National Council of Provinces - 18 November 2003
TUESDAY, 18 NOVEMBER 2003 __
PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
____
The Council met at 14:09.
The Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS - see col 000.
SUSPENSION OF SOUTH AFRICA'S AMBASSADOR TO INDONESIA
(Draft Resolution)
Ms C BOTHA: Chair, I hereby move without notice as follows:
That the House notes that - (1) aving previously rejected a motion calling for the Minister of Foreign Affairs to suspend South Africa’s Ambassador to Indonesia, Mr Norman Mashabane, reconsiders its position …
The CHIEF WHIP OF THE COUNCIL: Chairperson, I rise on a point of order. If such a motion has been made in the past, there is no point in repeating it. It is against the Rules.
The CHAIRPERSON OF THE NCOP: I think it is normally the Chair who would make a ruling with respect to the Rules.
The CHIEF WHIP OF THE COUNCIL: Thank you, Chair.
The CHAIRPERSON OF THE NCOP: Let us proceed.
Ms C BOTHA: May I complete before you give your ruling?
The CHAIRPERSON OF THE NCOP: [Inaudible.]
Ms C BOTHA:
(1) … reconsiders its position in the light of the fact that subsequent to Mr Mashabane having been found guilty in December 2001 of 21 charges of sexual harassment, he has again been found guilty at a disciplinary hearing last week on a further charge of sexual harassment committed from his position as ambassador, which position he has occupied without interruption despite his previous conviction;
(2) instead, his victim has been moved to Korea;
(3) his appeal has still not been finalised;
(4) Foreign Affairs Minister Dlamini-Zuma’s failure to conclude this matter can be considered as having created a foreseeable opportunity for further misdemeanours on the part of Ambassador Mashabane as well as the impression that Ambassador Mashabane is above the law; and (5) demands that Minister Dlamini-Zuma instruct his immediate recall to South Africa and action on his appeal.
The CHAIRPERSON OF THE NCOP: Hon member, as you are well aware in terms of the Rules, you cannot propose a motion of the same substance as a motion attempted earlier for presentation before the House.
I will look at the content of the resolution you have tabled now, because I note certain elements which are different but the substance appears to remain the same. I will then render a ruling on the matter. I am not going to table it, because I do believe it is in contravention, but we will make a definitive ruling later this afternoon after studying the substance.
CONGRATULATIONS TO THE SANDF ON APPOINTING NIKIWE DUBE
(Draft Resolution)
Rev M CHABAKU: Chairperson, I would like to move without notice:
That the Council -
(1) congratulates the SANDF on its appointment of Nikiwe Dube of the AMHU Free State as the only indigenous and first African female RSM in the South African Military Hospital Service in the country;
(2) notes that she is the daughter of a mineworker and was trained at Baragwanath Hospital in Soweto, Johannesburg General Hospital and Randfontein Mines;
(3) further notes that she is very involved in the Women’s Forum and is a trade unionist and a world traveller;
(4) expresses its pride in the new South Africa where there are equal rights and opportunities for all; and
(5) commends the SANDF on their continued openness and for striving towards equal representivity in all spheres of life.
Motion agreed to in accordance with section 65 of the Constitution.
CONGRATULATIONS TO THE DEPARTMENT OF HEALTH ON IMPROVED HEALTH CARE
SERVICES
(Draft Resolution)
Ms D M RAMODIBE: Chairperson, I move without notice:
That the Council -
(1) notes with pride the achievements of the Government since 1994 to provide health care that is affordable and accessible to all South Africans;
(2) acknowledges in particular -
(a) that there are now over 4 350 public health care access points
available to the population;
(b) the elimination of deaths due to measles and the reduction in
polio as a result of increased rates of immunisation; and
(c) the increase in the utilisation of antenatal care facilities
resulting in a dramatic decrease in births without antenatal
care; and
(3) commends the Minister of Health and her department for the excellent work they have done in making access to affordable health care a reality for millions of poor South Africans.
Motion agreed to in accordance with section 65 of the Constitution.
TAXI-RELATED VIOLENCE IN KWAZULU-NATAL
(Draft Resolution)
Mrs J N VILAKAZI: Chairperson, I move without notice:
That the Council -
(1) notes the death of six passengers in KwaZulu-Natal taxi violence on Tuesday;
(2) further notes that the attack on the Stanger Taxi Association came after two members of the rival Mapumulo Taxi Association were shot in Kwadukuza on Thursday last week;
(3) believes that the dispute between the taxi associations revolves around the exclusive use of taxi ranks and certain routes;
(4) further notes that 19 people have been killed in taxi-related violence in Kwadukuza since June this year; and
(5) therefore urges the Minister of Transport to intervene and to ensure that the perpetrators of violence in the taxi industry are brought to book.
Motion agreed to in accordance with section 65 of the Constitution.
The CHAIRPERSON OF THE NCOP: Order! I would want to alert members to ensure that their motions are directed at the appropriate Minister who has responsibility for that particular area, because we do direct motions that are adopted to the executive for action.
GOLF TOURNAMENT AT FANCOURT AND SOUTH AFRICAN REFEREE FOR RUGBY WORLD CUP FINAL
(Draft Resolution)
Mr N M RAJU: Chair, I move without notice:
That the Council -
(1) notes that the prestigious President’s Cup in golf is scheduled to commence at Fancourt near George on Thursday, 20 November 2003, between an international team captained by the “Black Knight” Gary Player and an all-American team captained by Jack Nicklaus;
(2) also notes that the world’s top three golfers, No 1 Tiger Woods, No 2 Vijay Singh and No 3 our own Ernie Els, will no doubt be vying for top honours on Sunday;
(3) welcomes the world’s leading golfers to South Africa and wishes them a most enjoyable stay in our country;
(4) further notes that, although the Springboks have been eliminated from the Rugby World Cup finals, the South African flag will still be flying high when our own André Watson, assisted by another South African, Jonathan Kaplan, referees the final match between hosts Australia and England; and
(5) congratulates these leading South African referees for the singular honour they bring to South Africa.
Motion agreed to in accordance with section 65 of the Constitution.
The CHAIRPERSON OF THE NCOP: Order! We won’t put the amendment put by Mr Ackermann.
OPENING OF DIABETES CENTRE IN ALEXANDRA
(Draft Resolution)
Mrs E N LUBIDLA: Chairperson, I wish to move without notice:
That the Council -
(1) notes with joy the opening of the state of the art Lilly Diabetes Centre in Alexandra by a pharmaceutical company Eli Lilly;
(2) further notes that the opening comes in the wake of a global study of diabetes which concludes that people suffering from diabetes run an increased risk of developing kidney and heart diseases;
(3) commends the ongoing contribution of companies such as Eli Lilly in providing a much needed treatment and testing centre for the residents of Alexandra and beyond who suffer from diabetes;
(4) acknowledges that a coordinated response between the Government and roleplayers in the health sector is crucial to combat these and other diseases; and
(5) calls on other companies in the private health sector to assist the Government to provide greater access to health by ensuring that public health considerations take precedence over commercial interests.
Motion agreed to in accordance with section 65 of the Constitution.
The CHAIRPERSON OF THE NCOP: You’re not objecting, Mr Kolweni? Oh, okay, because Mrs Lubidla is looking at you.
ACDP'S DISCLOSURE OF PRIVATE FUNDING
(Draft Resolution)
Mr K D S DURR: Chairperson, I move without notice:
That the House notes that -
(1) the ACDP has become the first political party in South Africa to voluntarily open its books and disclose private funding;
(2) the ACDP has submitted audited accounts for scrutiny to the Institute for a Democratic South Africa - Idasa - because it feels political parties should support political transparency and accountability to the electorate;
(3) Idasa has welcomed our disclosure that complies with their request to reveal the sources of private donations, and has subsequently dropped legal action against the ACDP but will, however, proceed with legal action against the ANC, DA, New NP and IFP;
(4) we believe the ACDP is setting the example, and we encourage other political parties to release this information to help curb opportunities for corruption and a conflict of interest within political parties and the Government, because it is vital that voters do not feel the need to question the legitimacy of decisions made on their behalf because of the influence of donors;
(5) the ACDP has stood firm in the face of pressure from a particular donor who wanted to influence the party’s economic policy, but we indicated that we would only accept the donation on condition it would not influence our policies;
(6) South Africa requires a system of government that is transparent, accountable, representative and open, and the ACDP feels that this is a good opportunity to show our willingness to do just that;
(7) the ANC, DA, IFP and New NP are on record as wanting to oppose court action to reveal their donations as they believe disclosing names will hinder their ability to raise funds, whereas the ACDP believes that parties that refuse to disclose their donations and sources must be questioned as to what they are trying to hide; and
(8) the ACDP challenges other parties to follow our example.
I thank you. [Interjections.]
The CHAIRPERSON OF THE NCOP: Is there any objection to that motion? There is an objection. The motion will therefore become a notice of motion.
CONGRATULATIONS TO PASTOR MARY CROCKETT, WINNER IN THE MAMA AFRIKA
COMPETITION
(Draft Resolution)
Ms C BOTHA: Chairperson, I move without notice:
That the Council -
(1) congratulates Pastor Mary Crockett of Qwaqwa in the Free State who has been designated the winner in the Mama Afrika Competition for her unselfish service to the community in many areas, including Aids, the provision of food and study loans to poor students;
(2) notes with pride that she has also been nominated for further international recognition; and
(3) further notes that she has achieved everything in spite of the fact that she grew up an orphan.
Motion agreed to in accordance with section 65 of the Constitution.
COMPLAINTS REGARDING RECENT INCIDENTS AT PENSION PAYOUT OFFICES IN NEW GERMANY AND PINETOWN
(Draft Resolution)
Mr P A MATTHEE: Chairperson, I hereby propose without notice:
That the Council -
(1) takes note -
(a) of complaints received by New NP Councillor, Esther Bawden, from
elderly pensioners regarding recent incidents at the pension
payout offices in New Germany and Pinetown, KwaZulu-Natal, to
the effect that a certain man was demanding amounts of R100,00
from pensioners to ostensibly fund a new political party known
as "The KwaZulu-Natal Liberation Coalition of the Rainbow
Nation" and when they refused they were threatened with the
words "I know where you live and I will get you"; and
(b) that there were young men who were ostensibly selling land to
pensioners for R100,00, which land was then found not to even
exist;
(2) requests the SA Police Service in KwaZulu-Natal to whom the said incidents were reported to give special attention to the information brought to their attention;
(3) also requests the SA Police Service countrywide to give attention to the protection of pensioners at pension payout points; and
(4) calls on pensioners to immediately report any similar incidents to the nearest SAPS station and to their public representatives so that their safety and protection against these criminals can be ensured, because it is only together that we can succeed in turning the tide against the criminals.
Motion agreed to in accordance with section 65 of the Constitution.
CLOSING OF HOME AFFAIRS OFFICE IN RUSTENBURG
(Draft Resolution)
Ms B THOMSON: Chair, I move without notice:
That the Council -
(1) notes the closing of the Home Affairs office in Rustenburg by the Department of Labour for contravening health and safety regulations;
(2) expresses its concern that this is the third Home Affairs office closed for similar reasons in a short space of time;
(3) acknowledges the important role Home Affairs offices play in providing the poor with identity documents in order to access social grants and participate in democratic elections; and
(4) calls on the Department of Home Affairs to urgently look into this matter.
Motion agreed to in accordance with section 65 of the Constitution.
PROMOTION OF SOUTH AFRICA AS A PREFERRED DESTINATION FOR TOURISTS AND
INVESTORS
(Draft Resolution)
Mr Z S KOLWENI: Madam Chair, I rise to submit a motion without notice:
That the Council -
(1) acknowledges the ongoing efforts being made by the South African Government to promote South Africa as a preferred destination for investors and tourists;
(2) notes in this regard that our reputation as a preferred destination was significantly enhanced when South African products scooped a number of awards at this year’s World Trade Market in London;
(3) believes our success is a reflection of the growing confidence investors have in the South African economy despite the negativity displayed by some sectors of our society; and
(4) congratulates all the South African exhibitors on their world-class products and on having made South Africa proud.
