WEDNESDAY, 7 JUNE 2006

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          PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES


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The Council met at 15:04.

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.

             NINETEEN PEOPLE INJURED IN SASOL EXPLOSION

                         (Draft Resolution)

Mr C J VAN ROOYEN: Chairperson, I move without notice:

That the Council –

 1) notes with shock that 19 people were injured during an explosion at
    the Sasol plant in Sasolburg yesterday;


 2) further notes that this is the sixth serious explosion at this
    plant since July 2004;

 3) extends its best wishes to the injured and wishes them a speedy
    recovery; and


 4) calls on the Sasol management to stop “putting profits before
    workers” by providing a safer working environment for all its
    workers at all its plants.

Motion agreed to in accordance with section 65 of the Constitution.

                         APPROPRIATION BILL


                           (Policy debate)

Vote No 16 - Health:

The MINISTER OF HEALTH: Chairperson of the NCOP, hon members and MECs present, when I addressed this House last year, I committed the Department of Health to implementing a range of interventions aimed at strengthening the delivery of services at all levels of the health system. I am therefore pleased to return to this House to report on what we have achieved.

I will focus on both the achievements of the health sector during 2004-05 and 2005-06, as well as on the priorities for 2006-07 that the National Health Council, which has representation from all three spheres of government, adopted in January this year. I would also like to use this opportunity to outline our plans for utilising the resources allocated to us from the national fiscus for the financial year 2006-07.

Chairperson, in 2005 we informed the National Council of Provinces that we were going to finalise the National Human Resources Plan for health. I am glad to report to this House that on 7 April 2006, we launched the NHRP for health at a function attended by the regional director of the World Health Organisation Africa Region. The day of 7 April was observed as World Health Day and it was dedicated to celebrating the efforts of health workers throughout the world under the theme: “Working Together for Health.”

Although we now have a national plan for human resources, we need to cascade this plan to provincial level. During 2006-07 we will support all provinces to develop provincial human resources plans. These plans will outline strategies for improving the production, distribution, recruitment and retention of health personnel in each province.

Health workers are the most valuable and treasured asset of our national health system. Chairperson, this year we will finalise the discussions with National Treasury and the Department of Public Service and Administration to improve the remuneration packages of health workers. This is one of the critical aspects in our strategy to recruit and retain our health workforce.

Hon members, you will recall that the President raised the issue of re- opening nursing colleges in his state of the nation address in order to increase the number of nurses that we train nationally. We are set towards achieving this during 2006-07. The Department of Health is committed to ensure a steady supply of health workers to ensure good quality service delivery to communities.

We have already started with increasing the number of intake into nursing colleges in some provinces this year. For instance, the number of new nursing students registered in the Free State doubled from 130 in 2005 to 250 in 2006, and also in Limpopo from 100 to 210 during the same period. Gauteng increased from 689 to 862, North West from 276 to 350 and Western Cape from 522 to 538. We expect other provinces to join this upward trend in the number of students admitted to our nursing colleges.

Chairperson, primary healthcare services constitute the first level of care for our communities. These health services are provided by health workers in communities, in clinics, in community health centres and in district hospitals.

The number of people utilising these services increased significantly across provinces between 2003-04 and 2004-05. This illustrates that our people have confidence in the primary health care services that the public sector provides.

In the Eastern Cape, PHC headcounts increased from 13,9 million in 2003-04 to 17,7 million in 2004-05. In KwaZulu-Natal headcounts increased from 18,5 million in 2003-04 to 18,8 million in 2004-05. In Mpumalanga figures increased from 6 million visits in 2003-04 to 6,5 million in 2004-05. The PHC utilisation rates for under-fives also increased in the Eastern Cape, Mpumalanga and Western Cape between 2003-04 and 2004-05.

During this financial year we will continue to support provinces as well as districts to strengthen planning, implementation, monitoring and reporting. At district level we will place particular emphasis on the production of good quality District Health Plans to, amongst other things, strengthen clinic supervision, improve immunisation coverage and further increase the quality and the utilisation of our PHC services.

These plans will be synchronised with the integrated district development plans of local government. They will outline the level of intersectoral collaboration that will be reached between health and other government departments. The district health plans are beginning to contribute to the development of provincial plans.

Hon Chairperson, the PHC approach extends far beyond the confines of health facilities and incorporates community settings where our people live and work. During 2005-06 we undertook a number of healthy lifestyle campaigns and by September 2005, 21 000 community members had participated in these campaigns initiated by the national department.

In addition, more than 2 000 people were screened for eyesight, oral health, blood sugar, blood pressure and body mass index during these campaigns. I should add that these numbers will become significantly larger once we add the efforts of provincial departments of health.

During 2006-07, we will expand our healthy lifestyle programme to districts and local municipalities, schools and workplaces. Thousands of schools will be assisted to establish school-based food gardens, to implement tobacco control programmes and the strategy on diet, physical activity and health. Health promoters will be trained in all provinces to implement this strategy. We intend that these programmes reach 5 000 schools during this year.

We also contributed during the past year, Chairperson, to enhancing women’s health by improving access to reproductive health generally, including access to choice on termination of pregnancy services. We produced a seven- year evaluation report on the implementation of the Choice on Termination of Pregnancy Act focusing on the period 1997 - 2004. The evaluation shows that access to termination of pregnancy has increased every year over this seven-year period. About 76% of TOPs were conducted in the first trimester of pregnancy as recommended and about 24% in the second trimester.

We have also strengthened the implementation of the roll-back malaria strategy in the three malaria endemic provinces, namely KwaZulu-Natal, Limpopo and Mpumalanga. Between 2004 and 2005 there was a 46% reduction in the number of malaria cases and a 38% reduction in the number of deaths.

The decline in the number of malaria cases, as well as fatalities, is due to the increase in the number of houses covered by the indoor residual spraying programmes using DDT and improved collaboration with neighbouring countries. Coverage with indoor residual spraying increased to 83% during 2004-05, and is set to increase further to 90% during 2006-07.

Our success with the responsible use of DDT has convinced the WHO to revise its own malaria control strategy, which until now was largely centred on the use of impregnated bed nets. In fact the sssistant director-general of the WHO responsible for malaria visited us in April to learn from our experiences in this regard.

Whilst we are doing well in reducing both the cases and fatalities, the case fatality rate for malaria is marginally above our own national target of 0,5%. Multiple factors contribute to this, such as imported malaria cases in cross-border areas, delayed presentation and case management challenges at health facility level. Moving into 2006-07, I am convinced that the health sector will reverse this trend as the three malaria endemic provinces are now using the more effective artesunate-based combination therapy for malaria, training more health workers and improving coverage of indoor residual spraying, as already mentioned.

Chairperson, tuberculosis continues to pose a challenge to the public health system, with cure rates of 56,7%. Our efforts to counter this disease amongst others focused on improving the directly observed treatment short course programme and improving the laboratory services.

In line with the resolution adopted by WHO/AFRO last year to declare TB an emergency, we launched a National TB Crisis Management Plan during this year’s TB Day. We have identified four districts in three provinces as focus areas due to the high number of cases and poor cure rates in these districts.

These districts are Amatole and Nelson Mandela Metro in the Eastern Cape, eThekweni Metro in KwaZulu-Natal and the City of Johannesburg in Gauteng. In developing district level plans in each of these districts we have held meetings with both the province and local government, so that the plan integrates the efforts of all three spheres of government.

Chairperson, we have also strengthened our efforts to combat HIV and Aids. We continue to implement the comprehensive plan for the management, treatment and care of HIV and Aids. Since our last report to the NCOP, voluntary counselling and testing services have been made available in all fixed clinics and community health centres in the Eastern Cape, Gauteng, Mpumalanga, the Free State, KwaZulu-Natal and the Western Cape, and in most district health care facilities in other provinces.

Services to prevent mother-to-child transmission of HIV are now also offered in 100% of facilities in KwaZulu-Natal and the Western Cape and in about 70% of facilities in other provinces.

In keeping with the WHO/AFRO resolution declaring 2006 as the year of accelerated prevention of HIV, we are finalising the implementation of our accelerated HIV prevention strategy, which will be more targeted in its messaging and approach.

Hon Chairperson, the emergency medical services is the interface between communities and primary health care services and hospitals in times of crisis. We have worked hard to improve this service during the last financial year.

The provision of ambulances increased in many provinces benefiting especially rural parts of the country. In four provinces, ie the Eastern Cape, KwaZulu-Natal, Mpumalanga and Gauteng, a comparison of the availability of ambulances during 2003-04 and 2004-05 shows significant increases during the latter period. The number of emergency calls, as well as patients transported on a routine basis, increased in these provinces between 2003-04 and 2004-05.

Although the number of hoax calls to EMS has decreased, it still remains a challenge. We plead with our communities not to call out ambulances when not needed, as this reduces the availability of this service to those in need. A hoax call could compromise the life of a person in real need of emergency medical care.

During 2006-07 all nine provinces will produce plans to strengthen EMS. An acute shortage of paramedics still affects the provision of EMS. The department will be addressing this as part of the implementation of the NHRP for health by accelerating the training of EMS personnel.

By strengthening our EMS for our own patients, we are also contributing to the national effort to prepare for the 2010 Soccer World Cup. I wish to assure hon members that the health sector will be ready and able to deal with any eventuality that is posed by our hosting of the nations of the world in 2010.

Chairperson, we have also strengthened our efforts to improve quality of care at public hospitals. It is our policy that hospitals should continuously assess the quality of the services that they provide to their communities and take stock of the outcomes of service provision.

In keeping with this, 100% of district hospitals in the Free State, Gauteng and the Western Cape have held monthly morbidity and mortality meetings. We want all clinical departments to conduct clinical audits and peer reviews. During 2006-07 we will strengthen the monitoring of complaints from users of our health services.

We will also strengthen the quality of care in hospitals by implementing hospital improvement plans in each and every hospital as of January this year. This covers minor maintenance issues like the fixing of broken windows and leaking taps, and includes critical matters like improvements in infection control and conducting clinical audits.

In addition, we have commenced with a process of strengthening hospital management. Delegations to hospital CEOs, as well as capacity to use the delegations, are under review. We are confident that we will meet the deadline of September set by the President in the state of the nation address.

Chairperson, we wish to raise the issue of the utilisation of budgets provided to the health sector. The National Treasury acknowledged in its press release of 28 April 2006 that health sector expenditure has grown when compared to previous years. During 2005-06 the health sector spent R46,9 billion of the allocated budget of R47,2 billion, which amounts to 99,5%.

With regard to capital spending which was previously an area of concern, the National Treasury pointed out that provincial health departments had spent R3,8 billion of the allocated R4,1 billion for the 2005-06 financial, year which amounts to 92,4% of the budget.

On the whole, Chairperson, provincial departments of health recorded many significant achievements during the last financial year. The budget for the public health sector has grown from R33 billion in 2002-03 to R51,7 billion in 2006-07, and stands to grow to R60,8 billion in 2008-09.

The nominal increase in provincial budgets is 11,6% and the real increase is 7,4%. The 2006-07 public health sector budget amounts to 3,02% of Gross Domestic Product (GDP) and 10,9% of government expenditure.

Chairperson, before I conclude, may I take this opportunity to thank the chairperson and members of the select committee, my colleagues the Deputy Minister of Health and the MECs for Health and the members of Salga for their support during the last financial year. I am sure that this support will continue and be strengthened during this financial year.

Chairperson, I request that this House pass the budget of the national Department of Health. I thank you.

Ms J M MASILO: Hon Chairperson, hon Minister and Deputy Minister, hon MECs from the various provinces, special delegates, colleagues, on 8 May 1996 the people’s representatives of our country adopted the Constitution for the Republic of South Africa Act, Act 108 of 1996. This year thus marks the 10th anniversary of our Constitution, as was celebrated by the two Houses recently.

The freedom we attained through the adoption of our Constitution will later this year best be explained and demonstrated through the 50th anniversary of the heroic women’s march to the Union Buildings on 9 August 1956. The 50th anniversary of this march should, therefore, exhort us to assess progress we have made and challenges recorded in our efforts to achieve gender equity and the advancement of women’s rights.

Chairperson, this month we also celebrate the 30th anniversary of the events of 16 June 1976. This anniversary within the context of health is a significant symbol to instil hope of empowerment and development of our youth’s life skills and education.

On 9 May 2006 the Department of Health briefed the select committee on its strategic plan and also unveiled its financial plan for 2006-07. The objective of the briefing was for the department to account to the committee on how the intended service delivery programmes related to the following: Administration, strategic health programmes, health service delivery and human resources.

The aim of the Department of Health is to promote the health of all the people of South Africa through a caring and effective national health system based on primary health care, to proceed with the programme of revitalising hospitals, the further expansion of health infrastructure, the refurbishment of existing clinics and hospitals and the reopening of nursing colleges.

Progress has been made with regard to the following: The doctor residents at Boitumelo Hospital, private ward facilities in Folateng, the Kimberley Hospital, the Colesberg and Calvinia Hospitals and the Swartruggens Hospital in the North West.

The select committee will do the following as oversight mandates: Monitor government plans for upgrading hospitals and refurbishing clinics, including the transformation and restructuring of hospital management; monitor government operational plans for the comprehensive prevention treatment and cases of HIV/Aids; and monitor government spending through the upgrading.

With regard to allocation to the health sector, the committee raised a concern about the reduced amounts for the following: Condoms were reduced from R143,2 million to R138,2 million; the global fund from R20 million to R16 million; the comprehensive plan against HIV/Aids has been reduced from R42 million to R40 million and Lovelife from R50 million to R10 million for 2006-07.

The following have not been much affected by the decreased budget: Lovelife, standing at R23 million for 2005-06 and NGO funding, which increased from R49,7 million to R52,7 million. Capital budget and MTEF satisfactorily increased for 2006 to 2009, especially for the Northern Cape and KwaZulu-Natal, which increased from R1,7 million to R1,9 million and from R1,3 million to R1,5 million respectively.

The department’s achievements include the following: The training of 20 qualified national paramedics for a period of four years for the health department. There is also progress regarding the development of mid-level workers.

Three universities will register students in degree programmes to clinical and medical associate levels in the districts. Recruitments will start in September 2006 and the programmes will be in operation by 2007.

The Primary Health Care, EMS and hospital service delivery system have all been strengthened. Implementation plans for the healthy lifestyle campaigns, including community-based health programmes, have also been set. All 53 districts, including schools, will implement the school health policy.

