KZN Legislature Pietermaritzburg: 25th March 2011
For too long the vast majority of people in
KZN have been subjected to declining quality of health care, longer
queues and ever increasing waiting lists for medical treatment.
Without sound financial management it is impossible to provide basic
health care on a day to day basis, which I may add is a
constitutional right. The health budget was intensively
interrogated. What was clear was money is very tight: hence
spending priorities must be right.
The IFP believes in an alternative budget.
Despite increasing efforts and volumes of state funding, the
incidence of HIV/Aids, the single biggest crisis our healthcare
system is facing, remains stubbornly high. This crisis is
exacerbated by the fact that our public health facilities are
failing. The economic cost of HIV/AIDS is a huge cost to an
individual, household, community and the economy. This further
impacts on the quality of life of families, communities and policy
While the public healthcare system continues
to be grossly underfunded, significant portions of the funds that
are available, such as the conditional grants set aside for hospital
revitalization, are not being used due to a lack of capacity.
The IFP’s alternate budget will focus on the
establishment of new 20 to 30- beds private patient wards in a
number of public hospitals KwaZulu-Natal. In yesterdays debate
Minister Cronje agreed, but said there was difficulties with the
practical implications. The public health sector would bring a
significant source of income into the public sector’s purse. In the
long run, however, such a marriage of convenience between the
elements of the public and private sectors could facilitate the
transfer into the public sector of private sector’s highly trained
medical personnel, sophisticated technology and advanced managerial
The second allocation proposed by this
Alternative Budget Framework is towards interdepartmental
programmes, a holistic or multidisciplinary approach that is
designed to prevent ill health, not merely treat it.
We want programs that are sustainable;
health is also linked to other disciplines such as water,
agriculture, food security.
In a report published by the SAIRR's reports
of health spending in provinces, our dept of health was the biggest
spender, with a litany of reports on wasteful expenditure,
expenditure that cannot be accounted for, assets which have
vanished, debts which have not been paid, duplicate payments, lack
of sufficient controls, staff who cannot be found - performance
payments that cannot be justified, payment for goods and services
which were not received, and on and on.
Minister accountability, responsibility and
transparency go hand in hand. And I think that the hospital
managers can learn a lot from this. We need managers who can
manage. There must be consequences for mismanagement or the
current unacceptable and unsustainable situation will continue.
Yesterday, Minister Ina Cronje said that financial literacy was a
prerequisite for the successful implementation of numerous
I think there has to be certain standing
items on the report back sessions with MINMEC, this must include the
NHLS. I remember we discussed this issue a year ago with the
Honourable Minister; we have to look into this and ensure that we
get optimum benefit; it cannot be business as usual. Building of
alternate office space to house NHLS will definitely put a further
strain on the budget; we have to relook at the memorandum of
understanding. We need to hone in on the controls and protocols
necessary to reduce costs. This trend is unacceptable.
Secondly, financial leadership and
management are required to develop and manage the process on a
day-to-day basis. There must be consequences for actions; corruption
cannot be allowed to seep through the cracks. We need proper and
adequate monitoring tools.
Honourable Minister, with regard to the
forensic pathology services, it is imperative that these problems
with mortuaries are dealt with.
We still hear too many complaints about
staff attitude and service delivery problems. What we need Minister
is an independent complaints commission, a campaign that will
investigate complaints from patients.
This program can be used as a gauge or
barometer to address the quality of health services ranging from
complaints, patient safety, infection prevention and control,
cleanliness, waiting times, staff attitudes and stock management. We
need client satisfaction and shorter waiting times. It is
unacceptable that poor people, dependent on health services should
be treated poorly. This cannot be allowed to continue.
District hospitals will remain under
pressure, due to increasing patient numbers. This will be further
augmented by the strain of HIV positive patients. We have heard
about the problems relating to the hospital revitalization grant.
We know what happened at the Rietvlei hospital.
Thirdly, due to the lack of budgeting and
technical skills at institutional level as well as the inability to
understand and interpret data, urgent training of line managers and
financial staff in the districts and at health institutions is
Improved data would lead to provide better
motivations to National and Provincial Treasuries for funding. With
such skills the health sector would also be able to accurately
determine: Whether the sector is adequately funded for new policy
mandates; needs, by comparing current staffing and funding levels
to accepted norms; This is imperative, we need data that is decent,
data is reliable and helps us make deductive inferences. If our
information management systems are slack, then I’m afraid, the
monies needed just would tally. The dept must perform a critical
assessment of the integrity of the data.
For ten years in the National Assembly we
grappled with the issue of vacancies in the public service, but the
recurrent answer to the problem was the same: incentives,
The other area that the IFP is concerned
about is the high rate of teenage pregnancies; these young females
have to become parents, face a huge emotional, financial and medical
strain, increased threat of HIV /AIDS, and consequently have to
abandon their studies.