Motion agreed to in accordance with section 65 of the Constitution. RACIST ACTIONS IN THE WESTERN CAPE
(Draft Resolution)
Mr C M DUGMORE (Western Cape): Chairperson, I would like to move without notice:
That the Council -
(1) notes -
(a) the existence of affidavits alleging racist statements made by
the two DA councillors in the City of Cape Town during the
registration weekend in which they referred to our President in
derogatory racial terms;
(b) the unspeakable attack on Nosipho Mkhize from Edgemead by a
fellow student, her mother and her boyfriend; and
(c) the attempts by the DA in the Western Cape to exonerate their
councillors and their silence in regard to racism in our
schools, on the farms and at the workplaces in the Western Cape;
(2) therefore resolves to commend the ANC, members of the community and parents from Edgemead High School for tackling the issue of racism and supporting the Mkhize family;
(3) calls on -
(a) the Human Rights Commission to speedily complete their inquiry
into the allegations against the two DA councillors;
(b) the people of the Western Cape to expose racism at all levels
of our society; and
(c) the Department of Justice and Constitutional Development to
speedily complete the trial of those who attacked Nosipho
Mkhize; and
(4) urges the Western Cape department of education to take firm steps to eradicate racism in whatever form from all of our schools.
The CHAIRPERSON OF THE NCOP: Is there any objection to that motion? There is an objection. The motion will therefore become a notice of motion.
PAYMENT OF MUNICIPAL ACCOUNTS IN TSHWANE
(Draft Resolution)
Mrs E N LUBIDLA: Chairperson, I move without notice:
That the Council -
(1) while acknowledging the obligation on consumers to pay for the municipal services they are using, recognises that many people are not able to do so because of unemployment and poverty;
(2) further recognises the increased financial burden caused by the accumulation of interest on arrear accounts on people that already find it difficult to keep up with their municipal payments;
(3) commends the decision by the Tswane Metro Municipality to write off interest amounting to R156 million on arrear accounts in the municipality; and
(4) expresses the hope that this decision will positively influence people to realise that the Council is prepared to meet them halfway provided they make an extra effort to pay their municipal accounts.
Motion agreed to in accordance with section 65 of the Constitution.
NATIONAL HEALTH BILL
(Consideration of Bill and of Report thereon)
The MINISTER OF HEALTH: Chairperson and hon members, thank you very much for the opportunity to address the NCOP and I am pleased to present the National Health Bill. It comes almost at the end of the second term of office of our democratic dispensation. In the last almost ten years we have been operating on a very old Bill, the Health Bill of 1977. This really means that not much transformation has taken place with regard to the Health Bill in this country.
Let me also hasten to say that this National Health Bill has been in consultation ever since I was the chairperson of the Portfolio Committee on Health in 1994. There has really been wide consultation around this Bill, so it really gives me pleasure to present it to the NCOP today. I am conscious that you are passing another milestone in the process of reshaping our system.
The Bill, as many of you will appreciate, is key to the fulfilment of Government’s constitutional obligation to ensure the progressive realisation of the right of access to health care services in the country. The provinces, more than most Government structures and organisations, understand just how complex and intractable challenges related to health care services can sometimes be. Provincial health departments are at the coalface when it comes to service delivery in our country. It is they who often witness first-hand, the obstacles that people encounter in accessing health services: The poor state of roads leading to services, the difficulties in attracting human resources to outlying areas, the logistical problems of ensuring that health technology is adequately maintained in the rural environment and the challenges of transporting medical supplies and personnel across considerable distances every day. These and other issues like them need to be addressed on all fronts from the angle of appropriate strategy, adequate finance, enabling legislative provisions and the development of operational competency.
It is critically important for us to enact laws that will lay the foundation for efforts on all other fronts to ensure equitable access to health services for all. The Constitution itself acknowledges the enormity of our task in allowing the progressive realisation of the right to access to health care but progressive legislation means that we must start somewhere. We are going somewhere. We must be making progress.
The National Health Bill is a legislative road map, it is a sound route and the mechanism by which we intend to fulfil our obligations and achieve our goals. It indicates the form our efforts will take to ensure both equity in access to health services and equity in the quality and standards of those services throughout our country. It informs and emphasizes the rights of users and providers of health care services. The need for a legislative framework that can be easily understood and used by health service users and providers, in both the public and private sectors, is therefore very obvious.
Within the different spheres of Government we need to understand what our respective obligations are in the delivery of health services and we need to make sure that we have the power to fulfil them efficiently and effectively. Unnecessary duplication of health services between provinces and municipalities is a wastage of scarce resources and also creates legal and logistical problems. Within the public and private health sectors it is important to improve and maintain standards and ensure adequate distribution of health services. The National Health Bill seeks to address these issues.
As I said at the beginning, over the ten years it has taken us to draft and consult on this Bill, it has become clear that equitable distribution of health services does not happen on its own. Active intervention of Government is necessary to identify priorities and get people to take a fresh look at the real health challenges that face our nation. In the South African health sector in particular we have inherited huge imbalances from the past that market forces have proved incapable of correcting. Consequently we need legislative measures that would enable us as Government to take certain corrective measures. I will not go through every chapter of the Bill in detail, since I am sure all of us are already familiar with it. I would like to explain some of the principles within the Bill, especially those of interest to the provinces.
The Constitution requires the national executive to set national policy and prepare and initiate legislation. The provinces in their turn are given the executive authority to set provincial policy and prepare and initiate provincial legislation. The Constitution requires that the three spheres of Government respect each other’s authority and powers. No sphere may encroach on the authority of the others. This power-sharing arrangement is further complicated by the fact that health services are a function area of concurrent legislative jurisdiction of the national and provincial spheres of Governmment.
In preparing the Bill we have been very careful to take cognisance of these constitutional principles and have obtained the advice of all the state law advisors as well as independent experts on the constitutionality of the Bill. In its draft stages the Bill was presented to both the PHRC, a committee of the heads of the national and provincial health departments, and a meeting consisting of all the political heads of health sitting together with their operational counterparts. This was to ensure that full account was taken of provincial concerns and interest in the delivery of health services. The Bill was also published for public comment and we received a number of very useful comments from provinces and municipalities, which we incorporated into later drafts. Consequently, we are satisfied that the Bill preserves the integrity of each of the three spheres of Government and allows them the freedom to operate unrestricted by the others.
In Chapters 3 and 4 of the Bill the primary mechanisms for determining health policy are established: they are the national and provincial health councils, which take into account the principle of co-operative governance but at the same time, acknowledge the powers of the Minister and the MECs to determine policy in the national and provincial spheres respectively. There is provision for representation of the municipal sphere of Government in both these structures.
Chapter 5 of the Bill deals with municipal health services and the interphase between municipalities and provinces in the provision of health services. It is important to emphasize that the provisions of this chapter had to be sufficiently flexible and take into account the many possible permutations that arise with regard to the provision of health services by municipalities.
The Bill sets municipal health services as the lowest common denominator. This is the type of service every municipality is required to provide effectively and equitably in this kind of operation. Due to the fact that different types of municipalities can have different functions and these functions can at times change, we have avoided being overprescriptive. We have tried rather to provide a legal framework which would ensure adequate service delivery at all levels.
Over and above that, municipal health services were renowned for the possibility that municipalities may provide other types of health services by means of agreement with the relevant provincial government. The formal agreement is a constitutional necessity, as section 156 of the Constitution requires national and provincial governments to assign, by agreement, the administration of certain matters, including health services. Such assignments can only take place if the service would be most effectively administered locally and if the municipality has the capacity to undertake it. I am sure that you are all aware that municipalities vary widely in terms of their capacity and resources and for this reason alone, one must provide for a variety of possible scenarios.
On the issue of compliance, we have indicated in the Bill that there is a need for mechanisms, both at national and provincial levels, to ensure that the Bill’s objectives are met. There is provision for an inspectorate of health in each province to be established by the relevant MEC. There is also provision for an office of standards compliance within the national Department of Health. It is envisaged that these structures will work together in a relationship of mutual co-operation and support in order to ensure that the provisions of the Bill are both revered and that users receive the quality and standard of health care to which they are entitled as citizens of this country.
There is no point in passing framework legislation such as this, unless everyone at every level of Government is committed to ensuring that it is effectively and efficiently implemented. I trust that you will bear this in mind and lend us your wholehearted support when the Bill is finally implemented.
The issue of a single blood service was considered at length, and it was a very difficult discussion and debate. After much thought, we decided that it was the right way to go. The reason for this amendment, is that blood is a national resource. Everyone must be assured of access to it, whether they live in a big city or in a remote rural area. There is also a need to ensure uniformly high safety standards in our blood service, because we face a significant risk of contamination through blood-borne diseases. I am sure you will agree that we cannot afford to risk compromising the integrity of such a vital resource. Furthermore, it is contrary to our moral, social and ethical values for blood to be treated as just another commodity of trade, and for donors and their blood to be the subject of competition.
We took a decision not to create a state-run national blood transfusion service, but to leave it in the hands of the private, not for profit, sector. This seemed a more appropriate arrangement because the donation of blood is indeed a voluntary act. However, it is very important to ensure that the nation’s blood supply is unified, uniform and universal. Fragmented blood services are more difficult to monitor and control than a single one. They are made for inefficiencies since the opportunity for economies of scale is limited and there is a possibility of unnecessary duplication.
There is also the risk that the supply of blood in one area will be better than in others, for reasons ranging from donor distribution, community disease profiles and cultural beliefs. The cost of supplying blood to remote areas could make this life-giving resource more expensive to the rural areas and for the poor, unless such cost is spread through the creation of a single national service. For all of the above reasons, we have therefore provided, in law, for the recognition of a single national blood system and service.
I wish to dwell for a little while on the subject of the certificate of need; a subject that was deliberated extensively also during the submissions to the portfolio committee. The provisions of the National Health Bill relating to a certificate of need are the tools by which we intend to address the inequitable distribution of health services over time. The provision is certainly not unique nor particularly new in the South African context. For many years in South Africa, traders have not been able to set up shops and businesses anywhere that they pleased. They could only establish them in areas approved for that purpose by the authorities.
The policy reasons for this are obvious. One needs to maintain a suitable and appropriate distribution of shops and businesses in relation to the residential areas, and to make sure that the needs and interests of the communities in which they operate are served and protected. I do not hear traders, business owners and shopkeepers complaining that this is unconstitutional. In many other countries, including the United Kingdom, the United States of America, Canada and Australia, there are systems of licenture of medical practitioners, nurses, dentists and other health professionals. Licenture does not always include conditions as to where one may set up practice and what kind of service one may provide, but it often does.
Sometimes these conditions are implicit in the system. In the United States for instance, medical doctors licensed to practice in one state cannot necessarily … Sorry, I didn’t touch the gadgets, but something happened. May I continue? In the United States, for instance, medical doctors licensed to practice in one state cannot necessarily lawfully do so in another. They are restricted in terms of their licence to a particular geographical area. In Germany, there are regional restrictions for setting- up a medical practice with compulsory health insurance based on overall levels of demand and supply.
According to the World Health Organisation, equity in health care means that health resources are allocated according to need. Health care is provided in response to the legitimate expectations of the people. Health services are received according to need, regardless of prevailing social attributes, and payment for health services is made according to the ability to pay. The certificate of need process is not intended to be an instant remedy to the problem of the inequitable distribution of all professionals and health establishments in our country. The emphasis will be on implementing it progressively, to achieve the right of access to health care services. Let us not be naive. We recognise that it will take time to achieve this objective.
Pessimists may argue that we will never achieve a totally equitable distribution of health care services because it is an ideal that few, if any other countries in the world seem to have achieved. But access to health care for all is our constitutional goal. We do not take our Constitution lightly, nor are we a nation of pessimists. The Bill allows for regulatory distinctions to be made between situations of health professionals with established practices or existing health establishments and those who set up a practice or develop an establishment after the Bill comes into effect. It is not our intention, after the Act comes into effect, to immediately order existing medical practices and health establishments to close down and relocate to a place chosen by the state.
Transformation of a national health system is not effected overnight. It is not our intention to act contrary to the provisions of the Constitution concerning the limitations of rights. But I want to point out that the Constitution does allow for the limitations of rights and sets up parameters for them. We believe that the Bill conforms to these parameters and gives us the legislative tool to effect the much-needed transformation of the health sector in our country.
I believe that we have done our best to present to you a piece of transformative legislation that will go a long way towards assisting us in achieving our strategic goals in the health sector - and that is transforming our health sector. There is often inborn resistance to change, as you know. People usually prefer the devil that they know. But we in South Africa are not strangers to change. Since 1994, we have had ample opportunity to witness what a positive thing it can be. Change can really be a positive thing. Let us take this Bill as an opportunity to effect the changes that our heads and hearts tell us are necessary in order to create a more humane and healthy South African society.
