National Assembly - 13 May 2003
TUESDAY, 13 MAY 2003 __
PROCEEDINGS OF THE NATIONAL ASSEMBLY
____
The House met at 14:06.
The Speaker took the Chair and requested members to observe a moment of silence for prayers or meditation.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS - see col 000.
WELCOMING OF MEMBERS
The SPEAKER: Hon members, welcome back. I trust you have had a good rest. [Interjections.] Well, I regret to advise you that the House will not be adjourning for some weeks to come, so you are not allowed to rest in the Assembly!
SAULSPOORT DAM TRAGEDY
(Draft Resolution)
The CHIEF WHIP OF THE MAJORITY PARTY: Madam Speaker, I move without notice:
That the House -
(1) notes with sadness the tragedy that befell workers at Saulspoort Dam on their way to the 117th Workers Day celebrations in Phuthaditjhaba resulting in 51 workers losing their lives;
(2) supports and commends the effective actions of Mr Leonard Slabbert whose patriotism found practical expression as he acted bravely to save the lives of fellow South Africans; and
(3) expresses its profound sympathy and conveys its sincere condolences to the families and friends of the deceased, to Cosatu and to the people of Kimberley.
Agreed to. DEATH OF MR WALTER SISULU
(Draft Resolution)
The CHIEF WHIP OF THE MAJORITY PARTY: Madam Speaker, I move:
That the House -
(1) notes -
(a) with profound sadness that, on Monday 5 May 2003, uBaba Walter
Max Ulyate Sisulu passed away;
(b) that this patriot spent all his life in the struggle, fighting
for the South Africa that all of us are today so proud of;
(c) that he, throughout his life, has been the rock that solidified
and embodied the courage and vision that characterise the
majority of the people of our country and continent;
(d) in uBaba uSisulu, South Africa produced a leader of profound
quality, disciplined and responsible, a father to all;
(e) that his life represents all that is good and beautiful in our
beloved country and he remains our model hero, he remains our
model father and he will always be our model human being; and
(f) that, when we sing the praises of uTata uSisulu, it is not of
our own choosing, it is because his life restricts us to saying
only good things about him;
(2) says: Hamba kakuhle Tata; and
(3) expresses its heartfelt condolences to the Sisulu family and friends.
Mrs N B GXOWA: Madam Speaker, Deputy President, Ministers, leaders of the opposition parties, colleagues, I feel very honoured to have been asked by the ANC to pay tribute to Tata Sisulu. This is a tribute to a giant of the liberation struggle, one of the architects and founding fathers of South Africa’s democracy.
Tata was a teacher, a mentor and a guardian to all of us. Tata served the ANC as its first full-time secretary-general. Later, in July 1991 at the first ANC national conference in South Africa since 1959, he was elected Deputy President of the ANC. He was a patriot whose heroism, humility and leadership earned him the respect and love of millions of people, as well as the people he spent his 26 years of imprisonment with on Robben Island.
Tata Sisulu was awarded the Isithwalandwe, the highest honour bestowed by the ANC, for his contribution to the struggle for liberation. Tata Sisulu made immeasurable sacrifices towards the liberation of the people of this country. He sacrificed the comfort of his wife and children. All his family were the bread and butter of the apartheid government. Anyone who was a Sisulu was in the daily diaries of the apartheid government.
I also want to say that Tata Sisulu’s children who hold posts in Government and other structures do not occupy those posts on the strength of their parents’ popularity. They are not tokens: they actually worked and suffered just like their father and mother.
I started working with Tata Sisulu when I joined the defiance campaign in
- We were young women then, working for trade unions, and from Tata Sisulu we were able to learn and understand the policies of the ANC. As young people surrounding him, Tata Sisulu always wanted to know our backgrounds. He never just wanted to work with one, not knowing where one came from.
He met our parents and recruited some of them into the organisation. Tata Sisulu, in his leadership, always looked for talent among the youth and then developed it. He would then give one a task that he knew one would be able to perform. I am one of his products and am proud of the lifestyle that I am living today because of his contribution to my life. He developed me politically.
Before the banning of the ANC Tata Sisulu, the late O R Tambo and Madiba wanted to send me to school. The late O R Tambo wanted me to do law, but when everything was finalised I was served with banning orders restricting me to the Germiston area. I was banned from entering the premises of any educational institution or any factory under the Factories Act; or from attending any wedding or funeral by the then Minister of Justice, J B Vorster. I could give you more examples of what Tata did for everybody.
The best way for us to honour Tata is to ensure that we continue with the struggle to push back the frontiers of poverty. We must make sure that we continue the struggle for the emancipation of women. We must also make sure that all South African citizens live in peace and prosperity. We must continue the campaign aimed at ensuring that every South African has an identity document. We must do this to ensure that our people obtain IDs not only for voting, but also to access the benefits that this Government is providing for those who are in need of pensions, social and disability grants, etc.
We also note that the majority of people in this country now have water, electricity, communication systems and health facilities. These services are especially critical in addressing the plight of women and children. Our people are no longer hewers of wood and drawers of water because Tata Sisulu fought for them. He made sure that today, 10 years later, we have legislation in place to address all these issues.
I would also want to say, ``Hamba kahle, tata.’’ [Go well, father.] One thing he did was to draw up his own funeral programme. The atmosphere that we see today at Tata Sisulu’s home is that of a nonracial, nonsexist and democratic South Africa. [Applause.]
The LEADER OF THE OPPOSITION: Madam Speaker, colleagues, Deputy President, last week there were two events in our country which in one sense were completely unrelated, but if one thinks about them more closely they were very interrelated.
First is the event which we are gathered here to commemorate today, an event which drew national and international attention, the death of Walter Sisulu. An unrelated event on the face of it, 48 hours after he died, was the fact that South Africans and a whole variety of communities went to the polls to vote in a series of municipal bi-elections. There could be no greater monument to the life that we are celebrating today than to behold the free and fair elections which were held, open to all, regardless of colour, and which took place largely in conditions of peace and security.
Ten years ago we could only hope that such a thing would be possible. Fifteen years ago it was almost unthinkable. Thirty years ago, during the incarceration of Walter Sisulu, it was an absurd fantasy confined to damp prison cells on Robben Island. But Walter Sisulu never gave up on that dream. He never relented in his quest for democracy. Walter Sisulu was a man who stood among us, and yet he was beyond us. He was like the great cedar tree of Lebanon spoken of in the prophet Ezekiel’s book:
The waters nourished it, deep springs made it grow tall. It towered higher than all the trees in the field. All the birds in the air nested in its bowels. All the great nations lived in its shade.
On the day it was brought down to the grave, I covered the deep springs with mourning for it. All the trees of Eden, the choicest and the best of Lebanon, all the trees that were well-watered were consoled in the earth below.
And that perhaps is a very fitting tribute to the great cedar that has fallen, and the hero of South Africa who has also fallen.
Today we must deal, all of us, with the dawning reality that South Africa’s heroes are mortal. That one day we as a nation must walk into the future without their guidance. But to remember Walter Sisulu, all we need to do is look at the faces of the young people in this country who have grown up without knowing the terrible evil that came before. In their hope lies the enduring value of his life’s work which no doubt will endure. [Applause.]
The DEPUTY MINISTER OF SAFETY AND SECURITY: Madam Speaker, hon members, all great social movements are the work of millions of people. Millions of hands have produced the freedoms that we enjoy today.
And yet in the midst of that we have to remember and celebrate the lives of men like Walter Sisulu. There were three of them, three who made this revolution. And it really is something that we should examine that there should be three great friends, Walter Sisulu, Mandela and Tambo, who were able to produce the changes that we celebrate so much. But why were they able to do that? It was their style of work. They were able to win, first of all, the full support of the previous generation to them. Those whom we referred to in the old days as the old guard. They had the support of J B Marks, of Moses Kotane, of Prof Matthews and of Chief Luthuli. They had the support of the generation before them, and the support of the youth who followed them. In other words they straddled the generations, and it is that combined support which made the three stand out as we talk about them in one breath today.
And what was unique about one of them, Sisulu, more than the others, was his accessibility. Walter Sisulu was accessible to everybody. He was unique in that respect, and you will see that even in the tributes to him, everybody recognised the role of Sisulu. That was because he was the most accessible. He was not the most brilliant: the most brilliant was Tambo. He was not the greatest hero or the most fearless: that is Madiba, the aristocrat. But Walter Sisulu was a man of the people who was always accessible to everybody. [Applause.]
Dr B L GELDENHUYS: Madam Speaker, the late Walter Sisulu was undoubtedly a remarkable man. Believe it or not, he got a life sentence plus six years. He, therefore, became the only person that I know of who was in fact sentenced to spend his first six years in heaven in prison. Fortunately it turned out differently.
The Norwegian dramatist Ibsen said the strongest man upon earth is he who stands most alone. Circumstances forced Walter Sisulu on many occasions to stand alone in pursuance of a nonracist, democratic South Africa in which he believed implicitly. Sisulu’s legacy, in my view, could be best captured in what he said to the state prosecutor, Dr Percy Yutar, during what has become the most famous cross-examination in the history of South African courts. He said:
I wish you were in the position of an African and knew the position of this country. Mutual respect and understanding for each other’s position could have steered the cause of this country in a totally different direction.
Let us not repeat this catastrophic mistake again. And let us in remembrance of the late Walter Sisulu build our nation on the common understanding and respect for the respective positions we come from.
Namens die Nuwe NP betuig ek medelye met die ANC wat ‘n strydros verloor het, en met Mev Albertina Sisulu en haar kinders wat ‘n merkwaardige man en vader aan die dood moes afstaan. [Applous.] (Translation of Afrikaans paragraph follows.)
[On behalf of the New NP I convey my condolences to the ANC, who have lost a warhorse, and to Mrs Albertinia Sisulu and her children, who have lost a remarkable husband and father. [Applause.]]
Mr L M GREEN: Madam Speaker, I rise to salute one of the greatest South African leaders of all times, Walter Sisulu, a man all South Africans can be proud of. In life he carried himself with honour, integrity and dignity. He was a humble man and, like Mahatma Ghandi, he was a true altruist who never sought public acclaim or the status of political office. He was a teamworker and a maker of leaders. He was a sage, a man of reason in struggle and in freedom. He was a man of patience who believed in the true freedom of all South Africans.
During the dark days of apartheid his intellectual inspiration, personal warmth and determined courage shaped the vision of a South Africa for all its citizens. He had a vision for a free nation, a nondiscriminatory society led by people of character and integrity. He struggled against despots and greed.
For him the calling of the struggle was clear: resist all forms of human oppression, racism, violence and control. Such was Walter Sisulu. He epitomised the true character of liberation and of a leader.
He was a committed family man, one who loved his wife Albertina throughout. His children, whether his own or adopted, have all received equal love from Tata Sisulu. It is, therefore, also fitting that as a family man he should die in the arms of his beloved wife.
I wish to agree with the former president Nelson Mandela that Walter Sisulu, a servant of his country, stands out as a towering figure in the history of this land. The ACDP prays for the peace and presence of God to console the Sisulu family in their time of grief for a father who loved so much and asked for so little. [Applause.]
Ms N C NKABINDE: Madam Speaker and hon members, the UDM extends its sincerest condolences to the family and friends of Mr Walter Sisulu. We know that no words can lessen their loss.
The history of the human race has demonstrated that perhaps once in a generation, maybe less, a single person may rise above his peers in terms of scope of vision and willingness to realise that vision. Such a person may grasp the reins of historic opportunities and shape them for greater good or greater evil. It is our good fortune that this country was blessed to have such a person in Walter Sisulu, a person who strove selflessly to steer this country in the direction of freedom, democracy and equality. What sets Walter Sisulu apart, that which underlies his exceptional character even among the great men and women in history, is that he never claimed a position of influence as compensation for his efforts.
If we are to properly honour his memory, we can start at no better place than this Parliament. Walter Sisulu’s life provides us with incontrovertible proof that there can and should be honour in politics. We can pay no greater tribute to Walter Sisulu than by demonstrating in our daily conduct as parliamentarians that our word is our bond reason should prevail over hysteria and honesty, dedication and loyalty are the bedrock of leadership. In that fashion we can construct a little monument to a great man. [Applause.]
Dr P W A MULDER: Madam Speaker, Mr Deputy President, I like to believe that politics is about the future and how you as a politician would like to change or shape reality to fit your dreams and your ideals for the country in the future.
Very few politicians or individuals in history have had the privilege to see their dreams and ideals come true within their own lifetime. Walter Sisulu had a full life and had the privilege to see his dreams and ideals come true in his lifetime. For how many of us will this be true?
History will judge the role that he played in South Africa. Was he a big or a small tree in the forest that symbolises our history. An old proverb known to woodsmen working in the forest says that a tree is best measured when it is down. The reaction here today and in the media the last few days confirms that.
On behalf of myself and the FF I would like to use this public occasion to convey our condolences and sympathy to Mrs Sisulu and the Sisulu family. The FF wrote a letter to Mrs Sisulu to privately express our sympathy and condolences to the family. In the end, after all is said and done, they lost a husband and a father.
South African politics have wrecked many marriages and families. The way Mr Sisulu succeeded in keeping his family together and the way he was throughout his career - a family man - impressed me. Mr Sisulu lived in turbulent times. May he now have peace. [Applause.]
Mr P K H DITSHETELO: Speaker, the UCDP wishes to express its sincere condolences to the family and friends of the late Mr Walter Sisulu. Our hearts and minds are with them at this moment of bereavement.
Mr Sisulu’s name is synonymous with the South African liberation struggle. A history that truly reflects the liberation struggle in this country cannot be written without mentioning the role Tata Sisulu played. What a gentleman he was despite his enormous contribution to the struggle for freedom. At no time did he expect to be rewarded for the role he played in bringing about a nonracial and democratic society.
Having spent more than 25 years in prison on Robben Island, until his release in 1989, Mr Sisulu was never bitter. He never viewed his incarceration as wasted years behind bars as he continued to fight for what he believed was right for this country even after his release. His incarceration together with that of Nelson Mandela and other leaders, helped to bring to the attention of the whole world that apartheid was not only a crime against humanity but an evil system that needed to be abolished.
While some of his comrades today are enjoying our freedom with high paying political jobs and distinguished positions in the Government and private sector, for him the struggle was not about his career or for personal enrichment, as he never occupied any public office or aspired to do so expressly or by implication. It is through his life that we can learn more about personal sacrifice and dedication to one’s country. The way he conducted himself during his days as a freedom fighter, father and husband can shame so many politicians today.
For us to honour this great man and son of Africa we are therefore challenged to continue where he left off. There is no doubt that his will be a difficult act to follow, but his commitment to the upliftment of the people continues to be a source of inspiration for most of us.
Robala ka kagiso, Rre Sisulu. O dirile. [Rest in peace, Mr Sisulu. You have done your share.]
Mnr J P I BLANCHÉ: Speaker, namens die FA wil ek my meegevoel betuig met mev Sisulu en haar familie en die ANC, die party wat hy help bou het.
Wanneer ons as ‘n Parlement hulde bring aan ‘n afgestorwe staatsman dan dwing dit ons om aan ons Skepper te sê: Dankie vir hierdie oomblik wat Hy in ons lewe op afdwing om erkenning te gee aan Hom wat ons geboorte gegee het en ook toelaat om ‘n lewe te leef en bydraes te maak en dan af te sterwe. Dan kry ons die geleentheid om na te dink oor die rol wat elkeen van ons speel in ander se lewe en in dié se lewens wat na ons kom.
Ons is dankbaar dat Hy toegelaat het dat Walter Sisulu se drome vervul word en dat Hy hom gehelp het om ‘n beter Suid-Afrika te skep. Ons is saam met die ANC dankbaar en saam met die ander partye van die Parlement dankbaar vir die kanse wat aan Walter Sisulu gegee was om te help bou aan die nuwe Suid-Afrika. Ons opregte meegevoel gaan uit na sy vrou en sy kinders en almal wat naby hom geleef het.
Dit was ook my voorreg om as LUR vir Welsyn die eerste sooi te spit vir die Walter Sisulu-tehuis vir beskerming van kinders in Soweto en daarom het hy ook ‘n rol in my lewe gespeel en ek sê vir sy familie en vir almal wat hartseer voel op hierdie dag ons innige meegevoel met almal van u. [Applous.] (Translation of Afrikaans speech follows.)
[Mr J P I BLANCHÉ: Speaker, on behalf of the FA I wish to express my condolences to Mrs Sisulu and her family and the ANC, the party which he helped to build.
When we as Parliament pay tribute to a deceased statesman, this forces us to say to our Creator: We are grateful for this moment in our lives when He obliges us to give recognition to He who gave us birth, who allows us to live a life and make a contribution, and who then allows us to die. We are then afforded the opportunity to reflect on the role that each one of us plays in the lives of others and in the lives of those who come after us.
We are grateful that He allowed Walter Sisulu’s dreams to be fulfilled and that He helped him to create a better South Africa. We join the ANC and the other parties of Parliament in gratitude for the opportunities that were given to Walter Sisulu to help build the new South Africa. Our sincere condolences go to his wife and children and everyone who lived close to him.
It was also my privilege, as MEC for Welfare, to dig the first sod for the Walter Sisulu home for the protection of children in Soweto, which is why he also played a role in my life, and I express my sincere condolences to his family and everyone who is experiencing grief on this day. [Applause.]]
Dr M S MOGOBA: Madam Speaker, the PAC joins the nation in paying tribute to one of the giants of the liberation struggle who has given his entire life to this cause and who has served a prison sentence of more than a quarter of a century in one of our notorious prisons, Robben Island.
As one of those who tasted the bitterness of the Robben Island cup, I would like to salute him on behalf of the sufferers in that prison and on behalf of the whole nation. His name ranks with those of former president Nelson Mandela, Robert Sobukwe, Steve Biko, Oliver Tambo, to mention but a few.
Many tributes have been expressed in all the media for a whole week. That aside, I would like to single out three attributes of this great African father. First of all, his humility is an attribute we should all strive to emulate, because humility builds a nation. Secondly, his family life. Politics like a storm at sea hits hard at family life.
In Sisulu we have a model of a father and a family man. Albertina and Walter Sisulu are a delightful couple. A real example to political leaders and to all leaders of our nation. Thirdly, his general warmth and happy disposition.
Up to the end of his life he had a light shining on his face. This shining light on the face of one who had gone through great tribulation is one of the things that makes our country stand out amongst the nations of the world. This light and the positive message of co-existence, reconciliation and peace are what make the world look to us as a nation for help.
We salute a great leader and thank God for his life and for giving us such a wonderful gift in Walter Sisulu.
Robala ka khutso. [Rest in peace.]
Mr P J NEFOLOVHDWE: Madam Speaker, I stand here feeling privileged that I had the opportunity of being confined with Comrade Sisulu on Robben Island.
On behalf of Azapo we wish to convey our heartfelt condolences to Comrade Sisulu’s family and his relatives. To the ANC and the people of South Africa we say: Comrade Sisulu lived the life of a dedicated soldier who will be missed not only by his immediate family members, but by all who fought side by side with him to liberate our land and its people.
Azapo salutes this visionary, one of our own. A man who understood the revolutionary concept of happiness founded on the unity that governs the relationship between an individual and his people as well as the people of the entire world. He understood that serving his people does not necessarily mean being in Parliament or the status of a political office.
We in Azapo know him as a son of the soil who understood and practised a revolutionary consciousness that states that man is an integral part of a social objective of the people who engendered him and for whose existence and progress he must deploy all his efforts and his creative genius. Comrade Sisulu did all this.
South Africa has indeed lost a man whose capacities would be difficult to replace. Azapo joins all freedom-loving people in saying: Hamba kahle, Tata Sisulu. [Applause.]
Ms T E MILLIN: Madam Speaker, colleagues, Deputy President, may I, on behalf of the IAM, extend my sincere and heartfelt sympathies first to the family of the late Mr Walter Sisulu, in particular his grieving widow, as well as to his comrades in the ANC, particularly those with whom there are so many shared memories and experiences, and to the broad populace of our nation at the passing of a leader who played such a significant role in bringing all of us into the new South Africa, of which we are part.
This is a time for mourning, when all the country’s people put aside political considerations, because grief and the loss of a loved one transcend all political, racial and cultural divides. By all accounts Mr Sisulu, who could have savoured all the material benefits and accolades of high office, commendably chose instead to carry out his role of serving the people at community level, away from the media spotlight. His was a long life indeed, and as we all must inevitably shuffle off this mortal coil one day, what kinder and better way for Mr Sisulu than in his own home and in the arms of his lifelong wife and companion.
May his soul rest in peace. [Applause.]
Miss S RAJBALLY: Madam Speaker, Deputy President, Ministers, on behalf of the MF I convey our deepest sympathy and condolences on the loss of the hon Tata Walter Sisulu. The mark the late Sisulu has made in our fight against apartheid needs no introduction and the memory of his efforts and dedication to liberate our people, especially the youth, is a beacon of promise that we should all look upon and follow.
We extend our condolences to the bereaved family and friends of the late Tata Sisulu. We share in your loss and pray that Almighty God gives you patience and strength to get through this difficult time. To the ANC we convey our deepest regret on the loss of a powerful member and admirable comrade.
Tata Sisulu shall live on in our memory and in history as one of the great contributors to our liberation and freedom. The late Tata Sisulu was an important organiser of ANC activities during the apartheid regime. Tata Sisulu is appreciated, not only domestically, but globally too, showing the depth of his cause and the effects of this remarkable humanitarian. Tata Sisulu, may you rest in peace. You were an extraordinary leader in this world and you should lead us into the next world in the same way. Once again, I take this opportunity to convey our deepest sympathy to the bereaved family and the loved ones of the late Tata Sisulu. You shall be dearly missed. May you rest in peace. Hamba kakuhle, Tata.
Mr C AUCAMP: Madam Speaker, hon Deputy President, for me, coming from the established Afrikaner community, it is not a normal thing to pay tribute to somebody like the late Walter Sisulu. There was a time when he was known as one of the most prominent members of the enemy. Of course, we came from opposite sides of the history of strife and struggle.
This dilemma could easily be sidestepped by uttering a few clinical, politically correct words, but this is not necessary. I can assure you that when I, on behalf of the NA, pay tribute to the late Walter Sisulu today, it is not out of protocol or political correctness, but from the heart, from a feeling of sincere compassion and a conviction that we are really talking about a great fellow South African.
This is possibly an indication that something has, indeed, really taken place in South Africa between former enemies. We know that they have a common destiny and I sincerely hope that this approach and affection is reciprocal. I may have got to know Walter Sisulu better in the week after his death than during the years before. There is a Latin proverb which seems to describe him quite well: Suaviter in modo, fortiter in re, which means ``mild in his approach, but strong in his case’’.
