National Council of Provinces - 13 June 2000
TUESDAY, 13 JUNE 2000 __
PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
____
The Council met at 10:02.
The Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS - see col 000.
NOTICES OF MOTION
Mnr C ACKERMANN: Voorsitter, ek gee kennis dat ek by die volgende sitting van die Raad sal voorstel:
Dat die Raad kennis neem -
(1) van die arrogante, vermetele en slinkse manier waarop die DP die kwessie van opposisie-samewerking in Suid-Afrika probeer kaap het; (2) dat die DP die publiek mislei deur voor te gee dat sommige oorlopers nie finansiële voordele ontvang het nie;
(3) dat die DP die publiek mislei deur hulle nie in te lig dat verskeie van die oorlopers nie meer plaaslike regeringsraadslede is nie;
(4) dat die DP moontlik onkonstitusioneel optree en daardeur Suid-Afrika se Grondwet minag deur voor te gee dat daar nog oorlopers is wat reeds van party verander het, maar omdat hulle proporsioneel verkies is, nie nou hulle identiteite bekend kan maak nie;
(5) dat hierdie party deur hulle agterbakse optrede weer eens bewys dat hulle ‘n links-liberale party is wat hulle slegs beywer vir die belange van sekere individuele bevoorregte kiesers; en
(6) dat die DP maar eintlik ‘n opposisie vir die opposisie is. (Translation of Afrikaans notice of motion follows.)
[Mr C ACKERMANN: Chairperson, I give notice that I shall move at the next sitting of the Council:
That the Council notes -
(1) the arrogant, audacious and devious way in which the DP has tried to hijack the issue of co-operative opposition in South Africa;
(2) that the DP is misleading the public by pretending that some defectors did not benefit financially;
(3) that the DP is misleading the public by not informing them that a number of the defectors are no longer local government councillors;
(4) that the DP may be acting unconstitutionally and is thereby disregarding South Africa’s Constitution by pretending that there are more defectors who have changed parties but, because they were elected proportionally, cannot now reveal their identities;
(5) that this party, through its underhand actions, is once again proving to be a leftist liberal party which only exerts itself on behalf of the interests of certain individual, privileged voters; and
(6) that the DP is actually nothing but an opposition to the opposition.]
Mr K D S DURR: Madam Chair, I give notice that at the next sitting of the House I shall move:
That the Council -
(1) expresses its concern about the negative economic, social and investment impact of the current instability in Zimbabwe, and its impact on South Africa in general and on the Northern Province, the North West and Mpumalanga in particular; and
(2) calls upon the Government to prepare urgent contingency plans in the likely event of serious deterioration in that country in order to -
(a) ensure the safety and the possible repatriation of South African
citizens from that country;
(b) safeguard the security of our borders and to make arrangements
with the UN and other world refugee agencies to make it possible
for neighbouring countries to accept large numbers of refugees;
and
(c) make it clear, along diplomatic channels, to President Mugabe
that if he loses the election or if the election is not free and
fair and he is expelled or deposed by violent means, he will not
be welcome to take up residence in exile in South Africa.
Mnr J HORNE: Voorsitter, ek gee kennis dat ek by die volgende sitting van die Raad sal voorstel:
Dat die Raad kennis neem -
(1) van die onaanvaarbare situasie ten opsigte van die uitbetaling van welsyntoelaes in die Noord-Kaap;
(2) dat dié onbevredigende situasie daartoe gely het dat sekere inwoners van die Noord-Kaap tot ses maande laas hulle toelaes ontvang het en aan die genade van familie, vriende en vorige werkgewers oorgelaat is;
(3) dat dié onbevredigende en onaanvaarbare omstandighede gister tot ‘n protesvergadering gelei het in die Benede-Oranjeriviergebied en dat die inwoners van Grootdrink hulle afkeur getoon het deur ‘n betoging; en
(4) dat die protes vreedsaam was, maar dat, as omstandighede nie spoedig verander nie, dié vreedsaamheid nie gewaarborg kan word nie en dat protesoptrede sal uitbrei na ander dele van die provinsie. (Translation of Afrikaans notice of motion follows.)
[Mr J HORNE: Chairperson, I give notice that I shall move at the next sitting of the Council:
That the Council notes -
(1) the unacceptable situation with regard to the payment of welfare grants in the Northern Cape;
(2) that as a result of this unsatisfactory situation some inhabitants of the Northern Cape last received their grants as long as six months ago and have been left to the mercy of family, friends and former employers;
(3) that these unsatisfactory and unacceptable circumstances led to a meeting of protest yesterday in the Lower Orange River area and that the inhabitants of Grootdrink indicated their disapproval by way of a demonstration; and
(4) that this process was peaceful, but that, unless circumstances change swiftly, this peaceableness cannot be guaranteed and that protest action will spread to other areas of the province.]
Mrs J N VILAKAZI: Chairperson, I give notice that I shall move at the next sitting of the Council:
That the Council -
(1) notes with shock that thousands of newborn babies, especially those in poverty-stricken overcrowded communities where tuberculosis is rife, are at a high risk of contracting TB, due to a countrywide shortage of the BCG - Baciuuls Calmette Guerine - vaccine;
(2) further notes that this vaccine is administered 24 hours after birth and is effective in fighting tuberculosis; and
(3) calls on the Minister of Health to ensure that this important vaccine is more readily available and that shortages of this nature do not occur again in future.
Mr N M RAJU: Madam Chair, I give notice that at the next sitting of this House I shall move:
That the Council -
(1) expresses its dismay at the haste with which the Office of the Director of Public Prosecutions has offered indemnity from prosecution to Messrs H Cronjé, H Gibbs and H Williams, who are appearing before the King Commission of Inquiry into cricket match- fixing; and (2) notes that such a decision is seen as an intrusion into the judicial process of this country and clearly undermines the integrity of the King Judicial Commission.
ROAD ACCIDENT BETWEEN QUMBU AND MOUNT FRERE
(Draft Resolution)
Nksz P C P MAJODINA: Mhlalingaphambili, ndenza isiphakamiso:
Sokuba le Khansile -
(1) idlulise amazwi ovelwano kumaxhoba engozi ehle kuhola ophakathi koQumbu neMount Frere izolo apho abantu abane basutywe kukufa xa bekungqubene izithuthi zikawonke-wonke ezibini; kwaye
(2) yenze isindululo kuMphathiswa wezoThutho noMphathiswa weMisebenzi yoLuntu sokuba mabakhe baphonononge isimo sendlela kule ndawo yeshwangusha, kuba akuntsuku zingaphi abantwana besikolo abahlanu bephulukene nobomi babo kwakule ndawo inye. Kufandini luphi ulwamvila lwakho? Kufandini akunantloni; Uligongqongqo eliginya lingayeki. Ngxesini, bantu bakowethu. Akuhlanga lungehliyo. [Kwaqhwatywa.] (Translation of Xhosa draft resolution follows.)
[Ms P C P MAJODINA: Mr Chairperson, I move without notice
That the Council -
(1) conveys its condolences to the victims of the accident that took place on the national road between Qumbu and Mount Frere where four people died when two public transport vehicles collided; and
(2) recommends to the Minister of Transport and the Minister of Public Works that they look into the condition of the road at this deathtrap point, because not long ago five school children lost their lives at this same spot.
Death, where is thy sting? Death you are shameless, you are a monster that swallows up endlessly. Our condolences go to the victims’ families. [Applause.]]
Motion agreed to in accordance with section 65 of the Constitution.
25TH ANNIVERSARY OF IFP
(Draft Resolution)
Mrs J N VILAKAZI: Chairperson, I move:
That the Council -
(1) commends the IFP for having reached 25 years in politics; and
(2) notes that 80 members defected from various political parties and joined the IFP during the Curries Foundation celebrations in Durban on Sunday, 4 June 2000.
Motion agreed to in accordance with section 65 of the Constitution.
REPORT ON ELECTION IN ZIMBABWE
(Draft Resolution)
Mnr A E VAN NIEKERK: Voorsitter, ek stel sonder kennisgewing voor:
Dat die Raad -
(1) kennis neem van die verslag van die Democratic Union of Africa wat op 12 Junie 2000, na twee feitesendings, uitgereik is oor die verkiesing in Zimbabwe oor twee weke; en
(2) voorts daarvan kennis neem dat die verslag lui dat die verkiesing nóg regverdig nóg vry sal wees omdat -
(a) die kieserslys onder verdenking is;
(b) die kiesafdelings eensydig afgebaken is en tekens toon van
afbakeningsknoeiery;
(c) tekens van misbruik van staatsbates vir die verkiesingsveldtog
gevind is; en
(d) onverdraagsaamheid en intimiderende houdings in die landelike
gebied op en naby besette plase, onvrye omstandighede vir die
verkiesing skep. (Translation of Afrikaans draft resolution follows.)
[Mr A E VAN NIEKERK: Chairperson, I move without notice:
That the Council -
(1) notes the report of the Democratic Union of Africa which was published on 12 June 2000, after two fact-finding missions, regarding the Zimbabwean elections in two weeks’ time; and
(2) further notes that the report states that this election will be neither fair nor free because -
(a) the voters' roll is under suspicion;
(b) the electoral divisions have been demarcated unilaterally and
show signs of having been fixed;
(c) signs of misappropriation of state assets for the electoral
campaign have been found; and
(d) intolerance and intimidating attitudes in the rural areas on and
near occupied farms are creating unfree circumstances for the
election.]
The CHAIRPERSON OF THE NCOP: Order! Is there any objection to the motion? There is an objection. The motion will therefore become notice of a motion.
RATIFICATION OF DECISION OF JOINT PROGRAMME SUBCOMMITTEE ON FAST-TRACKING OF LOCAL GOVERNMENT: CROSS-BOUNDARY MUNICIPALITIES BILL
(Draft Resolution)
The CHIEF WHIP OF THE COUNCIL: Chairperson, I move the draft resolution printed in my name on the Order Paper, as follows:
That the Council ratifies the decision the Joint Programme Subcommittee took on 8 June 2000 in accordance with Joint Rule 216(2), namely that the Local Government: Cross-boundary Municipalies Bill, 2000, be fast-tracked by, where process relating to the Bill must be completed, in order to make it possible for the Bill to be passed by both Houses of Parliament by 23 June 2000 (see Announcements, Tablings and Committee Reports, p 500).
Motion agreed to in accordance with section 65 of the Constitution.
NATIONAL HOUSE OF TRADITIONAL LEADERS AMENDMENT BILL
(Consideration of Bill and of Report thereon)
The CHAIRPERSON OF THE NCOP: Order! I am sure that that is a cellphone of a special delegate. Those members will have to pay R500 which will be donated to a charity organisation as a contribution for leaving their cellphones switched on in the Chamber. [Laughter.]
Order disposed of without debate.
Bill agreed to in accordance with section 65 of the Constitution.
REMUNERATION OF PUBLIC OFFICE BEARERS SECOND AMENDMENT BILL
(Consideration of Bill and of Report thereon) Order disposed of without debate.
Bill agreed to in accordance with section 65 of the Constitution.
NATIONAL DISASTER MANAGEMENT
(Subject for Discussion)
The MINISTER FOR PROVINCIAL AND LOCAL GOVERNMENT: Madam Chairperson, whilst I am on my feet let me thank the House for carrying the motion on the Cross- boundary Municipalities Bill and passing two very important pieces of legislation, namely the National House of Traditional Leaders Amendment Bill and the Remuneration of Public Office Bearers Second Amendment Bill, without a single dissenting voice.
In the wake of the recent floods which afflicted South Africa, Mozambique and other countries in our region, the Financial Mail of 10 March 2000 had this to say:
Whatever the extent of aid from overseas, the events of the past few weeks have shown the world another side of Africa: the compassion and generosity shown by neighbouring states, the dedication and professionalism demonstrated by the rescue teams of the SA Air Force, and the speed with which South Africa and other Southern African Development Community countries responded to the disaster.
By the way, as we were helping out in Mozambique, we were simultaneously trying to mitigate the pernicious impact which the floods had on various parts of our country. This we did by way of carrying out rescue operations and distributing relief assistance to affected communities. As we speak, Government has set aside an amount of R577 million to rehabilitate and reconstruct the economic, social and public infrastructure which was either damaged or swept away by the floods. We are also helping to mend the lives of those whose souls and livelihoods were severely battered by the experience.
We lift up our hearts in gratitude for the abundance of generosity and compassion displayed by all those who made donations. Those donations touched the hearts, not only of the victims, but also of all people of goodwill. Those extraordinary events perhaps helped us to understand certain things about our circumstances better than we did before.
We now understand that the weather is no longer a neutral topic of conversation between acquaintances. We also understand that some of the things we cherish in life, such as water, have an ambivalent quality. No one will doubt, in the light of this experience, that, life-sustaining substance though it is, if it comes in excessive quantities, water can pose a serious threat both to lives and livelihoods.
Talk amongst scientists suggests that the long-range forecast for the world’s weather is less than reassuring. Global warming and population growth, so they say, will result in disasters happening more often. Most vulnerable will be the countries which are situated in a cyclone’s path or are located in disaster-prone regions. Also countries that have poor conditions of infrastructure, insufficient capacity and institutional development are in particular danger of being impacted upon negatively.
Countries with these types of traits will continually be exposed to the dangers inherent in weather patterns. The fact that some of these traits are often a function of the scarcity of resources underlines the correlation between poverty and the extreme magnitude of the impact of the disasters.
One of the silver linings of the terrible Cyclone Eline is that it provided a useful opportunity for us to reflect on our situation. When the SADC heads of state and governments met at a special summit in Maputo, they decided to embark on a process of building regional institutional capacity for disaster-preparedness. Cyclone Eline, therefore, served as a catalyst towards greater regional co-operation.
In my capacity as chairperson of a subregional Ministerial committee, charged with the responsibility of establishing this regional capacity for disaster-preparedness, I met with representatives of the United Nations High Commissioner for Refugees, as well as with those from the Norwegian and Swedish governments. I am happy to announce that the UNHCR is already conducting a feasibility study on our behalf. I am also happy to announce that the Swedish and Norwegian governments have pledged to fund the actual process of establishing our regional institutional capacity. Last week, I received an indication that the Japanese government would also like to join hands with the other two governments. I intend to meet representatives of the Japanese government and discuss this matter.
It is urgently necessary for us to adopt an approach which sees vulnerability-reduction as an integral part of the agenda for sustainable development. This must mean that, as we replace infrastructure that was destroyed by floods, we must design the new infrastructure such that we can be sure of its resilience to natural and other threats.
One of the mandates we gave the UNHCR is to assess the disaster-management capacities of the individual member states of SADC. If they diagnose weaknesses, which they surely will, we shall take appropriate steps to remedy those weaknesses.
Out of the recent disasters, we have learnt from what went well, as well as from what did not go well. It has become increasingly clear that community- based responses to disasters are more preferable to overreliance on the national centre. We are therefore intent on sustaining the decentralisation trends which were a salient feature of our Y2K-preparedness. In all these endeavours, we hope that we can count on the active support of members of this House as well as provincial and local spheres of government. [Applause.]
Mr J L MAHLANGU: Chairperson, during the conference on disaster management hosted by this House on 18 and 19 May, we were told that the subject of disaster management is a most boring one. We were also told that this subject only becomes very interesting during a disaster.
Members of this House, members of the National Assembly, provincial delegates, MECs and officials dealing with disaster management at various levels attended the conference. The conference was addressed, amongst others, by the Minister of Environmental Affairs and Tourism, the Minister of Water Affairs and the Deputy Minister of Defence, as well as the Deputy Minister of Public Works.
We were also honoured by the presence of the High Commission for Bangladesh and the High Commission for Madagascar. We were also graced with the presence of experts from Australia, Botswana, Mozambique, Zimbabwe, the US, experts from our own weather bureau, some universities and technikons, as well as NGOs. The conference set up four commissions. One looked at areas such as response management, response planning and early warning systems, as well as public alert systems, declaration of disaster, resource co-ordination and management, mobilisation of disaster response teams and relief-recovery strategies.
The second commission looked at mitigation, communication with disaster management structures, communication with affected communities, co- ordination of relief efforts, evacuation planning and operations and monitoring of disasters.
The third commission looked at risk management, disaster management infrastructure and administration, vulnerability and reassessment, prevention, preparedness, postdisaster analysis, disaster relief funds and insurance schemes.
The last one looked at establishing disaster research institutes, disaster management training and education, development of disaster information networks, database research to improve disaster mitigation, recovery and management, development of technology for use in counterdisaster activities and funding for research purposes.
The Department of Provincial and Local Government was represented by the DG who was with us from the beginning until the conclusion of the conference. We also had some members of the department who were seconded to the conference to do secretarial work.
During the conference, a report on the visits to provinces and the White Paper on Disaster Management served as source documents. This conference succeeded in raising the level of awareness among the participants of the threat of disaster to South Africa and its neighbours, and the role a comprehensive disaster management and emergency management system can play in reducing loss of life and property during a disaster.
In fact, the sharp focus on prevention and hazard mitigation by the conference’s participants and presenters was what we found most striking. It emerged at the conference that the future of emergency management lies in taking preventative action before the next disaster strikes. While we would always maintain a first-rate response and recovery programme, that is, reconstruction capability, we believe that the most effective means of minimising the terrible cost of disaster is through its prevention.
As we move forward towards building an effective and efficient disaster management system in our country and our region, which the Minister has referred to, the following thought, which is the most critical question asked during a disaster, should always be kept in mind: Who is in charge? Intergovernmental co-ordination of emergency activities, weather response, and reconstruction or prevention-orientated programmes are best accomplished by a single entity which, with the authority and support of the executive and legislative branches, will be able to marshall all the resources of Government as we design South Africa’s emergency management system.
The issue of intergovernmental co-ordination and who is in charge must be addressed early in the process. Once this question has been answered, the development and implementation of disaster programmes can be more successfully accomplished.
On the question of funding, as was stated in the conference, there are three critical areas of funding that will determine how successfully our Government will be able to help people face disaster. The first funding is for disaster operations at the level of Government at national, provincial and local level. The second area is the funding for individuals and communities in order for them to recover from damage caused by disaster. The last one is the funding for the design and implementation of preventative programmes and actions.
With regard to the community-based prevention which the Minister has just addressed us on, we have learnt that disaster prevention and mitigation are best accomplished at community level. We are also informed of the project Fima, which is an American agency for disaster management, and the initiative that was designed to promote the formation of a community partnership in order to identify risks, identify and prioritise risk reduction actions, and build the political and community support needed to take action.
We were also told of the remarkable success of these projects, and the reduction of disaster which they have brought about in communities. We were also informed about a 20-year community plan for flood reduction, a plan designed to protect citizens, community infrastructure, and community tourism-based economies. The implementation, we were told, began two years ago, and as a result of this initiative the community has been able to save lives and infrastructure, and create sustainable economic activity in that part of the world. During the conference … [Time expired.] [Applause.]
Mr P E NOE (Free State): Chairperson, members of the House, disasters are a serious sociopolitical and economic problem for many of our people and, in particular, the poor communities. We are making a conscious and deliberate start as a country on our way to ensuring a better life for all our people.
Mr A MARAIS: Chairperson, on a point of order, I am sorry to interrupt, but it seems the microphone is not working. Could the special delegate move to another microphone, and could that be taken into consideration regarding his speaking time?
The CHAIRPERSON OF THE NCOP: Order! I can hear him from here. [Interjections.] We certainly could hear the member, Mr Marais. It might be you who cannot hear from where you are seated. [Interjections.] Proceed, Mr Noe. [Interjections.]
Mr P E NOE (Free State): Chairperson, the occurrence of disasters impacts negatively on the new strides and achievements which our Government has made. This is therefore a call on all of us to be forever vigilant and ready for all sorts of disasters. It is a call on us to know and treat our environment better, and to ensure that all our people are constantly educated … [Interjections.]
The CHAIRPERSON OF THE NCOP: Order! Some members cannot hear what is being said. Could the technical staff ensure that the microphones are working, and not just the microphone at the Chair’s table, but all of them.
Mr P E NOE (Free State): Chairperson, I will have to start from the beginning. [Interjections.] Are the microphones working now?
An HON MEMBER: No. [Interjections.]
Mr P E NOE (Free State): Am I not welcome in this House? [Interjections.]
The CHAIRPERSON OF THE NCOP: Order! … [Inaudible.] I can hear you clearly, Mr Noe. So I am not quite sure what is going on. Perhaps members want you to be loud rather than heard, because I certainly can hear you.
Mr P E NOE (Free State): Thank you again for the opportunity to speak, Chairperson.
Disasters are a serious sociopolitical and economic problem for many of our people and, in particular, the poor communities. We are making a conscious and deliberate start as a country on our way to ensuring a better life for all our people.
The occurrence of disasters impacts negatively on the new strides and achievements which our Government has made. This is therefore a call on all of us to be forever vigilant and ready for all sorts of disasters. It is a call on us to know and treat our environment better, and to ensure that all our people are constantly educated and that our delivery and development plans are not only properly co-ordinated, but also complement each other.
I want to paint a picture of our province’s vulnerabilities regarding disaster response management and capacity, and administrative and financial concerns, to which we need to find lasting solutions if we are to successfully address the issue of disaster management. This will be done if we accept as a general premise that disaster is a product of both poor development planning and unknown natural phenomena. It is therefore a product of human behaviour resulting from omission and commission of various actions.
The Free State province is in the centre of the country and therefore technically immune from some of the disasters prevalent in the coastal areas of the country. In our province we have sparsely populated settlements with a concentration of people in about five towns, namely Sasolburg, Qwaqwa, Thaba Nchu, Botshabelo, Welkom and Bloemfontein. With the decline of mining in the gold-mining areas, leaving a significant number of our population unemployed, the province is predominantly agricultural. This means that, besides the obvious concentration of unemployment in larger towns, the province is dependent on the agricultural sector, which is itself vulnerable to seasonal and very disastrous veld fires that occur every winter.
As a province we have learnt the hard way that disasters know no boundaries. During the rainy season, sections of our province, particularly the Northern Free State, are under constant threat of floods from the potential overflow of the Vaal Dam. The recent floods have also brought closer to home the possibility of the Tugela River also affecting the Eastern Free State.
At provincial level, the function of disaster management is assigned to the MEC for local government and housing. The executive council has approved the establishment of a subcommittee comprising seven MECs, with the MEC for local government and housing as the convenor. At the administrative level the province has a subdirectorate responsible for disaster co-ordination, management and capacity-building. The subdirectorate co-ordinates a provincial disaster management committee, comprising government departments, business and NGOs.
There is also an intermediate structure that serves as a provincial joint operations committee for emergency reaction. Most municipalities also formed their own disaster management committees that provide co-ordination at local level. The subdirectorate provides a direct liaison between the provincial government and these local structures. It must be said, however, that all these structures do not have the ideal capacity to respond to all forms of disasters.
There is, therefore, a constant correspondence between municipalities and their local structures, as well as the provincial disaster management functionaries. The liaison was initially maintained through the radio network.
As a result of high maintenance costs, the network is currently not operational in some parts of the province, and urgent communication is maintained through the telephone system and letters. Parallel to these structures are safety and security structures such as Pococ - which is the provincial operations co-ordinating committee at provincial level - and the joint operations committee at regional level. Co-operative relations are kept between disaster management and safety and security structures. Although the structures function throughout the year, they become more active during disasters. The provincial joint operations committee is activated immediately a disaster occurs and the PMDC functions throughout the year, providing information dissemination, capacity assessment and programme implementation.
Knowing the overall impact of disasters is a very important element of disaster management. The province has entered into discussions with the University of the Free State to investigate the validity of the information that could be obtained from using satellite photos. A programme will be developed to capture and maintain data of affected areas. The importance of this is that it would enable us to know the impact on human settlement and other community facilities. It would also help in quantifying the magnitude of the damage. This will serve as a flip side of the weather bureau early warning system.
The proposed disaster management Bill provides that district municipalities should integrate disaster management into their integrated development plans. The proposal is commendable because it will ensure not only that resources are put aside, but that disaster management is part of the municipalities’ integrated development plan. The same would be the case at provincial and national level. However, the problem that still remains is the manner in which the funds are put aside for unpredictable future outcomes. Obviously, where there is a sense of predictability such as winter veld fires, resources should be put into reducing occurrence and impact.
However, natural disasters are unpredictable and costly. One set of costs is the opportunity cost of budgeting for an event that never occurs, and this leads to a loss in interest. The answer may lie somewhere in the management of our fiscus. Systems should be put into place to enable the national Government to borrow speedily in response to disasters, especially disasters of provincial and national magnitude. The responsibility for this should reside with the Department of Finance and trigger factors should perhaps be the recommendation of the interministerial committee. [Time expired.] [Applause.]
Dr E A CONROY: Chairperson, Minister, MECs and colleagues, the term disaster management, as it is being used here today, is actually a misnomer. When we talk of a disaster, we normally refer to things which happen in nature on a big and sometimes enormous scale, and which have a severe impact on our immediate daily lives and sometimes even for a much longer time after the actual disaster. Floods, tornadoes, hurricanes, earthquakes, volcanic eruptions, protracted droughts and forest fires would be classified as natural disasters and are normally referred to by insurance companies as acts of God. In other words, these are occurrences over which man does not have any control. As man cannot control nature, man cannot manage the havoc caused by natural disasters.
The most we can do in the context of disaster management is to manage ourselves and our own daily activities in such a manner that if and when disaster inevitably strikes, its effects on us, our lives and our surroundings can be managed and controlled to such an extent that they would be the least damaging possible. In South Africa and the Southern African region, natural disasters such as devastating earthquakes or volcanic eruptions are totally unknown, and it is not likely that these will ever occur here. We have, however, seen and felt the results of the recent flash floods, of droughts and protracted droughts which inevitably lead to forest and veld fires which devour everything in their way. It is therefore for these quirks of nature that we have to plan ahead, as far as humanly possible, for storms, floods, droughts and fire.
Wat egter baie belangrik is, is dat natuurrampe nie deur politieke partye gesien moet word as nog geleenthede om kleinlike politieke punte teen mekaar aan te teken nie, maar dat dit geleenthede is waar ons ons hande oor partyskeidslyne na mekaar moet uitreik. Beplanning, beheer, bestuur, vooruitskattings en weervoorspellings is almal elemente van ons menslike pogings om die uitwerking en eindresultate van natuurrampe te minimaliseer.
Tydens die onlangse konferensie oor rampbestuur wat onder die beskerming van hierdie Raad aangebied is, het die Minister van Omgewingsake en Toerisme gemeld dat nie eens die magtige VSA met al sy finansiële bronne, toerusting, satelliete ens in staat is om die pad, rigting, intensiteit en uiteindelike gevolge van natuurrampe te voorspel nie. Hulle kan gewoonlik nie met akkuraatheid vooraf sê presies waar dit gaan toeslaan nie en wat die presiese effek daarvan gaan wees nie. Die meeste wat hulle kan doen, is om die bevolking te waarsku dat so iets op pad is en dat hulle hulself daarop moet voorberei.
Daarom is dit so jammer dat hier in Suid-Afrika, onmiddellik na die tornado wat Manenberg getref het en die oorstromings waaronder ons onlangs gely het, beskuldigings van ondoeltreffendheid na die Weerburo geslinger is. (Translation of Afrikaans paragraphs follows.)
[However, what is important, is that natural disasters should not be viewed by political parties as further opportunities to score petty political points against one another, but that these are opportunities at which we should extend our hands to one another across party lines. Planning, control, management, forecasts and weather forecasts are all elements of our human attempts to minimalise the effects and end results of natural disasters.
During the recent conference on disaster management which was presented under the patronage of this Council, the Minister of Environmental Affairs and Tourism stated that not even the mighty USA with all its financial resources, equipment, satellites, etc, is able to predict the route, direction, intensity and eventual consequences of natural disasters. They cannot usually say beforehand with accuracy where they will hit and what the precise effects will be. The most they can do is to warn the population that something of this sort is on its way and that they should prepare themselves for it.
It is therefore such a pity that here in South Africa, immediately after the tornado which hit Manenberg and the floods which we recently suffered, accusations of inefficiency were levelled at the Weather Bureau.]
What is of the utmost importance is that our people be educated. It is especially the poor and dispossessed who, by virtue of their precarious existence, suffer the most. We must be educated that we should not build our dwellings under the floodline or on the river banks where, we have learnt from experience, water will, without mercy, take away everything that comes in its path. We must be educated that we should not throw away cigarette butts indiscriminately or make fires where we will not be able to control them, and we must be educated that we should not allow our land to be overgrazed or the water resources to be wasted or polluted.
Taking all that I have said into account, one comes to the conclusion that it is of the utmost importance for South Africa to eventually have a properly funded and fully functional national disaster management centre with a national disaster management strategy that supports local level response to emergencies and disaster mitigation in the long term; that gives comprehensive, coherent and appropriate disaster management training as far as community awareness, strategies and programmes are concerned, and that this centre will also assist in our neighbouring countries when disaster strikes there, as so compassionately illustrated during the recent floods in Mozambique. [Time expired.] [Applause.]
The CHAIRPERSON OF THE NCOP: Order! Dr Conroy, you mentioned in your input that man cannot control nature. I was not sure whether women could. [Laughter.]
Ms L JACOBUS: Chairperson, I want to indicate and put on record the apologies of our MEC for development planning and local government. He is otherwise occupied, but asked me to participate in this debate on his behalf and that of the province.
Comrade Chairperson, Comrade Minister, MECs, special delegates and members, the last few months have brought home the reality that our nation is indeed a developing country that is vulnerable to natural phenomena. The impact of the heavy rainfall in February 2000 on Gauteng was not as severe as it was on the Northern Province, Mpumalanga, Eastern Cape and Free State. However, the flood disaster in the Gauteng province must be treated as a warning of an impending disaster of phenomenal proportions, given the population concentrations in the most vulnerable areas. For example, the February rains displaced over 1 800 families in Gauteng, including in the areas of Diepsloot, Alexandra and Freedom Square on the Klipspruit River, causing over R800 000 worth of damage to infrastracture and countless thousands in human misery.
The flooding resulted in rivers rising to the 50-year flood level line. In other parts of our country, the floodlines were around the 100-year level. The Minister and the interministerial disaster management committee must be congratulated for their swift action in assessing the disaster danger and responding timeously.
Allow me to present to this House the impact of the flood disaster in Gauteng and also trace the causal factors. The heavy rainfall of February 2000 affected informal houses of 1 800 families. These included Diepsloot where 300 people were evacuated; Zevenfontein, where 550 families were evacuated; Freedom Square, with 300 families evacuated and Alexandra, where 1 350 families were evacuated. Emergency services of the northern, southern and eastern metropolitan substructure intervened and initiated a process of response, recovery and reconstruction.
The department of development planning and local government also provided support. The families in Diepsloot, Zevenfontein and Freedom Square were accommodated in schools and halls until the water subsided. A few homes were washed away. The worst-hit area was Alexandra. The affected 1 350 families were accommodated in temporary shelter such as tents, churches, schools and creches, including 125 families who lost all their belongings because their structures were washed away completely.
The eastern metropolitan substructure established a disaster relief fund. Substantial monetary contributions to this fund have been received. Together with this, a disaster relief centre was established in Sandton. The purpose of the centre was to receive nonmonetary contributions such as food, clothing and blankets in order to sort and distribute these to flood- stricken areas around Gauteng.
I must take a moment to thank the citizens of Gauteng for the huge outpouring of contributions received. This amounted to tens of tons of clothing, blankets and food amounting to the equivalent of millions of rands. Consequently, the distribution of goods was expanded to the Northern Province, Mpumalanga and even Mozambique. Utilising the moneys the relief fund generated, the Eastern MLC substructure made a decision to launch a reconstruction project.
In the suburb of Marlboro, adjacent to Alexandra, an area was identified for the establishment of a transit camp. The purpose of this transit camp was to temporarily accommodate victims of disaster-related events until they could be permanently relocated. The process of erecting 69 dwellings is nearly completed. This camp will be officially opened on 23 June 2000. The 125 families referred to earlier will be the first occupants.
Another transit camp, similar to the one referred to, is being erected on the Leeukop Prison property in the north of Johannesburg, at the initiative of the national disaster response team headed by Deputy Minister Lindiwe Sisulu. These shelters are being erected and completed as we speak. The rationale behind erecting the transit camps is to involve people in a process where eventually they will become the beneficiaries of housing development projects.
Alexandra is typical of the disaster-prone zones which were the result of apartheid planning and induced poverty. There are still 3 200 structures within the 50-year flood line. All these people automatically become part of the relocating process whose ultimate objective is to reduce their disaster vulnerability and enhance their standard of living.
The causal factors of disasters are firstly poverty, rapid urbanisation, rapid population growth, transition in cultural practices, environmental degradation, lack of knowledge and information, civil strife and misuse or abuse of modern technology. Alexandra, Freedom Square and other areas affected by the flooding are classic cases of having almost all the causal factors listed. Freedom Square is an informal settlement whose significant portion is located in the Klipspruit River. I wish to focus on Alex in explaining this problem. Today it is estimated that Alexandra has about 3 500 formal houses and flats, and approximately 30 000 shacks and informal houses. Regarding location, Alexandra is divided into two main areas, namely the formal housing - the upper income area - and the informal squatter community of Wes Bank, which also has a number of old formal houses. The two areas are divided by the Jukskei River.
The Jukskei River rises in the centre of Johannesburg and passes through Alex. There are an estimated 3 200 squatter huts located below the 50-year flood line along a two-kilometre stretch of the river. This figure excludes those huts situated in the three main tributaries that run through Alexandra to join the Jukskei River. [Time Expired.] [Applause.]