In conclusion, I would like to thank Ms Loretta Jacobus and the committee for the sterling work that they have done in processing the Bill. We thank them for the amendments that they have effected and we trust that the NA portfolio committee will endorse these amendments. Let me also take this opportunity to thank the officials of the Department of Health led by Mrs Matsau - the acting Director-General of Health. In particular, I would like to take this opportunity to acknowledge Dr Kenny Chetty who headed the team responsible for developing the Bill. And as I said at the beginning, I would also like to thank the committee in this House for having assisted us to come thus far. Thank you very much. [Applause.]
Ms L JACOBUS: Chairperson, I have always wondered why, when I sit down to write my speech, there is always a fly on the wall. I now know who sends the fly, it is the Minister, because she has taken so much of what I wanted to say. However, be that as it may, hon Minister, MECs - I see one present here - special delegates from provinces and members, the Bill before us today is the result of six years of hard work by the Minister, her predecessor, her department, their counterparts in the provinces and a whole range of stakeholders; all of whom made valuable contributions to this piece of legislation. It was also subjected to Minmec discussions on numerous occasions where the political heads of health of provinces, which are the MECs, made inputs on behalf of their respective provincial governments.
The National Health Bill also went through rigorous public hearings and interrogations by our portfolio committee in the National Assembly. Again, it was subjected to further public hearings and interrogations by provinces. Therefore, I am convinced that what we are passing here today is the product of very hard work by our parliamentary committees, our counterparts in the provinces and interested stakeholders at large.
What remains a concern to us is the lack of participation from Salga. They were invited to the initial joint briefing of the Bill and the subsequent two day workshop that followed. For reasons not known to us, they did not arrive. In Gauteng they were invited to the briefing, the public hearings and the committee discussions that followed, and again they did not show up.
The NCOP has a constitutional mandate to represent both the provincial and local spheres of Government at a national level. Without the voice of local government, this mandate becomes a bit difficult to carry. The sense I get is that this lack of participation by Salga, especially around the processing of section 76 legislation, is a common occurrence in most provinces, if not all.
Therefore, I would appeal to your good selves, as the presiding officers of this institution, to raise this matter with the leadership of Salga as a matter of serious concern. As we round off this, our second democratic Parliament, and move towards the inauguration of our third, let those who will arrive after us not be faced with the same challenge as us are here today.
In Gauteng, we had public hearings, and people as far the Western Cape came to make submissions into our process. They came from as far as the Western Cape to make input into our public hearings, and we perceive that as quite good, because we had far-ranging views appearing there.
The Bill before us establishes a framework for a structured uniform health system within the country, taking into account our constitutional obligations and other laws within the three spheres of Government which relate to health services. In doing so, it recognises the socioeconomic injustices, imbalances and inequities of health services of the past, the need to improve the quality of life of all citizens and to free the potential of each and every South African.
In terms of section 27(2) of our Constitution, the state must take reasonable legislative and other measures within its available resources, as the Minister said, to achieve the progressive realisation of the right of citizens of South Africa to have access to health care services, including reproductive health care. In terms of section 28(1)(c) of the Constitution, every child has a right to basic health care services, and in terms of section 24(a) of the Constitution, everyone has the right to an environment that is not harmful to their health or wellbeing. It is against this backdrop that this National Health Bill before us today has come to fruition.
The Minister has already given a very fair and good overview of the Bill. However, I would just like to highlight a few areas around which there was considerable discussion during our deliberations as a committee, as well as during the public hearings that took place in some of the provinces. I will not elaborate too much, because other colleagues will speak about them in more detail.
Clause 36 of the Bill deals with the certificate of need, and the Minister has also mentioned that particular clause. It requires any person who wishes to establish, construct, modify or acquire a health establishment to apply to the Director-General of Health for such a certificate. Before the director-general issues such a certificate, he or she must take into account a whole range of considerations. One being the need to promote an equitable distribution of rationalisation of health services, health care resources, and the need to correct inequities based on racial, gender, economic and geographical factors.
By way of an example, take for instance the distribution of private medical practitioners and health care facilities in general in the urban areas, as opposed to their distribution in rural areas. One will have to look long and hard to find a doctor or a health care facility in the deep rural areas of some of our provinces, whilst in the city centres, one can find one of these almost within a five kilometre radius of each other.
Just as it does not make sense to have two greengrocers next to each other, it does not make sense to have two hospitals or doctors’ rooms next to each other. Before issuing such a certificate, the DG will have to satisfy himself or herself that the need does exist for such a facility at that particular location, as requested by the applicant. Therefore, we, as the committee, are of the opinion that the certificate of need will complement the constitutional right of every South African citizen to access health care, health care facilities and the equitable distribution of these resources and facilities.
The other area which aroused considerable debate was Chapter 8, particularly clause 53. This clause deals with the establishment of one national blood transfusion service. Currently, the Western Cape and KwaZulu- Natal are the only provinces with their own blood transfusion services.
We cannot argue with the fact that blood is a national resource. The Bill therefore makes provision for the Minister to establish a blood transfusion service for the Republic through one licence holder, which is able to provide this service throughout the territory of the Republic. The holder of such a licence will be obliged to comply with certain requirements, which are also set out in the Bill, and the Minister has spoken about those.
Anybody other than the licence holder who provides such a service would then be in contravention of the law and, therefore, guilty of a punishable offence. One of the most important reasons for inserting this clause into the Bill is the concern for blood safety. I am sure we are all aware that blood is the one bodily fluid that sustains all one’s vital organs. Therefore, the utmost care has to be taken to ensure its safety. The department has at least four documented cases of litigation against it, because of the transfusion of unsafe or contaminated blood into individuals. This National Blood Transfusion Service will look at a whole range of areas, paramount of these being the insurance of blood safety.
Other areas that solicited debate from provincial inputs was that, firstly, no mention was made of the role of traditional healers in the provision of health care services. Traditional healers were very vocal in the provincial public hearings that were held. Their second concern was around clause 43, dealing with the minimum standards and requirements for the provision of health services in locations other than health establishments, for example, initiation schools in particular. Here they felt that their role and input had not been taken into account.
After careful scrutiny and input by the provinces, the select committee proposed further amendments, as the Minister said, to the National Health Bill. These have been tabled, and I will, therefore, not dwell on them. However, it is safe to say that they do not detract from the substance of the Bill. They also make the Bill read better, and in fact, add positively to its substance. I have had informal discussions with my counterpart in the National Assembly, and they seem to be agreeable to the further amendments proposed by ourselves. You can rest assured that the Bill will not go to mediation.
In conclusion, I would like to thank the Minister and her department for all the assistance given to the committee during the processing of this Bill. The whole of the department’s senior leadership are seated there - there are too many to mention - but they are all there for us to see.
I think now is also the opportune moment for me to recognise and pay tribute to our previous director-general, Dr Ntsaluba, for the role he played in the department in general, and particularly the role he played in the drafting and processing of this National Health Bill. It is unfortunate that he cannot see the Bill to its conclusion. As we all know, he has now taken up an even more demanding position, namely that of Director-General of Foreign Affairs. But as a committee, we would like to thank him most sincerely for his always-willing assistance and guidance during the time that he was with us, and we wish him well in his new position.
Thanks also go to the members of the committee, the provinces and all stakeholders who took the time to interact with us on matters which they found of concern. Last, but not least, a big thank you to Johannes, the Minister’s parliamentary liaison officer, who always shuttled between her office and us to ensure that everything went smoothly.
With these words, I submit to the House the committee report in support of the National Health Bill with the additional amendments, as adopted in the last committee meeting of the 26th. May I also just say, during that committee meeting eight provinces supported the Bill with its amendments, and one province, namely the Western Cape, abstained. Thank you. [Applause.]
Mr C M DUGMORE (Western Cape): Thank you very much, Madam Chair. As the previous speaker mentioned, I’ve got a difficult task today because my organisation, the ANC, both within our province and nationally, supports this Bill 100%. We feel it is an important tool to promote effective care, co-ordinating within our perimeters, and believe that it will in fact bring about much energy and strengthen our public health system.
Our MEC in the Western Cape, Mr Piet Meyer, was unfortunately not able to be here today, and I have been asked to speak on behalf of the province. I am sure that we find it very strange sometimes that whenever our ANC Government brings legislation which aims to transform our country, to bring about equity, and in this case, accessible health care, particularly for the poor, it is organisations like the DA that resist and decide to fight back.
This House, I believe, should be reminded that when our Minister, who was then the Chair of the National Assembly portfolio committee, passed legislation around the pricing of medicines which aimed to ensure access to cheap medicines for all South Africans, it was the DA who voted against cheap medicines for the people of South Africa. Today, through the efforts of our Minister and the members that worked then, we see the benefits of this legislation. Many generics are now available at far less than the branded product price and in fact chemists have a duty to inform the public that a generic actually exists. But it was the DA who stood up and voted against cheap medicines. That is what they did.
We will also remember in this House that community service for doctors and other health professionals was described then by the DA and certain elements within the South African Medical Association as Stalinist, as dictatorial and unworkable and yet today in our province … [Interjections.] This member on the left is mumbling something, saying that they were right. I want to tell him, Minister, that in our province, we are seeing the benefits of community service in Elsies River, Khayelitsha, Mitchells Plain and our rural areas, where those community service doctors and pharmacists are helping to build a strong public health care service in difficult circumstances, but that is in fact what is happening. It was your organisation, hon mumbler on my left, that actually opposed the issue of community health service. They are doing fantastic work, Minister, and they are helping to provide quality care. And once again, the prophets of doom were proved wrong.
I wonder if members of this House are aware of what the DA actually said in
the hearings that the chairperson of the portfolio committee referred to
and this is typical DA-speak. They said, While the principle of levelling
the playing fields is understood, the manner in which it is being done'' -
and they are referring now to the certificate of need -restricts freedom
of economic activity, stifles free competition’’, and listen to this,
``smacks of the old Group Areas Act which controlled where groups of people
could stay and trade’’. Do we really think that the DA has the moral
justification to talk about the Group Areas Act? Do we really think so?
[Interjections.]
And then they go on to say the following: The reality is that most
patients go to a practitioner of their choice.'' Do they live in South
Africa? Do most patients go to a practitioner of their choice? Not at all.
Most of you sitting here also do that. It is the right of the consumer to
choose the service provider and the certificate of need erodes that
choice.’’ Now the reality is that, for a period of two years, no medical
practitioner is going to have to apply for a certificate of need. So first
… die bangmaakstorie van die DA, wat sê dat mense se reg om ‘n dokter te
word, gaan weggevat word, is ‘n klomp nonsens. [… the DA’s scary story,
that the right of people to become doctors is going to be taken away is a
lot of nonsense.]
It is actually rubbish. What they are trying to do is to create scare tactics. Do you know, I want to inform the House about this as well, that under the DA in this province, when all provinces had an opportunity to send South African medical students from the rural areas to study in Cuba and when they had the opportunity to bring Cuban doctors in, do you know that for some bizarre, ideological reason, the DA opposed that? So now when we need doctors in Tulbagh and Touwsrivier, there are no rural students training in Cuba like those from the other provinces, and that is thanks to the DA. No wonder they are being rejected by the people of the Western Cape by the day! [Interjections.]
I am very happy, Minister, I am very happy, that we have clear provisions around local government, that there is a definition about what the provinces should do, there is a definition about what local governments can do. But I would like our Minister to note what is happening in one or two local authorities that are still controlled by the DA in this province. The national department and Treasury have asked local authorities to maintain the primary health care funding until the new arrangement kicks in next year. Do you know that there are some local authorities in Robertson and George that are threatening to pull the plug on primary health care funding now? They do not care. I think that is correct.
I am also very, very happy that in clause 22 of this Bill, in terms of the National Health Council, provision is made for the military to be part of that because, through the Chair to the Minister, in our province we have many big military hospitals - Saldanha and there are others - and we believe that if there could be a rational approach as to how these military hospitals could actually complement the health care services in our province, this would be a major boost for the public health care system and I believe that the provisions of this Bill, when it is passed, are definitely good. So, to conclude, it is obviously with a sense of disappointment that the coalition partner in the Western Cape, that is the New NP, because of one particular concern, decided that we could not take a position and that is why the Western Cape, on this particular Bill, is abstaining. But, from the ANC point of view, we are confident that this legislation will contribute. And I also want to say that the DA might now want to say: “Oh, you see the ANC and the New NP are now fighting.” [Time expired.]
