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Policy Budget Vote 16 Debate Speaker: Cde L.C Dlamini in the National Council of Provinces

19 June 2018


As the African National Congress has declared 2018 as "The Year of Nelson Mandela: The Year of Renewal, Unity and Jobs", it is important for every South African to make a commitment to live up to the ideals of Madiba, and those of Ma Albertina Sisulu.

As we reflect on the lives of these fallen icons, we do so in remembrance of the declaration made to the people of this country, in our momentous social contract of 1955, The Freedom Charter, when we declared that "free medical care and hospitalisation shall be provided for all, with special care for mothers and young children".

South Africa's health system has its roots in a set of Apartheid policies that were racially biased and skewed in favour of the minority population. The transformation of the health system in South Africa has been and remains an urgent priority for the ANC Government since 1994.

The right to health is fundamental to the physical and mental well-being of all individuals and is a necessary condition for the exercise of other human rights including the pursuit of an adequate standard of living. The right to health care services is provided for in the South African Constitution. This makes provision for access to health care services including reproductive health and emergency services; basic health care for children, and medical services for detained persons and prisoners. Universal access is provided for in section 27(1)(a) which states that "everyone has the right to have access to health care services, including reproductive health care..."

In an attempt to reduce poverty and inequities that characterised South African society, the new democratically elected government in 1994 committed itself to the Reconstruction and Development Programmme (RDP) which aimed to meet the basic needs of all South Africans and provide the assurance that each citizen would have a decent standard of living and economic security. A number of policies were implemented within the RDP framework to improve health and access to health care and to address the inequities that had been inherited in these areas. The policies implemented ranged from free health care for children and pregnant mothers, to clinic-building programmes and community service for medical and dental graduates.

Access to Healthcare in South Africa

There is growing international consensus that user fees at public sector health facilities are not an advisable way of financing health services. As noted by the World Health Organisation Director-General Dr Chan in her address to the World Health Assembly last year: "User fees punish the poor. User fees discourage people from seeking care until a condition is severe and far more difficult and costly to manage. User fees waste resources as well as human lives."The World Bank president, Jim Kim, has also supported this position. It is within this context that the National Development Plan, Vision 2030 states that "everyone must have access to an equal standard of care, regardless of their income", a position which has been consistently re-emphasized by the ANC, even in our most recent Conference when we resolved to reaffirm our long-standing position on our resolutions on the National Health Insurance (NHI), and to ensure that the implementation of the NHI remains a priority of government.

High costs of health care in the private sector remain a significant barrier to access to health care for the majority of South Africans. At the same time, implementation of measures to reduce these costs often encounters contestation from the private sector. The National Development Plan 2030 emphasises the need to curb the spiralling costs of health care in both the public and the private sectors. The implementation of NHI will contribute significantly in turning this situation around, as a means of ushering Universal Health Coverage.

The Equity of Access to HealthCare Services in Mpumalanga Province, for instance, focuses on the following key aspects:

  • Type or availability of services provided at various levels of care to serve the communities
  • Utilisation of available services
  • Improved health outcomes, which will indicate the relevance and effectiveness of the provided Health Care Services.

To increase access to health care services, the Department in the province renders health services through:

  • Community Based Health Services (300 Home Based Care, 235 Ward Based PHC Outreach Teams (WBPHCOTs) and 68 School Health Services);
  • 81 Mobile Clinics (29 Ehlanzeni, 25 Gert Sibande and 27 Nkangala), covering 2561 points (Ehlanzeni 984, Gert Sibande 1116, Nkangala 461);
  • 228 Clinics; and
  • 59 Community Health Centres.

The Mpumalanga province has a total of 59 Community Health Centres (15 Ehlanzeni, 22 in Gert Sibande and 22 in Nkangala). SEAD, is a clinic in Gert Sibande that has started to operate 24hours. Only 46/59 Community Health Centres operate 24 hours mainly due to staff shortage (15/15 Ehlanzeni, 13/23 Gert Sibande and 18/22 Nkangala). To address staff shortages in facilities, the Provincial Department will be introducing staffing norms and the equitable distribution of human resources, as well as the utilisation of overtime budget allocation for the appointment of lower category critical staff.