All districts had at least one service point by the end of December 2005. A patient information system was piloted in Mpumalanga and KwaZulu-Natal with good results. The Khomanani Social Mobilisation Campaign is also ongoing and there is continued corporate pledges with participation of companies. Multidrug resistance hospitals need upgrading and infection control measures have to improve, using global fund for Aids, TB and malaria.

Condom distribution for 2004-05 were 347 million against a target of 400 million for men and 1,1 million female condoms. The department needs to improve on women condoms, even if they are costly.

The good news is that condoms have been increased among our young people in the country as part of the prevention strategy. As South African public representatives, let us all take responsibility for community mobilisation and focus on the following: Voluntary counselling of the youth in and out of schools; men who have sex with other men; mineworkers; prisoners; drug users; sex workers and their clients, condom social marketing at the workplace, and so forth. The concern is that all this affects mostly women and children. Discriminating against them has also been at the forefront.

Globally, the Minister of Health and the department were congratulated by countries, amongst them Russia and China, for putting more money from their domestic funds into the HIV/Aids programme. These countries were applauded at the 2006 World Health Assembly at the United Nations in New York. Congratulations, Comrade Minister, on a job well done.

Our Minister was also highly recognised and given a platform on a daily basis to address the World Health Assembly. [Applause.]

The following challenges face provinces and are of great concern to the committee: Underspending on conditional grants, upgrading of hospital equipment, especially the X-ray department, and hospital mortuaries.

In conclusion, I would like to thank the Ministry, the director-general and senior management for the support that they have given to the committee. I would also like to thank the members of the select committee, the whip of the committee and Comrade Sulliman for his undivided support. The committee supports the Budget Vote. Ke a leboga. [Thank you.]

Ms N JAJULA (Eastern Cape): Hon Chairperson of the NCOP, hon members of the House, thank you for the opportunity to portray the programmes for 2006-07. The Eastern Cape’s department of health is committed to providing and ensuring accessible, comprehensive integrated services in the provinces, with an emphasis on primary health care for the present and future generations of the provinces, so that they can enjoy quality health and quality of life.

The focus of my presentation will highlight the commitment, the vision and the projects that form the backbone of the department’s turnaround strategy and plans for going forward. The budget allocation for this year is R6,8 billion, which also includes conditional grants. The conditional grant allocation is as follows: Comprehensive HIV and Aids, health professional training and development, hospital revitalisation, national tertiary services and forensic pathological services. The total amount budgeted for this is R9,5 million.

The grants are aimed to fulfil and implement the realisation of the specific policy objectives of the department that we seek to accomplish. We commend the national department for that effort.

The HIV and Aids comprehensive management grant will be continued by the department this year and build on and strengthen the HIV and Aids treatment, care and management programme to the amount of R218 million.

We will start 50 new sites that will provide antiretroviral programmes and will be accredited. A total of R29,8 million has been set aside to employ staff to manage this programme. The target is to have 27 000 clients who will have access to the antiretroviral programme.

A total of 38 awareness campaigns will take place in all the districts in order to destigmatise the illness. Further to this, we have a comprehensive prevention communication disclosure and antistigmatisation programme targeting women and others to be implemented around the Cacadu, Chris Hani and O R Tambo District Municipalities.

With regard to the training of health professionals, the department is targeted to train and develop 426 nurses to be absorbed into the employment of the department through this grant. The Walter Sisulu University was allocated R14 million to manage our health-training programme through a service level agreement between the department and the university. A total of 11 students are to be trained on medical, orthopaedic and prosthetic levels in Tanzania and Pretoria.

A total of 300 students who have completed their learnerships have been absorbed into the department’s permanent employment and 285 of them are enrolled nursing assistants. Almost 200 interns have been appointed for the first time this year on a 12-month programme funded to the tune of R13 million. A total of 193 students were recipients of bursaries for this year, of which 110 are medical students.

I am of the view that we need to ponder various strategies and innovations to recruit and retain health professionals through dedicated funding and stop relying on conditional grants. The recruitment and retention strategy planned by the national department will assist the department to recruit and retain health professionals, of whom we are in dire need. For this financial year the department is currently implementing a project under the revitalisation grant. There are five hospitals under construction, namely Mary Theresa, St Lucy’s, St Patrick’s, Rietvlei and Frontier Hospitals. We have also provided four hospitals with the appropriate modern and essential health equipment. Quality assurance programmes aimed at enhancing quality patient care have been initiated in six hospitals. We are planning the building of a new health resource centre at Lusikisiki.

The national Tertiary Service Grant is aimed at improving the effectiveness of and access to secondary and tertiary services through the rationalisation of the three hospital complexes in Mthatha, East London and Port Elizabeth. This will impact on the following: the rationalisation of clinic domains and services to optimise service delivery and address the space constraints in each complex with a budget of R48 million; supporting the human resources section in the recruitment of specialist scarce skills, and all responsible managers will undergo orientation with regard to the Public Finance Management Act and Treasury Regulations.

The department is also managing forensic pathology services grants of R79 million aimed at, inter alia, addressing the inequitable access to clinical forensic services to communities. Targets for this year include: 15 medico- legal mortuaries and 40 holding facilities to be transferred from the SA Police Service to the department; one clinical forensic medical service centre is to be established in each district.

Special projects to improve the health service will be introduced and consolidated under one banner. There are a number of flagship programmes that are aimed at re-engineering, improving not only the health services but also the quality of health care. The 21 projects are driven through the process of the turnaround strategy, which we as a province term Ivili Lenguqu.

The framework for the turnaround strategy for the department includes the following: The saving mothers, saving babies project aimed at reducing the maternal and infant mortality rates within the province and which is already underway in 20 district hospitals; 25 clinics have been identified as part of the clinics as centres of excellence project aimed at improving the conditions of service delivery at clinic level; the turnaround of emergency services include the acquisition of 48 emergency vehicles fitted with tracing devices, 14 planned patient transport vehicles and 14 rescue vehicles. All these vehicles are to be equipped with world-class equipment in preparation for the 2010 Soccer World Cup. This project is funded to the tune of R200 million this year.

The department has embarked on an aggressive facelift campaign in line with the Letsema programme aimed at restoring cleanliness and hygienic conditions, thus restoring the public’s confidence in our institutions, whilst at the same time boosting the morale amongst our staff. The targeted hospitals include Dora Nginza, Cofimvaba Hospital and Cecilia Makiwane Hospital.

With regard to the Cecilia Makiwane Hospital, I need to inform the House that it is going to receive a total facelift, and two portable generators are in place and the provision of an uninterrupted power supply will be completed on 9 June 2006.

Coming back to the infrastructure within this programme, there are new clinics to be built to support the conditional grants and 25 are to be upgraded, as well as two community health centres, at a cost of R132 million. There are 33 projects under the Letsema programme and together with the maintenance of hospital services, mechanical and medical equipment as amount of R107 million is budgeted for this year. An audit has been done through all district managers to determine the needs of hospitals with regards to linen, drugs, security and every supply to ensure an effective and efficient service.

In conclusion, the task at hand has challenges and seems enormous, but it is not beyond the ability and the commitment of the department to follow through and provide the quality service required by our people.

It is in this vein that I need to first extend my profound gratitude to the hon Minister for her continued support and guidance, her commitment and leadership to the cause and for providing the department with her exemplary leadership. The leadership of our Minister, together with the support of the hon members of the House, will see us realise our mandate to render a qualitative health service to the people of the Eastern Cape.

Hon members, you are our eyes and ears. With your support, no challenge is insurmountable. To the great health workers and professionals who are tirelessly sacrificing to serve the rural poor of our province, we salute you. I thank you, Chairperson. [Applause.]

Ms H LAMOELA: Agb Voorsitter, Minister, LUK’e, kollegas, daar is ’n Afrikaanse spreekwoord wat lui: ’n Gesonde liggaam huisves ’n gesonde gees. [Hon Chairperson, Minister, MECs, colleagues, there is an Afrikaans proverb that goes: A healthy body contains a healthy mind.]

Surely this is the dream of each and every South African. Yet this dream can only become a reality if progress in our health system is to increase. Our hon President said in his state of the nation address that we were entering the Age of Hope. Yet we are faced with so many challenges such as poverty, unemployment, hunger, drugs, drug abuse, alcohol abuse, HIV/Aids and TB. Surely, if this is the Age of Hope as proclaimed, I want to believe that it provides the best opportunity for the Department of Health to take us on a journey of prosperity regarding better service delivery for the health sector.

Healthy lifestyles are indeed the greatest option to a healthy body, but not all of us choose to engage in this exercise. Circumstances of the poorest of the poor prohibit them from taking part in these exercises, yet they are the ones who suffer most. The department, on the other hand, wants to improve their lot by means of large-scale organisation. This appears to offer the prospect of raising health care standards more quickly, with less duplication of services, and of delivering better care to people with a low income or living in rural areas. In the midst of the excitement to achieve success, the realities are usually minimised, forgotten or ignored. Equality of access to health care is a normal right, yet this right is still not enjoyed by so many of our communities.

Vir so baie pasiënte, veral op die platteland, het beter dae in primêre gesondheidsorg nog net ’n droom gebly. Dit is uiters kommerwekkend en ontstellend om steeds agterlike omstandighede in sommige van ons hospitale en klinieke aan te tref. As ek maar van my eie kiesafdeling kan praat, waar mense van Vrydag tot Maandag in ’n tipe wagkamer in ’n stoel moet sit en slaap en wag, totdat ’n dokter of ’n verpleegster hulle kan sien, net om dan uiteindelik aan ’n drup gekoppel te word om langer te kan vertoef.

Die menswaardigheid van pasiënte is geensins iets wat prioriteit geniet nie, omdat mans, vrouens, kinders en selfs babas van so oud soos agt maande in een lokaal geplaas word. Onlangs is selfs ’n kind met dubbele longontsteking tussen die groep geplaas. Daar was geen opening in ’n kindersaal om hom op te neem nie.

Gedurende die somermaande het ek selfs kinders met hul moeders op iets wat soos ’n matrassie lyk op kaal vloere sien lê. Skokkend om te ervaar dat ’n pasiënt wat ernstige messteekwonde opgedoen het, van die een Vrydag na die volgende Maandag vir ongeveer nege dae in hierdie einste lokaal moes wag of deurbring. Dis die waarheid. Ek kan vir jou soontoe neem.

Selfs hier het die tyd rondom die Batho Pele-beginsels gaan stilstaan. Hoe lank nog moet pasiënte van vroeg oggend tot laat middag wag om gehelp te word, net om teen 4 nm te besef dat hulle die volgende dag maar weer moet terugkom. Kan hulle ooit weer ’n R10 bymekaar maak om die plaaslike hospitaal of kliniek te besoek?

Kennisgewings soos “slegs ’n sekere aantal pasiënte word gehelp”; “alle pasiënte maak deel van ’n dag se getal uit” of “kliniek het ’n beperking, al is dit ook ’n verwysing van ’n dokter af”, word steeds op deure aangetref.

Skokkende omstandighede in staatshospitale en klinieke heers nog steeds daagliks op plattelandse dorpe. Hospitale wat die grootste bevolkingsgroep bedien, is heel buite die bereik van diegene wat eintlik die dienste moet benut of dit die nodigste het. (Translation of Afrikaans paragraphs follows.)

[For a lot of patients, especially in the rural areas, better days in primary health care remain but a dream. It is very alarming and disturbing still to experience backward conditions in some of our hospitals and clinics. If I may talk about only my own constituency, where people, from Monday to Friday, sit and sleep and wait, in a kind of waiting room until a doctor or nurse can see them, only to be put on a drip eventually to wait even longer.

The human dignity of these patients is not in the least something that is prioritised, because men, women, children and even babies as young as eight months are placed in one room. Recently a child with double pneumonia was placed amongst a group. There was no opening in a children’s ward for him.

During the summer months I even saw mothers with their children lying on something that resembled a small mattress on the bare floors. It is shocking that a patient with serious stab wounds caused by a knife should have to wait or linger in this very same room from one Friday to the next Monday, for about nine days. It is the truth. I can take you there.

Even here, for Batho Pele principles time has stopped. For how long must patients continue to wait from early in the morning till late in the afternoon to be helped, just to realise by 4 pm that they would simply have to come back the next day? Can they ever scrape together another R10 to visit the local hospital or clinic again?

Notices like: “Only a certain number of patients are assisted”; “All patients form part of the total for the day” or “Clinic has a limit, even if it is a reference by a doctor” are still found on doors.

Shocking conditions in state hospitals and clinics daily prevail in rural towns. Hospitals that serve the largest population group are completely out of reach of the people who really should be using these services or need them the most.]

I would like to salute all doctors, nurses and health workers who, under very difficult circumstances, perform their duties. Yet shortages of doctors and nurses in our country remain a huge problem. Nursing colleges should be reopened with the aim to increase the number of nursing professionals. Scarce skills allowances should be reconsidered, as well as salary packages for nurses and doctors. Better working conditions and resources needed to perform at top level should be investigated, while annual salaries such as rural allowances and scarce skills allowances are called for for nurses and doctors, yet roll-overs of R149,9 million in 2004- 05 in the strategic health service programme is still occurring in the department.

Our Department of Health is still battling to control the spread of TB and HIV/Aids. At present 6,6 million South Africans have tested positive and it is estimated that by 2010 there will be 1,8 million orphans in South Africa as the result thereof. HIV/Aids is undoubtedly South Africa’s biggest health crisis. This is aggravated by the fact that our public hospitals are failing, even as funds set aside for hospital revitalisation are not being used.

The DA does not question the effectiveness of antiretrovirals and we believe that although ARVs have known side effects, they are effective at reducing viral load and reducing infectiousness, combating opportunistic infections and extending life.

Surely to my understanding, the national Department of Health’s mission is to improve health status through prevention of illness and disease, through the promotion of healthy lifestyles, to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability. Though the Department of Health is working on their key priorities, capacity and skills to deliver better health services in our country are still lacking.

Regarding emergency services, with 28 000 ambulance assistants and 20 000 paramedics, complaints on EMS, especially in our rural areas, still continue and are of great concern. Members were told in our committee that this problem will be reversed by 2010, in time for the World Cup. But what is happening in the meantime, especially to our povertystricken areas, where emergency services are most needed?

During our oversight visits to provinces last year it was found that some hospitals did not have infection control units. In our recent committee meeting the Director-General of Health explained that a national team has now been set up to monitor and upgrade infection control units. I sincerely hope that this will be monitored at all three levels of health care, such as primary health care, secondary health care and tertiary health care.

