Chairperson, colleagues, MECs of Health from different provinces, hon members of the House, distinguished guests, and ladies and gentlemen.
I am presenting this budget under circumstances of serious challenges in health care in our country and around the world; namely, the H1N1 influenza and the global economic crisis. During economic crises, social outcomes are usually the first to suffer and the last to recover. Health is usually on the forefront of the social outcomes to suffer, because countries may be tempted to cut all social spending when faced with financial crises.
Let me start this presentation by reminding this House what His Excellency, President Jacob Zuma, said concerning health during the state of the nation address:
Fellow South Africans, we are seriously concerned about the degeneration of the quality of health care, aggravated by the steady increase in the burden of disease, in the past decade and a half.
This statement by the President is a clarion call to the Minister of Health and the MECs of Health in the provinces to put their heads together and decisively deal with the state of affairs. I'm therefore calling on my colleagues - the MECs from different provinces - to help me to deal with these issues without fear or favour.
In order to make a good start, we need to accept and acknowledge upfront that among the myriad of factors the following played a significant role and need to be carefully and urgently looked into: First, lack of managerial skills within health institutions; second, failure to act on identified deficiencies; third, delayed response to quality improvement requirements; fourth, unsatisfactory maintenance and repair services of our institutions; fifth, poor technological management; sixth, poor supply chain management; seventh, inability of individuals to take responsibility for their actions; eighth, poor disciplinary procedures and corruption; ninth, significant problems in clinical areas related to training and poor attitude of staff; and last, inadequate staffing levels in all areas.
I call upon provinces to note that, while some of these problems need a systemic approach, others are quite urgent and can be partially solved. That is, some problem areas need urgent impromptu solutions.
Let me take this opportunity to commend the Gauteng province on launching Operation Kuyasheshwa La. [Applause.] I wish to see such operations in all the provinces. At the same time, I want to share with the House our 10- point plan, which has been translated into our programme of action. The ruling party noted that there are problems within the health and education systems during their watershed conference in December 2007 and, hence, adopted and passed far-reaching resolutions. The binding resolution passed expected us to prioritise the health and education systems of the country in the next five years and beyond. The resolution was not just rhetoric, but a realisation of problems that we are faced with.
Since then, the ruling party came up with the 10-point programme, which has been officially adopted by the Department of Health as a programme of action. First is the strategic leadership and the creation of a social compact to better health outcomes. It is self-evident that if we don't provide leadership at all levels, including in the society, our health outcomes will never improve.
Second is the implementation of the National Health Insurance, NHI, which, unfortunately, has already been debated in the media even before the document was tabled.
Third is the accelerated implementation of the HIV and Aids Plan and the increased focus on tuberculosis, TB, and other communicable diseases.
I attended a session two weeks ago at the United Nations called by the Secretary-General of the United Nations and the Director-General of the World Health Organisation, Dr Margaret Chan. It was called because they worry about what governments around the world may do to health budgets when they are beaten by this global crisis, and they wanted to stop that. It was during that session that I was told, especially by leaders within the United Nations, that if South Africa failed to take the lead on the issue of HIV and Aids, the continent wouldn't be able to move. They were saying that, as the continental power house, South Africa needs to take the lead in the fight against HIV and Aids. For that reason, we need to be equal to the task and know that whatever leadership role and programme we take on HIV and Aids, it's not only for our country, but for the whole continent.
Fourth is the overhauling of the whole health care system and the improvement of its management. In this case, we will need to evaluate all hospitals' chief executive officers, CEOs, to ensure that they meet the minimum requirements for effective management of the set facility when instituting corrective measures where indicated that may include retraining and or redeployment of people. We are also doing a feasibility study for the establishment of a leadership academy of health managers.
In further overhauling the system, we'll evaluate and strengthen the district health care system and primary health care, which is not doing as well as expected. I want to remind the House that when we took over in 1994, the hallmark of the whole health care system and the central issue in our strategy was primary health care, which means the improvement of health right where the people are, in their homes and at clinics. At the moment, I think we are relying too much on hospitals, which is why there is so much overcrowding. So, we are going to have to look into that.
Fifth is the improvement of human resource planning, development and management. In this case, as I spoke about the shortage of staff, it is quite evident that when it comes to doctors, nurses, pharmacists and other related health workers, we are one team as a country. One of the most urgent things we are going to do is to open all the nursing training colleges to make sure that as many nurses as possible are trained. Presently, the training of nurses takes place at universities only. That is wrong and will not take us anywhere because it's like training an army with generals and no foot soldiers, and that needs to be changed as soon as possible. We also need to speak with our vice-chancellors from medical schools. The fact that only 1 200 doctors are produced by our eight medical schools, yearly, for the past eight years, needs to come to an end because we won't be able to move as a country if that doesn't change.
The sixth factor is to improve the quality of health care services.
The seventh factor is the revitalisation of the health care infrastructure.
The eighth is mass mobilisation for better health for the population.
The ninth will be the reviewing of the drug policy, which has been causing running battles between government, the pharmaceutical companies, pharmacists, etc. In this case, the fact that we have been able to bring drug prices down is a good starting point, but the whole policy on drugs in our country needs to be reviewed.
Last is to strengthen research and development in our country.
Let me indicate that by implementing this 10-point programme we will pay keen interest to the following four issues: Firstly, on the whole issue of financial management, whether at institutional, provincial or national government level, we are going to pay urgent and immediate attention to it.
Secondly, there is the issue of infrastructure or engineering services, including maintenance of health facilities, rather than to continue building new ones.
Thirdly is the issue of human resources for both the management and its development is something that we will keenly look into, because, as a country, I don't think we are doing very well in that regard.
Last is the issue of information communications technology, ICT, because in this modern world you cannot run a sophisticated department like the Department of Health unless the IT and ICT systems are up to standard.
These are the four main causes of the failures within the public health care system and there's no way we can implement the 10-point plan without looking at them. Our programmes of accelerating HIV/Aids are well catered for in our 10-point plan and when we get an opportunity we would like to expatiate on it. To conclude, if enough time was available, one would have liked to appraise the House about the present contemporary issues of the occupation-specific dispensation, OSD, because I'm sure that at some stage this House will need to know and understand what is happening. It doesn't help to get issues from the media because most of them have been distorted, misquoted and misdirected. It's puzzling because one won't exactly know what is happening in our country. I thank you. [Applause.]
Deputy Chairperson of the NCOP, hon Ministers, members of the House and guests, it is with utmost dismay and shock that I participate in this debate today. The primary reason for my statement is that these two Budget Votes are separate from each other and have the integrity and status to be handled as such. They both have the character of importance to assure a standard and quality nation, but I think this is nullified by the notion to club them together. This is wrong, although they are in a single cluster or in a social services committee.
Herrangskikking en regstelling ten opsigte van debatvoering moet gedoen word. [The debating process should be rearranged and rectified.]
The Department of Social Development has good structured planning, monitoring and evaluation and other mechanisms to manage it very well.
The 2008-09 financial year recipients for aid in grants total 13 137 million beneficiaries. This will grow by about 9% in the Medium-Term Expenditure Framework, MTEF, years. KwaZulu-Natal is the province which is the most vulnerable for the support of grants. It is understandable that government must assist where poverty is hampering the integrity of communities. That we must treasure.
We must eventually pose the question: ...
Is dit doeltreffend en effektief om 'n kindersorgtoelae te bestuur, veral indien dit die grootste deel van hierdie ondersteuningsmodel uitmaak? Het dit die beoogde uitwerking op die kinders en gemeenskappe? Sal werkskeppingsinisiatiewe nie beter doelwitte bereik om die menswaardigheid en integriteit van gemeenskappe te bou nie?
U weet die toelaestelsel skep liewer 'n goeie bron van inkomste vir gewetenlose geldskieters en onwettige drankhandelaars wat vet katte in die samelewing word. Die departement s dat dit moeilik is om die "AllPay"- kaarte en identiteitsdokumente in hierdie mense se besit te polisieer. Dit is egter onwaar, want wanneer daar op die begunstigde se dokumente beslag gel word, kan die begunstigde gendentifiseer word. Streng optrede en die intrekking van sodanige toelaes sal baie begunstigdes dan verhoed om hulle aan sulke wanbesteding skuldig te maak. Selfs kommersile besighede is aan hierdie wanpraktyke skuldig. Dit moet gestop word, want aan die einde van die dag probeer die regering armoede verlig, maar die armes bly arm en slegs 'n klein persentasie raak skatryk.
Kindersorgtoelaes spoor net mense aan om meer en meer kinders te kry en die las en druk op die regering raak net meer. Hierdie stelsel sal hersien en heroorweeg moet word. Om die familie te ondersteun, is 'n baie beter vorm van armoedeverligting. Met ander woorde, 'n kleiner familie met min geld het 'n beter kans om 'n beter lewe te lei as 'n groot familie.
Ons moet ons bejaardes in ouetehuise en inrigtings en kinders wat in inrigtings is beter versorg. Werkgeleenthede moet nooit vir toelaes ingeboet word nie. My tyd is te min en daarom gaan ek nou oor na gesondheid.
'n Goeie gesondheidstelsel is van kardinale belang vir die voortbestaan van 'n nasie. 'n Mislukking voorspel die verval en vernietiging van 'n land. Ons verstaan dat die land in 'n ekonomiese smeltkroes beland het. Daarom is dit moeilik om die begroting met die gevraagde behoeftes te balanseer.
Die begroting is egter besig om gevaarlike tekens te toon en dreig om in 'n krisis te verval. Ek s so omdat die voorafgaande jaar se verpligtinge in die volgende jaar aangespreek moet word. Hierdie tendens eskaleer en kan nie goedgepraat word nie. Die begrotingsaanbod op meeste van die lynitems was baie meer, maar die Tesourie het baie minder gegee, wat dreig dat die geld kan opdroog voor die jaar eindig. Ek wil veral die Huis se aandag vestig op 'n dokument wat almal gekry het, naamlik die Strategic Plan 2009- 10-2011-12. Op die een bladsy word daar baie duidelik die volgende ges:
Funding needs and pressures for 2008-09 which could not be funded are as follows: data capturer project, R10 million; vaccine purchases, R15 million; and health information system, R70 million.
So gaan dit aan. Die volgende bladsy gaan oor die "estimates" [begrotings] vir 2008-09:
Budget bids for occupation-specific dispensation, OSD, is R2,5 billion. The actual allocation for OSD is R1 billion. HIV and Aids is allocated R1 billion.
Wat ons gekry het, is R300 miljoen.
... Child mortality vaccines, R315 million ...
Wat ons eintlik gekry het, is R50 miljoen. So gaan die situasie aan. Dan word daar baie duidelik ges dat: ... the implication for underfunding is that ARV programmes cannot be rolled out as intended.
Dit s vir my dat mense wat hierdie gevaarlike siekte onder lede het, die gevaar loop dat hulle kan sterf as hulle nie die middels kry nie. Dit s vir my baie duidelik dat daar nie goeie bestuur in die departement en die regering is nie. (Translation of Afrikaans paragraphs follows.)
[Is it efficient and effective to manage a child support grant, especially when it comprises the biggest part of this support model? Does it have the intended effect on the children and communities? Would job creation initiatives not achieve better results in fostering dignity and integrity within communities?
You know that the grant system is actually creating a good source of income for unscrupulous moneylenders and illegal liquor traders who become fat cats in society. The department claims that it is difficult to police the "AllPay" cards and identity documents that are in these people's possession. This is, however, untrue because it is possible to identify the beneficiary when his or her documents are seized. Firm action and withdrawal of such grants would prevent such misappropriation by many beneficiaries.
Even commercial companies are guilty of these malpractices. This has to stop, because at the end of the day government is trying to alleviate poverty, but the poor remain poor and only a small percentage becomes very wealthy.
Child support grants are just encouraging people to have more and more children and increases the burden and pressure on the government. This system should be reviewed and reconsidered. Providing support to the family is a much better form of poverty alleviation. In other words, a small family that is poor has a greater chance than a bigger family to live a better life.
We should also provide better care for our elderly in old age homes and institutions, and to children who are in institutions. Job opportunities should never be jeopardised at the expense of grants. My time is limited, so I will now proceed with health.
A proper health care system is crucial to the survival of a nation. Failure predicts the decline and destruction of a country. We understand that the country has landed in an economic melting pot. Thus, it is difficult to balance the budget with the needs in demand.
However, the budget is showing dangerous signs of a looming crisis. I am saying this because the preceding year's obligations have to be addressed in the year that follows. This tendency is escalating and cannot be justified. The budget bids for most of these line items exceeded the actual allocation made by Treasury by far, which could pose a threat in the sense that the funds could run out before the end of the year. I would especially like to draw the attention of the House to a document that we all received, namely the Strategic Plan 2009-10-2011-12. On the one page the following is stated very clearly:
Funding needs and pressures for 2008-09 which could not be funded are as follows: data capturer project, R10 million; vaccine purchases, R15 million; and health information system, R70 million.
It continues like this. The following page deals with the estimates for 2008-09:
Budget bids for the occupation-specific dispensation, OSD, is R2,5 billion. The actual allocation for OSD is R1 billion. HIV and Aids is allocated R1 billion.
We received R300 million.
... Child mortality vaccines, R315 million...
What we actually received was R50 million. This is how the situation carries on. Then it is stated very clearly that:
... the implication for underfunding is that ARV programmes cannot be rolled out as intended.
This tells me that people living with this dangerous illness stand the risk of dying if they do not receive these drugs. To me this is a clear indication of poor governance by the department and government.]
The OSD and the problems running with the situation are a concern. Government has been sitting with this system from 2007. Due to infighting and sectional fighting in the ANC, government was not able to carry on with governance and government responsibilities. Now the ANC government wants to blame the medical doctors and their union for letting patients down, when the ANC government must actually take the blame. Why can't the people see through the wheeling and dealing of the ANC government? Just say the following words, "We are sorry. Give us more time to solve the problems."
Dit is baie, baie eenvoudig. Dit is verkeerd. [Tussenwerpels.] [Tyd verstreke.] [Applous.] [It is very, very simple. It is wrong. [Interjections.] [Time expired.] [Applause.]]
Ms M W Makgate: Deputy Chairperson, Ministers, Deputy Ministers, MECs present here and members of this House, I just want to indicate that I'm standing in for the Chairperson of the Select Committee on Social Services.
