Speech by Mike Waters MP, Democratic Alliance shadow minister of health, in the debate of budget vote 14: Health, June 30 2009

Mr Speaker,

The current crisis in the public health sector with regards to the doctor's strike has been a long time in the making. It is extremely unfortunate that doctors have been forced to go on strike in order to have their grievances heard.

The groundswell of support for the strike among doctors must set the alarm bells ringing for the ANC government. The fact that a junior doctor in the public sector earns the same amount as a bus driver is indicative of the indifference with which this government has taken doctors concerns over the years and the degree to which it has taken advantage of their commitment and compassion. It also clearly demonstrates where in the ANC priorities in health care actually sit.

If one looks historically at the budget allocation for public health it is obvious that from 1998 to 2003, in per capita terms, the budget flat-lined because the government was spending all its available money on guns to fight non-existent enemies. In 2003 the government began to realize its mistake and the budget did start to increase in real per capita terms. However, the automatic notch and rank increases of 1998 and budget constraints meant that as people left the public health system they were not replaced, and an estimated 60 000 people left during this period. Hospitals have still not recovered.

And while the government may say that from 2003 there were significant budget increases, most of this allocation went to clinics and to the new ARV programme. No compensation has really ever been made available to reduce the strain the whole health system was placed under during those years.

We must remember that the burden of disease has increased dramatically, placing an ever increasing strain on hospitals. Given that hospitals' budget allocations have been on the same trajectory since 1998, we have the current melt-down. As there were insufficient funds to replace doctors and nurses who left the public service, the work load increased and working conditions deteriorated.

You simply cannot offer a health service with 12 000 vacancies for doctors and 42 000 for nurses.

Equally you cannot neglect a system for so long and expect to fix it in a once off adjustment - it is obviously beyond this government's capabilities. You as a department mishandled nurses' OSD increases through grossly under estimating the cost to the fiscus, and now you cannot or won't deliver on the doctors' OSD increases. This ongoing neglect of 11 years is finally taking its toll.

Back in July 2007, some two years ago, the government promised through Resolution 1 of 2007 that they would implement OSD increases for doctors in July 2008. The ANC government reneged on that promise. 

My question to you, Minister, is if the government made a promise some 24 months ago, why then were no budget allocations made in the 2008/09 budget or even this year's budget? The answer is clear: this government had no intention of honouring it promise.

It was only after the doctors started marching and threatening industrial action that you, your department and this government sat up and started to take the doctors seriously.

The Doctors have been asking for a 50% increase, which may seem excessive to most South Africans. However, research commissioned by SAMA into doctors' remuneration shows that in the South African public sector, doctors are paid 50% less than other professionals such as accountants, engineers and lawyers. That is what I call a disgrace.

Since the threat of industrial action, the doctors' association and yourselves have been shut behind closed doors negotiating, when an agreement was expected to be announced last Wednesday.

However, in what can only be described as bizarre you made a public announcement on the doctors' increases while negotiations were still ongoing - thus undermining the entire bargaining process and showed bad faith. You announced in your media conference that doctors would receive increases of between 29% and 53%, which most organisations welcomed, including the DA. However, this was misleading to say the least.

When one scrutinises the finer detail, it is clear that the offer was not genuine, and either you deliberately misled the nation or your officials misled you, I believe the latter. Who's idea was it to hold a press conference while negotiations were still ongoing?

The real increases for most doctors range between 2% - 13 % over a two year period. The offer excluded experience and only commits itself at looking at this principle again in April 2011, subject to availability of funds!

There are also questions hanging over whether doctors have the right to strike - well it is entrenched in the constitution with a limitation clause, meaning that as an essential service, skeleton staff must be in place. After the 2004 and 2007 public sector strikes, the government agreed to negotiate a Minimum Service Level Agreement which would stipulate the conditions of industrial action, - surprise, surprise, this government still has not fulfilled this promise. How many more promises are you actually going to break?

Mr Speaker, the attitude of the MEC in KZN is also of concern, on what bases does a MEC state that there is a third force at play and doctors are destabilising the country? Dismissing doctors also won't help either, there are so few of them you will have to re-employ them anyway unless you want a further meltdown in health services.

If the government can find an extra R1bn for an expanding cabinet, and R 2 - R4 bn for saving the SABC, it can surely find the money to pay the doctors.

The question of budget allocations also needs to be seriously looked at. The ramifications of the miscalculations of nurses' OSD allowances continues to eat into the budgets of the Provinces and some health experts believe that by August this year, provinces will be running out of money and we will see a repeat of what happened in the Free State in the last financial, but on a much wider scale. The department also admitted that due to the lack of funds not everyone who is entitled to ARVs will actually be enrolled into the programme as there is simply not enough money, this Minister means people are going to die.

We need to separate the HIV/AIDS budget from the rest of the health budget. It should be treated as a grant where central government underwrites it and guarantees all who need ARV'S can access them.

Minister, whether you were misled by your officials with regard to the doctors' increases only you will ever know and whether you were set up for failure by hosting a premature press conference only you will know.

However as the political head of the Department of Health you, sir, and only you, must take political responsibility for the atrocious mess we find ourselves in.

I thank you.

Source: Democratic Alliance

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