KwaZulu-Natal Legislature Pietermaritzburg: 5 November 2009

Madam Speaker

The past six months have been a period marked by the National Health Insurance (NHI) vitriol, wildcat industrial action by doctors, the swine flu furore, hysteria from the outbreak of measles, ARV rollout tragedy and massive provincial budget over-expenditure.  Some of the health institutions are in a state of disrepair with collapsing roofs such as KEH, and there is a lack of essential equipment. On Tuesday, it was reported in the media that Addington Hospital in Durban is having to cut its budget on bare essentials such as surgical gloves, swabs and dressings. Other major hospitals are not faring any better.

The freezing of medical and nursing posts affects service delivery, deepens staff shortages, and prevents staff retention and professional development. The Honourable MEC is faced with a daunting task of turning around the Titanic of a public health system he has inherited from his predecessor which has been a victim of many years of gross maladministration and neglect. The province needs immediate and tough fiscal discipline to burrow its way out from under a R2-billion deficit, ongoing incompetence, fraud and appalling human resource management. 

A special series of the respected medical journal, the Lancet, was published in August focusing on the challenges of the South African healthcare system. It spelled out in painful detail how many of our health indicators are the worst in the world. South Africa is one of only 12 countries where mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. The report describes South Africa as a population overwhelmed by the quadruple of HIV, TB, violence, poor maternal and child health and increasing chronic diseases. The authors lay the blame for these poor indicators squarely at the door of government. The Honourable MEC would do well in embracing the scientific community following the hostile approach of his predecessor and take constructive criticism without becoming furiously defensive. 

The Lancet report does indeed make depressing reading. Years of mismanagement and neglect in the provincial public healthcare sector have taken a devastating toll in the last six months. Some of our statistics – infant and maternal mortality rates, for instance - are rising, and our tuberculosis and HIV epidemics are the worst in the world. We are also beset by inequities among provinces where the Western Cape children under five have a mortality rate of 46 per 1000 babies in comparison to KwaZulu-Natal’s 116 children who die for every 1000 babies. 

We understand that putting the mess to rights will be a lot tougher, because it is one thing to identify problems, and another to fix them. Until about six months ago, government’s response to these challenges has been marked by denial, lack of political will, and poor implementation of policies and programmes. However, since then, there have been notable achievements in the expansion of TB control efforts and scale-up of the ARV treatment plan. But, on the whole, decisive action is still needed to implement the Comprehensive ARV programme and TB control measures.

I wish to present the IFP’s perspective on these immediate challenges. We in the Official Opposition welcome the vigorous debate on the National Health Insurance (NHI). We welcome every initiative that seeks to address the key challenges facing the current healthcare system. Despite our cautious support of the NHI, the most urgent first step towards NHI is to improve the standards of service in the current public health sector, which the majority of South Africans continue to rely on.

The general public has to feel confident about using our health institutions. There has to be public confidence in the levels of staff training and competence. We all need to be reassured that the continuing problems of stng addressed head on, the interaction between the health professional and patient is empathic, medicines and medical equipment are available, facilities are clean, the confidentiality and privacy of patients is upheld, and waiting times are reasonable. 

There is serious shortage of skilled health staff and thanks to the ill-conceived decision to close a number of nursing colleges to save money during the immediate past government as many as 40% of nurses are due to retire in 5 to 10 years time. Poor leadership and failure to take responsibility by health managers continue to run like invasive cancer through the public health system. Many inexperienced managers have been placed in positions of seniority through the ruling party’s cadre deployment and these managers have struggled to deal with major challenges, particularly human resource management which has been centralised to Head Office. 

There must be an overhaul in the procedure of staff recruitment and retention where the ability to deliver rather than loyalty must be rewarded. Managers must be held accountable for their actions when mistakes have been made. The Department of Health must strive much harder to regain the public confidence which is being progressively eroded by stories of incompetence, failure and mismanagement. These are daunting tasks and it appears they are getting more daunting by the day. Drastic measures have to be taken to stop the rot and we in the Official Opposition can be relied on to support such measures.

I thank you!

Contact: Dr Bonginkosi Buthelezi, 082 516 0156