’n Paar jaar gelede is poste op provinsiale vlak geskep om toestande in provinsiale hospitale en klinieke te moniteer. Bestaan hierdie poste steeds? Sou hierdie poste nie meer bestaan nie, wie moniteer dan nou die toestande in hierdie hospitale en klinieke? Dit is dus duidelik dat ‘n ontsaglike uitdaging die Departement van Gesondheid in die gesig staar. Tog kan die departement suksesse behaal, sou die implementering van strategie deur toegewyde en bevoegde personeel behartig word. Ek dank u. [Applous.] (Translation of Afrikaans paragraph follows.)

[A few years ago positions were created on the provincial level to monitor conditions in provincial hospitals and clinics. Do these positions still exist? If these positions are no longer in existence, who is monitoring the conditions in these hospitals and clinics? It is therefore clear that the challenge that the Department of Health is facing is enormous. Nevertheless, the department can achieve successes, if the implementation of strategy is dealt with by dedicated and competent personnel. I thank you. [Applause.]]

Nksz F MAZIBUKO: Sihlalo, amalungu oMkhandlu, oNgqongqoshe nePhini likaNgqongqoshe kanye noNgqongqoshe abavela ezifundazweni, ngithi hhola kini nonke - bathi angifakele no-7. [Uhleko.] Mayelana naleli lungu eliqeda ukusuka lapha, ngesiSuthu baye bathi … (Translation of isiZulu paragraph follows.)

[Miss F MAZIBUKO: Chairperson, members of the NCOP, Ministers, Deputy Minister and the Ministers from the provinces, “hola” to you all - they say I must add “7”. [Laughter.] Regarding the previous member, in Sesotho they say …]

… ke bo mabina go tsholwa. [… they claim credit for something they didn’t do.]

UNgqongqoshe ubeseshilo ukuthi zonke lezi zinto ziyenzakala kodwa yena ngoba ufuna ukuyikhuluma ngesiNgisi esingcono, ubone kungcono ukuthi azosishayinela lapha. Siyazi thina ukuthi uhulumeni kaKhongolose owenza wonke lomsebenzi. Bona bayacula nje kuphela, bakhonkothe bese bejika beyichamela lemoto uma isihamba. Uhlelo i-Ten Point Plan umgomo osetshenziswa uMnyango wezeMpilo ukuze ukwazi ukuphucula izimpilo zabantu lapha eNingizimu Afrika.

Angizukuwasho onke lawo maphuzu aqondene nohlelo kodwa okubalulekile nengifuna ukukhulumela phezu kwakho yilokhu kokuqiniswa kwezempilo, ezosizo oluphuthumayo, ukuhlinzekwa kwezidingo ezibhedlela, ukuphucula izinga lempatho kanye nokuvikela amalungelo abantu.

Abahlengikazi abaningi sebalifulathela leli likaMthaniya belibangise emazweni angaphesheya kwezilwandle ngoba bethi kunamadlelo aluhlaza, kodwa iqiniso ukuthi siyazi ukuthi bebiwa yilaba abanye abanezimali eziningi kepha bona bebe behluleka ukuziqeqeshela abahlengikazi.

Nathi futhi siyazi ukuthi ukuqeqesha umhlengikazi kuthatha iminyaka emithathu kuya kwemine ukuze bafunde kahle bagogode, bangafundi njengabanye abavele nje bathathe ama-Blood Pressure, BP, nabanye ngesikhathi sisakhula ababebizwa ngokuthi oskikimeti. Angazi namhlanje ukuthi sebebizwa ngani kodwa sesabaphucula ngoba sebeneziqu futhi sebafaka lokhu okuthiwa ama- epaulets lapha emahlombe abo. Lokhu kwasibangela kakhulu ukushoda kwabahlengikazi ezweni lonke jikelele. Siyabonga Ngqongqoshe uma usuthathe isinqumo sokuthi kuvulwe amakolishi aqeqesha abahlengikazi. Ukwanda kwaliwa umthakathi. Usebenze kahle mama. Ukuvuselwa kwezibhedlela olunye uhlelo esilushayela ihlombe ngoba, hhayi bo, ezinye zalezi zibhedlela bezethusa ngempela, bekungathi taptapini. Amanzi abevuza ngoba ompompi bebephelewe amarabha akhona, izindonga beziqhekekile nophahla seluwela ngaphakathi.

Kwezinye nje izibhedlela ubuthola izibi zilahliwe ngaphandle – amabhandishi novolo okugcwele igazi. Amathuluzi wona okusebenza kanye nemishini exilongayo bese kukudala kakhulu. Le mvuselelo yezibhedlela izokwenza izibhedlela zethu zibe zihle.

Impatho ngaphakathi nayo mayibe yinhle ngoba amalungelo abantu awahlonishwa kweziningi izibhedlela. UMqulu weziGuli awunakiwe kepha iyalenga ezindongeni uma ngabe ungena emnyango. Uhlelo lwe-Batho Pele alukho - mhlawumbe bathi abantu kamuva. Asazi kwenzakalani. Kweminye imitholampilo kubhalwe ngesiNgisi yingakho abantu bakithi bengakwazi ukufunda futhi bengawazi amalungelo abo.

Ngqongqoshe, angikhulumi ngokuzwa ngabasiki bebunda. Ngikhuluma ngoba ngazibonela ngawami amehlo enyama. Ungalinge nje uphazame uye esibhedlela ngesonto noma ngoKhisimuzi ngoba abasebenzi banuka utshwala phu! Kule mpelasonto lena esibuya kuyo kuye kwenzeka ngaphelezela umuntu eya esibhedlela elimele isandla. Umlisa obesebenza ukubopha amabhandishi kanye nokufaka okhonkolo wayeyimvuthu. Iziguli ezibhedlela zilala ngezazo izingubo ezizilethelwa yizihlobo zazo. Uma ngabe ungenazo izihlobo, usesimokweni. Kwezinye izibhedlela iziguli zigezwa yizihlobo zazo. Umuntu ozimoshile uyoze alinde isikhathi sezivakashi ukuze akwazi ukugezwa. I-Batho Pele ayikho nalapho.

NgoKhisimuzi owedlule ngaphelezela umakhelwane wami bemgwazile – angithi ubesephuza amponjwana naye. Sakika eBharagwana ngehora leshumi ebusuku saze sahamba entathakusa. Hhayi ukuthi imigqa mide kodwa ngoba abahlengikazi kanye nodokotela bashaya ngonyawo lonwabu.

Uzofika kumabhalane ubhalise masishane, uyohlala emgqeni oya kumhlengikazi, usuke kubahlengikazi uyohlala komunye umugqa oya kodokotela, usuke lapho uye emgqeni wezithombe zamathambo, ubuye futhi ubuyele komunye umugqa okubuyisela kudokotela kanye nezithombe, uphinde uyoma komunye umugqa wokuthungwa, usuke lapho uyoma emgqeni wamaphilisi kuze kushaye ihora lesithathu entathakusa.

Abahlengikazi bathinta iziguli ezimbili, ezintathu bese bebheka amawashi abo baye etiyeni. Bafike bahlale laphayana enkantini baxovuze izindaba. Basuke lapho babuye kube sengathi bayashesha kanti cha benzela nje ukuthi kuhambe isikhathi. Yingakho nje nalokhu esithi yisikhathi sokulinda okubizwa phecelezi nge-waiting time siside kangaka.

Uhlelo lokuyalelwa kweziguli ezibhedlela nalo kufanele lubhekwe ngehlo elibukhali ngoba umuntu uyafika esibhedlela ahlale isikhathi eside umangabe elethwe ngenqola ethutha iziguli. Umangabe sekushaye isikhathi sokuthi bashayise laba abathutha iziguli, bavele bahambe bashiye iziguli lapho bese zilala emagumbini okulinda khona lapho ezibhedlela. Ucabange ukuthi lomuntu uphethwe yizinhlungu, uphuze namaphilisi kodwa uzobekwa khona lapho emabhentshini asesibhedlela. Usizo oluphuthumayo okunye futhi nakho okufanele kusukunyelwe ngoba siyazi ukuthi sinenkinga izwe lonkana. Isikhathi sokuthumela i-ambulense lokhu okuthiwa i-response time ngesiNgisi asikaphucuki ngempela. Uma useGoli ushaya inombolo ethi 10177, ucingo lwakho luphendulwa e-West Rand bese kuthi bona bahambise umlayezo ngo-ova bawuyise lapho kunesikhumulo sama- ambulense khona esiseduze kwakho. Konke lokhu kudla isikhathi. Kwesinye isikhathi abanye abantu baze baye enkatheni ngenxa yokuthi balinde i- ambulense.

Uma sengiphetha, ngizobe ngingawenzanga umsebenzi wami njengelungu uma ngingakhumbuzi amalungu ukuthi kumele bazivikele, baphile impilo engcono babuye badle nokudla okuhlanzekile. Ushilo uNgqongqoshe wathi akanibonanga ngenkathi bezijuxuza laphaya ngaphambili izolo. Empeleni Ngqongqoshe besingamenywanga yingakho besingalethanga izimpahla zethu zokuzivocavoca ngabe nathi usibonile sizijuxuza laphaya ngaphambili.

Izifo ezinjengoshukela no-BP zihlupha abantu abaningi ngenxa yalokhu kudla nangendlela eniphila ngayo yokujayiva kuze kuse. Izingxenye zomzimba ezingangena esikhundleni sezingxenye ezindala zabantu abangangani azisekho ngakho kufanele nizinakekele kanti namajazi omkhwenyana nawo nomakoti asekhona kanye nezinye-ke izindlela zokuzivikela. Masifundise izingane zethu ukuthi inyama enyameni iyabulala. Akusafani nakuqala ngesikhathi kusaphuzwa umhlonyane. Okwamanje awekho amakhambi. Wonke umuntu … Ngiyabonga. [Kwaphela isikathi.] [Ihlombe.] (Translation of isiZulu paragraphs follows.)

[The Minister has pointed out that all these things are happening, but she opted to speak in English; she found it better for being in the limelight here. We know that it is the ANC government that is doing all this work. What they are doing is singing about, barking at and criticising the progress. The Ten Point Plan is a policy that is used by the Department of Health to better the lives of South African citizens.

I will not mention all the points related to the programme, but what is important and what I want to talk about is the improvement of health, emergency services, the provision of hospital requirements, to improve standards of management and to protect the rights of people.

Quite a number of nurses have left this country and have emigrated overseas for greener pastures, but the truth is we know they are recruited by those rich countries, while they fail to train their own nurses.

We are all aware that training a nurse takes three to four years, which is how long it takes for them to complete their studies, unlike those who only take people’s blood pressure. When we grew up these nurses were called “general assistants”. Nowadays I am not sure what they are called, but they have been upgraded since they possess degrees and have what we call epaulettes on their shoulders. This resulted in a shortage of nurses in the whole of South Africa. We thank the Minister for taking the decision to open nursing training colleges. Thank you. Well done, Madam.

The renovation of hospitals is another programme that we applaud. Oh yes, some hospitals were in an appalling condition; water was leaking from taps due to loose washers, walls had cracks and the roofs were falling apart.

In some hospitals you would find rubbish dumped in an open area - bandages and cottonwool full of blood. Equipment needed to do the work and machines used in examinations were very old. These hospital renovations will make our hospitals beautiful.

Treatment of patients need to be good, because the human rights of people are not respected in most hospitals. The Patients’ Charter is not observed, yet it hangs in entrances to hospitals. The principles of Batho Pele are not complied with. Maybe they say “people last”. We do not know what is happening. In some clinics our people cannot read, nor do they know their rights, as the principles of Batho Pele are in English.

Minister, I am not talking of hearsay, I am speaking of what I saw with my own eyes. Do not make the mistake of visiting a hospital on a Sunday or Christmas day, because workers smell of alcohol. Last week I happened to accompany someone who had injured his arm to the hospital. The gentleman responsible for applying bandages and plaster of Paris was dead drunk. Patients in hospitals provide their own blankets brought by their relatives. If you do not have relatives, you are in trouble.

In some hospitals relatives bathe patients. A person who has soiled himself will only be bathed when relatives come during visiting hours. The principles of Batho Pele are not practised.

The previous Christmas, I accompanied my neighbour, who had been stabbed, to hospital. He had had a lot to drink. We arrived at the Baragwanath Hospital at 10 o’clock in the evening and we left in the early hours of the morning. It is not because the queues were long, but because the nurses and the doctors were very, very slow.

You would register with the receptionist, then join the queue for the nurse; from there you join the queue for the doctor; from there you join the queue for X-rays, then you come back to another queue for the doctor with your X-rays; once again you stand in another queue for stitches, and from there you queue for medication until three o’clock in the morning.

The nurses attend to two patients, and when they get to the third one, they check their watches and off they go to tea. They go to the canteen and chat for ages. They come back, and then pretend to be busy, whereas they are buying time. That is why one waits for so long.

The referral programme of patients to other hospitals also needs to be addressed. A person arrives at the hospital and waits for ages after being brought in by the ambulance. When it is knock-off time for the drivers, they just leave the patients, who end up sleeping in hospital waiting rooms. When you think of it, this person is in pain and has taken tablets, but is left on a hospital bench.

The emergency service is another area that demands attention, because the whole country has a problem. The response time, which is the time the ambulance takes to arrive, has not really improved. When in Gauteng you dial the number 10177, the call is answered, and on the West Rand they then radio the message through to the ambulance unit nearest to you. All this is time-consuming; it is a waste of time. Sometimes some people die whilst waiting for the ambulance.

In conclusion, I would not have done my work as a member if I did not remind members that they should protect themselves, live a better life again, eat healthy food. The Minister pointed out that she did not see you dancing in front yesterday. Minister, in fact we were not invited; we did not bring our dancing clothes or you would have seen us dancing in the front.

Diseases like diabetes and high blood pressure are a problem to many people because of the food they eat and their lifestyle of dancing until sunrise. Your old body parts are not replaceable, therefore you must take care of yourselves. Male and female condoms are available, as well as other methods of protection. Let us teach our children that sexual intercourse without protection kills. It is no longer like the olden days, when we used to drink medicine. Presently there is no cure. Everybody … Thank you. [Time expired.] [Applause.]]

The CHAIRPERSON OF THE NCOP: Order! I know you were very impressed with the speech. Order! Hon Ntuli, you are causing havoc. [Laughter.] [Interjections.] Now leave that; the member has been debating. What impressed me was the use of the language, and that is what I like the most, our using these languages. They are our own languages so let’s make use of them. It is very important.

