President Cyril Ramaphosa: Signing of Presidential Health Compact

25 Jul 2019

Address by President Cyril Ramaphosa at the signing of the Presidential Health Compact, Dr George Mukhari Academic Hospital, Ga-Rankuwa, Tshwane

Programme Director, Dr Bandile Masuku,
Minister of Health, Dr Zweli Mkhize,
Deputy Minister of Health, Dr Joe Phaahla
Acting CEO of George Mukhari Hospital, Prof JV Ndimande,
Labour Convenor in Nedlac, Mr Bheki Ntshalintshali,
BUSA Representative, Mr Stavros Nicolaou,
Public Health Entities,
South African Research Council,
Statutory Health Council,  
Traditional Health Practitioners and Allied Health Professionals
of South Africa,
Provincial and District Senior Officials Health,
Members of the Media,
Ladies and Gentlemen,

It is my privilege to join you here this morning on this truly historic occasion: when we will be signing the first-ever Presidential Health Compact that binds us as a collective to overcoming the challenges in our public health care system.

In my first State of the Nation Address in 2018, I issued a clarion call to South Africans to seize this moment of hope and renewal, and to work together to make a meaningful impact in the lives of our people. 

Since then people from all walks of life have affirmed their deep love for our great country, and their determination to see it thrive and prosper.

They have come forward and said, yes, Thuma Mina, send me.

There is nothing that reinforces the Thuma Minaspirit as much as seeing government, health and allied professionals, labour, business, communities, academia, statutory councils, traditional health practitioners and public health entities collaborating in pursuit of a common goal.

It brings to mind the spirit of social solidarity that attended the birth of our democracy.

It is the same spirit of social solidarity that has brought us to this point today.

A new era has begun in the field of health care in South Africa.

The signing of the Presidential Health Compact is the culmination of a long journey we have travelled together since we convened the Presidential Health Summit last year to find solutions to the crisis facing our health system.

It is fitting that we are signing this historic accord here at the Dr George Mukhari Hospital, where a groundbreaking and difficult operation to separate conjoined twins was performed in 2017 in collaboration with staff from the Nelson Mandela Children’s Hospital and a number of private sector doctors.

This successful operation cemented the good reputation of so many of our public hospitals that goes unrecognised.

This hospital is also the teaching facility for the Sefako Makgatho Health Sciences University, the first health sciences university established in post-apartheid South Africa.

The Sefako Makgatho University campus was once the campus of the Medical University of South Africa, known as Medunsa.

More than half of all African medical doctors and dentists in Southern Africa were trained at Medunsa, and no doubt many of them are among us today.

We acknowledge and celebrate the contribution of our pioneers who walked through the doors of Medunsa, and who received practical training at this hospital.

They blazed a trail for the young professionals who came after them, and who continue every day to make a difference in the lives of our citizens.

The signing of the Presidential Health Compact is part of our efforts to deepen cooperative and collaborative governance.

Government, working with various social partners, is embarking on a journey of reform of our healthcare system.

Through collaboration we will be able to pool our knowledge, finances, human capital and other resources.

We will be able to further our reach in our communities and we will be able to address backlogs.

We will be able to leverage development assistance and open up opportunities for community-based organisations to contribute to a better health system.

In my Presidency Budget speech to Parliament a week ago, I stressed the determination of this new administration to end the practice of government departments working in silos. 

This practice has led to fragmentation of service delivery, to inconsistency in policy application and to poor monitoring and evaluation, not just in health but in all sectors.

I said that we would be moving away from a ‘top down’ approach to development and taking our programmes to our people: in the villages, in the towns and in the cities.

This new decentralised approach, which focuses on service delivery at a district level, is perfectly aligned with the objectives of this Presidential Health Compact.

By working in a collaborative way, we will be able to reach our goals faster and implement them efficiently and with the best use of resources.

In fixing what is wrong with the public health care system we are mindful of the impact of our past.

We are mindful of the legacy of decades of skewed resource allocation and under-funding of facilities serving the majority of South Africans, especially primary health care.

Twenty-five years into democracy we have made strides in broadening access to health care, in reducing the burden of disease and in raising life expectancy.

In 2020 a new medical school will be established at Nelson Mandela University in the Eastern Cape, and recruitment for new students has already begun.

It is significant that more than 40% of clinics that serve the population today were built after 1994.

These are just some of the many successes of which we can be proud.

Our mission is to reform health care, to make it better suited to the needs of an ever-growing population, is part of a global movement towards equitable health care access that was given new impetus when the Sustainable Development Goals were adopted in 2015.

The targets set under Goal 3 – ensuring healthy lives and promoting well-being for all at all ages – mirror the aspirations of our National Development Plan.

