NHI briefing by the health minister Dr Zweli Mkhize, 12 July 2019



there will now be an opportunity for silent prayer meditation please be seated my request the service officers to close the doors on the left hand side please the session has started the Secretary will read the order debate on vote 16 health appropriation bill 2019 I now recognize the honorable the minister of health to introduce his budget of the Unruh Minister thank you house chairperson the Honourable the chair of the portfolio Committee on health and members of parliament my colleague the Deputy Minister and other deputy ministers ministers and cabinet members present my colleagues the embassies of health from the various provinces heads of public entities strategic councils professional bodies unions civil society Dean's and faculties Dean's of faculties of medical sciences and other academic institutions including medical research councils and other councils members of the public ladies and gentlemen and fellow South Africans it is indeed a pleasure for us to table today the National Department of Health budget for 2019 2020 at fifty one point four six billion rand the president in the State of the Nation Address in the sixth Parliament indicated that we have to attend to the capacity of our hospitals and clinics to this end of a social compact which is a emanated from the discussions in the presidential health summit in October 2018 it will be signed by the president to confirm the partnership between government the private sector academia health professionals civil societies including the organized labor to build the health system for the country that will be ready to implement the nation universal health coverage and if I welcome in the presence today of all the stakeholders who are partners in health who are amongst us here as I've indicated from the private sector from the members of the public patient associations and advocacy groups the academic and research community the various other sectors such as the representatives of various professional bodies and regulatory bodies who I here I really do appreciate your support throughout all this process we recently attended the g20 summit in which health and ministers health and finance ministers reconfirmed the commitment of our an our shared understanding while the need to strengthen health systems and health financing with the aim to achieve universal health coverage and a point we made is that investment in health expenditure on health must be seen as investment in economic growth the head of the director-general of whu-oh tetras depressors put it nicely and I quote he said about the potential payoff the universal health coverage that it's children who survive beyond their fifth birthday because they immunized it's women who are able to start small business because I don't have to don't spend all their capital on health care it's men who don't die before their time from non communicable diseases unquote so it's from this backdrop that we have to express our confidence to commit to this course despite all the existing challenges of staff shortage shortage of medicine aging infrastructure inequity in the access and inadequate equipment amongst others we have to use a critical levers of Health to narrow the gaps and bring about the resolution of the country's woes such as economic low economic growth inequality poverty unemployment and prevent the recurrence of human rights violations such as life a city many is it on this basis that on which people through their president have access and have sent a very strong message demanding improved services and elimination of long queues in health facilities and what we have to do in health is in line with our goals on the national development plan and on sustainable development goals the major challenge on health system is increasing burden of disease between epidemics of communicable and non-communicable diseases so based on the outcomes of the presidential Health Summit who have put together some steps to intervene until with the health system these interventions help to transform the system corrected witnesses but also create a platform on which to implement the nhi which is a way of providing social solidarity providing good health care for all by sharing money available for healthcare amongst all our people the health benefits that you receive will depend on how sick you are not how wealthy you are under the nhi health facilities and health workers will also be available to provide provide health services to all more equitably it all depends on our willingness to share as one nation and if we can feel and act in unity about sports surely we can do the same when it comes to issues of metals of life and death so the national health insurance is a chance therefore for South Africa to hold their hands together and really work together regardless of race gender or creed now we have said that there have been concerns about the readiness of our system to implement nhi I believe that too much of discussions have happened analysis diagnoses have been done I think it's time for us to just jump into implementation this is a luminous issue a system cuanto a koala opal a lychee we will continue analyzing the process the whole problem will end up never actually getting to petal and for that reason we believe therefore that a number of issues that we must tackle immediately and when we do so we're doing both the resolving the problems in the health system at the same time creating a platform for the implementation of the nhi the first is the issue of equitable funding for the public sector I think as we have been discussing across with my colleagues all provinces have got a feeling that health is significantly underfunded and therefore the current baseline needs to be corrected particularly if you look at the size of the Health Service the burden of disease and the quality that's expected out of it to this end we are engaging National Treasury to explore various modalities to adequately fund the health services but in the long term investment in the nhi when create funding mechanism that will permanently resolve this problem shortage of staff is the second problem we think that we believe that the shortage of stuff in the frontline service delivery needs to be eliminated once and for all we've identified the shortage of staff we have identified the shortage of staff that require attention so of the Fond 4143 medical officer positions we are ready to fill 2680 of those this year and then of course a proportion of the nurses allied professions and content workers have to be also given attention we give the figures in the detail of the text of the numbers that we think can be accommodated but to be able to do this were actually instructed our departments to go and look for possible sources of funding to divert to this particular priority and therefore the Department of Health and Treasury and now have got a team that's working on reprioritizing the budget looking at vacant posts looking at structures that are bloated they didn't to be downsized the current projects that needs to be abundant and also looking at restructure and conditional crunch all of this will reporters will move on but effectively we're looking for alternative additional sources of funding and mind you have said that even the original pace line does need to be looked at that of the issues is a supplier of Medicine I also believe yet that we need to give this attention budget of for medicine needs to be reinforced and protected to prevent drug stroke stock-outs so we are looking at an app which a mobile app which will allow immediate reporting by patients and civil society every time that vital medication is not available in clinics and hospitals so that there is a quicker feedback to the management to correct the situation both the provincial and at national level we have also identified situations where their global shortages we will always endeavor to ensure timeless alternatives there to must be supplied so that people don't go without any medication South African Health Products regulatory authority will also be strengthened to ensure that they speed up the registration of medicines and also build up capacity for local production of interactive ingredients as well as removal of application prep blocks and accelerates the applications to make it easy for drugs to be accessed we're also exploring a procurement of available software to ensure that we can actually dispense medication closer to where the patients are and we partnering with NGOs that have already done work on this this particular area focusing on the areas of townships and former settlements and rural areas there are areas already where we are able to get medication delivered without patients having to go to hospitals this again will assist to reduce the patient waiting time and people just walking to the hospital just for medication the impact of these steps that I've indicated will be that of reduction of patient waiting time less overcrowding on hospitals and managing patient workload for both staff in the clinics and hospitals and ensure that our people have medication without the inconvenience of an we'll DQ's in the hospitals the other issue to focus on is that of quality improvement here we welcome the reports by the global and local and international Lancet commissions on the quality of care the quality of care in the government-run facilities must improve to make the public sector service of choice in terms of access affordability availability appropriateness technical competence skills effectiveness respect and caring amongst others so when people approach our public sector they will be doing so because is their service of choice not because they've got no other way to go we will never be using the office of health standards compliance to monitor the improvement of quality at different levels we'll also be working on client satisfaction surveys to track some of the very sensitive issues which we believe that management miss will be elated quick enough quickly enough to be able to ensure Corrections such as quality of food linen hospital linen cleanliness attitude of staff etc all of these for us are non-negotiable for which we need to make sure that we partner with advocacy groups with civil society with our patients or our clients in ensuring that they give us feedback to help to correct the system then of course we want to correct we want to strengthen the office of the Ombuds person which is a channel where communities can raise concerns about the quality of health services this one we will strengthen and also we're going to work on a combined strategy of improved clinical care efficient administration backed by strong legal interventions to reduce medico-legal claims by more than 50% improving the fifth is improvement of governance here is we intend to strengthen leadership at various levels to bolster service delivery and place the patient at the center of care will review organic rums and also look at plotted inappropriate structures and review adjust delegations and ensure that these authority at the correct levels for effective decision-making processes and that way also fight corruption and promote ethical leadership and eliminate wastage consultation with the heads of specialist disciplines will be undertaken to strengthen clinical care and guidelines at tertiary and regional hospitals to ensure that we build capacity for all the managers and strengthen the system to improve governance also our health facilities will ensure that clinic committees and hospital boards are up and running by the end of this year these structures will be trained so that whenever this feedback report and mechanisms begin to come to kick in they are able to you know effectively assist management of a clinic or a hospital to make amends and correct the system so that the patient service is improved sixth is infrastructure built yeah we believe that for the public to believe in nhi the quality of the infrastructure has to be improved currently the but is 19 billion which has been set aside in the MTF to furnish it to refurbish a number of hospitals and build new hospitals at the same time in clinics but this is a lot of work that's been done but we also believe it's not enough the department at the moment has actually done a whole cost analysis and audit of the quality of the services and the cost it would take to revamp literally every hospital or facility in be in in the country so I've set up a team of experts in finance health and health infrastructure from Treasury and