The legacy of apartheid mismanagement continues to be with us and will be with us for some time to come. [Interjections.] We should not lament the past, but use our history to insure the future. It is impossible to correct the disparities and contradictions we have inherited in the short space of 15 years, but we do need to speed up delivery to our people.
Health, being a fundamental basic human right, compels our government, led by the ANC, the party that received the support of the overwhelming majority of South Africans, to fulfil this basic right. Hence we are beginning the process of implementing the National Health Insurance or NHI, as it is more commonly referred to.
There has been a great deal of speculation from various quarters, mostly negative. But what is it based on? We are still waiting for the tabling of a document that will guide the process to a conclusion that, hopefully, will satisfy all stakeholders.
The recession that we are now experiencing makes the NHI even more urgent in order to provide health care to the most vulnerable in our society. Some may continue to argue for a free market in health, but this cannot be justified when it hampers the fulfilment of a basic human right which our people are entitled to.
Through NHI we can achieve equity in health care as the current disparities cannot be allowed to continue. Also, through the consultation process, we will address the fears and confusion of the general public.
The process of developing the NHI will require reaching consensus with all relevant stakeholders on a few key elements, namely a basic benefit package, national health fund and the role of private funders and providers. The above will naturally follow the normal democratic process of in-depth discussion and engagement, with a view to finding the best solution that is practical and affordable.
In addressing the health care inequities and as a key component of the NHI, we also have to address the issue of human resources. Retention of staff is critical if you want to succeed, particularly in rural and remote areas where staff experience lack of equipment and, more critically, lack of support. It is critical for government to review the incentives it offers to attract health care professionals, but it is equally important to address the issues of equipment, structural deficiencies and support.
It is most unfortunate that health care professionals found it necessary to strike in order to make their point. I am, however, delighted that they have decided to return to work. I hope that government and the trade unions will resolve the issue of the occupation-specific dispensation, OSD, without any further disruptions in services.
Another key priority in this programme is hospital revitalisation, which also incorporates preventative maintenance to ensure good maintenance of our health facilities in the provinces. I am glad to note that five tertiary hospitals, when completed, will render T1 services and serve as provincial referral hospitals. Construction is intended to start at the end of this MTEF, Medium-Term Expenditure Framework, period, and will cover the new Nelspruit, new Limpopo Academic Hospital, the King Edward VIII Hospital, Kimberley and Rustenburg hospitals.
The ANC believes that poverty is created by society and it can therefore be eliminated by society. We believe that people are the fundamental resource of the country since they have the capacity to develop personally and are central to the development of the economy and the nation as a whole. The ANC's social development policy will accordingly pursue both the development and social services aspects in the context of social reconstruction, development and affirmative action.
ANC policy goals are aimed at the attainment of basic social development rights for all South Africans, irrespective of race, colour, religion and gender, through the establishment of democratically determined, equitable, just and effective social delivery systems; the redressing of the imbalances of the past through a deliberate process of affirmative action in respect of those who have been historically disadvantaged, especially women, youth and rural communities; and the empowerment of individual families and communities to participate in the process of deciding on the range of needs and the issues to be addressed through the local, regional and national initiatives.
ANC policy is based on the belief of human dignity of all in South Africa. We acknowledge that the state has a major role in meeting the legitimate and realistic expectations of all, especially the poor, disadvantaged and other vulnerable groups. We do not encourage the handout approach to social welfare provision, because it does not address the root causes of social problems. We believe in the importance of the family as it is understood within the social and cultural norms in South Africa, in the context of a normally functioning society. Special attention will therefore be given to promoting the reconstruction of family life.
In conclusion, the ANC commits itself to the following national social security system: Social insurance financed through contribution by potential beneficiaries and subsidised by employers, and social assistance for those who cannot provide for themselves because of circumstances beyond their control.
The 51st national conference of the ANC held in 2002 called for care and support for families to be elevated. As a result, care and support services to families experienced increases over the medium-term. At the 52nd national conference of the ANC in Polokwane, concern over the negative impact of poverty on our society was deeply debated.
The following priorities emerged as imperatives for social development from the conference: Firstly, a comprehensive social security net that provides a targeted and impeccable approach in eradicating poverty and unemployment; secondly, establishing a mandatory retirement fund and ensuring that retirement provisions cover low-income groups; thirdly, the child support grant should gradually be extended to the age of 18 years; and fourthly, our co-ordinated national drug campaign must be intensified to combat substance abuse. The ANC supports this Budget Vote. I thank you. [Applause.]
Mr O DE Beer: Chairperson and members of this House, Minister of Social Development, I read a story this week about Acacia Park being moved closer to this institution. I would like to see a situation where Acacia Park is moved to Philippi so that our people can benefit from the development that is going to take place at such a high cost for the sake of these members who are sitting here.
This department also has to rectify the perception that exists amongst the people out there that this is the most corrupt department. Every financial year, you will always find a report that reflects corruption involving grants in this department. Secondly, how many of these grants actually reach the beneficiaries? Most of these grants go to the loan sharks and the drug lords. We have to deal with those challenges as well.
Cope also supports the extension of the grant to 18-year-olds, but it must reach the beneficiaries; that is, it must go directly to the people. Thank you. [Time expired.]
Chair, hon Minister of Health, hon Deputy Minister of Social Development, hon MECs of various provinces, colleagues from the National Council of Provinces, distinguished guests and our management from the departments, ladies and gentlemen, and all guests who are here with us, good afternoon.
Chairperson, before getting into the substance of this Budget Vote, I would like to take this opportunity to say, on behalf of all of us here, that we really appreciate the work that was done by my predecessors, Dr Zola Skweyiya and Dr Jean Swanson-Jacobs, for the able leadership that they provided in this department and in this portfolio, in particular.
Social Development is tasked with tackling daily challenges afflicting society's most poor and vulnerable people. South Africa's poor, like their counterparts in most parts of the world, face additional challenges on account of the current global financial crisis, which is resulting in a humanitarian crisis, because, indeed, whichever way we look at it, the crisis that we are facing now is a humanitarian crisis. During these past few months, hundreds of thousands of jobs have vanished and hundreds of thousands of houses and other properties were lost, and consequently, the living conditions of the poor and the most vulnerable have indeed worsened.
The additional challenges being visited on the poor necessitate that we, as hon members gathered here today, deployed here in this Parliament and this National Council of Provinces, must deepen our socioeconomic responses, particularly as government responses to this crisis and, thereby, keep us steadfast in the pursuit of the goal of creating an inclusive and a caring society. As stated by our President in his state of the nation address, "We shall not rest; we dare not falter in our drive to eradicate poverty".
Before elaborating on our responses to the current humanitarian crisis, Chair, and also providing some details of our programmes and interventions, I wish to reaffirm the need for the social development sector, inclusive of all the national departments, our public entities and civil society organisations, to work in partnership. Partnership is indeed necessary, and I'm also referring to our nongovernmental organisations, NGOs, who are up there in the gallery.
Chairperson, last week I met with the MECs responsible for Social Development; some of them are here in this august House. In that meeting we assessed the progress made and also appreciated the tasks that lay ahead us. Collectively, we agreed that we need to work together and much harder as a single unit towards the fulfilment of the hopes of all South Africans to enable them to realise their own ambitions.
Social Development is a concurrent function, as we all know, which is performed by national and provincial departments. On the one hand, the national department, in line with its constitutional mandate, provides policy direction and oversight for service delivery. On the other hand, the provincial departments are responsible for service delivery, mainly in partnership with civil society organisations, hence this necessity for us to become one unit.
It is the policy of our department to ensure that we provide policy leadership and lend support to our provincial counterparts to enable them to improve service delivery in a manner that attains our policy and programme objectives. This commitment, Chairperson, can be seen in the increase of the expenditure on the number of new policy initiatives that speaks to our goal of creating a caring society and, indeed, also creating a better life for our people.
Our close co-operation with the provinces in the past few years has seen marked improvement in the provision for developmental welfare services, the diversification in the methods used to deliver such services, as well as the enhancement of quality. We will continue to accelerate the implementation of key pieces of legislation such as the Children's Act, the Older Persons Act, and the Prevention of and Treatment for Substance Abuse Act, amongst many others.
The impact of the financial crisis that I spoke about earlier on has been much deeper than expected, highly devastating indeed to many, and very destructive in its severity in respect of those who are on the margin in particular. We all must rally to the President's call for a decisive response. Drawing on the National Economic Development and Labour Council, Nedlac, framework agreement, on the response to the financial crisis, Social Development is rolling out a package of interventions.
At present, we do know, as a matter of fact, that over 13 million South Africans receive social assistance benefits, and of these beneficiaries, nine million are children. Whilst concerns may remain about the affordability and sustainability of this particular programme, it is undoubtedly government's most effective poverty alleviation intervention, no doubt about that. It is important, therefore, to remember also that section 27 of our Constitution makes the provision of social assistance an obligatory function. It makes it obligatory. The state can't look away from that; we are obliged to help those who are needy.
We have increased the age of eligibility for the child support grant to children up to 15 years in January this year, as was announced, and 70 000 men have benefited from the old-age pension as a result of our phased process towards equalisation of pensionable age between men and women at 60 years. At present it is from 61 years, those who are eligible for the old- age grant. We are moving towards that, and next year men and women will all be eligible for the old-age grant at 60 years of age. [Applause.] Over the medium-term, we will gradually extend the child support grant to children up to 18 years as it is policy and a requirement.
As from April this year, the values of grants were increased to ameliorate the impact of inflation. The old-age grant and disability grants were increased from R960 to R1 010; the child support grant from R230 to R240; the foster care grant increased from R650 to R680 and the care dependency grant from R960 to R1 010, obligatory measures.
In order to intensify the fight against child poverty, we will register an additional 20 000 children under 15 years by the end of August 2009. We will soon table a plan for the phased extension to 18 years of the child support grant to be implemented over the current Medium-Term Expenditure Framework, MTEF, cycle. I don't hear what you are saying; you will have your chance to stand here, please. [Laughter.]
The budgetary allocation for the provision of social relief of distress was increased fivefold by means of a special allocation in November 2008 as part of government's response to rising food prices and the resultant adverse socioeconomic circumstances that our people face. The special allocation increased the social relief budget from R124 million to R624 million. The rapid distribution of this additional fund, that allocation that we received, bears testimony to the positive co-operation between the national and provincial Departments of Social Development. The R624 million enabled us to reach a good number of 765 347 people through cash and in- kind benefits, particularly those not covered by the social assistance grants. These are needy people who have nothing.
From November last year to April this year, 568 909 food parcels and vouchers were issued to eligible poor households, 128 746 school uniforms were issued to eligible learners from poor households and 35 679 cash payments were made to other eligible beneficiary households while 32 013 eligible individuals received other forms of in-kind assistance in the form of blankets and so on. We will seek to augment to our resources and enhance our abilities to reach people who suffer undue hardships not of their own making. In partnership with the provincial departments of social development, we will explore working with faith-based organisations and NGOs, all in good standing also, to assist in the distribution of social relief to those in distress. This year we will introduce into Parliament a new Bill which is intended to amalgamate various relief programmes, being administered by the Department of Social Development. Of course, relevant consultation will take place, and this Bill will provide for the delegation of the administration of such relief programmes to the provincial Departments of Social Development, which will support and exercise oversight over it. We will also exercise support and exercise oversight over this programme.
Chairperson, with respect to improving the livelihood of the poor, our department will support community-based organisations and institutions that work towards the overall wellbeing of our people. This includes supporting community foundations and organisations which are involved in advocating for women's rights, women's protection and safety, as well as their inclusion in the economic activities of our country. And I want to say, whilst I'm here, that I may not say lot about issues of welfare, but the Deputy Minister will allude to those issues.
The department is also working with the Community Food Bank Network of South Africa and the Global Food Banking Network to pilot the food bank concept in our country. Four community food banks, which are already in place situated in Durban, Port Elizabeth, Johannesburg and one in the rural village of Umkhanyakude District are being supported through this initiative. I welcome the private sector's contribution to complement government's efforts towards the war on poverty, and I take this opportunity to appeal also to other sectors of our society to partner with us in this campaign.
Chairperson, clearly the antipoverty strategy and its concomitant war on poverty campaign are part of government's overall attempts to improve the livelihood capabilities of our people, and I hope somebody from Cope is listening, especially the speaker just before me. [Interjections.] Here too, our department has specific contributions to make. Our task in this respect is to collate information on the needs of households and communities in 150 wards so that government can respond to those needs adequately and systematically. And it is not only needs about grants, but also needs about what we can do to alleviate poverty and to actually make people able to fish for themselves instead of us, government, fishing for them. This we will do in partnership with provincial Departments of Social Development as well as, relevant civil society organisations and the Independent Development Trust, IDT, working through community development workers and Masupatsela Youth Pioneers, and I will speak about this Masupatsela later, in a few minutes' time.
The second phase of the Expanded Public Works Programme is important to our efforts in creating job opportunities for the poor. Our department will continue to co-ordinate training of an additional 1 500 community caregivers and over 25 000 early childhood development practitioners for our home-based or community-based care and early childhood development, ECD, programmes.
Chairperson, the issue of early childhood development may be one of our department's most important contributions to the challenge of promoting sustainable livelihoods and reducing intergenerational poverty over time. I hope also that the hon member from Cope understands that we are working on dealing with intergenerational poverty, even when we are providing food parcels. Early childhood development is indeed part of government's long- term goal on investing in human capital, which is pivotal to any society's efforts to beat systemic poverty. We will accelerate the registration of ECD sites from the current 13 743 to 14 401 and increase the number of children in registered ECD centres to 758 000. These goals, Chairperson, are informed by the ideal that everyone counts and everyone has a purpose in life, and, yes, everyone is significant.
We need to pay attention to developing our youth. The most critical aspect of our work with young people is to empower them, to instil the spirit of patriotism in them and also to ensure that they achieve citizenry. It is for this reason that we are implementing a programme called Masupatsela Youth Pioneer Programme as part of our broad national service programme. To date, 2 114 youth pioneers were recruited into the programme, while over 1 780 of them took part in the war on poverty initiatives throughout our country. We will support provinces in the creation of programmes and directorates that are specifically dedicated to youth matters and ensure that their concerns are treated with the attention that they deserve.
