National Assembly - 05 September 2003
FRIDAY, 5 SEPTEMBER 2003 __
PROCEEDINGS OF THE NATIONAL ASSEMBLY
____
The House met at 09:02.
The Chairperson of Committees took the Chair and requested members to observe a moment of silence for prayers or meditation.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS - see col 000.
UNPARLIAMENTARY LANGUAGE
(Ruling)
The CHAIRPERSON OF COMMITTEES: Order! On 2 September, during the Second Reading debate on the Liquor Bill, the Minister of Trade and Industry, the hon Mr A Erwin, expressed concern about a statement made by the hon Mr Lowe earlier in the debate.
The statement being contested appears in the following extract from Mr Lowe’s speech: “Some commentators have seriously wondered if the Minister hasn’t been bought by an industry still buried in apartheid.”
When the hon Mr Lowe said that he could not withdraw the statement on the basis that he did not make it himself but was merely quoting someone else, I undertook to examine the Hansard before making a final ruling. Having examined the Hansard, I wish to rule as follows. Order! Members, could you be seated, please.
I wish to rule as follows: To suggest that the Minister has been bought is clearly accusing the Minister, a member of this House, of being guilty of corrupt practices. The fact that the member was quoting commentators does not alter the effect of the statement. A remark is no less offensive if it is quoted as having been made by someone else. It would still be unacceptable to quote an unparliamentary assertion, even if this were done in the context of a question. By quoting such a remark made by someone else, a member is still casting a reflection on the integrity of another member in the House, and that is unacceptable. The statement is therefore unparliamentary, and I must request the hon Mr Lowe to withdraw it.
Mr C M LOWE: Mr Chairman, I would like to withdraw the statement and apologise to the House. I am sorry that the Minister is not here this morning, but I have written to him personally to apologise as well.
The CHAIRPERSON OF COMMITTEES: Thank your for that, hon Lowe. [Applause.]
Furthermore, during the same debate on the Liquor Bill, the hon Mr Pretorius raised a point of order in regard to an expression by the hon Minister of Trade and Industry addressed to the hon Mr Lowe. The hon Minister, in referring to Mr Lowe, said: “He is a little twerp who has done nothing in his past.” The Minister said that if the word “twerp” was unparliamentary, he would withdraw it. “Twerp” is an insulting and derogatory word and, as such, unparliamentary. Since the Minister has already indicated that he would withdraw the word, I accept that it has indeed been withdrawn.
On a further point of order, the hon Mr Ramgobin asked whether the hon Mr Lowe should not have been asked to leave the Chamber, as he had failed to withdraw the remarks when asked to do so by the Chair.
It is my view that as I had agreed to check Hansard before giving a final ruling, the member’s withdrawal from the House was not necessary. In addition to that, the hon Prof Turok indicated that in his response to a ruling by the Chair, the hon Mr Lowe had said: “Mr Chairman, if you had been listening to my speech, you would have heard that I had said …” The hon Prof Turok suggested that this amounted to disrespect for the Chair. Although this could indeed be perceived as disrespect for the Chair, I am of the view that in the context in which the statement was made it was not meant to show disrespect for the Chair. Therefore, I do not intend to pursue this matter any further and I would ever caution members always to show the respect that is due to the Chair. I thank you.
We now come to notices of motion. Does any member wish to give a notice of a motion? None. Are there any motions without notice?
CALLS TO PREVENT THE DEATH SENTENCE ON MS AMINA LAWAL
(Draft Resolution)
The CHIEF WHIP OF THE MAJORITY PARTY: Chairperson, before I actually raise the motion without notice, could I take this opportunity to thank yourself, the House, as well as members of staff for installing a microphone on my desk. That makes my work much easier. Thank you. [Laughter.]
I hereby move without notice:
That the House -
(1) is concerned about -
(a) the death sentence imposed upon Ms Amina Lawal by an
ecclesiastical court in Nigeria; and
(b) the violation of the letter and spirit of the African
Charter of Human Rights that this sentence represents;
(2) calls upon His Excellency President Mbeki, President of the
Republic of South Africa, and His Excellency President Chissano,
President of Mozambique and Chairman of the African Union, to use
their influence with His Excellency President Obasanjo of Nigeria
to -
(a) use his powers to prevent the carrying out of this
barbaric sentence; and
(b) ensure the physical security of the persons of Ms Amina
Lawal and her child, who have already suffered very deeply.
Agreed to.
BEST WISHES FOR SA CRICKET TEAM IN LAST TEST AGAINST ENGLAND
(Draft Resolution)
Mnr J DURAND: Mnr die Voorsitter, ek stel sonder kennisgewing voor:
Dat die Huis -
(1) die Suid-Afrikaanse krieketspan, wat tans met Engeland ``kolwe kruis’’, alle voorspoed toewens met die laaste toets in die reeks;
(2) kennis neem dat indien Graeme Smith en sy span dié toets wen, dit die eerste keer sal wees dat ‘n Suid-Afrikaanse span ‘n toets op die Oval en drie toetse in ‘n toetsreeks in Engeland wen;
3) duimvashou dat die Suid-Afrikaanse span krieketgeskiedenis gaan
maak. (Translation of Afrikaans draft resolution follows.)
[Mr J DURAND: Mr Chairperson, I move without notice:
That the House -
(1) wishes the South African cricket team, “crossing bats” with England at the moment, everything of the best with the last test in the series;
(2) notes that if Graeme Smith and his team win it will be the first time that a South African team wins a test at the Oval and three tests in a series in England; and
3) holds thumbs that the South African team makes cricket history.]
Agreed to.
CELEBRATION OF NATIONAL ARBOR WEEK
(Draft Resolution)
The DEPUTY CHIEF WHIP OF THE MAJORITY PARTY: Chair, I move without notice:
That the House -
(1) notes that -
(a) this week, from 1 to 7 September, South Africans celebrate
National Arbor Week - Iviki Lezihlahla;
(b) the week-long celebrations were officially launched at a
ceremony in Evaton, Johannesburg, on 28 August 2003, with the
theme ``Trees are our Heritage'';
(c) September, being Heritage Month, is the time to reflect on how
trees and forests contribute to all people having a better life;
and
(d) this year's celebrations focus, among others, on -
(i) how forests and trees are being utilised by communities,
in conjunction with the state, for the eradication of
poverty and promoting economic development; and
(ii) the promotion of behavioural change through
highlighting the destruction that veld and forest
fires cause each year;
(2) believes that, since 1994, the Government’s approach has been to recognise trees and forests as a national resource that must be protected; and
(3) calls on all South Africans not only to participate in this Arbor Week, but to commit themselves to the theme of ``Trees are our Heritage’’.
Agreed to.
The CHAIRPERSON OF COMMITTEES: Order! Hon members, can you take your seats, please. Thank you. Please proceed, hon member.
DEPUTY PRESIDENT AND ANC IMAGE
(Member's Statement)
Mr O BAPELA (ANC): Chairperson, recently the UDM and the DA continued in their efforts to …
The CHAIRPERSON OF COMMITTEES: Hon member, we cannot hear you. You are not audible. Could you start again.
Mr O BAPELA: Thank you, Chairperson. Recently the UDM and the DA continued in their efforts to gain cheap political mileage by attempting to destroy the reputation of Deputy President Jacob Zuma and the ANC. The real casualties of these attacks are the rule of law, and our Constitution, courts and institutions supporting democracy. These institutions have been subjected to a pattern of consistent and calculated attacks on their integrity.
Our society, led by the ANC, has advanced significantly towards accountable and transparent governance and is rooting out corruption wherever it might exist. Reputable studies domestically and internationally confirm that in South Africa most cases of corruption are exposed by the institutions of the democratic state through mechanisms put in place after 1994.
We must intensify the fight against corruption on the basis of tested facts. No one is above the law. The law must take its course. All persons must be presumed innocent until proven guilty. We must not fall prey to the appetite for lynching and trials by media which has seized opposition parties and much of the media in recent weeks. Until such time that a court of law or competent institution of justice passes a guilty verdict, the Deputy President should not be subjected to any disciplinary process or be asked to relinquish his position.
We will not be deterred from strengthening our criminal justice system, fighting corruption, pushing back the frontiers of poverty and building a united and democratic nation. [Applause.]
CALL FOR BROAD-BASED EMPOWERMENT TO START AT THE BOTTOM, NOT THE TOP
(Member's Statement)
Mr C M LOWE (DA): Mr Chairman, the need to transform our economy and empower millions of South Africans excluded by apartheid is more pressing than ever. But the DA believes that broad-based empowerment must start at the bottom, not the top; that we must empower many, not just a few.
True empowerment tackles poverty, unemployment and inadequate education, is measured by job-creation entrepreneurship and comes from giving people skills, resources and opportunities to realise their full potential.
Yesterday the DA launched its empowerment policy, “Opportunity for All”, from a fabric-painting factory run out of a tiny two-roomed shack in a back alley of Crossroads. We did so because we know that genuine and effective broad-based empowerment starts at grass-roots level, reaching real people who epitomise the kind of entrepreneurship that the Government’s BEE policy should target for assistance and advancement, but sadly has not. The people who need and deserve empowerment are not the ANC cronies, the fat cats and Wabenzi, but ordinary people in Crossroads and millions more like them across South Africa. Thank you. [Applause.]
GREATER COMMITMENT REQUIRED FROM ROLE-PLAYERS IN CRIMINAL JUSTICE SYSTEM
(Member's Statement)
Mrs S A SEATON (IFP): Chairperson, after presiding over a disappointing two- day criminal court session at Izingolweni in KwaZulu-Natal, a regional magistrate, Mr Johan Bester, said that unless the role-players showed greater commitment, the criminal justice system in our country would collapse.
His remarks came after four serious matters on the court roll could not be finalised as a result of incompetence by police and justice officials. One of the matters not finalised, an attempted murder charge, had to be withdrawn as a result of the investigating officer arriving at court without his docket.
Mr Bester has urged these officials to engage in some introspection instead of blaming everyone else for their shortcomings, and that if they are not dedicated to the creation of a society based on the notions of justice and democracy they should make room for people who are. Instances such as those that happened at Izingolweni should not happen at all. They cause people to lose confidence in the officials and the system that is supposed to be there for their protection.
We therefore urge all relevant role-players in the criminal justice system throughout the country to take note of what Mr Bester has said, so that we can work towards creating an efficient and effective criminal justice system that will inspire confidence in our people.
DA OPPOSITION TO BROAD-BASED BLACK ECONOMIC EMPOWERMENT BILL NOT REFLECTED IN MEDIA
(Member's Statement)
Mr M M MASALA (ANC): Chairperson, on 2 September, that is Tuesday this week, this House debated and passed the Broad-Based Black Economic Empowerment Bill. The Bill seeks to improve participation by the previously disadvantaged in the productive resources of this country and contributes towards the attainment of the constitutional right to equality.
The media reported that the Broad-Based Black Economic Empowerment Bill received overwhelming support from parties in this House. Given that the DA voted against the Broad-Based Black Economic Empowerment Bill, we call upon the DA to correct those media reports as they cannot expect to be credited with the economic empowerment of blacks and equitable economic redistribution when they opposed the Bill. Thank you. [Applause.]
BEST WISHES EXTENDED TO MARIA RAMOS IN HER NEW TRANSNET POSITION
(Member's Statement)
Mev ANNA VAN WYK (Nuwe NP): Speaker, die Nuwe NP het genoë om die Direkteur- Generaal van die Tesourie, me Maria Ramos, van harte geluk te wens met haar aanstelling in haar nuwe amp as hoof uitvoerende beampte van Transnet. Ons wens haar sterkte toe met die nuwe uitdagings wat vir haar voor die deur lê.
Suid-Afrika was bevoorreg om oor die dienste van iemand van haar kaliber in beheer van die dissipline van Suid-Afrika se staatsfinansies te kon beskik. Die wye aansien wat sy in finansiële kringe geniet, volg op die vertroue wat ondernemers, sowel as beleggers, in die Suid-Afrikaanse ekonomie ontwikkel het. Die feit dat finansiële markte nie tot dusver negatief gereageer het op die aankondiging dat sy haar pos gaan ontruim nie, dui daarop dat die verwagting bestaan dat streng finansiële dissipline oor staatsuitgawes gehandhaaf gaan word.
Die Nuwe NP het genoeg vertroue in die Minister van Finansies, mnr Trevor Manuel, om te glo dat hy ‘n betroubare beheerstruktuur in plek sal plaas om die leemte te vul wat die bedanking van me Ramos agterlaat. Suid-Afrika is trots op me Ramos, en die vroue van die Nuwe NP baie spesifiek. Dankie. [Applous.] (Translation of Afrikaans speech follows.)
[Mrs ANNA VAN WYK (New NP): Speaker, the New NP takes pleasure in expressing its hearty congratulations to the Director-General of Treasury, Ms Maria Ramos, on her appointment in her new position as chief executive officer of Transnet. We wish her all the best with the new challenges ahead of her.
South Africa was privileged to have had the services of someone of her calibre in control of the discipline of South Africa’s state finance. The great respect she commanded in financial circles was a result of the confidence which entrepreneurs, as well investors, had developed in the South African economy. The fact that up to now financial markets have not reacted negatively to the announcement that she is going to vacate her post indicates that the expectation exists that strict financial discipline over state expenditure will be maintained.
The New NP has enough confidence in the Minister of Finance, Mr Trevor Manuel, to believe that he will introduce a reliable control structure to fill the gap left by the resignation of Ms Ramos. South Africa is proud of Ms Ramos, and the women of the New NP in particular. Thank you. [Applause.]]
CALLS FOR MPUMALANGA HEALTH MEC AND HEAD OF DEPARTMENT TO STEP DOWN
(Member's Statement)
Ms C DUDLEY (ACDP): Chair, disgraced Mpumalanga health MEC Sibongile Manana and head of department Rina Charles should step down immediately and face criminal charges after shocking revelations of corruption and maladministration in the department.
After forensic audit reports revealed evidence of corruption, Manana was reshuffled to the Department of Sport, Recreation, Arts and Culture while Charles will trade jobs with the deputy director-general in the premier’s office.
What these officials have done is criminal and it is unacceptable that they remain in positions of responsibility within the Government. Taking money from dying people and squandering it on all kinds of scams and frivolity is disgraceful.
Both Manana and Charles have betrayed the people’s trust. The premier should follow through with disciplinary action against all those involved, and not merely redeploy them. The Department of Sport, Recreation, Arts and Culture is key to development within Mpumalanga, and Manana and Charles will carry the scandal with them.
Evidence of mismanagement and financial waste were already evident during the Portfolio Committee on Health’s visit to Mpumalanga last year, where huge pieces of hi-tech equipment stood idle in empty rooms with no staff to use them. The fact that the department ordered this equipment merely to use up their budget is despicable. All those involved in this corruption must be held accountable, and we welcome the handing of the forensic audit report to the Scorpions in order to prosecute those involved. Thank you.
BY-ELECTIONS IN GREATER GIYANI
(Member's Statement)
Mr C J MALULEKE-HLANEKI (ANC): Chairperson and hon House, through action the people of South Africa are conveying the message consistently that the tide has turned. On 27 August 2003 a by-election took place in ward 1 of the Greater Giyani municipality in Limpopo. The ANC participated in the elections and emerged with a landslide victory of 966 votes to the 145 votes for the opposition.
These achievements come a short while after the ANC won elections in ward 1 of Greater Letaba, unopposed.
Eka siku ra namuntlha hi rhandza ku hoyozela vaaka-tiko va ka Ximawusa, Blinkwater na Noblehoek va le ward 1 YA Giyani ku va va swi kotile ku hlawula ntlawa wun’we ntsena lowu nga wona wa ntikelo na vundzuku bya vona, ku nga ANC.
Hi hoyozela na yena murhumiwa lontshwa wa ANC khanselara James Ndlovu. Hi ri khoma swi tiya wena gaceni, wena wa wa zindlopfu azilubani zilubana ngomsindo. Ugaceni, udla imithi, ndlopfu. Khanimambo. (Translation of Xitsonga paragraphs follows.)
[Today we wish to congratulate ward 1 communities of Ximawusa, Blinkwater and Noblehoek for electing a political party, the ANC, that has their future at heart.
We congratulate the new representative of the ANC, councillor James Ndlovu. We wish you the best in your new challenge.]
