Deputy Minister Joe Phaahla: Health Dept Budget Vote 2017/18

16 May 2017

Deputy Minister of Health Dr MJ Phaahla Budget Vote Speech 2017

Honourable House Chairperson
Honourable Minister of Health Dr Aaron Motsoaledi Honourable Ministers and Deputy Ministers Present
Honourable Chairperson of Portfolio Committee for Health and Honourable members of the Committee Hon Dunjwa
Honourable members of The National Assembly Distinguished Guests
Ladies and gentleman

Thank you honourable chairperson for this opportunity to participate in this 2017 Budget Vote for the Department of Health. I wish to dedicate  my contribution to the memory of one of the most outstanding leaders of our struggle for freedom and democracy, Comrade President of the African National Congress from 1967 to 1991, Oliver Reginald Tambo who would have turned 100 years old if he was still alive .President O.R. Tambo stood for everything good in our society: selfless service, humility, integrity, honesty, always putting the people first. He was a scholar of science, teacher of mathematics but also an aspirant priest.

In his memory we must make sure that Universal Health Coverage is implemented as a means to improve the quality of health services to all our people.

According the 2015 report by Statistics South Africa on causes of the death, non communicable diseases continued their rise in ranking amongst the top 10 leading causes of death with diabetese mellitus moving from third in 2014 to second in 2015.

NCDS which contributed to the highest causes of death include diseases of circulatory system at 17,8%, respiratory system at 9.6%, Neoplasms at 9.1% and metabolic diseases at 6.9%.

Cancer

In terms of cancers the latest National Cancer Registry reports that the top five cancers in men are prostate at 18.45%, squamous carcinoma of skin at 10.43%, colorectal at 4.98%, lung at 4.72% and karposi at 3.2%.  In females the top five are CA-breast 21.79%, CA-Cervix 15.3%, CA Skin 6.94%, colorectal 4.14% and CA- Uterus 3.19%.

Our strategic Plan for prevention and control of non-communicable diseases 2013-2017 is coming to an end. We are therefore starting the process to review the impact and shortcomings so as to inform the new strategy to be launched in 2018. It is however quite clear that we need to improve our capacity to work with other role players including NGO's and private sector organisation in order to be able to:
 
a).  Increase awareness in society about the NCDS and measures to prevent them.
b).   Increase access to screening opportunities for early detection.
c).   Maximise access to effective, efficient and affordable means of treatment, including putting pressure on pharmaceutical companies to reduce prices of life saving cancer medications.

Access to care at all levels of the health system will be strengthened through the implementation of recently approved policies on breast and cervical cancer. These policies introduce access to essential medicines for treatment of breast cancer and appropriate technology for screening of cervical cancer to liquid cytology and ultimately HPV DNA testing. However noting prevention as best buy: South Africa's performance on implementing the HPV vaccine remains best practice globally. Vaccinating approximately 1 million girls against cervical cancer is an exceptional achievement.

As we do so we are aware that with our high burden of diseases and injuries, we must prioritise the Integrated Chronic Services Management Model which will also contribute to sustainability of more Ideal Clinics.

We are looking forward to the implementation of the tax on sugar-sweetened beverages by National Treasury which will help reduce high levels of consumption. We are in the process of amending the Tobacco Products Control Act and a proposed new Tobacco Bill which will strengthen regulations for tighter measures for creation of 100% smoke free Public indoor spaces. These will also lead to introduction of standardised Plain Packaging of tobacco products and also cover Electronic Nicotine and Non- Nicotine delivery systems.

Paliative Care

Honourable Chairperson and members we are pleased that we have joined only a handful of countries in adopting a National Policy Framework and Strategy on Palliative Care, which is based on a World Health Assembly resolution. This creates an enabling framework for the care of patients and families facing life-threatening illness, improving quality of life while maintaining dignity from time of diagnosis until death. The implementation of the policy will be overseen by a steering committee on Palliative Care chaired DR SM Dhlomo, MEC for Health in KZN who is an expert in this field.

Malaria

The Department of Health set the target of 0.2 malaria cases per 1000 population at risk for the 2016/17 financial year. Two of the 3 malaria affected provinces achieved the target with Mpumalanga recording an incidence of 0.20 and KwaZulu-Natal recording an incidence of 0.01 per 1000 population at risk. The Limpopo province had an incidence of 0.62 cases per 1000 population at risk. The key factor that could have resulted in the increase of cases were favourable climatical conditions for transmission in Southern Africa – this was evident from the good summer rains that we have received.