health to seek creative financing mechanisms and alternative models of delivering health infrastructure we've given them a clear directive to look at a program that can actually start delivering literally refurbishment of all the hospitals and creating by building new ones in within the within a horizon of five to seven years now this is a basis on which the nhi will be operating or current preliminary indications and that such is feasible and therefore we're gonna wake work upon a plan where once it's developed will then be approaching provinces and all other stakeholders to ensure that you can start at a massive infrastructure build seven is strengthening primary health care and reorganizing the district health system here we believe that strengthening various K does come to caregivers coming to health workers clinics in the hospital's nursing care as well as district hospitals working together particularly with outreach program from doctors to go and ensure that patients can be seen without having to go to hospitals and in the process also bring in the services of general practitioners in private to be part of this whole piece on which the nhi is going to be built and here this move is also called support from South African Medical Association unity forum for formula practitioners progressive Health Forum and so on so we have lots of guidance on this area to try and take that process forth it's important also to understand there's a role for traditional practitioners and other allied complementary health professions in the building of this primary health care and work going on with the discussions on how those roles must be further defined we've also got support from the Health Professions councils the pharmacy nursing Council traditional health practitioners councils all of whom are also looking at what role they can play in strengthening that whole system on stakeholder management we believe that we have to deal on this matter as a partnership literally all of us here have got an interest in the building of the health services and in therefore we will be looking at you know strong angles of dialogue to be able to deal with various aspects that will strengthen the health system and we have to then we are therefore going to be setting up an office for the implementation of the National Health Insurance there's going to give us a preliminary plan of how this this unit is going to operate this is about focusing on building on the nhi fund build on the capacity that is needed to manage the airway initial health insurance looking at the various models from various countries in terms of accounting pictures of service actuarial calculations all of those issues I won't be worked on by this team and in the process we also have decided that a number of people must be trained in this regard to start off with there is also the patient registration system which has a dibs moment registered 42 million South Africans and by the end of the year we intend to ensure that all South Africans are already registered for nhi in a single registration we'll also be working with the Department of Home Affairs for birth registration so the children are loaded onto the system all of this on the timeframes of the Department of Home Affairs we have worked with the teams of n heads of specialist disciplines to look at how to strengthen the capacity at the hospitals as well as in the administration so we are identifying 30 managers within the next four weeks who must go out and be placed in institutions across the world who are practicing the national health system or national health insurance system so that they can actually learn on this part and here we use the agreements that have come from chocka in Japan UK defeat French government then in addition the academic institutions will identify academics will also be part of this program and then we used twinning to be able to build capacity in South Africa so that ongoing capacity on management of nhi will be resident inside the country amongst the programs that we'll be identifying for purposes of initial loading on the identified district using the report on the pilots as well as the report of the health or office of standards and compliance will then be identified about 20 districts from which the first load of various programs is going to be focused on HIV and AIDS is one of those and we spoke about the 19 1990 goals and the need to raise two million other patients for tray for treatment as well as the elimination of default has with tuberculosis that will be focused on the campaigns that we want to deal with for focusing on vulnerable groups particularly the younger women and men for testing all of these were going to be focusing on we note the progress that has been made in improvement of the life expectancy because of the underwrote Rivera treatment but we are concerned that the numbers are still rising and so we have to reduce the incidence of TB incidence of HIV as well all of these are issues that we are going to be loading for a Lea focus as we start the program of nhi and so the other area is going to be access to rehabilitation for psychological and mental health services for all our people to deal with the issues particularly those who are you've got HIV and TB but also on issues of non unnatural causes the issues of domestic violence are the crimes and and so on we're gonna have to work together on all of these the other area that's going to have to be strengthened is that of the National Health liberado sevices which is doing brilliant work now in supporting all the hospitals and therefore their turnaround times have improved and their cost-effectiveness has improved and this is going to be fundamental in dealing with their supporting the nhi so amongst the services that we'll be focusing on immediately for those districts where we'll be strengthening nhi immediately is maternal and child health neonatal health services sexual reproductive and at relations health issues of support and rehabilitation for the disabled people services for the older people rehabbing a palliative care and particularly those patients with cancer and HIV terminal terminal stages will then be tackling both communicable and non-communicable Minister your time is now expired thank you very much thank you before I call the next speaker to the podium I would like to welcome our guests in the public gallery but I will request you that you switch off your cell phones please I don't want to disrupt the minister when he was busy with his speech but there is a number of cell phones that went off please switch it off so that we don't have any further disturbances the next speaker is the Honorable blummo honourable house chair honorable minister Tata's olympia our Deputy Minister to touch up our members of the follow comity of health honourable members of parliament who are present here or cast ladies and gentlemen let me take this opportunity to congratulate both our Minister and Deputy Minister for being appointed by our president to lead health in the country South Africa your past excellent contribution in health leadership in our country and in Africa and internationally will be a treasure for our country we would like to offer our support and good working relationship as we all discharge our different responsibilities to us improving health conditions of our citizens in 1978 leaders of the World Health activist social activist and all peace-loving and health promoting activists met in Kazakhstan to deliberate on issues of human development and health the meeting closed with a declaration which is known as Alma otta this declaration had a theme held for all by year 2000 health for all citizens of the world some citizens came back thinking that these 22 years of waiting was a long period to wait for a dream that would bring dignity at least our poor people needless to say that year 2000 came and it has now corn and there was no health for all in the world nineteen years have since been lived and there's still no health for all citizens in the world this dream has been delayed by those who continue to benefit from the inequalities of health in societies this dream for us in South Africa is an uncut on the Freedom Charter of 1955 Clause 9 which talks about the preventive health scheme shall be run by the state free medical care and hospitalization shall be provided for all with special care for mothers and young children the for maternal general of the ho2 democracy n has mobilized leaders of the world to universal health coverage so it is time now that we move to a progressive realization of this dream of the Freedom Charter the dream of the Alma ultra activist we cannot wait any longer we have we have termed our universal health coverage nhi in our shores we are saying can we be able to attempt to provide health for all what financing system are we going to put in place to provide such a noble program a program that emphasizes on social solidarity that talks about nhi being a public good that says we must carry along those who are less fortunate and less resourced to be able to provide health for themselves majority of whom are pledged in in general and Africans in particular opposing nhi is like a statement of a conversation that I could refer to and someone conversing with someone in this way dear my domestic worker I'm grateful to you for looking after my house my children while I'm in Parliament thank you for helping my children to know how to cross the road from school while I have a medical aid called permit I don't think that you deserve it over and above are not able to support any program that seeks to give you good health honourable Honorable Deputy Minister we have a speaker the podium let us keep the interjections down please I'm not sure why there's an objection posed I'm relating to a story that could be set by any person who has a domestic work at house I'm not referring to anybody in the house if there is anybody the house is fine and the conversation will go on to say we too have a pool of so many domestic workers around us who if your health deteriorates I'll go in picks one more and take and I don't have space and time to take care of you because good health is for those who are rich this is finally moral in an anchoring attitude of some of the citizens of the world and probably some of them in South Africa and probably there are some of them in the house they continue to say just fix your clinics and hospitals and everything will be ok our research shows that there is no country in the world no country in the world that waited for all things to be fixed clinics and hospitals before implementing universal health coverage will say we will fly nhi as we fixed our health system returning to the other program just last week we received 200 Cuban trained 5th year medical students returning to our motherland this week and next week we'll be receiving many more bringing a total to 67 6000 647 returning students we commend the Department of Health for this vision of sending students to Cuba when our universities at that time were either unwilling or unable to increase their enrollment the benefit of this returning students who come from all over South Africa of course except for Western Cape for reasons best known to the DA is that they bring with them a depth of knowledge in public health trained in the country that has achieved the following Cuba has improved the life expectancy above 70% 70s Cuba has eliminated malaria Cuba has little or no maternal death Hooper has little or no infant mortality Cuba is legally or no under five mortality if we want to strengthen primary care and of course nhi in our country we must tap on this model of training students in Cuba but I'll probably advise on a room minister to maybe look into a situation of maybe bringing such a model this Cuban training model in our universities in car country I live I received a letter on the 9th of July from MSM poor and poor Hank a president of the South African images the practitioners union I found miss them pouring the same day to advise to acknowledge his letter we further agree that our offices will set up meetings addressing the issues raised in the letter namely the plight of emergency medical officers in our country this meeting is since scheduled for the 23rd of July where we are going to tackle this matter it will be important to know owner Minister how you you plan to assist our workers who are in this category honourable minister and the our deputy minister I think it is staggering for people to come to our claims and hospitals finding nurses assisting