National Council of Provinces - 01 June 2005
WEDNESDAY, 01 JUNE 2005 __
PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
____
The Council met at 14:01.
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.
INCIDENCES OF VIOLENCE AGAINST WOMEN AND CHILDREN
(Draft Resolution)
The CHIEF WHIP OF THE COUNCIL: Thank you, Chairperson. I would like to move without notice:
That the Council–
(1) notes the increasing incidences in recent times of violence
perpetrated by men against women and children;
(2) expresses its shock and utmost disdain for these heinous anti-
social and soul-destroying acts against our women and children;
(3) further expresses extreme concern over this trend that leads to
unnecessary loss of life, especially of young innocent children,
due to uncontrolled adult anger;
(4) calls on all South Africans to build on the foundation of
negotiating through problems, mutual understanding,
collaboration, collective responsibility, and the ethos of a
united nation on which this new democracy has been founded in the
early 1990s; and
(5) further urges concerned stakeholders in civil society (churches,
NGOs, social workers, etc), government and the private sector to
increase its collective attention on this problem and focus on
isolating the possible causes with an aim to finding sustainable
solutions that would eradicate this trend from our young
democratic society.
Motion agreed to in accordance with section 65 of the Constitution.
CONGRATULATIONS TO CHIEF JUSTICE AND DEPUTY CHIEF JUSTICE
(Draft Resolution) Kgoshi L M MOKOENA: Thank you, Chairperson. I move without notice that:
That the Council–
(1) congratulates Judge Pias Langa and Judge Dikgang Moseneke on being appointed as Chief Justice and Deputy Chief Justice respectively;
(2) notes that these two legal gurus have assumed office from today, 1 June 2005, and is thankful to the President for these relevant appointments of high calibre;
(3) assures the two respectable Judges of its undivided support at
all times and wishes them all the best in their new positions; and
(4) calls upon all relevant structures to give them the necessary
support in their endeavours to transform the judiciary and to serve
the people of South Africa.
Motion agreed to in accordance with section 65 of the Constitution.
CHILD LABOUR
(Subject for Discussion) The CHAIRPERSON OF THE NCOP: Before I call upon the Minister, I would like to acknowledge the children in the gallery who are here today, and who have come to listen to the debate. I have had an opportunity to interact with them this morning. You are welcome in the NCOP Chamber.
As I told you this morning, we take things seriously in the portfolio dealing with children and people with disabilities located in the Office of the Presidency and indeed the Minister in the Office of the President is going to address this debate today and you will be listening to him and other members of the Council debating.
Hon Minister, there is a small podium here to make you feel comfortable. [Applause.]
The MINISTER IN THE PRESIDENCY: Chairperson, hon members of the NCOP, let me join you, once more, in greeting the children. I also had the pleasure to meet them this morning. All I can say is that they ask much more difficult questions than MPs. [Laughter.]
For those of you who are going to participate in the debate, if you are not up to scratch for the children, I am going to have to say so - and if they think I am not up to scratch they are going to have to say so.
Hon members, thank you very much for the opportunity to participate in this debate on the International Day of the Child. As you are aware, in South Africa we celebrate National Children’s Day on the first Saturday in November every year. It is also time for us more publicly to demonstrate our solidarity with the rest of the international community by mobilising, advocating and promoting the celebration of International Children’s Day.
Children are not the private property of their parents. They have the right to expect support, care and love from their parents, but they also have the right to expect other sources of support and care from their government and society. It is often said that a government must be judged by the extent to which it cares for the wellbeing of its most marginalised and vulnerable in society. And in our case that really and truly refers to all our children, but particularly those of our children who live under conditions of poverty.
The late Oliver Tambo, former President of the ANC, once wrote, and I quote:
The children of any nation are its future. A country, a movement, a
person that does not value its youth and children does not deserve its
future.
To be truly deserving of our future we have sought to ensure that in our Constitution children have rights, and the state has obligations to protect and meet those rights.
In particular section 28 notes, that:
Every child has the right to basic nutrition, shelter, basic health care services and social services.
For us children’s rights are an integral part of human rights. By spelling out the rights of children in our Constitution we have moved decisively in the direction of the vision for the future of our children so eloquently expressed by the late Comrade Oliver Tambo who, speaking in 1987 at a conference in Harare on “Children, Repression and the Law in Apartheid South Africa”, said:
We cannot be true liberators unless the liberation we will achieve guarantees all children the rights to life, health, happiness and free development, respecting the individuality, inclinations and capabilities of each child.
The wellbeing and the rights of the South African child remain significant challenges in our second decade of democracy. Too large a group of our children in South Africa still live under dire conditions of poverty, without access to basic social services. We have a constitutional obligation to make sure that we improve the living conditions of our children, to enable them to develop their talents and capacities to their full potential.
We recognise that there are many interrelated factors that combine in complicated ways to produce children in good health who are confident, content, competent, resilient and socially responsible and ready to take their rightful place as valued and contributing members of our society. We also recognise that child poverty does not exist in isolation. Child poverty is a reflection of family poverty and poverty and underdevelopment in society at large.
Poverty and underdevelopment deplete the talents and capacities of our children; it robs our children of their rights and their futures. Children must be protected, nurtured and assisted to become beneficiaries of and contributors to the creation of a truly non-racial and non-sexist South Africa – thus our consistent and determined focus on addressing poverty and underdevelopment in society.
We are working to provide early intervention and early-childhood education and care services designed to support parents by helping to reduce social exclusion linked to poverty, unemployment, marginal employment, disempowerment and social isolation. Dependable care for children is essential if mothers are to participate in the labour force. Poor accessibility to adequate child care contributes to gender exclusion from the workforce and to marginalisation of women across social classes. Without early intervention and early childhood education and care services, parents living in poverty do not have access to opportunities for education, training or paid work.
Investing in the education of our children is key to providing the intellectual and social stimulation that form the foundation of the future success of our children. Improving access to education also improves the life quality for our children in the here-and-now. Our government is going beyond basic health and safety requirements, to supporting children’s development and learning.
Our programme of action has to be multifaceted and targeted at children, as well as adults and families. Undoubtedly, protection and social security remain important foci because a significant number of our children come from families living in poverty, and for whom social security provisions remain the only means of income. Thus by default, and through no fault of their own, these children inhabit the second economy with all of its devastating impacts.
Breaking the vicious cycles of poverty and underdevelopment and closing the socio-economic distances and gaps between the first and second economies are essential pre- and co-requisites to improving the wellbeing of the children of our nation to ensure that we meet our obligations to the children of our country in general and specifically to girl-children and other children facing multiple disadvantages.
We have committed to the extension of the child support grant within two years with an additional 3,2 million children becoming eligible as the upper-age limit reaches 14. In the next three years we will spend R14,2 billion to help our people to gain access to basic shelter.
We are working to halve poverty in our country by 2014. We are investing in the National School Nutrition Programme, including social mobilisation for food gardens. We are developing a plan for implementation with community participation in 21 nodes. And, we are committed to ensuring that there is no learner or student learning under a tree, in a mud-built school or under any dangerous conditions. We are intensifying efforts to deal with logjams.
By meeting these targets we will have made progress and created better living conditions for our children. But this is not sufficient. We need a robust, rigorous monitoring and evaluation framework to track the advances of the wellbeing of our children. Our challenge in the year to come is to build on the capacity of local government to deliver programmes and services to children in need.
In the past decade, South Africa has been able to respond appropriately to international instruments that deal with children’s issues. The Office on the Rights of the Child in the Presidency was established with a mandate to ensure that our government structures advance the interests of children in South Africa. It also monitors the implementation of the UN Convention on the Rights of the Child, which we ratified in 1995. We are currently completing our second country report to the UN committee.
Let us recall the wise saying “It takes a village to raise a child”. So when our children go to bed hungry and are not well fed; when they are begging and not in school; when they repeatedly sleep on the streets and not at home; when they are malnourished and not healthy; when they are abused and are not safe, we are all culpable and we are all responsible. As communities we have to ask: “What are we doing to support our children?”
As government we put considerable resources into education, health care and other programmes that directly benefit children. We can, and do, pass legislation to realise the rights of the child and we implement policies to protect our children against all forms of abuse and exploitation. The Office on the Rights of the Child continues to play a role in ensuring that issues on the rights of the child remain on the agendas of the legislatures, executives and the judiciary.
But if we say that it takes a village to raise a child then we must build lasting and meaningful partnerships with organisations in civil society that work with and on behalf of children. We must mobilise more community resources for early-childhood education, care and activities through the Expanded Public Works Programme. We must pull together to convert the mandate of this government into meaningful and measurable programmes for our children.
Indeed, let us all work together and continue to develop a human-centred approach to our policies, programmes and our work which put children first. Protecting and advancing the rights of children to develop and thrive in safe, secure and healthy environments must be a top priority for all of us. Let us be mindful of the words of Charles Dickens, who wrote in Great Expectations:
In their little worlds in which children have their existence, there is nothing so finely perceived and so finely felt as injustice.
We have a collective responsibility to future generations to strengthen our measures, to protect and look after our children; and in so doing to prepare them to contribute to the building of a non-racial, non-sexist, people-centred South Africa. I thank you for your attention. [Applause.]
Mr D D GAMEDE: Chairperson, hon Ministers present, hon Minister in the Presidency, MECs from the provinces, colleagues and comrades, in the early fifties one of the architects of apartheid, one oppressor, one criminal, Hendrik Verwoerd, said, and I quote:
Let us create a system of education that will make a black person and a black child more inferior than he is, for we only need him for his labour.
One of the greatest leaders in Africa, and in the world, a freedom fighter, a liberator and a president, the President of the Republic of South Africa, the hon Thabo Mbeki, in his state of the nation address on 6 February 2004, said:
We commit ourselves to successfully addressing the important challenges of, amongst others, the disempowerment of our children and the proper care for our children.
Those are two people speaking from South Africa in different contexts. No one can get away from the fact that the huge inequalities that persist in South Africa between the rich and the poor originated in the system of apartheid. Because of that system, South Africa is still plagued by a high level of poverty amongst the majority of its people.
Poverty has a particularly harsh effect on the lives of our children. Poverty causes our children to be less cared for. They are not well protected and their development and education is not what it should be. Many poor children are forced onto the streets to live and work for their survival. Here they become vulnerable to abuse and exploitation.
These children often stop going to school and as a result give up their hope for a better future and so continue their vicious circle of poverty. Many of them are used by adults to do the worst kinds of jobs. This happens when they are supposed to be at school where they are safe, cared for and being educated, and developed to play an important role in this ever- developing democracy of ours.
In addition to this, we cannot ignore the fact that the number of children involved in child labour and the number of children living on the streets is increasing dramatically. One can say it is due to the death of parents or caregivers or as a result of HIV and Aids. As the ANC we are not ignoring these problems, in spite of the lies spread about this ANC-led government from irresponsible quarters. Some of these irresponsible people are in this House. [Laughter.] We are recognising these problems and we have programmes in place that deal with them.
No matter how many times one repeats a lie, it shall never become the truth. You keep on repeating a lie, a lie, a lie and it shall remain a lie. At one stage the lives of the children were ruled by the helicopter and the Hippos, and at once stage a certain lance corporal Leon was moving around in the country, pointing to places where black people and black children were to be placed. [Interjections.] At one point, children . . . [Interjections.]
Mr O M THETJENG: Chairperson, I am rising on a point of order: I request the member not to mislead the House with the statement he is making about one of the leaders of the political parties. The statement was made in the House, and I request that the member withdraws that.
The CHAIRPERSON OF THE NCOP: Order! It is very difficult in a debate for the presiding officer to differentiate the points put by the members. I am not too sure whether the member is misleading the House. I do not have the background of everything. Hon member, are you prepared to withdraw that statement?
Mr D D GAMEDE: Hon Chairperson, I referred to a certain lance corporal Leon. I am not sure whether . . . [Interjections.]
The CHAIRPERSON OF THE NCOP: You are not prepared to withdraw. Are you prepared to withdraw that statement?
Mr D D GAMEDE: If ordered by the Chair, I will withdraw.
The CHAIRPERSON OF THE NCOP: Okay, just withdraw and let us continue with the debate.
Mr D D GAMEDE: I withdraw, Sir.
The CHAIRPERSON OF THE NCOP: Continue.
Mr E M SOGONI: On a point of order, Chairperson: The member said that the member is misleading this House. I just want you to rule if it is parliamentary to say the member is misleading the House, because it is tantamount to saying that the member is lying.
The CHAIRPERSON OF THE NCOP: No, that is not correct. Many members have also said that in the House. All I am saying is that I am not too sure whether that statement is misleading. That is why I have put a question to the member. He is not out of order on that point. Continue, hon member.
Mr D D GAMEDE: Hon chairperson, our children are our future no matter how poor they are, where they live and what conditions they live in. This government will do its utmost to ensure that they are not taken advantage of.
Child labour in South Africa is regulated by the Conditions of Employment Act, Act 55 of 1998. It is illegal to let children work even if that child needs to sustain him- or herself simply because the parents are ill or unemployed. The state will come down hard on individuals who take advantage of such vulnerable children.
Much progress has been made since 1994. The ANC-led government has formulated policies and programmes for children through the Departments of Justice, Social Development, Health, Education, and Sport and Recreation, and many other departments.
The judiciary has been challenged to rule on issues affecting children, such as the Grootboom case. I need to mention that this morning some of the questions that we got from the children were where one child said he is 16 years old and does not have a birth certificate, and another is about to be 18 years old and does not have the correct surname in the identity book. These are the problems that the children face.
An important function of government is the establishment of the necessary legal framework within which civil society organisations can function to protect children.
It is important to reflect on especially the difficulty of children and youth who become involved in criminal activities due to poverty and their vulnerability. The ANC-led government recognises that their imprisonment is problematic. In this regard, we were encouraged by the Minister of Correctional Services yesterday that priority is given to children, youth, females and the disabled and the aged in the categories considered for special remission.
The education of children especially living in the streets is a further problem. While several NGOs and community-based organisations attempt to provide some education for them this remains a problem that needs serious action. Without a consistent effort to ensure their development and nurturing these children remain vulnerable to being abused in various forms of child labour.
I wish all the boys and girls, most of them in the gallery, a bright future and to all the caregivers and the hard workers in the NGOs and CBOs, I wish to strengthen you by saying that you have the support of the government since you are also supporting the government. It is a difficult task that needs more hands. We know that it takes a whole village to care for a child.
When the Congress of the People said South Africa belongs to all it meant that it belongs to children also. When the Congress of the People said the doors of learning shall be opened, it also meant that they would be open to children and children with disabilities. [Applause.]
Kgoshi M L MOKOENA: Chairperson, I don’t want to take hon members’ time. But I’m rising on point of order. The hon member said hon Gamede was in the House when he had said there was a certain corporal Leon who was flying around, pointing to where there were children. But we don’t know who this corporal Leon is because there are so many Leons in this country.
The CHAIRPERSON OF THE NCOP: Hon member, let’s not open a debate on that. I’ve made a ruling on that issue. I now call upon the hon Chen.
Ms S S CHEN: Hon Chairperson, hon Minister and hon members, our distinguished guests, ladies and gentlemen, child labour and important issues such as this should not be reserved only for the International Children’s Day. It should be our concern every day; we should pay attention to the issue of child labour in our country at all times.
What is child labour? According to the International Labour Organisation, child labour is work that deprives any person under the age of 18 years of his or her childhood and dignity, hinders the child’s access to educational attainment, and is performed under conditions that are hazardous to the child’s health and development. I’m certain that we all believe that children should be free to learn and play in an environment in which threat and exploitation are minimal, in order to develop their full potential. Our legislation reflects this plea and protects South African children well against child labour. However, there are still challenges ahead that we need to address. In the year 2003, research commissioned by the Department of Labour found that 36% of the South African children are involved in child labour as defined by the International Labour Organisation.
Poverty plays a crucial role in driving children into exploitative labour, and poverty is certainly not a foreign concept in South Africa. Huge inequalities presently continue in South Africa between the rich and poor, which was created by the system of apartheid before. Poverty in particular impedes the care, protection and development of children. Many poor children are forced onto the streets to live and work for their survival.
Child labour, therefore, results from a multitude of factors such as economic, political and social reasons. In some families children may be expected to pull their weight either in preparation of their future as a provider or to contribute to their household’s income. Unfortunately, I’m a typical example of such a situation, and had begun my career at the age of 13 to support my family. The issue of child labour therefore is very close to my heart.
To eradicate child labour, the following recommendations have been suggested: public education of children and the community of the right of children to be protected from child labour, and the dangers that some working conditions cause to them; government developing and implementing locally sensitive and rigorous legislation, which must be enforced and monitored; the appointment of child labour inspectors expected to monitor working conditions of employee children, those between 15 and 18 years of age, while ensuring that children younger than 15 years are not employed; provision of good quality primary and secondary education which teach children practical skills, as well as their rights; provision of economic alternatives through the sustainable poverty alleviation strategy, to families that are dependent on child income for economic survival; and finally, funds and resources must be made available to research and monitor the extent of the problem of child labour.
Our children are our future and to ensure a bright future for our beautiful country, we must treat our children with love and care, protecting them against all harm. Child labour exploits our children and threatens their future. This must be stopped. Thank you. [Applause.]
Ms A N T MCHUNU: Hon Chairman, hon members, hon Ministers and other Ministers who are here, the discussion on child labour has come at the right time to ring bells about what is happening around us. Children have a cause that is equal to their developmental status in society. These are done under the guidance of parents, extended family members or siblings. Where a child has no identified parental protection through the death of parents or sheer rejection by parents, children experience problems and are exposed to the harsh, cold and cruel world. Wars in Europe caused parental deaths and children ended up in streets and were eventually employed in factories to earn a living. Feeding and proper care of these children were nobody’s concern except that they were tools of production. This hard labour produced hard-hearted characters who had no mercy for anyone except for the grace of God.
In our country today, we have homeless children who litter the streets. Some children come from cold households that are not homes but just a house or a shelter for them to hide their heads. They have never known any bonding or human warmth in life. They have never known love and the hug, but are being given any amount of money they ask for to spend any way they like.
Those children have living parents but they are dead in their parenting skills. To these children money becomes the thing in their lives, and so they leave school to get paying jobs to buy what they like and what is in style.
HIV/Aids is also a contributing factor with regard to child labour. Children experience difficulties after their parents die of Aids and are left with no choice but to go and seek employment, especially for those kids who have younger siblings to take care of. Then adults take advantage of their situation and abuse them, making them to do all their dirty work for them.
