National Consultative Health Forum
19 July 2007
Programme Director
Colleagues from the provincial Departments of Health
Representatives of civil society
Ladies and gentlemen
It gives me great pleasure to be standing in front of you to officially open
the 2007 National Consultative Health Forum. Firstly, let me thank you all for
taking time to be with us for this important dialogue on the progress and
challenges towards the attainment of the Millennium Development Goals (MDGs).
We chose to dedicate this year's National Consultative Health Forum to the MDGs
for a very obvious and yet important reason. As you know, July 2007 marks the
midpoint between 2000 when the Millennium Declaration was signed and 2015 which
is the target year for all of the targets set out in the declaration.
To provide a short factual context to the Millennium Declaration, delegates
will recall that the six key values that underpin the declaration. These are:
freedom, equality, solidarity, tolerance, respect for nature and shared
responsibility. With respect to equality the declaration states: "No individual
and no nation must be denied the opportunity to benefit from development. The
equal rights and opportunities of women and men must be assured."
And on the value of solidarity: "Those who suffer or who benefit the least
deserve help from those who benefit most." I am sure you will agree with me
that in many respects, these values are incontrovertible. The challenge of
course is to practice them. The declaration also lists a number of resolutions
on a range of matters, including peace and security, development and poverty
eradication, protection of the environment, human rights and democracy,
protecting the vulnerable, meeting the special needs of Africa, and so on.
It is within the resolutions on development and poverty eradication that the
health and health related MDGs are listed. Clearly, the Millennium Declaration
recognised the link between health and development. A healthy nation is central
to development. Of course development provided that the benefits are shared and
that the poorest of the poor benefit also contributes to a healthy nation.
We must remember though that development, if it is measured in increased
income for example, can also lead to poor health outcomes. There are developed
countries that spend more than 15% of their Gross Domestic Product (GDP) on
health but still have a serious obesity problem as well as other 'diseases of
excesses.' This illustrates the need for societies to challenge practices that
generate both diseases of poverty and diseases of excesses.
Let me again quote the Millennium Declaration: "We will spare no effort to
free our fellow men, women and children from abject and dehumanising conditions
of extreme poverty, to which more than a billion of them are currently
subjected. We are committed to making the right to development a reality for
everyone and to freeing the entire human race from want." This is a very noble
goal, to which I am sure we all subscribe.
For us as the health family gathered here, the question is how do we
contribute to this noble goal? Recently, many public sector workers, including
some in the public health sector, went on strike action. Now, it is clearly the
right of workers to withdraw their labour should this be felt necessary to
support the demand for wage increases. However, health is an essential service
which means that health workers cannot by law abandon health service delivery
and go out on strike.
What was even more disturbing is the level of intimidation and acts of
violation of patients' rights shown by some of the striking workers. It is true
to say that their lack of concern for their professional values did impact
negatively on patient's lives and patient care. We need to all put our heads
together to think about how this can be prevented in future.
In addition, we need to think about how the post strike environment can be
managed in ways that build new values in the workplace. These are values that
will ensure that better quality of care is provided to our people, especially
the poorest of the poor.
It might be argued that the employer also needs to review what else can be
done to improve labour relations in general and the working environment of our
health workers in particular. By employer, I am referring specifically to the
public health sector but it can be argued that this applies also to the private
health sector as well.
As you know the Department of Health has a number of measures in place to do
just this. Perhaps the pace of implementation of these interventions is not
fast enough for all of us. Soon after the 1994 democratic elections, we
commenced with a clinic building and upgrading programme, more than 1 500
clinics have been built or upgraded thus far.
In 1999 we started with a hospital refurbishment programme, which was later
renamed the hospital revitalisation programme. This programme seeks to
completely revitalise our hospital stock within a 15 year time horizon, guided
of course by the availability of resources. The programme focuses on new
buildings, new equipment, strengthened management and improved quality of care
among others.
We already have stateâof-the art tertiary hospitals in the form of Inkosi
Albert Luthuli, Nelson Mandela and Pretoria Academic Hospitals and ten other
hospitals have been completed in the past three financial years. We currently
have 46 revitalisation projects with 30 already on site and 16 in the planning
stages. We hope to complete the following hospitals during this financial year:
Mamelodi Hospital in Gauteng, Worcester Hospital in the Western Cape, Rietvlei
Hospital in KwaZulu-Natal and Barkley West in Northern Cape.
Programme Director, ladies and gentlemen, allow me to draw your attention to
another area of healthcare delivery that is equally important. I am referring
here to the issue of human resources development. I am confident that most of
you have been following developments around our efforts to increase the human
resources for health in order to enhance health care delivery.
Amongst other things, we introduced community service, starting with
doctors. In January 2008 the first group of nurses who graduate at the end of
this year from the four-year programme will begin community service. We also
introduced a number of new mid-level categories like the pharmacy assistants.
With respect to remuneration we introduced the rural and scarce skills
allowance a few years ago.
However, we have reconsidered this strategy based on experiences and
interaction with all of the stakeholders in the process. Instead we have
decided on occupation specific remuneration systems, starting this year as I
announced last Friday in my meeting with CEOs of hospitals from across the
country. As you would have heard in subsequent reports, the recipients of this
occupation specific dispensation will be those in the nursing profession.