Mr T S BELOT (Free State): Hon Chairperson of the National Council of Provinces, hon Minister and hon Deputy Ministers, hon members, let me start by supporting this Budget Vote for Health. The Free State Department of Health ensures the implementation of quality health services in line with the five strategic priorities, as approved by the National Health Council this year. This is within the framework of the Free State provincial growth and development strategy.

The priorities proposed for 2006-07 are contained in the five-year strategic plan of the national Department of Health. They include, briefly, provincial service transformation plans, strengthening human resources, strengthening physical infrastructure for primary health care and hospitals, improving quality of care, and the priority health programmes specifically in terms of the promotion of healthy lifestyles, TB and the prevention of HIV.

The momentum for rendering quality health services has to be maintained, and I am happy to report that we have maintained this momentum in the Free State province in order to give content to our Age of Hope.

The core business of the Department of Health is to ensure the delivery of quality health services to the people of this country and in the provinces, and this is what the Department of Health is doing.

The Minister has shared with us a number of head counts that have gone through our facilities. I want to confirm that the Department of Health, in all provinces, is rendering quality services to our people.

For example, by the end of March this year, more than 5 million people had gone through our primary health care facilities. Also, a number of people, more than 1 000 of them, went through our other facilities. This then confirms that our health care system works for our people. We do not send people away when they do not have money to pay. All these people benefit because we are a caring government and a government that is committed to giving life to our people.

A 66,6% TB cure rate for new pulmonary TB cases for the province was achieved. The voluntary confidential counselling and testing programme has been extended to 97% of health facilities in the province, and a total of 90 790 clients were seen through this programme.

The expanded programme on immunisation, EPI, and the nutrition supplementation programme have been strengthened to improve child survival, and 90% of children under one year have been fully immunised. The first measles doses were given to 92% of children under one year. The vitamin A coverage for the children under the age of one year improved from 78% to 88%.

I am sharing this information, because the beneficiaries here – reflected by these percentages - are people who would not have gotten this if this government was not a caring government.

The Free State received the annual award for the best performing province with regard to cataract surgery for the second time. [Applause.] We have given our people back their sight and many of these people now have a vision for this country.

The department, for the second consecutive year, was awarded the certificate from the Southern African Institute of Government Auditors for having presented the best financial annual report in the Free State. The department was assessed to be among the top 10 departments both at national and provincial level in the country over a period of three years.

I am happy therefore to report that the takeover of primary health care personnel from local municipalities to the provincial department of health was successfully completed in April last year, and a total of 864 health workers were transferred from local municipalities to the provincial department of health. We are sure that this will assist in rendering quality health care services.

I need also to share with this House some of the major challenges that face the provincial departments in accelerating the implementation of priority programmes through funds allocated as conditional grants. But, at the same time, I am happy to share with this House the performance and achievements of the Department of Health in his regard.

In the Free State, for example, the Department of Health has been able to spend the conditional grants in the following manner: We have spent 100% of the health professional training and development grant; 100% of the hospital management and quality improvement plan; 100% of the integrated nutrition programme; and 100% in terms of national tertiary services. I think we deserve applause. [Applause.] I am not running away from revitalisation. I need to say that we have spent 96,9% in terms of our revitalisation programme and 99,6% of our grant on HIV.

The biggest challenge for the department was on hospital revitalisation. We have learned, and I am happy to say that the Department of Health has implemented measures to plan better and, with close support and collaboration with the Department of Public Works, we expect to do better in record time.

Our budget this year is R3,249 billion. It is 4,2% more than the budget allocated in the previous financial year. The budget allocation seeks to deliver on our mandate of rendering quality comprehensive health services and to contribute to achieving the priorities of the Free State growth and development strategy.

The department of health in the province has to render quality health services, ensure that it contributes to economic growth and skills development and alleviates the poverty of the people of the Free State. In this regard these goals will be realised through collaboration with our social partners, based on an integrated development plan.

The strategic plan of the Free State department of health is based on the application of the integrated health planning framework, the IHPF. The delegations for hospital managers are being reviewed and will be finalised in due course on the guidance by the national department. Following the takeover of the medico-legal mortuaries from the SA Police Service on 1 April this year, the department has developed a business plan to build a mortuary in Bloemfontein, and 10 holding facilities will be established in the province in the five districts.

The emergency medical services plan provides for the purchase of 20 additional ambulances and 15 planned patient transport vehicles. In addition to this, we have increased the uptake of training our personnel for emergency medical services.

It is easy for people to call for the numbers of doctors and nurses to be increased, as the previous speaker, hon Mazibuko, said. It takes time to train these people. We do not have supermarkets where you can get a trolley and take doctors and nurses off shelves. It takes time.

Following the proclamation of the National Health Act, Act 61 of 2003, a provincial implementation plan has been developed. The Free State provincial health Act will be amended to be in line with the National Health Act, and the Bill will be ready for tabling in the provincial legislature by the end of June this year.

I need to say that our government has adopted the Accelerated and Shared Growth Initiative for South Africa, Asgisa. The Free State province has identified that sustained economic growth … Thank you, Chairperson. We support the Vote. [Time expired.] [Applause.]

Nkk J N VILAKAZI: Sihlalo ohloniphekileyo, mhlonishwa Ngqongqoshe noMnyango wakho, bahlonishwa bonke abakhona kule Ndlu, usekhulumile udadewethu lapha ngabona ukuthi impela ukhuluma into esiyaziyo futhi akukho lutho olungajwayelekile kulokho abekusho. Ngiyamfakazela impela kule nto ayikhulumile. (Translation of isiZulu paragraph follows.)

[Mrs J N VILAKAZI: Hon Chairperson, hon Minister and your department and hon members present in this House, my sister colleague has said exactly what we know and there was nothing strange in what she said. I bear testimony to what she said.]

We acknowledge the budget of R11,2 billion for 2006-07, with an increase of 12% more than the amount given in 2005. However, it is faced with a litany of challenges. I wonder what the department will devise in order to cope with these challenges.

The current state of HIV/Aids infection demands treatment. Only 112 000 patients are being treated with ARVs at public health sites. The monitoring of these health sites shows that there is a need for more health workers. Despite provincial efforts to curb the disease, infant mortality owing to HIV and deaths owing to TB infections are increasing.

Inkinga endala engundabuzekwayo kwezempilo ngukuncipha kwabahlengikazi nodokotela. Sekukhulunyiwe ngakho kaninginingi. Okusele nje sekungukucebisana ukuthi maqondana nalaba abazinikele emsebenzini wabo, kuzokwenziwa njani ukubagcina beneme ezweni lethu, emsebenzini abawenzayo nobadinga kangaka.

Okokuqala okudingeka kwenziwe ukuqhubeka nokwenza ngcono indawo abasebenza kuyo. Sizwile ekhuluma umhlonishwa uNgqongqoshe, ngakho-ke siyethemba bakithi. Akuqhutshekwe ukulungisa izindawo abasebenza kuzona ngoba ngempela uma ezinye uzibona usheshe uhambe impela, ushaye isishwapha sakho ungathandi ukuba khona lapho.

Imali engumthoba-nhliziyo emukelwa yilabo abasebenza ezindaweni ezingasho khona, emakhaya phela, abayithole bonke le mali, kungakhethwa abathile kanti umsebenzi ubashisa kubo bonke ngokufanayo. Siyacela impela ukuthi mayibhekelelwe futhi ilungiswe le nto ngoba iyisikhalo sabo. Bayakhala kakhulu futhi nathi siyabona, siyezwa, siyabakhalisa ngaphakathi.

Okunye siyakwazi sonke okuxosha abezempilo: imali abayiholayo. Kodwa-ke ngimzwile uNgqongqoshe, bengimbhekile impela ukuthi uzolikhipha yini lelo gama. Ngithole ukuthi uyalikhipha impela igama lokuthi, cha, sengathi kuzoba ngconcwana. Siyabonga.

Imali abayiholayo, cha, bakithi, ayikho. Abalungiselwe amaholo afanele lo msebenzi obaluleke kangaka abawenzayo. Angisho ukuthi le mali eyisabelo esikhuluma ngayo yanele ukubhekana nalezi zinselelo ezikulo Mnyango ezingaka.

Siyabonga ngokubuyiswa kwabahlengikazi asebethathe umhlalaphansi, futhi siyathemba ukuthi lokho kuzosiza kakhulu kubantu abagulayo abadinga ukunakekelwa ebuthakathakeni babo. Sizwile ukuthi abanamuhla bathi besebenza bebe bebheke iwashi.

Kodwa ukuqeqesha abahlengikazi, odokotela nonompilo akuqhubeke kwenziwe ngcono. Umsebenzi wabo uyosiza kakhulu ezinkingeni ezikhungethe lo Mnyango wakho Nqgonqgoshe. Sizwile impela ukuthi nokho ziyavulwa nezibhedlela ezazivaliwe. Awavulwe amasango, abahlengikazi nodokotela baqeqeshwe ukuze sihlanganyele izifo lezi ezisilumayo.

Sengikubalulile okunye okuyizinkinga kulo Mnyango futhi ngeke ngiziqede, ziningi. Kodwa-ke, ukuze kusetshenzwe kubhekwe phambili, iqembu lami le-IFP liyasamukela lesi sabiwomali. Ngiyabonga. (Translation of isiZulu paragraphs follows.) [The historic challenge in the health sector is the shortage of nurses and doctors. That has been discussed repeatedly. What is left for us to do is to strategise as to how we can retain and keep those who are still dedicated to their work and happy in our country, which needs them the most.

The first thing to do is to improve the conditions of the working environment. We heard the hon Minister talking about this, therefore we have hope. Let the recapitalisation of their workplaces be continued, because when one sees some of those places one loses all desire to be there and wishes to leave soon.

Home-based care volunteers in rural areas are not paid; it should not only be certain people who are paid, because the kind of work they do is the same. We humbly request that this problem be solved because this is what they are complaining about. They are really complaining and we can see why; we are told and we sympathise with them.

Another problem that we all know chases away health workers is the remuneration they get. I was listening to the hon Minister to hear whether or not she would utter a word in that regard, and I heard her say yes, of course the remuneration conditions will be improved. We thank her for that.

The salaries they receive are meagre. Let us help them to receive salaries befitting the important job they do. I am not implying that the budget we are debating is adequate to address the many challenges that are faced by this department.

We are thankful for the recalling of retired nurses, and hope that this will help the sick people who need medical care a great deal. We heard that today’s health workers are watching the clock while they are working.

The training of nurses should go on, and the improvement of remuneration of doctors and health workers should continue. Hon Minister, their work will contribute positively in dealing with the challenges facing this department. We also heard that the hospitals that were closed down will be reopened. Let the doors of training for nurses and doctors be opened so that we can work together to fight the diseases that are attacking us. I have mentioned some of the challenges in this department, although I am unable to mention all of them.

The IFP supports this budget so that we can work together and look ahead. Thank you.]

The DEPUTY MINISTER OF HEALTH: Chairperson, united in our diversity, we adopted this Constitution so as to heal the divisions of the past, lay the foundation for a society in which government is based on the will of the people and every citizen is equally protected by law, and improve the quality of life of all citizens.

Hon Minister of Health, Dr Manto Tshabalala-Msimang, MECs, members, fellow- South Africans, as we debate this Budget Vote, may we be reminded of what inspired us in agreeing to heal our divided past and to move forward. We need to find common ground on health issues, we need to build a strong and united front, led by all leaders rallying our people to act together in the interest of health. Health is everyone’s concern and is more important than individual and party-political differences.

We have laid the foundation for the delivery of health services to all. Our policies aimed at addressing health disparities and implementing an integrated and transformed health system are in place. We have built a district health system to deliver basic health needs. We have also established structures for public consultation, participation, consensus building and multisectoral collaboration at ward, district, provincial and national level.

I wish to commend the NCOP for giving our people an opportunity to participate in building our country and our democracy. I had the privilege of joining the NCOP in their programme of “Taking Parliament to the People”. During the visits to Empangeni, Limpopo and Kuruman, I was exposed to the level of willingness of our communities to engage with government structures. [Applause.] When visiting Kuruman, I was touched and encouraged by the lady who said that her community had raised R25 000,00 in order to contribute to the Department of Health, so that we could buy an ambulance. This initiative confirms that our people are willing and ready to work with government to deliver services.

We must not lose sight of issues raised by our communities during these consultations and in this regard I am encouraged to learn that the NCOP will develop a register or report in order to follow up with departments the issues raised by our communities.

I would like to commend the Department of Health for always being able to respond on the spot and follow up with communities. I am talking about speaking our languages. I want to thank hon MECs Sekwati and Selao, who helped me when I was in Limpopo and the Northern Cape where I was challenged by the languages spoken by our people there.

We have prepared the ground for the provision of the minimum defined basic package that will provide a health care safety net for all. In the context of limited resources, the challenge inevitably involves reaching consensus around the content and delivery of this package, as well as weighing the costs of poor health as a result of not making additional investments in health care.

Kubiza kakhulu uma sebegula, lapho sekufuneka sibelaphe ezibhedlela. [It becomes very expensive when they are already ill and we then we have to have them treated in hospitals.]

We call on everyone to adopt health-seeking behaviour and to use our facilities to check our health status, even if we feel well. Many illnesses are silent killers, showing no symptoms at all in the early stages when they can be most easily and effectively treated.

The stigma attached to mental illness discourages people from seeking help. All of us must step up our efforts to raise awareness in our communities and to remove the stigma from mental health. And in this regard we thank the NGOs and CBOs that are helping us with this.

Our strategic plan for 2006-07 has prioritised the integration of mental health into primary health care. While ensuring that mental health review boards are appointed in the provinces, we are finalising the referral pathways and the list of facilities that will conduct 72-hour assessments.

The shortage of mental health specialists and problems of infrastructure and systems have had a negative effect on our efforts to implement the Mental Health Act. However, we are addressing these issues through hospital revitalisation and the Human Resource Plan.

We are strengthening policy on free health care for people with disabilities, assessing the accessibility of our public health facilities and developing a strategy on orientation and mobility services for the blind. The Guideline for the Implementation of the National Rehabilitation Policy and a revision of the price list for orthotic prosthetic devices have been completed.

Our policy on the elderly is to keep them in our community for as long as possible, in order to keep the family unit together and to tap into the wisdom of our senior citizens in moulding the characters of the young. We will in this financial year implement a long-term Home-administered Oxygen Programme and establish stroke units in all provinces.