Mr N M RAJU: Madam Chair, hon Minister, hon MECs and special delegates from the provinces, hon colleagues, in the words of John Donne, the famous English poet, and I quote:
No man is an island …
[Laughter.] [Interjections.]
Every man is part of the same continent. Any man’s death diminishes me, because I am part of mankind. Therefore never seek to the know For whom the bell tolls It tolls for thee.
It does not matter where in the world a disastrous calamity strikes, bringing in its wake chaos and upheaval, destruction and devastation; we all feel affected. Whether it is an earthquake in Turkey or Peru; a mountainous mudslide in a coal-mining village in Wales, engulfing a whole school full of children; a cyclone in Miami flattening homes and buildings; a volcano erupting in Japan and emitting its fiery liquid lava which flows down the mountainside upon villages and its residents; a runaway forest fire somewhere in America; the sudden floods that brought such drownings and overwhelming damage in neighbouring Mozambique; indeed, the heavy rains that suddenly fell in many parts of the Republic, electrifying our rivers and streams into currents of upheaval and disruption upon our unsuspecting communities, we all feel affected, because we are fragile and vulnerable human beings occupying a brief tenancy upon planet Earth.
Let us focus for a moment on the South African scene. In many parts of the country, especially in Mpumalanga, the Northern Province, Eastern Cape province and my own kingdom, the province of KwaZulu-Natal, the recent floods have played havoc with the community, shattering the even tenor of our communities, and, unfortunately, destroying the most vulnerable in our midst - our poor compatriots.
I do not wish to dwell on the seemingly uninterested manner in which the state has addressed the management of disasters in the country. When the Cape Flats were hit by floods in 1994, the Government showed an interest in assessing its policy on disaster management. In this regard, three years later Cabinet established the Interministerial Committee on Disaster Management - the IMC - including 13 different portfolio Ministers. A year later, ie in 1998, the White Paper on Disaster Management was approved. In January this year, the proposed disaster management Bill was finally produced for public comment. If we are serious about ensuring effective national disaster management and thus enhancing the general quality of life of our communities, then the Government must show a greater sense of urgency in addressing the problem.
The recent conference on disaster management provided a long overdue platform where various countries such as the United States, Australia, Bangladesh, Madagascar and Mozambique presented very interesting papers with a sense of immediacy on how they cope with their particular and peculiar situations of disaster. An interesting feature of the presentations was the fact that these countries were focusing on being prepared in anticipation of any calamity that may befall them. In South Africa, after the recent floods the Government and the public at large became embroiled in post-disaster management, which was necessary as such management was obligatory on the state.
The DP is not in any way minimising the importance of relief exercises to restore equanimity to the lives of communities shattered by flood disasters. However, activities dealing with preventative and mitigation elements need to be equally developed … [Interjections.] [Time expired.] [Applause.]
Mr Y BHAMJEE (KwaZulu-Natal): Chair, distinguished colleagues, comrades and friends, the fact that we are discussing national disaster management strongly indicates that South Africa has come of age in that we are prepared to occupy our rightful place in Africa and in the world.
As the Minister has clearly indicated, the world has recognised our humanity through our responses in Mozambique which clearly indicated that South Africa will go wherever is necessary to ensure that human life is safe. But, of course, we have inherited and we come from an apartheid past that has also generated human disasters, such as Sharpeville and June 16, which are all man-made disasters. We must never forget that, because apartheid has also created an imbalance, one hon member has indicated, in that apartheid planning and development are responsible for making people live on flood plains, something which is still very much with us.
We need to re-examine and revisit all these issues so that, at the end of the day, we are all committed to improving the lives of the poorest of the poor, because it is the poorest of the poor that live in these plains of disaster.
In KwaZulu-Natal we had a seven-day war and a whole host of tragedies, but we are moving forward in that we now have 72 rural committees in place which function on a voluntary basis and receive a sum of about R4 000 a year, in order to alert the regional councils of any possible disasters, in particular natural disasters. We also have 72 TLC municipal units in total, so that if a natural disaster occurs, we could put into effect 144 units. These will all be co-ordinated and filter their information via volunteer groups and municipalities to the province.
The province put in place the KwaZulu-Natal Civil Protection Ordinance of 1978, as empowered by the Civil Protection Act of 1977 to do so. We, of course, need to revisit some of this legislation and we are empowered by the disaster management White Paper and Bill to bring on board the importance of channelling resources and scientific observation to areas where the poorest of the poor live. We now have in place what we call a disaster management advisory committee, chaired by the provincial head of disaster management, which includes role-players such as the SAPS, the SANDF and other specified role-players. [Time expired.] [Applause.]
Mr P G QOKWENI: Chairperson, hon Minister and members, one would have thought that the tragic disasters to which some of our provinces have been subjected would have given us a few lessons, in order for us to make a shift from our purely eurocentric urban or periurban approach in order to provide responsiveness to the unique needs of the rural environment and rural strategy development. This would make us recognise the fact that some areas are exposed to a chain of constant disasters every season of the year, and that the sum total of these has an impact of a kind more severe than that of the eventful disasters to which we have so quickly responded.
We therefore need to revisit the laws that govern the subject, and use and maintain an integrated approach and co-ordination, to minister to the various material needs of the victims, because only a combined effort of the various spheres of Government, NGOs and research institutions can enable us to meaningfully confront the effects of disasters. We have to review the role of local structures and local government, especially in the light of the current levels of funding and skills where governance is concerned.
The transformation of the South African community must encompass capacity- building, not only of the bureaucracy, but also of the community members in order to make them respond vigilantly to disasters, and to cut down on the existing processes that precede service delivery. We must review the levels of readiness and availability of emergency services, set up early warning mechanisms and educate our people accordingly, and revisit the attitudes at which we provide residential settlements in some areas. [Applause.]
Mr D E AFRICA (North West): Chairperson, Minister Mufamadi, members of the NCOP, MECs, special delegates, any country which does not anticipate possible disasters and consequently prepare itself and its people to respond effectively will not be able to manage such disasters. It is therefore important to note that our ability to respond has been demonstrated beyond any reasonable doubt by our participation even outside the borders of our country. For that reason we want to congratulate the Minister and the department on the contribution that has been made in order to ensure that, within the context of the region, we are able and ready to deal with the effects of disasters, the migration of people and so on and so forth, thereby assisting in those countries affected.
Very recently, floods and disaster struck the province, and the need for an integrated approach cannot be overemphasised. As we may well be aware, the North West is a predominantly rural province which is very underdeveloped, and which is without basic communication systems in many areas. Therefore this was in itself a challenge that required very extreme and immediate responses to that situation.
The disaster affected approximately 800 families with a combined cost of R150 million in damages, inclusive of infrastructural damage. Damage to the agricultural centre was estimated at R57 million, damage to roads was estimated at R23 million, and 120 houses were destroyed. In fact, in the rural areas of the province mud houses collapsed as a result of the force of the disasters, therefore increasing the difficulties that we were facing. As a response, the province established a provincial disaster management team consisting of all the different departments, including the SAPS and the SANDF, under the chairpersonship of the department of developmental local government. At present we have a disaster management team which consists of the following departments: local government, housing and other entities within the province. It is our wish that as we develop this capacity, we will be able to also capacitate traditional institutions which, in the rural areas, are always the centre of help and hope for those people affected by this kind of situation. Given the rural nature of our province, we as a province are therefore working very closely with traditional leaders in order to ensure that they are also part and parcel of this effort to prepare ourselves for this eventuality.
We can say that disaster management is still in the early stages, and when all the necessary legislation has finally been passed, our ability to deal with the situation will be increased. The North West province is prepared for postdisaster assistance. We have a stock of accommodation tents, we have established a command centre and, in a sense, we have also increased awareness amongst rural communities.
We should, however, mention that unless we develop a civic education programme that will ensure that communities in the rural areas and throughout the country are properly prepared for this eventuality, our efforts will be minimal. We therefore wish to propose that the Ministry develops an effective postdemarcation education programme which will take into account the new municipalities, where municipalities did not exist before, and the capacity of existing municipalities that have been amalgamated in order to ensure that, at local level, the structures closest to the people, and even those that have been created as a result of the demarcation and restructuring process, are appropriately capacitated. We have established a disaster relief fund which is under the management of the department of welfare. We are currently developing a document that will guide our response to disaster so that we will be able to assist communities effectively. Our province does not have its own early warning system, and at present we rely on the weather bureau. [Time expired.] [Applause.]
Mr J NGCOBO (KwaZulu-Natal): Chairperson, hon Minister and colleagues, today’s all-encompassing topic is disaster management, but I am only going to deal with a segment thereof, namely situation management, which encompasses communication, relief and evacuation.
The national Government needs to create mechanisms for the integration and co-ordination of disaster management in accordance with the principles of co-operative governance and intergovernmental relations. Communication of information to the correct people in time for decisions to be made is the key to giving operational effectiveness to disaster planning and strategies.
Unfortunately, in South Africa there are countless numbers of people who lack the technological means, such as telephones. In other words, they have no call points to call for the necessary services and help in the case of a disaster emergency. These disasters sometimes happen at night when people are asleep, and without call points they become helpless and are sitting ducks for the ravages caused by those disasters.
There are various companies involved with the establishment of various communication centres, such as 107 companies, throughout the country. These companies, together with the provinces and newly demarcated local councils and district councils, could synergise their efforts in creating these communication centres. Radios were given to joint services boards during the local government elections in 1996 as part of the RDP in order to provide a communication network in rural areas. These radios used the nearnet system. Unfortunately, they were removed after the elections and they are currently being stored in the regional council or district warehouses. These radios could be supplied to the newly demarcated councils and be put to good use in order to enhance communication lines in rural areas.
Some relief measures need to be co-ordinated between the various tiers of government. This refers to activities aimed at supporting victims of disaster by the provision of shelters, essential supplies such as medicines, food, water and rescue services. Evacuation involves the temporal relocation of a population from zones of risk of a disaster or imminent disaster to a safer location. [Time expired.] [Applause.]
Mr J O TLHAGALE: Chairperson, hon members of the House, disasters are very often caused by natural events such as earthquakes, hurricanes, floods, fires and volcanic eruptions. However, in South Africa disasters are mainly due to localised incidents such as veld fires, seasonal flooding and accidents in the mining industries.
In January 1999 the Ministry for Provincial Affairs and Local Government issued a White Paper on disaster management. Unlike previous policies, the White Paper focused predominantly on relief and recovery efforts. It propounds a new approach of preventing human, economic and property losses. Whilst measures for more efficient rescue operations are still a priority, much greater attention should be directed at the introduction of preventive strategies aimed at saving lives and protecting property before it is lost.
The short-sighted view of one country dealing with disaster management in isolation must be abandoned. Regional co-operation in disaster management is vital and should be pursued at all costs. Joint standards of practice are recommended to be established in order to develop an early warning system that would reduce the impact of crossborder disasters.
The response to the recent floods in Mozambique is a good example of how regional co-operation and private-sector involvement could contribute to reducing human suffering to the minimum. An awareness campaign discouraging people from building their houses on sloping ground or low-lying ground would benefit our people. [Applause.]
Mr G E KWINTI (Eastern Cape): Chairperson, hon members of this House, Mr Minister, disasters have not hit the Eastern Cape on the scale that they have hit others in the recent past. When the floods hit us, we were institutionally unprepared. As a result, there was no rapid response in terms of welfare relief, shock amelioration.
The most vulnerable, whether urban or rural, have been the aged and children. These groups of our people have been the most notable victims of disasters recently. Where we have needed to respond to these natural disasters, part of that response has been to plan deliberately to move away from absolute dependence on central Government in terms of budgeting for disaster management and relief. We have budgeted a very modest amount for these purposes in this financial year. We needed to do forward planning as well. In this regard we fully agree with the proposal made by the NCOP delegation during its recent visit to the Eastern Cape, and that is that we should prepare people where they are. We fully agree with this approach. We have also established an interdepartmental team of politicians and technicians and established a disaster management centre. All this has been established in order to make comprehensive response possible, because, in terms of the understanding that we gained, particularly after lengthy discussions with the delegation, we are beginning to focus more on rapid response which will be based on our training the local people to respond to disasters, in order to begin to address issues of how to manage disasters in the long-term so that we can rely on such plans. Government can only come in at a later stage with those comprehensive responses which have medium- to long-term effects.
Part of our planning includes persuading people to move out of areas that are clearly disaster prone. This is a preventative measure which must be handled carefully. It is pleasing to note that in some of the areas in the Eastern Cape which have been hit by tornadoes, some people have begun discussing the question of moving from those areas, which have been frequented by that kind of disaster. This is the route we are following.
With the support we are getting from central Government and this House, we are convinced that we will go a long way. The advance of R40 million for emergency reconstruction which we received from central Government is welcome by our people. Plans of action are afoot. [Applause.]
Ms P C P MAJODINA: Hon Chairperson, Minister Mufamadi, hon MECs, special delegates, NCOP members, allow me to greet you in the name of democracy.
Today’s debate should assist all of us to have a proactive approach towards disaster management. Having led a delegation to assess the damage caused by disasters in the Eastern Cape, we became emotional on seeing the conditions there and the extent to which people lost their lives, property, crops and livestock.
No accessibility to neighbouring villages, not to mention hospitals and mortuaries, landed them an even larger blow. Bridges leading to paypoints had their banks eroded and, therefore, pensioners and people with disabilities could not receive their grants.
The destruction of infrastructure and the disruption of economic and social activities meant that the scarce resources that were earmarked for development projects had to be diverted to relief and reconstruction efforts, thus setting back economic growth and job creation in our country and the region.
People in regions such as Matatiele, Bizana, Mount Frere and Mount Ayliff were forced to keep their dead in houses with them because they could not be taken to mortuaries. At times they were forced to carry them on stepladders in order to cross rivers, something which posed the serious threat of death to those who crossed flowing rivers.
Schooling was affected. Some old mud structures serving as classrooms collapsed. Schoolchildren in Mobeni, Bizana, used their desks to erect a makeshift bridge so that they could cross the river. At times they slept in the veld.
A terrible scene was witnessed at Mzimvubu river, in which boys aged nine and 11 were operating string ferries, commonly known as shuttles, across the river, an exercise which was dangerous to both the children and those crossing on this half-cut drum pulled by a string. These heroic young boys were doing what is called community service at the expense of their own lives.
At Sisulwini, in order for cars to cross the river, a driver needed to call 15 strong men who would literally carry the car across the river. Livestock drowned and the few remaining stock need urgent veterinary treatment. Houses kept falling down because they were standing on wet soil and, being mud structures, they could hold water.
At Sidakeni there is the health and disaster risk of mountain soil moving closer to residents as the soil is disintegrating. There is the possibility of heavy mud slides hitting the residents, leading to loss of life. The consideration of removing and relocating these people is urgent. This could be done in consultation with traditional leaders.
We need to speed up rural strategy development so that rural people need not stay in mud huts, but have access to low-cost housing. An urgent reconstruction of roads and bridges by the Department of Public Works should be in motion. The Department of Education should replace mud structures, which have been built by communities for quite some time, with proper structures.
Capacity-building in local government is imperative in order to assist in dealing with disasters. There is a need to revisit two present laws which govern the subject when declaring an area a disaster area.
It was shocking to hear a story about a man in Mozambique who spent three days sharing the branch of a tree with a mamba. Three days after his rescue, the man became mentally disturbed, because of the terrible situation that he had found himself in. [Applause.]
Mr J MASWANGANYI (Northern Province): Chairperson, Minister, MECs present here, permanent and special delegates, I just want to indicate that in the first week of February 2000 the Northern Province experienced the worst floods in living memory. The severely affected areas were the northern region, the lowveld and the bushveld. Most of the damage was caused to road infrastructure, dwelling houses, schools, water systems, health and farms.
Heavy rains fell again on the weekend of 18 and 19 March 2000, mainly in the lowveld, northern and bushveld regions. About 100 lives were lost because of the flood: 49 of these were in the northern region, five in the central region, five in the bushveld, and one in the southern region.
The Government, together with the business sector, assisted the bereaved with coffins and burial arrangements. On realising that the extent of the damage exceeded the capacity of the government of the Northern province and various local governments, the provincial government appealed to the President to declare 39 magisterial districts disaster areas.
How did we respond to the disaster? Many homeless families were accommodated in schools, churches, public facilities, etc, and some were provided with tents. At present 19 232 families have been affected, and it will cost not less than R350 million to assist those families by providing them with decent housing. The department has since committed itself to providing houses to the homeless, and an amount of more than R196 million is earmarked for this. The number of damaged houses keeps increasing as the houses keep collapsing as a result of the after effects of the disaster.
Developers have been requested to rehabilitate the essential components of the internal road network. An amount of R90 million allocated by the national department, approved for the consolidated municipal infrastructure programme for this financial year, has been redirected towards the water, storm water drainage and sewer systems, which were damaged by the disaster. The national Department of Finance has since allocated R93 million as a conditional grant to deal with the infrastructural backlog, as well as with services that were damaged as a result of the disaster. Of this amount, R67 million will be used on roads and bridges, R3 million for rehabilitation of schools, R10 million will be used for the repair of water services, and R1,3 million on public services.
We learned that there is a shortage of trained officials in the Disaster Management Subdirectorate, and that there is a shortage, or a complete lack of appropriate vehicles to respond to disasters.
There is a need to build capacity in municipalities so that they can quickly respond to disaster situations. An early warning and public alert system will be put in place. Declaring areas as disaster-stricken areas immediately is important because delays prohibit donors and the international community from assisting. The Northern Province government will collaborate with institutions of learning so that they train officials and community members on disaster management. The province has stepped up its efforts on disaster management. A control board of trustees, composed of eminent members of civil society and business, has been appointed.
We have put in place a permanent joint operations committee, which is composed of officials from the department, the army and the Police Service.
In conclusion, we would like to pass a word of gratitude to the international community, sister provinces, the business sector, civil society and individuals who contributed massively to assist the victims of the disaster. Were it not for the above-mentioned parties, Government alone could not have risen to the challenge. We would also like to thank the security forces who worked tirelessly to rescue and evacuate close to 700 people, and airlifted food and tents to inaccessible areas. [Applause.]
Mr N M ISAACS (Western Cape): Chairperson, I would like to thank the National Council of Provinces for presenting a very successful two-day conference. The speakers who presented papers there gave us a good insight into disaster management in our region of Southern Africa and how we managed the different disasters that occurred over the last few months. The Western Cape had its share of disasters, with fires along Table Mountain and the West Coast, and floods in the central Karoo, Klein Karoo and Southern Cape regions.
It was interesting to note that other countries have the same problems as South Africa, such as Bangladesh with floods, and Australia with bush and forest fires. The important golden thread which ran throughout the conference was that the poorest of the poor communities are affected by most of the disasters. The theme ``Towards Proactive Disaster Management’’ led us to the objective of a White Paper on disaster management and the Bill that was published for comments. The focus of the White Paper and the conclusions drawn at the conference indicated that more attention should be given to the mitigation and prevention actions of disaster management.
The process for these actions would be to establish a data bank, a central information centre, from where risk analysis, risk deduction, mitigation and regional co-operation can be co-ordinated. This golden thread also extends to the Bill, which seeks to establish disaster management centres at all three spheres of government. The actions for these tasks should include all communities, urban and rural, and there should be a shift to smaller communities. This immediately raises the capacity-building and training that is required, especially in the rural and disadvantaged communities. NGOs, commerce and industry, and the public should enter a public-private partnership to make the functions of such a centre work.
In order to implement the Cabinet decision of 28 June 1995, the Department of Constitutional Development requested the provincial administration on 28 September 1995 to establish a disaster management structure at provincial and local levels. The central Government’s directive indicated that disaster management should be placed with the department responsible for local government in the province.
At present, in the Western Cape the disaster management function falls within the Department of Local Government’s sphere of responsibility, and therefore a disaster management co-ordinating structure has been implemented since 1997 by means of a provincial disaster management committee. This structure includes all role-players in the province at provincial as well as local level. The provincial disaster management committee includes all national and provincial departments that have a disaster management responsibility. The purpose of the above-mentioned function is to bring about effective provincial disaster management by means of prevention, relief, preparedness, response, recovery and development to improve the general quality of life of the province’s inhabitants.
The disciplines are also subdivided according to disaster risks into work groups that have an advisory role to the committee. The following provincial work groups, with sub-work groups, were established, convened and maintained by the following departments: the fire brigade work group at rural level; the flood work group; forestry and training capacity; the environmental disaster work group; the emergency relief group; the drought work group; the communication work group; the signal unit; and the urbanisation work group. The above provincial disaster management structure is duplicated at regional level and established at seven district councils in the metropole.
The regional committees and the work groups will address the paradigm shift from reactive to proactive actions, with the emphasis on prevention and information. These structures are then also responsible for all disaster management planning down to the community level through local authority structures in their respective areas. The Western Cape is proud to announce that the disaster management co-ordinating structures have been effective during several disasters in the Western Cape, as well as with the Y2K phenomenon, and have a good track record. The only negative comment I can make is that the transitional process of local government has had a negative impact on disaster management, but this should improve once the new local councils are functional. I also wish to mention that the Western Cape is looking at disaster management in a proactive way and therefore, after the major fire, a committee was appointed to investigate the fire and make recommendations to prevent such a catastrophe from occurring again.
The Western Cape can be seen to be already looking to address the problems identified, and to act on the recommendations made at conferences. Communities must be involved in capacity-building and form part of the disaster management structures. Business should realise that they have a major role in the public-private partnership, and must have a holistic approach to disaster management. The establishment of a disaster management data base is important, and the communities must be involved in the assessment of risks in their areas which pose a threat and can cause possible harm in these areas.
There should be timeframes set up to develop strategies for proactive actions that communities can implement to mitigate the negative consequences. Actions to be taken by the disaster managers … [Time expired.] [Applause.]
Mrs E N LUBIDLA: Deputy Chairperson, to avoid repetition, I will give precedence to the resolutions of the conference. The conference resolved that its report should be taken to the NCOP plenary, and should formally be handed over to the national Government, provincial governments and legislatures, and to the South African Local Government Association, with a recommendation that they take forward the debate on the issues raised in the report and provide feedback to the NCOP. It was also decided that a steering committee should be established to oversee implementation of the recommendations of the report.
It was further resolved that the NCOP should continue to play a role in providing leadership and maintaining the momentum of the debate on disaster management. It was decided that the NCOP should work closely with the Department of Provincial Affairs and Local Government on the proposed legislation dealing with disaster management. It was also decided that the NCOP should convene an annual conference on disaster management to review progress and promote a co-ordinated national response to disaster management. It was furthermore resolved that the NCOP should put forward a request to the national Government to establish appropriate protocol in the Southern African Development Community in relation to disaster management. Lastly, it was decided that the NCOP should keep all participants in the conference informed of developments in disaster management in South Africa. [Applause.]
The MINISTER FOR PROVINCIAL AND LOCAL GOVERNMENT: Chairperson, hon MECs, hon members, allow me to thank all who participated in this important debate. I promise that I will take to heart the advice which participants gave in the course of their interventions. I also wish to commend the NCOP for despatching a team which visited all the provinces that were affected by the recent floods. These visits must have given them the first-hand impression without which it is difficult to arrive at informed determinations.
I also want to thank them for convening an event which made the sharing of views on a transnational basis possible. This obviously can only enrich the effort which we are going to make in the future. I must also acknowledge receipt of a report arising out of that conference and, once more, I pledge, on behalf of national Government, that we are going to pay due attention to the issues which are raised in the report. Of course, as I said, many pieces of advice were given which we will take very seriously. By implication, there are certain things which were said in the form of advice which I want to take this opportunity to dismiss.
For instance, the hon Mr Conroy, who was very eloquent when he was talking about acts of God which cannot be controlled by man, started to say controversial things when he decided to revert to Afrikaans. [Laughter.] Now I want to share with this House that, last week when I was in the other House, an interesting occurrence was witnessed. The occasion was a debate on Vote No 22, a repeat of which will happen this afternoon in this House. Out of the blue, two hon members, one from the New NP and the other from the DP, started quarrelling on matters which had nothing to do with the Vote that was before the House. I noticed that today, the hon Mr Conroy and the hon Mr Raju did not quarrel with each other. It became clear, as they were speaking, that what they have in common is the patriarchy of language which they use when they debate issues.
Mr Raju accused Government of what he called the seemingly disinterested manner in which it attended to the disaster. He also said that Government had not shown a great sense of urgency. I noticed that time expired before he could give evidence of this charge. It is unfortunate that the small size of his party did not allow him enough time to provide evidence for the accusation that he was making. [Laughter.]
The hon Mr Qokweni decried what he called the eurocentric urban approach of the Government to disaster management. Perhaps he needs to be informed that urbanisation is not a peculiarly European phenomenon. After all, in some parts of this very continent, the process of urbanisation predates colonial invasion. I know there is not enough time to expand on this. I am prepared to run a workshop for the UDM in this regard in order to bring them up to speed with the modern world. [Laughter.]
We will be meeting later this afternoon to discuss Vote No 22, so I want to rest my case here. [Applause.]
Debate concluded.
UNPARLIAMENTARY LANGUAGE
(Ruling)
The DEPUTY CHAIRPERSON OF THE NCOP (Mr M L Mushwana): Order! I wish to take this opportunity to thank the hon the Minister for engaging this House in a lively debate.
Before this House rises, I want to deal with a housekeeping matter
regarding an incident which happened on 6 June in this House when the hon
Van Niekerk raised a point of order as to whether it was parliamentary for
a member - whom he later identified as Mrs Lubidla - to tell another member
hou jou bek''. [Shut uour trap’’] The hon Mrs Lubidla denied having
made such a remark. I then undertook to listen to the Hansard record of
proceedings and to give a ruling. Having listened to the tape, I am of the
opinion that the relevant section thereof was largely inaudible and that it
was impossible to hear the phrase that the hon Van Niekerk referred to. On
that premise, I am not able to make a ruling on that matter.
Business suspended at 11:47 and resumed at 14:04.
APPROPRIATION BILL
(Review of Policy)
Vote No 22 - Provincial and Local Government:
The MINISTER FOR PROVINCIAL AND LOCAL GOVERNMENT: Madam Chairperson, hon MECs, I would like to thank …
The CHAIRPERSON OF THE NCOP: Order! Could we ask the technical people to ensure that the sound system is working. We wish to hear the debate. Could we have the volume at the right level, please, because we cannot hear.
The MINISTER: The system does not appear to be working.
The CHAIRPERSON OF THE NCOP: Order! The system is not working. Maybe, Minister, you will support me, because we have been arguing for some time that we should build a new Chamber. [Laughter.]
The MINISTER: You have got my full support in the light of this. [Interjections.]
An HON MEMBER: In which province? Northern Cape? [Interjections.]
The CHAIRPERSON OF THE NCOP: I will not utter those political sentiments. Order! Hon members, take your seats. We are now ready to begin.
The MINISTER: Chairperson, hon MECs, hon members, let me first thank the Chief Whip of the Majority Party in the NCOP and all those who took on the responsibility of backing me up technically to make this address possible. Comparative experience shows that almost all countries continually put their governance processes under review. In most multisphere systems of government, it is important for governments to always keep the relationship between the various spheres on their radar screens. It is only if they do this that they are able to find better ways of achieving service delivery efficiency and sustainable economic development.
Governance today must address complex issues and find solutions to complex problems. It must ensure that dichotomies, which are inherent in all multisphere systems, are kept in healthy balance. These are trade-offs such as local discretion and national direction, local differentiation and national uniformity, as well as responsiveness and efficiency.
This is the context in which the recently released audit report on intergovernmental relations must be seen. I must hasten to point out that the audit report is not the last word on the matter. What it represents are the views of the role-players who were interviewed. It tells us what these role-players think about our intergovernmental relations systems, structures and processes. This report will henceforth undergo a process of extensive interrogation by focus groups made up of major stakeholders involved in intergovernmental relations. These focus groups will test the veracity of the statements contained in the report. The report will thus form a basis of discussion which must lead to the adoption of policy on intergovernmental relations. The release of the report could not have happened at a better time. It comes at a time when we are poised profoundly in order to consolidate the continuing emergence of a healthy society by completing the negotiated phase of local government transition.
Local government, despite its centrality to the development effort, has been the weakest partner in the governing relationship. In the circumstances, many of our attempts at building a better life for our people could not be crowned with success.
Parliament is about to finalise putting in place the legislative base for our country’s democratic municipal governance. We are now crossing the threshold into an era which will be characterised by municipalities which have a more functional economic, financial and administrative base, and we will also have more representative and focused political structures that have significant political powers. Those municipal entities will also have better administrative systems which will allow for greater participatory democracy and more equitable, efficient and effective financial arrangements.
Clearly, the national and provincial spheres have played and continue to play an important catalytic role in the process of bringing about a new system of municipal governance. Even as the process continues to unfold, we must look around the corner at the coming world and be prepared for what we will find there.
The President’s co-ordinating council, a forum which brings together the Presidency, the Ministry for Provincial and Local Government and the premiers, believes that inadequate support for local government by the national and provincial spheres is one of the reasons for municipalities’ inability to discharge their mandate.
It will be necessary, as we look at the audit report, for the National Council of Provinces to position itself in such a way that it helps to solve this problem. The Local Government: Municipal Demarcation Act and the Local Government: Municipal Structures Act encourage significant amalgamation of small local authorities with a view to providing more and better services at levels of government which are closest to the people. The proposals of the Municipal Demarcation Board are consistent with the provisions of these laws in that they will have the effect of increasing the size of government to achieve economies of scale.
One of the features of the new local government system will be the six metropolitan areas and secondary cities. Over 50% of the people of South Africa and a very high proportion of job opportunities are found in these areas. This means that these areas will continue to constitute our country’s productive base. However, the demographic reality of these areas will make them infinitely harder to manage. Together with their district counterparts, metropolitan councils will be strategic catalysts for local economic development. We need to determine policies and other instruments which will have to be put in place to ensure continuing national and provincial support for these municipal categories.
One of the reasons for the provinces’ lack of impulse to support and supervise local government has been the fact that we tend not to budget for the expenditure which the discharging of such functions entails. The NCOP, the National Assembly, the provincial legislatures and the national Financial and Fiscal Commission will have to look at this matter very closely. The President’s co-ordinating council attaches such importance to this issue that it directed the Department of Provincial and Local Government to co-ordinate the formulation of a national framework for monitoring, support and supervision.
As we formulate this framework, we shall be guided by the following principles: Firstly, the framework must be of a co-ordinated and intersphere nature. It must also draw upon existing monitoring processes which are premised on the provisions of the Constitution. The different spheres must assist each other for the benefit of the entire country and all its people and, lastly, all spheres must be part of a mutually reinforcing programme in order to improve governance outcomes.
Although our Constitution provides for national and provincial interventions in crisis situations, we are firmly of the view that interventions tend to produce an unintended consequence, namely that they tend to undermine the integrity of the sphere they are intended to help. It is preferable to adopt a proactive approach which prevents crises from occurring and, therefore, makes interventions unnecessary.
It is against this background that the President’s co-ordinating council provided an input which is intended to enable all three spheres of government to perform their functions and exercise their powers. The rationale for this originates from sections 125(3) and 154(1) of the Constitution which require that national Government assist provincial and local governments to develop the capacity for the effective exercise of their powers and functions.
Although all national Government departments have the obligation to build provincial capacity within their particular line function terrain, the Department of Provincial and Local Government has the responsibility to co- ordinate and facilitate capacity-building efforts. It is for this reason that we have undertaken a project to assess capacity-building programmes conducted in the past five years and to identify capacity needs which must be met. It is envisaged that the project will run until the end of February 2001.
If properly approached, the quest to achieve more effective methods and levels of collaboration between spheres of government will bring forth great feats of the human imagination. It requires the collective will to adopt flexible habits where conditions call for such habits to be adopted. For instance, we need to ask whether the current arrangement where organised local government enjoys only an observer status in the NCOP is the best way in which to protect and promote the interests of this important sphere of government. This question extends to those executive intergovernmental structures which promote co-operation in areas of concurrent jurisdiction.
We must consider ourselves fortunate to live in the present time, a time of change and excitement. It is a time which brings forth questions which must be answered in order for the search for a better life to remain on course. It is my fervent hope that the NCOP will find a niche for itself in the frontline trenches of the continuing search for a people-centred system of governance in our country. [Applause.] Mr M BHABHA: Chairperson, I will continue with the philosophical note on which the Minister ended. The famous writer Thomas Hardy once said:
The offhand decision of some commonplace mind high in office at a critical moment influences the course of events for a hundred years.
Indeed, the decision to transform local government is not the work of some commonplace mind. It stems rather from an understanding that, to transform our society, we need to address, or should I say redress, the conditions at the level which bore the brunt of the apartheid system.
It is at local government level that spatial separation and the implementation of the Group Areas Act resulted in the traditionally white municipalities being protected from bearing the responsibility for servicing the disadvantaged black areas.
The Local Government Transition Act has regulated local government for the past five years or more. While there has been success in addressing backlogs and extending services, it is patently clear that delivery on new municipal mandates cannot be achieved within the existing institutional framework.
To illustrate my point I believe it would be appropriate to refer to a very real statistic. In the Cape Metropolitan Council, for example, 88% of the households use electricity, 90% make use of flush or chemical toilets, and 91% have refuse disposal once a week. These are indeed impressive figures. But, when one studies the demographics of those that do not have access to these services, one realises that unless we change the present institutional framework we will never be able to confront the challenges before us. The stark reality is that 95% of the people in the Cape Metropolitan Council that do not have access to these services happen to be African households.
