Budget speech of Honourable Dr Aaron Motsoaledi, MP, Minister of Health, delivered to the National Assembly, Parliament of the Republic of South Africa, June 30 2009

Honourable Chairperson
Honourable members of the house
Distinguished guests
Ladies and gentlemen

Good afternoon

It is an honour for me to present to this house the budget of the National Department of Health for 2009/10, for your consideration. I am presenting this budget at a very challenging time in the history of health care in our country and around the world as a whole.

Let me start with the world

There are two contemporary issues about healthcare around the world:

* The ever threatening H1N1 Influenza which has spread so widely that it has moved up to stage six. Fortunately it is not virulent but just spreading widely. However I must state that it is under control. In our country we are able to control it despite the fact that we were having many visitors from all over the world in recent weeks
* The second issue is the global economic meltdown. It has a great bearing on healthcare around the world and especially in third world countries like ours.

For this reason, the United Nations (UN) Secretary-General, Mr Ban Ki-Moon convened a Secretary's General Forum on Advancing Global Health in the face of crisis two weeks ago at the UN headquarters.

His rational was that the world has learnt during previous economic crises that social outcomes are the first to suffer and the least to recover during such crises.

He went on to point that during such crises, countries are tempted to cut on social spending such as health. The results are that while rich people inside rich nations may lose their jobs and assets like mansions, luxury cars and other property, these they may recover when the economy recovers. But in poor countries, poor people may lose their life through extreme poverty and poor healthcare and they will never ever recover this lost life after the crises.
Hence I wish to bring this message home to my own country that this is the time the poor need protection more than ever before, to cushion them from the devastating effects of these crises. Coming back home challenges are overwhelming.

During the State of the Nation Address, the President of the country, his Excellency Mr Jacob Zuma said: "fellow South Africans, we are seriously concerned about the degeneration of the quality of healthcare, aggravated by the steady increase in the burden of disease, in the past decade and a half."

We have no option, but to be fired up to take the bull by the horns in tackling this state of affairs and deal with it decisively. Unfortunately, the present event within the public health sector does not help the situation either. Chairperson, I need to mention that we as the governing party started being concerned sometimes back. Hence the resolution at the African National Congress (ANC) conference, that health and education is the top priorities for the next five years and beyond.

To this end, the government adopted a 10 point plan which is our programme for the next five years. The public health system is also forced to carry the ever increasing burden of diseases, obviously made worse by poverty, HIV and AIDS, and other communicable diseases. However, honourable chairperson, let me accept and acknowledge upfront that some of the factors contributing in no small measure to the problems the health system is carrying, are the following:
* Lack of managerial skills within health institutions
* Failure to cut on identified deficiencies
* delayed response to quality improvement requirements
* Unsatisfactory maintenance and repair services
* Poor technological management
* Poor supply chain management
* 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
* Inadequate staffing levels in all areas.

We are going to be facing all these issues head on and we will do so without fear and favour. We owe it to our country that these issues be tackled head on.
Honourable chairperson, some of the issues I have mentioned as contributing factors to the problems the health system is facing are very urgent and will be dealt with urgently. For instance, Gauteng Provincial Government has already launched "operation kuyasheshwa-la" to deal with such urgent matters.

Our programme of action however with its ten point plan, has been designed to deal with the issues systematically and in a sustainable manner. Its implementation will be both decisive and incisive.

Hence honourable chairperson, our 2009/10 to 2009/14 will allocate resources for the following ten priorities in line with the programme of action:
* Provision of strategic leadership and creation of a social compact for better health outcomes. While issues of strategic leadership are very clear, I wish to add up the social compact part of this point speaks to "working together we shall achieve more"

Mooney (2008) also states that:

"The view of patients as passive receivers of health care is being replaced by one of communities as equal partners in decision making about health care priorities, contributing their opinions alongside those of bureaucrats and policy makers."
We shall follow this line very closely.

