Minister of Health, Dr Manto Tshabalala-Msimang, on behalf of the Social
Cluster
10 February 2006
We begin this year with a clear mandate arising out of the State of the
Nation Address that we should move faster to address the challenges of poverty,
underdevelopment and marginalisation confronting those caught within the Second
Economy.
We must sustain and improve the effectiveness of our social security system
targeted at providing a cushion of support to those most exposed to the threat
of abject poverty.
As the President said, Government is committed to respond with all necessary
seriousness and determination to all these challenges and play its role to give
new content to our age of hope.
We will achieve this by ensuring that the machinery of government, at all
levels, discharges its responsibilities effectively and efficiently, honouring
the precepts of Batho Pele and the Patients Rightâs Charter.
Health infrastructure
While progress is being made to improve primary healthcare (PHC) and
hospital infrastructure, we have to continue to pay particular attention to the
expenditure on capital projects. While Treasury have noted significant
improvement in this area this year compared to last year, we need to sustain
our efforts to increase expenditure. This relates particularly to the hospital
Revitalisation Conditional Grant where we need to ensure that we monitor and
assist provinces that are struggling to optimally use the allocated
resources.
We are also finalising the Hospital Improvement Plan, which should address
issues of maintenance of buildings, the provision and maintenance of equipment
and historical backlog as a result of neglect in psychiatric hospitals.
The Hospital Improvement Plan will also deal with issues of governance of
hospitals and improvement of the quality of care. Working together with the
provinces, we will determine additional authority that will be delegated to
hospital management to ensure that they are held accountable for the
functioning of hospitals by September this year.
We will also ensure that functional hospital boards support the hospitals in
responding adequately to the needs of our communities. We are conscious of the
fact that without a strong referral system with the PHC facilities as the main
entry point into the health system, our hospitals will not be able to cope with
the demand for services. The Plan will therefore seek to strengthen these
referral systems and encourage outreach programmes at both clinic and hospital
level.
Human resources
The functioning of the health system is dependent on the adequate supply and
equitable distribution of health workers. On 7 April, which is the World Health
Day, we will be launching the Human Resource Plan for Health. This document
will illustrate training needs for the country and outline interventions that
have to be made to improve the supply of health workers in the country.
We will be reopening some of the Nursing Colleges to improve output in this
area and the list of these colleges to be reopened will be finalised in due
course. The challenge we are addressing is the recruitment of tutors who exited
the public service. We are discussing with the Department of Public Service and
Administration to ensure that even those who took voluntary severance packages
can be considered as part of this recruitment drive.
We will be extending community service to cover nurses as the last group of
health professionals to participate in this programme.
The process of reviewing remuneration packages for healthcare professionals
should be completed this year and we hope that it will go a long way in
improving our ability to attract and retain health professionals in the public
sectors and rural areas in particular.
Tuberculosis (TB)
After playing a leading role in World Health Organisation (WHO) Afro
discussions on declaring TB a crisis and declaring 2006 as the year of
accelerated HIV prevention, we are ready to lead by example in implementing
these resolutions.
We have developed a TB Crisis Management Plan which will be formally
unveiled during the World TB Day on March 24. The Plan identifies at least four
districts that are facing the most challenges in terms of the prevalence of TB
and low cure rates. We are mobilising extra resources to ensure tangible
improvements in these districts while we strengthen TB control programmes in
all provinces.
We will be issuing a new tender for our Communication and Social
Mobilisation Campaign which is currently valued at R160 million. This campaign
should focus on improving awareness and TB cure rates and have messages
targeted at specific groups that still pose a challenge in terms of the
prevalence of HIV.
HIV and AIDS
This year, we want to ensure that prevention reassumes its rightful position
in the response to HIV and AIDS as we observe the year of accelerated HIV
prevention. Our aim is to increase the number of facilities that provide
Voluntary Counselling and Testing, Prevention of Mother-to-Child-Transmission
programmes and the management of sexually transmitted infections, especially
herpes.
We will continue the care and treatment of those who are infected and
affected through the Comprehensive Plan for Management, Care and Treatment of
HIV and AIDS. At least 374 000 people have benefited from the nutrition
component of this programme. An accumulative number of people initiated on
antiretroviral therapy in the 229 accredited sites in the country was more than
100 000 by the end of December 2005. Concerted efforts have to be made to
strengthen our patient information system to ensure that we are able to track
patient compliance and establish the impact of this programme.
The Department has increased the annual budget allocated for the support of
non-governmental organisations (NGOs) involved in the response to AIDS and TB
from R49 million in 2005/2006 financial year to R56 million in 2006/2007. Close
to 70 organisations had applied for this funding by the closing date on 6
February.