We have a great shortage of qualified personnel in the area of health technology. I appeal to our youth to take up training as health engineers, health technologists and technicians. These skills in this rewarding career are in huge demand and I hope you will assist us in encouraging our youth to take up these careers. As a medical laboratory technologist I found the career rewarding, as well as valuable, in my present post as Deputy Minister of Health.

And as you know, our Deputy President has a programme called Jipsa, which is the skills development programme for priority skills for Asgisa. And in this regard I am hoping that our youth are going to take up the opportunities that are going to be provided by that programme.

We are transforming the delivery of oral health care and are integrating it into primary health care, healthy lifestyles and neonatal care.

Sifuna ukuthi lithi liqala liphuma lelo zinyo, liphume liqinile futhi londlekile. [We want to ensure that when the first tooth comes out, it is strong and well-nourished.]

Our programme for schools is assisting us to identify other health ailments. I visited Gauteng and I am planning to visit other provinces. The Phelophepha train has helped us in taking health care to our people. In this regard I wish to thank Transnet for donating a second train to Phelophepha.

Our community service programme for new graduates in the health sciences is playing a valuable part in nation-building, especially in underserved communities. I am sure hon Vilakazi will be pleased to know that a doctor doing community service at Ngwelezane Hospital had this to say:

I would like to thank you for the opportunity to work in a rural environment. I have found it extremely worthwhile and can only hope that I have been of good service to the community. I have gained a lot of experience. For this I am so grateful. Enkosi Kakhulu.

[Thank you very much.]

I wish to add my own thanks to all the young medical personnel doing community service, and in my own constituency I would welcome a young journalist, an artist, a social worker, a beauty technologist and a philosopher to come and do community service there.

In April this year, Medico-legal services were transferred from the South African Police Service to the Department of Health. The transfer is aimed at ensuring separation and autonomy. We have also set aside R1,5 billion for refurbishing our mortuaries and building new ones.

I want to acknowledge the sterling work being done by the Gender and Justice Unit at Groote Schuur Hospital under the leadership of Professor Lorna Martin, helping us to monitor the implementation of the Domestic Violence Act. This is very important work. She is also training our health personnel in diagnosing domestic abuse, as well as issues of gender-based violence.

In conclusion, I also want to thank our research councils and our universities that are doing wonderful work, doing research that will help us fight disease. I believe that by working together in the spirit of co- operation and communicating effectively, affirming each other’s achievements, correcting and supporting one another with compassion when we fail, we can achieve the goal of comprehensive and quality health care for all. Ngiyabonga. [I thank you.]

Mr M S GININDA (Mpumalanga): Chairperson, hon Minister of Health, Dr Mantombazana Tshabalala-Msimang, the hon Deputy Minister Madlala-Routledge, hon MECs from our sister provinces, hon members of this House, compatriots, ladies and gentlemen, South Africa celebrated its 10th anniversary of our first-ever inclusive democratic Constitution, which guarantees our rights as individuals and guarantees our collective prosperity.

Contained in this noble document is the Bill of Rights, which serves as a guiding tool in all facets of our human activities and also places the necessary obligations upon us as government to not only provide services, but to do so with the utmost respect for human dignity.

We will also celebrate the 30th anniversary of the Soweto uprisings. We remember a year in which our youth fought gallant battles against the use of Afrikaans as the medium of instruction, thus creating a necessary turning point in the struggle against apartheid.

As we gather here today to consider and debate the health Budget Vote, we are aware that we carry enormous responsibilities and that our people correctly have faith and trust in us. We have made a promise in 1994, when we said a better life for all, and we will continue with that mandate and address many socio-challenges, which are part of their daily experiences.

The coming into effect of the National Health Act in May last year has without a doubt created a necessary platform that allows us to achieve our long-held objectives of equity, access and affordability of our health care services to all our people.

We are also pleased with, and commend the visionary leadership of our Minister, so that for the first time we are launching the national health human resource plan, which seeks to address many challenges facing us with regard to training, recruitment and retention of health professionals in our public facilities, especially in the rural areas.

We are further pleased by the announcement that new cadres of health worker medical assistance will commence training in 2007. Upon completion of their training they will inevitably add the necessary impetus in addressing staff shortages, especially in provinces like ours - Mpumalanga.

To give greater effect to the Nepad processes, the African Ministers of Health held a meeting at Maputo in Mozambique last year, whereupon they confirmed our view that Africa must unite and collectively address her own challenges. It was at this meeting that TB was declared a crisis, thus calling on all of us to refocus our energies in the fight against this deadly disease.

Following on the National TB Crisis Plan, our province has already begun work in this regard. We will be strengthening our electronic TB register to improve our patient management and follow up. Our fight against communicable and noncommunicable diseases is on course.

Informed by this need of regional co-operation, we will continue within the Lebombo Spatial Development Initiative to work with our neighbours, Mozambique and Swaziland and our two sister provinces of Limpopo and KwaZulu-Natal, in our concerted effort to eradicate malaria.

The recent heavy rains during the malaria season have increased the number of notified cases of malaria. However, we are pleased that our fatality rate remains below the 0,5% national norm.

The fight against HIV and Aids is on course. We should, against all odds, continue with our comprehensive operational plan against the pandemic, because it remains the most relevant strategy that equally covers all aspects that relate to the disease.

We are further pleased that the World Health Organisation in Africa has declared this year the year of accelerated prevention, because of the correct understanding of the role of preventing new infections in responding to this major challenge.

In our province we launched the Mayihlasele Izazi Campaign on World Aids Day last year. This campaign targets mostly girls and encourages them to abstain and, quite importantly, to know their status. We are also training them to be multipliers of information amongst their peers and in the communities they live in.

We have also, for the first time in our province as part of ensuring quality of care in our facilities, commissioned the survey on patient satisfaction in our facilities. This survey has highlighted a number of gaps and we have since put in place plans to address them. The other positive element of this survey is that it empowers our patients to have their say about how they want to be treated in our facilities.

Last year, some of the parties represented in this House made some wild allegations about the state of some of our hospitals. They did this without acknowledging the road that has been travelled in addressing some of the disparities caused by the former apartheid government in terms of infrastructure, human and financial resources, many of which service our poor communities that cannot afford private health care. We welcome this budget because we believe that it does not only show that we are on track but, importantly, that we are on the correct track of advancing the course of providing accessible, equitable and affordable health care services to our people.

Kuyasimangalisa noko kuva letinye tinhlangano letikhona lapha kuleNdlu lehlon, titsi yiNdvuna yeLitiko Letemphilo lecosha bodokodela nabonesi kutsi baye kulamanye emave. Sikubona kuliphutsa loko lokushiwo nguletinhlangano.

Phela sisho ngobe iNdvuna yeLitiko ayizange nangalelilodvwa lilanga seyike itsi bodokodela abahambe baye kulamanye emave, kantsi futsi nakubonesi, nakutisebenti tetemphilo lesitidzingako asizange sesimuve lona wekunene atsi atihambe tiye kulamanye emave. Bamcalela emanga nje ngobe bafuna kutitfolela emavoti lamanyenti.

Lokusijabulisako kutsi i-ANC iyaphila, iyahola futsi bantfu bayinikete emagunya langetulu kwawo onkhe emandla kwekutsi i-ANC ilibuse lelive. Nome bangakhuluma batsini sengitsi labaphetse nyalo, futsi ngitsi kuphela. Ngiyabonga kakhulu, Sihlalo. [Tandla.] (Translation of Siswati paragraphs follows.)

[We are shocked by comments made by some of the parties present in the House today, that the hon Minister of Health is responsible for the mass migration of doctors and nurses to seek employment in other countries. This is a mistake on the part of these parties. We say this because the Minister has never on any occasion instructed these much-needed health workers to leave the country. This is a ploy to solicit voter support.

We are happy for one thing though, that the ANC is thriving and that we are receiving our full salaries because the citizens of this country have given us the authority. So, no matter what these other parties say, we are still in leadership through the support of the people. Chairperson, I thank you. [Applause.]]

Mr T JEEBOHD (KwaZulu-Natal): Hon Chairperson, hon Minister, Deputy Minister, staff and colleagues, it is indeed our pleasure, from KwaZulu- Natal, to participate in this Health budget debate. Our Constitution, Act No 108 of 1996, section 27, states:

Everyone has the right to have access to health care services, including the reproductive health care;…

The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.

Eleven years into our independence, freedom and democracy, our health services have come a long way. Despite the many challenges, we as a nation shall overcome. When the ANC-led government went to the polls in 1994, its prime mandate of a better life for all beckoned to all and we cannot fail.

I want to confine my speech specifically to an issue of extreme concern on which our future depends. If we come back to this earth – those of us who will depart in 30 years time – we will see that our policies have worked and our future generations will thank us for that. The future of this country lies in the hands of our future generations. If we have no children, we have no future. Investing in the health and the wellbeing of the children is an investment in the future.

South Africa has a relatively youthful population, with a third of its population under the age of 15 years. The health of these children needs to be a priority – a principle adopted at the ratification of the 1990 United Nations Convention of the Rights of a Child, of which South Africa is a signatory.

The mortality rate is the fundamental indicator of child health and understanding the cause of death of children provides insight as to how it can be reduced.

The 1998 demographic and health survey found that the infant mortality rate was 45 per 1 000 live births, and the World Health Organisation’s target was 50 per 1 000 live births.

South Africa’s rate in 1970 was 115 deaths per 1 000 births. This has come down significantly in 2002 to 65. In comparison with other emerging Third World countries, South Africa is on a par with Brazil at 36 deaths per 1 000 births; China at 39 deaths per 1 000 births and Turkey at 42 deaths per 1 000 births. We compared this with First World countries – Australia six per 1 000 births; Germany five per 1 000 births; Japan five per 1 000 births; United Kingdom seven per 1 000 births and the United States eight per 1 000 births.

We compared this with other poorer countries in Africa – Uganda 141 per 1 000 births; Nigeria 183 per 1 000 births; Mozambique 197 per 1 000 births and Ghana and Botswana 100 and 110, respectively.

Of this child mortality in South Africa, 40% can be attributed to the killer disease HIV. By 2002 and 2003 it has begun to rise. All of the percentages of deaths due to HIV/Aids are higher in the one to four-year age groups. The largest number of deaths occurs in the under one age group. Added to that is the low birth weights, diarrhoea, lower respiratory infections and protein-energy malnutrition. These account for 30%.

A large number of these deaths are preventable due to the delivery of the standard primary health care package approach. Birth defects, particularly of the heart and neural tubes, are also amongst the top ranking infant deaths. Other preventative factors are reducing poverty, meeting basic needs and adopting a comprehensive primary health care approach. With the renewed figure it must be high on the agenda.

Poor socio-economics are also associated with these factors. As children get older - the 6 to 10-year bracket - other factors such as road accidents and drownings tend to become relevant factors. From 6 to 18 years there’s an added dimension. One of the most tragic consequences that ravage our country is the huge number of child orphans as a result of losing both parents due to HIV/Aids.

In South Africa, up to now the number of these orphans has been increasing quite slowly and from a lower base, and hence had attracted relatively little attention to date. South Africa’s Aids epidemic is still in its early stages, relative to other African countries. The levels of orphanhood seen elsewhere in Africa have yet to be experienced in this country. As the epidemic matures and Aids mortality increases, the number of orphans increases.

Currently 5,5 million people in South Africa are infected and this is more than in any other African country. Ultimately we will have to look after the orphans, which are amongst the highest number that come from Aids relatives.

South Africa will face significant costs in the long term if we don’t plan to look after these orphans now. If we fail the children, then we fail South Africa. We welcome the increase in hospital services’ sub-programmes. The conditional grounds given to provinces makes a marked impact on infrastructure spending. We in KwaZulu-Natal are very grateful that the new hospital is going to be built with the funds from the conditional grant and will be ready for 2010, and this will ease the load on existing hospitals.

We also laud the Minister on major initiatives, which will include implementing and monitoring hospital improvement plans focusing on basics such as keeping hospitals clean and improving basic maintenance, managing staff performance and improving training for hospital managers.

I just want to state to the House that the hon Minister paid a surprise visit to the small rural hospital in Bergville and the boost in morale that it had brought amongst the staff was beyond words. The papers the next day carried very favourable reports that this tiny hospital in the rural area could produce such significant service to its community, so much so that where the previously advantaged used to shy away from, and ultimately the white people stayed away from this hospital, they are now flocking to this rural hospital because the service, despite its many cut-backs, is greater than what the city is offering. Thank you, Madam Minister, for this. [Applause.]

It must be noted that whilst the First World countries continue to steal our staff – poaching our health professionals – an agreement made like the one they shared in the paper with the UK, barring the recruitment of health professionals is in place. We as a country are still very short of skilled staff to fulfil and satisfy domestic needs.

Our professionals are in great demand, mainly because of the standard of excellence this country produces and the ethos of hard work and caring.

I want to give an example of the export of professionals. There’s a little province in the South of India called Kerala Avd Tamil Nadu, where the major export is not finished goods, but the export of professionals to other countries.

Madam Minister, look at a system where we could produce extra nurses and doctors and fulfil our own domestic needs and then export the rest to anybody who wants them. In that way we’ll be serving doubled edges – we’ll be fulfilling our needs, and at the same time our health professionals can ply their trade and come back with the skills they acquired in other countries.

We in KwaZulu-Natal wholeheartedly support this budget. I thank you, Chairperson. [Applause.]

Ms E S SELAO (Northern Cape): Chairperson, Madam Deputy Chairperson, hon Minister Dr Manto Tshabalala-Msimang, Madam Deputy Minister, members of executive councils, hon members of the NCOP, comrades and friends, it is a great honour and pleasure for me to be granted this opportunity.

We heard the address by the hon Minister of Health, Dr Manto Tshabalala- Msimang yesterday, on the occasion of the Budget Vote for the Department of Health. We can definitely say that there is undoubtedly an absolute grasp by the department of the actions that need to be taken to tackle the health challenges of our country.

Through the political leadership that has been provided to date, as a province we’ve been able to align our plans and strategies with the national vision. We want to thank the Minister for her leadership.

Last year, through a broad and consultative process, we developed a provincial plan to respond to the challenges facing us. This is the 2014 health plan of the Northern Cape province. It deals with the existing conditions in the province, outlining our remarkable achievements to date, such as the expanded access to health care.

It then puts targets that must be achieved on an annual basis, leading up to 2014. This will enhance accountability, quality assessment, performance and delivery. Our 2014 health plan outlines 14 areas that we deem critical for us as a province in order to achieve health service excellence for all as per the vision of our department.