COLLAPSE OF SERVICES AT ONDERSTEPOORT
(Member's Statement)
Dr A E VAN NIEKERK (FA): Chairperson, the hon Minister of Agriculture Thoko Didiza remains silent on the serious erosion of services at the Agricultural Research Council. Dr Freek Potgieter, a research leader and manager of undisputed merit at Onderstepoort, was suspended. In addition, key services at the Onderstepoort Veterinary Institute have collapsed.
While the Limpopo province experiences more and more outbreaks of foot-and- mouth, the Onderstepoort centre is increasingly unable to respond to crises of an epidemic nature. This threatens the livestock assets of rural people, human health and access for our exports to world markets.
I have asked Minister Didiza whether she believes that Onderstepoort, the ARC and the national Department of Agriculture are still able to play their former role as the effective provider of remedies for veterinary crises and other Southern African countries, that is, for stalling the spreading of diseases to South Africa.
Neither the Minister and the national Department of Agriculture nor the ARC appears able to answer these questions.
THE IMPORTANCE OF STUDENTS OBTAINING SKILLS
(Member's Statement)
Dr S E M PHEKO (PAC): Chairperson, education is the key to a successful life. It is a tool for mental liberation. It enables the people to take charge of their cultural and psychological direction. Our education must be tailored to the needs of our people so that every educated person with a profession of skill can contribute to the welfare of our people.
The PAC wants our education to be diversified. It must be a good mixture of academic and vocational subjects. No student must reach matric without a skill of some kind, which he or she can use to earn a living. The massive unemployment that we see today dictates that our system of education promotes self-reliance through vocational courses without compromising academic education for those who would like to go to universities or technikons.
Because education is so important, the PAC is advocating free education for students from poor homes. Africans, in particular, have been denied proper education for many years under colonialism and apartheid. Too many students cannot complete their studies today because their parents are poor and are unable to pay the fees.
The PAC is disturbed that recent statistics show that 60% of our matric students countrywide have dropped out of schools and that only 40% will write matric exams this year. Many university students are owing fees and cannot complete their degrees. [Time expired.]
WITHDRAWAL OF STATEMENT
(Member's Statement)
Mr F BHENGU (ANC): Chairperson, in a statement made in the National Assembly on 2 September 2003 by Anthony James Leon, the leader of the DA, he abused parliamentary privilege by launching an unwarranted an unsubstantiated attack on the ANC and Minister Essop Pahad. [Interjections.]
The ANC rejects the allegations completely and insinuations contained in Mr Leon’s statement to the effect that the ANC or Mr Pahad had in any way undermined the investigation of alleged wrongdoing in the arms procurement process.
The ANC has written to the Speaker of the National Assembly submitting that Mr Anthony James Leon contravened both the letter, as well as the spirit, of a resolution of the Assembly which states that a member who wishes to bring any improper conduct on the part of another member to the attention of the House should do so by way of a separate, substantiative motion comprising a clearly formulated and properly substantiated charge. Except for by way of such a substantiative motion, the member should not be allowed to impute improper motives to other members or cast personal reflections on their integrity as members or verbally abuse them in any other way. [Interjections.
The ANC has asked that the statement be ruled out of order and Mr Leon be requested to withdraw his statement unconditionally and apologise to Mr Pahad and the House. [Applause.] [Interjections.]
Mr G B D McINTOSH: You are such babies!
The CHAIRPERSON OF COMMITTEES: Hon member, your time had expired but you ignored my call, and we let you complete that.
THE REDEPLOYMENT OF SIBONGILE MANANA
(Member's Statement)
Mr B G BELL (DA): Mr Chairperson, the reshuffling of the former Mpumalanga Health MEC, Sibongile Manana, to the Department of Sport, Recreation, Arts and Culture by Premier Mahlangu indicates the lingering malaise in Mpumalanga. Premier Mahlangu is known to have said that politicians caught lying to the public should be not be axed or disciplined because the practice is widespread and accepted political technique.
Also redeploying Manana’s former DG, Rina Charles, to the position of deputy director-general in his office, and yet in her former capacity the department lost two court cases and was ordered to pay legal costs after failing to evict Gripp from the province’s hospitals for supplying antiretrovirals to rape survivors.
Why did the ANC’s redeployment committee, allegedly headed by Deputy President Zuma, with the knowledge and approval of President Mbeki, approved these redeployments? These two individuals should have been redeployed to the unemployment line and not put in another job where they can waste taxpayers’ money.
This move highlights the lack of a sound, moral and ethical basis within the ANC when it comes to fighting corruption and mismanagement. [Applause.]
PORNOGRAPHIC MATERIAL
(Member's Statement)
Dr U ROOPNARAIN (IFP): Mr Chairperson, last weekend police in Durban uncovered a pornographic syndicate involving a Russian couple. This couple performed sordid sexual acts with their own children, aged between three and four, and thereafter produced pornographic videos and magazines from these ghastly and disgusting acts.
Furthermore, these children were totally unaware that they were being abused and used by their own parents. This is a crime against children and their innocence. This Parliament needs to say: Enough is enough and no more.
The IFP welcomes the efforts by the SAPS in cracking the case and calls on the Minister of Justice to ensure that this couple and other perpetrators of crimes against children are brought to book. Let us not stagger or waiver but ensure that our children are safe. A SOUTH AFRICAN STUDENT SCOOPS WATER AWARD
(Member's Statement)
Mrs R A NDZANGA (ANC): A 17-year old Claire Reid, a grade 11 student at Saint Teresa’s Mercy in Rosebank, Johannesburg, was recently awarded the prestigious 2003 Stockholm Junior Water Prize for her water conservation project called `` reel gardening.’’ Claire’s project involved developing a water-wise reel gardening system, a simple and effective seed planting system that cuts down water usage by as much as 80%.
The Minister of Water Affairs and Forestry, earlier this year, launched the first South African Youth Water Prize, known in Northern Sotho as Bafsa le Meetse. The award, which is to be held annually, recognises the role that South African youth plays in promoting water, sanitation, hygiene and hygiene-related issues in the country.
The ANC congratulates Claire for her achievement of winning both the national and international awards. We also want to extend our congratulations to the winners of the second and third prizes of the Bafsa le Meetse award. Thank you. [Applause.]
BRAIN DRAIN IN HEALTH CARE
(Member's Statement)
Dr S J GOUS (New NP): Mr Chair, a recent World Health Organisation report which stated that 38% of health workers in South Africa plan to leave the country due to the deterioration of the health system is alarming.
What is even more alarming is the proposal for a certificate of need in the National Health Bill which is, today, before Parliament because this will certainly increase the above-mentioned brain drain. The certificate of need will be a prerequisite before any health practice might operate in a certain area. This means that health professionals will not be allowed to practice in areas of their choice. The New NP as well as the majority of inputs presented at the hearings on the National Health Bill strongly opposed this measure.
According to the SA Registrars’ Association, which consists of young doctors who are currently specialising, the intention of the certificate of need will exponentially intensify the insecurity and demoralisation of the junior doctors. They also stated that a career in the public health sector is not popular any more due to the general deterioration in the public health system. Though private practice is another possible career, the spectre of the certificate of need has cast huge doubts over this sector. Therefore, the only option that remains for them is to leave the country. Thank you. [Applause.]
FREE EDUCATION
(Minister's Response)
The MINISTER OF EDUCATION: Mr Chairperson, in fact, three areas were touched on regarding the education social sector but I will not take up the time of the House, although I’m fit and willing to do so.
I would like to remind the hon Mr Lowe that you can’t, on a Friday morning, forsake an understanding of the topic through a kind of professional earnestness. It may be due to a Friday morning that there is a kind of mental geriatrics stirring up emotions here.
However, I want to reply particularly to the hon Dr Pheko. We are embarking on this reform of the matriculation examination in order to allow young people not only to do the academic courses in the whole matric but also the occupational and technical courses through Setas. So, young people will have an equal opportunity and equal status to do this for the first time. I met with a German delegation - in fact, we are working very closely with the German approach. The Germans have the best system in Europe, which also takes into account the needs for middle-level technology. I hope that we shall be able to debate this because Cabinet has passed the new national curriculum statement. Another point is that it is not true that 60% of matric students drop out; it is the figure of how many people who enter school drop out. We have the highest participation rate in primary school. We meet the ``education for all’’ conditions which were laid down by the United Nations. We have 100% participation rate in primary schools. All of that has been done in the last four years! We have the highest participation rate in secondary schools: Fifty-three per cent of the kids of that group go to secondary schools. And I’m pleased to announce to the House that the majority of secondary school children are in fact women. This puts us in the same level with many economically advanced countries of the OECD. We have a high participation rate, like those countries.
As for free education, let me tell the House: There ain’t no such thing as free education. The taxpayer pays for that. Regarding the countries that you quoted who have free education, their educational system is in an appalling state. What we are trying to do is to provide for the per capita grant for the poorest 20%, 40% and 60% of the children. So, it must be an anti-poverty drive rather than providing a larger subsidy to the middle class, if you have so-called free education, because we will have to pay grants to the schools that, in fact, maintain larger numbers of teachers and have more subjects that are taught. In fact, we don’t want to transfer more money to those who are privileged already in the educational system.
However, I think it is important to recognise that we have to embark on lifelong learning in such a way that our children acquire skills in schools which they are able to use - whether in technikons, universities, for Setas or at the revamped and reorganised technical colleges. I think that’s a much more sensible way of looking at it than referring to the fat cats who are always there, historically, and all the cronies that you have had from the society that has nurtured you. And, finally, you are the original upholders of the Wabenzi policies.
BRAIN DRAIN IN HEALTH CARE
(Minister's Response)
The MINISTER OF HEALTH: Chairperson, I just want to rise to say it is unfortunate that Dr Gous, in the first instance, did not attend the meeting of the WHO in Johannesburg. In fact, the party was visibly absent.
However, I think it is wrong to then take a report and analyse it glibly and not come and give all the facts here. I think what he should have told this House is that most South Africans said, in the survey that was done, that they wanted external experience. This is the core reason why South Africans are leaving. Therefore, this gives us an opportunity to actually plan how we can recruit and make them return around that issue of wanting to gain external experience.
To pre-empt a debate that is still going to take place regarding the certificate of need, I think, is also wrong. I think he should have waited until we debate the National Health Bill so that we can give Parliament the real truth of what we mean about the certificate of need, not what he has just said. Thank you very much. And, I shall do that in a while.
APPOINTMENT OF MARIA RAMOS AS CHIEF EXECUTIVE OFFICER OF TRANSNET
(Minister's Response)
The MINISTER FOR PUBLIC ENTERPRISES: Chair, as a shareholder Minister in Transnet, I’m very happy about the appointment of Maria Ramos to the helm of Transnet as chief executive officer. Because Transnet is one of the premier logistics and transportation companies in Africa, and, as the President has indicated recently, because transport is increasingly going to play a critical role in the economic transformation of our country, having a person of the calibre of Maria at the helm of Transnet will propel Transnet into a higher level than the predecessors have done thus far. We are going to see a lot of action in Transnet, with a lot of funds being spent for infrastructure development in the rail, air and ports sectors. So, I was just responding to that comment by the hon member. We think it’s a very good choice that we have done, as Government, to appoint Maria. [Applause.]
NATIONAL HEALTH BILL
(Second Reading debate)
The MINISTER OF HEALTH: Chairperson, hon members, it is my pleasure to be presenting to you one of the most important pieces of legislation in the health sector. I am sure you will agree that, given the divisions of the past, the values of equity, justice and human dignity are essential to the establishment of a fair, just and credible health system that cares for all.
The Bill deals with matters that require uniformity across the nation and provides norms, standards and framework for health service delivery and the implementation of a national health policy. A key feature of the Bill is that it is embedded in the Constitution. The Bill sets the patient at the centre of the national health system. It creates a national health system that sets out governance structures across all spheres of Government. It reinforces the primary health-care approach to health service delivery. It creates a framework for both public and private health sectors to work closely together to achieve a common vision of a national health system and, most importantly, it lays the foundation for equity in the health sector.
One of the primary concerns and a theme that runs throughout the Bill is the issue of quality. In the context of health services, quality is not just something that is nice to have - it must be an integral part of a system. A health-care system that does not meet certain minimum standards of quality in service is simply not health care. Since the Bill is quite long, I am not going to discuss each chapter in detail because the portfolio committee did this work. Rather, I will point out to you the key principles within the chapters.
Firstly, let me say that each of the chapters cover a critical area of successful health service delivery - notably, the rights and duties of users and providers of health services; the national provincial and municipal structures that must ensure the provision of such services; health establishments; human resources; the control and use of various types of human tissue; health research, evaluation and monitoring; and mechanisms to ensure compliance with its provisions.
The first chapter acknowledges and elaborates upon the broad objects of the Bill and the constitutional obligations of the Government to protect, respect, promote and fulfil the constitutional rights that involve access to health services. It sets out the roles and responsibilities of the three different spheres of Government to ensure the provision of health services and allows for the Minister of Health to prescribe conditions under which categories of persons are eligible for certain free health services.
The second chapter deals with the rights of users and providers. Users’ rights to have full knowledge of their health status and treatment and to consent to or refuse treatment are acknowledged and emphasised in the Bill, including the right not to be refused emergency medical treatment. Chapter 2 seeks to protect users concerning health information and health records and to ensure that no one has unauthorised access to sensitive health information. Health information is personal to all of us and it is important that there are safeguards in place to prevent its abuse. The chapter further seeks to empower users so that they themselves promote the quality and standard of health services, by making provision for a system for the laying of complaints.
We have also frequently heard of our health-care professionals, who work so hard and sacrifice so much, who have been abused and mistreated by patients and families. The chapter entrenches the rights of providers to be treated with dignity and respect. Chapters 3 and 4 set out the functions of the national and provincial departments of health respectively and the structures that must be in place to ensure the delivery of health care. Both chapters balance the Constitutional requirements of co-operative government on the one hand and the distinct separate identities of three different spheres of Government on the other.
For this reason, the national and provincial health councils established by the Bill are advisory bodies only. It is the responsibility of the Minister at national level and the MECs at provincial level to make health policy. Provision is also made in these two chapters for consultative forums to meet at both national and provincial level at least once a year so as to ensure that there is significant interaction …
The CHAIRPERSON OF COMMITTEES: Order! Hon Minister, there is a problem. You are not being heard. I just want to check the system quickly. Can we also ask members to pay attention to the Minister’s speech? We are just checking the system quickly. Please proceed, hon Minister.
The Minister of Health: Provision is also made in these two chapters for consultative forums to meet at both national and provincial levels at least once a year so as to ensure that there is significant interaction with relevant stakeholders on issues that affect them.
The preparation of national and provincial health plans covering strategic, medium-term and human resources matters is mandated. Our health plan has been based on the PHC approach that has been endorsed by the World Health Organisation and adopted by many countries. We recently had a very successful conference celebrating 25 years of the Alma Ata Declaration on Primary Health Care. It is therefore fitting at this time in the history of the health sector that chapter 5 establishes a district health system as the foundation for primary health care.
Although many municipalities are still finding their feet and there is still work to be done with regard to the building of capacity and funding of the different roles of different types of municipalities, the Bill envisages an end point where most municipalities will be providing primary health-care services in accordance with the national health policy.
Let me now turn to the process of planning and development in the health sector. Prior to 1994, the process of planning in the health sector was virtually nonexistent or, at least, it was geared towards planning first- class health services for a privileged few only, thus maintaining the apartheid policy of the previous government. This resulted in the fragmentation and unnecessary duplication of services. This irrational planning process has not only had an impact on the users but the providers as well.
Chapter 6, therefore, is a very important chapter as it seeks to ensure and promote improved access to health services. It does this through a certificate-of-need process, which is a rational planning tool that is designed to promote good organisation, efficiency, and effectiveness, and prevent unnecessary duplication of health-care facilities and services, unlike what Mr Gous said. It will guide the establishment of health facilities and health services that best serve public needs.
Our objective is to provide health services of the same standard and quality to all. I need to stress that the certificate-of-need process not only protects the users, but it also protects the providers as well. Multiple providers cannot survive in a saturated market, hence a rational planning tool such as the certificate of need will ensure that services are delivered according to need. Similar systems operate successfully in the United States and Italy, to name but two countries. The very great and disparate health needs in South Africa dictate that we cannot afford to permit an oversupply of resources in some areas at the expense of others.
There is great agreement that human resources are one of the most critically important areas in the health sector. This is an issue that countries throughout the world are grappling with. This was highlighted at the World Health Organisation Conference of the African region that we recently hosted. Chapter 7 covers the critically important areas of human resources for the health sector.
