Budget Debate – Health (Vote 7)
By Dr BT Buthelezi MPL, Leader Of The Official Opposition


KZN Legislature Pietermaritzburg: 25th March 2011



Honourable Chairperson


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 rife. 


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 other stakeholders.


I thank you.


Contact: Dr Bonginkosi Buthelezi, 082 516 0156