The transformation of the institutional framework from its present form to one that will address the challenge of uniting our communities, address the backlogs of infrastructure and create municipalities that are able to compete in a global community, is indeed a daunting task. The approach is a multifaceted one that requires appropriate policies and consistent legislation, all of which has to be complemented by mature political leadership and skilled human resources.
Although the new systems and structures will only become operative after the forthcoming local government election, we will be required to anticipate problems of implementation. We will be required to use our imagination and have the will to take difficult decisions. The level of preparedness of our provinces and municipalities prior to the forthcoming election will determine the speed with which municipalities will be able to perform after the election.
We simply cannot afford a recurrence of the experiences of the 1995 election. There was prolonged uncertainty about powers, functions, areas of jurisdiction and a host of other matters. All this was happening while there were increased expectations and demands on delivery. No doubt our experiences in the past years have informed, and will continue to inform our legislation, but legislation only provides the framework for a system. It is the implementation and the related details that prove to be crucial.
It is in this regard that the select committee is pleased to note that most municipalities have already set up restructuring committees to usher in the integration of municipalities. However, it is suggested that the functioning and decisions of these restructuring committees be monitored very closely by the respective members of the provincial executives. I say this for three reasons. Firstly, many of the small municipalities do not have the capacity to perform what is a huge task. Secondly, the persons involved in the workings of the restructuring committees are often negotiating their own futures, particularly the members of the administration. A lack of capacity, together with an overreliance on the administrative staff for information, could prove ineffective and somewhat costly. Thirdly, the decisions of the restructuring committee must be consistent with national and provincial objectives.
Restructuring will entail the redeployment of personnel from one structure to another, be it from the district council to category B municipalities or from one existing municipality to another. After all, one of the key deficiencies in the present system that the White Paper on Local Government seeks to address is the issue of duplication of functions. The restructuring process in 1995 did create uncertainty amongst personnel. In retrospect, it appears that the fears that emanated from this uncertainty at the time were largely unfounded.
I would urge employees throughout the country not to view this transformation from a narrow perspective, and instead to view it from a perspective that sees the transformation as a process that is necessary, uncomfortable perhaps, but essential nonetheless.
The committee is and will be processing important legislation in the forthcoming months. Its provisions will have far-reaching effects. None of us has illusions about the fact that the structures and systems that are consequently established will be a panacea for many of the shortcomings of the present system. What we are certain of is that the present system requires overhauling, and what is introduced after the forthcoming elections will go a long way in addressing these deficiencies. Of course, some tweaking may be necessary as this develops organically. After all, the advanced democracies of the world, such as Australia and the United Kingdom, are still adjusting and sometimes make sweeping changes as the demands of the economy and the needs of the communities increase.
One thing is certain: Whatever structures we establish, it will be the people that occupy these structures that will determine their success or failure. And at this stage I would urge the department and the Ministry to concentrate appropriately on the area of training.
I believe it is appropriate at this juncture to discuss the NCOP. In assessing the role and function of this institution, I am always mindful of one incontrovertible fact. I just find it remarkable that in a young democracy such as ours, and in a country where political parties were so ideologically divided at the time of the signing of the Constitution, there have been almost no constitutional cases that have emanated from interspheral disputes. In fact, I find it miraculous. I believe that an assessment must start from the premise of the contribution this House has made in maintaining stability amongst the constitutional structures.
That said, we cannot detract from the fact that an assessment of the role of this House in the constitutional order, particularly in the area of intergovernmental relations, must be visited. We cannot detract from the fact that the executive intergovernmental relations processes have eclipsed their function. By the time legislation does come to this House, it has already been thoroughly discussed by members of the provincial executives in the Minmecs. We obviously cannot expect a fresh approach from the same members that now participate in this House as members of the legislatures.
However, as this House develops and grows, it is beginning to find an area of particular significance. This House is beginning to play a significant reviewing function, scrutinising specific national and provincial executive actions affecting the distinctiveness of another sphere. We are still in the embryonic stages, but, sure enough, as we come to terms with this function, the effectiveness of this role will also increase.
I am not so sure that the Minister is entirely impressed with what I am saying at this juncture, but I am prepared to bet my bottom dollar that he will agree after he has heard the views of all the respective provinces. I am certain that his department will leave wiser and armed with the knowledge of how implementable the Ministry’s policies are.
In keeping with this function of review is the all-important role that the NCOP has been playing with regard to interventions. Our experience in the several interventions that we were involved in has led us to a number of conclusions. One of the most important conclusions - the Minister did touch on it - is that, with a proper monitoring system and the use of the right measures of support, some of the interventions could have been prevented. Amongst the lessons learned from our experiences is that if the provincial department had understood its supporting role better, an intervention would not have been necessary.
But these are conclusions that are drawn in a period of transition, where circumstances are extraordinary. Many of the councils were nonstarters from inception and no amount of support will take them off the critical list. The town of Noupoort, for example, has an unemployment rate of 80%, and we can hardly expect the council to thrive under such dire economic conditions, all the more reason why the demarcation process was necessary. Since this is the last review before the local government elections, I would like to take this opportunity to thank and compliment councillors and members of the administrations throughout the country for the role they have played in helping us usher in the new system of local government. They have often been asked to perform, and were judged, in conditions that worked against them rather than for them, especially in an atmosphere of heightened expectations. The MECs deserve a word of appreciation in this regard.
Finally, I just wish to inform the Minister that I am blessed with a very talented committee, one that has been ever obliging and has worked very hard. May I just thank the Minister and his department as well. [Applause.]
The CHAIRPERSON OF THE NCOP: Order! Hon members, I am sure that you will agree that the presiding officer must express appreciation at the presence of so many special delegates from the provinces. I am sure we will get to hear a great deal about the specific context of provincial and local governance this afternoon. I am really very pleased that we have such an attendance.
Mr P DIKGETSI (Northern Cape): Madam Chair, hon Minister, fellow colleagues from provinces, friends and comrades, the agenda of the ANC-led Government, at both national and provincial level, is focusing increasingly on performance of both individuals and organisations. These shifts are embodied in recent regulations and legislation, including, amongst other things, the Public Service regulations, the Public Finance Management Act, the Local Government: Municipal Structures Act, the Local Government: Municipal Demarcation Act and the new Local Government: Municipal Systems Bill, which is about to become an Act.
Better planned and more effective service delivery, which is monitored against predetermined targets, represents a model for the future management of institutions. As the economy of South Africa develops, it is critical that there is tighter control over public expenditure. In essence, the Government has to deliver more and spend less.
Given the pressures of the past five years to meet the needs of previously disadvantaged communities, the province has geared up its resources and processes to speedily deliver infrastructure and housing projects to disadvantaged communities. Over the next five years, that is between now and 2005, the Northern Cape department of housing and local government has set targets within projected resources available to alleviate poverty and assist the Northern Cape province to develop in a sustainable way. Our department is, therefore, playing a key role in alleviating the plight of the rural poor, through provision, via local governments, of housing, water and sanitation schemes.
In the next five years, in line with national and provincial aspirations, the province will shift its priorities towards facilitating a developmental local government that is viable. The mission of our department for the next five years is to ensure the provision of basic services to all our citizens and to reduce poverty through effective local government. We are striving towards reorientating our work to deliver this imperative. The systems in operation in our department enhance some outputs, but we also need to develop new approaches and increase effectiveness in our work with district and local municipalities.
The department is gradually moving away from a monitoring role, which emphasises enforcement, to an approach of interactive co-operation and facilitation that enables local governments to play their developmental and governance roles in line with national policies and legislation. This enables us to meet the level of requirements for proper regulation and facilitation of local government performance. The aim is to build the capacity of municipalities so that they are able to serve and meet the needs of the citizens and communities directly.
In addition, the department will continue to provide an enabling legal framework, manage national and other resources earmarked for local authorities, and facilitate local government structures with advice and guidelines.
The national Government and provincial governments have sought to enhance and improve municipal performance through the management support programme. I must indicate that this process is successful thus far and will definitely give results. However, there are still many deficiencies, and a large skills gap still exists at local government level, which we will address.
In addition, the new municipalities which are being created through the demarcation process represent the biggest and most challenging structural change since the transformation of local government began. The result of the current demarcation process will see, in the Northern Cape, 26 category- B municipalities, four district municipalities, one crossboundary district municipality and one crossboundary local municipality.
Many of the newly demarcated municipalities in the province are set to cover large geographical areas, which are currently only tenuously connected. The amalgamation will bring together a new body of elected councillors, many of whom will have had very limited or, perhaps, no previous experience. The increase in the size of municipalities, although offering opportunities for cost reduction, will further challenge accountability and good governance, especially as it relates to community involvement in developing sustainable services and poverty eradication.
To meet these challenges, the department has sought to assist municipalities through the formation of multiskilled regional facilitation teams in the six regions that exist in the province. Members of the teams are drawn primarily from staff within the department, but also include staff from other provincial departments and some municipalities. These teams began with integrated development planning, but are now addressing governance, demarcation and amalgamation issues.
However, this work has only started, and facilitating the newly established municipalities, after elections, will be a highly challenging task that would require that the facilitation teams acquire a range of interdisciplinary skills. The regional facilitation teams are seen as the department’s frontline support for municipalities, and there is a need to communicate this effectively through the municipalities. There is also a need to determine how specialist staff in the head office can support this work.
Also, over time, substantive information and know-how on assisting municipalities will build up within these teams. There is a need to embed the experience gained in the department and the provincial government at large, and for the lessons to be more widely disseminated within the province and nationally.
The focus is to have a multiskilling of the facilitation teams. In particular, the department is keen to ensure that municipalities approach development planning, budgeting and administration as an integrated process. The need to deliver workplans, in terms of the LDO and IDP process, has been largely achieved through interaction between regional facilitation teams and local governments at both official and elected member level, as well as community organisations. We have also been engaged in integrated development plans. Through this process of facilitation and integrated planning, it is anticipated that new infrastructure and housing will be targeted to reduce the poverty of the rural poor.
The demarcation of local government will require this work to be revisited and redefined as the new local governments take shape and become operational. Among the consequences of demarcation will be that of opening old arguments about priorities between communities. The skills of the facilitation teams and their intervention will be critical to the resolution of conflict and to defining a way forward that captures the essence of integrated planning.
The facilitation team will need support over the next two years to deliver the form of integrated development plans and developmental local government that will seriously tackle poverty reduction through sustainable local economic development objectives.
May I take this opportunity to thank the Minister and his department for his leadership in the demarcation process, and also to thank my colleagues in other provinces. It is only through the process of co-operation, provincially and nationally, that we will be able to achieve good results in terms of this transformation agenda. [Applause.]
Mr J MASWANGANYI (Northern Province): Chairperson, hon Minister, MECs, and members of this honourable Chamber, let me first congratulate the hon the Minister on the budget which he presented, which will seek to build strong and viable local government structures.
The current restructuring of local government, as stipulated in the White Paper on Local Government, is based on the following premise, and I quote:
…. that apartheid has fundamentally damaged the spatial, social and economic environments in which people live, work, raise families, and seek to fulfil their aspirations. Therefore the new democratic state’s mission is that of meeting the new developmental objectives which will help to create a better life for all.
This process intends to erase all concepts such as R-293 towns, coloured and Indian management committees, Bantu Affairs Administration Boards, community councils and black local authorities from the South African local government Statute Book, and immortalise the current people-centred developmental local government. This is done in the context of satisfying the South African constitutional requirement, that local government is a sphere of government in its own right and no longer a function of national or provincial government. Local government has been given a distinctive status and the role to build democracy and promote socio-economic development. This framework should continue to be our reference point as we engage collectively and severally in this often laborious process of restructuring local governments.
The demarcation process, as the Minister has outlined, is nearing finality as the board is speedily dealing with the conclusion of wards delimitation. The board has already determined the delimitation of 26 local councils, from an initial 49 TLCs, and six district councils, of which two are crossboundary municipalities with Mpumalanga. The Minister has already determined that the number of councillors in the new demarcated municipalities would be 1 232, an increase from 510 councillors. As required by the provisions of the Local Government: Municipal Demarcation Act, the board has already availed of the preliminary assessment of the administrative and financial capacities of district and local municipalities in order to perform certain functions.
In terms of section 14(5) of the Local Government: Municipal Structures Act we have already established the four district transitional committees and two crossboundary district councils in consultation with my colleague in Mpumalanga province. These committees will facilitate the disestablishment of existing municipalities and the establishment of the newly demarcated municipalities. In terms of the provisions of the Local Government: Municipal Structures Act, the transitional committees will in practice assist MECs to develop section 12 notices and further advise on issues which arise as a result of the transitional processes. All committees are given definitive time frames until the end of August 2000, with the exception of assignments such as the transfer of staff and assets.
The Northern Province and Mpumalanga have agreed to establish crossboundary municipalities as provided for in the Constitution and the Local Government: Municipal Structures Act. The provinces have further agreed to establish a joint administration in these two crossboundary municipalities. In this regard, we have requested officials to outline the contents of the joint administrative framework, as it is a new concept in South Africa. The details and options which will be preferred in this framework will help to guide and direct the business of the crossboundary municipalities between the two provinces. We have to state that all these activities mentioned above will require massive assistance from the national Government.
The consolidated municipal infrastructure programme - CMIP - intends to redress infrastructural backlogs in poor municipalities and improve the state of infrastructure in cases of developing municipalities. The current realities in our province indicate that we have a massive infrastructural deficit. Furthermore, it indicates that over the past six years we were able to provide bulk infrastructure, but that we were not able to provide reticulation, which would bring about the immediate use of the provided bulk infrastructure.
We require a massive capital injection to kick-start the reticulation programme in an effort to ensure that we realise the potential capacity of municipalities to generate their own revenue. This fact informs us that if we are striving to unlock the revenue base potential of our municipalities, the R90 million allocated for this financial year represents a significant increase from the R60 million allocated last year. We thank the national department for this. However, in this regard, we have already received 780 applications of which 395, amounting to R670 million, were processed. The R90 million allocation for CMIP represents 13,4% of the processed allocation and this already gives us a shortfall of R540 million.
The municipal support programme intends to redress the deficiencies as identified by the project viability study. The programme will assist in developing adequate credit control systems, revenue and tariff collection systems, and budgeting and financial systems. In this regard, the programme is already beginning to show some improvement in a number of towns, such as Warmbaths and Potgietersrus.
In relation to other towns, we acknowledge the fact that the clock cannot be turned back overnight, because in practice we are dealing with technical and critical municipal systems. During this financial year we have been allocated an amount of R5,8 million by the Department of Provincial and Local Government in order to concentrate on traditionally urban TLCs. However, our intention is to extend the programme in order to support the former R293 towns.
With regard to equitable shares, this programme intends to assist municipalities to take care of their institutional and subsidisation needs. However, because of the lack of a revenue base, most municipalities have utilised these funds outside the stipulated guidelines. This is because a number of municipalities have statutory obligations to meet, and with no alternative source of income, they end up using their equitable shares.
Regarding local economic development, this programme intends to enable local communities to exercise a significant measure of control over their own economic life. This would be achieved by developing and designing projects which have the potential to contribute to meaningful economic growth. In this financial year there are six municipalities implementing various projects to the value of R8 million, which is a conditional grant from the national department. Over and above this, eight other municipalities are making an assessment of the impact of the retrenchments experienced as a result of the decline of production from any sector of the economy. This item is funded through the social fund.
The current Constitution obliges municipalities to be agencies of local economic development. This is also done in anticipation of the newly demarcated municipalities coming into effect after the local government election. We should be geared to ensuring that we enable these municipalities to carry out and satisfy their constitutional assignments. This should be more visible in those municipalities which will be obtainable in the areas which are rural and peripheral in nature. We are convinced that the budget, as presented by the Minister, will go a long way in addressing the needs of our people, in particular those in rural areas. [Applause.]
Ms C BOTHA: Madam Chairperson, hon Minister, is it a service or is it a business? This is one of the crucial questions confronting local government today.
While service delivery to the poor and the extension of infrastructure are at the heart of white paper reform and express common values which we all espouse, the mere transformation of the local government system is no guarantee that we will achieve this aim. The old system was perfectly capable of delivering to the entire community, but grossly lacked the necessary communal values and, despite the intent, there is no guarantee that we will be any more successful with a new system than with the old, if we retain the same untenable dichotomy as that which characterises the present struggle in government of labour policy versus macroeconomic policy, thus choosing sides between the community and the municipality, as if the two need always be in opposing camps. At present, communities are not receiving the services they require while municipal workers are being paid by borrowing from pension and medical contributions to overcome the gap left by nonpayment of rates. Instead of operating as an organic whole, municipal finances are more or less a case of robbing Peter to pay Paul. This cannot continue, no matter what system of local government is in place.
Consider that we spent R40 million on management support programmes - as the previous speaker also mentioned - in the previous budget year, and now we have budgeted for an 85% increase to R75 million to bolster the present lack of municipal capacity. Added to this is the fact that funding has not been made available for the structural adjustments necessary to facilitate the change-over to the new system, including provision for the retrenchment of staff, writing off of bad debt, etc, and furthermore, approximately R14 billion is owed to municipalities by defaulting ratepayers. How do we move forward against these odds?
The Minister himself speaks of the daunting challenges facing municipal service delivery in South Africa today. Conservatively, it is estimated that the total cumulative backlog in municipal infrastructure and service is approximately R50 billion. According to the analysis of the previous year’s Medium-Term Expenditure Framework, if these backlogs were addressed by public sector resources alone, many communities would only receive adequate supplies in the year 2065 - 65 years from today. This figure alone should be enough to persuade communities, labour unions and committed councillors to welcome the private sector as partners in the service of the community. Furthermore, we should grasp the challenges of economic change at local government level through an honest assessment of performance capabilities, particularly the more rural areas.
There is only one answer to the question posed at the beginning: It is not a case of asking: Is it a service or is it a business? If it is not a business, it will not be a service - not to employees and not to ratepayers. The make-or-break of the present structure of local government will lie in facing harsh realities, and making tough choices. It may result in short-term political gains, but will be paid, as always, in the long term, by the very people our new system is supposed to prioritise. [Applause.]
The CHAIRPERSON OF THE NCOP: Order! Hon members, I am trying to have the technicians look at the sound system. We have had problems before. I think we should proceed, given the time constraints we face, both today, and in terms of our programme generally.
Mr N J NGUBANE (KwaZulu-Natal): Madam Chair, hon Minister, members of the select committee, ladies and gentlemen, it seems as if I am the only MEC here who has been given six minutes. I do not know whether that is because I am shorter than others! [Laughter]
In September last year, in my keynote address to the annual general meeting of the Provincial Local Government Association, that is, Kwanaloga, I said that Minister Mahommed Valli Moosa, during his tenure as the Minister for Provincial Affairs and Constitutional Development, had gone on record as saying that South Africa had been given a rare and historic opportunity to transform local government to meet the challenges of the next century. I also mentioned that I did not know whether he had also gone on record as saying that the path of transformation would be far from easy.
As this meeting is focused upon the budget hearings of the Ministry for Provincial and Local Government, I will not dwell on the deep concerns which amakhosi, especially those in my province, have concerning the incorporation of traditional areas within new municipalities. I can, however, unequivocally state that the demarcation process has created financially nonviable municipalities and is akin to a time bomb waiting to explode.
The chairperson of the Municipal Demarcation Board, Dr M Sutcliffe, chairperson of a constitutionally independent body, has himself said in my presence that, in the country as whole, more than 60% of the B municipalities or local councils will have neither a qualified engineer nor a qualified treasurer. The local councils will, therefore, in many instances or cases, be nothing more than empty shells. There will be councillors who can adopt resolutions, but who will not have the staff or finances to carry out those resolutions. They will have to depend upon the district councils to do so for them, and yet, in my province, the board has seen fit to redemarcate our existing seven financially sound regional councils into ten new district councils, one of which will have absolutely no financial, administrative or technical capacity whatsoever. It does not even have a core or mother municipality within its boundaries. We believe this is fundamentally unsound, and is a recipe for disaster.
Presently, at local government level, the issue of debt is worrying. At last count in my province, there was some R1,3 billion owing to municipalities. I also understand that, in Gauteng, arrears owing at the end of December 1999 stood at a massive R7,8 billion. I think it is clear that the full financial implications of the new demarcations have not been sufficiently considered, and that the majority of the new municipalities will actually be considerably worse off in the new dispensation, both from the point of financial viability and in terms of per capita spending.
My colleague, the provincial Minister for finance, Mr Peter Miller, and I predict that while the local government dermacation process, politically driven as it is, might be considered a success by the powers that be, the financial consequences will be disastrous. The chairperson of the Demarcation Board often refers to national grants to assist district councils. Whilst I agree that intergovernmental grants have their place, no self-governing or self-respecting government in any sphere would wish to be almost entirely reliant on grants.
I wish to pause here for us to consider the realities prevailing at present. We have noted the severe financial strain on local government. Let us now examine the common causes: one, the lack of skilled personnel; two, the lack of management capacity; three, the culture of nonpayment; four, poor credit control and lack of policies and regulations; five, inadequate management information in billing systems; six, an inadequate rates base; seven, poor communication between council, staff and community and the last one relates to prolonged debt-collection processes.
Monitoring mechanisms to pre-empt cash flow problems have, in the past, achieved limited success for two reasons. Firstly, monitoring was conducted on a quarterly basis. Secondly, information was collected at national level and reported to the province for the institution of remedial action. In some cases, up to nine months elapsed between data collection and reporting. Even within a three-month data-collection interval, a municipality can suffer irreversible financial damage. A quarterly monitoring interval is therefore too long. The CHAIRPERSON OF THE NCOP: Order! I am afraid your time has expired, hon member. [Applause.]
Mr N J NGUBANE: [Inaudible.]
The CHAIRPERSON OF THE NCOP: Order! I beg your pardon. What was that? Did you have a point of order, hon member? I did not hear the comment you made.
Mr N J NGUBANE: No, Madam Chair. I said, as I have said already, that I was the only MEC given only six minutes.
The CHAIRPERSON OF THE NCOP: Order! The reason appears to be that you have two special delegates and your time has been shared between the two who are speaking on local governance matters.
Mnr J HORNE: Mevrou die Voorsitter, agb Minister, LUR’e en agb lede van die Raad, plaaslike regering is een van die belangrikste vlakke van regering. Dit reël mense se lewens tot op ‘n persoonlike vlak. Waar goeie regering plaasvind, orden dit gemeenskappe, en is die vooruitsig op vordering ‘n moontlikheid. Dit bring egter mee dat plaaslike regering en gemeenskappe ‘n goeie verhouding moet nastrewe. Wedersydse gesprek en die erkenning van mekaar se beskikkingsreg moet voorrang geniet.
In hierdie opsig het die Departement van Provinsiale en Plaaslike Regering gepoog om gemeenskappe saam te neem wanneer wetgewing ter sprake kom. Die wetregtelike vestiging van die Huis van Tradisionele Leiers is ‘n voorbeeld daarvan, en die departement en sy amptenare behoort daarmee gelukgewens te word.
Die afbakening van nuwe plaaslike owerhede maak egter die goeie bedoelings van die departement ongedaan. Die slagspreuk van die Regering dat regering na die mense toe gebring moet word, het heeltemal in die slag gebly. Die Munisipale Afbakeningsraad het onverpoos soos ‘n stormram voortgestorm en plaaslike regering buite die bereik van die mense op die grond geplaas.
Die vraag ontstaan hoe doeltreffende regering kan plaasvind as besluite in sommige gevalle honderde kilometer van die mense op die grond geneem word. Ook die samevoeging van bankrot munisipaliteite met ander wat finansieel gesond is, laat veel te wense oor. Gesonde besigheid het nog nooit in die praktyk ‘n bankrotboedel gered nie. Dit is ‘n valse droom.
Plaaslike owerhede in plattelandse dorpe is groot rekeninghouers by banke, en die wegdoen met ‘n groot aantal munisipaliteite sal ook meebring dat hulle hul deure sal moet sluit, veral in plattelandse gebiede. Die uiteinde is ‘n bose kringloop van omstandighede.
Wat egter kommerwekkend is, is dat openbare verhore aangehoor word sonder dat dit enigsins ‘n tasbare uitwerking op die versoeke en die vertoë van die gemeenskap het. ‘n Ordentlike voorbeeld hiervan is die Munisipale Afbakeningsraad. In kort kom dit daarop neer dat die openbare verhore slegs ‘n skyn van deursigtigheid is. Om plaaslike regering beslag te laat kry, sal die wil van die mense op die grond erken en gerespekteer moet word. [Applous.] (Translation of Afrikaans speech follows.)
[Mr J HORNE: Madam Chairperson, hon Minister, MECs and hon members of the House, local government is one of the most important tiers of government. It regulates the lives of people at a personal level. Where good governance exists, communities are ordered, and the prospect of development is a possibility. However, it also means that local government and communities must strive towards a good relationship. Mutual dialogue and the recognition of one another’s right to manage their affairs must take precedence.
In this regard the Department of Provincial and Local Government has attempted to include communities in so far as legislation is concerned. The statutory establishment of the House of Traditional Leaders is an example of this, and the department and its officials should be congratulated on this. However, the demarcation of new local governments nullifies these good intentions of the department. The slogan of the Government that governance should be brought to the people, has fallen away completely. The Municipal Demarcation Board has stormed ahead unremittingly like a battering ram and placed local government out of reach of people at grass- roots level.
The question arises as to how effective governance can occur if decisions, in certain instances, are taken hundreds of kilometres away from the people at grass-roots level. The merger of bankrupt municipalities with those that are financially sound also leaves much to be desired. Sound business has, in practice, never saved a bankrupt estate. It is a false dream.
Local governments in rural towns are large account holders with banks, and the removal of a large number of municipalities will also result in their having to close their doors, especially in the rural areas. The result is a vicious circle of circumstances.
However, what is alarming is that public hearings are held without this having any tangible effect on the requests and the representations that the community may have. A proper example of this is the Municipal Demarcation Board. In short, it amounts to the fact that public hearings are a mere pretence of transparency. To give effect to local government the will of the people at grass-roots level will have to be recognised and respected. [Applause.]]
Mr K KLAAS (Gauteng): Comrade Chairperson, Comrade Minister, MECs and hon delegates, it is an honour to address this House on the debate on the Budget Review for the Department of Provincial and local government. The challenge that faces Government is the full implementation of the Constitution, in other words, ending the undemocratic interim phase of local government, as it is known in the Local Government Transition Act.
This process has come to be known as local government transformation. As outlined in the speech of the Minister, the major steps are the demarcation of municipalities, the establishment of the newly demarcated municipalities, and the end of the interim phase of local government or the conclusion of the Local Government Transition Act on the day of the municipal elections. In short, we stand on the brink of a new era of local governance and, indeed, a deepening of our hard-won democracy.
The demarcation process was concluded after the successful implementation of the following steps. Firstly, the outer boundaries for municipalities in Gauteng were published on 2 March 2000, reducing the 51 local authorities to 15 municipalities. These include three metropolitan cities, three districts and nine local municipalities.
Secondly, the number of municipal councillors was determined by the Minister without variation by the MEC and published on 9 May 2000. Incidentally, the trepidation with which we anticipated this occurrence was unnecessary. There was no widespread anger about the reduction in the number of councillors, which reflects the maturity with which the challenges facing our country are being met.
Thirdly, the ward boundaries have been finalised. Again, the only complaint has been the rapid pace of the process. Fourthly, four crossboundary municipalities, two between Gauteng and the North West and two between Gauteng and Mpumalanga, have been agreed to in principle by the provincial legislatures concerned. These municipalities will, among other things, address the legacy of the Balkanisation of our country in that our country was divided into Bantustans. We therefore await with anticipation the passage of the national legislation to facilitate the agreements between our respective provincial governments which will establish these crossboundary municipalities.
The demarcation of new municipalities has created major opportunities as well as major challenges. The creation of the three metropolitan cities of Johannesburg, Pretoria and the East Rand, and the large secondary city of Lekoa Vaal, has addressed major institutional challenges. These are as follows. The first challenge is the balance between powers of primary local authorities and the imperative redistribution of resources to overcome the skewed development between previously black and white apartheid local authorities.
Secondly, the lack of clarity in the Local Government Transition Act has already resulted in a Constitutional Court challenge and decision about rates collected in Sandton being utilised elsewhere in the Johannesburg metro. Thirdly, the lack of synergy between local and metro functions continues to be a source of financial instability. Both Johannesburg and the Lekoa Vaal metros have required intervention in terms of section 10 of the Local Government Transition Act to create greater synergy and financial stability.
The fourth challenge is the necessity for a common focus to achieve a sustainable developmental agenda. The East Rand metro will address two symptomatic examples, ensuring that there is a focus on the largest heavy- industry base in the country which is already the target of a national and provincial spatial development initiative in Wadeville, Alrode, and the current duplication of airports between Johannesburg International in Kempton Park, the Rand Airport in Germiston, in which the council has a 20% stake, and the proposed airport in Springs/Brakpan being promoted by the two councils.
However, the demarcation has also presented us with a two-edged sword. The three district councils in the west, south and northeast of Gauteng face serious economic and financial challenges. Their economic base has been eroded with the closure of mines and factories, so much so that the financial viability of many municipalities, including the district municipalities, is in question. I can only reiterate our call that the Department of Provincial and Local Government urgently come up with appropriate arrangements with the Department of Finance to ensure the viability of these districts.
The establishment of the newly demarcated municipalities and the disestablishment of the existing local authorities are major undertakings for MECs of local government throughout our country. The task can only be accomplished with the assistance and support of the affected municipalities. As hon members are aware, most provinces have established facilitation committees in order to provide such dedicated support. The appointment of members is well under way, including the appointment of technical people, in order to assist in the transformation. To this end, funds have been made available by the Gauteng department of development planning and local government in order to appoint transformation managers in five of the six metropolitan areas and districts.
One of the key undertakings of bringing about an awareness of transformation is the naming of the newly demarcated municipalities. The establishment of the future municipalities is but a first step in the dynamic transformation process. The passage of the Local Government: Municipal Systems Bill and the proposed Local Government: Municipal Finance Management Bill presents challenges in ensuring ongoing transformation in order to meet the requirements of this far-reaching legislation.
During discussions with chief executive officers of municipalities, it became clear that funding for assisting in the transitional process is of vital importance. With the present cash-strapped situation of municipalities in Gauteng, it becomes crucial that municipalities are assisted financially in order to ensure a smooth transition. The second phase of the transformation which will take place after the elections may result in significant costs on common IT systems for personnel, billing and other financial packages, employment of appropriate treasury and accounting staff, and other transformation costs. We, again, call on the Minister to make every effort in releasing funds for the transformation process. Our vision of viable and sustainable municipalities that will accelerate change in order to ensure a better life for all our citizens depends on the successful transformation of the existing municipalities.
I have referred to the financial situation in many municipalities in Gauteng. I believe that it is crucial that we address the financial stability of these municipalities by looking at our approach to the indigent policy, the Masakhane campaign and the financial accounting system of the local sphere of government.
In the past a provincial Masakhane co-ordinator operated within the office of the MEC. We have taken an important step in ensuring that the Masakhane campaign is based in every municipality. The approach of the department is to include Masakhane in our day-to-day work and ensure that it becomes a part of the work of the department and municipalities. We need to emphasise that Masakhane is about building together. In other words, it is about mobilising communities to be part of the municipal service delivery system. It includes community initiatives and taking responsibility for payment of services, and is not, as the opposition parties state, about punishing communities, the privileged few, who have the benefit of full access to services.
It is important that we all challenge this notion that is being propagated by the DP that Masakhane is dead, and emphasise the fact that it is no longer a campaign but the way in which we approach local governance. It is being institutionalised.
The indigent policy, as it is currently formulated, requires significant capacity in order to administer it effectively. Without effective administration, it creates controversy and an environment for conflict between the community, the municipal officials and the councillors.
The department has put forward the notion of lifeline services as one of the innovations designed in relation to the indigent policy. The implementation of lifeline tariffs is vital in supporting any measures to meet the needs of the poorest of the poor. An advance on this approach has been made with the concept of lifeline services that may be defined as a tariff at no-cost charge for a specified volume of service utilised.
In order to achieve the goal of a lifeline service the following methods can be used: firstly block free - equivalent to a very basic service; second block, breakeven usage, which is calculated at total cost or less - equivalent to a service to facilitate economic participation; third block, equivalent to cost plus limited profit to facilitate investment in maintenance, replacement of necessary infrastructure and expansion; fourth block, high-level consumer, equivalent to cost plus higher profit, to meet the shortfall in the breakeven tariff and investment in infrastructure to address the scarcity of supply. Currently this system is being used in Durban and is proposed for Johannesburg. The Gauteng water services forum is investigating generalising this system in all municipalities in Gauteng.
The approach has been taken up by the Minister of Water Affairs and Forestry and is being discussed at the Department of Water Affairs and Forestry Minmec. It is considered that national policy to implement this concept is necessary to cover, amongst others, areas where cross- subsidisation is not an option. This approach reduces the administrative burden and allows citizens to manage their own resources. The other innovations that have been introduced in the indigent policy is incorporating the community through a forum and the proposed ward committees in order to manage the identification of indigents and the implementation of the policy.