injured people and threatened nurses to stop saving lives those incidences have happened in various parts of our country recently routing and haze @n we need to collectively condemn these atrocious acts rockin Minister we need to work with you on the plate on the utterly on these social ills after all safety and security of our staff members and patients is one of the pronouncements of the department as the non-negotiables we have since learned that on infrastructure vulnerable Minister you having plans this government has actually done quite large but we need to look back that not only were you building new clinics but you had to revitalize a lot of clinics and hospitals who appealed previously by the apartheid government in our homelands but there were no maintenance plans that were put in place to really make sure that those systems are in place that is why among other things I just referred to the province where I come from that Carroll Hospital has actually been revitalized by money over 200 million following stamped images that came to that province in other parts of the country in various hospitals all our Minister you need to review your plan on infrastructure as you'd like to support you on any efforts that you put in this regard there's more pressure to build new facilities but also we have to look backwards and improve those that you have ready built on my own my previous life as a soldier I actually am pad I'm really concerned Minister well I noticed this in health that when a member of the SI n TF a soldier were to report to a palpable sickbay he or she will produce a first number and the medical file was brought out that visit is also recorded and chronically for there not only for the member but also for the dependents of that member when the same soldier comes into one mill in Pretoria and two million Cape Town and actually the file is retrieved within seconds so there's no waiting times for files in the sick days of the SNCF there is no file lost in the Army in our country and there are no unscrupulous lawyers that visit our and take our government to court because the medical records were were lost and they are not found in that situation therefore a another Minister we now know that there are no litigations that come to the army and planned and unable to deal with because we don't get files lost you don't have patients waiting two hours to get a file all the roominess that we really plead that this must really be looked into as a matter of agency we on the staff so sheet we note what we have said and we actually I support that but would wish that Honorable Minister you consider among other things other categories of stuff to be employed beyond those that you mentioned Porter's clerks cleaners a clean Hospital would not need a professional nurse taking those who have left this world into the new world into motorists is not done by nurses and therefore in shortages so if you live and ignore these other categories you might just find not a hospital working very well will note your comments on the medicals talk out but we note we would like to say the expression given by the department that the medical shortages is a global problem that affect all countries due to supplies of active pharmaceutical ingredient would one the department to be proactive among other things announce another plan of how institutions who are experiencing drug shortages would currently convey that message to the public it is not acceptable that if the medicine is not available and therefore cannot be given for me before good reasons there is no proper communication to the citizens of this country as to when and how I will get the next medication where another Minister would like to get a detailed plan of a departments fight against non-concurrent diseases your annual performance plan does touch on this matter and it talks about exercise in fighting diabetes and hypertension countries that have had a good life healthy lifestyle have actually impacted very positively or non comparable diseases because it's like those delay the onset of diabetes they remember your time is now expired we support the passage of the Minister Thank You honourable member the next speaker is the Honorable for uber half straight person South Africa is one of the countries that spends the most amount on health care with an accumulative budget of over two hundred and twenty two billion ran across all departments and it's entities one would think a department with a budget this large will be delivering at the very least an adequate level of care but all of us in this house know this not to be true this is confirmed by the poor health outcomes of the majority of the provinces and the lived experiences of the people that we are meant to serve 25 years later who Sahab and robert GG swag we clinic say to Appelbaum aluminium metal corner usako oh mama Abba para Bible a girl especially who can irrigate torches a cell phone Oberon become band there are still hundreds who died an unlicensed indoors during the AC t many tragedy and thousands who were sentenced to death by a completely preventable oncology crisis as was the case in was a lunatic and the doctors beliefs in Islam this is the direct result of poor policy and no consequence manager for provincial departments that underspend and embezzle public money and the sheer lack of excellence driven leadership at the political level yesterday the cabinet announced that the nhi bill will be approved and will be later presented to Parliament it is unclear whether costing has been finally done and whether in its finalization the lessons learned from the failed pilot project have actually been taken on board this bill came at an initial price tag of 259 billion rand and then the previous minister then admitted that this was in fact a fam sack the legislation will see nationalization of health care the creation of a state-owned enterprise which will be the perfect breeding ground for mass corruption and slow delivery of care energy I pilot projects across the country have failed in a spectacular fashion as such the minister and his predecessor have sat on a report that will give a fair assessment on this project when I asked the minister last week about this report he simply said he does not care what it says he said it does not matter how much the bill will cost to implement this government will simply push ahead our honourable members order don't drown the speaker with your interjections minister this is quite frankly a dereliction of your constitutional obligation and your responsibility to the people of this country more concerning Lee we are aware that there are provinces that I hear to be fully engaged with what will be expected of them with the rollout of nhi there has never been a constructive discussion about this legislation at the National Health Council with the nine provincial Amy C's in the heads of Department to add insult to injury over the medium-term budget there has been a nine billion rand reduction in the investment of primary health care which is the real interface with our communities any legislation that will see the improvement of a health system needs to do so from the bottom up and it needs to start at the primary health care level it cannot start in the corridors of loo to Lee house the minister what is clear to me is that you are here to fight for the ANC in an ideological win on the other hand the DA's here fighting for the people of this country nationalization nationalization of health care will not bring about the dignity to the millions who depend on public health care their roads to universal health care does not have to be paved with fundamentally bad policy proposals South Africa can have universal health care that will see the entire system transformed so that it can serve the people who've been left behind for 25 years under a da health plan people would need not to wait for 15 years for their lives to improve they would not need to wait for billions of rams that we do not have in order for them to have access to achieve the day would roll out universal health care in five to eight years I remember the podium let me just take this point of order while rising on remember the Honorable member on the podium it's a maiden speech and can you please protect well the webs of the DA should have informed me it's a maiden speech you didn't inform me other members a maiden speech is usually given the opportunity to be heard however if you become controversial and you raise issues the way you are taking other parties then you must expect to be echoed as well and I will and I will order order and I will intervene where necessary continue on remember it will be delivered through restructuring and reprioritization of the current health budget it can be financed in two interventions we would remove the medical aid tax benefit afforded to medical aid clients availing immediately 17 billion rand that would improve primary health care which is the bedrock of the system it would it be invested in maternal and child health it would improve their provision of medical emergency medical services with those interventions alone the health system would drastically improve it would not end there we would assign his recent South African with a subsidy that would afford them as a health package can the member take a question but they did not indicate check asian honourable members it's a maiden speech let's allow the Honorable member to continue during order order switch off your mic on all member during a maiden speech you don't ask questions to a member who is delivering a maiden speech I'm told the member of spoken in the house before in another debate although member you prepare to take a question it would not matter if you are in private health care or the remembers you would still be fully covered under a da health system this means under a da system ours our people will not be relegated to a second-class health system they'll be able to access whatever health facility they want instantly the system of insiders and outsiders would be done away with in order to bridge the gap between those who have medical aid and those who do not the DA would impose a health justice fund this would be cross subsidization funding model to provide a standard package of health care that is of quality in this way we would give agency to our people we would regulate the private health as scheme so that people are not exploited and we would ultimately roll out universal health care that will not destroy the economy but that will also be affordable our fight is for the excluded and the victims of a system that has cost millions their lives it is not against the ANC it is not against you honourable minister we are bringing solutions to the table to afford people dignity we hope that the ANC government would finally place the patient at the center of reforms and legislations coming to this Parliament if not if it does not we will fight this bill on behalf of those people at home who be left behind for decades under the ANC leadership O'Donnell members the next speaker is the Honorable came back while orderable members order this opportunity the economic freedom fighters did let 2018 the air of public health we committed ourselves to visiting all public health institutions across the country to find out for ourselves the conditions under which the public health services are provided Minister we found a public health system in distress suffering from many years of neglect incompetence and general lack of strategic leadership from the highest office on the land responsible for health care just in the Eastern Cape alone there were 110 health facilities clinics and hospitals which were without electricity around the country over 600 health facilities had asbestos ceilings 570 head as baseless roots and over 116 had asbestos internal walls exposing poor seek South Africans and medical practitioners to long term damaging health risks when we asked our department told us that the department was short of over 18,000 to necess 2,250 doctors in 154 dentist is over and above the total collapse of oncology services in kwazulu-natal in general shortage of other specialists across the country in addition to this we have poorly trained Ospital CEOs overworked and underpaid doctors and nurses hospitals without necessary medical medication and machinery the general state of public health in this country is in crisis in a pervasive state of disrepair and is exposing poor South Africans to health risks that could otherwise be prevented while the majority of the poor predominantly black and