B Hogan: Debate on State of the Nation Address

9 February 2009

Chairperson, Mr President, Madame Deputy President

Many people have referred to the distressing conditions in which many of our
healthcare workers have to perform their tasks. As the Minister, and as the
Ministry, it is very disturbing, when on a daily basis; you get letters of
pleas and desperation. Let me read to you just one such a letter. It comes from
a head of a Paediatric Unit in a very large hospital in a province of ours, and
it starts, it says:
"Dear Minister Hogan, it is out of sheer frustration and absolute desperation
that I write this letter to you. I am head of the Paediatric Unit at this
hospital. Ours is an extremely busy unit, despite functioning only at a
district level of care. At present we have a few vacant entry level medical
officer posts.

"At the end of this year, we will be losing four doctors, one of our doctors
will be going to work abroad and as a result of the moratorium that was placed
on the appointment of new employees on 13 June this year, we are unable to
advertise the posts that will be vacated at the end of the year, let alone the
posts that are presently vacant. Our human resources department has sent
motivation after motivation to the district and head offices, yet these posts
remain frozen.

"Our human resources department and senior management have tried so hard and
continue to do so, but it appears that we are asking for the impossible" and
then he asks the question: "Does anyone realise the enormity of the crisis that
is looming ahead - in January we will not have enough doctors to maintain the
workload, and there is going to be a total collapse in service delivery?".

Now, this is a kind of letters that we receive. And I want to pay tribute to
these people who have chosen to remain in the system, under extremely difficult
circumstances and soldier on and continue to fight the good fight.

I want to pay tribute too, to the 60 000 community-based healthcare workers,
who every day with virtually little compensation, go out and care for our
people in the communities. Who look after people who are desperately ill, who
themselves suffer enormous depression about having to face the scale of the
problems that we face in this country.

And I want to pay tribute to the nurses, who are the backbone of our health
system, who despite low wages, despite lack of recognition, continue to work in
primary healthcare districts in our hospitals with vigilance, with strength,
with courage. Because what we are facing here is just no simple crisis - just a
matter of mismanagement, or backhand, or corruption.

What we are facing is unprecedented in most countries. We have one of the
highest HIV and AIDS prevalence in the world. We have one of the highest
tuberculosis (TB) prevalence in the world. We came to government in 1994, where
there was hardly a primary healthcare (PHC) clinic in black communities. And so
at that very moment when we were poised to roll out healthcare to the majority
of our people, we were hit by a burden of diseases that none of us anticipated,
and perhaps we did not respond fast enough, but I defy any country to respond
to the scale of the burden of disease which we are battling under at the
moment.

And so we have certain things that we do announce and we say with triumph in
the phase of a toned down in government spending, in those early years when
fiscal prudence and hostility was the name of the game and we all encouraged
it, we were still able to roll out over 1 800 clinics and community centres
since 1994. This means that 95% of our people are able to reach a clinic within
a five kilometre radius that is extraordinary.

It has enabled us to double our headcount usage of PHC from 67 million
visits in 1998 to more than 101 million this year people are using our
facilities. The Hospital Revitalisation Programme has seen eight new hospitals
being built since its inception a couple of years ago, and about 33 projects
running currently on site.

We are improving the nurse's salaries - we have started with a process and
at this stage we are now seeing - despite the teething problems - a welcome
return of the nurses to the nursing profession. They recognise that they are
being recognised.

Let us not forget the huge and courageous battles that this government
undertook in the early 2000 against pharmaceutical companies and the prices of
medicines. Let us not forget the battles that were undertaken in the United
States, and in this country alone. We have been able, through those battles, to
reduce the prices of medicines by 30% in the last five years - a considerable
achievement.

And we have had a number of successes in other diseases in this
country:
* we were declared a polio-free country a little while back
* we have reduced the incidences of malaria significantly - and in this last
year once the headcount is in, we will see how significant that reduction has
been
* we are battling the TB epidemic, and we are fighting it with every ounce of
strength we have - we have TB tracer teams throughout the country, and we are
hoping and confident that we are going to record an ever greater increase in
success than we recorded in previous years.