Chairperson, we are embarking on strategies to improve our institutional capabilities to better respond to, and indeed also to protect the poor from the adverse effects of poverty. This includes improving the capacity of the South African Social Security Agency, Sassa, as a key service delivery institution. A thorough business process re-engineering initiative will be implemented here in Sassa in order to, amongst other things, ensure that we improve the turnaround time for processing grant applications. I am saying amongst other things; we will do many things through this business process re-engineering, BPR.
We are working with the Post Office as well, on measures to reduce the cost of grant payments. My time is up. Unfortunately, I still wanted to talk about occupation-specific dispensation, OSD, but I'll find a way of dealing with those issues. Thank you very much. [Applause.]
Hon Deputy Chairperson, hon Ministers of Health and Social Development, hon Deputy Minister of Social Development, MECs from different provinces, hon members, special delegates, ladies and gentlemen, good afternoon.
As you know, 11 days from now Mr Nelson Rolihlahla Mandela will turn 91. People of the world and our country will celebrate the life of this great leader, the icon of our struggle, a legend, a trendsetter par excellence, a true patriot and a hero of our people. It is therefore correct that all of us should join hands and heed the President's call to celebrate 18 July as Mandela Day. It will indeed be a fitting tribute to this great leader of our people.
I am indeed privileged and humbled to participate in this Budget Vote debate of the Department of Health. The Minister's speech refers to continuity, innovation and decisiveness on the urgent steps we need to take to improve our country's health care system. As the Free State province we are combat-ready to implement the issues, as continually raised by the Minister on different platforms, in the aftermath of this global economic meltdown. To us this means the application of new methods of doing things without compromising our priorities.
Our people have overwhelmingly renewed our mandate and they have understood the call that together we can do more. They also believe that together we can create decent work and sustainable livelihoods, that together we can implement a comprehensive rural development strategy, agrarian reform and measures of food security, and also that together we can create a health care system which promotes a healthy nation able to participate in a developing society.
As the Free State health department, we are a service point for 364 589 patients in our district hospitals. Over six million patients visited and were treated at our primary health care facilities. We have progressively expanded accredited locally based sites to provide comprehensive care and treatment for HIV and Aids patients. We have surpassed the 90% national average on immunisation. Our province has the second highest TB cure rate and the lowest TB default rate in the country. All our districts have fully functional governance structures with health plans linked to IDPs.
Whilst preparing for our Budget Vote, which is scheduled for 22 July, the following areas will remain at the top of our agenda this financial year. These are sustainable medicine and antiretrovirals, ARV, roll-out; revamping our health care infrastructure and medical equipment for our facilities; revamping our emergency medical services; reorganising our nursing college and recruiting new ones; promoting primary health care; improving our patient information management system; and improving access to rural health care, including building and consolidating our relationship with traditional healers through the traditional health practitioners' forum. We will articulate our plans clearly when we present our Budget Vote on 22 July, as I indicated earlier.
It would be unfair of me to leave this podium without setting the record straight on what has been an element of entertainment by opposition parties, especially Cope, when they took part in the Budget Vote debate in the National Assembly. This was with regard to an issue that has been in the public domain: the provision of ARVs in our province. We do acknowledge that there were challenges, but despite the negative publicity that was given, we can say proudly that the target of 27 000 we set for ourselves was achieved far beyond ...
A point of order, Chairperson.
Just hold on. Yes, hon member, what do you want to say?
Hon Deputy Chairperson, in terms of the Rules of the House, the hon member is not allowed to refer to a previous debate or a debate in another House. Thank you. [Interjections.]
Okay. That's fine. Continue, hon member.
Thank you, Deputy Chairperson. Despite their negative publicity, we can say proudly that the target of 27 000 we set for ourselves was achieved far beyond our expectations by the financial year- end of 31 March 2009. As the financial year was drawing to a close, more than 35 000 people were on our programme and many thanks go to our national Department of Health and our ANC-led government, not forgetting our donors, for lending a hand during difficult times when the provincial department was faced with a financial shortfall in coping with the numbers that were on the ARV programme, while striving to serve those who were in dire need.
We are determined to maintain this record and make our contribution towards the achievement of reaching 80% of people in need of ARVs by 2011. Our own Operation Hlasela, launched by our premier during his state of the province address, will be our battle cry in achieving our objectives for better health care services - from overhauling our supply-chain management to auditing skills in supply-chain management. With this we will indeed also be looking at the efficiency of our management and personnel in responding to the call that laziness will not be tolerated this time around.
I would also like to extend our appreciation to those doctors in my province and other provinces who stood by their oaths and declarations as the department and unions deliberated issues of salaries. We are humbled by their humane gesture by continuing to serve our people with dignity. In closing, allow me to quote Madiba:
The time comes in the life of any nation when there remains only two choices - submit or fight. That time has now come to South Africa. We shall not submit and we have no choice but to hit back by all means in our power in defence of our people, our future, and our freedom.
Our time has arrived to fight for optimal quality health care services for those living under the South African sun and the Free State as a province. I thank you. [Applause.]
UMntwana M M M ZULU: Mgcinisihlalo, amaLungu ahloniphekile ale Ndlu, abahlonishwa oNgqongqoshe namaPhini abo, oNgqongqoshe bezifundazwe abakhona ikakhulukazi abasekhaya uMkhabela nawe Bhungane - enethunga ayisengeli phansi. Bafowethu ngiqale lapha eMnyangweni Wezempilo ngoba kuyiMinyango ecishe ihlanganiswe noma ihlukene nje. Ngithi uMnyango Wezempilo ungumgogodla ngoba welapha bonke abantu abagulayo ngazo zonke izindlela.
Ngithi kuMhlonishwa uNgqongqoshe laphaya ezindaweni zethu emakhaya, abathi eMpumalanga Koloni kusezilalini, kuyofuneka ukuba uMhlonishwa uNgqongqoshe abhekisise ukuthi imitholampilo ikhona yini kuzona zonke izifundazwe. Ngoba asikho isifundazwe esizimele esingeke silawulwe nguwe njengoNgqongqoshe ophathiswe lo Mnyango. Ngoba uma kukhona okonakalayo siyobe sesifaka kuwena isibhaxu njengoNgqongqoshe ophethe lowo Mnyango, wena-ke bese usifaka ezinganeni zakho.
Bese ngibuye ngithi Mkhabela angisho ukuthi ngithini. Inkiyankiya owangena phezu kwayo eMnyangweni owuphethe ngokutholakala kokuthi kukhona okungahambanga kahle ekukhishweni kwamathenda, ngiyocela ukuba uNgqongqoshe akubhekise ngoba okuyihlazo nje singeze sakuvuma ukuthi kuqhubeke ezweni lakithi. Ngoba uma singaqhuba amahlazo ezweni lakithi ngabe siqonde ukuthi leli phupho elishiwo nguMongameli wezwe lingafezeki.
Ukungena-ke kwabahlonishwa kulezo zinto lezo angikuthandisisi kahle ngoba siyabahlonipha basuke beqokwe ngokwamakhono abo bahambe bayosihola khona. Bese ngithi kuMnyango Wezokuthuthukiswa Komphakathi, Mhlonishwa Ngqongqoshe eMnyangweni wakho ngiyazi ukuthi ungene ezicathulweni lapho bekuphethe khona indoda umhlonishwa uDokotela uZola Skweyiya.
Namanje-ke ngiyasho ngithi laphaya kwesikababomkhulu isifundazwe - angithengi amehlo ngoba mina angiyena uthengamehlo - uBhungane ubesawuqhuba kahle umsebenzi kulezi zinsuku esikuzo ondla labo bafelokazi nalezo zingane ezashiywa ngabazali bebulawa yisifo socansi ingculaza kanye nezinye-ke izifo kubantu abasuke bekhathazwe yizifo ezisuke zibaphethe ngokwenyama.
Ngithi-ke lo Mnyango wakho kulesiya sifundazwe ngokwami nje njengoMuntukaphiwana kaBantubathini kaSolomi kaDinuzulu ngikubona kusewumsebenzi oqhubeka kahle angeke ngaqamba amanga ngoba ngikolunye uhlangothi bese ngithi umsebenzi awusetshenzwa kahle. Bese ngithi-ke kodwa okufanele kubhekisiswe yilabaya bantu abakwizikhungo eziholelayo. Kufanele nibanikeze phela Ngqongqoshe noNgqongqoshe abakwizifundazwe ithuba lokubeka imibono yabo ngalezo zikhungo ngoba zisebenzisa izimali zomphakathi, ziphakela umphakathi egameni likahulumeni. Ngiyathokoza. (Translation of isiZulu speech follows.)
[Prince M M M ZULU: Chairperson, hon members of this august House, hon Ministers and their Deputies, the MECs who are present here today, especially those who come from my province, namely Mkhabela and you, Bhungane - we should not suffer because we have the resources. Gentlemen, let me start with the Department of Health because it looks like an integrated department, although it isn't. The Department of Health is the backbone because it treats everyone who has any kind of illness.
Hon Minister, you must check if all the rural areas in each province have clinics, especially in the rural areas where some of us come from, which are referred to as ezilalini in the Eastern Cape. Because no province is independent from you as the Minister in charge of this department. If something goes wrong, we will hold you accountable as the Minister who is in charge of this department and you will also hold your subordinates accountable.
And coming to you, Mkhabela, I don't have much to say because you were placed in a department that was in a mess when it was discovered that there had been a scandal with the awarding of tenders. We will therefore request the hon Minister to look into that because we cannot allow such things to go on in our country. If we allow such scandals to go on in this country, we would be responsible for causing the President's vision not to be realised.
I don't like the involvement of Ministers in such scandals because of the respect we have for them, and they were also appointed to those positions because of their expertise so that they can lead us. And when coming to the Department of Social Development, hon Minister, I know that you stepped into the shoes of a man among men, Dr Zola Skweyiya.
In my grandfather's province - I am not merely putting in a good word for him here, because I am not like that - Bhungane is doing his tasks well so far by taking care of the widows and those orphans who lost their parents due to Aids, as well as other illnesses which attack people physically.
I am therefore saying that according to me, Muntukaphiwana, the son of Bantubathini of King Solomon, the son of King Dinuzulu, your department in that province is doing well so far and I cannot just tell lies because I am from a different party by claiming that the job is not done. But I wish to say that you need to look into those structures which are paying out state grants. Hon Minister, you must also give the MECs a chance to air their views with regard to those structures because they use public funds, and they also render a service to the community on behalf of government. Thank you.]
Hon Chairperson, Ministers and Deputy Ministers, MECs from various provinces, good afternoon. It is true that the Department of Health has to promote the health of all the people of South Africa through an accessible, caring and high quality health system based on the primary health care approach. This aim must be achieved.
With the budget allocation of R17,5 billion for the 2009-10 financial year, we want to see the department ensure that its 10-point plan is implemented without any excuse, such as lack of capacity and human resources.
I heard during his presentation here that the Minister is very serious about seeing his department implement the 10-point plan. We'd appreciate it, hon Minister, if you could ensure that that happens, for the sake of South Africans.
Let me just highlight some aspects that have been reflected in the 10-point plan which we will ask the committee to pay attention to. Of course the Minister has touched on other aspects, such as the finalisation of the National Health Insurance and the implementation plan and improving the quality of health services which, of course, in terms of the 10-point plan, will focus on 18 districts.
We will also pay attention to the strengthening of community-based leadership structures in health through the training of hospital boards. If we don't have hospital boards that are trained - that know what to do and what their responsibilities are - then we are in for it.
We will also pay attention to the establishment of a well-capacitated office of standards compliance. We will also focus on strengthening management by enrolling 150 chief executive officers of hospitals into the hospital management training programme, as well as the revitalisation of infrastructure.
We will guard against shoddy work by most of our building contractors. We will pay attention to that and we will ensure that your department supports provinces in implementing and reporting on the health lifestyle strategy in all 52 districts.
With those few words, we support the Budget Vote of the Department of Health. Bjalo ke tla go Kgoro ya Tlhabollo ya t?a Leago. Modulasetulo, ntumelele ke thome ka go tsopola baswana ge ba re kgomo ga e latswe namane ya e ?ele; e ka seke. Na se se ra goreng? Ke kgopela gore mohlophegi Tona, ge a ka kgona, a hlalose taba ye moragonyana ge a efa phetolo.
Hlogo ya Naga ge a bolela le set?haba sa Afrika-Borwa le lefase ka bophara mo mat?at?ing ao a fetilego, o bolet?e a ahlame ebile a sa met?e le mare, a laet?a boitlamo le boikgafo bja mmu?o go hlabolla le go kaonafat?a maphelo a badudi bja wona, kudu ba dikobo di magetleng. O t?wet?e pele ka gore, gome ke a mo tsopola:
Le ge re ka t?wela pele ka seemo sa go hlola dikgoba t?a me?omo le t?a kgwebo, re swanet?e go tseba gape gore go na le badudi bao ba tlago t?wela pele go nyaka thu?o ya t?helete ya go iphepa mmu?ong. Thu?o ye ya t?helete ya go iphepa ke mokgwa wo o ikemi?edit?ego go fedi?a le go fokot?a bodiidi set?habeng sa ga borena. Kgweding ya Hlakola - Mat?he- ka di-31 go be go ?et?e go na le batho bao ba fetago dimilione t?e 13 bao ba amoget?ego thu?o ya t?helete ya go iphepa, gomme gareng ga batho ba, ba go feta dikete t?e 8 ke bana.
Ke mo tsopot?e. Monatsebe a kwe a kwele ruri.
Lehono re eme mo pele ga set?haba gomme re begela Ntlo ye ka ditekanyet?o t?a thu? o ya t?helete ya go iphepa. Re re di feti?we gomme di ye go ?omela set?haba sa rantsho go ya ka lenaneo la kgoro morago ga gore lenaneo leo le begwe ga komiti. Lenaneo le le hlalosa ka bophara ditekanyet?o t?a ngwaga wa dit?helete wa 2009-10 le lenaneokgoparara la go fihla ka ngwaga wa 2014. Komiti e t?weledit?e dintlha t?e di latelago go kgoro: Go kgaot?wa ga thu?o ya t?helete ya go iphepa balwet?ing ba bangwe; go se ?ome ga dikliniki diiri t ?e 24; go hloma diboto t?a maokelo; le thu?o ya go bala dit?helete t?a bat?ofadi mafelong a go lefela, fao e lego gore bat?ofadi ba ga borena ba a lla gore dit?helete di na le go se balwe gabotse.
Re le maloko a komiti, re thekga ditekanyet?o t?a kgoro t?eo di fihlago go R64 milione. Re tla lebelela t?homi?o ya ditekanyet?o t?e ka leihlo le nt?hot?ho. Re na le lehut? o la go feta legonono.