As a person his unselfishness, his humbleness and his uncomplicated personality struck me the most. As a political figure and leader, his commitment to his cause, his country and his people serves as an example. In the field of his political thinking, most outstanding for me is that Walter Sisulu crossed the rubicon from Africanism to what is often called charterism, believing that South Africa belongs to all its people. The NA pays tribute to the late Walter Sisulu and expresses its sincere condolences to his family, and especially to a fellow member of this House, the hon Minister Lindiwe Sisulu, his daughter, as well as to his colleagues and his party. [Applause.]
Mr M F CASSIM: Madam Speaker, I rise to salute one who, in the words of the hon Joe Matthews, was one of the many millions who contributed to our freedom, but was, among the teeming millions, a truly singular individual. He has to be the proverbial one in a million, a truly remarkable soul.
To Ma Sisulu and the Sisulu family I extend my deepest condolences, and offer the following four-stanza verse:
Walter Sisulu is no more yet he shall be forevermore. Wipe then all your streaming tears hear the tributes of his peers and in song your voices forever raise to give him everlasting praise.
A paragon of dignity with humility will he be till eternity. As a grand message he lived his life in both pleasant times and in dreadful strife and all of us who follow behind must call this constantly to mind.
The things that he was wont to teach let us keep within our reach for as most of us can recall the greatest mentor was he to us all. His memorable life had so vast a scope as to give us everlasting hope.
Walter Sisulu is no more yet he shall live forevermore and when we’ve wiped our tears and taken to heart the tributes of his peers our voices in song we shall raise singing his everlasting praise.
[Applause.] The DEPUTY PRESIDENT: Madam Speaker, hon members, Mama Albertina Sisulu and family at home, at a time like this, when we are bidding our final farewells to one of the most remarkable men known to us and the world, it is very difficult to find the right words with which to do so. Words seem so inadequate and so limited in describing a man with so many great achievements in his lifetime, a man who gave everything and wanted nothing in return except the freedom of his people.
We not only mourn his death but also and more importantly celebrate every aspect of his life which he sacrificed selflessly on the altar of the struggle for freedom for his country. Having been born in the same year as the organisation to which he dedicated his whole life - the ANC - Tata Sisulu was at the heart of ANC affairs from the 40s up to his arrest at Rivonia in 1963, to Robben Island, to his release and until his last days. He was the main defence witness in the Rivonia Trial and spent 26 of his best years incarcerated on Robben Island. Through it all, he never relinquished his commitment to the struggle. When the prison doors were opened for him and some of his comrades in 1989 he continued his sterling work of campaigning, mobilising and organising for the ANC.
It is well known that Xhamela was both guide and mentor of Nelson Mandela upon Madiba’s arrival in Johannesburg for the first time. It was also he who recruited into the struggle many outstanding leaders. He worked with Mandela, Oliver Tambo, Anthony Lembede and others in the ANC Youth League whose invigorating ideas transformed the ANC, steered our country towards freedom and brought about democracy, the restoration of South Africa’s dignity and respect for its citizens.
In recognition of Xhamela’s personal worth, dedication and firmness, he was elected secretary-general of the ANC at its 1949 congress where the programme of action was adopted. It was Walter Sisulu, through his unrelenting efforts and his organising brilliance, who held everybody together through the defiance campaign, the congress of the people, the treason trial, the strikes and boycotts, and the stresses and conflicts of the late 1950s into the highest point of a nonviolent struggle. It was he who guided the ANC underground after the banning of the movement in 1960. He laid the foundation for the shift to active self-defence against the violence of the state which gave birth to uMkhonto weSizwe.
Tata Sisulu was a living embodiment of the people’s struggle for liberation as well as the ANC, its principles and revolutionary philosophy. He was selfless, giving, dedicated and displayed an outstanding commitment to the ANC and the struggle for liberation. He gave us his life, time and energy as well as that of his wife and children. He was always there, ready and willing to continue to work, give guidance and play the advisory role that everyone came to admire.
Tata Sisulu radiated a calm persona born from careful judgment and an unequalled capacity to listen, deliberate and empathise. That is one of the main reasons that everyone, even those from other political formations, sought his counsel and saw his views as crucial. It is all these qualities and countless others that not only give him a unique place in our history but place him in that special category of giants who dedicated their lives to resisting colonial oppression and apartheid so that, at the end, we achieved our freedom.
Those of us who were fortunate and blessed enough to have had personal and intimate contact with Xhamela will be most mindful of his absolute belief that, as freedom fighters, we had a fundamental obligation to serve the masses of our people and country. He believed that, in spite of the differences and disagreements which at times emerged in the course of the struggle, we should never mislead or divide our people and that, instead, our task should always be to unite them.
I must repeat that words alone are not enough to pay homage to such a valiant cadre and leader. I therefore support the call made by his friend and comrade, Madiba, that we, as a thankful nation, should eternalise the life and times of Xhamela with an appropriate memorial. I appeal to members of this august House to work tirelessly in support of these ideals to ensure that the memory of Xhamela is treasured for many generations of Africa’s children.
I would like to say to Mama Sisulu, Comrades Max, Mlungisi, Zwelakhe, Lindiwe, Nonkululeko, Jongumzi, Gerald, Bailey and Samuel, as well as the extended family and loved ones of Tata, that we are all gravely saddened by this immeasurable loss that we share with all South Africans and all the peoples of the world.
We must be grateful that Xhamela lived the last 14 years of his life outside Robben Island and with his loving wife and family. We must also be thankful that he tasted the sweet fruits of the freedom for which he fought for his entire life. Hamba kahle Xhamela! [Go well, Xhamela!] We will always hold up your life, your exemplary behaviour and your humility as a torch with which to light up the unknown - that future which we are preparing for future generations. [Applause.]
The SPEAKER: Hon members, there are no objections. The Deputy Speaker and I join you in the sentiments that you have expressed today. The condolences of the House will be conveyed to the Sisulu family together with the record of the tributes that have been expressed.
I want to remind all members that a special interfaith service is being organised for tomorrow by Parliament, the Western Cape government and Unicity. The service will be from 12h00 to 14h00 in the Good Hope Centre. Archbishop Ndungane will officiate. I trust that you will all join us.
Debate concluded.
Motion agreed to.
ESTABLISHMENT OF AD HOC JOINT COMMITTEE ON REPARATIONS
(Draft Resolution)
The CHIEF WHIP OF THE MAJORITY PARTY: Madam Speaker, I move:
That the House ratifies the decision by the Speaker and the Chairperson of the National Council of Provinces, acting jointly, to establish an Ad Hoc Joint Committee on Reparations in terms of Joint Rule 138(1)(b) (See Announcements, Tablings and Committee Reports, 24 April 2003, p314).
Agreed to.
INTERNATIONAL NURSES DAY
(Member's Statement)
Ms S K MNUMZANA (ANC): Madam Speaker, yesterday the world observed International Nurses Day with the theme being ``Fighting Aids stigma and caring’’. It is fitting therefore to salute our 220 000 nurses who form the backbone of our health system. With other policy shifts from curative to primary health care, our reliance on providing care and treatment becomes even more critical.
Nursing, in particular, is a profession that needs to be nurtured, supported and rewarded, for it is in the frontline of health care. Some may be working under trying conditions, but we salute their commitment to the oath of Nightingale, their commitment to the professional execution of their duties and their service to the people.
BY-ELECTION RESULTS
(Member's Statement)
Mnr F J VAN DEVENTER (DA): Geagte Speaker, die DA het op 7 Mei met die tussenverkiesings in Grassy Park in Kaapstad en South Hills/Moffat Park in Johannesburg bewys dat hy ‘n sterk, goeie potensiaal het onder alle Suid- Afrikaners.
Die DA het met hierdie twee uitslae, en andere, bewys dat pogings van die Nuwe NP en sy junior vennoot, die ANC, om die party te smeer as regs, rassisties en onpatrioties, nie deur die kiesers geglo word nie. Suid- Afrikaners is polities volwasse genoeg om te besef dat dié soort inkruiperige vennootskap wat die Nuwe NP met sy junior vennoot, die ANC, voorstaan, die einde van veelpartydemokrasie in Suid-Afrika sal beteken.
Die DA wil in 2004 die Weskaap, en in 2005 die Uniestad, terugwen om Weskaaplanders te verlos van ‘n vinkel-en-koljander keuse. Weskaapse kiesers is geregtig daarop om deel te wees van veelpartydemokrasie.
Die Nuwe NP is reeds bekommerd dat sy reklamewaarde minder is as dié van advokaat Barbie. Dit is die prys wat betaal word as ‘n opposisieparty homself laat manipuleer deur poppemeesters met verskuilde agendas. (Translation of Afrikaans member’s statement follows.)
[Mr F J VAN DEVENTER (DA): Hon Speaker, the DA demonstrated on 7 May, in the by-elections in Grassy Park in Cape Town and South Hills/Moffat Park in Johannesburg, that it has a strong, sound potential among all South Africans.
The DA demonstrated in these two results, and others, that attempts by the New NP and its junior partner, the ANC, to smear the party as right-wing racist and unpatriotic, are not believed by the voters. South Africans are politically mature enough to realise that this sort of fawning partnership that the New NP stands for with its junior partner, the ANC, will mean the end of multiparty democracy in South Africa.
The DA wants to win back the Western Cape in 2004, and the Unicity in 2005, in order to relieve the people of the Western Cape from a choice of six of one and half a dozen of the other. The voters of the Western Cape are entitled to be part of a multiparty democracy.
The New NP is already concerned that its marketing value is less than that of advocate Barbie. That is the price that must be paid when an opposition party allows itself to be manipulated by puppet-masters with hidden agendas.]
RETENTION OF NURSES
(Member's Statement)
Dr R RABINOWITZ (IFP): Madam Speaker, every month thousands of trained nurses leave our shores for better-paying jobs in hospitals overseas. If we are to improve health care throughout the country, we have to find inventive ways to keep nurses in our country.
The Gauteng health department has embarked on a project to prevent the services of nurses being lost indefinitely. The department is considering using exchange programmes and financial incentives in the hope of retaining the services of some nurses at state hospitals. They have embarked on an exchange programme with King’s College Hospital Trust in the United Kingdom whereby nurses will be sent overseas for two years and on their return contracted to work for the department for the equivalent time they spent working overseas.
We encourage other provinces in the country to follow the example set by Gauteng, and use this as an example of how valuable provincial initiatives can be.
CONFLICT IN DEMOCRATIC REPUBLIC OF CONGO
(Member's Statement)
Ms F HAJAIG (ANC): Madam Speaker, just recently we all applauded the successful conclusion of talks on a political transition in war-torn Democratic Republic of Congo. The Inter-Congolese Dialogue ended with checks providing for a government of national unity, a new constitution and the first democratic election in more than 40 years.
Since the war broke out in August 1998 it is estimated that some 3,3 million people have died. Therefore, it is with great regret that we learn of the latest outbreak of renewed violence in the northeast area of the DRC. United Nations officials deployed in the area say that in the latest massacre some 20 civilians were killed. Among them three babies had their throats cut and their heads smashed in.
Militias have also attacked the UN mission headquarters, despite the fact that it is sheltering thousands of innocent civilians. Some UN humanitarian aides have left, as their security could not be assured by the peacekeeping force.
We support President Thabo Mbeki’s call to the United Nations to review its mandate to the DRC, ie that United Nations forces there be mandated to protect civilians under imminent threat of physical violence. They can no longer stand by and observe these atrocities.
We hope that the UN Mission in the DRC or MONUC can speedily send peace enforcers to these areas to engage the violaters of the peace accord, so that the people of the DRC can continue the challenging task of rebuilding institutions and getting on with the peace and reconciliation process.
TRANSFORMATION IN SABC
(Member's Statement)
Mev A VAN WYK (Nuwe NP): Mevrou die Speaker, die Nuwe NP steun omvorming in die uitsaaidienste en weet dat die verandering wat hiermee gepaard gaan noodsaaklik is, maar voel ook baie sterk daaroor dat die omvormingsproses sinvol moet wees. Die kind moenie saam met die badwater uitgegooi word nie. Omvorming moet verbetering bring. Daar moet daarteen gewaak word om meer skade as goed te doen. Die konteks waarin omvorming plaasvind, moet in die eerste plaas deeglik geëvalueer word voordat enige stappe gedoen word. Daar moet gekyk word na die kliënte wat bedien word, in watter mate uitsaaiers hulle bevredig en hoe hierdie marksegment vergroot kan word.
Die Nuwe NP glo dat dit ‘n fout sal wees om mense wat deur die jare geloofwaardigheid opgebou het, wat hulle as gesaghebbend gevestig het en groot aanhang het by kykers en luisteraars, af te dank en nogal as rede aan te voer dat hulle te oud sou wees. Wat van uitsaaiers soos Larry King, Walter Cronkite, David Frost en vroeëres soos David Dimbleby en Barbara Walters? Die kliënt is koning en die rede hoekom die betrokke uitsaaiers so ‘n hoë kykersgetal handhaaf, is dat net soos met genoemde voorbeelde, die publiek erkenning gee aan hulle geloofwaardigheid en kundigheid. Die SABC moenie krap waar dit nie jeuk nie. Verbeter eerder dié dienste wat swakker vaar. [Tussenwerpsels.] (Translation of member’s statement follows.)
[Mrs A VAN WYK (New NP): Madam Speaker, the New NP supports transformation in the broadcasting services and we know that the change associated with this is necessary, but we also feel strongly that the transformation process should be meaningful. The baby should not be thrown out with the bath water. Transformation should bring about improvement. It should be ensured that not more harm than good is done. The context within which transformation takes place should, in the first place, be thoroughly evaluated before any steps are taken. The clients who are served, to what extent broadcasters are satisfying them, and how this market segment can be increased, should be examined.
The New NP believes that it would be a mistake to dismiss people who have established credibility over the years, who have established themselves as authoritative and who enjoy a large following among their viewers and listeners, and then to give a reason for this that they are too old. What about broadcasters such as Larry King, Walter Cronkite, David Frost and earlier ones such as David Dimbleby en Barbara Walters? The client is king and the reason why these broadcasters have such a large number of viewers is that, as is the case the aforementioned examples, the public gives recognition to their credibility and expertise. The SABC should not try to fix what it is not broken. Rather improve the services that are not faring so well. [Interjections.]]
LEGISLATION ON PLASTIC SHOPPING BAGS
(Member's Statement)
Mr L M GREEN (ACDP): Madam Speaker, the ACDP would like to register its concern about the Government’s misdirection in its national priorities concerning the passing and enforcing of laws concerning plastic bags by committing resources to advertising this legislation and effectively communicating these laws to the public at the expense of more important issues such as communicating clearly its position on HIV/Aids to the public.
The appointment of plastic bag monitors to inspect shops who flout the laws is an indication of the skewed prioritisation of the Government, which is viewed as uncaring of the needs of people who live in terror because of lawlessness and rampant crime owing to the inability of the Government to provide adequate resources and manpower to deal with this problem. The Government has also miscommunicated to the business sector the actual law that has been passed, as Government officials are consistently declaring that there is no 45-day phasing-in period while the businesses claim that there is. The Government should make itself clearly heard on national issues that affect people’s lives more directly, such as housing, employment, health care and HIV/Aids rather than spending its time and resources on plastic bags.
RELIGIOUS PRACTICE IN SCHOOLS: DRAFT POLICY
(Member's Statement)
Mr R P Z VAN DEN HEEVER (ANC): Madam Speaker, the draft policy on religion in schools which has been published for public comment has elicited widespread response from the general public.
The main objection was against the discarding of religious practice during school assemblies. As part of the consultative process our President has met with a national forum of religious leaders to discuss this matter. It now appears that the various parties are on the point of reaching consensus on the disputed clause on religious practice during school assemblies.
We want to congratulate the Minister of Education on the transparent, accountable and democratic manner in which he has dealt with this process. It has not been an easy task to determine how religious expression can take place in our schools, which reflects the multireligious nature of South African society, in an appropriate manner.
In this democratic practice of policy formulation on religion in schools the Minister is setting a shining example to a country which had the doubtful distinction under apartheid that Christian National Education was autocratically forced down the throats of all and sundry, with catastrophic consequences for the country as a whole.
ALLOCATION OF RDP HOUSES
(Member's Statement)
Mr I S MFUNDISI (UCDP): Madam Speaker, there have been, and continue to be, reports to the effect that the allocation of RDP houses is riddled with problems. Almost every other day there is a complaint about how and to whom these houses are allocated. Such complaints are common in almost all provinces. Officials of the municipalities and in some cases those of provincial housing departments are implicated. Investigations are being mounted in an effort to get to the root of the corruption, but little success is being registered.
We call on all South Africans of goodwill to assist the authorities in tracing these criminal elements in our offices and in society. The rot that has set in in the Ekhuruleni Metro should be rooted out. The continued corruption by some councillors in the Tshwane Metro who sell such houses irregularly should be halted.
We hope the success achieved by the Gauteng provincial department of housing in arresting such people in the Orange Farm area will inspire other local councils to leave no stone unturned in their efforts to bring the culprits to book. The department is urged to be more on the lookout for such pitfalls, otherwise housing the nation will continue to recede like a mirage. RELIGION IN SCHOOLS
(Member's Statement)
Mr C AUCAMP (NA): Madam Speaker, the matter of religion and religious education in schools has raised extreme concern among the different religious communities. The NA is concerned not only about the content of the new policy, but also about the whole process. Needless to say, with regard to such a sensitive issue, given the pluralistic nature of South African society, transparency should be of paramount importance.
The NA appreciates the meeting which President Mbeki had with different religious leaders and the fact that that meeting presumably resulted in a most welcome and much-needed turnabout in the proposed prohibition of religious practice in public schools. The NA is, however, concerned about the confidentiality of the revised document and would like the hon the Minister to give full particulars and clarity on the status of the different documents. Furthermore, it must be stated that merely allowing religious practice in schools will not calm the disturbed waters of our religious communities. The most serious concerns are the proposed religious education and the fundamental point of departure that the state, and not the parent, is the main stakeholder in the education of the child. The NA appeals to the hon the Minister: Please do not try to fix something that is not broken. [Interjections.]
EMPLOYMENT PROJECTS IN KWAZULU-NATAL
(Member's Statement)
Miss J E SOSIBO(ANC): Madam Speaker, in my constituency, Ladysmith in KwaZulu-Natal, 250 new permanent skilled jobs have been created and 88 of these employees are women. Our community joins others that benefited from the Industrial Participation and Counter Trade provisions of the Strategic Defence Procurement process. A capital expansion project totaling R173 million will be launched at two of Dunlop Tyres’ factories in KwaZulu Natal, R115 million of which is earmarked for Ladysmith.
The project, part of Global Defence Systems Company, Bus Systems and National Industrial Participation is linked to South Africa’s purchase of Raven and Hawk aircraft. This capital equipment-upgrade project is expected to generate about R23 billion in new tyre exports over the next 10 years.
The ANC reaffirms its support for Government’s decision to enter into this transaction with the aim of modernising our arms equipment and opening up chances for job creation. Steadily and surely our Government will continue to achieve its objective of creating a better life for all.
CRIME IN SOUTH AFRICA
(Member's Statement)
Mnr D H M GIBSON (DA): Mevrou die Speaker, die grootste tekortkoming van die ANC die afgelope dekade is sy versuim om met misdaad en kriminele af te reken. Misdaad tref alle bevolkingsgroepe, wit en swart, alle inkomstegroepe, ryk sowel as arm. Die ANC laat ons mense in die steek. Daadwerklike stappe wat misdaad onder beheer bring, ontbreek. Drie agtereenvolgende Ministers het gefaal. Dit maak die Regering kwesbaar, want behalwe vir die beleid wat tot verlies van werkgeleenthede lei, is daar niks wat ons mense so dwars in die krop steek as die onaanvaarbare vlaag van misdaad en veral van gewelddadige misdaad wat hoogty vier nie. (Translation of Afrikaans paragraph follows.)
[Mr D H M GIBSON (DA): Madam Speaker, the biggest shortcoming of the ANC over the past decade has been its failure to deal with crime and criminals. Crime affects all population groups, white and black, and all income groups, rich as well as poor. The ANC is letting our people down. Real measures which keep crime under control are lacking. Three successive Ministers have failed. This makes Government vulnerable because save for its policy which is leading to the loss of job opportunities there is nothing which annoys our people as much as the unacceptable wave of crime and especially violent crime which is running rampant.]
Crime is bad everywhere, but it seems to be particularly bad in Johannesburg. Among the thousands of people who have been victims, seven friends of mine have in the last two weeks been the victims of violent crime. And what those people - together with all the other thousands in South Africa - are asking is what the ANC is doing to protect us. [Interjections.] The answer must be, not much.
The DA says, what we have to do is put 150 000 policemen on the streets where you live and we will start beating crime. [Interjections.] [Applause.]
SECOND FIXED-LINE OPERATOR
(Member's Statement)
Ms S C VOS(IFP): Madam Speaker, the second round of bidding involving the controlling stake in our future second fixed-line telephone operator is nearing completion and five bids have reportedly now been submitted. The process of finding a suitable candidate for the second fixed-line operator has been an arduous and controversial task for all concerned.
In this regard we must salute the Independent Communications Authority of South Africa for its tenacious and principled protection of its mandate. We now look forward to the introduction of much-needed competition in the industry and the benefits to consumers envisaged without any further delay.
RETURN OF BOTSHABELO PEOPLE TO THEIR LAND
(Member's Statement)
Mrs B M NTULI(ANC): Deputy Speaker, the people who were forceably removed from Botshabelo in Mpumalanga province in 1972 have been granted the right to return to their land by the Land Claims Commission. They are now the proud owners of title deeds to the 150- year-old mission station and 2 500 hectares of land where they can continue with farming. This also gives them access to the tourist areas that have been developed in this locality.
The ANC calls upon the Land Claims Commission to speed up the process of returning land to its rightful owners. While we are aware that this is not an easy task, the commission and communities must work hand in hand to deliver land back to its owners. We further call upon the people of Botshabelo to take responsibility for their land and develop it to the benefit of the province and the country. [Applause].
RELIGION IN SCHOOLS
(Member's Statement)
Mrs M E OLCKERS (NEW NP): Madam Deputy Speaker, the New NP welcomes the new measures as proposed by the hon the Minister of Education relating to religious practices in schools. But after wide consultations - which are still going on - and an outcry from various religious groups through the media and to the President, the New NP wants to put on record once more that the proposed new initiative by the hon the Minister is, as it is presently presented, still unacceptable to us.
We believe that the Constitution of South Africa, especially section article 14, should be honoured in full by the Government and not selectively. We maintain that the freedom to practise religion should reflect the ethics of the school as identified by the governing body. A separate comparative study on various religions is supported on condition that the person who will be teaching this subject is fully knowledgeable of the variations of the subject. Also, learners should only be exposed to this subject in schools once they have formed their own religious beliefs as practised in their homes and elsewhere.
In South Africa there has never been a situation where we killed each other in the name of religion, as is the case in Ireland, the Middle East, etc. The New NP requests the Government not to disturb the peaceful co-existence of the various religions in South Africa. We thank the hon the President for his intervention. We must build in this country, not demolish.
