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Cablegate: South African Parliament Holds Robust Debate On

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E.O. 12958: N/A
TAGS: KHIV PHUM SOCI TBIO SA
SUBJECT: SOUTH AFRICAN PARLIAMENT HOLDS ROBUST DEBATE ON
THE NATIONAL HEALTH MINISTER'S BUDGET SPEECH

1. Summary: South African Minister of Health Aaron
Motsoaledi recently gave his first budget speech to a packed
Parliament chamber. The Minister's speech came at a
difficult time with an ongoing doctors' strike and a public
health sector in dire straits. Minister Motsoaledi outlined
the government's ten-point action plan to address the needs
and problems facing the country's public health-care system.
He emphasized that the country needs to approach health
financing from a new angle and announced the future
implementation of a National Health Insurance (NHI) scheme.
Motsoaledi also cited the results of a recent PEPFAR-funded
survey of a random sample of South Africans during 2008,
which included people from all races, age groups, rural and
urban areas in all nine provinces. The survey showed a
decrease in overall new HIV/AIDS infections as well as a
change in behavior among South Africans. Several opposition
Members of Parliament (MPs) declared that the current budget
allocation for the Health Department did not reflect the
governing party's alleged commitment to health over the next
five years. Others called for a new salary scale for public
sector doctors and decried the poor state of the public
health sector overall. End Summary.

What are the Problems?
----------------------

2. National Minister of Health Aaron Motsoaledi recently
provided an overview of his Department's priorities and
objectives for the next year to Members of Parliament and
other invited guests in the Parliament's Old Assembly
Chamber. The Minister presented his budget speech amidst an
ongoing doctors' strike in the public sector and
deteriorating public health facilities that are increasingly
constrained from providing decent healthcare. The Minister
frankly acknowledged the problems facing his Department and
promised to deal with them decisively. He specifically cited
an overall lack of managerial skills in the health system,
delayed responses to quality improvement requirements,
unsatisfactory maintenance and repair and poor disciplinary
procedures and corruption, among others.

3. The Minister additionally emphasized that the current
system of financing healthcare is grossly inequitable and
out-dated. He shared that the government's priority will be
to realize greater "fairness" in the provision of healthcare,
which in turn will promote greater social cohesion and
stability in the long term. Motsoaledi quoted United Nations
Secretary General Ban Ki-Moon in the latter's General Forum
on Advancing Global Health in the Face of Crisis. Ban
Ki-Moon pointed out that in times of crisis, social outcomes,
such as spending for health, are the first to suffer and the
last to recover. In times like these Ki-Moon continued, rich
people in rich nations stop buying their luxury cars and
mansions. However, when the crisis ends, they will begin
buying these items again. Unfortunately, poor people in poor
countries may actually lose their lives during economic
downturns, and they obviously will not recover once the
crisis is over. The Minister, in like manner, declared that
the poor need protection now, more than ever, including
access to adequate healthcare. The government, he added,
will ensure that they have it.

What's His Plan?
----------------

4. The South African Government (SAG) will endeavor to
improve public health sector operations through a ten-point
Plan of Action outlined by the Minister. The SAG and the
QPlan of Action outlined by the Minister. The SAG and the
Department of Health will strive to 1) provide strategic
leadership to the sector and create a social compact for
better health outcomes. Motsoaledi volunteered that the
compact will involve the different stakeholders, including
patients, working together to achieve better results. He
noted that patients are increasingly becoming equal partners
in decision making about health care priorities and that
their voices would complement those of doctors, bureaucrats
and policy makers. 2) To address the "fairness" factor in
health care, the SAG intends to implement a National Health
Insurance (NHI) scheme to all South Africans in the future.
As noted earlier, the current system of health financing is
highly inequitable. The Minister pointed out that the
healthcare system now spends 8.5 percent of GDP on health
expenditure. Five percent of this healthcare spending goes
to the health needs of only fourteen percent of the
population or seven million people. The remaining 3.5
percent of health spending goes to a staggering eighty-four
percent of the population or forty one million people. The
Minister declared that this state of affairs could not be
allowed to continue. Motsoaledi indicated that the new NHI
will provide universal healthcare coverage to every citizen
whether or not s/he is employed, young or old, sick or
healthy, or black, white, or yellow. In this way, the
Minister added, South Africa will achieve better healthcare
for everyone and ensure greater equity within the system.
Despite these assertions in favor of NHI, the Minister
provided no elaboration on how the scheme would be financed.
To date, the Department of Health has not provided formal
documentation to Parliament for consideration although
Motsoaledi says it will be forthcoming shortly. Debate on
the NHI is already happening in the media, and the majority
of it is unfavorable.

