ADDRESS BY DEPUTY PRESIDENT DAVID MABUZA AT THE PRESIDENTIAL

HEALTH SUMMIT

BIRCHWOOD CONFERENCE CENTRE, EKURHULENI

19 OCTOBER 2018

Programme Director,
Minister in the Presidency, Dr Nkosazana Dlamini Zuma,
Minister of Health, Dr Aaron Motsoaledi,
Ministers and Deputy Ministers,
Director of Health Care Financing, World Health Organization, Mr Joe Kutzin,
Members of the Executive Councils (MECs),
Executive Mayor of Ekurhuleni, Mayor Mzwandile Masina
Directors Generals,
Heads of Statutory Councils,
Members of the Chapter nine institutions,
Members of the medical, nursing, allied health workers, civil society and labour,
Distinguished Guests,
Ladies and gentlemen,

Good Morning!

We are all gathered here today because we share a commitment to making affordable
quality health care accessible to all.

In its 54th National Conference, the governing party, the ANC underscored health as a
priority for government and the country and resolved to reaffirm its resolution on the
National Health Insurance.

Among other key priority issues, the Conference resolved to pay special attention to four
major issues that impact negatively on public health system namely: Human Resources,
Procurement or Supply Chain Systems, Financial Management and Maintenance of
equipment and Infrastructure.

In transforming the health care system for the better, we need to ensure that we have
committed and appropriately skilled health care professionals. We need to ensure that
proper governance systems are in place to improve accountability for performance across
all levels of health care delivery in our system.

The development and maintenance of infrastructure is critical to ensuring that our health
care facilities meet the minimum norms and standards.

In his State of the Nation Address, his Excellency, the President, made a commitment to
hold the Presidential Health Summit to ensure that, collectively, as government, business
and civil society, we gather in this fashion to reflect on the state of our health system, and
develop targeted responses to challenges and difficulties that we are facing in the health
sector.

The Presidency has taken stewardship of the National Health Insurance process and
consequently the development of a quality health system in support of the Ministry of
Health to ensure that the country can achieve affordable quality health care within a
reasonable time.

Under the leadership of the President, all the key players and stakeholders in the health
sector are mobilized and galvanized to work together in finding solutions aimed at
turning our health system around.

We are grateful that you have all heeded the President’s call by attending this historic
health summit so that you become part of the debates and solutions that will emerge from
this summit.

We are a resilient nation that can rise to the challenges that are facing nation. No
challenge is insurmountable if we work together to find common solutions.

Our history bears testimony that when we work together we succeed in tackling difficult
challenges.

In the Health Sector, this was demonstrated, for example, in our collective battle against
HIV. Whereas we started on a completely wrong footing in our initial response to the
HIV and AIDS Epidemic, once we corrected our wrongs, the world had sit back and note
with appreciation.

Over the last ten years, more than 44 million people were mobilised to test and know
their HIV status.

Public sector workers, their trade unions and professional associations were all mobilised
in the fight against HIV.

Our scientific community has been hard at work to understand and find lasting solutions
to the HIV-AIDs challenge.

Civil society organisations, prominent individuals and most political parties were at one
that we need to fight stigma, discrimination and ignorance.

We rolled out the largest public sector ARV programme in the world, funded mostly
from our own domestic resources.

We turned the tide.

Life expectancy has dramatically improved and many lives have been saved.
The health system has contributed to the reduction of HIV-related deaths, child deaths,
TB diseases and TB-related deaths.

By 2004 a total of 70 000 babies were born HIV positive on an annual basis. But through
our very successful Prevention of Mother-to-Child Transmission (PMTCT), the figure
has dramatically dropped to less than 4 500 babies by 2017.

Eighty percent of infants under one-year-old are vaccinated to protect them against
preventable diseases like measles, and 300,000 people receive treatment for tuberculosis.

We must express our thanks and appreciation to the doctors, nurses, pharmacists and
other health professionals and workers who work in the public and private health system
who make these successes possible.

