FRIDAY, 6 JUNE 2008 __

          PROCEEDINGS OF THE NATIONAL COUNCIL OF PROVINCES
                                ____

The Council met at 09:07.

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.

                          NOTICE OF MOTION

Mr R J TAU: Chair, I hereby give notice that I shall move on the next sitting day of the Council:

That the Council –

(1) takes note of the fact that during the Morning Live programme on Friday, 6 June 2008, it was reported that the De Aar area in the Northern Cape has been declared, or is recognised as, the South African capital of foetal alcohol syndrome;

(2) notes that there are farms that are still using the “dop” [tot] system as a form of payment to farm labourers;

(3) further notes that this practice has been declared illegal as expressed in our labour laws;

(4) condemns in the strongest possible terms the abuse by farm owners of farmworkers, who are vulnerable, by using the “dop” [tot] system; and

(5) supports any form of investigation that shall unravel and ensure that those who are responsible for the usage of the “dop system” on the vulnerable, the poor and the workers in these farm areas are brought to book.

Thank you.

                         APPROPRIATION BILL

                           (Policy debate)

Vote No 14 — Health:

The MINISTER OF HEALTH: Chairperson, it is always a pleasure for me to come and interact with members of this House. I would like to recognise my colleague, the MEC from the Eastern Cape, who is here with me today. Hon members, ladies and gentlemen, good morning. May I just mention that in the gallery I have members of my family and friends who have come to support me today. [Applause.] So, it does give me great pleasure to present the national Department of Health’s budget to this House.

Whilst the budget largely provides for the operations of the national Department of Health, it also provides for a number of conditional grants which are used by provincial departments of health. In addition, I would like to highlight a few critical issues that apply to specific provinces, since the business of this House relates to the performance of provinces as much as to the role of the national department in supporting provinces.

Over the past few weeks, the national and affected provincial governments have been working tirelessly to respond to the incidents of attacks on non- South Africans in our country. I wish to condemn in the strongest possible terms these acts of violence and convey our sympathies and condolences to those affected.

In addition to handling injury cases, the Department of Health has been part of the intersectoral collaboration to address challenges relating to the displacement and relocation of those affected. The national Department of Health has issued other guidelines very clearly to assist provinces to prevent transmission of infectious diseases in the temporary sectors that have been provided. The guidelines require that we ensure access to primary health care for people accommodated in these shelters, and patient transport is provided for referrals.

Our interventions focus on health promotion, which covers prevention methods, signs and symptoms of common infectious diseases and personal hygiene. The guidelines also cover the prevention of waterborne and foodborne diseases, providing advice on appropriate handling of food and prevention of contamination of water sources.

We are verifying the immunisation status of children. Where there is no proof of immunisation history, immunisation against polio is provided for children up to 5 years of age and against measles for children between 6 months and 15 years of age. Surveillance of infectious and vaccine- preventable diseases is being upscaled to track cases of cholera, polio, measles, meningococcal diseases and other diseases that could cause serious outbreaks. Health workers have been advised to report suspected cases of any infectious diseases immediately.

What I need to mention is that these are equally important measures to take for all the people of our country. If you know of children who have not been immunised, please encourage caregivers to take them to our clinics for vaccination.

This year, we commemorate the 30th anniversary of the adoption of the Alma- Ata Declaration on Primary Health Care. The policies and legislation that we have adopted as the foundation of our health system is based on the Primary Health Care Approach. Key principles that underpin this approach, which we have included in the National Health Act, include: equity; solidarity; community participation and involvement; intersectoral collaboration; and decentralisation of the management of health care services.

But, in this context, the service transformation plans and the provincialisation of personal primary health care services become absolutely critical. Municipalities must ensure that they strengthen the environmental health services, which is one of their core responsibilities.

The intersectoral collaboration, in particular, is critical to the achievement of good health outcomes. Health outcomes are determined by a range of factors — many of which are outside the direct control of the Department of Health. These include: access to clean water and proper sanitation; food security and good nutrition; access to educational opportunities, especially for women and children; and access to sustainable livelihoods and other factors generally known as the social determinants of health.

Significant achievements have been recorded in a number of areas in line with our strategic plan for 2007-08, and I shall highlight a few of them. Firstly, achieving the Millennium Development Goals, MDGs, with respect to child health requires, for example, that we have to improve our immunisation coverage. We have in this regard increased our coverage of the fully immunised under 1-year-olds to 84% in 2007-08. In fact, provinces such as Gauteng, Free State, Northern Cape and Western Cape have already exceeded the national and global target by achieving immunisation coverage rates of above 90%. Going forward, we will strive to reach our overall national target of 90% coverage in all 52 of our health districts. We are on target to achieve the Millennium Development Goals.

We have also increased the provision of vitamin A to infants and mothers. This, together with the fortification of staple foods and the establishment of food gardens, contributes to improvements in the nutritional status of South Africans. One hundred per cent of children aged between 6 and 12 months, and 61% of their mothers, received vitamin A supplementation. However, we must increase the percentage of mothers who receive vitamin A to 100% this year.

As hon members know, I have been an advocate of food gardens, as this assists in ensuring food security and providing better nutritional status. It is therefore pleasing to note that, for example, KwaZulu-Natal has established 327 food gardens over the past few years. It is important that we also monitor the impact of these food gardens – what impact they have on the nutritional status of our people. We can provide food parcels when there are emergencies, but we also need to focus on food security.

You may as well say yes, this is very good progress. But why is the media reporting deaths of children in the Eastern Cape? In addition to an investigation by the National Outbreak Response Team and the committee on the mortality of children under 5 years of age, I personally visited the district with a team of officials last week, and this is what we found.

I found that this is a deep rural district with a population of 350 000. It has a poverty rate of 77%, which is why it was designated as one of the rural nodes in the Integrated Sustainable Rural Development Programme. There are significant challenges with respect to access to safe water and proper sanitation in this district. To compound this situation, the piped water that is available is not always adequately chlorinated.

There are challenges of food insecurity, and the majority of children who died were indeed malnourished. Babies are going hungry because they do not get the benefits of breast milk, as many live with their great-grandmothers and grandmothers. To make the baby milk formula go as far as possible, it is often overdiluted to the point of being nutritionally inadequate.

Given the high levels of poverty, there is a need for easy access to social grants. A challenge is that the local office of the Department of Home Affairs is a long distance from those most affected, in particular the informal settlements and farm dwellers. The need for a mobile office has been identified to address this challenge. We will be working closely with Home Affairs in this regard. These conditions contributed to the significant increase in the number of children who died between 2007 and 2008.

Let me now turn to the health system’s response to these deaths. Most of the children who were presented at the district hospital were already in a critical condition. The children who were presented were also from a number of villages. So, it took a while for the district to realise that cumulatively there was a large increase in the number of deaths. This means that the surveillance system and clinical auditing systems need to be strengthened at facility and district levels.

So, what have we done to address the challenges that exist in this district? Briefly, using community health workers and retired nurses, we have strengthened our health promotion activities, which now include door- to-door visits during which issues like correct feeding practices, including the importance of breastfeeding, basic hygiene, the need to start food gardens, etc, are explained to our communities.

In addition, we have strengthened the knowledge and skills of health professionals in the area of integrated management of childhood diseases. Within the next three months, we will be introducing two new vaccines into our expanded immunisation programme. This will assist us to prevent deaths from pneumonia and diarrhoea. We plan to formally launch this initiative in this district. I must emphasise that even with vaccination, we must ensure that we provide safe water and proper sanitation and indeed improve the nutritional status of those in that district and improve hygiene practices. Vaccines and immunisation won’t solve the problem.

In addition, we have requested the World Health Organisation, WHO, to provide us with technical assistance in the form of technical experts from both WHO-AFRO and WHO headquarters in Geneva. These experts will assist us in consolidating our findings and recommendations, as well as assisting with building capacity for surveillance and early detection.

I have established expert ministerial committees to investigate and report on neonatal, child and maternal health. I have asked these committees to ensure that I get regular reports so that speedy remedial action can be taken to prevent avoidable deaths. The Committee on Confidential Enquiry into Maternal Deaths is 10 years old this year. Eighty-five per cent of public hospitals are currently implementing the recommendations contained in the third report of this committee. Our prevention programmes, with respect to HIV, show signs of sustained success. Last year I reported a 1% decline in HIV prevalence in women attending antenatal clinics in the public health sector. The results of the 2007 HIV antenatal survey show a similar reduction.

The findings of the 2007 survey show that HIV prevalence was at 28,0% in 2007, as compared to 29,2% in 2006. HIV prevalence in the 15 to 19-year- olds dropped from 13,7% in 2006 to 12,9% in 2007 and a decrease was observed as well in the 25 to 29-year-old group, from 38,7% in 2006 to 37,9% in 2007. The rate in the 20 to 24-year-old group was sustained between 2006 and 2007.

Taken together, these figures indeed do suggest that we have an overall trend of decreasing prevalence in the younger age cohort in particular. I think our youth really do deserve our congratulations in this regard. We achieve these encouraging trends because of our intensive prevention campaigns, which we believe are starting to make a difference.

I must commend the three provinces in which malaria is endemic — KwaZulu- Natal, Limpopo and Mpumalanga. By strengthening their programmes through training, the use of indoor residual spraying and the use of new combination drugs, as well as collaboration with our partners, Mozambique, Swaziland and Zimbabwe, they have succeeded in reducing the number of malaria cases by 57% between 2006 and 2007. The next step is to ensure that we further decrease the case fatality by working closely with communities to ensure that anyone with malaria symptoms is diagnosed and gets treatment as early as possible.

Whilst some progress has been made in increasing the TB cure rate and decreasing the defaulter rate, we need to accelerate progress to ensure that we decrease drug-resistant TB. To address the challenges of drug- resistant TB, we provided provinces with R400 million last year. These funds are largely used to pay for additional drug costs and to provide additional beds to isolate patients who are drug-resistant. We have patients who are isolated because of the danger they pose to others. Understandably, some of them are unhappy because of the extended hospital admissions. We are doing all we can to make their stay in our facilities as comfortable as possible.

The key to addressing drug-resistant TB is to “turn off the tap” — that is, to cure patients the first time they contract TB. In this regard, the national department, with support from the European Union, has trained and deployed 72 tracer teams to find defaulters and ensure that they are put back on treatment. We are confident that we will meet the target of decreasing the defaulter rate to less than 7%, as indicated in the President’s state of the nation address earlier this year.

We have signed an agreement with the Chamber of Mines of South Africa and the National Union of Mineworkers to strengthen our ability to do a benefit examination of miners and ex-miners who presented occupational health problems. This will also increase access to occupational health benefits for qualifying miners.

The world is slowly waking up to the increasing incidence of noncommunicable diseases. This was one of the major issues discussed at this year’s World Health Assembly in Geneva. We recognised this several years ago as South Africa, hence our efforts on healthy lifestyles. Our Healthy Lifestyles programme is now 3 years old and it continues to focus on physical activity, proper nutrition, responsible sexual behaviour, control of tobacco use, responsible alcohol use and no drug abuse. The last Friday of February each year is now declared a Healthy Lifestyle Day for both our country and our beautiful continent, Africa.

With respect to control of tobacco use, South Africa will, in November this year, host the third session of the Conference of the Parties to the Framework Convention on Tobacco Control, FCTC. This meeting will deliberate on practical steps that need to be taken to reduce tobacco use and its harm to human health, the economy and the environment. The conference of the Parties is a body that monitors progress in the implementation of the FCTC, which was ratified by our Parliament in April 2005.

Hon members will know that prevention is better than cure. Unfortunately, health facilities have been designed for the sick the world over. However, we need to also make sure that they focus on keeping people healthy. One way to do this is to establish wellness centres in all our facilities. These centres can advocate a wellness approach in all parts of our facilities, especially for our health workers. I shall work with MECs to find ways of ensuring that we start the process of establishing these centres in earnest during this financial year.

It is important to alert this House to the resolution of the World Health Assembly last month to include noncommunicable diseases on the list of indicators monitored in addition to MDGs. The world is increasingly becoming aware of the growing challenge of noncommunicable diseases — something we have been highlighting for a long time as South Africa. Besides the emphasis on noncommunicable diseases, the delegates to the World Health Assembly also reiterated in the context of MDGs, amongst others, the need to strengthen health systems. We cannot only focus on priority health programmes. For sustainability and long-term success, we must focus on the health system as a whole.

To further expand our primary health care system, a number of provinces commissioned new clinics in 2007-08. The North West province, for example, completed 9 clinics, built 2 new community health centres and upgraded 2 others and is on track to complete another 6 community health centres in

1. The Free State upgraded 2 clinics and 1 community health centre last year at a cost of R11 million and upgraded the emergency unit, which I had the pleasure to visit, at the Pelonomi Hospital. These are just a few examples. I am sure the MECs who shall take the floor will provide additional details.

Similarly, we have made progress with the Hospital Revitalisation Programme, as we need hospitals to conduct primary health care and provide quality health care as well as a healthy working environment for our staff. During the last two financial years, 3 new hospitals were opened, bringing to 8 the number of new hospitals we have built in the country. These are the George Hospital in the Western Cape; Madzikane KaZulu Memorial Hospital in the Eastern Cape and Lebowakgomo Hospital in Limpopo. An additional three hospitals will be completed by the end of this financial year. These are the Dilokong and Nkhensani hospitals in Limpopo and the Barkly West Hospital in the Northern Cape.

New buildings contribute to better working environments for our health workers and in turn to improvements in quality of care. However, quality of care at all public health facilities remains a challenge, and we have taken additional steps to improve the quality of care that we provide as the department.

The Department of Health has established a set of core national standards reflecting the degree of excellence we wish to attain in delivering acceptable and quality health services. These standards cover a broad range of performance areas. For instance, with respect to safety, we will look at safe handling and storage of medicines, patient safety systems and infection prevention and control.

A total of 27 hospitals and 4 community health centres have been identified as initial focal points for appraisals based on these core standards covering all provinces and all levels of care. The first report is expected in July in this regard. I hope I can come and present the report.

African Traditional Medicine Day is on 31 August each year. This year we will celebrate progress made in finalising our policy on African traditional medicine and intensify its implementation. In preparation for implementation, we shall be hosting a colloquium on African traditional medicine to launch the national institute of African traditional medicine and also participate in a continent-wide review of progress during this Decade for African Traditional Medicine. The continental review will take place under the chairpersonship of your Minister, the Minister of Health of South Africa, who is the current Chair of the Bureau of African Ministers of Health, in Yaoundé in Cameroon on 30 August this year.

Key to achieving all this has been and will continue to be a strong cadre of health workers. We are proud of our health workers, many of whom work under difficult conditions. We know that by and large they are dedicated to providing the best possible service in our country. Like many other countries with a growing burden of disease and migration of health workers, the strain felt by the health system is significant in our country. Hence, we have implemented a number of strategies to increase and stabilise our health workforce. These include the community service nurses strategy which commenced this year, as you know.