Dr G M RAMOKGOPA (Gauteng): Thank you, Mr Chairperson. The Gauteng province votes in favour of the National Health Bill subject to the understanding that when the Minister exercises her powers under clause 93(3) for the transition period, she will have due regard to the national implications of the delivery of municipal health services, for Gauteng and also for the country at large.
It is important to note that the implications of taking this matter into account specifically will result in protecting the primary health care services in our country from losing about a billion rands. For the Gauteng province, this amount is estimated at half a billion rands, which the province would otherwise be unable to raise.
We also take note and support the Minister in her undertaking that, when specific provisions of the Bill or the Act then are implemented, this will be done in a phased-in manner to enable provinces, municipalities and the national Ministry to put systems in place to make sure that we are effectively implementing the provisions of the Bill. Guided by the constitutional rights to have access to health care services and that no one should be denied emergency treatment, the ANC-led Government has ensured the progressive realisation of these rights by our citizens.
The Bill under discussion today should enable us to build on the progress that we have made. As has been said, the Bill has undergone several drafts from the first term of the democratic dispensation to date. This has eventually allowed us to have an instrument that will ensure that every citizen has recourse in the law, not only in policies and the Constitution but also in legislation that provides for public, private and nongovernmental health care services. Regardless of whether a citizen is serviced by the public or private sector or the nongovernmental health service provider, their rights will be protected.
Health is a conditionality for sustainable development. Health is a very important element when we consider the investment in human capital for our economy to grow in a sustainable way. Health is an essential component of an integrated approach to intercept the cycle of poverty and to protect the human rights including those of children, women, the disabled, the elderly, workers and society in general.
As we move towards the celebration of 10 years of our democracy, the Bill enables us to build on the implementation of policies and programmes that have enabled us, firstly, to improve access to health services by deliberately focusing on building new clinics and improving the quality of services at primary care level.
I just want to share with the House that in 1994 over one million patients visited our clinics in Gauteng. In 1997, four million patient visits were experienced and, last year, these had increased to 10 million patient visits per annum. More and more of our children now have access to immunisation services, pregnant mothers have access to antenatal care services, patients with chronic illnesses can also now attend local clinics and do not have to travel long distances to queue in hospitals together with those who are acutely sick.
The Bill also allows us to strengthen the management of hospitals, in particular ensuring that there is compliance with norms and standards for quality care and also for the management of available resources in a more accountable way through effective and efficient systems. The Bill also ensures that we have South African trained and registered professionals who would meet the health care needs of our people throughout the country. Of particular importance in this Bill is the attention it gives to health care service users. An independent social audit commissioned by the Gauteng province revealed that whilst 50% of the general public were satisfied with the improvements made in the public health services, for those who used services in the last 12 months of the audit in Gauteng, the satisfaction level was at 80%.
Whilst we strive to ensure that all service users, 100% of them, are satisfied with the improvements, the results show the positive impact of the Batho Pele policies, the patients rights charter, the service pledge signed by managers and professionals and support staff, the accreditation programme and other quality assurance initiatives that were designed to protect the rights of service users.
This is despite the increase in patient numbers and the 20% increase in the population sites in the province between the two previous censuses. The Bill now makes it compulsory that norms and standards are developed and that systems are put in place to ensure compliance and that all people who use our services are assured of recourse should they not be satisfied.
As the Minister has outlined, the Bill will enable the country to advance in the transformation of health services, to ensure that there is equitable access and distribution of health services and health human resources between and within provinces. It will ensure a seamless, integrated national health care system and do away with the fragmentation, especially at local level, and entrench the rights of citizens to quality health care whether provided by the public or private sector or even by nongovernmental health care providers.
The Bill will also enable us to advance with respect to outlining the rights and responsibilities of health workers and to ensure that norms and standards are developed and monitored. This will enable us to send a very clear message that the issues of workloads and creating positive work environments are addressed in order to send a clear message that we value our health workers just as much as we expect them to provide high quality care at all times.
South Africa is not getting optimal value for the resources that it spends in the health sector, both public and private, put together. This is also of great concern because the trend is that more and more of our citizens are utilising public health services whilst the private sector looks after less and less citizens, but uses more and more health resources.
We acknowledge that a number of provisions in the Act with specific reference to health establishments, the certificate of need and the introduction of the inspectorate will be implemented in a phased-in manner, but we certainly welcome the need to make sure that these resources that are also utilised in the private sector are used for the optimal benefit of the country and also of the workers and employers that contribute to private health insurance.
It is also important to highlight that the promotion of co-operative government between all three spheres of Government is entrenched and clearly outlined as the community participation structures that have been established through the various councils and at district level through the clinic committees and the district health councils. The Bill also enables us to have a vision of a common South Africa with a single health system, a seamless health care system that ensures that wherever the citizens in our country find themselves, they are assured of good quality health care.
With those few words, I would like to thank the Minister for the leadership that she has provided, the chairpersons of both the National Assembly and the NCOP for the work that they have done in consultations and also acknowledge the inputs of my colleagues as well as the members of the National Assembly, the province, and the NCOP in various provinces as well. I also express my thanks for the inputs that have been made by various stakeholders because, indeed, this is watershed legislation that would advance us in terms of strengthening the health services.
I just want to also indicate that I have discussed the issue of the concern around primary health care resources and that it is a shared concern and that we need to look at mechanisms to make sure that primary health care expenditure is protected in the implementation of this Bill. Thank you. [Applause.]
Ms M P THEMBA: Hon Chairperson, hon Minister and hon members, I’m going to deliver this speech on behalf of my MEC who couldn’t make it at the last minute because of some emergencies.
The national Department of Health, in this Bill, is implementing its constitutional right to restore and ensure that our people live in a dignified manner, and also promote healthy lifestyles. The reason why I assert that this is a human rights issue is based on the fact that the objectives clearly attempt to realise that effort, an effort of setting standards that will uphold the rights and duties of health care providers, health care workers, which was not the norm before, and also that health institutions and the users of health services must respect, promote and fulfil that national obligation, and the desire to progressively realise the importance of access to health care services, including reproductive health care.
It is vocal on the rights of patients and of health workers. The Bill also aims to create an enabling environment that is nonharmful to the health or wellbeing of the citizenry, where no chance would be allowed for purposes of research to violate the rights of others to be used as guinea pigs. Our children’s rights, especially to basic nutrition and basic health care services, should be prioritised. Hon Chair, the ball is now in our court to make sure that the dreams of our people are realised and put into concrete action.
The issues contained in Chapter 2 struck my heart the most because it deals with the rights that I am asserting. This area is what will make or break us in regard to the social contract that we entered into with our people, the contract that binds and guides our mutual understanding and working relations towards the achievement of access to affordable health care services. History will judge us based on how we fare in this regard.
Key to all elements that would make us achieve health care services is the responsibility and duty to disseminate information, the information that would be binding to the national and provincial departments and local government structures in ensuring that adequate and comprehensive information is disseminated on health care services for which each organisation is responsible to our communities.
The obligation to keep safe health records, adherence to the right to confidentiality and laying of complaints by would-be aggrieved parties, just to mention a few observations, will win the hearts of our communities. It will also create trust between Government and its citizenry.
It gives me great pleasure to be part of this debate and to give my inputs in the formation of the National Health Bill of 2002. Never in the history of South Africa will things be the same again, especially in relation to the promotion and adherence to the rights of our people who come from a bitter history of denial and segregation. Our people deserve the best of all in service provision and I think that this Bill attempts to do just that.
Gone are the Darwinian eras, where the survival of the fittest was the norm. Our era requires that we do things in a civilised manner where things are put in black and white for the purposes of transparency and accountability, as democracy requires. The purpose and the intention of the proposer of the Bill, in this case the policy-maker, should be clear and understandable to everyone. We are gathered here to debate on those pertinent issues and to understand the intention of the Bill as proposed by the National Minister, Dr Manto Tshabalala-Msimang.
My humble understanding of the object of the Bill is that it strives to improve health care services by regulating and setting standards that would be uniform to all. These will include the public and private service providers throughout the country in the best interest of the people of South Africa, for them to get value for money spent and the utilisation of scarce resources.
Access to health care services is key to the sustainable development of this country for economic, social and political growth, hence the right to health care services, which is regarded as a human rights issue and forms part of the highest priority on the national agenda. My point of entry into today’s debate would focus on the strengthening, observance and inculcation of the culture of human rights agenda in an inclusive manner to health development in the 21st century. This would also encourage the principle of Batho Pele in our quest to promote participatory democracy in as far as health care services are concerned. It would also be strengthening the understanding between patients and health providers in the observance of matters affecting their health status and making choices on decisions they would be making.
Chapters 3, 4 and 5 have come out clearly on the guidelines in as far as roles are concerned of all spheres of government health institutions within the national, provincial and district health councils. They also attempt to further strengthen issues of integrated approach and the provision of a basket full of services to our communities. Issues contained in these chapters, especially on the establishment of the national and provincial health councils and health committees will be of great benefit to the political head of the Government to draw broader expertise from different health workers and also to encompass the needs of communities who will be represented in one way or the other in these forums.
The responsibility of handling of classification of health establishments through political heads at both national and provincial level demonstrates the political will to address the imbalances of the past in terms of equity, location, size and the nature of levels of health care services to the communities as per their geographic location and the demographic reach. [Time expired.] [Applause.]
Mr E NOE (Free State): Deputy Chairperson, hon Minister, members of the NCOP, colleagues from other provinces, ladies and gentlemen, we rise in support of the Bill, because we believe that the Bill brings about new and fundamental changes to the health service delivery process, as outlined in the long title and the preamble to the Bill.
I’d just like to mention a few of these changes in that, firstly, the Bill provides for the fulfilment of the constitutional obligations of the Government with regard to the rights relating to health care services within the available resources; secondly, it provides for the regulation of the national health system and provides for uniformity in respect of health services by establishing a national health system for both public and private providers of health services; and, thirdly, it sets out the rights and duties of health care providers, health workers, health establishments and users. These are critical values that need to be supported by all of us, and there is no question about the fact that this Bill is aimed at ensuring that these values permeate our society.
Allow me to briefly reflect on some of the specific elements of the Bill, which we are in support of, and to identify what we consider still to be a limitation. We support this Bill. Firstly, the issue of certificates of need has already been referred to, and we will hammer this point home until those who are opposed to this provision agree to it. The opposition parties are vehemently opposed to this provision of the certificates of need, which is one of the critical positives in this Bill in terms of our bringing about the fundamental changes I have spoken of.
There is no question about the fact that our society has inequitable access to health services, owing to the concentration of private hospital beds and technology in urban areas. The process of registration will thus ensure that we rid our society of bogus medical practitioners. Moreover, this process is also aimed at ensuring equity in our society in terms of the distribution of medical doctors in our communities. Surely there is no point in having 10 doctors concentrated in one small area, while other areas do not have a single medical doctor? The distribution of skills in communities is something that needs to be enhanced.
Secondly, the issue of the uniformity of health services is a necessity that cannot be avoided at this stage. The Bill encourages this by ensuring that co-operative governance becomes the order of the day. I must state that for us in the Free State the Bill comes at a most opportune time, since we have already moved miles towards the goal of making sure that our municipalities are ready for the devolution of health services to them. Several interactions between the province and municipalities have already taken place towards this goal.
Thirdly, as the Free State province we are also happy about clause 19 of the Bill. Through this clause the Bill encourages and promotes the issue of voluntary testing so that individuals are able to take complete charge of their health. It thus promotes the spirit of self-reliance among individuals and communities when it comes to their health status. While we are faced with the pandemic of HIV/Aids, this clarion call of voluntary testing, as contained in this Bill, is a noble idea.
Regarding this issue of voluntary testing, before I came into this House I was approached by one of our members who said to me that I must say that he read in one of the health journals that in Zambia while some people have been calling for the introduction of antiretrovirals, having succeeded in amassing their services, other people who have been at the forefront of calling for these services are now pushing from the back. They are running away from testing, because you cannot be provided with antiretrovirals unless we know your status. We hope that in this country those who are vocal, whilst the department and Government ready themselves to roll out antiretrovirals, will be at the forefront of testing.
However, it must be further emphasised here that individuals are called upon to take full charge of their health. There are many other conditions, such as tuberculosis, high blood pressure and so on that individuals need to test for and about which they need to know their status so that they can deal with them. Thus, we support the Bill in this regard.
