Hon House Chair, my colleagues Deputy Ministers and Ministers, chairperson and members of the Portfolio Committee on Health, hon members of the House, invited guests, ladies and gentlemen, it is now documented and generally understood that South Africa faces a quadruple burden of disease. Many other countries are faced with only a double burden.
These four are: a very high prevalence of HIV and Aids which has now entered into a synergistic relationship with tuberculosis; maternal and child mortality and morbidity; an exploding prevalence of noncommunicable diseases mostly driven by risk factors related to lifestyle; and, lastly, the issue of injuries and violence.
These four colliding epidemics resulted in death notification doubling between 1998 and 2008 to 700 000 per annum, as noted by the National Planning Commission. Life expectancy in the country also took a knock and declined to worrying levels. We had to respond to these very urgently and very decisively.
In addition to our 10-point programme, the Department of Health signed a negotiated service delivery agreement with the President of the country. We committed to four objectives, which we called outputs, during this term of government. These objectives are: one, increasing life expectancy; two, reducing maternal and child mortality; three, reducing the burden of diseases like HIV and Aids and TB; and, lastly, improving the efficiency and effectiveness of the health care system.
After going into a deep analysis of these problems, it became clear that unless we dealt decisively with HIV and Aids and TB, it would be foolhardy to believe that we could ever decrease the high levels of mortality and morbidity in our country. Therefore, our plans had to have a very strong element of desire, commitment and passion as far as HIV and Aids and TB are concerned. This did not mean that the other epidemics were less important, it simply emphasised that the central driver of morbidity and mortality in South Africa, by and large, is HIV and Aids and TB.
We responded comprehensively through well-designed plans to deal with HIV and Aids and TB, and the implementation of these plans was well executed. Among other things, we increased the number of health facilities providing antiretrovirals, ARVs, from only 490 in February 2010 to 3 540 to date. The number of nurses trained and certified to initiate ARV treatment in the absence of doctors was increased from only 250 nurses in February 2010 to 23 000 nurses to date. This programme is called Nimart - the nurse- initiated management of antiretroviral therapy.
Hon Chair, there is noise from this side and I can't concentrate. Please help me. Nimart made it possible to increase the number of people on treatment from 923 000 in February 2010 to 1,9 million to date - actually doubling the number of people on treatment. [Applause.] I wish to take this opportunity to thank all health workers for this sterling performance, especially the nurses without whom these numbers would have been impossible to achieve, given the small number of doctors the country has.
Very recently we introduced the ground-breaking fixed dose combination, or FDC, therapy, which made it necessary to train 7 000 health workers for smooth implementation. Another very important windfall from these FDCs is that in February 2010 it used to cost us R313,99 per patient per month to provide ARVs, but now with FDCs it costs us only R89,37 per patient per month. We are now able to treat a lot more people per month with the amount of money that we used to treat one person in 2009. [Applause.] The results we achieved from these endeavours have been very sweet indeed.
By the end of last year, local and international researchers started reporting a dramatic increase in life expectancy in our country. They also reported a decline in the mortality of children under five and in maternal mortality. Our biggest challenge, however, is still the neonatal mortality rate. These researchers include our Medical Research Council's Rapid Mortality Surveillance Report, the prestigious medical journal The Lancet and United Nations programmes, such as the Joint United Nations Programme on HIV/AIDS, UNAids. All these researchers attributed the decline in mortality and the concomitant increase in life expectancy in South Africa to our comprehensive response to the HIV and Aids epidemic, especially the ARV treatment programme. The fact that we are testing large numbers of our people and that large numbers are on treatment has brought much relief to individuals, families and communities.
As far as TB is concerned, we started in earnest on 24 March 2011 to introduce new programmes. We have unveiled new strategies to combat TB. Firstly, we unveiled the GeneXpert technology. The last time the world unveiled a new technology to diagnose TB was more than 50 years ago. We thought then that we had defeated TB. Now we know better. We are hence immensely relieved that a new, faster and very effective technology has now been unveiled by scientists commissioned to do so by the World Health Organisation's Stop TB Partnership.
Before GeneXpert technology, it used to take us a whole week to diagnose TB, but now it takes us only two hours. [Applause.] It used to take us three months to conclude that a person had multidrug-resistant TB, now it takes us only two hours. [Applause.]
I'm very proud that South Africa was the very first country on this continent to unveil the GeneXpert technology. Since its unveiling on 23 March 2013, we have distributed 242 units around the country. These 242 units constitute 80% of all facilities we would like to cover. We have spent R117 million, shared by the national Department of Health, the Global Fund and the Centres for Disease Control and Prevention in the USA to achieve this 80% coverage. We have conducted 1,3 million tests since using this technology in 2011. These 1,3 million tests constitute more than 50% of the total tests that were conducted throughout the whole world in the same period.