Ge ke felelet?a, ke rata go tsebi?a ba mekgatlo ya kganet?o gore taba ya dimilione t?e 13 t?a batho bao ba filwego thu?o ya t?helete ya go iphepa ga se nke e diragale mmu?ong wo o fetilego - mmu?o woo ba bego ba o thekga. Ba be ba godi?a bat?ofadi ba ga borena ka morago ga kgwedi t?e tharo. Lehono bat?ofadi ba ga borena ba gola kgwedi-ka-kgwedi. Ke a leboga, mohlomphegi Modulasetulo. (Translation of Sepedi paragraphs follows.)
[Now I would like to touch upon the issues in the Department of Social Development. Chairperson, allow me to start by quoting a proverb of the elderly which says that a cow does not lick a calf which does not belong to it; it doesn't. What does that mean? I would like the hon Minister, if she can, to explain this later on in her response.
During his state of the nation address a few days ago, our Head of State spoke loudly and clearly, indicating government's commitment and dedication to develop and improve people's lives, especially those of the poor. He went on to say, and I quote:
While creating an environment for jobs and business opportunities, government recognises that some citizens will continue to require state social assistance. Social grants remain the most effective form of poverty alleviation. As of 31 March 2009, more than 13 million people received social grants, more than 8 million of whom are children.
I have quoted him. The message is loud and clear. Let it be borne in mind.
Today we stand before the public reporting to the House on the budget allocated for social grants. We request that the budget be approved so that the public can get assistance according to the departmental programme after it has been reported to the committee. This programme explains in detail the appropriation of funds for the financial year 2009-10, as well as the major programme up until 2014. The committee has raised the following points to the department: Termination of social grants for certain patients, non-operation of clinics for 24 hours, establishment of hospital boards and assistance with regard to counting the old-age grant monies at various paypoints where our elderly usually complain that their monies were not counted properly.
As members of the committee we support the departmental budget of R64 million. We will monitor how it is used, but we are very hopeful that it will be used appropriately.
In conclusion, I would like to inform the opposition parties that the fact that 13 million people are receiving social grants is something the previous government could not achieve - the very same government they were in favour of. The elderly only received their grants after three months. Nowadays they get it on a monthly basis. Thank you, hon Chairperson.]
Chairperson, hon members, Ministers present here, Cope acknowledges that departments have to contend with the fact that funding for health services and social development can never be sufficient to match the demand for quality health services and social support systems.
We accept that government's policies on social development and health care are well intentioned but misguided. For many years, tax revenue ran ahead of targets. This emboldened government to expand social grants. Now that the tax revenue has fallen, government has to fund expenditure from borrowings. When this is projected forward, it means that borrowings will have to be serviced; grants payments will have to be increased; and costs will exceed revenue by larger and larger margins.
There has been a public outcry that many women become pregnant purposely in order to access grants. [Interjections.] We said that the Minister should actually develop a strategy to look into this matter because it's a very serious matter.
Every weekend, people abuse alcohol and drugs, and many end up as casualties in hospital wards. Encouraging a healthy lifestyle has never been a key plan in the government's policy framework.
Cope believes that a strong and cohesive community will prevent many of the problems with which the taxpayer is burdened. A healthy community is less taxing on the health system. A socially cohesive society is less taxing on the social support system. By fixing communities, government gets to fix the cause and effects of a multitude of problems all at once.
The Department of Social Development has a constitutional obligation to respond more effectively to the material and social needs of the poor. This is highly commendable. However, ordinary people don't want to hear what the department's key priorities are. They want to see actual delivery. They want details in respect of the number of youth and ... [Time expired.] [Applause.]
Deputy Chair, good afternoon. It's good to be back here, colleagues. I want to greet the Ministers respectively: The Minister of Health and the Minister of Social Development, the Deputy Minister of Social Development, my colleagues from the different provinces and members of this august House.
I think it is silly to suggest that the young women who get pregnant do so because they want the R240 child support grant. You must find out what it means to raise a child and what it means for a woman to fall pregnant, instead of coming here to make uninformed political statements.
We speak to a number of these women at the paypoints where they get their grants. One of the things that we have committed ourselves to doing in the province is to engage these women by putting them through skills development programmes to help them get out of the system.
It is important to get hold of the missing fathers. The state is not the father of these children; they have their fathers. We understand where men are not employed, the state must take responsibility, but where fathers are employed, maintenance courts must look for them and make sure that they maintain their children; it is not our responsibility to do so.
The ANC election manifesto is unequivocal about the tasks that are supposed to be undertaken to ensure that health outcomes in South Africa benefit the poorest of the poor. The commitment made in the 2009 election manifesto is informed by the consultation we've had with different stakeholders. Indeed, we have a mandate from the people of South Africa to say the sort of things we are saying.
When the hon Minister spoke in the National Assembly on 30 June 2009, he tried to deal with some of the problems that bedevil the health system in the country as a whole. Therefore, I will not bore you with some of those details, which are the same across all provinces.
However, we've begun a process of having a strategic partnership with DPSA and service providers from the private sector, and those are Netcare, Medscheme and Lifecare, to bring them on board regarding what we're trying to do in the province. I can guarantee you that in the next two years you're going to see significant changes in the province. When people go to clinics and hospitals, they will be given good quality health care. They will no longer stand in long queues at pharmacies, because the systems are going to change for the better.
We acknowledge that resources are not going to be enough. What is important is for us to make sure that the resources allocated to the department of health and social development in the province are used for the benefit of the citizens of our province.
Again, in terms of the manifesto, we committed ourselves to dealing with the issues of management and provide leadership in the health care system through Operation Kuyasheshwa La, for instance, which we launched about two weeks ago. According to the programme, we must stabilise and improve the health care system, and we must make sure that it is sustained. If we do not stabilise, improve and sustain it, we will simply be working backwards.
We are committed to making sure that the issues that are identified, such as linen management, equipment, maintenance of infrastructure and the distribution of medicine, form the core of the work of providing health care. These issues further include the personnel: doctors, nurses and allied health workers across the board. The province is committed to this.
However, the fact that citizens generally prefer to be treated in hospitals rather than in clinics or in the community health care centres is also our continuous concern. To that end, we have introduced family physicians in the district health system to make sure that we strengthen the primary health care system in the province. Many people, as I said earlier, believe that when they are sick they must be seen by a doctor. The introduction of the family physician is to ensure that when people present themselves at these facilities, there will be a doctor that will see them 24 hours a day. We are extending hours in many of these community health centres and in some clinics, particularly where the volumes are high.
We are also looking into making sure that the hours of operation are extended and that clinics do not close at 15:00 in the afternoon. Instead, they must close at 19:00 or 21:00 in the evening, and open some Saturdays. We believe that, by doing so, we'll be giving the citizens in the province better health care.
We'll continue with our efforts to strengthen the prevention of mother-to- child HIV transmission. I think it is also relevant to indicate that when we came to power we were aware that the issue around mothers who didn't get the baby formula was a big story. It is important to note that the systems have been stabilised and that we are in the process of making sure that all key service providers in the province are paid, so that we don't end up at the same point as when we began our term.
The programme is being implemented across the province and we are planning to increase the numbers in the province from the current 185 000 adults and 15 000 children to about 250 000 people by the end of this financial year, that is March 2010. We'll accredit 10 more sites for antiretroviral treatment and increase the total number of sites from the current 66 to 76.
In terms of the election manifesto, we are also committed to decreasing the new infection rate by 50%. We are working with all municipalities to make sure that the resources allocated to municipalities in the province go to the programmes aimed at creating awareness around testing so that people can continue to test for HIV.
Throughout the province, testing is done in any government facility. On Monday we were at Thembisa, at one of the paypoints for old-age pensioners. We provide health care services there. Old-age pensioners can now test for blood pressure and so forth. We intend extending these services to shopping malls, particularly at the end of the month because there are many people who pass through those shopping malls.
If we were to extend those activities, we would be in a position to make sure that people know their status, not only for comfort purposes, but also to be able to get the necessary treatment.
Chair, I have a few more issues to deal with. As I said at the beginning in response to Cope, as social development, we have committed ourselves to making sure that all the young mothers that receive the child support grant are linked to the Department of Labour. This is done through any EPWP, Expanded Public Works Programme, in the province and is aimed at making sure that these young mothers are given skills and are in a position to get jobs on their own, without relying on the state.
We are also working very closely with professional women's organisations and the private sector, which came forward and offered to work with us. We are in the process of finalising our plan for these women, including exploring an arrangement in terms of which we let them handle some of the services provided in hospitals, such as doing the laundry, catering, running the kitchen and cleaning services.
Maybe we should be establishing co-operatives. We've begun work with a number of women in the province, and they should be travelling to KwaZulu- Natal to learn what that province has done in terms of running hospitals.
We are well in advance in terms of the public-private partnership projects that we want to implement in the province. These relate to hospitals in particular, as well as making sure that all the hospitals that are in operation in Gauteng are in a good state of functionality wherein patients can recuperate.
We are conducting a feasibility study in the province with the aim of making sure that the hospitals that were closed some time ago are reopened. Currently, we are running short of space, particularly for ICU beds and for other general admission purposes. Hence the headlines about Gauteng from time to time; we are trying to manage space.
We are a province that is friendly to children, from Grade R up to the age of 14. The province has a programme called Bana Pele under Social Development. That programme is meant to assist the most vulnerable children. We provide school uniforms for those who get to Grade 1, as well as a nutrition programme. Children also have access to free health care. As you know, former President Mandela introduced this programme in 1994. Government provides scholar transport for those who live more than 5km from school.
Lastly, the other important issue that is going to be a major focus for us in the next five years is making sure that care for the elderly in the province is not left to chance. The majority of senior citizens to date is not cared for properly in our society.
We have clear programmes, and we have worked with different organisations, including the veterans' league. We want to ensure that old-age pensioners who are currently on the waiting list are admitted to the old-age homes that are currently available. Thank you very much. [Time expired.] [Applause.] USEKELA NGQONGQOSHE WEZOKUTHUTHUKISWA KOMPHAKATHI: Mphathisihlalo, Ngqongqoshe Wezokuthuthukiswa Komphakathi, uNgqongqoshe Wezempilo, ozakwethu abaphuma ezifundazweni, Abahlonishwa bethu, izihambeli zethu ikakhulukazi omama ... (Translation of isiZulu paragraph follows.)
[The DEPUTY MINISTER OF SOCIAL DEVELOPMENT: Chairperson, Minister of Social Development, Minister of Health, colleagues from the provinces, hon members as well as our guests, especially the women ...]
... I would like to join the hon Minister in extending my gratitude to our predecessors, the hon Dr Zola Skweyiya and Dr Jean Swanson-Jacobs. The ANC recognises that poverty, unemployment, violent crimes against women and children, and the increasing number of orphans and vulnerable children, as well as the increasing level of substance abuse in our communities remain areas of major concern.
Our work during the current Medium-Term Expenditure Framework, MTEF, period is geared at addressing many of these challenges. Today, through unity of purpose, we must prepare to implement our progressive social policies embodied in the provisions of various pieces of legislation that were passed over the last 15 years in order to realise the goal of creating a caring society.
The scourge of substance abuse constitutes a great threat to the wellbeing of our society. Only last week, law enforcement authorities intercepted a large consignment of illegal drugs with a street value of more than R10 million. Had those drugs reached their destination, they would have destroyed countless lives, especially those of young people, leaving families shattered and in need of reconstruction services.
Two weeks before that, police shut down a number of illegal drug manufacturing sites in and around Cape Town. There is no doubt that our law enforcement agencies are growing equal to the challenge. There is, however, a great need for more work to be done to bolster the provincial substance abuse forums and community structures: in this case the local drug action committees.
Today dagga, alcohol and methamphetamine are still the most abused substances in South Africa. Methamphetamine is what they call tik. And, as I stated during the debate in the National Assembly a few days ago, our focus will be on reducing the demand for drugs and support for treatment. And in this regard we will continue with our effort to strengthen the implementation of our drug prevention initiative known as Ke Moja - I am fine without drugs - campaign, which targets young people through arts, sport and the transfer of critical life skills.
Equally important is the prevention of substance abuse in the adult population and, in this regard, we are developing a prevention model specifically targeting adults. Research shows that alcoholism and multiple drug abuse have been associated with the alarming rate of crime and exposure to violence. If we can deal with this problem successfully, we will simultaneously address associated problems such as crime, unwanted teenage pregnancies and HIV infections.
The 52nd conference of the ANC in Polokwane recognised that children are the future of our country and that, accordingly, mergers to invest in their development have to be given priority. Our contribution to this commitment is geared towards tackling child poverty and the provision of child protection services. The department will implement the new Children's Act which introduces the fundamental changes with regard to the protection of the constitutional rights of children in South Africa.
The increasing number of children who are orphaned in this country requires us to utilise all available options and resources to provide for these children not only with alternative care, as in the form of foster and residential care, but with a stable permanent home environment through natural adoption by South Africans themselves.
We know that the numbers of adoptions remain very low, at an average of 2 000 per annum, compared to the number of foster care placements, which stand at more than 450 000. We also know that there are large numbers of children, approximately 15 000, who are moved away from home to residential facilities at any given time, and that many of these young people have been away from home for over a year and are unlikely to be able to go back.
We are rightly putting these children at the centre of our work and we will make several suggestions to improve the handling of orphans and the vulnerable children in this country. We will among other things go out on a campaign to encourage South Africans to adopt children who need permanent placement, and develop a register of adoptable children and adoptive parents. This will ensure that all children who are vulnerable and eligible for adoption are known and matched with prospective parents in South Africa.
We are also undertaking research to determine reasons for the low interest of South Africans in adopting children. I should emphasise that we do not see adoptions as replacing foster care-foster care should remain part of our legal system as it provides a uniform of security with the best outcomes. Through these interventions, we are therefore putting the family at the centre of our strategies to deal with challenges facing children and the society as a whole.
The protection of orphans and vulnerable children is of great significance to us. In this respect, we will continue working with our partners through the National Action Committee for Children Affected by HIV and Aids to improve the quality of our services to children affected by HIV and those living with Aids. We will also develop strategies which outline the kind of support we will lend to child-headed households.