These NGOs work in the following areas:
* Governance and Programme Leadership
* Community Home Based Care
* Treatment Adherence Counselling Including TB Directly Observed Treatment
Strategy
* Voluntary Counselling and Testing Services
* HIV and AIDS Life Skills Programme including peer education.
We have had an honour of being invited by The Joint United Nations Programme
on HIV/AIDS (UNAIDS) to be members of Global Steering Committee that is
assessing global progress in responding to HIV and AIDS since the adoption of
the UN Declaration of Commitment on HIV and AIDS in 2001. South Africa chairs
the working group on sustainable financing of prevention, care and treatment
within this Steering Committee.
Access to medicine
We will make additional resources available for the research and development
of traditional medicines which have the potential to add much value in the
management of HIV and AIDS and other diseases.
We will continue our efforts to make medicine more affordable. The Pricing
Committee and the Department of Health has consulted extensively with
stakeholders on the issue of the dispensing fee that can be charged by
pharmacists.
I expect the Pricing Committee to make recommendations to me on the revised
dispensing fee for medicine during the course of this month. After considering
their recommendations, I will announce a draft dispensing fee which will be
open to public comment. We will consider the comments and make final
determination of the new dispensing fee.
We appreciate the co-operation we have received from the major players in
the retail pharmacy industry in this process. We are determined to set a
dispensing fee that meets the government objective of making medicines more
affordable, but also ensure that the country maintains a viable retail pharmacy
industry.
Consultation process is underway and we should be able to finalise the
Charter for the Health Sector. Improving access to health should also
include efforts to reduce the overall cost of private health care including
hospital fees.
Healthy lifestyle
Much work has been done to make South Africans to be more conscious of the
importance of caring for their health. This has included efforts to promote
regular physical activity and good nutrition while discouraging risky
behaviours such as smoking, alcohol abuse and unsafe sexual practices.
Through the healthy lifestyle awareness campaign, we want to deal with most
of the main causes of ill-health and death in the country which can be grouped
into three categories:
- Communicable diseases (such as HIV and AIDS, TB and Malaria)
- Non-Communicable diseases (such as Diabetes, Cancer and Hypertension);
and
- Violence and trauma
We will sustain this public health campaign by combining the use of the
media for raising awareness and encouraging more utilisation of health
screening services to enable the prevention, early detection and management of
diseases such as diabetes, breast, cervix and prostate cancers. We will also
extend these efforts to areas such as foot care and dental therapy.
We continue with our tobacco control efforts and South Africa has been
selected to be the co-ordinator of the African group on health matters and in
the WHO process of implementing the Framework Convention on Tobacco Control. We
will also be tabling in parliament the amendments to the Tobacco Control Act
aimed at tightening some of the loopholes in the Act and increasing fines for
non-compliance.
We should be able to move ahead this year with our efforts to highlight the
negative health social effects of alcohol by putting warning labels on the
container of alcoholic products.
Work has already commenced to look at the state of readiness of our
Emergency Medical Services to handle the 2010 Soccer World Cup event. We will
be reporting further on this matter during the course of the year.
While we call on our people to take care of their health, the state has a
responsibility to create a healthy environment and to improve access to basic
services that enhance good health.
Access to safe water
Government is committed to ensuring that everyone in South Africa has access
to functioning basic water supply services and that everyone has access to a
functioning basic sanitation facility by 2010. Government is also committed to
the eradication of bucket systems in formal settlements by 2007.
In 1994 15.9 million people out of a population of 39.8 million people did
not have access to basic water supply. By April 2005 Government had provided
clean safe water to a total of 15 million people (population growth of 1.98%
per annum amounts to 48.1million total population), which include those served
at higher levels than the basic level of service. Of this 10 million people
were served with a basic water supply service to Reconstruction and Development
Programme (RDP) level.
The current backlog for water supply as on 1 April 2005 is 3.7 million
people who have no access to any form of water supply infrastructure plus 5.4
million people who have some access but who have to be brought up to a basic
level of service (RDP level). The water supply target for 2006/07 is that 1.5
million people be provided with basic water supply.
In Minister Sonjicaâs budget speech in 2005 she referred to a national
survey, which reflected that 63 % of municipalities could not confirm whether
they complied with drinking water quality standards. Following the outbreak of
typhoid in Delmas Department of Water Affairs Forestry (DWAF) followed this up
with a more detailed survey and the development of a monthly reporting system.
This information will be audited by DWAF regional offices.