Others end up in prostitution and abuse drugs since they cannot stand the situation they are faced with. And in times of conflict, when communities become unstable, it is children who leave school and their families, who are employed by bosses who use them in conflict as child labour to run battles or gun down opponents. These children are destroyed in their formative stages as they can never repair their personas after being used as killing machines.
Child labour of any form hardens and destroys the growing person in a child. The destruction of that persona in childhood results in an adult who never matures and is never satisfied with anything in life. Poverty of love in the midst of plenty of material goods results in children leaving households to do jobs outside.
Families have to be assisted to be nurses of love and be caring so that children become real children in a family setting, doing what is expected of children till they finish school and get into the adult world as adult job seekers. Families should therefore be able to feed their children, clothe them and provide a warm, loving home.
Communities have to provide support to children who have lost parents or who appear neglected. Extended families or childcare centres have to be kept to help with nutritious feeding of children and general physical, mental, emotional and spiritual care. The government is endeavouring to satisfy the needs of children, but this has to be done with the close collaboration of parents, extended family members or guardians. It is the duty of all of us to assist children individually or as organisations.
We love our children. Children belong to us. No one should injure our children or abuse them. The world belongs to our loved ones. And I thank you for listening to us, and to our children, who have already gone, but children are ours and they belong to our world. Thank you very much. [Applause.]
Mr K SINCLAIR: Chairperson, there is an African proverb that says: “There is no wealth where there are no children.” When we debate the issue of children and their rights today, we engage one another about tomorrow, the future and hope. Because of the past of oppression, huge inequalities presently persist in South Africa between the rich and the poor. Poverty is the greatest cause for atrocities against children.
Many poor children are forced into the streets. Here they become vulnerable to abuse and exploitation. These children often stop going to school and as a result give up hope for a better future, and so they continue the vicious cycle of poverty.
The number of children involved in child labour and the number of children living on the street is increasing dramatically due to the death of parents or caregivers as a result of HIV and Aids. A study which was called the “Survey of Activities of Young People” estimated that about 3,4 million children are working in economic activities ranging from subsistence farming and trade to manufacturing.
What is, however, of great concern is the number of children engaged in exploitive child labour. According to the above-mentioned study, close to 250 000 children were engaged in child labour. I agree with the Network Against Child Labour that this is a gross underestimation. It must be more.
The point is, however, that as a caring government it is of utmost importance that we must realise and acknowledge the problem, and also address it.
The Children’s Bill is certainly a huge step in the right direction, but I want to plead for a more practical approach. Firstly, local government must play a greater role regarding child labourers and other children under especially difficult circumstances. Why, hon Minister, can’t local governments assist in ensuring that shelters and places of safety are established in communities?
Secondly, schools, teachers, principals and governing bodies are obliged to identify children who are absent from school regularly. These children are usually the victims of exploitation.
Thirdly, hon Minister, and for today’s debate, the most important issue, there are about 15 million children out of a population of 43 million in South Africa. Given that the number is close to a third of our total population, hasn’t the time arrived that government consider a children’s Ministry? If we look around in the streets, in the townships, in the rural areas, I really believe that it is necessary.
An intersectoral approach between government, NGOs and CBOs, culminating in an overarching policy-driven department, might be the answer. Maybe the words of Kahlil Gibran, when he wrote about children in The Prophet, will come true. He said:
You may give them your love but not your thoughts, For they have their own thoughts. You may house their bodies but not their souls, For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams. You may strive to be like them, but seek not to make them like you. For life goes not backward nor tarries with yesterday.
I thank you. [Applause.]
Ms F NYANDA: Hon Chairperson, hon Ministers, delegated guests, members of the House, I am speaking today about the problem of child labour. But I also want to speak about the effects of HIV/Aids, poverty, and sexual exploitation, and how it leads to our children becoming involved in child labour and sometimes crime.
Right at the beginning, I want to say that whilst those problems are there, our government has placed admirable safety networks in place to protect our children.
Imiphumela lemibi lebangelwa sendvulela ngculaza kanye nengcula kubantfwana, itidzinga tonkhe tinhlangano letinakekela bantfwana ekuhlukumetekeni kwalomashayabhuce kwekutsi titfole tindlela letinsha naletincono ekumelaneni nalobubi kanye nebukhulu bemonakalo lodalekile ngalenkinga.
Umphumela kutemnotfo kanye nasemangweni loletfwa sandvulela ngculaza kanye nengculaza, kuba liphango, kuhamb’uhlala ubete likenu, ungalitfoli nelitfuba lekufundza ngalokukwenelisako, nekungatfoli temphilo. Ngekuhlukumeteka kwengcondvo ngalomashayabhuce kudaleka kwesaba, kutivela unelicala, kanye nekucindzeteleka emoyeni, loku lesitsi yidipreshini, kanye nekukhubateka kwengcondvo kokuphela.
Imiphumela yanawuhlanganisa konkhe loku lesengikushito ngenhla, ngiyo lebangela kutsi bantfwana batsatseleke kalula etintfweni, njengaso lesandvulela ngculaza kanye nencgulaza, kungafundzi, kusetjentiswa kwebantfwana, nalokunye kuhlukunyetwa kwebantfwana.
Indzawo yekucala yekuvikeleka kwebantfwana icala emakhaya, emindenini kanye nasetihlotjeni. Kuyaye kutsi nase kudlanga bulukhuni kubantfwana immango ikwati kungena iphutfume ifake sandla. [Kuhlaba lulwimi.] (Translation of Siswati paragraphs follows.)
[The negative results of HIV/Aids on children need all organisations that care for children affected by this pandemic to find new and better ways to deal with the bad aspects of and the great damage caused by this problem.
The economic and social effects of HIV/Aids are hunger, having to move from place to place, not having a home, or a family, not getting a chance to be adequately educated and not getting health care. The psychological disturbances caused by this pandemic include fear, guilt, and emotional stress, which we call depression, and permanent psychological damage.
The results of the combination of all these things that I have mentioned above lead to children being vulnerable to things like HIV/Aids, illiteracy, child labour, and other forms of child abuse.
The first place where children must be protected is at home, by families and relatives. It happens that when difficulties amongst children become worse, the communities are able to come in quickly and assist. [Interjections.]] The CHAIRPERSON OF THE NCOP: Order! Hon member, I am just informed that there is a problem with the interpretation. Could one of the staff members please deal with that? Continue, hon member.
Mk F NYANDA: Letinsita letingakahleleki ngito leticala kucala kusita labo bantfwana labahlukumetekile, tibe kantsi futsi ngito letisita linyenti lalabantfwana. Kusitwa nguhulumende kanye netinhlangano letitsite temango, nako kuyasita kutsi kwengete lapho ingasefikeli khona imimango ekusiteni bantfwana labahlukumetekile.
Hulumende loholwa yinhlangano yeaKhongolose, I-ANC, uyentile imizamo lemikhulu yekusita bantfwana labasetjentiswa ngalokungekho emtsetfweni. (Translation of Siswati paragraphs follows.)
[These unorganised services are the ones that start helping those children who are abused, and they are also the ones that help the majority of these children. Being assisted by the government and some community organisations also helps to add where the community efforts have not yet reached in helping children that have been abused.
The ANC-led government and the ANC have made a great effort in helping children who are abused so illegally.]
The economic and social effects of HIV and Aids infection in children include malnutrition, migration, homelessness and reduced access to education and health care. Psychological effects include depression, guilt and fear, possibly leading to long-term mental health problems. The combination of those effects on children increases their vulnerability to a range of consequences, including HIV, illiteracy, poverty, child labour, and other types of exploitation, and the prospect of unemployment when they are grown up.
The first line of support for vulnerable children is their family, including extended families and distant relatives, while households that struggle to meet the needs of vulnerable children may be assisted by members of their community.
These informal safety net mechanisms are responsible for the care and support of the majority of vulnerable children in South Africa. Formal mechanisms, such as those provided by government and civil society, also provide services, especially for children living in situations of extreme vulnerability.
The ANC-led government provides particularly strong support to children who are vulnerable to child labour due to their impoverished and unhealthy conditions. We must recognise that because the scale of the challenges is so huge, it is necessary for an integrated manner to be followed in our method of struggling against its effects on our children.
Mr Gamede referred to this integration between different levels of government and with the NGOs and CBOs.
I want to raise the issue of especially a girl-child, who is particularly vulnerable. Our government was amongst the 122 governments that ratified the Declaration and Agenda for Action of the First World Congress Against Commercial and Sexual Exploitation of Children, held in August 1996.
After that congress, South Africa adopted a comprehensive action plan to combat and prevent the sexual exploitation of children in South Africa, which the government and NGOs developed jointly. We put monitoring mechanisms in place and have forwarded information to organisations such as End Child Prostitution, Child Pornography, and Child Trafficking of Children for Sexual Purposes International.
To add to the aspect of integration levels of governance and structures aimed at ensuring a safety network for vulnerable children, which Mr Gamede referred to, I want to refer to other ways in which we ensure children’s protection against child labour.
The commercial sexual exploitation of children is a form of child labour. The government of South Africa has established specialised sexual offences courts, one-stop crisis centres and shelters for victims of abuse, including sexual abuse. Service providers, including police officers, judicial officers, prosecutors, social workers and health workers were trained especially to ensure the success of our programmes. We have in place a national committee on child abuse and neglect consisting of government and NGOs. [Time expired.] [Applause.]
The MINISTER IN THE PRESIDENCY: Chairperson, if you don’t mind, to the children, I should like to say that sitting next to me is the Minister of Health, and if any of you have problems with your health, you should write to her. [Laughter.] And also sitting here are all the MECs for health, I think, from all nine provinces. [Applause.]
I am very glad that you slotted this debate in while they are here. I hope that they have taken the opportunity to listen to what we have to say about children.
First of all, let me thank all of the speakers who participated in this debate and all those speakers who spoke and paid very special attention to challenges that arise from the use and exploitation of child labour. I think it is very correct that we need to continuously fight the use and exploitation of child labour.
What I didn’t hear from all the hon members is what they are going to do about it. Mr Sinclair says it’s the responsibility of local government, but this House is supposed to be responsible for dealing with local government; monitoring, evaluating and interacting. Don’t ask me. I think you’d better ask yourselves what you are going to do, what you need to do, how you are going to do it, how you are going to go to local government, and how you are going to go to provincial government and get them to do what you think they should do.
I am really raising this because I think we ourselves should ask what we should do, not what someone else is. This Minister will go and sit in the Union Buildings in Pretoria again. So, I think it is important for this House to ask itself these questions.
In the course of our own work and this critical work around the whole issue of implementation of government policies, around the issues of monitoring and evaluation, around the question of, for example, child labour, we should determine what is being done or not being done and how we then, within the three spheres of government, ensure that government itself does what its own legislation asks it to do. I think that it is very important that we should do that and I think it is very important that we should concentrate some of our attention on the issue of child labour. So, I really cannot but agree with what has been said here.
Hon Sinclair, I like my job very much and one of the responsibilities I have is that of the Office on the Rights of the Child. If I go to the President and say he should create a Ministry for children, I might lose my job. [Laughter.] So what I suggest we do is that when my time expires, we then demand a child Ministry so that somebody else can come in. No, I am not going to take this message to the President. I really am not in the business of doing myself out of a job, and if I am out of a job, how will I get to come here and address you?
I want to take this opportunity to address the children before they leave. Mr Gamede and the chairperson of the committee from the National Assembly, Wilma, made some promises to the children when we met them this morning. It had to do with the issue that Mr Gamede had raised. For example, there is the 15-year-old who does not have a birth certificate, or the child who has the wrong name on the identity document. What our two wonderful chairpersons have undertaken on your behalf - I think they have a right to undertake it on your behalf - is to deal with all of these questions that will be raised with MPs.
The MPs themselves, when they go out and do their constituency work and go out to where they come from, should then be sensitive to some of these problems that our children are facing. If you heard them this morning, you’d know they were really very concerned that either they do not have the birth certificate because the processes are perhaps, in their view, not sufficiently in place, or if the wrong name is on the ID, it means that for the rest of their lives they are going to suffer some severe consequences because they will not have an ID, which we require for all the things we want.
So, hon Gamede, I am just following you, chief, and I am supporting you, but you have got to use your power to mobilise because I think it should be a very important part of our responsibility as members of Parliament, when we go out, to ensure that people are registered; to ensure that those who qualify for social security grants get it; to ensure that we get into the schools and where we are not giving our children, who deserve it, proper nutrition, we should take this issue up, so that when we say “putting our children first”, we mean what we say. So, in our own work as members of Parliament, all of us, myself included, let us in the course of our work put our children first.
Once more, Chairperson, as you know, I always find it a very great pleasure to come to the NCOP. I like this House very much. Thank you very much. [Applause.]
The CHAIRPERSON OF THE NCOP: Thank you, hon Minister. That is a compliment to us, and we also like you to come and address us from time to time. We really wish to thank you very much for coming to lead this debate.
Hon Deputy Minister, now you are disturbing me whilst I am talking to the Minister. He did not hear what I was saying, and now he is leaving.
Debate concluded.
APPROPRIATION BILL
(Policy debate)
Vote No 16 – Health:
The CHAIRPERSON OF THE NCOP: Just before I call upon the Minister, there is one remark, Minister, that I would like to make. I want to repeat this - I said it yesterday - and I am repeating this precisely because I want to drive the message home.
Yesterday I encouraged the MECs that were here when we were debating the Water Affairs and Forestry Budget Vote and the Transport Budget Vote, and I want to repeat it today. I have been in the Council for three years, and one thing I have noticed is that health MECs are the ones who attend when the Budget Vote is being debated in the Council. [Applause.]
I have calculated that there are six out of nine here, which is very good attendance. I know that you have busy schedules, but the point I am making is that when the national Minister delivers his or her budget speech, and MECs are here, it makes great sense to us as permanent and special delegates to get the provincial perspective as well. And, not only that, the NCOP is a national debating forum that brings together your national government, your provincial government and your local government spheres in one House for a debate. For us to understand these issues, when we play our oversight role and function, we shall have heard both perspectives.
Now I want to congratulate you, and convey the wish that you pass on the message to other MECs that they should do the same. I know you are busy in your provinces. It is only once a year that this time comes, and on behalf of the House I really want to congratulate you.
Minister, also to you, I know you wrote to me and raised the concern that we did not invite you when we went to Umhlanga, especially when you would really like to participate in NCOP matters. I have already apologised on behalf of the Council; we will not forget you next time. We will definitely invite you. I want to express appreciation for the concern you raised with me and for the way you love the NCOP in terms of participating in these issues. Thank you very much. [Applause.]
Now I call upon the Minister to address us. How you get them all here I don’t know. You must tell us.
The MINISTER OF HEALTH: Chairperson, it is because we are a winning team. [Laughter.]
Chairperson, members of the NCOP, MECs for health, ladies and gentlemen, we observed two health days this week. On Monday we held functions nationwide to promote physical exercise. The main event to launch the “Move for Health” campaign was in Alexandra township, an area designated for the Urban Renewal Programme.
We are encouraging all South Africans, including you, to engage in some form of physical activity – and you don’t have to have a lot of money to do this; you can do it in your own offices – in order to maintain optimal health and prevent various chronic diseases of lifestyle, such as diabetes and heart and cardiovascular diseases.
In fact, we are prepared to work out a programme with you so that we can engage in physical exercise. I hope you can appoint one or two people who will work with the Department of Health so that we can assist you in this regard. [Applause.]
Yesterday we marked the world No Tobacco Day in the Free State, where we encouraged South Africans to keep up the positive trend of reducing the number of people who smoke in our country. I hope amongst you there is no one that smokes.
Both physical exercise and tobacco control are critical elements of our Healthy Lifestyles programme, which also encourages good nutrition – I hope you don’t eat McDonalds and chips and stuff like that, and Nando’s. This programme also encourages the responsible use of alcohol. Mark, I am not saying don’t use alcohol at all. I am saying there must be responsible use of alcohol – and safe sexual behaviour. What that means I leave to your own imagination.
I call on all the members of this House to mobilise their constituencies around these key elements of the Healthy Lifestyles programme and to contribute towards reducing the spread of infectious diseases, high levels of non-communicable diseases and the prevalence of violence and trauma in our society.
As you know, the role of the national department and mine, as the Minister of Health, is to provide stewardship over the national health system as a whole – both the private and the public sectors. Let me remind this House again that the national health system consists of two sectors, the public and the private health care sectors.
Our stewardship role includes the responsibility of the national Department of Health to set national policy and to prepare national legislation. In this regard, we wish to announce that the President has proclaimed into law much of the National Health Act, which was passed in this House. The National Health Act, Act 61 of 2003, came into effect on 2 May 2005 with the exception of some of its clauses. This is a major victory for the national health system, which up to 2 May 2005 was governed by the Health Act of 1977.
The national department also plays a role in supporting provinces and monitoring the implementation of national policies. To this end, the national department and I have visited all the provinces through various initiatives during the 2004-05 financial year.
In the past few months, the Health Minmec visited facilities in two provinces – the Northern Cape and the Free State. In addition, I have held imbizos in Limpopo, KwaZulu-Natal, Mpumalanga and the Western Cape. In general, we found that most health workers were dedicated to their work and provided a good service, sometimes under very difficult circumstances, I must admit.
We also found that good management resulted in a motivated workforce. This was true in newly built hospitals in the Northern Cape and at facilities like the Kimberley Hospital, as well as at various clinics in the Free State. I therefore wish to take this opportunity to salute all health workers and managers around the country for the good work that they are doing.
We also found that both the communities and health workers faced a range of challenges. Communities and patients complained of long waiting times and of overcrowding in both hospitals and clinics. A lack of shelter for those who arrive early and who have to wait for service; insufficient health facilities; hospitals or clinics that are too far from homes; a shortage of ambulances; and the negative attitude of some of the health workers were some of the complaints given by the communities.
For their part, health providers in some facilities complained of an insufficient amount of personnel and heavy workloads. There were also specific cases that we attended to outside of this long-term programme in terms of visiting our facilities and interacting with communities.
We visited two mental health facilities in KwaZulu-Natal – the Townhill and Fort Napier Hospitals – in order to address reported cases of the inappropriate treatment of mental health patients. A commission of inquiry we established to investigate these issues has provided a report, and we are implementing its recommendations. This was in line with our efforts to implement the Mental Health Act, which emphasises human rights and the treatment of mental health patients with respect and dignity.
We also visited St Barnabas Hospital in the O R Tambo district of the Eastern Cape, where there was an outbreak of a parasitic brain infection caused by a tapeworm that infects pigs. Efforts were made to provide clean and safe water and to educate the community on how to avoid the infection. The immunisation campaign has also been intensified following reported cases of measles in this district. I will come back to this issue of measles later on.