RELIGION IN SCHOOLS
(Minister's Response)
The MINISTER OF EDUCATION: First of all, let me say quite clearly: There has been no turnabout. There has been no intervention by the President. When the President met the faith communities this matter was not discussed because the agenda was very different.
Now these figments of the imagination do not help in any debates taking place. It has been entirely the initiative of the Council of Education Ministers, where this process has been taking place. And let me therefore say there are three different aspects. One is that religious education will now be part of the curriculum. This was adopted after a huge public scoping exercise. I regret to say the New National Party has woken from its slumber some time or other, because this is part of a Cabinet decision. This is part of a Cabinet decision and we will therefore be reinstating the values and spiritual aspects of religions in our schools. We are reviving it then.
Secondly, there is the question of observance of the Constitution. We have given this very careful consideration. Nothing has been finalised regarding this matter, but may I ask the honourable House to remember that in fact people who have come from the old tradition of Christian National Education should not make emotional statements here about the extent to which religious bigotry does not exist in our schools. There is a degree of religious bigotry - which I will disclose at a press conference - that is taking place in about 200 schools. This is totally out of line with the Constitution because it excludes the vast majority of our people.
We are now a multireligious society and the school system must reflect that. And so, therefore, as far as practices are concerned, there is general agreement. Instruction shall be after school; it is for families and parents. If you want to have instruction, it will, on an equal basis, include the Zionist Church, 4,5 million members of which have largely been discriminated against in this country, and now we will open the schools for all religious denominations.
This is followed by the assemblies. It is quite clear, as has been pointed out …
The DEPUTY SPEAKER: Order! Hon Minister, the two minutes for your first question have expired.
The MINISTER: But there were three points.
The DEPUTY SPEAKER: You can proceed to the next one.
The MINISTER: I will proceed to the next one and that is the question of school assemblies. We have consulted very extensively on this and we do this on the same basis as we do with the language issue.
Now, of course, give a dog a bad name, and hang him. There are people, and, I must say, not always on this side of the House, who raise populist cries about language. We have settled the issue on a proposal made by the Minister and accepted by the Cabinet. There is absolute agreement. In fact, the language issue in higher education has been finalised, I regret to tell the Leader of the Opposition, who went to Stellenbosch and said: ``We will fight Kader Asmal. He wants to destroy the Afrikaans language.’’ And Stellenbosch is the main instrument of acceptance of the policy.
In the same way, as regards to school assemblies, what we are saying is that we are a multireligious country. We must take into account the fact that there are sensitivities and delicacies involved in this. Our appeal, as is emerging now, is that school governing bodies should decide on assemblies. Not all schools have them. The black schools do not have assembly halls. So I think we must give some credence to facts. They do not have assembly halls. It is only the former white schools that have them.
Where assemblies are held, they are not always held with a religious purpose. Where there is a religious purpose, the multireligious aspects of our country must be taken into account. No one can object to that, except the bigots. The bigots want their version of the deity. The bigots want their version of transcendental philosophy. What we are saying here is that we must accommodate the different religions in South Africa and I do not think that is a particularly divisive thing.
So I must turn to the hon Cassie Aucamp. We had no turnabout. One has to fix things by reference to the Constitution. That is what we are doing. Tolerance, reconciliation and understanding are the principles that operate. And I am sure that what will emerge in a few weeks’ time will have broad and general acceptance.
NEW POLICY ON PLASTIC BAGS
(Minister's Response}
The MINISTER OF ENVIRONMENTAL AFFAIRS AND TOURISM: Thank you very much. I was taken aback by the pro-garbage, pro-litter, anti-environment speech of the hon Green. Where does he get his name from? [Laughter.] I suggest the hon members changes his name.
Madam Speaker, can he who loves the plastic bag so much show the House what bag he is carrying today? Hon Green, if you do not mind, please? There, you are, it speaks for itself. He is carrying a paper bag. If that is good for you, it is good for people out there. And let me tell you, hon Green, regardless of what you say, Christians and Muslims and Jews and Hindus all want a clean country. Nobody wants to live in litter. I do not know where you come from.
Talking about spending a lot of money on advertising, last week the acting Minister of Environmental Affairs and Tourism was the hon Minister Asmal and he, because of his personality, generated a tremendous amount of free advertising on this question. So I can assure you it did not cost us any money. I did not even have to pay him. There was no overtime pay for him at all.
Now, hon Green, I think it is in the Book of Proverbs - you will understand that this is not really my area of specialised knowledge - that it says: Cleanliness is next to godliness. [Applause.]
CORRUPTION IN HOUSING SECTOR
(Minister's Response)
The MINISTER OF HOUSING: Madam Deputy Speaker, I would like to assure the hon Mfundisi that indeed we are committed to fighting corruption and that in fact in my consultations with MECs one of the aspects we discussed was possible irregularities or corruption around the provision of housing. All I really have to say is that we are on top of the issue.
MEMBERS OF SA POLICE SERVICE
(Minister's Response) The MINISTER OF SAFETY AND SECURITY: Thank you, Deputy Speaker. Members of the SA Police Service are not only loyal and dedicated to our Government, they do their work to the best of their ability. And they are well trained for this work.
But what I want to raise here is the fact that they are better educated than they have been in the past. They read and analyse what people say and they also pay particular attention to what members of this House say and they analyse those statements. They will know that what the hon Gibson said was not an attack on the ANC. It was a direct attack on those members of the SA Police Service because he said those members were unable to do their work and he did not even appreciate the fact that those members of the SA Police Service even die defending this country and its people.
It is the members of that Service that he is attacking. He is saying they are unable to do their work and among members of that Service that he is attacking in this fashion are possibly members of his party and they will understand, therefore, that what he is saying is that the support that they possibly give to his party is not appreciated. [Applause.]
The DEPUTY SPEAKER: We still have room for one more ministerial response.
SA DEPLOYMENT IN DEMOCRATIC REPUBLIC OF CONGO
(Minister's Response)
The MINISTER OF DEFENCE: Madam Deputy Speaker, I appreciate the concern that members are raising with regard to the killing of civilians in the eastern part of the Congo and I want to say that we are the country with the biggest deployment in the DRC. I would like to remind members that we are deployed there as a peace support operation and not as peace enforcement.
We went there on the understanding that the parties that were in conflict with each other had signed a ceasefire agreement and that they would respect that. It is still too early to establish firmly and clearly who was responsible for the slaughter of the civilians, but it is important at this point in time, as the armed forces of the surrounding countries are pulling out of that region, that we possible take a second look at the mandate of the forces deployed and at whether there might not be an urgent need for that mandate to introduce peace enforcement. That, of course, is a serious question because peace enforcement would mean that our own people there would have to be ready to engage in war with the factions that are there.
This is a very serious matter. It is receiving attention, but I would like to appeal to members to continue firmly to support the deployment there.
APPROPRIATION BILL
Debate on Vote No 16 - Health:
The MINISTER OF HEALTH: Deputy Speaker, Deputy President, hon members, maqabane apho phezulu, ndiyanibulisa [comrades up there, I greet you], over the past year we have been on a journey of discovery, a discovery of our nation’s capacity to rise to the many challenges of our times; a discovery also of our ability to remain steadfast and advance our cause in the face of obstacles and setbacks.
We have experienced the highs that come with evident success, but we have also experienced the lows of occasional failure. Through this one thing has remained certain: we shall not be deterred, for we know that through our efforts our health system is today better positioned to respond to the expectations and needs of our people.
As we near the end of the first decade of freedom, we know that we have built a unified system for health care delivery, with institutionalised mechanisms such as Minmec, that gives concrete expression to our system of co-operative governance. More South Africans today have access to health care. We have deracialised our clinics and hospitals, built new facilities and physically rehabilitated many of the existing institutions. The distribution of medicines has improved, and we are on the threshold of significant changes that will see further reductions in the cost of medicines. The private health care sector remains robust and provides credible choices for those willing and able to pay for their care.
We are expanding partnerships between the public, private and NGO sectors, driven by the imperative to gain optimum benefit from resources and make health care more affordable and accessible. Our academic and training institutions continue to provide credible platforms for the generation of future leaders in the health field. We are increasingly seeing professionals from the ranks of the historically disadvantaged rising to take the helm as deans of faculties in the health field.
Our pre-eminent research institution, the Medical Research Council, is stronger today and is expanding to respond to a broad spectrum of challenges, adding the public health dimension to a more traditional biomedical approach. Our National Institute for Communicable Diseases, backed increasingly by skilled outbreak teams in the provinces, ensures that we are able to respond to any disease outbreak. We have also consolidated our medical laboratory infrastructure and established the National Health Laboratory Service.
We have better information to monitor fiscal flows and the impact of our policy interventions to ensure the necessary relationship is maintained between policy priorities and resource allocation. All these are important achievements in a concerted effort to build a secure national health system that is robust enough to respond to the varied health needs of our people. In this context, I have the privilege and the responsibility again to stand before this House and propose the adoption of the Health Vote.
The Health allocation amounts to R8,38 billion and forms part of a larger amount of about R40 billion devoted to the public health sector. A significant portion of the budget will be used to consolidate existing programmes. However, I would like to highlight a notable feature - that is, the special allocation to attract and retain the valuable services of skilled health professionals.
Important elements of the budget include substantial increases in the school-based nutrition programme; capital works to revitalise selected hospitals; and expansion of programmes to combat HIV/Aids, TB and sexually transmitted infections. Of course, we will not neglect the area of noncommunicable diseases.
If we take a few steps back - far enough to see broadly and to achieve the perspective of a decade of progress - we can confidently say that South Africa in 2003 is a better place than South Africa in 1994. The tide has truly turned.
I would like to outline our plans to consolidate on this foundation by highlighting priorities for the coming year. Firstly, our intentions in terms of securing the foundation of care are our skilled human resources. In the health sector, quality of service depends critically on the availability of adequate numbers of appropriately skilled professionals. There has always been a poor distribution of health professionals between the public and private sectors and between the urban and rural areas.
The problems in the public sector have become more acute as we have expanded access to care, particularly to meet the health needs of the people living in the least developed parts of our country. Our well-trained health professionals have also become a sought-after resource in high- paying industrialised countries. However, the actual number of health workers leaving the country is less dramatic than media reports suggest. It is the abrupt nature of these departures that causes great destabilisation.
In recognition of this critical situation, the health sector has been allocated R500 million for the first time this year to recruit and retain scarce professionals and attract new recruits in rural areas. The Medium- Term Expenditure Framework provides for some expansion - to R750 million next year and to R1 billion in 2005-06. The money will be used to introduce a system of allowances for professionals with scarce skills and for professionals serving in rural areas, and to change the salary structures of health professionals where the state pays rates significantly lower than the private sector. We therefore have our sights set on implementing the new allowances from 1 July 2003, subject to the collective bargaining process.
In a few days’ time, at the World Health Assembly in Geneva, health Ministers will be discussing this issue. On 18 May health Ministers from the Commonwealth will adopt a code for ethical recruitment that will be binding on all Commonwealth nations.
We have made progress towards the introduction of mid-level workers to assist professional practitioners. Several professional councils have amended scopes of professional practice to accommodate mid-level assistants and have created new occupational categories.
In addition to the human resource factor, the state of health facilities and the availability of the appropriate equipment are key factors in improving the quality of hospital and clinic services. Our capital investment in hospital buildings and major equipment under the hospital revitalisation programme will be R717 million this year and is due to rise to R911 million next year and to R1 billion the year after. This substantial increase in the national budget is mirrored by capital spending increases in most provincial budgets.
The revitalisation programme is proceeding well, with an additional 18 hospitals now added to the initial nine. A total of 18 out of the 27 projects involve the building of new hospitals, either to replace a dilapidated facility or to create a new service.
Hon members will recall that we embarked some years ago on the construction of three major academic hospitals in Durban, Pretoria and Umtata. The first of these, the Inkosi Albert Luthuli Hospital in Durban, is now open for business. It is a large hospital - 840 beds - and has already notched up an award for the private-public partnership that manages its information technology and medical technology.
The Nelson Mandela Complex in Umtata is now almost complete. With 460 beds, it provides Unitra with a top-class teaching facility. We expect to see patients in beds before the end of this year. Phase two of the new Pretoria Academic Hospital, which will be a 780-bed facility, will be completed in 2004.
We recognise that improved management is a critical factor in achieving better health. Earlier this year we established the Arthur Letele Institute for Health Care Management. The institute was named after a medical practitioner and veteran in our struggle for democracy, who embodied the qualities of service and expertise we aspire to.
In the middle of last year we launched a consultative process with our medical specialists on the future of tertiary health care services. The goal is to develop a 10-year vision that will involve some reorganisation of services in order to equip them better, ensure their long-term sustainability and generally make them effective.
Expanding universal access to a clearly defined basket of primary health care services is a major challenge that we continue to confront. Over the past nine years more than 701 new clinics have been built and another 249 have been substantially expanded. The singular importance of expanded access to primary care is its impact within a broader programme of poverty eradication.
Therefore, it is particularly disturbing to note that the Intergovernmental Fiscal Review reflects major discrepancies in primary health care allocations among provinces. In 2002-03 the per capita allocations ranged from R70 to R238, with the national average running at R148. A clear area of focus in the coming years, therefore, must be the tracking of resources allocated to primary care in all districts and municipalities across the country, driven by the imperative to provide adequate funding at this level. This is critical to ensure that we attain targets for immunisation that we fully implement the Integrated Management of Childhood Illnesses and that we are able to make the changes recommended by the Committee for Confidential Inquiry into Maternal Deaths.
A strong emphasis on vaccine-preventable diseases is one of the most effective and affordable ways of limiting child mortality and illness. In 2002, 72% of children were fully immunised at one year, representing a significant increase compared with 63% in 1998. But we still have a long way to go to achieve the targeted rate of 90%.
The World Health Organisation has adopted ``Healthy Environments for Children’’ as its theme for 2003, drawing attention to the fact that environmental factors play a critical role in the deaths of about 5 million children worldwide each year. I invite all members of Parliament to sign the pledge at the health exhibition on building healthy environments for children.
In order to recognise the significance of environmental health interventions, the department last year launched the Alfred Nzo Awards for outstanding work by environmental health officers. It is perhaps not widely known that our first Minister of Foreign Affairs of the democratic era was an environmental health officer.
Maternal health services at all levels have been under close scrutiny since we received the last report of the Committee for Confidential Inquiry into Maternal Deaths. The report indicated a rise in maternal mortality. Whilst this was partly attributable to the increased impact of HIV and Aids, other factors also played a part - factors related to the management of the health system, the skill of the individual practitioner and the social circumstances of the patient.
Disability is a substantial contributor to poverty and, in recognition of this, President Thabo Mbeki announced, in his state of the nation address, that health care should be made available free of charge for people with disabilities. I am now in a position to elaborate on the President’s announcement by indicating that this provision will cover outpatient visits to hospitals as well as admissions, including all inpatient care and major assistive devices, such as wheelchairs and hearing aids.
The benefit will include people who have permanent disabilities that result in moderate to severe difficulty in executing the normal tasks of living. It will include older persons who are considered to be frail and long-term patients in institutions for mental health care. However, it will not be available to people who have medical aid cover, who have a temporary disability or who have a chronic illness that does not cause substantial loss of functional ability. The extended health benefit will come into operation on 1 July this year.
There is currently still a backlog in the supply of wheelchairs and hearing aids. The department aims to eliminate this backlog by this time next year, expending about R30 million to assist those currently on waiting lists. This means that provinces will be responsible under the free health care policy only for replacement devices and for assisting those newly disabled.
In terms of combating hunger, the primary school nutrition programme has proved its worth in sustained delivery over a period of nine years. Last year Cabinet made a series of recommendations to strengthen this programme. As a result of this, the budget allocation for the programme has been substantially increased - from R592 million to R809 million.
The increased funding offsets the impact of inflation and ensures that provinces can meet the standard menu requirements and the minimum number of feeding days. There will also be a slight increase in the number of Grade R children who were included for the first time last year. Regulations are now in effect for the mandatory fortification of food and mealie meal with specific vitamins and minerals.
This Government and this Parliament have adopted the approach of building the nation’s health by tackling major health risks. Our early recognition of tobacco use as a major public health risk that contributes to 4 million deaths a year worldwide enabled South Africans to play a significant role in the successful negotiation of the global Framework Convention on Tobacco Control. Consensus on the Framework Convention was reached in March 2003 in Geneva and will be presented to the World Health Assembly later this month for adoption. We intend to draw on the experience of the past two years to amend the Tobacco Products Control Act again this year.
Government’s effective controls on tobacco use inevitably raise questions about our commitment to tackling the abuse of alcohol. Government has little doubt about the dangers of alcohol abuse and its ability to destroy lives. In the Northern Cape, one in 10 children starting school shows signs of foetal alcohol syndrome caused by the mother’s consumption of alcohol during pregnancy. These children suffer a range of physical and intellectual impairments. The situation is also extremely serious in the Western Cape, where one in 20 children is affected.
Indications are that we are dealing with a problem that takes a grip very early in life. Our reference in this regard is the youth risk behaviour survey undertaken on our behalf by the MRC. Mortality figures show that 46% of male deaths in the age group 15 to 29 years in the period 1997 to 2001 were due to unnatural causes, ie accidents, suicides and crime, often linked to alcohol use. Any effective strategies against alcohol misuse must take account of the complex nature of the problem, and this requires a wide range of organisations to play an active role.
I have been encouraged by the approach of producers in the preliminary discussions that we have had with them. In contrast to tobacco, which is harmful, no matter how one uses it, alcohol can be safely and healthily consumed. This means that our strategies in relation to alcohol would differ in some respect from our approach to tobacco. The department has researched the effectiveness of warning messages and will soon be in a position to publish regulations under the Foodstuffs Act.
This brings me to the National Programme on HIV/Aids, sexually transmitted infections and TB. A total of R616 million will be allocated in the national Health Vote for interventions in this regard. This amount is almost equally divided between the national office and provinces. By far the largest amount allocated for these programmes, an amount exceeding R141 billion, falls outside the ambit of this Vote, as it is contained within the equitable share to provinces.
No matter what route state funding takes, it all goes towards reinforcing the implementation of the strategic plan on HIV/Aids, TB and sexually transmitted infections. Therefore, whatever the challenges we continue to face, they should not detract from our national effort in confronting the two epidemics, ie TB and Aids.
Every passing day confirms the wisdom of a comprehensive approach to this challenge, an approach that is anchored and based on the developmental perspective. The year ahead will see the continuation of Government’s Khomanani awareness campaigns, with their strong prevention and care elements. They also play a vital role in promoting and mobilising care support.
Between September last year and February this year the Khomanani campaigns reached 21 million radio listeners and 60% of the country’s 8,5 million television viewers. The year ahead will also see strong advocacy initiatives on TB.
The facts are quite simple: TB is curable, even in the face of HIV infection. Treatment is free and available at our public clinics. Failure to complete the six month course of treatment is a major problem that contributes to the spread of drug resistant strains of TB, which are extremely hard and costly to treat. TB, no less than HIV and Aids, requires strong social partnerships. We need to build these in the year ahead. The fact of the matter is that TB is on the increase, and last year alone we saw about 200 000 new cases countrywide. The cure rate is well below our intended target of 85%. Only two out of three patients complete their treatment. Hunger is a factor in the interruption of TB treatment. In our country, where vast numbers live below the breadline, nutrition must become an essential part of the treatment.
Another major focus this year will be the promotion of voluntary counselling and HIV testing. There is clear evidence that good nutrition and the use of immune-boosting supplements, including some traditional herbal remedies, constant emotional support and generally healthy lifestyles prolong good life, and good health and delay the onset of Aids.
In the case of traditional medicines that are quite widely used in relation to HIV and Aids but poorly understood, the MRC has set up a unit on indigenous knowledge systems to evaluate the safety and efficacy of these traditional herbal remedies. The programme to prevent mother-to-child transmission of HIV infection through the provision of Nevirapine has been expanded. There are now more than 650 service points participating in this programme. A selected cohort of mothers and babies is being studied to establish the impact of the programme, in terms of the health and status of the mothers and the babies. Research into the possibility of sustained drug resistance to this programme is also continuing.
The latest HIV prevalence survey, which is the 13th, undertaken at our antenatal clinics, confirms that the rate of infection has stabilised, but has not yet declined overall. However, for the fourth year in a row, we are seeing a small drop in the levels of infection amongst our teenagers.
When it comes to treatment, three absolutely critical factors are: a good health infrastructure; adequate numbers of knowledgeable health workers; and the availability of affordable medicines. This remains true to varying degrees, whether or not the element of antiretroviral drug therapy becomes part of the treatment programme.
Hon members will be aware that Government appointed a joint Health and Treasury task team to undertake a comprehensive projection of the cost of various treatment options, including the use of antiretrovirals. The report of this team will be presented to Cabinet in the very near future, and a decision will be taken on this issue that has come to dominate the public debates on HIV and Aids.
The budget also provides for increased support to organisations involved in home and community-based care. Good progress was made last year to strengthen this form of care by appointing co-ordinators, standardising treatment, training and providing guidelines, and distributing care kits. But we admit that we still have a long way to go in developing care outside of institutions.
In a letter following his recent visit to South Africa, Prof Richard Feachem, Executive Director of the Global Fund, said he had been very impressed by the commitment he had seen in South Africa, in both the public and civil society sectors. Despite technical requirements that delayed the signing of the Global Fund Agreement, the fund’s visit was fruitful and he was confident that the agreement would shortly be formalised.
Turning to the legislative programme for this year, I am confident that this session of Parliament will, at last, deliver the National Health Bill. The delays in tabling this Bill since its approval by Cabinet last year relate to the length of the legislation and some complex constitutional issues.
The draft traditional healers Bill is currently in the public arena for comment. This Bill aims to establish an interim council for the self- regulation of various types of traditional health practitioners. We believe that this legislation benefits both the practitioners themselves by recognising their practice, and the public by assisting in safeguarding them from dangerous practices.
When we passed the legislation on the termination of pregnancy, our concern was to ensure reasonable access to safe abortion, as a life-saving public health measure. Certain quality problems seem to arise from an overload on limited numbers of designated facilities and we are continuing to see some deaths due to septic abortions. For this reason, we propose to change legal requirements that apply to health institutions where terminations may be performed.
On 2 May, the two Medicines Control Amendment Acts and their regulations came into operation, activating mechanisms to increase access to essential medicines. I am confident that that date will stand as a milestone in our national project to build a better life for all, and I want to thank all those who contributed to this achievement, including some members of the pharmaceutical industry.
We are continuing to expand and strengthen the administrative capacity of the Medicines Control Council. We are reconstituting the council and we have already called for nominations for the pricing committee. On 2 May, a provision of the Pharmacy Act also came into effect, opening ownership of pharmacies to non-pharmacists. We are confident that this will significantly improve the public’s access to safe medicines of good quality.