Regarding financial accounting, the proposed Local Government: Municipal Financial Management Bill that duplicates the approach of the Public Finance Management Act is long overdue. The current practice results in arrears growing annually because the existing municipalities, in general, budget for expenditure of 100% of their revenue. The following changes are necessary: Changing from accrual budgeting to cash budgeting - the practice of compiling a budget based on the accrual concept results from the expected consumption levels of service and assessment raised due to municipalities …
The DEPUTY CHAIRPERSON OF THE NCOP (Mr M L Mushwana): Order! Your time has expired, hon member!
Mr K KLAAS: Chairperson, in conclusion … [Laughter] [Interjections] … we would like to congratulate the Minister, Comrade Sydney Mufamadi, the Department of Provincial and Local Government, the Municipal Demarcation Board and its chairperson, Dr Michael Sutcliffe. [Applause.]
Mr R M NYAKANE: Chairperson, Schedule 4 and 5 of our Constitution oblige our provincial and local governments to render certain functions in our communities. The Northern Province government and its local governments are grappling with a lot of constraints in trying to meet these obligations. It is difficult to govern, especially during times of transformation, because people’s attitudes, perceptions, beliefs and values have to undergo a process of transformation as well. Given this background, one need not exacerbate conditions that will make good governance unattainable.
In the Northern Province a situation prevails in which a police station is allocated only one pick-up bakkie to serve an area with a population 80
- The combating of crime and maintenance of public order are impossible to achieve under circumstances of this nature. There are only two ambulances allocated to Mankweng Hospital which serves as a referral centre in the Northern Province. I believe we all know what goes together with this type of situation. It is my humble submission to the Minister that it is high time that one considered the injection of adequate funds for the purchase of Government vehicles for our police stations and provincial hospitals.
Five days ago, I felt very despondent when I learnt that my province owed Telkom R39 million and that 700 government vehicles had gone missing. It is a disturbing situation because things of this nature can easily be avoided.
Lastly, I am delighted to note that the delimitation of our municipal boundaries will position the local government in a better and economically more viable position. Even then, we still need to acquire financial management and other administrative skills. [Applause.]
Mr P UYS (Western Cape): Chairperson, hon Minister, hon members, I thank you for this opportunity as we approach the final phase of demarcation, not only of our outer boundaries, but also of the ward boundaries. We also received the capacity report from the Demarcation Board.
In the Western Cape, at this moment in time, we have studied the documentation and we are well on track in looking at both the financial and institutional capacity to render services at our category B and C municipalities. I do not think it is going to be an easy process, because the B municipalities would like to retain all the services, while the C municipalities are saying exactly the same.
What we must be very wary of is having vertical integration of services between the C and B municipalities. We have learned that lesson in the Cape metropolitan area, where we tried to split the same functions, powers and duties between the metropolitan council and the metropolitan local council, giving a co-ordinating role to the one and an implementing role to another authority. Our experience was that that did not work. Although members were from the same political party there was still rivalry between, let us call it, the metropolitan council and the metropolitan local councils.
I therefore have to say that in the Western Cape we are very wary of that process. We are engaged in providing vision to our local authorities on how to approach this and take it forward. I am also pleased to know that there will be a policy framework from the hon the Minister on the table very soon to help and guide us if we need to change any of the powers, duties and functions in terms of the Local Government: Municipalities Structures Act, and specifically in terms of section 85 of that piece of legislation.
I must just briefly refer to our approach to the transformation process in the Western Cape, which is that it is really an opportunity for innovation, an opportunity to modernise local government. I think it is necessary that we take up that specific challenge. It is also an opportunity to create working local authorities and municipalities, and of course to put the necessary structures in place to perform the functions that are necessary and deliver the services that are so needed by the community.
In November last year already we in the Western Cape established a unicity commission, with the one unicity that will be created and five district transformation forums, to guide the process and also to advise me and make recommendations on the disestablishment and establishment of municipalities.
One thing I am pleased to hear is that there will very soon be legislation that will enable us to place a moratorium on certain aspects within local government that will really not be to the benefit of the integrity of the new municipalities. Although I did address that in my section 14(5) notice, I think that we need national legislation to address that.
I want to refer to all the draft Bills that are at this stage on the table. We have the Municipal Finance Management Bill, as well as Disaster Management Bill, the Systems Bill, the Property Rating Bill and also the White Paper on Municipal Services Partnership that are really welcome.
I would, for the moment, just like to refer to the Property Rating Bill. I am not going to try to discuss the content of that Bill at this moment in time. I would like to urge the hon the Minister that we should really get going with the legislation. Yes, I do not agree and I will make my input to certain sections on that draft proposal. But, what is important at this moment in time is that we cannot wait another month. I really challenge the hon the Minister today to be upfront and to take this forward, to open up this draft 10 of the proposed legislation for broad discussion. Let us try to move it forward.
I know that there was a consultative process in November 1998, but it is now 19 months later and we in the Western Cape cannot wait any longer. We need either to move forward and amend the provincial ordinance or we urgently need a national framework. We are engaged in an evaluation process in the metropolitan area alone and that will cost the metropolitan area between R70 million and R80 million.
We need not only physical inspections but also computer-assisted mass appraisal systems. At this moment in time only national legislation can put that enabling legislation on the table. Referring to a municipality like the City of Cape Town, some of the evaluation rolls were last evaluated in
- One can think that between 1978 and where we stand at this moment in time major problems with regard to evaluation have developed. Members will recall that was the time when the DP took themselves to court to oppose their own piece of legislation in the City of Cape Town. That is where the problem started in the City of Cape Town and I am still stuck with that problem.
I therefore ask the hon the Minister today that we should get going with that legislation. Let us open it up, let us start a debate and let us get it on the table.
The next issue that I would like to address is that of transformation, and specifically the transformation fund. I think that it is high time that we get money for local government, and specifically provincial government, to support and help us. We would really welcome that. I believe there was a Cabinet decision in this regard that will take the process forward. It is bit late, and I urge the hon the Minister not to direct the money to local government, but to get provincial government involved in this process, which I think is a very important process.
We on the ground must implement the transformation process. The Minister trusts us with implementing the transformation process. He should also trust us with allocating the money and looking at the needs of local government in the transformation process itself. That in itself is a challenge and we need to move forward. It is not only a process for after 1 November or after the election. It concerns money that we need at this moment in time.
I would briefly like to refer to Masakhane. Mention has been made of this already.
In die Wes-Kaap het ons nog ons eie Masakhane-program, en dit is op koers. Ek wil ook egter die agb Minister vra waar ons in hierdie stadium staan met betrekking tot die nasionale Regering se beleid. Die laaste wat ons enige woord gehoor het oor Masakhane was seker nege of 10 maande gelede, en ons moet begin kyk of hulle van die nasionale kant af nog ernstig is oor Masakhane, of word dit in hierdie stadium suiwer oorgelaat aan die provinsiale en plaaslike regerings? Ek verstaan dit baie duidelik as nie net ‘n beleid om beter kredietbeheer te kry nie, maar ook om ons gemeenskappe te bou, en ek wil graag die Minister se standpunt in daardie verband ook baie duidelik hoor.
Die laaste punt wat ek wil aanroer, gaan oor plaaslike owerheidsopleiding. (Translation of Afrikaans paragraphs follows.) [In the Western Cape we still have our own Masakhane programme, and it is on track. However, I also want to ask the hon the Minister where we stand at this stage in relation to the national Government policy. The last time we had any word on Masakhane was probably nine or 10 months ago, and we should begin to look at whether those at national level are still serious about Masakhane, or is it simply being left to the provincial and local governments at this stage? I very clearly understand this to be not only a policy aimed at achieving better credit control, but also at building our communities, and I should also like to hear a very clear expression of the Minister’s standpoint in that regard.
The last point I want to raise relates to local government training.]
We have a SITA in place for local government, but there is no proper link between our Minister for Provincial and Local Government and our Minister of Labour. I think we should start that discussion, because there is a breakdown in local government training. We cannot wait until 1 November and then try to regenerate this whole process of training. It must be ongoing. If the Minister is not aware of this I must inform him today that there is major breakdown and a major vacuum that has been created. I urge him also to put pressure on that process to get it going.
Ek wil dan die geleentheid gebruik, en ek sluit graag af, om die Minister te bedank vir sy toespraak, en ook die ander kollegas wat hier is. (Translation of Afrikaans paragraph follows.)
[Then I should like to take the opportunity, and I should like to close with this, to thank the Minister for his speech, as well as the other colleagues who are here.]
I also thank the director-general, Mr Zam Titus, specifically for the working co-operation that we receive in the Western Cape and in Minmec. [Applause.]
Mr K D S DURR: Chairperson, Minister, may I first say that we wish the Minister well with what is going to be an enormous enterprise. We hope he will succeed. I have to tell him that we as a party are not against rationalisation or bringing together communities that belong together, or undoing the mistakes of the past. But, the ACDP fundamentally disagrees with the new proposed megacities because we believe they are simply too big.
We in the Cape have had 36 local authorities consolidated into six, and now into one. The megacity typically will have a massive bureaucracy, larger than some provinces, sometimes rivalling their own provincial governments. I would like to ask the Minister whether it is perhaps the objective of the Treasury, for control purposes, to bypass provincial governments and to take on the oversight role themselves for, say, 20 or so of the largest local authorities, leaving the provincial governments to look after the smaller district councils? Would the Minister reply to us whether that is the intention of the Government? If this is the intention, we should know it, because it would be a major shift to centralisation, something to which my party is totally opposed. We believe in local government on a human scale that ordinary people can relate to, and they should not feel alienated by it.
The second question I would like to ask the Minister is the following. Rumour has it that the central Government wishes to fund the megacity with massive rates hikes based on market value. This would effectively mean that the Government would attempt to use the rates mechanism as an extra tax to shift the burden of the very poor onto the shoulders of the taxpaying, ratepaying home owners at a local level. Would the hon the Minister perhaps answer us on that? We would be delighted to know, because I have to tell him that I cannot think of a quicker way to destroy private property rights. We believe it would be desperately wrong-minded.
The third thing that I would like to say to the Minister is that good people can make bad systems work, but bad people cannot make good systems work. I really think - and I do not aim this at the Minister, but at all parties, including my own party - that we should all see that we get the best possible councillors in at the next election. No matter how good the structure is that we may or may not create, or how good or bad we may think it is, the reality is that if we do not put competent people in power, and if the parties do not have a responsible system of nomination to make sure that the people we put there can actually do the job, we will destroy local government in this country.
I implore the Minister to talk to his party mechanisms, as indeed, I can promise him, I will talk to mine. I think we all have the responsibility to see to it that we put forward the very best people that we have, not only representative people, but people who can actually do the job.
So, with those few words, may I say that we wish the Minister well, and we hope that things will go smoothly for him as we move ahead this year. [Applause.]
Mr Y BHAMJEE (KwaZulu-Natal): Mr Chairman and colleagues, I was caught napping a bit, but let me try and see if I can adjust very quickly. [Laughter.]
Firstly, I have to say that we welcome the DP’s statement, in a sense, when it says that it wants the local government system to remain the same because it is capable of providing services. We ask, providing services to whom? To the privileged few that it has always served? [Interjections.]
The second point I wish to make is that what the NNP colleague has clearly said informs me as to why the DP wants to be in opposition. If the DP were to become the ruling party it would be taking itself to court all the time. [Laughter.]
I think the most important issue, as far as local government is concerned, is that it is important that we change our mind-sets. If we belong to the old school of thought, it will mean that we are servicing the interests of those who benefited in the past. The vast majority of our people did not enjoy such services, and hence they were not in a position to improve their general quality of life.
South Africa is rich enough to ensure that all of us have fresh water and electricity, but why are these not going to our people on the ground? I think it is crucial that when we look at transformation, we are saying that we want our lives to be reorganised. We want an assessment of what we have in place, and if we cannot deliver immediately, then we want to take our people along with us. It is for this singular reason that we welcome the integrated developmental plans as envisaged in the Local Government: Municipal Systems Bill. The Bill is saying that Government must follow a bottom-up, instead of a top-down process. An integrated system is saying that people must participate and understand what their needs are, and that they must decide collectively, at ward level and local government level, how their lives should be determined. If that principle is adhered to, I am fairly confident that even if there is a delay in delivery, people will understand why that delay exists. If people are part of the process, part of decision-making, they will be able to defend it.
So, as the Constitution clearly says, we must make sure that there is wall- to-wall local government, and this also means that people’s minds must be applied to the process to determine where we want to go. However, we have inherited huge inequities. The imbalances are too great. I do not think there is any magic wand. However, we would like the Minister to review the strengths and weaknesses of the equitable share. It translates into unconditional grants to municipalities, hence there is a possibility that the poorest of the poor may not be reached. The indigent must become part of the municipalities, and if the equitable share becomes obligatory, or if there is an obligation on the part of the municipalities to ensure that poor people are brought into the process, then one will be able to impact the culture of nonpayment.
We will be able to come to an understanding, through a socioeconomic study in each municipality, of those who are indeed poor and those who are being opportunistic. By so doing we will be able to identify those who need support and those who can pay on a cyclical basis. The moneys will go towards payment for projects. If that is done, then I think all will become proud to be a part of the local municipality concerned. So it is important that the reasoning and the objective behind the equitable share be revisited. We know for a fact, as some hon members of this House have indicated, that some municipalities have used the equitable share for purposes other than the one that was set out and that all of us wished for, and that is to improve the quality of life of the poorest of the poor. Thus, the moneys can easily be misused, and in that way we will not be able to restore dignity and credibility to our people.
It is also important to recognise that transformation means transformation. It does not mean reform. Reform effectively means that one wants to maintain the status quo by introducing one or two concepts whilst the elite class remains intact. Transformation effectively means that one wants to transform the understanding of how we receive services. The Constitution says that all of us are entitled to basic services, and it is through the equitable share that the poorest of the poor will obtain these. We need to have an organisational review in terms of what the IDP plan is and where it is going to go. We need to establish new constitutional structures and systems to rationalise existing systems and also to achieve our development objectives for municipalities. If this is done in partnership with labour, communities and other stakeholders, then I am confident that we will be well on our way to transformation.
There should be a change in the culture of organisation. We need to achieve transformation in the whole of the public sector. We need to make sure that the officials, who were part of the previous status quo, come on board and are not only critical of our councillors. We know where we come from. However, it is important that a team approach is put into place to ensure that if councillors are in the wrong or are misguided, then it is the responsibility of the officials to guide them. They, too, must accept responsibility if our work is not moving in the direction that we intend it to. [Time expired.] [Applause].
Mr G E NKWINTI (Eastern Cape): Deputy Chairperson, in our legislature we have four colleagues who, whenever issues are raised, most of them positive ones, always rise and say– that their party objects to the motion, etc. We are trying to find out if colleagues in other provinces have similar experiences with the DP. [Laughter.]
The NCOP provides provinces with a platform to address national issues from the perspective of provinces. We appreciate this opportunity that has been created by the Constitution of our country. Perhaps the greatest challenge facing us in local government at the present moment is that of making resources, especially financial resources, available for relatively rapid social delivery, including capital infrastructure development, in the context of developmental local government.
Achieving this is not just a function of budgetary allocations and downward management of legislation dealing with wages, however important this may be. There are other variables. Among them are the strengthening of the capacity of local and district municipalities so that they are able to make the best use of whatever resources they have. Another variable is eliminating corruption so that money gets to where it was meant to be in the first place. Effective credit management strategies are also important, as are better interdepartmental co-ordination of programmes and the deepening of democratic practice.
We must continuously address these things so that we can be able to progressively create enabling conditions for our people in partnership with Government and other social partners to improve the quality of their lives. Part of what we have budgeted to do in this financial year are the following things. Firstly, the finalising of the integration of R-293 staff with TLCs is important. This is proving to be a very great challenge. Secondly, financial management capacity improvement is also very important, both in the departments as well as in local authorities. Thirdly, functional alignment within the departments as well as between departments and local authorities and districts is important. Fourthly, integrated planning and implementation within and across departments must be done. Fifthly, budgets must be aligned with strategic plans within the department as well as the strategic plan of the province. Sixthly, pressure must be put on municipalities to improve or to involve people in budgetary processes, and on elected councillors to account regularly to people and to involve them in major decisions.
With regard to the strengthening of this capacity of local and district municipalities, which we regard as a very important function, we think the municipal support programme and municipal demarcation processes are going to assist us, particularly in this regard. Also important is the building of departmental capacity to effectively manage conditional grants. These seem to be small things, yet they are very small things which are very important in managing the little resources which we have. In particular, getting communities to pay for services rendered to them by municipalities means customising some of the services that we are providing to them, so that we are able to exercise some kind of influence over them.
Developing democracy includes preparing for the elections that are coming, and getting eligible voters to apply for IDs, which, again, is a major challenge, particularly in rural areas. This also includes voter education and mobilisation. We are aware that the co-ordination of this function of election is a responsibility of the IEC, but we think that organised local government and the department have a role to play in terms of assisting in these processes. We also have to ensure that traditional leaders are on board, something which has become a very important process in the democratisation of our country. Getting eligible ID holders to register and vote is the ultimate objective of involving our people in the democratisation process.
We are very happy that the department, under the leadership of the Minister sitting here with us, the hon the Minister Mufamadi, helps us whenever we pick up the telephone or meet in Minmec meetings, and that we get the support that we need in all of these processes. With regard to the question of downward management of the legislation dealing with wages, there are some dynamics involved, and we are happy to report that the department and the Ministry are sensitive to these. At the present moment the employee has the final say as to whether or not he or she should be transferred to a local municipality. This is really one of the tensions that relate to the integration of the R-293 staff to the municipalities. The Ministry is dealing with this matter and we are pleased with that.
On strengthening local authorities as well, we are very pleased that the hon the Minister and the staff of the Ministry in the Department of Local and Provincial Government show consideration, because the financial years of the municipalities and of central and provincial governments are different. We are pleased to observe that there is a measure of consideration by trying to massage these kinds of tensions and differences in such a way that we are able to effectively manage the conditional grants that we get through our department to local government over the MTEF period. We are pleased that the Ministry is dealing with these issues.
Finally, we do have to foster sound relations between the Government and traditional institutions in the province and perhaps in the country as a whole, and with regard to the deepening of democracy as well. Strengthening this communication and contact has become critical, especially at this time of demarcation, because without that this process will run into serious difficulties. Providing basic infrastructural and institutional support to particular regional traditional authorities has become imperative if that communication is going to be kept vibrant. We must help traditional leaders to come up to speed with social, economic and political trends, both nationally and internationally. This has become one of the urgent matters that have come out of the interaction with traditional leaders in our province.
With regard to the building of partnerships in rural development, we are pleased to say that these processes have commenced in our province and we are interacting with traditional leaders. We do not decide on our own. We will continue with efforts of persuading traditional leaders to accept the bona fides of Government with regard to municipal demarcation. This is a matter that we are addressing all the time. We are pleased that the Ministry for Provincial and Local Government, with the Minister in the lead, is assisting us in this regard. [Applause.]
Mr D E AFRICA (North West): Chairperson, hon Minister Mufamadi, Members of the NCOP, MECs and special delegates, it is our responsibility as South Africans to make our system of governance work. It is with this in mind, therefore, that we want to support the Ministry in the review of policy to ensure that with the introduction of new system of local government, proper intergovernmental relations are established. It is indeed necessary to do so, given the fact that the new system of local government is almost similar to the provincial system in terms of the way it is going to operate. Therefore that review is necessary and we want to record our support for that initiative.
In November 2000 South Africa will see the introduction of new municipal structures throughout the country. These new structures will replace the transitional structures which have operated since the first local government elections in November 1995. Guided by the White Paper on Local Government, the new municipalities will assume the final municipal form, which is developmental local government. Developmental local government will be achieved through the implementation of a range of legislative measures deriving from the White Paper. This developmental legislation includes the Local Government: Municipal Demarcation Act, the Local Government: Municipal Structures Act and the Municipal Systems Bill to be enacted later this year.
This legislation and other legislation that will address various aspects of local government finance and intergovernmental relations has been introduced to overcome some of the structural and systematic weaknesses identified within the transitional local government structures. The Local Government: Municipal Demarcation Act, for example, has redemarcated all municipalities, reducing the total number of municipalities from 843 to approximately 300 throughout the country.
Within our province, the effect of the demarcation process has been to reduce the present 53 municipalities to 29. We believe that the demarcation process was intended to achieve a closer correlation between the economic, social and political functional activities of South Africans within their municipal boundaries.
The demarcation process also sought to enable us to improve the financial viability of the new municipalities by seeking to capture sufficient income- generating capacity within each municipal boundary to enable municipalities to meet their development needs and, therefore, address the legacies of underdevelopment and disparities at local level.
The Local Government: Municipal Structures Act has introduced new types of municipalities in South Africa. The most significant change has been the introduction of executive mayors. The executive mayors will be confronted with new and, as yet, little understood challenges, and will require significant support to ensure the success of this bold experiment in local governance.
The Local Government: Municipal Structures Act will also increase the importance of district municipalities, both in terms of their responsibilities to provide services to rural communities, and in terms of their responsibilities to co-ordinate the development activities of municipalities and other stakeholders within their areas of jurisdiction.
The Local Government: Municipal Systems Bill will enable us to transform the mode of operation of all municipalities through the overhauling of existing financial management systems, the introduction of a streamlined integrated development planning process and the implementation of a new municipal performance management system. These new operating systems will increase the transparency and accountability of municipalities, requiring municipalities to consult with their communities through their budgeting procedures and through the assembly and implementation of the integrated development plans. This, in itself, will ensure the enhancement of democracy at local level and the consolidation of participatory democracy and, therefore, make people critical to the development process.
The role of provincial government will be influenced by the transition to developmental local government. Provincial government will have an increased responsibility to monitor the capacity of municipalities and to perform their powers and functions within nationally determined norms. Provincial governments would therefore be required to assist with the development of capacity within municipalities and to intervene when municipalities lack the capacity to perform.
At the centre of the provinces’ enhanced role is a need to accurately monitor municipal performance through a performance management system, financial monitoring and through integrated development planning to ensure that targeted assistance as well as a co-ordinated capacity-building programme can be provided. The changes that are being implemented in the transition to developmental local government will have a profound impact on democratic local government in South Africa and on the ability of the South African Government, in general, to deliver basic services to all. It is therefore of vital importance that appropriate systems and mechanisms are put in place to ensure that the transition causes as little disruption in service provision as possible, and that the new developmental municipalities quickly assemble the necessary capacity to deliver services.
What are the key strategic challenges facing us in the post-election period? In the North West Province, the total number of municipalities will decline from 53 to 26, resulting in the complete transformation of the municipal map of the North West province. Only three municipalities will remain relatively unchanged by the demarcation process. All other municipalities will be formed from the expansion of boundaries to incorporate both rural areas and neighbouring municipalities.
This transition will bring with it complex institutional development challenges which will need to be both identified and managed by the department and the province. These challenges are the following: institutional development, the need to identify ideal staff and resource complements for each new municipality based on functions and powers and, of course, the need also to develop a framework for assisting the new municipalities that did not exist before.
The other challenge will be to look at overcapacity and undercapacity within the new municipalities to ensure that we normalise and restructure staffing within those municipalities, and the appropriate positioning of seconded provincial employees within the municipalities so that appropriate staff is directed at the needy municipalities.
Other challenges are the post-demarcation budgetary challenges. The implementation of the new developmental municipalities will come at the midpoint in the municipal financial year. The amalgamation of municipalities to form the new developmental structures will require rationalisation and amalgamation of the municipal budget. It will be necessary to undertake a comprehensive analysis of all financial instruments of all predecessor councils. It will also be necessary to determine the new financial base of the new municipalities so that the developmental municipalities can pass a new or interim budget as soon as possible.
Another challenge that we think we will be facing in the post-demarcation process is that of integrated development planning. We see the IDP in the province as set to become central to the achievement of this new innovation of developmental local government. The new developmental municipalities, therefore, will need the necessary capacity and the necessary co- ordination, and we believe that IDPs will be an important instrument in combining and integrating all planning activities of the new municipalities. During the transition, each transitional local council had its own IDP. The achievement, therefore, for developmental local government will be dependent upon the rationalisation of existing IDPs from transitional structures into a single IDP for the new municipality.
It is our intention, in the province, to ensure that appropriate data is collected. It is common knowledge that, during the transition process, the data collected to inform the IDPs was inadequate, and it was criticised for being inadequate. We will therefore need to ensure that the kind of data collected will enable us to develop those instruments for planning that will make it possible for the new municipalities to work.
As a department and a province, we are working with Norweloga to design a new standard IDP based on national guidelines which will ensure the capture of the same data from each municipality. This standardised approach to the IDP will facilitate provincial monitoring of the IDPs and enable province- wide information about municipal performance to be distributed, improving the capacity of municipalities. It is within this context that the department is negotiating with the department of developmental local government for a post-demarcation IDP process framework.
We are also anticipating that the municipal performance management system will be ready for implementation at the time when the new municipal structures are in place. This performance management system will enable each municipality to: identify the unit cost of service provision; compare each municipality’s level of service provision with other municipalities within the province and establish whether value for money is being provided; determine the most appropriate method of service delivery including PPPS, and provide accurate data on municipal performance to the provincial department.
It is important also to note that, given the fragmented information gathering system at local level … [Time expired.]
Mr L TSENOLI (Free State): Chairperson, the challenge that we face as a country is a problematic one in that, unlike other countries who are not necessarily going through the same process, we have to prepare for a national election, a very significant election, which posits us into an important phase of local government transformation.
The second challenge is that, in addition to preparing for a national local government election, so to speak, we also have to introduce a new system of local government, a thorough transformation characterised by the introduction, amongst others, not only of four to five critical pieces of legislation such as the Local Government: Municipal Demarcation Act, which has been referred to, the Local Government: Municipal Structures Act, the Local Government: Municipal Systems Bill that is upcoming and the Local Government: Municipal Finance Management Bill that is going to come, but that that part of government too faces the necessity to implement the Skills Development Act and the Employment Equity Act. In a sense, those challenges are particularly tough and, for us, this is not an easy challenge as a country, in particular.
I thought it appropriate that I remind the House that tomorrow is the birthday of a very prominent 20th century revolutionary, Che Guevara. [Interjections.] Someone who recalled him, a Latin American writer, says that he read an article published in a Moscow magazine talking about bureaucracy. He says that bureaucracy sees to it that action, words and thoughts never meet. Action stays at the workplace, words in meetings and thoughts on the pillow. [Laughter.]
This is a very important observation by that writer about bureaucracy, and the success of our transformation, amongst other things, lies in the work that has to be carried out by the bureaucracy - the new and the old that we have inherited - to make this transformation a success.
I thought, in participating in this discussion, that we must agree, which I believe we do, that we are faced with a challenge. As the President of the country, addressing the conference on intergovernmental relations in March last year, which was called ``Fostering Mutual Co-operation’’, said:
Our challenge is to create a developmental state, to wage a constant struggle against bureaucratisation, and to ensure a people-centred society in which provincial and local government will have an important role to play.
This is what the President said. By the way, his birthday is in four days to come as well. That is the vision for a local government and for our country as a whole. As we have said, we are in the process of constructing a developmental state, a people-centred society.
There are a couple of issues that we face, as we go through this transformation, which are very significant. We have to continue - as the hon Minister probably remembers from his days as a shop steward - to fight, to negotiate and to ask for an increased share of national revenue. Local government deserves to get more of nationally collected revenue. In arguing for co-operative governance, we are saying that we are undertaking an important process of ensuring that that part of Government is the most important one, because it is the closest to where we deliver services.
An NGO in our province observes that there is constantly tension between sectoral planning and integrated development. What we are arguing about is that, instead of some of these sectorial plans and budgets going through the sectorial structures, these should be allocated to local government through the integrated development plans, so that the work of local government becomes increasingly meaningful. They cannot be expected to do much with their dependence on water and electricity revenue that is being generated. In other words, we will continue to negotiate that we should reallocate resources in that manner.
The second point, which is quite crucial, is that one of the objects of local government is the promotion of social and economic wellbeing of those communities. But in order that local government can play this role, and play it significantly, we need a significant infrastructure, at least in every one of those municipalities. We need to have people who are constantly looking for, and, are dedicated to identifying, obstacles to local economic development, and also identifying opportunities for local economic development. In that way, we will deliver a death blow to joblessness. This is a very important aspect. It does also mean that we must constantly try to find ways in which we must increase this infrastructure of persons and institutions that play that role.
The third one which relates to the challenge that I referred to earlier and which confronts … [Interjections] … You are out of order! … [Laughter] … in the transformation process is that the amalgamation of the different TLCs and TRCs will require a significant organisational development programme, and that does not come cheaply. Unfortunately, democracy is not a cheap exercise. We are going to have to use resources to ensure that that happens.
Right now, as we speak, the success of the facilitation committees that we are talking about is going to depend on the crucial work that is being done by the TLCs and TRCs that are continuing to meet to identify the challenges that the post-election municipalities are going to face. That function is critical. We are going to have to find resources to ensure that that work happens.
As we speak, the current problems that are faced by municipalities are not only to continue to deliver services but, as we are saying, to continue to work with other municipalities to prepare for single municipalities after the elections, in addition to ensuring that delivery continues at a pace which people expect. That is the kind of challenge that we face in the local government transformation process.
The vision of creating a people-centred society, in which local government and provincial government play critical roles, is going to depend on our collaboration as the different spheres of Government. But to make the interdepartmental and intersectoral collaboration meaningful is key to ensuring that we make meaningful our legislation which is going to be calling for integrated development plans. Unless our provincial and national departments critically co-operate and collaborate with local government in putting together those LDOs and IDPs, they will become meaningless, in that such plans without money are meaningless. Therefore, that co-operation is quite critical.
I would like to add my words to what the hon Mr G E Nkwinti said, that, with the leadership of the Minister, and, of course, our collaboration with other MECs, the challenge that we confront with local government, of course, through its associations, is going to be a tough one. We would expect others from other sectors to begin to recognise the critical role that is now being played in this part of the final phase, as envisaged in the final White Paper on Local Government. We have to play it and it is our obligation.
In the UNDP’s Overcoming Human Poverty Report 2000, our country is reported as having undertaken to obliterate absolute poverty by 2020. It is measured in some form and they explain it in the publication. Thus, everything that we are doing here, the legislative and the institutional changes that we are making, are all aimed at achieving that objective.
I believe that with collaboration and support and with the co-operation that is called for in Chapter 3 of the Constitution, we cannot fail, and, whilst we do accept that we must do more with less, we do wish to urge the Minister to continue the struggle for more resources for local government. Without necessarily making a direct comparison, because the UK is a different kettle of fish, they give local government 40% of nationally collected revenue. It is a nice target. [Applause.]
The MINISTER FOR PROVINCIAL AND LOCAL GOVERNMENT: Mr Chairperson, hon MECs and hon members, I want, once more, to thank all the participants for their contribution to this debate.
I think it is actually an understatement to say that many of the contributions made in this debate will significantly strengthen our programmes as we face current and future challenges. Some of our esteemed opinion-makers are of the view that the transformation which is currently under way is unnecessary; after all, the current dispensation is okay.
I think there are others who are of the contrary view. I think it is also important to make the point that the Constitution of our country sets out a vision of local democracy, such vision is guiding the current transformation processes that are under way. Therefore, transformation is not a kneejerk choice we are making, it is a constitutional imperative. But I think people are right to also say that we will still experience many difficulties in future, and I think that all of us have no illusions about those difficulties. We see those difficulties as challenges which must be faced by policy-makers and lawmakers.
We think that the approach we have taken will indeed ensure that, in the end, we succeed as we tackle these challenges. For instance, one of the hon members identified a number of weaknesses which characterise local governance at the moment. I think the same member should have said that the Municipal Systems Bill is seeking to address many of the weaknesses that he identified. We do not think that, in the immediate aftermath of the forthcoming elections, we are necessarily going to have financially viable municipal entities. However, we think it will be necessary for us to put in place strategies which will enable us to achieve that financial viability in the medium to long term. This is the approach which is taken in all jurisdictions that the one can think of.
I was talking to my counterpart in Britain who told me that after they
amalgamated their municipal entities it took them about eight years to
achieve real financial viability. I am not saying that it must take us that
long. I think the challenge on the part of all of us is to ensure that it
must take us the shortest possible time to achieve that financial
viability. Of course, many of the MECs raised questions here, I think the
hon Mr Uys said, I challenge the Minister to answer the following
questions''. I think I must inform this esteemed House that Mr Uys is a
member of Minmec, the structure which brings the Ministry and the MECs for
local government affairs together to discuss precisely these issues. So, he
did not have to come here and challenge me. We have a joint responsibility
to address the issues which he is challenging me to answer on. But, of
course, I do understand that he must go back and say:Ek het hom
vertel!’’ [I have told him]. [Laughter.] It is important. [Interjections.]
Mr P UYS (Western Cape): Chairperson, can I ask the Minister a question?
The MINISTER: Chairperson, the Minister will not take that question. [Laughter.] There is a concern expressed in the name of traditional leaders of South Africa. They are supposed to be worried about the intended integration of their areas into new municipalities. I think one speaker, earlier on, quoted a distinguished novelist and poet by the name of Thomas Hardy. I want to steal the title of one of his books to say that perhaps this is not an episode which should play itself Far from the Madding Crowd. [Laughter.]
I think it is important that when traditional leaders express their concerns they must, at all times, use the interests and aspirations of the people they lead as their frame of reference. I am waiting for the day when I will be told that the majority of the people in my area of jurisdiction as a traditional leader do not want to belong to a democratic local governance system. I am waiting for the day that I will be told such a story, because I want to ask how they reconcile themselves with the requirement that the same people who live in these traditional areas are proved to have participated in all the elections that have taken place since 1994, be they for the establishment of local government structures, provincial government structures or national government structures?
