KZN Health Budget Debate (Vote 7)
by Dr BT Buthelezi MPL
Leader of the Official Opposition and Spokesperson on Health
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KwaZulu-Natal Legislature
Honourable Chairperson; MEC for Health, Dr D.M. Dhlomo; and Honourable Members of this august House
In his State of the Nation address on 03 June 2009, President Jacob Zuma lauded the ‘functional constitutional democratic system’ of South Africa, as demonstrated by the ‘seamless transition’ in the political leadership. This is an admirable achievement; however, political stability and functional democracy are not guarantee of a functional and sustainable health care system. The public health sector is seriously challenged by infrastructural, organizational and staffing shortfalls. Whether one blames this on the legacy of apartheid or the last 15 years of ineffective leadership at the helm of the Department of Health depends on one’s political lens. Honourable MEC, the Official Opposition wishes to put it on record that the taste of victory by the ruling party is the burden of responsibility.
High infant mortality rate, low life expectancy, the often appalling state of our health clinics and hospitals with their shortages of equipment and medication, the critical shortage of health professionals at public hospitals and the poor treatment of overworked and underpaid health professionals by the previous Minister and MEC for Health – the symptoms are numerous and the diagnosis unmistakable: South Africa’s health care system is ailing. But like a patient who coughs his way through his or her TB, the previous administration has often been reluctant to act decisively on matters pertaining to health. However, the good news is that that’s changing. Dr Aaron Motsoaledi’s frankness is refreshing, his diagnosis and prescription (and hopefully Dr Dhlomo’s) are spot on. I say this because for the first time in 15 years a Minister of Health has admitted that the deterioration of public health services could be blamed on government’s neglect, chronic underfunding, as well as a host of bad decisions, poor management and wastefulness.
The previous administration’s lack of commitment to doctor recruitment and retention – over 22 000 doctors left the country in the past 6 years – is scandalous. Dr Motsoaledi has scored points with opposition parties including the IFP when he admitted in Parliament that the medical profession was underpaid and he would “do everything to make sure that our medical doctors and other health professionals are happy and remain in the system. I want as many doctors as possible to stay in our country. I want to draw the best doctors to the public sector. I want as many matrics as possible to want to study medicine. I want to increase the intake of doctors three- or fourfold.” It’s hard not to believe the Honourable Minister’s intentions are honourable.
Two weeks ago the Minister further admitted in a candid interview with the Sunday Times that he had found a system that allowed provinces to do as they pleased, resulting in dysfunctional health institutions and this included KZN. He added that, “In South Africa, you find a teacher running a hospital. Why was that allowed to happen? That was wrong?” We welcome the Hon. Minister’s assessment of the problems in the DOH and the blame he levelled at many ill-qualified hospital CEOs for many of the department’s problems, including the huge number of vacant posts for medical staff – some of which have not been filled in over a decade. We sincerely hope that the provincial Department of Health (DOH) will be streamlined to implement the bold plan to overhaul the healthcare system, which has already been approved by parliament, and the Minister’s intentions to improve management through the retraining or redeployment of unsuitable hospital CEOs is a step in the right direction.
The Official Opposition supports the national Ministry’s priorities and the MEC can be guaranteed that we will support him and his department in these priorities: • Provision of strategic leadership; • Improving the quality of health services and establishing a national quality management and accreditation body; • Improving human resources planning, development and management, which includes the reopening of nursing colleges, the recruitment and retention of professionals and the specification of staff shortages and training targets for the next five years; • Revitalization of infrastructure, including the refurbishment and maintenance of all health facilities; • Review of infrastructure revitalization programme funding, which will include the participation of the private sector to speed up the programme; • Accelerated implementation of the HIV / AIDS plan, by implementing paediatric and adult treatment guidelines and increased focus on TB and other communicable diseases; and • Intensifying health promotion programmes, including maternal, child and women’s health, land placing more focus on non-communicable diseases, patient’s rights, quality and accountability.
