Hon Speaker, hon President and Deputy President, fellow colleagues and Ministers and Deputy Ministers, hon members of the House, ladies and gentlemen... hon President you have spoken and those who have ears will have heard you. As for those who did not want to hear, of course, we can't force them.
But, listening to the opposition parties, if you were to go along with what they claim or even demand you should have included in your speech, you would have needed a five-hour state of the nation address. This is so because, seemingly, they want you to be a Minister of every department rather than the President of the country. But, as for those of us who heard you very well, we have taken the instruction.
Mr President, you have instructed that we improve the remuneration of doctors and other health workers. As you spoke, I did take a look at the Minister of Finance and I'm convinced that he has heard you because I saw him nodding his head very emphatically. I do promise, Mr President, that working together with him we are definitely going to put something decent on the table. We will put on the table something that is a good beginning for this long journey of correcting something that has gone wrong for so long a time. As a Chinese saying goes: "A journey of a thousand miles starts with the first step."
So, Mr President, I want to assure the health profession, through your instruction, that we will indeed take a decisive first step. We shall do so within the next few days, and not weeks. [Applause.]
Long before your state of the nation address, Mr President, there were already articles about your possible announcement of the implementation of national health insurance, or NHI. The articles have been written by people who profess to be knowledgeable of what is good for me and you and what is good for the man in the street, as far as our health system is concerned. There is absolutely nothing wrong with that, because you will agree that in the ANC we actually encourage every single South African to engage on any policy matter that has been put on the table by government. We welcome all forms of engagement as long as they contribute towards building our country and not destroying it.
I would like to take this moment to highlight a few of these issues in regard to the engagement I have seen in the papers about national health insurance. Firstly, I want to state that we have not yet, as government, released any official policy document for public engagement on national health insurance. We are still going to do so and we will do so very soon. What there has been so far are the intentions in our election manifesto and the announcement by the President of the ANC, on the campaign trail, about the desire of the movement to implement national health insurance.
Of course, the first government announcement about NHI was given by you, Mr President, just two days ago in your well-received state of the nation address. Up to now, since that day, we have never released any official document for engagement either by the profession, stakeholders or the public. We are going to do so within a few days' time.
But, since some people have already started to engage in several newspaper articles, I think it is desirable that I do not keep quiet. One of the articles states that, and I quote: "Formulation of a complex policy behind closed doors was dangerous." It goes on to say, "Lowest quality policy emerges from processes in which you insulate yourself from any critique."
Every single policy I know of on this planet starts somewhere by a few people who formulate it. They then canvass it and allow others to engage. If it is government policy, it finds its way into Parliament and to public hearings for public scrutiny. So, I don't understand this behind-closed- doors story and insulation from the critique phenomenon. I do not understand, because NHI policy will be discussed in each and every corner of this country and will eventually find its way into this House for public scrutiny.
Another article said that it was vital that proposals be based on hard evidence and not on ideological assertions and beliefs. Frankly speaking, we think we know what is at play here. There are certain people who are benefiting hugely from the present inequalities in the health care system. These people are trying to transform their own fears and personal concerns into public fears and public concerns, and that cannot be done. [Applause.]
There is nothing ideological about NHI. The Constitution, under the Bill of Rights, section 27, asserts that health is a right of every citizen. NHI is going to be implemented in order to make sure that every citizen in the country, rich or poor, is able to exercise this right.
Fortunately, one of the experts engaging in this, Dr Lucas Ntyintyane, a PhD Fogarty International Clinical Research fellow, wrote in the Sunday Times this very Sunday, and I quote:
I hope that the new leadership and the introduction of the proposed health insurance will give meaning to the adage "health is a human right". Ordinary South Africans should have access to quality health care just like their Members of Parliament. We should encourage private-public partnerships to ease congestion in our state hospitals.
We welcome this engagement, Mr President. But, because some are asking for facts and not ideology, let me give them fact number one and not ideology number one. The World Health Organisation, WHO, recommends that developing countries spend 5% of their GDP on health. In South Africa we have already far exceeded this recommendation. We are at 5,8% of GDP but our health outcomes are very unsatisfactory and rank amongst some of the worst in the world. That is why we agree with you, Mr President, when you raised your concern about the deteriorating quality of health care in our country.
