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Speech by Hon. Dr Hunadi Mateme (MP) During the Policy Debate of the Health Budget Vote in the National Council of Provinces

19 June 2018

Honourable Chairperson
Honourable Minister Motsoledi
Honourable Deputy Minister Bogopane-Zulu
Honourable members
Special delegates
Respected guests
Ladies and Gentlemen

The year 2018 presents an opportunity for our nation and humanity as a whole to remember the indelible legacy of the great icon of our liberation and fearless revolutionary, Isithwalandwe Tata Nelson Mandela. It is a year when we recognize the great contribution of Mama Albertina Sisulu for her bravery and steadfastness in championing the plight of our people, especially the women of South Africa.

Honourable Chairperson, Nelson Mandela delivered our first State of the Nation Address before the first democratically elected parliament on the 24th of May, 1994. In that Address he quoted from a poem by Ingrid Jonker.

In that poem Ingrid Jonker said:

"the child is present at all assemblies and law-giving
the child peers through the windows of houses
and into the hearts of mothers
this child who only wanted to play in the sun at Nyanga
is everywhere
the child grown to a man treks on through all Africa
the child grown to a giant journeys
over the whole world
without a pass!"

Nelson Mandela then went on to say:

"And in this glorious vision, she instructs that our endeavours must be about the liberation of the woman, the emancipation of the man and the liberty of the child.

"It is these things that we must achieve to give meaning to our presence in this chamber and to give purpose to our occupancy of the seat of government.
"And so we must, constrained by and yet regardless of the accumulated effect of our historical burdens, seize the time to define for ourselves what we want to make of our shared destiny.

"The government I have the honour to lead and I dare say the masses who elected us to serve in this role, are inspired by the single vision of creating a people-centred society.

"Accordingly, the purpose that will drive this government shall be the expansion of the frontiers of human fulfilment, the continuous extension of the frontiers of freedom.
"The acid test of the legitimacy of the programmes we elaborate, the government institutions we create, the legislation we adopt, must be whether they serve these objectives."

Honourable Chairperson, these remarks sum up the expectations of our of people and the national tasks that continue to guide the ANC, as it is continues with the national task to transform South Africa.

To take from Nelson Mandela, our endeavours are about the liberation of the woman, the emancipation of the man and the liberty of the child inspired by the single vision of creating a people-centred society.

Our drive is work tirelessly for the expansion of the frontiers of human fulfilment, the continuous extension of the frontiers of freedom and changing the lives of people.

Honourable Chairperson, we do so with greater recognition of the enamours task that we have to redress the historical imbalances that we inherited and interchanged legacy of apartheid decimation, inequality and socio-economic exclusion.

When the ANC government came to power in 1994, it inherited a society with massive fragmentation and enamours disparities in access to health care, health status, income and otherwise. The apartheid government developed a health care system which was sustained through the years by the promulgation of racist legislation and the creation of institutions for the control of the health care sector with the specific aim of sustaining racial segregation and discrimination in health care.

The net result was a system that was highly fragmented, biased towards curative care and the private sector, ineffective and inequitable access to the majority of the people of South Africa. Health care services were furthermore geared to the needs of a minority of the population and sharply divided between the private sector, for those who can afford to pay and/or who belong to medical aid schemes with the public sector solely left to services the poor and largely urban communities.

To address this historical imbalances and inequities, the ANC government had to design a comprehensive policy and programme to redress social and economic injustices and to completely transform the health care delivery system and to review legislation and institutions related to health with the main objectives to:

  • place emphasis on health care and not only on medical care;
  • redressing the harmful effects of apartheid health care services and achieve health for all through equitable social and economic development;
  • developing comprehensive health care practises that are in line with international norms, ethics and standards;
  • recognising the community as the most important component of the health system;
  • reducing the burden and risk of disease;
  • providing free health care in the public sector for children of a certain age, pregnant mothers, the elderly, the disabled and certain categories of chronically ill; and
  • promoting preventative care; etc.

In terms of section 27 of the Constitution of South Africa, every person has the right to have access to health care services and the state is responsible for creating the framework within which health is promoted and health care is delivered. It is also a major provider of health services and a single comprehensive, equitable and integrated National Health System must therefore be created and legislated for.