5. In addition to the strategic leadership and NHI, the
Minister noted that the SAG plans 3) to accelerate
implementation of its HIV/AIDS Plan and to focus more on
tuberculosis and other communicable diseases. As part of the
HIV/AIDS Plan, the SAG intends to introduce targeted
interventions in provinces with especially high HIV
prevalence, such as KwaZulu Natal. It also plans to assist
young women who want to have children to be able to do so
without risking HIV infection. The government also aims to
intensify its efforts to help provinces to implement
interventions aimed at reducing rates of multiple sexual
partners, including intergenerational sex. The Minister
further indicated that the Department of Health will work
with provinces in 2009/10 to ensure that eighty percent of
HIV-exposed infants receive ARVs for the Prevention of
Maternal-to-Child Transmission (PMTCT), using dual therapy.
This figure will increase to ninety-five percent during
2010/12. In like manner, the Department hopes to increase
the number of HIV pregnant women on dual therapy to
ninety-five percent by 2012. Still other HIV/AIDS
interventions include increasing the proportion of pregnant
women who are tested for HIV to ninety-five percent by 2012,
and increasing the distribution of male and female condoms.
Regarding treatment, the Department of Health seeks to start
215,000 new patients on ARVS in 2009/10 and increase the
number to 320,000 in 2011/12. Currently, 781,465 people are
already using ARV treatment.

Some Good News About HIV/AIDS
-----------------------------

6. Minister Motsoaledi also discussed the results of a
PEPFAR-funded survey that several health agencies had carried
out around the country in 2008. The agencies recently
published their report that collected data from a random
sample of South Africans of all races, age groups, rural and
urban populations in all provinces. The report showed that
HIV prevalence at the national level had decreased by almost
fifty percent among children aged 2-14, between 2002 - 2008;
and slightly among youth aged 15-24 from 2005 - 2008.
Encouragingly, the report also showed that a substantial
decrease in the number of new infections had occurred in
2008, compared to earlier years. The Minister added that the
most encouraging outcome was a change in behavior among South
Africans. The survey indicated that fifty-percent of South
Africans now know their HIV status; ninety percent of youth
aged 15-24 have been reached by HIV/AIDS programs; 83.6
percent of adults between 25-49 have been reached; and 62.2
percent of adults aged 50 and above have had exposure to the
programs. In addition, the survey showed that South Africans
of all age groups are increasingly protecting themselves
against HIV through the use of condoms and more than
ninety-five percent know where to access them. He thanked
PEPFAR for funding the survey.

More of the 10-Point Plan
-------------------------

7. To round out the SAG's ten-point Action Plan, the
Minister briefly discussed 4) overhauling the healthcare
system and improving its management. One idea is to evaluate
all hospital Chief Executive Officers (CEOs) to ensure that
they have the minimum requirements for effective management.
In cases where they do not meet requirements, the government
will institute corrective measures, whether it be retraining
and/or redeployment. Another idea is to perform a
feasibility study for the establishment of a leadership
academy of health managers. Other steps the Department plans
to use in tackling the sector's massive problems include 5)
human resource planning, development and management; 6)
improving the quality of health services; 7) revitalizing
health infrastructure; 8) mobilizing on a massive scale for
better healthcare; 9) reviewing existing drug policy; and 10)
strengthening research and development.

