N Madlala-Routledge: Consultative Meeting of African, Caribbean and
Pacific countries

17 March 2006

Distinguished Chairperson;
Your Excellencies Ambassadors;
Honourable Members of the European Union (EU);
Distinguished delegates;
Ladies and gentlemen

It is an honour and a privilege to be afforded an opportunity to address
this forum today. Let me start by conveying sincere apologies and well wishes
from my colleague, Deputy Minister of Social Development, Dr Jean Benjamin. She
would have loved to join you and contribute at this important consultation,
however, she had to attend to an urgent ministerial obligation in Cuba.

Chairperson, I would also like to take this opportunity to commend the EU on
the strategy for Africa. We are also certain that this quantum leap in
EU-Africa relations will not in any way negate nor relegate EU co-existence
with other ACP areas namely the Caribbean and Pacific regions.

It is imperative that developing countries maintain the momentum by actually
engaging the EU with specific projects. The issue of EU-African Union (AU)
strategic development partnership should not be allowed to fade into background
of the 2005 December ACP-EU Council of Ministers meeting. Development cannot
wait for the realisation of good governance and democratisation processes.

Development is the result of the process that has been emerging, growing and
developing over the years. The use of this process as a precondition to
development assistance programmes would only be counter productive and a
negation of progress made so far. Also the African Renewal Programme is not
only about Africa but the entire African Diaspora at large, especially in the
developing world.

We look forward to the successful completion of the partnership agreement
between the EU and all the regions of ACP. In the Southern African Development
Community (SADC) region, South Africa is driven by the integrationist approach
that seeks to align the bilateral trade and development co-operation agreement
(TDCA), the Southern African Custom Union (SACU) and the SADC EPA processes
towards a customs union in 2010 and monetary union by 2015.

The SADC-EU partnership agreement objectives are classic examples of a
vehicle that would, among others, foster the realisation of the Millennium
Development Goals (MDGs) with progress and prime challenges such as health
facilitation throughout the developing world. In South Africa the fundamentals
are correct because we have the political will which is strengthened by the
people’s will as guided by our Constitution. Our Constitution has the Bill of
Rights which deals with among others health, security, gender, and etc. Chapter
2 of the Constitution stipulates basic human rights that have a direct positive
bearing on the status and lives of women. South Africa undertook to adhere to
the principles established at the Convention on the Elimination of all forms of
Discrimination Against Women (CEDAW), the International Convention on
Population Development (ICPD) and Beijing +5 to improve the status and health
of women.

In addition, South Africa has committed to deliver on the MDG three of which
are directly health related. These are:
* Goal 4: Reduce child mortality
* Goal 5: Improve maternal health
* Goal 6: Combat HIV/AIDS, malaria and other diseases

When our country became a democratic state in 1994, many Acts and policies
were put in place to improve the lives of South Africans, especially those of
women and children. We also implemented the Reconstruction and Development
Programme (RDP), which emphasised the need to improve access to basic services
and the development of all the people of South Africa.

In dealing with maternal, child and women’s health issues, the South African
Department of Health has directorates with a multitude of programmes that
impact on the well-being of the women, men and children of South Africa. These
are:

Women’s Health and Genetics – this unit facilitates, supports and
strengthens implementation of programmes such as family planning, choice on
termination of pregnancy, prevention and management of cervical and breast
cancer, prevention and management of sexual assault, promote and encourage
men’s involvement in reproductive health, maternal health services,
confidential enquiries into maternal deaths, prevention of mother to child
transmission of HIV (PMTCT), perinatal care, prevention and management of
genetic defects and disorders and biotechnology (human cloning, etc).

We are currently working towards addressing other reproductive health
concerns such as menopause, sub-fertility/infertility, other female
malignancies such as ovarian cancer and intersex.

Family Planning - Contraceptive prevalence rate is 61% in South Africa and
is considered as one of the highest in the African Region. There is, however, a
big discrepancy in contraception usage between urban and non-urban women with
women in urban areas more likely to use contraception. In addition condoms are
freely available to all for not only pregnancy prevention but also prevention
of sexually transmitted infections (STIs) and HIV. There is, however, a
significant unmet need for contraception, which is mainly reflected by high
teenage pregnancy rates and requests for termination of pregnancy. The
Department of Health is working with the Population Council to assess the best
method of integrating voluntary counselling and testing for HIV in North West
Province.

Termination of Pregnancy (TOP) - Access to TOP services has improved
remarkably and requests for TOP services continue to increase annually. In 2004
about 70 000 women accessed TOP and 62% designated facilities were functional.
The facilities offering TOP are mainly hospitals (~90%) with only about 10% of
services offered by primary health care services. Access for women in rural
areas is poor as most hospitals are located in urban areas. A study was
commissioned to evaluate the health impact of the Choice on Termination of
Pregnancy (CTOP) Act 92 of 1996 in 2000. The results showed that whilst the
incidence rate of incomplete abortions remained unchanged, there was
significant reduction in morbidity from complications of incomplete abortion
compared to a similar study conducted in 1994.

In addition, through the confidential enquiries into maternal deaths, there
has been a reduction in deaths resulting from unsafe terminations of pregnancy.
Most of the deaths occurred in women resorting to unsafe termination of
pregnancy in the second trimester. Although we have had success with the
implementation of the Act, there are challenges that we are grappling with such
as shortage of staff, conscious objection and legal issues.