Implementation of a National Health Insurance (NHI)

Honourable chairperson, in recent weeks there has been a ranging debate in the public arena about the intended introduction of the NHI by Government. This debate was introduced prematurely by people who wanted to scuttle the NHI as an unworkable system. South Africans were urged to run for cover because the NHI is going to be a marauding monster that will destroy everything that you hold dear in the health care system of the country.

Honourable chairperson, while I am not yet presenting an official document as yet on NHI, because it is a policy that is still to come (though very soon), I wish to make the following known:
* The present system of healthcare financing can no longer be allowed to go on, because it is simply unsustainable. No way can we perpetuate a system whereby we spend 8,5% of the Gross Domestic Products (GDP) whereas 5% caters for 14% of the population or 7 million people, on the remaining 3,5% cater for a whooping 84% of the population or 41 million people. Nowhere in the civilised world can you find that state of affairs
* The present model of healthcare financing is just outright primitive and we are going to abandon it. The General Secretary of the United Nations, Mr Ban Ki-Moon, on the 15 June 2009, which is just two weeks ago, had this to say, "out of pocket expenditure, is the worst form of healthcare financing." That says it all.

Critics of the NHI were hard at work to prove that we are going to overburden the rich, and the economy will not cope.

Honourable chairperson, what is NHI?, it is a system of universal healthcare coverage where every citizen is covered by healthcare insurance, rich or poor, employed or unemployed, young or old, sick or very healthy, black, white, yellow or people of whatever persuasion.

It is this part about covering the poor and the unemployed that is bringing discomfort and unprecedented anger in the minds of the enemies of NHI. Let me read the following paragraph of the speech made by Dr Margaret Chan Director-General of the World Health Organisation (WHO), at the meeting of the United Nations. Dr Chan was the Minister of Health in Hong Kong before taking over as Director-General of WHO, "Fairness, I believe, is the heart of our ambition in global health". A quest for greater fairness dominated the agenda of the UN Forum.

We see this as our concern about vulnerable populations and about health systems that exclude the poor. We see this in your support for global health initiatives and funding mechanisms that redistribute some of the world's riches towards health needs of the poor.

On the issue of fairness, let me again state the obvious. Our word is dangerously out of balance also on matters of health. Differences within and between countries, in income levels, opportunities and health status are greater today than at any time in the recent history.

She went on to say, "Let me make another obvious point a health system is a social institution. It does not just deliver pills and babies the way a post office delivers letters. Properly managed and financed health systems that strive for universal coverage contribute to social cohesion and stability.
Honourable chairperson, the aims and objectives of NHI is to achieve exactly what the WHO Director-General has alluded to nothing more, nothing less.

Accelerated Implementation of the HIV and AIDS Plan and increased focus on TB and other communicable diseases.

Honourable Speaker, let me go back to the President's State of the Nation Address, "we must work together in the implementation of the comprehensive plan for the Treatment, Management and Care of HIV and AIDS so as to reduce the rate of new HIV infections by 50 percent in the year 2011. We want to reach 80 percent of those in need of ARV treatment by 2011. Honourable chairperson, here is the score-card on HIV and AIDS challenge that South Africa is facing.

This year, on 9 of June, The Human Sciences Research Council, together with its partners the Medical Research Council, centre for AIDS development, research and evaluation and the national institute of communicable diseases published a report on HIV based on interviews and testing of a random sample of the population in South Africa during 2008. The survey included people of all races, age groups, rural and urban and all provinces. The researchers concluded that:
* The epidemic is stabilising at 11 percent between 2002 and 2008
* HIV prevalence at national level decreased by nearly half among children aged 2 to 14 years, between 2002 and 2008
* HIV prevalence decreased slightly among youth aged 15 to 24 from 2005 to 2008
* Encouragingly there was a substantial decrease in new HIV infections in 2008, in comparison to 2002 and 2005, especially for the single age groups 15, 16, 17, 18, and 19
* What was most encouraging was the change in behaviour among South Africans. More South Africans for all age groups protected themselves against HIV infections by using condoms. More than 95 percent know where to access condoms and use has increased
* Furthermore, half of South Africans now know their HIV status, which means that the message on "know your status campaign" is being heeded
* The researchers also reported that there has been an increase in exposure to one or more HIV and AIDS communication programmes from 2005 to 2008 with 90,2% of youth aged 15 to 24 years being reached, followed by adults 83,6% of 25 to 49 years and 62,2% of adults 50 years and older
* However, despite these successes, there is still some unevenness in infections as well as behaviour change
* HIV prevalence is still highest in KwaZulu-Natal (15.8%) and Mpumalanga (15,4%)
* It is also still highest among young women, aged 25 to 29 years, where a third of the women are HIV positive
* Among all provinces, Free State continues to have high rates of multiple partnerships, perhaps due to the migratory labour patterns in that area.

