Debate on the President`s State of the Nation Address by the Minister of Health Dr Aaron Motsoaledi

13 February 2019

Honourable Speaker
Honourable President
Honourable Deputy President
Fellow Cabinet Colleagues and Deputy Ministers
Honourable Members
Ladies and Gentlemen

Thank you Mr President for giving the Nation marching orders on the issue of the biggest health revolution that is going to hit the shores of our country - the National Health Insurance (NHI).

To quote you, you said: "After extensive consultation, the NHI Bill will soon be ready for submission to Parliament. The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities. By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care."

It was very important for you Mr President to put your stamp of authority on NHI because there are individuals and some institutions who are working around the clock to undermine it.

Many oppose it vehemently without even understanding what it is. Their opposition is based on hearsay and unguided emotions.

In 2011, the prestigious British medical journal (the Lancet), in its editorial said that Universal Health Coverage, which in South Africa we call NHI, is going to be a third transition to health since human beings started populating this planet.

The Lancet went on to explain that the first ever transition to health happened in the 18th century, and that is when clean running water, sewerage and sanitation were introduced to humankind. While some may believe that this was a small step and take it for granted, in health terms it introduced a totally new world all together. Mortalities and morbidities around the world dropped in a dramatic fasion. Dying due to unsanitary conditions was no longer a certainty.

The second transition arrived in the latter part of the 19th century - that was the introduction of vaccination. Many diseases were vanquished and swept off the face of the earth without a cure ever being found, e.g small pox - declared no more by the World Health Organisation in 1970 due to worldwide immunization of human beings. No cure was ever found for this disease that before the second transition (vaccination) had exterminated lots of people around the globe. But the second transition wiped it off and it is still gone today, more than 50 years later.

The Lancet went on to say that the third transition is now beckoning. It is simply the manner in which healthcare is going to be financed. It is called Universal Health Coverage by the United Nations (UN) and the World Health Organisation (WHO) and we call it NHI. It simply says, from the total wealth of the country, who gets what for their healthcare needs?

For the first time in the history of our country NHI is going to make sure that receiving healthcare has nothing to do with the depth of your pocket.

Honourable Speaker, transitions in health are not just inventions, discoveries or new innovations.

There was a question by some when the Lancet mentioned the three transitions I referred to above. They wondered why one of the greatest achievements by humankind, the first ever heart transplant on earth, performed by a South African, our very own Dr Christian Barnaard, does not qualify as a transition.

The first heart transplant was no mean feat - it was one of the greatest human achievements of our century but it does not qualify as a transition in health. Transitions in health are those that change the whole population - total transformation of human experience. Transitions in health are those that will change even the lives of people who would not have heard about them.

Actually Honourable Speaker, linking the first heart transplant with NHI, I wish to bring it to the attention of this House that the recipient Louis Washkansky, was an ordinary South African. He did not even have to know what a heart transplant cost. He never had to suffer the anxiety of not having money. All he knew was that he was sick and doctors told him that he needed a new heart, otherwise he was going to die. The rest was left to the State.

Today, anybody going to have a heart transplant needs to crunch figures and numbers and calculate their bank balances and audit their assets. Two years ago, I was faced with a problem of an agony of a family whose child was dying and the hospital demanded that the family pays R3 million for an auxiliary heart and a heart transplant that was going to follow later. This cannot be allowed to continue. NHI is designed to completely change this state of affairs and give South Africans the Louis Washkansky experience of health.

Universal Health Coverage was a central issue in many commissions I attended in Davos at the World Economic Forum last month.

It was the central issue in the Africa Leadership meeting called: Investing in Health to receive the Africa we want, on Saturday last week at the African Union. In September 2019 it is going to the high level meeting of Heads of State at the United Nations.

Because of the worldwide appeal for Universal Health Coverage or NHI, critics of NHI have now changed their tune. They are now saying, "we support NHI but..!

They always put a big. "But we want the public health system to be improved first then we can have NHI later".

Honourable Speaker, improving a healthcare system is a lifelong undertaking of any nation on earth. It is not a once off event. It has no endpoint. No country on earth can ever stand up and say we have now successfully improved the healthcare system and now we are ready to open access to the poor. Yet, we are being asked to do exactly that in our country. We not prepared to commit social suicide.

Why should the poor always wait. All of us in this House enjoy free healthcare at the point of service. Yes that is what your medical aid allows you to do - it provides free healthcare at the point of service and is heavily subsidized by the State - last year alone, subsidized to the tune of R57 billion. None of you was ever asked to wait for something to be improved first. We cannot ask the poor to wait. We are the African National Congress.