Of course all of these strategies need to be accompanied by at least two
things: The first is a health professional who values her or his work and puts
patient and the health of the community first. We need to apply our minds as to
how we can produce and nurture this type of health professional.
Secondly, we need to strengthen our management practices and systems in the
health sector, including our ability to manage our human resources. If 60-65%
of our health expenditure is on human resources, clearly we need to be
investing more in the management of this asset. There are simple things that we
can and in fact must do to ensure that our facilities function optimally. For
example, we have to ensure that ward rounds are done, detailed patient notes
are kept and instructions are followed.
Doctors that are on call should not disappear and leaving junior staff to
fend for themselves. The nurse in charge of the ward should account to the
nursing service manager for what happens in the ward. Support staff should do
their work and professional staff should not be doing porter and clerical
work.
The clinical director of a facility has to ensure that clinical audits are
done and that corrective measures are implemented. The heads of our
institutions have to be delegated the authority and responsibility necessary
for them to effectively and efficiently perform their work. The provincial
Health departments have to provide support to these facilities and the national
department should support provinces.
We need to ask the human resources working group to interrogate all of these
things and develop recommendations for the National Health Council to
consider.
Let me now turn to the health programmes. As a developmental state, we must
invest in prevention of diseases and health promotion. This implies that we
need to mobilise our communities and work more closely with other government
departments whose activities contribute to health, such as Education, Water
Affairs and Forestry, Social Development and Housing to name a few.
Equally we must also work with departments in the economics cluster to ensure
that our economic policies generate the type of development that is conducive
to promotion of good health.
We need to work hard at community level to generate greater social cohesion
between individuals and groups. In many communities the social fabric appears
to be coming apart and we see the consequences in increasing inter-personal
violence, mental illnesses, abuse of women and children, alcoholism and use of
illicit drugs. We need to work harder, outside the walls of the clinics and
hospitals to ensure that we rebuild our communities thus strengthening our
nation.
Without pre-empting the deliberations of this meeting, I am confident that
South Africa is making reasonably good progress in reaching some of the MDG
targets. Our best data from two demographic and health surveys (one conducted
in 1998 and the other in 2003) suggest that with respect to child health, our
infant mortality rates are around 45 to 1 000 live births. While this mortality
is very low compared to other countries in the region, we feel that the death
of any baby is one death too many.
In protecting our children, we have implemented several immunisation
campaigns which have resulted in the overall immunisation coverage increasing
to 83%.
In addition, our country has been declared as being polio free by the Africa
Regional Certification Commission which is a sub-committee of the Global
Certification Commission.
Another strategy to improve child health is to provide vitamin A
supplementation. Currently 100% of infants between 6 and 11 months of age
receive vitamin A supplementation. In addition, we extended the implementation
of the community and household component of the Integrated Management of
Childhood Illnesses strategy to 67% of health districts. Forty-two percent of
public health facilities with maternity beds have been accredited as baby
friendly. In addition, we have expanded the Prevention of Mother to Child
Transmission Programme to 90% of public health facilities.
We have made progress in the area of child and adolescent health as well.
Infants aged 12-59 months receive vitamin supplementation, more than 40% of our
health districts implemented the Youth and Adolescent Health Policy guidelines,
and 89% of health districts implemented phase one of school health
services.
The department established a Confidential Inquiries into Maternal Deaths
Committee to investigate every maternal death in public hospitals. We are in
the process of implementing the recommendations in 85% of public health
facilities that have maternity units. Equally, the department is intensifying
programmes on womenâs health including increasing access to cervical cancer
screening to prevent invasive cervical cancer.
With respect to HIV and AIDS, we have announced that the 2006 antenatal
survey results show a statistically significant decrease in the prevalence of
HIV amongst pregnant women who use public health facilities. This is mainly as
a result of our continued focus on prevention as the mainstay of our response
to combat HIV and lead to an HIV free society. The full report of Antenatal
Survey, which will for the first time cover information of district, will be
released at the end of this month.
We have developed the National Strategic Plan for HIV and AIDS for 2007/11
which builds on the gains of the Strategic Plan for 2000/05. We are doing
everything within our power and means as the Department of Health to contribute
to the successful implementation of the National Strategic Plan.
Programme Director, whilst the MDGs are a significant point around which all
of us must rally and which as a country we must try to achieve, we have to be
aware of the omissions in some of the targets. This relate particularly to the
fact that that the MDGs are silent on non-communicable diseases and injuries
and trauma and that many countries, especially those that may not reach the
targets, do not have reliable baselines and health information. I will
therefore encourage delegates to also consider these issues when you discuss in
you commissions.
In conclusion, chairperson, while we engage in robust discussion around the
many issues relating to the MDGs, we must also ensure that at the end of these
discussions we distil out some key interventions that this forum would like to
propose. For my part I shall take your proposals to the National Health
Council, which meets on 23 to 24 August for further discussions and
decisions.
I wish all of you fruitful deliberations
I thank you!
Issued by: Department of Health
19 July 2007
