Chairperson, hon Minister, Deputy Ministers present, hon members of the House and guests, I will focus on the primary health care approach and the management and delivery of the district health system.
Hon Minister, health is a human right enshrined in our Constitution and is a priority for our nation. In 1994 in South Africa, the introduction of a model for a people-orientated health care system and the mainstreaming of primary health care was a dream and an idea whose time had come. It signalled a dramatic shift.
The big challenge came when people needed to translate the national policies of the new government into effective practices to enhance service delivery. A lot has been said about hospital revitalisation, but primary health care revitalisation is always in future plans. This is very weird, because it is the entry point of the entire health system in terms of a basic health approach and disease management. I believe that had we started with the revitalisation of primary health care, we would be far by now. We should have focussed on a preventive health care system and not on the expensive, unsustainable curative health care system we are currently running.
Health promotion and education should be delivered more through field work or mobile clinics. The national Department of Health developed a comprehensive and integrated package and a set of norms and standards. Fifty-three health districts were established and, as one of its priorities, the promotion of a healthy lifestyle was a critical programme. However, 14 years since democracy, and nine years since the comprehensive introduction of the norms and standards, the promise of primary health care in South Africa remains largely unfulfilled.
We still have problems, such as poor service delivery of basic primary health care; the lack of delivery of the very comprehensive services that we are talking about; low levels of managerial competence; poor referral systems; lack of accountability; and a misalignment of the policies with the management of primary health care. These are still challenges. A primary health care audit was commissioned during 2007-08 to generate comprehensive information on primary health care infrastructure and services. To date this has not been done.
Only now, during the 2010-11 to 2012-13 planning cycle, will the department conduct this audit. Does this mean the government has been allocating a budget to district health during this time without having comprehensive information? This is unacceptable. The ANC-led government must stop postponing. Many processes are either "in process" or "in planning for the future".
More should be done because South Africa needs health services now. Monitoring and evaluation of the efficiency and the effectiveness of our system should be an ongoing process, not something to be done nine years later. South Africans do not want free primary health care services; they want access to free and high-quality primary health care services.
According to the briefing by the Department of Health to the committee, there was a 10% increase in the number of patients accessing the primary health care facilities between 2007-08 and 2008-09. However, the question remains, was this increase due to the beautiful services that we are offering, to the community having confidence in us as the Department of Health, or is the increase due to the lack of health promotion and education and the increase in the burden of disease? The answer is that no analysis has been done to assess the reason for the increase. I think it is very important for such an analysis to be done.
Health care is not about numbers but about impact. It's about significant behavioural change, measurable reduction in the burden of disease ... [Applause.] ... improving health conditions and securing better health for all.
New evidence indicates that access to public service remains a challenge to the poorest and the sick. The changing profile of disease and the rise in the occurrence of chronic illness continue to increase the demand on the primary health care system.
The poorly managed and understaffed centres are unable to absorb the emerging pressure. The decline in life expectancy and high levels of maternal and infant mortality indicate the inability of the current district health system to cope with the needs. Challenges of quality and coverage of health remain, despite the structural transformations and reforms that had been effected over the past 15 years.
Hon Minister, the time has come to match words with action. The nation is looking to you, sir, to lead in delivering as promised.
Batho ba kgathetse ke ditshepiso tsa bophelo bo botle empa ba sa bone tema. Letona, Setjhaba se a fela, ha re phethiseng. (Translation of Sesotho paragraph follows.)
[People are tired of empty promises of a better life without seeing any positive results. Minister, the nation is diminishing, we must deliver.]
The challenge to provide a quality primary health care system in South Africa is a great one. This further compromises the ill health of patients and staff. Statistically, there is a huge disparity between the number of trained primary health care nurses and the number of patients seen per day. The lack of resources, support and sustained and committed leadership at the highest level of government and the medical establishment stifles delivery. Careful consideration of the skills and competencies needed in the primary health care system is critical to its success. This paralysis of strategic uncertainty and operational inertia cannot be tolerated anymore. The department needs more resources and systems to overhaul the delivery of health as a whole. A lot of money is wasted on consultants' fees and travelling. We need a fresh approach to explore the introduction of a "train the trainer" type of training programme in primary health care.
We in the DA firmly believe that no society can prosper without an affordable, high-quality and easily accessible health system. Such a system requires both a dependable primary care network that prevents diseases and treats minor illnesses, and a quality secondary and tertiary network to provide hospital-based care for more serious illnesses.
In conclusion, hon Minister, the district health system or primary health care facilities are failing the health system as a whole and, as long as we do not fix the problem ... [Time expired.] Thank you. [Applause.]