African and largely dependent on that dis integrating public health system a tiny minority of about 16% of the population is well taken care of in the public health care this people with medical aids can access the best quality healthcare because they have the money to buy health provisions for the 4% of all the health care spending is concentrated in the private sector which serves only 16% of the population their remaining 84 percent those with the largest share of the burden of disease who need the most key rely almost entirely on the under-resourced and dysfunctional public sector as a result of this there's a huge public inequality massive unmet health care need in South Africa and a failure to approach anything near universal health coverage through accessible equitable and effective health care services this cannot be allowed to continue and the country as a whole must go back to the drawing board for a social compact to eliminate these discrepancies as a matter of agency we need to do following outlawed the dual nature of health provision in the country where the rich can go to private care while the poor are subjected to poor conditions in public health system we must develop one quality healthcare system that provides the best possible health care to all our people this must be done through legislating for universal health coverage under there over aching national health insurance framework that will ensure each and every South African regardless of the state of wealth has access to the best medical care in the country they're wrong out of the NH I will be meaningless and will only amount to posturing if it is not preceded by a massive investment in public health infrastructure 'old evelopment in employment and retaining of medical practitioners in procuring medicine and machines for all public health facilities there must be a clinic in every word in South Africa and all clinics must open 24 hours a day with neces and a doctor in each clinic our focus on clinics is informed by they believe that the country must focus on primary health with a commitment to attain the universal health coverage with the intention of decreasing infant mortality rates and increasing the life expectancy of all people of South Africa we must recognize and fully integrate community health care workers as full employees of the state who will be responsible for provision of quality health care in each and every community we must as a matter of agency built 24-hour integrated post sexual trauma centers in all district hospitals for urgent medical forensic collage akahl and social assistance directly linked to policing and detective directories their majority of South Africans believe in traditional healing methods this must be integrated to the manor public health services are provided consequently each hospital must be equipped with consultant rooms for traditional and indigenous health practitioners traditional healers and traditional hapless to use for free in all district hospitals establishing at least one health care training facility per province ensuring that there is no province without a medical school in addition to this issues Minister you need to commit yourself that all these clinics and hospitals without electricity will be fully electrified within a year you must commit that your department identified young South Africans from grade 10 who will be supported to study medicine and nursing after completing grade 12 these students must be supported in every possible way despite the 18,000 shortage of nurses around the country in loosey-goosey in the Eastern Cape there is a group of over 300 qualified nurses who studies were funded by the department but who have been unemployed for the past three years we must all agree that the past decade and the Minister mutual aid II was a complete member your time is expiring and we must correct it as a result AFF reject this pattern Lord on the remembers order the next speaker is honorable slain one old honorable members speaker under minister in house at large speaker our public health system in South Africa is in crisis there is a lately – no indication of this sector facing the reform needed people to not trust our health sector in South Africa but have no alternative other than to use it Minister a case 8nc t'as voulu chi o kona appeal Antoine a la paix mcleaney Kosovo FEMA crash subpoenas vomo gucci who men estos Papa Zulu Clemenza nama costigan a noble cannabis airborne amazing a lease a concession stands egg spinach small penis a photo ooh – tada – ah Makka pakka – Amma traditional healers na motley team Obama traditional healers azox a bell rang a mid-october tells of a summons also massive economic clergy to heal the spiritual path the health professional Council of South Africa HPC as a for instance has serious allegations against it the HP's CS a allegedly past races and stereotypical remarks to qualified ring foreign trained doctors solicit a tech open privately by telling graduates that people who pay get attended to th to the HP CSA also favored those who have political connection to jump the queue to write for exam an exam question on the subsequently led to those who pay or politically connected quite simple this is unconstitutional privately racism patriotic and political favor in any institution will not be tolerated what is more demeaning in the in that the HP CSA is meant to have the highest possible possible stand of professionalism in a sense the HBS CSA is saying that it does not place the value of hours construction professionalism quality of service and standard as eg it as it is in u.s. men esta esta la cerva wala mm Bevo ET Norma Sabinas I'm a clinic so if mama Giamatti 80 nanometers night ol quadrant ojos del Gucci a menace to Iowa's law colonies La Jolla a pendulum a clinic we are shorter Cabazon aware common ISA caliphate a burka bar eheh conjugal kona Nellie crisis a saga eating asparagus visuals la Loba meta eco known as Maya short Auto Union AMA huka Pele a Mufasa resume graduated le Makai neighbor Kashi way back Australia contract agony Barros you say mommy permanent ago Zima 7z robos masala menaced on Yaffe so voce humanistic Reagan la loco booty Sushil una manera ban tobacco committed MC benzene hoon alert case in JSA archaic on hospitality win Abu Nidal Roberta alain de monaco committed MC benzine nicosia LOH aluminio Blondell Alok Oh monument zero would mum descends in case Pelican island away or Moshe winning down a Bahama shallick I go bomb angiomas OPA Oh Masha wedding da got a CMO shillelagh megasis aglow Kosovo Melek Oh bogna Minister Uma Bharti Beretta le lapin a semi on Wynonna's aya Frizzle Amma post Queensway in Lock banter a Bakula our Aboriginal afrezza post went wild dog vs. Linda laganja need equality young Sabine's spelling furthermore the IFP calls on the department to place all graduates who hold pass arrays with the department before the median team budget reports the department must work together with as ApS to ensure that the ambulance are fitted with the tracking device and imagine the panic button remember your time is now expired the IFP supported this project issues remember your time is expired the next speaker is the Honourable van Statten old honourable members guests a graphically brisk up on ammo and air bit but after star fit in a hospital the offal of Iraq on the frame the home Stan athira Mahalo and Freda res Prime Minister in the presidency announced yesterday but when a tional health insurance ball is on its way to Parliament after cabinet's approval but an aroma minister also said and I quote it will address the current health system it serves only 60% of South Africans vows excluding the armor whelming majority of South Africans the ff+ is of opinion that South Africa as a public health case sector but as a footprint in even the smallest of settlements but that is characterized by poor provision and a lack of expertise on the event a private FK sector maintains world-class standards but is expensive and inaccessible the biggest challenge in a public health care it's not a lack of money but a lack of expertise mass management and corruption have destroyed our health care institutions the obsession with transformation means that even more expertise is fought are forced out of a sector public health care infrastructure must first be upgraded before in its eye scheme can even be considered the image I can not be used for these upgrades to Emily are truant free rip react but nyet for Boris name South Africa is not other countries in shorten the image I must be terminated at once for scepter he feels blessed after appetite beifuss kaya marisa fermium that in fear fear said africa's hassan tights or a Nevada after on Khan and still there are hearing three riders on for envelope on the dank that in fear fear installing Hebraic on board a hospital and clinic as infrastructure of the bow in optic knob the hearing will be safe that in Kiev Ian needed the court from Marisa Khan on dry in fur underneath Mart Okafor honey that others are foreign Mira see but no here as said Africa eluate skull comfort lot done for sitter as Allah drama and scurvy and that con said Africa and a horrid creases lot stupider Karev see in Bahrain on ballast tank but dollars calc mere for and warlock on the wind akka brag on for dinner for players Connie I drove funny in fear fear on moon clock mark for his department solidary tight it after I sent 500 – dare that manner for peer kanakas sinner – interfered in the Arbeit macht patria for has dafuq bone it her qualifies a little player person you know foresee element of dieting midfielder percent after name bucum one as well I'm at work Lauren Oliver had the long array elaborate and willecombe stone Akira Bella barks blacker the also have black and honest in an interesting and on hospital and clinic in the ascetic or on health and de clinica first there marco mcfist elephant offer e but as an account of her own flock and hospital and said africa secret ID by aaron Sterling's as lance by jewish work that were players lives doctors student ambassador all around in self across world so it's very affluent i'd my hospital and bloom from time could be read by the re self to hospitals garza vehicle order at a pursuant republic of Kadosh me Topanga and so on that Canon longer to follow up warning what by hospital and other preferences I entered dr. Shapiro stirs Severus and Farkas tell Vince suaq secret I also soon it's or as an to taller house a near inland North women as unscareable said Africa so his own taste also as an enormous crisis or said maka'ala bar patient and hospital upstairs on the freedom stronger here a person involvement of opium Ahmad ibn hebraica Melissa T says and women after accompany this is not from hospital often doc any real and only tight pair 2013 to 2015 Eric how things Sundays departments cabins but Robert all for now flew 500 in fear Tasman runt bins nullified array of kalupia Viacom the dory insta preferences the part I mean not a feather in Mali art around sir acts as an official star was it has seen but online initiatory is the many trajeron norm Knox wapt's tiffaney department in van at monstrosity much worse it'll literally come from IV acid a star from directing corrupt auntie Nora in firmly in Al Arab Dora tied up retrievers but in full form viroqua's and to entertain rates especially ownership unite for slot either electric in were on earth and it based I said President Jacob Zuma and Ozzy first law though I difference from Tom's item on the remember your time is expired thank you the next week order the next week is the Honorable Deputy Minister of Health thank you very much of the house my colleague Minister honorable kisser ministers and deputy ministers present a missus present our chair percent of the portfolio committee honorable said it no more and members of the committee honorable members of this house the various stakeholders represented yeah distinguished guests ladies and gentlemen Chapas and our debate on this on our budget vote today takes place just six days before we celebrate Mandela Day which is which this year marks 101 years since our icon was born this is also 25 years since President Mandela led our country into a peaceful transition from apartheid to freedom and democracy over and above leading us into the establishment of our democratic state based on the Constitution and establishing the key institutions that anchor the state President Mandela let us in focusing on access to basic social services to the most vulnerable in society in his first hundred hundred days in office he introduced