Budget Debate – Health (Vote 7)
By Dr U Roopnarain MPL
Shadow MEC for Health


KZN Legislature Pietermaritzburg: 25th March 2011

Honourable Chair, 

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 makers. 

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 skills. 

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 programs. 

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 needed. 

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, incentives, 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 ISSUES. 


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 baby’s life.

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 depend. 

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