We take note of the recommendations made by the researchers, especially that we need to introduce targeted interventions in some provinces with high HIV prevalence.

Secondly, that we assist young women who want to have children, to do so without risking HIV infection. We plan to support research that will generate evidence to be used in attaining this goal.

We furthermore, support that we intensify our efforts to help provinces implement interventions aimed at reducing rates of multiple sexual partners, including intergenerational sex.

We also take the recommendation that we should consider implementing provider-initiated HIV testing in all health care facilities.

Finally, we take seriously the concern that Khomanani should increase its reach and coverage to all South Africans, particularly those who are aged 50 years and older.

I would like to thank the following people for continuing to undertake research that informs policy and programme development on HIV and AIDS; these are Dr Olive Shisana, Professor Leickness Simbayi, Professor Thomas Rehle and their staff at the Human Sciences Research Council (HSRC) as well as their colleagues from the Medical Research Council (MRC) and Cadre especially Dr Warren Parker. Finally, the support of the United State (US) President's emergency plan for AIDS relief in conducting this important study is very much appreciated.

Hence honourable speaker, we will work with provinces in 2009/10 to ensure that 80% of HIV exposed infants receive ARVs for Prevention of Mother to Child Transmission (PMTCT) based on dual therapy. This figure will increase to 95% over the two years of the MTEF 2010/11 and 2011/12. The proportion of pregnant women who are tested for HIV will be increased from 80% in 2009/10 to 95% in 2010/11 and 2011/12. To strengthen the prevention of mother-to-child transmission of HIV, 80% of pregnant women who are eligible will be placed on ARV Prophylaxis based on dual therapy in 2009/10.

This figure will increase to 95% in the outer two years of the MTEF period. 30% of eligible pregnant women will be placed on HAART in 2009/10. This service will be expanded to cover 50% of pregnant women in 2010/11 and 75% in 2011/12. South Africans and men in particular, will be encouraged to do voluntary counselling and testing (VCT). In line with the result of the research by the Human Science Research Council and others, we will increase distribution of male condoms from 283 million to 450 million in 2009/10, and 45 million condoms in the other years of the planning cycle. Female condom distribution will increase from 4,5 million in 2009/10 to 5 million in 2010/11 and 2011/12.

We will start 215 000 new patients on ARVs and grow the figure to 320 000 in 2011/12. This figure of patients will add to the 781 465 people already on treatment.

Overhauling the healthcare system and improve its management

We will draft proposals for legal reforms to unify the public health service. We shall also develop a decentralised operational model including new governance arrangements.

Honourable speaker, we shall also finalise delegations for all managers at all levels of the public health system. We will spend attention on hospital managers or CEOs to ensure decentralisation of management. We shall also strengthen health specific management capacity for programmes and facilities, especially hospitals.

In this case we shall:
* Evaluate all CEOs of hospitals to ensure that they meet the minimum requirements for effective management of the set facility and institute corrective measures where indicated, including retraining and/or redeployment
* Do a feasibility study for establishment of a leadership academy of health managers
* In further overhauling the health system, we will evaluate and strengthen the district health system and primary health care.
* Improved human resource planning, development and management
* Improving the quality of the health services
* Revitalisation of health infrastructure
* Mass mobilisation for better health for the population
* Review of drug policy
* Strengthen research and development.

In conclusion, honourable speaker, I wish to appraise this house, about the issues of Occupational Specific Dispensation (OSD)

I thank you

Issued by: Department of Health

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