Provision is made in this chapter for many different kinds of regulations that can be written to address the many and varying aspects of health human resources that we encounter every day. These aspects include retention, education and training of health-care personnel, strategies of recruitment, and identification of shortages of key skills, expertise and competencies within the national health system, so that we can work together with the educational sector to address these.
The chapter also allows the Minister of Health, in consultation with the Minister of Education, to establish academic health complexes at the various levels of the health system for training and research purposes. An important policy principle addressed in this chapter is the establishment of the Forum of Statutory Health Council as a statutory body. There already is such a forum, but it was important to give it formal recognition in this Bill in order for it to play a more meaningful role. It has been beefed up with community, departmental and educational representatives.
The forum has been given statutory powers so that it can be a force to be reckoned with in calling the statutory health councils to account for their performance as public authorities. Its work includes the monitoring and setting of performance improvement targets, protecting the interests of the public and users, acting as an ombudsperson for complaints about particular councils and advising me on matters that cut across two or more of the statutory health professions.
Chapter 8 deals with the replacement of Human Tissue Act of 1985. It regulates who may acquire, use, supply and store human tissue, including blood, organs and gametes and for what purposes. The World Health Organisation has stated that it is very important that countries have a single national blood transfusion service for a number of different reasons. In these days of lethal blood-borne diseases such as HIV/Aids and the haemorrhagic fevers, it is critical that we ensure the integrity and safety of the nation’s blood supply. A single supplier is more easily monitored and regulated especially concerning quality and the observation of prescribed standards and procedures.
A fragmented service increases the possibility of service gaps where people in outlying areas can be underserved because it is uneconomical, from a business perspective, to operate there. It is important to ensure that there is no competition between blood suppliers as this compromises blood safety and that economies of scale in this area are optimised. This chapter also covers the very controversial aspect of human cloning. It distinguishes between cloning for two different purposes. Cloning for reproductive purposes is prohibited for a number of reasons that are internationally recognised.
The right to human dignity is inextricably bound up with who we are, including our physical make-up. Reproductive cloning strikes at the heart of our physical identity and our value as individual human beings. Cloning for therapeutic purposes can be permitted in terms of the chapter, but only in restricted circumstances. We do not want to create a market for human tissue in this country. It has always been reprehensible to us as a society that people should be made to trade in human tissue as though it was just another scarce commodity. It is a matter of recognising the fundamental value of a human being and human life. There is the potential for exploitation of the poor, for unethical and morally unacceptable practices, involving human embryos and there is a significant proliferation in human tissue markets. Therapeutic cloning must therefore, of necessity, be carefully regulated.
Chapter 9 deals with national health research, monitoring and evaluation. As Government, we cannot make meaningful policy decisions concerning health services if we do not have sound information upon which to base our decisions. It is important, in order to effectively and efficiently address the needs of our people, that we identify national health research priorities so that the scarce funds are spent in areas where people can derive the greatest benefit. It is important to protect people who are used as subjects in health research, given the potential for their exploitation and the importance of human dignity within our legal system. It is especially important to protect our children in this area. It is a serious indictment of South African society that they are one of the most abused and exploited sectors of our population and we cannot allow them to become just another commodity in the health research setting.
This chapter establishes a national ethics committee whose job is to identify and prioritise areas of public health research and ensure the focus on priority health problems. The National Health Research Ethics Council is established to ensure that all health conduct in South Africa is of an acceptable ethical standard and to act against those who do not have sufficient respect for established ethical norms, standards and guidelines in health research. Provision is made in this chapter for a national health information system which is based on information coming from provincial and district health levels.
Let me now turn to the important issue of compliance, monitoring and evaluation. Too often, we see good pieces of legislation being rendered ineffectual because of lack of capacity to enforce compliance. Chapter 10 of the Bill gives it teeth. It creates structures at provincial and national level to ensure compliance with the provisions of the Bill. The director-general must establish the office of standards compliance within the national Department of Health. It plays an important role not only in ensuring compliance with the certificate of need provisions and conditions, but also in monitoring and evaluating and promoting the quality of health services throughout the country. Every province must have an inspectorate for health establishments that must monitor and evaluate compliance by health establishments and agencies within the province. It is the intention that these inspectorates will work in co-operation with the national office of standards compliance on areas of common interest to ensure a national health system that is safe, effective and accessible to all.
Chapter 11 provides for regulations to be made in many important areas involving health services. The regulation of the health sector is a complex and intricate business because the health sector itself is a dynamic and developing environment. For this reason, it is neither advisable nor appropriate to make provision for every matter in the Bill itself. Hence, the Minister may, in terms of chapter 11, make regulations on communicable diseases, health research, health technology, emergency medical services, rehabilitation, human resource development and other matters.
Chapter 12 is the final chapter of the Bill. It allows the Minister to appoint advisory and technical committees that are necessary to achieve the objectives of the Bill. It also allows for the assignment of the duties and delegation of powers by the director-general and myself to other persons. The legislation that will be repealed by the Bill is listed in the schedule. The main laws that will be repealed are the Health Act of 1977, the Health Tissue Act of 1983, the National Policy for Health Act of 1990 and the Academic Health Centres Act of 1993.
We have taken a long time to present this Bill before you today. As you can see, the Bill is complex. I believe that there are benefits in taking time to do a thing properly. I can assure you that, in the true spirit of the ANC, consultation on this Bill has been extensive. We did our best to accommodate the concerns of many stakeholders, even though there were sometimes conflicting interests.
In conclusion, I would like to thank the portfolio committee for their active participation in strengthening the Bill. In particular, I would like to thank Comrade James Ngculu, the Chairperson, for his able leadership during the deliberations, and of course, the ANC for its progressive health policies whose aim is to provide better health for all South Africans. I thank you. [Applause.]
Mrs S V KALYAN: Chairperson, the objective of the National Health Bill, to provide a framework for a structured uniform health system which will redress the socioeconomic injustices, imbalances and inequities of the past, is indeed a noble one.
The reality, however, is that the Bill in its present form fails to meet the intended objectives as it lacks tangible, coherent and concrete plans to address past and existing inequities in the system.
Structures, standards and mechanisms to regulate the health-care industry dominate the Bill in a manner that is quite punitive to the private sector. The Department of Health lacks the capacity to sustain all that the Bill envisages.
The Bill gives the Minister too much power, so much so that she is both a referee and a player in the same game.
It would appear that, in her haste for some glory before she is unceremoniously dumped in the next election, the Minister of Health is presenting us with legislation that is fatally flawed.
The South African Government has a history of taking failed policies of other countries and implementing it. The certificate of need is a case in point. In the early seventies, 38 states in the United States used the certificate of need. It failed, because it was anti-competitive and unduly regulatory in nature.
There appears to be a specific need and express purpose on the part of the Minister to regulate the private industry, yet private sector participation in the process has been inadequate. While the principle of levelling the playing fields is understood, the manner in which it is being done restricts freedom of economic activity, stifles free competition and smacks very much of the old Group Areas Act, which controlled where groups of people could stay and trade. Why can positive incentives not be used to achieve an even distribution of services in rural areas?
The state is both the allocator and competitor when it comes to the certificate of need. It grants itself the certificate when it comes to public health establishments. Now, how equitable is that?
The reality is that most patients go to a practitioner of choice. Many travel to do so. Many of you sitting here also do that. It is the right of the consumer to choose a service provider, and the certificate of need erodes that choice. Furthermore, how can continuity of care be ensured if the Director-General of Health does not re-issue a certificate of need?
The director-general will be awarding the certificate of need. This person will surely have to be blessed with superhuman powers to be able to determine geographical reach and the size of a supporting base from his office in Pretoria. Furthermore, has the impact of the lack of services where the certificate of need is not granted been considered? The Bill is also quite silent on what happens during the appeal process.
The criteria for granting a certificate of need is not specified in the Bill. We are told it will be in the regulations. Now, that is highly problematic because too much has been deferred to the regulations, which have yet to be published. The result of this is a lack of clear guidelines on the legislation. Furthermore, the legislation is dependent on regulation in order to be effectively implemented.
It is highly regrettable that the Minister is so insistent about the certificate of need. It is a most inappropriate regulatory measure, and it is certainly going to accelerate the exit of highly competent and qualified health-care professionals from South Africa. A World Health Organisation report released on Wednesday claimed that 58% of health workers wanted to leave South Africa mostly because of the deterioration of the health-care system. It is also going to act as a disincentive to the private health- care sector to invest in health care in South Africa and, therefore, the objects of the Bill cannot and will not be realised. Co-existence is surely the answer and the certificate of need antagonises the private sector.
There are sure to be two major consequences of this legislation five minutes after the ink dries. Firstly, there will be a constitutional challenge. I doubt, however, that this bothers the Minister, as she has already proved to be so incompetent in her portfolio, and the precedent of the health of South Africa being decided by litigation has already been set. Furthermore, she openly defies court orders and no action is taken against her. So she will clap hands childishly and go on her merry way in blissful ignorance.
Secondly, amendments will be proposed and this Bill will be back here again very soon. Quite frankly, I cannot wait to say ``I told you so’’ because, indeed, caution has been thrown to the wind.
The National Health Bill in its current format will not meet the main goal to transform health in South Africa. It is vague and unclear on how implementation will actually improve access to quality health care. Furthermore, it does not provide an enabling framework or system to address management of the huge crisis that faces South Africa, namely HIV/Aids. While I do acknowledge that general legislation does not address the management of a specific disease, the truth is that the Aids pandemic will and is already having a devastating impact on the health-care system in South Africa. Instead of catering for this, the Bill hides behind cop-out phrases like health services will be provided “within available resources”. What that really translates into is that treatment for HIV/Aids will not be provided because the budget is inadequate.
What the Minister should actually do is look at tried-and-tested ways of improving health care in South Africa instead of advocating potato salad solutions.
The DA cannot, in the best interest of good health in South Africa, support this Bill. [Interjections.]
In conclusion, I wish to place on record sincere thanks to the chairperson and the committee for the manner and the spirit in which we engaged on this Bill and, also, the DA would like to extend good wishes to Dr Ayanda Ntsaluba, the former DG of Health. We wish you well in your new position.
Thank you. [Applause.]
Mr L V J NGCULU: Thank you very much, Chairperson. As the ANC we want, from the outset, to declare our unqualified support for this Bill.
This Bill marks a fundamental break with the past. The National Health Bill radically moves away from the backward and parochial 1977 Health Act. As did Moses, this Bill will also take the health system of our country to the promised land of equity and equality, efficiency and quality, and accelerate the long road to a better life for all.
The 1977 Health Act completely ignored the issues of access and equity, but focused more on milk sheds and the animal feeding system. The Bill before us, therefore, seeks to transform the entire health system in South Africa.
The Bill is embedded in the Constitution. It responds to the injunction of the Constitution to address the injustices, imbalances and inequities of the past that require that the state take reasonable legislative and other measures, within available resources, to achieve the progressive realisation of the right of the people of South Africa to have access to health-care services.
In this regard, the Bill states in no uncertain terms that no one may be refused emergency medical treatment. This is reflected in the Constitution. This provision indeed responds in particular to a situation in which people who do not have medical aid or financial standing are simply turned away and not attended to during an emergency, on the basis of their socioeconomic status.
Some people have argued that we should, therefore, define `emergency’ in the Bill, but our view as the portfolio committee is that it is not our duty to interpret the Constitution. Our duty is to protect the people and allow them access to health in conditions of emergency.
The DA strenuously opposed this position on the basis that this will be a disincentive to private-sector investment. They further stated that we should specify categories. We stated in the portfolio committee deliberations, and we do so here again, that our responsibility is to the people of South Africa, particularly the poor and the vulnerable.
We are saying that in emergencies people must get attention and stabilisation without regard to monetary gain, because the health of the people should come before anything else. We requested the DA to state whether, as it stands, it has no regard for the poor and marginalised and is more interested in the interests of the rich and the private sector. The answer was as confused as their intervention again shows in this debate.
Another important element in this Bill is that it entrenches the rights of patients and facilitates service delivery. In this regard, it guarantees that the user must have full knowledge of his or her health status except in circumstances where there is substantial evidence that the disclosure would be contrary to the best interest of the user. The user must consent to the health services provided and his or her confidentiality is guaranteed in terms of this legislation. It specifies instances of departure from this provision.
Even more critical is the provision and procedure to lay complaints. We have proposed again here that such procedures and information must be clearly stipulated in the health establishments. Here we would like to stress that we have seen too many instances where people have been treated in the most objectionable way and thus their confidence in the services Government provides them is simply eroded.
Throughout this Bill our particular emphasis on the user’s rights and duties is unambiguous. We once more want to ask the people who stand in the way of the poor and the vulnerable in relation to health, as to where they stand in relation to the issue of the poor and vulnerable, such as when Thozama Ngongo, on 14 August 2003, went to a hospital in the Western Cape and waited 17 hours before she could be attended. Even when attended, the procedure was performed without anaesthetic, causing her extreme pain. When the hospital staff were asked about this, they stated in the most callous manner that she did not complain.
We have referred this matter to the Minister of Health. However, the point we’re emphasising here is that this legislation is aimed at putting a stop to all practices of this nature.
The National Health Bill shall ensure that people like Thozama and many others like her shall never again become victims of the most uncaring and cruel system at the hands of the people who are supposed to be providers of quality health care. The other important provision of this Bill is that it establishes the district health system and district health councils. In this way the Bill strives to achieve equity, overcome fragmentation and duplication, and introduces better integration. It states that the district health council must promote co-operative governance and ensure co-ordination of planning, budgeting, provisioning and monitoring of all health services that affect residents of the district for which the council was established; that every metropolitan and district municipality must ensure that appropriate municipal health services are effectively and equitably provided in their respective areas.
Again, this is a significant departure from the fragmentation and duplication that were promoted by the 1977 Health Act, which permitted national, provincial and local government to duplicate services. This does away with such duplication and fragmentation and streamlines everything.
The Bill allocates environmental health services to municipalities with the exception of port health, malaria and hazardous substances. It also envisages a situation where primary health care shall be delegated to certain categories of municipalities, such as metropolitans and districts.
Mindful of varying capacities at local level, this Bill shall allocate such resources on the basis of service-level agreements. This is a huge step forward for the organisation of primary health care, which is the basic `plank’ of our health system.
Another significant proposition in the Bill is the issue of the certificate of need. It prohibits the establishment, construction, modification or acquiring of a health establishment, or increasing the number of beds without the possession of the certification of need.
Some among us have strenuously opposed this section in the Bill. Before one deals with the contents of this opposition, one would like to first explain the aims and objectives of the certificate of need.
The certificate of need is designed to address the trend of the inappropriate establishment of health establishments, particularly the unbridled proliferation in the private sector, which in turn duplicates services. Such a duplication and unbridled proliferation inadvertently leads to pushing up the cost of medical care.
The certificate of need seeks, therefore, to promote cost containment. It is always important to remember that any health system must look at the question of cost, quality and access, and the state has a responsibility to progressively meet the health needs of the population. In other words, the certificate of need should be seen as part of Government policy to achieve efficiency in the public health.
The certificate of need, therefore, is another intervention of redressing the imbalances of the past and seeks to achieve a fair and equitable distribution of services to where they are needed.
Some, in their opposition to this provision, even called the certificate of need another form of pass laws or Group Areas Act. People who never carried a passbook and who were the beneficiaries of Group Areas Act say this. They deliberately forget to remember that the skewed distribution of resources, including health provisioning, is but a consequence of the iniquitous system of apartheid.
When we try to correct this imbalance, which favours a particular class and race, in order to arrive at a rational and fair distribution of health services, some people have the gall to protest.
The hon Ruth Rabinowitz of the IFP even called on us not to regulate on the basis of the certificate of need and should rather leave this to the market forces. I am not sure what the IFP members would say, those who live in far- flung areas where they have to walk distances in order to get their health- care services. Would they agree with hon Rabinowitz’s call to leave health- care service to chance, in other words, “tata ma chance, tata ma health?” I strongly doubt that she speaks on their behalf. [Laughter.].
We, however, would like to once more stress to all those who are opposed to this provision that as the ANC we cannot govern on the basis of chance. We are a caring Government that always puts people first. We entertained about twenty oral submissions and many written submissions. People who made their submissions supported the broad principles of the Bill. We have in our deliberations accommodated many of the views and suggestions that were made. We wish, therefore, to thank all those who made the effort to join in the making of history in South Africa.