The IFP welcomes the plan to reopen nursing colleges since the country is short of 42 000 nurses in the public sector and to address the imbalance where there are more professional nurses (98 000 in total) compared to 35 000 auxiliary nurses. Fifteen years of what may be termed fiddling while Rome burns is being replaced by a need to urgently address the situation in the manner outlined by the Minister. At the coalface, too many people have died needlessly from a flawed healthcare system. Honourable MEC, there is a lot that must improve in your department. Statistics on infant mortality and morbidity, and maternal and child health have illustrated that we have managed to do more harm than apartheid did to the health of the nation. Communicable diseases such as TB have increased because those given the task of ensuring that TB is cured have failed dismally at their task. Health professionals including doctors, pharmacists, dentists and others have been on strike and taken to the streets to get appalling conditions and salaries addressed. As this happens with recession, it is unfortunate that the DoH is the big culprit in the provincial budget overdraft of some R1.5 billion.
It is quite coincidental that the new South African government has introduced the National Health Insurance in the same year that the Obama administration has promised to offer universal health coverage, introduce electronic health records and wrestle health care costs under control. However, that is where the similarities between the two health plans end. The ANC’s undisclosed National Health Insurance (NHI) document has caused quite a stir. To many, the NHI is the only answer to the enormous inequalities in South Africa’s healthcare system. Others fear it may limit the variety of health services available in the country. And some warn that it will mean the end of the private practice and medical schemes.
Whatever the case may be, we know that the implementation of the NHI is inevitable and we wait with bated breath for the release of the new White Paper on Health that’s in the wings of the DoH, and we know that this process is being driven by the former Director-General of Health, Dr Olive Shisana. The rest of the NHI picture is pretty murky, and surrounded by many fears and questions than answers. We understand that NHI has been bandied about for more than 15 years, and the reason it’s back in the spotlight is that the ANC promised in its election manifesto for the 2009 elections that the NHI system will be phased in over the next five years. No doubt it can be a wonderful system – if it works. But the problem is the time frame and its affordability. The critics say that it is impossible that South Africa can possibly afford such a system with that time frame, and too much of our health infrastructure has to be repaired first. The public statements made by Dr Motsoaledi, in an effort to allay fears that the ANC does not want to destroy the private hospitals and medical schemes by introducing NHI and that government would first upgrade the public health sector before implementing NHI, are noted with a pinch of salt. Even, the former Finance Minister, Trevor Manuel has expressed doubts about the practical side of the plan since after all it took Germany more than 120 years to achieve an inclusive health insurance system.
The IFP is worried about the ANC’s closed door policy with regard to the NHI document and the fact that government has not yet released any official document and that they have not yet engaged with the professional stakeholders nor with the public. Even more worrying is a letter dated 17th June 2009 written by the General-Secretary of the South African Communist Party (SACP), Dr Blade Nzimande with a title, “Capitalist vulture opposed to NHI.” The Official Opposition wishes to caution that hasty decisions and implementation of policy could have disastrous consequences for both the private and public health sector. We await the written commitment made in the ANC Today’s online website by the ANC Subcommittee Chairperson on Education and Health and the member of the Task Team on the NHI, Premier Z.L. Mkhize who said that the ruling party would consult key stakeholders. We hope that the Premier and the MEC for Health will consider taking us into their confidence on this very important matter of national importance.
We note with concern that the provincial Health Departments owe more than R1 billion in unpaid laboratory bills as these debts may lead to some critical laboratories being shut down, resulting in collapse of health care in provinces. KZN is the second worst offender after Gauteng with a debt of R169 million. This situation has worsened the woes of the department since it was also the worst over-spender in the KZN government’s budget overdraft of some R1.5 billion. It will be very interesting to learn how the department intends to pay back this new debt in light of the 7.5% budget reduction to be instituted by all provincial departments.
I would conclude by reflecting on the poem written by Robert Frost in 1912, ‘The Road Not Taken:’ I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I – I took the one less travelled by And that has made all the difference.
Honourable MEC, we sincerely hope that you would be inspired by Robert Frost’s poem and make tough choices in this department by picking the road “less travelled by” your predecessor and in retrospect future generations will credit you with rescuing this department.
The IFP supports the budget of Vote 7 (Health).
I thank you!
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