Certain provisions under the Medical Schemes Act will soon come into effect. These allow medical schemes to designate preferred health service providers, either in the public or private sector, which their members will be required to use. The regulations also prescribe minimum benefits for medical scheme members in the area of chronic illnesses, which will especially benefit the elderly. We are hard at work on the social health insurance component, and a firm proposal will be on the table in the latter half of this year. The Regulations for the Mental Health Care Act will be implemented in July.
We continue to engage in international activities as Africans, guided by the objectives of Nepad, firmly anchored in the SADC region. In April, we participated in a major advocacy and social mobilisation initiative, known as Racing against Malaria. This involved convoys of vehicles traversing the length and breadth of Southern Africa, spreading the message of malaria prevention along the route, and converging in Dar es Salaam for a unique joint celebration of Africa Malaria Day. In September this year, South Africa will host the annual WHO Afro Regional Conference. It is a privilege to hold this significant meeting in our country and to receive health Ministers from the entire continent.
Throughout 2003 we will make every effort to fulfil our part of the global programme to eradicate polio. If we fail now to meet the high disease- monitoring standards set by the WHO, we will not be able to declare ourselves polio-free at the end of 2005.
The recent outbreak of Severe Acute Respiratory Syndrome, Sars, has underscored how critical international co-operation is in the containment of emerging and re-emerging diseases. Infectious diseases know no boundaries, and it is only through scrupulous surveillance and sharing of information across nations that we can protect our people.
Our international activities are driven by both global public health agendas and wider considerations. Major diseases, particularly communicable diseases, are increasingly recognised as global strategic issues with the potential to influence and shape geopolitical trade and demographic configurations.
In these opening years of the 21st century, health is emerging as a key factor in stability across the world. Consistent with the general objectives of our foreign policy, we shall do everything possible to contribute to the preservation of peace and the pursuit of development through the instrument of effective global public health initiatives.
The task at hand remains a daunting one, but the price is high. We need all hands on deck. We need the private sector and civil society in all its varied formations. We need individuals inspired by the spirit of Letsema to help us build the caring humane society of our dreams. Every day we take comfort in the fact that, whatever occasional failures we may experience, history and destiny have afforded us a rare opportunity to be architects of a better tomorrow.
I wish to thank members of this Assembly who have guided us towards this vision, most notably the chair and members of the portfolio committee. I also wish to express appreciation to my Cabinet colleagues, especially those in the social cluster. To my provincial counterparts, the MECs for health and the Deputy Minister, I am indebted to you for your support. In President Mbeki we have a leader who neither denies the enormity of poverty nor seems overwhelmed by it. [Interjections.] I am deeply grateful that the challenges of health can be addressed with an increasingly substantial response to poverty and the challenges of development.
Finally, and with heartfelt appreciation, I acknowledge the managers and workers of the public health system, foremost and most uniquely, the Director-General of Health, Dr Ayanda Ntsaluba. Particular mention should also be made of the support I received from the ministerial advisers, the co-operation of provincial heads of health and representatives of the SA Local Government Association.
Furthermore, I wish to extend my thanks to each and every person who has worked with dedication and the spirit of serving. We appreciate the repeated calls that you have made for more resources, in order to provide the quality of care that our people deserve. To all health workers, the call to battle is simple and clear: Let us endure. Now the tide has turned. Surely we shall prevail. [Applause.]
Mrs S V KALYAN: Madam Deputy Speaker, the White Paper on the Transformation of the National Health System commits the national Department of Health to providing leadership and guidance to the National Health System and to providing caring and effective services through a primary health care approach. However, quite frankly, the Minister of Health has failed dismally in this commitment. [Interjections.] She has failed to provide the leadership so necessary to this vital portfolio, or to mobilise the available resources to carry out her mandate.
It is quite obvious that she sees life through rose-coloured spectacles, because she sees no problems in the portfolio. But the health of South Africa is definitely not in the pink, Madam Minister. You have failed to get a handle on the HIV/Aids pandemic in South Africa. Your mishandling of it has cost the taxpayer close to R3 million. I am referring here to the legal action brought by the TAC and the subsequent ruling of the Constitutional Court, which you have yet to fully comply with. [Interjections.] That R3 million could have improved the quality of life of HIV patients.
Spending on HIV/Aids conditional grants was a problem in the past year, and the main problems identified were: the hospital infrastructure being unable to tackle the additional burden of HIV/Aids; the lack of a framework to guide programme implementation; no counsellors trained for pre- and post- test counselling and no nurses trained in HIV/Aids rapid testing. Also, the late transfer of additional funds to provinces impacted seriously on the provinces’ ability to spend their conditional grant budget, hence the roll- over.
The Presidential Aids Advisory panel has not disbanded and is still undertaking experiments, and the full cost to the taxpayer has yet to be ascertained. People continue to identify themselves as members of the panel. Most notable of all is Roberto Grinaldo, the Minister’s new best friend. He believes that poor nutrition causes Aids and the Minister of Health wants to employ Grinaldo as a ``nutritional advisor’’. [Interjections.]
This character recommends that HIV-positive patients eat a combination of garlic, onions, African potatoes and virgin olive oil. The Minister of Health heartily endorses this view, which is seriously flawed in many respects. Most notably, the African potato was found to damage bone marrow, and because HIV patients’ bone marrow is most susceptible to immune suppression, that is the last thing they want. Some 40% of all South Africans live in poverty and a large percentage of them is HIV-positive. Madam Minister, how are these poor people going to afford virgin olive oil and garlic? [Interjections.]
The Minister has a history of making rash, unsubstantiated statements. She should devote more time to discovering a cure for the foot-and-mouth condition she appears to suffer from. I have yet to look into the goody bag that she has supplied, but I wonder if there might be a booklet entitled How to Combat Air Rage authored by the hon Minister of Health.
South Africa is presently experiencing a serious crisis in respect of the loss of skilled health professionals due to emigration. The retention strategy is a typical case of too late, too slow. It is predicted that we will lose 400 doctors this year. It is a pity that the Minister is blaming the media for the exaggeration, but 400 doctors leaving us is a serious indictment. While the DA recognises that the Cuban doctor programme goes a long way towards improving service delivery, which suffered as a result of the South African brain drain, the fact that South Africa is party to some of the conditions in the government-to-government contract is unacceptable. The Department of Health has lost sight of the fact that South Africa is a sovereign state.
According to this contract, Cuban doctors are allowed to bring their families to South Africa with them. However, any child of a Cuban doctor … [Interjections.]
The DEPUTY SPEAKER: Order! There is a point of order.
Mrs S F BALOYI: Madam Speaker, could the hon member withdraw the remark saying that the Minister is suffering from foot-and-mouth disease? [Laughter.]
The DEPUTY SPEAKER: It is not exactly a swearword, so it is not particularly unparliamentary. Please proceed, hon member. Mrs S V KALYAN: Madam Speaker, according to this contract Cuban doctors are allowed to bring their families with them to South Africa, but any child of a Cuban doctor who turns 15 has to return to Cuba. Now, is this not a violation of the basic human rights of a family, as enshrined in our Constitution?
Cuban doctors who have completed their contract may not seek employment in the private sector in South Africa, and 57% of their salary of those who work for us is sent back to Cuba. Furthermore, every Cuban doctor and his family have to take a compulsory annual holiday in Cuba at the expense of the Department of Health. Now, where in the budget is this holiday reflected, Madam Minister?
The Department of Health is currently embroiled in litigation with several Cuban doctors, and it is a sad indictment on our Government that health delivery in South Africa is being decided by litigation and not by a competent Minister. Foreign qualified doctors are treated shoddily by the Health Professions Council of SA, which falls under the Department of Health. They cannot get registration as general practitioners in South Africa.
Prof Paula Yates, a cardiothoraxic surgeon from Austria with more than 10 years of experience, was denied registration by the HPCSA. She is married to a South African doctor, has permanent residence, and is highly qualified and internationally published, but she has been told to serve an internship and do community service in order to get a licence. Surely, in view of the serious brain drain, we should be doing our best to retain these skills which come into our country?
The Minister of Health is a foreign-qualified doctor. Did the Health Professions Council of SA apply these regulations to her? Was she also treated as a first-year doctor, despite her experience? Trying to contact the HPCSA for any answers is about as successful as getting the Minister to say HIV causes Aids.
South Africa has many health challenges which need a Minister who is dynamic, proactive and up to tackling the challenge. While the officials in the Department of Health are competent, their sterling efforts are constantly being undermined by the hon Tshabalala-Msimang’s incompetence.
At the present time her only claim to true fame is the title ``Mampara of the Year, 2002’’, on which I would like to congratulate her. [Interjections.] Given that she was in the running with the likes of Mad Bob, Moyo and Marais, she polled over 60% of the votes. It is also my understanding that she looks set to retain the title this year with her latest air rage episode.
The hon Minister of Health has failed in her task to provide health care for all. She is a liability to the health of South Africans. The DA urges President Mbeki to appoint someone who is more up to the task of keeping South Africa healthy. [Applause.]
Mr L V J NGCULU: Madam Deputy Speaker, hon members, dear comrades, we start by proclaiming our unequivocal support for the budget before us today. No one can deny in the space of a mere nine years the Government has brought changes that have completely confounded both friend and foe. [Applause.] Indeed, we have responded to the challenge of our epoch, that of transforming ourselves from the status of object of history to that of masters of history. [Applause.]
The profound changes we have made in South Africa may appear to have made the distance traversed seem so short and the end so sudden. A true testimony to the fact that we are, indeed masters of our history is the Budget introduced by the Minister of Finance in February 2003, which was hailed by all as a good budget: a budget that allocated more money to social spending, with Health getting significant increases.
Yesterday women and children could not access free medical care at places nearer to where they lived. Today we boast of the monuments of freedom by the number of clinics and hospitals dotted across the length and breadth of our country. Where it could have taken kilometres to reach them, now the clinics are nearby.
Yesterday some hospitals were dilapidated and in a poor state. Today, through the Hospital Revitalisation Programme, we have seen great improvements in hospitals, including facelifts, refurbishment as well as decentralised management capacity. We have at least two major projects per province to result in brand-new state-of-the-art hospitals.
Yesterday the quality of care and service to the patients was far from satisfactory. Today we can boast of improvements in this regard, through Batho Pele, the Patients Rights Charter and the National Policy on Quality. These policies are aimed at improving the quality of care by giving patients the opportunity to complain about service, strengthening the supervisory systems, providing for accreditation for health facilities and also for peer review systems. The national patients complaint system has been strengthened together with the system to monitor the conducting of patient satisfaction surveys and the implementation of corrective measures. Patients and communities now have mechanisms to raise their problems with regard to treatment and service. We will continue to strive for a more caring society and a responsive health system.
Yesterday many children left home hungry and left school hungry, which undermined significantly their capacity to learn and nutritional wellbeing. Today the Integrated Nutrition Programme has seen a dramatic jump from R500 million to R1 billion. There is a strong emphasis on standardised menus and food fortification.
HIV/Aids continues to present us with serious challenges. It is a challenge the Government has grasped with both hands. We are indeed gratified to see a marked increase in the allocation to enhance the response to HIV/Aids, STIs and TB to the tune of R3,3 billion over the MTEF period. Obviously we base our response to HIV/Aids on the comprehensive strategic plan that addresses prevention, treatment and care, research and human rights. Our prevention programme is regarded as the best on the continent.
Most provinces are now extending PMTCT programmes to more facilities. By the end of 2002, as regards VCT facilities these were between 100 and 982 sites throughout the country. Home-based care facilities have been introduced, exceeding the target given by Cabinet of 500 sites by 2002.
The national Department of Health has initiated a range of activities to assist provinces with some of these programmes. These included the appointment of co-ordinators and administrative staff in key programmes of voluntary counselling and testing, home-based care and PMTCT. Already, 2 000 home-based care-givers have been trained nationally, together with 180 master trainers for VCT, ie 20 per province.
A number of measures are being implemented in the arena of treatment, including the early effective treatment of opportunistic infections, strengthening the immune system including improved nutrition and the use of antiretroviral therapy at appropriate stages of illness. There are measures that the Government is involved in that focus on lowering the cost of treatment, including the legislative process. The clarion call that all of us should respond to is the need to embrace the call for partnership and extending a caring hand of hope.
The issues I have highlighted above are not new. They are found in Government documentation, either in the 17 April 2002 statement or the 19 March 2003 statement. These statements are further testimony to the commitment of our Government to meeting its obligations.
Many South Africans and some who are not South African, including the president of UNAIDS and the executive director of the Global Fund have hailed our programmes and achievements. Yet as South Africans we treat this as another political football with some of us prepared to celebrate death as long as it fits a particular agenda. We watched with awe and curiosity the alacrity with which certain circles tried to seize on the Human Rights Commission’s 4th Report on Economic and Social Rights. As usual the negative was seized on as the defining aspect of the report. This is not the platform to engage in this report. Allow me, however, to highlight just two aspects of it.
Firstly, the first shortcoming of this report is that the context is limited to constitutional aspects of the assessment, but falls short of the changing dynamics, of South Africa. The South Africa of 2000 is different from the South Africa of 2003. Thus the report fails to acknowledge the simple fact of where the country comes from, the progress the country continues to make and the way forward, including improvement in the quality of life especially of the poor.
Secondly, on HIV/Aids, the report seems to confuse the matter of PMTCT and access to antiretrovirals in the public health system. It thus calls on the Government to implement the Constitutional Court ruling on Nevirapine as if there has been a dispute on this. It calls for allocation of more resources to HIV/Aids treatment without examining the totality of the campaign, the comprehensive issue of treatment itself and progressively increasing budgets to this programme. These are two of the shortcomings I have observed in the Human Rights Commission’s report.
We have thus highlighted the two aspects above owing to space and time. We hope that the Human Rights Commission shall recognise these shortcomings. We, however, accept these shortcomings believing that they arose as result of its endeavour to execute its responsibility.
There are, of course, some people who continue to peddle a sustained lie that our Government is uncaring and doing nothing in the field of health in general and HIV/Aids in particular. We are daily treated to the platitudinous refrain that 600 people die every day. We are treated to an insidious argument that has tended to trivialise human suffering in order to serve egos and nefarious agendas that scavenge on the suffering and death of our people.
Some have declared a civil disobedience to a Government led by a movement that steadily fought for this democracy. The people that we as the portfolio committee have met and listened to are pioneering this campaign. In this campaign no one is immune. A command is issued to agree with a particular view and any attempt to engage in dialogue is treated with scorn and abuse. Elected representatives of the people are called murderers, a serious attack on the very tenets of democracy.
We stand on this podium calling on those in the struggle for a better health care system to together join hands for the challenge is too huge for any single individual or group to arrogate that responsibility to itself. It is in terms of this struggle that we should respond to the Cabinet’s call for partnership and joining hands together.
All of us need to put our shoulders to the wheel and lend a helping hand in the struggle for better health. The road is still long and complex. The legacy we inherited shall not be eradicated in the space of a mere nine years. This is a mess that took centuries to create. We never stood on the pavements wailing and crying about this legacy. We rolled up our sleeves and faced the challenge with the same zeal and commitment that we had when we faced the challenge to remove the obnoxious system of apartheid. We did so united in action.
We are approaching the first decade of freedom with a sense of satisfaction and confidence, satisfied that we have managed in the space of a mere nine years to remove the dark clouds of despair and usher in a new season of hope. We are confident that the season of hope has imbued our people with a sense of pride that their organisation, the ANC, has remained true to them.
No organisation in South Africa today has policies and programmes that enjoy the accolades of the people of South Africa and the world other than the ANC. [Applause.] We salute the Minister and the Deputy Minister of Health for the excellent execution of their responsibilities. There are still challenges that lie ahead, but we are indeed humbled by the fact that the tide has turned.
We have listened attentively to the speech by the hon Sandy Kalyan. As is characteristic, nothing positive comes out of the DA. As the Afrikaans saying goes:
Al dra ‘n aap ‘n goue ring, hy bly nog maar ‘n lelike ding. [Gelag.] [One cannot make a silk purse out of a sow’s ear. [Laughter.]
Indeed, in the context of listening quite attentively to find out what policy interventions, policy challenges and policy directions the DA was going to offer, one was left with a surprising lack of depth, lack of policy direction, lack of direction, doom and gloom as a characteristic landmark of the DA. We in the ANC, we the people of South Africa, remain convinced that the path we have chosen is indeed the correct path. No one can deny that in the space of a mere nine years, the South Africa of today is better than the South Africa of yesterday. [Applause.]
Dr R RABINOWITZ: Madam Deputy Speaker, the IFP congratulates the hon Ministers of Finance and Health, the DG and his team and the probing committee chair on a health budget that is moving in the right direction. But in my nine years of work with the health portfolio committee, I have seen some problems that persist and others that become steadily worse. Therefore, I make no apologies for focusing on the dangers that lie ahead and highlighting weaknesses in Government policy that render much of the hard work done by the department futile.
The IFP supports the budget, but we are going to give constructive criticism as usual, hoping that, as we have influenced some policies in the past, we will continue to do so in the future. When we speak of health and medicine it is necessary that we think increasingly about war. Had we confronted the Aids war at the outset, we would not have landed ourselves in the current quagmire. We are only into the third year of the new millennium, but it is high time we paid attention to the defining feature of this century namely biotechnology, which has the capacity to change the face of living, healing, war and dying. Like all other technologies it can be used creatively or destructively.
While gene therapy has the potential to halt anthrax, Aids and TB, it also has the capacity to design biological agents that put warfare into the realm of nightmare and science fiction. Our own preoccupation with the TB- Aids-Malaria triad, should not blind us to the possibility of South Africa becoming a haven for maverick bioterrorism. And even as we begin to make progress with the war against Aids, we need to build watertight regulations around this field of research and experimentation to prevent the horrors of science fiction becoming the scourge of reality.
To give hon members some idea of the scope of bioterrorists, I shall give these examples: Polio viruses have recently been made synthetically from mail-ordered DNA, using genetic information available on the web, and in future any virus can be engineered in this way; more lethal forms of anthrax or smallpox can be engineered to become resistant to normal methods of destroying them; and microbes living normally in the gut can be engineered to create disease-producing toxins.
The list is as long as the human imagination. South Africa has as much potential to utilise the tools of biotechnology as most other countries in the world, as was recently proved by Fute the calf, a private endeavour. But we have not clarified the ethical boundaries in which the research should be done, nor do we have adequate controls to ensure that it remains safe. While we have clear records of having destroyed our nuclear arsenal, we do not have such clear confirmation of the whereabouts of apartheid’s biological arsenal. Other than funding the MRC, mainly for vaccine research, very little money is being dedicated to biotechnology in health.
As to the current war in which we are engaged, that against Aids and TB, the budget per se is moving in the right direction. But as the Finance Minister told the Millennium Fund director last year, it is not so much money we need as the capacity to use it.
The ethics that inform our Aids strategy also leave much to be desired. Other than preventive advocacy, most of the good that is done for people with HIV or Aids has been squeezed out of Government, either by the TAC, opposition parties or the courts. The treatment of pregnant mothers and rape victims are examples this. Meantime the Aids epidemic grows apace; TB is on the increase, as is the resistant form of TB which is ten times more difficult to treat and more dangerous to halt.
The way to beat both these diseases is to have sound ethical principles, use rights fairly, increase provincial autonomy and expand partnerships with civil society. A mere R43 million is budgeted for NGOs. Last year 34 projects were approved but many lacked capacity to access funds timeously. There must be accountability, but Government makes the process complex and does not adequately or effectively support communities, traditional leaders, traditional healers or international donors. Conditional grants are admittedly higher but remain difficult to spend because the mechanisms are bureaucratic. Centrist controls still hamper progress on the Aids front. It is almost a year since the Global Fund offered to fund the KwaZulu-Natal Enhancing Care Initiative, which was stalled by red tape and politics.
We still have anonymous testing, people who refuse to know their HIV status and no laws that realistically assist people infected knowingly by a sex partner. The IFP has draft Bills that effectively criminalise the wilful transmission of HIV which we are sharing with the Justice department, and we support their efforts to have alleged sexual offenders tested.
The IFP’s view on Aids therapy is to treat where there is capacity, beginning somewhere and expanding our care. Do away with anonymous testing, broaden pre-test counselling, let every pregnant woman know if she has HIV and all who test positive should be told their status. Knowledge protects both the infected and the uninfected. And why, Madam Minister, should we as MPs have access to antiretrovirals at public expense, while members of the public are denied such treatment?
On the issue of health funding and the medical schemes, we have yet another bad dream. No matter how the medical schemes council engineer matters, schemes are becoming more expensive with fewer members. The IFP proposal is for all who earn to be on an enforced scheme of their choice, with a Government low-cost scheme offering basic care as one of the options. Make greater use of private-public partnerships to bridge the gap between public and private sector care and bring down costs in the private sector. If we privatise the entire chain of medicine distribution to the state from producer to user, there would be less theft and lower prices.
As the costs of medicine and technology soar, we should focus more money and attention on homeopathy, ayurveda, Chinese medicine, herbalism, naturopathy and traditional medicines. We should strengthen our partnerships with traditional healers through collaborative workshop programmes and research. Hundreds of people are taking sutherlandia and the African potato, the basis of Moducare, but instead of encouraging research in these products we have Government encouraging research into Russian electromagnetism.
We have created a jumbled council for alternative health care, mixing well- trained practitioners in established ancient health paradigms, with fly-by- night therapists who have done weekend courses. It is virtually impossible for the public to differentiate between the categories. The accountability and interaction with conventional medicine that would be encouraged by well- trained professionals is diluted - in fact, neutralised - by the wishes of beauticians and holistic healers. These are valuable complementary therapists, but should not be confused with doctors trained for six years.
Government’s logic in the formulation of this council remains difficult to understand. We welcome the regulation of traditional healers and hope that it will lay the foundation for better collaboration between orthodox medicine than has been laid by the alternative health council. And we feel that we must try, however inefficient and lacking in funds and accountability the alternative council, to make greater use of alternative health care to the public’s advantage.
We are on a path of moral renewal and hear much about a health charter. The Minister referred to a turnaround, but it seems that much of the turning around is done on the spot. Right money and right words are of little value without integrity, clarity, accountability, right understanding and right action. We are in large measure wasting our talent, our human goodwill and the lives of our people. Let us use the money budgeted for health beyond politics to contribute to healing and happiness. [Applause].
Dr S J GOUS: Agb Adjunk-Speaker, gesondheid was nog nooit die plek om ‘n politieke loopbaan te bevorder nie. Om die waarheid te sê, ek dink dis ‘n politieke doodloopstraat. Wanneer ons hierdie stelling ontleed, is die redes eintlik baie eenvoudig en voor die hand liggend. Hoe beter en vollediger die gesondheidsdiens is wat ‘n instansie lewer, hoe groter word die verwagtings van die publiek. Dink net ‘n oomblik daaroor. Almal verwag die nuutste en die mees gevorderde tegnologie wanneer dit by hul eie gesondheid kom. Kortliks: net die beste is goed genoeg. Voeg nou hierby ‘n baie vinnig ontwikkelende wetenskap met hoogs gevorderde tegnologie mens kan verstaan dat die eise van die publiek amper onmoontlik begin word.
