Debate on the State of the Nation Address by Honourable Mahlalela

19 February 2018:

Honourable Speaker/Chairperson of the NCOP
His Excellency, President of South Africa
Honourable Ministers
Honourable Deputy Ministers
Honourable Members and
Distinguished guests

"The biggest enemy of health in the developing world is poverty". This is what the former Secretary-General of the United Nations, "Kofi Annan, said on the 17th May 2001 to the fifty-fourth World Health Assembly.
The view that good health is good for individuals, families, societies and central to economic development is well established globally and not contested. In fact, the World Health Organisation noted that:
"Better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more"

It is therefore not surprising that both the Millennium Development Goals as well as the Sustainable Development Goals include health as goals. In addition, the National Development Plan notes the importance of creating the conditions for people to develop their capabilities to the fullest, including: ensuring political freedoms and a human rights culture; providing social services like education, health care, public transport, social security and safety nets.
Health is a human right which is enshrined in various global institutions such as the Universal Declaration of Human Rights. Article 25 of the Universal Declaration states:
"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control".

It is clear therefore that human rights are central to health and the provision of health services. The poor health outcomes are not necessarily an exclusively reflection of the health system alone. There is a vast range of genetic, socio-economic and behavioural factors influencing a population's health status, and of such factors that drive poor health outcomes are present in South Africa. These issues include but not limited to housing, access to clean water and sanitation, clean environment, poor diets amongst others. These social determinants of health create high levels of need for health care services, imposing heavy burdens on the country's health professionals.
Our own constitutional mandate in relation to health care is properly articulated in Section 27 of the Constitution which provides that: "everyone has the right to have access to health care services, including reproductive health care". It further stipulates that "the state must take reasonable legislative and other measures, within its available resources, to progressively realise these rights and no one may be refused emergency medical treatment.

The World Health Organisation (WHO) postulates that the goal of UHC is! "Improving equality in the use of needed health services, improving service quality and improving financial protection. The affordability of health care services is a key factor in assessing the extent to which a society can be said to have Universal access to health care.

Despite the significant burden of disease from HIV which is coupled with very high rates of TB, of which according to the World Health Organisation (WHO), South Africa has the third-highest incidence of TB in the world after India and China, and we have made progress in the past few years. We must however admit that we are still faced with many challenges in this regard and therefore much more still needs to be done to build a resilient health system. The 90-90-90 strategy by 2020 will go a long way in eliminating the scourge of HIV.

The World Health Organisation lists 6 building blocks of a health system. These are: governance and leadership; service delivery; health workforce; health information systems; access to essential medicines; and financing. Without these ingredients we cannot have a resilient health system.

The public sector on the other hand with the same amount of money has to provide a health service to the remaining more than 80% of the population relies on the public sector. This level of inequity is naturally wrong unacceptable.

The fiscal federalism in the allocation of health funding that has been introduced since the establishment of the new democratic dispensation has exacerbated the creation of a comprehensive and integrated health system as envisaged in the White Paper on the Transformation of the Health Care System.

The process as outlined by the hon President of establishing NHI is a means to address the financial allocation of resources across all levels of government, correcting management problems, reducing disparities in access to quality health care and focussing on health outcomes. It is in this context that as members of the ANC, we highly welcome and support the introduction of a system of universal health care through the NHI legislation which will soon be tabled to this parliament for processing.

NHI requires the full participation of all health professionals, including those in the private health sector. We must use the skills of all health professionals at all levels of care. Since the International Conference on Primary Health Care held in Alma Ata in 1978 there has been global agreement of the importance of primary health care as the foundation of the health system. It is clear that for NHI to work for everyone we must strengthen PHC. Improving quality of care in the public sector facilities remains an absolute priority by the Department of Health. The Department of Health has started with the process to improve quality of services by introducing two key initiatives, which are the introduction of the office of Health Standards Compliance, and the Ideal Clinic Initiative as part of Operation Phakisa. As part of the OHSC development, a set of national core standards were developed, against which all health facilities in South Africa are being assessed. The Ideal Clinic initiative provides detailed benchmarks for what is regarded as a well-functioning clinic or primary health care facility.

This integrated approach will ensure that our people get the best possible care when they visit primary health care facilities. It will also help us to ensure that patients do not bypass clinics and seek care in hospitals for primary health care! At this point in time 1270 clinics have all the components necessary to ensure that they are 'ideal'. We must move with great speed to ensure that the remaining clinics reach ideal clinic status as soon as possible! It is critical that our people experience these clinics as 'ideal'. This will be proof that our clinics are providing the best quality care possible!

A good primary health care system does not only depend on clinics. We must also focus on prevention of disease and the promotion of health. Our country is confronted with a rapidly growing rate of non-communicable diseases resulting largely from lifestyle changes that include obesity, smoking, and abuse of alcohol consumption, unhealthy diet and lack of exercise. This results towards a range of diseases such as diabetes, hypertension, cancer and cardio vascular diseases. This leads to premature deaths and high absenteeism which in turn contribute to low productivity at work and therefore slow economic growth. Tackling these risk factors is a whole of government and whole of society responsibility. To avoid the NCD tsunami in our country (globally 7 of 10 deaths are currently attributable to NCDs) we must take a very robust approach to how we deal with these risk factors. This includes engaging the food industry to ensure that they produce health food which is affordable (less sugar, less salt, regulated advertising of tobacco and alcohol products, etc).

Cancer has become the latest opportunistic disease that kills people infected with HIV. As announced by President Ramaphosa, the Department of Health with its partners will launch a national cancer campaign this year. The campaign must focus on the risk factors for the various cancers to increase awareness of these risk factors. The campaign must also focus on the importance of self-examination where possible, as well as early detection and treatment. Critically, our people must also have the information to help them to prevent cancers in the first place. The general risk factors that apply to NCDs, also apply to the cancers.

Despite all the measures that we can take to prevent diseases we know that people do get sick. When this happens we must be able to provide patients with the best possible clinical care in our hospitals. This means ensuring that we have the skilled health professionals, procurement systems (to ensure that they have all the medicines, equipment and other commodities necessary to be fully functional), financial systems so that they pay suppliers within the mandated 30 days after being invoiced, as well as the infrastructure.

One of the challenges of providing health care services is the escalating costs and litigation. The prices of medicines, diagnostic technologies as well the remuneration of health workers are all increasing above general inflation. We have to put measures in place to contain costs and this is what we intend to do in how we implement NHI.

To inspire us to work hard and work collectively to implement NHI to ensure that we have a resilient health system based on human rights principles I end by quoting our icon, Madiba:
"Health cannot be a question of income; it is a fundamental human right".

I thank you!