However, despite our progress in some areas, our rates of diabetes, cancer and
hypertension are rising.

We have very high rates of mental illness.

This means that a large proportion of our population is not only developing preventable
diseases but also do not access quality health care promptly.

We all agree that our health system is in crisis and needs urgent attention.

For us to improve the health system, we need to understand the causes of the crisis.

We need a systemic change that will outlive us and become a gift to the new generation.

According to the World Health Organisation (WHO), one of the six building blocks of a
healthy and resilient healthcare system, is the health workforce or human resources for
health. Over the past few months, there has been a serious outcry from all corners of our
country about the shortages of the workforce in the public sector. Whereas the President
has agreed to inject a certain number of the health workforce as part of his stimulus
package, this is just but a temporary measure for immediate relief. This Summit has to
come up with an everlasting solution on this issue.

To this end, the gross inequalities that have developed in the provision of human
resources between the public and the private health sectors, need to be faced head-on and
resolved speedily.

We need to urgently produce a national human resource operational plan that each level
of health care can use in planning service provision.

The second major cause of problems in the provision of good quality healthcare, is poor
procurement or supply chain management systems that makes it impossible to have
adequate pharmaceuticals and other important health commodities.
Although we have an essential medical equipment list and an essential medicine list
accompanied by the delivery of chronic medicines distribution programme, we still have
challenges resulting from the inadequate maintenance of equipment and stock-outs of
medicines.

Poor maintenance of equipment is a barrier to accessing vital services.

To ensure quality, safe and relevant technologies we need to involve the end-users –
primarily the health workers – in the procurement of equipment to ensure they can be
used effectively and efficiently.

Because medicines are produced from active ingredients sourced from other countries,
their supply may be affected by decisions outside South Africa.

This implies that our country should always look for alternative drugs in cases where the
supply of the main drug is from one source.

The State needs to work with Civil Society groups to monitor availability of medicines
and other commodities in our healthcare system.

The public needs to keep us on our toes to ensure that the population gets what is due to
them.

This is a good example of the type of compact we need to make the health system
functional.

The third major area needing interrogation is in health services provision.

To ensure every South African has access to care that is affordable, available and
acceptable, it is necessary that the services should be of good quality.

It must also be comprehensive and include preventive, curative, palliative, rehabilitative

and health promotion services.

At the moment, the primary health care component of our healthcare system is very weak
and is found wanting.

The provision of comprehensive primary health care services is inadequate. Our

healthcare system is by and large curative, hospicentric and unable to provide
comprehensive healthcare.

The facilities are congested, often inappropriately staffed, with long queues of patients,
with too many repeat visits for the same condition.
There is currently inadequate regulation of the private and public sectors in terms of
quality of care.

As we plan to introduce NHI in a phased approach from 2019, we need to incrementally

accredit the health facilities to meet the standards set by the Office of Health Standards
Compliance.

We are establishing learning centres to implement these standards, develop sustainable

quality improvement programmes and ensure there are robust corporate and clinical
governance structures and processes in place.

At facility level, we need to ensure that agreed quality standards are met in the provision
of health care services. This must be supported by the recruitment and deployment of
appropriately skilled personnel to ensure quality service delivery.

To achieve excellence in service provision, we must promote clinician leadership as key

to improving clinical governance and oversight.

We are in discussions with the Health and Welfare SETA, which is considering
redirecting their support to focus on capacity strengthening of the health system to
provide quality healthcare training through the coordinated learning centres.

Again, this is the kind of compact we are looking for, one that uses existing resources
wisely to make a more significant impact on health services.

We look forward to the speedy finalisation of these negotiations so that we can begin our
ambitious project of improving each health facility to meet the quality standards of care.

More critically, we must address the challenge of poor leadership and governance at
every level of the healthcare system.

Our hospital boards and clinic committees are not functioning optimally, with
communities not engaged to ensure quality health care for the population in the
catchment areas.

The management of hospitals needs to be improved through delegation of managerial

authority to the hospital CEOs to allow them to take full accountability for the
performance of their facilities.