Of course, the concern was raised also about Masakhane: Is it dead or alive? Masakhane is alive and kicking. If one looks, for instance, at the Municipal Systems Bill, one will see that the same principles which underpin Masakhane are being institutionalised. They have found their way into this legislation. The issue of mass participation in matters of governance includes taking responsibility for ensuring that municipalities have a strong fiscal base.
The hon Mr Durr made reference to a number of what he calls rumours and he wanted me to confirm or to decide whether or not to confirm some of those rumours. But, I think he also made a very important call on all political parties, I do not think it was necessarily on me alone, by saying that they must make sure that the people they field as candidates in the forthcoming local elections are people who will be equal to the task. I think it is an important call, which we must join him in making, but I think we must also say that these are the sort of people who must be less inclined to take decisions on the basis of urban legends and rumours. They must be more inclined to take decisions on the basis of verifiable facts. So, I hope he is not expecting me to come to this honourable House to discuss rumours. [Laughter.]
There is, again, the issue of transformation and transition. We have said several times, and I want to repeat this, that there is a degree to which provision has been made for the exigencies of transition. In the current year, this House and the National Assembly voted for the Division of Revenue Act of 2000. Contained in that Act is the provision of R300 million for the current year to assist in this restructuring process.
Of course, we do not believe that it is adequate, but as to how much will be adequate, we still do not know, which explains why we approached Cabinet and asked for the authority to embark on a process of determining what, in totality, will be required to fund this transition. In other words, we got Cabinet to accept the principle of transitional funding and the actual determination is in the process of being made.
This does not exonerate municipalities from collecting outstanding debts. It is important that debts are collected. It is important that individual residents settle their outstanding debts. However, that is not limited and this call is not limited to individual residents. We have corporate citizens who also owe lots of money to municipalities, just as we have government departments that owe lots of money to municipalities. I think that it will be important for them to consider assisting municipalities to raise the much-needed revenue.
Again, one of the speakers wanted to know whether we are prepared to make sure that the process by which the proposed Property Rates Bill is going to become an Act will be a consultative and participatory one. I am happy that, whereas in the beginning some people were pretending that there was no consultation at all, at least now we are all saying that there was a consultation process, but some believe that that consultation has stopped. The fact of the matter is that the draft which is to be put before Cabinet, or which is under consideration by Cabinet, was itself put together following a process of consultation, which the hon Mr Uys referred to.
Like with all other Bills, once this Bill has been given due attention by Cabinet, it will come into the parliamentary system. So there is no need, really, for anybody to start painting doomsday scenarios about this Bill. The Bill will be coming into the parliamentary system. But, in view of the attempt to use this Bill as one of the weapons in the arsenal of electioneering, we have decided to meet leaders of the various opposition parties. I want to announce that that meeting is going to take place tomorrow. Perhaps then we will establish a better basis on which we can all be honest in our interaction with the public about what this Bill entails.
One of the hon members raised concerns about the fact or the allegation that the Northern Province government has not settled its telephone bills with Telkom. I want to say that I am just as concerned as the hon member about this matter. It is for that reason that I took the trouble of talking to the Premier of the Northern Province about this issue, who told me that they do not dispute the fact that they owe Telkom money. However, they disagree as to the exact amount that they owe Telkom. We have offered, as this Ministry and department, to work with the Department and Ministry of Communications to help resolve and mediate in this matter, because we believe that whatever it is that the Northern Province owes, it is important that the two parties sit together and arrive at a mutually agreed determination as to how much exactly is owed. I think, again, that it is important that neither of the two parties, since they are parties in dispute, be crucified on the basis of one-sided versions. That is why we want to bring them to a round table to discuss this matter. I am happy that, at least, both parties have agreed to this offer of mediation. So, this matter will be handled in as responsible a manner as possible.
I do not know, Chairperson, whether we need to go beyond this point. I think it is important that all of us, having seen each other for so long today, agree that we need come to a point where we part ways with a view to meeting again. [Applause.]
The CHAIRPERSON OF COMMITTEES: Order! I must recognise our visitors in the gallery. I commend you, as senior members in the department, for coming to give the Minister such support. I am tempted to mention your names, but I do not have the time! [Laughter.]
Order! What is the commotion now? It is only the Minister who is leaving now. I do not know what is happening!
APPROPRIATION BILL
(Review of Policy)
Vote No 13 - Health: The MINISTER OF HEALTH: Madam Chairperson, when I entered I was not sure what to say, because I saw you, but did not know whether to address you as Chairperson or just as hon member.
Hon Chairperson, hon members, over the past five years, we have seen profound changes in the delivery of health care in our country. These changes have confirmed the promise that our Government has made to ensure a better life for all the citizens of our land.
We take pride in what we have achieved, but we are also cognisant of the many challenges ahead. The project of a better life for all has to succeed, if only to secure the ideal of a stable, democratic and nonracial South Africa. But, we want more than that. We want a society that is nonsexist, humane and caring, a society that contributes positively to the forward march of all humanity. We want to be an example of the true and full celebration of the liberation of the human spirit.
But, this can never be where poverty is rife or disease cuts brutally short too many lives, where more than half of all humanity is condemned to perpetual subservience on account of being born a woman, and where illiteracy condemns human beings to being passive bystanders in a world whose rapid changes carries both the potential for success as well as self- destruction.
No doubt, ours is an ambitious project. Let our detractors call us dreamers. But dream we must. Yes, let us dream like the toddler who dreams that one day he may drive a car of his own, or become the president of this Republic or, for that matter, our visionary forebears who, in the face of the brutality of the apartheid crimes against humanity, dared to proclaim that, one day, we, too, shall be free.
Let us draw our inspiration from the knowledge that all can be done and can come true, that through our own actions it can be done, but above all, let us be driven by the same determination that transformed us from being a pariah state to being a respected and responsible member of the international community of nations in less than a decade. That would be a fitting tribute to the many who sacrificed their lives for us to be free, so that we can make these choices.
It also will be a tribute to the patience and understanding of the African woman from Nquthu who continues to walk miles to fetch water or take her child to the clinic in the next village, because drugs are not available in her own. For, in spite of all our achievements, there are instances where we continue to fail our citizens. We can say this openly and confront the challenges this brings, because we are sincere in our commitment to serve. For those who commit themselves to the service of their country and people, no difficulty is insurmountable. In fact, true patriots only see challenges and vow to stay the course until the job is done.
I wish, at the outset, to pay tribute to my colleagues, the nine MECs for health and the elected representatives of local government who participated in our meetings. We, without exception, have worked well together, and for this I thank them most sincerely. We have held each other’s hands as we navigated what, at times, were turbulent waters. We have been constructively critical of each other’s positions at times, and sometimes our debates have been robust. However, whatever discomfort might have been caused in the process, it pales into insignificance when compared to the constructive outcome of our deliberations. I make this point here in order to underscore my firm conviction that our system of intergovernmental relations is functional, and, as a collective, I believe we are well equal to the task we have been mandated to perform.
A major achievement of our co-operative interaction has been the elaboration of our strategic framework, the 10-point plan, which guides our activities for the period 1999 to 2004. This document, copies of which are available, constitutes our collective assessment of the priority areas we need to tackle in the life of this second democratic Government. This assures us that, as we labour in our different areas of assignment, we all move in one direction. This is critical to ensure that none of our citizens remain perpetually disadvantaged only on account of what province they happen to be living in. After all, South Africa is a unitary state. However, this framework acknowledges that there may be real differences in the provinces that may call for different approaches to the same problem. We take the view that we should celebrate this diversity as it, if properly channelled, provides a richness of experience and lessons that could be put to good use. This perspective informs our work at our Minmecs. We use these meetings as fora for constructive dialogue, sharing experiences and the joint monitoring of our programmes.
One of the priority tasks we face is the need to complete the process of putting lasting building blocks in place for the creation of a unified health system. Two very fundamental elements have been largely achieved. The first has been the need to root the primary health care perspective in the South African psyche as the correct strategic approach to underpin our health sector transformation. The urgency of this task cannot be overemphasised as it increasingly becomes obvious that the narrow biomedical model is inappropriate to deal with the major global health challenges of our times. Such is the global experience, for example, with the twin scourges of HIV/Aids and tuberculosis. This requires that we co- ordinate our activities across departments and other stakeholders, as well as the different spheres of government.
The second element has been the successful construction of one national and nine provincial administrations out of the myriad of 14 disconnected entities that constituted health administrations in 1994. The key challenges that we continue to face in the execution of this important task include, firstly, the need to build on the recent advances made with the demarcation of local government to ensure the building of viable health districts as vehicles for the delivery of integrated primary health care services. This will, of necessity, mean a reconfiguration of the interim health districts that, as hon members would recall, have already been advanced and created. However, we have always indicated that we would adjust the boundaries of these interim districts once local government demarcation was completed. We do so, so that we can align our health districts with those of other sectors. This is necessary to facilitate intersectoral co-ordination, a key element of the strategic approach of primary health care. In this regard, we are finalising a defined package of comprehensive services that will be delivered to be available incrementally to every citizen of this country by 2004. We see the health districts playing a critical role in delivering this package.
A related challenge is the need to build a seamless referral system to create the necessary incentives for the health system to be entered at the the lowest possible level. We need to launch campaigns that discourage communities from flocking to the major tertiary and regional hospitals with minor ailments which can be effectively dealt with at the primary level facilities. Such an approach is not only cost-effective, but, more importantly, facilitates better quality care throughout the health system. Success in this initiative hinges on our ability to raise the credibility of our public clinic system. This is a task in which we have to succeed. I take this opportunity to invite hon members to actively participate to ensure the requisite success.
The second important challenge in the building of a unified national health system is that of closely aligning the activities of the public, private and the NGO sectors. The challenges we face as a country require that we pool all our resources and expertise. The Chinese wall that continues to exist between the public and the private health sectors needs to be broken down. We need to promote areas of synergy, both in the provision as well as the financing of health care. We need to engage in a consultative, national process to define workable strategies for a lasting partnership. In this regard, we strongly support the decision of Government to increasingly explore alternative service delivery models. In so doing, we shall draw on our ongoing experience in the outsourcing of both clinical and nonclinical services. We also follow, very closely, the current initiatives which are exploring options for public-private partnerships in the supply of equipment for the new Inkosi Albert Luthuli Central Hospital. We shall proceed on this path not in a doctrinaire way, but guided by the overall objective of extending affordable, good quality care.
As regards provision, for example, we need to grasp that it is not in the interests of our country to expand our physical infrastructure when there may be possibilities of entering into contractual arrangements, utilising existing resources more efficiently. To succeed, however, this approach has to be underpinned by some fundamental prerequisites. Among these are the need to improve affordable access and the need to share a common perspective on the key objectives of our health reform agenda, as reflected in our White Paper.
As regards health financing, we need to encourage as many of those who can afford to do so to make some contribution towards the financing of their health care needs so that we can better target our limited fiscal allocation to more adequately assist the many in our country who remain trapped in poverty and require our assistance. This approach underpins the amendments to the Medical Schemes Act which hon members passed into law in 1998, and also informs our determination to work hard towards the introduction of a social health insurance as a component of an appropriate social security system.
Allow me, at this point, to briefly outline the progress we have made with implementing the Medical Schemes Act. The Medical Schemes Act, with all relevant regulations in place, finally came into effect on 1 January 2000. The move to enhance regulatory capacity in the Council for Medical Schemes is progressing well. A new registrar has been appointed to spearhead the new council’s operations. We have been working with the registered schemes to ensure that their rules and constitutions are amended to comply with the law. We have focused, in particular, on ensuring that the amended rules allow as many people as possible to join schemes without any unfair discrimination on the basis of age and health status. A lot of work has gone into ensuring that the schemes restructure their benefits to incorporate the legislated minimum benefits. So far, approximately 150 out of 170 registered medical schemes have submitted their amended rules for evaluation. We expect to finalise these reregistrations before the end of June.
A considerable amount of time has also gone into putting in place mechanisms for the protection of the interests of members. We have ensured that health care brokers are accredited. These measures will, over time, ensure that people are protected from harmful behaviour in the market. We are also putting in place substantially enhanced complaints resolution mechanisms in the council. The intention of these mechanisms is to resolve members’ complaints as quickly as possible.
Another fundamental task facing us is the need to reorganise our support services to support a unified national health system. In this regard, we focus on a number of areas, ie, the unification or our blood transfusion services, the improvement of pharmaceutical services, ensuring better information for planning, the consolidation of the telemedicine project, the transfer of medicolegal services to health, and the provincialisation of emergency services and their separation from the fire services. Together with my colleagues the MECs for health, we have taken a firm decision to accelerate the development of a comprehensive human resources plan for health.
This is going to be no easy task, but we are convinced that its further postponement can only cause more harm and bring about a reversal of some of our gains. Last Thursday we had occasion to receive the preliminary report of this team.
Some of the key messages are as follows: the need to move more rapidly and forcefully to ensure greater representation of the previously disadvantaged in all our institutions and at all levels, the need for the above to be supported by effective support programmes to ensure that improvements in intakes also translate into improvements in outputs; the urgent need to curtail areas of overproduction in our system; greater emphasis to be put on appropriate strategies and numbers of midlevel and multiskilled health workers; the need for curriculum reform to ensure that, early on after their studies, young professionals can impact positively on the drive towards universal access to good quality primary health care services; and the need to formulate workable strategies to deal with the high levels of emigration and exodus to greener pastures of some of our key and experienced personnel, thereby reducing our capacity to deliver quality care to our citizens. Whilst all of the above is going on, we shall continue to deepen our system of community service to help extend services to the rural areas. So far this programme has been a success. We are extending it to include dentists, beginning this July, and then pharmacists next year.
Last November in our consultation with hon members, we shared some of the findings of the report of the confidential inquiries into maternal deaths. We indicated that all of us had committed ourselves to initiating the measures necessary to rectify shortcomings. That work is ongoing, so is the work on improving access to termination of pregnancy services, particularly for the rural poor. The portfolio committee hearings last week also helped to highlight a problem that strikes at the heart of the constitutional promise of the right to reproductive choice.
Evidence is indeed accumulating that shows the benefits of the Choice on Termination of Pregnancy Act. Maternal mortalities from complications of abortions have decreased. Of course, this will be a gradual process. We continue to improve the skills of health workers to perform this procedure. We need, however, to address the problem of health workers who negate the provisions of our Act, thereby putting others at risk. Let it be clear that whilst we respect the views and the constitutional protection of those who themselves would not wish to render their services to perform terminations, we also unequivocally uphold the constitutional protection to reproductive choice which all women should enjoy.
At the same time, we regard as imperative that the right of women to have access to emergency medical services and the right to proper and accurate information on services available to them, are protected. In this regard I appeal to all health workers to understand their obligations and not engage in activities that will deny others their right to exercise their choices. We shall attend to this matter with a greater sense of urgency. I appeal to hon members for their active participation in this task. We cannot continue to betray the women of this country, particularly rural and poor women.
Another area that we shall be giving greater attention to is hospital development. All of us in all provinces are familiar with both the reality and the perception of serious public health concern over the state of our hospitals. These concerns span the entire spectrum from levels of cleanliness, attitudes of staff, poor management, poor work ethos and physical dilapidation, to overall concerns about quality. We need to deal with all these elements comprehensively, and we will. A primary challenge in this regard is the need for a comprehensive national strategic plan for the hospital sector. Such a plan must build within it elements that will create a network of facilities for the 21st century, factoring in such concepts as access for people with disabilities, as well as women- and baby- friendliness. At the same time, we need a hospital plan that relates to our reality of the growing burden of HIV/Aids.
An important element of our hospital reform is the need to empower managers locally by decentralising management authority. We have linked this initiative with a move towards general management where it is no longer the case that only doctors stand at the head of our institutions. We hope that this initiative will attract many good managers to carve a career for themselves in the health sector. The success of this initiative depends on the presence of appropriate incentives. One such incentive is revenue retention. We are encouraged by the recent moves in the Western Cape and Gauteng provinces in this direction.
Last year hon members provided us with R200 million for hospital rehabilitation and reconstruction. An amount of R155 million of this money has been allocated and spent, with the remainder fully committed and due to be spent in this financial year. A further R400 million has been allocated for this year. A major obstacle so far has been the absence of comprehensive provincial strategic plans. This is currently being addressed and should lead to an acceleration of the programme.
An area of major concern for us is the continuing significant underinvestment by all provinces in capital expenditure and routine maintenance. This is a recipe for disaster. Whilst all of us can rationalise our current spending patterns on account of the crowding effect of our personnel budgets and the consequent reduction of our nonpersonnel expenditure, the truth, however, is that these perfectly rational explanations are no cause for comfort.
I wish to note the progress with two major hospital investments which we are undertaking. Firstly, there is the new Nelson Mandela academic hospital in Umtata. This new hospital will have approximately 540 level 2 beds, with 60 specialist spinal beds at the existing Bedford hospital. This will improve referral and specialist services for a significant part of the largely rural population of the Eastern Cape. In addition, this hospital will contribute to a more appropriate teaching platform for the health science faculty at Unitra. The current Umtata General Hospital will be rehabilitated and remain open on the adjacent site as a level 1 facility. This new Nelson Mandela academic hospital should be completed in November next year. A key challenge now is to ensure that appropriate human resources, both clinically and managerially, are available for this institution.
The second major investment is the inkosi Albert Luthuli central hospital in Durban. This will be a major central hospital providing highly specialised services for the whole of KwaZulu-Natal and the northern part of the Eastern Cape. This major project is due for completion later this year. This facility will also contribute to the improvement of the teaching platform for the health science faculties in the greater Durban area. This will complement the major contribution made by King Edward Hospital. At this point I wish to salute the health workers of King Edward and Groote Schuur Hospitals. These two state hospitals have been rated amongst the top 10 medical facilities in the country in a survey covering 100 hospitals nationwide. This recognition should spur all of us into action to emulate these examples. These two major hospital investments contribute in a very concrete way to the correction of a historical injustice perpetuated by the previous regime, and are a fitting tribute to two outstanding heroes of our liberation struggle.
A related activity is the concerted effort we are making in respect of developing specialised services in the five relatively underdeveloped provinces, namely Mpumalanga, the Eastern Cape, the Northern Cape, North West and the Northern Province. This initiative is important in the promotion of greater equity between different regions in our country.
We all know that our major institutions are particularly concentrated in Gauteng and the Western Cape. This is not sustainable in the long term. Whilst we recognise that there are services that it is neither cost- effective nor desirable to provide everywhere, we do, however, believe that there are specialist services that it is desirable for every province to be able to provide. This work is facilitated through the redistribution of a specialised services grant. Other critical purposes of this grant are the reduction of crossprovincial referrals, and the building up of expertise, specialist training, clinical standards and the overall quality of care.
Two examples where this grant has been particularly effective are Potchefstroom in the North West and Witbank in Mpumalanga. In Potchefstroom we established a new oncology centre which is currently treating 250 patients per month, whereas previously all these patients were being referred to Gauteng. Similarly, the renal dialysis unit here has quadrupled its capacity, thereby providing a service for people closer to their families.
Witbank has been transformed from being a level 1 hospital to being largely level 2, comprising nine specialist departments with 13 full-time and a number of sessional specialists. Other developments include the establishment of a 15-bed ICU and the provision of equipment for a trauma unit, which is an important development on the national road. Early this year I had the opportunity to visit this hospital and witnessed, first hand, some of the changes. From this platform I wish to recognise the enthusiasm and dedication of the health workers that was in evidence. To date, R110 million has been spent on various projects under this grant. In this year’s budget an additional allocation of R176 million has been allocated to advance these initiatives.
Another related initiative has been to encourage our teaching institutions to decentralise their teaching platforms to facilities in other provinces as well. We do so out of a belief that it is good both for the development of our students as well as for the services. It is important that our students are familiar with the reality and diversity of our country. This enables them to be better prepared for service.
At the same time there is absolutely no question that when teaching takes place at peripheral institutions, it helps attract human resources and results in overall improvement in the quantum and quality of care at the periphery. This has been the clear picture emerging from the partnership between the Pretoria University and Witbank, as well as from the partnership between the Northern Province and Medunsa through its satellite campus at Pietersburg/Mankweng. We look with interest at the partnership between the Northern Cape and the University of the Free State, as well as at the discussions between the North West and Wits for specialist support for Klerksdorp, Potchefstroom and Mafikeng hospitals.
It should, of course, be stressed that the decentralisation of the teaching platform referred to should also extend to other facilities at different levels within the same province. In this regard we welcome the initiative in the Free State to open a satellite campus at the Goldfields Regional Hospital. I wish to convey a clear message to our teaching institutions of the eagerness of my department to be partners with them in these important undertakings. I also believe that our overall funding for health personnel training should more and more explicitly provide incentive for these initiatives.
All these activities have one fundamental objective, namely, to improve access to good quality services for all our citizens. An important and critical component essential to our success is the mobilisation of all our people to participate actively in their own interests. We hope that the Patient’s Rights Charter that was launched on 2 November last year will become a rallying point, highlighting a lot of necessary social dimensions of quality. We shall follow this with a comprehensive policy on quality this year, which we believe will guide such interventions as peer review systems, clinical audits and complaints mechanisms.
I am happy to note a lot of activity driven by my colleagues, the MECs, to ensure that these initiatives take root in the provinces. I appeal to hon members, as elected representatives, to put their shoulders to the wheel and mobilise for the success of these activities because, despite the many examples of outstanding service alluded to, there is that minority that does so much to betray our people. They need to be exposed and rooted out. Our services for equality, a caring nation and a humane society oblige us not to compromise on this.
This address would not be complete without dealing with the twin scourges of HIV/Aids and TB. In my address to the National Assembly, I raised a number of pertinent points in this regard. Time does not permit me to repeat those here. However, I wish to highlight just a few of them. We have demonstrated clear and unambiguous political commitment to dealing decisively with the scourge of HIV/Aids. We have also demonstrated our commitment to true partnership in this endeavour. Sanac is a concrete manifestation of this. I am also happy to note the enormous progress in provinces to create similar structures. This task will be completed before the end of this year. We now have, as a country, a five-year strategic plan formulated with the participation of many stakeholders. We have adopted adult treatment guidelines for the treatment of opportunistic infections, as well as guidelines for obstetric management of HIV-positive pregnant mothers.
These are now ready for implementation by the provinces. Working together with Welfare, we are also progressing well with finalising a framework for home-based care for those infected with HIV and Aids and those affected as well. We have endorsed an integrated strategy for dealing with children infected and affected by HIV and Aids. This is an intersectoral programme between Health, Welfare and Education, and is funded from the special allocation of R75 million announced by the Minister of Finance not so long ago. We strongly believe that a successful response to HIV/Aids has to be developmental in character and extend well beyond the narrow biomedical model. This is why we support the initiative by the President on the need for information that would facilitate a comprehensive intervention. We remain firm in the view that prevention remains the primary area of focus for us. Let us remember: There is no cure for Aids. Whilst we continue to support our scientists who are searching for an appropriate vaccine, the reality is that this is at best a medium- to long-term prospect. Prevention measures constitute the only effective vaccine - a social vaccine.
We are happy with the progress we continue to make in our efforts against tuberculosis. However, we recognise that a lot more still needs to be done. We are working particularly hard to try to reduce the incidence of multidrug resistance. An important area we need to confront in the funding of our Aids programme is the significant difference in the funding by the different provinces. This is too important an area to be left to chance. We propose that all provinces move to a system of topslicing a provincial HIV/Aids allocation from the equitable share. Such topsliced resources would then be used for intersectoral programmes, thereby reducing the current trend in which the burden falls squarely on the limited budgets of the health sector.
Added to the HIV and TB burdens, our country is witnessing a significant rise in malaria cases, particularly in KwaZulu-Natal, Mpumalanga and the Northern Province. We are responding to this in our own country, as well as by working with neighbours within the structures of SADC. Recently, Cabinet resolved to lend financial support to these provinces. With our neighbours we have also decided to continue with the programme of controlled and restricted use of DDT because of the growing resistance to the insecticides that we are using.
Finally, let me report on progress we are making with our systems of internal controls. We are happy that for two consecutive years, the Auditor- General has given us a clean bill of health. We have consolidated this with the establishment of a functional internal audit unit and an audit committee in line with the PFMA. We are proceeding with the implementation of other components of the PFMA. Similarly, progress is being made in the majority of our provinces. This address would, however, be incomplete without a comment on a disturbing pattern in the allocation of the budget for Health in the different provinces. The poorer provinces, notably Mpumalanga and the Northern Province, continue to have a significantly lower per capita expenditure on health. This has significant implications for equity - a cornerstone of our health policy. In hon members’ oversight function this must receive their attention. In conclusion, let me take this opportunity to thank this House for its support. Special thanks go to the Social Services Committee and its chairperson, Comrade Lorreta Jacobus. I wish to confirm my willingness to work with hon members across the political divide. My thanks also go to my organisation, the ANC, and to the President for having entrusted me with this most rewarding, but challenging task at this critical stage in our history. To the many health workers at all levels, the vast majority of whom are true architects of our glorious future, I say: Isizwe siyabonga [The nation thanks you.]
To all South Africans, together with my colleagues, we pledge our loyalty to the cause of a better life for all. Whatever the cost to ourselves, we shall serve them. We shall not fail them. God bless our beautiful land. [Applause.]
Ms L JACOBUS: Chair, hon Ministers, MECs present, members and special delegates, it is once more an honour for me to be able to address this House in the presence of the Minister and key implementers of policies and laws regarding the health of our nation in our respective provinces. We have moved a long way since 1994 towards putting in place legislation that will deliver quality health services to the majority of our people. However, as our Minister in the Health budget debate in the National Assembly last week said: ``That a lot more still needs to be done, is just a measure of the enormity of the challenges we face.’’
For the purposes of this debate we thought it appropriate to isolate the following areas of concern to our respective provinces and these also impact on all the nine provinces’ financial resources.
I must also indicate that these issues which I want to highlight are nothing new. We have raised these issues in previous debates and interactions with the Minister and the department. But they still remain very sore points for the people of our provinces, and hence we thought it appropriate to raise them again. The first issue is the deployment of medical staff; secondly, the availability or nonavailability of medicines and medical equipment; thirdly, the management of hospitals and clinics; and, fourthly, the impact of HIV/Aids on the health care system.
Regarding the deployment of medical staff, this is a particular problem in rural areas. In previous debates, I quoted the ratio of doctors to patients in the various provinces and I am not going to repeat that. In preparation for this Budget Review debate we had a very lengthy briefing by the department giving us a general overview of the budget and specifics pertaining to the four isolated areas mentioned. A question was raised as to whether the provincial allocations had been adjusted to accommodate the deployment of medical staff to the various provinces. We were uncomfortable with the response that there had been no allocation adjustments made. None of us are financial experts. Maybe the department and the Minister can explain to us why this had not been done.
During the constituency period, in May, we as the ANC focused on the delivery of health care. The two hospitals in my constituency, namely Coronationville and Helen Joseph, both reported a shortage of medical staff
- doctors and nurses in particular. I am sure that this is not a common complaint, even if the Minister is confronted by this question during her visits to our constituency. We were also told by the department that posts for community service doctors are made available to the department on an annual basis using existing provincial budgets. I do not want to speak on behalf of provinces, as the MECs and special delegates are here to do that for themselves, but I am convinced that provincial budgets are stretched beyond the limit as it is. How these provinces are expected to cater for this much-needed service from the existing budgets, I fail to understand.
I say to the comrade Minister that we pledged to this nation that we would develop a comprehensive, affordable and accessible national public health system. The shortage of medical staff hampers this pledge substantially. We, as Parliament, together with the Minister and her department, need to unpack this goal and see how best we can work towards achieving it. Regarding the availability or nonavailability of medicines, in this specific area we, as permanent delegates of the NCOP, have a very definite role to play in monitoring the various health institutions to determine the availability of medicines that appear on the essential drug list or EDL as it is commonly known. From reports received over a number of years, some institutions either do not have all the drugs appearing on this list or drugs have disappeared through theft committed by staff of the institution and others. We have also had reports of towels, bed linen and nightgowns being displayed on the washing lines of our communities. A very strong message must be sent to those guilty of the theft of public property. They, as all other criminals, must be hunted down and dealt with using the full might of the law.
A delegation from the select committee and portfolio committee visited the Rietvlei hospital in the Eastern Cape in December 1999. Patients told us that they had to bring their own bed linen if they were to be hospitalised. There were no trolleys to serve meals. Those who could walk, including heavily pregnant women, had to queue at the kitchen to receive their meals. This we witnessed for ourselves. I am happy though to see that the Rietvlei hospital is one of the hospitals earmarked for reconstruction and rehabilitation.
We need to examine the issue of accessibility. I have interpreted accessibility to mean much more than just being able to physically enter an institution - in this instance, a health institution. To me, it includes the availability of resources and services.
I cannot conclude this section without referring to the question of service delivery in relation to the termination of pregnancy to which the Minister has already alluded. Last week, the portfolio committee conducted public hearings around the implementation of the Choice on Termination of Pregnancy Act. These hearings coincided with widespread media coverage in terms of nondelivery of hospitals that were identified as designated hospitals for this service.
These allegations are not new. A few months ago there were media reports about a woman who went to Kalafong Hospital in Gauteng for a termination of pregnancy. She was asked to wait in an empty room with no equipment. At the end of the day, she had to leave without having received any medical attention. The Choice on Termination of Pregnancy Act was one of the major transformatory pieces of legislation passed by this Parliament since its inception.
We cannot allow a situation in which those who do not want to identify with change retard the process of transformation and, by so doing, put the lives of women in jeopardy. The reports from these public hearings, with the recommendations from the portfolio committee, must be placed on the agenda of the department as a matter of urgency to be acted upon.
Regarding the management of hospitals and clinics, during the health consultative meeting in November 1999 the MECs of the nine provinces, the portfolio committee, the select committee and the representatives of the nine standing committees participated. The Minister, in her opening address, made reference to hospital restructuring and management. Since then, a number of general managers or CEOs have already been appointed at various hospitals. These CEOs are not necessarily medical doctors but, in some instances, they are, for example - I am sorry to use this example again - the CEO of Rietvlei hospital which we visited in the Eastern Cape. During discussions he highlighted that this dual position brings with it a whole range of problems which I will not elaborate on at this point in time. These individuals, together with their communities, should be tasked with the sole responsibility of managing these institutions. The Minister mentioned that the department, at that point, was in the process of developing performance agreements with these CEOs. I think that it is now opportune for us to know at what stage these developments are.
We also want to encourage the Minister to fill vacant managerial posts within the department. This will assist a great deal in the effective and efficient management of our health care system as a whole. Human resource development goes together with good management. Human resource development should be linked to quality service delivery. We are very encouraged to note that one of the plans in the 10-point Plan of the department is the strengthening of human resource development and human resource management. The department has committed itself to a national human resource plan that will link our human resources to our needs. This is in keeping with what our President, Thabo Mbeki, said in the National Assembly this morning when he mentioned the improvement of the professional competence of the Public Service, including directors-general, as one of the most important challenges facing our Government at present.
We must salute countries like Cuba who have selflessly made medical doctors and health researchers available to assist us in areas where they are most needed, for example in our rural areas. The 129 South African students currently studying medicine in Cuba are doing so with the understanding that, on their return, they will be deployed to these rural areas where most of these Cuban doctors are at the moment. This is clearly one of the steps towards a more sustainable intervention with respect to improving our human resource capacity.
Regarding the impact of HIV/Aids on the health budget, the evidence from the research done on a number of hospitals indicates that about 60% of beds are occupied by patients with HIV-related infections and problems. This, in itself, should be an indication of the toll that this disease is about to take, both on our finances and in terms of human life. Although we acknowledge that HIV/Aids knows no boundaries, a situation analysis done in 1998 found clear indications that the HIV epidemic is severely affecting the young, black, economically poor population of South Africa.
Part of the fight against HIV/Aids is to maintain a healthy lifestyle. By this we include access to clean drinking water, proper sanitation, healthy and nutritious food and, generally, a clean environment. I have to make reference again to the three farms in the Phillipi area that we visited in the past two weeks accompanied by one of the health inspectors from the provincial department of health in the Western Cape. We were told that these farms are collectively known as the food basket of the Western Cape.
I found dogs and cats living under better conditions than these farmworkers on those farms. Firstly, their living quarters were dilapidated and inadequate. Their earnings could not even buy a loaf of bread a day, let alone a nutritious meal. On one of the farms, the farmworkers had to relieve themselves in the area surrounding their homes, which means that there were no toilet facilities. On the other two farms, one toilet was provided for all the farmworkers and their families.
A whole range of initiatives has been embarked upon in the fight against Aids, one of them being the Partnership Against Aids where business is represented. Creating a better life for all involves private-public partnerships. The question should now be put to Government, particularly the Departments of Health, Welfare, Education, Land Affairs and Agriculture, and the private sector, especially those businesses that benefit from the produce of this so-called food basket: How are you collaborating to ensure, at the very least, a healthy lifestyle for these farmworkers and their families? [Time expired.] [Applause.]
Mev A M VERSVELD: Mevrou die Voorsitter, 12% van die totale Begroting, omtrent R32 miljard, is toegewys aan Gesondheid. Daar is egter soveel nood in hierdie departement dat R32 miljard maar soos ‘n druppel in die emmer sal wees. As ons net dink aan die groot nood wat vigs meebring, dan kan agb lede verstaan waarom ons hierdie begroting bevraagteken.
