% and as you can see, we are heading there very fast.
Honourable Chairperson, for 50 years, the world had relied on the same drugs to treat TB. However, there is now a new drug – very 1st one after 50 years, to help treat MDR-TB. It is called bedaquiline and we in South Africa moved very fast to procure it and make it available to MDR- and XDR-TB patients.
In the entire world, there are only 600 patients on bedaquiline and I can confirm that 60%, i.e 361 of them, are receiving their bedaquiline in South Africa alone!! In fact South Africa is the only country that has the drug available programmatically – for the rest of the world, it is only accessed if you register yourself for a clinical trial or other research platforms.
Honourable Chairperson, it takes us six (6) months to treat one MDR-TB patient with bedaquiline at a cost of R9 000.00 per patient within that 6 months period. Regardless of these expenses, we decided to aim very high.
Our target is that by the end of this financial year, we will have increased the number of patients on bedaquiline by 840% to 3 036.
We wish to work hard to reach this target!!!
Honourable Chairperson, on 29 May 2015 we launched a very important project for mine workers in our country. We launched it at Carletonville in Gauteng.
This project, was a follow-up to another milestone project we launched in Mthatha and Carletonville.
This is how the projects came about. As I have said, mineworkers, especially in the Gold mines, are generally vulnerable to TB.
The MBOD, or Medical Bureau for Occupational Diseases, works together with CCOD or Compensation Commissioner for Occupational Diseases. These two units function within the Department of Health and provide services for current and ex-mine workers.
The CCOD’s main objective is to compensate workers for occupational lung diseases. The MBOD makes the diagnosis first and refers to the CCOD for compensation. The key diseases are silicosis and chronic obstructive lung diseases. Associated with silicosis is TB.
- If you are HIV positive, your chances of getting TB increase 3 times;
- If you have diabetes, your chances to get TB increase 5times;
- If you are HIV positive but you also acquire silicosis, your chances increase 18 times.
Silicosis is very common in the Gold mines and it commonly affects you 20 years after you have left the mine. Hence, compensation must be for current mine workers and ex-mine workers.
It means that ex-mine workers ought to be screened continuously even 20 years after they have left the mine. You are aware that this was not being done except for white mine workers who were screened every two years after leaving the mine.
The CCOD hence developed huge backlogs of compensation and was almost dysfunctional.
However two years ago, we started a process of turning around this unfortunate state of affairs in the Compensation Commissioner’s office.
We brought in new management and together with the Ministry of Mineral Resources and Labour, we launched in April last year, One-Stop-Centres.
The 1st Centre was launched in the labour sending area of OR Tambo district in Mthatha – Eastern Cape.
The 2nd one in West Rand in Carletonville in Gauteng.
These One-Stop-Centres serve current and ex-mine workers in 3 ways:
- Screen for silicosis, TB or any occupational lung disease. The centres are well equipped with XR machinery spirometersand CT scans to diagnose and also assess lung function;
- Treat the worker and rehabilitate those that need rehabilitation;
- Help those who need compensation with data to claim their compensation money.
Honourable Chairperson, I am happy to announce that this work did bear some fruits.
Since its inception last year, the Mthatha side has serviced 4 000 ex-mine workers and the Carletonville side has serviced 3 500 workers and ex-mine workers.
Secondly the new management of CCOD has been able to analyse more than 200 000 files. That verification process yielded 105 000 mine workers and ex-mine workers who qualify for compensation.
We worked very hard with the mining houses, to raise that compensation money and I am happy to announce that the 105 000 current and ex-mine workers are being compensated for R1,5 billion.
We worked together with 5 unions – NUM, Amcu, Numsa, Solidarity and UASA as well as the mining houses and together, on the 29 May we launched project Ku-Riha to start compensating the workers.
Note that 56% of those compensated are being compensated for TB!!
The mine workers who are being compensated by Project Ku-Riha are not only South African, but also from SADC countries especially Mozambique, Lesotho, Swaziland and Botswana.
But there are those who are from Europe, especially, Italy, Spain, UK, Poland and other parts of Eastern Europe.
Our next step Honourable Chairperson, is to launch a One-Stop-Centre in Kuruman in the Northern Cape and in Burgersfort in Limpopo. You will understand why we chose those two areas.
The other step is to verify 500 000 files of mine workers for possibility of compensation.
During last week’s World Economic Forum held here in Cape Town, I announced an amount of R1,2 billion from Global Fund and the World Bank to help combat TB in the mining sector within SADC.
We will spend part of that money to put up One-Stop-Centres in our neighbouring countries which were mostly labour sending areas, in order for them to also benefit for compensation.
But above everything else Honourable Chairperson, we have a task team consisting of the Departments of Health, and of Mineral Resources, the mining houses and the 5 Unions I have mentioned earlier, to work around the clock for us to bring to Parliament new laws that must protect mine workers from acquiring these occupational diseases – especially TB.
This is our ultimate goal!!
I thank you!
