Speech by Minister of Health, Dr Joe Phaahla, MP, At The South African Primary Health Care Conference, East London International Convention Centre, Eastern Cape
Programme Director
Deputy Minister of Health, Dr Sibongiseni Dhlomo
Member of Executive Council for Health, Eastern Cape Province, Ms Nomakhosazana
Honourable MECs for Health from other provinces
Heads of Provincial Departments of Health and their staff
Managers and staff from the National Department of Health
International Guests
Academics and Researchers
Representatives from private sector and development partners
Representatives from NGOs and civil society organizations
Ladies and Gentlemen
The month of September 2023 marked 45 years since the historic Alma Ata Conference on Primary Health Care in Kazakhstan, and October 2023, marked five years since the International Primary Health Care Conference in Astana. Worldwide, nations have committed to the attainment of Universal Health Coverage and enshrined this in the United Nations’ Sustainable Development Goals to be achieved by 2030. South Africa is a signatory to the Sustainable Development Goals.
To give effect to the realisation of the Sustainable Development Goals, the National Development Plan 2030 of South Africa re-affirmed the country’s commitment to strengthening the Primary Health Care approach at the community level. There is no better time than now for South Africa, Africa, and the world to implement Universal Health Coverage to strengthen health systems.
It is therefore necessary and fitting that during this year, we reflect on and review South Africa’s journey towards the ideals of Primary Health Care over our 30 years of democracy.
Inequity remains the biggest challenge to the health system, and it is threatening the sustainability of healthcare for everyone in the country. Expenditure on health in the private sector remains unabated while the public sector allocations are reduced, thus widening the inequity. Over the coming years a series of reforms will be implemented to achieve an integrated national healthcare delivery system that makes all resources available to everyone. This includes but is not limited to the implementation of National Health Insurance.
A key focus of the 1978 ALMA ATA DECLATION ON PRIMARY HEALTH CARE was this inequity. The Alma Ata Conference strongly reaffirmed that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal.
In line with this statement in the Alma Ata Declaration, the Government of South Africa, together with stakeholders and partners strive to facilitate, for all South Africans a socially and economically productive life. We believe that Primary Health Care is the key to attaining this target.
Within our district health system, we have set up services spanning from community level, to Primary Health Care services in mobile clinics, clinics and community health centres and to higher levels of hospital care if required. Our community-based services include, the community health worker programme, the school health programme, environmental health services and the central chronic medicine dispensing and distribution programme.
The clinical services will only be as good as the support they receive from administrative, financial, supply chain, and information and communication services. It is for this reason that we must have an appropriate balance between clinical and support resources - both financial and human resources.
I am aware that security services at primary health care and other facilities have become a costly challenge. When our facilities are not properly guarded and secured it becomes stressful for health workers to perform their duties. This problem must be addressed in a multi-faceted manner by the Director General, Provincial Heads of health and senior managers in the district health system. Multifaceted, because amongst other interventions, communities must be mobilised to assist government in securing health facilities.
In the first 15 years of our democracy, we have significantly grown the number of people who use primary health care services such that in 2013, we recorded a 120 million visits to primary health care facilities. The facilities were under extreme pressure because of this good attendance by our communities and the need for the Central Chronic Medicines Dispensing and Distribution programme was recognized. As the Central Chronic Medicines Dispensing and Distribution became known, it grew in popularity such that its number increased from 26 thousand people in 2014 to 5.6 million people in the last financial year.
This programme has brought some relief to primary health care facility staff and to community members for whom waiting time queues have been shortened. Community health workers in South Africa contribute positively to the success of the Central Chronic Medicines Dispensing and Distribution programme. We continue to improve the quality in primary health care facilities through the Ideal Clinic Programme which has seen the number of facilities, meeting standards, grow from 0 in 2014 to 2046 (59%) in 2022.
We see South Africans as whole, multi-faceted human beings and we aim to provide holistic care that will cater for all an individual and family’s health needs without the inconvenience of multiple clinic visits which put further strain on their finances. For this reason, as part of the integrated clinical services model of the ideal clinic framework, we, in 2014, implemented the Adult Primary care Model which guides health care professionals on how to manage different illnesses, including comorbidities.
While annually, millions of South Africans leave our health facilities after being satisfactorily attended to, there are however still unfortunate events taking place that leaves much to be desired. I cannot speak to an audience in the Eastern Cape Province without thinking about the young woman who lost her life after she sought care from one of our primary health care facilities, after a sexual assault. This is despite the presence of a good tool such as the Adult Primary Care Model which clearly explains how someone who has been sexually assaulted need to be managed. This incident, and others in our other provinces points to the fact that more attention needs to be paid to training, supervision, and progressive discipline.
Another area that needs strengthening in our primary health care services, is the Environmental Health Programme. This programme is central to the safety of South Africans from all forms of possible environmental harm and if we are to continue our good track record when it comes to the prevention, early detection and management of waterborne and foodborne illnesses, and as well as harm that could come from air pollution, we need to increase the number of environmental health officers that are appointed by municipalities.
Improvements in the health of South Africans also depend on multisectoral interventions, and in this regard, we need to work even more closely with departments of agriculture, education, housing, social development, water and sanitation, the private sector especially the food and beverage industry, NGOs, academic and research institutions, civil society and our communities. This collaboration with key stakeholders is the only way to succeed in addressing social determinants of health and without addressing the social determinants of health, we will not achieve the desired health outcomes.
To put the resources that we have to the best possible use, I cannot overemphasize the importance of health promotion and disease prevention. This will spare healthy South Africans and the country’s fiscus from high level cost health interventions. In the past 10 years and to date we are growing the proportion of funding for the district health services, which is the commitment that we have made and continue focus on health promotion and early intervention at primary health care level.
In line with the 2018 Astana Declaration on primary health care, South Africa will:
- Increase capacity-building of all health cadres.
- Support research and share knowledge and experience while learning from each other as provinces and also take onboard good practices from other countries.
In doing this we will improve health outcomes by ensuring access for all people to the right care at the right time. I remind you that this aim, the aim of Universal Health Care, also requires the right funding mechanism for health services, and therefore the importance of the implementation of the National Health Insurance.
The Astana Declaration encourages countries to periodically review the implementation of this Declaration, in cooperation with stakeholders. This is the purpose of this conference. We are using this conference to hear what stakeholders are saying about South Africa’s primary health care services. We are eager to hear from you what in your opinion is working well and what are weaknesses. Your input will culminate in a conference report that will guide our planning and implementation of primary health care services within South Africa’s district health system, going forward.
Together we can and will achieve health and well-being for all, leaving no one behind.
I thank you.