In five months' time, we will achieve 100% coverage in all the district hospitals with the GeneXpert technology. From there we will move to the big community health centres. The biggest of these machines can diagnose 48 patients at a time, while others can do four or 16 only. The biggest are called GeneXpert 48. We have only two of them in the whole country. We have placed one in the eThekwini Municipality in the Prince Mshiyeni Memorial Hospital in KwaZulu-Natal. The second one is in the Cape Metro at the National Health Laboratory Service at Greenpoint. We have done this because both eThekwini and the Cape Metro are the most heavily challenged cities as far as TB is concerned.
On World TB Day on 24 March this year, the Deputy President of the Republic unveiled GeneXpert technology at Pollsmoor Prison on behalf of all correctional service facilities. This was in response to a Constitutional Court ruling in which an inmate took government to court and the state was held liable for inmates contracting TB in jail. Yes, it is now well established that the highest rate of TB in our country is in correctional service facilities. They too will be supplied with GeneXpert units to screen all inmates on entry to correctional service facilities and to screen them twice a year once they are inside.
We will also request the names of those are who found to have TB by GeneXpert from the Minister of Correctional Services, in order to send health workers to their families so that the whole family of an inmate can be screened for TB. One person with TB has the potential to infect 15 others in his or her lifetime.
The second strategy we have adopted is to establish family teams. On our database we have 405 000 families in South Africa which have a member diagnosed with TB. The family teams are visiting these families to screen all members of the family. About four weeks ago, the Statistician-General went to the Thabo Mofutsanyana region in the Free State to release Statistics SA's yearly figures on the causes of death. He released the figures for 2010 and announced that TB was found to be the number one killer in the country. This is not surprising, given the synergistic relationship between TB and HIV and Aids, as I said earlier.
We are eagerly waiting for the 2011 and 2012 figures to see how effective our programmes have been. For now, we can report that in 2008 our TB cure rate was only 67,5%, but in 2012 it improved to 75,9%. The target set by the World Health Organisation is an 85% cure rate. We are steadily but surely moving in that direction. However, I have one very serious request to make. Having turned the corner should not be regarded as a signal to South Africans to be complacent. We still have a very long road to travel with HIV, Aids and TB. The National Development Plan has clearly indicated that by 2030 we must have a generation of under 20s free from HIV and Aids, and we must have a decrease in the TB contact indices.
At the recent SA National Aids Council, Sanac, plenary we decided that the Presidency will need to relaunch for us the HIV counselling and testing campaign in the country. This relaunch must happen at the Gert Sibande district in Mpumalanga. This district has now been officially declared as the district with the highest prevalence rate of HIV and Aids in the country. I have a serious complaint: since the campaign started there is one extremely powerful place in this country where the HIV counselling and testing campaign was never launched. That place is called the Parliament of the Republic of South Africa.
Hon Chair, may I humbly ask that the Speaker please choose a date on which we will come and publicly launch this campaign here in Parliament, with the Speaker and the Chairperson of the NCOP taking the lead, followed by leaders of all political parties in these hallowed chambers. The provincial legislatures, district councils and local councils will follow suit. I will then have the power to encourage churches, schools and other centres of civil life to choose their own dates to do so. I promise to supply Parliament with a GeneXpert unit and a mobile X-ray unit on behalf of members in this Parliament. This is because you also need to be screened for TB and HIV and Aids.
Let me now deal with an intractable problem that the health care system is faced with, that is Output No 4 in terms of our negotiated service delivery agreement. Output No 4 is: Efficiency and effectiveness of the health care system in the country. You are well aware that our flagship programme to change the efficiency and the effectiveness of the health care system in the country is the National Health Insurance, NHI, system.
While South Africans have been throwing mud at each other about NHI, I need to indicate that we need to stop wasting our time. NHI has now gone global. The World Health Organisation, the United Nations, the World Bank and prestigious institutions of higher learning, such as Harvard University, have recently entered the fray in support of NHI and in giving well- researched guidance to countries on how to go about implementing NHI - and not to debate whether it is needed or not. The world has gone far beyond that stage.
Recently - only a month ago - the World Bank and Harvard University organised a workshop for all Ministers of Finance to guide them on how their treasuries should support NHI for the benefit of economic growth in the world.