Gesien in die lig van die groot afmetings van die las wat MIV-vigs op die begroting plaas, bly dit vir ons onverskoonbaar dat 40% van die begrote geld verlede jaar nie eens gebruik is nie. Is dit ook ‘n geval van onbeholpenheid in die administrasie, soos in die geval van die Departement van Welsyn, wat veroorsaak dat die mense daar buite net meer ly? Kan ‘n mens dan nie maar vir eens en vir altyd die interne departementele sake regstel en dan juig oor hoeveel daar begroot is om probleme in die Departement van Gesondheid op te los nie?
Ons staan voor ‘n massiewe probleem as ons aan vigs dink. Volgens navorsing en projeksies gaan 17% van die bevolking in die jaar 2006 deur vigs geaffekteer wees. Vigs ontsien niemand wat nie gesond lewe nie. Professor Coovadia, voorsitter van die Vigs 2000-konferensie, het ‘n uiters kommerwekkende uitspraak gemaak toe hy gesê het dat een uit elke 12 lede van die Parlement reeds MIV-positief is. Nee, ons moet ons eie huis in orde kry wat vigs betref, en ophou om die virus te bevraagteken. (Translation of Afrikaans paragraphs follows.)
[Mrs A M VERSVELD: Madam Chairperson, 12% of the total Budget, approximately R32 billion, has been allocated to Health. However, there is such a great need in this department that R32 billion will be a drop in the ocean. If we think of the great need caused by Aids, then hon members can understand why we are questioning this budget.
In the light of the tremendous burden placed on the budget by HIV/Aids, we find it unforgivable that 40% of the budgeted money was not even used last year. Is this also a case of ineptness in administration, as in the case of the Department of Welfare, which simply causes the people outside more suffering? Can one not once and for all rectify the internal departmental affairs and then rejoice at the amount budgeted to solve problems in the Department of Health?
We are faced with an enormous problem when we think of Aids. According to research and projections 17% of the population will be affected by Aids in the year 2006. Aids respects no one who does not live a healthy life. Professor Coovadia, Chairman of the AIDS 2000 Conference, made a very distressing statement when he said that one out of every 12 members of Parliament are already HIV-positive. No, we must get our own house in order as far as Aids is concerned and stop questioning the virus.]
Let me deal with some other problems relating to the state of health services in our country. The majority of our provincial hospitals and clinics continue to face financial crises year after year. In some provinces major hospitals are faced with the total closure of wards, dysfunctional medical equipment, rentals on equipment not being paid, shortages of linen, drugs and food, critical staff shortages and frozen posts.
The primary health care institutions are also experiencing major problems, which include local authorities not being paid their due moneys to pay clinic sisters, extreme shortages of drugs, inadequate emergency rescue vehicles and clinics with no water or electricity, especially in the Eastern Cape, district surgeons not being paid and patients turned away due to lack of transport to main hospitals. Does the budget address these problems in the provinces? I say categorically, no! [Interjections.] Budget inadequacy is like treating a serious wound with a Band-Aid strip.
One must start by treating one’s health workers properly. They are the poorest and most overworked people in our Public Service. One cannot blame them for seeking greener pastures overseas and in the private sector.
Ons moet regmaak wat verkeerd is. As ons goed kyk na ons mediese werkers, sal hulle goed na ons siek mense kyk. Ons soek ‘n gesonde Suid-Afrika, en ons soek gelukkige werkers. Dan kan ons met reg sê Suid-Afrika is op pad na ‘n beter, voorspoediger en gesonder toekoms. (Translation of Afrikaans paragraph follows.)
[We must rectify what is wrong. If we take good care of our medical workers, they will take good care of our sick people. We want a healthy South Africa, and we want happy workers. Then we can rightly say that South Africa is on its way to a better, more prosperous and healthier future.]
Mr B J MKHALIPHI: Chairperson, hon Minister, hon special delegates and hon colleagues, the first remarkable commitment to health care service delivery in this country was made by a group of people at Kliptown on the occasion of the Congress of the People. These people were not living in the best of times, as we ourselves, but nevertheless, they resolved, under very trying and difficult conditions, inter alia, and I quote:
A preventive health care system shall be run by the state. Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children. The aged, orphans and disabled shall be cared for by the state. When these resolutions were adopted as part of the Freedom Charter on 26 June 1955, exactly five months and three days before I was born … [Laughter] … the prospects of realising these noble ideals were very bleak indeed. But, thanks to the unwavering commitment, sacrifice and consistency of the leadership of the present Government, we have never reneged on these commitments made nearly 45 years ago. Even during the adoption of the Constitution these commitments were candidly catered for in the Bill of Rights, that is section 27 of the Constitution.
True to our passion for the most vulnerable sector of the community, especially in the rural areas, we have taken commendable steps to deploy medical professionals to these areas. We have had remarkable success in deploying medical doctors to these areas and arrangements are in place to deploy pharmacists as from next year. Arrangements for the deployment of dentists will hopefully proceed successfully.
However, we should be wary of prevailing trends, especially in Mpumalanga, where some medical professionals are absorbed into administrative positions as directors, communication officers and so forth. We believe that medical personnel should, as far as possible, remain in their specialist fields for the sake of stability and growth in the health sector. A programme is however being implemented to address this situation in the said province.
We are witnessing a remarkable improvement in the dispatch and control of medical supplies in hospitals and clinics, but room still exists for improvement. The scourge of theft is still prevailing, though in reduced proportions. In Carolina, for example, during the constituency week from 20 to 24 March this year, we embarked on Operation Mazibuye and managed to recover 372 textbooks and return them to the relevant schools. Of course, many of these books were outdated and no longer in use. Our major aim of recovering bed linen and cutlery for the hospitals was hampered, partly because the hospitals’ assets and medical supplies are not clearly marked. The hospitals are however rectifying this shortcoming.
We are also noticing some undesirable spin-offs of the strict control of medical stock, in that the availability of essential drugs in emergency cases during the night is sometimes hampered, since in some hospitals there is only one pharmacist working a 7-to-5 shift.
We are confident that the recent undertaking by pharmaceutical companies to lower the price of medicines will further improve the availability of these drugs. The unprecedented success achieved by this Government in insisting on pharmaceutical companies appreciating the national cause is truly remarkable in that it was achieved in a mutual understanding of recognising the importance of observing the imperatives of the rule of law on the one hand and patent rights on the other. It is therefore a partnership with the private sector which requires neither of these parties to compromise its responsibilities or rights in order to address the needs of the public, especially the poor.
The management of hospitals and clinics has had more direction and focus since the introduction of the 10-point plan and the Patients’ Rights Charter. This initiative has had the effect of directing the service provider and the service to move closer to one another. The community health committees have realised that they too have responsibilities to strive for, and this strengthens the partnership.
Another area that is receiving attention is the question as to whether medical doctors, in their capacities as hospital superintendents, are efficient managers of these institutions. Initiatives such as the appointment of a hospital manager or CEO are most welcome, but we are urgently challenged to explore whether a specific curriculum in hospital management could be developed in close co-operation with the SA Management Development Institute and tertiary institutions. [Time expired.] [Applause.]
Dr P J C NEL: Chairperson, hon Minister, health is one of the most important portfolios in Government. Will Durant once said:
The health of nations is more important than the wealth of nations.
‘n Departement van Gesondheid wat egter steier as gevolg van ‘n tekort aan die nodige fondse om ‘n behoorlike gesondheidsdiens te lewer kan katastrofiese gevolge inhou vir die hele bevolking. In die paar minute tot my beskikking wil ek enkele aspekte uitlig wat ‘n negatiewe uitwerking het op die lewering van gesondheidsdienste in die Vrystaat.
My party is bekommerd omdat daar weens die tekort aan fondse in die afgelope drie jaar se begrotings geen voorsiening in die Vrystaat gemaak is vir die aankoop en vervanging van toerusting vir hospitale, klinieke en ambulanse nie. In werklikheid was daar die totale besnoeiing van R65,5 miljoen oor die afgelope drie jaar op hierdie enkele spesifieke item. Die totale bedrag wat byvoorbeeld vir hierdie doel vir die tersiêre hospitaal in die Vrystaat bewillig is, is ‘n skrale R800 miljoen. Dit is nie eers genoeg om ‘n enkele gewone x-straalmasjien aan te koop nie.
Die agb Minister het ons vandag meegedeel dat die Universiteit van die Vrystaat en die Departement van Gesondheid beplan om ‘n subkampus vir die mediese fakulteit in die Goudveldse streekhospitaal te vestig. Daarvoor het ek self groot waardering, maar ek is bevrees dat dit nog groter verpligtinge op die departement gaan plaas, want toerusting sal vir seker aangekoop moet word om kwaliteit opleiding moontlik te maak vir die nagraadse studente wat daar opleiding gaan ontvang. Ek versoek die Minister om iewers fondse te vind vir hierdie doel.
Ek stem saam met die voorsitter van ons komitee. Die integrasie van die aktiwiteite van die publieke en private gesondheidsektore is seker nou belangriker as ooit tevore. (Translation of Afrikaans paragraphs follows.)
[However, a Department of Health that is staggering because of the lack of funds needed to deliver a proper health service may have catastrophic consequences for the whole population. In the few minutes at my disposal I would like to highlight a few aspects which are having a negative impact on the delivery of health services in the Free State.
My party is worried because, owing to the shortage of funds in the budgets of the past three years, no provision has been made for the acquisition and replacement of equipment for hospitals, clinics and ambulances in the Free State. Regarding this single particular item there has, in fact, been a cut- back of R65,5 million over the past three years. The total amount that was voted for this purpose to the tertiary hospital in Free State, for instance, was a mere R8 million. That is not even enough to purchase a single standard x-ray machine.
Today the hon the Minister has informed us that the University of the Free State and the Department of Health are planning to establish a subcampus for the medical faculty at the Goldfields district hospital. I myself am very appreciative of this, but I am afraid that it will place even bigger obligations on the department, because equipment will definitely have to be purchased in order to make quality training possible for the postgraduate students who are to receive their training there. I request the Minister to obtain funds somewhere for this purpose.
I agree with the chairperson of our committee. The integration of the activities of the public and private health sectors must now be more important than ever before.]
Section 2(4) of the White Paper for Transformation of the Health System in South Africa clearly specifies that, and I quote:
The activities of the public and private health sectors should be integrated in a manner that makes optimal use of all available health care resources.
I am very pleased to hear from the MEC in the Free State that her department is in the process of privatising 120 hospital beds of the Pelonomi Hospital in Bloemfontein. This will enable the department to generate funds to purchase, at least, some equipment, and is a step in the right direction I would like to congratulate the MEC on that.
However, I can ensure the hon the Minister that the department needs much more money for equipment.
Die geldelike verliese wat gely word weens die diefstal van medisyne en mediese hulpmiddele beloop steeds astronomiese bedrae in die Vrystaat. Volgens die mening van die LUR is dit te wyte aan die groot tekort aan aptekers in diens van die staat, met die gevolglike tekort aan behoorlike kontrole. Die hoofrede wat hiervoor aangegee word, is steeds die swak salarisse wat die staat aan aptekers betaal. Ek wil die agb Minister versoek om tog persoonlike aandag te gee aan hierdie saak wat reeds ongeveer vier jaar sloer. Die huidige salarisse van aptekers is afwaarts aangepas toe alle ander gesondheidswerkers se salarisse opwaarts aangepas is. Dit is nou hoog tyd dat hieraan aandag gegee word.
‘n Ander saak wat ek wil bespreek, is die syfers wat die agb Minister onlangs as antwoord op ‘n vraag wat aan haar gestel is, bekend gemaak het, naamlik dat daar verlede jaar meer as 40 000 swangerskappe in Suid- Afrikaanse hospitale beëindig is. Dit is vier maal meer as die aantal mense wat jaarliks op ons paaie sterf. Die feit dat daar nou meer onwettige vrugafdrywings gedoen word as voor die implementering van die Wet op Keuse oor die Beëindiging van Swangerskap, dui daarop dat korrupte gesondheidswerkers hierdie stuk wetgewing misbruik en die wet dus nie daarin slaag om die onwettige vrugafdrywings te voorkom nie.
Ek is ook ontsteld daaroor dat die Minister onlangs gesondheidswerkers aangesê het om hulle plig voor hul oortuigings te stel. Ek wil as Christen vandag by die agb Minister pleit om haar daarvan te weerhou om gesondheidswerkers te forseer om hul godsdienstige oortuigings en die Hippokratiese eed wat hulle afgelê het, te verontagsaam. Dit is ook die grondwetlike reg van dokters om godsdiensvryheid te beoefen. [Tyd verstreke.] [Applous.] (Translation of Afrikaans paragraphs follows.)
[The monetary losses that are being suffered because of the theft of medicine and medical resources still amount to astronomical figures in the Free State. According to the opinion of the MEC this is due to the great shortage of pharmacists employed by the state, with the resultant lack of proper control. The main reason that is being advanced for this still remains the poor salaries that pharmacists are being paid by the state. I want to request the hon the Minister please to turn her personal attention to this issue, which has already been dragging on for about four years. The current salaries of pharmacists were adjusted downwards when the salaries of all the other health workers were adjusted upwards. It is now high time for this matter to be attended to.
Another matter that I want to discuss involves the figures recently announced by the hon the Minister in reply to a question put to her, namely that last year more than 40 000 pregnancies were terminated in South African hospitals. This is four times the number of people who die on our roads annually. The fact that more illegal abortions are being performed now than before the implementation of the Choice on Termination of Pregnancy Act indicates that corrupt health workers are abusing this piece of legislation and that the Act is therefore not succeeding in preventing the illegal abortions.
I am also alarmed about the fact that the Minister recently ordered health workers to place their duty before their convictions. As a Christian I would like to appeal to the hon the Minister to refrain from forcing health workers to disregard their religious convictions and the Hippocratic oath which they have taken. It is also the constitutional right of doctors to practice their freedom of religion. [Time expired.] [Applause.]]
Mr R A M SALOJEE (Gauteng): Chairperson and hon Minister, I thank you for this opportunity to address the NCOP in this the Health policy review debate. Gauteng can show that positive improvements in a number of directions have resulted in advancing the process of equity and transformation. Thousands of patients who previously had little or no access to basic health services now can and do receive a relatively comprehensive primary health care and supportive curative care service. The backlogs in primary health care infrastructure are being actively reduced and statistics show that a rapidly increasing number of patients are using these facilities, but that the referral system to higher levels of care is still dysfunctional.
At the same time, in spite of a tight budget and limited allocations of funds, the Gauteng department of health, for the first time, has been able to align its previous annual overspending within the allocated budget with a nominal saving. This has been done by boosting fiscal discipline, management efficiency and public accountability. The Gauteng department of health has rigorously presented, without any excuses, the realistic problems and shortcomings. This ensures speedy solutions to problems arising out of often difficult, inherited inequities of the past, and new problems emanating from formidable challenges and tough decisions that need to be made for transformation and greater equity to take place. These are knotty questions facing any country which is trying to restore existential normality, promote percolative equity, establish a durable economy and concretise a pervasive democracy.
Since the presentation of the Gauteng commission of inquiry into hospital services and its far-reaching recommendations, a number of steps, short- term and long-term, have been introduced towards ameliorating the situation. The process of appointing chief executive officers at hospitals on performance-based contracts has been instituted. Both the Chris Hani Baragwanath and Johannesburg Hospitals already have CEOs. However, the pool and quality of people applying for these jobs are quite limited and very minimal.
Hospital boards and clinic committees, health institutions as course centres, fees and outstanding debt collective measures, incentivised by revenue retention for each hospital, and further decentralisation and devolution of responsibilities and budgets at institutional level have been introduced. Anticorruption tasks teams have been appointed. Step-down beds and home-based care facilities are being introduced.
The District Health Bill, based on the local government option, is soon to be introduced, whilst hospital service norms are being circulated for adoption. Improvements in health indicator programmes and greater comprehensive service delivery at primary health care clinic level are being extended.
Thus the thrust of the Gauteng department of health has been to follow mandatory strategic transformatory plans to give effect to the principles of Batho Pele. Whilst it is necessary for us to monitor and keep a vigilant eye on the performance and pace of transition and transformation which must continue, we have to admit that even with the best professional will, management efficiency and improved standards of care, the effects of critical, as yet poorly defined and incompletely quantified external factors will continue to handicap and incapacitate our health services.
Neither vehement criticism of the services provided nor heaping of uninformed denunciations on the way departments of Health manage their portfolios will result in anticipated outcomes. This is not something which will happen very readily. Unless we adopt an integrated approach to health care and cast our nets wider to reduce poorly quantified pressures caused by these determinant factors outside the direct control of the Health Department and by the limits placed by unrealistic budget allocations, it will not result in immediate trouble-free, problem-free services consistent with expectations, notwithstanding the Patients Rights Charter or even the service pledge.
Excessive levels of deterioration in lifestyle behavioural patterns, which the health system cannot control, dysfunctional families and antisocial activities in turn result in abnormal levels and forms of violence and abuse of children, the aged and women, rape and other forms of sexual violations. HIV/Aids and other forms of preventable, communicable and noncommunicable forms of lifestyle diseases, natural disasters and epidemics are also beyond the control of the Department of Health.
Abnormal levels of fatal and nonfatal injuries; motor vehicle accidents; robberies with aggravating circumstances; including hijackings; assault with intent to inflict grievous bodily harm; trauma; bad eating habits and nutritional deficiencies; smoking and substance abuse and/or alcohol addiction - one can go on and on - are dysfunctional aspects of the socioeconomic situation in our country that impact on the health system, and which the Health department can do very little to control.
Then we have economic determinants such as social and unhealthy consequences of unemployment; indigence; poverty; homelessness; overcrowding; environmental pollution; lack of basic amenities; the sprawling masses of shacks littering the periphery of our urban areas and poor occupational safety measures in the workplace. These are some of the other factors which the Health department has to contend with, but does not have the capacity to control. This requires the whole society to participate in this process.
We also have the problem of refugees and uncontrolled, unregistered immigrants - I will not call them illegal immigrants. [Interjections.] There are national and interprovincial cross-border flows of patients who are unreferred and crowded prisons as well as corruption and pilfering from health institutions. The cumulative effect of all these factors and stresses on Gauteng’s limited health facilities and strained health resources in particular, must of necessity create, in the health sector, the kinds of problems regularly blazoned across our daily news media.
To this we must add the insufficient budgetary allocation for capital expenditure and infrastructure upgrading; ageing equipment; and lack of sophisticated equipment and technological support systems. A backlog in repairs, replacement and maintenance, previously estimated at R1,8 billion in Gauteng, has now increased to over R2 billion. The amounts that have been allocated in the present budget are not going to address this problem. Unless we harness the support and receive the co-operation of communities, NGOs, CBOs, business, workers …
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! Hon member, your speaking time has expired.
Mr R A M SALOJEE: Chairperson, I was told that another special delegate from Gauteng was erroneously allocated some of my time. As a result, I have 10 minutes. [Interjections.] I was told so by the Whip.
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! Hon member, there has been a bit of confusion. Please continue.
Mr R A M SALOJEE: Thank you, Chairperson. Unless we harness the support and receive the co-operation of communities, NGOs, CBOs, business, workers, and all sectors and tiers of government to contain and control these abnormal dysfunctional societal excesses which adversely impact upon the health system, the drain and strain on our delivery of services will continue. Unless we also stem the tide of the massive loss of professionals, doctors in complementary disciplines and nurses from the public sector, we face a tough and challenging battle.
Whilst our emphasis on primary health care must remain one of the important pillars of our system, we must not allow secondary and tertiary health care to deteriorate. At present we note significant gaps between the Health department and academic medical institutions. At least in Gauteng, we believe that this decision-making process, which is often not too formal, interactive, structural and uniform, will continue to create the divergencies which will affect the public health system as a source of the kind of excellent health centres which in the past established South Africa
- and still does, I believe - as a country producing health professionals of a very high calibre.
Owing to financial constraints and a reduction in the number of professional medical appointees at our tertiary institutions, specialist training is becoming limited and incentives for highly qualified professionals, in terms of research and postgraduate training, are becoming scarce.
If South Africa wants to remain the engine of excellence and promote itself as a leader in advancing Africa’s medical renaissance, then we need to take a more concerned look at the relationships that exist and opportunities available at the tertiary level of training. Our tertiary health environment is becoming less attractive for recruiting and retaining staff. For example, Gauteng previously had three chairs for a professor of radiology, which were recently reduced to one. Yet, in 15 years - I was informed by the dean of the faculty of Medicine at Wits - Gauteng has not been able to recruit a single person to fill the single professorial chair. This is rather disastrous for a country we need to take to a position of excellence and keep there.
In view of the limited time, I cannot elaborate further, but there is definitely a need to dissect the causes and find solutions so as to remedy a situation we neglect at our own peril. Our reservoir of professionals in public sector teaching is being eroded. We hope that the long-awaited national health Bill will soon be enacted so as to resolve these important issues. Without this Bill, I feel, we would face a hiatus which would add to the kind of gaps that exist in our health system.
The problems are not insurmountable, but our will to succeed must be stoked by an urgency to tackle the fundamentals timeously, creatively and judiciously, and I think we do have the capacity. We hope that the country as a whole, and not only the Health department, will take up the challenge and change the nature of health care in our country. [Applause.]
Ms M KHUNWANA (North West): Chairperson, hon Minister, MECs present here, members of the NCOP, members of provincial legislatures, distinguished guests, ladies and gentlemen, the vision of our provincial department is optimum health for all individuals and communities in the North West province. The department’s management vision in the North West is the delivery of an accessible, equitable, affordable, efficient and effective developmental health system through community participation. In order to achieve this vision, the department has to embrace the following core values. It must be people-driven and people-based, according to Batho Pele [people first] principles. They must try to understand their customers’ needs and put people first every time. They must be performance- driven and strive to improve and excel. The department is trying hard to deliver health care services to people through promotive, preventative, curative and rehabilitative public health services, which are delivered through primary health care, district hospitals, committee health centres, clinics and health programmes in the communities.
Secondary care is provided by district hospitals, and specialised and specialist services through the three regional hospitals. All the aspects I have mentioned are genuine wishes of the department, but because of insufficient funds the mission, vision and objectives are frustrated. One may look at the massive budget of the department and think that it is enough, but due to a backlog of health services in our province it is really difficult. The people in the rural areas are suffering.
Professor Crous conducted his survey with his expertise in primary health care implementation and good intentions, but because of his lack of knowledge of our provincial structure, he allocated clinics according to a statistical ratio, disregarding the vastness of the rural areas. He also closed most of the 24-hour service clinics in the rural areas, exposing poor rural people to a lack of health services, and defeating the brilliant Madiba project of free health services for children below six years of age and pregnant women. They are now expected to pay huge amounts of money for fares to the nearest 24-hour service, and health services are now no longer free, as intended.
With regard to the deployment of medical staff, we all know that medical staff in the North West province are insufficient. Clinics in the rural and urban areas serving black people never had medical doctors. The distribution was unbalanced. The department has nevertheless tried to distribute doctors as evenly as possible. This has been done through a transformation process. A clinic in town is no longer servicing whites only, but everybody living in that vicinity.
For example, in Ottosdal there is one hospital in town, which has only 14 beds. In a clinic in the township services are rendered as follows. All patients in the townships and on all the farms around this area are serviced through primary health care at the clinic in the township, irrespective of colour. All patients who are to be hospitalised are admitted to the hospital in town, irrespective of colour. But this wonderful effort is being frustrated by the shortage of staff. The total population is well over 50 000, but they are looked after at the clinic by two professional nurses, two assistant nurses, two cleaners and one gardener, who work eight hours a day and five days a week. They do not work over weekends and on public holidays. One can imagine what happens at this clinic.
This scenario is not only being experienced in Ottosdal, but in most former TPA and CPA areas and at rural clinics. Most of these clinics, especially in Ottosdal, depend on the medical services of the most incompetent district surgeon. Nevertheless, the department - through the assistance of a government-to-government agreement - has introduced Cuban doctors who have alleviated the problem of the shortage of medical staff. We have seven Cuban doctors in Klerksdorp, four in Mafikeng, three in Tharakgalo, and six in Rustenburg. They are also assisted by the community doctors, who have enabled the rural clinics also to be visited by a doctor at least once a week. There are also 30 dentists deployed in the rural areas.
As regards the availability of drugs, since drug distribution has been outsourced to Vuna, availability is much improved. This is especially true of hospitals, where it is much better in level 2 and less so in level 3 hospitals. However, the distribution to clinics is still inadequate. This is due to the fact that medicine is being delivered to hospitals, and hospitals in turn are expected to supply clinics. This is done with great difficulty because of a lack of transport. Level 3 hospitals cover between 60% and 75% of the essential drug list delivery, whilst level 2 hospitals cover between 80% and 95%. This is being frustrated by theft, owing to lack of security at hospitals to which these drugs are delivered. There is still a lack of security in the reception and storage areas in hospitals.
With regard to the management of hospitals and clinics, the province has three categories of hospitals, namely regional hospitals, which consist of levels 1 and 2, district hospitals, which consist of level 1, and community health centres. The department has appointed general managers in nine hospitals, whose main responsibility is to run the hospitals with regard to finances, human resources and clinical services.
The hospital management team consists of general managers, clinic managers, and nursing services managers. The Department of Health provides an induction programme for the first intake of general managers. That is funded by means of European fund assistance. The second intake will begin work in July/August, and this already includes seven general managers interviewed in May 2000. Advertisements will be forthcoming for a general manager for George Stegman.
As regards delegation, the department has set up a task team to work on powers and functions to be delegated to the general manager, notwithstanding the provisions of the new Public Service regulations, the Public Finance Management Act and related pieces of legislation. The organisational structure under the general manager is as follows: clinical manager, medical manager, nursing manager and administrative manager.
The blockages being experienced by the Department of Health in hospitals are as a result of lack of accountability of general managers. There are also bureaucratic procedures that tend to create more bottlenecks. The province has fully implemented the district health system, with 18 well- functioning health districts. The department has appointed 16 health district managers.
With regard to challenges, the demarcation process has reduced the number of local authorities from approximately 54 to 22, therefore … [Time expired.] [Applause.]
Dr U ROOPNARAIN (KwaZulu-Natal): Chairperson, hon MEC of Health, and members of the NCOP, as we participate in the health review debate, we need to bear in mind that health is not just the absence of diseases. Health is an investment in human wellbeing, physically, mentally and spiritually. Today I am pleased to be part of this debate in the NCOP Chamber. As legislators we realise that we are often faced with the challenge of allocating state resources and getting a better return from the money which the province spends. This is also true for the Ministry of Health, which is an output-driven entity striving towards affordable and equitable health care for all citizens.
Today I will concentrate on HIV/Aids in KwaZulu-Natal. It is patently clear that the rapid growth of HIV/Aids infections in KwaZulu-Natal is a cause for serious concern. An estimated 33% to 35% of the population is infected. A recent survey of one of the provincial hospitals showed that 50% of the patients tested were HIV-positive. The epicentre of the epidemic is KwaZulu- Natal. The most accurate figures describing the epidemic originate from antenatal clinics, which serve as sentinel sites to monitor the epidemic. Worldwide there are approximately 33 million adults and children infected with HIV/Aids. Africa, especially the sub- Saharan region, has the highest burden of this disease.
The spread of HIV/Aids is nothing short of catastrophic. We as Government need to take stock of the disastrous consequences of HIV/Aids and give our very highest priority to the management and containment of HIV/Aids. We face a provincial emergency that calls for a renewed response to the epidemic, not just as a health issue, but as a development issue.
Unlike other diseases that fell the old and the very young, the disease predominantly cuts down the youthful, the fertile and the economically active sections of our population. It is beginning to kill so many adults in the prime of their working and parenting lives. It decimates the work force, fractures and impoverishes families, orphans millions, and shreds the fabric of our communities.
The question we need to ask is: What is it going to do to our health budget? This question reverberates all the time. It causes the health budget to shrink and shrink. HIV/Aids infection causes increased multiplication of viruses resulting in increased complications which means increased medical treatment and care. So the focus of budgets is shifted to the management of opportunistic infections. The cost it imposes will influence the Government to make some heartbreaking choices. The health sector is the first to feel the burden of increasing illness. Increased demand for health care is directly related to the prevalence of HIV/Aids infection.
Studies also show that adults with Aids use more health care prior to death than those who die from other causes. The increase in HIV/Aids-related admissions would also make it difficult for patients who are not HIV/Aids infected to get medical treatment. This year, medication costs have escalated to alarming proportions, as people with compromised immune systems require greater quantities of drugs or more expensive types of drugs. A further problem that exacerbates the hospital budget is the rise in Aids-related illnesses such as pneumonia, tuberculosis and meningitis. This means that Aids-related deaths begin to compete with cardiovascular diseases which are the leading cause of death in many of our hospitals. This translates into spending millions of rands treating Aids patients, apart from the awareness campaigns.
In a country where adults consume 25% of the health care budget prior to treatment for Aids and where the prevalence of infection remains stable at 5% and the average time from infection to death is ten years, the epidemic will cause a 26% increase in the demand for health care. Many of the decisions we make, such as the allocation of resources and the management of opportunistic infections and the provision of antiretroviral treatment, will challenge our thoughts and ethics on human rights to their maximum, and no sector will be able to isolate itself from the impact of HIV/Aids. Both public and private sectors will need to work together with civil society and people living with HIV/Aids to translate constitutional rights into practice for all South Africans. We cannot detract from the fact that we, as political leaders, need to take political responsibility for the decisions we make. [Time expired.]
Mrs J WITBOOI (Western Cape): Chairperson, I would like to take this opportunity to thank you for allowing me to comment on certain critical issues in the health care sector. After a long period of drastic downscaling and restructuring of health services, following a drop in real- term expenditure of just under 10% over the past four years, the health branch is eventually entering a period of stability with the opportunity now to consolidate and redefine health care in this province. We share a vision of a society where the health care needs of every person are optimally met, the dignity of every patient is respected and protected and where health facilities provide an environment conducive to healing and are a source of pride for both our staff and the communities we serve.
I would like to take this opportunity to share with hon members how the Western Cape intends to make good that commitment. The key to our strategy lies simply in service, where, in this case, S stands for spending wisely, E stands for efficient and effective management, R stands for revenue generation, V stands for visible improvement in preventative and control measures for HIV/ Aids and TB, I stands for improving public perception, C stands for caring more, and E stands for entering into partnership with the private sector.
I wish now to address the topics that the NCOP has identified as especially relevant to the purpose of today’s discussion. With regard to the deployment of staff to rural areas, there has been an active policy in the Western Cape to upgrade rural health services both at primary care and hospital levels. Substantial progress has been made towards building an appropriate primary care infrastructure and with upgrading hospitals. In respect of medical staff, the introduction of community service doctors has been a real boost, and has had a stabilising effect on the medical workforce in many institutions that previously were unable to recruit doctors with any reliability. For this, the national Minister must be commended, even though the creation of posts and the allocation of funds were initially highly problematic. At least the principle was correct.
In our rural regional hospitals we have implemented a policy of employing general specialists in the main disciplines of medicine. We are pleased to announce that the Western Cape is now able to provide a full package of specialist services in all our rural, regional hospitals.
Tweedens konsentreer ek op die bestuur van hospitale en klinieke. Van meet af moet gesê word dat dit ‘n noemenswaardige besluit was om bestuur te desentraliseer, maar dat daar in die Wes-Kaap maar stadig gevorder word met die implementering daarvan. Tot dusver het ons net beperkte sukses met die afwenteling van bepaalde finansiële en personeelpligte behaal.
Die grootste sukses was die vermoë van die streekdirekteure om poste waarvoor geld voorsien is te vul en verantwoordelikheid vir dissiplinêre prosedures op instellingsvlak te aanvaar. Boonop word die akademiese hospitale en al ons psigiatriese instellings nou as aparte diensplatforms bestuur om doeltreffender gebruik van hulpbronne deur die onderskeie instellings moontlik te maak. Dit was ‘n uiters suksesvolle strategie. Die Wes-Kaapse departement het ook ‘n ferm aanbeveling gedoen dat distrikgesondheidsdienste in die volgende boekjaar as deel van die skepping van ‘n distrikgesondheidstelsel na plaaslike owerhede oorgedra moet word. Dit sal die bestuur en koördinering van primêre gesondheidsorgdienste onder ‘n enkele gesag in ‘n distrik versterk.
Wat betref die beskikbaarheid van geneesmiddels en hulpbronne aan plattelandse gebiede, is dit ‘n betreurenswaardige en gevaarlike feit dat baie van ons instellings tekorte aan en uitgeputte voorraad van noodsaaklike geneesmiddels ervaar. Daar is talle redes hiervoor, maar dit het meer met ondoeltreffende leweransiers as probleme met die diens self te doen. Soms was daar wêreldwye tekorte aan aktiewe bestanddele en kan vervaardigers die vraag nie bevredig nie.
Na ons mening is die huidige Comed-stelsel vir die toewysing van nasionale tenders omslagtig en moet provinsies hul eie geneesmiddeltenders kan aanvra. Om die probleem op provinsiale vlak te verlig, gaan die Wes-Kaap meer geld aan ons sentrale geneesmiddeldepot toeken, sodat hy meer voorraad kan dra. Die provinsie het ook tenders vir die verspreiding van geneesmiddels van die SGD na instellings gevra om die hele proses doeltreffender en doelmatiger te maak. Laastens sal die rekenarisering van ons apteke dit moontlik maak dat instellings betyds toepaslike bestellings by die SGD kan plaas. (Translation of Afrikaans paragraphs follows.)