In the Gauteng Provincial Department of Health, the Province has adopted the deliverology methodology to fast track and improve citizen's experience of health care services. The Office of the HOD has established a service delivery intervention unit (war room). The reach of WBOT presents an opportunity to benchmark against the Sukuma Sakhe operation. Gauteng achieved the highest percentage of Ideal Clinics across the country between 2015 to 2018 with a total of 75% (281 of 372) of clinics accredited as ideal. This, in light of the fact that the Gauteng Public Health Facilities continue to be a refuge for many. Majority of people still go to Public Health Facilities according to the 2015 Gauteng GCRO qualify of life survey. There has been a 5% increase in the percentage of Gauteng's population reliant on public healthcare since 2008 from 66% to 71% by 2015. Despite these challenges, there has been key developments in the Province worth celebrating:

  • The life expectancy is now 64 years: an improvement in lifespan since 2006 when women could expect to live to 54.7 years and men to just 52.3 years, with a population average of 53.5 years.
  • Gauteng has the second largest ART programme contributing to people living longer.
  • Mother to Child Transmission of HIV has reduced from 2% to estimated 0,9%.

Under the National Health Insurance, Primary Health Care will be the backbone for health service delivery. To this end, a number of initiatives in the Northern Cape Province are underway aiming at improving the quality of service delivery. The Ideal Clinic Initiative is currently the main vehicle for the improvement of quality at PHC level. To date, 89 facilities have achieved the Ideal Clinic Status, and a further 25 have been targeted for the current financial year in the province. The National Health Insurance (NHI) aims at providing good quality health care services, accessible to all, based on needs, irrespective of socio-economic status. The province is progressing with transformation initiatives such as Central Chronic Medication Dispensing and Distribution (CCMDD). To date, there are 44 404 patients enrolled on CCMDD and a further 5000+ is planned for this year to bring the number to 50 000. On the Health Patient Registration System (HPRS) and other facility improvement initiatives, 325 494 (32%) of targeted patients are already registered on the system.

We note the deficiencies on the Western Cape Department of Health, under the DA-led administration and urge the Department looks at measures to address some of the findings contained in the Annual Inspection Report compiled by the Office of Health Standard Compliance. Some of these findings included, but not limited to, the following:

On population based planning and service delivery, the average sub-domain score obtained by the Western Cape was 33%. The deficiencies noted included:

  • No documented evidence that management had assessed the disease burden in the catchment population.
  • No evidence of a plan to address the needs and health outcomes of the community.
  • No structured outreach programme for services addressing community needs.

On disaster preparedness: Average sub-domain score obtained by the Western Cape was 21%. The deficiencies noted were as follows:

  • Disaster management plan not available (E-Essential).
  • Management and staff not aware of the disaster and disease outbreak plan (E-Essential).
  • Lack of in-service training information on disease outbreaks (E-Essential).
  • Emergency drills to test preparedness for disaster not conducted (E-Essential).

On staff welfare and employee wellness: Average sub-domain score 31%. Deficiencies noted:

  • No evidence that medical examinations were performed for all health care professionals exposed to occupational hazards.
  • No evidence of measures to prevent incidents of harm to staff.
  • TOR of the occupational health and safety committee not available, and minutes not detailing occupational risks.
  • Reports not showing remedial actions taken in the event of an accident or potential harm to staff.
  • Records of needle stick injuries and zero reporting not available.
  • The results of staff satisfaction surveys show that majority were not satisfied with working conditions.

More often than not, it the poor and downtrodden that will bear the brunt of these deficiencies and so it is encouraged that the Western Cape Department of Health looks into resolving these matters with the urgency they deserve.

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