22 June 2004
Chairperson, honourable members
The vision of the Department of Health is to create a caring and humane society in which all South Africans have access to affordable, good quality health care. This vision can be realised only if all of us roll up our sleeves and get down to work, in a people's contract for health care delivery. Health is a key ministry in the government's commitment to achieving human security, equity and dignity for all. It is a key indicator of our success or failure as a nation. The large scale transformation of the health system since 1994 bears testimony to this.
In his State of the Nation Address in May, President Mbeki outlined the Government's priorities for this year. Many of these, though not the responsibility of the Department of Health, affect the health of the nation. These include the elimination of poverty and unemployment, the provision of basic services such as water, sanitation and electricity, the provision of social services and housing.
More than 80% of our people depend on the public health sector. This means that Government has a major responsibility not only to provide stewardship of the health system, but also to deliver health services. When a person is ill, regardless of their economic status, what they would hope for is the best health care service possible. Much progress has been made to improve quality of care at all levels of the health system.
DELIVERY OF QUALITY HEALTH CARE
We have built 1 345 clinics and upgraded a further 263 in our effort to bring health care services closer to our people. As a result of the expansion of facilities and services and the free primary health care policy, the number of visits per person to our primary health care facilities has doubled in some cases, between 1992 and 2003. I am acutely aware of the pressure this has created on our health personnel, the majority of whom work under extremely difficult conditions.
The clinical services in rural areas are provided almost entirely by nurses. Some of the major problems include high vacancy rates, high absenteeism, high turnover of staff, ageing staff and the increasing demands of new policies. Staff in rural areas has thus been subjected to continuing and increasing stress, often with very little recognition or reward. Many people do an amazing job with the resources available, but morale is generally not good. I want to use this opportunity to express my appreciation for the work done by our front line health workers.
I will be working closely with the Deputy Director General for Human Resources in the National Department, Provincial and Local Government and civil society organisations to ensure that these issues are addressed. We will be paying special attention to the Human Resource needs for health care, especially in the under-served areas.
COMMUNITY BASED HEALTH CARE
Our ability to reach every household in need of health care depends on our ability to mobilise communities to volunteer their services. Community Health Workers, DOTS and HIV and AIDS community based care workers provide an invaluable service. All these groups can render an even better service if we give them support. We will be paying much attention this year to such issues as stipends, training, supervision and career guidance.
We will ensure that support services required for good clinical care are stepped up. Issues of management, infrastructure, transport, communication, electricity and roads will be addressed jointly with other government departments in the social cluster and under the hospital revitalisation programme.
Imagine what a nurse must do who works in a rural clinic where the telephones don't work, or there is no electricity and no running water. Imagine how better such a nurse would feel about her job if she was in a position to send an e-mail to order her supplies or to reach a tele-medicine service. President Mbeki shared a story once of a village in the Eastern Cape, which was transformed almost over night through the installation of electricity and computers. Suddenly the community nurse could send a digital image of the cases on which she needed help with diagnosis and treatment advice.
Chairperson, we must deal with the issue of the differences in conditions of service and salaries for health care personnel paid between different municipalities and between municipalities and provinces as well as the differences between the community health workers and the new community development workers. These differences contribute to fragmentation and inefficiency and, above all, to inequity.
A nurse employed in a rural local municipality earns much less, for the same level of responsibility, compared to her counterparts employed by a metropolitan municipality. A nursing supervisor responsible for five clinics and 50 staff in a city, can visit every clinic every morning, and still have time to do other things. By contrast, a nursing supervisor responsible for 5 clinics and only 25 staff in a rural area, has a much more difficult job. She will spend hours traveling over bad roads to visit clinics and cannot visit each one more than once a week.
This is one of the major reasons why provinces have to remain, for now, the major employers of Primary Health Care Staff.
I am very pleased that a task team, led by Minister Geraldine Fraser-Moleketi's department is currently working on a framework for a Single Public Service. There will be some tough negotiations to ensure that it is easy for people to move between posts in national, provincial and local government. I look forward to seeing a draft framework in 2005 and legislation in 2006.