[Secondly I want to concentrate on the management of hospitals and clinics. One must say at the outset that decentralising management was a remarkable decision, but that slow progress is being made with its implementation in the Western Cape. As yet we have only achieved limited success with devolving certain financial and staff duties.
The greatest success achieved was the ability of the regional directors to fill posts for which money had been made available and to accept responsibility for disciplinary procedures at institution level. Apart from that the academic hospitals and all our psychiatric institutions are now managed as separate service platforms in order to enable the various institutions to utilise resources more efficiently. This was a very successful strategy. The Western Cape department also made the firm recommendation that district health services should be transferred to local authorities during the next financial year as part of the creation of a district regional health system. This would strengthen the management and co-ordination of primary health care services under a single authority in a district.
As regards the availability of medicines and resources to rural areas, it is a regrettable and dangerous fact that many of our institutions have shortages and exhausted supplies of essential medicines. There are many reasons for this, but it has more to do with inefficient suppliers than with problems in the service itself. Sometimes there are worldwide shortages of active ingredients and manufacturers cannot meet the demand.
In our view the present Comed System for the allocation of national tenders is cumbersome and provinces must be able to request their own tenders for medicines. To alleviate the problem at the provincial level the Western Cape is going to allocate more money to our central medicine depot, so that it would be able to carry more stock. The province has also requested tenders for the distribution of medicines from the CMD to institutions to render the entire process more efficient and effective. Finally, computerisation of our pharmacies will make it possible for applicable orders to be placed at the CMD in good time.]
With regard to poverty alleviation programmes, they are a subject of great controversy in this country. The Western Cape believes that the vast amount of money which has remained unspent is not only due to inefficiency, but is also a result of problems in procedures within the Public Service and the bureaucracy we all face.
With this in mind, the Department of Health has focused on a limited number of projects that are assured of effective implementation. Given the vast amount of poverty in this country and the urgent need to address poverty as one of the key issues leading to ill health, it might be more relevant for poverty alleviation programmes to become the function of departments which are geared specifically to manage these types of programmes. [Interjections.] [Time expired.]
Mr J O TLAGALE: Mr Chairperson, hon members of this House, in the North West there was uncertainty about the role of these sectors due to the integration of the previously fragmented systems and the creation of a district health system. The province had inherited some state-aided hospitals from the former Transvaal and Cape Provincial Administrations.
However, in spite of a few teething problems, the system is geared to provide appropriate health service and care. At present, a concerted effort is being launched to curb the theft of drugs which see their way to some unscrupulous private practitioners. However, control mechanisms have been tightened and it is believed that the potential drug-thieves will be frustrated. [Laughter.]
The HIV/Aids epidemic continues to rear its ugly head in many areas of the province. In spite of the various control measures and awareness campaigns, people are dying every day. One wonders whether the secrecy and nondisclosure of the causes of death are not probably the reasons why people do not heed the preventive messages in respect of the seriousness of the epidemic.
Our concern as the UCDP is the availability of drugs and other medical supplies on a regular basis at health facilities and to communities. It would be appreciated, for the general good of the public, if clinics and hospitals could be stocked on a more regular basis.
In conclusion, I wish to congratulate the hon the Minister for her detailed presentation in which she proved that she has information about our provinces at her fingertips. The UCDP supports this Budget Vote. [Applause.]
Ms D E PETERS (Northern Cape): Mr Chairperson, I just want to indicate here that at times we, as provinces, when we are requested to give specific indications of what our needs are, get excited believing that we will get good responses. I just want to indicate here that in March we were requested to come and present before the NCOP Select Committee on Social Services and I am a bit disappointed to say that, since then, we have not heard anything about the inputs that we presented.
On 18 May, to be specific, we presented our budget profile to the NA
portfolio committee, and I am happy to say that, at least, we have had some
feedback to indicate that the NA portfolio committee is actually doing
something about our concerns. If a mother says to her child: O rwala size
mang?'' [What size do you take?] obviously, it says to the child's mind:
O ya go nthekela ditlhako’’ [She is going to buy me shoes]. I am not
going to disappoint my chairperson of the select committee. I will confine
myself to the relevant areas in which we are expected to respond.
Concerning the deployment of health staff, I would like to indicate here that we have a total of about 105 full-time doctors in the Northern Cape, of which 78 are stationed at Kimberley Hospital, 12 at Upington and 15 are rotating through the smaller hospitals. In addition, we also employ part- time or sessional doctors.
It should be noted that we only have four full-time South African specialists in the province, and the rest, which are 19, are foreign specialists, mainly from Cuba. I need to indicate here that 18 of the 19 doctors are from Cuba. Of concern is the fact that all the specialists at Upington Hospital are Cubans, which raises the question of long-term sustainability.
At present we have a full-time dentist who is the manager of the oral health programme. Clinical dental services are being rendered by part-time dentists. Their services will, however, be terminated at the end of June and 12 community service dentists will be deployed throughout the province.
Various categories of therapists are employed in the province. We have about five physiotherapists, five occupational therapists and one speech therapist, all stationed at Kimberley Hospital. They do, however, visit the outlying areas as part of the outreach programme. Emergency care practitioners are distributed throughout the province. Of the 193 practitioners, 112, which is about 60%, are reservists.
Two clinical psychologists have recently been employed. They will play an important role in patient care and staff support. We have 1 659 nurses employed in the province. They are subdivided as follows: 50% or 813 are professional nurses, 18% or 298 are staff nurses, and 32% or 548 are assistant nursing staff. These nurses are distributed between the following facilities: Kimberley Hospital Complex - 40%, Gordonia Hospital - 8% and the other hospitals and clinics have about 52%.
Nurses are the most versatile and, perhaps, the most misutilised of all employees in that they stand in for many occupational classes in the remote areas. They take X-rays, act as porters, telephonists and admission clerks. We certainly owe them a debt of gratitude.
On the budget implications, the Northern Cape has certain unique characteristics, which are known to all of us here, and which result in a higher per capita cost for the delivery of health services. In spite of this, the proportion of the provincial budget allocated to health is relatively low. The provincial discretionary budget is divided in the following manner: Education gets about 39% of the provincial budget, social welfare 28% and health 17%. This gives us about 84% for social services.
This is 1% less than the 85% proposed for these 3 departments. The total of 1% underfunding is visited on Health that receives 17% instead of 18%. This is one of the lowest percentages of all the provinces. This 1% underfunding represents about R20 million or 5% of the health budget. We will have to phase in a shift of the R20 million from the nonsocial Ministries to Health to increase the health allocation to 18% and that of the 3 departments collectively to 85%.
Another area in which we are forced to provide services at levels which are not optimally efficient is in the need for a multiplicity of small hospitals. We have a total number of 33 acute hospitals and 20 hospitals with less than 30 beds. These hospitals are expensive to run because a critical mass of personnel numbers is necessary to ensure a functioning hospital. A reduction in bed numbers can therefore not be accompanied by a similar proportionate reduction in personnel.
These large numbers of small hospitals result from the need to provide in- patient facilities to small communities because of the distances. The bed- to-population ratios for district hospitals is 1:1000. Therefore a community of 7 000 would need a hospital of seven beds. This is not usually achievable and a hospital of 15 to 20 beds would be in place with consequent higher per capita costs. For example, we have a community with a population of about 18 000 in Colesberg with a hospital having 29 beds.
In Noupoort, we have about 7 754 people with a 12-bed facility, and in Garies, a community of less than 1 500 people, there are about 12 beds. Our budget will also be influenced by the Gordonia Hospital at Upington being upgraded from a district to a regional hospital, which will require an increase in the recurrent expenditure. This is because the acceptable staff- to-bed ratio of a district hospital is 1:7 and that of a regional hospital is 1:2.
As regards the outreach programme, in order to ensure access of the population to specialised services, an outreach service is in place. This involves air travel because the vast distance makes road travel inefficient and dangerous. This service was delivered at a cost of about R4.6 million in the year 1999-2000. Such a service is expensive compared to that in a metropolitan area where patients can attend specialist hospitals. Instead of many patients being seen at one site with all facilities immediately available, fewer patients are seen at different facilities with consequent low economies of scale. The outreach programme provides a range of specialist services, that is obstetrics and gynaecology, paediatrics, internal medicine, surgery, orthopaedics and other smaller specialities. These specialities are provided at the following hospitals or centres: Springbok, Calvinia, De Aar, Postmasburg, Kuruman and Douglas.
On the question of the availability of medicines and resources, the pharmaceutical services component of the department endeavours to support health services in the province by ensuring a continuous supply of safe and effective drugs and surgical requisites according to the national drug policy. The contract for the outsourcing of procurement, storage and distribution of pharmaceuticals was awarded to Sekunjalo Medical Logistics which started operating on 1 December 1999 from a depot in Kimberly.
The nature of the contract is such that the procurement is a joint function between the department and the contractor because certain functions, according to tender regulations, cannot be performed by a private contractor. The storage and distribution is done by the contractor, who must ensure that drugs and surgical requisites reach their destinations, which is clinics and hospitals, according to the agreed delivery periods. The commission which has been agreed upon averages about 12% of the value of the issues.
The primary essential drug list has been implemented to the extent of about 86%, and ongoing work is being done to implement the secondary EDL. Workshops are due to be held with doctors and other stakeholders so that the implementation can be fast-tracked. The budget for pharmaceutical and surgical requisites has been decentralised to districts, and it is the responsibility of district managers to allocate appropriate budgets and to monitor such budgets with the assistance of district pharmacists. The total allocation for pharmaceuticals amounts to about R35 126 000 from the total sum of R411 857 000 for the year 2000-2001.
On the management of hospitals and clinics, I would like to say that Kimberly Hospital, our provincial hospital, has recently appointed a chief executive officer to manage the complex. A medical director, who reports to the CEO, has also been appointed to manage all clinical services. This is the only hospital in the province that has appointed a CEO. Gordonia Hospital in Upington is in the process of being upgraded to a secondary hospital. At the moment, a medical superintendent is managing the hospital. The current restructuring of this hospital will lead to a management structure similar to that of Kimberly Hospital. The rest of the district hospitals form part of the district health system and under the district manager’s … [Time expired.] [Applause.]
Ms B THOMSON: Chairperson, please pardon us for inconveniencing the House. I am sure you will be in a better position to understand, because you are from KwaZulu-Natal. [Laughter.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! Your point is taken!
Ms B THOMSON: Chairperson, KwaZulu-Natal welcomes the budget allocation given to the provincial department of health. However, enormous challenges face the province. Because of budget constraints, the provincial department of health has been forced to freeze some posts. The department has 50 000 staff members instead of 59 000, and this causes a big problem because it interferes with the care of patients. In spite of all the constraints, it is pleasing that the provincial department of health has been able to do a wonderful job and save lives.
Two weeks ago, our three institutions, namely Addington, King George V and Ukhahlamba in Mtshezi district received the PricewaterhouseCoopers Premier’s Good Governance awards. A staff member of the ambulance emergency and medical services was also awarded an Ubuntu award. On top of that, the King Edward V-III Hospital came out as one of the ten hospitals, in the whole country, that is rendering high quality care to the people.
The availability of medicines in the rural areas is a broad subject. Medicines are supplied to hospitals from the provincial medical supplies centre. A private sector contractor is responsible for the distribution from this centre, depending on the size and location. Other clinics, including mobile services, are supplied from nearby hospitals. Clinics are supplied with medicines listed on the primary health care essential drug list. However, there are several challenges, many of which have been overcome. However, some remain and are being attended to in order to ensure the provision of a sustained supply of medicines to the clinics, especially to those in the rural areas.
A referral system that is part of the district health system is ensuring that patients are treated close to home and receive quality care at clinics. This is a challenge that the department has to face in that the system that has been put in place has to ensure that relevant medicines for particular patients are available when required and if they are not on the primary health care essential drug list. Budget constraints are a challenge, but the department is doing its best to provide more with less and to provide services to all patients by exploring innovative ways of ensuring that the reduced budget does not curtail the provision the services. Distribution is being contracted out, in certain cases, from the provincial medical supply centre in order to improve the effectiveness of the distribution of drugs and to reduce shrinkage.
Training amongst primary health care nurses is being addressed in order to improve the quality of diagnosis and prescription to patients. Furthermore, training of clinic managers is important in order to ensure a constant availability of drugs at the clinics. Regional pharmacists have been appointed in all eight regions. This will assist with the supervision of the clinics and primary health centres management by ensuring effective stock management of drugs and the cold chain for vaccines.
The department is encouraged by the motivation and commitment of the majority of the staff in the department. This commitment is translating into an effective health delivery system. Open discussion within the department is ensuring that challenges are not hidden, Instead, they are aired and solutions are developed to overcome them, and to ensure that the principles of Batho Pele are internalised and remained visible with all staff. A full-time member in the communications section has been tasked with driving the Batho Pele principle within the department by ensuring that a … [Time expired.] [Applause.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! I am sure that you will agree that to make a mistake once is not a mistake, but to repeat it is actually a mistake.
Mrs J N VILAKAZI: Chairperson, hon Minister of Health, Dr M Tshabalala- Msimang, hon MECs and colleagues, as a former nurse of more than 20 years, it is very difficult to talk about the current situation in the health services generally. Primary health care at the beginning of the past decade was a most valuable tool and was taken to be the first tool towards achieving health for all by the year 2000. At that time, no one could have predicted the existence of this disease or scourge and the dilemma it would create in our health services.
We hope that the Health budget which we all support today will be able to improve conditions and make health delivery in all sectors achievable and sustainable. This can be made possible through the improvement of work facilities, manpower resources, equipment and supplies. A conducive therapeutic environment may then be achieved.
The IFP sees the increasing disease rate hindering health care services in a big way. The prevalence of tuberculosis, HIV/Aids and malaria in some provinces such as KwaZulu-Natal, where I come from, are all a threat and strangulate the promotion of good health services. It is shocking to hear that despite an increase in the occurrence of these dreadful diseases in the country there has been no BCG vaccine available to give protection against tuberculosis in all newborn infants. This is really shocking. It is also shocking to note that, despite the ever-increasing numbers of malaria cases in northern KwaZulu-Natal and other provinces near the border, DDT which effectively prevents the spread of anopheles mosquitoes has not been sprayed as was formerly the case, because vegetation is being protected at the expense of people’s lives. This is indeed shocking.
It is also shocking to note that despite the high incidence of HIV/Aids and tuberculosis, some maternity wards are a high risk factor because of the appalling hygienic conditions. The HIV/Aids pandemic is engulfing the whole country. According to a new study, it is suggested that six million people will be HIV-positive by the end of the year. The number of deaths will rise by 180% in the next five years. Sectors that are most at risk are mining, Government, manufacturing and construction. Despite all attempts to curb the spread of the disease, it remains the most feared of all diseases in South Africa.
It is surprising then that some of the papers have been busy creating a scandal regarding the death of a member who recently passed away. This is just wickedness and a failure to respect one’s name and dignity. I truly admire the words of Andile Noganta in City Press of 11 June 2000, and I quote:
Now doesn’t scandalising an Aids death like that defeat the purpose of a high-profile personality’s status being made public? Doesn’t it add to the stigma attached to the killer disease?
The sad part is seeing people who should know better lapping up the remains of this media feeding frenzy. And in case they’re shouting from safe positions, may I offer this challenge to anyone who thinks that because people have a duty, by virtue of being public figures, to come out: Please do it yourself first!
Ngithi kumhlonishwa uNgqongqoshe wezeMpilo: Bhukula nkosazana. Kuyabheda kwezempilo. Ubusela bubhokile khona kunjalo. [Kwaphela isikhathi.] [To the hon the Minister of Health, pull up your socks, lady. Things are bad in the Department of Health. The level of stealing is too high. [Time expired.]]
Mr K D S DURR: Chairperson, I would like to link up with the excellent speech by my colleague, Mrs Vilakazi, who just sat down. When the Minister sat down she asked God to bless us. Those were the last words she said. I think for that to happen, one should have a deep, abiding reverence for life. I have to say I cannot help feeling some cynicism at the choice of the words ``health review debate’’, when our countrymen and our women, as Mrs Vilakazi so adequately put it, are beginning to die of Aids on an increasingly gigantic scale, and when our hospitals, according to the Cape Argus, have performed more than 100 000 abortions since 1994. Because of Aids, 50% of people alive today in South Africa will not reach the age of
- A quarter of a million of our fellow countrymen will die this year of Aids.
The impact on our economy is an annual loss of GDP of 3,1%, which will climb to 4,7% in 2011. By the year 2008 - and these are actuarial figures, not something sucked out of one’s thumb - life expectancy will have fallen from 60 to 40 years of age. The Minister spoke of improving termination of pregnancies for rural people. The doctors and nurses are rebelling against this mass killing. We have abortion on demand and sometimes the killing of a live baby in the womb by what they call the top procedure before performing the abortion procedure, where they crush a baby of nine months. They crush the baby’s head and then abort the baby. We simply cannot live like that. We cannot then say to doctors that they must do their constitutional duty and perform these procedures.
Proabortionists claim that baby killing is legalised by the Act up to nine months after reproduction. Baby killing is not part of reproduction. It happens after reproduction. [Interjections.] We do not believe that section 27(1) of the Bill of Rights is a constitutional right to kill babies. [Interjections.] Section 15(1) of the Constitution says: Everyone has the right to freedom of conscience, religion, thought, belief and opinion.
I have a serious request to make to the Minister. In the Defence Act there is a provision for conscientious objection. [Interjections.] I ask the Minister to bring clarity on this point and request her to amend the law to allow for conscientious objection from doctors and nurses whose consciences will not allow them to perform abortions. [Time expired.]
Mrs C NKUNA: Chairperson, hon Minister of Health, hon members in this House, I wish to thank you. Allow me to start by telling the ACDP that right now, as we stand here, there are women committing backstreet abortions. We would like to know from the ACDP what programmes it has to curb or stop this, because what is happening at the moment is that hospitals are busy treating a lot of unfinished abortions.
In this second term of office in our province we along with the national Government, have put the emphasis on the quality of service delivery to all our people. With this quality service delivery firmly entrenched in our minds, the department embarked upon quality assurance initiatives such as the Batho Pele principles, the patients’ rights charter, children’s rights protocol and the rights of the elderly, to mention but a few. People in the Northern Province now enjoy privacy. They enjoy consultation in privacy, and allow me to also say that the question of human dignity is taken on board.
The department of health and welfare in our province has developed a set of core functions which we believe will assist us in delivering on our Batho Pele principles. The health core functions are as follows: to manage and administer the overall management and administration of health services in the Northern Province; to render district and primary health care services; to provide a platform for the training of health workers to render health care support services; to provide for new health core facilities and the upgrading and maintenance of existing facilities.
In addition, our province has intensified our HIV/Aids awareness campaign and we are moving beyond mere awareness and towards a stage of effectively dealing with this scourge. The challenge will now be the provision of infrastructural support for our HIV/Aids campaign so that facilities for voluntary testing, counselling and home-based care for people living with Aids can be provided for.
We are also not looking at HIV/Aids in isolation, but at all opportunistic diseases in general and, with this in mind, we are working on strengthening and expanding management and treatment protocols for these diseases. Over and above government assistance in combating HIV/Aids and its effects, our province will continue to rely on the support of all our sectors and communities including business, NGOs, CBOs and faith-based organisations.
Ku vile na ku humelela lokukulu eka lembe leri ra 1999-2000 laha eka swin’wana swa swona ku nga na leswi. Xo sungula, ku engeteleleka ka nhlayo ya 24 wa tiawara ta titliniki ku sukela eka 115, ku fika eka 175, ku pfuriwa ka 15 wa titliniki letintshwa, ku pfuriwa ka 5 wa swibedlele swa swifundza, ku thoriwa 136 wa madokodela ya vaaki va ndhawu na 82 wa madokodela lama ha ku thwaselaka tidyondzo ta wona. Ku tlakuka ka nhlayo ya vadokodela ku suka eka 392 ku fika eka 522.
Ku tisiwa ka madokodela ya ku huma eka matiko man’wanyana, ku fana na le Cuba, swi antswisile nhlayo ya vavabyi eka dokodela. Sweswi ndzi vulavula hi xiyelo xa dokodela na muvabyi. Eku sunguleni, dokodela eka Xifundzankulu xa N’walungu, a fanela kuva a vonana na vanhu va 30 000, swiya-swiya dokodela un’we a vonana na vanhu va 10 000. Kutani eka nkarhi wa sweswi dokodela un’we u vonana na vanhu va 6 000.
Mfumo lowu wu fikile ekule mayelana no lulamisa vukayiveri bya madokodela eka tindhawu ta matiko-xikaya. Ndzi pfumelele ndzi vula leswaku vumunhu byi kumile vundhawu eka vanhu. Mfumo lowu wu kombile ni ku tinyiketa ka wona eka vantshwa va ka hina hi tlhelo ro va nyika tibasari to ringana 217 eka swichudeni leswi dyondzelaka vudokodela etiyunivhesithi, na leswi swi dyondzelaka tidyondzo ta nhlayiso wa vanhu. Hi na 187 wa swichudeni leswi nga heta ku dyondzela tidyondzo ta swona. Na 11 leswi dyondzelaka vudokodela eCuba. Mayelana na ndzetelo wa lava va hi tirhelaka eka ndzawulo hi leterile 2 708 wa vanhu n’wexemu.
Ndzi navela ku komba mhaka ya mintlhontlho ya mpimanyeto wa Rihanyu. Xifundzankulu xa hina xi kumile leswaku minkavelo ya timali leti tirhisiweke eka Xifundzankulu yi hambanile ngopfu ni ya Swifundzankulu leswin’wana, laha xa hina xi nga xa vumbirhi ku sukela ehansi. Leswi vulaka leswaku ku fikelela eka swa mintirho ya Rihanyu ka ha ri na ku hambana lokukulu, laha a hi ta navela leswaku ku tekiwa magoza yo hlawuleka yo lulamisa ku hambana loku nga kona. Laha ndzi vulavula na n’wina Holobye. Ku hambana ka mavangwa lamakulu ya swiyimo swa le henhla, na ku tlakusiwa eka mintirho yo sukela ka leyintsongo, leswi nga humelela hikwalaho ka nkanelo wa 1996, wo kanela mayelana na miholo naswona swi vangile ntshikelelo eka mpimanyeto wa Rihanyu.
Kambe handle ka ntshikelelo hi ringetile leswaku swi nga khumbi xiyimo xa vahlayisi eka swiolovisi swa hina, naswona hi nga ha va ni ku angarhela lokukulu. Ndzi anakanya leswaku hi humelerile. Xo hetelela, nhluvuko no aka hi vuntshwa swi tshama swi ri karhi swi ri ekuendlekeni. Kutani swipimelo leswi hi ti vekeleke swona, swi ta antswisa vutomi bya vanhu va ka hina, ngopfu ngopfu eka Xifundzankulu xa N’walungu. (Translation of Tsonga paragraphs follows.)
[There have been some remarkable achievements during the 1999-2000 financial year where, amongst other things, the following was achieved. First and foremost, there was an increase in the number of 24-hour clinics from 115 to 175, the opening of 15 new clinics, the opening of 5 district hospitals, the appointment of 136 community doctors and 82 medical interns and the increase in the number of doctors from 392 to 522.
The influx of doctors from foreign countries like Cuba has improved the number of patients each doctor sees. I wish to address myself to the issue of the doctor to patient ratio. In the past, the doctor to patient ratio in the Northern Province was 1:30 000, and as time went on, the ratio was 1:10
- At present, one doctor treats 6 000 patients.
This Government has gone a long way in addressing the shortage of doctors in rural areas. Allow me to say that humaneness has found its place amongst people. This Government has also shown its commitment to our youth by awarding 217 bursaries to full-time medical students at universities as well as students studying social work courses. There are 187 students who have completed their studies. A total of 11 medical students are studying in Cuba. In as far as in-house human resource training is concerned, the department trained 2708 people last year.
I wish to highlight budgetary challenges in the Department of Health. Our province has found that the allocation to cover expenditure in our province differs substantially from that of other provinces, since ours came second lowest of them all. Essentially this means that to a great extent access to health services remains unequal. We would like to see special measures being implemented to address this disparity. I am conveying this request to you, hon Minister of Health.
The broadbanding and the rank and leg promotion for higher and lower posts resulting from the 1996 wage negotiations have also added their pressure to our Health budget. But despite the pressure we have tried to ensure that these external pressures do not affect the overall standard of care provided in our facilities, and we may be in a position to save in a big way. I think we have succeeded. Lastly, development and reconstruction are an ongoing process. The limits which we have put in place will help to improve the lives of our people, especially in the Northern Province.]
Chairperson, I hope I have a few more minutes left, because I want to utilise them tomorrow. [Laughter.] [Applause.] The DEPUTY CHAIRPERSON OF COMMITTEES: Order! Unfortunately, you do not have any.
Mr P G QOKWENI: Chairperson, hon Minister, MECs and members, we are participating in this debate in support of this Budget Vote and motivated by the vision of a healthy nation in order to have a world-class nation. To put it in the Minister’s words: ``A better life for all in a united, caring and humane society.’’
No matter from what political pedestal one speaks, matters of health or ill health fear no political boundaries and will make their impact across the political divide. The same applies to HIV/Aids, which is reducing our life expectancy to only 40 years. This is also the case with tuberculosis, which affects almost every family and household in the rural areas.
In closing a health consultative conference on 13 November 1999, the hon the Minister expressed the following encouraging sentiment:
The health of our nation is too great a price for us to sacrifice at the altar of political expediency. We hereby act in response thereto.
One of the hallmarks of the struggle for democracy was the demand for the redress of historical imbalances, albeit true that the problems cannot be solved overnight. In fact, I note the political will to address the issues of inequity and redistribution of resources in the public health sector of the new democracy. I can only encourage the department to be more vigilant in addressing the maldistribution of health professionals between rural and urban areas. It militates against the aim of the health care policy, which is to provide quality services that will help the poorest out of their disadvantaged position in order to achieve equity.
I also recognise the plans to put in place a system of devolved management of resources in order to improve the management of health centres. Hopefully, this will include intense capacity-building programmes; developing an increasingly socially accountable, patient-centred empathy and work ethos; reducing patient queues; rooting out the theft of drugs and other corrupt practices; and increasing revenue.
The challenge lies in promoting transparency by giving effect to the initiatives mentioned by the Minister, such as the patients’ charter, the peer performance review system and a complaints system that will reinforce the policy of providing quality care. [Applause.]
Ms P C NGWENYA (Mpumalanga): Chair, hon Minister, hon MECs present here, hon members of the NCOP, hon members from the different legislatures and guests, it is an honour for me to have been given the privilege of participating in this important debate.
The health of our people is a priority. Primary health care services are important to ensure that people get health services in their areas instead of having to travel long distances to get to hospitals or clinics, especially in the rural areas. The shortage of primary health care nurses, professional nurses, doctors and support staff in the rural areas is a problem, but I am happy that the department has identified this problem.
At present the department is doing a skills audit in order to identify overstaffed and understaffed institutions. After this process has been completed, the rightsizing and redeployment of personnel to areas where they are needed will take place, especially in rural areas.
The department is also in the process of reducing the number of districts from 15 to 3 according to the demarcation process, with the aim of redeploying personnel to clinics. This will enable us to achieve our goal, which is the improvement of primary health care. The restructuring of the provincial administrations will assist in making sure that clinics and hospitals are fully resourced.
The shortage of drugs in the rural areas is still a problem and has been caused by the decentralisation of the payment of drug suppliers who supply the districts. Drug suppliers were not being paid on time, but the problem has now been solved. The payment of suppliers has been centralised, and it is hoped that this will address the issue of the shortage of drugs. The implementation of the essential drug list will also be a solution, but theft still contributes to the shortage of drugs.
Another problem has been the lack of capacity in respect of pharmacists. Despite efforts to restructure the pharmaceutical industry, salary scales in the public sector have remained unattractive and this has led to a lack of professional support. The introduction of community service from January 2001 will compensate for these needs in the provinces. The chief pharmacist in each of the three provincial districts will be responsible for supervising and monitoring suppliers and their facilities.
Our vision is to ensure the provision and promotion of transparent social services that address the basic needs of the inhabitants of Mpumalanga through a decentralised, holistic primary care approach in a caring and gender-sensitive manner in order to develop self-reliance in a safe environment.
In order to achieve these goals and objectives, the department of health in Mpumalanga has implemented the following mechanisms. These are the development and implementation of a district health system, meaning that the management of health services, based on a primary health care approach, has been decentralised, ensuring the provision of health care services and the opening of clinics that are accessible to our people; implementing the programmes that have an impact on quality of life; integration of the private and public health sectors; the promotion of the optimal use of skills, experience and expertise of all health personnel; and the implementation of the provincial health facility Bill, which will ensure that communities are involved and consulted in the management of health facilities.
With regard to poverty alleviation, Mpumalanga is a rural and poverty- stricken province, so poverty alleviation projects will enable needy communities to generate income and improve their households. Two poverty alleviation projects are targeted in each district. The beneficiaries of those projects are women, the youth, the disabled, the unemployed and the community at large. There are 31 poverty alleviation projects, with still more applications awaiting funding. Owing to financial constraints, the department failed to fund them all.
The issue of HIV/Aids needs to be taken seriously. Mpumalanga is the province second most affected by this pandemic. Its impact will be seen in staff losses, a reduction in staff functioning and service provision. This reduction will have a ripple effect on the cost to the province and to the general public. Interventions should be made, such as an active strategy on HIV/Aids prevention, targeting health care workers. Policies and guidelines should be established to limit its impact. Procedures should be speeded up, such as boarding, early pension and finding alternative work when necessary. The interdepartmental working groups have been established, which include representatives from the provincial health management team. The provincial health department programmes will remain a key and integral part of the overall HIV/Aids programme.
HIV/Aids will have a profound impact on every area of our society. Everyone must be involved to prevent the spread and limit the impact of this illness. The Department of Health will experience this more than any other department and this will occur during a time of severe financial constraints, staff reductions and profound demands for service by the community.
Mpumalanga had a prevalence of HIV/Aids of 22% amongst antenatal women in
- In 1999 there was an increase of 4%. HIV/Aids is promoted by multiple- partner exchange, unprotected intercourse and untreated STDs. Our province has employed 11 200 health workers and it is estimated that 2 000 staff members are currently HIV-positive. The total number of employees affected is around 2 800 to 3 300. This could mean that the department could lose over 400 staff members per year as the Aids pandemic becomes established within the province.
The impact of HIV/Aids among the lower categories of staff such as gardeners, cleaners, and assistants, where there has been minimal training, will be lower than in the areas of higher training. From a humanitarian perspective, lower categories of staff should not be neglected with regard to preventive and care intervention. Currently, 40% of medical admissions are patients who are HIV-positive. They dominate other diseases within the health facilities. An additional number of 10 000 Aids patients can be expected to attend the health institutions by 2004.
The department has developed an awareness programme on HIV/Aids, which includes the provision of condoms to all staff members and communities, and also the training of staff and communities on sexually transmitted diseases. Voluntary HIV testing and counselling are to be offered to staff on request. Peer group support mechanisms are to be developed for staff who are infected. The infected must be trained about personal protection and healthy lifestyles.
Home-based care programmes are in place with the aim of reducing the impact of Aids on hospitals. NGOs should be used to offer hospice services. Links between NGOs, the private sector, public systems and communities must be strengthened. Close co-ordination with the Department of Welfare must be developed in response to Aids. The impact of Aids on the Health department will be similar to that on all Government departments. [Time expired.] [Applause.]
Ms S N NTLABATI: Chairperson, we have an MEC for health who wholeheartedly supports this budget. If we are talking about health, we are talking about a priority which overrides all other priorities. It is priority in that, if you are unhealthy, no other priority can continue. [Laughter.]
The Free State province’s access to health care was increased for many thousands of people during the programme on building and upgrading of clinics and through the implementation of free health care at primary level. Reproductive health was improved through the progressive implementation of a free choice with regard to the termination of pregnancy. I am going to speak as a Christian and as a practising Methodist. If one supports the right to choose, one is supporting the right to life, because one is saving a mother from dying from a backstreet abortion. [Interjections.]
Infrastructure and a policy framework for health care are essential. With regard to ambulances, we are on the right track regarding the number of ambulances we have bought. I admit that a lot still needs to be done to improve the quality of health care which we provide to our communities, but I think that we are on the right track. I will mention a few things that we need to do in order to achieve this. The first is the appointment of appropriately skilled personnel. The province is committed to this. The province has trained primary health care workers. Personnel remains the dominant standard item in the health budget of the province. In the Free State an amount of R1 186 000, which is 66% of the total budget, is allocated to this. We are happy to say that we have highly trained health personnel, because we also have the advantage of having a faculty of health sciences. We are filling the critical posts that are vacant and prioritising those, within the available budget, of course.
The implementation of community service for dentists, which will come into effect in July 2000, is going to be in place and we commend the dentists, because they came to us first, even before the health department went to them to get them on the bandwagon.
Another area which we think people have to take note of, is that when we speak of community service, there are reactionary people who always say it is similar to conscription. This is an international practice everywhere. After one has finished, one has to return that money for at least one year, and not many years.
With regard to committed and caring personnel, we are giving incentives to reward committed personnel. The Patients’ Rights Charter is being popularised throughout the province, and it will go a long way towards improving the attitude of health care providers. The Free State Health Act of 1999 sets out the rights and obligations of both health care providers and users.
