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Policy Debate on the Health Budget Vote - 16 Dr Aaron Motsoaledi, Minister of Health NCOP

19 Jun 2018

Honourable Chairperson of the NCOP
My Cabinet Colleagues and Deputy Ministers present
Deputy Minister Joe Phaahla
Chairperson and members of the Select Committee on Social Services
Honourable Members
Distinguished guests

Good afternoon!

It gives me great pleasure to present the 2018/19 budget to this House and to outline our plans for the 2018/19 financial year.

This year we honour the memory of our beloved Madiba who would have celebrated his 100th birthday this year. In the same vein we also honour Mama Albertina Sisulu who would also have turned 100 this year.

Issues of health are occupying the minds of each and every South African at this moment in time.

The word "Health" is on the tips of the tongues of every South African.

This week, lots of delegates around the globe are gathered at Sun City in a Conference of the Board of Healthcare Funders (BHF) which is an umbrella body of more than 80% of all the medical schemes in the country. The main topic there is "Financing of Health Care".

In May this year, the Ministers of Health had from around the globe gathered in Geneva, Switzerland for the annual World Health Assembly. The theme was "Health for All: Commit to Universal Health Coverage".

On Thursday this week, I will be releasing two Bills to the Nation in a press conference - the Medical Schemes Amendment Bill and the NHI Bill.

As you have already noticed, a storm is already brewing furiously in the media.

I actually expect a Hurricane on Thursday, not just a storm. All this is happening because South Africa, like the whole world, is poised to make history that will shake the world. This question of Universal Health Coverage, which we call NHI, is not going to leave the world unshaken. This is what we are going to be announcing on Thursday.

Actually, in 2011 the prestigious British medical journal (The Lancet), dedicated one of its editorials to Universal Health Coverage.

They said when it happens, it is going to be only the 3rd transition of Health ever since human beings started populating this planet.

The Lancet said the 1st ever transition of health happened in the 18th century and they call it the demographic transition. It was when the world introduced clean running water, sewerage systems and sanitation.

I am sure this sounds like an anti-climax to many of you because you would have expected a historic transition in health to be some extremely complex science and advanced technology. But this simple transition, have had an impact on humanity that is still reverberating today. It saved millions of lives and markedly increased life expectancy in the planet. Dying was no longer as common as it was before that transition.

The Lancet goes on to describe the 2nd transition. It says this transition took place in the latter parts of the 18th Century and the beginning of the 19th Century. It is called the Epidemiological transition. This is when the world introduced vaccination. Many diseases like small pox were completely vanquished due to this transition. The world is now on the verge of vanquishing Polio and many other diseases. Again, it looks very simple and not so impressive an achievement of the world. But to millions of babies and even adults who would have died or suffered life-crippling morbidity, this achievement is huge!!

Now, the Lancet stated that the 3rd transition is beckoning.

This transition is called Universal Health Coverage - NHI. Like the other two transitions before it, it is not a complicated medical science or some advanced technology, NO. It is simply the world coming to its sense, which should have happened long time ago. It is about social justice and equality.

It is simply about the way countries share their money for health. Who gets what when. It is not about sharing budgets of health, NO. It is about redistribution of the wealth of the country for the health of each and every citizen regardless of the socio-economic status or their status in life.

The United Nations has adopted it as one of the 17 Sustainable Development Goals. It is Goal 3.8.

The United Nations contends that the world will never ever develop to its potential without this goal. It sounds very funny then for it to raise a storm or rather the expected Hurricane in our country. But if you understand it, you will realise why. The outgone Director-General of the World Health Organisation, Dr Margaret Chan, called it the equalizer between the rich and the poor. She said it is the ultimate that health had to offer to the citizens.

Equalising society is not a Sunday school business. It evokes emotions both sides.

Actually it will not be an exaggeration to say that the NHI is the "Land question" of health. In the same way the land issue is raging all over the country, NHI is going to rage in a similar way, not only in the field of health but in the economic and social lives of our people.

Why are issues of health so important and so emotive? If I were to ask you in this House which before is more important - Education, Social Development, the Economy, Safety or Security or Health.

You may not easily reach any consensus. But this question was answered sometimes in the 18th Century.

A German Philosopher, Arthur Schopenhauer who was born in 1788 and died in 1860 said: "Health is not everything, but everything without Health is nothing".

No country can fight poverty, unemployment and grow the economy with a very sick population. Hence every citizen, to reach their potential in all other aspects of their life, needs good quality equitable health care regardless of who they are. To achieve this, equitable and fair financing of Health is an inevitable occurrence. Yes, under NHI, the rich will subsidise the poor. The young will subsidise the old. The healthy will subsidise the sick. The urban will subsidise the rural.

For this reason, we are contending that this will be a substantial policy shift. It will necessitate a massive reorganisation of the whole healthcare system, both public and private and completely change the relationship between our spheres of Government, but also change the relationship between the rich and the poor.

We are going to be asking you to change most of the laws that you have painstakingly cobbled together since the advent of democracy.

You might have had to dismantle some of the relationships between spheres of Government and also rattle the corporate world in health. That is what we will mean by a massive reorganisation of the health system.

We have already identified 12 Acts that will have to be amended by this House to accommodate NHI.

In this instance we are going to be asking you to pay special attention to the 4 issues that have emerged as distabilisers of the health care system in the manner in which they have been designed and arranged now.

These are:
1. Human Resources: Who has the power to hire who, where, and how many;
2. Financial Management: No proper financial management, no services;
3. Procurement and Supply Chain Management; and
4. Maintenance of Infrastructure and equipment.

All the major disasters in health that occurred in our country are about these four and the way they are governed and controlled.

Life Esidimeni, Oncology in KwaZulu Natal, Mediosa and Buthelezi ambulances and the issue of shortage of staff stem from these four.

Major major changes will have to be implemented in NHI to deal with these four once and for all.

While waiting for the legislation on NHI, we will in the meantime implement what the President instructed during his SONA, "the time has now arrived to finally implement Universal Health Coverage, through NHI".

The approval by Cabinet of the Medical Schemes Amendment Bill and the NHI Bill which I am releasing on Thursday, are the steps in that very direction.

In conclusion, let me take this opportunity to thank my colleague Deputy Minister Joe Phaahla, the Chairperson of the Select Committee on Social Services, Honourable Dlamini and her National Assembly counterpart Honourable Dunjwa for their support and working together throughout this period. I also wish to thank our Development Partners for the massive financial and technical support.

Finally, I wish to thank my team of officials led by the Director-General Ms Malebona Precious Matsoso and her Deputies, as well as the entire staff of my Department.

I thank you!!

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