at the Human Rights Commission Hearings on Public Health
30 May 2007
Chairperson
Deputy Chair of the Human Rights Commission (HRC), Professor Ngwena
Colleagues from the health sector
Ladies and gentlemen
Thank you for the opportunity to address you today as we reach the end of
this very valuable three-day exercise. I should first express my appreciation
to the Commission for facilitating this session which has provided yet another
platform for engagement on health.
The hearing is building on the work that we are also doing through Izimbizo
and the National Health Consultative Forum, as well as through mechanisms like
public hearings and public comments, both oral and written, on all proposed
legislation and major policies, in order to engage with communities and
stakeholders on the best measures to be taken to achieve our vision of a better
health for all.
Let me also express my appreciation to the various stakeholders that have
taken their time to prepare submissions, and to make oral representations in
the last three days, and even those that have been in attendance to listen and
to participate in these discussions.
I am sure Chairperson that you and your panellists have had a feel of the
interest our people have in matters of health, as well as the robustness and
the passion with which they engage in these issues.
Chairperson, before I get to the substance of what I have to say a response
from government, allow me to challenge the Commission, and indeed all of us, to
think very carefully about how in future we ensure that the voice of the people
for whom the service is meant are represented much more than at this
hearing.
I am always concerned that what we term public hearings, tend by and large
to be hearings from a few expert groups, who though they may have all the
analytical tools to enable them to speak eloquently on these matters,
nevertheless cannot in all honesty claim to be speaking for the majority of the
people who are affected by the experiences of either realisation or violations
of their human rights.
Chairperson, it is also not my intention to respond to each and every
stakeholder that has made representations here. I only want to respond to the
broad themes that have emerged throughout these hearings.
Let me begin chair by stating categorically that this government is
committed to the realisation and the protection of all the rights that are
enshrined in the constitution, and in this case, those enshrined in Section
27.
We agree as government that as our Constitution enjoins us, we need to see
these rights in a positive light, meaning that we are not merely expected to
protect them, but we are enjoined to take positive steps to ensure their
realisation.
We further agree that the Constitution talks about "the right of access to
healthcare servicesâ¦" which are provided within the context of other rights
such as the rights to equality, human dignity, life, housing, and food, water
and social security, etc. In this regard it is therefore appropriate for this
inquiry to focus on access to services as such.
I have stated these two points in order to underline the fact that our
understanding of this process is that it is not meant to test or measure
whether and to what extent the government is committed to ensuring access to
health services as enjoined by the Constitution. Nor is it meant to put the
Commission in judgement over our commitment to these rights.
I would therefore not agree with the stakeholders that have given the
impression that following these hearings the Commission must hold the
government bound to certain methodologies of policy development, or budgeting
for the realisation of the right to healthcare services.
I would rather we saw this as a process of engagement, which may and should
allow the commission to make some recommendations based on its conclusions
after this process.
We have taken the view that some aspects of our Constitution, such as the
concurrent powers, if not dealt with in our jurisprudence as we build our
democracy, will create more difficulties for us in future. This matter is
explained very well in the chapter on the right concerning health, co-written
by one member of this panel, Professor Ngwena, in a 2005 book on
"Socio-economic Rights in South Africa.", details of which I will leave to the
said esteemed member of the panel to provide to those interested.
In this chapter Ngwena and Cook present an analysis of the extent to which
the courts in different cases took a conservative or interventionist view to
this issue of separation of powers. There will still be more cases that will
come, where this matter will still arise, because it is a matter we are all
still grappling with. There is nothing wrong or untoward with a government
using constitutional means, such as the courts, also to clarify these
matters.
More importantly perhaps, all laws, including the Constitution as the Supreme
law of our land, are subject to interpretation. The Constitutional Court is the
final arbiter on matters of interpretation of the constitution.
Therefore, when other people exercise their right to approach the
Constitutional Court, using resources available to them from whatever source,
for relief from a particular interpretation by government, we as government
have the same right to approach the court to present a contrary view.
This therefore should never be construed as government's reluctance to
ensure the realisation of the rights enshrined in the Constitution, as has been
suggested by some of the inputs.
The second matter I would like to deal with is the one raised by yourself
chairperson, and supported by some stakeholders, that of needs based approach
to budgeting. Again let me solicit the assistance of Professor Ngwane here, by
quoting from the chapter I have alluded to above: "Healthcare is competing with
other sectors, such as educational and social welfare where there was equally a
legacy of long years of neglect and gross inequality. However committed the
state might be in effecting radical transformation on egalitarian lines, in the
short term, it must be conceded that the South African economy does not have
the capacity to render a comprehensive and universal system of healthcare
delivery" (page 150).
All the matters referred to in this quote by Professor Ngwane are driven by
the Constitutional imperative. The question that arises then is; do we need to
get into an exercise, which will be very expensive and costly, of determining
for all these areas and others the extent and the resource requirements of the
backlogs, in order to determine needs based budget for the realisation of the
rights in the Constitution?
The other challenge you would face, Chairperson, is the process of defining
and agreeing on the package of services you would regard as meeting the
Constitutional standards. It is my submission Chairperson, that policy choices
and budget processes must be left to government. This then allows for
contesting views from various constituencies to input, influence, and even act
in any other legal ways, to ensure that they are listened to by government.
That is democracy.
The third broad issue I would like to address Chair relates to the many
horrifying and sad stories we heard during these hearings, including the ones
presented by the children's sector. As Minister of Health and I am sure I speak
on behalf of the MECs, I am appalled at some of the stories of neglect and lack
of care for human life that is demonstrated by these incidents. I agree with
the presenters that if these are reflective of a general malaise in our system,
then we have a long way to go.