The Minister had spoken about the impact and progress we made in increasing the number of children who are receiving the early childhood development, ECD, services. And we need to improve on the accessibility of this service to children in rural areas. Our plan is to mobilise rural communities in order to support them in the establishment, the registration and the subsidisation of the ECD centres and programmes, because rural children's rights are equal to those of urban children.
The rate of child abuse, neglect and exploitation in this country is disturbing. To this end, the department will contribute to efforts of mobilising communities to take a firm stand against violence and other crimes committed against children. Our society needs the full involvement of our young people in its remaking. We therefore need to develop strategies of taking children away from criminal activities that put them in conflict with the law.
We agree with the hon Mahlangu that caring for older persons and the protecting their rights is important. During this financial year we will expedite the implementation of the Older Persons Act of 2006 to improve delivery of social services to older persons and develop programmes that are designed to ensure that our elderly are not alienated from their communities. They still have a role to play in our communities and they still have a role in transferring or transmitting positive cultural values, which contribute towards social cohesion in families and communities.
It is encouraging to see that some provinces, like the Western Cape, are setting up recreational activities for older persons. We want to see all provinces embracing the concept of Golden Games and making this an annual campaign solely to honour senior citizens ... I still have 20 seconds, Chairperson ... Thank you very much. [Time expired.] [Laughter.] [Applause.]
Hon Chairperson and all protocol observed, it is a privilege to address this House on the occasion of the Budget Vote for Health. We have made a great deal of progress, but much still has to be done, and the ANC-led government is determined to deliver on its election promises. In this regard, we will be working harder to deliver on the mandate the majority of South Africans gave the ANC.
Our health reform strategy aims to improve performance, efficiency and optimal quality of service. To achieve this it requires improvement in management, performance monitoring and accountability.
As part of the 10-point plan for health there will be a review and refining of the department's human resource plan for health that is due for completion by March 2010. The Department of Health will then assist provinces with finalising their plans.
We welcome this commitment, which is in line with the research commissioned by the Department for Public Service and Administration, DPSA, in 2005 and also the research undertaken by the National Labour and Economic Development Institute, Naledi, on behalf of Nehawu, which was titled, "Transforming Chris Hani Baragwanath into a people's hospital." Chris Hani Baragwanath is the biggest hospital in the southern hemisphere and, as a test case, is plagued by staff shortages, lack of funding, resource mismanagement, low staff morale and poor accountability.
If the 10-point plan is implemented, it will address the issue of doctors leaving patients after operating on them without stitching them up - as happened at Chris Hani Baragwanath in March of this year - because of a lack of drips and other resources.
The department has produced a draft disaster management plan during the 2008-09 terms and, over the next Medium-Term Expenditure Framework period, will produce an integrated disaster management plan as prescribed by the Disaster Management Act. The plan will be phased in, with the first phase being implemented during the 2009-10 period by the national Department of Health and all nine provincial departments.
Phase two will also be implemented during 2009-10 and will involve 45 preidentified hospitals for 2010. An additional 200 hospitals will implement the plan by the end of the MTEF period. We commend the department for budgeting zero for consultants and hope that provinces will copy this.
I am concerned that the emergency medical service plan will not be ready in time for the Fifa World Cup that will take place in our country in 2010. Once again, progress is being hampered by the lack of resources, particularly in rural areas and townships. The problem lies with the inadequate funding of health. I have to emphasise that health, as a key priority for this administration, has to be given particular consideration with regards to funding.
Of concern, as well, is the scarce skills problem that prevails in our health care facilities. We have recently experienced the strike by doctors over unfavourable working conditions and salaries. I am grateful that we are now returning to normal and our people can once again enjoy the service of our health professionals.
The occupation-specific dispensation, OSD, has been implemented for nurses and the 2009-10 period will see the turn of the doctors, dentists, pharmacists and emergency services staff. I hope we will see a speedy and amicable solution to this issue come 25 July 2009.
It is interesting to note that the department introduced some mid-level categories such as pharmacy assistants and physiotherapy assistants who are being categorised as subprofessionals. This, I believe, will go a long way towards relieving the burden of work on our health professionals.
Cuban doctors, who are here serving in a government-to-government capacity, received a three-year extension on their treaty permits, as well as their registration with the Health Professionals Council of South Africa, HPCSA, in 2008. This is most welcome and offers some relief to our problem of scarce skills.
Thirty-six Tunisian doctors were also appointed and deployed to five provinces in 2008. We welcome the refinement of the HR plan for health and the specification of staff shortages and training targets for the next five years that would contribute towards the creation of jobs and the filling of vacancies.
Opening up colleges to train nurses is ongoing and will assist in alleviating the scarce skills shortage in the long term. In the interim, the government will have to continue to enter into treaty agreements with countries that have surplus health professionals. As outlined in our manifesto, this will contribute towards ensuring that there are no long queues at our hospitals. The challenges remain huge and complex, but we cannot be distracted by the enormity of the task at hand.
In conclusion, I refer to an article in today's Sowetan, which claims that close to 40 million people in South Africa do not have medical aid. A case in point is the one that happened last week, when a domestic worker was knocked down in Sandton by a car driven by a soccer player. The paramedics phoned Charlotte Maxeke hospital, but were told that it was full and too far from the scene of the accident. They phoned Baragwanath hospital, and were told that it, too, was full. They then decided to call Morningside clinic, which was just a stone's throw from where the accident had occurred.
Had the soccer player needed hospitalisation, the paramedics would not have hesitated to phone Morningside, as the soccer player would have been able to pay the medical bill. The domestic worker, however, was made to wait until the paramedics could phone all the public hospitals, because she did not have money at hand or access to medical aid. Those paramedics thus violated the constitutional rights of the patient. We hope that the Gauteng province and the Department of Health will bring the culprits to book.
I want to close my presentation by saying this: We welcome the implementation of the National Health Insurance system. We hope that it will contribute towards access to quality public health by all the working class. We are awaiting the speedy implementation of the National Health Insurance system and of the Private Patients' Plan, PPP. I thank you. [Applause.]
Chairperson, hon Ministers and Deputy Ministers, all protocol observed. Speaking in three minutes on two budget speeches is impossible. [Interjections.] It is not fair. It will never be fair.
Let me just say that I would like to congratulate the Minister of Health on his recent appointment to what is an extremely challenging position. Let me congratulate the Minister again for his honesty when he spoke about the 10 points he has found to be wrong. He said that that is what he has found out. At least he is honest. When a man is honest, he can get somewhere.
Inequalities in health care have always been a major concern to us, and this is why we have advocated for a national health insurance. We cannot continue to have a situation where only 35% of doctors cater for 35 million people in public health facilities, while 65% of doctors cater for 7 million people who are covered by private medical aid.
However, it is crucial that this mammoth task is performed carefully and with the best interest of our people at heart. The Freedom Charter that was adopted by the people says, "There shall be houses, security and comfort for everybody." [Applause.]
Let me speak about social development.
The role of the Department of Social Development is crucial in a country where millions of our people are unemployed, live in poverty and are caught up in a daily struggle for survival.
During the current and ongoing recession, however, it is absolutely imperative that we extend the reach of this department to provide a safety net for all the vulnerable people in our society, especially our children. [Interjections.] No, there's no conclusion yet! [Laughter.]
The department also needs to run joint programmes with the Department of Home Affairs to ensure that vulnerable households are able to access identity documents and therefore the grants to which they are entitled.
We also call on our President, the hon Jacob Zuma, to sign the Children's Act urgently, which would ensure the provision of money to cash-strapped civil society organizations providing services to children. The Children's Act itself was passed in 2005, its amendments were passed in 2007, and the full regulations were approved by Parliament last year. So, we call on the President to sign that Act.
Let me say this in conclusion: Let us be fair to the people and also vote for the opposition parties, so that their voice can be heard in Parliament, so that we can have chance of debate. Thank you. [Applause.]
Dr S M DHLOMO (KwaZulu-Natal): Chairperson, hon Ministers present, Minister of Health and Minister and Deputy Minister of Social Development, colleagues, MECs from various provinces, Director-General of Health, Mr Thami Mseleku, and Director-General of Social Development, Mr Vusi Madonsela, on 30 July, I will get an opportunity in the province from where I come to expand on the budget that I will announce as an allocation for our province. It suffices to say that it will be R17 billion.
It is the second highest budget allocation in the province, the highest being the education budget. It is also worth mentioning that 60% of that budget will go to personnel, since health care service delivery in any country, including ours, is a labour-intensive process. However, programmes must continue to be done within those constraints, despite that challenge.
Our Minister has expanded on the 10-point plan, and I will speak about one of the 10 points later in my contribution. It is worth mentioning that at the 14 hospitals that I have managed to visit over the past few weeks since I was deployed to be the MEC for Health in that province, I have met various management leaders in those hospitals, and it is true what the Minister has said: The most common problems you pick up in those hospitals are in finance management; infrastructure and procurement services and processes; recruitment and retention of staff; revitalisation programmes that have been delayed and health information systems.
In my previous deployment as a brigadier-general in the SA National Defence Force, SANDF, it was very humbling to notice that our SANDF has a very good health information system. A soldier in the Western Cape can travel the whole country and be picked up in Limpopo, and you can tell their health profile by just pressing a button. We are humbled to know that our Minister of Health has tasked us to look into these issues in our various provinces, and we will take that responsibility.
The Minister has spoken about the 10-point plan, and some of these points touch on the Millennium Development Goals. I would like to refer to some of them in relation to my province. KwaZulu-Natal has the highest HIV and Aids prevalence and incidence, and we, therefore, probably need to do more than other provinces. Therefore, there is a priority that this department must work in a militaristic approach in the province.
Why do we need the militaristic approach? Because there is evidence that our former MEC for Health, who is now a premier, Dr Zweli Mkhize, once had control of malaria in the areas of Indumo and Ingwavuma. It was a door-to- door campaign identifying those who were infected, spraying homes, giving people treatment and supplying them with bed nets. From over 30 000 people who were infected and more than 1 000 deaths, death controls were achieved, and they had zero deaths in a year. We are, therefore, confident that if it worked on this, we will also be able to achieve that.
Maybe I should indicate what our militaristic approach will be. It will be to deal with the following: It will focus on the 10-point plan called Accelerated Implementation of HIV and Aids. It will zoom in mainly on infant mortality. The number of children who are born, but do not celebrate their first birthday, is unacceptably high. All these deaths are related to preventable diseases which are largely infectious.
We know that there are pockets in the country that are doing well and others that are not. For instance, in my province, Durban North is one of those suburbs that have a low infant mortality as opposed to Inanda, Amawoti and other areas like those. It is not a pleasing picture that children under the age of five die in our country. The highest contribution, again, is related to infectious diseases.
TB is one of the problems that we still have to deal with. There is evidence that if people are tested early and put on treatment, we can prevent HIV progressing to Aids. We also have evidence that if people start treatment with a very high CD4 count of about 200, we then have a low mortality rate amongst those. Therefore, now that we know it works, we need to give it to them.
Sifuna ukubelapha besesesimweni esigculisayo. [We want to treat them before their health deteriorates.]
We would like to also scale up, as an honour to our women in the country, cervical cancer screening in the province. Such screeening is unacceptably low.
With regard to maternal mortality, in some villages in South Africa, giving birth has ceased to be a happy experience. Either the mother or the child, or even both, die before they go home. The highest common causes of these deaths are HIV and Aids, hypertension in pregnancy, and mothers not attending clinic sessions so these can be picked up very early.
In our province, within a month, my colleague, the MEC for Education, and I will be launching a campaign called Siyafunda Sakha Isizwe Esinempilo. As an answer to one hon member from Cope, we will be looking at adolescent health; we will be promoting the "no drugs and no weapons in schools" campaign while we are also putting up the programme of health.
We know that the success of this programme is pivotal to what our province has taken as a point of departure, being agriculture. We want to talk about one school, one garden; one clinic, one garden; one hospital, one garden; and one church, one garden. Those who may not need these gardens must do it for the sake of those who do. We would like you to do this even if you may have to donate this to other people. Food supplements are, strangely, now part of medication. Patients cannot be started on TB and HIV treatment unless they have food parcels. We want to do away with this, and get them food parcels from other sources rather than it becoming part of medication.
Lastly, we hope that doctors in our community will take up government's offer and stay there and work. In my province, one of the leading doctors had just lost in the by-elections where he was standing as a Cope candidate. [Applause.] We are very mindful that improving patient care and delivery in our hospitals is necessary prerequisite for the National Health Insurance, NHI. Thank you.
Chairperson, hon Ministers and Deputy Minister, what is important to Salga is a strategic planning process and the family agenda, which we build up from ward-based planning into municipal integrated development planning, IDPs, that informs provincial planning. We also welcome the fact that here we see two important strategic departments' Budget Votes being dealt with by the NCOP. The SA Local Government Association, Salga, is very honoured and pleased to participate in the first Budget Vote debate on Health and Social Development.
The question of the family agenda that I referred to earlier on is that social problems, social issues and social conditions prevalent in the wider society are experienced to varying degrees at community level: within houses, within streets, within towns, and so forth. The local sphere is the space where the day to day lives of people are lived, where there is the direct interface between the personal, the household, the family, the neighbourhood and the community.
It is here where the social, economic and political processes take place and where there is the greatest potential for action and interaction between government and the different role-players who can pool their resources, knowledge, experience and understanding of local conditions to meet the needs, build community assets and enhance social cohesion.
It is noteworthy that the department has given priority to the building and strengthening of the civil society sectors as active partners in sustainable development. This is a process supported by Salga, who views this sector as a critical element in the enhancing of service delivery, building social cohesion, assisting with job creation and focusing attention on issues of social and economic justice.
We would urge the Minister to enhance the funding flows to local level for the specific coverage of processes that build cohesive communities. Issues of migration, urbanisation and xenophobia are placing pressure on local resources and require a strategic and intergovernmental level response.
If we were to address the issue of poverty alleviation, it is important that mainstream poverty alleviation programmes and poverty must be viewed as a national challenge requiring a multisectoral approach. It is vital that there is ongoing co-ordination and attention to building coherence in implementation processes at all levels.
We propose that the following is needed for the effective implementation of poverty alleviation programmes: Firstly, policy coherence and the integration of different types and levels of policies, for example macro, sectoral and spatial policies.
Secondly, the co-ordination of implementation by different actors and spheres of government.
Thirdly, clear delineation of roles and responsibilities for different dimensions of the policy process from policy initiation and formulation through to implementation. This point in particular raises the question of what is guiding the party political issues within government, but we will get to this when we deal with health.