Die enigste probleem is, iemand moet hiervoor betaal. Ons moet aanvaar dat mediese inflasie as ‘n reël sowat 3% hoër is as normale inflasie dwarsoor die wêreld. Dit is juis as gevolg van die hoë tegnologie, en ons in Suid- Afrika is nog verder onderhewig aan die rand/dollar-skommelings. Die Suid- Afrikaanse gesondheidsstelsel gaan verder ook gebuk onder die dubbele las van grootskaalse armoede en Vigs. Voeg daarby ‘n paar natuurlike rampe soos droogtes en vloede en mens kan verstaan dat die gesondheidsstelsel nie anders kan as om te kapituleer onder hierdie druk nie. (Translation of Afrikaans paragraphs follows.)
[Dr S J GOUS: Hon Deputy Speaker, health has never been the place to promote a political career. As a matter of fact, I think it is a political cul de sac. When we analyse this statement the reasons are actually very simply and obvious. The better and more complete the health service an institution delivers, the greater the expectations of the public become. Think about that for a moment. Everyone expects the latest and most advanced technology when it comes to their own health. In a nutshell only the best is good enough. Add to this a very rapidly developing science with highly advanced technology and you can understand that the demands of the public are becoming virtually impossible.
The only problem is, someone has to pay for this. We should accept that as a rule medical inflation is 3% higher than normal inflation everywhere in the world. This is precisely as a result of the advanced technology, and we in South Africa are also subjected to the rand/dollar fluctuations. Furthermore the South African health system is saddled with the double burden of largescale poverty and Aids. Add to that a few natural disasters such as droughts and floods and one can understand that the health system has no option but to capitulate under this pressure.]
What I am saying is that health not only has to bear the brunt of disease but also of poverty, Aids and the effects of unemployment and disasters. It therefore becomes clear that health is certainly not the place to promote a political career and throughout our history there has never been a popular Minister of Health. Our current Minister of Health is certainly doing her share to maintain the status quo.
At the same time, health budgets seem to be a natural target or victim when funds need to be diverted or a budget seriously cut. This brings me to the concept of equity. Provinces receive their funds in two ways. Firstly, via equity share and secondly, via conditional grant. When we consider equity, we must not only look at interprovincial inequity, but also consider equity within the provinces themselves.
Interprovincial inequity remains a major challenge facing the public health system of South Africa. Recent research by the Department of Health indicates that the inequities in per capita expenditure in the public health services have actually deepened. This despite serious efforts to try and rectify the situation. The fact is that fiscal federalism offers limited scope for influencing provincial health allocations.
One of the problems is that the so-called political capacity is dependent on an infrastructure inherited from a previous system. This political capacity determines the size of the equity share or conditional grant. This explains why areas like the Eastern Cape, Limpopo and Mpumalanga have serious difficulties, because they all started from a very low base. As far as the National Department of Health is concerned, they only have a very limited capacity to interfere and can virtually only offer help and advice.
At ground level the result of inequity is non-delivery of transport, ambulances, clinics, medicines, staff and equipment. We are all very much aware of the horror stories that appear in the newspapers almost daily. The point is that many of these stories can be traced back to basic inequity in terms of health funding. In political terms we refer to it as administrative collapse. For the official opposition, of course, it is a source of great excitement and practically the reason for their existence. Over the past few years we have seen some improvement in addressing this inequity and we must not give up now. We as parliamentarians must accept the challenge to rectify the inequity and that these provinces need to be supported and not vilified.
HIV/Aids is such a serious threat to this country that this entire debate could have been dedicated to HIV/Aids. It is interesting to note that whenever we mention the terms HIV/Aids, it implies that the Human Immunosuppressive Virus is the cause of the Aids. Any true dissident should therefore never refer to HIV/Aids but simply to Aids. The only outstanding matter in this debate is the use of anti-retrovirals for Aids sufferers. When one looks at the full page advert that Government placed in March, it reads as follows:
Because antiretroviral therapy can improve the health of people living with HIV/Aids if used appropriately, Government continues to address barriers to introducing it, namely high prices, weaknesses in health infrastructure and treatment compliance.
This statement seems to confirm the position of the New NP, which has over a long period of time maintained that the use of antiretrovirals for Aids sufferers is inevitable and simply a question of time. One of the barriers mentioned is cost. The fact is that Government has not used any of the very powerful tools available to bring down cost. Think of the tender process and genetic licensing and manufacturing.
If one considers the argument that antiretrovirals are not a cure, the implication is that we should also not bother treating people with diabetes, hypertension and many other diseases. The resistance issue is exactly the same as with antibiotics. The lack of infrastructure does not only apply to HIV/Aids and antiretrovirals but to the health system as a whole. The South African Medical Association, or Sama, must be congratulated and supported in their efforts to train doctors in the use of antiretrovirals.
The new buzz word is SARS and it is not the one that collects the taxes. We are referring to Serious Acute Respiratory Syndrome. At the moment its most destructive effects are being experienced on the economy and tourism of Asian countries. The fact is that it also has the potential to cause millions of fatalities. At the moment, it is said to have a 50% mortality rate in people older than 60 years of age. One shudders to think what the effect is going to be on people who are immunocompromised, as with Aids. It appears not to be a case of if it will come to South Africa, but when. It is clear that a whole new challenge awaits our health system. In this regard it must be said that our Government’s opposition to Taiwan becoming a member of the World Health Organisation is now coming back to haunt us.
Om op te som, die 2003 Gesondheidsbegroting reflekteer ‘n verhoging in uitgawes in bykans alle aspekte. Veral kritiese elemente wat dienslewering verseker, het die nodige finansiële ondersteuning gekry. Hier dink ons aan voedingsprogramme, hospitaalhernuwingsplanne en die uitgebreide reaksie op MIV/Vigs. Die behoud van hoogs gekwalifiseerde gesondheidswerkers en die verspreiding van gesondheidswerkers in die landelike gebiede het ook die nodige aandag gekry. (Translation of Afrikaans paragraph follows.)
[To sum up, the 2003 Health budget reflects an increase in expenditure in virtually all aspects. Critical elements, in particular, which ensure service delivery, received the necessary financial support. Here we are thinking of feeding schemes, hospital renewal plans and the comprehensive reaction to HIV/Aids. The retaining of highly qualified health workers and the deployment of health workers in the rural areas have also received the necessary attention.]
All that is left now, is to thank the Director-Genearal, Dr Ntsaluba, and his team for a task well done under very difficult conditions. Last, but definitely not least, I want to thank the Chairperson of the Portfolio Committee on Health, the hon Mr L V J Ngculu, for his very able and inspiring leadership in the portfolio committee.
Mrs S F BALOYI: Madam Speaker, hon Minister and hon members, I would have loved to respond to the hon Kalyan, but I shall not dignify her utterances, because some people suffer from chronic verbal diarrhoea.
I rise in support of the 2003-04 Health Vote. Allow me to thank Dr Ayanda Ntsaluba and his team, whom I would have loved to mention by name had time permitted, for their commitment and dedication to the delivery of quality health care in our country.
I believe that there must have been times when they thought we were more than a thorn in their flesh. However, the many briefings, discussions and interactions we have had over the years with both the national and the provincial health departments have proved, during the recent briefings, to have been essential. We are now seeing and experiencing the fruits of this, from the improved delivery of our health services, as outlined, through to our own oversight role.
Thanks to Comrade James Ngculu for his able leadership, which has enriched the functioning of both the study group and the portfolio committee. [Applause.] To Lynette, always in the background, your hard work has not gone unnoticed.
As we enter the first decade of our democratically elected Government, we do so proud of its achievements in the delivery of health care services, taking cognisance of our past. We cannot lose sight of where we come from, where we are and what we hope our health services will be like in the future as we grapple with the legacies and injustices of the past, as well as the inequities which have resulted in huge backlogs that affect processes of effective, quality service delivery. Of importance is that the department is doing everything possible to ensure that services are provided, even in the most remote rural villages, no matter how basic the service is.
Health care needs are many and varied, thus the need for Government to try and provide a service that will ensure that all these needs are covered, and not just concentrate on one specific health need, as some people would like to see happening. That way the majority of our people can enjoy minimum basic health care services. The quality of care and service provided is spread to most of the rural areas through mobile clinics. Some are in the process of being introduced even in the remotest areas that are difficult to reach, for example in the Eastern Cape, where we know that the terrain is very bad.
Children, pregnant women and the indigent continue to receive free health care. As for the President’s announcement regarding free health care to the disabled, we hope that this will be implemented as soon as possible. Our Government continues to deliver improved care on a daily basis to many who never before had such services.
For a mother who has watched her child die in her arms or on her back whilst in search of a clinic to get help, there is now hope. She now walks a short distance to the nearest clinic. To her that is delivery. For those who have a specialist at their beck and call, getting such help is not important, because this is not high technology care. To us this is basic, life-saving care.
The WHO norm for walking to the nearest clinic is 5km, but our Government is making sure that services are accessible to all by building clinics within the communities or as close to them as possible. We have reached high immunisation levels: where before our children used to die from preventable communicable diseases, we now see far less succumbing to diseases like measles and polio. We want to have a look at the impact of HIV/Aids on children. We, therefore, call on all mothers and communities to bring their children to the clinics, to come and have the life-saving injections that are given free of charge.
We are encouraged by the provincial briefings that show that polio and measles have almost been eradicated in our country, because of our immunisation programme, which is very effective. In fact many young mothers do not know what a child with measles looks like today. We would also like to applaud the Minister for her collaboration with and support for neighbouring countries such as Swaziland and Lesotho, to make sure that polio is permanently eradicated.
This year we have seen substantial increases in the Health budget. The Ministry’s and Treasury’s efforts to make meaningful service delivery affordable are applauded. However, although the Health budget has increased in nominal terms, health inflation is higher than general inflation and, therefore, absorbs a substantial portion of growth as most pharmaceuticals and medical equipment are very expensive and important.
Currently, the rate is about 18%. This negates the growth in real terms. This fact needs to be taken into consideration when looking at next year’s budget, Minister, to ensure that cuts are not made on key services to fund other services that are thought to be more important, or to address priorities as indicated during the provincial budget hearings, for example by Limpopo and others. My concern is that, in spite of the budgetary increases, interprovincial inequities still remain, as the hon Dr Gous indicated, which is still of major concern.
We are also concerned about the ongoing intraprovincial inequities, where the urban areas are more resourced than the poor, rural areas per capita. The per capita gap seems to be widening. Last year Limpopo spent R586 per capita compared to the Western Cape, which spent R1 261 per capita. This reflects the first and third world standards of care, as the best facilities, equipment and professionals are mainly urban based. The result is that those provinces that are better off continue to render higher standards of care to those who have always enjoyed better care, at the expense of the majority of our rural poor.
This anomaly in the gap needs to be rectified. However, with the many improvements that have been introduced in our health service delivery, we call upon all our people to utilise these services that they were denied before. I am encouraged by the increase and the incentives that will be introduced through this year’s budget to address some of our concerns. Hon Minister, community service still poses a problem in respect of supervision. Systems and structures need to be put in place for monitoring, supervision and the transfer of skills to build up the confidence of interns and enhance the quality of care.
Innovative initiatives have been taken by the provinces of KwaZulu-Natal and Northern Cape, who have entered into exchange and twinning partnership agreements with hospitals in the UK. This is welcome. Such exposure and incentives will keep the morale of nurses high, with the knowledge that there are such opportunities opening up for them. In turn, South Africa’s excellent quality of care system will be transported abroad.
We want to see more programmes where nurses are given the opportunity to go and work abroad in order to gain experience and do research in nursing, and then come back home to plough back their experience and knowledge. So far, 14 nurses from the Northern Cape have been in this programme and some others will soon go abroad.
Despite reports about the brain drain, we know that not all health professionals go overseas because they are emigrating. The majority go abroad to gain social and professional experience. Many health professionals have returned and have said that, upon reflection, the grass in not always greener on the other side. It is just that these professionals who return are not headline news for the media.
The capital health expenditure allocation has tripled between 1999 and
- There have been great improvements on this grant, thus improvements in the quality of care such as major upgrading, replacement and transformation of hospitals are essential in that respect. We all know and have seen some of the old dilapidated hospitals that date back to the missionary days. We need hospitals and clinics that are a reflection of our new South Africa to restore the dignity of our people after past humiliation, where they were accorded very little privacy. Our people need to see and experience the difference in the way they are now cared for, as compared to the past. Hence the number of hospitals the Minister mentioned to, and we are very proud of this great achievement.
Minister, provinces that have large grants requested that you assist them in absorbing these budgets. Health care is a human-intensive resource service, therefore the decentralisation of the specialities to poor areas is critical. In training these are some of the categories that need to be sorted out, so that these people can be sent to the rural areas where people do not want to go. The quality of health care has improved drastically.
I would also like to say, hon Minister, that HIV/Aids is not a respector of persons. Some of our nurses are infected and affected by HIV/Aids, and we hope that this will also be taken into consideration. Yesterday was Nurses Day. We want to thank all our nurses …
The CHAIRPERSON OF COMMITTEES: Order! Hon member, your time has expired.
Mrs S F BALOYI: Thank you, Chairperson. In conclusion, I just want to say that the tide is turning. The ANC is moving ahead. We are on track in securing a caring, humane society for all South Africans. [Applause.]
Ms C DUDLEY: Chairman, the ACDP rejects the Health budget, primarily due to the Department of Health’s abortion policy and plans to increase the number of termination of pregnancy facilities throughout South Africa. During budget presentations last month, departmental officials revealed plans to expand services through 24-hour maternity facilities, saying that this would make the abortion procedure of foetuses that are 12 weeks or older safer - not for the baby, of course.
Statistics reveal that over 30% of abortions in South Africa are performed after 12 weeks, but health workers in many hospitals report that the figure is closer to 60%. Government’s response is to promise hospitals that the 12- week limit to abortion on demand will increase to 15 weeks, and the Choice on Termination of Pregnancy Amendment Bill is currently in the pipeline.
The department has also declared its intention to focus on a more widespread use of abortion drugs, which, according to health workers, are already being used. These drugs, known to be harmful to women, are given to induce abortions at home, which are later recorded at health facilities as miscarriages.
This strategy circumvents some of the challenges that the department has with health workers who consider abortion to be murder. This way they are forced to assist. Exhausted and emotionally drained health workers report having to pick up the tiny babies, often still making sounds, putting them in paper bags and disposing of them in incinerators. Others, I believe, go to their death eaten alive by chemicals, while some babies born alive are thrown in buckets to drown or are just left to die.
The ACDP, secondly, supports calls for antiretroviral treatment to be available through the public health system. The desperation of health care workers facing the daily struggle of caring hopelessly for millions of victims is tragic and delays in providing treatment are impacting negatively on the economy. Although antiretroviral drugs are not a cure, they clearly prolong and improve the quality of the life of Aids sufferers, who are then able to lead productive lives working and caring for their own families. This is a huge consideration in the light of the orphan statistics.
The use of antiretrovirals in the US led to a dramatic decline in the deaths of Aids patients admitted to hospitals. As the pharmaceutical bill increased, the in-patient bill decreased and in the end the drugs paid for themselves. Countries like Brazil have also experienced this cost benefit and, having witnessed the desperation in overcrowded South African hospital wards that are filled with HIV/Aids patients waiting to die or commit suicide, this option looks even better.
Medical data also shows that antiretroviral therapy significantly decreases the incidence of TB and may be a powerful strategy for the control of HIV- associated TB. The ACDP calls on Government to declare a state of emergency as HIV/Aids-related illnesses take, we are told, in excess of 1 700 South African lives per day. Finances must be made available for urgent implementation of antiretroviral therapy, compulsory testing and notification of this deadly infectious disease.
State hospitals, of course, face other problems too, with dire needs in oncology wards and the absence of even basic nutrition for many cancer patients. The Minister’s efforts to prioritise nutrition and natural medical solutions are commendable. Sadly, though, the lack of foresight in handling HIV/Aids has totally discredited these valiant efforts, which are seen instead as diversionary tactics. It is also true that prevention is key in the fight against HIV/Aids, but Government has missed the boat completely, with LoveLife being its official prevention campaign.
Abstaining from sex outside of marriage and being faithful in marriage is the only honest message with proven results. Mixed messages on condoms, masturbation, oral sex and homosexual lifestyles dilute the abstinence message and fuel the pandemic. Enough is enough! Hon Minister, South Africa is giving you notice … [Time expired.]
Mrs N C NKABINDE: Chairperson, hon members, ladies and gentlemen, the definition of ``health’’ contained in the constitution of the World Health Organisation acknowledges the broader dimensions of health. It states, and I quote:
Health is the state of complete physical, mental and social wellbeing, and not merely the absence of diseases or infirmity. It can therefore be said that health is the product of a person’s positive interaction with his or her total environment.
All of us in this House know that health for all is vital for human security. To put it simply, unless people are healthy we will not see economic growth, stability, human dignity or the fulfilment of human rights, and we will not be at peace. I do not mean that health is everything, but good health is essential to secure the future of our country.
We live in a country where we tend to focus on inequities and crises - and, indeed, there are many. Let us, in the same vein, not forget what has been achieved by Government in the past few years - achievements such as the addressing of mental illnesses, which are a major cause of suffering. Million of children are being vaccinated against common childhood illnesses such as measles, diphtheria, whooping cough, tetanus and TB.
We have clear strategies to confront TB and malaria. However, the UDM is still of the opinion that we do not have clear strategies for confronting HIV/Aids. HIV/Aids should be made a national priority and a notifiable disease.
Allow me to salute thousands of dedicated health workers, nurses and doctors who made these achievements possible, even though they work under difficult conditions. It is important for the public sector and civil society to join hands with Government in the fight against diseases of poverty such as undernutrition, unsafe sex, unsafe water, poor sanitation and poor hygiene, by empowering affected communities to take action for equity.
We need to invest in a better health system, bringing benefits to those who need them. The UDM welcomes and supports the budget which has been tabled before this House. The budget before us represents one of the pillars of Government’s service delivery. The UDM is pleased to note that there is an increase on HIV/Aids programmes compared to last year’s budget, though we still have reservations about the way this programme is being implemented. When one considers the number of years Aids has been in existence and its impact on families, communities and the economy, one can bear with me when I say that little has been done.
After the Constitutional Court ruling, the UDM was hoping that a clear programme would be developed. The President, in his state of the nation address on 14th February, and particularly his announcement on the proposed full compliance with the Constitutional Court ruling on HIV/Aids treatment, gave many hope. However, it is disappointing to note that some provinces are still not complying. For example, in the Eastern Cape, out of 68 hospitals, only nine are offering Nevirapine. In Mpumalanga only six hospitals are offering this service.
The UDM appreciates the number of new clinics and hospitals, but express its concern about the availability of this service in some institutions, because some do not provide a 24-hour service. Some of the service providers are not user-friendly. The shortage of ambulances, especially in rural areas, needs serious attention. The UDM would appreciate it if a proper programme involving local government, amakhosi, the Department of Transport and the Department of Health could be developed to ensure the maintenance of roads, as well as the availability and accessibility of health services to everyone regardless of class or area of residence.
Sengivala-ke ngiyacela kuNgqongqoshe ohloniphekile ukuthi ake avakashele lezi zibhedlela [In conclusion, I would like to ask the hon Minister to visit the following hospitals]:
Prince Mshiyeni - nicknamed ``Mshiye aze afe’’, which means that one leaves a person there to die - Edendale, Hlabisa, and Ngwelezane, especially on weekends and public holidays. [Applause.]
Dr E E JASSAT: Mr Chairman, hon Minister, hon members, in this second decade of the HIV/Aids epidemic no cure or vaccine has been discovered. The epidemic continues unchecked, with African countries at all levels of society bearing the heaviest burdens of the scourge.
The global commitment to confront Aids has never been higher. The pronouncements of African political leaders attest to their recognition of the problems posed by HIV/Aids, and the readiness to fight the epidemic. Yet the overall response and actions are much less than optimal.
It is time we get our priorities right. No terrorist attack or war has ever affected the lives of 50 million people the way HIV/Aids has done. Of course, Aids affects everyone. Seventy-five percent of these people live in Africa. Indeed, Africa is a continent in crisis. Whilst Africa represents 10% of the world population, it accounts for 83% of deaths due to Aids, and 95% of orphans due to this epidemic.
We are informed that in Botswana 39% of adults are infected with HIV/Aids. In South Africa 20% are infected. In fact, we in this country have the largest number of people living with Aids - a massive and staggering 5 million people. Interestingly, the prevalence rate is very low in North Africa. Algeria has a prevalence rate of 0,1%, Morocco, 0,03% and Libya, 0,05%. The reason for this low prevalence should encourage us in the southern tip of Africa to study these societies and their sexual behaviour patterns.
Previously the HIV/Aids scenario was one of doom and gloom. However, we now believe that the whole process can be reversed if we act systematically, with vigour and haste. The consequences of inaction are too horrendous to contemplate. First, the demographic consequences we face would be the lowering of life expectancy, which could decline to about 30 years in countries hit by Aids, such as Botswana, Mozambique, Namibia, Swaziland, Zimbabwe, Lesotho, Malawi, Ruanda and South Africa.
Premature death will lead to a shortage of labour, as well as increased and new needs for public welfare. For unknown reasons, HIV/Aids rates are extremely high amongst teachers in our country, leading to teacher shortages and a negative impact on education. This will be replicated among our agricultural workers, Defence Force members, health personnel and various other individuals.
The impact on health care is already being felt, with hospitals increasingly treating opportunistic infections such as tuberculosis and fungal infections. In many cases HIV/Aids patients take up more that 50% of the beds in some hospitals. In sub-Saharan Africa the annual direct medical cost of Aids has been estimated at about $30 per capita, at a time when annual overall public health spending is less that $10 per capita for most African countries.
After two decades of fighting against the spread of HIV/Aids, strategies that work have been identified and need to be implemented. These are advocacy and establishing an enabling environment; education and communication, including peer education; using the mass media; the availability and use of condoms, as well as other safe-sex practices; voluntary counselling, testing and referrals; and assistance in improving the lives of people, thus getting rid of poverty, involving families and parents through home-based care.
Others are reaching out to the youth who are especially at risk through Love Life - and I differ with the previous speaker on this - and working towards finding a prophylactic and eventually a curative vaccine. This has been taken up by the South African vaccine initiative. There is a need for our MRC to initiate research to find indigenous treatment for those who are already suffering from this illness. Finally, of course, there is the offering of antiretroviral treatment to those who need it and can comply with the process.
Although HIV/Aids is threatening every part of the world, Africa is the hardest hit. Aids is not only a health crisis in Africa, but is also a political and social economic crisis. Aids is turning back the clock of development and threatening political stability. Aids is taking its toll in at least five areas, namely population, education, health, agriculture, the economy and business.
