Speech by Dr Manto Tshabalala-Msimang, at the 30th Anniversary of the Durban South Doctors' Guild

21 August 1999

'My vision for Health and the role of Public Private Partnerships in the Health Sector'

Master of Ceremonies, Distinguished Guests, Ladies and Gentlemen, it gives me great pleasure to address you on this the 30th Anniversary of the Durban South Doctors' Guild.

I invite you to go back with me and reflect on what sort of health service we had in South Africa, 30 years ago. In 1969, if you were Black in this country, you did not exist at all, even though you occupied space. In other words, no health services were planned for Black people, hence today it is the Blacks who share the greatest burden of disease.

If we look back at the role of the medical profession, 30 years ago. We see a similar picture. Most of you had no choice but to receive your medical education at the 'infamous' University of Natal, Black section. For those who ventured to the 'Whites Only' Universities like Wits and UCT, they had to receive special permission from the government of the day. And yet here you are, as living testimony that Black people are not inferior to White people, as some forced us to believe, 30 years ago.

I stand here to pay tribute to the doctors of 30 years ago, who despite of all the difficulties and prejudices of racial discrimination and the policies of under-development, you have fought a good fight.

I know that some of you were not even allowed to practice medicine amongst African people, and yet you risked your lives by going into the townships with or without permits and with or without police escort, in order to provide services to the poorest of the poor.

It was against this background that the organisations like the Doctors' Guild, NAMDA, ESG, etc. were formed from the 60s, through the 70s and the 80s. The primary objective was to serve our communities, irrespective of the boundaries of race, colour or creed. During those days, the University of Natal was the centre of excellence and intellectual leadership for many Black doctors. It was no less than Makerere University in Uganda.

The Guilds, throughout the whole country, produced doctors of a different kind. These doctors were;

• caring and respectful to patients;
• touched by human suffering;
• proud of who they were;
• not motivated by profit but by their commitment to alleviate suffering, poverty and deprivation;
• committed to the development of society; and
• not hindered by any man-made borders and boundaries.

Let us now consider some of the challenges which face doctors in the 90s.

• In spite of many technological and scientific advances in medicine, there is greater suffering and the burden of disease has increased;
• There are vast inequities between Black and White, Man and Women, Urban and Rural, in access to basic health care;
• Health care is perceived by many health care providers as a booming business rather than a service to the public;
• Economics in every region in the developing world are becoming weaker and weaker, governments are operating on reduced budgets, and health care services are becoming unaffordable to the majority;
• Even though we have witnessed a rise in affiliation to private medical health insurance schemes, even by Blacks, medical insurance is rising at more that double the inflation rate and many of these schemes are in serious financial crises.

Ladies and Gentlemen, it is against this background that government has to make very difficult choices with regard to policies that will improve the quality of life, and well-being, for the majority of South Africans.

During the past five years, government has focused on improving access to basic health care services and to reduce the inequities in access to health care.

To name but a few, government has implemented the following progressive policies to achieve these objectives;

• Free primary health care to all and free health care to mothers and children under 6 years of age;
• We have focused on improving the health status of our children by introducing Hepatitis B and Hib onto our immunisation schedule and thus improved child protection and the immunisation coverage;
• More women now have access to ante-natal services and the Termination of Pregnancy Act will reduce the number of back-street abortions;
• We have instituted a Maternal Mortality Notification system to ensure that we as society are accountable for the death of every woman who dies during child bearing and birth;
• We have taken active steps to provide doctors in rural areas through our community service programme and the recruitment of foreign doctors to rural areas where there we previously no doctor service at all;
• We tackled the pharmaceutical and tobacco industries.

Of course, during this process of drastically transforming the health service, we had some short-comings. It was not always possible to have thorough-going consultations because we had to balance to had to balance public needs against vested interests.

None of us had the experience to run government, but I am sure that you will agree with me when I say that the ANC has gone through this initiation with flying colours, especially when compared with the previous regime.

Master of Ceremonies, Ladies and Gentlemen, during the second term of the ANC in government, I am committed to build on the foundation laid down by my predecessor, in transforming the health service. I have also identified the following areas as priorities during my term of office:

• South Africa is currently faced with a the fast growing HIV/AIDS epidemic in the world, with an estimated 1600 new infections daily. This is our number one priory. We will concentrate on public awareness. We want to mobilise every sector of society to take an active part in the prevention of infection and the provision of care and support to those who are infected and affected by HIV/AIDS. We are committed to do everything within our powers to ensure that we treat STDs, TB and explore mechanisms to make drugs for the treatment of these conditions available at affordable cost.
• Alongside HIV/AIDS, TB demands equal attention;
• We are committed to implement the District Health System and we will build the capacity of local government to provide and manage the delivery of comprehensive Primary Health Care services to our communities.
• The physical condition and management capacity in our public hospitals leaves much to be desired. Therefore, we will concentrate on decentralising authority, building the management capacity in these institutions and maintaining this precious capital stock in a good state of repair.
• We will put in place mechanisms to recover revenue in our hospitals and to plough these resources back into those facilities.
• We will strengthen our co-operation with the private and non-governmental sector in the provision of health services, especially in areas where the state has no capacity to render basic health services.
• We will strengthen our international relationships especially with our neighbours in SADC and Sub-Saharan Africa.

I have been asked to specially refer to partnerships between the public and private health sectors. In my view, here are some of the possible areas of co-operation between the public and private sector:

• Many provinces are already farming out some on the non-clinical activities such as drugs distribution, logistics and administration, and contacting out of laundry, catering and maintenance services;
• We are obviously looking for new ideas and would like to share experiences in the efficient management of our public hospitals;
• We are looking at innovative ways or cost sharing especially in expensive and sophisticated equipment;
• We are very keen to upgrade our public facilities in order to accommodate private patients in public hospitals and thus improve our revenue, especially in under-utilised hospitals;
• In planning for the establishment of the number and types of hospitals beds, we are looking at an integrated planning framework which takes into account available beds both in the public and private sectors, within any locality. In other words, we will only build hospitals where they are needed, carefully look at the beds already available in both sectors, and we hope that the private sector will do the same;
• I would like to encourage more and more private doctors to consider doing sessions in public hospitals because we desperately need your expertise. Our young doctors need indigenous and experienced mentors

In closing, Master of Ceremonies, I do not want to bore you with a long speech. I would rather join you in the celebration of your 30th Anniversary. I pray that the bond and the commitment which has kept you going for so many years, should continue to do so, and we, together, should lay a solid foundation for our children and future generations.

Thank you very much for inviting me to speak to you at this august occasion. I wish you the very best for the rest of the evening. I again want to pay tribute to the contribution that you have already made to the upliftment of the health services in this country and together let us work for A Better Life for All!

Minister of Health
Dr Manto Tshabalala-Msimang