I would also like to thank the Portfolio Committee on Health for the manner in which we dealt with the Bill. Even though at some point we differed, we never lost sight of the singular importance of this Bill. We also would like to thank the research staff for the way in which they provided backup support to the committee.
Our thanks also go to the Department of Health, to the former director- general in particular, and to the Ministry for steering this Bill to its logical conclusion.
We are indeed very happy that by the time we go to the 10th anniversary of freedom, the 1977 Health Act will have been consigned to the dustbin of history. Throughout the history of the ANC, we’ve never hesitated to take bold decisions, especially when those decisions were designed for the betterment of the lives of the people. The National Health Bill is another illustration of our resolve to transform and change our society.
When the next generations look at this Bill, a Bill we are certain shall endure posterity, they will cherish those of us who had the foresight to champion this legislation.
Once more, the ANC supports this Bill. We have indeed come full circle. I am certain that the doctors who served the ANC in the camps in Angola, doctors like Dr Nomava Ntshangase, Peter Mfelang and medical officers who served with them and are no more, would be proud that we remained steadfast on our road to a better South Africa. We have not failed their ideals. We support this Bill. [Applause.]
Dr R RABINOWITZ: Chairperson, the hon chairperson of health is absolutely wrong. Neither the IFP nor have I ever advocated a free market in health or persons taking their chances in health care. We advocate minimum standards, accountable and efficient services and decentralisation, rather than control.
However, democracy is alive and well in the health committee. Under the able chairmanship of Mr Ngculu the committee paid heed to every submission brought before it. Many concerns were addressed.
The admin staff were superb, the advisers competent and helpful. So why is the IFP so disappointed in the National Health Bill? Because it is a law reviewed by a great team in the service of a facile dream, which may in reality become a perfect nightmare. The IFP would have preferred to usher in a health Bill that would lead us to greener pastures.
The viewpoints I am representing are not those of the private sector or the large health conglomerates that dominate the health industry, nor are they the views expressed by health practitioners in the leafy suburbs of South Africa. I am representing the views of people in rural and outlying areas, who are tired of the poor health services they receive. I represent the views of hard-working doctors in outlying rural areas, who give excellent services to their patients, some prescribing and treating for remarkably low prices.
The wealthy institutions made no representation on this Bill. The hospital association made a muted one. They can pay their way through this maze. I represent millions who believe in accountable, reasonably priced health services, and people who believe that democracy means the freedom to choose.
We all know what the National Health Bill needs to do. It needs to reverse the overspending of health on the world’s rich and the neglect of the world’s poor. We need the same restructuring in South Africa.
There are two opposite responses to such unbalanced services. One is the tried and failed method of control and bureaucracy: Control every drop of health spend and then try and force it into channels where we want it. The other is the more flexible, realistic and effective approach, which the IFP favours.
Firstly, accept the money offered to us by the rich nations of the world and use it accountably; secondly, minimise the bureaucracy; thirdly, actually spend a high percentage of public money on the rural and urban poor. Government can contract top-quality care to serve rural and deprived areas, with competitive contracts to NGOs and private consortia; fourthly, implement functional rural development plans; fifth, draw health personnel through incentives to the areas where they are needed and encourage well- motivated medics from all over the world, not just Cuba, to visit South Africa and work for the poor; sixth, decentralise authority and allow flexibility, and seventh, appoint objective health ombudspersons to ensure that minimum standards are maintained in all private and public health establishments.
This Bill applies the certificate of need. Aptly, the acronym is a con to all health services in South Africa. We’ve seen it before, affecting dispensing doctors and people who want to buy medicine, but this applies it across the board.
Through the certificate of need, the director-general will attempt to, amongst other things, correct inequities based on race, gender, economic and geographic factors; promote the correct mix of private/public partnerships; measure the potential advantages and disadvantages for existing establishments; attempt to establish demographic and epidemiological characteristics of the population to be served, the potential benefits to research and the probable financial sustainability of the health establishment.
Our new director-general will need to be a fortune teller, in addition to a diviner of all possible health truths. The cost of setting up such an operation will be astronomical, and this will be money directed away from the very services that are needed. It would, in any case, be a long time before our country could boast of such a system, and until then subjectivity and fairness, legal challenges, mistakes and a host of unintended consequences will be the order of the day.
Even after a practitioner has passed the qualifying exam and obtained a licence to practice from the respective council, and paid the registration fee, the certificate may or may not be granted by the director-general. This key need certificate would be as much an invitation to bribery and corruption as honey to a bee. The appeal mechanism for this process need not exist, as the appeal against the director-general goes to the Minister.
Not only does this apply to the private sector, but also to provincial MECs. Talk of decentralisation, yet introduce this form of centralisation. We support the decentralisation of district health services in practice, not only in word.
The Bill also provides for numerous new bodies and committees with duplication of responsibility and the creation of yet more bureaucracy. On none of these is there explicit reference to traditional healer, NGO, academic, or private representation. The Minister can override their advice with her unfair discretionary powers, and she has virtual carte blanche to appoint members to committees or to terminate their services.
Another major feature of the Health Bill is the regulation of stem cell research. This new field of biogenics challenges our understanding of the soul, the meaning of life and the difference between humans and animals. When one can carry a container filled with hundreds of frozen zygotes that are potential human beings, from one continent to another, or when one considers the setting up of factories to farm human embryos for the development of body parts and ideal babies, the matter becomes food for serious ethical consideration.
The Bill makes the Minister the soul judge of what research will be licensed, and no minister, whether she be Manto Tshabalala or Mother Theresa, should be given such power.
Ethical considerations are a critical factor in the future of health care. But, unfortunately, the history of ethics in the South African health policy has left much to be desired. This Bill encourages, rather than curbs, questionable practices in future. Even donor funding for the provinces goes through the filter of the Ministers or MECs for health, nationally and provincially.
If the debacle of the global fund did not warn us of the dangers of such controls, then we are naive dreamers who believe that politicians only use power for the public good. Reality teaches us otherwise. The National Health Bill legislates undemocratic practices that expose the public to a health system open to corruption, mismanagement and further deterioration. It is with regret that the IFP cannot support it.
Dr S J GOUS: Madam Deputy Speaker, the National Health Bill has been eagerly awaited and is long overdue. It is a very necessary and commendable piece of legislation that seeks to establish a legislative and regulatory framework for the delivery of health services throughout South Africa. The NNP accepts most of the measures and structures as proposed to effect implementation and delivery of uniform health services, except the so- called certificate of need, the big CON.
Unfortunately, this is such a fundamental concept that the NNP had to consider its support for this legislation as a whole, based on this certificate of need. Now the question is: What is this certificate of need? Clause 36 states that a person may not: (a) establish, construct, modify or acquire a health establishment or a health agency; (b) increase the number of beds in, or acquire prescribed health technology at a health establishment or health agency; (c) provide prescribed health services or continue to operate a health establishment or health agency after the expiration of 24 months from the date this Act took effect, without being in possession of the certificate of need.
When you consider the definition of a health establishment, it becomes clear that this certificate of need will affect everyone from the biggest corporate business, public and private, to the individual practitioner, which will, by the way, include the nurse who wishes to do voluntary home- based care. Let’s also not forget that this certificate of need is renewable and this has to be implemented within 24 months of the date of this piece of legislation taking effect. Indeed, there is a big task ahead.
The NNP accepts the principle that health services may be regulated by way of licensing or accreditation. But we cannot support the principle of a certificate of need. The certificate of need is based on poorly defined criteria and could eventually lead to subjective or political decisions that do not adequately respect the rights of an individual.
The motivation for the certificate of need is to address the maldistribution of health workers and facilities, especially in the rural areas. We believe that it will not have the desired outcome and we would rather support a system of incentives.
There is a possibility that such a measure would also encourage the brain drain and have an overall negative effect on the health system. The constitutionality of this certificate of need also needs to be confirmed.
The NNP’s opposition to this measure is shared by the majority of the inputs at the hearing on the National Health Bill. It is clear that this certificate of need is arbitrary, subjective, destructive and anticompetitive.
The NNP predicts that it will have the opposite of the intended effect and will be the grease on the slide of the brain drain. This is confirmed in no uncertain terms by the young doctors as represented by the SA Registrars Association. A possible positive effect could have been that the certificate of need could have given value to a practice. However, the certificate of need is granted to a person, which means that it lapses when the individual dies or leaves the practice for whatever reason.
Some of the submissions likened the certificate of need to the reinstitution of the Group Areas Act, to influx control and the pass laws. It could easily become the health workers’ “dompas”, as he or she will not be allowed to practise his or her profession in a certain area of his or her choice, whether that be based on personal, family, health or any other considerations. The NNP finds this immoral and unacceptable.
Sections 21 and 22 of the Bill of Rights guarantee freedom of movement and profession. This may be limited by section 36(1). The NNP believes that section 36(1)(e) would be applicable as there are surely many less restrictive means to achieve this purpose.
Other clauses that the NNP is objecting to are those that place an unfair burden on an individual, for which he is not primarily trained or qualified.
The clause on record keeping is also contentious because it is not clear for how long records should be kept. Regarding public liability insurance, I need to know whether there is any legislation that prescribes to lawyers how they must insure themselves. Why should health workers be subjected to this?
Entry and search without a warrant is totally unacceptable to the NNP. Another worry is the possible duplication of complaints against professionals for whatever reason.
Lastly, regarding the issue of sunset or grandfather clauses, the NNP finds it morally unacceptable to jeopardise the youth’s future for short-term gain. We must accept that this is groundbreaking legislation, and new legislation, and we are, therefore, bound to make mistakes. The NNP asks that we admit to these mistakes sooner rather than later. This piece of legislation should be amended before it creates havoc and destruction in sectors of the national health system.
In closing, I would like to thank our Chair, Mr James Ngculu, for the way he handled this very complex and difficult piece of legislation, and the rest of the committee. I also wish our leaving or departing Director- General of the Department of Health, Dr Ntsaluba, all of the best in his new career. I thank you. [Applause.]
Ms N M TWALA: Madam Speaker, this National Health Bill represents a milestone in the ANC’s endeavours to transform the health-care system into one where the health system will benefit everyone equally, but with a special focus on the poor and the most vulnerable.
Our Freedom Charter is clear when it provides us with a benchmark for health. And, as ANC members, we feel we are mandated to develop a preventive health system which is run by the state; and, where free medical care and hospitalisation are provided for all, with special care for mothers and young children. We believe we are still on track in achieving this goal.
Chapter 2 of this Bill, which deals with the rights of users and duties of health-care providers, marks a fundamental step in restoring the dignity of the patient and providing fair treatment to all citizens of this country, irrespective of whether they come from urban or rural areas.
Another far-reaching measure that this chapter introduces is the enforcement of emergency treatment for all, in the delivery of health services. What this means is that no health-care provider or health establishment shall ever again be able to refuse anyone emergency treatment. We shall remember the incident in 1996, in Khayelitsha, where a patient was brought for treatment on a wheelbarrow. The patient died without being attended to because they were sent from pillar to post and health-care providers were more interested in rushing to get off duty. This will never happen again.
We heard, time after time, stakeholders asking, ``Who is going to pay for this emergency treatment and what exactly is an emergency treatment?’’ But, throughout the discussion, money was the main concern, with hardly any discussion on saving the life of the individual who is unfortunate enough to need emergency treatment to save her life. The ANC was clear on this subject. Whichever health-service provider is at the scene of the emergency must take care of the patient who needs that treatment - whether it be an ambulance, local doctor, private hospital or a clerk at the admissions office who wants to check the medical-aid number first.
Many of those who made laws in the past era never saw to it that patients were informed of the benefits, risks, costs and consequences generally associated with each option. This was very common with black people, in general, and the uneducated, in particular. Our people never knew that they, as patients, had the right to refuse health services or had the right to information about their treatment.
Umntu omnyama ubengakhathalelwa, engenalo ilungelo lokwazi nokuzithethela ngempilo yakhe. Bangaphi oomama abazibhaqa sele bekhutshwe izibeleko bengazange bacaciselwa ngaphambi kokuba kwenziwe oko nezizathu ezenze into yokuba kufikelelwe kweso sigqibo? Isininzi sabo yayingabantu abamnyama in the homelands. (Translation of Xhosa paragraph follows.)
[The black people did not have rights and could not speak for themselves and about their health. How many women have had hysterectomy, removal of the uterus, without it being explained to them first? A majority of them were women from the former homelands.]
I remember, when I was training as a nurse in King Edward VIII Hospital, an incident of a patient from KwaNongoma who had a hysterectomy done without her knowledge. She wondered why she could not conceive. It was only after attending an infertility clinic that she discovered that her womb had been removed. Neither she nor her husband had given any consent.
With this Bill, it is going to be compulsory that the user fully participates in any decision-making that affects his or her personal health treatment and it has to be done in a language that she or he understands. This Bill protects the patient, once they are discharged, by ensuring that health-care providers or nurses and doctors issue the patient with a discharge report. The health establishment would therefore be compelled to give information such as the follow-up treatment, recommended medicines, date of next visit and so on.
This initiative is taken because we have seen instances where, when a patient goes for his or her follow-up treatment, there are no reports on their previous condition, what treatment was given and what subsequent steps were to be taken. This is usually problematic when the patient visits another place and she or he has to begin the investigation all over again. This could be costly and also detrimental to the patient’s life. Moreover, it contributes towards wasting the taxpayer’s money.
In Frere Hospital, in East London, a patient was treated for serious dog- bite wounds. Her legal representative could not proceed with the court action against the accused because the user’s records were nowhere to be found at the department where the records were kept. This court action dragged on for almost two years. After the victim had come to my constituency office for assistance, I contacted her lawyer who told me that that was not the only case, but that there were many motor vehicle assurance cases, submitted as claims to the Road Accident Fund, that were backed up because of missing records from the same hospital. I then contacted the head of the hospital and the MEC. After four days the records were traced and the attorney was able to proceed with the case.
This legislation will make sure that hospitals and clinics set up control measures to prevent unauthorised access to those records. Any person who changes or destroys a record without authority commits an offence and is liable for conviction, a fine or imprisonment for a period not exceeding one year, or both a fine and imprisonment.
This Bill will also enable any person, who wishes to lay a complaint about the manner in which she or he was treated at a hospital or clinic, to have the complaint investigated. These measures ensure greater accountability towards the patient, but the patient, too, must adhere to the rules of the health establishment when receiving treatment or using health services. We hope that these complaint mechanisms will be introduced as a matter of urgency.
Cosatu, during public hearings, alluded to the fact that dignity and respect shall be restored with the implementation of this Bill. This Bill moves away from the narrow biomedical model, where a doctor is perceived as God, into a participatory health-care model, where the patient has the right to be treated in a humane and dignified manner.
The ANC, once again, delivers to the people. As the ANC, we say, ``Health for all, dignity for all and quality services for all’’.
Today, those in this House who oppose this Bill are doing that because they are opposed to the provision of a better life for our people. It clearly shows that they have no interest in ensuring that our people get a better life in this country. Only the ANC stands for a better life for all. [Applause.]
Ms C DUDLEY: Deputy Speaker, since 1998 - when the ACDP submitted a Private Member’s Bill with regard to the prohibition of human cloning in South Africa, the ACDP has been calling on Government to urgently reassess the need for a separate Bill prohibiting human cloning and the use of embryos for stem-cell research in South Africa.
We, therefore, welcome the inclusion of these issues in the National Health Bill which is, at last, before Parliament. However, while the Bill includes a prohibition on reproductive cloning of human beings, it allows for 14-day- old foetuses to be used for research - which the ACDP strenuously opposes. We are also concerned that the Bill offers insufficient protection against therapeutic cloning, which involves the intentional creation and nurturing of an embryo which is then sacrificed and cells are harvested. The health department officials, defending research done on developing human beings, said that it was justified because of the importance of its results but did not respond to whether or not they were implying that the importance of research then justifies the use of human beings as guinea pigs for experimentation.
Of course, the department does not consider a developing human foetus as a human being, especially before 14 days. And, provided that the donor gives consent and research is documented, it is legal. Apart from the fact that nothing changes within 14 days from conception to make the foetus any more or less a developing human being, this creates a market for foetuses, and cash-strapped people could consider this a new method of making money. Since it is legal in South Africa for a developing life to be terminated merely for convenience or economic reasons, or no particular reason at all, this approach is not surprising. In fact, once people have been convinced that 14 days is OK, why not 24 days or even 54 days; and then, come to think of it, why not children under 2 years as, at least one academic has suggested that not even they are viable and should be expendable.
