Health-e (Cape Town)
Anso Thom
6 June 2008
Health minister Dr Manto Tshabalala-Msimang this week presented what may be her final budget as head of the health portfolio. She used the opportunity to mainly present "successes" by her department.
The minister also used the occasion to claim victory in the battle against AIDS declaring that the 2007 HIV antenatal survey has shown a 1,2% drop in HIV prevalence among pregnant women.
The full survey was not released, but Tshabalala-Msimang said the figures suggested "that we have a trend of decreasing prevalence overall and in the younger age cohort".
Tshabalala-Msimang highlighted the slightly decreasing HIV prevalence in the 15 to 19 and 25 to 29 year age groups. She did not mention the 30 to 39 year age group where there have been significant increases in HIV infection over the last six years.
Access to primary health care services doubled over the past decade with more than 101-million patients using these services in 2007/8 compared to 67-million in 1998, she reported.
In a veiled reference to her axed deputy and earlier newspaper reports on high numbers of infant deaths at Frere Hospital in East London, the minister said: "Disturbing incidents in a few facilities have created a false impression that we are not doing enough to address issues of maternal and child health.
"I wish to state categorically that the Department of Health is fully committed to improving the health status of women, mothers and children of our country and to achieving the Millennium Development Goals (MDGs)."
However, experts say that South Africa will not reach the infant and maternal MDGs and that South Africa's under-five mortality rate is increasing.
The country is currently one of only 12 countries globally that has increasing rates of child deaths. Yet it is estimated that over 40 200 child deaths as well as many maternal deaths and stillbirths could be avoided with simple, internationally recognised interventions.
At least 260 mothers, babies and children die each day in South Africa.
The minister acknowledged that multi-drug resistant TB and extensively drug resistant (XDR) TB posed a particular challenge. She said the TB strategic plan would focus on community mobilization, decreasing the TB defaulter rate and the training of health personnel.
She said the department was on track to reach the 7% defaulter rate "as set by our President in the State of the Nation address".
Tshabalala-Msimang reported that Umsinga district in KwaZulu-Natal, which includes Tugela Ferry where XDR-TB was first reported, had reported a zero percent defaulter rate. However, critics have pointed out that a lot of resources had been sent to Umsinga, while other districts failed to control TB.
According to the latest District Health Barometer districts such as Nkangala (Mpumalanga), Amathole (Eastern Cape) and Ugu (KwaZulu-Natal) continued to record TB cure rates well below 40%.
Democratic Alliance (DA) spokesperson on Health Mike Waters responded to the budget speech by saying that "all we have seen from this minister is business as usual, no accountability, no sense of urgency, no idea what the challenges are and no grasp on reality.
"If the President and the ANC really had the health interests of the public at heart, the minister would have been fired a long, long time ago.
"Fortunately for the 47 million South Africans, this is certainly the Minister's last budget speech," Waters told Parliament.
DA MP and member of the portfolio committee on Health Sandy Kalyan said Tshabalala-Msimang had been "a spectacular failure as Minister of Health and I humbly appeal to the incoming leadership after the next elections to ensure that the voice of reason prevails, and to never ever again entrust you with the health of South Africa".
The minister's full speech follows below:
BUDGET SPEECH OF THE MINISTER OF HEALTH NATIONAL ASSEMBLY
5 JUNE 2008
Madam Speaker,
Honourable Members,
My Colleagues MECs
Members of my family and friends
Distinguished Guests,
Ladies and gentlemen
I am honoured to present to this august House the National Department of Health's Budget for 2008/09 for consideration.
Honourable Members, 2008 is also symbolic as it is the last complete financial year of the term of office of this government and close to 15 years of democracy for our people. As you know that the next general election will take place in 2009.
We shall focus in our speech on what the Department of Health has achieved in strengthening health service delivery. We shall also highlight what we intend to achieve in this financial year.
As the Department of Health, we strongly condemn the incidents of violence that have affected some parts of our country over the past few weeks. The national and affected provincial governments have been working tirelessly to respond to the acts of violence. The Department of Health has been part of the inter-sectoral collaboration to address this problem. We are responding to all the health challenges that have arisen in this regard ranging from emergency response to ensuring access to health services for those accommodated in temporary shelters.
This year marks the 30th anniversary of the adoption of the Declaration on Primary Health Care (PHC), in Alma Ata, in the former Soviet Union. The philosophy of Primary Health Care has driven the transformation of the health sector in South Africa since 1994. We reshaped the health system from a fragmented, inequitable and disjointed system to a unified and integrated health system which strives to meet the health needs of all South Africans by focusing on equity, solidarity, inter-sectoral approach, community involvement and decentralization of health care delivery.
Primary Health Care
In keeping with the philosophy of the Primary Health Care approach, it is with great pleasure that I report back to this House that access to Primary Care Services has almost doubled over the last decade. A total of more than 101 million patients used our Primary Care services in 2007/08, compared to 67 million in 1998.
This has been achieved through health policies that prioritized the poor, and the marginalized, and which included:
Elimination of user fees for primary health care and hospital services for prioritised groups;
Development of essential drug lists for primary and hospital levels of care;
Massive expansion of health infrastructure for the delivery of Primary Care Services through the building and upgrading of more than 1600 clinics; and
Increases in the number of health professionals employed in the public health sector, including training of midlevel workers in a range of health disciplines.
To some extent the budget for the public health sector has increased to meet the increased healthcare needs and expansion of the public health sector. In 2001/02 the total public sector health budget was R29.3 billion and it increased to R53.2 billion in 2007/08. Off course, this increase does not take into account the effect of inflation.
Disturbing incidents in a few facilities have created a false impression that we are not doing enough to address issues of Maternal and Child Health. I wish to state categorically that the Department of Health is fully committed to improving the health status of women, mothers and children of our country and to achieving the Millennium Development Goals. Let me provide some information to demonstrate this.
Child Health
We have strengthened various health programmes to improve service delivery. In 2007/08, we fully immunized 84% of children under the age of one year, to protect them against vaccine preventable diseases. The number of children that have been confirmed by laboratory tests to have had measles in South Africa decreased from 829 in 2004 to only 31 in 2007 and we have had no deaths from measles in the last two years. However, imported cases remain a major threat to the progress we have made in this area.
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p_steyn@adeHIV-related disease will kill one every 42 seconds.