There are government-to-government recruitment agreements, especially of doctors, the most recent being with Tunisia. We were the first department to implement a new approach to remuneration adjustments called the occupation-specific dispensation. In January this year, the first cohort of 23 students started training at the Walter Sisulu University. The Walter Sisulu University will have a further intake into this programme in July this year. The University of Pretoria will enrol 40 students, and I understand it will now be 60 students in June this year, and will have a further intake in January 2009. The University of Witwatersrand will start in January 2009 with an intake of 24 students. The University of Limpopo is working towards commencing this programme in January 2009.

The programme I am referring you to is the Clinical Associate Programme, which is a 3-year programme that will produce a cadre of health professionals who will work mainly in community health centres and district hospitals. Upon qualification, they will be registered with the Health Professions Council of South Africa with a defined scope of practice. They will be able to assess patients, make a diagnosis, treat and prescribe appropriate therapy and undertake minor surgical procedures under the supervision of medical officers.

We have a large cadre of community health workers in the country doing a number of tasks. We have taken a decision to review this programme. We have to ensure that these workers are trained to provide a number of services. They should work closely with the community caregivers employed by the Department of Social Development, which also provides home and community- based care. We should also be working in this instance with the Department of Public Works.

However, I still believe we can do more to ensure better co-ordination, monitoring and support for this programme. We shall be assessing the situation and taking the steps necessary to strengthen the role that this cadre plays and what they should do during this financial year. This will take into consideration the need to increase community participation and involvement in health.

We will continue to strengthen our relations with our international partners, especially in Africa and countries in the south. We hosted an AU Workshop on Maternal, Newborn and Child Mortality Reviews, which came up with proposals on interventions needed towards meeting MDGs 4 and 5 beyond

1. The recommendations of this workshop have been adopted by the AU Health Ministers and will be tabled for consideration, and hopefully for adoption, by the heads of state and government at their summit in June - this month. The AU Health Ministers have also given me the honour and the responsibility to be the AU Goodwill Ambassador and Champion for Women and Child Health. [Applause.]

South Africa will also assume the role of chairing the SADC Health Ministers meeting in the second half of this year. All of these responsibilities reflect the confidence and trust that our sister countries in SADC and Africa have in us as a country. We will also be attending the global celebration of the declaration organised by the World Health Organisation in October this year. We are also attending the UN General Assembly Special Session on HIV and Aids. I am leaving for New York tomorrow to attend this session.

We have concluded a number of agreements with other African countries that will enable them to refer their citizens to our tertiary hospitals. We are assisting Namibia with setting up a cardiac unit in that country, and the unit is expected to conduct its first open-heart surgery soon. I shall attend that session. We are also collaborating with Namibia on the management of drug-resistant TB. In addition, we will continue to play an active role in the development of a code of conduct for the international recruitment of health personnel, and it must be transparent. This process is a result of efforts by Africa to highlight the negative effects of migration of health workers on our health systems. Our view is that all countries should make an effort to train for their own needs.

Let me turn to the budget of the national Department of Health before my time expires. The budget that I am tabling before us today calls for the spending of R15,1 billion by the national Department of Health. For the first time, the budget is provided in the new six-budget programme format. The development arises from the restructuring of the department from the old four-budget programme structure to the new six-budget programme structure, which will provide resources to strengthen the management structure of the department by the addition of two more deputy directors- general.

In terms of funding available for the operations of the national Department of Health, I wish to highlight the following: The budget for the department grows by 14% between 2004-05 and 2010-11; R10,7 million is allocated for personnel over the MTEF — R2,278 million in 2008-09, R3,7 million in 2009- 10 and R4,687 million in 2010-11; and R21,7 million again over the MTEF for nonpersonnel components of the Vote — R6,506 million in 2008-09, R6,974 million in 2009-10 and R8,266 million in 2010-11. In addition, R10 million has been granted for 2008-09 to undertake research and to develop detailed implementation plans for the recapitalisation of nursing colleges, including more detailed planning on the supply and demand for nurses within the national health system. An amount of R5 million has been budgeted for the SA Medical Research Council to compensate for inflation over the MTEF.

In addition, a number of conditional grants are provided for. As hon members know, these funds are transferred to provinces by the national department. The Hospital Revitalisation Conditional Grant is R600 million for 2008-09, R500 million for 2009-10 and R900 million for 2010-11; the HIV and Aids Conditional Grant is R350 million for 2008-09, R600 million for 2009-10 and R1,1 billion for 2010-11; and the National Tertiary Services Grant is R193 million for 2008-09, R247 million for 2009-10 and R639 million for 2010-11.

I want to clarify that these are not total figures for conditional grants for the 2008-11 MTEF. They are additions to baselines. Whilst provinces are responsible for expenditure on these conditional grants, the national department is expected to monitor expenditure to ensure that they are within both the provisions of the Division of Revenue Act and business plans. We will be working more closely with provinces during this financial year to ensure that expenditure on conditional grants is carefully monitored and that rapid corrective steps are taken when necessary.

Much has been achieved in 2007-08 which fortifies the cumulative milestones we have achieved since 1994, guided by the Primary Health Care Approach. Our priorities and budget for 2008-09 reflect our commitment to improving health service delivery to all the citizens of our country.

I wish to thank the members of this House for their support to the health system, and in particular wish to pay tribute to the Chairperson and members of the Standing Committee on Social Services. Much of the success of the department rests with the leadership provided by my colleagues, the MECs for health, some of whom are present today. I wish to thank them for their support.

In addition, I wish to thank the officials of the department led by the director-general, Mr Thami Mseleku, and the heads of the provincial departments of health for their support. Choose a healthy lifestyle, like me. Thank you. [Applause.]

The CHAIRPERSON OF THE NCOP: I realise that some of the visitors up there in the gallery are struggling to see the floor; it is because of the way in which the House is constructed. It’s a heritage site and we can’t change it. So, I would request that the shortest who would want to see, because they keep on standing, should move to the other side; perhaps they will see better. I see there are very short ones who can hardly see the floor. [Laughter.]

Ms J M MASILO: Hon Chairperson, hon Minister of Health, the MEC present, hon members of the House, director-general and senior managers, ladies and gentlemen and comrades, the Department of Health promotes the health of all South Africans through a caring and effective national health system based on the Primary Health Care Approach.

In 1994, government started providing free primary health care services for children younger than six years and for pregnant women. During the same period up to July 2007 government initiated a programme that resulted in more than 1 500 clinics being built or upgraded. Where necessary, patients with complications are referred to higher levels of care such as hospitals.

Primary health care services include immunisation; communicable and noncommunicable disease prevention; maternity care; screening of children; integrated management of childhood illness and child health care promotion; counselling management of chronic diseases and diseases of older persons; rehabilitation, accident and – the hon Tau and the other member you are really disturbing us at the podium - emergency services; family planning and oral health; and district and countrywide integration of mental health and substance abuse into primary health care.

During 2006-07 the Healthy Lifestyle campaign was expanded to district and local municipalities, schools and workplaces. Even here in Parliament a programme has been implemented and we are on a Healthy Lifestyle programme as members.

Thousands of schools were assisted in establishing school-based food gardens, implementing tobacco-control programmes and implementing a strategy on diet, physical activity and health. We welcome this initiative by the department.

The audit findings of the 2006-07 annual report of the department noted as challenges the late submission of business plans, late or nonsubmission of monthly and quarterly reports, lack of capacity and monitoring, inadequate evaluation of reports, and inconsistencies between monthly and quarterly reports.

With regard to emergency medical services, EMS, the department stated that there are major improvements which include 200 ambulances which have been acquired for the provinces, an air service available in four provinces, and training and provision of personnel in this area. My colleagues will add information on the same issue.

Regarding conditional grants and earmarked funds, the department also funds national and some provincial nongovernmental organisations, NGOs, which provide health services. The committee’s main concern is the monitoring and accountability of these NGOs. On Tuesday, 3 June 2008, NGOs in the North West province marched and presented a memorandum to the office of the MEC for health for not getting their stipend for the past three months. This is a national problem, that NGOs complain about late payment as service providers. Even during the Taking Parliament to the People programme in Pniel in the Western Cape, and Tlokwe in the North West in particular, similar complaints were raised.

The transfer of the major conditional grants to provinces is to fund specific functions. These funds flow to provincial health departments from where spending takes place against activities as contained in the preapproved business plans from various NGOs. The select committee wants to know the progress of health promoters in all provinces. Has training taken place as it was supposed to be implemented in the strategy for the financial year ending this year, March 2008? Have the nurses who were expected to start their community service in January 2008 started? Is the department on track with the implementation? Has the opening of extra nursing colleges taken place?

Positive financial allocations to health are the following: An effort to increase health personnel through interventions such as scarce skills and rural allowance strategies is yielding results, with the health personnel employed in the public sector increasing by 14,5% since 2004. Public sector personnel have increased by 31 710 since 2004, with 3 253 doctors, 13 202 nurses, 5 433 ambulance personnel and 531 pharmacists. A massive increase in health facilities and equipped infrastructure has resulted in the refurbishment of over 40 hospitals in all nine provinces. Integrated special development and the building of clinics, together with greater emphasis on the implementation of primary health care services, has resulted in increased visits to these centres. There are 20 million visits annually as compared to five years ago.

It is acknowledged worldwide that South Africa runs one of the best developments on HIV/Aids programmes. We, as the House, have to acknowledge that. The department estimates that over 300 000 people are on Aids treatment. At 313 sites across 53 health districts, over 500 000 people are estimated to be infected by HIV/Aids in South Africa.

With regard to other diseases, we, as the ANC, at the national conference in Polokwane in 2007, resolved that diseases such as TB and cancer should be given special attention. The national Department of Health must be commended for providing leadership to provinces with regard to increased expenditure on HIV/Aids by 29,9%, health facilities and management by 11,6% and primary health care by 8%.

In line with the ANC national conference in December, the resolution was to accelerate programmes for hospitals revitalisation. We note that spending on hospitals has increased and improved by 4%. Expenditure on hospitals increased from 10,2 to 23%.

In relation to discussions on health-related challenges during the public hearings when taking Parliament to the people, these issues were raised: shortage of staff, nurses and resources; lack of medication in public hospitals; long hours that people spend in queues to get assistance in clinics and hospitals; poor ambulance services and the response time; caregivers not receiving their stipend - I have mentioned that - and they do not get protective equipment when doing their work; clinics need clerks to assist in the administration; struggle to get visiting doctors after four every day; pharmacy assistants are needed to reduce the current workload of the professional nurses; management of laundry and linen seems to be very poor in most of our clinics and hospitals; and also the Batho Pele principle and the patient charter is not practised by most of our officials. It means we have to look at the lack of management in particular.

In conclusion, let me take this opportunity to thank the Minister and the department for inviting the Chairperson of the Select Committee on Health to the African Union Conference of Ministers of Health this year in April, where the Minister is the Chairperson, and also to congratulate her for being appointed as an ambassador of the AU’s Ministers of Health; she has already alluded to that. Well done, Minister. This achievement is for us as South Africa and Africa.

Let me also thank members of the committee for their dedication and support, not forgetting the ANC study group for their guidance and support all the time. Ke a leboga. [Thank you.]

Ms H LAMOELA: Hon Chair, hon Minister and hon members, MECs and officials, our Department of Health’s vision is an accessible, caring and high-quality health system.

Yet, the biggest challenge facing our country in the second term of democracy is that of a quality health care system which can deliver sustainable quality health care to all our citizens. The 2008 state of the nation address emphasised the need to accelerate the implementation of the national strategic plan for HIV/Aids and sexually transmitted infections.

Year by year, the department presents its strategic plans. Every year the challenges facing the implementation grow bigger and bigger. Just to name one: the HIV/Aids challenge which has inflicted immense suffering on our citizens. Millions have been infected and died. Fifteen million children have been orphaned by Aids and millions more made vulnerable. The disease kills at least 900 South Africans every day. Yet, at times I shudder to think that our Department of Health is in denial that the pandemic is escalating. Since 2004, the mission of the Department of Health was to improve the health status through prevention of illness and disease; promote healthy lifestyles, and we are now in the third year of healthy lifestyles; and consistently improve delivery systems by focusing on access, equity, efficiency, quality and sustainability.

Regular and continuous checks are made on the 2010 World Cup stadiums. Intense monitoring is taking place on a monthly basis and yes, we all want this event to be an unforgettable one. We want to be extremely proud South Africans. We want it to be a world-class event. Yet, audited monitoring and evaluation in our health care system affecting about 48 million citizens is lacking.

Recently six disabled children died of — as the media stated it – an overdose of injection given by a health professional. The health professional has since been on special leave to allow the investigation to take place. The hon Minister spoke about the children who died in this democracy of ours today in the Eastern Cape. Who monitors it? Last year while visiting the Northern Cape we found that geysers in two main hospitals were not working and ordinary urns were used to provide hot water. Who monitors? What happens to infection control under these circumstances?

Vacancy rates in the health sector can have disastrous effects on quality service delivery. Although there are a staggering number of vacant posts around the country for medical specialists’ doctors and nurses, neither the national nor provincial governments are really exploring many creative ways to reduce these vacancies. This lack is disastrous for South Africa’s health care system.

The vacancy rates for medical specialists range from the lowest, 51% in the Free State, to 86% in Limpopo. For doctors in the same provinces the vacancy rate is 35% for the Free State and 63% for Limpopo. Is this government actually serious about addressing the skills crisis in our hospitals?

A brand-new x-ray machine installed four months ago is still unused in the Lenasia Clinic in Lenasia Extension 5 because of a lack of qualified staff. Every month hundreds of patients are sent all the way to the Chiawelo Clinic in Soweto for x-rays. Nearly 5 000 patients are waiting for surgery in Gauteng’s four major hospitals. Last weekend at the Livingstone Hospital in the Eastern Cape two armed men burst into the casualty ward, killing a patient and injuring a doctor.

There are many dedicated and extremely hardworking nurses and doctors in our hospitals and clinics throughout the country, but even the most dedicated professionals cannot ensure standards don’t slip, given the lack of human resources. In addition to all this, their security is not even guaranteed.

A Health System Trust Conference in October 2007 made it clear that South Africa’s nursing shortage crisis is not created by a lack of South Africans who want to be nurses, but rather by the Health department’s complete failure to put in place a concrete plan to train nurses. I am actually pleased to hear that the Health Recapitalisation Plan will now be put in place. Thank you, Minister. Currently, 60% of our nurses are over the age of 50. This means that within a few years, as these nurses retire, we will be facing an even greater crisis than we are now.

Despite the many problems there are those who, on a daily basis, do their utmost to alleviate the pain and suffering of the patients, like the two health professionals from KwaZulu-Natal that I met outside the House yesterday as I was on my way out — those who still work endlessly to make a difference for the love and care of the job. To all those unsung heroes, a big thank you for your dedication and interest shown. I thank you. [Applause.]

Nk N F MAZIBUKO: Sihlalo, ngibingelela namalungu, ngibonga leli thuba leli engiliphiwe nami ukuthi ngikwazi ukuphefumula ngezempilo, okuyizo ezenza ukuthi ezomnotho lapha eNingizimu Afrika zisimame. Isizwe esihle isizwe esiphilile.