Honourable Chairperson, the ANC is well aware of the acute challenges facing the health care in our country. It is for this reason that we have not only reasserted the constitutional right of our people to have access to health care but also galvanised our national resources to transform and expand the health care sector.

As the ANC, we have galvanised our national resources to give urgent attention to the development of mechanisms to ensure synergy between the provision of health and welfare, as well as the economic conditions facing our people. Promoting and protecting health requires far more than improving medical services. Health promotion however first entered the South African health system in 1990 and the first significant piece of new policy for health promotion in South Africa appeared in the ANC health policy document.

We are also aware that the health care sector is faced with serious disparity and inequality in the distribution of medical professionals, between the urban areas and the poor and rural areas and especially between the public and private sectors. The vast majority of health care professionals work in the private sector, even though they serve a minority of the population. For example, while every specialist in the private health sector serves an average population of less than 500 people, each specialist employed in the public health sector serves nearly 11 000 people.

According to statistics almost 15% of the population is covered by medical schemes and are able to secure most of their health services in the private sector. A further 21% use the private sector on an out-of-pocket basis mainly for primary care, but are likely to be entirely dependent on the public sector for hospital care.

The remaining more than 64% is entirely dependent on the public sector for all their health care services. The structure of the private sector has created incentives which allow financial interests to take precedence over patient's interests. Private practitioners will have to be attracted to the public sector, deriving their income from health authorities while they be allowed to maintain their independence.

We are also aware of inherent challenge facing the provision of adequate and equitable primary health care services in the rural areas. The need to make it accessible is of prime importance with particular attention also to be given to improving and providing health facilities, human and financial resources and transport. The elderly and other vulnerable groups have been neglected by an uncaring apartheid society. Elderly Africans, particularly those living in rural areas have suffered even more. Particular attention will therefore have to be given to the development of outreach and home care services.

To enable government to ensure universal access to good quality and affordable health care services to all South Africans, government envisages to introduce National Health Insurance (NHI) and to phase it in over the next few years.

The broad objective of the National Health Insurance system is to enable the creation of an efficient, equitable and sustainable health system in South Africa, based on the principles of the right to health, social solidarity and universal coverage. National Health Insurance will be a compulsory scheme requiring membership by all South Africans, among others on the basis that there is no payment at the point of the service. Access will be based on need and not affordability. It will however not be a free service but rather a prepaid service that promotes the principle of payment of contributions according to ability to pay and benefit according to need for care. It is envisaged that the scheme will be funded from a levy or tax deducted from the salaries of those in the formal sector and by the State for the unemployed.

Although the initial focus will be on improving the quality and efficiency in the public sector, government has embarked on a process to assess the existing framework of legislation of health care in South Africa and to align it with government's objectives by reviewing and affecting certain amendments relating to all aspects of access to health care. In this regard it is significant to note that among others, the following legislative amendments had in the meantime been affected:

  • amendments to the Medical Schemes Act, 1967, to remove risk-rating and provide more equitable entry criteria for the admission of persons to medical schemes so as to increase the accessibility of private healthcare benefits and to introduce designated service providers so as to allow medical schemes to negotiate appropriate costs for such services on behalf of its members;
  • introduction of community service for healthcare professionals in terms of the Health Professions Act, 1974, so as to provide healthcare services in areas considered to be under-serviced by healthcare professionals;
  • admission of corporate ownership for pharmacies so as to allow for larger corporations to enter the pharmacy industry so as to provide cheaper pharmacy services through their economic muscle - thus reducing overhead costs and in turn, making pharmaceuticals cheaper and more accessible;
  • introduction of regulated medicine pricing so as to introduce a wider base of medicines - thus expanding the base for medicines available for the treatment of medical conditions;
  • introduction of the accreditation of healthcare providers so as to ensure that healthcare services are only available from a specifically accredited provider.

Chairperson, in conclusion I call upon all political parties and other roll players to join hands and to support the Ministry of Health and the government in the national drive to transform the health sector and to improve health care delivery in South Africa in order to ensure that all South Africans have access to quality healthcare services that are equitable, sustainable and adequate. As the ANC, we support the health budget vote.

I thank you.

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