The Opposition Gives their Perspective
--------------------------------------

8. Opposition party MPs expressed their views on the
Minister's budget speech. Mike Waters and Emmah More from
the Democratic Alliance questioned the ANC's commitment to
financing the public health sector. More noted that the
public health care system provides low cost care to many poor
South Africans and for that reason, the government should
nurture and prioritize it in order for patients to receive
compassionate and quality care. However, she asserted that
the budget, as it stands now, does not correlate to the
Department's overall plans, and that there is not enough
money to cover all the individual programs. She called for
the budget to be reviewed.

9. Mike Waters' comments were even blunter. While thanking
the Minister for his "refreshing" candor, he decried the
SAG's lack of action on increasing the salaries of doctors in
the public sector. Waters claimed that a junior doctor in
the public sector makes as much money as a bus driver and
that overall, doctors make fifty percent less than other
government professionals, such as accountants and lawyers.
(An opthamalogist, working in the public sector, also
asserted in a newspaper article that he had helped improve
the sight of 300 pairs of eyes during the year, and yet, he
did not get paid enough to get a mortgage.) Waters alleged
that the government was indifferent to the doctors' plight
and that it had taken advantage of their compassion and
commitment. Waters additionally pointed out that the health
budget from 1998 to 2003 had essentially flat-lined in per
capita terms. He scathingly asserted that the SAG at that
time was more concerned about purchasing guns through the
arms' deal to fight "non-existent enemies" than it was about
its own citizens' healthcare. Waters opined that if the
government could find an extra R1 billion (USD 130 million)
to expand the cabinet and R2-R4 billion (USD 260 - 519
million) for the public broadcaster SABC, it could find the
money to pay its doctors.

10. Congress of the People (COPE) MP Alfred Kganare gave the
harshest criticism to the government's management of the
health sector. He declared that the government needed to
strengthen public healthcare and that service delivery should
be "seen" and not just talked about. He further agreed with
other MPs that working conditions and salaries must be
improved. Kganare, referring to the lack of documentation on
the NHI, acidly told the Minister that the latter's "few
days" of delivering the documents had instead become "a few
months." He also questioned the ANC's commitment to public
healthcare and blamed the party for using money on T-shirts
during the elections when it could have been used earlier for
desperately-needed ARVs in the Free State.

An Update on the NHI
--------------------

11. Mike Waters, MP for the Democratic Alliance and a member
of the Portfolio Committee on Health, told Econoff later that
the Department of Health still has not released any
information on the cost of the NHI. He volunteered that
rumors indicate that South Africans with medical insurance
will pay eighty-five percent of their current contributions
to the NHI and those individuals without it will pay five
percent of their salary. How that will affect medical
insurance schemes and contributions is not yet clear. A
recent article of the Cape Times also quoted Human Sciences
Research Council (HSRC) official Olive Shesana as stating
QResearch Council (HSRC) official Olive Shesana as stating
that the funding for the NHI would come from both income and
VAT taxes. However, Waters indicated that VAT taxes would
hurt the poor more, and that the ANC would probably not
accept it. As to its implementation date, he noted that
colleagues are saying that the Department of Health wants to
have the initiative implemented by April 2010. Others say
that implementation could start as early as November 2009.

12. Comment: Probably no one envies the position of the new
Health Minister with the massive challenges his Department
faces. The state of the public healthcare sector is pitiful
and in dire need of attention and resources. While the
Minister appeared well-intentioned and decisive, he and his
Department cannot possibly tackle all the problems alone. He
will need the assistance of the entire government as well as
signifcant partnerships with the private sector and other
NGOs. MPs of the opposition say with some justification,
that the government and the ruling party need to put their
money where their mouth is and address these challenges
head-on. Only time will tell if they do so. End Comment


MAYBERRY

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