Isizwe esiphilile isizwe esiphila impilo engcono. Impilo engcono impilo elangazelelwa yiwo wonke umuntu ohlala lapha eNingizimu Afrika. Lapha eNingizimu Afrika kunenhlangano eyodwa nje kuphela okuyiyo eyaziyo ukuthi impilo zabantu kumele ziphucuwe futhi zibe ngcono. Leyo nhlangano ibizwa ngokuthi uKhongolose obizwa nge-ANC ngamafuphi.

Ukhongolose kuphela oweza namasu kulokhu okubizwa ngokuthi i-Manifesto ngonyaka ka-1994 nango-1999 kanye no-2004 ecacisa ngokusobala ukuthi yingani ezempilo zibalulekile, nanokuthi kufuneka kwenzekeni ukuze kuphilwe impilo engcono, lokhu okuthiwa i-Health for a better life. Yibona futhi abakwazi ukuza namaphuzu ayishumi lokhu okubizwa ngokuthi yi-Ten Point Plan, ukuze izimpilo zabantu ziphucuzeke.

Inhlangano kaKhongolose kuphela eyathi wonke umuntu oya emtholampilo angeke akhokhe ngisho nendibilishi, ngoba inhlangano kaKhongolose kuphela eyaziyo ukuthi abantu badinga ukwelashwa. Inhlangano kaKhongolose kuphela eyathi esibhedlela uma ungenayo imali yokukhokha noma uhola impesheni wena uzokwelashwa mahhala. Yilungelo lakho lelo futhi akekho ozokuphindisa emuva.

Inhlangano kaKhongolose kuphela futhi eyaziyo ukuthi nezingane ziyagonywa futhi kumele zinakekelwe, zidle ukudla okunomsoco zithole wona amavithamimi A ukuze zingashoni. Inhlangano kaKhongolose eyeza namakhambi okwelapha isifo sengculaza kanye nesandulela ngculaza ukuze abantu bakwazi ukuphila impilo engcono bedla ukudla okunomsoco. Ngisho noNgqongqoshe uyagqugquzela ukuthi masidleni ukudla okunjengemifino ukuze sikwazi ukuphila impilo engcono. Inhlangano kaKhongolose kuphela eyathi imitholampilo yonke nezibhedlela mazibeke obala i-Patient’s Charter okuwuMqulu Weziguli ukuze bonke abantu bawazi amalungelo abo, babuye futhi bayibhale ngazo zonke izilimi ukuze wonke umuntu akwazi ukuqonda kahle ukuthi isho ukuthini. Kuningi-ke engingakubala okuhle okwenziwa nguKhongolose kepha nonke niyazi ukuthi zikhona izinselelo. Ukhona futhi umuntu okunguye ongumshayeli wazo zonke lezi zinto onguNgqongqoshe wethu uDokotela uManto, umama uShabalala- Msimang.

Siyazi ukuthi uNgqongqoshe nguye oyibambe ngezihluthu futhi sengizwile nezikhundla eziningana asezitholile ngoba bayancoma umsebenzi omuhle esiwenzayo lapha eNingizimu Afrika. Ngeke ngazibala futhi siyakuhalalisela Ngqongqoshe kuzo zonke lezo zikhundla osuziphiwe. Kuyabonakalisa ukuthi yithi kuphela lapha eNingizimu Afrika esaziyo ezempilo, futhi nguwe ohamba phambili ukuqinisekisa ukuthi abantu baphila impilo engcono.

Niyazi namanje ukuthi uNgqongqoshe ubambene ngezihluthu nalaba bezibhedlela zemitholampilo yangasese, laba abafuna ukwenyusa amanani ezibhedlela. Bakhona ngingababiza ngamagama kodwa kungaze kushone ilanga. Ngqongqoshe, qinisa isandla sakho. Laba bantu mabathobele umthetho ngoba kungenxa yemisebenzi yakho ukuthi nabo bakwazi ukubhaliswa lapha eNingizimu Afrika, ukuze bakwazi ukusebenza, kepha namuhla bafuna abantu bakhokhiswe imali engangekhulu beyibiza ngemali yezindleko zokubhalisa. Uma uhluleka ukukhokha bathi kuwe kufanele ukhokhe izinkulungwane ezine ngaphambi kokuba welashwe.

Eziphakamisweni zethu zasePolokwane siye sagcizelela ukuthi ezempilo zibalulekile, nanokuthi nathi singamalungu ezindaweni esizimele masiphumeni ngobuningi bethu siqiniseke ukuthi abantu baphila impilo engcono, futhi baphila impilo ezihlanzekile.

Cishe sonke siyazi ukuthi uMnyango wezempilo uthola imali eningi kakhulu uma kuqhathaniswa neminye iMinyango, yiwona futhi oqhasha abantu abaningi abangasebenzi bengabodokotela, amanesi, abahlengikazi njalonjalo, phezu kwayo yonke lemali ekhishwayo nemigomo emihle abasebenzi bakahulumeni impatho yabo kwiziguli ayishintshi , i-Batho Pele. Ayikho kepha ukutoyiza baphuma phambili yebo siyazwelana nabo uma belwela amalungelo abo.

Ngqongqoshe kulamasonto asanda kudlula ubaba wami ubegula, kepha ugule kwembulwa kwembeswa usesibhedlela i-South Rand kubengathi ufa uhlangothi, bathi simthwale simuse e-Jo’burg General. Kuze kwaba udokotela wangasese othole ukuthi ushukela wakhe wenyukile, namuhla usephilile.

Mangisho ngithi bangaki abaya kwimitholampilo yethu okungatholwa ukuthi yini ngempela ebaphethe. Ezokuphepha nazo zise yinselele, abasebenzi kwi zibhedlela abaphephile, laphaya esibhedlela e-Baragwanath umfundi owudokotela uye wanukebezwa ngokocansi, ngenxa yalaba abazicabangela bebodwa bengacabangi ngamakhanda kepha becabanga ngalokhu okesemabhulukweni abo.

Futhi sizwile ngodokotela oye wadutshulwa yilabo ebezodubula umngani bemqedelelela esibhedlela, ngisho nalabo abakhuthuzwa besemsebenzini bathathelwe amaselula kanye nezimoto ezebiwayo emajagcekeni ezibhedlela.

Ngithemba Ngqongqoshe nawe ungakuthakasela ukuthi imitholampilo isebenza amahora angamashumi amabili nane ngosuku, amalanga aiyikhombisa esonto, izinsuku ezingama 365 ngonyaka , kepha ngeke kuphumelele lokho uma izinswelaboya zibhokile. Sekumele uNgqongqoshe axoxisane noNgqongqoshe Wezamaphoyisa ukuze bancede ngezokuphepha kwimithola-mpilo.

Ezosizo olusheshayo (Emergency Services) hawu kwembulwa kwembeswa, Ngqongqoshe kudingeka siphakamise amasokisi lapho akubi ngcono, ikakhulu kumalokishi anje ngoSoweto. Yebo imigudu eyenziwa ukuphucula lelo sizo kepha isendelendlela.

Uma ngiphetha Kuwo wonke lawo maphuzu ayishumi (10 point plan), mahlanu balulekile uMnyango owusebenzela phezu kwawo, njengokkwenzangcono izinga lezempilo kanye nemphatho kubantu, ukuqiniseka ukuthi izingqalasisinda ziba seqopheni eliphezulu ikakhulu kwimithola mpilo nesezibhedlela, Izinhlelo ezithi mazikhuthaze ukuthi siphile kahle, ukwelashwa kwesifo sofuba, abantu bazivikele kwisifo sengculazi, izinhlelo ezibhekene nomame kanye nezingane nokuthi izingane zigonywe zisencane.

Ngithanda ukucaphuna uNgqongqoshe wezempilo wase Gauteng ngenkathi siseSebokeng ngonyaka owedlule, siyise iPhalamende ebantwini wathi ngiyamcaphula: “Mina angisiyena uNgqongqoshe wezifo kepha nginguNgqongqoshe Wezempilo.” Waqhubeka wathi umasinikezwa ukudla asibuzi ukuthi ngabe usawoti utheliwe kepha sithatha usawoti sithele ekudleni, wabuye wathi thina bantu asizwani nokuzelula imizimba yethu siyenqena sikhetha ukuhamba nge-lift kunokuba sihambe ngezitebhisi. Asisadli imifino nokudla okunomsoco kepha sidla loku ngesingisi kuthiwa yi-deep fried food – ukudla okunamafutha amaningi, yingakho ke sikhuluphele sinezifo zoshukela, isifo sokuphakama ko-mfutho wegazi (high blood pressure). Imizimba ubuthakathaka nje engenywa yizifo zonke lezi ezazingaphathi ogogo nomkhulu bethu, izifo zesimanje manje ezenziwa impilo esiyiphilayo. (Translation of isiZulu speech follows.)

[Ms N F MAZIBUKO: Chairperson, I greet the members. I am grateful for the opportunity that I have been given to talk about health, because that is what makes South Africa thrive economically.

A good nation is a healthy nation. A healthy nation is a nation that lives a better life. A better life is a life envisaged by everybody who lives in South Africa. In South Africa there is only one party which understands that people’s lives need to be improved and be made better. And that party is the African National Congress.

The ANC is the only party that highlighted the importance of health in its 1994, 1999 and 2004 manifestos, stating clearly what should be done for people to live a better life. It is also the ANC that came with the idea of the Ten Point Plan, so that people’s lives could improve.

It is only the ANC that suggested that everybody who attends clinics will not pay even a cent, because it is only the ANC that understands that people need to be given medical care. It is only the ANC that suggested that if a person does not have money for hospital fees or is a pensioner, he or she would be given medical treatment free of charge. That is a personal right and no one should be chased away.

It is only the ANC that understands that children need to be given immunisation and that they need to be cared for, that they need to eat healthy food as well as Vitamin A in order to prevent their death. It is the ANC that introduced the antiretrovirals to fight the spread of Aids and HIV in the body, so that people can be able to live a better life, more especially if they eat healthy food. Even the Minister herself encourages us to eat foods like vegetables so that we can live a better life. It is only the ANC that suggested that the Patients’ Rights Charter must be displayed in clinics and hospitals so that all people can know their rights. We also suggested that the Patients’ Rights Charter must be translated into all official languages so that people can clearly understand it. There are many good things that I can mention here which have been done by the ANC, but as you all know, we still have challenges. And the person who is driving all these initiatives is our hon Minister, Dr Manto Tshabalala-Msimang.

We know that the Minister is tackling the matter head-on, and I have heard of different positions that she has been given because they commend the wonderful work that we are doing in South Africa. I cannot count them all, but we congratulate you, hon Minister, on the different positions that you have been given. This clearly shows that we are the only ones in South Africa who know about health, and you are the only one leading in ensuring that people live a better life.

You all know that the Minister is tackling the issue of increasing fees by private clinics and hospitals head-on. We know those hospitals and clinics, but I cannot mention them because mentioning them could take me the whole day. Hon Minister, you must be firm. These people must abide by the law, because they got registered and were able to start working here in South Africa through you, and now they want people to be charged a fee amounting to R100 for registration. And if you are unable to pay, they say that you must pay R4000 before you receive any medical treatment.

In our resolutions in Polokwane, we stressed that health is important, and that we are also members as constituency representatives; we go out in numbers in order to ensure that people live a better life, and they live in a clean environment.

Almost all of us know that the Department of Health gets allocated a lot of money when it is compared with other departments. It employs many people as doctors, nurses, etc. But despite all the funds allocated to it and the good working principles and charters in place, the way government employees treat patients has not yet changed. The Batho Pele principles are not applied, yet they excel when it comes to toyi-toying. Despite this, we accordingly sympathise with them when they fight for their rights.

Hon Minister, in the recent weeks, my father was sick, he was critically ill and was hospitalised in a South Rand hospital. It looked like he was suffering a stroke. They told us to transport him to Johannesburg General Hospital. We were only helped by the private doctor who managed to find that his blood sugar levels were very high. Today he has fully recovered.

It is clear that there are many people who go to our hospitals and clinics and get misdiagnosed. Safety and security is also a challenge. The staff in hospitals are not safe. Just at Chris Hani Baragwanath Hospital an intern doctor was sexually assaulted by those who do not use their brains to think, but instead use what is inside their pair of trousers.

We also heard about the doctor who was shot by those who had come to finish off his hospitalised friend. We also heard about those who were mugged and had their cellular telephones and cars stolen inside hospital premises.

I hope, Minister, that you would also be happy to see clinics open 24 hours a day, seven days a week, and 365 days of the year. And this will not succeed if criminals are on the rampage. The Minister must now engage the Minister of Safety and Security so that they can help with safety and security at the clinics.

The emergency services are still not up to the desired standard, hon Minister. We need to pull up our socks when it comes to emergency services, especially in the townships like Soweto. Yes, there were measures taken to improve that service, but there is still a long way to go in this regard.

In conclusion, of the Ten Point Plan, five are very important and the department is working on them — points such as improving the standard of life and the way people are treated; ensuring that the facilities are of the highest standard at the clinics and hospitals; the programmes that encourage us to live well; the treatment of tuberculosis; the programmes that encourage people to protect themselves from being infected by Aids; and the programmes that focus on mothers and children and that children must be immunised when they are still young.

I would like to quote the Gauteng provincial minister of health, who spoke during Taking Parliament to the People visit to Sebokeng last year. I quote: “I am not the provincial Minister for diseases but for health.” He continued to say that when we are given food to eat, we do not ask if the food has salt or not, but we take salt and add it to our food. He also said that as a people we are too lazy to exercise, we prefer using lifts instead of using stairways.

We no longer eat our vegetables and healthy food, but we eat deep-fried food – food with a lot of oil — and that is why we are so obese and suffer from diabetes and high blood pressure. Our bodies are weak; they are attacked by all the diseases that our grandmothers and grandfathers never had, the diseases of our times caused by the lifestyle that we are leading.]

Mr S BELOT (Free State): Hon Chairperson, hon Minister and hon members, allow me to congratulate our national Minister of Health for the award and appointment which were announced yesterday. Today that shows that the world and the continent have confidence in our Minister of Health. Madam Minister, congratulations to you. Allow me also to thank the Minister and the team for making health care services accessible and affordable to millions of our people in the country; people who never had the opportunity to access these services. The Minister has shared in her speech with us the millions of people who have gone through our facilities to attest to the fact that in the Free State province during the last financial year, out of the 2,8 million people in that province, 6,57 million visits were paid to our primary health care services.

This does not mean that we have a sick population, but it confirms that people now have access to the services which they never had before. I am also happy to confirm that our people use these facilities. As a result, in the Free State we are now able to boast of the lowest TB defaulter rate in the country, thanks to our home-based carers and to our supporters.

It is common cause that members of our communities depend largely on public health care. Very few people use the private sector. It is for that reason that the public sector has to be supported and strengthened. I want to appeal to all members that whenever we deal with the public sector, we have to keep in mind that there are men and women who do their best and do work for those who cannot afford the heavy payments that have to be paid, and we have to respect and appreciate the work that they do.

All our districts in the Free State have a functional governance structure and we are happy with the support that we get from these governance structures because they are the link between our communities, the Department of Health and government. I want to express appreciation for the work that all our governance structures are doing, as well as our hospital boards and clinic committees and all of those structures that are established in terms of the National Health Act.