massive as defeating schemes at primary schools free health services for children and six years and pregnant women in his lifetime he also established the Nelson Mandela Children's Fund and thanks to that initiative we today have a long lasting memorial for him the Nelson Mandela Children's Hospital another impactful legacy of our icon is the Nelson Mandela Fidel Castro medical training program which dr. Ramel spoke about earlier on which is based on a cooperation agreement which is signed with President Castro in 1995 as of today this program has contributed 751 South African trained doctors in Cuba and also hundreds of doctors from Cuba national Cuban Nationals who are working in our health services mostly in rural areas I just last Friday on the 5th of July the seven days ago we witnessed the graduation of 87 young doctors conducted by the rector of the miracle University of Havana at what residual University and Tata the overwhelming majority of this graduates are serving in rural areas one of the graduates of this program is dr. Linda we'll see dolly she is the first black African female cardiothoracic surgeon operating at inkosi Albert Dooley hospital in case that Edie she comes from rural Eastern Cape in the integer area and like many other families in the rural areas they had to migrate together with father who's a band worker to the northwest province an area called Werner cop yeah but in the arresting back where she grew up and matriculated if it wasn't for this program dr. Linda versa dally would never have been a medical doctor not to mention a cardiothoracic surgeon we are currently in the process of bringing back 647 students to complete the integration and and they would be studying that probably the integration program from the 25th 20th of July up to the last to start will be on the 1st of August the two groups of this students have already landed the last the second group which Linda just yesterday at o R Tambo through an SH at that flight from Havana and the last group would land on the 15th of July the equipment trained doctors will add a lot of impetus into the improvement of our health human resource with a major focus in primary health care we are going to be our building blocks on capacity in primary health care services in our districts as we have stated many times honorable sheperson nurses are the bedrock on which our health services are built the process of restructuring nursing education is at an advanced stage all public nursing colleges have been restructured into one main nursing college per province with sub campuses in districts in with a total of 76 of this sub campuses in the whole country three national curricula were finalized and used to develop province specific curricula new three-year diploma in missing as well as the one-year Advanced Diploma in midwifery and selected postgraduate diplomas have been prioritized by all the nursing colleges these programs will be offered in a phased approach commencing with a three a basic nursing diploma at the beginning of next year in January 2020 prioritization is aligned to the primary healthcare re-engineering agenda and also to other national priorities the department of higher education is in the process of developing regulations for the nursing colleges as higher education colleges in terms of the Higher Education Act these regulations will specify that Messing colleges while established under the Higher Education Act of 101 of 1997 as amended will operate under the administrative oversight and management of the National Department of Health in terms of a protocol to be signed by the two DG's this will make possible for transitional mechanisms through which these colleges will continue will be able to operate as of the beginning of next year even when the regulations might not have been concluded the man colleges for regional colleges and campuses will commence with the diplomas that mentioned earlier further other campuses will also start with other postgraduate diplomas such as in critical care in trauma and other specialized causes postgraduate diplomas studying in 2021 honorable chairperson non-communicable diseases continued to outstrip infectious disease in our country as illustrated by a report by States as a huge chunk of these deaths are due to cardiovascular diseases and strokes and diabetes but cancer also has been a rising epidemic these developments can be attributed to among others urbanization commercial determinants of health risk risk behavior such as tobacco use and also harmful use of alcohol but also unhealthy diets and let of physical exercise the challenge of McD's is also not just local but global and as a result in September last year a high-level meeting of the UN General Assembly was convened by the secretary-general and our own President Rama pasa was one of those who attended and we were also there as a ministry and Department to give support to attend various parallel sessions and also civil society sessions the Assembly passed a political declaration which amongst others expressed concern at the financial and human cost of NCDs especially in developed developing countries estimated that over seven trillion dollars over the next 15 years the assembly reaffirmed the primary role of governments in responding to the challenge by developing adequate national multi sectoral responses our leaders committed to among others I quote strengthen our commitment as heads of state and government to provide strategic leadership of prevention and control of NCDs by promoting greater policy coherence and coordination through whole of government and health in policies as approaches and engage in stakeholders in appropriate coordinated comprehensive and integrated bold whole of society action and response so our leaders made very bold commitments and also committed that acceleration of the World Health Organization Framework Convention on tobacco control without interference by tobacco industry also committed themselves to do everything to eliminate the the marketing of alcohol amongst young people now in this country as a department and also with our stakeholders we have taken some steps to make sure that this declaration can be a reality among others draft legislation on tobacco control was published in May last year to advocate a zero tolerance policy which will now prohibit indoor smoking in public places including including removal of smoking areas in restaurants and baths and bass introduced regulation to restrict various categories of foodstuffs in terms of level of salt tax on sugar has already been implemented the DTI is reading together with our department in enhancing visible health warning labels on alcohol beverages and also reduce the age of where you can purchase alcohol from 18 years to 21 so these are some of the measures which you are taking as I've mentioned the cancer is also and becoming an epidemic not only in our country but also all over the world and we have taken some steps in this regard launching a national cancer campaign in October last year in the Kaiser and province of shepherdson purchasing a number of linear accelerators to support our major hospitals especially shallowed Mata and investors in broome contain the HPV vaccine also has been rolled out as a form of prevention for cervical cancer also in the area of mental health which is also part of our meant non communicable disease epidemic steps have been taken amongst others and to secure more psychiatrists from the private sector to support the public health system especially in the area of forensics where there's a cloaking of the system due to the fact that in the in the courts many lawyers when we when they represent their clients we put mental illness as part of the defense and this is clogging our system so we have to procure more psychiatrist to unlock the system sheperson in the area of malaria our country has prioritized elimination not just a reduction of malaria by 2023 this means that we want to make sure that by this time we have zero a new malaria cases this is a very very strong aspiration we have made progress in terms of citizen action in terms of the incidence of malaria over the last 18 years by as much as 73% the death rate for malaria have also come down by rate of 74 percent but we still have challenges among the challenges is the migration and mobility across country of people and mosquitoes those mosquitoes don't need passports so they move from one country to another so we have to work with our neighboring countries and we are doing that with Mozambique Zimbabwe and sott but also we have to work with our provinces to make sure that we can do indoor residual spraying very effectively there are three provinces in the country which are affected which is an improper by province poor malanga in case attend and we have worked well with our national treasury to procure an amount of 90 million run to support these provinces and I hope our colleagues I see the admission of Limpopo in case that they are sitting together I'm sure they will be planning how to do the indoor residual spraying together honourable chairperson just a few comments on some of our entities with but very effective entities within our department the South African medical research continue to produce excellent scientific output through an NR f rated scientists including two of those NRF a rated scientists in the leadership and I see both of them here in the gallery the chair of the SMR and MRC and also the president also here thank you very much Marcia's amongst others just to highlight some of the achievement discovered the new gene called CD h2 which predisposes young adults especially athletes to certain sudden cardiac arrests and this has been done and identified with other global collaborators also undertaken amongst others a national TV prevalence survey with field workers already working in the Eastern Cape collaborated with Agricultural Research Council there in and a company called a free pets which deals in wellness products to produce a substance which is one of the identified a substance which is one of the active ingredients of rooibos tea I hope you all take ribose tea this product will help you in managing cholesterol amongst others blood glucose and also insulin resistance so thanks to the MRC for this work also working on the center establishing a study for antimicrobial resistance because this is becoming another problem in the country and in the world the MRC has also received 10 million grant to assist young South African scientists who are studying towards phd's because we want to increase our PhDs in clinical health research in the national health scholarship program from the public health enhancement fund which is our collaboration as the department with various private sector companies this scholarship program has recently been renamed the bongani Miocene national scholarship program in honor of our late just to come to comment or the honourable member there from the ff+ one of our entities is the council for medical schemes which regulates medical schemes and our rule I'm not going to but that's a very relevant point which I want to bring to your attention that the medical schemes industry in the last financial year paid out a total of 172 billion rent to beneficiaries but also had in reserve sixty two billion runs now when you add this two together it means the medical schemes were managing a budget in terms of paying claims and also reserves of 234 billion rand now in the same financial year the total allocated budgets for national health and also provinces was just to forty two billion what a difference of eight billion now when this this this is this 234 billion grant was used to service only 15% of the population 15.5% now that difference of 8 billion accounts for a fan switch math service the rest of the 48 million South Africans 85% of the population and the difference between the two budgets is just 8 billion to service 1515 % and so while we must accept the fact that there's a lot as a minister has indicated that there areas where we can be able to make savings but the fact of the matter remains that this skewed you know funding cannot be sustainable can work nowhere in the world can this be sustainable so that's why universal health coverage is very key so that they can be equity in the ways the funds are utilized Deputy Minister your time is now expired I want to know that department is ready to implement the in-vessel health coverage who are ready for to me Minister thank you for your input the next speaker is the Honorable suckers honorable chairperson the