The hon Speaker Mme Modise, hon President Ramaphosa, hon Deputy President Mabuza, fellow Cabinet colleagues, Deputy Ministers, hon members, ladies and gentlemen and fellow South Africans, the President has made a bold declaration of his vision for a future health system as a clear instruction to the sixth administration, which I stand here to commit to and want to quote to what the President said: Putting in place a quality national health care system that ensures all South Africans have access to quality health care, based on need and not on the ability to pay, promoting social solidarity and working towards a cross-subsidisation of services, contributing to the collective health and wellbeing of one another, ensuring that resources are well managed and efficiently deployed.
The President has highlighted the challenges experienced by our people as they approach the health services such as staff shortages, shortage of medication, inadequate infrastructure, the raging burden of noncommunicable and communicable diseases. He has offered the clearest instructions on what needs to be implemented to correct the health services. I rise here to pledge that the entire health sector, both on the public and the private sector stand ready to respond to the President's injunction.
Both private and public sector have responded positively with huge enthusiasm to the fundamental reorganisation of the health services.
All the issues tabled by the President are a reflection of the issues raised with the President, whilst moving from house to house seeking a mandate and his visits to various institutions and hence constitute the undertaking to the sixth administration to deliver health care as a human right and not as a privilege.
Despite our post1994 democratic breakthrough and the multiple efforts that were aimed at improving access to health care services especially for the vulnerable, the South African health system has stubbornly remained two- tiered, fragmented and inequitable and consisting of the public and the private health sectors.
From a funding perspective, the private sector has grown from being a complementary service provider in the 1960s to now being a significant source of health care funding and expenditure. On the other hand, the public health care sector which is the backbone of delivery for the majority of the population, whilst achieving major strides in tackling South Africa's quadruple burden of deceases such as consisting of HIV/Aids, TB, maternal and child mortality, noncommunicable diseases, injuries and violence, now faces many challenges mostly related to the inadequate funding, poor quality, and inequitable access to health services.
In his state of the nation address the President noted that we as a country must reach the 90-90-90 targets for HIV epidemic
control. This means 90% of all HIV positive persons must be diagnosed, and that they must be provided with treatment and 90% of those must have the virus suppressed. We have shown that it can be done. In fact hon members, with the support of communities, we can reach the 90-90-90 targets. There has just been a study report which is released by the Doctors Without Borders in Eshowe, where they have shown increase on testing from 76% in 2013, to 90% in 2018 and also an increase in viral suppression from 93% to 94%. So, this in effect means that the 90-90-90 targets have therefore being reached well before the December 2020 deadline.
Mr President, you have given us quite an intense and immense task, but we are determined to achieve these targets. We want to plead to the members of this House that we need to work together for this task requires all South Africans working together.
As noted by the President, we are working hard to ensure that we initiate an additional 2 million antiretroviral treatment by December 2020. We still need to do more by initiating treatment
of these affected and infected individuals. To achieve this, we need to work with partners and communities at all levels.
Available evidence indicates that adolescent health and young women require special attention as they are most affected. Men and boys also, have to be given attention. They should not be left behind. No one should be left behind. We will also work with men's civil society leaders, developmental partners, political leaders, business and labour to facilitate provision of health services targeting men and boys from all walks of life and encouraging them to be tested and put on treatment.
We will be working with SA National Aids Council, Sanac, led by the Deputy President and its men's sector for the successful initiatives to promote testing amongst men and boys and also improving access to care.
So, we want to ask the members of this House to work with us in this particular campaign and I want to note that the hon Buthelezi has been very consistent on this, in that regard; I think all of us need to emulate and join him in this fight.
I also wish to inform this House of the state of this epidemic that we have estimated 7,4 million people living with the virus. At the end of March this year, about 4,6 million people are on antiretroviral treatment. Now this is also an important issue, because it estimates that we also apart from that we have another 300 000 who are on the private sector. Of course, the government in the past few years has achieved quite a lot in putting many people on antiretroviral treatment and achieved what we could call an epidemiological improbability of raising the life expectancy from about 49 years to about 64 years within a space of under 10 years.
However, it is clear that we cannot depend on treatment alone to stop the infections. Therefore, we need to really focus on stopping the infections. Regrettably the highest number of new infections is still amongst the adolescent girls and young women. It is also important to note that it is older men infecting younger girls and that is an issue that we have to confront as society.
Amongst them, we have an estimation of 212 infections per day. So, a lot more needs to be done in this regard. Therefore we need to ensure that the department also continues to increase the efforts on a number of areas like the provision of information on the risks of early sexual debut and unprotected sex, improve information about condoms and access to pre- exposure prophylaxis as well as focusing on men and in this particular case older men who are infecting younger women.
We also need to strengthen collaboration with various levels of government such as municipalities as well. We also have to focus on the issues of partnership with various sectors of communities. This for me is where this campaign has to go.