We are also following developments in the pattern of the burden of diseases and as a result we had to provide 15 new ambulances, 20 response vehicles and 40 patient transports, which added to our existing fleet. Five of these are dedicated to transporting MDR and XDR patients. We are aware of these developments and it is for this reason that we are also taking new initiatives. Emergency helicopters have been introduced into our province, and this has made the work of our doctors easier. I can share with the House that the helicopter does not only ferry patients, but it also takes doctors and specialists to the patients in rural areas of our province.

We are well prepared and ready for the management of emergencies in the event of disasters, and also ready for international events such as the Confederations Cup in 2009 and the Fifa World Cup in 2010. Our new communications centre has improved our response time, I can boast to the House and say that we are now able to track our ambulances and see where they operate. We have gone past the complaints of people that say that they call the ambulance and they never get a response.

It will be an incomplete report to this House if I do not share with the House the many services that we give to our communities. A total of 210 119 people were treated as outpatients in our hospitals, 100 344 people were admitted, 12 753 deliveries were managed and 24 182 surgical patients were treated in our facilities. These figures speak for themselves, to the effect that health care services are now available to many people.

At our central hospital we gave the following services to the people: A total of 17 300 were outpatients at the Central Hospital where we give specialised treatment, 28 000 were admitted, 498 deliveries were managed and 80 243 surgical procedures were conducted.

It is always important that members remember that these figures must be translated into rands and cents. We performed 9 893 open-heart surgery procedures, and we know how much this costs at the private level. Nobody has ever performed and imagined how much we do at the public facilities and who pays for this. It is important that we acknowledge that our government is really making this service available to our people.

We are aware of the shortages, and it is easy for people to come and say there is a shortage of doctors and nurses. As government we are making the effort: A total of 261 full-time bursaries have been given out, with 147 for medical doctors, 29 for ENS, 89 for nursing and 94 for people who are studying part-time.

We are aware that you do not have supermarkets where you can merely go with a trolley to get nurses and doctors from the shelves. We need to train these people and where you are fortunate to be trained as a nurse, you do not take less than four years. As we are aware of these shortages, let us appreciate the fact that government is aware of them and has a programme to deal with these shortages.

I need to hasten to add that even our own professionals who have left the country are beginning to stream back. We are very happy that we share the support of our sister countries where they have a surplus of professionals. They then share them with us. This shows our commitment as government to deliver this service, and I need to thank the Minister for the initiative that she has taken. Thank you.

Mr W M DOUGLAS: Hon Minister, hon Chairperson and hon members, the ACDP supports the aim of the Department of Health, which is to promote the health of all people in South Africa through an accessible, caring and high- quality health system based on the primary health care model. The ACDP hopes that the total allocation of R75,5 billion, with R6,6 billion earmarked this year to fight HIV and Aids, extreme and multidrug-resistant TB and to improve hospitals, would help government achieve its national strategic plan for HIV/Aids and sexually transmitted infections.

It would lessen the number of new HIV/Aids infections by 50% and reduce the impact of HIV/Aids on individuals, families, communities and society by increasing access to a suitable package of treatment, care and support to 80% of all persons diagnosed with HIV. Maybe one day I can convince the Minister to change the emphasis of the campaign from condomise to abstinence before marriage.

As the Department of Health aims to achieve their Ten Point Plan, a few concerns need to be highlighted, and they are: Government’s plans to regulate doctors’ fees are not a good idea. The nation’s health care system is already under relentless strain and regulating prices will only serve to drive away the few remaining doctors and specialists residing in South Africa.

On the lack of access to quality health care for a large portion of South Africans, the ACDP expects the Department of Health to view this as a major challenge that needs critical attention. Whilst we struggle with the challenges left by the legacy of apartheid, we must acknowledge that more could have been done over the past 14 years to upgrade the levels of training and development of black doctors and nurses, and in building an infrastructure closer to where the poor people are in our country. On the regulation of private health care prices, government’s main aim is to focus on the problems plaguing the public health service, but that being said, overcharging by private hospitals must be regulated. While it is logical that we should be looking for access and affordability of hospital services, we should also not neglect the lack of delivery by public hospitals in the process.

Health care waste is a mounting problem in South Africa as in many other countries. Studies show that 45% of health care waste generated in the KwaZulu-Natal province alone cannot be accounted for. This clearly suggests that it is being illegally dumped, buried or burnt somewhere, thus affecting the health of people and the environment around us.

Now is a very difficult time. Government’s role in public health care has never been more pivotal or vital then in this present time in the light of the global food and fuel crisis. We support this Bill and hope that it will help us achieve the aims that are set out by the Department of Health. Thank you.

The DEPUTY CHAIRPERSON OF THE NCOP (Ms P M Hollander): I would like to caution members not to be out of the House during a debate when they know they are on the speakers’ list. Ms A N T MCHUNU: I thank you, hon Chairperson. I had a bowel problem.

The Health budget takes a big slice of the total budget of South Africa, as it deals with the holistic life of people and not just the treatment of the diseases.

Great strides taken fast contribute to overactivity of all systems and wear and tear of cells, leading to exhaustion. For the health human resources and development programme, care of the staff is very important as health needs caring and empathetic personnel. Health personnel needs are a priority in the budget. We have to make sure that staff are really cared for. A simple thing like providing tea means a lot to the staff because it peps them up. This is one thing that has been omitted of late; the staff do not even get tea.

In a primary health care approach, early childhood development programmes and home-based care, as they are being promoted, require family files that are kept in nearby health centres, so that the clients do not need to be interviewed all the time for their social history. At the end of the day, they may even tell stories which are not true and lie about their social history. These confidential files should be accessible to supporting personnel like community nurses, social workers and caregivers. Some clinics get so busy that a clerk may be needed to manage the file room.

Despite a good budget, the morbidity and mortality rates are still high, especially in KwaZulu-Natal. Preventative and health education strategies have to be reviewed. School and community services are still a priority, if any dent is to be made in disease prevention, especially HIV/Aids, TB and extensively drug- resistant TB. The recent crisis of polluted water indicates a warning of health hazards.

Despite the great health needs, the hospital revitalisation grant tends to be underspent. There is a great need to re-examine the root causes of the underspending.

In KwaZulu-Natal’s public hospitals there are chronic shortages of doctors, qualified nurses and medical supplies. Scores of public buildings have been declared unsafe. These bad and stressful working conditions need to be eradicated at once because they lead to one obvious outcome — a poor quality of nursing care. They also result in the mass exodus of nurses to greener pastures.

Some of the public hospitals in KwaZulu-Natal are so overcrowded that one may even find patients sleeping in the passages, while others return home without getting the necessary health care, or dying due to a lack of care.

Now, this means that there has to be co-operation between the communities and the health caregivers so that, if there are problems, this may be known by the communities.

In conclusion, success in the steadily worsening public health services will depend on efficient management and administration. If there is no co- operation, efficiency may be reduced in all spheres of policy implementation, in that not a single noble policy objective will be reached, regardless of how much money we spend.

Moreover, the health Ministry and the department have to …

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

Ms A N T MCHUNU: Thank you, hon Chairperson. Again, I must thank you for giving me time to present my speech.

Ms N JAJULA (Eastern Cape): Chairperson, the wellbeing of any nation is a culmination of various interdependent actions and interventions. Accelerated shared growth and development, accompanied by the reduction in unemployment and poverty, and the general improvements in the creation of a better physical and natural environment, will have a positive impact on the quality of health of the population that we are striving for.

Our movement has declared the Departments of Education and Health to be prioritised as the core elements of social transformation. Any nation depends on these two departments. The Eastern Cape department of health is committed to meeting the targets and the call of the President that the work and the approach, starting this year, is “Business Unusual.” Today, therefore, we are presenting the policy and budget speech to this House with a clear focus on the resolution of the ruling party.

If we are to realise the health targets set out in the Millennium Development Goals, and the Provincial Growth and Development Plan, we will have to drastically increase the pace at which we do things, and to integrate more as a government, and further strengthen collaboration and partnership with our communities, labour and public sector.

I wish to reflect on a few points of strengthening, which include the following: primary health care to become the first port of call for our patients; intensification of campaigns on communicable diseases; the prevention of the spread of TB and containing the spread of multidrug- resistant tuberculosis and extensively drug-resistant tuberculosis; intensification of the campaign on HIV/Aids; acceleration and promotion of healthy lifestyles; the reduction of maternal deaths and infant and neonatal mortality; building the capacity of the department to implement its mandate and to improve service delivery and accountability.

It is critical that we need to improve our call centre services in light of the high rate of emergency services needed. We also need to improve the distribution of drugs as well as our preparation for 2010.

The province has already started to deal with critical areas to ensure that primary health care is the one that gets the biggest slice. We have allocated R4,2 billion to this programme. We are strengthening primary health care as a cornerstone of district health care. This is in regard to the continued implementation of a project that regards clinics as centres of excellence, thus ensuring that primary health care services are accessible to our communities.

We are increasing these clinics from 50 to 60. We have community health centres providing a 24-hour service and we are increasing them from 30 to

1. Maternal and obstetric units have been increased from 18 to 40.

We will once more emphasise the living of a healthy lifestyle. It is critical that we promote this at our schools as well. We are increasing the number of healthy lifestyle promoting schools from 182 to 360. We are increasing health promotion correctional service sites from 7 to 14. We believe that the campaign to detect congenital defects will be enhanced through home visits and other activities.

Regarding the e-Health programme, our commitment is to take care of the health of our citizens in the province. This is illustrated by our emphasis on providing access to health and addressing the challenges of noncommunicable diseases as reflected in this and other speeches, both yesterday and today, as well as in the speech of the Minister.

The Department of Health is strengthening the life of the people to be healthy. It is true, this department is not for ill people; it is a department for healthy people. We are not there purely to cure diseases, but to ensure that people are kept healthy.

Regarding the issue of HIV/Aids, we have a programme which is strengthened by a strategic plan which was implemented in the province. I do hear that some hon members deny the fact that this is stabilising and that the figures are decreasing. We need to move together to understand what is happening in our environment.

The department is going to focus on TB and other resolutions of the 52nd conference of the ANC. As a response to this call, we are going to develop our own provincial war room in order to engage senior citizens, health professionals, clinicians, traditional leaders and traditional healers, religious communities and all stakeholders in seeking a multiple solution to address the MDR issue.

It is a crisis in the province whenever there is a public holiday. People want to go out on a pass-out. They want to go home. It is a challenge. It is not a challenge for the department; it is a challenge for society, knowing the type of condition that they are going to receive.

We are very proud that we are increasing the number of clinics and health centres in the province. We are going to be opening eight clinics on Monday next week and one health centre at Mtanzani. It is critical to mention that this very January we increased the number of school health services by 30 new ones, as well as 63 emergency services. We have employed 350 unemployed graduates who will be deployed in different administrative areas and 1 341 postgraduates of whom 12 are going to be gaining some jobs in the near future.

Because of the time allocated to me, I need to reflect that with the department of health in the Eastern Cape, one does see the difference. When you have your constituency week, just visit some of the areas. You will see the difference and see how people are really working as a team in partnership with the department.

We have introduced a training programme which is a complete partnership with the health centres; caregivers, whereby we offer direct observed treatment, in conjunction with DOTS; ward councillors and ward committees. These stakeholders work together in driving this programme.

The Minister has reflected that what happened at Ukhahlamba is broader than the Department of Health. To deal with that, we need to deal with health education and other people who are there. I do believe that, in order to address the power outages, we have set aside R50 million to procure generators for the province.

In conclusion, I do believe that if we move together within these plans that we have put aside for ourselves, and make sure that we account correctly, we will reach the targets and complete the assignment which was given to us by the ruling party. I thank you. [Applause.]

Nksz A N D QIKANI: Sihlalo, Mphathiswa, maLungu eSigqeba esiLawulayo kumaphondo, ngakumbi elaseMpuma Koloni, Malungu eNdlu, manenekazi namanene, mandinibulise ngegama leNkosi. Le ngxoxo yanamhlanje indichukumisa kakhulu ngoba ithetha ngempilo yabantu. Iphondo endivela kulo, laseMpuma Koloni, lelona lithwaxwa kakhulu yintlupheko. Ngelishwa, abantu bakhona ngabantu abangathathi ntweni nabangenanto. Izinto ezisemgangathweni ekufanele ukuba babe bayazifumana abantu zifana nqwa nokukhangela izinyo enkukhwini phaya kwela phondo laseMpuma Koloni.

Mandiqale ndenjenje, kwisibhedlele saseGcuwa – ndithetha ke ngesibhedlele endandiye kuso ngexa umntakwethu wayefumene ingozi yemoto – akukho nenqwanqwa eli lokuthatha umntu emotweni ukwenzela ukuba angeniswe esibhedlele. Wahlala iiveki ezintathu umntakwethu engafumani ncedo.

Ndiyabulela kwamanye amalungu ale Ndlu, ngoba ndawafowunela ndicela uncedo kuwo kuba akanayo i-medical aid, aze andincedisa ngemali ukuze akwazi ukungena kwisibhedlele i-St Dominique’s, apho khona kufuneka ube nama-R15 000 okuvula ifayile. Urhulumente esikuye ngowabantu kwaye kufuneka sibajonge abantu abaphantsi ekuhlaleni.

Andazi ukuba ndingathetha ndithini na ngephondo leMpuma Koloni. Ngokubhekisele kwisifo sorhudo esivele kuKhahlamba, akufuneki ukuba abantu bade bafe phambi kokuba urhulumente abe nokunceda kwaye alungiselele abantu. Aba bantu baxhomekeke ngokupheleleyo kumaLungu ePalamente nakwaba bantu babaphetheyo. Ndicinga ukuba abavoti esinabo ngabantu abangathathi ntweni, abenza phantse ama-70%, kwaye kufuneka sibakokosile.

IMpuma Koloni yona siyihambela ngeenyawo. Andifuni kuthetha ngoba akukho nto phaya, nakooma-Cecilia Makiwane kunjalo. Eyona nto imbi nangakumbi – xa ndiza kugqibezela ndihlale phantsi - yeyokuba urhulumente, ngeSebe lezeMpilo, wanikezela ngezigidi eziyi-R4,7 kwithenda yokucoca amashumi amawaka eekhilogramu zamashiti nezingxobo zemiqamelo yesibhedlele, okanye ilineni, kwindoda engenayo noomatshini bokucoca.

Leyo ke into ayintlanga, ngoba abantu ababendwendwele indawo yalo mntu bafika abantu behlamba le lineni ngezandla bakugqiba bayiayine, lineni leyo eyayivela kwisibhedlele sesifo sephapha iNkqubela. Ngaba ayikokuxhatshazwa kwabantu abasezantsi abangathathi-ntweni na oko, ukuba abantu, ngenxa yokuba befuna imali, basetyenziswe kwiimeko ezinje? Urhulumente othi ngowabantu makazijonge iimfuno zabantu. Siyaluxhasa olu hlalo lwabiwo-mali. Enkosi. (Translation of isiXhosa speech follows.)