Allow me, further, to point out that we are also happy as a province to support this Bill in relation to clauses 22, 24, 26 and 28, because they relate to the critical issue of community participation in health matters as we know that South Africans complain too much about consultation. Through these clauses the Bill promotes the direct involvement and participation of communities in health issues through the establishment of the national and provincial health councils. The purpose of these councils will be to interface with communities on a constant basis and advise the Minister or the MEC for health accordingly.
There is no question that if we are to succeed in terms of quality in health service delivery, we need to take the ordinary people along with us in the planning and implementation of plans. These are just some of the many points in this Bill that we want to communicate our support around.
There is one issue of limitation which we think has not been taken on board, as we proposed amendments. There is a limitation as far as clause 41(7)(c) is concerned, which reflects on the composition of hospital boards and states that a provincial representative has to be appointed in each of the hospital boards in the hospitals within the province.
We believe that this creates an unnecessary burden on the MECs. We also believe that departmental officials within the districts, or within the hospitals themselves, already represent the provincial department and thus their presence on the boards is sufficient. We also want to propose that the concept of provincial representatives be revisited as it may create confusion.
In conclusion, I want to reiterate that this Bill is indeed breaking new ground in terms of health service delivery. The points in support of the Bill far outweigh the limitations that we have pointed out. Overall, this Bill needs to be endorsed and we do so as the Free State. Thank you very much, Deputy Chair. [Applause.]
Ms E C GOUWS: Deputy Chair, hon Minister, colleagues, spare me a minute as I just want to thank the hon Dugmore who, instead of speaking on the National Health Bill, decided to focus on the DA. Thanks for the advertisement. What a bonus. The country will take notice of that. Thank you very much. [Interjections.]
We all acknowledge the fact that the health services pre-1994 were unbalanced, inequitable and unjust, both socially and economically, and that a Bill which addresses these issues would be very welcome. The objectives of the National Health Bill are to provide a framework for a structured and uniform health system which will redress these injustices and imbalances of the past. The reality, however, is that this Bill fails to meet the intended objectives. [Interjections.] It lacks measures to address past and existing inequities and gives the Minister too much power. It appears that there is a need and purpose on the part of the Government to regulate the private industry. The areas of greatest concern are clauses 41 to 45 which deal with the certificates of need.
In their reaction to this Bill, the SA Medical Association broadly supports accreditation systems and the incentivisation … [Interjections.] Chairperson, please! The association broadly supports accreditation systems and the incentivisation of doctors to establish practices so as to address health care needs in underserviced communities.
They have serious concerns, however, regarding the certificates of need. Accreditation systems and the certificates of need have to be balanced with the existing rights of doctors, and must be practicable and economically viable. The doctors of South Africa will need assurances that the regulations relating to the certificates of need are drawn up in consultation with the stakeholders.
The only existing avenue of appeal if the director-general refuses an application for, or withdraws a certificate of need, is to the Minister of Health. This makes the Minister both referee and player in this game. It is unacceptable. [Interjections.] The introduction of the certificates of need violates the free-market principles of supply and demand. We must take cognisance of the fact that the SA Medical Association supports sensible and open public-private partnerships.
If we look at our Bill of Rights, we find the following in section 22 on freedom of trade, occupation and profession. I quote: ``Every citizen has the right to choose their trade, occupation and profession freely.’’ [Interjections.] Section 36 of this Bill strikes at the heart of this right of medical practitioners to choose their profession freely. It prohibits a person from establishing health establishments, such as hospitals and surgeries, without a certificate of need, which is to be obtained from the director-general in terms of regulations. The fact that no minimum standards or required qualifications are stated is unacceptable. The only judge for the necessity of a practice is the director-general. This is an infringement of the basic freedom to work enshrined in our Constitution.
It is regrettable that there is a certificate of need. It is a most inappropriate regulatory measure and is certainly going to accelerate the exit of highly competent and qualified health care professionals from South Africa. We must rather give reason to our skilled workers and professionals to be loyal to their country than place obstacles in the road. Certificates of need antagonise competent and qualified health care professionals. The country can ill afford this. My party cannot support this Bill. Thank you. [Interjections.] The DEPUTY CHAIRPERSON OF THE NCOP (Mr M J Mahlangu): Order! Order!
Mr A T MANYOSI (Eastern Cape): Deputy Chairperson, hon Minister, hon members of the NCOP, and hon special delegates, firstly, I must apologise on behalf of the MEC for Health in the Eastern Cape. He is not able to be here - although he intended to be here - because he has had two bereavements at his home. However, I am representing the standing committee on health from the Eastern Cape.
To the province of the Eastern Cape, the National Health Bill comes as a remedy for a multitude of social ills of the past dispensation, as much of the land constituting the province was a testing ground for all the practices envisaged to achieve separate development. Those practices affected all aspects of the lives of our people, including health services. It may be of relevance to quote from the TRC’s final report where it says:
Those who benefited, and are still benefiting, from a range of unearned privileges under apartheid have a crucial role to play. This means that a great deal of attention must be given to an altered sense of responsibility, namely the duty of obligation of those who have benefited so much through racially privileged education, unfair access to land, business opportunities and so on, to contribute to the present and future reconstruction of our society.
Health services have not been uncontaminated by the system of racially based allocation of services, especially in the Eastern Cape. In a province where the concentration of advanced health services has been in towns and cities, the provision of a framework for a structured health system or regulation of health services that takes into account the socioeconomic injustices, imbalances, and inequities of health services of the past and recognises the need to improve the quality of the lives of all citizens, brings a sigh of relief to all our people, including the previously disadvantaged.
The Bill provides for a certificate of need as a requirement, inter alia, to address the problem of the concentration of health services in one section of society to the disadvantage or exclusion of others, as had been the case in the past, a situation that has continued to resist remedial interventions by Government thus far. This may be negatively construed to be inhibiting the rights of individual health practitioners to exercise their professions where they like, but that right should never be allowed to undermine the rights of the rest of society.
In fact, it is actually intended to ensure co-operation and a shared responsibility among public and private health professionals, a condition without which we cannot successfully address the backlogs that remain a challenge for all of us. The system of licensing will facilitate the decentralisation of health services, especially in provinces where health professionals are scarce.
May I mention that in our standing committee we have all the political parties, including the political party that is represented by the hon Mrs Gouws. We decided that, despite constraints of time, we would give them enough time to express their views. They expressed their views, and after reaching a stage where they could no longer bring new points we reached consensus.
Without going into detail about the provisions of the Bill, the Eastern Cape province supports the adoption of the National Health Bill, as amended. I thank you. [Applause.]
Mr D M KGWARE: Deputy Chairperson and hon Minister, the ANC, which is the majority party and also the ruling party, believes that the provisions for a certificate of need in this National Health Bill are well thought out, comprehensive and well balanced. At the same time it will promote improved access and utilisation of health services, as well as encourage improved quality of care. I would like to emphasise this point in Chapter 6. The members have been repeating it. We want to stress this point so that despite the perception that has been created outside by the opposition, people should realise there is nothing to fear.
Unlike some opposition parties we do not believe that it is a dompas for doctors, health care professionals and those providing good health care facilities. In fact, to make such a comparison is not only highly insensitive to those comrades who suffered exceptional degradation and humiliation under the inhumane dompas system, but also grossly misrepresents the certificate of need in its totality.
There are certain basic requirements to be met in order to obtain the certificate of need. The director-general tasked with issuing a certificate of need will have to take into account, amongst other factors, the need to promote an equitable distribution and rationalisation of health services and health care resources, and the need to correct the inequities based on racial, gender, economic and geographical factors.
When the Minister introduced the debate, she touched on some of the points. In an effort to overcome the disparities which we have inherited from our apartheid past, also built into the certificate of need application process is a mechanism to stop any kind of abuse that may emanate from the DG, namely, an appeal process directed to the Minister against any decision to grant a certificate of need. Therefore, it is extremely difficult to understand why any of the above provisions, and those provisions set out in Chapter 6 of the Bill, could be thought to be unfair in any way and to any particular group.
Clearly health services and health providers have to be regulated in some way or another. In the absence of such a legal framework and guidelines, as has been the case till now, we would have a poor quality of service provision, overservicing and wastage of scarce and precious resources.
We are also not claiming that this regulatory measure is unique to South Africa. Indeed, we are in very good company with most of the first world nations who believe that there should be appropriate regulation of health services and health care providers. Registration of health care professionals and placement of health facilities, the international equivalent of the certificate of need, occur in virtually all countries, such as Canada, Australia, the United Kingdom, the Unites States, Germany and most European countries. Their requirements are even more stringent that those proposed in our National Health Bill.
In South Africa currently, health professionals have an effective monopoly in a number of areas. Among these health professional groups, pricing levels are set, competition is not allowed, marketing and advertising are not allowed, and entry into the profession is strictly controlled. Very often what happens in an unregulated monopoly is that levels of efficiency and quality of care are likely to drop as there is little incentive to maintain these.
Even users of the health care services are disadvantaged by an unregulated service in a number of ways. Users, especially the poor and vulnerable, do not have sufficient information to decide on the types of service they require. This could lead to the level of servicing being decided by the health professional alone.
In the private sector especially, this could lead to overservicing. In other words, you may be charged for a service that is not vital to your continued good health. This is more likely to occur when many health professionals provide a service to a small number of people. Therefore, the ratio of health care professionals to populations should be controlled.
An unregulated health service would tend to perpetuate gross inequities in the geographical location of services. Most health professionals would prefer to practise in urban and wealthy areas, with very few willing to operate in peri-urban and rural areas. This would mean that the population living in the peri-urban and rural areas, where there are critical shortages, would have much less access to health services.
Over and above the other argument outlined, the ANC feels that the state has paid for the major cost of training health professionals and, therefore, should have some ability to intervene should the situation warrant it. It is at this juncture in our transformation process that there is a need to provide a mechanism to achieve equity and efficiency in the deployment of health professionals and safeguard standards in order to ensure a reasonable quality of care to our people. So, we make no apology for the inclusion of the certificate of need.
The recent Sars outbreak and our continuous battle with cholera and malaria make it imperative that health service provision throughout the country is regulated and co-ordinated to meet the needs, not only of the individual, but also of the larger community. To this end, regulation is essential as the unregulated market is simply incapable of providing for group needs on such a large scale.
The ANC considers it a dereliction of duty if this Ministry should fail to institute effective, efficient and equitable regulation for health service provision. The conditions to be met to obtain and renew a certificate of need, as laid out in the National Health Bill, effectively, efficiently and equitably address the health service regulation duties of the Government. The ANC is, therefore, convinced that the certificate on need is a vital component of the National Health Bill. [Applause.]
Dr P J C NEL: Agb Voorsitter, agb Minister, die Nasionale Gesondheidswetsontwerp het ‘n baie lang aanloop gehad en ook nie sonder moeite nie. Daar is in die parlementêre proses alleen byvoorbeeld 115 wysigings aangebring deur die portefeuljekomitee en ‘n verdere 24 deur die gekose komitee. Dit alles ten spyt, selfs al die wysigings aan klousule 36, maak dit nie vir die Nuwe NP moontlik om vir die wetsontwerp te stem nie. (Translation of Afrikaans paragraph follows.)
[Dr P J C NEL: Hon Chairperson, hon Minister, the National Health Bill has had a very long run-up, and was not without difficulties either. For instance, in the parliamentary process alone 115 amendments have been effected by the portfolio committee and a further 24 by the select committee. Despite all of this, even all the amendments to clause 36, it is not possible for the New NP to vote in favour of the Bill.]
The New NP supports most of the measures and structures as proposed in the Bill that we believe will assist the Department of Health in its attempt to implement a health system in South Africa of acceptable quality for all South Africans. The New NP is fully aware of the dilemma in which the hon Minister finds herself as far as the delivery of health services in the rural areas is concerned and that something has to be done to solve the problem.
The New NP is, however, of the opinion that the implementation of the certificate of need will not assist in solving this problem. We are actually of the opinion that it will have the opposite effect. The New NP has recently done some research on the use of the certificate of need programmes in other countries. Available resources consulted had little or no information on whether the certificate of need is used in countries outside the United States of America, although the hon Minister has mentioned a few today.
The use of the certificate of need was established in the USA as far back as the early 1970s. The primary purpose was to reduce the record increases in health care costs. Since 1986, 11 states have repealed their CON programmes. However, a number of states are still implementing the certificate of need programme, but it applies mainly to major health establishments and tertiary services - not to individuals.