Amongst the points that we highlight are matters that we have already achieved so much success in, in the past 12 months and the preceding period. These successes include, amongst other things, the revitalisation of our health facilities and the building of new facilities as part of the strides we are making.

We are building about five clinics per annum. In the clinics that are about 50 km from the nearest hospital we also include a maternity section.

There has been an increase in our conditional grant and in the building of new facilities, such as the new mental hospital in Kimberley. We are increasingly putting emphasis on information technology to reduce the distance between space and time through, amongst other things, the introduction of the electronic management of patients’ records. Very soon the issue of files being lost will be a thing of the past in most of our facilities.

In terms of the attraction and retention of staff, we’ve really done a good job in this respect, especially at our tertiary hospital in Kimberley, where our specialists have been increased many-fold. In the year 2000 we had only two specialists; today we have 29 at the Kimberley hospital complex, … [Applause.] … and more than 200 doctors.

Clearly, we have to do much more to close the skills gap that exists. To this effect, work is already being undertaken to align our provincial human resource development plan to the national human resource plan, whilst articulating local needs.

We’ve been responding to the challenges of providing emergency care in a province as vast as the Northern Cape, by revitalising our ambulance fleet and putting in place processes to train our emergency care practitioners in intermediary and advanced emergency care.

We have also introduced an emergency air mercy ambulance, which has reduced the distance in our vast province. This has also freed ambulances from travelling long distances, thereby saving more lives through quicker medical interventions. Cases needing specialist care are also transported by air.

We have also dealt with the general transport needs of our patients through the acquisition of the patient transport vehicles. Some of the vehicles we previously had on the road were themselves a hazard to our patients.

We are further responding to the national goals by putting emphasis on priority areas, such as communicable diseases, particularly TB and HIV and Aids, which we are working to stabilise using the comprehensive approach of government.

We believe that through the ABC message we can reduce the spread of HIV and Aids, whilst taking care of and managing the disease in those who are infected.

Poverty has besieged our society. In the light of this, the sustainability of health care, in particular diseases of poverty, needs a comprehensive and integrated plan. It is against this background that we welcome the increase in the conditional grant for HIV and Aids. This increase will enhance our efforts to ensure that we address the nutrition part of our comprehensive plan through the provision of healthy and nutritious food parcels.

The province remains committed to building momentum around the healthy lifestyles campaign through health promotion and advocacy. Alcohol and substance abuse, eating healthy food, exercise and health screenings have received great attention in our work.

Through investing in health technology, we are saving lives by doing our work in a much more cost-effective way. We used to refer a selected number of cases to private providers for the MRI scanner. Now we can afford to benefit many of the poorest of the poor because we own the scanner. We are also going to save about R5 million, which would have gone to a private provider, whilst simultaneously providing access to a greater number of people.

The achievements of the past 12 months at our tertiary hospital have been remarkable. They are also the outcome of investment in people and technology. In the past 12 months we have established a maxillofacial unit because we were able to attract the correct skills. As recently as April we conducted our first cochlear implant surgery.

Hon members, it is unbelievable what a rural province such as the Northern Cape can achieve. However, as the ANC-led government we are not to be overtaken by our own achievements. We have always raised the point that much more needs to be done to achieve the vision that was so well- articulated in the Freedom Charter.

We are all aware that because of the inherited objective realities our people live in, what we have achieved is only the foundations for the efforts that need to be invested. Very importantly, we are prioritising issues of maternal and children’s health by, amongst other things, stipulating them as the first point on our 2014 health plan. This is not just because this happened by chance, but because our interventions at the level of facilities and communities are directed at making real impact in this regard.

This is critical for our country, if we are to meet the required outcomes in terms of women and children’s health, as stipulated in the MDGs. Our vision as a department is health service excellence for all, because we care about the quality of care we provide. Hence we are focusing on increasing our development capacity. We are putting the issue of Batho Pele on the agenda every time we engage with our employees.

There are many other things that we have implemented, but, unfortunately, time does not permit us to elaborate on these. The process of taking over the forensic services from the SA Police Service has been undertaken on a progressive basis. All the critical posts have been filled. We can say that the process has been undertaken without major hassles so far.

We are also placing particular emphasis on the need for statutory compliance, particularly with the National Health Act that was acceded to by the hon President in 2003. We have focused on the establishment of consultative structures and bodies that are articulated in the Act. Even our 2014 health plan is in many ways a product of the provincial consultative health forum that we convened at a health summit last year.

As the Northern Cape, we are not without challenges though. Many of these emanate from the unique character of our province. The Northern Cape is very vast and sparsely populated, thereby making the challenge of taking health services across the province more costly than it would otherwise be for such a small population.

The challenge to provide access to services is, amongst other things increased by the reluctance of health professionals to settle in areas where they would not have access to schools of their choice for their children and to other general amenities. As a result, our doctors visit these areas on certain dates to ensure that services are provided in these communities.

In the medium and long term, we are also training our nursing students from these communities with the understanding that they sign contracts to go and plough back into their communities. But we all know that the professional nurse is not produced instantly. It is a process that you undertake, and you cannot always guarantee the outcome.

The vast distances are also a burden on our meagre budget. Travel and transportation of goods such as pharmaceuticals cost a lot. The challenges are also increased by our achievements. The more our services improve, the greater the number of people who present themselves to benefit from them. Yet in real terms our provincial department’s budget has increased in nominal terms over the past few years. Thank you, Chairperson. [Time expired.] [Applause.]

Mrs A N D QIKANI: Hon Chairperson, hon Minister, Deputy Minister, MECs from different provinces, hon members, special delegates and dignitaries, the UDM gives compliments to the hon Minister for the current project on the improvement of working health facilities.

I also encourage the hon Minister to continue with rebuilding and enhancing the health condition of and services to South Africans with accelerated performance.

Sihlalo, bendicela ukuba isebe khe liqwalasele kakhulu izibonelelo zabongikazi ezijongene nokusebenza emaphandleni, i-rural allowances, ngamanye amazwi. Bayakhala abongikazi abaninzi, ngakumbi eGcuwa eMpuma Koloni. Bathi kudala belila, abazi ukuba kutheni esi sibonelelo singahlawulwa.

Ndiyavuya ngokuba uMama uJajula ekhona, kwaye ndiyathemba ukuba uza kukhe awujonge lo mba. Ndiyathemba ke ukuba into wakuyibhekisa kumama, noko inimba iyasika.

Ndiyabulela kakhulu kuMphathiswa ngokuvuselela izibhedlele. Hayi, mntakwethu, besele kukubi kakhulu, ngakumbi kwizibhedlele zasezilalini. Siyancoma ke noko, Mphathiswa, ngokuthi ulande abongikazi abadala, oontangazethu, kuba bona bayakwazi ukunonophela izigulana. Anditsho ukuba aba bongikazi bancinane abakwazi kuzijonga, kodwa ke noko thina, njengabantu abadala, siyamazi umntu ogulayo. Izinto ebesikhala ngazo, Mphathiswa, mandincome ukuba zisiwa iso. Xa kuncoma umntu osuka eMpuma Koloni, yazi ke noko ukuba izinto ziyenzeka. Amayeza ezikliniki ebesoloko enqongophele kakhulu, kodwa kungoku nje noko abantu bayawafumana. Ndiyabulela, Mphathiswa. [Kwaqhwatywa.]

Okokugqibela, siyacela ukuba xa uphinda usithi thaca uhlahlo lwabiwo-mali lwakho uluguqulele nakulwimi lwesiNtu ukwenzela ukuba naba baphantsi bakwazi ukulufunda. Ezinye izinto ziyabaphosa. Zithi zintle, sithi thina, okanye abantu abakwaziyo ukuziguqulela esilungwini, bangazikhuphu ngohlobo olufanelekileyo. Ndicinga ukuba kubalulekile ukuba uhlahlo lwabiwo-mali lwakho uluthi thaca ngeelwimi ngeelwimi ukwenzela ukuba noko nabaphantsi bakwazi ukuxhamla. Lilonke i-UDM iyaluxhasa olu hlahlo lwabiwo-mali. [Kwaqhwatywa.] (Translation of isiXhosa paragraphs follows.)

[Chairperson, I plead with the department to apply its mind to the issue of rural allowances for nurses. There is an outcry from nurses especially at Butterworth, Eastern Cape. The nurses have raised their concerns a while ago and they cannot understand the reason why this is not implemented.

I am happy that Mrs Jajula is present and I hope she is going to look after this matter. I believe that if you give a task to a woman it will be accomplished.

I am grateful that the Minister has revived those hospitals. The situation of hospitals was bad, more particularly in the rural areas. We appreciate what you have done, Minister, by allowing retired nurses from our age group to take care of patients, as they have the skills and experience. I am not saying the young nurses do not have the expertise, but the older people are better.

Let me convey my thanks to you, Minister, that our queries were held onto and looked at. There was a scarcity of medicines at the clinics but now they are available. I thank you, Minister. [Applause.]

Finally, I ask you that next time you present the budget speech you translate it into African languages for the benefit of the grass-roots level people. They miss other aspects of the debate because of a lack of understanding. There are aspects that are important, but they do not understand them because of misinterpretation. It is advisable that your next budget speech be tabled in other languages as well for the benefit of the people at the grass-roots level. The UDM supports this Budget Vote. [Applause.]]

Mr C SEKOATI (Limpopo): Hon Chairperson, hon Minister of Health, Deputy Minister, hon members of the NCOP, colleagues and comrades, at the dawn of the new Age of Hope, we can pride ourselves on the strides made in the production of quality health care over the past decade, and the continuing intensified efforts to improve our performance in the years ahead. Under the visionary leadership of our Minister of Health, we have already geared ourselves towards ensuring that the plans that we have put in place to actualise the five priorities decided upon by the National Health Council, are brought to fruition.

Primary health care remains the backbone of our health system. In this respect, the intensification of the clinic-building programme and the extension of the number of clinics rendering 24-hour service are on track.

We are also in the process of ensuring that most of our clinics are provided with clean running water and commission-free sanitation services. The move towards ensuring that communities should access primary health care facilities within five km of where they stay is gradually moving towards realisation.

In line with the national department the province has adopted the emergency medical services expansion and optimisation plan. Our objective is, amongst others, to expand EMS coverage to communities that were previously not covered, especially the rural and disadvantaged communities.

Due to sustained health promotion, and proper co-ordination of our great response teams, we were able to meet the challenges put by the malaria outbreak head-on.

In 2006-07, we will ensure yet another increase in the range of immunisations provincially. The greatest success of the immunisation programme has been the elimination of deaths due to measles and polio.

In this budget year, we will re-energise and mobilise for the acceleration of an HIV/Aids prevention plan, with the ultimate aim of ensuring the reduction in new infections.

The comprehensive care, treatment and management plan is also on track. To date, 28 sites have been accredited to provide a continuum of services to those in need, and 503 facilities, including nonmedical service points, offering voluntary counselling and testing, with 182 home and community- based care groups funded.

Tuberculosis has also been declared a crisis in the African region in August 2005. This has meant that efforts must be stepped up to confront the pandemic, and the department is proud to announce that the Multidrug Resistance TB Hospital in Modimole is now fully functional.

We will also continue to intensify our public awareness campaigns to inform our citizens about best practices to deal with the spreading of diseases. To this end, resources have been put aside during this budget year.

The hospital revitalisation programme is intended to refurbish the infrastructure in hospitals to strengthen management and to improve the quality of care. Since its inception in 2004, a total of four hospitals have been upgraded. This is intended to provide access to quality health care for all our citizens.

While we experienced challenges in expending our entire allocated budget in the previous financial year, we believe that, this year, we will need more than what is allocated in order to meet our targets in the hospital revitalisation programme.

In support of the launch of the national human resource plan earlier this year, the department has awarded 386 bursaries to students, particularly to those from disadvantaged backgrounds studying medicine and other health- related fields, in an effort to ensure that essential health personnel will be available in the near future.

We are further extending our nurses’ training and also, we have reopened our EMS training college.

In order to further attract and retain scarce skills, the department has embarked on two phases of building new staff accommodation units. A total of 279 units from the first phase of the project to house both the critical and obligatory staff will be completed in the first half of the budget year, with the second similar phase to follow.

In his state of the nation address this year, President Thabo Mbeki issued a clarion call:

We must, constrained by and yet regardless of the accumulated effect of our historic burdens, seize the time to define for ourselves what we want to make of our shared destiny.

Ours is a programme to build a better life for all. We will not tire in our efforts to attain and contribute to the broader efforts to attain this goal. We are encouraged by the selfless efforts of many of our partners in this endeavour. As a province, we support the national health budget, and we believe that it will go a long way towards supporting provinces in reaching the goals that we have set for ourselves. Ke a leboga. [Thank you.][Applause.]

Mr N D HENDRICKS: Hon Chairperson, hon Minister, hon Deputy Minister, hon members in the House and MECs, this is not a day for point-scoring, but I think we need to talk straight. This is health we are talking about.

Whilst the overall programme allocation is sufficient to achieve measurable outcomes, leadership around HIV/Aids, supply of antiretrovirals to prisoners and the continued marginalisation of groupings such as the Treatment Action Campaign and other civil society groupings, does not assist with efforts to address the pandemic.

Recent studies – and we have heard it – have shown that with over 5,5 million infections, South Africans have the highest infection rate in sub- Saharan Africa. I want to say that that is not the true figure. We are probably hitting 10 million to 12 million right now, and unless we make this a notifiable disease, and I know people will kick against it, but we are not going to get to the accurate figures.

It might be that we need to look at that because, coupled to this, and we have heard it already, we are going to have a lot of orphans …

The DEPUTY CHAIRPERSON OF THE NCOP (Ms P M Hollander): Is there a point of order, hon Ralane?

Mr T S RALANE: Is the hon member prepared to take a question?

Mr N D HENDRICKS: No, my time is … [Laughter.]

With regard to human resources, the health system is still losing medical staff at an increasing rate. Just recently, in the Weekend Argus, I saw an advertisement from the United Kingdom. I am happy to hear that the government is talking to the UK government about this, and perhaps we need to look at the conditions and remuneration of staff, because at some of the hospitals here, some of the staff are really demotivated. We need to look at that.

Then I just want to ask the Minister something. I have had a lot of contact with Groote Schuur’s renal unit, and they tell me that they send back 75% of their patients to die, because they can’t handle it. They haven’t got the facilities. [Interjections.] Those are not my words; they are the words of the people from Groote Schuur.