In cases where drinking water quality does not meet the standards DWAF will
provide the necessary support. A most successful program is already running in
the Free State where this program of monitoring, audits and support has
rectified many problems and compliance has risen remarkably.
DWAF as the national regulator for water services will report on the
performance of all municipalities through a report to be published in April
which will tell the public where we stand with Drinking Water Quality as well
as other performance indicators.
The Free Basic Water programme is making a huge difference to the poor,
(defined as households with less than R 800 income/month). 15.2 million poor
people are receiving Free Basic Water (FBW) via formal infrastructure, some
with infrastructure slightly below the basic level. A further 4 million have
infrastructure and although they do not yet have a formalised FBW
administrative system in place, are getting their water free. Thus in total
19.2 million of the 22.4 million, (85%), poor are getting their water free of
charge. In total 35,3 million people or 73,46% of the population (48 081 483)
are receiving free basic water.
Proper sanitation
With regards to Sanitation services, in 1994, 20,4 million people out of a
population of 39.8 were without adequate sanitation services.
By April 2005, with an estimated population of 48,1 million (population
growth of on average 1.98 % per annum), the backlog is estimated at 16 million
people (3.9 million households). The target for 2006/07 is to provide 300 000
toilets serving an estimated 1.2 million people.
2,3 million people have been reached through the health and hygiene
programme. The sanitation backlog in schools has been reduced from 4300 in
September 2004 to 2505 by December 2005.
By 2007 the bucket system will be eliminated in formal settlements in the
country. This amounts to approximately 231 000 bucket toilets that need
to be replaced with adequate sanitation.
The Sanitation Job Creation Programme was officially launched in Limpopo in
December 2005. Training of the Limpopo Municipal Managers and DWAF
District Water Services/Sanitation Managers on Sanitation Planning within the
context of Health and Hygiene is soon to take place.
Support to municipalities
The Departmentâs support to the municipalities comprises the following:
* Planning support with regard to Integrated Development Plans (IDPs) and
the Water Services Development Plans (WSDPs)
* Monitoring of the water purification and wastewater treatment works
operations
* Facilitation of project selection, feasibility studies and service level
options
* Support with regards to implementation of the tariff structure and FBW
policy
* Support for Section 78 process (division of powers and functions for water
services between district and local municipalities) and selection of Water
Services Providers
* Training of councillors and officials in water services and water demand
management
* Resource mobilization to support municipalities.
Forestry
Forestryâs contribution to the second economy is through the facilitation of
small growers into the forestry sector as well as the facilitation of new
afforestation especially in the Eastern Cape and KwaZulu-Natal. The growing of
trees in these areas will add to the economy, as well as providing employment
and entrepreneurial opportunities to the local people.
The Department has been involved in planning for the expansion of forest
areas in the Eastern Cape, where most forestry opportunities are available and
where the local rural economy needs stimulation very badly. A Strategic
Environmental Assessment has been conducted in the Eastern Cape and it shows
areas for new afforestation, which is being pursued.
It is estimated that at least an initial 30 0000 hectares of land could be
afforested and that possibly this could be increased to more than 150 000
hectares of land once the project gains momentum. The areas could
accommodate small growers and community afforestation if correctly planned and
it could expand the broad base of black people engaged in forestry.
Within KwaZulu-Natal, options for new afforestation also exist and conservative
estimates shows between 30 000-40 000 hectares suitable for this purpose. This
will create substantial employment opportunities in the Eastern Cape and
KwaZulu-Natal.
The Forestry Broad Based Black Economic Empowerment Charter process was
launched in 2005 and the final charter should be completed in the first half of
this year.
The core business of the Working for Water programme is to contribute to the
sustainable prevention and control of invasive alien plants. In doing so, it
addresses poverty relief and promotes economic empowerment and transformation
within a public workâs framework, therein seeking to further develop the second
economy.
Since Working for Waterâs inception in 1995 it has cleared more than one
million hectares of invasive alien plants providing jobs and training to
approximately 25 016 people per annum from among the most marginalised sectors
of society. Of these, 52% are women.
Working for Water currently runs 303 projects in all nine of South Africaâs
provinces. Short-term contract jobs created through clearing activities are
undertaken, with the emphasis on endeavouring to recruit women (60% target),
youth (20%) and disabled (5%).
Government will continue with its programme of ensuring all South Africans
have access to basic services including health, water and proper
sanitation. No group should be excluded. Free Basic Services play a
vital role as it ensures that all South Africans have access to basic
necessities.
Issued by: Ministry of Health
10 February 2006