a CDP notes yesterday's approval of the national health insurance ball by cabinet which the president in his State of the Nation Address said aims to reduce inequality and improve access to public health and private health facilities we have one common enemy in this room and that is indifference indifference to the plight of the poor and the vulnerable indifference is at the heart of a man who died outside a Western Cape Hospital provincial hospital after waiting to be treated since the early hours of the morning in deference when a nurse cringes to perform basic observations on a patient because of the state of his appearance indifference when a young mother inexperienced scared and overwhelmed after being up all night with a sick infant is not addressed in a mother tongue but made to feel foolish and unintelligent because a primary care nurse could not be bothered to take the time to listen or to call an interpreter we have to ensure that we foster a caring and compassionate health sector as set out in the white paper on health the target set out by the department of 50% satisfaction a primary health care facilities does not reflect that aim it is sadly sadly far from being realized this said we can learn from the example of health facilities where I am experienced firsthand the commitment to best practice the example should be lauded and emulated throughout our nation pockets of best practice is being displayed in some facilities and a facility that I visited in Ravens meet I met a young woman WiDi passionate about the health profession a third-generation health professional and she impressed me with a with a enthusiasm we need to develop a retention strategy for doctors pharmacists nurses and we need to make sure that they are safe we cannot afford to continue to bleed talented passionate elf professionals effective inter-sectoral collaboration is cited by researchers as key to address social determinants Honorable Minister we as the a CDP are calling on this department together with the ministries of social development in human settlements to address with urgency the need for special housing we have been urging the government for years to respond adequately to the plight of our most vulnerable people this includes those suffering from mental illness trauma or abuse and the elderly families are suffering under the weights and the trauma of caring for those who are mentally disturbed our current facilities are limited and individuals who can be restored to health deteriorates even further due to a lack of treatment and care that includes special needs housing mental illness has increased due to drug addiction and the destructive effects of drugs such as tucked in under we implore the minister to support this policy it has been waiting for the last 20 years care cannot be siloed lastly I wish to quote Florence Nightingale who said and I quote it may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm close quote our Hospital should not be more Therese but places of healing thus we appreciate the comments and we appreciate what dr. Domeier said yeah some Africans are waiting for this house for all of us to wait to get to work together to make their lives better and I thank you thank you and remember the next speaker is the Honorable Ismail this is the members maiden speech good day and all protocols observed honorable house J whenever incident mama Elsa last week from a man cleaning informal settlement in Italy knee I found her ill and cloning with pain aster you should have been getting any treatment she told me that she has been the entire day from before sunrise at a public health care facility after waiting for more than eight hours she eventually got to see a doctor mama said doubled in pain on uncomfortable benches with no food and no explanation she said the nurses treated her with disdain when she finally thought should be hopped she was advised that the medication she needed was out of stock and should have to come back later the thought of trying to find taxi money out of a grant and another day no long queue made her feel worst she is just one victim of our collapsed Health System the shameful attitude of the state to the poor and vulnerable is if you get sick ty quickly shocking absolutely shocking health care is a constitutional right but this department cannot even get the pay pay six right Noah Punto in part to paly principles apply it unprofessional and uncaring attitude to patients patients have no sense of recourse is members on the board a political Cadis I've been made such trouble pregnant and in labor she rushed to a clinic for assistance because of poor facilities she was told to go by ambulance to the hospital so she called one was her water broken and in a final throes of labor no ambulance arrived baby see a ponga was born outside the clinic the ambulance arrived three hours later thankfully there were no complications otherwise we could have lost two lives the EMS services in a way out system are dysfunctional yet the department includes the budget for emergency services by only four point seven percent from 2018-19 to the current 2019-20 budget primary health care received the smallest budget allocation of 221 point in rain which is less than 1% of the department's budget the park of the project budgets are transferred to provinces but this is exactly where this horror story stem from Minister what are you going to do about it one such example is Otero our tombow Hospital inbox back in Italy now we you about planes in more planes but no implementation on the ground for 25 years chairperson the ANC government is putting the cart before the horse they are wanting to drive through a problematic piece of legislation in the name of achieving universal health care in reality without the investment in primary healthcare we will never improve the lives of our people billions have been spent on nhi but what exactly can the department show for it first let's do clinic and hospitals show very little it is time to stop the talk and begin to deliver every day lives are lost billions have been plowed into nothing it the cost of the poor and sick we want universal health care for people but we do not want a piece of legislation that will destroy our system as we know it I thank you thank you remember the next speaker is the Honourable gala is it a maiden speech honorable chair Minister and Deputy Minister of Health chairperson of the portfolio committee on health stakeholders of the Department of Health ladies and gentlemen the ANC rises in support of the ANC rises in support of budget vote 16 on health ANC policy has always been biased to the working class and has placed it imagine alized in the poor at its centre the 50-50 second National Conference resolved that the health should be one of them two key priorities parrot eyes of government and blend this second phase of transition to be characterized by decisive action to affect economic transformation and democratic consolidation critical both to improve the health to improve the quality of health life of all South Africans and to promote nation-building and social cohesion as such government has maintained the balance between the number of policies interest based on priority and agency by ensuring that the National Department of Health receive one of the largest share in the budget a budget allocation so that we can address all the challenges that we have faced as the Department of Health preventing and treating communicable and non-communicable disease one round one condom no condom no sex so we must try to practice a have a healthy life style as you maintain in combating HIV and AIDS remain a priority of the ANC let government that Department is committed to the 1990 packets of the joint United Nation program on HIV and AIDS in this regard the HIV and AIDS component will receive the bulk of grantee allocation in order to continue the implementation of universal test and treat policy for ARV treatment saya Cuba Mose Vaishali possums and Africa no kostina tetras reach Oguchi a bona mezzo buyer born a banana behave hey LC n ZM Sabin's um cool ooh Ellington lessons and Africa nom flange a a ban to buy a corner of Humana Emma Chris I believe form on our own to ability amania actual appeal so we want to lead a healthy society as a country the ANC led government has made substantial progress on its policy responses the at 8:00 a.m. a patek sorry epidemic and implement virus inter inter inter related intervention to entire internet in sorry for that inter related intervention to to mitigate and to stop the spread of HIV some of this intervention include but not limited to one national strategic plan for HIV TP and STI 2017 2022 which serve as an over inching policy plan south africa south african national sex workers HIV plan 2016 2019 the national policy for the prevention and management of Lenna pregnancy we know we still have a challenge at school of teenage pregnancy which we must make sure that we address that and as ANC government will do that comprehensive sexuality education young women and girls program sponsored by the Global Fund Zazi know yourself know your state has it's very important to go and test so that you can live a long life because as ALC government we can give you the ARV as you know that that is they they they medicine to make sure that we give our people she conquers program in persuade and in interest rate our program to a long and healthy life for all South Africans as a second by the national development plan vision 2030 South African is in vet South Africa is investing significantly on Vera's intervention in the area of Public Health came some of the essential intervention to improve primary health care in South Africa include roll out of the main medical circumcision program which is an aggressive roll out Intendant on reducing the number of men who are living with HIV it is second that scaling up MMC should have significant health benefit not for the men but also for the women in South Africa fix those combination ARV pills the recent introduction of FD cierva peel is the one that is is the one that is them greatest access in the in the agency led government has made the following outbreak of HIV and AIDS epidemic FD clz pill is a while or it's a once-daily pill as I've indicated our society Lantry means oh Tanja appeal Isabella appeal dosage and makes it easier for those living with the virus the P the pill is healthy free as it improves and enhance and and portability implementation of mum Connect which aims which aims the strengthening health services and reduce maternal and child mortality TB has been identified as the leading underlining cause of death in South Africa I would like I would like to employ members of this August house to heal to the call and be part of the global action known as TT p caucus which was first established in October 2014 remember your time is now expired we support the budget thank you the next speaker the Honorable shake you mom Thank You honorable House share Minister Deputy Minister our colleagues in the house and our colleagues in the gallery allow me minister to congratulate you and your team on your appointments in the SONA debate the president spoke about a dream and yes indeed 57 million people in South Africa have been dreaming and they've been dreaming for a better equal healthcare in South Africa and despite 25 years into democracy many of our people continue to be deprived of that right of equal health care in South Africa some are privileged others are not as if if you are poor or under privilege your life has no value or if you have all your privilege then your life is valued more and that's what the oppression is but also there seems to be a perception out here that private health in South Africa is excellent service and I bid to differ on that time and time again I get complaints and concerns from the general public and private health care facilities and our poor the services are so there is challenges both in the public sector and in the private sector but one of the challenges we as the NFP identified is that in the appointments of Emmie seas and CEOs and DG's and DG G's particularly at provincial and local level those at national level like ministers and things have very little or nothing to do with it but it is the National Department that has to account for it and one ideal example is what I've heard from the former Emmie she from the Western Cape she said how well they perform in the Western Cape on how well they're gonna provide the services but I can tell you that if she goes on a tour with me just for