I also visited the farming areas around Utrecht and spoke to farmworkers who reported many instances of abuse. They complained about a lack of access to safe water and sanitation, health services, land and housing. In one case, a farmer had dumped the carcass of a cow into the only source of drinking water for the community.
I want to assure everyone in this House that this government is committed to ensuring equity in access to basic services and will strive to meet the challenges presented by communities, like the ones that I visited in Utrecht. We will be revisiting this area later this month to address some of the challenges that they raised. We will also be visiting the farming community in Newcastle on the 11th of this month.
I now return to what will be done this year to address the priorities as contained in the strategic plan of 2004 to 2009. I will start with the National Health Act, the provisions of which we are implementing. We have established and held the first meeting of the National Health Council, which now replaces the Minmec. So please don’t call us Minmec anymore. Please call us the National Health Council. We established this in May 2005.
The Act requires that MECs for health convene provincial health councils within 90 days of the announcement of the Act. This means that this should be done by the end of July 2005. The Act also requires the MECs to establish district health councils. These structures will strengthen the governance of the health system and provide avenues to improve the quality of care.
The National Health Act requires all levels of government responsible for health delivery to develop strategic plans. We have developed templates for these plans and will require provinces and health districts to develop coherent, strategic and operational plans for the 2006-07 and 2008-09 MTEF periods that take into account national priorities as well.
The Act mandates the creation of a national health information system and the establishment of provincial health information committees by 1 July
- All these information systems must speak to one other. The role of these structures is to strengthen the collection, analysis and use of health information for the planning and monitoring of service provision.
The Department of Health has been working with stakeholders to develop a Human Resources for Health Strategic Framework, which is now ready for consultation and finalisation. Some of the interventions that are currently being made in addressing the challenges around human resources include expanding the community health worker programme, providing a rural and scarce skills allowance, and providing a well-established community service programme covering most categories of health professional.
We will be phasing in community service for nurses once the Nursing Bill has been passed by Parliament. In addition, we initiated a programme to train mid-level health workers, such as pharmacy assistants, and we envisage commencing with the training of medical assistants early next year. The mid-level health worker will enable us to staff our facilities with skilled personnel. We are going to address the problem of the fly-by-night nursing schools that exploit young people wishing to enter the nursing profession. This is a very serious matter. Most probably we will be closing some of these schools. [Applause.]
In the 2004-05 financial year we had 26 hospitals in the hospital revitalisation programme that is meant to refurbish the infrastructure, strengthen management and improve quality of care. I am pleased to announce that as part of this programme we completed four new hospitals in the last financial year. These are the Piet Retief Hospital in Mpumalanga; the Swartruggens hospitals – those from the North West know about them; the Manne Dipico Hospital in Colesberg, Northern Cape; and the Abraham Esau Hospital in Calvinia, which is also in the Northern Cape.
During this financial year we will enrol 16 hospitals in the revitalisation programme, and we hope to complete the revitalisation of four hospitals that are currently under this programme. I have difficulty pronouncing Afrikaans names, but these hospitals are the Vredenburg and George Hospitals in the Western Cape, as well as the Lebowakgomo and the Jane Furse Hospitals in Limpopo.
We are concerned about the measles cases and deaths reported in Gauteng, KwaZulu-Natal and the Eastern Cape. These cases continued despite a successful mass immunisation campaign conducted last year.
We have therefore asked for the assistance of the World Health Organisation in order to understand this problem. As soon as we obtain the final report from the team of experts that is examining this problem, we shall announce the steps that will be taken to address this matter. In the meantime it is important to continue encouraging every parent to bring each and every child to our facilities for immunisation.
It is critical that we sustain our interventions aimed at improving the health of women and children, highlighted by the theme of this year’s World Health Day, which was: Making every mother and child count. We are encouraged by the positive trends in the maternal mortality rate, which decreased from 150 per 100 000 live births in 1998 to 123 in 2002. We are hoping to see this trend continue. This while the infant mortality rate came down from 45,4 per 1 000 live births in 1994 to 42,5 in 2002. We hope we can continue along this trajectory as well.
We are strengthening the TB control programme by, amongst other things, appointing TB co-ordinators in each and every district; strengthening the laboratory system; strengthening the implementation of the directly observed treatment strategy; and mobilising communities to ensure that patients complete their treatment. We hope that the members of this House can also assist us in this regard.
The challenges posed by TB emphasise the need to address the weaknesses that still exist in our national health system and the importance of a comprehensive approach to the management of diseases in our country.
We are implementing the Comprehensive Plan for Management, Care and Treatment of HIV and Aids. Note that it is not a roll-out plan on antiretrovirals; it is indeed a comprehensive plan for the management, care and treatment of HIV and Aids in their entirety with much more vigour and we are indeed achieving results.
In line with our stated goals, we were able to establish a minimum of one service point in every district in the country before the end of the last financial year. Our endeavour in the coming years is to ensure that these services are made available in every local municipality in order to increase the accessibility and uptake of our programme.
However, it is important to emphasise in this House that the extension of services, as contained in the comprehensive plan, requires the strengthening of the national health system to ensure that we provide good quality health services, and that we are not just chasing numbers.
Government’s efforts to reduce the price of medicines through the implementation of the Medicines Control Act have paid dividends. The removal of perverse incentives and the introduction of the single exit price for medicines have resulted in a 19% reduction in the price of medicines. This translates into a saving of approximately R2,3 billion in the private sector.
However, the impact of this reduction on the overall cost of medicines for the consumer has been limited owing to the lack of co-operation at the retail pharmacy level, including the introduction of unnecessary administration fees and levies and photocopying. We hope that the Constitutional Court will rule in our favour so that consumers can fully enjoy the benefits of the reduction in the price of medicines in our country.
Now, let me turn to the budget that has been allocated to the national Department of Health. This budget increased by 11,4% from 2004-05 to 2005-
- The conditional grants which flow via the national Department of Health to provinces grew by 13,2%. The budget for HIV and Aids grew by a staggering 45%. The hospital revitalisation grant increased from R912 million to R1,027 million. Therefore it increased by 12,6%.
Early figures indicate that in total the nine provincial health departments spent 98,6% of their 2004-05 budgets. I think we need to congratulate the MECs and the heads of department on having been able to spend 98,6% of their budgets in 2004-05. [Applause.]
Further good news is that their 2004-05 expenditures grew by 7,5% from 2003-
- Budgets allocated for the provincial health departments for 2005-06 are on average 9,4% higher than the previous year.
I sincerely hope that we have demonstrated to this House that the ANC government has the capacity and a committed cadre of health workers and managers to achieve our strategic goals and targets for 2005-06. We are determined to ensure that we deliver quality services to all our citizens, even with the limited resources that we have. We will do this in collaboration with other government departments and the private sector, as well as organs of civil society in order to ensure that we attain the targets set particularly in the Millennium Development Goals, which we are party to as a member of the international community of nations.
Let me turn briefly to what we do on an international level. We have continued to play our international role, including our active participation in the World Health Organisation and the World Health Assembly that was held in Geneva last year. Thank you very much to the MECs who accompanied me to the World Health Assembly.
During this assembly we successfully mobilised member states to support our effort to ensure that the World Health Organisation implement the resolutions aimed at addressing the challenges of international recruitment and migration of health personnel. Human resources for health is expected to be the main subject for the World Health Report to be released by the WHO early next year and will be the theme for next year’s World Health Day. The focus on human resources should create an opportunity for African countries in particular to highlight the severe impact of recruitment and migration on our national health systems on the continent.
We were able to influence strongly the resolution on infant feeding and nutrition, and we are very proud to announce this today especially as it is International Children’s Day. This is because what we sought to do there was indeed to protect our children, and South Africa did play a very prominent role in the drafting of that resolution.
During the assembly I had an opportunity to meet with the ministers of health of India and Brazil, when we discussed the ways in which we could strengthen health co-operation amongst our three countries within the context of South-South co-operation. We will be meeting soon as Ibsa – that is India, Brazil and South Africa – to approve the action plan for co- operation among the three countries.
On the continent we hosted representatives from the Sudan and shared with them some of the experiences we have had in rebuilding our own health system. We are also working closely with the department of health in Nigeria in sharing the experiences of the development of our National Health Act. We will be studying their efforts and that of other countries in establishing social health insurance.
During the assembly I also had meetings with the Ministers of health of Mozambique and Senegal to discuss bilateral co-operation. We are looking forward to signing a co-operation agreement with Mozambique, focusing, amongst other things, on malaria control around the Lubombo Spatial Development Initiative and the Sasol gas pipeline. The agreement should also deal with the provision of health services to communities along the borders of Mozambique and, in particular, Limpopo, Mpumalanga and KwaZulu- Natal.
Recently, we hosted the WHO Commission on Intellectual Property Rights that deals with the major issue of balancing patent protection for investment in the development of new medicines against the dire need for access to affordable medicines.
The commission was here to brief us on the progress in this area and ascertain our position on these issues. As the members of this House are aware, this country is determined to provide access to affordable, quality medicines.
The hon members may be aware that the chairperson of the Portfolio Committee on Health, Mr James Ngculu, was admitted to hospital. On behalf of the Ministry and the Department of Health, we wish him a speedy recovery. Thank you very much, Chairperson. [Applause.] Ms J MASILO: Hon Chairperson, hon Minister, hon Deputy Minister, MECs from the provinces, colleagues, senior officials from the department: “There shall be houses, security and comfort!” The Department of Health produced a White Paper that adopted comprehensive primary health care as the lynchpin for the unified health system to ensure access to quality health care for all South Africans.
It draws its inspiration from the ANC’s health plan and the Reconstruction and Development Programme. Several key health policies and programmes have been developed and implemented. This culminated in the development in 1999 of a five-year framework for accelerated health service delivery entitled the Health Sector Strategic Framework, 1999-2004. The ten priorities identified in this document were: legislative reform; improving quality of care; revitalising public hospitals; primary health care and a district health system; strategic intervention to reduce morbidity and mortality; human resources and management; communication and internal co-operation.
Since 1994, this democratic government has set about systematically reconstructing and developing all areas of health care delivery that had previously been racist and fragmented. Once we had developed the principle of Batho Pele, it was incumbent of health care providers to not only adopt this principle in theory but to implement it in practice.
However, in reviewing the past ten years of our democracy, we have become increasingly concerned that those programmes and policies were not being embraced or practiced in the way that it was intended. Many of our people are complaining about the inadequate quality of health services that is delivered to them. These include hospitals that have insufficient medical stock, linen and food to those who have inadequate and often no infrastructure to speak of.
The 2005-06 budget takes place in a crucial period which marks the celebration of 50 years of the Freedom Charter and the start of the second decade of our new democracy, and as such we are reminded of the important role we as a committee play in the government: ensuring that our people, indeed, have a better life.
I think we can all agree that the delivery of health services is a complex matter and as such it requires all types of strategic partnerships, including co-operative governance among the three spheres of government. In addition, we need partnerships between community health centre NGOs, the community it serves and other sectors in government, all working together in tandem with our local authorities.
With regard to the strengthening of our system of local government, the Department of Health is promoting integration between provincial and local government with success in some districts in the Eastern Cape, Free State and Western Cape; has published a format for service agreements between provinces and district municipalities - all 13 rural nodes produced service delivery improvement plans for 2004-05; and has produced district health planning guidelines to strengthen the development of health plans at district level human resources.
Whilst the select committee applauds the Minister for putting into place a national health human resources plan that will give direction to the planning, development and management of human resources, we know that this is just the first step in trying to overcome the chronic staff shortages in our clinics and hospitals throughout the country.
The department’s commitment to implement scarce skills in rural allowances and the training of more community health workers is another welcome step to redressing critical staff shortages. The utilisation of 7 000 trained nurses will indeed do a great deal to strengthen the dispensing of medicines at our health centres. Each of these endeavours collectively demonstrates that the Minister is systematically trying to turn around the low staff rates.
Hopefully, the ongoing discussions and negotiations on adequate remuneration packages for the health sector in our health care centres will similarly continue to remain a priority with the Minister.
The select committee recommends that, in the case of filling of crucial vacant posts, the department should take at least three months to fill them to ensure that there is continuity and quality service delivery. The committee applauds the implementation of 30% gender balance in senior management and two per cent for people with disabilities.
The select committee has been impressed by the great strides that this department has made in increasing free access to primary health care for children under five years, pregnant women, older persons and persons with disabilities. Provinces have co-operated to ensure that sub-districts under their jurisdiction provide full primary health care packages, including standard treatment guidelines, the essential drug list and the norms and standards for clinics, as well as the standards for pharmaceutical services. According to the department, we are now at 70% of our delivery rate, which is a good place to be.
The Department of Health commenced with the accreditation of health care facilities for the implementation of the Comprehensive Plan for HIV/Aids Care, Management and Treatment. A total of 113 health facilities across the nine provinces were assessed during 2004. The programme is being implemented nationally.
The select committee has seen the Minister’s commitment to the HIV/Aids Comprehensive Care, Management and Treatment Programme, which was successfully implemented in its first year, 2003. The programme has been rolled out at 113 sites and 28 786 people were put on antiretrovirals.
The Khomanani mass communication campaign was visible and promoted on World Aids Day; a men’s march and a range of radio and television awareness campaigns, and also guidelines for nutritional supplementation for people living with HIV and Aids have been developed. Favourable indicators such as increased condom usage by households, declining rates of new infections and teenage pregnancy in the younger age groups were observed.
We will go on enumerating all the things that have been done by the department, but let it be sufficient to say that the select committee can see many signs of the concerted efforts that the Ministry has put in place to deal with the HIV/Aids pandemic. Perhaps the Minister should work on the manner in which she carries over the messages to the media, because if one is to believe the press and some opposition parties, she is doing nothing to fight HIV/Aids, which is clearly untrue.
What the Minister needs to focus on, however, is the proper functioning of the SA National Aids Council – Sanac. The office of the Auditor-General was disturbed that they did not seem to have done much since their establishment.
The Hospital Revitalisation Programme was able to cover 30 hospitals initially. The projects will increase to 59 over the current MTEF period. During the oversight visit to Pretoria Academic Hospital in Gauteng Province, the select committee observed and reported that this new state-of- the-art hospital has been completed, though it is not yet being utilised.
It is our belief that the department will fast-track the staffing and equipping of the new hospital so as to offer world-class medical care to our communities and to keep up with the demands of improved access and to minimise overcrowding in smaller hospitals.
Regulation on the pricing of medicine came into effect in August 2004. The select committee applauds the breakthrough in the pricing and dispensing of medication in the wake of court cases by certain interest groups.
An oversight visit to Odi Hospital, in the north of Tshwane, North West province and Gauteng cross-boundary area, revealed problems related to the state of the mortuary. Here only two out of five storage places for corpses were in good working order. The same problem regarding the state of mortuaries was observed in KwaMhlanga Hospital, Mpumalanga. It seems to the select committee that some of the problems experienced in this regard as to who is responsible for the mortuaries could be resolved if that function is dedicated to the municipalities.
The select committee acknowledges the key output to improve women’s health and nutrition. We are happy to support Budget Vote 16 on Health. [Applause.]
Ms P NKONYENI (KwaZulu-Natal): Hon Chairperson, hon Minister of Health, Dr Manto Tshabalala-Msimang, hon Deputy Minister, hon MECs, my colleagues, hon members, on behalf of the people of KwaZulu-Natal – the kingdom – I hereby convey our gratitude for being afforded the opportunity to address this august House today.
Now that I am here, I also want to thank our hon Minister, Dr Manto Tshabalala-Msimang, for the privileged invitation she extended to us as MEC
- hon MEC Mr Bellot and me – when we attended the 58th session of the World Health Assembly in the past two weeks.
Madam Minister, we were very proud to observe that South Africa is indeed playing a meaningful role in the health sphere. Hon members, other member states would wait for our hon Minister, Dr Manto Tshabalala-Msimang, to give direction before taking positions on issues. [Applause.] South Africa is leading the African continent and the world with regard to health issues. I also wish to say that the ANC leads! [Applause.] Again, I wish to say . . . “Wathint’abafazi wathint’imbokodo, ozokufa!” [You strike a woman, you strike a rock!] Finish!
I have also thought it wise to utilise this opportunity to brief and update the House on the progress we are making, as well as frustrations we are encountering in our endeavours aimed at creating better health for all our people.
As a province, we have fully embraced the Healthy Lifestyle Campaign as central to our response to the causes of mortality and morbidity, particularly in the reduction of communicable and non-communicable diseases. On 5 December 2004, together with the hon Minister, the Department of Health in KwaZulu-Natal launched our programme at KwaNgcolosi. It remains our believe that once the concept is fully understood and embraced by the majority of our people, the burden of disease heaped on our institutions will decrease.
As a province, we are taking the World Health Day theme very seriously, as it pronounces: “Make every mother and child count.” In support of the national initiatives in this regard, we have succeeded in creating 31 fully accredited baby-friendly hospitals. We are leading the country in the promotion of these institutions. [Applause.]
We also have established 27 accredited adolescent-friendly clinic initiatives - these in pursuance of the Millennium Development Goals, specifically the ones intended to reverse the incidence of infectious diseases.
I have indicated that we are striving to provide better health for all our people and as such I have to concede that we are still faced with a number of challenges. To start with, we still have a long way to go in attaining acceptable response time for our people in distress.
Currently, our province only has 450 ambulances and as such cannot meet the requirement of one ambulance per 10 000 people. In addressing this situation, I can report that in this financial year we will be purchasing 100 more, as well as 121 emergency support vehicles. Of course we deserve a big round of applause! [Laughter.] [Applause.]
We are struggling with reducing waiting times for our patients in some of our hospitals. This is partly because of the infrastructure backlog in the construction of clinics and the refurbishing of the hospitals. To redress this, we have now decided not to rely on only on the Department of Works of KwaZulu-Natal but to also utilise the expertise of services of the Independent Development Trust, as well as the Ithala Development Corporation, which is one of our parastatals in KwaZulu-Natal.
The acute shortage of accommodation, especially in our facilities in the rural areas, adversely affects our efforts of recruiting and retaining professionals with scarce skills.
As part of the solution to the above-mentioned problem, I have to disclose that we are in the process of approaching the honourable Premier of our province, Dr S’bu Ndebele and the executive council to allow us to convert the erstwhile Ulundi Legislature into a regional hospital that will serve our people at Ulundi, Nongoma and Mahlabathini, whilst offloading the burden in our existing facilities around Northern KwaZulu-Natal. [Applause.]
We have a people’s contract to create work and to fight poverty and also to provide a better life for all. As the KwaZulu-Natal health department, we have decided to allocate 10% of our procurement budget to co-operatives. In this venture we are working closely with the department of finance and economic development in changing the standing procurement policies.