We intend to show that we care for all our front-line health workers, and particularly for those with the most difficult jobs. As we care better for our health workers, we know that they will feel better about themselves and about their jobs, and they will give better care to our people.
The Patient's Rights Charter which was launched in November 1999, and which clearly outlines the rights of patients and the complaints mechanism, enhances the delivery of quality health care services. In 2001 a National Policy on Quality was launched and all provinces now have their own policies. They have also established quality assurance units to co-ordinate and lead efforts on quality improvement.
There are many examples, which illustrate the effort being made to improve and maintain services. In the Northern Cape, the Kimberley Hospital Complex won the Premier's Gold Award for service excellence for two consecutive years. 23 hospitals in the North West Province were enrolled into an external accreditation system, which uses international norms as a benchmark of quality.
I hope to work closely with members of this House, Provincial Legislatures and municipalities to ensure that these policies result in the delivery of quality health care.
MENTAL HEALTH
Suicide, homicide, child and spouse abuse are on the increase. We know that often these problems are precipitated by stress caused by unemployment, drug and alcohol abuse and other mental health problems.
A year ago, we passed the Mental Health Care Act. The regulations will be published this year. This progressive law takes mental health services out of the rigid custodial care into the light of community integration.
We need to strengthen mental health and related social services to ensure that we do see visible declines in the rates of these problems in the next five years. We must also ensure that the Social Cluster of Directors General develop comprehensive interventions to deal with these issues. I pledge to play a leading role in support of activities to address these issues.
ENVIRONMENTAL HEALTH
On 1 July this year environmental health care services will become a core function of metropolitan and district municipalities. This is a change from present arrangements where some local municipalities and provinces render environmental health services. In addition, the rendering of primary health care will form the core function of provinces.
Provinces may delegate primary health care delivery to municipalities by agreement and with the necessary resources. This new decision of powers and function will result in clear role definition and, equally importantly, will result in a single health authority for each health district thus eliminating duplication and fragmentation of service delivery.
We are also convinced that this decision will strengthen the role of developmental local government in the delivery of basic services and that the health of our citizens will improve as a result. This is consistent with the fact that health is the result of many factors and not just the provision of clinical services.
SOCIAL MOBILISATION
Tackling these issues requires new approaches and new thinking. Social mobilisation is a very important element of our national strategy for accelerating delivery of health care. My first public event as Deputy Minister of Health saw me launch a public-private partnership in Standerton, Mpumalanga, on World Candle Light Memorial Day, to honour and remember loved ones we have lost to AIDS. Organised under the banner of our programme Khomanani, this event demonstrated the amount of goodwill in our communities and the willingness of our people to be part of the national campaigns.
We need to strengthen the framework through which all our people can participate more effectively at community level. Once the National Health Bill comes into effect, we will have a more coherent legal framework for the establishment and functioning of clinic and district health committees and hospital boards.
Through these committees, communities will be better able to play a direct role in making sure that health care workers in clinics and other community health centers are putting people first. We expect the youth to play an active part in these structures to ensure that health services are youth friendly.
I urge members to get lists of hospitals and clinics in your constituencies and make a point of visiting them. Ask to review the minutes of meetings of clinic committees and hospital boards. Mobilise communities to take pride in these services; to protect the personnel; and to work with management to ensure the staff respects the users of the services. It is only by combining our efforts that we will strengthen service delivery and make services more responsive to the needs of our communities.
CONCLUSION
In conclusion, Chairperson, I wish to pledge that as a member of the Health team, I will work closely with other departments in the Social Cluster, with provinces and local government and with our social partners to ensure that we join hands in strengthening the delivery of services to our people and thus restoring their dignity. I will ensure that we strengthen our communication and relationship with the media so that they report the good news and achievements of our department.
I realise that in order to fulfill all these difficult tasks, I need to be fit, both physically and mentally. Long hours, travel, hectic schedules, poor diet, and lack of exercise - all contribute to poor health. I call on you honourable members to join me as I embark on a fitness campaign. There are two gyms in parliament. Pick up your running shoes and let us together strive to get physically and mentally fit - FIT TO GOVERN!