The National Department of Health in collaboration with the Provinces are responding to the increase in malaria cases by strengthening case management at the primary healthcare level: by insuring adequate stocks of diagnostic tests, drugs and training in front line healthcare workers. In addition malaria prevention is being scaled-up through community behavioural change programmes and focal Indoor Residual Spraying. Lastly the malaria programmes have set up screening and treatment mobile facilities close to the malaria transmission hot spots.

We are also encouraged to inform you that the Elimination 8 Initiative – malaria collaboration among 8  countries:  Angola;  Botswana; Namibia;  Mozambique;  South  Africa; Swaziland; Zambia and Zimbabwe is fully operational. We are hoping that this regional initiative will help curb the spread of malaria in the Southern African region.
Moreover, our collaboration with Swaziland and Mozambique, through the MOSASWA- Mozambique, South Africa and Swaziland Cross Border  Malaria initiative is bearing fruit. The intervention areas of Northern KZN and Swaziland recorded the lowest number of malaria cases in Southern Africa for the 2016/2017 financial year. This is particularly encouraging; hence we will be scaling up our efforts regarding the MOSASWA Cross Border Malaria Initiative in the 2017/18 financial year.

The South African Medical Research Council

The MRC continues to provide invaluable support to the health service system. The council plans to extends the 3 year memorandum of understanding with National Institutes of health in the U.S.A by two more years .This is to fund biomedical and behavioural health research in HIV/ TB and HIV- associated malignancies, and to build long term collaboration between the service providers, South African Universities and other Institutions. This collaboration is projected to make a significant impact on HIV and TB outcomes in South Africa.

The council has launched a three-year R30 million grand challenges South Africa programme on maternal, infant and neonatal health, in collaboration with the Bill and Melinda Gates Foundation, to identify innovations in gestational diabetes, perinatal haemorrhage, pre-eclampsia and neonatal survival. The council also collaborates with a number of other research partners, including the Newton Fund, the British Medical Research Council, GlaxoSmithKline and Canadian Institutes of Health Research. Expenditure growth on innovation and technology is expected to slow down to 2.5 per cent per year over the medium term

Council for Medical Schemes

The Council for Medical Schemes suffered a major blow this year when its newly appointed CEO Dr Humphrey Zokufa died suddenly after  only about three months in office. We again pass our condolences to his family. The process of finding a new CEO is quite advanced.

The CMS principal role remains the protection of the rights and benefits of members of medical schemes and their dependants. The Council will advice the department of health on the future role of medical schemes in a National Health insurance context and investigate any reported irregularities in the governance and compliance of medical schemes within the law. The Council has improved the turnaround time for resolving complaints from scheme beneficiaries and is aiming that by 2019-2020 85% of all complaints are resolved with 120 days.

The National Health Laboratory Service

The NHLS remains the main provider of diagnostic and other clinical laboratory services in the public sector. Notwithstanding administrative and governance challenges from time to time, the NHLS has remained dependable in providing these services.

The National Health Laboratory Service will, over the medium term, continue to conduct affordable, sustainable and high quality laboratory services to healthcare facilities, mainly in the public sector. The organisation will focus on the national priority programmes, created in 2010 to address the Department of Health’s need to increase access to patient testing, including HIV and associated opportunistic infections, such as tuberculosis, Cryptococcus and hepatitis. The organisation will also continue to provide a training platform for pathologists and other health professionals, and conduct research through the National Institute of Communicable Diseases and the National Institute for
 
Occupational Health, both housed within the service. These are seen as important contributions to the National Development Plan’s goal of improving the quality of healthcare services and controlling epidemics, and to the realisation of outcome 2 (a long and healthy life for all South Africans) of government’s 2014-2019 medium-term strategic framework.

Through the National Institute for Communicable Diseases and the National Institute for Occupational Health, and through its own research programme, the service contributes to research and development and provides a training platform for students of pathology. Altogether, these three programmes are allocated R2.8 billion over the MTEF period. A total of 242 registrars are in training to become pathologists and 27 intern scientists are in training to become scientists. In 2015/16, 27 pathologists and 10 scientists were qualified and the plan is to admit 35 registrars and 50 intern medical scientists per year over the MTEF period.