This Bill, unfortunately, does not give the much-needed protection and further exposes women and unborn children to exploitation and abuse in the name of science. At the same time, the issue of a certificate of need is a concern because these clauses lack clarity and create uncertainty. They undermine constitutional rights currently enjoyed by licensed or registered members of the private sector and, potentially, undermine health-care services in general.
While the certificate of need applies to both the private and public sectors, the Department of Health, as the responsible regulator, would be receiving and granting applications from and to itself while actively competing with the private sector. The director-general will decide whether or not a service can be provided in an area that is dependent on the department’s perception of the need. Gatesville, in Mitchells Plain, is a black-owned hospital and a case in point. The department has refused them a cath lab on the grounds that a city hospital has a cardiac department and, therefore, they see no need for it. This is a blow to black empowerment and to the people of Mitchells Plain.
New restrictions on hospitals will allow for contracts of between 10 and 20 years. While this may inconvenience large hospitals, it will not adversely affect their business. Smaller hospitals, however, will have shorter periods over which to off-set costs and this, coupled with their restricted bargaining power, will cause prices to go up. That, in turn, will make it easier for them to be swallowed up by bigger hospitals.
The ACDP also queried clause 41(6)(d), which could be used against health establishments that refuse to perform medical functions that they consider immoral, such as abortion. The department, however, insisted that that was not the intention because providers still have the constitutional right to refuse to do an abortion, but cautioned that, in terms of regulations, it is already a criminal offence to refuse to refer a person to a facility where they will get an abortion.
Clause 45 states that any person who performs any of the acts contemplated in clause 41 without a certificate of need could commit an offence and be liable to a fine or imprisonment of five years. Churches, NGOs and anyone caring for people independently would need to qualify for a certificate of need. And this could negatively affect thousands of people who give vital home-based care in a country so seriously affected by HIV/Aids.
While the ACDP has welcomed the National Health Bill in principle, as a vital piece of legislation that could potentially improve the quality of life of people in South Africa and increase life expectancy, we must, regrettably, vote against the Bill primarily on these grounds. Thank you.
Ms N C NKABINDE: Deputy Speaker, hon Minister and hon members, the core of this Bill is, perhaps, best captured by the following section in the preamble, which sets the legislation out to:
… establish a health system based on decentralised management, principles of equity, efficiency, sound governance, internationally recognised standards of research and a spirit of enquiry and advocacy which encourages participation.
If this Bill can be implemented in a fashion that can actually achieve these objectives, then surely we will be providing the people of South Africa with the health care that they deserve under a democratic dispensation. In fact, I dare say that if these principles had been consistently applied in the past five years, we would not have witnessed the continuous and damaging uproar over the management of HIV/Aids treatment.
The Constitution demands not only extensive health-care provision, but also the progressive realisation of these rights. It is, therefore, correct that Chapters 1 and 2 set a clear benchmark of what these rights are and the duties of the administration, health-care professionals and users in this regard.
We express the hope that the provisions of Chapter 3 will create the co- operative and consultative atmosphere that is required for the policy environment to respond adequately and effectively to the health-care needs and challenges of this country. The role of the National Consultative Health Forum requires further expansion, and it is hoped that this body will play a central role in shaping a policy.
The decentralised management of health-care described in Chapters 4 and 5 is, in our view, the correct approach. We are hopeful that this, indeed, will lead to the resources and services reaching the people at grass-roots level. It is absolutely vital that the billions of rands budgeted for health care every year are actually deployed at the level where these services are required. Only by doing this can we bring an end to the deplorable situation where health-care facilities are constantly lacking in terms of medicines, basic supplies, equipment and adequate personnel.
The UDM supports the Bill. [Applause.]
The DEPUTY MINISTER OF HEALTH: Deputy Speaker, hon Minister and hon members, I’m very glad to be able to participate in the debate today, because an unusual situation has arisen in respect of the consideration of the National Health Bill, in that I’m obliged to contextualise my position on this important legislation by referring upfront to the co-operative governance agreement between the ANC and the New NP, in terms of which I serve in the national executive as the Deputy Minister of Health.
That agreement provides for the two parties concerned to seek agreement on any matters of policy on which they differ, and if they fail to reach agreement, to respect the principle of the majority view, in this case the ANC, prevailing whilst the New NP has the right to hold a differing view and to express and promote that view publicly. The clear intention of the agreement is also, of course, that should such a difference arise, it must be dealt with in a responsible and positive spirit. The National Health Bill is an example of such a difference of opinion, which now has to be dealt with.
Against this backdrop, I wish to say that the New NP is supportive of the broad objectives as outlined in the Bill, and fully recognises not only the socioeconomic injustices, imbalances and inequities of health services of the past, but the need to deal with them with vigour and commitment, underpinned by a number of obligations which flow from the Constitution and from the Bill of Rights. We are also in agreement with the four broad objectives set out in the preamble of the Bill. However, it is actually on the basis of the fourth objective set out, which I wish to quote, that we have identified problem areas, the most important being clause 36 and following articles relating to the so-called certificate of need.
The objective that I refer to says:
To promote a spirit of co-operation and shared responsibility among public and private health professionals and providers and other relevant sectors within the context of national, provincial and district health plans.
In line with this objective, we contend that South Africa needs a thriving private health-care sector that can address the needs of as many citizens as possible and, in so doing, take some of the pressure off an overburdened public health-care system. However, the problems we have identified are mainly those provisions which could easily discourage rather than encourage private-sector providers which, in our view, would be highly regrettable and must be avoided. The New NP’s position in respect of the certificate of need is a matter of public record that was put forward directly for consideration to those taking the final political decisions immediately after the public hearings, and our position was also extensively articulated by the New NP spokesperson, Dr Gous, during the portfolio hearings and again today.
There are other aspects of the Bill that are problematic, which Dr Gous has also dealt with, but I would like to say that there are two particularly positive aspects of the Bill, which I would like to emphasise our support for, even though the certificate of need provisions are obliging us to oppose it. They are clause 4, which actually relates to free health services in public health establishments, and the clauses in Chapter 2 relating to rights and duties of users and health-care providers, and specifically provisions for the lodging of complaints, an area which, in my view, must enjoy ongoing attention and high priority in the interests of perceptions about and credibility of the whole public health system. I also wish to quote from the vision and mission of the Department of Health, as set out in the 1999-2004 Health Sector Strategic Framework which, I must emphasise, my party and I fully support. It says, and I wish to quote:
Our vision is a caring and humane society in which all South Africans have access to affordable, good-quality health care. Our mission is to consolidate …
it says,
… and build on the achievements of the past five years in improving access to health care for all and reducing inequity, and to focus on working in partnership with other stakeholders to improve the quality of care at all levels in the health system, especially preventive and promotive health, and to improve the overall efficiency of the health- care delivery system.
I would just also want to say that our submission is that, irrespective of differences we might have now as to how to achieve this vision, all of us should agree that it must, indeed, be achieved. I also know that in the course of the discussions in the committee, mention was made a few times of the need for greater private-sector representation in certain of the bodies which are envisaged, and I would like again, today, to reiterate support for that view. In conclusion, I would like, on behalf of myself and also my party as a whole, to very sincerely thank Dr Ayanda Ntsaluba for his outstanding contribution and service to health care in South Africa over a period of many years, and to wish him every success in his very challenging new position. The gain of Foreign Affairs is certainly our loss. I thank you. [Applause.]
Mr I M CACHALIA: Madam Deputy Speaker, hon Minister, hon members and the Department of Health, we start with the premise that health care is a right as enshrined in the Constitution and that the state is responsible for ensuring that all South Africans have access to good-quality health care.
The massive inequalities associated with access to quality care is one of the key challenges that faces the health-care system. This lends itself to weak health-care outcomes, despite the fact that considerable progress has been made since 1994.
It is almost a truism that human resources determine the success or failure of the health-sector transformation. Human resource development is increasingly being recognised as the key to improved health service delivery. Health-sector transformation policies have to acknowledge that health is a human system and has to address itself to the issues of personnel staffing the service, improving planning, capacity and management.
The section on human rights in the draft National Health Bill has undergone numerous changes over the years. In the August 2002 version, the whole of Chapter 7 is devoted to human resource planning and academic health service complexes. By the Department of Health’s own admission, the Bill is by far the most important Bill in the health sector. By implication, it is also one of the key pieces of legislation to ensure the progressive realisation of human rights enshrined in the Constitution of the country. The Bill provides for a structured uniform health system taking into account the obligations imposed by the Constitution on the legislation on the national, provincial and local governments with respect to health services. The Bill provides a regulatory framework for the provision of health care in the private and public sectors and sets out the rights and duties of health-care providers, health workers, health establishments, as well as users of health services.
Let us have a brief look at the human resource challenges facing the Department of Health and the strategies that have been implemented to address them.
Firstly, there is the issue of capacity and skills. There are many skills lacking amongst frontline health workers encompassing a broad spectrum of services. Secondly, there is the issue of workload. There is much variation in terms of the number of patients seen. Workloads are determined by structural differences, such as location, size, staffing levels, infrastructure and resourcing. Thirdly, effective management and support are central to the performance of health personnel. Notably good management and support will improve work satisfaction and staff’s ability to function, whereas lack of same contributes substantially to low productivity and demotivation.
Fourthly, The SA Health Review 2002 states, and I quote:
It can be said that HIV and Aids arguably pose the greatest challenge to the human resource development in the health sector.
The health department is faced with the double burden of having to cope with not only increased morbidity and mortality in its own ranks, but also has to carry the impact of an increasing disease burden in the general population. Fifthly, there is the issue of migration. The SA Health Review 2002 cites lack of management, work overload, poor working conditions and emotional burnout as factors which contribute to low productivity, staff morale and quality of care. This in turn contributes to the brain drain or migration of health workers.
Clause 56 states that the Minister may consult with the Minister of Education to establish academic health complexes. The hon Minister has already alluded to this clause in this debate.
Clause 57 permits the Minister to make regulations regarding human resources within the national health system. In Clause 53, the policy and guidelines contemplated must, amongst other things, facilitate and advance: the adequate distribution of human resources; the provision of appropriately advanced skills at all levels of the national health system to meet the population’s health-care needs; the effective and efficient utilisation, functioning, management and support of human resources within the national health system.
The health department has been allocated R500 million for the first time this year to retain those professionals who are in particularly short supply and to attract more to the health sector. The Medium-Term Expenditure Framework provides for some expansion over the next few years - to R750 million next year and to R1 billion in 2005-06. The importance of remuneration, improved housing conditions, more generous bursaries, including the creation of better management and a better resourced work environment, is also being recognised.
Whilst the Bill makes important provisions that will to some extent address the human resource challenges faced in the health sector, much more can be done to strengthen and give more effect to the provisions made.
In addition, the necessary budgetary resources would need to be allocated in the next financial year, to give effect to the provisions made in the Bill. I am greatly encouraged by the emphasis and policies being paid to human resource development by the Ministry of Health. We, in the ANC support this Bill. I thank you.
Mnr P J GROENEWALD: Agb Mevrou die Adjunkspeaker, die Vryheidsfront sal nie hierdie wetsontwerp steun nie, en die hoofrede gaan basies oor die sertifikaat vir nodigheid.
Die taak van die agb Minister is om gesondheidsdienste uit te brei, maar die agb Minister kom met hierdie wetsontwerp en plaas ‘n beperking op die uitbreiding van gesondheidsdienste. As die agb Minister die hospitale besoek, behoort sy te kan besef dat die huidige aantal hospitale wat daar is nie eens na behore die aantal pasiënte kan hanteer nie. As ‘n mens by hospitale kom en as ‘n mens in die media kyk, is daar hoeveel gevalle van mense wat selfs ure in toue moet staan net om gehelp te word. Daarom kan die Vryheidsfront nie verstaan dat die agb Minister kom en ‘n beperking wil plaas in terme van die ontwikkeling van privaathospitale en dienste nie.
Behalwe dat dit tog seer sekerlik deel van die ekonomiese kragte is dat, as daar mense is wat sulke fasiliteite beskikbaar wil stel, hulle dit kan doen, beperk die agb Minister ook die groei van die ekonomie. Ek wil vir die agb Minister sê, die groot probleem van die agb Minister is dat sy nie meer antwoorde en oplossings het wat sy kan aanbied nie en omdat sy dít nie kan doen nie, kom sy en gryp terug na die verlede en beskuldig apartheid. En as hulle nie apartheid kan beskuldig nie, dan kom gryp hulle die kwessie aan van die verskil tussen ryk en arm; en dan is dit nou die rykes se skuld dat daar nie dienste gelewer kan word nie.
Die agb Minister moet na vore tree en begin dienste lewer en, as daar mense is wat gesondheidsdienste wil bevorder en verder wil uitbrei, vir hulle eintlik aanmoedig om dit te kan doen; nie ‘n beperking plaas soos hierdie huidige wetsontwerp nie. Dankie. (Translation of Afrikaans speech follows.)
[Mr P J GROENEWALD: Hon Madam Deputy Speaker, the Freedom Front will not be supporting this Bill, and the main reason basically concerns the certificate of need.
The task of the hon the Minister is to extend health services, but the hon the Minister introduces a Bill that restricts the extension of health services. If the hon the Minister visited the hospitals, she would realise that the present number of hospitals cannot even cope properly with the number of patients. If one visits hospitals and looks at reports in the media, one sees that there are many instances where people even have to queue for hours simply to receive assistance. This is why the Freedom Front cannot understand why the hon the Minister comes here wanting to impose a restriction with regard to the development of private hospitals and services.
Apart from the fact that surely it is part of economic forces that if there are people who want to make facilities such as these available, they can do so, the hon the Minister is also restricting the growth of the economy. I want to say to the hon the Minister that her main problem is that she no longer has answers and solutions to offer, and because she cannot do this, she comes and harks back to the past and blames apartheid. And if they cannot blame apartheid, they seize upon the question of the difference between the rich and the poor, and now the rich are to blame for the inability to deliver services.
The hon the Minister must step forward and start delivering services and, if there are people who want to promote health services and expand them, in fact encourage them to do so; not impose a limitation such as this present Bill. Thank you.]
Dr S E M PHEKO: Madam Speaker, the PAC supports the National Health Bill. We observe that, particularly in its preamble, it recognises the socioeconomic injustices, imbalances and inequities of health services of the past, the need to heal the divisions of the past and establish a society based on social justice and fundamental human rights, and the need to improve the quality of life of all citizens of our country.
It is painfully observed by all justice-loving people that, at present, there are hospitals for the poor and there are those for the rich. It is known that those who do not have money do not get proper treatment and, therefore, their life expectancy is short.
In many institutions of health, especially in the rural areas and in the townships where the majority of the poor live, the standard of hospitals is atrocious. In many of them, there are no medicines, ambulances, and the medical staff working there is demoralised. Hence, we have seen large numbers of nurses leaving the country to go and work in countries such as Britain and Saudi Arabia.
Chapter 1 of the Bill is, to a large extent, in accordance with section 27 of the Constitution, which inter alia reads that everyone has the right to have access to health-care services and that no one may be refused emergency medical treatment.
Many times this is happening because many government hospitals are not capacitated to give the appropriate medical treatment and privatised hospitals are too expensive. There is a need for private hospital fees to be regulated. Many private hospitals are butcheries; to them money comes first, then the care of human life. They are too profit-motivated.
Chapter 2, however, must provide also for the protection of the rights of providers. The PAC welcomes clause 49. This referral from one public health establishment to another is helpful, but it must be extended to private hospitals if more lives, especially those of the poor, are to be saved.
The PAC admits that there should be no interference with private institutions, but in order for the vast majority of this country to advance there needs to be a certain degree of state intervention in matters of national importance, especially those that deal with the basic necessities of life.
The poor, through privatisation of essential services, are denied the basic necessities of life. However, the PAC supports this Bill in the hope that it will, when it has become law, be amended with a view to improving it so that it can benefit the poor who cannot afford high medical fees. Rights to access without capacity to afford are no rights.
Dr A N LUTHULI: Madam Deputy Speaker and hon members, at the very outset I want to state that my party, the ANC - the party of the majority of the people of South Africa - supports this Bill, Minister.
The Department of Health’s strategic framework for 2000-04 identifies improvements in the quality of care as one of the four key challenges facing the health sector in South Africa.
Provisions relating to the health officers and compliance procedures in Chapter 10 of the National Health Bill are essentially concerned with ensuring good service delivery within health facilities.
Quality of care relates to the interface between provider and patient, and between health services and the community. A quality perspective changes the focus from establishing structures to addressing what happens in these structures. Improving the quality of health services should, therefore, be seen within the context of the broader transformation of health services in South Africa.