one day I will show her what the conditions of health care is in the Western Cape so it clearly shows it clearly shows that Minister if you don't have a role to play in appointing these images this is what you get they don't know what's happening in their own areas but they're going to come out here and tell you how brilliant the job they're going to do now let me tell you let us be honest the challenges that we face exist countrywide there is no doubt about it we have challenges countrywide but those were some of the reasons why we face what we face one of the concerns that we have is that the 15 to 24 age group HIV new infections are still at about 1,200 per week which is extremely high and we believe that ARV is wide it's a temporary solution is not the ultimate solution the preventative measure should be rather considered more importantly because we can't be continuously rolling on ARVs we need to see what is go I know I have a different idea of why there is HIV where it came from to some of my other colleagues that is my view I personally believe man-made that is why we are where we are today I don't honestly believe that it is anything to do with that is clearly my own I think there needs to be greater oversight by the and not only by the committee but the department's because what we find time and time again we've gone on oversight of the Health Committee I mean why is it that they needs to be a stopped out and the only time you find out what it when it's in the media and remember your time has expired anyway the national thank you the next speaker is on Roland Riggs Thank You honorable chairman my son Ismail is in the audience he has meant that you city students to develop apps for the ball and is doing his PhD on the nhi and I hope the minister will follow minister Naledi and also to a doctoral degree honourable minister you promised to jump in together in a chaebol a proof but you must take a giant leap to establish a state-owned pharmaceutical industry and factory to reduce costs this will be the two most revolutionary steps the country will have taken since the dawn of a democracy I agree with the finest the infrastructure must be fixed our facilities must be within walking distance of as many people in South Africa as possible he casa must give the Health Department the own 5g spectrum so your department can take the lead the social Africa's ready for the fourth Industrial Revolution and be the first citizens of the cyber civilization as amah supports the budget jump and leap Honorable Minister thank you to cabinet for proving the balls that Africa is shamed buying being named as the most unequal country in the world the inner table will be the silver bullet and the first step on the way to equality who many in this house fought for cabinet approved the nhi bill on the eve of Mandela Day they've jumped the gun now it is up to you honourable minister to fire the silver bullet as far as our demise concern the bill is now in an act expropriation of land without compensation of the fighters in the nhi people voted for by the people must be the first steps to bring about equality in South Africa tax payers money to save lives is money well spent so Honorable Minister get the ball past no matter what the cost we can recover from starving but the poor cannot recover if they are dead equal universal health care must be a top priority in the land but we need all political parties to work together not to talk about equality but implemented in the healthcare field this is a unique opportunity to put politics aside and get to work to get to do real work for the country thank you remember the next speaker the Honorable Wilson Thank You chair and through you to the minister or we have heard today is empty rhetoric and your own back-slapping about the few things you have got right a few more bowels and will soften you can throw yourself a party but over two hundred billion has already been spent on nhi but the stage of Health in South Africa is nothing to celebrate nothing no one who relies on the public health system is celebrating you know this and we know that the last week is highlighted just a few of the horrors patients in the public health services have had to endure our early citizens tied to chairs elderly certain citizens found with maggots in the mouth and a pregnant woman in labor being turned away because who womb was cleaning itself none of them were in the Western Cape Kazuma natal is an ongoing oncology crisis and inland purple and by the way Thank You chairperson of the portfolio for the oncology crisis an inland purple the time between diagnosis of cancer and oncology treatment is 12 months this is yet another death sentence like those of life is a domain II but billions have been spent on nhi provinces who are allocated the bulk of the health budget play a crucial role in the delivery of we healthcare but astonishingly the primary health budget has the smallest budget there is a chronic shortage of critical medicines equipment consumables and health professionals despite this the provinces lack housing for example under speed the budget for critical equipment by 504 million various mind-blowing the lawyers who represent the hurting health department in medical claims have always drawn their services due to non-payment provinces and the national department now face 18 billion ranked in medical malpractice claims 80 billion this is not budgeted for just recorded as a contingent liability if just half the claimants win their cases provinces and the department have to find 40 billion out of their budgets he goes your nhi your infrastructure and building budget your HR performance bonuses and critical equipment budgets already departmental and provincial and provinces accrued in the 20 16 and 17 years 13.8 billion in accruals and the situation is not improving simply put Minister you are robbing Peter to pay Paul and as always it will catch up with you you start in the red before day one of the next financial year we all know that the billion spent on nhi have done little or nothing to prepare for a universal health care system in fact in most instances monies have been diverted from doctors infrastructure and equipments to pay accounts the state of health has gone backwards since we started yesterday cabinet approved the disastrous nhi and we're still waiting to see concrete plans and budgets we're just talking talking talking by the way shaky month the Honourable among the NEC of the Western Cape is not sure but the person behind hundreds of cancer deaths in kwazulu-natal is Minister we always talk about this practice so go where there is best practice in South Africa and even you cannot deny it the DA governed Western Cape is the leading province in terms of health service delivery you cannot deny it it is clear we are yet to be in a position where we understand how your plans and what you have yet to present to us and what the total budget of this plan is are we going to not begin where we should at grassroots level and improving the basics in primary health care before we spend another 200 billion that is going to waste and nothing to show for it the wisdom Cape has done it we've done it right we've done it without the nhi the next week is your pneumonia ours chairperson honourable frolic many start deputy minister respectively honourable members guests and fellow fellow people of South Africa as a whole good morning as members of parliament of the Republic of South Africa we are delighted and we are welcome the cabinet approval of the nhi nhi bill we will be which will be table here in this August ourselves August as house as protocol and agendas possible now that we've been a little bit attacked I think it's important that we'll go out to be able to address those issues accordingly we believe the department will develop a systemic improvement program within the national framework of of annual performance plain we have absolutely no doubt that the department need to strengthen the systems processes environment that helped to sustain improvement and quality of service his Excellency President Xi Jinping of the People's Republic of China I quote a set by quote the growing gap between the rich and the poor is unfair and sustainable he goes on to say the development is meaningful only when it is inclusive and sustainable I will talk to it later on the context of the nhi I think what we have seen from the left from the DA it's important that we reflect on what Maksym kokia said truth doesn't heal the wounded soul the DA is heavily wounded and doesn't matter what progress the people the people glorious movement AMC led government can do also can do they will continue to be forces opposed to proclaim progressive change and development towards national Democrat society it is within this context that their ideas or the geologists flawed right wing ideology that seeks to advance objective answers rather than the objective reality I know they've mastered now the Left views of Lenin open quote and lie often told enough becomes the truth they use the media or the Fourth Estate he and referred as the media and elected unelected media to convince society to confuse society and project the African National Congress and its members as corrupt this is untrue where does this confusion arises from right – in neoliberal agenda subjective which is subjective of reality for the past 25 years it remains a fact that the insolate government has been building clinics and hospitals going forward were concerned about building the quality of health care to this end we expect our honourable minister to come up with a with scientific mega aboard infrastructure inspection proposal how to build a new smart hospitals and clinics to accommodate nhi services this will be aligned with the population growth which will be fundamental necessity consistent with the 20/20 vision more South African are living longer the average life expectancy increasing to 64 years and 2018 from low to 53 years in 2005 progress in life expectancy reflects improvement in the quality and availability of health care our massive campaign to turn the tide against the HIV and AIDS and our effort to meet the basic needs like access to clean water electricity and adequate adequate housing more than 4.5 million people all South Africans living with a child HIV and AIDS receiving and Revolt shipment are from 2.5 million 2014 making the biggest and rovol treatment program in the world we have made dramatic progress in prevention mother-to-child transmission of HIV in 2004 over 70,000 babies born to HIV positive mothers become became an affected by 2018 this figure has planted up to 4500 saving tens of thousands of newborn babies per a new HIV infection F decrease to our collective fights continuous to the hiv-free generation in 2009 there were 30,000 60,000 TB related death and by 2016 this had pumped dropped to 20 29,000 access to free primary healthcare has been expanded from pregnant women and and and children under six years at the eight under success of age in 1994 to three primary LK for all today despite all this such despite all this achievement the struggle for good health K will continue all sheperson the president and the Minister collectivity most rated leadership on the end nhi which the most elite political commitment to the bold 54th National Conference of the ANC as the prison's Rama pasa said open code NH is fundamental is fundamentally about social justice nhi will be sure that all our people whether you are black or white rich or poor you will be able to access a comprehensive range of healthcare services this one we agree we agree today we spend as a country not as a government over 8% of the gross domestic product on health care this band is far higher than many other countries of our economy size and more in line with advanced economy according to many studies this is more than the this is more than enough to provide everyone to good health care going forward despite high spending on on as a country and despite progress made many of health outcomes remain stubbornly disappointing we know that despite this yourself care resources the country has a good health care in front of everyone there are many who do not get health care when they need we must respond to this important question as to why as the NZ led government the root causes of can be found in too tired health health system we inherited from the apartheid era which which reproduce the system in systemic inequalities in access and good quality care it is a system made of huge medical aid funded and highly resourced private health