26 April 2012
The Treatment Action Campaign and SECTION27 Welcome the Minister’s Health Budget Vote. But More Needs to be Done to Deliver on the Right to Health. Announce and Implement Plans Urgently!
“A long and healthy life is not going to be achieved through wishes and sloganeering. It is not going to roll-in on the wheels of inevitability. There has to be a well thought and well executed plan to achieve this.”
Minister of Health
The Treatment Action Campaign (TAC) and SECTION27 cautiously welcome Health Minister Aaron Motsoaledi’s health budget speech delivered to Parliament on 24 April 2012. We congratulate his department on a number of important achievements made since Dr Motsoaledi became Minister. In particular we commend the department on growing evidence of some success in turning around the response to HIV and TB, including:
- Promoting voluntary HIV testing so that more than 20 million people in South African now know their status;
- Increasing the number of ARV sites from 490 at the beginning of the 2011/12 financial year to more than 3,000 at the beginning of this financial year;
- Dramatically increasing the number of people reciving ARVs with more than 1.6 million people now reported to be on treatment;
- Substantially decreasing the transmission rate of HIV from Mother-to-Child by over 50%. In just over two years the rate has decreased from 8.5% to 3.5%, preventing 30 000 children from contracting HIV;
- Increasing the number of nurses certified to initiate ARV treatment from 250 in 2010 to more than 10 000 by the end of the last financial year; and
- Ensuring that more than 320 000 males have been circumcised through Voluntary Male Medical Circumcision.
This is a great step forward. Yet in each of these intervention areas there are problems with the quality of services which must get urgent attention.
We are concerned that Dr Motsoaledi’s speech did not provide the concrete “plans” which are needed to deal with a number of important issues that are hindering the equitable provision of good quality health care to all South Africans. In particular we urge the Minister to provide detail on:
- How precisesly funds allocated for the implimentation of NHI in pilot districts will be used;
- Timeframes for establishing the Office of Health Standards Compliance;
- The measures that will be taken to prevent the ongoing shortages of critical medicines at facilities around the country;
- His view on the compassionate use of the drug TMC207 (Bedaquiline) for patients with XDR TB;
- What steps the Department intends to take to manage pending budget shortfalls in provinces that continue to mismanage resources available to them; and
- What concrete steps are being taken to root-out corruption, which is draining valuable resources our health system, as well as to control the escalation of prices in the private health sector?
National Health Insurance:
We agree that a tremendous improvement in the quality of healthcare in the public service, which will take place through the overhaul of the public sector, is non-negotiable and necessary for successful implementation of the NHI.
We welcome the naming of ten districts to be used as ‘pilot sites’ for the implementation of aspects of an NHI system, and the allocation of a budget of R1 billion over the Medium Term Expenditure Framework (MTEF) for this purpose.
Most of the pilot sites are in districts that TAC has strong branches in. Therefore, we will actively collaborate with and closely monitor progress at these sites to ensure that they contribute to bringing about an improved health care system. It is essential, however, that the Minister make public business and strategic plans for the pilot districts which outline how funds transferred to provinces will be used. Without this information it will be difficult for social justice organisations, such as the TAC, to actively participate in the pilots. The success of this process depends on the full participation of all who have an interest in making the NHI work.
We call for the urgent convening of NHI forums in these districts.
Speedily establish the Office of Health Standards Compliance!
A key aspect of the health systems strengthening in preperation for the NHI and for the improvement of services more generally will be the establishment of a single, independent and accountable institution which has the power of ensuring that quality health care services are provided in both the public and private health systems. As the Minister notes in his speech, the government is busy reviewing draft legislation that will provide the establishment of a Office of Health Standards Compliance which will fufill this responsibility.
We call on the Minister and the Portfolio Committee on Health to take steps to ensure that the review and finalisation of this legislation is prioritised. We also urge the Committee to take seriously the comments provided by organisations such as SECTION27 on the content of the legislation.
Prevent Drug stock-outs!
The TAC continues to receive reports of shortages of essential drugs such Tenofovir and Abacavir at facilities in Mpumalanga, Limpopo and Gauteng. Any disruption in the supply of these drugs is potentially catastrophic for people living with HIV.
To make matters worse, there is also an increase in the number of reports from these provinces indicating that the supply of essential medicines, including antibiotics and even paracetamol, have also been severely compromised.