However, the good news is that there is hope. Broad-based, committed strategies can eventually turn the tide if they are developed timeously, applied vigorously and disseminated widely. Aids prevention strategies that focus on the youth must be innovative, creative and comprehensive. They must address both individual behaviour that places young people at risk, and the various social, cultural and economic conditions that contribute to risky behaviour.
A concerted strategy to end Aids is well within the world’s financial capacity. Last year at the Aids summit in Abuja, the Secretary-General of the United Nations, Kofi Annan, formally proposed a global fund for HIV/Aids, TB and Malaria. He asked for $7 billion to $10 billion annually from all sources. Unfortunately this target has not been met. However, we in South Africa will be beneficiaries of this move, as our Minister has indicated.
What is needed at this stage of the epidemic is leadership at the highest political level, and this we do have. Our Deputy President leads this group. It is the single most important factor in reversing the epidemic. It is in the light of this that we welcome the New Partnership for Africa’s Development, Nepad, which aims to formulate a comprehensive programme, fashioned by African leaders themselves. Its goals, with a view to tackling the HIV/Aids pandemic, are, amongst others, lessening poverty, reducing infant and maternal mortalities, schooling for every child, enforcing gender equality and boosting the growth rate throughout Africa.
The Nepad document, however, warns, and I quote:
One of the major impediments facing African development efforts is the widespread incidence of communicable diseases, HIV/Aids, tuberculosis and malaria. Unless these epidemics are brought under control, real gain in human development will remain an impossible hope.
We as the ANC component of the health portfolio committee support the health budget.
I have one minute left, and I would like to use it to differ from the diagnosis made by my colleague, Mrs Baloyi. She said that a certain member suffered from verbal diarrhoea. [Laughter.] The same member accused the Minister of looking through rose-coloured spectacles. I would like to offer a diagnosis: I think she is totally blind and needs an eye transplant. [Applause.]
The DEPUTY MINISTER OF HEALTH: Hon Chair and hon members, as this is my first participation in a health debate in my current capacity, I would like to record my appreciation for the warm welcome I have been accorded by the Ministry and the Department of Health, as well as the provincial health MECs, the Chair and members of the Health portfolio committee, and the private health sector.
Dit is ‘n voorreg en ‘n geleentheid vir dienslewering om betrokke te wees by iets wat so die moeite werd is soos gesondheidsorg en mediese dienste vir al ons mense. [It is a privilege and an opportunity for service delivery to be involved in something as worthwhile as health care and medical services for all our people.]
Today I am contributing to the debate on the Health Vote from the specific perspective of someone who has thus far stood outside the health sector and only recently became part of it. This has helped me to appreciate the major gap that exists between perceptions about the public health sector and the reality which prevails within the system. The heat and dust stirred up by reports on substandard facilities, on the poor management of a minority of patients and, unfortunately, on aspects of the Aids programme, tend to obscure the good work that is being done by health workers in many parts of the country every single day - work that benefits millions of our people.
I take pleasure in supporting the Budget Vote on Health, knowing that the major programmes that it supports are well conceived and targeted at improving critical areas of health. However, the reality is that all the efforts of the backroom planners and health workers are, at the end of the day, subjected to a single acid test, and that is the service provided by our hospitals and clinics.
The departments of health at national and provincial level have put in place various measures to improve quality of care. But I would like to suggest that consumer power is one of the most effective guarantees of improved services. It is more than three years since the launch of the so- called National Patients Rights Charter, which sets out in clear terms the basic standards of service members of the public may expect and are entitled to. This was an important and positive step in our health care effort.
It is also encouraging to note that all provincial health departments have introduced uniform complaint systems and that most provinces keep a consolidated complaints register. Over 75% of public sector hospitals and clinics do have functioning complaints mechanisms. It is, therefore, encouraging that patients are beginning to use the complaints system more frequently and I urge them to do so increasingly, where this is justified. Their hand will also be further strengthened with the passing of the National Health Bill that entrenches some of these patients rights.
The Minister has referred to various interventions to improve the working conditions of health professionals, and to reward those who are prepared to serve under difficult circumstances in remote, underdeveloped areas. The process of addressing the future of tertiary services at hospitals in this country and ensuring that they are viable and well-resourced is another critical factor. There is no reason why professional posts in the public- sector tertiary services should not be the most sought after, prestigious positions in the entire national health system. I believe that this is a goal we should be aiming for, and that it is within our reach.
Today I would, therefore, like to appeal to young health professionals who have been nurtured by this country and received this country’s support throughout their schooling and professional training, to stay in South Africa and make a difference where they are most needed. I say this, even though most of those who go overseas actually return to South Africa in due course. I say to them: If your true calling is to bring relief from suffering and ill-health, you would make an infinitely greater contribution here than somewhere else in a rich, highly developed country. By staying here, you would not only be filling a vacant post, but also helping to develop our health system at a crucial stage in our national history.
The quality of patient care depends on many factors in the health care environment and I would like to highlight the importance of two such factors, namely laboratory services and access to safe, effective medicines. The Medicines Control Amendment Act should go a long way towards making medicines more affordable, without sacrificing any of the safeguards that are presently in place.
However, as in most other matters, technology has introduced new risks and new challenges in the area of medicines control. The illegal marketing of medicines across national borders by means of the Internet is a threat to the sound control systems that have developed under the Medicines Control Council, of which we are justifiably proud.
The growth of the Internet has provided opportunities for unscrupulous individuals to advertise and distribute controlled substances, counterfeit medicines and unproven quack remedies. Inspectors of the Department of Health, acting on behalf of the Medicines Control Council, have found that many of these Internet pharmacies exist only in cyberspace. Their stock is often scattered across various countries, chosen because of their weak controls, and the profits are routed through numerous bank accounts around the world.
The smuggling of medicines is another growing problem and the department is aware of individuals and organisations who are facilitating the smuggling of poor-quality medicines into the country. To date six cases have been handed to the SA Police Service for further investigation and prosecution. Effective action against these criminals and other threats to medicine safety demand international co-operation as well as joint action by the governments, the industry and regulatory institutions. We are mindful of the fact that this challenge must be met.
Turning to the matter of laboratory services, the National Health Laboratory Service, NHLS, is beginning to consolidate its four branches that cover the entire country. Members might be aware that the National Institute for Communicable Diseases, NICD, is a specialised entity within the NHLS and combines the strength of two esteemed organisations, namely the Institute for Virology and some sections of the SA Institute for Medical Research.
The NICD already functions as an outreach facility for disease surveillance, research and training in the Southern African region and, in some respects, in the entire continent of Africa. Our vision for the NICD is that it should realise its role more fully in the years to come. Suitable facilities are critical for it to achieve this goal and R33 million has been allocated to upgrade the Biological Safety Level 4 Laboratory and relocate the HIV/Aids unit at the institute.
The HIV/Aids unit of the NCID has expanded rapidly in the last few years and is now the largest section of the institute. It is the only internationally accredited unit outside of the United States for immunological monitoring of the vaccine trials conducted by the Global Vaccine Trials Network. The unit also conducts viral resistance tests for the whole of the SADC region and undertakes the annual testing of the large HIV-prevelance surveys at antenatal clinics nationwide. Although the National Health Laboratory Service is an independent entity, there will be a continued need for Government to invest in this, to enable it to maintain a leading position as a critical resource for our continent in the field of disease control. We should also not underestimate the importance of developing the regional laboratory network throughout the country. When we talk about the need to build health infrastructure for better service delivery, the laboratory system is every bit as critical as hospitals and clinics.
In passing, I wish to share with hon members that as recently as this week, the National Health Laboratory Service announced the commercialisation of a discovery that will drastically reduce the cost of monitoring HIV/Aids patients on antiretroviral treatment. Dr Debbie Glencross discovered a new method of counting white blood cells, which are the key in the management of the disease. This will be taken further by the laboratory and I am sure that hon members will join me in congratulating Dr Glencross and the National Health Laboratory Service on this achievement. Now I wish to turn to the major challenges of the HIV/Aids and TB epidemics. I return to the point I made at the outset. The view from outside the system, as reflected in reports in the media, simply does not accord with the commitment that I have seen within the public health sector of strengthening our ability to face up to the twin scourges of HIV/Aids and TB.
Die feit van die saak is egter ook dat die New NP wel deurlopend en konsekwent ‘n standpunt gehandhaaf het oor ‘n belangrike aspek van die hantering van die MIV/Vigsprobleem en dit gaan spesifiek oor die kwessie van anti-retrovirale middels. [The fact of the matter is also, however, that the New NP has continuously and consistently maintained a position on an important aspect of the handling of the HIV/Aids problem and it deals specifically with the issue of antiretrovirals.]
The consistent view of the New NP on the highly topical issue of the provision of antiretrovirals is a matter of clear public record and was articulated again recently by the national leader of the New NP as follows, and I quote:
We say South Africa has a moral duty to assist millions of our fellow citizens who are infected with HIV/Aids. We, therefore, call on Government to spell out its road map for comprehensively treating millions of South Africans already infected, especially with regard to rolling out the use of antiretrovirals.
We believe that for the millions of people who are living with HIV, a clear, unequivocal commitment from Government would provide great hope for those who need it most, and this needs to happen as soon as possible.
However, apart from this issue, I have come to appreciate the sense of purpose that lies behind a clear programme of action that is unfolding in accordance with the department’s five-year national strategy. The claim that there is no plan for HIV/Aids is simply not true. The challenges that the national, provincial and local health authorities face are enormous and, in some respects, almost overwhelming.
Precisely because of the extent of these challenges, I believe that it is highly desirable that health should be more of an area of commonality and shared objectives, than an area of partisan political contestation. I am not suggesting a suspension of criticism or the unquestioning acceptance of critical action - not at all. What I am arguing for is an underlying constructiveness in the health debate, a solution-oriented approach which gives credit where it is due, and an attempt to find commonality, especially on major issues like HIV/Aids. Of course, it would be up to each of us as individuals to act in such a way that this necessary balance in health debates can be achieved. But with the necessary will, I believe that it can be done.
In conclusion, I have pleasure in recording my appreciation for and give thanks to all those who are working every day for a healthier South Africa, not least the Director-General and the staff of the Department of Health. I also urge all members of this House to support this Vote.
Ek steun graag hierdie begrotingspos. [Applous.] [I take pleasure in supporting this Vote. [Applause.]]
Mrs P TSHWETE: Mr Chairperson and hon members, before I commence with my speech I would like to thank the President, the Deputy President, hon members, the executive and the South African public at large for the support they gave my family and I when I lost my husband. Last weekend we unveiled my husband Steve’s tombstone and we once again felt and witnessed their unfailing love and support. Thank you very much. [Applause.]
Today my speech will focus on primary health care and the district health system, which have soared. I am sure you will agree with me that the principles of democracy, accountability and transparency are alive and well at Government level. Our democratic Government has introduced a number of programmes in the health system.
The basic plan of this programme is primary health care, which is now available to the majority of people in every corner of South Africa. Our Government commands us to work hard, so as to fulfil the mandate we were given by our constituencies and the Constitution. Health services are becoming more affordable, more accessible and more equitable.
I am happy that the process of establishing the district health system is proceeding well. The Department of Health, NGOs, CBOs, communities and even the private sector must be commended for their efforts during the past years.
Ndifuna ukuthetha nje kancinane malunga nempendulo enikwe nguNksz uKalyan
kunye nomama weUDM obethetha ngento yokuba i-ANC ithi myeke aze afe'.
Ndifuna ukubaxelela into yokuba thina kwi-ANC asitsho okokuba myeke aze
afe’. Thina sithi `mnike ukutya, mnike indlu yokuhlala, aphile ubomi
obude’. Ayikho into yokuba umyeke aze afe. [Kwaqhwatywa.] (Translation of
Xhosa paragraph follows.)
[I just want to speak briefly on the response given by Mrs Kalyan, as well
as the woman from the UDM who talked and said that the ANC says, Leave
him to die''. I want to tell them that we, in the ANC, do not say,Leave
him to die’’; we are saying, Give him food, give him a house to live in
and let him live a long life''. There is no such thing asleave him to
die’’. [Applause.]]
Our policy shift from curative to primary health care is about the prevention and controlling of illnesses. This is a major shift from previous top-down approaches. Provinces and local government are exploring ways of working together to ensure that there is functional integration, so that patients can experience similar services regardless of the authority that is providing those services.
The MECs and local government councillors are themselves establishing structures to co-ordinate the delivery of health services at primary level. One example that I know about is in my province, where the MEC for health and the MEC for local government have established a provincial health authority. In fact, last Tuesday both MECs convened a workshop with local government councillors, to plan for the delivery of health services at local government level.
We know that the delay in tabling this national Bill was cause for concern, because it has the potential to provide a clear understanding of co- operative governance and a framework for delivery. I would also like to urge that we work harder to create a single Public Service in this country, because the existence of two public services and different bargaining councils is posing a threat to the integration of health personnel at local level.
I am also happy that the Minister of Health has elaborated on this programme during the Vote. I am sure that this good news will be welcomed by the South African public, in particular people with disabilities. I would like to spell out some of the programmes that Government is implementing in order to expand access to primary health and improve the quality of life of all South Africans.
Today over 300 clinics have been built and upgraded in the Eastern Cape, and 750 new clinics have been built nationally. This is due to our Government’s commitment to ensuring that clinics, even in remote villages, are part of the comprehensive health service. We are also providing something to eat every day to more than 6 million school-going children. The spin-off is that more children are attending school and there is, therefore, less absenteeism and malnutrition.
The challenge for us has been to improve the quality of life of the elderly. To this end thousands of assistance devices, such as hearing aids and wheelchairs, have been distributed throughout the provinces. This has made a difference to the quality of life of our citizens.
We have introduced TB programmes that work. We have in the process co-opted community members to support TB patients, especially in KwaZulu-Natal and the Western Cape. We have created jobs by training lay persons as community health workers. Some of them are here today, sitting in the gallery. They are from Philippi, Victoria Mxenge, Guguletu and Khayelitsha, where I worked before. [Applause.]
This House has approved legislation which will contribute towards the lowering of drug prices. We are happy that the Minister has ensured that this legislation is being implemented as from 2 May 2003.
Kwakhona, ndicela ukuthi gqabagqaba, ndixele okokuba abaya bantu abahleli phaya ngoobani na. Phaya eGuguletu, ngexesha bendingumongakazi, ndisebenze kakhulu. Ndicela ukwazisa ilungu elihloniphekileyo uKalyan okokuba aqaphele iHiv angayifundi encwadini, ngoba bona abayifundi ncwadini, bayazi kubo. Phaya eMxenge kunye naseGuguletu, nasePhillippi … (Translation of Xhosa paragraph follows.)
[Also, I want to explain briefly who those people are that are seated there. During the period I was a nurse in Gugulethu I worked hard. I want to warn the hon member Kalyan not to depend solely on what is extracted from books about HIV, because they do not base their experience solely on books. They have personal experience. In Mxenge, Gugulethu and Phillippi …]
… we have people who go from door to door. It is not true that the only solution to HIV is antiretroviral drugs. She mentioned that there are no VCT people who are trained to deal with HIV patients, but this is not true. We have trained such people. [Applause.] We have amongst us the Qabuka NGO, which is dealing with people infected with HIV. They are going from door to door. [Interjections.]
Hon Kalyan, you are making me come back to you, and I am going to do that because you are disturbing me. The people who are there are trained, and all of them were unemployed. They are now working in the clinics. They were lay counsellors, but we are now talking about community health workers who are working full-time in the clinics. [Applause.] So it is not true to say that there are no trained people. The hon Kalyan does not know what she is talking about.
I also want to take this opportunity to commend the Department of Health for their excellent and inclusive health promotion and education campaigns with respect to reproductive health, and their foresight in directing these campaigns towards our men as well. Perhaps the biggest challenge which our clinics and staff face is to involve men in taking responsibility for their own and their families’ reproductive health.
We would like to urge the Minister of Health to strengthen programmes on women’s health, amongst them the choice on termination of pregnancy. This has decreased the thousands of illegal abortions every year which had resulted in the appalling rate of illnesses and deaths. [Applause.]
Ke ngoko, siyacela kubantu abangazi nto ngokukhutshwa kwezisu (abortions), ngabantwana abacholwa ezitratweni, bathule ngaloo nto, bangathethi ngabakufunde eBhayibileni. [Therefore, we ask those who know nothing about abortions, children found in the streets, to keep quiet about that and not to speak about something they read about in the Bible.]
With regard to cervical and breast cancer screening, we would be happy if the hon the Minister could extend these services to all the rural and urban nodal points identified by the President.
Whenever one takes decisive action to transform an institution after more than 40 years of neglect, there are bound to be people like the hon Kalyan, who are unhappy. Mistakes will also be made. But before we point fingers, we must look at the big picture in the health system, and the big picture looks excellent. I fully support this Health Vote. [Applause.]
Dr P W A MULDER: Chairperson, it is tradition in this House that a new member is congratulated on making a maiden speech, and I want to stick to that tradition and congratulate the previous speaker. [Applause.] But I must also add that it is tradition that the maiden speech is not controversial, thus making it easier, in a sense, to congratulate the speaker.
The most important challenge facing the health systems today is to close the gap between policy initiatives on the one hand and implementation on the other. What makes the health situation worse is that some provinces and departments still underspend allocated funds. This cannot be allowed in a country with so many health problems.
HIV/Aids statistics continue to shock. New statistics estimate that in sub- Saharan Africa almost 30 million people are believed to be living with the disease. Already, almost three quarters of the world’s total number of Aids sufferers are in our part of the world. Mixing politics and health is shortsighted and irresponsible for all of us. The Government’s HIV/Aids policy is a sad example of what happens when politicians take decisions on health issues, instead of leaving that to the medical experts. The HIV/Aids policy still does not provide universal access to antiretroviral drugs for people living with Aids. The Constitutional Court ruled that the Government should roll out Nevirapine on a national basis at public health facilities, and this has not yet been fully complied with. Neither has the requirement that Government devise and implement a comprehensive and co-ordinated programme to progressively enable pregnant women and their new-born children to have access to health care services, in order to combat the mother-to-child transmission of HIV. For me personally it becomes a legal and constitutional question, ie what happens when a Constitutional Court order is not implemented?
Because of international failures and double standards, the recent war in Iraq has caused the loss of thousands of lives. Another war has just begun for people around the world, ie the battle against Sars. However, the same international mistakes are being made again. The outbreak of Sars has highlighted the illogical decision to exclude Taiwan - or any other country, for that matter - from the WHO.
Politics must not be, and should never have been, allowed to influence health issues. We also learned this the hard way in South Africa, in our history. For example, Taiwan is a major transport hub in East Asia, with almost 18 million visitors and 2 million inbound visitors last year. This includes thousands of South Africans.
Surely the world and the WHO needs all countries, including Taiwan, to be engaged in the fight against this deadly disease, much as Taiwan needs WHO on the political front. Can we not keep politics out of these health issues and fight the political fights on another level?
Mme M A SEECO: Modulasetilo, bagaetsho ba ba tlotlegang, go na le dilo tse re di fentseng mo botshelong. UCDP e dumela fa le mo boitekanelong re ka nna bafenyi ba boitekanelo ka kakaretso. Go tlhokega gore mongwe le mongwe a tshameke karolo ya gagwe ka botlalo mo botshelong, gore re tle re nne setshaba se se fodileng. A re boeleng kwa morago kwa setsong, re tshele botshelo ka botlalo, ka dikgato tsa bone di le supa.
Mokwadi mongwe a re kgato ya ntlha ke ya gore lesea le dumela go fepiwa ka maswi, gonne le ka betwa ke dijo tse di thata. Kgato ya bobedi e ka ga ngwana yo o gagabang, yo o sa ntseng a thibiwa mo dikotsing. Kgato ya boraro e ka ga ngwana wa sekolo yo o ithutang ka fa tlase ga tlhokomelo le tataiso. Kgato ya bone e ka ga lekau kgotsa lekgarebe le le simololang go nna le dikgatlhego, le batla mokapelo wa ditoro tsa lona.
Kgato ya botlhano e ka ga mogolo yo o itseelang ditshwetso ka go akanya tsotlhe tse dintle tse a eletsang go nna le tsona, jaaka go nna le bana le khumo. Kgato ya borataro e ka ga mogolo yo o fitlheletseng dikeletso tsa gagwe ka katlego, mme a nna a rotloetsa ba bangwe. Kgato ya bofelo, e le ya bosupa, e ka ga mogodi yo o batlang tlhokomelo le go ka tshegediwa mo botshelong jwa botsofe, a tshetse botshelo jwa gagwe ka botlalo.
Motlotlegi Tona ya Boitekanelo, tekanyetsokabo eno e ka fitlhelela maitlhomo a yona a ntlha a go tokafatsa matshelo a Ma-Aforika Borwa. Go tlola dikgato tsa botshelo go ama boitekanelo ka kakaretso. Tekanyetsokabo eno e ka re tlhabololela matshelo, kago le bodiredi ka kakaretso fa maitlhomo a yona a ka diragatswa. (Translation of Tswana paragraphs follows.!
[Mrs M A SEECO: Chairperson and hon members, there are things that we have defeated in life. The UCDP believes that even in the Health Department we can become victors of health in general. There is need for everyone to play his full role in life, so that we should become a healthy society. Let us go back to our culture and live our lives fully in seven steps.
One writer says that the first step is that a toddler believes that he should be fed with milk, for he could be choked by harder foodstuffs. The second step is a crawling baby, one who is still protected from danger. The third step is a pupil who learns through being guided. The fourth step is a young man or woman who starts to have interests, looking for a partner of his or her dreams.
The fifth step is a mature person who makes his decisions by thinking about all that he wishes to have, such as to have children and wealth. The sixth step is a middle-aged person who has achieved his wishes successfully and has continued to encourage others. The last step, which is the seventh, is an elderly person who wants to be looked after and supported in old age after living his life to the full.
Hon Minister of Health, this budget can achieve its first objective of improving the lives of South Africans. To skip the steps of life affects life in general. This budget can improve our lives, as well as restructuring and services in general, if its objectives can be implemented.]
Some 40% of all South Africans live in poverty and 75% of these live in rural areas, where health services are least developed. There are some clinics which are still closed over weekends. The national Department of Health received an allocation of R8,386 billion in the 2003-04 financial year, which represents an increase of approximately 9% compared to the previous year.
The Department of Health’s budget includes both co-funding for the role that the department plays as co-ordinator of the national health system and transfer funds to provinces for the delivery of health services. The overall amount voted for health amounts to R39 billion and health grants to provinces represent 44% of the total conditional grant allocation in provinces. [Interjections.] [Time expired.]
Dr M S MOGOBA: Chairperson, the debate on health is not only about health and wellbeing, but also about the survival of the nation and of the human species. It should, therefore, be undertaken with all the seriousness that Parliament can muster.