And so we can go on some of the achievements that we have achieved, at great
cost and dedication. But let me say that there are real issues that we do have
to confront. This is not something that we say is something that we have just
got to live with. In the last two years, particularly in the last 18 months, it
is on record that every provincial health department in our country has been
overspending significantly. We can play political games with that, we can point
at MECs, we can do what we like, but the reality is that every provincial
department of health is facing significant spending pressures.

We know that some of this is related to HIV and AIDS and the roll-out, and
we are proud of the fact that we have over 700 000 people on ARVs, which
exceeds the target that we had set for us for this year.
* But what is it that is driving the cost of health
* What is it that is forcing a head of the department of a major hospital, of
which this Paediatrician is head of a unit, to declare a moratorium on
employing new people
* What is it that is forcing, as has been pointed out, limitations on stocks in
hospitals so that we are running out on basics - what are those
cost-drivers.

We are unable to say at this moment exactly what they are, but from the
national Department of Health, we have assembled a team of over 15 people,
under the leadership of the ex Deputy Auditor-General, with the consent of all
our MECs and our health departments which we reached at our National Health
Council last week.

They are going out into each and every province; they are going to be
sitting with Chief Financial Officers (CFO) and Heads of Department. They are
going to be speaking to auditors and Accounts-General, to discover for us and
bring to us what they believe are the chief cost-drivers in health at the
moment.

We cannot go forward around budgeting until we know what these cost-drivers
are. We anticipate that some of them are the fact that we have had extremes in
inflation in this country as we have had worldwide, and these have particular
implications for health in South Africa.

But we are awaiting the report of these teams urgently, because it is only
once we start to understand what the cost-drivers are, are we going to
understand how we budget better. Along side of that, we are drawing up and
finalising our human resources policies for health. In other words we are
saying these are the numbers of people we need if we are going to have to
produce. So, the whole aim at this moment in time is to improve our planning
and budgeting capacities, so that we do not have these stock-outs.

But we would be misguided to believe that this in only a budgeting and
managerial solution. We have to look at innovative solutions as well within our
healthcare sector. And we have already and I have spoken to these matters about
a whole range of other initiatives which we have in place, which we want to
roll-out within the next couple of months.

Very critical to all of this, is an understanding that both our National and
Provincial Treasuries and our departments of health, need to be speaking to one
another. Too often we find people dumping saying this is treasury's fault or
treasury saying this is health's fault. We can no longer afford those budgeting
games; we are going to be speaking with one voice in addressing these
issues.

But the National Health Insurance must become a very important debate in our
country. We are aware that in the private sector, more money is expended on
fewer people than it is in the public sector. The public sector is left to
handle more people with less resource than in the private sector. This does not
mean to say that we are now going to attack the private sector, take away
funding from it but every country in the world generally, in the developed
countries, have moved to a National Health Insurance.

We cannot look just simply at revenues gained from the National Treasury to
fund health alone. We have to look at a particular form of a national health
insurance, to see how we can increase the envelope for funding in health. And
that will be the subject Mr President, of a long conversation in our
country.

It is not going to be something that we are just simply going to impose, but
the rationale for national health insurance can never be surely more
persuasively argued now, when we face the critical funding shortages that we
have here.
And so we look forward to that debate and we look forward to engaging. We look
forward to the private sectors who have been meeting with us on a regular basis
now, to explain ways in which they can assist us to achieve the targets that we
want.

Finally, we want to thank the many people who been engaged in litigation
against us in the National Department of Health, such as the dispensing
doctors, the pharmacists, with their decision to withdraw litigation. And we
are now engaging to get an interim agreement with them, so that we do not need
to be involved anymore.

That is the spirit of co-operation we are wanting from our country that is
the spirit that we need from all in sundry in the health sector. And so Mr
President, the health sector is facing significant challenges, but as I have
said before, I am so impressed with the level of dedication, the spirit of
co-operativeness and the spirit of innovation in this country, that I am
certain that we will be able to make significant differences to our
healthcare.

Thank you.

Issued by: Department of Health
9 February 2009
Source: Department of Health (http://www.doh.gov.za)