[Mrs A N D QIKANI: Chairperson, Minister, MECs, especially from the Eastern Cape, members of this august House, ladies and gentlemen, let me greet you in the name of the Mighty Lord. Today’s debate is very important to me because it is about the health of the people. The Eastern Cape province, where I come from, is the province hardest hit by poverty. Unfortunately, people who live there are poor and they are suffering. The Eastern Cape province does not have the resources to provide for the needs of the people of the province.

Let me start off by indicating that at Butterworth Hospital – I am talking here about a hospital at which I once visited my brother who had been involved in a car accident – there was not even a stretcher to carry an injured person from a car into the hospital. My brother was in that hospital for three weeks, without getting any help.

I wish to thank other members of this House, whom I phoned asking for assistance as my brother did not have medical aid. They lent me some money so that I could take him to St Dominique’s Hospital, where one needs R15 000 before one can be admitted. The present government is a people’s government and, therefore, we must look after the people at grass-roots level.

I do not know what I can say about the province of the Eastern Cape. Concerning the diarrhoea outbreak in Ukhahlamba District Municipality, government must not wait until some people have died before providing help. These people depend completely on Members of Parliament and on their leaders. I think that the people from whom we draw most of our voters come from the category of the poorest of the poor, who make up about 70% of our voters; therefore we must take care of their needs.

We are tackling the question of the Eastern Cape. There are no facilities even at hospitals such as Cecilia Makiwane Hospital. Worse still – in conclusion, and before I sit down — the government, through the Department of Health, gave out a tender for the washing of 10 000 kg of hospital linen to a man who does not have even have one washing machine.

That is not acceptable at all; the people who visited the place this person worked from, found people there who were busy washing the linen by hand. After that they ironed the linen, which belonged to a TB hospital called Nkqubela. Is it not an act of abuse against the poor people that because they need money, they are made to work under these difficult conditions? A government that claims to be a people’s government must look after the needs of the people. We support this Budget Vote. Thank you.]

The HOUSE CHAIRPERSON (Mrs M N Oliphant): Hon Minister, I think that today you have a duty to check whether hon members are okay or not. I am not sure whether this hon member is also suffering from the same disease that hon Mchunu said she was suffering from. Hon member, you may continue.

Mr J GELDERBLOM (Western Cape): Deputy Chair, I can only say it wasn’t a health matter.

As with previous Health budgets, this budget also invests in providing quality health care to all our people and speaks of the ongoing progress in health care in this country and all its provinces. It also reflects positively on our commitment to transforming health care, bringing it closer to the people who need it most, always mindful of the principle of Batho Pele or “people first” that motivates us.

Allow me to highlight briefly some of the more recent achievements in health care in the Western Cape. In order to improve health service delivery and ensure its long-term sustainability, we are committed to the transformation of health care. To give effect to this commitment, the Comprehensive Service Plan was approved during 2007. We are proud of the fact that we reduced the infant mortality rate in our province to 26 per 1 000 live births in 2007. The immunisation coverage for children under one year of age in 2007 increased to 93%.

To improve maternal health, a basic antenatal care programme that focuses on the early identification of pregnant women at risk and their referral to an appropriate level of care, was rolled out at our provincial health care facilities.

The number of sites dispensing antiretrovirals increased from 18 in March 2004 to 62 at the end of March 2008, with the number of patients on antiretroviral treatment increasing from 2 295 at the end of March 2004 to 37 435 in March 2007.

In the previous financial year, we provided 22 high-burden TB and HIV health facilities with additional resources to improve TB control and achieve an improved outcome. Across the province, new smear-positive cases cured at first attempt stood at 74% in 2007. We have taken steps to upgrade and strengthen our TB hospitals to deal more effectively with multidrug- resistant and extensively drug-resistant TB.

Given the burden of disease in our province, government has made better management of chronic diseases a priority. One of the steps taken was the establishment of a chronic dispensing unit that dispenses prepacked chronic medication to over 83 000 stable patients each month.

To streamline and improve the quality of service at primary health care level, we assumed responsibility for the provision of personal primary health care services in the rural districts. We allocated resources to improve emergency medical services, response times and quality of care to emergency patients.

We also introduced the HealthNet planned patient transport system to improve patient access to health institutions. Planned patient transport services in the Western Cape transferred approximately 70 000 outpatients annually from health facility to health facility and back home.

The occupation-specific dispensation for nurses was implemented in 2007 and there has already been an increase in the number of nurses as a result. We are thankful to national government for this intervention.

We have undertaken an aggressive health facilities revitalisation programme since 2004. This is evident in the revitalisation taking place in George – as the Minister also mentioned – Worcester, Brown’s Farm, Simondium, Montagu, Swellendam, Stanford and Tulbagh, to name a few.

New ambulance stations have also been opened in Atlantis, Riversdale, Caledon and Beaufort West — I think hon members might be very happy with this – with more opening in the near future. As per our commitment in 2007, we now have 90 district-level beds in each of the Khayelitsha and Mitchells Plain district hospitals established at the Tygerberg and Lentegeur hospitals.

We have also invested in providing new equipment in the amount of R180 million at health facilities throughout the province. I hope that the people of Groote Schuur notice that.

The total Vote for health in the Western Cape reaches R8,6 billion in 2008. This is 34,7% of the Western Cape’s budget. Our gratitude goes to our national Minister, as well as the provincial government, for their understanding and for heeding our calls for additional funding.

Our work is not done. We will intensify our efforts to improve health care in the year ahead, focusing in particular on the following key priority areas: the ongoing transformation of health care in line with the needs of our people by implementing the CSP to bring health care closer to the people; the district health system will be further strengthened with the development of district and subdistrict management offices, including opening new offices in Khayelitsha, Mitchells Plain, southern and western subdistricts based in Retreat, Northern and Tygerberg subdistricts based in Bellville. New offices will also open in the Karoo in Beaufort West and in the Overberg region in Caledon.

District health service delivery will be further improved through outreach and support to district hospitals, community health centres and clinics. Pressure on our district hospitals will be relieved by additional capacity at Mowbray Maternity Hospital and level-one obstetric beds at the Khayelitsha district hospital hub at the Tygerberg Hospital.

We will restructure the service platform to ensure that the management of hospital beds is according to a defined level and package of care, that is, level one, two and three beds in our district, regional and central hospitals.

Another priority will be ensuring equitable access to tertiary services in our central hospitals; strengthening TB programmes with a special focus on improved cure rates and the management of MDR and XDR-TB; expanding our HIV and Aids programme, with a greater focus on prevention; and addressing service pressures in mental health. Our psychiatric hospitals will support district hospital services to open step-down facilities for approximately 90 new long-stay patients.

The ambulance fleet at emergency medical services will be increased to 240 vehicles and will cover 14,4 million kilometres this year. We will also be expanding community-based care services through the Expanded Public Works Programme to enable people to be served in communities where they live. In this regard, an additional 1 000 home-based carers will be trained. We will be increasing the number of appointed home-based carers to 2 300 and the number of clients seen by 10 000, to 23 000.

Other measures include the maintaining and upgrading of public health facilities across the province as well as the building of new facilities, with a special focus on construction of the 230-bed Khayelitsha district hospital to commence on 1 October 2008; ongoing investment in training and support of health care staff, and improvements in the remuneration of doctors, dentists, pharmacists and other health care workers.

Our forensic pathology service will be provided via two academic forensic laboratories in the metro, three referral FPS and smaller FPS laboratories and holding centres in the West Coast, Cape Winelands, Overberg, Eden and Central Karoo districts.

We understand that for our country to truly succeed, we need everyone at their best. For us, this means delivery of health services that address the real needs in our communities, while also acknowledging that each of us needs to take more responsibility for our own health by living a healthy life.

I want to tell you, Minister, you did an excellent job there. You look out for the poor people of this country, and that is important. In your position, when some people have the flu, they will blame you. When they have other problems, they will also blame you, but you have the guts to stand strong. We support you and we support this budget. I thank you.

The HOUSE CHAIRPERSON (Mr T S Setona): Hon Chairperson, hon Minister, distinguished special delegates, fellow colleagues, friends and comrades, this policy debate takes place on the occasion of the 14th Youth Month since our democratic breakthrough on 27 April 1994. The month when the eyes, minds and efforts of our nation are focused on the youth of our country in memory of the legacy of the selfless heroism of the generation of 1976.

We celebrate the 32nd anniversary of June 16, 1976, inspired by the fact that some amongst these generations lived to witness the construction of the very first nonracial, nonsexist democratic Parliament under which roof we are debating this Budget Vote this morning.

In this regard, we debate this Budget Vote with fresh memories of Comrade Ramoshwane Peter Mokaba, the indisputable living embodiment of our times of the legacy of 16 June 1976. This is so because in three days from now, on 9 June 2008, South Africans will once again lower their banners in fitting memory of the sixth anniversary of the untimely death of this fearless giant of our revolution. Let the generation of the youth of today emulate his legacy.

We, as the ANC, enter this debate cognisant of the immensity of challenges facing us as a country and as a nation. We do so, mindful of the fact that for close to 350 years of white minority colonial rule, our public health system was deliberately designed to exclude the overwhelming majority of our people in this country.

In 1994, the area where I come from in the Free State had a population in excess of 500 000 people, with only three clinics, one hospital and two ambulances. During the same period, in the white part of Bloemfontein, there were three highly resourced hospitals with each suburb having a fully functional clinic, catering exclusively for the white section of the population.

At its recent 52nd national conference, the ANC resolved, amongst others, to make health the key priority for the coming years, and reaffirmed the implementation of the national health insurance system by further strengthening the public health care system and ensuring adequate provision of funding, developing a recruitment and human resource development strategy for our health professionals and accelerating the programme for hospital revitalisation.

The programmes designed by the Department of Health take their cue from the resolutions and policy directives of the African National Congress to radically improve the lives of our people. Fourteen years into our democracy, President Mbeki’s two-nation thesis in contemporary South Africa continues to define the realities of our country’s state of health service delivery.

The historically marginalised and the poor of our country continue to bear the brunt of a lack of access to quality health care, whilst the rich continue to enjoy the unfettered monopoly of access to quality health care and services. In this regard we support you, hon Minister, in your effort to regulate the prices of medicine, and we would continue to support you. That is in the best interests of the majority of our working-class population.

The capacity to improve effective management of our hospitals and community health centres remains one of the critical challenges that ought to be addressed with a great sense of urgency. It cannot be accepted that, 14 years into our democracy, we continue to witness some hospitals operating without basic necessities such as tablets, linen, pillows and blankets. As late as last month I witnessed with great disbelief, in the hospital, the horrific incident in which patients were literally told to go home and fetch their own blankets.

In some of these clinics there are no medicines. We must make our position very clear, namely that we understand fully that this is not a policy responsibility of the Minister; this is the management responsibility at hospital level. We are, therefore, calling on you, hon Minister, and provincial MECs to beef up the capacity of management and administration at that particular level of delivery. We believe that through that capacity we will be able to deal with other wide-ranging problems, such as theft of our medicines and other items within our public health institutions.

The Constitution, as the supreme law of the land, spells out the right of everyone to have access to health care services as one of the fundamental rights. The Constitution goes further to say that no one may be refused emergency medical treatment. Unfortunately, as a democratic developmental state, we still have a long way to go in terms of ensuring that the masses of our rural poor join their counterparts in the urban centres in enjoying these rights. I think some of the members have alluded to this.

Against the backdrop of the limited resources, a need for ongoing strategic leadership and innovations on the part of our government, through such efforts as private-public partnership initiatives, is critical.

The late Steve Bantu Biko once said: “Black man, be on your own!” Perhaps it is time that we should ask ourselves the fundamental question, whether it is not time that we as South Africans then begin to say: “Can we be on our own?”

I am raising this question because throughout our oversight activities, we have come across pockets of best practice models within South Africa which, if they can be replicated as a coherent national intervention strategy to deal with some of the challenges, can actually help our people a lot.

There is also a certain tendency within South Africa, and all of us should take responsibility for it; I’m not blaming this thing on government. When we want to address a particular problem, we want to go to Brazil, Canada, the US and Germany, when some of the best practices are basically here in South Africa.

I’m speaking, hon Minister, about some of the most exciting initiatives in the province of North West, where the provincial government there has a partnership with the commercial white farmers. It is a partnership that ensures that in all the districts of that province there is at least a community health centre that is able to be accessed by the rural masses of our people in those communities.

We do have community health centres in other provinces within the rural communities, but they are on an ad hoc basis and not in a coherent and systematic manner, such as is the case in the North West province. We are therefore challenging our hon MECs and special delegates to actually go and begin to look at whether they cannot replicate that particular practice as is the case in the North West. In conclusion, we must report before this august House that throughout our oversight activities, the NCOP’s Taking Parliament to the People, in particular, and the oversight activities by the committees, we seem not to have a response that is requisite to the urgency of the demands that our people put before us as elected representatives, or those made by our provincial governments.

You go back to Limpopo - and you have been there in the last three years; MECs, Ministers, and everybody was there. But when you go there after three years, not a single problem that our people have raised has been addressed. This is a matter of concern that we are talking about, and it is not simply the Department of Health, but we are talking about this particular problem as a general problem that is confronting our government in general.

This is fundamentally related to the issue of accountability. Accountability is not just a word that is enjoyed within the boardrooms of politics, but it’s a duty and an obligation. Thank you very much. [Time expired.][Applause.]

The MINISTER OF HEALTH: Deputy Chair, you asked me a very difficult question at the beginning, namely what was happening in the House and why members were not in the House when their turn to speak came. I hope that the Ukhahlamba bug has not descended onto the NCOP; I hope not. Of course, we are here to assist where it is necessary, with our health promotion, making sure that water is safe and that there is proper sanitation.

I’ll just pick up on and respond to a few comments that were made by hon members. First of all, let me thank all the hon members who have participated in this debate, and those who sat and listened very carefully, and because singabakhaya [we are homeboys], to my regret I didn’t hear the KZN voice. I hope you will attend to that, Chairperson, because there are good things happening there. Charity begins at home; it must.

I thought the hon member from the IFP would continue from where the hon member in the National Assembly, Dr Rabinowitz, had left off … [Interjections.] Yes, a member of the IFP. I thought the hon member was going to continue with the lyrics and say: “Baa baa, black sheep …” because she started telling us stories that reminded me of when I was at crèche, but didn’t – thank you very much.

Kusho ukuthi sikhula ngokwahlukeneyo. [This means that we are getting old in different ways.]

Hon Masilo, I do take your points very seriously, regarding the late submission of documents relating to financial matters. But I thought I did mention that we’ll be working very closely with the provinces this time around. [Interjections.] I would request, through you, Chair, that hon members don’t disturb hon Masilo, because I am indeed responding to her. We will be working very closely with the provinces this time around to make sure that all financial expenditure is carefully monitored.

Of course, as you know, to a certain extent our own Constitution makes it a little bit difficult for us to do that. However, because this is the last term of this government, we will take very bold steps this time around just to ensure that we leave a clean record.

Madam Masilo, the health promoters – those that do health promotion, that is the educators – were there yesterday and in large numbers from all over the country. I think this was an indication to me that indeed we are on track with this cadre that we have introduced as peer educators; we are doing very well.

