The Official Opposition wishes to thank the Honourable MEC, Ms. N.P. Nkonyeni for delivering her Budget Policy Speech in this House. It was the prophet Micah who declared that where there is no vision people perish. And this department seems to have a vision on paper which is not implemented and it is felt by our people at the receiving end of health service delivery. The DoH is in terribly poor state than at any time since 1994 and the IFP expresses its grave concern about the following indicators:

• over-expenditure of the 2007/ 8 budget by R141 million; a qualified audit report - the first in many years;

• a shady rental deal for over R2 million per annum for buildings belonging to certain senior government officials;

• the resignation of the HoD under a cloud of corruption;

• a moratorium on the filling of most critical posts;

• often appalling state of our clinics, community health care centers and hospitals despite a national budget boost in the Hospital Revitalization grant to help provinces equip and modernize hospitals and failure of KZN to step up its own hospital maintenance budgets and the failure of the department's multi-year plan to upgrade facilities which started as 5-year plan and because the targets were not met it was extended indefinitely to multi-year plan and still the department is failing badly to meet its own targets;

• shortages of equipment and medication experienced by most of our health care facilities;

• critical shortage of health professionals at state hospitals generally and rural hospitals in particular compounded by indiscriminate suspensions of medical doctors by the provincial department of Health; and statistics released by the South African Institute of Race Relations (SAIRR) which paint a grim picture of KZN's public health sector, with worst health indicators of the nine provinces.

The provincial budget planning and management is in an appalling state and it is felt at the institutions and up to now their budget is not known and there are no cash-flow statements to approve payment. Payment of services has been centralized to the province in this period and the service providers and suppliers have not been paid since the end of February 2008 and that hampers service delivery because they refuse to further supply institutions services such as medical equipment, sundry and electricity;

T.S. Elliot may have thought that April was the cruelest month of the year and as far as the Department of Health is concerned this statement can never be closer to the truth. Honourable Chairman, it was on this very occasion, 24th April 2007 to be exact that I stood up in this House and sounded the alarm bells of corruption involving the former Head of Department, Dr Busi Nyembezi. Exactly a year later, the Accounting Officer of this department has unceremoniously resigned her position when the findings of a Premier-appointed Strauss Daily Report found our allegations to be true and recommended that the HOD should be fired. However, the IFP is concerned about the Hon. Premier's decision to withhold forensic audit findings of the Strauss Daly Report and his frenetic attempts to privately negotiate smooth exit of a potentially incriminated official employed by his administration have resulted in a climate of non-transparency and secrecy which stands in the way of public scrutiny. The generosity of R1.8 million package offered to Dr Busi Nyembezi in a department which has over-expended its 2007/ 8 budget by R141 million and received a qualified audit report flies in the face of a 'better life for the people of this province.'

A top-down approach can simply be defined as "imposition of ideas or decision by anyone, upon others, without considering criticism or dissenting views." Usually it is done by those in authorities who at times think they know what is best for those under their rule. There seems to be a Damascus experience with 25 January 2008 the national health department finally announced a new national protocol for PMTCT, adding AZT to the 5-year old nevirapine-only regimen. Can this be described as a top-down approach? My answer would be a definite 'yes.' The IFP has for the past year or so called on the department to improve PMTCT programme by using the dual -therapy prophylaxis of Nevirapine and AZT which could prevented more than 15 000 deaths of babies in this province last year alone. We said this because we know that KZN is the province worst affected by the HIV/ AIDS epidemic. In 2002, the IFP provincial government led by the Hon. Dr L.P.H.M. Mtshali successfully took the Minister of Health to court in a joint class action with the TAC to compel the DoH to provide ARVs to prevent mother to child transmission of the HIV virus. Hon. MEC, had your department introduced dual therapy at the same time as the Western Cape (2004) KZN would have prevented more than 60 000 deaths of innocent babies i.e. children who would fill capacity Durban's ABSA Stadium.

At the South African National AIDS Council (SANAC) plenary meeting held on 28 November 2007, the Deputy President and D-G of Health committed to publishing a new PMTCT protocol within two weeks. This did not happen and 5 000 babies were lost in KZN during that time of procrastination. Simply put, the dual therapy protocol is not merely over 3 months late but it should have been adopted in November 2003 when the WHO amended its PMTCT guidelines. At the above meeting both the Deputy President and D-G of Health agreed that nothing legally stops provinces from implementing improvements to the current nevirapine monotherapy. The Western Cape has implemented a dual-antiretroviral prophylaxis since 2004 and has significantly decreased infant HIV infection to fewer than 8% while KZN has increased to 22%. Statistical modeling has shown that dual therapy will reduce MTCT of HIV from 35% TO 10%, meaning that the number of children infected during childbirth would drop from 70 000 to 30 000 annually across the country.

Honourable Chairperson, It is therefore unacceptable that numerous health facilities with adequate capacity to improve their programmes were restricted in this province from offering dual-therapy. A dramatic example of rigid and punitive national and provincial health bureaucracy happened when Dr Colin Pfaff of Manguzi Hospital was suspended earlier this year for having obeyed the Hippocratic Oath and used dual therapy prophylaxis - acting in the best interest of children and most recently the suspension for one month without pay of an experienced CMO, Dr Mark Blaylock, CMO at the same hospital, for allegedly throwing a picture of a politician in the name of KZN Health MEC into a dustbin. This is utter madness and it would cost lives of innocent patients in Manguzi.

South Africa is 1 of only 9 countries in the world where the child mortality rate is increasing instead of decreasing, mainly because of AIDS. The Medical Research Council (MRC) Saving Babies report last year said that 1 in 5 baby deaths were 'completely avoidable.' Other preventable local tragedies included Klebsiella pneumoniae outbreak that killed 21 babies at the Mahatma Gandhi Memorial Hospital in July 2005 and more than a dozen children at Prince Mshiyeni Memorial Hospital, Umlazi last year. Hospital infection control, mainly in public sector neonatal wards, has dominated health care headlines in recent years, reverberating at the highest political levels when tragic truths of Klebsiella infection emerged. The figures show that it is almost impossible for South Africa to reach UN's Millennium Development Goal of reducing by two-thirds the mortality rate of children under 5 by 2015. This country fares badly when compared with several poorer African countries that are succeeding in slashing their neonatal mortality rates. Malawi, for example, has reduced its rate by 25%.

Contact: Dr Bonginkosi Buthelezi, 082 516 0156