Our Department of Health has tackled health challenges like malaria, cholera and TB with fairly good successes and we would like to encourage them to increase their dedication. What beats me, however, is the half- hearted way in which the HIV/Aids pandemic is being handled. The emphasis on the need for good nutrition in raising the resistance of the body is also welcome, but why continue to downplay the link between HIV and Aids? Why is the Ministry refusing to be emphatic about it? Why should the Government not offer free antiretroviral drugs to all Aids patients? That is surely cheaper than burying hundreds a day, or caring for Aids orphans.
We have seen how the government of China, after many denials and semidenials, had to tackle the Sars danger in their country. This is a lesson to us in this country. When a health hazard threatens this country, it should be tackled head-on. It does not make economic sense to wait until the danger assumes alarming proportions.
Weekend after weekend hundreds of people, mostly young people, are being buried in our townships and villages. No one in these places is in any doubt about the cause of this carnage. Without putting a racial slant on it, we all know that those who are dying in large numbers are poor blacks who cannot afford expensive drugs, and whose diet cannot fortify them against this danger. That is all the more reason why the Government should cut spending on all budgets to fight the Aids pandemic.
We welcome the increase in the amount earmarked for HIV/Aids from R350 million to R1 billion. However, we feel that this is still inadequate and should be increased, because HIV/Aids is a national emergency. We should also take advantage of the goodwill of the world. It seems our Government is not encouraging the international community to lend us its support. Aids does not belong to one nation. It is a national, continental and global threat. [Applause.]
Mr I M CACHALIA: Chairperson, hon Minister, hon members, ladies and gentlemen, in this debate I shall focus on the health imperatives of our country, the national Department of Health’s response to the role of the private sector and a possible direction in the quest for an equitable solution to the burden of ill-health and disease.
The medical aid industry was deregulated in 1989 and again in 1993. That was in response to the industry’s call to free it from control on the grounds that it limited its ability to deal with escalating costs. The amendments allowed for risk rating and the removal of statutory minimum benefits. The objective was cost avoidance and resulted in the dumping of patients on an already overburdened public sector once their benefits had been exceeded.
Medical aid contribution increases in registered schemes have consistently outpaced inflation since the 1980s, at times rising to double the rate in the 1990s. To explain rising costs and the shift in the balance of expenditure, the industry cites factors such as the cost of new technology, an ageing population, the emergence of new diseases and the declining value of the rand.
The rand has, however, strengthened recently in relation to major currencies. Imports should therefore become cheaper, which would, hopefully, address one of their concerns. Furthermore, administrators claim that the cost under the more complex environment of community rating and the introduction of prescribed minimum benefits has resulted in increases.
Indeed, some of these factors are relevant and the strategies the industry uses may have some impact on costs. Some may even be successful in controlling utilisation, but there are other factors which are contributing to the lack of cost control and have negative implications for equity.
First and foremost is the fee-for-reimbursement system, which creates incentives for oversupply. Secondly, high administration costs, including inappropriate reinsurance contracts and high broker fees, have sliced off a neat little package from the top of the contribution income. Instead of targeting providers, more schemes have taken the unacceptable route of burdening members with premiums which double the rate of inflation.
With reference to prescribed minimum benefits, the question being asked is whether administrators are now extracting profits from administration and managed care. In a study by the Centre for Actuarial Research Care, Prof Heather McCloud has stated that prescribed minimum benefits should not put upward pressure on contributions.
Drug acquisition costs are a major part of recurrent costs. The cost to patients from the time the drug leaves the manufacturer skyrockets by 107% in comparison with international standards, where the average margin across the value chain is 43%. Medicine costs comprise 33% of total health care costs in South Africa, compared with only 12% in developed countries. In 2001 schemes paid out more than R10,2 billion, accounting for more than 30% of annual spending.
Since the mid 1990s there has been little significant growth in the number of people covered by medical schemes. From a public health care perspective this is of concern, because it means that as the population continues to grow, a disproportionate burden of health care is being placed on an already underresourced public health sector.
The level of medical scheme coverage has coincided with an exponential increase in contributions over the past few years. Both health care benefits and nonhealth care expenditure of medical schemes are made in relation to health care benefits. Of these benefits, expenditure on hospitals and medicines has been the subject of significant inflation over the past few years.
Clearly if expenditure on medicines and profiteering through the excessive pricing of medicines, especially HIV/Aids medicines, remains unchecked, it would impact negatively on both access to medical scheme coverage and the range and comprehensiveness of benefits offered to existing members. The type of practices engendered by the 1988 and 1993 Acts promoted a stronger role by Government in stewarding the private markets towards achieving social goals, including affordability and fairness in financial contributions.
However, interventions in the industry need to be carefully monitored with respect to impact on equity, efficiency and quality of care. Amongst the legislative highlights of 2002 was the passing of the Medical Schemes Amendment Act and the Medicines and Related Substances Control Amendment Act. The regulations of the new Medical Schemes Act of 1998 were implemented in January 2000 and were followed by several amendments. Acceptance of all eligible applications became mandatory. Contributions could now be differentiated only on income and the number of dependants, and not on community rating and the introduction of prescribed minimum benefits. This Act therefore promotes the principle of social solidarity, provides for cross-subsidisation and addresses the cherry-picking of low- cost members by schemes.
The Medicines and Related Substances Amendment Act of 1997 addresses the high cost of medicines. It provides for the parallel importation of medicines for generic substitution and the establishment of a pricing committee. Changes in the Pharmacy Act provide for the deregulation of pharmacies. These Acts are to become operational this month. The department’s vision of a transparent pricing system appears to be based on a single-exit price.
In this respect my concern is whether there will be transparency in the base or manufacturer’s price and how the department will address the mark- ups in the distribution chain, because this will also determine what the consumer will eventually pay. Government will have to move quickly to implement the concept of risk equalisation to prevent risk selection and capitation, to address the negative incentives created by the fee-for- service reimbursement and give teeth to legislation aimed at bringing down the cost of pharmaceuticals.
[Only when managed care is implemented properly throughout the industry with extensive use of provider networks that are reimbursed through risk- sharing arrangements, will costs be brought under control and affordable private-sector care be made available to low-income earners. The Government has a role to play as a legislator, a provider of health care and as the single largest employer in the country. All interventions need to be monitored carefully with respect to the impact on the cost and quality of care provided to private patients, as well as the broader contribution to equity in the health sector.
The Intergovernmental Fiscal Review reports that the health sector comprises about 8% of the GDP. This is an unusually high proportion by international standards. The total health care budget for 2003-04, including national and provincial spending, amounts to just over R39 billion. The total public-private spending for the current financial year is estimated to be over R80 billion.
Within the parameters of total health care funding, both private and public, and further funding emphasised in the MTEF, hopefully we should be moving towards equity in the field of health. According to the Director- General of Health, Dr Ntsaluba, we do not want the private health sector to implode and the formation of strong public partnerships will hopefully go a long way towards making our vision of an affordable health care a reality.
The Health Department needs our thanks and appreciation for all the hard work they have done. We support this budget. [Applause.]
Ms T E MILLIN: Chairperson, with an average of 600 to 1 700 people - a staggering number - dying from Aids every day in South Africa, many of whom could have had their lives improved and extended, had they timeously received proven and effective medication currently not provided by the state institutions, the Aids pandemic, and appropriate treatment thereof, is and should be the number one priority of our Department of Health, its political head, the hon Minister of Health and, ultimately, the President of the Republic. The ravages of this holocaust in South Africa have already assumed genocidal proportions, passive or otherwise, through which dreadful accidents such as the May Day Bethlehem bus disaster that killed 51 people, pale into insignificance. Clearly, in order to make any inroads into reducing the appalling Aids death rate, we need a team of dedicated public servants headed by an equally single-minded and focused Minister, with an unqualified, unequivocal mandate from the Presidency, united in co- operating with all the similarly dedicated NGOs; and other organisations, as well as doctors, nurses and all manner of health care workers, spread all too thinly across our country.
But instead, we experience obstruction, prevarication and obfuscation, to the extent that the UN representative of the Global Fund for Aids, having come to South Africa recently, specifically to sign and formalise an agreement aimed at giving hundreds of millions of rands for the express purpose of providing treatment for Aids victims, was instead witness to a tirade of insults from the hon Minister of Health against a highly respected and authoritative South African expert on Aids from one of our top academic institutions, who was also attending the aforementioned function. The end result was, there was no signing of the agreement, which would have set into motion the handing over of a huge amount of funding for the prevention and treatment of Aids.
In KwaZulu-Natal, my home province, our health department, under the able and dedicated leadership of the hon Minister Zweli Mkhize, was set to receive an amount in the region of $80 million - which was then, early 2002, at about R11,00 to the dollar, a great deal of money which was successfully tendered for and awarded to KwaZulu-Natal by the UN Global Fund, until the hon national Health Minister intervened, insisting that all funding be channelled through national offices. The tragic consequence of this filibustering is that KwaZulu-Natal, the hardest hit by far by Aids and its hydraheaded opportunistic diseases, still awaits this desperately needed funding, as does the rest of our Aids-devastated country.
It has been reported very recently that doctors and nurses at Edendale Hospital in Pietermaritzburg, in the Midlands of KwaZulu-Natal, are so demoralised at watching HIV/Aids victims of all ages dying like flies, watched by doctors and nurses unable to administer the antiretroviral medication that would largely restore the health of victims, that they are, as a last resort, leaving the state institutions’ employ, no longer able to stomach such a wholesale and unnecessarily premature death rate.
On speaking recently to a businessman from Port Elizabeth in the Eastern Cape, who travels extensively in the rural areas of the Eastern Cape and Transkei, I was told: Where once there were rolling green hills, there are now whole hillsides peppered with hastily dug graves, no doubt creating further health hazards with the inevitable seepage into our water resources.
Has the time not come in the wider interests of all in South Africa to put aside religious, cultural and traditional differences to, firstly, make Aids a notifiable disease and, secondly, legislate for the cremation of the remains of all HIV/Aids victims, in the greater interest of survivors?
In conclusion, we note with some encouragement, with regard to the hon Minister’s recent air rage incident, that the four-letter expletive uttered by the hon Minister at least indicates that she acknowledges the root cause of the HIV/Aids pandemic.
Dr A N LUTHULI: Chair, the Minister spent quite a bit of time talking about the subject of human resources within the Department of Health in the country. That actually underlines the importance of this topic. I am also going to add my views on the same topic.
I want to start by stating that I support this budget, which puts money into more areas of health care than before. As noted in the SA Health Review of 2002, which devotes a chapter to human resources development, this is increasingly being recognised as key to improving health service delivery and health sector transformation. Policies thus have to acknowledge that health is a human system, and that reforms have to address the issue of personnel and staffing in the service, in the process improving planning, capacity and management.
Indeed, the discussion papers of the Department of Health’s summit in 2001 recognised that the successful expression of the department’s vision of quality health care for all South Africans was closely linked to human resources. Of late media reports have focused much attention on this issue, specifically looking at the migration of health workers, in particular doctors and nurses, from South Africa.
Now, what are the human resource challenges facing the health sector? The first one is capacity and skills. Research cited in the SA Health Review of 2002 indicates that there are still many skills lacking amongst frontline health workers. Skills for HIV/Aids and STIs with regard to clinical treatment and management are urgently required. Concerted, large-scale training inputs and continuous support to health workers are thus needed in both the public and private sectors of health.
It is further reported that in a review of the clinical management of severe malnutrition amongst children in rural hospitals, a lack of capacity, as well as poor management, the use of outdated equipment and inappropriate treatment practices resulted in high fatality rates. The study, however, concluded that, given the necessary training and support, hospital staff, even in the most underresourced areas, had the ability to identify and begin to rectify poor practices.
It should be unequivocally stated here that to a very large extent, the human resource problems encountered now are a direct legacy of half a century of apartheid policies, in particular education and training policies via Bantu Education which did not impart to the trainees the correct mindset and attitude towards work.
On the question of management and support, the same study indicated that these are central to the performance of health workers. Good support and management will improve work satisfaction and the staff’s ability to function. The opposite results is low productivity and demotivation.
It was found in the Eastern Cape that the fragmentation of services, unfilled posts and unclear lines of accountability have an immediate and negative impact on the staff. In spite of these difficulties, there are many health workers who are committed to working hard and successfully under these conditions, and they deserve recognition. In our visits to the provinces we have come across many such workers, for example at Lusikisiki in the Eastern Cape, Kwa-Hlabisa in KwaZulu-Natal and in many other hospitals and clinics we visited. Some of these workers deserve awards such as the Cecilia Makiwane award.
The same SAHR 2002 reports that careful and regular supervision is another factor that impacts on the quality of service delivery. Lack of supervision can leave staff feeling unappreciated and insecure, especially when it comes to the implementation of new policies and treatment regimes.
Another factor is HIV and Aids. HIV/Aids is a great challenge and arguably poses the greatest challenge to human resources development in the health sector. The Health Department is faced with the double burden of having to cope with increased morbidity and mortality within its own ranks, as well as having to carry the impact of an increasing disease burden in the general population.
The other challenge is that of migration, to which other people have referred. Lack of management, pressures in working conditions, lack of appropriate skills and emotional burnout are often cited as factors that contribute to lower productivity and staff morale, as well as a poor quality of care. However, I would add that lack of patriotism does play a part within a small minority of our population.
In turn, these contribute to the brain drain or migration of health workers, both in South Africa and other African countries. South Africa invests large amounts of public funds in the schooling and tertiary education of health professionals, only to see three forms of professional migration occurring, namely rural-to-urban, public-to-private sector, and South Africa-to-overseas migration. This results in a lot of stress within the sector. The challenge, therefore, is to move quickly to improve working conditions and salaries, which is what Government intends to do and has done in the new budget.
This ANC-led Government has, via the Department of Health, undertaken certain initiatives to meet these challenges. The Department of Health’s Strategic Framework 1999-2004, recognising the importance and urgency of developing a national human resource plan, has appointed a task team to determine, amongst others, the human resource needs for each level of health care - a skills mix that is affordable, develops norms and standards for human resources, and looks into the training of health workers during and after study. The findings of the task team are being implemented and should in due course produce results.
The task team also indicated that, compared to other middle-income countries, South Africa does not have an overall shortage of health professionals. However, their sharply skewed distribution between the public and private sectors, as well as between provinces, is creating severe shortages in the rural areas. The Department of Health has taken the following step, in an attempt to ensure that health professionals serve in rural areas.
On the question of community service, I just want to address my colleague, the hon Kalyan. She talked about Cuban doctors generally, and it is unacceptable to her that they serve in South Africa. But in the same breath she is actually asking the Ministry of Health to extend its hospitality to a European doctor who wants to settle and serve us in this country. Come on, what are you saying? [Interjections.] Rural areas were neglected by previous minority governments, but since 1998 this ANC Government has implemented community service for health professionals, with doctors, dentists and pharmacists being allocated a one- year period of service. The main objective of community service is to ensure an improved provision of health care to all citizens of South Africa. As from 2003 a further seven professional groups, including physiotherapists, occupational therapists and speech therapists, will also do community service.
Then there is the Cuban Training Programme. Through a government-to- government programme concluded by South Africa and Cuba, students from disadvantaged backgrounds receive fully funded bursaries to go for medical studies in Cuba. These students will return from their Cuban training with a certain mindset, ready to practice their skills in any part of the country, including the rural areas. Also, they will add to a pool of practitioners with a strong primary health care orientation, which is a vision of this Government.
In relation to the current budget … [Time expired.] [Applause.]
The CHAIRPERSON OF COMMITTEES: Order, hon Rajbally. Can I appeal to the House not to converse so loudly? There are a number of private meetings going on, and the speakers at the podium are battling to be heard. Please continue.
Miss S RAJBALLY: Will I get my three seconds back, Chairperson?
The CHAIRPERSON OF COMMITTEES: I am sure you will make up for it!
Miss S RAJBALLY: Chairperson, may I take this opportunity to congratulate the hon Tshwete on her maiden speech. You have done well.
The health and wellbeing of our people are affected by many factors, such as our history, the economy, resources and the environment. We have stated in our Constitution that the health of our citizens is a priority and a human right. We need not mention how taxing poverty has been on the advancement and provision of health. However, the MF notes the department’s hard work, ie the many hours and effort put into the many projects and endeavours to provide for the health needs of our people.
The good health of our people is a duty upon all sectors and spheres and, most of all, it is an individual responsibility. The public at large has to realise the individual responsibility of each and every one of us when it comes to our health. There is only so much that Government can do. However, we do have a duty, as major role-players, in this large epidemic, which concerns us greatly as it is eating away at our people. Need I even mention the horror of HIV/Aids, tuberculosis, cholera and malaria, not to mention the new global scare of Sars.
We have watched HIV/Aids claw into South Africa from region to region. Projects have been embarked upon, eg sex education, and many efforts have fallen on deaf ears. HIV/Aids is very rife and its presence within KwaZulu- Natal is scary. Besides killing our people, it is leaving many children orphaned. With minimal resources, the Government is unable to sustain this increase, leaving our economy in a panic. The same applies to the efforts to curtail TB.
However, are we doing enough? And if we are, how many successes have been noted? We have had some success with malaria in South Africa. Malaria statistics provided by the Department of Health report 15 582 cases and 96 deaths, compared to 26 506 cases and 119 deaths in 2001. There has been an improvement. These statistics have been boosted by the department’s two- year R5 million project, which the MF applauds. This is a major achievement, considering that malaria is the biggest killer disease in the world. The Severe Acute Respiratory Syndrome, better known as Sars, is now a global concern and the MF hopes that the department has embarked on efforts to monitor this.
However, the MF notes that the department’s tasks are vast and large in curtailing killer epidemics. Hospitals, vaccines, medical professionals, medication and numerous other medical and health concerns fall within the ambit of this department. The MF finds the department’s efforts in formulating health policy and legislation to be thorough and productive, and furthermore hopes that the allocated budget will be utilised effectively within this financial period. The MF supports the Vote. [Applause.]
Mr M WATERS: Chair, throughout history many governments have had to make tough decisions when faced with a national crisis. Some governments rose to the challenge and tackled the issues. Others, unfortunately, hesitated and resorted to the ostrich mentality by hiding their heads in the sand, hoping their problems would simply disappear.
Unfortunately the ANC chose to be an ostrich and the only thing that is disappearing is people - 900 000, to be exact. That is the estimated number of people who have died from Aids in our country while the so-called Government of the people dilly-dallied from one lame excuse to another. History will judge this ANC Government harshly. Over the years the Minister of Health has only raised reasons as to why we cannot have a national antiretroviral roll-out campaign, instead of finding solutions to the problems. The capacity constraint of the Public Service has been one such excuse. The DA believes that this is not a sufficient reason not to start. We have to start somewhere, sometime and the time is now.
In order to beef up the capacity of the Public Service to meet the needs of the antiretroviral roll-out campaign, there needs to be greater co- operation between the public and private sectors. This lack of co-operation is resulting in the duplication of valuable resources.
The only time we have seen any action from the ANC was when it was taken to court and forced to provide antiretrovirals to rape victims and Nevirapine to HIV-positive mothers. Sadly, the enforcement of this judgment has been met with the usual Government approach to the pandemic: slapdash, with some provinces enthusiastically implementing the judgment and others doing everything in their power not to do so.
The excuse that we cannot afford a national roll-out of antiretrovirals was always flawed, since the state spends an estimated R4 billion on treating patients for opportunistic infections. A mere 10% reduction in the number of patients being treated for Aids symptoms would save hospitals an estimated R400 million. It was pure penny wise and pound foolish to refuse to treat Aids on the one hand, while treating its symptoms on the other.
Apart from the over R1 billion allocated in this year’s budget for Aids treatment, pharmaceutical companies such as GlaxoSmithKline have slashed the price of HIV/Aids medicines for nonprofit groups in poor countries by up to 47%, and last week the Government’s own task team gave the green light for a national roll-out, describing it as affordable and achievable.
The DA welcomes the findings of the report and believes that Cabinet should deal with this issue as a matter of national urgency, even if this means calling a special Cabinet meeting. It is with great disappointment that we hear the Minister informing us today that the report will be submitted to Cabinet at a later date. With 600 deaths per day we dare not wait another day to submit the report, hon Minister.
In order to reduce the cost of antiretrovirals to the taxpayer, the DA would like to make the following suggestions: Firstly, when free drugs are offered, such as when Boehringer Ingelheime offered free Nevirapine for five years, we must accept all reasonable offers. This offer was made to every province at the July 2000 Aids Conference in Durban.
Unfortunately, only three of the nine provinces have accepted the offer, namely the Free State, KwaZulu-Natal and the Western Cape. The state is literally flushing R9 million worth of Nevirapine down the drain. In order to ensure that all reasonable offers of free medicine are accepted, the DA believes that a task team from the national Health department should be tasked with ensuring that all offers are indeed accepted by provinces.
Overseas funding such as the Global Fund grant of $72 million should be accepted with enthusiasm and not as our Minister reacted, ie by being offensive and obnoxious to the very people who want to help us. If she had acted at the time the offer was made as any other reasonable Minister would have, South Africa would have received R786 million in aid. However, with the strengthening of the rand, South Africa will now only receive R527 million. This is a loss of R259 million, thanks to the Minister.
Another rich source of funds would be the cancellation of certain aspects of the third tranche of the arms deal. The contract allows the Government to cancel the order for training planes by 50% and the fighter jets by 33% without any penalties, as long as this is done before 2004. This would save the taxpayer about R8 billion, which is more than enough to fund an antiretroviral campaign.
The DA also believes that VAT should be removed from all medicines needed to fight Aids, and the implementation of the DA’s Private Member’s Bill would allow for the manufacture of generic antiretrovirals, which would slash the price of these drugs overnight.
The question the hon Minister should be asking herself is not whether South Africa can afford antiretrovirals for its infected, but rather how we can ensure that the 500 000 people with advanced-stage infections can obtain life-saving drugs. Since the Government announced its so-called turnaround in the HIV/Aids policy on 17 April 2002, an estimated 234 000 South Africans have died unnecessarily.
The ANC often states - and I say here, sometimes with just cause - that life has indeed improved for the majority since 1994. However, when we look at the estimated 5 million South Africans with HIV who have a time bomb ticking inside them, can we in all honesty say life has improved for them? No, we cannot. Can we say that life has improved for the 500 000 Aids orphans who, apart from seeing their parents die before their very eyes, are battling to obtain child and foster grants? No, we cannot. And what about the more than 250 000 South Africans who will probably die this year from Aids? No, life has not improved for them either.
Let history not judge us in this House today as those who failed our country. We have one of the highest rates of HIV infection in the world and the best health care system on the continent. Those are both reasons for us to have been first in treating the disease. But we are in danger of coming last - dead last. [Applause.]
Mrs M M MALUMISE: Chairperson, I would like members to compare the Minister and Kalyan and see who of the two suffers from foot-and-mouth disease. May I take this opportunity to welcome our Deputy Minister, Dr Schoeman, to the club. I would like to say to him: Welcome. [Applause.] I would also like to take this opportunity to thank the chairperson of the committee who has given political direction to all of us in this committee in order to be able to articulate issues effectively. [Applause.]