The South African Health Products Regulatory Authority (SAHPRA)

As of April 2017, the South African Health Products Regulatory Authority was established as a schedule 3A public entity responsible for the regulation of medicines, medical devices and radiation control. These functions are currently performed by the Medicines Control Council which will transition into SAHPRA during the course of 2017. The transition will allow SAHPRA to operate more independently and retain the revenue collected from the pharmaceutical industry.

Over time, SAHPRA aims to absorb some of the external evaluators as full time employees to enhance its capacity. By doing so it will reduce the current backlog of applications and gradually improve turnaround times for applications and priority products to 75% within three months 2019/20.

Once regulations for medical and diagnostic devices have been developed and gazetted in 2017/18, SAHPRA will also regulate these products and control certain non- medical products for hazardous radiation.

Emergency Medical Services and Forensic Pathology Services

The regulations relating to the provision of emergency medical services have been finalised after a wide range of consultations with both public and private sector stakeholders. These regulations will facilitate the standardisation of EMS in the country and will be promulgated this financial year.

We have also finalised the regulations relating to mass gatherings, also awaiting promulgation this financial and they will help in avoiding or dealing with related disasters at mass gatherings. We are working with the department of Telecommunications and Postal Services to fast track implementation of the 112 Emergency number.

We have reviewed regulations relating to rendering of Forensic Pathology Services in order to meet the needs relating to non natural causes of death and to fast track autopsy reports. These regulations will be promulgated together with revised scope of Practice Guidelines during course of 2017/2018. In the area of toxicology, the ministerial committee chaired by Prof. Gert Saayman has determined that we should move towards a more targeted analysis so that turnaround times can be reduced in finalising cause of death.

We are looking into the plight of Forensic Pathology Officers by establishing a career path in collaboration with the HPCSA. Regulations for their Scope of Practice are being finalised which will contribute to their professionalisation.

Trauma and injuries remain a major challenge in our health facilities and we are therefore making sure that our EMS personnel are well skilled to deal with this especially violence against women and
 
children. We will strengthen even more capacity of our health facilities to respond to violence against women and children and also in support of the Criminal Justice System. We are working with the Department of Social Development in implementing the Program of Action. We will also ensure that our facilities provide Post-Exposure Prophylaxis (PEP) for victims of sexual violence and ensure that evidence is taken to support successful conviction of offenders.

Eye Health

We have made notable progress on strengthening eye health services. We are confident that we will meet cataract surgery targets for the first time in many years. An Eye Health Policy has been developed and is currently being costed, which will enable majority of the indigent population to get the gift of sight. We are also addressing the problem of poor eye sight for children which becomes a barrier to learning at school

Nelson Mandela/ Fidel Castro Medical Collaboration

Honourable Chairperson and honourable members the Nelson Mandela / Fidel Castro Medical collaboration program continues to add value to the human resources capacity of our health services. We currently have 427 Cuban doctors deployed mostly in our rural health facilities with only a handful in Gauteng Province .520 Graduates from the program are in our services since inception and in July this year 53 more graduates will enter internship.

Currently a total of 2905 students are in the program in Cuba with 76 in the fifth year of study. An important shake up to our system will be in July next year (2018) when about 900 out of the current 919 fourth year students will come back home to complete their final year of study. This will be a big jump from the average of 70 who have been coming home each year. We are working with all the Medical Schools and the Provincial Health Departments to prepare for the intake and integration of this big number of final years. We have agreed with all stakeholders that this presents a challenge and an opportunity to fast track:-
a). The broadening of the training platform which will help to reduce the need to send large numbers of South Africans abroad for medical training.
b).  Will also provide impetus for us to speed up transformation of our undergraduate training system from the current city based hospi-centric approach to one based on Primary Healthcare approach.

We believe that if the bigger number of Cuban- trained doctors are properly utilised they can add lot of value to the implementation of the NHI with Primary Health as its foundation.

Honourable Chairperson , in this year of OR Tambo we believe that it is time to move our Health System radically forward the implementation of the NHI with Primary Healthcare as its foundation.

I thank you.