We remain committed to implementing the comprehensive approach to management of HIV/Aids, which entails prevention, care, treatment, nutrition and support. We are very determined to fighting and conquering this pandemic, not only HIV/Aids, but all diseases that are poverty related, like TB.
Developing countries have targeted our professionals. They are deliberately recruited to work in those countries. The question is: Does that reflect the notion that the lives of the poor people in developing countries are not as important as those of people in developed countries? I wish that hon members could deliberate on this issue because it is a political issue. I regard it as another form of imperialism, and the DA should pronounce on this issue because they are a reactionary force that is always used by imperialists.
In conclusion, I wish to indicate that we remain committed to efforts aimed at improving the health status of our people. I support the budget. I thank you, Chairperson. [Applause.]
Ms H LAMOELA: Hon Chair, hon Minister, hon MECs and hon members, the key role of the national Department of Health is the development of legislation and policies, while provinces and municipalities are responsible for implementation.
Nevertheless, it still remains the key responsibility of the national Department of Health’s aim to promote, and protect the health of all our people, especially the most vulnerable, against illness and injury. The Department of Health’s chief aims should still be: to strive to ensure a caring climate for service users; to create a positive work environment; to obtain the greatest benefit from public moneys; to provide excellent training for health workers, and to improve overall health services.
Consistent and regular monitoring of the performance of the health system is central to the attainment of the aims outlined above. A big thank you goes to the Minister for working towards providing free primary health services for children under six years, pregnant women, people with disabilities and for those who cannot afford it. Improved access to health services by building of clinics and revitalisation of hospitals is highly appreciated.
Yet efforts to combat TB and to improve mental health services need to be intensified. Whilst TB can be cured, it remains a major public health problem and a socioeconomic burden, especially on the poor and the unemployed.
Ek glo stellig dat werkloosheid en huisloosheid siektes soos TB en MIV/Vigs bevorder. Behandeling- en bewusmakingsprojekte vir dié siektes is goed en wel, maar as omstandighede waarin die pasiënt of betrokkenes hul bevind nie verbeter nie, is alles taboe. Behoorlike behuising of goed-geboude strukture met goeie ventilasie - en sommige van dié eenhede huisves tot ongeveer 16 mense – aparte toilette met deure wat toemaak, en gepleisterde mure om nattigheid uit te hou, kan reeds die staat op die langer duur baie geld spaar.
In die Wes-Kaap ondervind ons reeds uiterste winters en baie van ons mense is werkloos en verarmd. Boonop veroorsaak die geweldige invloei van mense uit ander provinsies, veral die Oos-Kaap, ‘n groot krisis aangaande behuising. Longontsteking is aan die orde van die dag, wat uiteindelik tot TB-gevalle lei.
Mense kan nie herstel deur slegs medikasie of vitamines te gebruik, waarvoor baie mense vanaf die vroeë oggendure by daghospitale moet wag nie, maar wel deur ‘n gesonde dieet en goeie verblyf te geniet. Lewensomstandighede speel dus ‘n groot rol in die herstel van geaffekteerdes. Dienste, werkgeleenthede, en behuising moet in alle provinsies dus ook op standaard gebring word om te verhoed dat die invloei van mense, veral na die Wes-Kaap, bekamp word.
Die impak op die begroting is oorweldigend en verhoed die departement om hul beste, soos belowe in die agb President se toespraak aan die nasie vroeër vanjaar, te lewer. (Translation of Afrikaans paragraphs follows.)
[I firmly believe that unemployment and having no place to live are contributing factors to diseases like TB and HIV/Aids. The treatment of and awareness projects for these diseases are all well and good, but if the circumstances in which the patient or persons involved find themselves do not improve then everything is in vain.
Proper housing or well-built structures with adequate ventilation – some of these units house up to approximately 16 people - separate toilets with doors that can close and plastered walls to keep damp out can save the state a lot of money in the long run.
In the Western Cape we are already experiencing extreme winters and many of our people are unemployed and indigent. In addition the enormous influx of people from other provinces, especially the Eastern Cape, is creating an immense crisis concerning housing. Pneumonia is the order of the day, which eventually leads to cases of TB.
People cannot recuperate merely by using medication and vitamins, which many people have to wait for from early in the morning at day hospitals, but by following a healthy diet and having proper housing. Living conditions therefore play a big role in the recuperation of those affected. Services, employment opportunities and housing must therefore also be brought up to standard in all provinces to avoid the prevention of the influx of people, especially to the Western Cape.
The impact on the budget is overwhelming and prevents the department from delivering its best, as promised in the hon President’s state of the nation address earlier this year.]
As far as Aids is concerned, the HIV/Aids epidemic has a disastrous effect on children’s lives, and it is indeed a growing cause of concern for children’s rights. Though Prevention of Mother-to-Child Transmission is offered at some public hospitals and some community centres, Prevention of Mother-to-Child Transmission programmes are still considered as key interventions and should be rendered continuously.
There can be no doubt that children orphaned by HIV/Aids is a national crisis and this should be treated as such. The government should be ashamed that South Africa has been named as one of three countries lagging behind as the World Health Organisation attempts to reach its goal of delivering antiretroviral drugs to three million people by the end of this year.
Indeed, of the 20 countries that have the highest antiretroviral need, South Africa fared the worst. We are seen as a country without the political will to deal with the pandemic. The daily number of Aids-related deaths in this country will not be reduced if, firstly, the governing party continues to fail to meet its own target; secondly, continues to shift the goal posts in a feeble attempt to cover its inefficiencies; and thirdly, without a massive and immediate upscale in the dissemination of ARVs. The results will be catastrophic.
In fact, they already are. Our teachers are dying in droves, and research shows that the number of children admitted to Grade 1 has dropped dramatically. Yes, we are aware that antiretroviral drugs cannot cure HIV/Aids, but they can do the following: Firstly, prevention of mother-to- child transmission; secondly, extending the life of the sufferer to a reasonable age, particularly mothers and fathers, who need to take care of the children. This will reduce the number of children that are orphaned, and lift the burden on the state coffers.
Regarding primary health care, the impact of migration from other provinces is worst felt on the primary health care level, and the situation is compounded by the shortage of staff. An in-depth survey on patient ratio per professional nurse should be done to ensure quality service at all times. We need to remember that professional nurses are held accountable for the patients’ wellbeing while in their care.
Is the burnout syndrome for professionals perhaps the reason for absenteeism during working hours? Or is the persistent pressure of a shortage of staff, professional nurses and doctors the reason for immigration to other countries rather than gambling with patients’ lives? Filling of critical posts such as professional nurses and doctors is a priority that is continuously ignored.
Some hospitals situated in townships still struggle to compete with other hospitals in attracting and retaining professional and skilled personnel. Long queues are still experienced by patients as some hospitals do not have a booking system and thus work on an ad hoc basis. Migration of our professional nurses and doctors to other countries remain a great concern.
The department should urgently look at ways to prevent our staff from leaving our hospitals and clinics by ensuring that all role-players agree on a human resources strategic plan; review the remuneration of health personnel, especially nurses, bringing it up to a reasonably competitive level; intensify the training on HIV/Aids at primary health care level, where staff feel overwhelmed and not competent enough to deal with some of the issues related to the epidemic; and urgently upgrade the infrastructure at certain institutions.
We need to realise that health professionals are the cornerstone of a good health system, and need to be acknowledged for their opinions and experiences. Regarding our health care centres, there are a number of hospitals in some provinces like Limpopo that are to be converted into health centres. These hospitals are located in areas where people are generally poor. Conversion means other critical services cannot be provided, and the sick will have to travel long distances for such services despite their economic background. Maybe the hon Minister can explain what the rationale is behind this conversion of these hospitals into health centres.
On the matter of the hospital revitalisation grant, while it is clear that the hospital revitalisation grant poses a specific challenge to provinces, spending in some of the provinces such as Gauteng, KwaZulu-Natal and the North West province has been particularly slow for two consecutive financial years. Currently, spending trends are of particular concern, taking into account that the administration of conditional grants was a qualification item in the 2003-04 audit report for the Department of Health.
In conclusion, conditional grants subject to slow spending are in essence the ones that have important implications for achieving the goals identified by the President’s 2005 state of the nation address. I thank you. [Applause.]
Dr B GOQWANA (Eastern Cape): Chairperson, I have already accepted your apology. It is Goqwana. Chairperson, Madam Minister, Deputy Minister, MECs from different provinces, members of the NCOP, ladies and gentlemen, I am tempted to start off by saying that I think the MEC for health, uMaMtolo from KwaZulu-Natal, has actually displayed the relationship between the provinces and the national department. We can see that that relationship is very good and I don’t have to go into detail about that.
I just want to make a few comments before I start to represent the Eastern Cape here. I think we started to walk in these corridors in 1994. I tend to believe that there were people who were walking in these corridors even before 1994, and some of them are still here. During that time poverty was present and it was worse than it is now. Yet, they now seem to be the advocates of poverty better than they were during that time. The interesting thing is that HIV/Aids was present even at the time. There was no money that was put aside to fight HIV/Aids. And, as I know now, there is no country that gives more money per head of HIV-positive person than South Africa. [Applause.]
The other thing that is very interesting is that – coming from the medical profession myself – before 1994 there was very little that was said about nutrition, even at medical school. I think it was left out deliberately so that we could push the other pharmaceutical interests. Now, when people start to mention nutrition as part of prescription, people have started to say that that should not be done. Yet, that is supposed to have been the key and that should have been done long before it was mentioned by this government. I thought I should make those comments before I talk about the Eastern Cape.
The end of the last financial year and the beginning of this new one have been marked by unprecedented challenges in the provision of health services in the Eastern Cape. The outbreak of various preventable diseases among children in rural areas has put our state of readiness to the test in terms of resource allocation, flexibility and responsiveness. Whereas there has been an ongoing immunisation programme, it has become clear that the epidemiological profile is linked to the province’s socioeconomic development.
While responding to these immediate threats, which obviously call for an increased budget allocation, the reality is that these are part and parcel of the provincial growth and development plan. The challenges facing the province cannot be addressed overnight, nor will increased funding for health services alone create healthy people.
The amount allocated for health care service delivery for the 2005-06 financial year is R6,08 billion. Over the past four years the Department of Health has acknowledged that primary health care services are fundamental to the delivery of quality health care to the uninsured population. For this reason, between 45% and 55% of the departmental budget was consistently allocated to this programme and the ensuing year will be no exception, as 45,9% of the budget will be spent on these services.
The gross inequalities in the distribution of resources in the past have created unimaginable backlogs in health-related infrastructure. The past year burdened us with considerable challenges such as budgetary constraints and limitations. But, in spite of this, the department has recorded tremendous progress in a number of areas. As a department we are now refining our focus and energy so that the service delivery system necessary to support the quality of care is in place.
Consequently, our turnaround strategy is centred around, and driven by, the following 10 key focus areas that guide and underpin our programme of action. The 10-point plan is made up of these points: strengthening the service delivery platform, revitalisation of the health institutions; strengthening the quality assurance system; promoting partnership and public participation; ensuring compliance across all sectors; improving and re-engineering business processes for long-term sustainable quality health care delivery; long-range planning towards a quality public health system; strengthening the information system; improving overall organisational performance; and effective communication and branding of the department.
Let me just talk a little bit about emergency services. This is one of the areas that is a sore point for most provinces. The department has compiled a status quo report of emergency services and subsequently put together a breakthrough strategy to reposition the unit, confront its challenges and tangibly make a turnaround in its operations. The strategy is aimed at integrating the emergency services into primary health care and will enhance community health through an organised system of injury prevention, acute care and rehabilitation.
Regarding quality health care and assurance systems, I would like to reiterate that our primary focus and in fact our theme is “improving the quality of care”. We shall achieve this by addressing the following issues: accurate and comprehensive patient records and database; ethical conduct underpinned by Batho Pele principles and the Patient Rights Charter; effectiveness of the complaint system; monitoring and evaluation; and focusing on disease surveillance and notification.
Concerning clinical services, I shall deal with five key priority programmes. The first one is HIV/Aids and I am not going to dwell on this one, except to mention that we are on track with the comprehensive treatment and management plan. I am not going further than that.
The second programme deals with TB. All I want to say about TB is that, interestingly, much as I am not going to disclose the time when I was born, I think when I was born there was a cure for TB. But up to today, old as I am now, we are still faced with the fact that TB kills our people. It shows that there is something that we didn’t put into the equation. The part that we left out is the role of poverty.
We rush and say people must be given the treatment that can cure them without considering the fact that if those people take treatment, they must have food that they are going to eat. That is why we still have TB. We are trying to concentrate on making sure that people have food on their table while taking this TB treatment.
The other thing that is really hitting us as the friendly province of the Eastern Cape concerns problems related to circumcision. I am not going to dwell on that, except to say that we have managed to reduce the deaths and amputations that have happened before. We are going to continue to make sure that this does not happen in the Eastern Cape.
The fourth programme that we think we will concentrate on in this financial year is that, as a department, we are going to concentrate on saving mothers and saving babies. Even on this one, I am not going to dwell much. But it’s one of the programmes that we think are going to be very crucial in this particular budget year.
Regarding the integrated nutrition programme, I have mentioned that you can look at your diseases such as HIV/Aids, TB and measles that are giving us problems, or even diarrhoea, but all of them are related to the fact that there is poor nutrition and poverty in those areas. That is why we think that, as the department of health in the Eastern Cape, we should concentrate on this integrated nutrition programme.
As has been mentioned by KwaZulu-Natal, 25% of our hospitals in the Eastern Cape have thus far been declared baby-friendly, and 12 of them were declared so in the past financial year. Regarding this, we meet and subscribe to the standards of the World Health Organisation, and we are monitored by the national department. Thirty-two clinics have gardens that target malnourished children and those people who are HIV-positive. We also have nutritional supplement programmes that we give out to the clinics.
Concerning the budget allocation, the single most significant event that affected all departments has been the implementation of the austerity measures to address the overdraft that most us know we had in the Eastern Cape. In the spirit of assisting the province and the desire to be part of the solution of this problem, the Eastern Cape department of health had to surrender a substantial amount of its 2004-05 budget, that is R200 million. This resulted in a year-on-year budget reduction of 0,42% in 2004-05. Added to that, the department overspent by R131 million, which is 3% of the 2003- 04 budget. That required the department to make good the overdraft from the 2004-05 budget.
Needless to say, these two incidents have had a profound impact on service delivery and the finances of the department as plans needed to be amended to remain within the available budget. The department, therefore, projected an underspending of R41 million to reverse the overdraft situation and start 2005-06 with a positive bank balance.
In summary, despite the real increase of 10,5% in the budget of the previous year, the per capita funding of the Eastern Cape department of health’s budget still lags substantially behind provinces such as Gauteng, Western Cape, Northern Cape, Free State and KwaZulu-Natal. Thank you. [Applause.]
Nkk J N VILAKAZI: Sihlalo ohloniphekileyo, mhlonishwa Ngqongqoshe womnyango namalungu onke ahloniphekileyo ale Ndlu, imikhakha yonke, uMnyango wezeMpilo namhlanje ubhekene nobunzima. Angisayiphathi-ke eyesimo esishaqisayo lapho abahlengikazi sebefika emsebenzini begqoke izingubo zokulala. Kulukhuni impela. Ongaphika lokhu ongaboni emehlweni futhi engenazo nezindlebe zokuzwa.
Isabelo salo mnyango onezinkinga ezingaka sincane kakhulu ukufeza nje utho. Ezibhedlela kugcwele kuyaphuphuma. Izifo zithe bhe. Angisayikhulumi eyegciwane nesifo seNgculazi. Abahlengikazi asebemnkantsha ubomvu kwezokuhlenga bayawela. Labo abasele umsebenzi usemahlombe abo. Isikhalo esikhulu esokuqashwa kwabasebenzi abanele bokwenza lo msebenzi ukuze kwehle umthwalo kwabasebenzayo, futhi basebenze bekhululekile ukwenelisa abagulayo. Umhlonishwa uNgqongqoshe womnyango wezempilo KwaZulu-Natali, ethula inkulumo yakhe yesabiwomali sesifundazwe, wathi, ngiyamcaphuna:
Umsebenzi wezempilo udinga inqwaba yabantu. Ukuze siphumelele kumele siqinisekise ukuthi sinabasebenzi abakhuthazekile nabazinikele, bebe benamakhono adingekayo nenani labo libe lenele.
Lawa mazwi wodwa nje afakazela engiqeda ukukusho ukuthi amakhono amaningi ayasishiya kusale isikhala esingavaleki kalula, abantu bebancane, umsebenzi uhlezi emahlombe abo. Abakwazi ukuhlenga ngesineke nangothando oludingwa umuntu ogulayo.
Isabelo sezempilo kudingeka sibe ngesiningi kunalokhu ukuze simelane nezidingo zalo msebenzi obaluleke kangaka. Okunye okudinga imali ukuze kweneliseke odokotela nabahlengikazi abenza lo msebenzi onzima kangaka ukuba neholo eligculisayo kubona bonke, kuyo yonke imikhakha eyenza umsebenzi – kungaba ofundelwe, onobuchwepheshe noma ongafundelwe kodwa ogculisayo. Izikhalo abazibekayo azicutshungulwe kuhlangatshezwane nazo. Izindawo abahlala kuzo mazinakekelwe – leso ngesinye isikhalo esisitholile ngenkathi sihamba sibonabona izindawo laphaya ezibhedlela. Bakhala kakhulu ngezindawo abahlala kuzo.
Izindawo abahlala kuzo mazinakekelwe noma zakhiwe uma zingekho, ikakhulu emitholampilo esemakhaya. Abahlengikazi abakhelwe izindlu ezenelisayo ukubadoba ukuze bawuthande umsebenzi abawenzayo. Izindawo abasebenza kuzo mazinakekelwe. Odokotela nabahlengikazi abaziqhenye ngomsebenzi wabo; abaziqhenye ngendawo abasebenza kuyo; futhi abaziqhenye ngokuhlenga abagulayo ngesineke nothando abaluzwa ngaphakathi ekwanelisekeni ngomsebenzi wabo.
Imitholampilo kudinga yenelise imiphakathi eseduze nayo. Imithi ayitholakale emitholampilo. Imoto ethutha iziguli, i-ambulense, ayibe khona ukuze iphuthume ezimweni ezivelayo. Kuneziguli ezifayo i-ambulense ingafikile ngoba ingekho emtholampilo ukuze iphuthume izimo ezinje. Ngizwile-ke nokho uNggongqoshe wami wasesifundazweni ethi basazofaka ama- oda. Kuhle ngoba ngikhona KwaZulu-Natali, ngizovula amehlo nendlebe.