May I appeal to the presenters and the commission to let us have the
information about these incidents, so we can act on them. Nevertheless let me
hasten also to say that we have many, many, many unsung heroines and heroes in
our public healthcare system. Their stories do not find platforms like these
for articulation. As a result our health professionals, who continue to do
excellent work even under difficult conditions, get painted in the same brush
as these few individuals who have lost a basic sense of Ubuntu.
I want to link this to my comment about statistics and information. One of
the things we did in the process of developing the National Strategic Plan was
to invite those that have some contribution to make to statistics to share that
within an ongoing process.
The figures that were presented during these hearings point to the need for
some form of control of the point of reference for official or generally
accepted statistics. Issues such as infant mortality rates, maternal deaths,
etc were presented with figures that look strange to us in government. I am
told this issue was raised by officials from my department during the
discussion. I want to urge the Commission to engage with us further on this
issue before using figures that may be completely baseless.
Chairperson, there are many other broad issues I could have responded to,
but time does not allow me to do so. Let me just address myself to our
perspective as government on the main question as I understand it. The main
question is to what extent has the state taken measures to ensure the right of
access to health. Since the constitution talks of progressive realisation of
this right, we can debate forever the pace and effectiveness of the measures
taken by the state in this regard over the past 13 years.
I must mention upfront that we move from the understanding that the people
of South Africa are today better off in terms of access to healthcare today
than they were before 1994.
Since 1994, Government sought to shift the health system from a curative to
preventative approach with primary healthcare playing a significant role and
serving as an entry point into the health service. I am sure the Commission
appreciates that this was a major ideological shift which had to gain momentum
both within the health sector and amongst our communities.
In line with this new approach, we introduced free primary healthcare for
all and built more than 1 500 clinics to increase access in underserved areas.
These clinics are linked to a network of hospitals allowing the patients to be
referred up and down depending on the required level of care. Many of these
hospitals themselves were debilitated and required an estimated R10 billion
capital investment in 1996 to bring them up to an acceptable level.
In protecting vulnerable groups, we also introduced free healthcare for
pregnant and lactating women, children under six and people with disabilities,
all of these, we believe, have increased access to healthcare. I am glad that
this hearing also addressed issues of maternal and child health, the elderly
and people with disabilities which I think are critical.
While we made all these changes in the health system, our society was also
changing. Changes in lifestyles have had an effect on disease burden. We see an
increase in non-communicable diseases as a result of poor nutrition and lack of
exercise and high levels of violence and trauma many of which are associated
with alcohol and substance abuse. Social conditions of poverty,
underdevelopment and migration have provided favourable conditions for spread
of communicable diseases such as tuberculosis, HIV and AIDS.
An international phenomenon of recruitment of health workers from developing
countries to developed countries has had a major effect on our ability to
retain and distribute our human resources in an equitable manner. The issues
rose in the HRC report on overcrowding, long waiting times, high workload and
other symptomatic manifestations happened because the people historically
excluded from health service delivery now have better access to the services.
It is common knowledge that the preventative interventions require long-term
sustainable implementation before desired returns can be realised. For
instance, our emphasis on HIV prevention over the past 13 years is only now
beginning to show stabilisation of HIV prevalence in the country. Actually
Chairperson, the latest Antenatal Survey Report that is going to be released
soon reflects that there is a statistically significant decrease in the
prevalence of HIV in the country.
Chairperson, we have attentively listened to a number of presentations on
the major challenges of inequity in resource allocation between the public and
private sectors. It has been demonstrated how access to private health services
remain stagnant (medical scheme coverage remaining at seven million for several
years) while the costs continue to escalate.
These have also demonstrated the over-concentration of services in the
private sector which outstrips the demand, e.g. bed occupancy of only 53% and
over-procurement of expensive equipment with equipment/population ratio that is
higher than most of developed countries.
Chairperson, the Department of Health has made efforts to address this
situation what the chairperson described on Wednesday as "over-servicing the
healthy while under-servicing the needy". Sure, dear colleagues, this cannot be
right.
You also asked Chairperson whether the proper regulation of private health
sector can bring benefits to the public health sector and the general public in
need of healthcare. The answer is yes.
Extending health insurance coverage for instance, will ensure that those
outside of the medical scheme targeted market will be covered. Over time, this
will increase the revenue base for the public health sector. But above all, the
health of the entire nation will be assured. Painfully though, our efforts to
improve access to affordable, quality medicine have been met with fierce
resistance from some of the stakeholders. Pharmaceutical companies, dispensing
doctors and some groups of pharmacists have independently taken us to court to
fight against the Medicines Act which seeks to improve access to affordable,
quality medicine. It has been an uphill battle which we hope to overcome.
We rely on the National Health Act to address other cost areas in the
private health sector and to promote equitable distribution of health
resources. As mentioned in one of the presentations here, "the market cannot
always accommodate people's needs. It has other people that it is accountable
to - the shareholders not the constitution."
We therefore invite all stakeholders who are concerned about access and
quality of healthcare in the country, to address the challenge of inequity
between the public and private health sector.
In conclusion Chairperson, I would like to once again to thank the HRC for
initiating this dialogue. It is clear that we have made significant progress in
ensuring that our people are aware of their rights and are able to use various
forums to ensure that these rights are promoted.
These hearings have indeed served to help us refocus on gaps that might be
present in our system. We appreciate this a great deal. Our vision of a better
health for all has been deepened. Let us work together towards achieving this
goal and we thank you all.
Issued by: Department of Health
30 May 2007
Source: Department of Health (http://www.doh.gov.za)