I also referred to the lack of medication, long queues and the safety of patients. I did say that indeed we have introduced a programme around the core national standards in order to benchmark the quality of services that we provide to the citizens of this country. So, I think that in that regard we ourselves had identified this challenge.

We now have a very viable unit that deals with these matters in the Department of Health, and indeed we are continuing to employ clerks and porters – that is critical. So, you can rest assured that our programme does address all the concerns that you have raised. This month, we’ll also have a workshop with the donors, precisely because we want to look at this issue of donor funding and the NGOs, and another workshop to evaluate the Community Health Worker Programme. As you know, we had taken decisions that the community health workers would be the responsibility of nongovernmental organisations, and that we would transfer funds to the nongovernmental organisations so that the stipends could then be paid by them. However, there do seem to be problems in this regard.

I’d like to address myself to hon Lamoela and hon Douglas, by saying that they were not listening to me; absolutely not. In fact, I think the chunk of my input this morning was really to demonstrate to you what we have achieved through our prevention approach with regard to HIV and Aids. So, to say that we are denialists, I don’t know … I don’t want to repeat what a member in the other House said yesterday. The member said he or she didn’t know whether we are in dreamland or on earth, and that he or she would prefer that we be in this country and not in dreamland because it doesn’t quite help.

I gave you all the statistics, and if you think that is an indication of being a denialist, then I don’t know. You don’t have to convince me about the ABC approach in terms of prevention – I think I’ve been an advocate for that, so I don’t need any convincing in that regard.

I think what you need to do is to tell this House what your activities are in your constituencies, to make sure that you don’t just talk of treatment, but also understand that the cornerstone of containing the spread of HIV and Aids in this country is prevention and a contribution by us to the moral regeneration of our country. So, I thought I should just mention that.

Hon Faith Mazibuko, thank you very much for promoting the Healthy Lifestyles programme, but I regret and must express my disappointment that you didn’t mention garlic and beetroot. [Laughter.] I hope that in your constituency, you will talk about beetroot and garlic. I really regret that.

Hon Qikani, I have heard the story several times – your laments. But, I think what we should be doing is not to wait until we come to the Budget Vote debate. You have a Minister, so you can write to me directly. It doesn’t help to just remember one day, for three minutes, that you must raise a particular issue. Write to me if you don’t derive any joy from the Eastern Cape. I will stand up and make sure that things do happen. I think that’s how we work. However, it won’t help if you wait for just the three minutes you are allocated, and come and demonstrate how bad things are in the Eastern Cape, because I can also cite wonderful things that are happening in the Eastern Cape.

To MEC Jajula, thank you very much for underscoring the social determinants of health.

I have been to the Free State, MEC Belot, and I can testify to the fact that indeed we are doing a lot there to ensure that we beef up our EMS, emergency management services, to meet the needs of our communities and to prepare ourselves for the World Cup.

As I sit down, let me just say to all those that I’ve listened to, that this year we intend to finalise the Rural Health Strategy, because we think that it is absolutely critical for us to be comprehensive in the manner in which we address issues in that regard.

Unfortunately, I don’t have the time to go into detail about the legislative programme for this year, but may I just plead with you, hon members, that you assist us to pass these pieces of legislation, in particular the National Health Amendment Bill, which indeed seeks to ensure that there is stability in the private sector, contrary to what we seem to hear in the media, that we want to destroy the private sector – that is very far from the truth.

If also you can assist us to make sure that the Medicine Control Amendment Bill is passed. Mam’ uMasilo, if you can invite me to your committee so that we can talk about other things that are very pertinent in this regard. For me the sore part of it is the clinical trials on HIV and Aids in this country. And I don’t think we grasp the difficulties, the challenges and the dangers around those activities. I think we need to wake up, particularly us from KwaZulu-Natal.

Indawo yakwaHlabisa iyangihlupha kakhulu … [KwaHlabisa area is worrying me so much …]

… so I would really like to come and talk to this House about these matters, so that we all understand what is happening out there. With regard to the Medicine Control Amendment Bill, I think what we are trying to do is to ensure that we have a vibrant regulatory authority. That, in part, takes very seriously the issues of public interest. Even as we register medicine in this country, I think we’ve had many experiences, which, if I had time, I would go through to demonstrate what I mean.

I would like to plead with members to assist us to make sure that they adopt and pass the Tobacco Products Control Amendment Bill. Just to give you the insights, we were almost the first people to sign the FTCT. Some countries have already overtaken us in this regard. Germany, for example, is legislating against smoking in your own house. They understand the dangers of smoking. They are also legislating against smoking in cars to save the lives of the children travelling in cars.

Britain is banning tobacco dispensing machines in public places and we hope we can do that for the citizens of our country, particularly in the public sector. I am, indeed, just about winding up with the good news that lunch is at 12 o’clock in the Marks Building. As is our tradition, you are all invited for lunch. [Applause.]

The HOUSE CHAIRPERSON (Mrs M N Oliphant): Order, please! Thank you very much, hon Minister. Hon Minister, I want to assure you that, of course, next time we will invite the MECs, in particular from KZN, to participate in the debate. I think that other delegates from other provinces would probably like to go to KZN and see what is happening.

Unfortunately, I have to be biased because I know what is happening. For example, if the Select Committee on Health can visit uMhlathuze and have a meeting with a group of doctors who are volunteering to assist the public free of charge, I believe that they can also share that information with other provinces.

Thank you very much, hon Minister. I also want to thank the MECs who are present here and the special delegates, and also to recognise members of the public in the gallery and the department officials. We thank you very much for participating and listening to this debate. I hope all members are happy to hear the responses and the discussions from the members. Thank you very much, hon Minister. [Applause.] Debate concluded.

             JUDICIAL SERVICE COMMISSION AMENDMENT BILL

            (Consideration of Bill and of Report thereon)

The DEPUTY MINISTER FOR JUSTICE AND CONSTITUTIONAL DEVELOPMENT: Chairperson, hon members, comrades and friends, ladies and gentlemen, …

… ek gaan nie kole gooi nie. [I’m not going to be throwing coals.]

I’m a lover, not a fighter. It is true that the principle of the independence of the judiciary, as a cornerstone of the doctrines of the separation of the powers, is an essential element for upholding the rule of law and safeguarding fundamental liberties and human rights in the democratic society. This reality is expressed in and implied from various international and regional instruments. Article 10 of the Universal Declaration of Human Rights of 1948 provides, and I quote:

Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

The Commonwealth’s Latimer House Principles of 2003 state further that, and I quote:

Judicial officers have a duty to uphold and defend judicial independence, not as a privilege of office but as the constitutional right of everyone to have disputes heard and decided by impartial judges.

What constitutes an independent and impartial tribunal is provided for in the UN Basic Principles on the Independence of the Judiciary of 1985, and the Beijing Statement of Principles of the Independence of the Judiciary of

1. These concepts have been the subject of prolific discussions, writings and even various judgements of apex courts of many democracies over the years.

Invariably, whilst many address the distinctions between independence and impartiality, most also affirm the close relationship between these concepts. Of significance is the judgment of the European Court of Human Rights, which opined, and I quote:

The court recalls that in order to establish whether a tribunal can be considered as ‘independent’ regard must be had, inter alia, to the manner of appointment of its members and their term of office, the existence of guarantees against outside pressures and the question whether the body presents an appearance of independence. As to the question of ‘impartiality’, there are two aspects to this requirement. First, the tribunal must be subjectively free of personal prejudice or bias. Secondly, it must also be impartial from an objective viewpoint, that is, it must offer sufficient guarantees to exclude any legitimate doubt in this regard.

The concepts of independence and objective impartiality are closely linked.

Against this background, it will be no exaggeration to say that, for many decades now, the increased independence of the judiciary has been perceived as central to the strengthening of judicial performance. However, this should not mask an equally important international trend, which has gained considerable momentum, especially in the last decade.

Linn Hammergren deals with this phenomenon thus, and I quote:

For decades, increased judicial independence has been perceived as central to strengthening judicial performance. More recently, it has been joined by another element, the demand for greater judicial accountability, with some critics arguing that absent this second factor, the drive for independence may go too far, producing a variety of new problems.

He then concludes as follows, and I quote: The judiciary is one of the last major professional groups to face the demands for accountability arising with the spread of more democratic, political and social cultures. While the shift is not universal, it clearly is linked to the prior advancement of greater judicial independence. Despite the impressions of some judges, the two developments are not contradictory; at least in the current environment, more independence seems to require more accountability, and accountability in some instances can be seen as enhancing independence. There are nonetheless enormous differences among and within national systems as to the extent of the demand, and the form, and the content of the mechanisms promoted.

Like in many other democratic societies, this issue of the relationship between judicial independence and judicial accountability has also occupied the attention of the South Africans, mainly since the advent of democracy.

So, while section 165 of our Constitution guarantees judicial independence, this must be understood in the context of section 177 of the Constitution providing for an impeachment procedure for judges, and section 180 of the Constitution, which makes provision for the enactment of national legislation to provide for procedures dealing with complaints about judges and for training of judges. Probably of even more importance is the constitutional injunction in section 1 of the Constitution, which enjoys a unique status in our Constitution that provides that, and I quote:

… South Africa is … a multiparty system of democratic government, to ensure accountability, responsiveness and openness.

The judicial is, of course, included within this injunction.

Much has been written and much more can be said of where the balance lies or could or should lie between these complementary and also competing concepts of independence and accountability. That debate, however, is for another day.

Suffice it for now for me to contend that any mechanism ensuring or providing for the integrity, ethical conduct and high professional standards of judicial officers in our country must, at least, strive to obtain the following objectives: to uphold and enhance public confidence in their administration of justice; enhance and promote respect for the institution of the judiciary; and protect and enhance the reputation of the individual judicial officers and of the judiciary as an institution. In summary, the wisdom of these words of Justice Anthony Gubbay, the former Chief Justice of Zimbabwe, find favour with me, as it strikes a pragmatic balance between these concepts, and I quote:

… the independence of the judiciary should be balanced with responsible professional conduct, competence and integrity.

It is against this background that I commend the Bill before the House today, which relates to judicial conduct and ethics and, particularly, a mechanism for dealing with complaints about or against judges.

The provisions of this Bill go to the heart of protecting the independence, impartiality, dignity and legitimacy of our courts and our judicial officers. It is squarely aimed at building and enhancing public confidence in the integrity and the ethical conduct of our judiciary, whilst also introducing an essential component of judicial accountability, underscoring the fact that the courts and the judiciary are not found to be on some distant pedestal in Nirvana, but are, in fact, an integral and inseparable part of South African society.

I turn to an analysis of the five main focus points dealt with in the Bill, which are the following: Firstly, provision is made for a Code of Judicial Conduct to be compiled by the Chief Justice acting in consultation with the Minister, which must be approved by Parliament and which shall serve as the prevailing standard of judicial conduct that judges must adhere to.

Secondly, disciplinary procedures are provided for to deal with misconduct by judicial officers. The Judicial Conduct Committee is established as the committee of the judicial service commission. This conduct committee will be chaired by the Chief Justice and will comprise only judges. The committee will, in terms of the procedures provided in the Bill, deal with complaints against judges. The chairperson will be the first port of call for the lodging of a complaint about a judge. When a complaint against the judge is received, one of three processes can be followed.

Firstly, if a complaint is related to a judgment by a judge, in other words a matter that can be taken on a peer review, or if the complaint is frivolous or hypothetical, that complaint will be rejected out of hand.

Secondly, if there is substance to a complaint, the chairperson or a member of the conduct committee may conduct an investigation and, if necessary, a hearing and dispose of the matter. But if a valid complaint could lead to a finding of incapacity, gross misconduct or gross incompetence, which are the section 177 constitutionally laid down grounds for the removal of a judge from office, the conduct committee must refer the matter to the Judicial Service Commission, along with the recommendation that the appointment of the Judicial Conduct Tribunal must be considered to investigate the matter formally and report to the commission on its investigation.

An appeal mechanism is also provided for in respect of the first two processes.

Thirdly, provision is made that a judge, whether on active service or discharged from active service, may not hold any other office of profit or receive payment for any service that is not payable in his or her capacity as a judge subject to the following exceptions: With regard to serving judges, the Minister, acting in consultation with the Chief Justice, may grant written consent for a judge to receive royalties for legal books written or edited by that judge. That’s the only exception.

Judges who have been discharged from active service may, with the written consent of the Minister, acting after consultation with the Chief Justice, hold another office of profit or do other remunerated work, but such consent may only be granted if the Minister is satisfied that the granting thereof would not: firstly, adversely affect the efficiency and effectiveness of the administration of justice, including the undermining of any aspect of the administration of justice, especially the civil justice system; secondly, adversely affect the image or reputation of the administration of justice in the Republic; thirdly, in any manner undermine the legal framework which underpins the judge for life concept; fourthly, result in any judge engaging in any activity that is in conflict with the vocation of a judge; and fifthly, bring the judiciary into disrepute or have the potential to do so. In addition, the Minister may, by notice in the Gazette, issue guidelines regarding any other criteria to be applied when considering the granting of consent for discharged judges.

In the fourth instance, provision is made for the establishment of a Register of Judges’ Registrable Interests in which judges must disclose such financial or other interest as to be the final regulations made by the Minister, acting in consultation with the Chief Justice. It’s the same as we do in Parliament. A registrar will be appointed in the office of the Chief Justice to supervise the register under the control of the Chief Justice.

Finally, provision is made for the establishment by the Chief Justice of Judicial Conduct Tribunals to inquire into and report to the Judicial Service Commission on impeachable conduct, including allegations of incapacity, gross incompetence or gross misconduct against judges as provided in section 177 of the Constitution.

I am aware that the Select Committee on Security and Constitutional Affairs under the chair of the honourable and inimitable Kgoshi Mokoena gave particular attention to the consideration of this Bill and also entertained public representations on the provisions contained in it. I would like to thank the select committee for the enthusiasm and wisdom displayed in dealing with this matter.

One of the amendments proposed by the select committee relates to the issue of whether or not the hearings of a tribunal should be open to the public. The Bill, as referred to the committee and the new section 29, makes provision for a tribunal hearing to be attended only by certain participants and interested parties, including any person who is present when the tribunal considers it to be necessary or expedient.

The committee heard representation that all forms of disciplinary hearings of judges should be accessible to the public. Noting that disciplinary hearings of judges are, as a rule and as an international best practice, of a confidential nature and bearing in mind that unfounded allegations have the potential to damage the reputation of the judiciary, even if found to be without merit, the committee has proposed a compromise, namely that a tribunal president, who shall always be a judge, be given discretion, if it is in the public interest and for the purpose of transparency, to direct that a hearing or part of the hearing take place in public.

In this manner, every hearing will not automatically be closed to the public as the Bill now stands but it will always be up to a senior judicial officer, namely the judge heading the tribunal, to strike the necessary balance between the protection of the dignity of the courts and the public legitimate interest and safeguarding the integrity of the third arm of government, namely the judiciary. I regard this compromise suggestion as eminently sensible and therefore I support this proposed amendment.