care herein referred as the first type first year designed primarily rich elite and public underfunded public health care for the poor majority of our people as we fade in as a second tier despite 25 years of the major intervention to transform our health system and many achievement recorded two-tiered unequal system remain stubbornly high we in the ANC have declared the abdicate that the answer thought I'd to tie the health care system is not an incremental market forces driven solution as suggested by the DEA in the left two problems of our health coverage in ALK equality LK all D is what seeks to do is two main the central two main the central of a private health insurance in our national health system here by reproducing projecting inequality which is not as which is not sustainable in health care and will be rejected this will be rejected by this experiment we what needs to be done to change the true tied health system itself only then see have a solution to all the people to allow people to this end we have proposed a publicly financed elevational health insurance program that will fully cover K for all South African nhi therefore is a universal comprehensive affordable will be provided to provide full free health care to the point of use we will eliminate the need to tight health care system dominated by the private health insurance we will put in forward progressive single unified national health care system as the nhi wad paper notes open code nhi represent substantial policy shift that will necessitate massive massive reorganization of the current health care system to address the structural changes that exists in both the public and private sectors it reflects the kind of society we wish to live in one based on the values of justice fairness social solidarity implementation of the nhi is the consistent with a global vision that hell cash will be a social investment the white paper also knows that open code the implementation of the nhi is underpinned by division to annotate e of the National Development Plan which in visas that the 2030 everyone must have access to equal standard of K regardless of their income and that Common Fund should be enabled to be to enable equitable access to LK regardless of what people can afford or how frequently they need to use the service as the ANC we are a clear with a clear lateral mandate to ensure that we do achieve this by 2025 2026 these are targets here in which the nhi fund will be fully functional with access to all revenue collections covering majority and also entire populations with purchasing capacity to pay accredited healthcare providers who made quality standard therefore one of the immediate priorities of this experiment is to ensure the tabling of energy beam to set a foundation to roll out of inertia implementation I'll share it is part and parcel of the energy implementation to ensure that we strengthen provision of healthcare services particularly in the private sector in public sector not private sector with strong emphasis on primary health care this could entail the the building of the primary alfc a network that includes school health care services and radical improvement in the performance in quality service of primary health facilities nhi implementation will require adequate planning for that production and distribution of human resources for help including as option of the 10,000 tens and thousands of the earth care workers who the minister talked about earlier who are paid above national minimum wage minimum wage we also need to strengthen Nessen colleges a medical school this the Deputy Minister talked about while building the successful partnership and medical training programme with Fidel Castro dr. Nelson Mandela program a country renowned for its own best Cuba a country renowned for its best health care system in the world I'll share the cost of medicine and drugs has been a major concern of the NZ NZ government we played an important role in reducing the cost of the same essential drugs and continued to do so however as part of our efforts we need to build a mystic capacity to produce our own medicine by similars and medical equipment through creations of the state-owned infamous enterprise this is consistent with our own boss 53rd and 54th National Conference within the department of the within the department of of health we need to have capacity to meet the needs of our national health system the intervention must be understood hojae that the context of afford to drive industrialization through localization and la leveraging on the economy of healthcare through its huge public procurement spent health is a global business international relation political economy and related international trade South Africa Mary must reject and I think it's important to say that we indicate that Professor wood from Oxford University analysis and I said that there's a global economic shift in the whole in the globe that the the shift is in the developing nations so therefore the developing nation led by China have the capacity have the capacity to be able to acquire strategic asset which can benefit all the developing nation as a whole so it is important that you must reject unilateralism of trump and remain solid and shaky label on the multilateral systems we must make sure that World Health Organization who must be able to spend most of his capacity and work within the developing nations the country is an importer not exporter that is linked to hard currency suggest online euro I mean of these air tracks and other medicine it is the so it is the currency volatility which will continue to affect the pricing and import of drugs because they shipped in large volume their artisanal cost of logistic and warehousing will definitely impact on their higher posts of procurement or on medicine which will be banned by the body but by the patients it is within this context that the fifth third and fourth National Conference resolution I repeat again resolve on the establishment of the form a circle state-owned company we can no longer postpone this issue Minister the health care sector is not blind the healthcare sectors not blind to digital revolution especially on artificial intelligence could unleash huge potential in digital healthcare technologies ensuring enhanced access for good quality K especial or people in rural and remote areas and part of the country part of our country we therefore looking forward contribution of the Department of Health K to universal health care services including smart health facility within the context of the nhi implementation consistent with the Department of Health a linear angle performance plan on the strategic approach on national strategy framework 2014 2019 open code the era of digitization technology will be extremely extensively used to leapfrog health system to implement energy policy in taking forward this decision portfolio committee also resolved that the ministry need to have an inter-ministerial engagement with Department of Communication in this the transition to secure at telecommunication spectrum dedicated for ie governance with the key focus on healthcare technology to reduce the cost of services we are very clear that the spectrum will also be utilized to make sure that artificial intelligence intelligence or technology will be able to provide surveillance and face recognition technology scan platform that will be able to ensure that safe and secure hospitals and clinics and combat fierson of medical drugs such as air V's they have make us all remember your time is now expired thank you the the next speaker is the Honorable Minister of Health who will respond to the debate on Oh Minister thank you house chairperson and thank you to all the members for all the comments and the suggestions and the input I just want to finish off by also indicating indicating that the full package of services that we'll be looking at is contained in the speech so it will be sent through but I want to thank all the excuse me want to thank all the stakeholders who are here in particular I want to congratulate the Medical Research Council on the 50th anniversary of excellence I also believe that which they are celebrating this year it's important for us to celebrate the hard work the excellence the professionalism of all the public servants in our system dedicating their lives in making sure that we get the best best services so I want to salute all those public servants who work in our system in particular I also congratulate as the Deputy Minister dr. C dolly Lindy West Ali who was the first cardiothoracic surgeon and professor Medusa falero again on being the first or to do well transplant middle ear bone on 3d technology and in thanking everyone I'd like to also thank president for his leadership the deputy president for his son our leadership colleague ministers and the department deputy minister for all the work that they've done to help us with this speech it's time now for us to implement it's time for cowl laser and therefore we ready to go to to petal the nhi bill is out from cabinet it will be a process by this house and will continue to support we're doing proofing to the media they also give them a sense because there's a lot of interest the issues that they've raised amongst them is that we are create that there's a need for strong consequence management I just want to say to honorable Rama I agree with you or not I remember most countries that have done any child they've done so when they were the economy was lowest Japan did the same you hated the same we're there with them they were actually explaining you can't be more wealthy to implement any child just go ahead I also think that chair the Honorable Paco Bay I'm very sorry honourable member I think you decided to distort the issue in the first instance I did say that the pilot report is not out but I said specifically it does not matter what the weakness is that it will show we will have to solve them anyway so that is the attitude we will solve whatever the attitude doesn't matter where they are we will solve them now I see that the TA spin doctors were busy playing around I think you're also trying to polish your marbles the issues of the TA already you now are no longer opposed to removal of tax benefits h-how that's new that's interesting then the regulation of medical is for years you've been opposing this welcome to the club now or we should say more official for men in a teeny the honorable to change a while well you support the nhi somewhere along the line you don't like the budget let's work with the support I don't mind the rest the Honourable Cheng hua your issues the president of the HPA CSS here this is a body of professionals with high integrity so just bring us the report all the things you report are not about the HPSA if the individuals were misbehaving we will investigate them and deal with them so the other issues that have been raised here don't try and dissociate yourself from the health system as witnesses I looked at the VTP figures Western Cape is just as bad as the whole of South Africa so we take responsibility for the witness in your system we take responsibility if you have delusions of dissociation that's your problem we are going to work on this system and fix it it doesn't matter which side so the other member was saying that we spent 200 billion on nhi sorry get your figures right that's wrong the other issue of 80 billion and medico-legal those are projections we haven't spent that money so but some if you have fixed to criticizing the ANC do it on facts so that we can deal with the issues properly now so we are going forward to fix the health system Emek iossef is Abbas booty Cephas uber is samosas and pillow goon repair Amica emitters pedal rhetorically meaty which Oregon October tell about singles abandoning no no Pinot Baba corner you're not girlie initials from by NZ go uncle oboe Cunha Sjogren's Robin specialist longest funguses ox Evans so when's Iran Iran what absorbance interest car universes each corner gala Gong kazoo in salute teenagers K Telugu T C sevens and about the saloon GCC more simple C way later wife aside my name is elegance it here humbleness and the energy I October thank you thank your new minister on the road members that concludes the debate I just have the order I just have the following announcement to make the Honorable Minister is inviting honourable members and guests to a cocktail reception at the Grove restaurant immediately after the setting this many plenary will now rise thank you

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