This budget reflects the substantial reprioritisation that has been achieved since 1994. We have increased our spending on social services and infrastructural development which are targeted at the needs of the poor. The Government is to be congratulated for laying a secure foundation for sustainable social development. Not only have we drawn from a wide spectrum of development policies and practices, but we have shown our commitment to the people of this country by investing in them.
Our key priorities have been people-driven. We have upgraded schools, hospitals and clinics. What more do you want? We have built homes and given millions of people roofs over their heads. Yes, we have. We have created and are still creating jobs to relieve the shocking levels of poverty which are a legacy of the past. In the past nine years we have worked hard to ensure effective and balanced spending on public services.
We are moving closer to a much more efficient tax system. We have introduced the Medium-Term Expenditure Framework process which is a significant improvement on the incremental ad hoc approach to budgeting of the past. We are already seeing the benefits of improved planning at subnational level and improved policy co-ordination, which provide a much- needed link between inputs, outputs and outcomes. That is something which they never knew in the past.
We have transformed the face of local government in order to enhance local government’s ability to upgrade municipal infrastructure and provide electricity, water, sanitation, refuse removal services and health services in total. Those are services which have been sadly lacking in many parts of our country due to the inhumane policies of the past.
This year, we see conditional grant allocations increasing even further in the areas of HIV/Aids and the integrated nutrition programme because one cannot separate medicine and nutrition. It is impossible. [Applause.] Go and read medical pamphlets. The doctor will always say, ``Take this medicine before, during or after meals.’’ [Applause.] Nutrition plays an important part.
In five provinces thus far we have seen wall-to-wall roll-out of the mother- to-child infection prevention programme of providing Nevirapine. We are confident that the rest of the provinces will be able to catch up with the additional funding that they have received. In particular, conditional grants have been allocated to protect the funding of provincial, academic and central hospital services, to improve the quality of education and so on.
We have unravelled the past by laying the foundations for an effective and efficient health services. Today pregnant women, young children and the elderly have access to free health services. Women and young girls have far better choices in terms of their reproductive health because they can now make choices about their own health and reproductive organs. [Applause.] We therefore welcome the integration of the termination of pregnancy services into all health facilities in order to further improve access and give dignity to the women who use these services.
We have sent out a very strong message through our targeted approach to men that they, too, have to take responsibility regarding contraception, HIV and so on. We have increased the supply of doctors to areas where they are needed. We have built new clinics and upgraded existing ones. New information systems have been implemented. The provincial health information budget has gone from nothing to R8 million per year. Major new legislation has been introduced to deal with key issues which affect both the public and private health sectors. We have taken firm measures to ensure that people living with HIV/Aids are not discriminated against and, more importantly, that they are not prevented from joining medical aid schemes. In addition, we have broadened the definition of a dependent to make it more consistent with South African families.
We are putting a stop to the domination of commercial interests which have begun to take precedence over the needs of the public at large. We introduced the Tobacco Products Control Amendment Act to discourage people, and especially children, from starting to smoke and to protect the rights of nonsmokers. We have also introduced groundbreaking mental health legislation.
With regard to HIV/Aids, we have correctly anticipated the rising demand for health and social services. No individual, family, community, business or organisation can insulate itself from that impact. But, our Government has been working hard to mitigate the impact by managing a process that can redirect the path of the epidemic and make a difference to the lives of women, men and children - people affected and infected by HIV. The test of the national response does not lie therefore in the many disparate activities undertaken nor in the organisationally efficient ways in which these are approached but rather in the process of engagement with people living with HIV/Aids and with the broader society. Before I conclude, I want to direct a few comments towards the opposition parties. They have sustained their attacks on reform and in particular health care reform in this country. They, the DA and others, are constantly contradicting the interests of their own voters. On the other hand, the IFP is a party which has raised many objections to especially health reform and transformation but which, surprisingly, has no policy, reform agenda or particular vision. [Laughter.] Let us not forget the NP as we are daily confronted with the consequences of the decisions resulting from that party’s disastrous period in power. Everything that we do and every day that passes involve transformation and trying to extricate our country from our chaotic and ruinous past.
Today, we are introducing better systems, improving management structures and finance, making Government more transparent and open to external audit and public scrutiny. These are things that the DA and their partners are silent about. Why? [Applause.] We have much to be proud of. We have achieved more than what we set out to do. But, it will give me more pleasure to see resulting successful outcomes as they materialise in the next few years. [Interjections.] [Applause.]
The MINISTER OF HEALTH: Chairperson, thank you very much for the opportunity to respond. I would like to thank all the members of the portfolio committee who participated in this debate constructively. I would also like to thank the members for having sat right through the debate in order to understand which direction the department and the Ministry are moving.
I would like to make just a few comments because I do not have enough time. The delinquent and very rude remarks from - and I do not know whether to call her Mrs Kalyan or what - really do not deserve my response. I would just be sinking to her level and I am not going to do that. Seeing that she missed the opportunity to cross over to a decent and more civilised political party, she can only go from bad to worse. That is all that can happen to her.
I would like to thank Comrade James Ngculu very much for educating the House about the policies and programmes of our organisation, the ANC, which are not matched by any political party in this House, especially those. [Applause.] We will obviously need the help of Dr Rabinowitz to get the traditional healers’ Bill on track. To Dr Gous, I would like to say thank you very much for highlighting the inequities between and within the provinces. Obviously, we will need the help and support of the portfolio committee to interrogate the subject of inequity as he indicated and also come up with proposals to address this challenge.
I want to assure Mrs Baloyi that we are also seized with the issues of quality and equity. In fact, last week, when I met the MECs, we decided to have an extraordinary meeting to address just this subject of equity. Ms Dudley has left. She sent me a note that she has had to rush off somewhere. For the last three years, honestly, I have been responding to Ms Dudley’s comments about abortions. I thought that this time the debate would be elevated so that we could engage at a different level. She forgets that we had not come, this time, to discuss the subject of abortion. This is a health debate. When the Choice on Termination of Pregnancy Act was passed, the key consideration was the health of women, especially poor women, who ended up with sceptic incomplete abortions while rich women could obtain safe abortions outside the public health system. She forgets that. Would she seriously tell her constituency of many Christians that she rejects this general health budget without being stoned?
Thank you very much to Mrs Nkabinde and the hon Rajbally, for supporting the Vote. I would like to say to Dr Jassat that we should be careful that Aids statistics do not shock us and lead to inaction. Let us sit down with the committee to review and evaluate the strategic plan and strengthen the areas which are inadequately addressed. I thank the hon Tshwete for her support. She is still very young and energetic to take on the hon Kalyan. We have learnt to ignore her views and comments which are often not constructive. It is just hot air coming out of her lungs and mouth. [Interjections.] So we ignore her. I think that the hon member will soon join us in ignoring her.
Hon Mulder, we must get it into our minds and heads that I am the Minister of Health, not the Minister of Aids and Health. [Applause.] I am the Minister of Health. I would like to say to the hon Millin that it does not help to mislead the nation with misinformation. The Global Fund has awarded grants to those projects and no money will be lost. The delay is not even with my office. There are outstanding issues which must be sorted out with the Treasury and Sars and then the agreement will be signed. It has nothing to do with the department. So, she is misleading the nation and deliberately so, too. I think Aids is a very easy subject for anyone. I again remind this House that I am not the Minister of Aids and Health. I am the Minister of Health. Amongst other things, I deal with HIV/Aids. So those members should not be agitated. These agreements will be signed very soon.
I have been asked to comment a bit more on what steps South Africa has taken with regard to Sars. I think that the Sars outbreak abroad has highlighted our need to expand skills and knowledge in infection control and outbreak management across the national health system. It has highlighted the importance of really strong surveillance systems. It has highlighted our dependence on international co-operation.
Some of the steps that have been taken in South Africa regarding Sars include, amongst others, monitoring passengers and crew arriving on vessels and aircraft from affected areas at all seaports and airports; equipping the crew to manage passengers if anyone becomes symptomatic aboard a flight; developing and distributing information sheets to those passengers arriving from affected destinations; and developing and revising guidelines for health workers so that they can know more about Sars.
These guidelines deal with management of patients as well as measures to control the spread of infection; strengthening our outbreak response teams in all provinces; designating certain public hospitals as admission points for suspected Sars cases through the National Institute for Communicable Diseases; ensuring that South Africa has the relevant diagnostic tests and operates on the same standard as other laboratories internationally; preparing to tackle the less obvious entry routes, for instance inland border posts; and initiating contact with neighbouring states for a stronger regional response.
At this point, I want to say that South Africa is free of Sars. We continue to get a number of false alarms each week. The media sometimes sensationalise those. But, we would rather that members of the public and their doctors err on the side of caution than expose anybody to unnecessary risk. [Applause.]
Debate concluded.
The House adjourned at 18:29. ____ ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
THURSDAY, 17 APRIL 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- Classification of Bills by Joint Tagging Mechanism:
(1) The Joint Tagging Mechanism (JTM) on 16 April 2003 in terms of
Joint Rule 160(3), classified the following Bill as a section 75
Bill:
(i) Petroleum Pipelines Bill [B 22 - 2003] (National Assembly
- sec 75).
Draft Bills submitted in terms of Joint Rule 159:
(1) Mining Titles Registration Amendment Bill, 2003, submitted by
the Minister of Minerals and Energy on 11 April 2003. Referred to
the Portfolio Committee on Minerals and Energy and the Select
Committee on Economic and Foreign Affairs.
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Home Affairs:
Draft Immigration Regulations in terms of section 7(1)(b) of the
Immigration Act, 2002 (Act No 13 of 2002).
- The Minister for Justice and Constitutional Development:
(a) Treaty between the Republic of South Africa and the People's
Republic of China on Mutual Legal Assistance in Criminal Matters,
in terms of section 231(2) of the Constitution, 1996.
(b) Explanatory Memorandum to the Treaty on Mutual Legal Assistance
in Criminal Matters.
(c) Government Notice No R 359 published in Government Gazette No
25023 dated 14 March 2003: Amendment of Regulations in terms of
the Recognition of Customary Marriages Act, 1998 (Act No 120 of
1998).
(d) Government Notice No R 360 published in Government Gazette No
25024 dated 14 March 2003: Regulations in terms of the Special
Investigating Units and Special Tribunals Act, 1996 (Act No 74 of
1996).
(e) Proclamation No R 22 published in Government Gazette No 24698
dated 20 March 2003: Commencement of the Constitution of the
Republic of South Africa Amendment Act, 2003 (Act No 2 of 2003).
(f) Government Notice No R 423 published in Government Gazette No
24596 dated 27 March 2003: Procedure of Commisssion in terms of
the Judicial Service Commission Act, 1994 (Act No 9 of 1994).
- The Minister of Environmental Affairs and Tourism:
(a) Strategic Plan of the Department of Environmental Affairs and
Tourism for 2003-2006.
(b) Annual Report of the Johannesburg World Summit Company for 2001-
2002.
THURSDAY, 24 APRIL 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
-
Assent by President in respect of Bills: (i) Division of Revenue Bill [B 9D - 2003] - Act No 7 of 2003 (assented to and signed by President on 16 April 2003);
(ii) Pensions (Supplementary) Bill [B 11 - 2003] - Act No 8 of 2003 (assented to and signed by President on 23 April 2003);
(iii) Deeds Registries Amendment Bill [B 65B - 2002] - Act No 9 of 2003 (assented to and signed by President on 23 April 2003); and
(iv) Usury Amendment Bill [B 1 - 2003] - Act No 10 of 2003 (assented to and signed by President on 23 April 2003).
-
Draft Bills submitted in terms of Joint Rule 159:
(1) Firearms Control Amendment Bill, 2003, submitted by the Minister
for Safety and Security on 14 April 2003. Referred to the
Portfolio Committee on Safety and Security and the Select
Committee on Security and Constitutional Affairs.
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Speaker and the Chairperson:
(a) Decision by the Speaker and the Chairperson of the National
Council of Provinces to establish an Ad Hoc Joint Committee on
Reparations in terms of Joint Rule 138(1)(b):
(1) The Speaker and the Chairperson of the Council acting
jointly, after consulting the Chief Whip of the majority party
in the Assembly and the Chief Whip of the majority party in
the Council have decided, in terms of Joint Rule 138(1)(b), to
establish an Ad Hoc Joint Committee on Reparations to consider
recommendations made by the President in terms of section 27
of the Promotion of National Unity and Reconciliation Act,
1995 (Act No 34 of 1995).
(2) The Committee to consist of 19 Assembly members and 9
National Council of Provinces members.
(3) The Committee to submit a report to both Houses by 12 June
2003.
(4) The Committee may exercise those powers in Joint Rule 32
that may assist them in carrying out their task.
(b) Report of the Auditor-General on the Financial Statements of the
National English Literary Museum for 2000-2001 [RP 200-2002].
(c) Report of the Auditor-General on the Financial Statements of the
President's Fund for 2001-2002 [RP 236-2002].
(d) Report of the Auditor-General on the Financial Statements of the
Truth and Reconciliation Commission for 2001-2002 [RP 243-2002].
FRIDAY, 2 MAY 2003
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Speaker and the Chairperson: (a) Report of the 44th Commonwealth Parliamentary Association (CPA) Africa Executive Committee Meeting held in Nairobi, Kenia on 26 March 2003.
(b) Report of the Commission on Gender Equality on Intergrated
Development Planning - A Gender Perspective.
- The Minister of Environmental Affairs and Tourism:
(a) Proposal for the Leasing of Water Space in terms of section 6 of
the Sea Shore Act, 1935 (Act No 21 of 1935), to the Maribus
Industries (Pty) Ltd Seaweed (Gracilaria) Cultivation Project.
(b) Report of the South African Weather Services for 2001-2002,
including the Report of the Auditor-General on the Financial
Statements for 2001-2002 [RP 18-2003].
National Assembly:
- The Speaker:
The President of the Republic submitted the following letter, dated 24
April 2003, to the Speaker informing Parliament of the employment of
the South African National Defence Force:
EMPLOYMENT OF THE SOUTH AFRICAN NATIONAL DEFENCE FORCE IN COMPLIANCE
WITH THE INTERNATIONAL OBLIGATIONS OF THE REPUBLIC OF SOUTH AFRICA
TOWARDS THE UNITED NATIONS ORGANISATION
This serves to inform the National Assembly that I authorised the
employment of South African National Defence Force (SANDF) personnel in
order to fulfill the international obligations of the Republic of South
Africa towards the UN in Republic of Burundi as part of overseeing the
implementation and verification of the respective cease-fire
agreements, and assist in the disarmament, demobilization and re-
integration (DDR) programme.
This employment was authorised in accordance with the provisions of
Section 82(4)(b)(ii) read with Section 227(l)(b) and (c) of the
Constitution of the Republic of South Africa, 1993 (Act No 200 of
1993), [which Sections continue to be in force in terms of Item 24(l)
of Schedule 6 to the Constitution of the Republic of South Africa, 1996
(Act No 108 of 1996], read further with Section 3(2)(a)(iv) of the
Defence Act, 1957 (Act No 44 of 1957).
A total of 1 600 personnel, including the members of the SAPSD already
deployed in Burundi, will be deployed for a period of 12 months.
The expected costs for the deployment of personnel to the mission area
as from the 24 April 2003.
Amount (Rm)
Mission Equipment 247.6
Sustainment of the Force 312.6
Mobilisation and Training 13.1
Aircraft Charter 210.0
Total 783.3
The National Treasury advised that the shortfall should be addressed
through the normal budgetary process.
I will also communicate this report to the Members of the National
Council of Provinces, and wish to request that you bring the contents
of this report to the notice of the National Assembly.
Regards
T M MBEKI
THURSDAY, 8 MAY 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- Introduction of Bills:
(1) The Minister of Minerals and Energy:
(i) Mining Titles Registration Amendment Bill [B 24 - 2003]
(National Assembly - sec 75) [Bill and prior notice of its
introduction published in Government Gazette No 24634 of 31
March 2003.]
Introduction and referral to the Portfolio Committee on Minerals
and Energy of the National Assembly, as well as referral to the
Joint Tagging Mechanism (JTM) for classification in terms of Joint
Rule 160, on 9 May 2003.
In terms of Joint Rule 154 written views on the classification of
the Bills may be submitted to the Joint Tagging Mechanism (JTM)
within three parliamentary working days.
National Assembly:
- Referrals to committees of tabled papers:
(1) The following paper is referred to the Portfolio Committee on
Safety and Security:
Memorandum of Understanding between the Government of the Republic
of South Africa and the Government of the Republic of Rwanda on
Police Cooperation, tabled in terms of section 231(3) of the
Constitution, 1996.
(2) The following paper is referred to the Portfolio Committee on
Home Affairs:
Draft Immigration Regulations in terms of section 7(1)(b) of the
Immigration Act, 2002 (Act No 13 of 2002).
(3) The following papers are referred to the Portfolio Committee on
Justice and Constitutional Development for consideration and
report:
(a) Treaty between the Republic of South Africa and the
People's Republic of China on Mutual Legal Assistance in
Criminal Matters, in terms of section 231(2) of the
Constitution, 1996.
(b) Explanatory Memorandum to the Treaty on Mutual Legal
Assistance in Criminal Matters.
(4) The following papers are referred to the Portfolio Committee on
Justice and Constitutional Development:
(a) Government Notice No R 359 published in Government Gazette
No 25023 dated 14 March 2003: Amendment of Regulations in
terms of the Recognition of Customary Marriages Act, 1998 (Act
No 120 of 1998).
(b) Government Notice No R 360 published in Government Gazette
No 25024 dated 14 March 2003: Regulations in terms of the
Special Investigating Units and Special Tribunals Act, 1996
(Act No 74 of 1996).
(c) Proclamation No R 22 published in Government Gazette No
24698 dated 20 March 2003: Commencement of the Constitution of
the Republic of South Africa Amendment Act, 2003 (Act No 2 of
2003).
(d) Government Notice No R 423 published in Government Gazette
No 24596 dated 27 March 2003: Procedure of Commisssion in
terms of the Judicial Service Commission Act, 1994 (Act No 9
of 1994).
(5) The following papers are referred to the Portfolio Committee on
Environmental Affairs and Tourism:
(a) Strategic Plan of the Department of Environmental Affairs
and Tourism for 2003-2006.
(b) Annual Report of the Johannesburg World Summit Company for
2001-2002.
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Speaker and the Chairperson:
(a) International Convention on Prevention and Punishment of Crimes
against Internationally Protected Persons, including Diplomatic
Agents, tabled in terms of section 231(2) of the Constitution,
1996.
(b) Explanatory Memorandum to the Convention on Prevention and
Punsishment of Crimes against Internationally Protected Persons,
including Diplomatic Agents.
(c) International Convention Against the taking of Hostages, tabled
in terms of section 231(2) of the Constitution, 1996.
(d) Explanatory Memorandum to the International Convention Against
the Taking of Hostages.
COMMITTEE REPORTS:
National Assembly:
CREDA INSERT REPORT
MONDAY, 12 MAY 2003
TABLINGS: National Assembly and National Council of Provinces:
Papers:
- The Speaker and the Chairperson:
(a) Report of the Auditor-General on a Performance Audit conducted
at the Independent Development Trust on the extent to which the
present operations and processes are consistent with and support
development and sustainable poverty alleviation [RP 237-2002].
(b) Submission of the Financial and Fiscal Commission on the
Division of Revenue for 2004-2005, tabled in terms of section 9 of
the Intergovernmental Fiscal Relations Act, 1997 (Act No 97 of
1997).
(c) Report of the Public Service Commission on Blacklisting.
-
The Minister of Finance: Strategic Plan of Statistics South Africa for 2003-2006.
-
The Minister of Public Works:
Memorandum by the Minister of Public Works setting out particulars of
the Building Programme for 2003-2004 [RP 26-2003].
- The Minister of Minerals and Energy:
Strategic Plan of the Department of Minerals and Energy for 2003-2006.
COMMITTEE REPORTS:
National Assembly:
-
Report of the Portfolio Committee on Justice and Constitutional Development on the Public Protector Amendment Bill [B 6 - 2003] (National Assembly - sec 75), dated 16 April 2003:
The Portfolio Committee on Justice and Constitutional Development, having considered the subject of the Public Protector Amendment Bill [B 6 - 2003] (National Assembly - sec 75), referred to it and classified by the Joint Tagging Mechanism as a section 75 Bill, endorses the classification of the Bill and reports the Bill with amendments [B 6A - 2003].
The Committee wishes to report further, as follows:
-
The provisions of the new section 2A(9) to (12) that are to be inserted in the Public Protector Act, 1994 (Act No. 23 of 1994), and which regulate the removal from office of the Deputy Public Protector, are, to a large extent, similar to the provisions of section 194 of the Constitution, which regulate the removal from office of, among others, the Public Protector.
However, the Committee, during its deliberations on the Bill, deemed it appropriate to regulate the suspension from office of the Deputy Public Protector in terms of the new section 2A(11) in more detail than the suspension from office of the Public Protector is regulated in section 194(3)(a) of the Constitution.
-
In the light of the above, the Committee recommends that the Minister for Justice and Constitutional Development be requested to direct his Department to investigate the desirability of amending the provisions of section 194(3) of the Constitution in order to bring it in line with that of the new section 2A(11). Should it be determined that such amendments are desirable, the Committee further recommends that those amendments be included in the next Constitution Amendment Bill which the Minister for Justice and Constitutional Development intends to introduce in Parliament.
-
Report to be considered.
TUESDAY, 13 MAY 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- Bills passed by Houses - to be submitted to President for assent:
(1) Bill passed by National Council of Provinces on 13 May 2003:
(i) Geoscience Amendment Bill [B 7 - 2003] (National Assembly
- sec 75).
- Introduction of Bills:
(1) The Minister of Minerals and Energy:
(i) Petroleum Products Amendment Bill [B 25 - 2003] (National
Assembly - sec 75) [Explanatory summary of Bill and prior
notice of its introduction published in Government Gazette No
24752 of 15 April 2003.]
Introduction and referral to the Portfolio Committee on Minerals
and Energy of the National Assembly, as well as referral to the
Joint Tagging Mechanism (JTM) for classification in terms of Joint
Rule 160, on 14 May 2003.
In terms of Joint Rule 154 written views on the classification of
the Bill may be submitted to the Joint Tagging Mechanism (JTM)
within three parliamentary working days.
- Draft Bills submitted in terms of Joint Rule 159:
(1) Petroleum Products Amendment Bill, 2003, submitted by the
Minister of Minerals and Energy on 8 May 2003. Referred to the
Portfolio Committee on Minerals and Energy and the Select
Committee on Economic and Foreign Affairs.
COMMITTEE REPORTS:
National Assembly:
- Report of the Portfolio Committee on Trade and Industry, dated 16 April 2003:
"1305-T&I" on L:T
Report to be considered.
- Report of the Portfolio Committee on Provincial and Local Government on Study Tour of Municipalities, dated 15 April 2003:
"1305PROV" on L:T
Report to be considered.