Of course, it is not called NHI in every country. The World Health Organisation and all UN agencies are using a generic term: universal health coverage. We in South Africa will stick to the term NHI. The prestigious British medical journal, The Lancet, launched a series late last year to allow academics, health activists and researchers to write articles to guide countries about this concept of universal health coverage. It doesn't matter what you call it - the concept is the same and it means that every citizen has the right to access good quality, affordable health care, and that that access should not be determined by the socioeconomic condition of the individual. Whether you call it NHI, as we are doing in South Africa, NHS as they do in England, Seguro Popular as they say in Mexico; or Obama Care as the Americans call it, the concept is the same.
The editorial of The Lancet, Volume 380 of 8 September 2012, states that, and I quote:
Certain concepts resonate so naturally with the innate sense of dignity and justice within the hearts of men and women that they seem an insuppressible right. That health care should be accessible to all is surely one such concept. Yet in the past, this notion has struggled against barriers of self-interest and poor understanding.
The editorial goes further to say:
Building on several previous Lancet Series that have examined health care systems in Mexico, China, India, South East Asia, Brazil and Japan, today we try to challenge those barriers with a collection of papers that make the ethical, political, economic and health arguments in favour of Universal Health Coverage and will be presented in New York on September 26, to coincide with the UN General Assembly. The Series was facilitated by the Rockefeller Foundation and led by David de Ferranti of the Results for Development Institute in Washington DC. The conclusions support the World Health Organisation Director-General Dr Margaret Chan's assertion that 'universal coverage is the single most powerful concept that public health has to offer'.
The editorial goes on to say:
UHC, like any other health system, must be accountable for the quality of its outcomes and the compassion of its care. The emphasis should be on responsiveness to service users, rather than on profit for shareholders.
It is very clear that the whole world, not only our country, is gearing itself to get rid of archaic health care financing systems that cater for the privileged few and punish the poor, in favour of health care systems that will benefit all - and all citizens of a country.
This assertion led to another article in The Lancet Series I have just mentioned. It argues that universal health coverage is poised to be the third health transition. It argues that there have two transitions since the beginning of humanity. The first was the demographic transition that began in the late 18th century and changed the world in the 20th century through public health improvements, including basic sewerage and sanitation, which helped to reduce premature deaths.
The second transition, which began in the 20th century and reached even the most challenged countries in the 21st century, was when the world started tackling communicable diseases through immunisation. Now, they say a third transition is sweeping the globe and challenging health care financing, because for a long time health care has meant first paying a fee to a provider, a practice that effectively burdens the poor.
In implementing NHI or universal health coverage, countries are clearly going to pay different prices for different durations in time, depending on internal objective factors and dynamics within each country. Hence, a country like Qatar is going to implement NHI starting from July this year and finishing in December next year. Here in South Africa, we have given ourselves 14 years to achieve the same owing to our internal objective factors.
Unlike Qatar, there are two main prices that South Africa has to pay to successfully implement NHI. The first price is the quality of services in the public health system. It has to drastically undergo a metamorphosis - the quality simply has to improve and there is no running away from that.
The second price is that the cost of private health care has to decrease drastically. We need to firmly regulate the prices in private health care.
As the Department of Health, we strongly welcome last week's announcement by the Minister of Economic Development, the hon Minister Patel, that through the amended Competition Act, the Competition Commission will launch a public market enquiry into the costs of private health care. We are ready for them, and for those who do not understand where this comes from I wish to refer to our National Development Plan: Vision 2030, which states that:
A national health insurance system needs to be implemented in phases, complemented by a reduction in the relative cost of private health care and supported by better human capacity and systems in the public sector.
As to how we are going to pay the price of quality health care in the Public Service, we shall outline this in the White Paper to be released soon. We are aware that this is long overdue, but there were many things that we had to consider before we could release it, and we will do so very soon.
It will be released with a plan on how NHI is to be implemented. These are elaborate plans and it will be impossible for me to give them here with the time allocated to me. They will be made available in due course. They will include the whole concept of non-negotiables in health care; the delegation of powers to CEOs, who are being newly appointed and trained; and abolishing the dreaded depot system of drug supply to allow CEOs to get medicines directly from suppliers.
I wish to take this opportunity to emphasise over and over again that the NHI will be based on a preventative and not a curative health care system. I will repeat this on many more occasions to come: that primary health care, meaning the prevention of diseases and the promotion of health, is going to be the heartbeat of NHI in South Africa.
We will drive this health care system according to the dictates of the National Planning Commission, which clearly state that among the most important things to be done, is the need to reduce the burden of disease and not allow diseases to flourish and for us to run helter-skelter in trying to cure them.