In conclusion, one can only concur with the following sentiments expressed by Shameela Seedat in March 2007 when she said the following, and I quote:

The independence of the judiciary must not only be constitutionally protected; it must also capture and maintain the confidence of the public it seeks to protect. Loss of confidence in the judicial system due to perceptions of a lack of independence and impartiality is extremely damaging to the effective working of the justice system.

Because the judicial institution has such important and wide-ranging powers, including the power of judicial review, there is a growing feeling that the judiciary must also be held “accountable” - so that minimum standards of competence and ethical standards can be maintained. Judges often face ethical issues in the course of their service - for instance, they may be uncertain about whether to present their views on matters outside of the courtroom or may wonder whether the circumstance of bias exists. From the perspective of litigants in particular, the timely resolution of cases and the assurance of courteous and nonprejudicial court behaviour are important ethical concerns. Where rules are in place to promote judicial ethics and those rules are visible to the public, confidence in the administration of justice is both maintained and enhanced. In fact, judges have strongly expressed the view that sensitivity to ethical rules, both on and off the Bench, helps protect the independent and impartial status of the courts.

With this, I commend this Bill with its proposed amendments to this House for its unanimous and enthusiastic report. Thank you very much.

Mr D A WORTH: Hon Deputy Chairperson, Deputy Minister, hon members, on a lighter note to begin with, regarding the case of Darryl Worth versus the hon Deputy Minister for Justice and Constitutional Development, I would just like to state the following in defence. And, believe you me, I am not being paid the fee of senior counsel — I wish I was — but just the ordinary salary of an ordinary MP.

The Select Committee on Security and Constitutional Affairs was recently addressed by two judges, namely Judge Howie and Judge Friedman, by Advocate Paul Hoffman of the FW de Klerk Foundation, by the Centre for Constitutional Rights, and an opinion was also expressed by Mr Hilton Seligson, SC, and various other interested parties regarding the constitutionality of clause 11. I must just state right from the outset that my party and I don’t have any problem with the Bill whatsoever. We agree with everything, except for this contentious clause, clause 11 and I want to go through it again –

A judge who has been discharged from active service may only with the written consent of the Minister, acting after consultation …

… mooi luister [listen well]…

… with the Chief Justice, hold or perform any other office of profit or receive in respect of any fees, emoluments or other remuneration or allowances apart from his or her salary and any other amount which may be payable to him or her in his or her capacity as a judge.

The judges and other organisations submitted that the requirement for retired judges to obtain permission in writing from the Minister – this is the big bugbear – before engaging in any economic activity for profit is unconstitutional, in that it infringes on section 22 of the Constitution, which guarantees their right to choose their trade, occupation or profession freely.

Now, you must remember that judges are bound by a code of conduct. Whether they are retired or not retired, there is a set code that states that they may not bring the judiciary into any disrepute. Otherwise, they can be hauled before the Judicial Service Commission. So it is highly unlikely that a judge, even after retirement, is going to open a brothel or a bookmaker shop or whatever. Judges normally behave themselves after retirement.

The justice department, however, stated that the limitation was necessary to prevent the Bench from being brought into disrepute, and as retired judges receive a salary for life, they were, in fact, judges for life. Therefore it was important to regulate their conduct even after their discharge from active service.

Retired judges rejected this argument, stating the following: Firstly, the notion of a judge for life was flawed because the salary that they received was, in fact, a pension or reward for the work they had done previously. Secondly, the salary for life was intended as an incentive to attract advocates to the Bench, as many were reluctant to leave their practices for a less profitable position. You must just remember that a good advocate or a good SC receives, probably, for two or three days’ work the salary of a judge for a whole month. So bear that in mind.

Thirdly, retired judges or judges discharged from active service no longer had to report to the office and were, in fact, bound only in terms of the code of conduct.

Fourthly, the fact that in certain instances parties had bypassed certain judges, perceived to lack the necessary skills or experience to go to arbitration, would not be addressed by limiting the right of retired judges to adjudicate arbitration matters, as arbitration in itself is a valuable procedure that helps alleviate the already overloaded court rolls.

Now, we must remember that if you have two firms who don’t wish to go to court, who know a judge acceptable to both of them and the matter is conducted out of court, obviously that retired judge would get paid a fee for doing that. Also, bear in mind that 60% of cases are struck off the roll anyway because the rolls are so overcrowded.

Fifthly, retired judges should be able to perform work related to the judiciary which they have, in any case, been granted permission to do in the past and should not have to apply to the Minister – a member of the executive – for such permission.

Sixthly, it does not reflect positively on the independence of the judiciary for the executive to exercise so much power over retired judges. Instead, if permission should be obtained, it must be obtained from the Chief Justice and not the Minister.

It is the hidden agenda of stopping retired judges from acting as arbitrators that gives cause for concern, since the Department of Justice and Constitutional Development is known to have an animus – that is not an animal or something; it’s Latin, not Sesotho – against arbitrations. That’s a grievance.

There is a perception that arbitrations reflect a lack of confidence on the part of the legal profession in the transformed judiciary and that if retired judges act as arbitrators, they are showing support for this attitude. This perception exists despite the fact that there is a long- standing tradition in South Africa, as well as in other countries, for retired judges to sit as arbitrators where the parties have agreed to have their dispute resolved by way of arbitration.

It is contrary to the interests of society to deprive it of the value that retired judges might add through being able to use their expertise and experience in performing remunerative work. This will not prevent arbitration since the shoppers, that is other businesses, will simply take their business elsewhere, usually to senior silks.

Clause 11 has nothing to do with the transformation of the judiciary, but is a blatant attempt to control arbitration cases by judges after they retire. This is a direct attack on the independence of the judiciary, and it is for that reason that the DA offered several alternative wordings, such as obtaining consent in writing from the Chief Justice, or the Minister acting “in consultation” – not “after consultation” – with the Chief Justice, or from the Judicial Service Commission. [Interjections.] Sorry, I’ll finish now.

As the chairperson of our committee, the hon Kgoshi Mokoena will vouch …

The HOUSE CHAIRPERSON (Mr T S Setona): Your time has expired.

Mr D A WORTH: … there were heated discussions with regard to clause 11, which I’m sure could have been resolved with some amicable compromise being reached. I thank you. [Time expired.] [Applause.]

The HOUSE CHAIRPERSON (Mr T S Setona): Hon members, you know if you want to convince people, say it in one word. If you are not going to convince them, you can say it in a thousand or a million words, you won’t convince them. When I say the time has expired, it has expired. I want to appeal to members to take that seriously.

Kgoshi M L MOKOENA: Chairperson, colleagues, hon members, comrades and friends, you will agree with me that the Deputy Minister has explained why it is necessary for us to have this Bill in this Parliament - the contents thereof, the advantages and all that pertains to it. The advantage of having such hands-on and dynamic Ministers makes it easy for some of us to simply say we support the Bill and then sit down. The only thing he did not talk about is the short title. Everything is typed there.

Let me, on behalf of the committee, thank the officials from your department, Deputy Minister, in particular Johan de Lange, not related to the Minister of course, for the role he played in explaining this Bill to members. He explained it so thoroughly that we understood this Bill to such an extent that we were even discussing it without looking at those particular clauses. Thank you very much, Johan.

The committee, as was explained by hon Worth, invited judges to appear before it to raise their concerns. Indeed, they came and addressed the committee, which we appreciate very much.

Let me not waste the House’s time by trying to explain the role of the Judicial Conduct Committee because that was done by the hon Deputy Minister. I also am not going to waste time by trying to explain the role of the tribunal and why it was established because of course we know that they deal with some of these challenges, complaints and so on. Even how members of the public are expected to participate or to come and listen when there is a complaint about a judge was fully explained.

The committee had made some amendments to this clause in terms of the public having access to the hearing when a judge is appearing. I am happy with the manner in which the Deputy Minister has explained this and for their support to the amendment by this detachment. Thank you very much for your understanding. One of the amendments that we have made is with regard to the register of assets for judges. This register will be tabled in Parliament once every twelve months. But when it comes to judicial conduct the report will only be tabled in the National Assembly. This is one inconsistency that as a committee we felt had to be corrected. Hence, we said the report of the register will be tabled in Parliament. Even the report on judicial conduct must also be tabled in Parliament. Hence we proposed this change as far as that is concerned.

I want to, from the outset, thank members of my committee from all political parties, because when we were debating the sensitive and famous clause 11, they were not politicking but were pointing to some of the facts that they wanted their committee to look at.

Let me remind the House that when we were dealing with this particular clause 11, there were strong views for and against, such as, for example, those of the judge referred to by hon Worth, Judge Friedman, and those advocates who came to appear before us, and even Dr Marlowe on behalf of the media. What was clear from their input was that they did not agree with the Minister giving permission for them to do this other job simply because they are no longer receiving a salary. What will interest members here is that they feel so good to receive this money from this Minister, but they do not want the same Minister to have anything to do with them.

Members must note again that these judges will receive this salary for their entire life. When the unfortunate thing happens and they pass on, their families will continue to receive the salaries for the rest of their lives. If a judge gets an increment, those retired judges also get increments for the rest of their lives, but they tend to say they enjoy this money from the Minister and all the increment, but they must say anything about that money. I mean this doesn’t make sense, really. Let’s be honest.

With regard to the matter of arbitration, it is so sad and painful to some of us, especially here in Cape Town. Unfortunately, there are very good advocates here in the Western Cape, but there are those who, when they come in that particular court and they notice that the judicial officer presiding is a black person, remove the case and go for arbitration. Why? If we are going to leave this as a free-for-all, what are we implying as this government? I don’t think, in a sober sense, hon Worth, we can accept that we allow these black judicial officers to be really abused and sidelined simply because of their colour. We can’t accept that.

I have a list of more than 68 judges who have asked permission from the Ministry. I am saying 68 judges, but the applications that they have made number more than 200, and of those applications not even one was declined or refused by the Minister. It is surprising to say it is fine to ask permission from the Chief Justice, but not from the Minister. What’s wrong with that? You want money from the Minister, but not his permission. You want to get permission from the Chief Justice, but not from a person who is feeding you! It’s pathetic. To some of us it’s so surprising.

Thank you very much, hon Deputy Minister. I would explain this even further. I just hope people will wake up and smell the coffee. Let’s pray that one day they will wake up. But as the ruling party we are saying this particular Bill is long overdue. I thank you, Chairperson. [Applause.]

Mr M A MZIZI: Chairperson, I was tempted to heed the call that I should merely support the Bill and sit down but nonetheless, with the very limited time that I’ve got I was not going to debate on this piece of legislation, but I thought there was a highly contested section, and that is clause 11. I also thought that I should add my voice to that one.

The Bill before us seeks to clarify some of the functions performed by judges, either active on service, or a judge who has been discharged from active service.

The crux of the matter is that the provisions on judicial conduct in Part II of this Bill are straightforward. I do not want us to miss the point about a judge performing active duties for other remuneration or allowances, apart from his or her salary and any other amount which may be payable to him or her in his or her capacity as a judge. If a judge wishes to engage in anything which is contrary to the above provision, he or she must get permission from the Minister.

The above provision is applicable even to retired or discharged judges. The Minister may give written consent if he or she is satisfied that the granting of such consent will not adversely affect the efficiency and effectiveness of the administration of justice.

We had briefings from the department, and that is a well-known fact. We also had presentations from retired judges. If I may quote one instance: One of the strongest arguments coming from the presentations by retired judges is that there is no such thing as a judge for life. Therefore, the argument is that there is no difference between the salary of an active judge and of a retired judge. Both do not contribute anything towards pension. They do not receive pensions when they retire. They receive a full salary, 100% every month. If the remuneration for active judges is revised, it must also apply to the retired judges.

If retired judges are happy with these 100% full-time salaries, then they should also accept the other conditions which apply to the active judges. Simple and straightforward – they do receive even gratuities but over and above, they still complain. We did not say this because we wanted to prejudice the judges. We respect them, but the law is the law. If we would allow that when we have active judges who are there to serve in many other duties, as required by the public, then why would we then say: You retired judges can do whatever, as freely as you want to. No, I don’t think that is right. I think the judges …

… zonke nje azingene ejokeni bese zidonsa ziya ndawonye zonke. Akungabikho edonsa iye le eceleni. [… should all work together and should work harmoniously. There shouldn’t be anyone who doesn’t want to work as a team.] We support the Bill. [Applause.]

Mr W M DOUGLAS: Chairperson, hon Deputy Minister, hon members, the provisions of the Judicial Service Commission Amendment Bill relate to judicial conduct and ethnics, in particular as a mechanism for dealing with complaints by judges. It is a mechanism that deals with complaints against judges and it is very important, primarily in view of the controversial incidents involving judges, in particular Cape Judge President Hlophe.

The issue of judges earning income other than from their official duties is one reason Judge President Hlophe has been dogged by controversy. By law judges are required to get the Minister’s consent before receiving income from outside duties.

In 2006, the ACDP raised the issue of Judge President Hlophe receiving consulting fees from Cape Town asset management company, Oasis, while the Judicial Service Commission Amendment Bill strictly proscribes judges from earning additional income, with the exception of royalties from authoring legal textbooks.

Thus to reiterate, the ACDP in particular welcomes section 11, which sets out the conditions under which a judge may receive income from outside work. The need for such regulation was pointed out by the Judicial Service Commission when it dealt with our complaint.

Etienne Mureinik, South African’s leading public lawyer of the time, stated, and I quote:

If the new Constitution is a bridge away from a culture of authority, it is clear what it must be a bridge to. It must lead to a culture of justification — a culture in which every exercise of power is expected to be justified.

Hence the ACDP supports a statutory framework within which the Judicial Service Commission can deal with serious complaints against judges, such as those relating to incapacity, gross incompetence and gross misconduct, which can result in impeachment proceedings. However, the ACDP is concerned about the submission made by Chief Justice Pius Langa on the Bill in August last year.

The submissions made pointed out a number of problems with the Bill and questioned the constitutionality of the proposed judicial conduct committee, claiming that it usurps the functions of the Judicial Service Commission, as spelt out in the Constitution, and that it is therefore inconsistent with the Constitution.

I would really like the Deputy Minister to maybe give us some light on that particular issue, but furthermore the ACDP supports the Judicial Service Commission Amendment Bill. Thank you. [Applause.]

Mr S SHICEKA: Thank you, Chairperson. We are debating this Bill today on the day when the unsung heroes and heroines from Mpondoland are commemorating the massacre that happened in that area. Many people were killed, others were imprisoned and 33 were hanged in Pretoria. It is the biggest hanging that has happened in the history of this country, with the people in that part of the world. This barbaric act happened in 1960, 48 years ago. As we are gathered in this august House, people are gathered at the scene where this incident happened. Their only sin was to refuse to pay tax for domestic animals.

We are dealing with this Bill, which is aimed at developing mechanisms that will ensure that complaints about and against judges are handled, but informed by the principles of openness, transparency and accountability.

Before I come to the subject matter, I want to pose a question to the Deputy Minister, as he is here, on an issue: Why is there such noninvolvement of the NCOP in dealing with the issue? Why are the complaints handed to Parliament after the Judicial Service Commission and its bodies have dealt with the matter? Why are they only submitted to the National Assembly? This issue does not only occur in this case but it does appear in quite a number of pieces of legislation – not only in general legislation but also in the Constitution. The appointment of the SABC board is done by the NA, as an example. No involvement whatsoever of the NCOP and other areas. What was the logic to that?