While the Minister has committed to dealing with the causes of these shortages, including the non-payment of pharmaceutical suppliers, his speech does not describe the concrete measures needed to give us confidence that he will be able to do this in the near future and over the long-term. Even though the Minister’s clear and absoulte disdain for the rampant profeteering from the provision of basic goods and services to the health system is a breath of fresh-air, his actions must speak louder than words.
As a first step we call for the setting up of a system within the Minister’s office for ongoing monitoring of drug and other essential medical supplies.
Make TMC207 available for compassionate use for people with XDRTB!
The TAC welcomes the political commitment to tackling TB. But again, actions will speak louder than words. We draw the Minister’s attention to demands recently agreed by the TAC National Council which we believe would strengthen the response to TB:
TAC NC resolved to support and be part of a call to the Medicines Control Council (MCC) to permit the compassionate use of TMC207 (Bedaquiline) for named TB patients who have failed other TB drugs. Although Bedaquiline is still an experimental medicine and not yet registered, the NC noted that there is significant evidence of its efficacy and safety and that for this class of patients the benefits outweigh the risks. Its use for compassionate treatment is also endorsed by clinical experts.
TAC is angered at the MCC’s resistance to permitting the compassionate use of this drug for patients with XDR TB. This issue serves to highlight weaknesses with the MCC. For far too long has the MCC been a barier to access to new drugs rather than a mechanisim to protect the safety of patients. The Minister must take an active and decisive role in fixing the MCC.
Take steps NOW to prevent impending budget crises!
Failures in the provision of health care extend beyond drug stock-outs though. Over the last two years we have seen a number of provincial departments, including Gauteng, Limpopo and the Eastern Cape, failing to pay service providers and deliver basic infrastructure and equipment. The causes of these failures were identified
more than two years ago in the IST reports. They relate directly to overspending, mismanagement of funds and unrelenting corruption.
Despite the deathly consequences of numerous provincial budget crises over the last few years, other than the section 100(b) ‘taking over’ of the Limpopo Health Department (which we fully support), we have yet to see decisive action taken to deal with fruitless and wasteful expenditure and loss through corruption in other Provinces. We have already started to recive information that the Gauteng department of health, for example, faces the very real risk of depleting their budget well before the end of the financial year.
The Minister’s announcement that funds have been allocated to establish a unit to support provincial financial management and improve audit outcomes is a step in the right direction. But we have heard these promises before and we believe that more decisive action needs to be taken in resolving the causes of overexpenditure and taking action against officials implicated in corruption.
To prevent a further crisis we call on the President to initiate similar action to resolve the management and corruption crisis that plagues Gauteng.
Stamp out Corruption!
In the next month SECTION27 and Corruption Watch will publish an investigation that shows that dealing with corruption could save the health system (public and private) billions of Rand each year. Even though there ample evidence of this kind, we continue to see the government dragging its feet on dealing with instances of alleged corruption. For example, despite the Special Investigating Unit (SIU) finalising a report on allegations of corruption in the Gauteng Department of Health while under the control of former Health MEC Brian Hlongwa, this report and evidence of action taken against those implicated has yet to be made public.
Is a cover up taking place? We need to know.
Regulate prices in the private health sector!
In his speech the Minister states that “the second precondition for NHI “was that the pricing in the private health sector must be regulated!” But we are concerned that he announces no plans about how to do this. The Minister must stop acting like King Lear: threatening lighting and thunder but incapable of doing anything!
Reasonable price regulation is essential. Health users, many of them already members of medical schemes, pay over R20billion rand per year out of their won pockets.
We therefore call for the President and the Minister of Health to ensure the proclamation of the Competition Amendment Act – which has now been waiting for the President’s signature for three years – so that a proper market enquiry can take place into pricing practices in the private health sector. This is vital to inform lawful regulation of prices for health care.
Step up campaigns and programmes for health!
We acknowledge that government has shown progress in the last financial year, particularly with improving access to HIV treatment care and support. But we do not believe that enough is being done to meet its obligations with regard to ensuring that the promise of section 27 of the Constitution, the right to health, is delivered to all South Africans.
In the Minister we have someone who is willing to take up this fight but we must see more decisive action from his department. We cannot rest on the incomplete achievements made in our response to HIV and TB. Now is the time to show true leadership.
For comment or further information contact:
TAC: Vuyiseka Dubula TAC General Secretary firstname.lastname@example.org or 082 763 3005
SECTION27/ Chairperson TAC email@example.com or 0741042450
SECTION27: Daygan Eagar at firstname.lastname@example.org or 0722493873