The New NP is also deeply concerned about the brain drain of health workers. A spokesman of the Young Doctors’ Association recently said, and I quote from the article in The Argus of 22 September:
As many as 60% to 70% of my friends in other medical sectors plan to emigrate. Another 20% will stay to specialise and then they will also leave. The majority of the rest will immigrate internally to the private sector.
The South African Registrars’ Association (Sara) representing the young specialising doctors, stated recently that the levels of frustration felt by doctors, nurses and other health providers because of major problems in the public sector at all levels, are almost unquantifiable.
The public sector as a career option is therefore dwindling in popularity. Though private practice is another career option the spectre of the CON has cast huge doubts over this sector. The only option left for many young doctors is to leave the country.
The New NP is of the opinion that the main reasons health workers in the public service are looking for greener pastures are: Poor working conditions, poor living conditions, lack of security at work, poor salaries and a lack of incentives. The New NP is in favour of and supports the incentive to the amount of R500 million announced and earmarked by the hon Minister for the improvement of these conditions. The New NP is of the opinion that increasing this amount annually and applying this programme promptly and correctly would be a better option to solve this problem.
In the light of all the points I have made in respect of the certificate of need I would like, on behalf of the New NP and on behalf of many people outside of this Chamber, to appeal to the Minister to amend this provision and look again at the whole concept of the certificate of need, the merits of which are in serious dispute and contention. It is not too late to get rid of this source of unnecessary contention and division.
What we need now is a common effort, a collective will to tackle the enormous challenges which we face as we work to bring health care, of acceptable quality, to all South Africans. That is what the New NP wishes to see in our country and we will continue to work hard to achieve this aim. I thank you. [Applause.]
Mr S W MCOYI (KwaZulu-Natal): Hon Deputy Chairperson, hon Minister, hon members of Parliament, ladies and gentlemen, I am delighted to be here, not just because it is the first time that I am here, but because I am bringing a statement of wellness from our tranquil KwaZulu-Natal. [Applause.]
We find that this Bill has its roots in the Constitution of our country, so there was no way of doing otherwise. The Constitution says that everybody must have access to health care. All branches that come up on the stem come from the roots of our Constitution.
Chapter 1 of the Bill outlines the objectives of the Bill, the issues it seeks to address and how these are to be addressed. The Ministry of Health is established as the responsible body for the provision of health care services to users. The oversight functions rest with the Minister. The responsibility for health care provision is also vested in the provincial and municipal structures, which gives expression to the principle of co- operative governance.
This chapter goes on to set out criteria for the eligibility of health care services in public health establishments. The Government’s intention is to adhere to the provision of social rights, which includes the right to health care. This right is inclusive of both health care users and providers.
Chapter 2 of the Bill expresses and outlines the commitment to the realisation of the rights and duties of users and health care personnel. The rights reflected in this chapter range from the rights to access to emergency treatment, to full knowledge of the medical condition by the user, the consent of the user to any medical treatment to be administered, thus resulting in participatory decision-making.
In this way, a user is likely to feel safe in receiving health care treatment when he or she is part of the decision-making concerning his or her health. This chapter encourages transparency and calls for health care providers and users to deal with one another in good faith where all parties have access to information.
Chapter 3 outlines the responsibilities of the national sphere of Government in terms of health services. The different functions of the national department are set out. These duties are mostly related to policy development and oversight to ensure implementation, and to ensure compliance with the national health policy provisions.
This Bill calls for the establishment of the National Health Council. In this body the health MECs, Ministers, organised local governments and other stakeholders will meet to discuss matters of common interest. The chapter outlines the duties of the council and its powers.
Chapter 4 focuses on the provincial spheres of government with regards to health. This chapter places an obligation on provincial departments to comply with the provisions of the national health policy. Provincial departments are called upon to act on these provisions and implement principles of the national policy at provincial level. This responsibility brings with it financial implications. The Bill calls for the establishment of the Provincial Health Council whose function is oversight over the implementation ÿ.ÿ.ÿ. [Time expired.]
Mrs V TAMBO (KwaZulu-Natal): Chairperson, hon members, Minister of Health and hon members of the NCOP, it is with great satisfaction and fulfilment that today I stand here representing my province KZN. KZN is indeed in full support of the Bill and its amendments of which the intentions are very clear in terms of the balances and inequities of health services of the past and there’s more room for improvement. Indeed a structured uniform health system within the country was long overdue and finally the team has assembled what is best for the citizens of RSA. Congratulations to all involved: We are proud of you. KwaZulu-Natal, the most populated province of all, fully supports the Bill and its population stands to benefit with the rest of the provinces.
This department has transformed through its consistent revision of policies and legislation in a way never seen before in the history of this department which used to be obscure during those days when it only serviced the so-called first class citizens. The enormous good work done by the team in fine-polishing the amendments and the research put in, in order to make sure that the Bill complies and is also user-friendly and simple has also been taken into consideration.
This marvellous job is in line with the commitment of the department, which has always had the ordinary John Citizen in mind when making any piece of legislation. Therefore any tool, any piece of legislation, that is designed to make it function more effectively or make life better for all must be welcomed. The Bill’s pieces of legislation that are being proposed by the ANC-led Government turn our resolutions into solutions. They are action- packed and really bring prosperity through mobility.
Mr J O TLHAGALE: Hon Chairperson, hon members and hon Minister, the Bill under discussion seeks to create uniformity across the nation in the delivery of health services by establishing norms and standards, frameworks and national policies. In other words, it brings about transformation across the board in health services. For that reason, a schedule of 12 Acts enacted from as far back as 1977 until 1993 have been repealed in their entirety and their functions and provisions are replaced by this new Bill. I am constrained from delving into the details of the Bill owing to time limitations and can only pick up the pieces in order to comply with the rulings of the House.
According to clause 5 of the Bill, a health care provider or health establishment may not refuse a person emergency treatment. My province, the North West, and two others, the Eastern Cape and Mpumalanga, were concerned that the term ``emergency’’ should have been defined so that all of us are on the same wavelength regarding that term. However, it was explained by the legal advisers of the department that the term was used as used in the Constitution, and that defining it in any way could render this Bill unconstitutional. Of course, we all accepted the explanation.
Another interesting provision of the Bill concerns the rights and duties of
users relating to having full knowledge of their health status, the consent
of users to medical treatment, participation in decisions that affect them,
discharge reports and so on. These provisions are an indication that health
issues are no longer a matter of it is good enough for them'', or dit
is goed genoeg vir hulle’’, but takes into account that we too are people.
That is ``le rona re batho’’ in Setswana.
The UCDP supports this Bill. [Applause.]
Ms R P MASHANGOANE: Hon Chairperson, hon Minister … moswara thipa ka bogaleng … [… the one who stands for problems …] … hon special delegates and hon members …
… ke tla thoma ka Sepedi sa go re ``hlaba pitse o hlabe hlogo, o se ke wa senya moetse wa ngaka’’. Go e ra go re. Motho ge a rera molato a seke a hloya mong wa molato fela a nyakisise seo elego phoso go re molato woo a tle a ahlolwe ka tshwanelo go sena lengalatsepa. (Translation of Sepedi paragraph follows.)
[… I will start with the Sepedi saying which goes: ``Look at the merits of the case, instead of at the accused.’’ This means that when people are deliberating a case they are not supposed to hate the accused, but investigate the case so that a decision can be taken in a fair manner.]
Ouma Gouws, dit is ``people’s power’’, nie paraffienkrag nie. [Gelag.] Ek wil net u een vraag vra: Waar was die DA, waar was Ouma Gouws? [Gelag.] (Translation of Afrikaans paragraph follows.)
[Grandmother Gouws, it is people’s power, not paraffin power. [Laughter.] I just want to ask you one question: Where was the DA; where was Grandmother Gouws: [Laughter.]
O be o le kae? [Where were you?] Where were you? Where were you circa 1912?
Ge mokgatlho wa ANC o tlhongwa, ge mokgatlho wa ANC o thal a lenaneo leo re bolelago ka lona gona bjalo. [When the organisation of the ANC was established, when the organisation of the ANC came up with the programme that we are talking about now.]
Waar was jy? [Where were you?] O be o le kae? Where were you? [Laughter.]
… ge kutullo ya ANC ele go Freedom Chart ka di 26 tsa June 1955 e adoptiwa. [… When the revelation of the ANC which is the Freedom Charter was adopted on 26 June 1955.]
Waar was jy? [Gelag.] [Where were you? [Laughter.]] O be o le kae?
… the aged, the orphans, the disabled, the sick shall be cared for by the state, being the ANC Government. [Interjections.] But we do not forget and we won’t forget. We do forgive …
… maar vergeet, dit sal nie maklik wees nie. [Tussenwerpsels.] Waar was jy? [Gelag.] [Applous.] [ … but forget; that won’t be easy. [Interjections.] Where were you? [Laughter.] [Applause.]]
The National Health Bill tries to accommodate all aspects of health and health-related matters.
Molaokakanyo wo, nepo kgolo ya wona e lego go sokolla mabosaedi ka moka ao a hlotswego ke Mmuso wa maloba wa kgethologanyo moo molwetsi ge a be a lwala, arego go kaone ke hwele ka mo ntlong ye, go phala gore ke ye ngakeng ke ye go tlaiswa ke dingaka le baoki. Tshwaro e mpe. (Translation of Sepedi paragraph follows.) [This Bill aims to address all the wrongs caused by the previous apartheid Government, for example, when a patient was sick, they opted to die at home, instead of going to a medical doctor to be abused by doctors and nurses. Very bad treatment.]
It also seeks to bring the Department of Health in line with the national health obligations contained in our Constitution. However, I believe that one of the most important features that this National Health Bill brings about is the number of rights it gives to users of the health services across the country. Not only does this piece of legislation ensure broadly that every person using the service is treated with dignity and respect, but it also puts a similar obligation on users to treat those bringing the service to them, that is doctors, nurses, etc, with the same dignity and respect. In fact, throughout Chapter 2 of this Bill the principles of Batho Pele are emphasised.
All of us can tell stories of our children, parents and grandparents going to the hospitals, clinics or day hospitals in our neighbourhoods where they were either treated badly or treated only with respect, depending on where they found themselves. It has been our unfortunate legacy that it was usually those who came from poor, disadvantaged and rural backgrounds that found themselves at the receiving end of poor treatment. Those who had all the advantages received privileged and dignified treatment. Nurses and doctors, too, can relate stories of how they were verbally abused and even had their lives threatened by patients using the facilities.
The apartheid era health system saw to it that patients were never informed of the benefits, risks, costs and consequences generally associated with each option. Black people in general and those undereducated in particular were disregarded in decision-making about their own health. People were treated like ignorant children.
With this Bill, our people are given back their dignity. They have the right to refuse unnecessary health procedures or medication. Even their personal health status may now not be revealed without their knowledge and approval. This Bill therefore determines the policies that provide a framework of how users of health care facilities across the country should be treated once they present themselves for treatment.
Another far-reaching measure that this chapter introduces is the concept of emergency treatment for all. This means that no health care provider or health establishment can refuse to give anyone emergency treatment. This obliges even ambulances which are contracted to hospitals, to stop to provide treatment. [Time expired.] [Applause.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Thank you, hon member. I was starting to panic, thinking that perhaps you would say, ``Where was I?’’ [Laughter.]
UNGQONGQOSHE WEZEMPILO: Sihlalo, angethembe ukuthi awuzukulibheka iwashi ngoba ngizokhuluma isikhathi eside. Ngicela ungangihlalisi phansi khona ngizokwazi ukuphendula kahle. Nesikhathi sisesiningi futhi ngoba kuseyimizuzu engamashumi amabili emva kwehora lesine. (Translation of isiZulu paragraph follows.)
[The MINISTER OF HEALTH: Chairperson, I just hope that you are not going to look at the clock because I will speak for quite some time. I appeal to you not to cut me short so that I can reply fully. It is also still early as it has just gone twenty minutes past four.]
Let me, first of all, thank all the members who have participated in this debate. I think it’s been a very lively debate. I also think it has underscored - except for one province and two parties - the unanimity with which we want to adopt this piece of legislation. Thank you very much to everybody.
