KZN Legislature Pietermaritzburg: 25th March 2011
South Africa spends a greater percentage of its
gross domestic product (GDP) on health than other BRIC (Brazil,
Russia, India and China) countries, yet we score worse on indicators
such as maternal mortality rate and tuberculosis (TB).
The national budget allocates no less than R360.6 billion to
health over the MTEF and in 2011/12 financial year, about R113
billion will be spent on health in the nine provinces.
Out of this budget, KwaZulu-Natal spends most on
health, followed by Gauteng and the Eastern Cape. Despite these
substantial allocations, the poor health outcomes in South Africa
are primarily due to government’s failure to transfer power to the
local level and to hold health workers accountable for their
actions. Instead, health programmes are centralised at provincial
level and key jobs are political appointments that have no direct
accountability to the communities they serve, and corruption is
The challenge that we have observed as the
Official Opposition in the last two terms of this Legislature is
that the provincial delivery system remains largely centralised and
has become vulnerable to the changing dynamics with the Executing
Authority. This results in the breakdown of formal accountability
which is important in the healthcare system and has also left the
floodgates open to fraud and corruption.
To turn this situation around the Department of
Health must overhaul the country’s entire health system and
implement governance and accountability structures and move towards
primary health care (PHC) to respond to the local needs and also to
allow hospitals to account for their own budgets. As a step towards
the National Health Insurance it is very important that we improve
the primary health services. We commend the decision by the Minister
of Health to draw on Brazil’s experience and enact a policy that
will lead to the setting up of family health teams to drive change
in the country’s new primary healthcare model, which currently has
very few public service doctors available outside hospitals.
To achieve this, we sincerely hope that the R1.2
billion earmarked for the envisaged family health teams (made up of
doctors, nurses and community health workers) will be used to
improve the quality of healthcare in hospitals and that these teams
will work at local level, with a strong emphasis on preventative
medicine and reducing the load on public hospitals.
The department must take concrete steps towards
achieving the outcome of a long and healthy life for the citizens of
KwaZulu-Natal. The following issues must be addressed by the
department including the extension of service hours in all clinics
and community health centres, the shortening of waiting time and
long queues at hospitals and the turnaround strategy for the
renovations, refurbishments and revitalisation of all provincial
public hospitals to make them look like hospitals.
In his Budget Policy Speech, the Honourable MEC
for Health promised that the province’s health system can expect a
much needed boost in 2011 with the department planning to train more
doctors and nurses, upgrade hospitals, prioritise children’s and
women’s health and to focus on the appointment of appropriate and
qualified people to the right positions and not to succumb to the
ruling party’s policy of cadre deployment.
The department must take appropriate steps to fill all 15,362
funded vacant posts in the health institutions and further ensure
that further posts that will be created by the scrapping of the
infamous labour brokers would also be filled.
Government policy allowing doctors to be paid for
remunerative work done outside public service (RWOPS) and the
procedures that needed to be followed are contained in the Public
Service Act, but we note that this policy is difficult to manage and
the experience on the ground is that this is a serious challenge.
...ice Act provides for doctors to work outside the public service with
written permission from the relevant Executive Authority (MEC for
Health), based on the considerations in the Act.
This policy was intended to allow doctors to
augment their income but with the Occupation Specific Dispensation
(OSD), this aspect has been partly addressed because very senior
doctors were on R1.4 million to R1.5 million packages but still did
private-sector work. These doctors would come in the morning, work
for an hour and then leave for their private rooms, leaving junior
doctors to work without supervision.
The doctors who spent most of their working hours
in the private practice would proceed to public hospitals when they
are tired and ineffective. We, therefore, call on the Honourable MEC
to investigate the pros and cons of having this policy reviewed and
to take into account whether or not the outside work could interfere
with the individual doctor’s functions in the public sector or
constitute a contravention of the code of conduct.
About 40% of high school learners say that they
have sex and 19% of these say that they have more than one sexual
partner and just over a quarter of girls aged 12 to 18 years old
reported having had cross-generational sex with men who were at
least five years older. A significant proportion denies that they
are at risk of HIV infection, this according to the study by the
Foundation for Professional Development.
As part of government’s HCT campaign launched in
April 2010 aimed at testing 15 million South Africans by June 2011,
the Health Department’s plan to introduce HIV Counselling and
Testing in high schools is fraught with challenges and has met with
concern from various organisations and individuals.
Many fear that the implementation of the campaign will create
more problems, including breeding stigma and discrimination.
It was not until public debate erupted that the
start date for learners testing was postponed by the Department of
Health and a nationwide consultative meetings are held with relevant
stakeholders to formulate a national policy for school-based HIV
testing, as well as guidelines and recommendations for the country’s
nine provinces. We call
upon the Honourable Premier and the MECs for Health and Education to
request for a slot in the Legislature’s programme to allow members
to debate this important issue during this period of consultation by
I thank you.
Contact: Dr Bonginkosi Buthelezi, 082 516 0156