UMnyango wezeMpilo uphethe impilo yabantu esizweni jikelele. Kunesikhalo kulo mkhakha. Imitholampilo kwayona ayenele ezindaweni ezisemakhaya, kusahlushekwa. Isabiwomali sezempilo asethembisi ukuthi siyokwazi ukufeza yonke le misebenzi esingiyibalile. Kuphinde kube nezinkinga kulo mnyango ovele unezinkinga obhekene nazo. Noma sengiphawule kanje kodwa i-IFP iyasisekela lesi sabelo esithuliwe. Kodwa futhi angiphinde ngithokoze. Kukhona okusha engikuzwile lapha. Ngizwe uNgqongqoshe wami wesifundazwe ethi indlu yesishayamthetho yaseLundi isizokuba yisibhedlela. [Uhleko.] [Ubuwelewele.] [Ihlombe.] Ngithi-ke mina, hhayi, ngolunye udaba-ke lolu. [Uhleko.] Siyazidinga vele izibhedlela ngale koThukela. Yilokhu zakhiwa uhulumeni omdala nezimishini. Uma ngempela njengoba lucwebezela lunje uLundi luzoba yisibhedlela, hhayi, sonke siyolala khona. [Uhleko.] [Ihlombe.] Ngiyabonga. (Translation of isiZulu speech follows.)
[Mrs J N VILAKAZI: Hon Chairperson, hon the Minister and the hon members in their respective portfolios in this House, today the Department of Health is faced with difficulties. I am not even talking about the astounding conditions where nurses come to work wearing nightdresses. It is indeed difficult. Only a person with neither eyes nor ears can deny this.
The budget allocation for this department that has so many problems is extremely small, too small to move an inch. Hospitals are extremely full. Diseases are also posing a gigantic challenge, let alone the question of HIV and Aids. Experienced nurses are leaving this country. And those who stay behind have a lot of work to do. The major complaint is that vacancies should be filled so as to reduce the workload, to enable nurses to work freely and be in a position to nurse all those who are sick.
During the Budget Vote for the provincial department of health in KwaZulu- Natal, the hon MEC said, and I quote:
The health sector is a labour-intensive area. To succeed we have to ensure that we have motivated and committed staff with the right skills mix in adequate numbers.
These words alone bear witness to what I have just said now that experienced workers are leaving this country and there are staff shortages, which are not easy to eliminate, and a lot of work. Thus they cannot offer the patience and love needed by the sick.
The budget allocation for the health sector should be higher than it is now so that it could match the needs of such an important task. The other thing is that all doctors and nurses who are doing such a gigantic task in all their working spheres should be paid satisfactory salaries, if their work is satisfactory, regardless of their training or expertise. Their complaints should be analysed and their requirements met. Their residences should be taken care of as this is one of the complaints that we received when we were inspecting their residences at hospitals. They are extremely concerned about their residences.
Their residences should be taken care of and if they do not have any, especially at the rural clinics, they should be built for them. Good residences for nurses should be built so as to encourage them to love the profession they are in. Places where they are working must be taken care of. Doctors and nurses should be proud of their work; and should of the place in which they are working; and also of nursing the sick with care and love that they feel deep down in their hearts because they are experiencing satisfaction in their work.
Clinics should satisfy the communities they are situated in. There should be medicines at the clinics. There should be an ambulance to cater for the emergencies. There are patients who die waiting because there is no ambulance available at clinics for emergencies. I, however, did hear my MEC say they will place orders for ambulances. This is quite good, because I am in KwaZulu-Natal and I will keep my eyes and ears open.
The Department of Health caters for the health of the people in the whole country. There is a complaint in this department. There are not enough clinics in rural areas, where there is still destitution. The budget allocation for the health sector does not promise to be the one that will carry out all the work that I have mentioned. There are problems in this department on top of those it is already faced with.
Notwithstanding my comments, the IFP, however, supports the tabled budget. There is also something new that I heard here that makes me happy. I heard my MEC saying that the former Ulundi legislature building would be converted into a hospital. [Laughter.] [Interjections.][Applause.] I am therefore saying . . . [Interjections.] . . . well, that’s another matter. [Laughter.] We clearly need hospitals beyond the Tugela River. The only hospitals there are the ones built by the old government and the missionaries. If the glittering Ulundi is converted into a hospital, well, we shall all be admitted there. [Laughter.] [Applause.] I thank you.]
Ms G RAMOKGOPHA (Gauteng): Deputy Chairperson, hon Minister, Dr Manto Tshabalala-Msimang, our Deputy Minister, my colleagues, members of the House, it is indeed my privilege and pleasure to address this important House 26 days away from celebrating 50 years of the adoption of the Freedom Charter in Kliptown, Johannesburg.
Just to share with you some of the ideals around the health of our forebears, these include a preventative health scheme which will be run by the state, free medical care and hospitalisation which will be provided to all, with special care for mothers and young children. The aged, orphans, disabled and sick will be cared for by the state.
I think we have over the past 11 years put together not only the constitutional framework, but also the legislative and policy frameworks that have made sure that when we celebrate these 50 years of the ideals of our forebears, we indeed say we have delivered an improvement in the health of our people in South Africa and in our various provinces.
I would like to thank you, hon Minister, for having provided the leadership in the last term, in the second term, as well as continuing to provide leadership in this term.
On Monday, 6 June, that will be next week, I will also be tabling the health budget vote for the province, which is R9,2 billion, and representing about a 4% increase from the previous financial year. This is for about nine million people.
This budget has taken on board the priorities of the national Health Ministry, as well as the provincewide goals that have been set in the province, to halve poverty, to halve unemployment, and to reduce the burden of disease by investing in our people in the next 10 years, by the year 2014.
We are already in the second year of our third term of our democracy, linked to democratic values that we uphold. We also committed ourselves, as the province, as the department, to listen, to communicate and work with our people. The people’s contract in our department is entrenched.
This is also experienced by our visits, which are quarterly visits to sub- districts in our province. In the last term the visits were to districts, so we are really getting down and now we are at the sub-district level.
These visits ensure that we understand fully the status of health services, and also listen to our people in terms of making sure that our services respond to their needs. This term we are also focusing on a very strong commitment to the Batho Pele service excellence and quality of care, and entrenching the Patients’ Rights Charter and own service pledge. But we have also committed ourselves to an efficient and effective use of our public resources. With respect to healthy lifestyles we acknowledge that the first step towards the reduction of the burden of illnesses lies in the adoption of healthy lifestyles.
We were very privileged to participate under the leadership of the Minister at the Move for your Health campaign in Alexandra on 30 May this year, where the message of a healthy lifestyle was driven home.
In our province we communicate quite regularly that our ministry is not a ministry of diseases and illnesses and injury, but it is a ministry of health. Our first priority, our primary responsibility, is to do what is usually not visible, and that is to promote health and make sure that our people are not sick, and to contribute to a productive South Africa.
With respect to tobacco control, I am very pleased to share with you that all our buildings in the department are 100% compliant with the provisions of the current tobacco control policy.
It is also encouraging to learn that there are fewer young people who take up the habit of smoking. This is indeed proves that our policies which, among others, are the most stringent and progressive in the world are beginning to bear fruit.
I was disappointed, although I think it was not deliberate, that Sawubona magazine that I looked at as I was coming here, Madam Minister, also focuses on youth - which is a very important thing, but I was a bit disturbed - one of the pictures portrays school youth as youth that are smoking. I think that is something that they would take very positively when we give them feedback.
I wish to commend the Heart Foundation and the Cancer Association who contribute to working as strategic partners in marketing healthy products, as well as good and healthy lifestyles, in addition to supporting the survivors, and their families, of diseases relating to unhealthy lifestyles.
We welcome the publication of the draft regulations regarding labelling of alcoholic beverages; just as negative results of smoking are clearly printed on the cigarette cartons, we also need to spell out the negative social and health consequences of alcohol abuse.
Earlier in the year the province held campaigns to warn communities against the foetal alcohol syndrome that affects babies whose mothers drink alcohol during pregnancy. With respect to mental health our focus is on the promotion of the mental wellbeing, and the strengthening of early diagnosis treatment and support for people living with mental illnesses.
Child and adolescence psychiatry is treated as a priority, with a special budget set aside to establish an in-patient unit for these services at Tara and Chris Hani-Baragwanath Hospitals.
With respect to child health, today in our province we are launching, under the leadership of the Premier, a programme called Bana Pele, a Sesotho phrase for “children first”. This programme is a joint programme between the departments of health, education and social development.
It aims at making sure that our commitment to putting children first in our country is realised by making sure that the department, which deals with children, does not put up unnecessary barriers, but work together in a co- ordinated way so that children registered as indigent with the health department can also access services in social services and education accordingly, and will not have to fill in different forms.
We have also launched, today, the third addition of the health guide for teachers, of which I have a copy, and I will leave it with the House. Our schools services have also screened about 150 000 learners last year for obstacles to learning, when 15 000 learners were found to have problems and referred to appropriate facilities. Also, 2 100 learners were given spectacles. [Applause.]
I want to take up the challenge from KwaZulu-Natal, as well as the Eastern Cape, around the number of baby-friendly hospitals or facilities that have been accredited. We are trailing behind but surely awarding a further four facilities as baby-friendly shows that we will also be neck-and-neck with you. I take the challenge, that you are ahead of us, as a positive.
In terms of women’s health we have continued to provide cervical and breast cancer screening. In the last financial year alone, we screened more than 50 000 woman, which is an over 100% increase over the past five years.
Madam Minister, TB continues to be a burden, even in Gauteng. Whilst the cure rate is increasing, over the years the challenge still remains that the absolute number of new infections is also on the increase. We have set ourselves a dedicated programme to make sure that we indeed work with other stakeholders to reduce this burden.
Eating healthy food and in the correct proportions are also an important aspect of maintaining good health. We need to join hands to ensure that every child appreciates the importance of vegetables, fruit, proteins, carbohydrates as well as of drinking enough clean water. We always say water is a forgotten nutrient.
Those who are ill and have chronic illnesses also need nutritional supplements. Because of unemployment and poverty, many people with chronic and debilitating diseases and children are vulnerable to malnutrition. In the last year 22 000 adults and 6 500 children benefited from the nutrition programme in our budget . . . [Interjections.] Thank you. And in this year R8,8 million has been set aside. We support the Budget Vote and we will endeavour to make sure that in our province the goals are realised. Thank you. [Time expired.] [Applause.]
Mr K SINCLAIR: The Northern Cape has just concluded a very successful first provincial health summit under the theme “The new dawn of health service excellence”.
On behalf of the Premier, the hon MEC, who is unfortunately absent today, and the people of the Northern Cape, we want to thank the Minister and the national department for their support and guidance with regard to the inception of the summit.
Currently, the Northern Cape has the second-lowest infant mortality and HIV- infection rates in the country. Despite the vastness of our province we have been able to create access, particularly to preventive health care, for most of our communities on a continuous basis.
Working jointly with the Red Cross, as from last month, patients referred from the Namaqua district were flown to our tertiary hospital in Kimberly, and 490 patients have already benefitted from this service.
The distance between Kimberly and the farthest point in our province is well over 1 000 km, and we just could not afford the spate of accidents we had in the past as a result of driver fatigue. The reality is that it’s closer to Durban than it is to Port Nolloth, but if I listen to the problem that the people have in KwaZulu-Natal, and especially in Ulundi, I would rather go to Port Nolloth. [Laughter.]
Ambulances in these areas can now focus on emergency cases. We hope to introduce this service to other parts of our province in the near future. I want to congratulate the hon Minister and the department, because every year the Northern Cape is getting new ambulances and it has done away with these “skorokoros” that also cost our people’s lives.
These are notable achievements, which we certainly intend to improve on, particularly based on the outcome of our provincial health summits. Our province appreciates the ongoing work that has been done by our home caregivers. They have extended the ability to provide population-based health care.
Their contribution has been critical in the realisation of the tenets of the people’s contract, and there are currently 1 009 caregivers in the province. We intend to recruit more in the coming months, placing particular focus on the areas of need.
The foetal alcohol syndrome is a continuing problem in our community. The problem of the abuse of alcohol presents us with numerous challenges. And we must break the cycle of destruction.
We wish to thank the Minister for the increase in the hospital revitalisation grant. We have already completed two hospitals, as the Minister has mentioned, in Colesburg and Calvinia.
Regarding the Manne Dipico Hospital in Colesburg, a very unfortunate incident happened recently involving the hospital minister. I have requested that the MEC for health in the Northern Cape lodge a departmental enquiry regarding the issue. In terms of the Batho Pele principles, government officials must serve all our people, black and white, with dignity and respect. The people using the hospital certainly deserve better treatment than they receive form the hospital management.
Over the next two years the hospitals in Upington, De Aar, Barkly West and the mental hospital in Kimberley will be constructed.
What I have just spelled out is what the people who had no hope envisaged 50 years ago, when they accepted the principles of the Freedom Charter, which include accessibility and affordability, quality health care and comfort. I thank you. [Applause.]
Mr S BELOT (Free State): Hon Chairperson, Minister and Deputy Minister, MECs, hon members, thank you for the privilege to participate in the Budget Vote for Health. A few weeks before we celebrate our 50th anniversary of the Freedom Charter, I’m happy to share with this House the achievements of the Free State’s department of health, which are based on the Alma Ata Declaration.
To remind the House, the Alma Ata Declaration provides for primary health care services that are compatible with the vision of the Freedom Charter. The primary health care approach is a holistic and comprehensive approach that seeks to develop the human potential and eliminate the socioeconomic causes of ill health. Our business is to ensure the delivery of quality health services to the people of the province and I wish to share with the House that in 2004 the Department of the Health was able to see, examine and treat more than 7,4 million outpatients at all our facilities in the provinces. Of these, 6,1 million people were treated at our primary health care facilities and 789 708 outpatients visited the district hospitals. There were 299 954 outpatients at regional hospitals.
I am sharing with the House these statistics in order that we could agree that our people receive services from our facilities and that our government is committed to giving quality health care to our people in the province. The length of stay in our facilities has decreased to 3,5 days at regional and tertiary hospitals. The number of emergency medical services calls that were handled were 131 217 and more than 118 000 patients were transported through the planned patient transport to our facilities to receive the treatment to which they are entitled.
The budget allocated to the department for this financial year is R3,7 billion and these are some of the things that will be done during this financial year. I need, of course, to put this in context and remind this House of what our President said in his state of the nation address on 11th of February this year. He said:
In addition, campaigns to reduce non-communicable and communicable diseases as well as non-natural causes of death will continue through the promotion of healthy lifestyles and increased focus on TB, Aids, malaria, cholera and other waterborne diseases, and generally increasing the standard of living of the poorest among us.
He further said:
Broad trends in mortality confirm the need for us to continue to pay particular attention to the health of our nation. With regard to Aids in particular the government’s comprehensive plan, which is among the best in the world, combining awareness, treatment and home-based care, is being implemented with vigour.
It is for this reason that our main focus is to address the triple burden of diseases in the Free State. That is the diseases of lifestyle, communicable diseases, trauma and violence. Chronic diseases of lifestyle, like hypertension, diabetes, heart problems, strokes and cancer are affecting communities in great numbers. We therefore implement prevention and health promotion programmes to address the impact of these chronic diseases of lifestyle.
Health programmes are targeted at mothers, children and youth, the disabled and elderly and vulnerable groups in all our districts. Initiatives to prevent and reduce cervical, breast and other kinds of cancer, maternal deaths, perinatal and genetic defects have been strengthened. The department is implementing and expanding the comprehensive care management and treatment plan for HIV and Aids in all our districts.
All our primary health care clinics have nutritional products for patients who are underweight, malnourished and vulnerable. We have ensured that there is sufficient availability of appropriate medication for all communicable and non-communicable diseases like hypertension, diabetes, heart problems and lung diseases.
Presently there are 5 600 people with disabilities registered in the disabilities and rehabilitation database that qualify for free health care services. The department will intensify the registration of people with disabilities and also promote awareness among communities at large of the availability of this service.
Speech and audiology equipment to the value of R1,5 million and assistive devices to the value of R2,7 million have already been purchased and will be distributed in all districts. The programme for survivors of sexual assault and victim empowerment will be strengthened this year in collaboration with other departments and a new victim support centre will be established in the eastern parts of the province. Post-exposure prophylaxis is being offered to all rape survivors presented at health facilities within 72 hours. Our VCCT programme will be extended to all our health facilities because our slogan is: “Know your status”.
An integrated approach on home-based care, which includes all chronic and terminal cancer patients, is implemented in partnership with non- governmental organisations and home-based care. The department has also ordered 10 000 vials of flu vaccine to be given to older persons and to vulnerable groups.
On mother, child and women’s health, the department will reduce micronutrient deficiency disorders by providing at least 78% of children under the age of one year with vitamin A doses according to a defined schedule. We also ensure that maternity facilities are baby-friendly. This year six new hospitals will qualify for baby-friendly status. We will improve our immunisation coverage by ensuring that 85% of children under one year are fully immunised and 85% of children receive their first measles dose. We are aware of the problem of measles.
With regard to cataract surgery, we have prioritised this to reduce blindness in the province in the process. Initiatives are implemented to improve the cataract surgery rate to 666 per million of the population in the province. I can share with the House that we have thus far performed 680 operations. I am happy to announce that we have given vision to our people and now they can see.
With regard to the emergency medical services, we have strengthened our services by purchasing a further 15 new emergency vehicles and we are going to appoint inspectors to monitor the utilisation of our emergency service vehicle in all districts. We are aware of the abuse of this service. It is in this regard that we are appointing these inspectors. I can assure this House that these inspectors will not stop vehicles when they are carrying patients for emergency services, but they will inspect them when they find them where they are not supposed to be.
With regard to our clinic facilities and equipment, the clinic upgrading and building programme, as well as our hospital revitalisation programme, has been implemented and it is based on the Expanded Public Works Programme. We are aware that as a department of health we have a role to play in the implementation of the Expanded Public Works Programme and in creating employment.
As a result an amount of R5 million has been allocated to purchase equipment for the primary health care clinics in all our districts. This will ensure that basic essential equipment is available for critical primary health care services in our province. As I . . . The CHAIRPERSON OF COMMITTEES: Hon member, I regret your time has expired. Mr S BELOT (Free State): Thank you. I wish to say we support the Budget Vote. [Applause.]
The DEPUTY CHAIRPERSON OF COMMITTEES: Hon Chairperson, hon Minister, hon Deputy Minister, hon members of the executive councils of our provinces, distinguished special delegates, hon members, friends and comrades, officials of the department under the gallant leadership of Mr Thami Mseleku, I join the nation in congratulating you on your appointment to a new workstation. We are confident that your vigour and energy will add a new sense of urgency and purpose, like your predecessor, Dr Ntsaluba.