We wish to demonstrate the example of the Rotavirus vaccine and the pneumococcal vaccine. Since their inception four years ago, we have seen miracles in three places. The Ngwelezana Hospital used to admit 1 000 children with diarrhoea every day, but the ward at the hospital was recently closed because no more children are being admitted with diarrhoea. [Applause.] In Cape Town and Gauteng generally, diarrhoeal admissions have decreased by 70%, which is attributable to the Rotavirus vaccine.
Seeing the success that vaccines can bring, our next target is cancer of the cervix of the uterus - one of the biggest killers of women in our country. According to Prof Lynette Denny and Dr Yasmin Adam of the Department of Obstetrics and Gynaecology at the Groote Schuur Hospital and the Chris Hani Baragwanath Hospital respectively, cervical cancer affects 6 000 South African women annually. Eighty percent of them are African women. Of the 6 000 affected, between 3 000 and 3 500 die annually as a result of this cancer. More than 50% of the women affected are between the ages of 35 and 55. Only 20% are older than 65. HIV-positive women are five times more likely to get it than HIV-negative women. Women who smoke are two times more likely to get cervical cancer than nonsmokers.
This cancer is caused by another dangerous virus, the human papillomavirus. The good news is that there is now a vaccine against this virus. Unfortunately, this virus is also sexually transmitted. The very bad news is that the prices are prohibitive: between R500 and R750 a dose, and you need three doses to be covered. Even in the private sector the uptake is very slow because of these costs.
At the moment, to make these vaccines affordable, the Bill and Melinda Gates Foundation established what is called Gavi: the Global Alliance for Vaccines and Immunisation, to help poor countries. Unfortunately, South Africa does not qualify for Gavi as we are regarded as a rich country, even though there are times we are told that we are poor. We are also aware that the Pan American Health Organisation has negotiated a price of $13,00 a dose for Latin American countries.
I am extremely happy to announce that, in consultation with the Minister of Finance and the Minister of Basic Education, we have decided that we shall commence in administering the human papillomavirus vaccine as part of our school health programme by February next year. [Applause.] We will enter negotiations in our own right to also be given a fair deal. We are advised by scientists that the vaccine is fully effective before sexual activity. Therefore, we shall administer this vaccine to 9 and 10-year-olds in Quintiles 1, 2, 3 and 4 schools. This will cover 520 000 girls between the ages of five, nine and 10. We will give a booster dose five years later. We are not discriminating against Quintile 5 schools, but just the parents that can afford the vaccine. Parents must please try to buy the vaccine on their own until we are able to cover them. I am calling on all medical aid schemes in the country to pay for these vaccines to help parents with this category of learners because the benefits far outweigh the costs. I was told that it costs about R100 000 per patient in the public sector to treat one of these 6 000 cervical cancer patients. I'm scared to give you the prices in the private sector.
Very bad news emerged recently from our hospitals about an entity called RWops, or remunerative work outside the Public Service, in terms of which doctors fully employed by the state conduct their own private work during working hours. RWops is not illegal. It was passed by Cabinet around 1994. The only problem is that it is being abused by some unscrupulous individuals. I must emphasise that the overwhelming number of doctors in the Public Service are very decent, law-abiding, hardworking citizens who are deeply committed to their patients. It is only a few who are tarnishing the name of the profession. I am appealing to the public that the events that unfolded this week in the media should not be misconstrued in that most doctors are involved in this practice and for people to start regarding all doctors as criminals. I repeat: the majority of doctors are ethical individuals who understand their calling.
The very few who are involved are not only punishing patients, but are also destroying medical training in the country. This is because they leave their medical students to their own devices. Even specialists in training are badly affected by being abandoned by people who are supposed to guide them in every step of their training.
I have already warned the private sector that is benefiting from this bad practice that in the long run they will also lose, because we will have poorly trained doctors in the whole country. I have given this matter to the deans of all the medical schools to deal with, and I'm waiting for their recommendations. We will call all stakeholders to discuss this matter because to me it is a national problem. For those that have been found guilty - because we know their names - we can't avoid criminal charges. We will refer their names to the SA Revenue Service to check if they are paying tax on the double income they are earning.
We are also appealing to the private sector that is hell-bent on attracting these public servants with lots of lots of perverse incentives, to please stop this practice because it is not only destroying the public sector, but will also destroy them in the long run. Very soon - and I'm not threatening - we will not have private health care or public health care in South Africa owing to this practice.
I wish to take this opportunity to thank the Deputy Minister, the director- general, all managers in the head office and facilities. Our health workers remain our heroes and heroines, despite the few who want to tarnish the good name of their profession. I wish to thank them for their sterling work and performance, done sometimes under very trying circumstances. [Time expired.] [Applause.]