The fourth proposal is that of coherence and consistency in targeting beneficiaries, and lastly the issue of effective monitoring and evaluation.
Whilst the devolution of developmental responsibilities to local authorities is an important element in furthering community development efforts, there is likely to be little progress on the ground until there is more local and national financial support, together with a concerted capacity-building initiative to enable efficient delivery. Examples that support this need to be given to nongovernmental organisations is important so that together we can do more. We invite the Minister to work more closely with Salga in the furtherance of the department's aims, and we would encourage greater flows of funding to the local level to better enable effective implementation of social development related efforts.
When we have to turn to the Budget Vote on Health, Salga remains committed to working closely with the department to create an enabling environment in which all South Africans can enjoy accessible, caring and high quality health care. We realise and recognise the importance of an integrated and rationalised approach to delivery of health. On the question of primary health care, the 2005 resolution that triggered the issue of provincialisation of primary health care is something that we, as Salga, feel involved limited consultation and poor communication. Local government and the national government must find a process to ensure that this confusion and the fact that staff are demoralised are attended to.
At Salga's national members assembly held in June 2009, it was proposed that Salga could opt to support provincialisation on the basis that there must be progressive decentralisation of primary health care to municipalities that have the capacity to fulfil the function.
This position is in line with the constitutional framework for the division of powers and functions. If it is accepted that primary health care is a Schedule 4A function and the provincialisation is therefore supported, the Constitution, section 156(4), instructs national and provincial government to assign the function to municipalities that have the necessary capacity.
Ons raak siek by die huis. Ons raak nie nasionaal of provinsiaal siek nie. [We fall ill at home. We don't fall ill nationally or provincially.]
Furthermore, this position is in line with section 32(2) of the National Health Act, 2003, which provides that the provincial executive must assign such health services to a municipality in his or her province as contemplated in section 156(4) of the Constitution. The National Health Act thus provides that provinces must assign primary health care services to those municipalities that have the capacity to perform the function.
There are a number of practical issues. A full cost analysis of the assignment must be done, but this we can discuss with the National Treasury and the Financial and Fiscal Commission, particularly on the future division of revenue raised nationally between the spheres of government as required by section 214 of the Constitution.
Is there a point of order?
On a point of order: Yes, Chair. I just want to know whether it is parliamentary for a member to read a newspaper in the House, and if it's parliamentary for a member to take photographs with his cell phone in the House, as the ID and DA membersare doing. That is why they are asking all these funny questions, because they don't listen attentively.
I think it would be extremely unparliamentary for members to behave in such a manner. We tried to address this matter last week, particularly with regard to the way in which members must behave in the House, and so forth. We said there is nothing wrong with engaging and interacting, but behaviour that is distracting and not in line with the intention or the objective that we want to achieve, is out of order and unparliamentary. Members should desist from doing that, if it did indeed happen. Thank you very much. You may proceed.
In particular, the issue of emergency medical services needs to be addressed. While the provincialisation of emergency medical services has been put on hold until after 2010, it is recommended that a similar approach be taken with that of primary health care. Essentially, what is also required is an approach which promotes the co- ordination and implementation of services at local government level, with sustainable funding arrangements and not through grants.
In the 2008 national members assembly, the following were raised by local governments as factors which impacted on effective functioning: Firstly, insufficient funding for ambulances and emergency services. Municipalities had to provide for the financial gap and this in essence translated to municipalities funding provincial government.
Secondly, there is a need to approach fire, ambulance and emergency services with adequate funding as integrated services. This will allow for the provision of a critical and co-ordinated response, and efficient, effective rendering of the service as they are all interlinked. A third factor was that of the location of fire services and emergency medical services closest to communities for effective response turnaround time.
Lastly, we have to assign ambulance services to local government with sustainable funding through the appropriate delegation and agreement process.
We are very pleased to note that the delayed audit of the primary health care service and infrastructure in all nine provinces has now been highlighted as a priority for this year's budget. We would urge that the Minister include an analysis of capacity within this audit and an assessment of the communication and representation processes within the district health councils, where these are established at local levels.
Municipalities need information in order to define their parameters of action, and communities need to have clear mechanisms for raising their health issues and concerns. To this end, we welcome the department's prioritisation of strengthening the district health information system and other monitoring tools for the delivery of primary health care in all provinces.
Salga is also committed to working closely with the department and the SA National Aids Council on combating the scourge of HIV/Aids and we support the two Budget Votes tabled. Thank you. [Applause.] Dr B M RADEBE (KwaZulu-Natal): Chairperson, thank you. May I lodge a complaint that the microphone is a bit short; it needs to be extended. [Laughter.] Deputy Chairperson, Ministers present, Deputy Ministers, my colleagues from other provinces and members, I just want to start by saying that I'm a bit disturbed, because sometimes we, as the ANC, unveil or discover fraud and corruption, but the opposition will jump up first to announce that as if they are the ones who have found the corruption.
I am not responding; I'm not the Minister, I'm just an ordinary MEC. A member of Cope spoke about corruption, but they can't tell us the first corruption which they have committed ...
... bashintsha amagama beyobhalisa kwa-IEC. [... they changed names when they registered with the IEC.]
That is the highest degree of fraud and corruption when, once you are given a list to submit to the Independent Electoral Commission, IEC, then you change the list on the way. But you are not talking about that, you are talking about us.
I am standing here to support the budget speech ...
... ka-Minister [Ngqongqoshe] wethu but [kodwa] ngifisa ukuthinta lezi zinto ezibalulekile ... [... of our Minister, but I wish to touch on these important issues ...] Still talking about corruption as public representatives, there is no pension. All pensions are paid in wards where there are councillors and Members of Parliament deployed in those particular areas. What then are you doing to stop that, rather than coming to make a big noise here? What are you doing?
There are no criminals who fall from the sky. They are within the community. What are you doing, other than making a big noise in this House? I think this is an embarrassment; we are elected because people trusted us, then we come here ...
... thina sizokhuluma nge-corruption [inkohlakalo] ...[... we are going to speak about corruption ...]
... as if we are living in the sky. Let me make an example because this is already public knowledge. One of the spokespersons of my predecessor is out on bail of R30 000 for fraud and corruption. We have inherited ...
... i-corruption [inkohlakalo] ebikhona ... [... corruption that was already in existence ...]
... in the previous government. But because we are revealing this corruption, then it's us.
Izono zabazali ziyokwehlela kubantwana. [Uhleko.] [The sins of the parents fall on the children. [Laughter.]]
That is my problem. I can tell you, Chairperson...
Ukuthi... [that ...]
... I was appointed in November 2006. I only served 28 months in the last term. But this department, which one DA member was saying is corrupt, is not corrupt. I never even fired one chief-director in the department, but we were able to turn the department around. It is one of only a few departments that is respected in the KwaZulu-Natal province.
Not only did we do that, we came up with ...
... ama-ideas [imibono], ama-one stop development centre ... [... ideas such as, one-stop development centres ...]
The Deputy Minister was present when the President opened one of the one- stop development centres in Nkandla. In one shelter, Home Affairs, the SA Social Security Agency, Sassa, the Department of Labour, Education and the Saps gathered. Under one roof, you could apply for your ID, social grants, disability grant and all the other grants. I finalised with the Minister of Home Affairs on Saturday that they are going to deploy ... ... abantu ... [... people ...]
... in those areas. For the first time ...
... abantu baKwaZulu-Natali eNkandla ... [... people from Nkandla in KwaZulu-Natal ...]
... are able to walk in, apply for an ID and go back home without paying a cent for transport. It's for the first time ...
... abantu KwaNongoma, Mtwana, eSkokonko ... [... that people from Nongoma at Skokonko, Prince, ...]
... are able ...
... ukukhipha izinkomo bazibeke ngaphandle ... [... to take their cows to the grazing fields ...]
... and go to apply for a grant, and come back without paying a cent. It's the first time in Mboza that ...
... abantu bakhona ... [... the people from that area ...]
... are within walking distance from where they can go and apply for social grants, IDs and everything, and go back without paying a cent. What were they doing before us? Yini ekade beyenza yonke le minyaka? Yini ekade beyenza yonke le minyaka? Kukhuluma abantu abenza umkhonyovu emaphepheni okubhalisela ukhetho, bazotshela thina nge-fraud and corruption. [Ngomkhonyovu nenkohlakalo.] (Translation of isiZulu paragraph follows.)
[What have they been doing all these years? What have they been doing all these years? Then they come here and tell us about fraud and corruption - the very same people who committed fraud on the voter registration papers.]
It's an embarrassment. It is really an embarrassment.
I also want to say to the Minister that I'm happy about your stance in trying to assist us at provincial level, especially with the working relationship between us. Our head of department, HOD, and the Sassa Executive Manager are meeting on Friday. They are now fine-tuning the working relationship in our province, and I can tell you that it will be one of the best.
We have already deployed our social workers to these one-stop development centres, which should cost us R56 million. For ...
... abantu bakithi ... [... our people ...]
... as I said, for the first time.
... umuntu waseNkandla ... [... a person from Nkandla ...]
... will never walk 96km again in order to go and make applications ...
... abesegwaziswa; futhi okunye ... [... and have to pay a bribe. Another thing ...]
... is that as public representatives we need to create a good relationship with the business sector.
Iphini likaNgqongqoshe ... [The Deputy Minister ...]
... will know an area called Ofafa. There was a disaster. We went to address and ask the business community to assist. They did not build four- roomed houses, but fully furnished five-roomed houses, free of charge. We handed over those houses ...
... kubantu. [... to the people.]
The same thing happened in Gobandlovu; the hon Gamede was present. People were sleeping in water, not ...
... ukuthi kumanzi ... [... that these houses were damp.]
We went and approached the business community. He was there when those houses were handed over - five-roomed houses with furniture and digital televisions, not the old-fashioned ones. [Laughter.] Again, this Thursday, we are going to Umkhanyakude to hand over a house to a nine-year-old child who lives with her aunt because her grandmother was burnt beyond recognition.
It was not through our competence, but if you create a good relationship with the business community, you can do more because our department cuts across almost all departments.
One initiative ...
... esiyithathile njenge KZN, ukulekelela abafelokazi. [... that we undertook in KZN, was to assist the widows.]
They are caught in the crossfire in the sense that they don't qualify for pension because of their age. At the same time, nobody is employed. They have children. I gave the example ...
... kwi-Minmec mayelana nomndeni wakwa wakwaMyeni ePaulpietersburg. [... in Minmec of the Myeni family from Paulpietersburg.]
An eight-month-pregnant woman who had three other children decided to kill herself with that child in the stomach because she could not take the pain of her children crying to her almost everyday, going out into the streets to beg, and yet she knew they had nothing to put on the table. She left a note that said that maybe when she's dead, the government would take care of her kids.
They are now forming co-operatives to make sure that, once people like her are mentored, they will be handed over to economic development to be able to survive, because the majority of them are HIV positive. The previous speaker, Dr Dhlomo, spoke about HIV and Aids. It's rife in any province.
We are hoping ...
... ukuthi sisazofika sizokhala kuNgqongqoshe. Ngoba sizocela ukuthi selekelelwe ngemali siyisifundazwe. [... that we are going to go and plead with the Minister. We are going to ask for financial support as a province.]
We have also started...
... uhlelo lukaMasifundisane i-Abet. Ngoba inkinga ekhona kulaba bantu bempesheni ... [... an Abet programme called Masifundisane, because the problem that the pensioners face is that ...]
... they go and collect their pension and get 50% of their pension. The rest will be taken away by ... ... yilabo-stick sweet abakhona. Abakwazi nokuthi bazibalele ukuthi yimalini imali ekufanele iye kubona esandleni. [... the fraudsters who are there. They even calculate the amount that they will steal.]
So I'm saying with my colleague ...
... ubaba uDlomo ... O! Ngigoqe baba? [... hon Dhlomo ... Oh! Should I conclude?
Yebo. [Yes.]
Dr B M RADEBE (KwaZulu-Natal): Oh, okay.
In conclusion, I want to call on Cope to set an example. If they talk about corruption, they must be the ones who must publicly apologise for forging ...
... amaphepha ayofakwa kwa-IEC. [... voter registration papers at the IEC.]
I thank you.
Hon Chairperson, hon Minister of Social Development, hon Deputy Minister, hon MECs in the House, hon members of the NCOP, guests, ladies and gentlemen, in the tradition of the West Coast, good afternoon. I want to congratulate the Minister on her appointment and that of the Deputy Minister to the portfolio of Social Development. I also want to express my gratitude for being part of a team whose mandate is to contribute to the fulfilment of the ideals enshrined in the Constitution of the Republic of South Africa.
To the hon Minister and the Deputy Minister, thank you for your leadership during our first Minmec meeting last week in Johannesburg. In her budget speech, the Minister outlined the government's programme for the next financial year.
It is important that we embarked on a road that has, as a commitment, our dedicated service to the people of our country, especially, in the language of the Minister, the poorest of the poor.
Our commitment in this House should be not as a slogan of government, but as a deep personal commitment of people first. Whilst the global economic recession has affected us immensely, we should pull our strings together to ensure that all South Africans have a share in the unfolding of the South African promise, a promise of opportunities for all.
In complementing the work of the government's programme of action in the Western Cape province, we are deeply concerned about the current state of abuse against children in this province. It has reached crisis proportions, and we are currently mapping out a strategic government response to the abuse of children. The nature, the magnitude and the depth of this problem requires an intersectoral and intergovernmental approach with clear targets to create a safe environment for all children in South Africa.
A report from the Human Sciences Research Council has also revealed that most of these things happen in the presence of family, friends, neighbours and people living on the same land where children are abused.
The Western Cape government has already accorded the establishment of an office for a commissioner of children as its top priority. In line with the Western Cape provincial constitution, we are planning to appoint a commissioner for children. The Department of Social Development in the Western Cape's key deliverables for 2009-10 moves from the premise that to realise a self-reliant society, opportunities need to be created for all citizens of the Western Cape who are poor, vulnerable and have special needs.
For 2009-10, the department received the total budget of R1,1 billion. Of that budget 59,4% goes for payments for nongovernmental organisation, NGOs. This represents 4% of the total provincial budget.
This will be cost-effective and efficiently spent to create social economic opportunities for all, but it is a deep concern for me. If you have a budget of R1,1 billion and you spend 59% of that budget towards NGOs and faith-based organisations, you must ensure deep quality control over the allocation of this money.