Hon Minister, your budget policy debate takes place at the most exciting, yet challenging moment in the history of our country and its people. It takes place on the occasion of International Children’s Day the day when nations and governments across the globe pause to take stock of how their policies and programmes have impacted on the plight and welfare of the children, the very bedrock and foundation of our future. In this regard we must accordingly vow that never shall we allow the graves of our country to be littered with the corpses of children who die of curable diseases and malnutrition.
It takes place hardly a few weeks before our people’s movement for change, the ANC, in whose hands the future of this country has been firmly placed by the millions of the electorate, is poised to assemble for its national general council, which will take stock of the path it has traversed since its 51st national conference.
This budget policy debate takes place when, in the next 24 days, our people, united in their diversity, will be poised to assemble in Kliptown and other parts of the country to celebrate the 50th anniversary of the Freedom Charter. This is the vision of hope and the future for the people of our country under the leadership of their glorious movement, the ANC.
Hon Minister, the invincibility and the unifying force of the Freedom Charter, as the only vision that can rid South Africa of all forms of inequalities, racial class and gender prejudices, have never been witnessed more than in this House in the recent past. The unprecedented popular support by the people’s representatives across the party-political spectrum in this House has, once again, confirmed to the world and South Africa to note that there is no other route to a better future than through the Freedom Charter.
I think hon Lamoela was just afraid that Mr Tony Leon would ban her from the party if she should quote the Freedom Charter, but in her introduction she alluded to the vision of the Freedom Charter. [Applause.]
Today, some amongst us, as the elected representatives of the people, in a naked attempt to advocate the domination of the rich over the poor, the powerful over the vulnerable, have made it loud and clear that the Freedom Charter, which so many men and women have died for, is a political manifesto of the ANC and is not the people’s charter for freedom. What an insult to the fighting history of our people for this freedom that we enjoy today.
These are the echoes of those who stole the votes of our people by promising them a better life and future; lying to our people about having broken ranks with the past of prejudice and discrimination against and exploitation of the poorest of the poor. One does not need to be a university professor to understand, in the whole history of our struggle by the masses of our people against apartheid oppression, that never has a single programme or vision by any political party emerged that has enjoyed the overwhelming legitimacy and support of our people like the Freedom Charter.
This is not so because of any cohesion or manipulation, but simply because the people of South Africa, in their diversity, know that the people’s congress in Kliptown, which adopted the Freedom Charter 50 years ago, was not an ANC congress, but the Congress of the People, who were united by the common hatred of racial class, gender, religious and all other forms of discriminations engendered by the apartheid colonial system.
Ms J F TERBLANCHE: Chairperson, on a point of order: We are debating Budget Vote No 16 - Health, but Mr Setona is giving us a lecture on the Freedom Charter. Maybe he should just stick to the topic, please. Could you rule on that? The CHAIRPERSON OF COMMITTEES: Hon member, I do believe that you have an understanding that every member has the freedom to speak on anything that he or she wants to speak on. Continue, hon member.
The DEPUTY CHAIRPERSON OF COMMITTEES: Chairperson, I am not addressing hon Terblanche. I am addressing the masses of the people who have voted for the ANC to expose the lies of the DA, saying that the Freedom Charter is an ANC pamphlet.
According to the late President of the ANC, the late O R Tambo, one of the finest architects and icons of our struggle for the kind of society we seek to build today, during what he proclaimed the year of the Charter in 1980, said:
The Freedom Charter contains the fundamental perspective of the vast majority of the people of South Africa of the kind of liberation that we all of us are fighting for. Hence it is not merely the Freedom Charter of the African National Congress and its allies. Rather it is the Charter of the people of South Africa for liberation.
Because it came from the people, it remains still a people’s Charter, the one basic political statement of our goals to which all genuinely democratic and patriotic forces of South Africa adhere.
Except the DA.
On the occasion of the statement of the ANC on 8 January 2005, the President of the ANC went on to say this:
These words remain true to this day. The Charter embodies a vision of an alternative society to the society we inherited. It constitutes the programme of the people of our country for the creation of a truly democratic, non-racial, non-sexist, united and prosperous country.
We, in the ANC, enter this debate with a great sense of pride for the remarkable achievements of government in the transformation of our health system, to serve all our people. We also appreciate and acknowledge that ours is not an easy struggle, one to be warned by declaration and sweet- talking in the boardrooms, but a complex and protracted struggle to undo a legacy created over more than three centuries of colonial oppression.
In this regard, the road ahead to achieve the full realisation of the vision and the ideals of the Freedom Charter is still long and bumpy. There are no readymade formulae to resolve all our problems. Despite these, as we celebrate the first decade of our democracy, the people’s government, under the leadership of the ANC, has made qualitative strides within the health sector, in line with the vision of the Freedom Charter.
This includes, amongst others, introducing a sound legislative and policy framework in line with our Constitution and the Freedom Charter, deracialising both the public and the private health sectors in our country, providing free and basic health care services to children from age 0-6, and pregnant women, expanding health services to the rural communities and revitalising our hospitals.
Underpinning our approach to the provision of health care services is a fundamental principle of human dignity and respect for life, the principle that has been at the core of our struggle for liberation. In this regard, by making health care services accessible to millions of our people constitutes a fundamental milestone in the struggle to protect the life and restore the dignity of an African, which was not worth anything in the eyes of those who governed this country before 1994.
I think hon Gcobana, with due respect, has captured that in more detail. [Laughter.] When taking our memories back to before the 27 April 1994 democratic breakthrough, a sense of agony and despair afflicts men and women who are today widows and widowers because they lost their partners due to ailments that could have been cured, but because of the colour of their skins they were deliberately denied access to health care and services. I am not sure whether hon Lamoela was audacious, before 27 April 1994, to talk on behalf of the people who do not have access to health care and services in this country. Today he is making much noise, as if the DA could be a champion of the aspirations of our people.
It is thanks to the Freedom Charter, which proclaims that free medical care and hospitalisation shall be provided for all, that this is happening. In every debate that has to do with health, it is common cause that the DA will always make a noise about the HIV and Aids pandemic. In doing this, they seek to project themselves as the solution to this pandemic, in the manner in which they usually evoke sensation about the genuine plight of our people to win their sympathy for votes.
What they forget is that HIV and Aids is neither a social nor a political construct that you could easily tackle with a political will, as they are suggesting. It is a disease that is so complex that not even a single developed country has found a cure for it yet. Unless they show us - I don’t think we as ANC are going to be arrogant - if they can show us a single country that has an absolute remedy for HIV/Aids I think the ANC will accept it, in the interests of our people. [Applause.]
For us who live amongst and with the poorest of the poor, the section of our society mostly vulnerable to all forms of communicable diseases, including HIV and Aids, it is clear that it is due to poverty and lack of decent housing. The best cure for Aids is prevention, as there is no medical, scientific cure for this dreaded disease.
The ANC will continue to do everything it can to fight the scourge of the HIV/Aids pandemic, as well as tuberculosis. To this end, the Treasury and the Ministry have prioritised all activities relating to the control and prevention of HIV and Aids, including in the 2001-04 MTEF, as well as an initial focus on awareness to more practical activities in 2004 and 2005, which saw the budget grow to monitor and control HIV and Aids in a comprehensive manner.
In this regard, hon Minister, we will give our full support to the government’s comprehensive approach to health, which is anchored in prevention, care and control. We do this because we know that no amount of noise from the DA will cure our sisters and brothers who are infected and affected by this dreadful disease. For us the pain inflicted on those affected . . . The CHAIRPERSON OF COMMITTEES: Hon member, I regret you’re your time has expired.
The DEPUTY CHAIRPERSON OF COMMITTEES: The ANC supports the Budget Vote. [Applause.]
The DEPUTY MINISTER OF HEALTH: Mphathisihlalo, angiqale ngokubingelela ngibonge koNgqongqoshe bezifunda ngokuba khona lapha ngothi lwabo bese ngibonga nezikhulu eziqhamuka eMnyangweni kazwelonke wezeMpilo. [Chairperson, let me start by greeting and thanking the provincial ministers for their presence here and allow me to thank the senior officials from the national Department of Health.]
It is a great pleasure for me to support the Budget Vote of the Minister of Health, Dr Manto Tshabalala-Msimang.
As we enter the second decade of our democracy we have a responsibility to make real the call of our people for a health system that cares. The Department of Health has developed goals, among which I wish to single out the following: to promote equity, accessibility and utilisation of health services; to extend the availability and ensure the appropriateness of health services; to develop health promotion activities; to foster community participation across the health sector and to improve planning of the health sector, and the monitoring of health status and health services.
The World Health Organisation defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.
Good health, like so many things, is unequally distributed. Entering the 21st century, about half the world’s people have been left behind, unable to achieve their health potential. There is a vast burden of preventable diseases amongst those less privileged, the majority of humankind. This is reflected also here in our own country and our policies are specifically aimed to overcome these disparities.
We are developing an integrated health system integrating primary, secondary and tertiary care. If this is to be offered equitably, all must have equal access irrespective of where they live or their financial circumstances. It requires a transformation in the way staff in our tertiary facilities see their tasks from being concerned for those who walk through the door to having a concern and responsibility for all the people in their catchment area.
When their health fails, people want to be able to access the best health care available. They want a hospital that functions and is adequately staffed, that has appropriate equipment in working order for diagnosis, medicines for treating their illnesses and people who care. We have prioritised getting our health technology systems in top working order. We will be publishing regulations that provide for the licensing and registration of medical equipment and service providers.
The regulations will provide for the selection of appropriate technology to ensure equity in distribution, affordability and sustainability, as well as cover the competencies needed for safe and proper utilisation of equipment.
As part of this process I paid a surprise visit to Pelonomi Hospital in the Free State. The visit was to observe and assess a day in the life of a clinical technologist with a view to proposing lasting and sustainable solutions. What I found was that despite the difficult conditions and budgetary constraints the clinical technicians remain committed to serving our people. We address these issues in a report that recommends simplifying procurement processes and addressing personnel and equipment shortages, as well as issues of infection control. This will require partnerships and co- operation with other state departments and the private sector to develop a blueprint that would be applicable to all provinces.
The World Health Organisation defines health promotion as the process of enabling people to increase control over their health, to achieve a state of complete physical and social wellbeing. An individual must be able to realise aspirations, to satisfy needs and to change or cope with the environment. Health is a positive concept emphasising personal and social resources, as well as physical capabilities. Health promotion, therefore, is not just the responsibility of the health sector but goes beyond healthy lifestyles to wellbeing.
Health promotion is essentially an intersectoral issue. We will take our campaign for healthy lifestyles to all the spheres of government at all levels, as the Minister has said, as well as civil society, to create a culture of taking responsibility for our own health and the health of the nation.
As we approach the problems of obesity and other preventable chronic illnesses we will benefit from the knowledge regarding socioeconomic and cultural factors that compound the problem. We will partner with research institutions and our universities to understand the psychological conditions that provide fertile ground for the exploitation of our people by the multibillion rand quick weight-loss industry.
This lucrative industry markets their products as fat trappers, fat burners or starch blockers with testimonies of unsubstantiated results. To date the only effective and scientific method of weight loss is a calorie restricted diet and adequate exercise. Vuka, South Africa! [Wake up, South Africa!] Eat less, move more.
We will mount our campaign to educate our communities about safe and evidence-based methods of weight loss. We have begun preparing regulations that will help us tighten the control around the marketing of these products, as well as paying attention to the labelling of foodstuffs. We will be working closely with provincial and local law-enforcement agencies to ensure that the law is upheld and that our people are protected.
Last year I spoke about mental illness, including depression, anxiety, stress and suicide. To understand the problem, we have conducted the South African youth behaviour risks survey, which found that suicide is common among our young people with almost half of the cases in the 20 to 34-year age group.
Some of the mental health stresses have manifested themselves in the increasing incidence of family killings. Men are killing their spouses, their children and themselves. This increase in family killings is linked to many issues, including poverty, gender inequality, alcohol and substance abuse, depression and anxiety, social violence, HIV and post-traumatic stress disorder. Strengthening the implementation of the Mental Health Act requires looking at issues of training and staffing of our primary care centres. We will improve the integration of mental health into primary health care. We will campaign to destigmatise mental illness and strengthen mental health programmes for children and adolescents.
I am concerned about the capping of benefits for mental patients by some of our medical aids. We will ensure that this is addressed as part of a common approach to care management and treatment of mental illness. If properly managed and treated, mentally ill patients have a good chance of recovering and returning to active community life.
We will be upgrading psychiatric facilities and developing norms and standards for in-patient and community services. This is to address the problem, which the Minister of Health has mentioned in her address.
I am saddened and shocked by the alleged ill-treatment of mentally ill people. Working with our provincial department, we will ensure that this comes to a stop. Earlier this year Minister Tshabala-Msimang visited KwaZulu-Natal to investigate reports of the abuse of patients at our institutions and ordered a high-level investigation that will assist us in understanding and addressing this problem that we are determined to stamp out.
Gun violence puts significant stress on our health resources. We therefore welcome the national effort to reduce the number of guns in circulation in our country.
Violence is also fuelled by alcohol and substance abuse. We will therefore fight these social ills as part of reducing violence and promoting healthy lifestyles.
The health status of our mouths often reflects our general health. One of the manifestations of Aids is oral thrush, which occurs quite often when the immune system has been weakened. The department has initiated a range of programmes to promote oral health. Five provinces have developed operational strategies to strengthen oral health services.
We are finalising a national oral health promotion framework, as well as a manual on oral health for community and home-based care. In August this year we will be going to Limpopo to launch our National Oral Health Care Month. I am looking forward to your participation in this important campaign.
This month our country will be commemorating our youth, remembering those young martyrs who contributed to our struggle to free South Africa. Our healthy lifestyles campaign must be driven by the youth of our country in the same way as they were able to mobilise for our freedom from apartheid. I am calling on the youth to mobilise for health and the promotion of healthy lifestyles with a special focus on sexual and reproductive health, including HIV and Aids.
In dealing with these key priorities we have formed partnerships with civil society such as the Planned Parenthood Association of South Africa, which implements the loveLife campaign. We particularly need such partnerships in critical areas of delivery of health care where the state is unable to reach because of a shortage of resources or the inability of our health system to cope.
The Planned Parenthood Association of South Africa plays an important part in loveLife, South Africa’s national HIV prevention campaign for young people. They have partnered with government to turn back the epidemic of HIV and Aids and related epidemics of pregnancy and sexually transmitted infections among our teenagers.
I am concerned with the high levels of teenage pregnancy. This says that something is blocking our messages about safe sex and we therefore have to step up our efforts, as well as seek new and more effective ways of achieving behaviour change.
Our comprehensive plan to fight HIV and Aids is considered one of the best in the world. It involves prevention, care, management and treatment. Its emphasis on prevention takes into account the fact that there is as yet no cure. It encourages voluntary counselling and testing. It helps those who test negative to remain free of the virus. It helps those who test positive and need treatment to make informed choices, including that concerning treatment with antiretroviral drugs, which is the only scientifically proven, effective form of therapy.
Having achieved our target of establishing service centres for this programme in all our districts, our task, as the Minister has said, remains to expand the service and thus increase access. We are stepping up these efforts to improve training and deploy our staff to these sites so that we can reach greater numbers of people who so desperately need care.
There is some considerable confusion, hon members and the public, which does not help people living with HIV and Aids regarding the role of nutrition and treatment. As reaffirmed recently by the Deputy President, who is chair of the SA National Aids Council, and our Minister of Health, Dr Manto Tshabalala-Msimang, government policy is that good nutrition does not only promote good health but is also a critical component of a comprehensive response to this disease.
But, nutrition is not a substitute for appropriate treatment. As members of Parliament and the public we have a responsibility to communicate this message, which is our national policy. We have a responsibility to ensure that everything possible is done to give more people access to information and evidence-based treatment options. This is a life and death situation and we must reach out and use our power and resources to save the lives of our people. I thank you. [Applause.]
Mr P UYS Western Cape: Chairperson, hon Minister, hon Deputy Minister, hon colleagues, hon MECs, hon members, I want to congratulate the hon Minister of Health for presenting us with a budget that continues to expand access to equitable, affordable and good quality health services.
As envisaged in the Freedom Charter, government continues to make quality health care more accessible to the poor through, among other things, the provision of new clinics, free health care, especially for pregnant mothers, young children and people with disabilities. At the same time it remains committed to improving the services provided in our health facilities, through improving training, recruitment and retention of health personnel, improved infrastructure and enhanced health promotion and awareness.
In supporting this Budget Vote, I want to assure the Minister that the provincial department will this year not only take health closer to the people by making it more accessible to those with the highest level of need, but work hard to promote healthy living in our communities.
Saam met ander rolspelers in die nasionale en plaaslike regering is ons gereed om armoede en ongelykheid die stryd aan te sê en om ’n nuwe bestel tot stand te bring waar almal gelyke toegang tot beskikbare gesondheidsbronne het. (Translation of Afrikaans paragraph follows.)
[Together with other role-players within national and provincial government, we are ready to start the fight against poverty and inequality and bring about a new dispensation where there will be equal access for all to available health resources.]
The association between social and economic conditions and ill health is well established, whether socioeconomic status is measured in terms of income, education and employment or housing, people living in poor conditions suffer the worst health. Our care will therefore focus on strengthening the frontline of our health services by providing seamless primary level services, community-based care and preventive care, while maintaining a core of essential, highly specialised health care services. We also need to promote good health and healthy lifestyles within our communities in line with the national programme of action, adopt urgent strategies to recruit and retain health professionals, especially nurses, to ensure the future stability of the health services.
In building on the national Budget, we are spurred on by the goals set by the Minister in her budget speech. Those goals speak to our health departments and we need to work to increase the impact of the campaigns against alcohol and substance abuse, smoking, unsafe sexual behaviour and unhealthy behaviour in general.
It also addresses the important matter of the health of our women and our children. Much work still needs to be done to provide women with adequate preventative and curative interventions. In this regard we will give more attention to the management of rape victims, and screening for cervical cancer. At the same time, we will more vigorously tackle diarrhoeal diseases and expand the programme of immunisation that impacts directly on the health of our children.
Allow me also to highlight some of the critical areas in which we are building on the Minister’s budget. In the 2005-06 financial year the Western Cape will receive R1,2 billion from the national tertiary services grant to help fund three central hospitals, namely Groote Schuur, Tygerberg and the Red Cross Children’s Hospital. A large percentage of the health professions training and development grant received from the national department will also go to these hospitals.