My focus for the debate on this important Bill will be on the areas of national health research and information; health officers and compliance procedures; the importance of co-ordinating the health research agenda and national health information system, and procedures to ensure compliance, safety and efficacy. These are covered in Chapters 9 and 10 of this Bill.
Let me, briefly, mention some of the research agencies in the country: We have the Medical Research Council, the Council for Scientific and Industrial Research, the Agricultural Research Council, the Human Sciences Research Council, and many others which exist in the academic institutions. They will be subject to the provisions of this Bill.
The Bill recognises the setting up and the importance of the National Health Research Committee of 15 persons by the Minister of Health after consultation with the National Health Council. The National Health Research Committee acts as a co-ordinating body whose function is to help the country determine its research agenda according to the country’s needs, our needs.
The aim is to use our limited resources in the best interest of our health needs. It is important in countries such as ours, with limited resources, that research should be sensitive to this issue and thus its relevancy. Determining the research agenda informs the required health budget. The National Health Research Committee advises the Minister.
At the moment, for instance, if we look at what is happening, the developed world is focusing increasingly on disease research relevant to them rather than on research to develop drugs that are cheaper and effective to address diseases such as HIV/Aids, TB and malaria that are a serious scourge in the developing world and in countries such as South Africa. Therefore, research must be relevant and dictated by the disease needs of the country.
It must look at cost and human resource implications of interventions. Again, looking at HIV/Aids, cost implications are closely coupled with human resource considerations. This has been said again and again by the Ministry of Health in this country. When we consider implementation, both are crucial and especially relevant now that we have moved to the district health system. We need to constantly audit our human resource component. It is all about planning.
Historically, there has been extensive exploitation of humans for research purposes in our country. Clause 76 addresses this. For instance, the Mail and Guardian exposed a professor at Wits University who did cervical cancer research on women without their consent. There are many instances from the past where people were exploited in this manner simply because they belonged to population groups that were devalued by segregationist governments, including apartheid.
This ANC Government needs to correct this situation. We say we need to inform the persons involved of the objectives of the research, the possible positive and negative consequences on their health and lives, and get their written consent. More vigilance is required in the case of the vulnerable in society.
Clause 77 sets up the National Health Research Ethics Council. Because of our history and the developed countries coming to underdeveloped countries to do research, we need this council to set up norms and standards for conducting research. For the first time, because researchers will have to register their research with this council, it becomes possible for the Department of Health to monitor and know what is going on.
If these researchers are not adhering to the norms and standards, interventions can be made to effect more protection of people on whom research is being done.
Clause 79 provides for the creation of a comprehensive national information system. The national department must facilitate and co-ordinate the establishment, implementation and maintenance of this information system by provinces, districts, municipalities and the private sector.
Clause 82 sets up the inspectorate for health establishments to monitor compliance with the Bill. It will be set up by the relevant MECs in all the provinces to ensure accountability, transparency, safety and efficacy. It reports quarterly to the MEC and the MEC must submit an annual report to the Minister.
This Bill establishes an Office of Standards Compliance set up by the director-general to keep the Minister of Health informed of the quality of services throughout the country, and advises on norms and standards for quality in health services. The visits of the Portfolio Committee on Health to various provinces indicated the need for such a provision.
The Office of Standards Compliance will also advise on norms and standards for the certificate of need processes. Its agents must inspect every health establishment and health agent, at least once every three years to ensure compliance with this Act, but may conduct announced or unannounced inspections of such a facility at any time. Transgressions can result in the withdrawal or suspension of the certificate of need, which has been talked about a lot. This is to ensure that malpractice, exploitation, maldistribution and health establishments offering low-quality services do not survive.
The IFP and the DA were set against this body, but this is a very important step towards ensuring quality health services and protecting patients who come from the underprivileged of our society that the IFP and the DA claim so much to represent. They lead the forces who are against transformation. Also, the IFP opposes any powers being given to the Minister to make it possible for her to effect transformation.
This Bill has aroused a lot of interest from the public, including academic institutions such as UCT, UWC and others, as was evident during public hearings.
The existing National Health Bill dates back to 1977. It is essentially an apartheid health Bill designed to cater for the interests of a minority of South Africans, excluding the majority. The Bill before us caters for all South Africans and it’s progressive.
There may be opposition to the Bill from some opposition parties, but we in the ANC want equity, quality, safety and efficacy in the provision of health services. All this Bill does is to take us a step closer to our goal of a better health and life for all, as envisaged in the Freedom Charter and the Bill of Rights. I thank you. [Applause.] Miss S RAJBALLY: Thank you, Madam Deputy Speaker. The importance of this Bill has to be taken seriously, since it seeks to establish a legislative and regulatory framework for the delivery of health services for all South Africans, and throughout South Africa.
It also seeks to create uniformity across the nation in the delivery of health services. The objects of the Bill are taking responsibility for health and the eligibility for free health services, and to fulfil the constitutional obligations of the Government, with regards to the rights relating to health-care services, and to provide the population of the Republic with the best possible health service with the available resources it can afford.
It also seeks to empower the Minister to make regulations in order to provide free health services to certain categories of persons. This Bill also makes provisions regarding the rights of users of health services, and health-care providers, to information on health services. The provisions relating to the national Department of Health in providing for the establishment of the National Health Council are most welcome.
But the Bill does not make provisions for the number of times that the National Health Council should meet in a year. Therefore the Minority Front kindly requests the department to relook certain sections of the Bill for clarification.
The appointment of certain hospital boards by the Minister and MECs, and the delivery of health services at non-health establishments like schools and other public places is most welcome.
In supporting the Bill, the Minority Front applauds the department on the introduction of this comprehensive Bill and hopes that it meets its obligations successfully and speedily.
In respect of the demarcation of health districts, with due regard to municipal boundaries relating to municipal health care in this regard, the Minority Front feels that a proper structure should be put in place in the provinces so as to have proper consultations with communities on health matters. Thank you, Madam. [Applause.]
Mr C AUCAMP: Madam Deputy Speaker, when I studied this Bill I had to pinch myself to make sure that I am in South Africa, and not in Cuba - indeed, it is the most totalitarian piece of legislation I have ever seen.
The Bill states as one of its objects to establish a health system based on decentralised management. The national Minister, however, got a de facto open mandate to regulate every single matter concerning health care in South Africa, and every decision of the Minister, after consultation with one of the many councils created by this Bill.
The National Action regards this Bill as promoting a top-heavy structure, by creating structures and more structures, regulating the field of health care in South Africa instead of improving it.
The most draconic chapter in this Bill is Chapter 6, which deals with the certificate of need.
Kortliks kom dit daarop neer dat die Minister deur hierdie instrument effektief kan besluit waar elke enkele dokter, spesialis of professionele gesondheidswerker mag werk en waar nie. Die Minister kry effektief die reg om deur manipulering van hierdie sertifikaat geneeshere te verplaas asof hulle lewenslange staatsamptenare is. Hierdie hoofstuk is onkonstitusioneel en die Minister kan haar gereed maak vir nog ‘n draai in die Konstitusionele Hof.
Ek kan u verseker, agb Minister, markbeginsels van aanbod en aanvraag is reeds ‘n bevestiging van “need” al dan nie. Hierdie wet gaan nie die standaard van mediese dienste verhoog nie. Dit gaan kompetisie uitsluit en onderpresteerders in ‘n veilige hawe verskans. Dit maak van die staat speler en skeidsregter en ontneem die keusevryheid van die verbruiker, en oorreguleer die privaatsektor.
Dit gaan lei tot ‘n reuse uittog van voornemende en praktiserende geneeshere na die buiteland, net om plek te maak vir meer Kubane wat daaraan gewoond is. (Translation of Afrikaans paragraphs follows.)
[Briefly it means that the Minister may, by means of this instrument, effectively decide where every single doctor, specialist or professional health worker is allowed to work and where not. The Minister effectively gets the right to transfer doctors, by means of manipulation in terms of this certificate, as if they were life-long public servants. This chapter is unconstitutional and the Minister can prepare herself for another session in the Constitutional Court.
I can assure you, hon Minister, that market principles of supply and demand are already a confirmation of need or no need. This Act is not going to enhance the standard of medical services. It is going to exclude competition and entrench underachievers in a safe haven. This makes the state a player and an umpire and takes away the choice of freedom for the consumer, and overregulates the private sector.]
In prescribing this Bill for a sick patient called South Africa, the doctor
has made the wrong diagnosis again. The slogan should have been Service!'
and not Regulation!’
This is illustrated by a black person who said: In the old days blacks and whites had to use separate entrances to hospitals, but at least we received treatment. Today we pass through the same door, but nobody gets treatment. The National Action will vote against this Bill. I thank you.
Ms T E MILLIN: Madam Deputy Speaker, because of time limits the IAM will get straight to the point in stating absolute agreement with the cogent arguments against this Bill, articulated with such authority by the hon Dr Rabinowitz, as well as those members of the DA and others.
The progressively arbitrary use or misuse of power that certain ministries, namely land affairs, education and health, are appropriating unto themselves should be of deep and growing concern to all South African citizens.
Never were such omnibus powers more evident than in the infamous so-called CON with the ostensibly commendable aim of spreading, far and wide, doctors and private health-care institutions where the Government nanny deems such should be.
If ever there was stronger incentive for doctors and potential medical entrepreneurs to pack up and leave, thus escaping the excessive infringements on freedom of choice and movement, then this is it. And for this section alone, the hon Minister and her department can look forward to constitutional challenges once this Bill is enacted.
It is significant that the official opposition, together with the IFP and others, will not be supporting this Bill.
As a former IFP member in the KwaZulu-Natal Legislature, who vigorously opposed the Provincial Health Bill, namely the CON, and unfortunately vilified by my caucus under the chairmanship of the Premier for doing so, as well as for my suggestion at the time that the IFP should align with the DA in opposing the Bill, the decision then was to vote with its coalition ANC partner in support of the Bill.
However, it is good that common sense and sound democratic principles will prevail when this vote is taken and those opposing its overriding abuse of power are counted.
Crazy or not, thank goodness I’m sufficiently sane to discern a dangerously crazy piece of legislation. I thank you, Madam Deputy Speaker. [Applause.]
Dr E E JASSAT: Madam Deputy Speaker, hon Minister, hon Deputy Minister, colleagues and friends, at the outset, may I remind hon Aucamp - I am certain he does not know where he is - that he is not in Cuba but he is in a new and free South Africa. The National Health Bill constitutes an important milestone on the road to the achievement of a sustainable and uniform health system within the Republic - one which is, moreover, cognisant of the requirements and principles of our new Constitution.
Historically, we have, in this country, two blood transfusion services. Firstly, there is the SA Blood Transfusion Service, which currently provides blood transfusion services, under a licence issued in terms of the Human Tissue Act 65 of 1983, exclusively to all provinces of the Republic except for the Western Cape and part of the Northern Cape. The SA National Blood Service, or SANBS, provides approximately 83% of all blood transfusions in South Africa.
The second is the Western Cape Blood Transfusion Service, which provides blood transfusion services to the Western Cape and part of Northern Cape. In addition, we have the Natal Bioproducts Institute, which is the largest fractionation centre in our country. It is also an association not for gain. It is incorporated under section 21 of the Companies Act and also registered as a nonprofit organisation. Its board of directors are appointed by the SANBS board of directors and, hence the ultimate control of the Natal Bioproducts Institute rests with SANBS.
The national policy on blood transfusion in South Africa determines that all blood supplies must be regarded as national resources and be obtained and utilised in the national interest. This policy was formulated and adopted by the Health Minmec on 25 and 26 September 1997.
The main motivation behind a well-organised and nationally co-ordinated blood transfusion service is to improve and ensure the safety of blood and blood products. Blood can and does save lives when used correctly. On the other hand, it can also cause great harm if it is used incorrectly or if it is not safe.
The amalgamation of the blood transfusion services is an international initiative and, endorsement has been received from various organisations, at various times, since 1973. In that year, the International Conference of the Red Cross recommended that each national society and government should undertake a strong combined effort to attain humanitarian objectives of a total national blood service based on broad voluntary participation of the people of the land. The World Health Assembly of the World Health Organisation supported this approach and urged member states to promote the development of a national blood service, based on voluntary and nonremunerated donation of blood.
Further endorsement was received from the General Assembly of the International Society of Blood Transfusion, in 1980, when they resolved that the development of a national transfusion programme regulated by the appropriate national authority was essential if a nation’s need in therapeutic blood products were to be met in full.
Confirmation for the need of a national service also came from scientists who worked in the blood transfusion systems of the World Health Organisation’s Global Programme on Aids who stated, in 1994, that in order to ensure that an effective and efficient blood banking system was established, it was recommended that a national blood transfusion programme be instituted.
In Africa, South Africa is one of only two countries with a regional blood transfusion service. The World Health Organisation also seeks to establish a global database of blood safety in all its regions in order to identify where action is needed. South Africa, being a member country, is required to participate in the global database initiative …
The DEPUTY SPEAKER: Order! hon members, please lower your voices.
Dr E E JASSAT: Madam Deputy Speaker, South Africa, being a member country, is required to participate in the global database initiative and the policy framework to which it should adhere.
The policy framework that we have to adhere to is governmental commitment to blood safety; sound organisational structures; safe blood donors - that means low-risk blood; quality management on blood screening, storage, transportation, distribution and donor care; appropriate use of blood products; equal accessibility; and a cost-effective and efficient service. South Africa will comply with all of these after amalgamation. This framework should be supported by legislation and the Bill does that.
Over and above the main aim of an amalgamated blood transfusion service of ensuring blood products and blood safety, many other benefits are obvious and tangible. For example: No duplication or fragmentation of services will take place; there will be optimisation of scarce resources; there will be no overlapping supply, research and volunteer donors; there will be no competition between institutions and organisations; the national preparedness for disaster will be efficient and effective; there will be one pool of resources for research - for example funding can be used on research that will benefit the whole country; blood products and blood safety will be recognised as a major public health issue; continuity and standardisation in training, and development of human resources and education will take place; quality assurance can be improved because it will be standardised and centralised; risk-sharing, especially of high-risk donors, will be undertaken; equitable distribution of blood products and blood, especially in rural and underserved areas, will be undertaken; the services will be more cost-effective, economically viable and efficient because of economics of scale and economics of scope; and, it will allow maximum health gain per unit of expenditure within acceptable clinical, ethical and moral standards.
Now, blood fractionation is an issue that is not covered under the national blood transfusion service because the Medicines and Related Substances Control Act 101 of 1965 and the Pharmacy Act 53 of 1974 regulate it. An organisation or facility is licensed under Act 101 section 22(6) as a pharmaceutical manufacturing company and carries out business as a pharmacy. There is, thus, no requirement for it to be licensed in terms of this Act.
Coming to tissues and organs, all issues around the removal of tissue from living and deceased persons need very strict control, mostly to prevent trafficking, profit-making, and, unsafe and unethical practices. The removal and, also, the acquiring of tissues or organs and the consent thereof will be further regulated by the Minister. Any organisation, institution or person that will acquire, screen, test, store, and handle human tissue or tissue products for transplantation will require registration from the Department of Health.
The main aim for the registration and regulation of tissue banks and donations is to prevent organ tissue trafficking and remuneration to donors or professionals other than as stipulated in the Bill. The Bill further enforces respect, dignity and consent for any action on a deceased body. The right of donors and recipients of donated organs or tissue will be protected in regulations as well. The donation of organs and tissue is an act of generosity and love; it is a gift and should be protected as such. The noncommercialisation of organs and tissues is soundly established in this National Health Bill. We, in the ANC, support this Bill. Thank you. [Applause.]
Dr J T DELPORT: Madam Deputy Speaker, I may shock all speakers who opposed this legislation by stating at the outset that I felt there was something positive in the Bill, and that is the prohibition on human cloning. At least South Africa will be spared the possibility of a clone of the hon Minister of Health being let loose on the country.
In the chapter that sets out our Bill of Rights, we find the following in
section 22 on freedom of trade, occupation and profession: Every citizen
has the right to choose their trade, occupation or profession freely.'' It
goes on to say:The practice of a trade, occupation or profession may be
regulated by law.’’
But it is trite law and the provision that the practice of, inter alia, the profession may be regulated by law does not give carte blanche to Parliament. The regulation may not be such as to destroy the right that is protected and may not even be such that it seriously impinges upon the right. It may not strike at the heart of the protected right.
