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UNCLAS CAPE TOWN 000197 
 
 
PLEASE PASS TO AF/S 
 
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