Programme wat MIV en Vigs aanspreek sal R82 miljoen van die nasionale omvattende MIV en Vigs-toelaag ontvang. Dit spreek direk tot die regering se verbintenis om MIV en Vigs as deel van ’n omvattende program aan te spreek. Daar word op hierdie fondse voortgebou om ’n totaal van R167 miljoen vir die program in die jaar beskikbaar te stel. (Translation of Afrikaans paragraph follows.)
[Programmes that address HIV and Aids will receive R82 million of the national comprehensive HIV and Aids grant. It relates directly to the government’s commitment to address HIV and Aids as part of a comprehensive programme. These funds will be augmented so as to be able to make available a total of R167 million for the programme during this year.]
The treatment of tuberculosis remains a priority and will this year receive a total of R70,7 million in the Western Cape, of which R64,1 million is budgeted for TB hospitals. This is strengthened by R4,4 million for additional staff and laboratory services at our clinics. An amount of R2,2 million is also made available for the taking over of two municipal hospitals, in Paarl and Malmesbury, and the SANTA Harry Gumede hospital during this financial year.
The Minister, in her budget speech, stressed the importance of strengthening our mental health services and as result the amount of R4,9 million was allocated for the implementation of the Mental Health Care Act. Part of this funding will go towards the Mental Health Review Board, which will play an integral role in ensuring that the rights of the mental health care users are protected.
In line with national policy objectives, we have prioritised our hospital revitalisation projects. The R172 million received from the national revitalisation grant will help fund a variety of projects, such as those currently in progress in George, Worcester, Vredenburg. Work at the Paarl Hospital will commence during 2005, while planning is under way for the envisaged hospital in Khayelitsha.
Other major projects include the upgrading of the Mowbray Maternity Hospital, the Caledon and Riversdale Hospitals, a primary health care facility, a new clinic will be constructed at Brown’s Farm to replace the current container clinic, a new clinic will be constructed in Montagu, Elsies River will be upgraded as well as those at Simondium, Stanford, Swellendam and Wellington.
The department presently funds 320 student nurses, while the higher education institutions are training 115 registered nurses. This, together with a further intake of 74 nurse assistants at these institutions, as well as the colleges, will mean that more than 500 nurses are in training in the Western Cape at present. This is not enough but we are committed to recruiting and training more nurses in future.
In conclusion, this year will also see the implementation of the National Health Act, which will have far-reaching implications and challenges for the department, in particular the establishment of the provincial and district health councils and the provincial health advisory committee. This will build on government’s commitment to increase community participation in health care, the commitment that will also be visible in other areas, such as heeding the Minister’s call to work actively with our communities and our partners in supporting people to take more responsibility for their own health.
Furthermore, in bringing health closer to our people, this year will see the rapid expansion and improvement of community-based services in our province. These improvements include a new integrated model for home-based care and also for step-down facilities. So often we forget that health is about people caring for people, and about us having to care for our carers. Today we, as we must do every day, honour our carers and the noble work that they do. [Applause.]
As departement aanvaar ons dat ons by tye alles in ons vermoë moet doen om die beginsels van Batho Pele uit te leef, waarvolgens die mense eerste gestel word. Dit gaan juis oor die omgee vir ons mense en deur gesondheidsdienste te lewer waarop ons almal trots kan wees. [As department, we accept that at times we have to do everything in our power to carry out the principles of Batho Pele, in terms of which people are placed first. It is all about caring for the people and by providing health services that we can all be proud of.]
Allow me, Chairperson, to thank our hon Minister, our Deputy Minister and all the staff from the national department, but also in all the provincial departments and local government for the work that they do in caring for the people of this beautiful South Africa. I thank you. [Applause.]
Mr N S GININDA (Mpumalanga): Chairperson, hon Minister of Health, Dr Manto Tshabalala-Msimang, Deputy Minister Madlala-Routledge, hon MECs present here from different provinces, hon members of this distinguished House, ladies and gentlemen and comrades present here, I feel honoured today to be afforded this rare opportunity to address this august House.
This year we celebrate the 50th anniversary of the Freedom Charter. Contained in this historic document is the vision of a society that our people, who gathered in Kliptown in 1955, sought to create. They had already said then that South Africa belonged to all who lived in it, black and white, united in their diversity. These people envisaged a society where the state would play a central and pivotal role in the provision of key social services to its people.
The people’s charter says, and I quote:
A preventative health scheme shall be run by the state; and, free medical care and hospitalisation shall be provided for all, with special care for mothers and young children.
The ANC-led government gave an important impetus to the vision as contained in the Freedom Charter when it assumed power after the first democratic elections in 1994. Although faced with serious inherited apartheid debts, which inevitably would constrain any government in its efforts to provide much-needed social care to its citizens, the democratic government has reached commendable milestones towards the improvement of the living conditions of our people, thereby restoring their human dignity, which they had been denied by the then apartheid state for a very long time.
The health budget that we are to consider has been increased by 11,4%, with a further increase in the Medium-Term Expenditure Framework period. We are, therefore, confident that this will go a long way towards strengthening our capacity to respond to all challenges in the provision of effective, efficient and adequate health services to all our people.
One of these challenges, which remains a cause for concern, especially in rural provinces such as ours, is the mass exodus of health professionals either to urban provinces or overseas countries in what they call “looking for greener pastures”.
Just two months ago in our province we advertised 20 posts for professional nurses in two hospitals in the Nkomazi region, which is very rural. In one hospital we couldn’t even get a single application, whereas in the other we received just one. This is despite numerous interventions that have been introduced by the national department in the person of our Minister here, such as rural allowances, provision of free accommodation and others.
This also happens against the background of research results, which actually show that the salaries we pay in the public sector are more competitive than those in the private sector. We are, however, confident that through the efforts of our Minister, interacting with countries in the developed world, a mutual agreement on this issue shall be reached, and that many of those who left the country will come back and that more health professionals will follow them.
We have also made some interventions in our province by establishing a nursing college at the former Elijah Mango College of Education and have increased our student intake from 100 to 300 in the first year.
We are building comfortable houses in the rural areas for our health professionals and we will be looking into many other interventions that we need to make to retain these professionals in our rural areas.
We wish all our health students who study overseas and within the country everything of the best, and are looking forward to seeing them working in our rural hospitals after completing their studies.
Our Minister launched the Move for Health campaign in Alexandra just two days ago. We support this initiative because we share the sentiments that say that the health of each individual is actually his or her own responsibility. Accordingly, we will be hosting a provincial launch of this important campaign in our province on 10 June 2005, and we are going to cascade it down to all our municipalities in the province.
We also welcome the promulgation of the National Health Act last month, and we are convinced that these developments will undoubtedly revolutionise the health profession for all our people in the country.
We are pleased that this Act will address two important aspects in relation to provision of health care, that is accessibility and affordability.
We are further pleased by the commitment made by the Minister to provide free medical care to people living with disabilities. We also need to ensure that indeed all of our public institutions are accessible to them.
We would like to commend the progress made with regard to the Comprehensive Plan for the Management, Care and Treatment of HIV and Aids and the provision of antiretroviral drugs. We believe that returning to God and beseeching him to intervene is a prerequisite for the prevention and cure of the pandemic.
We have also made commendable strides in our province in the implementation of the comprehensive plan. Linked to this intervention, and equally important, are the efforts that must be made continuously to fight back the frontiers of poverty, because no matter how healthy you may be, if you have nothing to eat, you are obviously prone to diseases and frustrations.
Through all our programmes we need to create work and fight poverty so as to ensure that the living conditions of our people are improved and that we create a better life for all.
We will continue, without rest, to work towards building an efficient, effective and sustainable public health care system in our country. Our work is more unique than that of any other department in that we take care of people before they are born, we continue to take care of them for their lifespan and we take care of their next of kin, even after death.
Indeed, we care. Siyanakekela. [We care.] We are a caring and a humane society. Vuka South Africa; vuka Mpumalanga; move forward; move for health. Mpumalanga supports the Budget Vote. Thank you. [Applause.]
Mr S C SEKOATI (Limpopo): Thank you, Chairperson. Hon Minister, Deputy Minister of Health, hon members of the NCOP, fellow MECs present here, officials from the Department of Health, we feel honoured to participate in this historic debate when as a nation we are joining hands in celebrating the 50th anniversary of the Freedom Charter.
Primary health care, which is underpinned by the active community participation, remains the backbone of our health system. It is through our commitment to active participation that we have not only established clinic committees and hospital boards in line with the new National Health Act, but we have also launched district and provincial health councils.
The governing structures are well positioned to oversee the rendering of people-driven and people-centred service delivery as enshrined in the Freedom Charter, which remains a guiding document in our quest to create a better life for all our citizens.
We view promotion of healthy lifestyles as a foundation of our primary health care system. We ourselves, and our communities, shall continue to engage in undertaking physical exercise, and to put a stop to nauseating habits such as smoking and excessive use of alcohol. We will also continue to highlight our commitment to ensuring that no woman dies of pregnancy- related causes and no child dies of childhood illnesses. This commitment was demonstrated by the Minister of health, the hon Dr Manto Tshabalala- Msimang when she led the community of Turfloop, in Limpopo, in a walk on World Health Day under the theme “Make every mother and child count”.
The role of community health workers in providing health promotion and home- based care to those with debilitating conditions is critical. We commit ourselves to strengthening the Community Health Care Worker programme and to ensure that these workers are able to identify health care needs of communities and to refer them to the relevant health services.
We will remain focused on voluntary counselling and testing as part of our annual drive and encourage those tested to lead healthy lives. It is our aim to reach more clients with the condom distribution programme, where our primary health care facilities are a source of strength in management of sexually transmitted infections.
The department’s operational plan for the comprehensive HIV and Aids care management and treatment plan is the cornerstone of the departmental response to the HIV and Aids challenge. The operational plan was enriched by eight accredited ARV treatment sites, where some 10% of our patients currently receiving antiretroviral treatment are children.
The key element in the treatment is nutrition through a balanced diet and to this end all patients on ARV treatment are provided with nutritional supplements. The programme is backed by 10 facilities which provide step- down services, as well as 324 home-based care sites which support approximately 283 000 affected and infected individuals. The 1 047 caregivers attached to home-based care sites are currently given a stipend per month.
Our resource training centre is well positioned to train health professionals on the comprehensive HIV and Aids care management and treatment plan, to add to the current 305 health professionals that have already been trained.
While we strengthen our efforts to the management of HIV and Aids, TB remains a serious challenge, particularly the emergence of multidrug- resistant TB. To this end the department continues to focus on mobilising Dots supporters to ensure compliance by those patients on TB treatment.
Our multidrug-resistant centre is also completed and will be commissioned during this financial year. Much as we continue to encounter fatalities due to malaria, the number of malaria fatality cases remains stagnant. Thanks to our structured spray programmes we shall endeavour to improve and increase on the number of structures being sprayed in the endemic areas.
The budget of the hospital revitalisation has increased from R106,5 million in 2004-05 to R212,9 million in this financial year and it is through the availability of those funds that Lebowakgomo Hospital is almost complete, while Dilokong at Jane Furse will also be completed later this year.
The department also benefits from a provincial infrastructure grant and some of these funds are utilised to upgrade our clinics and to provide electricity and a reliable source of water to these primary health care centres.
The shortage of the staff in both the administrative and the health professionals’ fraternity remains a challenge that will take a number of years to bring to acceptable levels. Our ability to recruit and retain health professionals is difficult to manage because of the rural nature of our province.
The rural and scarce skills allowances introduced over the past year have assisted us to retain a few more professionals. This was augmented by our own initiatives on adjusting the entry salary levels for doctors and pharmacists. An additional budget has been set aside for the recruitment of additional staff where vacancies exist and is critical for service delivery.
We have also set aside funds to provide bursaries in an effort to attract students in critical areas to work for the department after completion of their studies.
The involvement of our citizens remains an important part of the way in which we conduct our service delivery. The departmental imbizos are held throughout the province, where the community is given opportunities to speak about expectations and later to be given feedback on issues discussed.
May I take this opportunity to acknowledge the leadership that the Minister has provided in setting strategic priorities and targets for the health services and to congratulate her on the unique manner in which these priorities have been highlighted in her budget speech.
Minister, you can rest assured of our full support towards achieving the priorities and we support the Budget Vote. Thank you. [Applause.]
Nk N F MAZIBUKO: Sihlalo, mangibingelele uNgqongqoshe kanye nePhini lakhe, oNgqongqoshe abavela ezifundazweni zonke kanye namalungu. Ngethemba ukuthi abaningi bese beshilo ukuthi ngoMsombuluko uNgqongqoshe ubethula uhlelo laphayana oluthi “Vuka Ningizimu Afrika”. Simbonile-ke uNgqongqoshe kumabonakude ezijuxuza elahla umlenze laphaya elokishini langempela e- Alexandra. Ngethemba ukuthi iningi labantu lizozejwayeza ukuzelula imizimba. Ngisho nalapha kukhona nejimu. Abaningi abazi nokuthi umnyango wakhona unjani. Ngethemba ukuthi abaningi bazoke bayogijima phezu kwalokhu okubizwa ngama- treadmill nabanye bashove namabhayisikili. Inselelo lena esiyiphonselwe nguNgqongqoshe yokuthi kusetshenziswane nomnyango wakhe ukuze iningi lethu lapha lingaphathwa yisifo senhliziyo ngenxa yamafutha.
Inkulumo yami namhlanje ngithanda ukuyifanisa nenja uma ngabe ibona imoto. Siyazi sonke ukuthi uma imoto imile ingenamasondo, izinja zilala kuyo futhi ziyinuke bese ziyichamela. Uma ihamba ziyayikhonkotha. Yilokhu-ke esikubonayo kwenzeka namuhla, ikakhulu kula maqenjana alwisana nenqubekela phambili. Thina sithi: Phambili Ngqongqoshe nempilo engcono, phambili!
Ngenyanga kaNhlolanja ikomidi lethu lezempilo lahamba lavakashela izifundazwe ezimbili, iGauteng kanye ne-North West. EGauteng savakashela isibhedlela saseNatalspruit kanye nesaseSebokeng. Esikutholile kuyakhuthaza kodwa okunye kuyadumaza. Kafushane nje, ziningi izinselelo kulezi zibhedlela.
Akuzona zodwa kodwa ziningi izibhedlela zethu, ikakhulukazi eziphethwe yithi singuhulumeni, ezibhekene nobunzima ngoba iningi labantu ligcwala khona ngenxa yokuthi alinamali. Abanye bane-medical aid kodwa ngenxa yokuthi abantu bayazethemba izizinda zethu zempilo beza babe baningi. Amaqenjana-ke lawa amancane uma ngabe ebona yonke le mihlola eyenzekalayo avele ayikhonkothe le nqola uma ngabe ihamba, ayichamele uma ngabe imile.
Esibhedlela saseSebokeng esikutholile ukuthi eminye imishini yeziguli ayisebenzi kanye nemali yokuyilungisa ayikho. Isibhedlela naso sesiqinisekisiwe, sabekwa ezingeni lesithathu kodwa kusafuneka siphucuke naso. Sekukhona negumbi lapho kulala khona abanezimali, njengamalungu ePhalamende nje. Kufanele axhase izibhedlela ezinjengalezo. Konke lokhu ngumsebenzi owenziwa inhlangano yabantu, i-ANC. Okwenziwa abanye uma bebona le misebenzi emihle ukuyikhonkotha.
Isibhedlela saseNatalspriut sona besisematheni nje ngonyaka owedlule. Abasebenzi bebetoyiza bethi kunonyawo lwemfene. Izinto sezisesimweni esigculisayo manje ngisho nemigqa iyohlala ilokhu ikhona ezibhedlela zethu. Igumbi labalimele lona lihlale ligcwele ngawo onke amahora ngoba abantu bayasethemba. Uma ngabe ulandela futhi nalaphaya okulandwa khona imithi, okuthiwa phecelezi “dispensary”, abalanda imithi bangakutshela ukuthi kuvukwa ngasikhathi sini. Kuvukwa ngehora lesine ukuze ube ngowokuqala emgqeni, ngisho laba okuthiwa bayaphinda.
Lokhu kuyabonisa ukuthi kusenesidingo esikhulu kwesikwenzayo kanti namakhambi abawatholayo ayabelapha. Konke lokhu sikwenza ngoba abantu basivotela. Sithi phambili ngempilo engcono! Abanye bona bayayichamela uma ngabe imile, bajike bayikhonkothe uma ngabe ihamba. [Uhleko.] Iqiniso ukuthi izinga lezempilo lapha eNingizimu Afrika lisezingeni eliphakeme.
Ezinye izinselelo ezikulezi zibhedlela yizinkinga zabahlengikazi laba esibaqeqeshayo. (Translation of isiZulu paragraphs follows.)
[Ms N F MAZIBUKO: Chairperson, I would like to start by greeting the Minister and the Deputy Minister, the MECs from all the provinces and members. I believe that it has been mentioned by most people here that on Monday the Minister launched a project called “Vuka Ningizimu Afrika”. We saw the Minister on TV, performing her slick dance moves in Alexandra, the real township.
I do hope that most people are going to exercise their bodies. There is a gym here, but most members have never set foot in that gym. I hope that most members will start to run on the treadmill, while others pedal on cycles. The Minister has challenged us to co-operate with her department in order to avoid being afflicted by heart diseases owing to the accumulation of fat.
I would like to compare my speech today to what happens when a dog sees a car. We all know that if a car is stationary and has no wheels, dogs sleep inside, sniff it and urinate against it. If it is moving, they bark and chase it. That is what we see happening today, especially these smaller parties that are against progress. On our part, we say: Minister, forward with a better life. Forward! In January our health committee visited two provinces, namely Gauteng and the North West. In Gauteng we visited the Natalspruit and Sebokeng Hospitals. Some aspects we observed there were encouraging and some were disappointing. In short, there are many challenges faced by those hospitals.
It’s not just these two that face difficulties, particularly among government hospitals, because most patients who go to such hospitals are poor. Even though some of them do have medical aid, they prefer to come to our facilities in their numbers because they trust them. When the smaller parties observe these unusual happenings, they bark at this vehicle when it moves and urinates against it when it is stationary.
At Sebokeng Hospital we observed that some medical equipment was not working and there was no money for repairs. This hospital has been upgraded to level 3, but still needs to be developed. A special ward has been set aside to cater for those who are well off, such as members of Parliament. Members need to support hospitals like these. All this is part of the work done by the people’s organisation, the ANC. When others observe this commendable work, they bark.