I also want to spend a few minutes
discussing maternal mortality. The IFP is seriously concerned about
the unacceptable levels of maternal mortality. ACCORDING TO
STATISTICS RELEASED BY UNICEF, IT SHOWS THAT MATERNAL MORTALITY
RATE HAS INCREASED BY 80% SINCE 1990. One of the driving factors
is that mothers are deterred from attending antenatal and postnatal
clinics due to the fact that they have to wait in long queues for
the entire day before they are seen. It is high time that scheduling
of appointments is implemented at all antenatal clinics.
This will allow a woman to arrive say half
an hour before her appointment and not waste her entire day when she
could be doing other things. Minister we know that there have been
some developments, but developments need to get more vigorous. The
IFP BELIEVES THAT WE NEED TO SHINE THE MIRROR ON CHILDREN'S RIGHTS
AS WELL. ACCORDING TO THE SAHRC, 1 IN 16 CHILDREN IN SA DIE BEFORE
THEIR 5TH BIRTHDAY. WE CAN'T GIVE SCANT REGARD FOR THE HEALTH CARE
OF CHILDREN; MATERNAL HEALTH, NEO NATAL HEALTH AND CHILDREN’S
HEALTH. IF WE MOVE AWAY FROM THE NUMBERS, THESE ARE THE SUBSTANTIVE
EVEN MORE STARTLING, STATS FROM SAHRC SHOW
THAT A CHILD IN BRAZIL WILL LIVE UP TO THE AGE OF 73, WHILE IN SOUTH
AFRICA THAT AGE IS 53. BOTH COUNTRIES WITH THE SAME LEVELS OF
INEQUALITIES. WE CANNOT ALLOW FOR RETROGRESSIONS.
It is imperative that planning be aligned to
priorities, the dept of public works needs to be talking to the
dept of health to mitigate the problems. On the infrastructure
side, there has to be that monitoring element. There has to be this
meeting of the minds, the IFP is concerned about the remedial work
that needs to be done. Still problems persist, the executive must
agree on agreed upon issues. We need to deal with this issue; these
expensive mistakes result in delays and therefore access to medical
institutions is denied or delayed. Hospital designers need highly
developed skills and can make costly mistakes. Skills must be
passed on, there has to be a mentoring or a coaching system - this
is a unique opportunity to enable the transfer of skills in hospital
design and architecture.
Most of the queues in the hospital also
related to patients coming in to fetch medicines, empty halls and
PATIENTS unable to access medicines.
The issue of moonlighting was to be dealt
with, Health care workers have to make a choice, Doctors cannot
leave institutions, and serve outside that slot. These also create
backlogs and queues, doctors who are committed to work in the public
sector have to suffer the strain of it. This increases the strain
on available staff. Training and availability of health care workers
is also a problem. Nurses are the backbone of the health care
system, and professional nurses are in short supply. The dept must
take this fight further in rolling out more colleges.
It is clear that you need a greater output
of specialists to alleviate the human resource problems. There
needs to be a multi-disciplinary shift for all departments, the
reality is that not enough specialists are produced, and the need to
fill on the ground will take approximately 10 -15 years to fill.
Prevention initiatives are a must; we must look at alternatives to
reduce the burden on the system. The intentions of the dept Minister
are honourable, but this cannot happen tomorrow. The doctor patient
and nurse patient ratio is a huge problem. This puts a strain on the
system, hence we need to maximize the utilization of clinics: here
again clinics have to be operational, well stocked, adequately
staffed and ready to roll out services. This will also enable the
full realization of the right to health care.
Maternal health is a critical area; a
mother’s survival is the key to her baby’s welfare and often her
A mother’s survival can ensure that her
children receive the right nutrition, ensure they receive their
immunizations, have a better quality of life. So saving the life of
the mothers, reducing maternal mortality is ONE OF the most central
of the Millennium Development Goals. Not peripheral. Not an
afterthought. Not on the margins. But right in the mainstream. The
goal upon which so much of the rest of our health objectives
It is what I would like to call the goal of
goals. A mega goal. A defining objective. You know that if a health
system is strong enough to cope with mothers in pregnancy and
childbirth, then it will be able to cope with so much else. A health
system that works for mother, works also for early infant care, for
vaccinations, for infection control, for blood transfusions, for
emergency surgery, for every member of the community. Policy needs
to become a living reality.
Money must be spent properly, to ensure
vigilance and cost cutting measures are in place. The right to
health care cannot be compromised, honourable members we must ensure
that this is fundamental right is realized.
I thank you.
Dr Usha Roopnarain
082 923 1038