Let me start, before you stop me, by answering some of the controversial issues. First of all, I want to deal with Mrs Gouws and Dr Nel because they spoke about supply and demand in particular. I think they should be informed that it is well known that health is an imperfect market. Therefore normal market theories don’t apply and, in fact, they provide pervasive incentives.
If there are too many facilities or professionals in one area then, in order to survive, there is overservicing and overprescribing. It also leads to situations of kickbacks, as we have seen happening. Therefore, the certificate of need prevents this from happening. If Mrs Gouws and Dr Nel were saying they don’t support the Bill because of the certificate of need, then they were saying or implying that they want overservicing, overprescribing and kickbacks to happen in this country. May I tell Dr Nel that I am not going to review this piece of legislation - it is perfect. He asked, as he was passing here, if we could discuss it. I don’t want to engage in any further discussions. I think this is a very perfect piece of legislation.
I think it was Dr Nel who also raised the issue of migration - the brain drain of health workers in our country. I just think he also doesn’t understand the issues. Maybe I should have come to address the NCOP about the efforts that we have been putting in place, as the Department of Health. Dr Nel and all of you - I think you will benefit, anyway - nobody in this country says we must stop people from travelling. It is their constitutional right. All of us suddenly have passports. You know, we never had the green book before. We now have the green book or the orange book, whatever you call it - the passport. You can shake your head but it’s true. You actually did not want to give us passports and now we have the passports and so anybody can travel.
However, the difficulty is that, as people travel, they cut bridges. They think it’s rosy out there; they stop paying their pensions; they stop paying their medical aids; and they sell their houses and cars. When they get there, what happens to them? They live in small rooms of this size, and they eat fish and chips. You know, they think the pound is much stronger than the rand, and what’s happening now? I think I feel very sorry for them.
In fact, I was in Britain just two or three weeks back. I attended the UK- South Africa conference to celebrate our 10 years of democracy in South Africa. This gave me an opportunity to speak to quite a number of nurses who actually asked for an appointment to talk to me. They all want to come back and they want to come and serve the country. They said it is not as they had been informed by the media or by the agencies that came to recruit them.
Unfortunately, they took voluntary packages and now we have to crack our heads to see how we recruit them back to South Africa because we need them, and they are South Africans anyway. So, please don’t spread the wrong information about health workers living in this country. You can go anywhere and I can tell you about a number of doctors who left and who now want to come back. I think we must really be very patriotic, as South Africans. We must tell the truth and advise our people correctly because to spread the wrong information, I think, is criminal.
Let me just also say that we have, in fact for the first time, signed a memorandum of understanding with the UK in which both of us - the UK and South Africa and we intend to do this with Australia, Canada, and so on - say, ``Yes, we allow you to come and recruit in our country. We are not stopping you but please be transparent in the manner in which you recruit. And, when you recruit please make sure that you don’t disrupt our health care services’’.
We have also agreed, in the memorandum of understanding, that Britain will assist us recruit there. And, as we recruit from Britain, people who will come and work in this country will be influenced, in fact, to go and work in the rural areas like the good old missionaries, you see. So you don’t have this information and, therefore, you are going to go around spreading the wrong information and, in fact, encouraging our health professionals to leave. I think that that is not correct. I would really really appeal to you, particularly because we are in coalition, to really spread the correct information. I think I have dealt with both of you in that regard.
I’d like now to thank the UCDP for supporting the Bill. Thank you very much.
Iyazi ukuthi sivelaphi nokuthi sifuna ukwenzani la eNingizimu Afrika. Ngibonge kakhulu futhi naKwaZulu-Natal. Beningangilahla kanjani kodwa? Angithi silungiselela abantu bakithi sonke. Abanye abazi ukuthi sifuna ukwenzani, bayazidabhuzela nje oGouws noNel. Thina siyazi ukuthi sifuna ukwenzani nokuthi sibhekephi. Sifuna ukuthuthukisa imiphakathi yethu nemindeni yethu ukuze babe nempilo ethuthukile emphakathini. (Translation of isiZulu paragraph follows.)
[They know where we come from and what it is that we want to do in South Africa. I would also like to thank KwaZulu-Natal. Anyway, how could you have let me down? It is true that all of us are improving things for all our people. Others do not know what we intend to do; Gouws and Nel do not have any direction. We know what we want to do and where we want to be. We want to develop our communities and our families in order to have a better life.]
Let me then also turn to Dugmore. I really feel sorry for you, my kind brother. I know the message you are bringing across but, of course, your hands are tied. How can you be linked with Nel, honestly, in this debate? It’s really a pity, but let me thank you for exposing the DA for who they are. I think that was a really brilliant exposé of who the DA are and I will not go into details about that.
Comrade Gwen - the MEC for health in Gauteng - let me say thank you for taking time to really come and debate this very important Bill which transforms the health care sector and services in our country. I really regret that my other colleagues are not here but, of course, I do not undermine the statements that have been made by the special delegates and the members of the NCOP. I think they have been very very valuable. Thank you very much for coming.
Let me just remind you that, obviously, our health care system which was adopted by this Government is based on primary health care. So there is no way that we all must stand back and see primary health care being ruined in this country. It is our responsibility, nationally and provincially, to always protect the principles of primary health care in our country. It’s not just the responsibility of the national Government, it is our responsibility collectively and, therefore, I really hope that the provinces themselves will find or mobilise resources in the provinces to make sure that we keep on improving delivery through primary health care. It cannot be just the responsibility of the national Government.
Let me, at the same time, really congratulate you, MEC, on the progressive improvement to access in your province and improving the quality of health care in Gauteng. I noticed that and I’m really excited about it.
I also want to comment just a little bit, and this will just be one sentence, around what was raised by Free State with regard to antiretroviral drugs. I want to say I am hoping that colleagues did read a statement in yesterday’s paper, This Day, and there was a photograph of our President there; and also This Day of 20 October, where Robert Gallo who is the founder and the one who identified the virus said: ``Beware of using antiretrovirals.’’ He warned - he said beware. He said instead he would encourage developing countries to do additional research and train their health workers but beware of antiretrovirals.
It’s not me but the man who discovered the virus. So I’m hoping you can get hold of that article and read it for yourselves. I don’t have enough time to elaborate on what he said. It is in This Day of 20 October and yesterday’s This Day, and in that article there is a photograph of our President. Also, last week there was a similar article in The Citizen. So, I hope you can really read that and begin to interrogate: What are these people saying to us as South Africans, because I know there is this Wooh! Wooh! Wooh: The other day I said I wish I could have all these antiretrovirals and stand out there and say, ``Come ye, come ye and chow these antiretrovirals!’’ But, I just warn, I just warn that it is not an easy programme. It is not an easy programme. I am glad that you raised this matter.
In the main, before you ask me to sit down, Chairperson, I’d also like to thank the MEC for Health of Mpumalanga for really focusing on and emphasising the human rights for both the health care users and health care providers as enshrined in the Bill before us. However, let me just thank my colleagues from the ANC who contributed in this debate. I would have been surprised because I think we have come a long way with this piece of legislation. It has its roots in the ANC health plan, the green book, and all that we are doing is to try and translate it into legislation and also the implementation thereof.
I’d also like to thank the chairperson of the committee very much and actually admit that it was an omission on our part not to refer to the traditional health practitioners in the Bill. But, I would like to say thank you very much to the NCOP for having highlighted that. Last night I had a very fruitful meeting with the traditional health professionals and practitioners and I think they are really on our side. Therefore, we need to work with them and do everything to support their efforts. After all, it is about us contributing to the African Renaissance and Nepad. It is also about us asserting ourselves regarding who we are and not always relying on western medicine. It is about us doing those things that India, China, Senegal and Burkina Faso are doing, supported by the WHO. So, I think we are well on track with regard to traditional health practitioners.
I also want to express my regret, as much as you have expressed your regrets, regarding the lack of participation in the consultations by Salga and Gauteng. However, we’ve been in constant discussion with the MEC of Gauteng. Obviously, it would have helped if they had come to participate when there were submissions in the committee. I also want to say that Salga has actually been participating in Minmec. I don’t know what went wrong that they did not come and participate when we were receiving submissions. I really do regret that and I hope we can do better next time.
As I mentioned, the National Health Bill has been extensively debated and discussed at no less than 17 PHRCs and 15 Minmecs over the last seven years. It has also been discussed with numerous other departments. I’m sure you will agree that there has been extensive consultation and I must point out that there has been agreement with all these various structures. The reason for agreement was captured in my speech to the National Assembly that this National Health Bill is the most important piece of legislation in the history of our country in transforming our health system.
I refer you back to our preamble, which states and I quote:
In terms of section 27(2) of the Constitution, the State must take reasonable and other measures within its available resources to achieve progressive realisation of the rights of people of South Africa to have access to health services.
The preamble further states:
In order to provide for a system of co-operative governance and management of health services in which each province, municipality and health district must address issues of policy and delivery of quality of health services …
Therefore, there can be no ifs'', there can be nobuts’’ and there can
be no ``on condition’’. It is our constitutional obligation to ensure
equitable access to health services within available resources.
Within the system of corporate governance, we all have a responsibility for this. Let me just say that members will remember that WHO rated us very low because of this perceived lack of stewardship by Government in order to address transformation of health care services in our country, particularly the private health care sector. Therefore, we are now really doing what is expected of us both by the Constitution and the international community.
I’m sure that in the spirit of transformation of our health system, all three spheres of government will work together to address operational and other issues that will inevitably ensure that legislation is, indeed, implemented. In fact, it is no longer a question of the cost of the implementation of this Bill; we should rather be asking what the cost will be to the country if we do not implement. Therefore, for the people of this country, I urge you all to unequivocally give your full support to this Bill, and I thank you. [Applause.]
Debate concluded.
The DEPUTY CHAIRPERSON OF COMMITTEES: I shall now put the question. The question is that the Bill be agreed to. As the decision is dealt with in terms of section 65 of the Constitution, I shall first ascertain whether delegation heads are present in the Chamber to cast their provinces’ votes. It looks as if they are all present. In accordance with Rule 71, I shall first allow provinces the opportunity to make their declaration of vote if they so wish. Yes, hon MEC.
Declaration of vote:
Dr G M RAMOKGOPA: Thank you very much, Deputy Chair. I have highlighted in my speech the reasons for supporting the Bill. The Gauteng province mandate is also very clear: The Bill is supported on the understanding that in implementing clause 93(3), the transitional mechanism will take into account the cost of redefinition of municipal health services. Thank you.
The DEPUTY CHAIRPERSON OF COMMITTEES: Thank you. There is no other declaration. We shall now proceed to the voting on the question. I shall do this in alphabetical order per province. Delegation heads must please indicate to the Chair whether they vote in favour or against or abstain from voting. Eastern Cape?
Ms N C KONDLO: I-Eastern Cape iwawuxhasa lo Mthetho oYilwayo. [The Eastern Cape supports this Bill.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Free State?
Mr E NOE (Free State): Chairperson, Free State supports the Bill.
The DEPUTY CHAIRPERSON OF COMMITTEES: Gauteng?
Dr G M RAMOKGOPA (Gauteng): Chairperson, Gauteng supports the Bill.
The DEPUTY CHAIRPERSON OF COMMITTEES: KwaZulu-Natal?
Mrs V TAMBO (KwaZulu-Natal): KwaZulu-Natal supports the Bill.
The DEPUTY CHAIRPERSON OF COMMITTEES: Limpopo?
Kgoshi M L MOKOENA: Limpopo le a go tshega mohlomphegi. [Limpopo supports the Bill.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Mpumalanga?
Ms M P THEMBA: IMpumalanga iyawesekela. [Mpumalanga supports.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Northern Cape?
Mrs E N LUBIDLA: Northern Cape supports.
The DEPUTY CHAIRPERSON OF COMMITTEES: North West?
Mr Z S KOLWENI: Re e nesetsa pula. [We support.] [Laughter.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Western Cape?
Mr C M DUGMORE: Ndidanile nyani, uyabona. Kodwa kwiphondo endilimeleyo siza kungavoti. Kodwa mna ndidanile nyani. [I am truly disappointed, you see. But in my province, we are going to abstain.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Does the Western Cape abstain? Mr C M DUGMORE: Yes, it abstains.
The DEPUTY CHAIRPERSON OF COMMITTEES: Thank you. Eight provinces voted in favour. I therefore declare the Bill agreed to in terms of section 65 of the Constitution. [Applause.]
