Debate on the President's State of the Nation Address by Dr Aaron Motsoaledi MP, National Assembly, Parliament, June 5 2009

Honourable speaker
Honourable President and Deputy President
Fellow Colleagues and Deputy Ministers
Honourable members of the house
Ladies and gentlemen

Honourable President, you have spoken and those who have ears will have heard you and those who do not want to hear, of course we cannot stop them. Listening to the opposition parties, if you were to go along with what they claim or even demand you should have included in your speech, you would have needed five hours state of the nation address. This is so because seemingly they want you to be a Minister of every department rather than the President of the country.

As for those of us who heard you we will do what you have instructed.
Mr President you have instructed that we must improve the remuneration of doctors and other health workers. As you spoke, I saw the Minister of Finance and I am convinced that he also heard you. I saw him nodding his head emphatically and I can promise you Mr President that working together with him, we are definitely doing to put something decent on the table. We will put on the table something that is a good beginning to this long journey of correcting that which has gone wrong for a very long time.

As a Chinese saying goes a journey of a thousand miles starts with the first step. And so Mr President, I want to assure the health profession through you that we will indeed take a decisive first step and we shall do so within the next few days not weeks.

Mr President, long before your State of the Nation Address, there were already articles about your possible announcement of the implementation of National Health Insurance (NHI). The articles are by people who profess to be knowledgeable about what is good for me and you and what is good for the man on street as far as our health system is concerned.

There is absolutely nothing wrong with that Mr President. As you will agree, we actually encourage every single South African to engage on any policy matter put on the table by government. We welcome all forms of engagement, as long as they contribute towards building our country and not destroy it.

Honourable Speaker, Mr President, what I would like to do at this moment is to highlight a few issues, in regard to a few engagements which I have already seen.

Firstly, we have not as yet as government released any official policy document for public engagement on NHI. We are still going to do so, and very soon we will.

What has so far happened are intentions in our election manifesto and the announcement by the President on the campaign trail about the desire of the African National Congress (ANC) to implement the NHI and of course the first ever government announcement about the NHI has been made by you Mr President just two days ago, in your well received State of the Nation Address. Up to now since that day we have never released any official document for engagement, either by the profession, stakeholders or the public. We are going to do so within a few days' time. But since some people have already started in several newspaper articles, I think it is desirable that I do not keep quite.

One of the articles states and I quote "formulation of a complex policy behind closed doors was dangerous. Lowest quality policy emerges from processes in which you insulate yourself from any critique."

Honourable Speaker, every singly policy I know of on this planet starts somewhere by a few people who formulate it. They then canvass for it and allow others to engage. If it is government policy, it even finds its way into Parliament and public hearings for public scrutiny. So I don't understand this "behind closed doors" story and insulation from critique phenomenon. I do not understand it because NHI policy will be discussed in every corner of this country and will eventually find its way into this House for public scrutiny.

Another article says, "It is vital that proposals be based on hard evidence not on ideological assertions and beliefs. Frankly speaking honourable speaker, we know what is at play here. Certain people, who are benefiting hugely from the present inequitable health system, are already trying to transform their own fears and personal concerns into public fears and public concerns. What is the fear?

Honourable speaker, there is nothing ideological about NHI. The Constitution, under the Bill of Rights Section 27, asserts that health is a right of every citizen and the NHI is going to be implemented to make sure that everybody exercises that right. If it is ideological, then I welcome that ideology. But because facts are being demanded, let me give them:

Fact one (and not ideology 1):

The World Health Organisation (WHO) recommends that developing countries spend at least 5% of their Gross Domestic Products (GDP) on health. In South Africa we have far exceeded this recommendation we are at 8.5% of the GDP. But our health outcomes are very unsatisfactory and rank among some of the worst in the world. That is why Mr President we agree with you when you are concerned about the deteriorating quality of health care in our country.

Honourable speaker, Mr President, we acknowledge and accept that some of the contributing factors are the following:
* Lack of management skills
* Lack of induction and inservice training
* Failure to act on identified deficiencies
* delayed response to quality improvement requirements
* Unsatisfactory maintenance and repair services
* Poor technological management
* Poor supply chain management systems
* Inability of individuals to take responsibility for their actions
* Poor disciplinary procedures and corruption
* Significant problems in clinical areas related to training and poor attitude of staff that honourable Meshoe referred to yesterday
* Inadequate staffing levels in all areas.

Having said so, I want to say that one of the most glaring and obvious reasons why the public sector is not doing well, is what the people who have started engaging are trying their best to hide. This is the manner in which this 8.5% of the GDP is distributed among the population of our country:

* 5% goes to 14% of the population
* The remaining 3.5% goes to the 86% of the population.

To simplify it honourable speaker, in this beautiful country of ours 7 million people enjoy 5% of the GDP to take care of their health and a whopping 42 million will have to do with the remaining 3.5% of the GDP. If it is ideological to resolve this state of affairs, then I fully subscribe to such an ideology, for it cannot be that humanity is allowed to go on like this. It is actually a shame to have allowed this state of affairs to exist for so long in our country.

Honourable speaker, all of us in this house together with our spouses and children, are part of this privileged 7 million. The people we asked to vote for us and promise that all shall be well, constitute this 42 million and we are supposed to turn our backs on them because we dare look at them, we are supposed to be driven by ideology.

It is said that NHI will destroy medical aids and damage the already well functioning privileged health care system in our country, which is ranked as one of the best in the world. We have absolutely no intention of destroying anything at all. What the NHI will obviously and unapologetically destroy is the present inhuman scenario.

Fact two:

Fear of the unknown is being driven into the minds of doctors in private practice that the NHI is going to close or destroy private practices.

Let me present the following fact to you:

Out of every R100.00 you contribute to your medical aid, only R3.00 goes to your medical practitioner. It is only better if you happen to be a specialist.

Hence I challenge you honourable members to go back to your own villages and count all the doctors that ever opened practice in your village, and tell me how many are left. They have all folded and closed and went to look for employment elsewhere, many of them in England and other countries abroad.

They were destroyed by the present distribution system which the NHI seeks to address. It is not the NHI that destroyed them. The NHI is not yet there.

Lastly Hon Speaker, I want to put it upfront that we will never impose NHI upon a poorly functioning and poorly managed health institution. Our first task towards implementation of NHI is to massively overhaul the system at all levels and top on our list of priorities in this regard is quality improvement plan for public health care facilities.

Within the next year we shall start a plan towards the establishment of closer Public Private Partnership (PPPs) in improving health facilities and of course such a plan will start by first being drafted behind closed doors before anybody is asked to comment. Even your responses to the President's address were drafted behind closed doors before you brought them here to Parliament for the public to hear.

Hence our quality improvement plan for public health care facilities will have the following objectives:
* Health facility performance indicators
* Quality improvement within facilities
* increasing access to HIV treatment to meet all the NSP goals
* Patient safety
* Disease management, prevention, curative, rehabilitative and primitive
* monitor health-related (MDGs) and strengthen indicators.

Further details will be released in due course.

I thank you

Issued by the Department of Health

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