Natalspruit Hospital was in the news last year. Workers were toyi-toying and claiming that there was corruption. Things are back to normal now, and long queues will always be present in our hospitals. The casualty ward is always full because people have confidence in this hospital. Those who collect medicines from the dispensary can also attest to the fact that you have to come very early. You have to be up by 4 o’clock in the morning in order to be the first one in the queue - I am referring to those who come to fetch their repeat medicines.
This shows that there our services are in great demand and that the medicines dispensed really help the patients. We do all of this because people voted for us. We say: Forward with a better life! Some urinate against a stationary vehicle, and bark when it is moving. [Laughter.] The truth is that the standard of health care is very high in South Africa.
Other challenges faced by these hospitals concern the nurses that we train.]
Ms J F TERBLANCHE: Chairperson, I rise on a point of order. I want you to make a ruling on whether it’s parliamentary to say parties are urinating on things, because I think it’s unparliamentary. Would you please make a ruling on that?
The DEPUTY CHAIRPERSON OF THE NCOP (Ms P Hollander): Are you ordering me to make a ruling? I think I’m still the Chair in this House, thank you. Sit down. That is not a point of order. You may continue, hon member.
Ms J F TERBLANCHE: Chairperson, on a point of order . . . [Interjections.]
The DEPUTY CHAIRPERSON OF THE NCOP (Ms P Hollander): Will you please sit down, Ms Terblanche. You said: “Will you make a ruling?” Will you please sit down? I will give the ruling now: Will you please sit. Will you please sit down. Thank you. Proceed with your speech hon member.
Nk F MAZIBUKO: Ezinye izinselelo ezikulezi zibhedlela yizinkinga zabahlengikazi. Siyazi sonke ukuthi abahlengikazi siyabaqeqesha kodwa onxiwamali bayabathatha baye nabo phesheya. Uhulumeni wabantu uyabaqeqesha kodwa uma besuka lapho bayayikhonkotha uma ngabe ihamba, bayichamele uma ngabe imile. [Uhleko.] Sixoxisana nezwe lamaNgisi ukuze iningi labahlengikazi abaye ngaphesheya kwezilwandle likwazi ukuphinda libuye, lingalahlekelwa imisebenzi.
Namuhla siyazigqaja ngokuthi sekwakhiwe imitholampilo eyi-1 300 ezweni lonke kanye nezibhedlela ezingama-30 seziphuculiwe, abakhulelwe nabo bayakwazi ukuthola amakhambi ukuze bangedluliseli igciwane ezinganeni zabo, nabakhubazekile nabo bathola izihlalo ezinamasondo abazithola mahhala, njalo njalo. Konke lokhu sikwenza laba bamaqenjana amancanyana bengakujabuleli. Isisho sesiZulu-ke lesi ebese ngisishilo ngaphambilini sithi uma ngabe ihamba bayikhonkotha, uma ngabe imile bayayichamela. [Uhleko.]
Kuningi-ke osekwenziwe uhulumeni kaKhongolose eminyakeni eyishumi. Olunye nje uhlelo olubalulekile yilolu lwezimo eziphuthumayo lapho kusindiswa khona izimpilo zabantu – lokhu esikubiza phecelezi, “emergency services”. Yebo, sinesivumelwano nohulumeni basekhaya, lesi esisibiza ngokuthi yi- Memorandum of Understanding, MOU. Lolu hlelo kukaningi luphathwa yibo.
Ngithanda-ke ukwenza isibonelo salaphaya engivela khona eSoweto – nami sengisebenzela ekhaya njengelungu uDlulane. EDiepkloof kusebenza kuphela i- ambulense eyodwa kepha abantu bayizi-100 000. Laphayana eJabulani kunama- ambulense amahlanu kuphela futhi nawo ajike abheke izindawo ezinjengo Deep Soweto, eMshayazafe naseZola eMabhodini. EDobsonville khona izinqola zimbili kuthi eSoweto ibe yinye kuphela inqola lena esiyibiza ngokuthi yi- response car. Isebenza kuphela emini kanti ebusuku ayisebenzi. Isimo sibi kangangoba uma ngabe kuvele ingozi, kuphendula kuqala izicimamlilo kube yizona ezifika kuqala ngaphambi kokuthi kufike ama-ambulense. Engifuna ukukusho kakhulu ukuthi kubalulekile ukuthi lo mnyango masiwubheke kahle futhi siwengezele imali ukuze wonke umsebenzi esiwenzayo ubonakale nabantu babe bephephile.
Uma sengiphetha, ngithi isabiwomali saseGauteng empeleni senyuke nje kuphela ngama-4% uma ngabe uqhathanisa nabantu abangama-20%. Empeleni uma ngabe sibhekisisa, sizobona ukuthi iningi labantu liye lilibhekise eGoli ngoba becabanga ukuthi kukwandongaziyaduma. Bashiya izifundazwe zabo ngemuva bephokophele phambili kodwa ngokwemali, asiyitholi kahle ngoba imali esiyitholayo iba ncane.
Ngithanda futhi nanokuthi uma ngabe uNgqongqoshe esebenzisana nazo zonke izifundazwe, kubhekisiswe kakhulu nale ndaba yokudatshulwa kabusha komasipala. Le ndaba ikhombisa ukuba wuhlupho uma ngabe siqhathanisa nezigidigidi zamaRandi lezi ezinikezwa bona.
Izifo ezithathelana ngokocansi nazo zisasihlupha kakhulu. Zibamba iqhaza elikhulu ekubhebhethekiseni isifo seNgculazi. Siyazi-ke sonke ukuthi alikho ikhambi eliselaphayo lesi sifo. Okubalulekile ukuthi sizivikele, kuthi uma ngabe siya ocansini, sifake ijazi lomkhwenyana kanjalo nabesifazane nabo benze njalo.
Kulesi sabiwomali salo nyaka, ngibone ukuthi kunemali engangezigidi eziyi- 14 zamaRandi ebekwe eceleni ukuze kuthengwe amajazi. Nokho, uma ngabe ngibhekisisa, thina besifazane asibalwanga kule mali. Abesilisa bano- Choice, ama-Rough Rider, ama-Durex nama-Latex kepha thina besifazane sinalokhu kuphela okubizwa ngokuthi ama-Femidom. [Uhleko.] Kubalulekile-ke ukuthi siziphathe kangcono ngaphambi kokuthi siye ocansini. Ubeseshilo noNgqongqoshe ukuthi ukuze siphile kahle futhi singabhujiswa yilesi sifo esiwubhubhisane, kubalulekile ukuthi siye ocansini oluphephile.
Maqondana nalawa abesifazane, baye bathi uma ngizolisebenzisa kufanele ngilifake kusasele amahora ayisishiyagalombili ngoba uma ngabe ngingalifaka sekuqhubeka umsebenzi, lizongibangela umsindo. [Uhleko]. Lawa awabesilisa wona bawakhipha masinyane. Masikhumbuleni-ke ukuthi uma ingekho i-Choice awukho umdlalo, uma ikhondomu ingekho alukho ucansi. Ikomidi liyaseseka isabiwomali. [Ihlombe.] (Translation of isiZulu paragraphs follows.)
[Ms N F MAZIBUKO: The other challenges facing these hospitals relate to nurses. We all know that we train nurses here but the capitalists take them away to countries overseas. The people’s government trains them. They then bark when it moves, and urinate against it when it is stationary. [Laughter.] We are in discussion with Britain so that most of those nurses who went overseas could return and not lose their jobs.
Today we are very proud that 1 300 clinics have been built throughout the country and 30 hospitals have been upgraded. Those who are pregnant also get medicines so as not to pass the virus on to their babies, while the disabled also receive free wheelchairs, etc. While we do all of this, the smaller parties do not approve of what we do. As I have mentioned earlier on, the Zulu have a saying, when it moves, they bark, and when it is stationary they urinate against it. [Laughter.]
A lot has been done by the ANC government in the past 10 years. Another very important programme is the emergency services, that save people’s lives. Yes, we have an agreement that is called a memorandum of understanding, an MOU, with the local government. They, in the main, run this programme.
I would like to give an example of where I come from in Soweto – I also work from home, like hon member Dlulane. In Diepkloof there is only one ambulance operating, yet there is a population of 100 000 people. In Jabulani there are only five ambulances, but they also operate in places like Deep Soweto, Mshayazafe and Zola in Mabhodini. In Dobsonville there are two response cars, while in Soweto there’s only one. It only operates during the day and not at night. The situation is so bad that if an accident occurs, the fire brigade responds first and arrives before the ambulance. What I particularly want to say is that it is very important that we look after this department very well, and allocate further moneys so that the work we do is recognised and people remain safe at the same time.
In conclusion, I think the Gauteng budget actually increased by only 4% compared to the population of 20%. In fact, if we look closely, we will note that many people are going to Johannesburg, hoping to get something better. They leave their provinces behind and head forward, but in so far as the money is concerned, we are not getting enough.
I would also like to say that when the Minister works with all the provinces, we should look at redefining the municipality issue, which poses a threat if we look at the billions of rands that they were allocated.
Sexually transmitted diseases are also troubling us. They play a very big part in spreading the HIV/Aids infection. We all know that there is no cure for it. What is important is that we protect ourselves by using a condom when having sex, and so should women.
In this year’s budget I noticed that R14 billion has been put aside for purchasing condoms. However, if I look closely, I see that we, women, were not included in this budget. Men have Choice, Rough Riders, Durex and Latex condoms, but we women have only what is called the Femidom. [Laughter.] It is therefore very important that we behave accordingly before we indulge in sexual activities. The Minister has already mentioned that for us to be healthy and not to die from this destructive disease, it is important to practise safe sex.
With regards to female condoms, they say if I am going to use it, I must put it in eight hours before because if I put it in during the action, it will make a noise. [Laughter.] The males ones are removed immediately. Let us remember, “No Choice, no game” and “No condom, no sex”. The committee supports the budget. [Applause.]]
The MINISTER OF HEALTH: Sihlalo, mangikusho ukuthi ngiphatheke kabi kakhulu ngenxa yokuthi ngeke ngikwazi ukuphendula yonke imibuzo, ngoba esikhathini esithi asibe yimizuzu eyi-10 kufuneka ngibe sengisesikhumulweni sezindiza.[Chairperson, I would like to state my concern that I won’t be able to respond to all the questions, because in ten minutes’ time I should be at the airport.]
I am going to New York for a high-level discussion on HIV/Aids. This is part of a mid-term report of the UNGASS declaration. And I must just say that when I get there, I am going to underline a few things, one of which, indeed, because I’ve been asked to speak on treatment, care and support on the panel, is to underscore that there are traditional medicines that actually help, that have been proven scientifically.
And we are not talking unproven things here; they have been proven scientifically. And, therefore, once the report is out and once we have demonstrated people have been using them; there are lots of anecdotal stories about the effectiveness of traditional medicine.
I shall also talk about the importance of nutrition, which is part of our comprehensive plan. I will also be underscoring the importance of nutrition to ensure that we prolong the progression from HIV to Aids, because we think that that is very important.
I shall also stress that we are not ashamed, Mama Lamoela, that in fact we have questioned the reason South Africa should be blamed for the WHO not reaching its three-by-five targets. We were not there when they set these targets. It is their own targets, and so if they fail to reach them they must not use us as scapegoats. It is not correct. [Applause.] We have our own targets as South Africa, and we will stick to them.
In fact, you do not know that when I was in Geneva I met with the Director- General of WHO, who apologised profusely for the statements made by his officials. So I don’t know who you are speaking for when you blame your own country, saying that we are not reaching the three-by-five targets. I don’t know who you are speaking for. You must tell us which passport you hold. [Interjections.]
The DEPUTY CHAIRPERSON OF THE NCOP (Ms P Hollander): Order! Order! [Interjections.]
The MINISTER OF HEALTH: No, I don’t want to sit, I want to listen to you speak like a South African, and I don’t need to see your passport. [Interjections.] I shall be . . . [Interjections.] . . . micronutrients as well, because I don’t think that we should be led up the garden path, into believing that the only thing we must use is antiretrovirals. I think that is not correct.
In the first instance we were told that antiretrovirals have very serious side effects. Now, when we talk about those side effects, it is wrong. We were told that you must monitor your patients in terms of their CD4 count and viral load. Now we are being told that, “No, it doesn’t matter for resource-constrained countries; you can just give them antiretrovirals. Just look at the wellness.” We will not do that.
We will continue to improve the health care system in this country so as to reach our own targets that we have set for ourselves. So these are the things that I will be saying in New York, in support of our comprehensive plan. I am going to say it vigorously and clearly enough that they understand where South Africa stands.
Chairperson, as I say, I am sorry that I am not going to be able to respond to all the comments made by hon members. I might take the opportunity to write to some of the members, especially those that I have not been able to respond to, and tell them where they make mistakes, particularly in their own comments.
Mama Vilakazi, I am hoping that you listened to other provinces as they talked about the human resource problems that we are facing. It seemed to me you have not been listening to us as we have been articulating some of the problems that we face, and what it is that we are trying to put in place to ensure that indeed we recruit and retain our health workers and health professionals. You were not listening.
But in your input you did not give us any suggestions as to what we should do. It is one thing to point fingers, but you must have suggestions as to how as South Africans we must address these issues. I think that is very important.
Hon Setona, thank you very much for reminding us where we come from, because the Freedom Charter is the basis for our Constitution. It is the basis for the legislation that we have put in place, for policies and programmes in the health sector and in the country generally.
We think that we must continue to educate those who do not know about the Freedom charter. We must, because you do not know of any other charter anyway. So the only charter that is available to you is the Freedom Charter. So I think you must subscribe to the charter. [Interjections.] [Applause.]
The DEPUTY CHAIRPERSON OF THE NCOP (Ms P Hollander): Order, hon members. Order! Will you please give the hon Minister time to complete her contribution. [Interjections.]
The MINISTER OF HEALTH: So if you don’t know what it is that we are doing, please ask the officials to come and brief you, even about the problems that we are experiencing with the hospital revitalisation programme. Don’t just think that we are we resting on our laurels. It cannot be that yesterday we were fighting for the improvement of the quality of the lives of our people, and today we are just dumping them. It is a contradiction in terms. It is not possible.
Come on board. Offer suggestions. Let’s work together. But if your suggestions do not add quality to what we are doing, you can keep them. [Laughter.]
As I said, I will not respond directly to each and every point raised by hon members in this House, but allow me just to express my appreciation to the Deputy Minister, the MECs for health and members of this House who have spoken in support of the Budget Vote for Health.
It is only through unity in action that we can achieve our goal of better health for all our citizens. Of course there will always be detractors who will find fault with our genuine efforts to improve the lives of our people. I will not respond to their criticism. “Engahambi iyachanyelwa; ehambayo iyakhonkothwa.” [Ihlombe.] [The stationary car is urinated against; the one in motion is barked at. [Applause.]]
I would rather use this opportunity to congratulate you, Chairperson, and members of this House for the decision you made to take the NCOP to the people, that is to hold your meetings in the various parts of our country. We are committed to supporting this initiative as the Ministry and the Department of Health. We would gladly participate in this initiative whenever we are required and requested to do so. Please join us in our healthy lifestyles. Vuka, South Africa! Move for your health! Vuka, South Africa! Move for your health!
During these campaigns we do something unheard of in this country. We screen our people for various diseases, hypertension, diabetes, cholesterol, cancer of the cervix, cancer of the breast and indeed prostate cancer. We think it is absolutely critical to raise awareness amongst our people so that they know what South Africans suffer from and to know the burden of illness in our country. And you can see they come in hundreds. In fact, we are overwhelmed by the number of people who come for screening. But we just don’t stop there. We also refer them to the facilities so that those who have illnesses are taken care of.
With these few words, I thank this House for supporting the budget of the national Department of Health. In gratitude for that, may I invite all of you to a cocktail party in the New Wing restaurant immediately after the debate. But unfortunately I will not be able to join you because I am already late. I should immediately move to the airport. Thank you very much. [Applause.]
The DEPUTY CHAIRPERSON (Ms P Hollander): Order! Order! Hon members, order please!
The CHIEF WHIP OF THE COUNCIL: Chairperson, I want to say two things, briefly. Firstly, earlier on I indicated that we did not receive any apology from the hon Rev Adolph. I have since discovered that his apology was sent directly to the Office of the Chairperson, hence the Whippery was not aware of it.
Secondly, I want to request that the standard of interpreting be looked at. In African languages there are certain proverbs which, when directly interpreted, may sound offensive, such as when you say: “Ayihlabi ngokumisa”. You cannot say: “It does not stand by stabbing.” [Laughter.]
The DEPUTY CHAIRPERSON OF THE NCOP (Ms P Hollander): Thank you, hon Chief Whip. That concludes the debate. Thank you, members. I want to thank the hon Dr Tshabalala-Msimang for her presence here today in our House. Thank you, Minister, for your important input and information regarding health services in our country. We wish you well on your trip to New York, America.
Take care. May you be blessed in your work, and we thank you for your contribution to society.
Debate concluded.
The Council adjourned at 17:57. _____
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS
ANNOUNCEMENTS
National Assembly and National Council of Provinces
- Introduction of Bills
(1) The Minister of Trade and Industry
(i) Patents Amendment Bill [B 17 – 2005] (National Assembly –
sec 75) [Explanatory summary of Bill and prior notice of its
introduction published in Government Gazette No 27529 of 26
April 2005.]
Introduction and referral to the Portfolio Committee on Trade and
Industry of the National Assembly, as well as referral to the
Joint Tagging Mechanism (JTM) for classification in terms of Joint
Rule 160, on 2 June 2005.
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.
-
Membership of Committees
(1) The following changes have been made to the membership of Joint Monitoring Committees, viz:
Improvement of Quality of Life and Status of Women Appointed: Mazibuko, Ms N F Discharged: Madlala, Ms N M
TABLINGS
National Assembly and National Council of Provinces
-
The Minister for Safety and Security
Agreement between the Government of the Republic of South Africa and the Government of Bulgaria on Police Cooperation, tabled in terms of section 231(3) of the Constitution, 1996 (Act No 108 of 1996).
COMMITTEE REPORTS
National Council of Provinces
-
Report of the Select Committee on Finance on Appropriation Bill [B 7 - 2005] (National Assembly - sec 77), dated 1 June 2005:
The Select Committee on Finance, having considered the subject of the Appropriation Bill [B 7 - 2005] (National Assembly - sec 77), referred to it, reports that it has concluded its deliberations thereon.
-
Report of the Select Committee on Security and Constitutional Affairs on Citation of Constitutional Laws [B5B-2005] (National Assembly- sec 75), dated 1 June 2005:
The Select Committee on Security and Constitutional Affairs, having considered the subject of the Citation of Constitutional Laws Bill [B 5B - 2005] (National Assembly – sec 75), referred to it, reports that it has agreed to the Bill.