The leadership has requested us to review these deals, look at them and come forward with proposals. I will be happy to get the benefit of this, because you are one of the people who were championing the drafting of our Constitution; therefore, subsequent legislation followed out of that. It will help a great deal.

The ANC as a movement has embarked on a course of building a nonracial, nonsexist society that is democratic and prosperous. The question, then, that must be asked is whether we have reached that goal as a country. The answer is clearly, no. We have seen that in this country the three branches of government are transformed. However, the judiciary is a body that is not yet where we want it to be.

We have also noted that the economy of this country is still in the hands of the few. It is not enjoyed by the majority. We know that the DA, as a party, supports the rich, the propertied and the bourgeoisie. The ANC is a party that leads everyone in society; however, it is biased towards the poor and the poorest of the poor. That is why we call ourselves a disciplined force of the left. That is the difference between the ANC and the DA. That is why the DA is a strategic opponent of the ANC, because we differ on these things.

The ANC is a leader of society. It is a locomotive force and an agent for change. Therefore, the ANC cannot abdicate its responsibility of championing change; the judiciary falls squarely within that responsibility. It is the ANC that will change the judiciary. It is the ANC that will transform the judiciary. We cannot give that responsibility to the judiciary. That, them, is why we disagree.

We disagree with the proposal of hon Worth, when he says that permission for judges to do work must not be sought from the Minister but it must be sought from the Chief Justice. We disagree with that. If we did that, we would be saying that change must continue at a slow pace.

Our view, as comrade Mokoena, our leader, has said, is that we feel that if we do so, people are going to go to the judges for matters of arbitration. It means we will be creating a two-tier judicial system in this country where the people who own the wealth of this country will be going to the old guard who have resigned, and giving them cases. It means the new guard will never benefit in this case.

That is the point of contention, because the DA supports the bourgeoisie. The ANC believes in transformation, and that is the crux of the matter. The argument that they are using here is that they are fighting the issues. They are not candid with the truth. That is where the difference is on this matter.

Therefore, we are saying as a movement that we believe that our Minister is capable of doing the right thing, is capable of reinforcing our judicial system. He is capable of ensuring that permission is given where it is necessary and where it is deserved. That is what we believe in. We believe we will not support the DA on this matter. We cannot. If we do so, we will be undermining ourselves, we will be undermining the course that we are taking of building a nonracial and nonsexist society.

We have seen the judiciary at the opening of Parliament for the state of the nation address and the lack of transformation that is there. We have seen it even in the Constitutional Court. We have seen it even in the Supreme Court of Appeal. Therefore, in that respect, we believe a lot still has to be done. With these words, we believe that what we have put there is what has to be done.

The DA, as a party that is attempting to be the party of choice, must change its approach and must not be a party that supports those that own the wealth. The conservative forces in this country must support people who are there for change, as the ANC is doing. Therefore, if you do so, we will be able to support you on issues that you raise. At this point in time, as long as you are still pursuing the course that you are pursuing, the ANC will not agree with you. Thank you.

The DEPUTY CHAIRPERSON OF THE NCOP (Ms P M Hollander): Can we have order, please. Hon members, I just want to bring one thing to the attention of this august House. I think yesterday or the day before yesterday, the hon Minister made a statement regarding this issue. It was not just a matter of opinion on the part of the Deputy Minister, but it is also in the Rules of the National Council of Provinces. Judges can only be expelled by Parliament. In terms of Rule 47(2) of the NCOP Rules, no member whilst addressing the Council may reflect upon the honour of a judge or a holder of an office whose removal from office is dependent upon a decision of the Council, except upon a substantive motion on the Council.

I am raising this, not making any specific reference to anybody, but because from time to time we have the sense that people want to get into some media hype around Judge John Hlophe. I am saying that we must be very cautious. The Rules do not allow that. Thank you very much. The DEPUTY MINISTER FOR JUSTICE AND CONSTITUTIONAL DEVELOPMENT: Chairperson, once again I thank hon members for their inputs. Obviously, we will take everything into consideration, particularly the sensible ideas.

I respect any person who gives his or her opinion and I will defend their right to do so, except if it has to do with racial, hatred or something to that effect, which I will never defend. Therefore, I defend very strongly the judges’ right to say what they want. I feel very strongly that if they disagree with a piece of legislation that affects them personally, they are fully entitled to go to court and pursue whatever arguments they wish to.

However, having said that, I do not agree with their approach. I fully and strongly endorse the approach we have taken, and I would want to point out, once again, that the law advisers and parliamentary law advisers also looked at clause 11, and in their opinion it is constitutional.

Regarding that part of the debate, of course, Mr Worth has left out the fact that the legal advisers had come to the committee and had actually raised these points. You know, what makes me angry about this is the hypocrisy of it all, particularly where National Party people are involved.

Anyone who doesn’t know the history of the salaries of judges can follow it in the legislation. In 1989, the apartheid government sat down with the judges of the apartheid regime and worked out the salary package for judges — not this government. We have not changed one iota of the package that the apartheid judges and the apartheid regime unpacked in 1989.

What they sat down and said is: “We want to create a concept for a judge for life. We don’t want to pay any pension, and therefore we don’t want a pension fund.” So judges don’t have pensions; they don’t pay, like you and all other citizens in the country, at least 7% of their salary into a pension fund. They didn’t want that in 1989; what they wanted was to be regarded as judges for the rest of their lives — “once a judge, always a judge”.

In line with that, they therefore received the salary of a judge for the rest of their lives plus the perks of a judge, which included a brand-new car every five years at BMW 3 or 5 series level, a very comfortable car that is maintained and paid for in full by the people of this country.

A judge receives a salary for the rest of his or her life after working for only fifteen years, not like you and I, who have to work for 30 or 40 years. After 15 years they get a full salary or a portion thereof — if it’s 10 years, two thirds of that salary — for the rest of their lives. If they die, their spouses receive two thirds of that salary for the rest of their lives. They also receive, after 15 years, a gratuity of R1,5 million, salaries and perks for the rest of their lives, and that is the deal that was agreed on.

When we drafted the Constitution, the judges argued that they wanted us to put a clause in the Constitution to protect their salary package as it was then. They didn’t want to change it; they wanted to leave it the way it was at the time.

The piece of legislation fully and utterly provides that if every single judge who’s been discharged wants to do any other work, he or she must get permission from the Minister. That’s their legislation and the package that was agreed on.

In fact, if you read the piece of legislation, it says that each judge that is discharged should make him or herself available for three months in a year to do a judge’s work. It’s like with white kids in army days, during apartheid: They spent three months a year in camp. The same thing applied to judges; they put it in that piece of legislation and it still stands today.

Of course, if they do other work over and above their official work, they get double their salary. So, a judge that has been discharged gets his salary for life, plus his or her gratuity. If he or she does any other work, including this three months, they get a double salary. So, if a judge leads a commission of inquiry, he or she gets double the salary.

This is an existing package. Now you want to tell me to go and ask the South African people to take this whole agreement, all the legislation and everything that has happened until today, get rid of it all and pay these people salaries for the rest of their lives, pay them gratuities and double their salaries if they do their work?

We must do away with all of that and allow people to do whatever work they want to do, bearing in mind that, because they are still judges for life, whatever they do in their private lives impacts on the judiciary as it stands. So, I don’t have a problem changing that scheme, if the judges want to come forward and debate how we change it — what new salary scheme we should create and that we don’t have judges for life, if that’s what they want.

However, if a judge wants to do whatever he or she wants after he or she has left the Bench and been discharged, after only 15 years of service, then I say they should not do so without the permission of the payer, who represents the interests of this society. Of course, we don’t do this in isolation. With this new law we have created space for those guidelines to be worked out with the Chief Justice, after consultation.

Now, of course, arbitration does play a big role in this, because that is where focus has been. I will never fight the whole issue of arbitration because it is a concept accepted in the rest of the world, and it is a necessary concept. But what I will not accept is for arbitration to start becoming an alternative to the court system in this country.

There is not much that I can do about that either, but if it does get more legitimacy as an alternative because judges are sitting on that body, and it then becomes an alternative court system where all large commercial matters in this country are removed from the court system, I will not be a party to that; I don’t care who says what.

What is happening today in this country is that in all big commercial companies, in the case of every contract that is signed — and there are some lawyers who do it just as a matter of course — all those cases go to arbitration. Those cases, therefore, are removed and are privatised from the legal system. They are removed from constitutional scrutiny and oversight because if you remove something from the court system, judges look at it with caution.

Whether constitutional or not, when you put something in a private system where no precedence applies — and those arbitration courts or tribunals do not have the right to interpret whether anything done in that tribunal is constitutional or not — you have privatised large commercial work outside of the Constitution. Why must we agree to that?

Why must we agree that we are going to take one of the most important jobs? Just like governments, power affects citizens. The power of big corporations sometimes has even more impact than a government decision. Those things are privatised outside of the justice system into the arbitration tribunals.

Now, as I’ve said, I don’t want to be misunderstood: We have no problem with arbitration as a concept. Of course, we can limit it if we want to, in terms of our Constitution, but we haven’t yet. But I have a huge problem when it involves people who are paid, by this government, salaries for the rest of their lives, together with their spouses and so on.

By putting in these arbitration structures with regard to the judges for life, you are creating a separate court structure and you are legitimising it as something better than the present structure. I will not be party to an agreement like that and I will oppose it with every fibre of my being.

I also want to make it clear that arbitration is not the only issue involved; there are other issues involved. I would not want to see discharged judges who are judges do that kind of work and, therefore, you need a mechanism to deal with that. And I want to say, again, that this is not a mechanism we developed; this is a mechanism that was in existence before we came to power. The obvious question to have asked those judges who complained is why they never, when they were judges on the apartheid Bench — not a single one of them - ever complained? Now, suddenly we get these complaints.

So, having said that, I really respect their views in the sense that they can express their views, they can fight for these issues, but they must be sure that we will go and fight this matter very strongly.

I also want to say in this House that I have sat in a meeting of all the highest judges in this country and every single black judge in that meeting categorically — and some of them very vigorously — is opposed to us allowing judges to do arbitration work, not just the executive.

If you look at our senior judges, you’ll see that they are all black, except two. All of them are opposed to arbitration work being given outside the system, because they are Judges President and form the leadership of this judiciary. They see the damage that that system does to their courts and their legitimacy and they are strongly opposed to it. So, I think that I haven’t given all the reasons; I’ve just touched on a few things. One day we will go to court and fight this matter there. I also find it very interesting that you want to be a judge for life and receive all the perks, but you want to duck every single one of the responsibilities that come with that.

If we politicians got the package that judges get, namely that if you are here for five or 10 or 15 years, you get a salary for the rest of your life without contributing anything towards a pension fund, and a gratuity of R1,5 million, and so on, while the only thing you have to do is you mustn’t act like a politician outside — you mustn’t be involved in politics, because you can’t say that you still want to be involved in politics and that you still want the package - that would be unconscionable. And it’s particularly unconscionable that it was very acceptable during a previous dispensation, but now, under a democracy, it’s not acceptable. So, again, for those who want to fight, we will definitely deal with and fight the matter accordingly.

On the issue of Judge Langa that hon Douglas has raised, you must not … [Interjections.] You see, as the ACDP, you must never support issues raised by the DA; it makes no good sense. This is from Mrs Camerer, and if you know that she is very “deurmekaar” [confused] usually, I can’t understand how it could be said that the creation of the conduct committee, which consists only of judges and is chaired by the Chief Justice, is going to undermine the Judicial Service Commission.

If any of you read anything about it at the time when I was still on the Judicial Service Commission, they argued that they had no power over judges and judicial officers. So, how can we today, when we provide a committee to oversee and do disciplinary work, be undermining them, if they themselves have decided? So, she is just very “deurmekaar” [confused].

Hon Shiceka, on your point on the NCOP, I think this is an important debate, but I also think that as time goes on, we’ve lost track of what the NCOP should be. The reason is that it is dealt with differently in the Constitution and legislation because the NCOP is not the mirror reflection of the NA. It represents the interests of provinces, from where you get your power, and deals mostly with section 76 interests.

Of course, there are some interests, like Justice, which are national competences; this is not a provincial competence, so provinces have no say over it. So, I think that when we drafted the Constitution we tried to stick to the constitutional frame of what is national. Try to keep it with the NA as much as possible, and what is provincial should be dealt with by the NCOP.

There was a lot of other thinking as well, also because you are only 90 people. If you have to get involved in everything the NA gets involved in, you are really going to struggle to be efficient and effective. So I think those are some of the debates and some of the thinking that we did not want. It would be a waste of money to duplicate and reflect whatever is in the NA just at this level; we wouldn’t want to do that. Those are just some of the answers, but I think that is a matter that we should debate further. Thank you, Chair, and thanks for your indulgence.

Debate concluded.

The HOUSE CHAIRPERSON (Mr T S Setona): Hon members, I shall now put the question, namely that the Bill, subject to the proposed amendments, be agreed to. In accordance with Rule 63, I shall first allow political parties an opportunity to make their declarations of vote if they so wish. Is there any party that wishes to make a declaration of vote? I will note the Democratic Alliance.

Declaration of vote:

Mr D A WORTH: The Democratic Alliance wants it to be noted that it is vigorously opposed to the Judicial Service Commission Amendment Act, specifically with regard to clause 11. I thank you.

The HOUSE CHAIRPERSON (Mr T S Setona): We shall now proceed to voting on the question. Those in favour will say, “Aye”.

HOn MEMBERS: Aye!!!

The HOUSE CHAIRPERSON (Mr T S Setona): Those against will say, “No”.

HON MEMBERS: [Inaudible.]

The HOUSE CHAIRPERSON (Mr T S Setona): I think the “Ayes” have it. The majority of members voted in favour. I therefore declare the Bill, subject to the proposed amendments, agreed to. However, the objection of the Democratic Alliance will be noted in terms of the Rules.

Bill, subject to proposed amendments, agreed to in accordance with section 75 of the Constitution (Democratic Alliance dissenting).

  CONSIDERATION OF REPORT OF SELECT COMMITTEE ON FINANCE – ISTANBUL
                             CONVENTION

Mr M O ROBERTSON: Chairperson, hon members. My flight only leaves at six this evening, so I have a lot of time. Chair, with your permission I would like the House to accept the Istanbul Convention as printed in the ATCs of 16 May 2008, page 758. Thank you.

Debate concluded.

Question put: That the Report be adopted.

IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West, Western Cape.

Report accordingly adopted in accordance with section 65 of the Constitution.

The Council adjourned at 12:24. ____

            ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS

ANNOUNCEMENTS

National Assembly and National Council of Provinces

The Speaker and the Chairperson

1. Draft Bills submitted in terms of Joint Rule 159

 (1)    Public Finance Management  Bill, 2008, submitted by the Minister
     of Finance. Referred to the Portfolio Committee on Finance and the
     Select Committee on Finance.


 (2)    Direct Charges Bill, 2008, submitted by the Minister of Finance.
     Referred to the Portfolio Committee on Finance and the Select
     Committee on Finance.