The pharmaceutical pricing debacle is still persisting, leaving consumers confused. There needs to be closure on the issue of interim pricing arrangements so that certainty can be brought to the legislative framework of pricing for pharmacies.

The policy aim of broadening access to medical schemes in the development of low-income schemes is praiseworthy and should be implemented as soon as possible.

The outputs of the Medical Research Council continue to impress at the centre of research and capacity-building.

Besides the HIV/Aids management issue, this budget sets out to achieve objectives stated in the strategic plan, and is therefore supported. Thank you. Ms M G VANTURA (Western Cape): Chairperson, 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 health services. As chairperson of the standing committee on social development, I want to assure the Minister that I will definitely investigate the allegations that were made around Groote Schuur Hospital. We are very particular with regard to our oversight role and, definitely, that will be a priority for us now.

Taking our lead from national government, there is no doubt where our priority as the government of the Western Cape lies. In his state of the nation address, President Thabo Mbeki made it clear that we have to move faster to address the challenges of poverty and improve service delivery to the marginalised in our society.

Ter ondersteuning van hierdie begrotingspos wil ek die Minister die versekering gee dat die departement van gesondheid in die Wes-Kaap ’n daadwerklike rol sal speel om inhoud aan ons Eeu van Hoop te gee, deur te verseker dat ons personeel en vennote hulle verantwoordelikhede doeltreffend en doelgerig sal nakom en dat hulle ook voldoening sal bring aan die beginsels van Batho Pele en die Handves van Pasiënteregte. (Translation of Afrikaans paragraph follows.)

[In support of this Budget Vote I want to give the Minister the assurance that the department of health in the Western Cape will play an active role in providing content to our Age of Hope, by ensuring that our staff and partners will fulfil their responsibilities in an effective and efficient way and that they will furthermore give effect to the principles of Batho Pele and the Patients’ Rights Charter.]

There are challenges and we do not shy away from addressing these in a constructive manner. A major criticism of health service is the long periods that we have to wait for some of these services. While funding and logistics play a role, often the shortage of specialised health workers is a major contributing factor. In addressing this challenge, the Western Cape is working in full support of the national human resource plan for health.

Die gehaltemonitering van ons gesondheidsorg uit die oogpunt van pasiënte asook ‘n tegniese oogpunt is uiters belangrik, en ten einde ons bestaande diens te verbeter word kliënte en personeel se tevredenheid jaarliks deur middel van opnames by al ons fasiliteite getoets. Hierdie inligting word dan verwerk, probleemareas word geïdentifiseer en regstellende stappe deur die bestuur gedoen. (Translation of Afrikaans paragraph follows.)

[Monitoring the quality of our health care from the patients’ viewpoint as well as a technical perspective is vitally important, and in order to improve our existing service the satisfaction of clients and staff is determined annually by means of surveys at all our facilities. This information is subsequently processed, problem areas are identified and rectifying steps are taken by management.]

Our home-based care programme, run in conjunction with the NPOs, continues to make an enormous contribution to improved service delivery. Last year 910 home-based carers saw 8 600 patients and paid more than 190 visits. Of course we need to keep our hand on the process to ensure that we do not lose focus.

A particularly exciting development is the massive extension of the Expanded Public Works Programme, where 1 430 community health workers will receive formal training that will both enable them to provide quality care to the patients for whom they care, and also to have marketable skills and opportunities for employment.

Another challenge that we face is the ongoing promotion of community participation through institutions such as the provincial health council, the provincial Aids council, district health councils –still to be established- facility boards and health forums that ensure that our health facilities respond adequately to the community needs. In conjunction with the national department we will continue to roll out the healthy lifestyle awareness campaign with the focus on the prevention of communicable and noncommunicable diseases and the reduction of violence and trauma.

A number of national priorities guided the 2006-07 budget of the Western Cape department of health. Consequently we dedicated a significant amount of our budget to specific national priorities. These include primary health care, HIV/Aids, tuberculosis, emergency medical services, human resource development and the information systems, the modernisation of our tertiary services and the Expanded Public Works Programme, which I described earlier on.

Die jaar wat voorlê sal van sleutelbelang wees vir die inwerkingstelling van dienstransformasie in ooreenstemming met nasionale beleid. Ons diensplan wat die bloudruk vir toekomstige dienslewering voorsien, naamlik Gesondheidsorg 2010, word tans gefinaliseer en inwerkingstelling sal volg sodra die openbare konsultasieproses voltooi is. (Translation of Afrikaans paragraph follows.)

[The year that lies ahead will be of crucial importance for the implementation of service transformation in compliance with national policy. Our service plan that provides the blueprint for future service delivery, namely Health Care 2010, is being finalised at the moment and implementation will follow as soon as the process of public consultation has been completed.]

Allow me, Chairperson, to highlight some of the critical areas in our budget. One initiative that I would like to highlight is the establishment of a directorate of nursing, given the critical role played by our nurses. It is my belief that such a directorate will add focus to dealing with the challenges of the nursing shortage. The task of the new incumbent will be to focus full-time on serving the 11 000 nurses in our provincial health team.

In modernising our tertiary services and health services in general, I am glad to report that there will be an increase in the funds provided for new equipment. We have budgeted R172 million for it.

Primary health care and the primary health care approach are extremely important to us. It is our aim this year to further strengthen the management and staffing of all these facilities. At the beginning of March 2006, we also took operational control of personal primary health care services in the non-metropolitan areas of the province, creating a seamless health service in these areas.

The budget also enables us to take concrete steps towards making health care more accessible and delivering services closer to our people. An additional R4 million is budgeted to provide a package of services during extended hours at 10 community health centres.

Daar is tans 17 000 pasiënte op ARV-behandeling by 43 persele regdeur die Kaap en ons is besig om daardie behandeling drasties te verhoog. Pasiëntebehandeling neem tans met sowat 700 per maand toe en ons stel dit ten doel om teen die einde van die boekjaar ’n teiken van 22 000 pasiënte op behandeling te hê. Nagenoeg 272 mense sal vanjaar vrywillige berading en toetsing ondergaan. (Translation of Afrikaans paragraph follows.)

[At the moment there are 17 000 patients on ARV treatment at 43 facilities across the Cape, and we are in the process of increasing that treatment considerably. Currently the treatment of patients is increasing with more or less 700 cases per month, and we are aiming at a target of 22 000 patients on treatment by the end of the financial year. Approximately 272 people will undergo voluntary counselling and testing this year.]

Tuberculosis remains a major challenge in the Western Cape. Currently it affects 967 per 100 000 of the population in our province. Moreover, TB is now responsible for a third of all deaths in HIV-infected people. In taking on this challenge it is clear that we need to combine and recommit our resources. To this end we are continuing with the provisioning of tuberculosis hospitals. We are also adding an additional R12,5 million to improve the programme of our clinics and our mobile clinics. Our aim is to achieve a cure rate of 72%.

Another service now provided by the department of health is the forensic pathology service. This service brings its own challenges with an expected total of 10 000 postmortems per year.

The EMS services or ambulance service and patient transport also remains a focus in this budget. This year we budgeted a further R2 million for new ambulances. We will also equip those ambulances and provide R3 million for additional staff. A sum of R3,7 million is budgeted for patient transport vehicles and R1,8 million to employ an additional 35 drivers.

Sover dit ons psigiatriese hospitale aangaan, maak ons goeie vordering, maar daar is steeds baie om te doen. Ons het onlangs ’n nuwe akute toelatingsaal by Valkenburg geopen. Dit is die eerste fase van hierdie opgradering van daardie hospitaal. Daar is ’n ernstige agterstand met verhoorafwagtende gevangenes wat psigiatriese evaluering nodig het. Ons werk tans saam met die Departement van Justisie en sekere ander regeringsagentskappe om die probleem te verlig.

’n Kwessie wat ek as deel van geestesgesondheid wil beklemtoon, is dwelmmisbruik. As die gesondheidsdepartement het ons hierdie uitdaging die hoof gebied en volgende maand open ons ons ontgiftingseenheid by Stikland- hospitaal, wat ons hande in hierdie stryd sal versterk. Ons het ook R2,5 miljoen bewillig om die eenheid met sy fokus op komplekse gevalle te bedryf. (Translation of Afrikaans paragraphs follows.)

[Concerning our psychiatric hospitals, we are making good progress, but there is still a lot to be done. Recently we opened a new acute admission ward at Valkenburg. This is the first phase in upgrading that hospital. There is a serious backlog with awaiting-trial prisoners who require psychiatric evaluation. At present we are co-operating with the Department of Justice and certain other state agencies to alleviate the problem.

An issue that I would like to emphasise as part of mental health is drug abuse. As the health department we have confronted this challenge and next month we are opening our detoxification unit at Stikland Hospital, which will strengthen our hand in this struggle. We have also allocated R2,5 million to help with the operations of the unit regarding its focus on complex cases.]

The budget for health sciences and training receives a boost to reach a total of R43 million this year. Currently we have 2 448 nurses in training and we expect that 366 will complete their studies at the end of 2006. However, there is no quick fix and it will take time to fill the shortages of nurses. We have begun to address it by investing in training and also to invest in mentorship. We are fortunate to receive a specific allocation in terms of the Expanded Public Works Programme. This amounts to R20,7 million that will help us appoint and train more home-based workers. Thank you. [Time expired.]

Mr B HLONGWA (Gauteng): Hon Chairperson of the NCOP, our national Minister of Health of the Republic of South Africa, Deputy Minister of Health, my colleagues from various provinces and esteemed Members of the House, let me state upfront that I rise to add both my voice and that of the province of Gauteng in supporting the budget that is being tabled by the Minister.

I am sure, Minister, that the budget we have tabled will go a long way in ensuring that we, indeed, build healthy, skilled and productive people who are then able to help us to achieve other targets that were set for the country. But inasmuch as there are lots of things I would have wanted to say, I have chosen to choose four themes. The first one that I thought we might have to deal with is this whole subject of the migration of various skills from our country and elsewhere.

I want to state the following facts. According to the most recent World Health Organisation survey, there is an estimated worldwide shortage of approximately 4,3 million doctors, nurses, midwives, and other health support workers across the globe. So this is not a phenomenon unique to South Africa. We in South Africa and in Gauteng have not escaped this global trend.

In his introduction to this report, the Director-General of the World Health Organisation, Dr Lee Yong-Wook, noted, and I quote:

People are a vital ingredient in the strengthening of health systems. But it takes a considerable investment of time and money to train health workers. Countries need their skilled workforce to stay so that their professional expertise can benefit the population. When health workers leave to work elsewhere, there is a loss of hope and a loss of years of investment.

Hon Minister, I think you need to be saluted for the great initiative you have taken in ensuring that we stop this bleeding, but I want to emphasise that it is not only South Africa that is faced with this problem. The United States of America has the same problem. They are spending more money than us but I don’t think they are healthier than us. They continue to have all sorts of problems. [Applause.]

In Gauteng we have to implement a human resource strategy against the backdrop of a sharp rise in demand for our services. The number of people visiting our primary health care facilities has risen from about a million in 1994 to over 12 million visits in the current financial year. This can be directly attributed to the successes of this government into improving access to quality care.

In this regard, allow me to quote one of the finest sons and leaders of our continent, the country and the world, Oliver Tambo, and this is what he had to say:

The challenges we face are ones that arise out of our successes. They impose on us the obligation to succeed even more, to succeed better and more quickly, and to succeed to achieve victory.

Hon Minister, I want to salute you also for continuing to stand firm where others would have wavered. But, speaking to you as your son, we would to say: Don’t try to respond to all of these things. Keep your focus. [Applause.]

In line with the health council’s decision, this year, in Gauteng, we will reopen one nursing college. Our objective is to double the number of nurses we produce by the year 2009. We are working with our partners in organised labour and professional associations to retain our existing nursing staff and improve the quality of their work environment.

This takes place through projects such as the caring for carers, which we are doing jointly with Denosa. We are doing some work with the International Labour Organisation, the International Council of Nurses and, indeed, with the Public Service International.

I agree with hon Faith Mazibuko that, indeed, there are a lot of things that we will have to do to improve the quality of care. We agreed that, in fact, we will have to criticise ourselves to ensure that we improve the quality of service. In that regard, we would want to evaluate and critique our services constantly from different perspectives.

We would want to evaluate our services from the perspective of the elderly gentleman who is waiting patiently in the queue to receive his medicine. We would also want to evaluate our services from the perspective of the victim of a shooting incident about to receive emergency attention. We would also look at our own services from the perspective of an expectant mother who is preparing to give birth to an infant; and we would also want to evaluate our services through the eyes of a young child who is just about to be immunised.

I am convinced that when we apply these yardsticks, we will find that there are many things to praise and to applaud within the health system. Every day, every hour and every minute, a medical doctor, a nurse, and a community health worker in our province and our country continue to perform minor miracles. As the Minister indicated, they continue to save lives, comfort the afflicted, prevent the spread of disease; and, yes, indeed, they influence positively the lifestyles of individuals.

More often than not, many of the dedicated professionals, as the Minister observed in her speech last night, do not receive the recognition they deserve for doing extraordinary things under very ordinary circumstances. I believe it is time that we recognise and acknowledge this. But, at the same time, I think that we must also admit that there are many things that can be improved in our system and that many drastic changes need to be made to ensure that we have a people-centred health system operating in our country.

I want to share with you my experience so far, knowing that I am a very newly appointed person. I have indeed spent the first few weeks since my appointment speaking to health managers, medical staff, nurses and other health care professionals as well as patients about both their expectations and experiences. I came away from most of these encounters with an overwhelming sense that, indeed, we are making progress, but that there is also significant room for improvement across the entire spectrum of our service.

However, I think I need to submit that sometimes the good work performed by dedicated health professionals is undone by our weak information systems, which contribute a great deal to the long queues of waiting people that we have. I have no doubt that a lot will be done to address this problem. But I think it will be appropriate that as we prepare to celebrate the 50th anniversary of the march of women of South Africa, we also evaluate the progress we have made in improving the health status of women.

In this regard, our health professionals in hospitals, unfortunately, continue to see, in my view, a large number of women survivors of sexual assault and physical abuse. Our women also carry a disproportionate burden of diseases because of the violence that they have to endure in relationships, within marriage and in society in general. However, hon Minister, this is not an issue that can be solved at the level of health services alone, it is something that I think we will have to take up, and is being taken up by our government, across the board.

