Motsamaisi wa dipuisano ya kgabane le Maloko a Palamente a hlomphehang, ntlafatso ya bophelo bo botle ke e nngwe ya dintlha tse hlokehang ho fedisa masalla a kgethollo. Kgethollo e ile ya qhelela batho ba batsho ka thoko mme ba iphumana e le hore ba mahlatsipeng, ha ba tsebe hore na mahlonoko ana a ho kotelwa ka thoko batla a etsa jwang. Ke ka hona mmuso o tlamehang ho etsa makgobonthithi ohle a hlokehang ho tlisa tekano le boleng ditshebeletsong tsa bophelo bo botle ho Maafrika Borwa ohle, haholoholo bathoo ba ileng ba eba mahlatsipa a kgethollo. (Translation of Sesotho paragraph follows.)
[Mrs S P KOPANE: Hon Speaker and hon members of Parliament, the improvement of the health care system is one of the measures necessary to eradicate remnants of apartheid. Apartheid was biased against Black people, who were victimised and who don't know how to handle the pain of discrimination. That is why the government must make every effort necessary to bring about equity and quality of life through service delivery with regard to health care for all South Africans, especially victims of apartheid.]
In an open-opportunity society, only people who are healthy, energetic and mobile are able to properly use their talents, follow their dreams and care for their families. Therefore, no society can prosper without an affordable, quality and easily accessible health care system that allows people to manage chronic disease and overcome serious illness.
Allow me to use these words of wisdom by Mahatma Gandhi, who said, "A nation's greatness is measured by how it treats its weakest members." If that is so, then the Department of Health must be held responsible for holding us back from the greatness we aspire to.
The primary problem with the public health care system is not about accessibility. The real problem with the public health care system is that it offers low-quality health care outcomes. This compromises the health of the nation and makes it virtually impossible to achieve the development improvements that we all aspire to.
The government's own National Planning Commission explains that the health care system is fractured, with pervasive disorder and multiple consequences, such as poor authority, poor accountability, the marginalisation of clinical processes, and poor staff morale. Centralised control has not worked because of a general lack of discipline, inappropriate functions, weak accountability, a lack of adherence to policies, inadequate oversight, and poor institutional links between different levels of services. The sad part is that all these issues that affect quality or standards are hardly mentioned in the national health care proposal.
Quality is ultimately a question of standards, targets and accountability. However, the National Health Insurance proposal focuses so little on the question of what minimum norms and standards are required to achieve quality health care outcomes. It does not set targets for health improvement that the system must attain. According to the Ministerial task team, "No part of the health system is held properly accountable for the poor health outcomes, or poor service delivery." This fact alone makes it virtually impossible for the system to improve since no one in it has any incentive to perform better.
The absence of a statutory body and independent quality assurance regulator further reduces the imperative of any health authority or service provider to become concerned about gaps in the standard of care offered, as they face no consequences and avoid publication of embarrassing information on their performance. The public health sector does not assess itself according to any known benchmark or target. The government does not know how to evaluate its own health care performance. This is a major problem.
During the public hearings, different stakeholders raised their concerns that there should be definitions of norms and standards. This is one of the private sector's biggest concerns, as they are worried that within the context of the NHI, these norms would include tariff norms. The majority of them were concerned about the independence of the office concerned.
The DA welcomes the establishment of an Office of Health Standards Compliance to accredit and regulate institutions, so performing a crucial oversight function. We believe that this is a step in the right direction. As the Portfolio Committee on Health, we agreed that board members should be appointed and that the Minister of Health should appoint members of the Office of Health Standards Compliance in consultation with board members. According to the National Health Amendment Bill, a chief executive officer and ombudsman will be appointed. The Minister will appoint the ombudsman only after calling for public nominations, including consultation with the board. The function of the ombudsman includes investigating complaints related to the norms and standards. The major problem with the Bill as it stands is clause 81A, which says:
(9) After each investigation, the Ombud must submit a report together with his or her recommendations on appropriate action to the Chief Executive Officer.
(10) The Chief Executive Officer may, subject to subsection (9), request the intervention of the Minister.
(11) Where the Chief Executive Officer fails to act in accordance with the findings and recommendations of the Ombud, the Ombud may request the intervention of the Minister.
From the international review it is clear that the ombudsman's office is essentially an alternative to going to court. The ombudsman should be someone who has the legal authority to take decisive action and set a precedent; thereby building consistency, predictability and deterrence.
For the sake of the independence of the office, the ombudsman must assume an adjudicative role and must be empowered to make findings against the inspectorate or standard-setting division of the same regulatory authority to which it is aligned. If the Office of the Ombudsman does not have powers of determination, then it cannot be called an ombud.
The fact that the ombud should report to the CEO, not directly to Parliament, means that the office will not be truly independent but will be open to political pressure and influence. This is undesirable and unnecessary. I believe that the ombudsman can submit the report to both the Minister and the CEO. However, reports must be tabled in Parliament and must be made public. Chapter 10 of the National Planning Commission document states that there needs to be "clear separation of policy-making from oversight and operations".
The DA strongly believes that the creation of effective accountability and governance structures requires an independent, neutral and transparent body. The DA will object to the current proposal as it stands now. [Applause.]