We are a Movement of All - All South Africans - the poor, the rich, black, white, brown, yellow, the employed, the unemployed, the young, the old, the healthy, the sick, the rural, the urban, and all other citizens who reside within the borders of our country. We are not inclined to tell others to wait for some undefined period in the future before they get good quality healthcare free at the point of service, simply because their pockets are shallow.

We are not like some organization which last week was excited for realizing for the first time in its history, that black people do actually exist and have a right to the economic pie of the country.

That party was so excited just for realizing that black people exist you would have thought they have just successfully performed the first brain transplant.

At any rate Mr President, you did not say NHI will just be implemented and completely ignoring the improvement of quality of care.

This is because NHI and improvement of quality of the public health system are not mutually exclusive. They are two sides of the same coin and actually go hand in glove.

To prove that Mr President, this is what you said during SONA:

"Realising the magnitude of challenges in healthcare, we have established an NHI and quality improvement War Room in the Presidency, consisting of various key departments, to address the crisis in the public health system, while preparing for the implementation of the NHI".

We have funded national quality health improvement plan to improve every clinic and hospital that will be contracted by the NHI.

By introducing the NHI together with a multi-pronged quality improvement programme for public health facilities, we are working towards a massive change in healthcare experience of South Africans.

Mr President, yesterday at Tuynhuys, stakeholders who had attended the Presidential Health Summit last year in October, came together to receive the Report of that Summit.

They consisted of Health Professionals, labour, academics, private sector, business sector, statutory bodies and civil society organizations. They once more committed themselves on working together to improve the healthcare system of the country.

They once more, as it was done in the Summit in October last year, endorsed the principle of one country, one healthcare system. In the next two weeks, they are going to come together again to sign a health compact.

In it, each sector is going to declare what their contribution is going to be to turn the healthcare system of the country around.

They do all these in preparation for NHI.

Honourable Speaker, the heartbeat of NHI is going to be Primary Health Care, PHC.

Primary Health Care rests on three (3) pillars, viz:

  • Firstly is prevention of diseases;
  • Secondly is promotion of health;
  • Thirdly is that the entry to the healthcare system when one is sick will no longer be at tertiary hospitals or specialists levels.

Senior hospitals and specialists will be referral points not points of entry. Points of entry will be clinics, General Practitioners (GPs) and allied health practitioners at non-specialist level.

In pursuing the pillars of prevention of diseases and promotion of health, we have decided to absorb and hire 54 000 community health workers by the middle of this year. Gauteng Province has already started absorbing 9 000 community health workers. The other provinces will follow.

All the community health workers are going to be on minimum wages and no longer be on stipend. They will all be on Persal as an integral part of the health workforce of the country.

In our manifesto as the African National Congress, we are planning to double the number of these community health workers in the next five years.

To improve our clinics, we have decided on the model of an Ideal Clinic. Among other characteristics of an Ideal Clinic, is the type of infrastructure - it has to be state-of-the-art.

We have already completed the building of eight (8) such clinics in the OR Tambo District of the Eastern Cape. They are Lusikisiki, Lutubeni, Sakhela, Genqwe, Maxwhele, Nolitha, Ukanga and Lotana.

We will start opening them officially from March or April.

Four (4) Ideal clinics in Vhembe District of Limpopo and four (4) in Gert Sibande District of Mpumalanga are now under construction at a very advanced stage.

So Mr President, the NHI is not just going to be what we dream on a piece of paper, it is going to be a living reality of our people with quality of care foremost in our plans.

I want to conclude by appealing to our people. As we come up with a system to provide access to healthcare free at the point of care, South Africans should not just allow themselves to fall ill. The burden of disease is very high and needs to be reduced. In 2004, we had only 400 000 people visiting our health facilities to receive their ARVs.

Today we have 4.5 million people and we will be having 6.1 million by December 2020. There is explosion of cancer, Diabetes, High Blood Pressure and Mental Health.

This is a huge burden on the healthcare system of our country.

Please participate in the wellness programme that we have launched.

Members of Parliament and society should support us when we fight tobacco use, excessive use of alcohol, poor diet, lack of exercise, sex without protection, motor vehicle accidents, excessive intake of sugar, salt and all the other vices human beings engage in. Please do not allow yourself to be captured by big tobacco companies, liquor companies or sugar companies. That capture will cause the country dearly. I picked up an element of capture when we debated the Sugar Tax. Let us not allow that in this Parliament.

If we regulate these human vices, NHI will be affordable and sustainable.

I thank you.