It is my submission that section 36 of this Bill strikes at the heart of the right of the medical practitioners and organisations offering services in the medical field to choose their profession freely. This section prohibits a person, inter alia, from establishing a health establishment such as hospitals, surgeries or to provide prescribed health services without a certificate of need, which is to be obtained from the director- general in terms of regulations.
This section does not set minimum standards nor does it deal with required qualifications or any other matter that really regulates a professional occupation. It simply says that a medical practitioner will only be allowed to practice his or her profession if the director-general judges there to be a need. What nonsense! It destroys the basic right of a person to offer his or her services wherever he or she chooses. It is an outrageous infringement on the basic freedom to work enshrined in our Constitution.
When I was a child, my mother taught me one good thing. She said that there was always room at the top. This is how one enshrines excellence. The only need is the need to be excellent, better than the next person and to make one’s living where one chooses.
Today, we appeal to the President, and we shall follow this up with a presentation to him, not to assent to this legislation but to follow the route set out in section 79 of the Constitution to test the constitutionality of this section. However, should the President assent, the DA shall have to pursue the other constitutional avenues to test its constitutionality. We shall go to the absolute limit to do so. In conclusion, there is a dire need to extend proper medical care to all our people throughout South Africa; not, hon Minister, aspirins only. The certificate of need is not the route to go. [Interjections.] Go and see a doctor. The only certificate of need that should be issued is a certificate that South Africa needs a new Minister of Health. [Applause.]
Mrs S F BALOYI: Deputy Chairperson, the Minister and Deputy Minister, hon members and colleagues, I rise in support of the National Health Bill.
It is a great privilege to participate in this debate because this Bill is the most important piece of health legislation to be passed by this House. It is the overarching legislation that covers all major aspects of our national health system. Today marks the culmination of a long process of broad consultation with relevant stakeholders as well as a very thorough process of public hearings, discussions and interaction even during the committee stage to ensure that the final result of the Bill is the result of a collective and inclusive process, which the opposition parties have acknowledged.
I want to thank Comrade James for a very thorough and democratic process. This is the way within the ANC. We appreciate the assistance of Drs Kamy Chetty, Thabo Sibeko, Eddie Mhlanga, Ms Debbie Pearman and Mr Horn, the law adviser, who guided us through this Bill, which was not an easy task. It was a very difficult Bill to deal with.
I also want to pay tribute to Dr Ayanda Ntsaluba for his impeccable record as director-general for the department. His contribution will be difficult to match. The department’s loss is Foreign Affairs’ gain. We wish him well in his new post.
I shall not waste my time by responding to some of the issues that were raised by opposition parties. They raised these issues because this Bill is the most transformatory of all the Bills that have passed through this House. They are concerned with making profits because this touches the private sector. We are bringing the private sector, which has exploited our people for many years, on board. [Interjections.] Whether these members like or not, we are going to proceed with this Bill. [Applause.] They talk of basic rights, but this is transformation. Our mandate is to transform the health system of this country and we shall do so. We are not going to ask for anyone’s permission. [Applause.] The ANC’s transformation agenda continues to fulfil the constitutional rights, including reproductive rights, of the people of South Africa to progressively realise access to quality health-care services. The ANC has been entrusted with representing the interests of the majority of our people. Our assessment must always be based on whether the poor and vulnerable benefit.
The private/public mix will ensure a fair distribution of facilities and equipment. A new private health establishment where there is underutilisation will not be in the interest or meet the need of the local community as is happening now. We are putting a stop to this. What will be best is for the private sector to enter into an agreement to utilise the facilities in the public sector that are underutilised and transfer that equipment and other processes that are being used in the private sector to the public sector. This will result in a fairer distribution.
The DA and IFP are just jestering for political expediency. They want to deprive our people of access to equal health care by claiming that this certificate should have no time limit as this will restrict health providers from practising. They have it all wrong. They need to be educated. They have also claimed that the certificate will restrict doctors from participating in the free market. I find this argument quite amusing considering that the USA and Canada, both proponents of the free market system and capitalism, have introduced the certificate of need. [Interjections.] Where do you come from? [Interjections.]
If we are to ensure equity and quality of services, we need to hold the health establishment accountable. We do so by granting them a certificate of need to operate for up to 20 years. I repeat ``for up to 20 years’’. I’m repeating this so that you can get it into your heads. Thereafter, they must apply for renewal, which will be subject to compliance with requirements as set out in the Bill. The requirements are set out in the Bill to meet the needs of our disadvantaged people, and not to meet your needs. [Interjections.]
Many stakeholders such as the Health Professions Council and others support the certificate of need, which they said was long overdue. We must take into consideration the number of health establishments that have mushroomed mainly in urban areas, which has resulted in overservicing and competition for clients, overcharging of clients and unethical and unprofessional behaviour and practices, and has been to the detriment of the patients and communities they serve.
We cannot and dare not turn back from passing this legislation. We also have a duty to ensure that we are fully aware of the implications for those who deliver services for profit or not for profit. In the health sector, the interest of the communities supersede those of the individual, especially if those individuals are already privileged within the broader class structure.
When the ANC came into power more than nine years ago, we promised to change all aspects of South African society to the betterment of all. This was done to address the legacy of inequities and disparities of the past. This is what we are doing. The ANC is delivering, and will continue to deliver accessible quality health-care services as envisaged and laid down in this Bill. This is to fulfil the mandate of our voters and the communities at large, even your communities.
Clauses 40 and 41 deal with the classification of a health establishment and the certificate of need. These clauses are key transformatory clauses to the establishment and provision of a national health system. A certificate of need is introduced as a critical intervention in the health sector. This certificate is designed to address the duplication of services resulting from an ever-increasing number of health establishments, which are usually private and for profit, and which, for all these years, have been insufficiently regulated.
The ANC feels strongly that it is not correct that the only consideration one thinks of in establishing a health facility must be how much profit one is going to make. This approach is totally wrong and will not be accepted.
At the hearings we became aware that stakeholders did not have a problem with the certificate but had perceived problems with its implementation. I believe that this concern will be addressed as consultations will be held during the development of the regulations of this Bill. Therefore, I must clarify that the certificate is a way of ensuring that the licensing of an establishment is linked with appropriate delivery of services and not the capability for financial gain.
Other misconceptions around this Bill will be implemented regardless of specific conditions in the area. Section 40 of the Bill stipulates that health establishments will be classified. Different considerations or criteria will be applied in each category.
Obviously, there will be a dispensation for existing health establishments which will hopefully encourage gradual change and positioning of health service delivery to be more appropriate and responsive to the needs of the poor and the vulnerable.
It has been a long road to travel since 1994 to bring about transformation to our country’s national health system. It is therefore proper that today we should rejoice at the processing of this very important Bill which provides uniformity in the health-care services.
The certificate of need is essential to address the inequities, access to and uniformity of the national health system and to address the anomalies of the past. The Bill promotes a need for an appropriate mix of public/private health services to address disparities. The ANC Government shall therefore not waiver nor be distracted by the DA or the IFP in addressing the issue of inherent disparities in the health sector. It will advance the programme of transformation by ensuring that our health system complies with the norms and standards of our national health system. I thank you. [Applause.]
The MINISTER OF HEALTH: Deputy Chairperson, I would like to thank everybody who participated in this debate. I have said it before in this House that I do not and will never take MP Kalyan seriously. I therefore will continue to ignore her in both my discussions and responses, both in this House and also in the portfolio committee, for as long as she discusses persons and not issues that are also not related to the Bill. [Interjections.] Despite our prohibition on cloning, we have experienced it in this Parliament - the cloning of the old apartheid NP into the present-day DA and I think we have let you loose for too long. It is about time we clipped your wings.
I now address myself to this House in response to the issues that have been raised. I think we must accept that even though the state is a service provider, it must also put in place legislative framework. This is at the core of the stewardship role of Government. It is unfortunate that the opposition parties have reduced this debate only to the issues of the certificate of need and actually they have misrepresented issues as well. I would like to emphasise what Comrade James said - that in fact the certificate of need is intended to break down the consequences of apartheid.
In addition, the director-general will not be doing all the work himself. He will delegate most of the work to be done at the provincial level. So it is not true that it is concentrated around the director-general. We must accept that to undo the ravages of the past we require special measures to ensure that all our people have equal access to health care. We will take all steps to ensure that health services are spread equitably throughout the country and in doing so we will not antagonise service providers. As my fellow comrades and as Comrade James stated, health is a public good. It cannot be left to market forces. We must take every step to protect the poor and make sure that there is universal access to basic health care for every South African.
Rabinowitz, I am really disappointed that you stand here and declare that you are speaking on behalf of the poor and yet you refuse to support this Bill on the basis of clauses that limit the powers and privileges of big business. I am really disappointed. You are not speaking on behalf of the poor.
I am also disappointed by your reference to the fact that there is no mention of traditional healers. You have a very short memory. You know that we are processing a Bill on traditional practitioners. I do not know why you wanted us to add it here when we have a specific Bill on traditional practitioners. You forget also … [Interjections.] … just on something - we launched the national reference sector for traditional remedies. However, you forget this very easily.
To Dudley, I am sure that the many Christians that voted for you across the whole country expect that you do engage the ruling party on broader policy issues and not just on the right to life. It has become a singsong for you
- abortion, abortion, abortion. [Laughter.] Mama Nkabinde, thank you very much for supporting the Bill. You are, of course, aware that the Bill will improve the quality of life of the people who elected us into this House, particularly the poor.
To Mr Groenewald, whether we like it or not, the legacy of our past and the disparity between the rich and the poor is a reality. This is not the ANC’s fault, in fact the ANC has liberated the freedom party too from the secular apartheid regime. Therefore, Mr Groenewald, let us embrace our past and work together to a brighter future. That is what the ANC stands for and we will carry you with us to freedom.
Hon Pheko, thank you very much for supporting the Bill and your pro-poor exposé. Hon Aucamp, I am flattered that you could mistake our health system for Cuba, considering the fact that every dollar invested in the Cuban health system is one invested in one of the most efficient and cost- effective health systems in the world in terms of the health outcomes and returns on investment. Hon Rajbally, I know I can always rely on you to provide constructive criticism but also to support a piece of good legislation when you see it.
Chairperson, I think this is as far as I can comment because I think I have covered everything else by declaring that this Bill actually is meant to redress the legacy of the past and I thank you very much. [Applause.]
Debate concluded.
Question put: That the Bill be read a second time.
Division demanded.
The House divided:
AYES - 210: Abrahams, T; Abram, S; Ainslie, A R; Arendse, J D; Asmal, A K; Balfour, B M N; Baloyi, M R; Baloyi, S F; Bapela, O; Benjamin, J; Bhengu, F; Bloem, D V; Bogopane-Zulu, H I; Booi, M S; Cachalia, I M; Carrim, Y I; Cassim, M F; Chalmers, J; Chauke, H P; Chiba, L; Chikane, M M; Chohan-Khota, F I; Cronin, J P; Cwele, S C; Daniels, N; Davies, R H; De Lange, J H; Diale, L N; Dlali, D M; Du Toit, D C; Dyani, M M Z; Fankomo, F C; Fazzie, M H; Fihla, N B; Frolick, C T; George, M E; Gillwald, C E; Gogotya, N J; Goosen, A D; Gumede, D M; Gxowa, N B; Hajaig, F; Hanekom, D A; Hendrickse, P A C; Hogan, B A; Jassat, E E; Jeebodh, T; Jeffery, J H; Joemat, R R; Jordan, Z P; Kalako, M U; Kannemeyer, B W; Kasrils, R; Kati, J Z; Kgauwe, Q J; Kgwele, L M; Koornhof, G W; Kotwal, Z; Lamani, N E; Landers, L T; Lekgoro, M K; Lekgoro, M M S; Lishivha, T E; Lobe, M C; Lockey, D; Louw, S K; Ludwabe, C I; Luthuli, A N; Lyle, A G; Mabena, D C; Mabuyakhulu, V D; Mabuza, D D; Magazi, M N; Magubane, N E; Magwanishe, G B; Mahlangu-Nkabinde, G L; Mahomed, F; Maimane, D S; Maine, M S; Makanda, W G; Makasi, X C; Malahlela, M J; Maloney, L; Maluleke-Hlaneki, C J; Malumise, M M; Martins, B A D; Masala, M M; Masithela, N H; Masutha, M T; Mathebe, P M; Mathibela, N F; Matlanyane, H F; Maunye, M M; Maziya, M A; Mbombo, N D; Mentor, M P; Meruti, V; Mlangeni, A; Mnandi, P N; Mngomezulu, G P; Mnguni, B A; Mnumzana, S K; Modise, T R; Modisenyane, L J; Moeketse, K M; Mofokeng, T R; Mohamed, I J; Mohlala, R J B; Mokoena, A D; Molebatsi, M A; Moloi, J; Moloto, K A; Moonsamy, K; Moropa, R M; Morutoa, M R; Morwamoche, K W; Moss, M I; Mothoagae, P K; Motubatse-Hounkpatin, S D; Mpaka, H M; Mshudulu, S A; Mthembu, B; Mthethwa, E N; Mtsweni, N S; Mudau, N W; Mzondeki, M J G; Nair, B; Nash, J H; Ndou, R S; Ndzanga, R A; Nel, A C; Nene, N M; Newhoudt-Druchen, W S; Ngaleka, E; Ngcengwane, N D; Ngcobo, N; Ngculu, L V J; Ngubeni, J M; Nhleko, N P; Nhlengethwa, D G; Njobe, M A A; Nobunga, B J; Nonkonyana, M; Nqodi, S B; Ntombela, S H; Ntuli, B M; Ntuli, J T; Ntuli, M B; Ntuli, S B; Nwamitwa-Shilubana, T L P; Nxumalo, S N; Nzimande, L P M; Olifant, D A A; Oliphant, G G; Oliphant, M N; Oosthuizen, G C; Phadagi, M G; Phala, M J; Phohlela, S; Pieterse, R D; Radebe, B A; Radebe, J T; Rajbally, S; Ramakaba-Lesiea, M M; Ramgobin, M; Ramotsamai, C M P; Rasmeni, S M; Ratsoma, M M; Reid, L R R; Ripinga, S S; Robertsen, M O; Routledge, N C; Rwexana, S P; Saloojee, E (Cassim); Schneeman, G D; Schoeman, E A; Seeco, M A; Sekgobela, P S; September, C C; September, R K; Sibande, M P; Sigcau, S N; Sigwela, E M; Sikakane, M R; Sisulu, L N; Sithole, D J; Sithole, P; Skhosana, W M; Solo, B M; Solomon, G; Sonjica, B P; Sosibo, J E; Sotyu, M M; Tarr, M A; Thabethe, E; Tinto, B; Tolo, L J; Tshabalala-Msimang, M E; Tsheole, N M; Tshwete, P; Turok, B; Twala, N M; Vadi, I; Van Wyk, A; Van Wyk, J F; Van Wyk, N; Van den Heever, R P Z; Van der Merwe, S C; Xingwana, L M T; Zondo, R P.
NOES - 48: Andrew, K M; Aucamp, C; Bell, B G; Bruce, N S; Camerer, S M; Da Camara, M L; Doman, W P; Dudley, C; Durand, J; Eglin, C W; Farrow, S B; Ferreira, E T; Geldenhuys, B L; Gore, V C; Gous, S J; Greyling, C H F; Herandien, C B; Johnson, C B; Kalyan, S V; Le Roux, J W; Lowe, C M; Mbuyazi, L R; McIntosh, G B D; Mdlalose, M M; Middleton, N S; Millin, T E; Morkel, C M; Nel, A H; Ngema, M V; Olckers, M E; Opperman, S E; Pillay, S; Pretorius, I J; Rabie, P J; Rabinowitz, R; Roopnarain, U; Schoeman, R S; Seaton, S A; Selfe, J; Shabalala, T; Sibiya, M S M; Simmons, S; Van Deventer, F J; Van Jaarsveld, A Z A; Van Wyk, A; Vezi, T E; Xulu, M; Zulu, N E.
Question agreed to.
Bill read a second time.
CONSIDERATION OF REQUEST FOR APPROVAL BY PARLIAMENT OF SOUTHERN AFRICAN DEVELOPMENT COMMUNITY PROTOCOL ON FORESTRY, IN TERMS OF SECTION 231(2) OF CONSTITUTION
Mr J F VAN WYK: Hon Chairperson, the members of the Portfolio Committee on Water Affairs and Forestry were unanimous in adopting the report in favour of the ratification of the SADC Protocol on Forestry. In doing so, we join our colleagues in the NCOP who have already ratified the protocol in line with the requirements of our Constitution.