Mr C M DUGMORE: Chairperson, something has just been brought to my attention by my colleague behind me that, in fact, he is the permanent delegate and I’m only a special delegate. I don’t want to affect the progress of this Bill but I’m informed by my colleague behind me that, in fact, he is the one who is supposed to abstain, not myself. I’m not fully aware of the Rules of this House but could you make a ruling.
The DEPUTY CHAIRPERSON OF COMMITTEES: Thank you. What we know is that you are representing your province here. Order!
FIREARMS CONTROL AMENDMENT BILL
(Consideration of Bill and of Report thereon) Mr L G LEVER: Chairperson, the principal Act, the Firearms Control Act, Act 60 of 2000, elicited a great deal of public debate. The contemplation of the regulations under the principal Act has also, to some extent, elicited debate.
The select committee tried to keep abreast of the issues in the debate by following the publications of both the programme lobby and the organisation, Gun Free South Africa. In the view of the select committee, there were no contentious matters or policy changes in this Amendment Bill.
Certainly, no contentious issues were raised in the committee when the Bill was considered. I have just been informed at the start of this plenary that one party considers a part of the Bill to be contentious, but more about that later.[Interjections.]
Well, I am sorry, it was not indicated. It was in confidence.
[Interjections.] In the main, the Bill proposes lexical and grammatical
changes. In clause 1, the definition of air gun'' is changed by defining
it in terms of both calibre and muzzle energy. The spelling of the word
calibre’’ is also corrected. There is also a consequent change to the
definiton of ``firearm’’.
The definitions of security officer'' and security service provider’’
are adjusted to be consistent with the Private Security Industry Regulation
Act, Act 56 of 2001. Clauses 2, 3, 4, 5 and 6 amend sections 4, 9, 16 and
20 of the principal Act respectively. The changes proposed in these clauses
are lexical in nature. They simply change the wording to aid in
interpretation and provide for greater clarity and definition.
Clause 7 of the Bill amends section 23 of the principal Act. I am informed that this is the clause to which an objection will be raised. Section 23 of the principal Act as it presently stands can be read to say that only one part of the firearm needs to carry a mark or an identification number, either on the barrel, the frame or the receiver.
The proposed amendment makes it clear that a firearm must be marked in two places on the barrel and the frame or on the barrel and the receiver. The proposed amendment must be read in the context of section 23 as a whole. Section 23(1) provides that a firearm licence can only be issued if it bears a mark by which it can be identified. Section 23(3) allows the registrar on good cause shown to depart from this requirement. Section 23(3) should be sufficient to deal with the concerns raised at the start of this plenary session.
Clause 8 of the Bill amends section 59 of the Act and allows both gunsmiths and their apprentices to perform certain works on firearms.
Clauses 9, 10, 11 and 12 amend sections 80, 98, 104 and 105 of the principal Act respectively. The changes are merely improvements in the wording to simplify and aid interpretation.
Clause 13(a) makes grammatical changes to aid in the interpretation of this section. Clause 13(b) proposes an amendment that makes it plain that it is the definition section of the principal Act that is being referred to. The amendments in clause 14 delete an unnecessary repetition and correct a spelling mistake.
The amendments in clauses 15 and 16 amend certain typographical errors that are necessary for the proper implementation of the principal Act. The amendments in clause 17 will allow the Minister to make regulations in relation to gun-free zones specifically relating to the demarcation and signposting of firearm-free zones to inform the public of the status of such premises as a firearm-free zone.
Clause 19 proposes changes to the transitional provisions to provide for a better description of a certificate to carry out the trade of a gunsmith under the previous Act. This clause allows for such certificate to be valid for a year from the commencement of the principal Act.
The amendments proposed in clause 22 delete certain errors in crossreferencing in Schedule 4 with the relevant sections in the principal Act. The Bill was unanimously accepted in the select committee. I commend it to the House for adoption.[Applause.]
Debate concluded.
The DEPUTY CHAIRPERSON OF COMMITTEES: That concludes the debate. I shall now put the question. The question is that the Bill be agreed to in accordance with Rule 63. I shall first allow political parties the opportunity to make their declarations of vote if they so wish.
Declaration of Vote:
Mr K D S DURR: Chairperson, the ACDP has made no secret of the fact that we are against the constant focus of the authorities on firearms that are lawfully owned, stored and used. It is like the traffic police harassing only law-abiding motorists and not focusing on dangerous drivers of stolen vehicles.
We consider the proposed amendment to have the identification number of the firearm retrospectively stamped on two parts of a weapon, namely on the barrel and/or the frame will be a massive fruitless, costly and unnecessary exercise simply inflicting damage upon the available firearms.
It is time the authorities began to turn their attention to the criminal owners of unlawful weapons, instead of expending the energy of law-abiding gunowners that are simply attempting to protect their lives and property because of the failure of the state to do so. The ACDP will vote against this legislation. [Interjections.]
The DEPUTY CHAIRPERSON OF COMMITTEES: We shall now proceed to the voting.
Those in favour say aye''; those against,no’’. I think the ``ayes’’
have it. The majority of members have voted in favour and I therefore
declare the Bill agreed to in terms of section 75 of the
Constitution.[Applause.]
Debate concluded. The Council adjourned at 16:40. ____
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
MONDAY, 17 NOVEMBER 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- Classification of Bills by Joint Tagging Mechanism:
(1) The Joint Tagging Mechanism (JTM) on 13 November 2003 in terms
of Joint Rule 160(4), classified the following Bill as a section
76 Bill:
(i) Older Persons Bill [B 68 - 2003] (National Assembly - sec
76)
-
Introduction of Bills: (1) The Minister of Health:
(i) Choice on Termination of Pregnancy Amendment Bill [B 72 - 2003] (National Assembly - sec 76) [Explanatory summary of Bill and prior notice of its introduction published in Government Gazette No 25725 of 13 November 2003.]
Introduction and referral to the Portfolio Committee on Health of the National Assembly, as well as referral to the Joint Tagging Mechanism (JTM) for classification in terms of Joint Rule 160, on 18 November 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.
-
Translations of Bills submitted:
(1) The Minister for Safety and Security:
(i) Wysigingswetsontwerp op Beheer van Vuurwapens [W 28 -
2003] (National Assembly - sec 75)
This is the official translation into Afrikaans of the Firearms
Control Amendment Bill [B 28 - 2003] (National Assembly - sec 75).
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Arts, Culture, Science and Technology:
Report and Financial Statements of the National English Literary Museum
for 2002-2003, including the Report of the Auditor-General on the
Financial Statements for 2002-2003.
COMMITTEE REPORTS:
National Assembly and National Council of Provinces:
- The Speaker of the National Assembly and the Chairperson of the National Council of Provinces as co-chairpersons present the Report of the Joint Rules Committee, dated 17 November 2003, on the Implementation of the Recommendations of the Joint Subcommittee on Oversight and Accountability, as follows:
National Council of Provinces:
-
Report of the Select Committee on Land and Environmental Affairs on the Montreal and Beijing Amendments to the Montreal Protocol, dated 17 November 2003:
The Select Committee on Land and Environmental Affairs, having considered the request for approval by Parliament of the Montreal and Beijing Amendments to the Montreal Protocol on Substances that Deplete the Ozone Layer, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Amendments.
Report to be considered.
TUESDAY, 18 NOVEMBER 2003
ANNOUNCEMENTS:
National Assembly and National Council of Provinces:
- Bills passed by Houses - to be submitted to President for assent:
(1) Bill passed by National Assembly on 18 November 2003:
(i) Armaments Corporation of South Africa, Limited Bill [B 18D
- 2003] (National Assembly - sec 75)
(2) Bill passed by National Council of Provinces on 18 November
2003:
(i) Firearms Control Amendment Bill [B 28B - 2003] (National
Assembly - sec 75)
- Introduction of Bills:
(1) The Minister of Finance:
(i) Revenue Laws Amendment Bill [B 71 - 2003] (National
Assembly - sec 77)
Introduction and referral to the Portfolio Committee on Finance of
the National Assembly, as well as referral to the Joint Tagging
Mechanism (JTM) for classification in terms of Joint Rule 160, on
18 November 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.
- Bills referred to Mediation Committee:
(1) Bill, as amended by National Council of Provinces, and rejected
by National Assembly on 13 November 2003, referred to Mediation
Committee in terms of Joint Rule 186(1)(b):
(i) Liquor Bill [B 23D - 2003] (National Assembly - sec 76) -
(Mediation Committee)
- Translations of Bills submitted:
(1) The Minister of Communications:
(i) Wysigingswetsontwerp op Telekommunikasie [W 65 - 2003]
(National Assembly - sec 75)
This is the official translation into Afrikaans of the
Telecommunications Amendment Bill [B 65 - 2003] (National Assembly
- sec 75).
National Council of Provinces:
- The Chairperson:
The following members have been appointed to serve on the Mediation
Committee, namely:
Ackermann, Mr C WesternCape New NP
Bhengu, Mr M J KwaZulu-Natal IFP
Mahlangu, Ms Q D Gauteng ANC
Mokoena, Kgoshi M I Limpopo ANC
Setona, Mr T S Free State ANC
Sulliman, Mr M A Northern Cape ANC
Surty, Mr M E North West ANC
Tolo, Mr B J Eastern Cape ANC
Windvoël, Mr V V Z Mpumalanga ANC
TABLINGS:
National Assembly and National Council of Provinces:
Papers:
- The Minister of Arts, Culture, Science and Technology:
(a) Report and Financial Statements of the South African Language
Board (PANSALB) for 2002-2003, including the Report of the Auditor-
General on the Financial Statements for 2002-2003 [RP 166-2002].
(b) Report and Financial Statements of the South African Heritage
Resources Agency (SAHRA) for 2002-2003, including the Report of
the Auditor-General on the Financial Statements for 2002-2003 [RP
104-2003].
COMMITTEE REPORTS:
National Assembly and National Council of Provinces:
PLEASE INSERT - ATCs PAGE 1417 TO 1429
National Council of Provinces:
-
Report of the Select Committee on Finance 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 Evasion in respect of taxes on income, dated 18 November 2003:
The Select Committee on Finance, having considered the request for approval by Parliament of 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 Evasion in respect of taxes on income, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Agreement.
Report to be considered.
-
Report of the Select Committee on Finance 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 Evasion in respect of taxes on income, dated 18 November 2003:
The Select Committee on Finance, having considered the request for approval by Parliament of 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 Evasion in respect of taxes on income, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Agreement.
Report to be considered.
-
Report of the Select Committee on Finance 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 Evasion in respect of taxes on income, dated 18 November 2003:
The Select Committee on Finance, having considered the request for approval by Parliament of 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 Evasion in respect of taxes on income, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Agreement.
Report to be considered.
-
Report of the Select Committee on Finance 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 Evasion in respect of taxes on income and on capital (property), dated 18 November 2003:
The Select Committee on Finance, having considered the request for approval by Parliament of 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 Evasion in respect of taxes on income and on capital (property), referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Agreement.
Report to be considered.
-
Report of the Select Committee on Finance on the Accession to the Protocol of Amendment to the International Convention on the Simplification and Harmonization of Customs Procedures, dated 18 November 2003:
The Select Committee on Finance, having considered the request for approval by Parliament of the Accession to the Protocol of Amendment to the International Convention on the Simplification and Harmonization of Customs Procedures, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Accession.
Report to be considered.
- Report of the Select Committee on Finance on the Accession to the Convention on Temporary Admission: Istanbul Convention, dated 18 November 2003: The Select Committee on Finance, having considered the request for approval by Parliament of the Accession to the Convention on Temporary Admission: Istanbul Convention, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Accession.
Report to be considered.
-
Report of the Select Committee on Finance on the Convention between the Government of the Republic of South Africa and the Government of the Federative Republic of Brazil for the Avoidance of Double Taxation and the Prevention of Fiscal Evasion in respect of Taxes on Income, dated 18 November 2003:
The Select Committee on Finance, having considered the request for approval by Parliament of the Convention between the Government of the Republic of South Africa and the Government of the Federative Republic of Brazil for the Avoidance of Double Taxation and the Prevention of Fiscal Evasion in respect of Taxes on Income, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Convention.
Report to be considered.
-
Report of the Select Committee on Finance on the Pensions Second (Supplementary) Bill [B 59 - 2003] (National Assembly - sec 77), dated 18 November 2003:
The Select Committee on Finance, having considered the subject of the Pensions Second (Supplementary) Bill [B 59 - 2003] (National Assembly - sec 77), referred to it, reports that it has rejected the Bill.