On the topic of HIV/Aids, the province has a provincial Aids council in place, which is going to take us somewhere. Although the department is a major role-player, there is an interministerial committee which is led by the premier’s office, to establish and ensure that the province responds in an intersectoral manner. We have established partnerships and they exist with, for example, churches, hospices as they look after terminally ill people, and the private sector is also joining in. Some churches are even raising millions to support this cause.
Properly maintained equipment and physical facilities are also our priority. In relation to the rehabilitation and refurbishment of hospitals, I must tell this House that all new and upgraded clinics are disability friendly. Hon members can go and see even now. Probably because of my height, I always place myself in this sector, ie the disability sector. [Laughter.]
The provision of essential medicines and medical consumables is on course, but we do admit that at times we run short. The problem we are still having is of people not getting out of the old habit of overservicing, eg giving antibiotics just for a common cold or a common flu. Efficient management of the limited health resources is our key objective and we teach everybody this lesson in the province, from the cleaner to the most senior person. The province boasts, as the Minister has said, of decentralised training.
Our faculty of health sciences carries the responsibility of boosting the Kimberly Hospital. Again, the Minister mentioned telemedicine. Our province is committed to that, and the House has to note how useful it is. A young doctor in Springfontein in the south of the Free State will have the ability to take an X-ray, if she cannot explain the problem, and then just communicate via telemedicine to the specialists in the Bloemfontein Universitas Hospital. She will then get the diagnosis, and be advised as to what too. Is that not good? [Interjections.]
I thank the Minister for the transfer of medico-legal services to the Health department. How nice it would be if our dead people were in the hands of caring people - trained health personnel. I request the Minister to ensure that the next thing is forensic training at basic level for nurses, especially those who are redundant, in order not to retrench them. I think, for the first time I have covered my time. I need to be commended: You did not tell me to sit down, as usual. I am still standing here. [Applause.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Order! Thank you, hon Ntlabati. You actually had 1½ minutes left. I must tell you that I see nothing wrong with your height, personally. Really, I do not know why you are ashamed of your height. [Laughter.]
Ms B N DLULANE: Chairperson, hon Minister, hon MECs, my colleagues, firstly I want to respond to Mrs Versveld. [Laughter.]
Umphathiswa osandula kuphuma kule Ndlu, uMphathiswa uMufamadi, usixelele ukuba xa amalungu abekekileyo e-DP efuna ukubhoxa nokumosha aye athethe ulwimi lwakowawo. Nam ke ndiza kuthetha olwasekhaya, kodwa andibhoxi. [Kwahlekwa.]
Asiyonyani into ethethwa nguNkosikazi Versveld yokuba oogqirha bakarhulumente bezithili eMpuma Koloni abahlawulwa. Andiyazi ukuba uyifumana phi loo ngxelo. Bekufanele ukuba asixelele ngaba gqirha bezithili benza ubumenemene eMpuma Koloni ngenjongo yenzuzo. Nantso into ebesiyilindele kuye. [Uwele-wele.] (Translation of Xhosa paragraphs follows.)
[The hon the Minister who has just left the House, the hon Minister Mufamadi, has told us that when the hon members from the DP intend to spoil the debate they speak their mother tongue. I, too, have decided that I shall speak my mother tongue, although I have no intention of spoiling this debate. [Laughter.]
It is not true that district surgeons in the Eastern Cape are not paid, as the hon Mrs Versveld alleges. I do not know where she got that information. She should give us information about those district surgeons in the Eastern Cape who commit fraudulent acts to enrich themselves. That is what we would have expected her to do. [Interjections.]]
All of us sitting in this House from the nine provinces have a mandate to ensure that we not only accelerate the delivery of health services to all, but also ensure that the service is qualitative and sustainable. There are, however, a few concerns about the conditions under which we in the Eastern Cape have to deliver health services, and our strategic approach to that delivery, which I need to bring to the attention of the House. For the purpose of this debate, I am just going to touch on a few concerns.
Iphondo laseMpuma Koloni lijongene noxanduva olukhulu, kuba iingingqi ezininzi ngamaphandle. Oko kwenza ukuba banqongophale oogqirha kwezo ngingqi.
Phantsi kwezi meko, sizamile ukuba sizifumanele oogqirha nabongikazi abazimiseleyo emsebenzini wabo wokuphucula impilo yabantu. Ingumbandela onzima kakhulu indima yoogqirha emaphandleni, kuba ugqirha emnye ujongana namawaka alishumi ezigulana.
Elinye icebo esinalo kwezempilo nelibandakanya uzwelonke, kukuba, okokuqala, sizame ukuphucula imivuzo ukwenzela ukutsala abongikazi abasafundayo sibatsalela kula maziko asandula ukuvula kwimimandla eyayisakuba kwiphandle laPhesheya kweNciba.
Okwesibini, ndifuna ukuthetha ngombandela wokufumaneka kwamayeza ezempilo. IMpuma Koloni inenyhweba yokufumana amayeza ezibhedlele nasezikliniki. KwiPrimary Health Care ngamayeza aziipesenti ezingama-89,4 afumanekayo, kanti ezibhedlele kufumaneka amayeza angama-85 eepesenti. Oku kufumaneka kwamayeza kuyimpumelelo, akusiniki zingxaki. Ingxaki ekhoyo kukungathunyelwa kwawo ngexesha afuneka ngalo. Enye ingxaki esinayo inxulumene nenkqubo yeethenda.
Ukubiwa kwamayeza kuyingxaki esaqhubekayo. Kanti kwizihlandlo ezimbalwa sikhe sahletyelwa ngalo mkhuba. Oku kwenza ukuba abo bahanahanisi bathi benze oku, basuba amayeza, bazibhaqe sele beqamele ngenqindi entolongweni. Siceba ukuphungula inani Labaphathi athi afikele kubo amayeza kunye nabakhuphi bamayeza kulo nyaka umiyo.
Okwesithathu, ndifuna ukuthetha ngezixhobo zokusebenza kwezempilo. Ngenxa yesabelo semali esincinane, zibe mbalwa kakhulu izixhobo zokunyanga ezithe zathengwa kule minyaka mithathu idluleyo. Le ngxaki ichaphazela kakhulu izixhobo zokunyanga esele zikho, ngakumbi kwezi ngingqi sele ndizichazile. Le meko ibangela ukuba ezi zixhobo zimana ukungasebenzi, ngakumbi ngamaxesha abalulekileyo, ze unyango olukhawulezileyo lungabi nakwenzeka.
Sizame ukufumana ezinye izixhobo ezibalulekileyo sisebenzisa amacebo azimeleyo esabelo sezigidi ezi-4,2 zeerandi kunyaka ka-1999 ukuya kowama-
- (Translation of Xhosa paragraphs follows.)
[The province of the Eastern Cape is faced with an enormous responsibility, because many of its districts are rural. This results in a shortage of district surgeons for these districts.
Notwithstanding this situation, we have tried to get doctors and nurses who are committed to their responsibility to improve the health conditions of the people. The issue of doctors in the rural areas is a very serious problem, because one doctor has to service 10 000 patients.
Another strategy we are using in the health sector nationally is, firstly, to try to improve salaries with a view to attracting trainee nurses to the centres that are being opened in the rural areas of the former Transkei.
Secondly, I would like to talk about the availability of medicines. The province of the Eastern Cape is fortunate in that medicines are available at the hospitals and at the clinics. At primary health care level up to 89,4% of the medicines needed are available, while 85% of the medicines needed for hospitals are available. The availability of medicines is not a problem for us. What is a problem is that medicines are not delivered timeously. The other problem we are facing has to do with tenders.
The stealing of medicines is a problem that is still pervading the health sector. However, on a few occasions we have received tip-offs in this regard. This has resulted in the apprehending of the culprits. This year we are planning to reduce the number of people who handle medicines.
Thirdly, I would like to talk about equipment used in the health sector. Because of budgetary constraints very little medical equipment was bought in the last three years. This situation affected mostly the areas I have already mentioned. It also resulted in the constant breakdown of available equipment at crucial moments, thereby making it impossible for emergency cases to be dealt with. We tried to get some of the equipment from the 1999/2000 budget of R4,2 million.]
Fourthly, on the question of the management of hospitals and clinics, through the equity project, the department has embarked on a two-year initiative, beginning with regions D and E, to improve the quality of care delivered by hospitals. The Council for Health Service Accreditation of Southern Africa, the Centre for Health and Social Support and the initiative for sub-district support will provide all the support we need. We also have a tender for a cost containment and management system for our 16 regions and referral hospitals that is currently being prepared.
Lastly, on the issue of the impact of HIV/Aids on our health system, we currently have a problem accurately quantifying the impact of HIV/Aids on the health care system in our province. We have some systems in place to measure some occurrence of the disease, but we lose out on a significant number of patients that are catered for in the private sector. Even within the public sector, there is no system of reporting the impact of opportunistic infections on hospitalisation, drug costs, monitoring costs, etc. Because of the paucity of data, we have had to conduct surveys such as those done by the epidermological unit, which ranked the most common causes of admissions in the medical and the paediatrics wards.
This study showed that HIV/Aids-associated illnesses are ranked fifth. Of all admitted medical patients whose blood was sent to the laboratory for diagnostic testing, the HIV/Aids test results were positive for 66,4%. About 44% of all paediatric patients and 32% of all surgical admissions tested positive. The testing was not uniform across the province, with a higher testing rate on the western side and a much lower rate on the northern side.
Based on these surveys, it was estimated that my province showed an 18% prevalence of HIV/Aids. The population of the Eastern Cape is estimated at 6,5 million, and 18% translates into approximately 1,2 million people. If one assumes that only 5% of the HIV-positive population have active Aids, then 60- 000 people should be medically catered for in this province. If one further assumes that 80% of these patients will go to the public sector hospitals, this would equal 48 000 people, and the cost would be R224 million per annum. Even if I stopped the calculation at this point, already the cost to my province is frightening. I am sure that the scenario in other provinces is similar. We cannot afford to be complacent.
The Eastern Cape will endeavour to do whatever task is required to ensure that quality delivery is made to all its people. [Time expired.] [Applause.]
Mrs E N LUBIDLA: Chairperson, hon Minister, hon members and hon MECs, the ANC has always used the Constitution as a basis from which it formulates its laws and policies. Its health policies are no different, and it is particularly section 27 which provides the Minister of Health with guidelines. Section 27(1)(a) says that everyone has the right to have access to health care services, including reproductive health care, section 27(2) says that the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights, and section 27(3) says that no one may be refused emergency medical treatment.
After listening to the Minister and some of the nine provinces reporting on where they are, what they have accomplished and what they still hope to achieve, I cannot help but congratulate our Minister and the previous Minister, Dr Zuma. They have, despite fierce opposition, remained steadfast in the cause to make health services more accessible, even to the extent of challenging multinationals in the pharmaceutical industry.
Of course, there have been problems. Trying to rectify an unequal heath care system that catered mainly for the white minority to the exclusion of others takes time. Trying to rectify all the wrongs will continue to take time, but one needs to take one bite at a time, and this is precisely what our Minister is doing.
We know that if she does something wrong, our very liberal democracy allows us to criticise and hold her accountable so that, where necessary, she can pull up her socks. One such means of informing the Minister of shortcomings is meetings, such as the health consultative meeting held from 12 to 13 November 1999. A hand was extended by the Minister to all politicians across all political lines within all provinces, and with the active participation of local government by the presence of Salga, so that, together, we can accelerate delivery in the health sector.
This active participation by all stakeholders becomes increasingly necessary if we want to overcome the HIV/Aids scourge. It will take joint planning, monitoring and evaluation of progress until we have, as a collective, managed to halt the spreading of this disease. We need to develop common views on this disease, in as transparent a manner as possible, so that, across party lines, religious and cultural beliefs, we as South Africans can together stop Aids from killing our brothers and sisters, and our mothers and fathers.
We know that there is no cure for Aids anywhere in the world yet. We therefore need to focus our attention in two areas. Firstly, by finding a cure through investment in Aids research and, secondly, through preventing the disease from occurring in our families and communities, by teaching young people and other sexually active people that it is both morally correct and healthy to be very sure when choosing a partner.
The ANC-led Government has restored confidence in equity in health in our country. Our health legislation, such as the Medical Schemes Act, is very progressive in allowing us to include extended family in our care to be covered by medical aid. We have launched charters such as health and patient charters to empower all our citizens on what to expect and demand from health services. If we were to take a step back, we would see clearly that all the progressive health legislation that we have passed was geared towards making our lives more healthy and reducing especially infant mortality and maternal deaths. This reduction in mortalities is especially clear to those who have experienced first-hand how the integration of a fragmented health system has improved their accessibility to primary health care.
In conclusion, we in the ANC want to support the Minister in all of her endeavours, both in our country and in the international arena. We believe that the route she is taking will ensure that we overcome the backlogs of the apartheid government and create a healthy environment for all. [Applause.]
UNGQONGQOSHE WEZEMPILO: Sihlalo, oNgqongqoshe abalapha phakathi kwethu namalungu ahloniphekile, ngiyabonga kakhulu futhi kungijabulisile ukuthi ngize lapha ukuzoxoxisana nani futhi ngibe yingxenye yenu yenguyazi eNdlini yeziNgwevu exhumanisa izifunda zonke zase Ningizimu Afrika. Ngibonga kakhulu ngenqubo esibe nayo ntambama nje. (Translation of Zulu paragraph follows.)
[The MINISTER OF HEALTH: Chairperson, Ministers and hon members, I would like to thank you for this opportunity. I am pleased that I am here to discuss things with you and that I am here as a member of the council that represents all provinces of South Africa. I am very thankful for the progress that we have achieved this afternoon.]
Our debate has spanned a number of themes. I am satisfied that we all have a common vision and understanding of how to consolidate access to health care with, of course, a focus and stress on good quality care.
Let me say upfront that it is only the DP and ACDP that have not grasped this. They have failed to do so. When Mr Durr stood up to speak, I knew exactly what singsong he was going to perform. [Interjections.] He obviously had not even listened to my input. Perhaps he wrote his statement before coming to this House and therefore found it very difficult to adjust it even after having listened to what I had to say. I will advise him to please go and read my speech, and if he so desires, he can pose a question, and I will come and answer the question here.
Of course, a number of concerns have been raised, and I shall deal with them very briefly, especially in view of the fact that I have only 10 minutes. There were concerns about the theft of medicines, and I concede that we do have problems in this regard. However, we are constantly trying to address these. We now have in place a joint working team with the SAPS. Yesterday, my director-general, Dr Ntsaluba, had a meeting with Commissioner Selebi on this matter.
I think we are satisfied that we are beginning to make progress. But hon members should allow us to not divulge today some of the findings. They are shocking indeed. In due course, we shall present to members a detailed intervention informed by the findings of the ongoing investigations.
There was also a concern about filling the vacant top management posts in the Department of Health. I think provinces have answered for themselves, but let me hasten to say that in the Department of Health we have indeed filled the deputy directors-general posts, and I am glad to say that two women were appointed - Dr Kamy Chetty and Nthari Matsau. In this regard, I want to thank Dr Pretorius for his committed work in the Department of Health. Dr Pretorius’s service spans over a period of 17 years. He leaves us at the end of the month, but we will obviously continue to tap into his experience and expertise. We shall miss Dr Pretorius in the department. [Applause.]
Another issue that was raised was about local government subsidies. To my knowledge, up until now there has been no policy or guidelines for the allocation of local government subsidies. However, we have now taken a deliberate decision as the department to strengthen local government so that it can deliver comprehensive primary health care. As members know, the Local Government Municipal Systems Bill allows provinces and local government to enter into service agreements in order to ensure sustainable subsidies to local government and accountability on the part of local government.
There was also a question raised around the performance management agreements. Let me say that this process has proved to be quite a complex one because, in order to make the agreements effective, considerable consultation was necessary, both with the Department of Public Service and Administration - DPSA - and the Department of Finance. However, we have had several constructive meetings, and these have enabled us to take the process forward. Blueprints are currently being drawn up to reflect the context of these discussions, and we hope to have them finalised in the next three months or so. Meanwhile, pilot decentralisation programmes are continuing, and we are carefully evaluating them. We remain firmly committed to the principle of decentralisation, and it enjoys high priority in the department. We aim to bring it to fruition as a matter of urgency.
There was also a question raised about the availability of drugs. This is closely linked to the question I referred to before, that is, the theft of drugs. We are also dealing with the shortcomings in the distribution process. Private partnerships are proving worthwhile, and I mentioned this in my input. For example, in the Northern Province, Mpumalanga, the North West and the Northern Cape the partnerships have resulted in significant improvements in the availability of drugs in our facilities. In fact, last year when we did a survey it was clear to us that 86% of our facilities have drugs on the essential list at any given time. However, we are looking forward to increasing this figure to 100% very soon.
Another reason for shortages is obviously funding. As all of us know, a large growing part of our budget pays for personnel expenditure. In the 1999-2000 budget, this accounted for 65%. We do need to contain the personnel cost while simultaneously spending more efficiently with the limited resources that we have. I believe if we correct some of these shortcomings, we could go a long way. I am terribly sorry about the coughing, this is a sick doctor. [Laughter.] Needless to say, there are instances in which we might need additional resources.
The other issue that was raised relates to how we can ensure that pharmacists and pharmaceuticals are always in place. I think I have referred to this already. With regard to pharmaceuticals, yes, I concur with the hon member who referred to this issue. In another two weeks’ time, the DG - and the provincial HODs will be deliberating on the results of an investigation into this matter, which has been done together with the Department of Public Service and Administration. We hope that in the near future we will be able to inform the House on the conclusions of those deliberations. However, we shall, ourselves, consider the matter in our Minmec when we are given the report by the officials. There was also a matter referred to with regard to the shortage of BCG. I would have failed in my responsibility if I did not address this matter because it is indeed a matter of concern. As members all know, the State Vaccine Institute in Cape Town supplies the state with percutaneous BCG. There were reported batch failures as early as May last year. This problem reoccurred a few weeks ago. When this occurs, though rarely, it creates problems with securing alternative supplies as South Africa was one of only two countries using the percutaneous vaccine. Fortunately, and acting on the advice of experts in the WHO, we then took a decision early this year to convert to intradermal BCG, beginning in July this year.
The first batches of intradermal BCG arrived for quality testing at our national control laboratory in Bloemfontein during May. This switchover will also make it relatively easier for us to secure alternative supplies where there are problems. However, I wish to stress that this shortage has not caused an undue increase in the risks to the newly born. All children born in high-risk environments are being put on effective TB prophylactics. So I say to Mrs Vilakazi to please be comforted. When the vaccines become available in the next month those children will be revaccinated. Let me also indicate that the pilot projects we have run in KwaZulu-Natal and Mpumalanga with the new intradermal vaccine have been successful. Therefore, we expect the further rolling out of this programme to be smooth indeed.
Let me refer to a subject which I am surprised members did not raise. This refers to the innovations in medicines regulation. As members know, in the past few months a lot of attention has been paid to the development of registration of new medicines in our country. Medicines regulation is a central pillar of a successful health system, both in terms of the safety and appropriateness of the medicines being used, and in terms of rational prescribing.
The clinical trials industry in this country has expanded significantly in the past six years and is now estimated to be worth as much as five hundred …
Iningi le mali, angikwazi ngisho nokuyibiza … [Uhleko] … kodwa amalunga ahloniphekile azoyifunda la ephepheni. [This is a lot of money. I cannot even say how much it is … [Laughter] … however, I am sure that hon members will read about the figure in the newspaper.] Many medical schools are using the process of clinical trials to support other research work. While innovations and investments are to be welcomed, it must be understood that clinical trials cannot be regarded as just an investment possibility.
The justification for undertaking clinical trials in the South African context has to be based on the need for new medicines which could prevent, treat or cure some of the serious common illnesses that continue to cause significant morbidity and mortality amongst our people. However, the system previously used to approve clinical trials has revealed serious shortcomings in the manner in which approval was granted. In some instances, inadequate attention was paid to the scientific design of the trial, the ethical standards of the trial, as well as the experience of the clinicians undertaking the trial. To address this concern, a clinical trials committee has been established as a central function of the Medicines Control Council.
Many of the clinical trial applications submitted do not meet the criteria that we would have wanted them to meet when we set up the criteria and, therefore, approval is refused until the required standards are met. I am also establishing a national ethics committee which will both set and maintain the standards of the local ethics committees and give advice on the conduct of critical national research initiatives, such as the Aids vaccine trials.
A second new focus of activity of the MCC is that of monitoring the safety of drugs that are registered and in use. This is called pharmacovigilance. The scale of serious adverse drug events in South Africa is not adequately known, partly because patients and practitioners are not reporting episodes and partly because some companies would appear to be reporting much less information locally than they do internationally. Therefore, in the South African context, we are also concerned that some of the newer drugs being introduced have been tested, to date, on Western populations, and this, in fact, refers mainly to the treatment for HIV through antiretroviral drugs, and unexpected side effects may therefore occur in local populations once they are widely used in communities.
Part of the responsibility of the MCC committee on pharmacovigilance, which I am proposing, will be to educate the public, practitioners and the industry on the importance of accurate reporting of drug side effects and reporting on the misuse of registered drugs.
The final area of medicine regulation that I am going to highlight is that of complementary medicine, and African traditional medicines, which are extensively used in our country. They, too, need to be regulated in a manner that recognises the different traditions of diagnosis and healing.
To this end, an African traditional medicines committee and a complementary medicines committee have been established as official committees of the Medicines Control Council. [Applause.]
Debate concluded.
The Council adjourned at 19:21. ____
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
FRIDAY, 9 JUNE 2000 TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Speaker and the Chairperson:
Report on Parliament for 1999.
MONDAY, 12 JUNE 2000
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- The Speaker and the Chairperson:
The following papers have been tabled and are now referred to the
relevant committees as mentioned below:
(1) The following paper is referred to the Portfolio Committee on
Provincial and Local Government and to the Select Committee on
Local Government and Administration:
Reasons for declaring a state of disaster in the Province of
KwaZulu-Natal in terms of section 2(1) of the Civil Protection
Act, 1977 (Act No 67 of 1977).
(2) The following papers are referred to the Portfolio Committee on
Public Works and to the Select Committee on Public Services:
(a) Report of the Department of Public Works for 1999-2000 [RP
100-2000].
(b) Memorandum by the Minister of Public Works setting out
particulars of the Building Programme for 2000-2001 in respect
of Programme 2: Provision of Land and Accommodation of Vote 26
of the State Account [RP 93-2000].
(3) The following papers are referred to the Portfolio Committee on
Justice and Constitutional Development and to the Select Committee
on Security and Constitutional Affairs:
Reports of the South African Law Commission on the -
(a) Constitutional Jurisdiction of Magistrates' Courts,
Project 111 [RP 80-2000];
(b) Conflicts of Law, Project 90 [RP 81-2000];
(c) Sharing of Pension Benefits, Project 112 [RP 82-2000];
(d) Review of the Law of Insolvency, Project 63 (Volume 1) [RP
89-2000];
(e) Review of the Law of Insolvency, Project 63 (Volume 2) [RP
88-2000].
(4) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance:
Recommendations of the Financial and Fiscal Commission on 2001-
2004 Medium-Term Expenditure Framework Cycle, submitted in terms
of section 9(1) of the Intergovernmental Fiscal Relations Act,
1997 (Act No 97 of 1997).
(5) The following paper is referred to the Standing Committee on
Public Accounts for consideration and report. It is also referred
to the Portfolio Committee on Finance and to the Select Committee
on Finance for information:
Report of the Auditor-General on Performance Audits completed at
the South African Revenue Service during 1999 [RP 96-2000].
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Education:
(1) Government Notice No 207 published in the Government Gazette No
20945 dated 1 March 2000, National Policy for designing school
calenders for ordinary public schools in South Africa, made in
terms of the National Education Policy Act, 1996 (Act No 27 of
1996).
(2) Government Notice No 208 published in the Government Gazette No
20945 dated 1 March 2000, School calender for public schools for
the year 2001, made in terms of the National Education Policy Act,
1996 (Act No 27 of 1996).
(3) Government Notice No 252 published in the Government Gazette No
20994 dated 24 March 2000, Appointment of a replacement to serve
as a member of the South African Qualifications Authority, made in
terms of the South African Qualifications Authority Act, 1995 (Act
No 58 of 1995).
(4) Government Notice No 400 published in the Government Gazette No
21093 dated 20 April 2000, Revision of the policy document: Norms
and standards for instructional programmes and examination and
certification thereof in technical colleges, Report 190 (92/04),
made in terms of the National Education Policy Act, 1996 (Act No
27 of 1996).
(5) Government Notice No 401 published in the Government Gazette No
21093 dated 20 April 2000, Provisos for the Senior Certificate
programme, made in terms of the National Education Policy Act,
1996 (Act No 27 of 1996).
(6) Government Notice No 402 published in the Government Gazette No
21093 dated 20 April 2000, The deletion of the category providing
for foreign candidates as contained in the policy document, a
Résumé of instructional programmes in public schools, Report 550
(97/06), made in terms of the National Education Policy Act, 1996
(Act No 27 of 1996).
(7) Government Notice No 449 published in the Government Gazette No
21143 dated 4 May 2000, Appointment of persons to serve as members
of the Review Committee to review the National Outcomes-based
Curriculum and Progress with its implementation, made in terms of
the National Education Policy Act, 1996 (Act No 27 of 1996).
(8) Government Notice No 404 published in the Government Gazette No
21093 dated 20 April 2000, The inclusion of a continuous
assessment component in the final Senior Certificate examination
at Grade 12, made in terms of the National Education Policy Act,
1996 (Act No 27 of 1996).
(9) Government Notice No 448 published in the Government Gazette No
21143 dated 4 May 2000, Call for comments on the draft document -
National Curriculum Framework for further Education and Training,
made in terms of the National Education Policy Act, 1996 (Act No
27 of 1996).
(10) Government Notice No 403 published in the Government Gazette No
21093 dated 20 April 2000, Approval of an extension of the Gauteng
Youth College Programme, made in terms of the National Education
Policy Act, 1996 (Act No 27 of 1996).
- The Minister of Finance:
Report of the Executive Officer of the Financial Services Board on the
Road Accident Fund for 1998-99.
- The Minister in The Presidency:
Report of the Government Communication and Information System for 1999
[RP 58-2000].
TUESDAY, 13 JUNE 2000
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- The Speaker and the Chairperson:
The following papers have been tabled and are now referred to the
relevant committees as mentioned below:
(1) The following papers are referred to the Portfolio Committee on
Trade and Industry and to the Select Committee on Economic
Affairs:
(a) Report and Financial Statements of the Investment South
Africa for 1998-99.
(b) Report and Financial Statements of the National Gambling
Board for 1998-99, including the Report of the Auditor-General
on the Financial Statements for 1998-99.
(2) The Report of the Auditor-General on the Financial Statements of
the National Gambling Board for 1998-99 contained in the Report of
the National Gambling Board for 1998-99 is referred to the
Standing Committee on Public Accounts for consideration and
report:
Report and Financial Statements of the National Gambling Board for
1998-99, including the Report of the Auditor-General on the
Financial Statements for 1998-99.
(3) The following papers are referred to the Portfolio Committee on
Health and the Select Committee on Social Services:
(a) Government Notice Number 341 published in the Government
Gazette Number 21042 dated 7 April 2000, Correction notice
regarding Government Notice No 149 of 11 February 2000 made in
terms of Pharmacy Amendment Act, 2000 (Act No 1 of 2000).
(b) Government Notice Number R.397 published in the Government
Gazette Number 21100 dated 14 April 2000, Amendment of
regulations, changing deadline for comment as published in the
Government Notice R.137 of 18 February 2000, regarding the
performance of community service by persons registering in
terms of the Medical, Dental and Supplementary Health Service
Professions Act, 1974 (Act No 56 of 1974).
(c) Government Notice Number R.427 published in the Government
Gazette Number 21136 dated 5 May 2000, Amendment of
regulations governing Microbilogical Standards for mineral
water made in terms of Foodstuff, Cosmetics and Disinfectants
Act, 1972 (Act No 54 of 1972).
(d) Government Notice Number R.428 published in the Government
Gazette Number 21136 dated 5 May 2000, Amendment of
regulations governing Microbilogical Standards for edible ices
and egg products made in terms of Foodstuff, Cosmetics and
Disinfectants Act, 1972 (Act No 54 of 1972).
(e) Government Notice Number R.450 published in the Government
Gazette Number 21144 dated 5 May 2000, Regulations regarding
the performance of community service by pharmacists made in
terms of the Pharmacy Act, 1974 (Act No 53 of 1974).
(f) Government Notice Number R.498 published in the Government
Gazette Number 21178 dated 19 May 2000, Amendment of
regulations regarding the performance of community service by
persons registering in terms of the Medical, Dental and
Supplementary Health Service Professions Act, 1974 (Act No 56
of 1974).
(g) Government Notice Number R.497 published in the Government
Gazette Number 21175 dated 19 May 2000, Date of commencement
of community service by dentists made in terms of the Medical,
Dental and Supplementary Health Service Professions Act, 1974
(Act No 56 of 1974).
(h) Government Notice Number R.499 published in the Government
Gazette Number 21178 dated 19 May 2000, List of approved
health facilities for the purpose of performing community
service by dentists in the year 2000-2001 made in terms of the
Medical, Dental and Supplementary Health Service Professions
Act, 1974 (Act No 56 of 1974).
(i) Government Notice Number R.547 published in the Government
Gazette Number 21237 dated 29 May 2000, Amendment to the list
of approved health facilities for the purpose of performing
community service by dentists in the year 2000-2001 made in
terms of the Medical, Dental and Supplementary Health Service
Professions Act, 1974 (Act No 56 of 1974).
(4) The following papers are referred to the Portfolio Committee on
Finance and the Select Committee on Finance for consideration and
report:
(a) Supplementary Estimate of Expenditure to be defrayed from
the National Revenue Fund during the Financial Year ending 31
March 2001 [RP 4-2000].
(b) Explanatory Memorandum to the Supplementary Estimate for
2000-2001.
(5) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Arts, Culture, Science and Technology and to the Select Committee
on Education and Recreation for information:
Explanatory Memorandum of Vote 4 "Arts, Culture, Science and
Technology", Supplementary Estimate 2000-2001.
(6) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Education and to the Select Committee on Education and Recreation
for information:
Explanatory Memorandum of Vote 8 "Education", Supplementary
Estimate 2000-2001.
(7) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Health and to the Select Committee on Social Services for
information:
Explanatory Memorandum of Vote 13 "Health", Supplementary Estimate
2000-2001.
(8) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Labour and to the Select Committee on Labour and Public
Enterprises for information:
Explanatory Memorandum of Vote 19 "Labour", Supplementary Estimate
2000-2001.
(9) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Provincial and Local Government and to the Select Committee on
Local Government and Administration for information:
Explanatory Memorandum on Vote 22 "Provincial and Local
Government", Supplementary Estimate 2000-2001.
(10) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Water Affairs and Forestry and to the Select Committee on Land and
Environmental Affairs for information:
Explanatory Memorandum on Vote 34 "Water Affairs and Forestry",
Supplementary Estimate 2000-2001.
(11) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Welfare and Population Development and to the Select Committee on
Social Services Affairs for information:
Explanatory Memorandum on Vote 35 - "Welfare", Supplementary
Estimate for 2000-2001.
(12) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Environmental Affairs and Tourism and to the Select Committee on
Land and Environmental Affairs for information:
Explanatory Memorandum on Vote 9 - "Environmental Affairs and
Tourism", Supplementary Estimate for 2000-2001.
(13) The following paper is referred to the Portfolio Committee on
Finance and to the Select Committee on Finance for consideration
and report. It is also referred to the Portfolio Committee on
Agriculture and Land Affairs and to the Select Committee on Land
and Environmental Affairs for information:
Explanatory Memorandum on Vote 3 - "Agriculture", Supplementary
Estimate for 2000-2001.
(14) The following paper is referred to the Portfolio Committee on
Housing and the Select Committee on Public Services:
Government Notice Number R.437 published in the Government Gazette
Number 21136 dated 5 May 2000, Dissolution of the Pretoria Region
Rent Board and extension of the area of jurisdiction of the
Southern and Western Region Rent Board to include the Pretoria
area, made in terms of sections 2(1) and 2(2) of the Rent Control
Act, 1976 (Act No 80 of 1976).
(15) The following paper is referred to the Portfolio Committee on
Provincial and Local Government and the Select Committee on Local
Government and Administration:
Report of the Department of Provincial and Local Government for
1999.
(16) The following paper is referred to the Portfolio Committee on
Justice and Constitutional Development and the Select Committee on
Security and Constitutional Affairs:
Report of the National Prosecuting Authority for 1998-99 [RP 99-
2000].
(17) The following papers are referred to the Portfolio Committee on
Finance and the Portfolio Committee on Transport and to the Select
Committee on Finance and the Select Committee on Public Services:
Report of the Executive Officer of the Financial Services Board on
the Road Accident Fund for 1998-99.
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister for Justice and Constitutional Development:
(1) Regulation Number R.14 published in the Government Gazette
Number 20997 dated 24 March 2000, Establishment of Investigating
Directorate: Corruption, made in terms of the National Prosecuting
Authority Act, 1998 (Act No 32 of 1998).
(2) Regulation Number R.16 published in the Government Gazette
Number 21039 dated 31 March 2000, Commencement of certain sections
of the Witness Protection Act, 1998 (Act No 112 of 1998).]