We acknowledge and accept that some of the contributing factors are the following, without exhausting the list: lack of management skills; lack of induction and in-service training; failure to act on identified deficiencies; delayed responses to quality improvement requirements; unsatisfactory maintenance and repair services; poor technological management; a poor supply chain management system; inability of individuals to take responsibility for their actions; poor disciplinary procedures and corruption; significant problems in clinical areas related to training and poor attitude of staff, as mentioned by the hon Rev Meshoe here in this House yesterday; and inadequate staffing levels in all areas.
National health insurance is going to be implemented to solve all the things I have mentioned. Having said that, I want to say that one of the most glaring and obvious reasons why the public sector is not doing well is what these people who have started engagement in the newspapers are trying to hide. This is the manner in which the 8% of GDP I mentioned is distributed amongst the population: Of the 8,5% of GDP spent on health, 5% is on 14% of the population. The remaining 3,5% applies to 86% of the population. To simplify what I am saying, in this beautiful country of ours, 7 million people enjoy 5% of the gross domestic product, GDP, to take care of their health. A whopping 42 million people have to make do with the remaining 3,5%.
If it is ideological to resolve this state of affairs, then I fully subscribe to such an ideology. For it cannot be that humanity is allowed to go on like this. In fact, it is actually a shame that we have allowed humanity to exist in this state of affairs. All of us in this House, together with our spouses and children, are part of this privileged 7 million. The people we have asked to vote for us and promised that all shall be well constitute this 42 million, and we are supposed to turn our backs on them because if we dared to look at them we are supposed to be driven by ideology.
It is said that national health insurance will destroy medical aids and damage the already well-functioning privileged private health care system in our country, which is ranked among one of the best in the world. We have no qualms with that, we know that. We have no intentions of destroying anything at all. But what the NHI will obviously and unapologetically destroy is the present inhuman scenario that is unfolding in front of our eyes.
Fear of the unknown is being driven in the minds of doctors in private practice - that NHI is going to destroy private practice. I don't know about that.
But let me present the following facts that I know of. Out of every R100 you contribute to your medical aid, only R3 goes to a medical practitioner. This is only better if it is a specialist. Tell me where the rest of the R97 goes to? And don't be surprised when you see all these newspaper articles and who is writing them. [Applause.]
Hon members, I am challenging you: Go to your village now and count the number of doctors that ever opened practice in your village, and tell me how many are left. Most of these practices have folded or closed down and the doctors have gone to look for employment elsewhere, many of them in England and other countries abroad.
They were destroyed by the present distribution or maldistribution in the health system, which the NHI seeks to address. It is not the NHI that destroyed them, because the NHI is not yet in place. Many doctors have been destroyed, and I'm sure you know them and would be surprised when it comes to where all these doctors have gone. The system is eating them up because there is maldistribution within it.
Lastly, I want to say upfront that we would never impose NHI on poorly functioning and poorly managed health institutions. Our first task towards the implementation of NHI is to massively overhaul the whole system at all levels. Top of the list of priorities in this regard is the quality improvement plan for public health care facilities.
Within the next year, we shall start a plan towards the establishment of closer public-private partnerships in improving health facilities. Of course, we will first start drafting such a plan behind closed doors, before anybody is asked to comment on it. Even the responses of the opposition parties to the President's state of the nation address were drafted behind closed doors before they brought them before this Parliament. [Applause.] And there is nothing wrong with us doing so. So, Mr President, our quality improvement plan for public health care facilities will have the following objectives: One, health facility performance indicators; two, quality improvement within facilities; three, increasing access to HIV and Aids treatment to meet all the goals of our national strategic plan; four, patient safety; five, disease management and prevention, and that is curative, rehabilitative and promotive; six, monitor health-related Millennium Development Goals and strengthen indicators. Mr President, further details will follow in due course, and we believe that it was not for you to put them before this House. We are going to do that for you. People must just remain patient. I thank you. [Applause.]