Since accepting office, the Western Cape government has outlined four broad strategic objectives: Firstly, is to modernise service delivery. This goal will address service delivery challenges at the service delivery points, at district offices and facilities under the management of this department. They will be subjected to effectiveness and efficiency audits in this financial year. This goal is closely linked to the theme "people first".
Later this month, the Department of Social Development will also sign a service level agreement with the SA Social Security Agency, Sassa, to ensure effective and efficient service delivery. I am glad that the Minister referred to this in her budget speech when she spoke about business process re-engineering to improve service delivery within Sassa. You can only modernise service delivery, colleagues in this House, if you appoint the right person into the right job. Therefore, in the Western Cape, every manager will undergo a compulsory competency assessment to get the right mixture of competencies to serve the people of the province. [Interjections.] Customer satisfaction surveys will also be conducted in this financial year to ensure that the department is responsive to the needs of the people of the Western Cape. There will be no cadre deployment in my province. [Applause.]
Finally, the modernisation programme will also allow the department to measure its performance through a provincial-wide dashboard system. Officials are already preparing to migrate from the current management information system to a province-wide dashboard system to monitor the performance of government.
The second objective of this department will be to improve financial governance. Part of this governance is to make sure that every one of the 1 800 organisations that our department is funding from the department will comply with the highest standards of corporate governance.
This province has already published live on the Internet for anybody in this House to click and see which organisations of these 1 800 are receiving government money through NGO networks. That's the depth of transparency in the Western Cape government.
We will also publish on the Internet not only the name, address and other details of these organisations, but their annual reports, MNE reports and the Auditor-General reports. Every single detail you require of these organisations will be published live before the end of this financial year. This will also be done to ensure accountability and transparency to the fullest. The third objective of this department is what we call social entrepreneurship. The vision of the department is to create a self-reliant society. If you want to create a self-reliant society, you need to ensure that you create opportunities for people.
We need to create opportunities so that people will benefit as a result of it. And I am glad that the Minister in her budget speech spoke about social entrepreneurship.
What is new is this, Market fundamentalism has proved not to be the tool for creating opportunities. State fundamentalism - that's new to you - has also proved not to be able to deliver self-reliance. Market fundamentalism fails because it lacks compassion - that's new to you.
State fundamentalism fails because it creates a handout system - a dependency culture which is not sustainable in the long run - that's new to you. [Interjections.] In order to navigate this government out of this predicament, we are committed to social entrepreneurship - that's new to you. [Interjections.]
Social entrepreneurship is an approach that unlocks opportunities in society. With regard to innovation and creativity, that's new to you. Thank you very much. [Interjections.] [Applause.]
Hon Chairperson, hon Ministers here with us today, hon members of the House, distinguished guests, ladies and gentlemen, the transformation of the health sector and dealing with poverty, as Cllr C Johnson from Salga has indicated, requires collective collaboration across the broad spectrum of government, the private sector and communities.
I take this opportunity to commend all those individuals and collectives who chose not only to point fingers, but to partner with the Department of Health and Social Development in the implementation of the departmental programmes and projects aimed at improving and promoting health care and social development provisions in our province and our country.
We say to all of you that your efforts are not in vain. They are the building blocks towards an integrated, sustainable, accessible and quality health care system and social services that endeavour to create a better life for the poor, the vulnerable and the excluded in our society.
I take this opportunity to pay tribute in memory and honour of our officials who fell in the line of duty, such as Mehloti Hetisani, one of our public servants who fell in the line of duty; the management of the Seshego Hospital that were murdered carrying out their responsibilities; the emergency care providers who die on our roads in the rush to save lives and in general the health workers who at times contract communicable diseases whilst in the process of serving others.
Indeed, the two Ministers have indicated that we are committed. This ANC- led government is committed to doing more in building infrastructure, providing equipment, purchasing more tablets, but indeed you can't buy compassion, commitment and empathy.
It's only those that have been there - that know what hunger is, that have slept without food, that have been dehumanised, whose dignity was trampled on - that can talk about compassion. Indeed there are some of our officials who have died, as I said, in the line of duty, showing such commitment. As a department we aim to emulate these individuals and continue from where they've left off.
In honouring them, we commit ourselves to serve with pride and rise above the many challenges that continue to impact negatively on the provision of quality health care and social services, which are - the Minister has talked about most of them - limited resources, both human and financial, infrastructure, difficult working conditions compounded obviously, in our province, by the rural nature of our province.
We embrace the call by the hon Premier of our province, Mr Cassel Mathale, who said everything we do must contribute in a direct and meaningful way to the improvement of the lives of our people and that the time for procrastination has passed, and that we have to revitalise a new culture of doing a job today and finishing it today, not tomorrow.
We further commit to address the issues raised by His Excellency President Zuma in his state of the nation address that there is a need to further reduce the inequalities in the health care provision, and the Minister has talked to all those; boosting human resources capacity of the department; revitalising hospitals and clinics; stepping up the fight against HIV and Aids and other diseases and paying urgent attention to the issue of remuneration of health professionals.
Note must be taken of the following top five killer diseases in the province, which are ischaemic heart diseases; cerebrovascular accidents, that is, bleeding into the brain, which causes strokes; infections of the lower respiratory tract, that is TB; gastrointestinal infections in children, attributed mainly to poor sanitation and lack of safe drinking water; and HIV and Aids-related infections.
Factors around maternal deaths still relate to issues of nonavailability of expertise in our institutions, such as gynaecologists and anaesthetists, integration amongst departments and health education within the communities.
A burden of disease project has been initiated, but is unfortunately not functioning optimally due to financial constraints. We will pay more attention to research, and the Minister has also talked to this, which will provide us with accurate baseline information for targeted intervention.
One of the challenges facing the department is a lack of basic information and vital statistics on causes related to infant mortality per district in our province. This is important, as we have indicated. If we are to embark on a targeted approach to reduce infant mortality, we have to be informed of what diseases are killing our children and in which areas, so as to channel all our resources in that fashion.
The budget proposal we are tabling before this august House affords us an opportunity to elaborate on our collective contribution towards further efforts in the creation of a better health system based on a principle that health, like education, is a precondition for development. A healthy nation contributes to innovation and development.
I must indicate that we have an allocation of R9 billion for the financial year 2009-10 and 59,7% of that goes to compensation of employees, whilst 27,2% goes into goods and services and part of that, of course, would be the programmes that we are running for the health branch. For Social Development we have an allocation of R761 million and 27% of that allocation goes for compensation of employees and 26% goes to goods and services.
The issue of poverty has been raised in this House, as well as in many of the forums. For us the passing of the Children's Amendment Act holds the promise of reversing this picture and is the dawn of a new era in the care and protection of children. To advance this prospect, we are relying on national, provincial and local government, as well as all other relevant stakeholders to implement the Act and to co-ordinate it in a manner that would maximise the limited resources.
As the Minister of Social Development indicated, integral to overcoming the effects of child poverty are programmes such as the Early Childhood Development, ECD, Child Care Protection, Foster Care and Orphans and Vulnerable Children.
In relation to the ECD in the province, we have renewed our registration drive of ECD centres. We have already registered and funded 1 263 sites during the past financial year and we will increase our subsidy from R9,00 per child a day per attendance to R12,00 per child a day per attendance. Going forward, we intend to register another 309 sites by March 2010; this would bring it to a total of 1 572 registered ECD sites.
An amount of R89 million has been allocated for the ECD programme. A call is hereby made on all stakeholders and, most importantly, our communities to ensure that children are taken to these centres and that parents and communities take an active role in monitoring and implementing these programmes as implemented in these centres.
With regard to child care protection, the Minister has talked a lot about it. As a province we have allocated R35 million for this purpose. The amount will be utilised for providing food parcels, supporting institutions that cater for these vulnerable children. We are still making a call to all stakeholders, especially relatives and families of these children, in the spirit of ubuntu ...
... gore kgodi?o le tlhokomelo ya b ana ke maikarabelo a rena re le set?haba ka moka. [T?hwahlelo.] [ Nako e fedile.] [... that it is the responsibility of the whole nation to raise and take care of the child.] [Interjections.] [Time expired.]]
Mr Chairperson, hon Minister, Deputy Minister, Deputy Minister, MECs, hon members and guests, thank you for the opportunity to take part in this Vote. I also want to take the opportunity to congratulate all the members who are newly appointed in their positions. I want to start by saying that, from the Western Cape government, we subscribed to most of these 10 points mentioned by the Minister of Health, except, of course, the one regarding the National Health Insurance, but for the others we certainly support that and subscrib to that.
Chairperson, our new provincial government is committed to the principles of an open-opportunity society that offers equal opportunities to all the people in our province dependent on health care.
I acknowledge that there are many things in the health sector that require urgent, radical change, innovation and attention, and that will certainly be my political challenge during my term. I must also place on record our concern that the funds allocated for health services in our province or to our province are inadequate to meet the needs and indeed the expectations of the people of our province.
A couple of years ago, this was also mentioned by hon President Zuma. Health services were certainly in a much better state of affairs than what it is currently in our country and also in our province. I acknowledge the good work of many health workers and staff working under very difficult circumstances, but we should urgently address staff attitudes and all issues relating to the delivery of quality health care services. The fact that poor people are dependent on and also entitled to free health care can never justify poor treatment and service to those people.
An issue of particular concern is the underfunding from the national conditional grant for HIV and Aids, which includes the antiretroviral therapy of which we had a deficit last year of R27 million rand, and we are budgeting for a deficit this year of a shortfall of R60 million in our province. I regard it as my political challenge and objective to narrow the gap between the available budgets on the one hand and the demand and the expectation in health care on the other hand.
Let me turn to key priorities of our Department of Health in the Western Cape: Firstly, through further implementation of the Western Cape comprehensive services plan, our department will address the important issue of the quality of health care delivery.
Secondly, service of tuberculosis, TB, together with HIV and Aids poses a major threat. We have to strengthen the TB programmes aiming to improve cure and management, especially of those patients with drug-resistant TB. We have to take the campaign against Aids and HIV to a higher level. And therefore we support the national Minister's endeavour and announcement in that regard.
Thirdly, we will have to address service pressures, which are the consequence of increasing burden of diseases resulting from particular trauma and substance abuse. We will have to strengthen services in the areas of mental health, obstetrics, surgery and emergency care. Fourthly, mechanisms should be strengthened to assess the burden of disease. Many of the reasons for people needing health services are not from the health sector, but from other sectors in our society of which we've also have today - many many reasons. We need increased funding for maintenance of the backlog in our facilities, which is in the order of about R800 million in our province.
The construction of two new hospitals in our province, one in Mitchells Plain and one in Khayelitsha, are very important projects in our province. The one in Mitchells Plain is really a challenge to our province, as there was now eventually a shortfall in the funding from the National Treasury for this hospital. It remains uncertain as to why this was initially approved by National Treasury along with the Khayelitsha Hospital and then fell by the wayside. It is of utmost importance to ease the burden on our G F Jooste Hospital and to proceed with both these hospitals in our province. I made a proposal, which was approved at our Cabinet, to cancel the current tender and retender within three months with an extended contract period from 36 months to 54 months. Therefore, we will be making our own plans with additional funding from the province to also do the Mitchells Plain Hospital, which is now a shortfall from the National Treasury.
It is about the National Health Insurance, which I want to express some opinion on. It is by now common knowledge that the national government envisaged implementing this National Health Insurance. And it is also common knowledge that the DA, as the official opposition in South Africa, and many other important role-players in our sector, are opposed to this plan and has expressed this concern. The DA has also communicated its alternative to the National Health Insurance. I will not repeat this again in detail this year, but I will instate the review of many of the alternatives to the National Health Insurance that our provincial government will be investigating to implement in our province.
We will establish a much closer working relationship with the private sector and the private health care and all the institutions represented by them. We will, certainly, also explore the possibility of interacting with private health sectors, investors and service providers to provide facilities such as hospitals and clinics or to tender for comprehensive public health care services as operators. We have little doubt that the only viable solution to our enormous challenge to provide and improve public health care can only be achieved through closer relationships with the private sector and not the other way around.
We will address the current mandate and functions of hospital facilities boards with the aim to improve the service ability, the oversight and participation in the operation and functionality of our hospitals and facilities. We will investigate various methods to improve ... Thank you. [Time expired.] [Applause.]
House Chairperson, hon Ministers, hon Deputy Minister, members of the NCOP, our delegates from various provinces, distinguished guests, ladies and gentlemen ...
... ke a le dumedi?a. Modulasetulo, ntumelele ke kgaleme lenyat?o pele ke tsena ditabeng. [... greetings to all. Chairperson, allow me to correct something first before I get into the debate.]
There is a problem if a person has an identity crisis, which leads to people losing direction. They will listen to everything, but be unable to take decisions. I am saying this because our Cope colleagues do not have an identity. As such...
... ga ba na molao. Molao ba tla o t?ea kae? Bjalo, ge ba se na molao ga go na fao ba tlago ya gona. [... they have no manners. Where would they have learnt that? They are going nowhere.]
As such they are going to allow the media to dictate to them and come here to debate issues that are not on the table, such as Philippi. We are not debating the public works budget here. [Applause.]
Again, if they talk about grants and beneficiaries that are not in place, they should know that we have these things in place.
Re na le SAPS le Dihawks. [We have the SAPS and the Hawks.] They will see to it that this thing goes well. As for the DA, self- criticism is part of our life as the ANC. When we falter, we make sure that we assess and evaluate ourselves and come with resolutions that will rectify the mistakes made. We are not going to wait to be told that we should be doing things your way. Remember who gave birth to you - the National Party. [Interjections.]
Let me continue to say that, given that the health needs will always outstrip available resources, we wish to commend the Department of Health for identifying and prioritising the Polokwane resolutions in their 10- point strategic plan and budget.
South Africa has the seventh highest TB incidence in the world and contributes approximately 80% of the total global burden of all TB cases. Having learnt that HIV and Aids and tuberculosis remain the focus area for the National Department of Health, we acknowledge that South Africa's cure rate is improving. However, we are worried that it is still below the cure rate of many developing countries.
The high defaulter rate has increased the probability for drug resistance. This impacts on achieving the targets for treatment success and cure. If we are to eradicate TB, we need to address the social determinants of the disease. This means that we have to address the socioeconomic needs of the affected people.