To give practical expression to Section 27 of our Bill of Rights, which affirms the right of everyone to have access to health care services, including reproductive health care, the NDP sets specific goals, priorities and actions towards achieving a health system that works for everyone.

Ensuring positive outcomes by raising life expectancy, reducing the burden of disease and reducing infant mortality is so much more than a health issue.

A healthy nation is a successful nation.

The transformation and effective resourcing of our health system is fundamental to our plans for building a just, equitable and prosperous society.

A healthy population is economically productive, is industrious and is the bedrock of any country’s economic development.

We are all aware of the challenges.

We are all aware of poor resource management, of underperformance in our facilities, of inadequate investment in people and skills, and of inequitable quality of care between public and private health care.

We are here because we share a common vision of the South Africa we want.

A South Africa where our entire population has equitable access to quality health care for themselves, for their children, and for their parents and grandparents.

A South Africa where our public health system is people-centered, is responsive to people’s needs, and where the views of communities are valued and respected.

A South Africa where our clinics and hospitals are centres of excellence, where they are well-resourced and adequately staffed.

We convened the Presidential Health Summit last year to address the failures that have hampered our progress towards an integrated and unified health system.

I was greatly encouraged at the high level of participation both in terms of the number of delegates and the quality of their input.

Following the Summit, social partners turned their focus to developing the Compact that we will be signing today.

We have already seen, and must applaud, the broad commitments our various social partners have made to strengthen the public health system.

One health service user group has committed to establish a corporate-funded youth employment initiative in the health sector that trains youth at risk to become lay counsellors, data capturers and community tracers. 

The private sector has a critical role to play in supporting government to train more young people who can continue the onward march towards the Fourth Industrial Revolution.

Another example is a collaboration between the departments of Science and Technology and Trade and Industry, working with the science councils, to establish an Active Pharmaceutical Ingredients technology innovation cluster. 

This will have significant consequences for access to medicines into the future.

In yet another example, health professionals have committed to promote the employment of community service professionals in rural areas, which is key to improving access to quality health care in the most far-flung parts of our country.

The labour movement has also committed to supporting the Department of Health by reviewing policies around remuneration for work outside the public service to limit its impact on service delivery.

Ladies and Gentlemen,

As you will be aware, Cabinet recently adopted the National Health Insurance Bill, and it will soon be tabled in Parliament.

As we move towards universal health coverage, the steps we are taking today will aid us in our efforts.

The plan of health service users to lobby for improved implementation of universal health access across public and private sectors, as well as the labour movement’s commitment to educate communities on NHI, is to be welcomed.

This Compact illustrates what we can achieve when we plan and work together to fix what is wrong with our country.

It has as its stated goal: One Country, One Health System.

This means quality of care must be the same regardless of whether you have money or not, and regardless of where you live.

In standardising the quality of services provided, we will be ensuring better health outcomes.

Under One Health System, patients are treated with dignity and respect, regardless of their social circumstances.

This is what we expect not just in the health care sector, but across the public service.

By the same measure, patients must also respect health care workers.

Under One Health System, all our hospitals, clinics and doctors’ rooms are appropriately staffed and resourced; there are adequate medicines, equipment and supplies; and infrastructure is suitable for the services to be provided.

Working in partnership, we have developed action plans with key interventions aligned to nine pillars.

There will be an expectation to meet these commitments within allocated timeframes.

As we forge ahead to give effect to the constitutional right to access to health care, assenting parties commit to execute their responsibilities in an ethical manner and to ensure that self-interest does not derail or detract from this goal.

They commit to working and participating actively in structured programme teams, with clear role allocation and responsibilities.

The partners commit to supporting transparency in funding modalities and impact assessments, and to promoted inclusivity in the dissemination of information.

The parties to this Compact further acknowledge that because it is a dynamic and organic document, it may require continuous review depending on the monitoring and evaluation of the stated outcomes.

Ladies and Gentlemen,

Access to quality health care is not just about a healthy body and a healthy mind.

It is about a healthy society in which all people are able to pursue their interests and achieve their potential.

Speaking at the Medunsa graduation ceremony in 1991, President Nelson Mandela described the importance of health care in these terms.

He said:

“There cannot be peace while our people lack basic social facilities, including basic health care.

“There cannot be peace, while the overwhelming number of doctors and medical facilities are concentrated in areas accessible only to a small section of the population.”

With the signing of this Presidential Health Compact, we are closer to the fundamental transformation of our health care system.

Through our actions, we are bringing our collective energies to bear to be of service to our people.

We are working together towards the achievement of redress.

We are working together for the public good, for social cohesion, for economic progress and, as Madiba said, for peace.

We are working towards building the South Africa we want.

I thank you.

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