As I am moving towards concluding, I want to mention that in Gauteng, generally, I think a lot of progress has been made. Notwithstanding the challenges that I have noted, we know that as a result of urbanisation and migration which, amongst other things, have to do with the role that Gauteng plays in the economy, we continue to attract people, not only from provinces within South Africa but also from outside our borders. People come from Eastern Europe, Pakistan and Nigeria. Indeed they are in Hillbrow, Johannesburg, and they all want services. We continue to extend services to all of these people. That being the case, we have no doubt that this will pose all sorts of challenges.

The burden of disease from chronic illnesses such as diabetes and hypertension, as the Minister mentioned, continues to rise in our country. Hon Minister, I think we have acknowledged over and over this thing of HIV and Aids. It’s one of the challenges. It is not the only health challenge South Africa has. [Applause.] I don’t think we must continue to respond to these things.

However, we acknowledge that HIV and Aids remain a challenge. In Gauteng alone, just to share a few statistics, we have over 54 facilities established to administer post-exposure prophylaxis to the survivors of sexual assault. In the current financial year, we will be opening five more facilities. We have screened over 37 000 women who have benefited from these services.

When it comes to issues of cervical and breast cancer, we have seen over 77 000 women. We continue to save lives. As you would know, even regarding cancer, when it is detected early a lot can be done.

Had time been permitting, I would have responded to issues of emergency medical services, which we are addressing very seriously in Gauteng. I am convinced that we are not only able, but willing and ready. We will address these problems. I thank you. [Applause.]

The HOUSE CHAIRPERSON (Mr T S Setona): Hon Chairperson, hon Minister, hon Deputy Minister, distinguished special delegates, hon members of this august House, colleagues, comrades and compatriots, Director–General of the department, Mr Thami Mseleku, and your dedicated team, 11 years into our democracy, during this epoch in the history of our evolving struggle that we have declared accordingly as “the Age of Hope”, the key entry to a health budget policy debate is to take stock of the state of health in South Africa since the 27 April 1994 breakthrough.

In doing that, we must honestly answer the fundamental question to what extent we have moved in addressing the aspirations of our people, as encapsulated in the resolve of the people’s congress 51 years ago in Kliptown. In that historic congress of our people assembled in a dusty open field of Kliptown, our people adopted the Freedom Charter, whose 51st anniversary we are celebrating this year, and declared, I quote, “There shall be houses, security and comfort.”

Proceeding from this very fundamental principle, they further went on to declare that, and I quote again:

The infant mortality rate in our country is amongst the highest in the
world and the life expectancy of Africans amongst the lowest. Medical
services are haphazard and costly. A preventative health scheme shall be
run by the state. Free medical care and hospitalisation shall be
provided for all, with medical care for mothers and young children. The
aged, the orphans and the disabled shall be cared for by the state.

That is the Freedom Charter as adopted in 1956 by the ANC. This is the basis against which we ought to measure ourselves in terms of health services as we continue with the struggle for the transformation of our country.

Indeed, the Constitution of our country as the supreme law of the land has drawn its very fundamental principles and values from the vision of the Freedom Charter, on whose basis our provision of health care for all is located. Therefore we must ensure that those of our people who laid down their lives in service of our oppressed and the country, and for the realisation of the vision and the programme of the Freedom Charter, have not done so in vain by providing health care for all. This is the task that we take seriously as the ANC. We will indeed never fail to accomplish it.

We are talking here about the 1960s death-defying generation of Vuyisile Mini, Joe Gqabi, Solomon Mahlangu, Barney Molokoane and the battalion of Soweto 1976 youth uprising. It will be a failure on our part if we don’t expedite the implementation of the vision of the Freedom Charter. It will be a betrayal of these martyrs who laid down their lives for the freedom that we are enjoying today.

It is therefore fitting to dedicate this Budget Vote to these successes that defined the generations of the young revolutionaries by reassuring South Africa and her people that free health care for all remains our principal mission as the ANC, and no one can stand in our way. [Applause.]

We do this not because of our permanent affinity for blaming the past, as some of our detractors usually assume, but because ours, under the leadership of ANC, is the struggle to undo the legacy which perpetuated itself for more than three centuries. In line with the vision of the Freedom Charter, we can say with pride today that our government has extended the implementation of the integrated management of childhood illnesses strategy to all 53 health districts of our country. This includes the integrated nutrition programme that includes youth nutrition.

My two daughters and millions of children, of course, today have access to free health care in their schools through the school health services, which have been rolled out in all provinces thanks to the ANC leadership and government. This was because my generation, under white minority domination, were denied this right in the land of their birth.

In this regard, we should salute the provinces of KwaZulu-Natal, North West and Mpumalanga for reaching 100% roll-out of this programme, which by far exceeds the 60% target set by the national department. Through these and other interventions, South Africa has witnessed a decrease in the infant mortality rate to 43 deaths per 1 000 live births and 58 per 1 000 under- five mortality live births. This is a record mortality rate that is inspiring, indeed, and confirms the correctness of our conviction that we are indeed in the Age of Hope.

Qualitative progress has been recorded in the reduction of the impact of genetic disorders and birth defects, and 30% of health workers were trained in human genetics in 2005–06. More to be appreciated is the raising levels of consciousness amongst our people regarding genetic disorders and birth defects. This has seen an increase in the reporting of birth defects from 350 000 per year in September 2005 to 400 000 per year in December 2005. This means an increase of 50 000 within a period of three months and it is, indeed, a great leap forward.

Governance and management of health institutions in our communities need some attention as a matter of urgency, particularly with respect to community participation. We cannot continue to blame government for the vandalism that happens to our public health institutions. We cannot continue to blame our government for some of the problems that we are facing, like the lack of fences in some of these particular institutions.

The hon Deputy Minister has alluded to a very shocking and indeed very moving experience concerning Kuruman, where members of the community said: “We are not going to wait for the government to do certain things for us but we are going to donate R25 000 as part of our contribution to bringing about a better life for all.” That was, indeed, a people’s contract in action.

We are, therefore, saying that governance and popular participation in the administration and management of these institutions should be a key issue, not only for the department but also for all political parties in order to ensure that our people, in communities where they live, are active in determining day to day management and the running of these institutions. I think that is the people’s democracy that we are talking about.

We welcome the department’s initiative to devolve some managerial functions to hospitals and community health centres. There should be a clear line between administrative work and health work in order to improve efficiency, and I think this point has been raised. It is therefore my conviction that, through mass participation at committee level, some of the problems that we have alluded to can be resolved without really making petitions that some political parties are displaying in these Houses.

Allow me to highlight some of the challenges and attempt to place them in their proper context. I think hon Brian Hlongwa, the MEC from Gauteng, has actually covered some of the issues that I wanted to raise. The first point against which our government must be measured, in terms of whether it is succeeding or not, is an understanding of the history of our country - where we come from, and by acknowledging the fact that South Africa does not have an abundance of resources to deal with all its challenges in just 10 years, when some of these problems have been entrenched for more than three centuries.

Hon MEC Belot has said that we do not have a supermarket somewhere, to which we could just go to with a trolley and get medicines, more money, and bricks to build new hospitals and new clinics. We are dealing with a century’s legacy and that is not possible. So we must proceed from that particular understanding. We must also proceed from the understanding that we have inherited the health infrastructure and system that was not designed to provide health services to all the people of South Africa, but only to a few minorities.

I can’t see the hon member of the DA. I don’t think she knew what the situation was in the health institutions in Soweto until the ANC came to political office in 1994. I don’t think they understand what the situation was regarding health services within our communities, particularly our rural communities, before the ANC came to office. So we must, at times, be patient and understand that it is the first time that they are gaining an understanding of the living conditions of our people, while some of them have benefited from the perpetuation of those undesirable socioeconomic conditions.

One need not be a rocket scientist to recognise that opening access to health care for the historically disadvantaged, who constitute the majority in this country, will result in huge backlogs in relation to infrastructure, personnel and other related services, thus placing huge pressure on the state. Some people do not understand that dialect. We have said all hospitals must be accessible to the majority of the people in this country and these hospitals were not designed to serve people who were from the former Transkei …

The DEPUTY CHAIRPERSON OF THE NCOP (Ms P M Hollander): Hon member, your time has expired.

The HOUSE CHAIRPERSON (Mr T S Setona): Thank you very much. On behalf of the ANC, I support the Budget Vote.

The MINISTER OF HEALTH: Chairperson, thank you very much, I shall indeed remain very focused - as my son advised me. In this regard I just want to do two things: Firstly, I want to make some announcements. From 6 to 9 June there is a conference on traditional medicine that is taking place in Gauteng. We are convinced that we really have to understand issues around traditional medicine, and in this regard we invited experts on traditional medicine from other countries such as China and India, who will come and participate in this conference and share with us their own experiences. We have written a letter to the Chairperson to invite as many of you as would want to come to that conference. You will have to pay.

The second announcement is that from 1 to 3 July, under the auspices of the Global Fund to Fight Malaria, TB and HIV and Aids, there will be a partnership forum that will take place in Durban and I hope most of you can attend, so that we can also make our inputs at that forum. Those who attended the one in Thailand two years ago will understand why I said so. Even some strange quarters are beginning to understand our approach to HIV and Aids. There are still those who want to attack us. For those who have understood the strategy of government, it would be proper for us to be there and defend this democracy.

There will also be a health and research development conference in Ghana from 15 to 17 July. Now that we have spoken about diabetes and understand that people don’t just die because of the Aids-defining conditions, there will also be a conference – I am sure I can announce it now – on diabetes here in Cape Town in December. I think we are beginning to move somewhere.

The last announcement that I’d like to make is that after I have made a few additional remarks here, you are all invited to dinner. At least you can save your rands this evening. Dinner is free. Just follow me and you will find the place.

Just a few more things before I wind up. I really get worried when we stand up and talk about additional directorates and nursing directorates because these things have not been discussed by the National Health Council. I thought that even at the lekgotla the President said we would have to align our organograms. We must really begin to consult each other before we create other structures that would not be aligned to what we have all agreed upon. I thought I should just mention that. I never really find the motivation for this particular directorate. Does the human resource directorate not fulfil these duties? And what about the Nursing Council? We will have a multiplicity of structures and it is going to be very difficult for us to manage those structures. We can debate that. If we are convinced, I am sure we can then see how we accommodate that directorate.

I’d be happy if hon Hendricks would ask Groote Schuur Hospital to write to me about the 75% of patients who are sent away. I was there earlier this year and this report was not made to me. It is a very new report and maybe it is still fresh, but it would help if I got a letter so that we can attend to this matter.

The other thing that none of us mentioned is the importance of research. This morning we discussed research and what worried us is that we are not seeing an increase in the number of researchers, particularly from the historically disadvantaged communities. We need to address that issue and how all of us can indeed proceed to ensure that we increase the number of researchers from those communities.

I have taken note of the request that maybe we need to translate the budget into other languages and we’ll see what we can do about that. We might do a small one in a book that is user-friendly, so that people can understand what we are talking about as we are debating the budget.

I’d also like to just say two more things. When we talk about health professionals, I think we need to be a bit more sensitive. Some of them do exceptionally well and therefore we can’t just club all of them and say that they come to work drunk. I think we really must say that some of them are drunk when they come to work. That is acceptable. We just discourage all of them if we say that all of them come to work drunk. If there is just one rotten potato in a bag of potatoes it can actually destroy all the potatoes.

I think we need to be more sensitive and if you come across such incidents you should write to the MEC or write to me, so that we can see how we can attend to such matters. We shouldn’t wait until we come here in order to articulate our own frustrations. I really plead for that. I really value our health professionals and I think they do sterling work. We really need to give them, right now, a round of applause. [Applause.]

The last thing that I wanted to say is that the hon member of the DA made a comment that the Department of Health is not controlling the spread of HIV and Aids. Of course it is not the department that has to control that. It is individuals themselves. All we can do is to give the messages that are necessary, in order for the individual to take care of his or her own health. I think we must begin to understand that there are several things that we need to do: We must make sure that through the manner in which we behave, we decrease the number of new infections, that we take care of our own health and lead healthy lifestyles, and that we eat nutritious food. I think we have said this over and over. I was just given some amadumbe [African potatoes] and this reminded me how very useful that is. I think I have already mentioned the issue of traditional medicine and I think we are going to go along those lines to research traditional medicines. Yes, we will provide antiretrovirals. When I say it, it is as though I don’t like antiretrovirals. They do have side effects. We mustn’t be shy to tell our people this.

Lastly, Ma Mazibuko, I think we have come a long way. MECs have mentioned our hospital revitalisation programme. At the moment we have about 46 projects. We have built quite a number of new hospitals that they mentioned and I sometimes think we really need to pat ourselves on the back. If we don’t do it, then nobody would.

Yes, we can criticise, but we must also acknowledge what we have achieved as a country. There are very few countries who have achieved what we have in less than 20 years. It is absolutely wonderful what we have done collectively. Your oversight has been absolutely brilliant. I urge you to continue to do that because it is only through your oversight that we can continue to improve what we are trying to do. [Applause.]

Thank you very much to the MECs because you have provided an overview of what is happening on the ground. Let me reiterate: Rome was not built in a day. I think what we have done is remarkable. I want to thank the MECs for the opportunity to work together, to achieve the aims of the ANC as articulated in the Freedom Charter, because that is exactly what we are doing. We are implementing the Freedom Charter. Every time we try and establish a programme it is because the Freedom Charter is guiding us.

This is the first time that MEC Jajula and MEC Hlongwa participated in this debate. Welcome to the family. Thank you. [Applause.]

Debate concluded.

The Council adjourned at 17:59. ____

            ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS

ANNOUNCEMENTS

National Assembly and National Council of Provinces

The Speaker and the Chairperson

1. Assent by President in respect of Bills

   1) Nursing Bill [B 26D – 2005] – Act No 33 of 2005 (assented to and signed by President on 22 May 2006).

2. Draft Bills submitted in terms of Joint Rule 159

(1)     2010 FIFA World Cup South Africa Special Measures Bill, 2006,
    submitted by the Minister of Sport and Recreation on 6 June 2006.

COMMITTEE REPORTS

National Council of Provinces

1. Report of the Select Committee on Economic and Foreign Affairs on the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management, dated 7 June 2006:

   The Select Committee on Economic and Foreign Affairs, having considered the request for approval by Parliament on the Joint Convention of the Safety of Radioactive Waste Management and on the Safety of Radioactive Waste Management, referred to it, recommends that the Council, in terms of section 231(2) of the Constitution, approve the said Convention.

Report to be considered.