Poverty eradication, nutrition, housing and improvement of living and working conditions are imperative in improving the cure rate. Community mobilisation is critical in achieving success. The community is critical in monitoring health and education intervention.
We have a stipend for community caregivers. This is in answer to the 500 000 jobs that the President alluded to. Having more community caregivers coming onto the scene is going to satisfy our needs and promises to our people.
The Department of Health has developed the draft tuberculosis strategic plan for South Africa 2007 to 2011 that will ensure effective public health and clinical intervention. This will certainly assist in ensuring effective management and eradication of TB and its complications.
Lack of access to health facilities also contributes to our people seeking help when the disease is at an advanced stage. However, we are happy, because the Department of Health's strategic plan includes establishment of the ombudsman's office, which will receive and investigate all complaints about the quality of health services and recommend appropriate interventions.
Ba ithutile gabotse. [They learnt a lesson.]
They know that they need to get recommendations and interventions. This is highly recommended.
We also welcome the introduction of a directorate in the office of the chief financial officer, CFO, that will work directly with the provinces to strengthen financial management systems and ensure that district management teams are established. We will ensure that we do oversight on this to make sure that these plans succeed.
We want to emphasise that the auditing of nursing colleges and their establishment, that should consider the demographics of our country, should receive speedy attention. Critical to respond to is the Aids pandemic and to ensure that all health facilities have the capacity to provide ARV treatment, notwithstanding the challenges confronting us in achieving this.
Equally, it is important to implement the National Health Insurance that will guarantee that all South Africans have free access to health care. The ANC-led government will ensure that this is implemented over the next five years. We will assist in the consultation process that will be taking place until next year in 2010. The DA will oppose this, because they do not know the pain of the poor who when suffering from illness, are not able to afford the medicine from the pharmacies. [Applause.]
We also want to commend the NGOs such as LoveLife and Soul City for making sure that awareness translates into behaviour change, as well as the Department of Education for including HIV and Aids education as a compulsory subject in the curriculum.
In conclusion, I support this budget as it forms a critical part in achieving the goals we have set for ourselves to deliver quality health care to our people. I want to appeal to all to give their support to the National Health Insurance as it will be beneficial to us. We do not expect it to be a simple process, but I believe that South Africans have the will to find each other on this very important issue. Just as we stand in support of our sport teams, we must also stand together in eradicating inequality in all its forms and build social solidarity. Thank you. [Applause.]
Hon Chairperson, I just want to call over members of the opposition, specifically in this case the DA, that as we debate these issues we must be painfully aware of who we are. We are elected here to represent all the people of South Africa. Once the elections are over and we are in these Houses, we represent all of them.
Now the DA likes talking about the Constitution, the country and that we must follow it to the letter. They don't want us to deviate even a bit. Firstly, we remind you that we held up the Constitution, because you had no way. All you need to do is support, but you are not going to pick and choose which part of the Constitution you support.
The issue of health care is in section 27(1) of the Constitution. It says, and I am reading for you directly from the Constitution, "Everyone has the right to have access to health care services, including reproductive health care." It is a right. Section 27 (2) says, "The state must take reasonable legislative and other measures, within the available resources, to achieve the progressive realisation of each of these rights."
It is our responsibility as the state to make sure that people have equal access to health care. It's an imperative of the Constitution; we have got no choice in the matter. [Interjections.]
We are faced with a situation where 41 million people in our country - that is 86% of the population - are not able to exercise this right. Unlike you, I know no member of the DA in this House, not a single one, who's not covered by medical aid, not a single one, and I know no single ANC member who is not covered by medical aid. In other words, all of us elected members are covered by medical aids.
When our children are sick, they know where to go to; they are safe as we are sitting here, but the people who voted for us can easily die. As with the example of this woman, they can easily die, very easily. The example people like giving here about what happened last week - it's not the first time. It's not even happening for the second time.
Let me remind you what happened next to a private hospital in Johannesburg. I don't remember whether it was in 2007 or 2008, but it was around about there, when somebody got into an accident next to a private hospital and he was asked whether he had medical aid and, on saying no, he was rejected and driven to the public hospital. He died on the way to the public hospital.
Now tell me: If this is not primitive, what is it? When a human being is about to die, you ask them first how much they have got? Tell me if this is not primitive. That is why a person no less than the Secretary-General of the United Nations Mr Ban Ki-Moon, on 15 June, not a long time ago, at the United Nations said, and I quote him directly, "Out-of-pocket expenses are the worst form of health care financing and it must be discouraged."
You can't keep on financing health care by saying people must pay out of their pockets when they are sick. Nobody decides to get sick. In the same speech he says that in the whole world, every year, a hundred million people are forced into poverty because they are forced to fork out money for their health when they are trying to defend themselves from dying and they get into poverty.
So we talk about health care financing. Let's forget about being in the opposition and face reality. Let's forget about which party we belong to. Let's think about the poor people of this country and show that ... [Interjections.]
Chairperson, on a point of order: Is it in order for the member of the ANC sitting right in front of me to say the DA wants people to die when the hon Minister is making a serious speech; to make that type of insinuation? [Laughter.] I ask you to rule on that.
I think it will be very difficult for me to make a ruling on that, because I don't even have the benefit of having what the member said, but maybe what you can do, hon member ....
But you can ask him on his honesty as a Member of Parliament to admit that he said so?
Hon member, please do not tell me what to do. Don't tell me what to do, because I think now you are out of order, hon Watson. I was trying to address your point of order. Now you want to tell me how to address your point of order, which is something that I'm not going to do. Hon Minister, you may proceed.
I was still saying when we deal with these issues we must forget which party we belong to, because the issue of health care financing, for your information, is not a South African issue. It's a global issue now. It's debated all over the world. That is why the Secretary-General of the United Nations said this.
The Director-General of the World Health Organisation, Dr Margaret Chan, who, by the way, was the Minister of Health in Hong Kong, actually took up this debate and said, "Let me make another obvious point. A health system is a social institution. It does not just deliver pills and babies the way a post office delivers letters. A properly managed and financed health system that strives for universal coverage contributes to social cohesion and stability."
In other words, she is calling on all of us to properly manage and finance health care systems and move towards universal coverage. What is universal coverage? It's a national health insurance system that covers every citizen, regardless of their status of employment, of their colour, of their religion and regardless of who they are. As long as they are human beings, they need to be covered.
In the same week when these two people in the United Nations were saying these words, Mr Barack Obama was also debating the same issue, because, while in South Africa 41 million people are not covered, in America it's 57 million people and he was worried about them. He also wants them to move to universal coverage, because how do you feel when a fellow human being can just die in front of you simply because they don't have money. How do you feel, in this era in time? It is primitive! It can't be allowed by humanity anymore. It's embarrassing. It can't be allowed.
Don't ask me where do we get the money to pay you and where do we get the money to cover. Why were you covered? You never asked anybody where the state gets the money from to cover you. I'm repeating that every Member of Parliament is covered by medical aid and that coverage of medical aid is from public financing and none of us stood up to ask ... [Applause.]
Really, we should be embarrassed. What is good for you must be good for the rest of the population and we can't keep on asking where the money is coming from. Why is it that every time when we talk about the poor there must be a debate? For goodness sake, they are human beings like us. I'll actually get very embarrassed to say that about these people outside. I can't look them in the eyes. But every time they are sick, they are asked how much they have got. I'll keep on repeating that no human being must be asked about that because they do not choose.
When you talk about universal coverage of humanity, we must all become human beings, not members of different political parties, please, because we told our people that we want to serve them. We didn't say we are coming here to this Parliament to obstruct their service delivery. We said we wanted to serve them.
How can it be that today in this democracy we are even worse off than during the era of apartheid? I was a medical student during the era of apartheid and I also worked at King Edward VIII Hospital. We were stopped by apartheid from treating white people. We were not allowed to, and they had to go to Addington Hospital, which was for whites. But when they got into an accident next to King Edward VIII, we were forced to resuscitate them to make sure that they live.
There were many white people who used to have accidents next to King Edward VIII with their scooters. We would take them into a black hospital and resuscitate them so that they would live before sending them to a white hospital.
Today it is no longer an issue of colour. It's an issue of money. You can't even be resuscitated in a private hospital before you are taken to a public hospital, not because of the colour of your skin, but because of money. It's now financial apartheid. Do we want to support it? No, it can't be! We can't allow that situation.
I want members of the opposition to please take off their caps as opposition and become fellow South Africans and human beings. Become members of the human race, please. Thank you. [Applause.]
Hon Chairperson, let me start by acknowledging all the inputs that were made by hon members, particularly starting with colleagues from provinces as MECs, for sharing with us your programmes as you are implementing them in various provinces. It is very clear that indeed we are on track.
Co-operative governance, as I referred to earlier, is being implemented and I thank you very much for that. That is why we gather in this National Council of Provinces to share views as we do.
I just want to turn to the Western Cape though. Appreciate, firstly, that the Western Cape province, which is part of our national government, does say, hon MEC, that the programme that you have implemented on child abuse - we appreciate that and indeed you did say that - needs an intersectoral approach and a multidisciplinary approach. We agree with that. However, it may be necessary, just as a word of cautionary advice, that we look at the causes of this problem, because you can indeed begin a programme of mobilising people when, in fact, you are not looking at the causes of the problem. In the Western Cape I think, hon MEC, it is necessary to look at the drug problem in this province. We need to embark on a very serious anti- drug campaign in this province, because two out of every five cases of child abuse, child molestation and all of those are actually caused by drug abuse. So let us address the causes and not just the symptoms. Having said that, I would like to say that we are in the situation that was spelled out earlier on of this global crisis, partly and mainly because of market fundamentalism - let's face it. Now we are being told that there is a province in South Africa called the government of the Western Cape that is actually following policies that we know have actually failed in the world. We have to contend with that and we have to say "yes".
No, we are not going to be able to do that. The entrepreneurship that we are talking about is indeed entrepreneurship within the context of the policies of this country, mixed economy focused on people, focused on the poorest of the poor, as well as developing them and not only the haves, as it always happens and as it is being propagated by the province of the Western Cape government.
With regard to the province of KwaZulu-Natal, hon colleague, I think we appreciate the fact that we are beginning to work with the SA Social Security Agency, Sassa. One hon member raised the issue about the need to devolve functions of Sassa to provinces. We have gone past this issue in our previous Minmec and we have resolved this issue to say there is a need to work with provinces. However, we cannot go back to the devolution and assignment and/or assignment of functions of Sassa, because of the famous Mashaba case that actually led to the formation of Sassa in the first place.
The hon member of Cope, if this matter of poverty were not so serious an issue, I would have really laughed myself sick at the poverty of ideas that was displayed by you here. Indeed, hon Chairperson, I think Cope deserves to be censured for the absurdity of the views they hold about the poor of this country, and in particular the women. This can only confirm that they are a party of the middle class and the rich, and a party that bears no consciousness indeed for the levels of poverty afflicting the citizens of this country.
Interestingly, what they assert has been contradicted by independent research. We in this department actually conduct research on everything that we have to make decisions on. Listen, for if you are a good listener, you will not repeat the same mistakes. According to research, there is no link between child-support grants and teenage pregnancy. The registration of children happens mainly at the age of two; between nought and two years of age the registrations are low. Now, if mothers were registering or getting babies for the sake of the grant, they would register them at month one. That is the linkage, and there is no linkage at all.
The social grants are self-targeting and that is what research says. The social grants are linked to positive social outcomes; that is what research says. For instance, the school enrolment actually increases where children are being fed; where poor children are being fed and assisted, they stand up and they go to school. Research has shown that access to health improves the quality of life of the people - fact that research has proven. The ability to search for employment - Luthuli House will teach you a lot - occurs where a person has been able to at least receive social assistance - a fact proven by research. So, the poverty of ideas that you come up with here, please leave it somewhere else and not here.
I just want to talk about the issue of the five-year local government plan, as raised by the hon member from Salga. Indeed, we agree that there is no place called national, or geographic space called national. We all converge at local government level. We have made a decision and we have agreed at Minmec level that we will invite Salga representatives to our Minmec and to such fora for the purpose of dovetailing and working together in this sphere of government. We also do know that the very heavy issues the hon member raised here are to be addressed within the context of the entire discussion that is being led by our Minister for Co-operative Governance and Traditional Affairs, which is a matter that has to deal with devolution of powers to local government and the future of provinces. That is where this debate is located. Let us wait for that debate and then deal with it as we come to that point.
The Children's Act has actually been signed by the President; we are just awaiting the finalisation of the regulations. As a caring government, a government that understands what it does, we have been participating in a public participation programme as these regulations were being drafted. We have just finalised that process and now at the end of July we will be dealing with the finalisation of that consultation process, and the President will certainly sign those regulations and the implementation of the Children's Act will happen.
I also want to touch on the issue of matters raised by the hon member about HIV and Aids and grants. We are currently looking at all these matters within the department and within the social sector in its entirety. But, for now, we actually hear that members in society are suggesting that we classify those who are HIV positive and Aids-infected to fall under the disabled, to consider that as the disability. Cabinet has agreed on a working definition of disability for now, but we do believe that these are matters that have to be looked at to ensure that we assist those who are sick, hon Radebe, because it is a necessary thing to do so that those vulnerable people who may not be working, but are unable to get any income, are also assisted. It is a broader part of discussions that are taking place.
I think that, hon members, on all the issues that have been raised, the remaining ones are fraud and corruption issues. Again, research tells us that here in South Africa, the norms of leakages on fraud and corruption are leakages that you find in any other and every other system. Here in South Africa we are currently ranging between 2% and 3%, and worldwide and globally on average we are between 3% and 5%. We are, in fact, just below that international average. However, that does not necessarily mean that we must be complacent. One of the things that I did not touch on and that I must bring into the speech is that we are actually, in Sassa and in the department, on a day-to-day basis, working on this issue of ensuring that we deal with fraud and corruption.
Very evidently, as the hon member was saying, when we do research and when we institute an investigation, the outcome is that people must be arrested and so on; somebody else must stand up and beat our drum. We are investigating many people on a daily basis. You know that more than 4 000 people were fraudulently on the system of Sassa. They were dealt with by this government. Now there are those that are from the private sector - we are dealing with those as well. So, please watch the space and watch the sky, because we are indeed dealing with these issues. Thank you very much. [Applause.]
Thank you, hon members. Before we conclude, there is just one announcement. On the instruction from the Chairperson, the programming committee meeting for tomorrow has been cancelled until further notice.
Debate concluded.