Hon members and hon President, today we woke with media reports stating that according to the Democratic Nursing Organisation of SA, Denosa, about 400 nurses have not found employment in Limpopo. These and many such stories are the reason why the President spoke about this issue and I quote:
We must attend to the capacity of our hospitals and clinics. An 80- year-old grandmother cannot spend an entire day in a queue waiting for medication.
All of these issues are issues that we need to be giving attention to. I have actually personally seen these concerns when we visited the Mamelodi and Pelonomi Hospitals, not only just about the issues of overworked health staff, but also the issues of the concerns around security. All of this is the work that we have to do to improve quality of the health systems. Therefore we are finalising the work that was done by the President on the Presidential Summit Compact so that we can then bring all the players to work together in dealing with the issues of health care services.
The President implored us to drastically improve the quality of care in our facilities. To ensure that our public health facilities meet the certification standards as prescribed the Office of Health Standards Compliance which is a national monitoring health system that we have embarked upon. To this end the Minister of Health will be embarking on a number of other
steps such as analysis indicating that patients who come to our facilities, a number of them come just to collect chronic medication. We therefore want to reduce these long waiting times in the public health care sector. We are focusing on a programme which we are expanding called the Centralised Chronic Medicines Dispensing and Distribution, CCMDD. This is a programme where you would get medication out to the community without people needing to go themselves to the hospital. This work is actually being done.
We also have a system to look at the stock visibility which means we not only look in the hospital, but we also look in the productive line within the manufacturers to see where the problem is arising which gives the shortage of medication.
Since last year, there has also been an outcry about the shortage of medicines particularly the antiretrovirals as well as the contraceptions. Now on these ones we have actually engaged manufacturers quite strongly, and therefore we indicated that the manufacturers that fail to deliver will be held to greater accountability for nonsupply.
Additionally, we are also working with Treasury to tighten up the alternative procurement mechanisms because when we are dealing with the National Conference on HIV and Aids the people living with Aids raised this issue very strongly. We have undertaken to work with them directly to monitor and ensure that there is improvement in the supply of medication, particularly in the supply of medication, particularly at the level of treatment of HIV and TB.
We would also like to hear a bit more from our patients. Therefore we want to involve them as we deal with the improvement on the monitoring over the supply of medication.
We shall be implementing the health patient records as well to ensure that we can monitor the movement of our patients as well as monitor the necessary interventions needed to improve on the medication.
Many of the private practitioners that we have spoken to; have indicated enthusiasm in working closely with our National Health Insurance, NHI, system, of course it is important for us to make
this point because I was a bit concerned when the hon Maimane raised the point of about a child borne in a clinic, almost creating an impression that there might be something wrong with such a situation. We actually still need those clinics, those community health workers and those private family practitioners working together in a well structured district health system based on primary health care. So, we must not create an impression that if you are in part of that system there might be something wrong with you. [Applause.]
It is also important that we deal with the issues of the equipment shortages in our facilities and also improve our procurement systems as well.
South Africa spends 8,6% of the gross domestic product, GDP, on health care, which is comparable to other middle-income countries with 4,1% of the GDP spent on the uninsured population, who receive care in the overburdened public sector. Private medical schemes cover approximately 16% of the population, with most of the principal members of these schemes
working in the formal sector. An estimated 4,4% is spent on 16% and that is a gross distortion that needs to be corrected.
Again here one has to be concerned about the statement that the hon Maimane raised that the NHI is unaffordable and it is expensive because we are doing a wrong calculation. When you calculate how much money you save and you do not calculate how many lives you lose, you then lose a count there. [Applause.]
In this case we just want to clearly say that universal health care coverage is the future and the National Health Insurance will happen. [Applause.]
We cannot ... [Interjections.] That is the only way we are going to be able to address the issue of inequality and therefore we can discuss different modalities, but we should not be going back to the question of whether we should or we should not be implementing the National Health Insurance. That debate is over.
The implementation of the National Health Insurance is aimed at moving South Africa closer towards universal health coverage,
wherein all citizens irrespective of their socioeconomic status will be covered to receive quality health care services based on their health needs. In the past it was racial. If you are on the wrong side you knew how the impact of the health services was going to be. This time around it should not be an issue of a socioeconomic division that determines whether you are going to die of simple deceases or not.
So, therefore in our case we are focussing on the National Health Insurance as a health financing system designed to pool funds and to ensure that these pooled funds are actively used to purchase health services with a cross-subsidisation of the healthier subsidising the more sick and then the younger subsidising the older and then we have a normal system like that. It is happening in most of the countries in Europe, UK, Germany, France, etc. We are actually copying the system that is already happening. So, we cannot understand why we must go back to a debate about whether we need it or not.
In this regard, the National Health Bill is actually on its way to Cabinet and therefore it is going to be introduced in this
House very soon. Out of that we really want to ensure that the strong governance mechanisms which are put in place, improved accountability on the use of all of the allocated funds. We want to make a huge progress on that one and on that basis therefore we need your support at that level. [Applause.]