After we in the National Assembly have ratified this protocol, it becomes binding, as an international agreement, according to section 231(2) of the Constitution. In doing so this week, we contribute to an awareness of the importance of forestry in our country, in our environment and in our social development - which are the goals of arbour - which we also celebrate throughout our country during this week.
In ratifying the SADC Protocol on Forestry exactly a year after South Africa successfully hosted the World Summit on Sustainable Development, we express our commitment to leading the nations of our region and of our continent towards a better future.
Why should we ratify the SADC Protocol on Forestry? Will it really help to achieve growth, eradicate poverty, protect the environment and bring about sustainable use of natural resources as it aims to do? The point is, these goals are attainable, provided we take steps, as a region, to work together on the implementation of policies, programmes and projects within the framework of economic integration. We must continue, as a region, to win the support and co-operation of international agencies in pursuing our goals.
We must live up to the ideals expressed in the founding document for SADC, the Declaration Treaty and the Protocol for the Southern African Development Community, signed by the heads of state in 1992 and acceded to by us in 1994.
The ideals of meaningful co-operation and good-neighbourliness will be taken forward with ratification of this protocol, which comes under the treaty. Our time does not allow us to go into detail of how the protocol will accelerate co-operation within SADC on a wide range of forestry- related programmes. I can simply highlight some areas that will be covered: Food security, regarding agriculture and generally; our management of natural resources and the environment; social welfare; information and culture. As a leader in the African Union and Nepad initiatives, South Africa should always be at the forefront in ratifying original agreements. The Portfolio Committee on Water Affairs and Forestry, having considered the report, unanimously recommended the ratification of this protocol. I thank you, Chairperson. [Applause.]
There was no debate.
SADC Protocol on Forestry approved.
CONSIDERATION OF REQUEST FOR APPROVAL BY NATIONAL ASSEMBLY OF LEASE OF SEA SPACE TO MARIBUS INDUSTRIES (PTY) LTD SEAWEED CULTIVATION PROJECT, IN TERMS OF SECTION 6 OF SEA-SHORE ACT, 1935
Ms G L MAHLANGU-NKABINDE: Deputy Chairperson, after consulting all the parties in the portfolio committee, we decided that there is no need for any speeches on this. We all agreed that the lease of sea space should be granted. Thank you.
There was no debate. Lease of sea space to Maribus Industries (Pty) Ltd Seaweed Cultivation Project approved.
CONSIDERATION OF REPORTS OF STANDING COMMITTEE ON PRIVATE MEMBERS' LEGISLATIVE PROPOSALS AND SPECIAL PETITIONS ON MEDICAL SCHEMES AMENDMENT
BILL AND ON PATENTS AMENDMENT BILL
Mr P A C HENDRICKSE: Chairperson, the purpose of the Medical Schemes Amendment Bill is to allow medical schemes to offer members a discount on their contribution rates when they retire or go on pension, and for this to be extended to the spouse upon death of a member.
The committee shared in the intention, that is, to assist pensioners who become liable for the whole subscription, both their own as well as that which the employer previously contributed. However, it is the opinion of the committee that this is not the correct vehicle to do so, as the proposal shifts postretirement liability for medical expenditure from the employer to medical schemes. Secondly, the medical schemes are in the business of receiving contributions and paying claims, which are short-term liabilities, and are not designed as a vehicle for prefunding postretirement liabilities.
We share the opinion of the Department of Health that postretirement provision for medical expenditure is an employee benefit, and that the appropriate avenue to correct declining provision being made for this by the employers is through labour-relation legislation. There is also the concern that such a proposal, whilst not intending to do so, may inadvertently open doors for discrimination against people with poor risk profiles, by not offering them these intended discounts.
The committee has recommended that the proposer take this concern for pensioners up with the Ministry of Labour and, if possible, have it channelled to Nedlac for discussion.
In conclusion, allow me to thank the Department of Health for its interactive relationship with the committee. I also want to thank the other stakeholders who appeared before it.
Lastly, may I congratulate the proposer, Mr Bell, for bringing before this committee what is a very good example of a private member’s proposal. This proposal received multi-party empathy, pointing intentions to a real concern, rather than what is so often the case, parties bringing Bills there purely to make party-political propaganda, or to override the policies of a democratically elected government. Thank you very much to all the members for their contributions to discussions in the committee.
We support the report. [Applause.]
Mrs S V KALYAN: Deputy Chair, the DA proposed an amendment to the Patents Amendment Bill some two years ago. The rationale behind the amendment was that by declaring HIV/Aids a national health emergency, South Africa could produce or import generic equivalents of antiretroviral medication, thereby making it affordable to persons who are HIV-positive. We based the proposed amendment on the success story of Brazil and Thailand. It is not stale news that people are dying of HIV/Aids.
After much humming and hawing, the Committee on Private Members Legislative Proposals turned down the proposed amendment without much substance, saying that trade agreements between South Africa and other countries would be affected. The reality is that South Africa is still in denial about the HIV/Aids pandemic. Well, guess what? On Friday last week, the World Trade Organisation acceded to an impassioned appeal from Africa, allowing the importation of generic equivalents. Their claim was based on compassionate grounds, because nearly 2,2 million Africans have already died from Aids.
Now, suddenly, South Africa is on board, and has also bought into the agreement. Had we acted two years ago on the recommendation of the DA, many lives would have been saved. [Interjections.] You can howl! As it stands, one in nine South Africans are HIV-positive. Regrettably, the committee’s vision was blinkered by party politics. The DA regrets that the committee could not see the larger picture and rejects its report. [Applause.]
Prince N E ZULU: Deputy Chair, I must also start by commending the proposers of these two pieces of legislation before us. The proposed Medical Schemes Amendment Bill purports to take cognisance of those fellow citizens who, for reasons beyond their control, become victims of old age and/or ill health, thus disqualifying them from being members of medical aid schemes.
The main income after retirement does not allow a member to continue contributing to a medical scheme, except in exceptional cases. This amendment seeks to provide a discounted rate for those members and their spouses. However, to work out such a scheme would be very complex and almost impracticable, given prevailing circumstances of crafting legislation that becomes difficult to implement. There is no appropriate suggestion that identifies potential solutions to that complexity. Therefore, the report of the Standing Committee on Private Members’ Legislative Proposals that the Bill not be proceeded with, is supported.
Further, the existing Patents Act provides various mechanisms by which the state can acquire the right to produce goods, of whatever description, for public need and purposes without necessarily legislating a compulsory licensing measure. The many sections of the Act make it abundantly clear that the state has much broader and more general access to patent rights than one would imagine, and those legal provisions render the said proposal more of a duplication of what is contained in the Act than a real, new and innovative proposal. Therefore, the status quo remains. Thank you.
Ms C DUDLEY: Chairperson, private members’ Bills are not treated with the respect that they deserve. Personally I have not laid eyes on either Bill before yesterday, and even the relevant ATC was missing. A private member’s Bill should be adequately debated, especially in relevant portfolio committees, which does not happen.
The Medical Schemes Amendment Bill is a positive development which the ACDP would support. Issues around patents and international trade agreements are of critical importance, but are usually drowned in the sea of politics and confusion, and obviously drowned in a sea of something else here in the House. The ACDP would welcome the possibility of these issues coming under the spotlight. I thank you. [Applause.]
Mr B G BELL: Deputy Chair, members of Parliament, thank you for affording me this opportunity to explain my suggested amendment to the Medical Schemes Act. This Act attempted to protect the public from unscrupulous medical schemes by ensuring that a single rate be imposed on their members. The contribution to belong to the scheme could only be varied according to income or number of dependants, not according to age.
The aim of this clause aims to stop schemes from exploiting persons of advanced age or poor health. Unfortunately, this clause has had unintended consequences by restricting some restricted medical schemes which had, within their approved rules, given a discount to their pensioners with the required number of years as members, on taking retirement.
This has resulted in pensioners who, until retirement, have had a portion of their contributions paid for by their employer now having to pay their entire rates. This could mean hard times ahead for those pensioners on a fixed income. The private members’ committee was sympathetic to my proposal. The labour portfolio, who discussed it after it was rejected, thought it was an excellent idea.
Medical schemes that operate this discount have done so from the start of the scheme. It is a pity that this factor was not taken into account at the time when the Act was passed. I’m sure that the result would have been very different if the Act had stated that one of the objectives is to protect the interests of all members. But, this Act has not done so for the pensioners of these schemes.
I thank you for listening to my plea. If this could lead to a change of heart, a large number of pensioners will be able to sleep better at night. I thank you. [Applause.]
Mr A R AINSLIE: Deputy Chair, Mrs Kalyan’s constant attempts to politicise the HIV/Aids question is to be condemned. To introduce the question of HIV/Aids into the debate today is just a red herring to obscure the flaws in her proposal.
It is clear that Mrs Kalyan has not even read the Patents Act. If she had, the hon member would know that the state already has access to articles and technologies under patent. The very amendments proposed in this regard are catered for in the Act. The amendments, therefore, do not represent a departure from current policy but are merely duplication of policy that is already contained in the Act.
The Bill recommends the introduction of compulsory licensing for noncommercial use of patented articles, but the Patents Act already provides state access to patented articles. It does so in three sections: section 4, section 56 and section 78. There are, therefore, various procedures by which the state may acquire rights to produce goods for public purposes.
The amendment that Mrs Kalyan proposes, therefore, in this regard, is superfluous. In fact, the provisions in the Act give the state broader, more general access to patented rights than the limited access Mrs Kalyan proposes. What the hon member proposes, therefore, is nothing new but merely a poor duplication of what already exists in the Patents Act.
In addition, it has been a puzzle to most of us on the committee as to why Mrs Kalyan would choose the Board of Trade and Tariffs to fulfil the function of administering these matters. The BTT is the body that evaluates antidumping claims and regulates tariffs. In addition, the BTT is to be replaced by the International Trade Administration Commission. It is envisaged that the ITAC will have a wider role in Southern Africa. It is very odd, indeed, that a body with transnational responsibility for antidumping actions should be called upon to adjudicate in these matters.
Submitting patents to the ITAC would be tantamount to giving the BLNS countries, that is the Southern African Customs Union countries, a say in an issue that is currently an exclusive national competence. This is, perhaps, the weakest link in the entire Bill and it is a pity that the hon member, when she spoke earlier, did not use her time today to throw some light on this matter.
Another shortcoming is the proposal for compulsory licensing in the case of a national emergency. The Bill does not define national emergency. One would, therefore, have to revert to a formal declaration of national emergency in terms of the Constitution. Now, Mrs Kalyan is clearly unaware that one of the key achievements of the developing countries’ negotiations at the WTO in Doha was to ensure that the use of compulsory licences was not made dependent on the formal declaration of national emergency. In terms of the Doha Declaration, each member has the right to determine what constitutes a national emergency or other circumstances of extreme urgency. The formulation in the Bill would amount to a reversion to the pre- Doha position. As a result of these and other flaws that I have indicated, the committee quite correctly rejected the proposal.
The committee had far more sympathy for Mr Bell’s proposal. There is clearly a need to address the financial difficulties experienced by pensioners in maintaining medical scheme coverage after retirement. But, as our chairperson has indicated, the best avenue to do this is through labour legislation.
I would like to thank Mr Bell, however, for the responsible manner in which he approached this matter. Thank you. We support the report. [Applause.]
Debate concluded.
The CHIEF WHIP OF THE MAJORITY PARTY: Deputy Chairperson, I move that the reports be adopted.
Motion agreed to (Democratic Alliance dissenting).
Reports accordingly adopted.
The DEPUTY CHAIRPERSON OF COMMITTEES: These private members’ legislative proposals will therefore not be proceeded with.
HEARINGS ON BROAD-BASED BLACK ECONOMIC EMPOWERMENT
(Consideration of Report of Portfolio Committee on Trade and Industry)
There was no debate.
The CHIEF WHIP OF THE MAJORITY PARTY: Deputy Chairperson, I move that the report be noted. Thank you.
Motion agreed to.
Report accordingly noted.
The House adjourned at 12:19. ____
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
THURSDAY, 4 SEPTEMBER 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- Introduction of Bills:
(1) The Minister of Environmental Affairs and Tourism:
On request of the Minister the following Bill was introduced by
the Select Committee on Land and Environmental Affairs in the
National Council of Provinces:
(i) National Environmental Management Second Amendment Bill [B
56 - 2003] (National Council of Provinces - sec 76) [Bill and
prior notice of its introduction published in Government
Gazette No 25289 of 1 August 2003].
Introduction and referral to the Select Committee on Land and
Environmental Affairs of the National Council of Provinces, as
well as referral to the Joint Tagging Mechanism (JTM) for
classification in terms of Joint Rule 160, on 5 September 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.
(2) The Minister of Social Development:
(i) Social Assistance Bill [B 57 - 2003] (National Assembly -
sec 76) [Explanatory summary of Bill and prior notice of its
introduction published in Government Gazette No 25340 of 8
August 2003.]
Introduction and referral to the Portfolio Committee on Social
Development of the National Assembly, as well as referral to the
Joint Tagging Mechanism (JTM) for classification in terms of Joint
Rule 160, on 5 September 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.
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Defence:
Report and Financial Statements of Vote No 21 - Department of Defence
for 2002-2003, including the Report of the Auditor-General on the
Financial Statements for 2002-2003 [RP 145-2003].
- The Minister for Justice and Constitutional Development:
Report and Financial Statements of the National Prosecuting Authority
for 2002-2003, including the Report of the Auditor-General on the
Financial Statements for 2002-2003.
FRIDAY, 5 SEPTEMBER 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
-
Translations of Bills submitted: (1) The Minister of Trade and Industry:
(i) Molaotlhomo oo Akaretsang go Abela Bantsho Dithatha tsa Merero ya Ikonomi [B 27 - 2003] (National Assembly - sec 75).
This is the official translation into Setswana of the Broad-Based Black Economic Empowerment Bill [B 27 - 2003] (National Assembly - sec 75).
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Finance:
(a) Agreement between the Government of the Republic of South Africa
and the Government of the Republic of Rwanda for the Avoidance of
Double Taxation and the Prevention of Fiscal Evation in respect of
taxes on income, tabled in terms of section 231(2) of the
Constitution, 1996.
(b) Explanatory Memorandum on the Agreement between the Government
of the Republic of South Africa and the Government of the Republic
of Rwanda for the Avoidance of Double Taxation and the Prevention
of Fiscal Evation in respect of taxes on income.
(c) Agreement between the Government of the Republic of South Africa
and the Government of the Republic of Botswana for the Avoidance
of Double Taxation and the Prevention of Fiscal Evation in respect
of taxes on income, tabled in terms of section 231(2) of the
Constitution, 1996.
(d) Explanatory Memorandum on the Agreement between the Government
of the Republic of South Africa and the Government of the Republic
of Botswana for the Avoidance of Double Taxation and the
Prevention of Fiscal Evation in respect of taxes on income.
(e) Agreement between the Government of the Republic of South Africa
and the Government of the Sultanate of Oman for the Avoidance of
Double Taxation and the Prevention of Fiscal Evation in respect of
taxes on income, tabled in terms of section 231(2) of the
Constitution, 1996.
(f) Explanatory Memorandum on the Agreement between the Government
of the Republic of South Africa and the Government of the
Sultanate of Oman for the Avoidance of Double Taxation and the
Prevention of Fiscal Evation in respect of taxes on income.
(g) Agreement between the Government of the Republic of South Africa
and the Government of the Republic of Belarus for the Avoidance of
Double Taxation and the Prevention of Fiscal Evation in respect of
taxes on income and on capital (property), tabled in terms of
section 231(2) of the Constitution, 1996.
(h) Explanatory Memorandum on the Agreement between the Government
of the Republic of South Africa and the Government of the Republic
of Belarus for the Avoidance of Double Taxation and the Prevention
of Fiscal Evation in respect of taxes on income and on capital
(property).
- The Minister for Water Affairs and Forestry:
(a) Report and Financial Statements of the Water Research Commission
for 2002-2003, including the Report of the Auditor-General on the
Financial Statements for 2002-2003 [RP 116-2003].
(b) Report and Financial Statements of the Trans Caledon Tunnel
Authority for 2002-2003, including the Report of the Independent
Auditors for 2002-2003.
COMMITTEE REPORTS:
National Assembly:
CREDA PLEASE INSERT - Insert “ATC0905e”