In addressing these challenges, we successfully amended the Act in 2005. The
CTOP Amendment Act 38 of 2004 provided for improving access to services
by:
* Allowing registered nurses, who have undertaken the prescribed training, to
render TOP services
* The designation of TOP facilities will be a provincial function of the
respective departments of Health and
* All 24-hour Maternity and Obstetric Units will automatically be designated
TOP facilities.

Cervical cancer screening - About 1 500 women die from cervical cancer
annually in South Africa making cervical cancer a significant public health
concern. One of the World Health Assembly’s resolutions of 2005 had specific
focus on preventable malignancies and cervical cancer is one of them. Currently
cervical cancer screening coverage is very low at about 1% of the target
population (women 30 years and above). Ideally the annual target should be at
least seven percent of the target population. A study conducted by Professor
Lyn Denny found that 90% of white women and only about five percent of black
women have had a Pap smear.

Challenges with implementation of the programme include inadequate
allocation of resources, limited number of trained service providers, poor
quality smears, limited laboratory capacity, poor communication and feedback
between clinics and laboratories and between levels of care, lack of reliable
client follow-up systems. A strategy has been developed to address these
challenges. Training of programme managers and health care providers is also
being addressed.

Maternal Health - Access to antenatal and delivery services is high in South
Africa with antenatal coverage reported to be about 94% and supervised
deliveries by trained healthcare providers 84%. Maternal mortality is however
high estimated at 150/100 000 live births indicating concerns with the quality
of care afforded to women. We have developed policy and management guidelines
for common causes of maternal deaths. All facilities are encouraged to have
protocols for common conditions easily accessible to healthcare providers when
providing care to pregnant women and their neonates. These enable healthcare
professional to provide quality care to pregnant women and neonates. South
Africa has also made maternal deaths notifiable and instituted confidential
enquiries into maternal deaths. Facility based morbidity and mortality reviews
occur at facility level and currently about 30% of facilities where deliveries
take place conduct morbidity and mortality meetings. Guidelines have been
developed to facilitate the process.

Confidential enquiries into maternal deaths - Maternal deaths were made
notifiable in 1997 in terms of the National Policy for Health Act, Act No. 116
of 1990. The aim of notification is to facilitate collection of information on
the circumstances under which the deaths occur as accurately as possible. This
also provides an opportunity to learn from these mishaps and ensure that
similar mistakes do not happen thus leading to reduction in maternal deaths.
South Africa is first on the continent to establish a national system for the
notification of and confidential enquiry into maternal deaths. The notification
of maternal deaths and the subsequent confidential enquiry has highlighted the
problems within the health system. The process of notification and enquiry
needs to be strengthened through the support of the assessors as well as
improving the information management for these officials. Implementation of the
recommendations from the confidential enquires process should lead to
significant reductions in maternal deaths.

As South Africa we identify with strategic actions as set out in the
Sino-African Co-operation Concept Document which seeks to achieve among others
the following:
* Capacity building for human resource development in management, research,
training, monitoring and evaluation and service provision within the context of
health delivery. The South African Health Ministry we will be launching the
National Human Resource Plan on 7 April 2006, which seeks to ensure that South
Africa has adequately skilled personnel to deliver health services that we
commitment to the electorate. As our personnel consumes over 60% of the budget
consistently across all parts of the health system, the human resources (HR)
plan is the most important part of the service transformation plan. The
objective is to restructure the service platform and the modes of delivery in
such a way to achieve 100% staffing in all disciplines (clinical specialties)
in all facilities offering tertiary, secondary and primary healthcare (PHC)
services.

Also the Accelerated and Shared Growth Initiative of South Africa (AsgiSA)
led by our Deputy President, Madam Phumzile Mlambo Ngcuka, has strong emphasis
on skills and infrastructure development;
* Infrastructure for comprehensive healthcare delivery;
* Reproductive health supplies security, including contraceptive; and
* Advocacy to create an effective Sino-African alliance to support the
population, health and development agenda.

As we move forward, we acknowledge challenges that are imposed by the HIV
and AIDS pandemic. Addressing the nation last month, my President Mr Thabo
Mbeki announced that the Operational Plan for Comprehensive Prevention,
Treatment and Care of HIV and AIDS has resulted in the upgrading of hundreds of
facilities. To date, over 100 000 patients are receiving Antiretroviral
Treatment and combined with patients in the private sector, South Africa has
one of the largest such treatment programme in the world. For 2006/07 our
budget for HIV/AIDS is R1.98 billion, almost €267 million.

With the increasing challenge of HIV/AIDS we are continuing with monitoring
and evaluating our interventions in order to measure our successes and
implement remedies where necessary. We have also developed a national
accelerated HIV prevention plan which will address the following:
* Increase Voluntary Counselling and Testing coverage, including the opt out
strategy (needs wide consultation and preparation before implementation);
* Increase coverage of Prevention of Mother to Child Transmission, including
the opt out strategy;
* Social mobilisation is the backbone of the accelerated HIV prevention
programme;
* Communication strategy to be finalised by the end of March;
* Greater focus on life skills in schools, especially primary schools in the
prevention plan (also youth clubs, tertiary institutions);
* A focused prevention programme targeting vulnerable groups such as women with
targeted messages; and
* A need to better understand what levels of awareness exist and how to
translate knowledge and awareness into behaviour change.

As South Africa we are committed to working towards delivering a well
co-ordinated, integrated and sustainable social service in partnership with the
ACP, EU and other multi-lateral initiatives on challenges of sexual and
reproductive health throughout the developing world.

I thank you.

Issued by: Ministry of Health
17 March 2006