We have seen many labour disputes that jeopardise the well-being of patients.

To remedy some of these challenges will require a change in the management culture of
hospitals that is underpinned by consultation between staff, managers and labour over
decisions that affect the work environment.
The consultative style of management between managers and labour will go a long way
to reducing conflict and resultant labour unrest.

Alongside these transformation initiatives, we need to prioritise the development of new

infrastructure in previously under-serviced areas, and ensure that existing infrastructure is
properly maintained to meet the required standards.

In many areas, our infrastructure is ageing, and unable to cope with service demands of a
growing population.

The drastic shortage of appropriate infrastructure means that people with a mental health
condition are often hospitalised in non-mental patient wards, and male and female
patients are hospitalised in the same ward.

There is often a lack of space in maternity, pediatric and neonatal wards. It is a

wellknown that overcrowding leads to disease outbreaks. What can be expected from
neonatal wards that are 132% full?

We have to develop a consistent 10 year infrastructure plan, using identified and ring-
fenced infrastructure resources. We believe that the President’s R400 billion
infrastructure stimulus package must also take care of the health infrastructure.

Our response to the health sector challenges will be incomplete if this summit does not
provide targeted solutions to inadequate health systems financing and management.

Financing of health care in South Africa has resulted in a very inequitable system of
health care between the public and private sectors, between urban and rural areas and
between provinces and local government.

The private sector uses a higher proportion of the GDP to serve only 16% of the
population, while the public sector uses a lower proportion of the GDP but to service
84% of the population.

Financing is biased towards the rich and the urban areas.

These inequities need to be identified and corrected in budget allocations.

The Office of the President, through the war-room, will be re-costing health system
funding to provide more realistic figures on the cost of this health system and estimate a
better model of allocation depending on the burden of disease per district.
We must admit there are challenges associated with the management of the financial
resources allocated in the public sector.

We need to ensure value for money in purchasing health services for the population.
Corruption is an enemy of our people, because no good quality healthcare can be
provided where corruption is very prevalent. We need to fight this with everything at our
disposal.

The challenges in healthcare are also found in the private sector, although they vary in
nature.

The private sector provision costs are unacceptably high and affordable only to a few, as
proved by the Health Market Inquiry headed by former Chief Justice Sandile Ngcobo.

Most medical schemes are unsustainable, demonstrated by high medical scheme

premiums that often increase faster than inflation; failure to grow their membership; and
reduction of the number of medical schemes, with many being insolvent.

Members are impoverished as a result of catastrophic health expenditure they incur with
private hospital admissions.
Medical scheme benefits are often exhausted before year-end, which forces patients to
have no cover and many end up using the public health sector.

The challenges in both the public and private health sectors require a new approach to
serve all South Africans and meet the Constitutional mandate of the progressive
realisation of the right to health care.

We need one health system for all – through a National Health Insurance – and not a two-
tiered health system where access to quality healthcare is dependent on one’s economic
status.

We need a publicly financed health system where services are provided by both the
public and private facilities delivered according to improved standards of care.

An integrated unitary health system under NHI does not negate the existence of medical
schemes for those who desire additional care that complements services provided under
NHI.

We invite participants in the public and private health sectors to come together during
this Presidential Health Summit and address these problems.

We must work on a system based on solidarity to give all of our people the best that we
can offer as a nation.
It is within our power to make quality health care accessible to all.

As we enhance collaboration in our entire health system, we need to build coordinated,

integrated and shared health information systems.

If we want this health system to function adequately, we need granular level data based
on health systems capable of generating valid information available at the right time and
in the right format to allow management to make informed decisions.
We want South Africans to have seamless access to their records at both public and
private health facilities in such a way that their medical history is accessible to the
doctors without compromising the confidentiality of their information.

To ensure that we have this seamless access to electronic medical records we need to
improve our Information Communication and Technology platforms to improve the
quality of health care.

In the era of the fourth industrial revolution, we must ask ourselves many questions
related to innovation in health care:

In what way can we use health technology to bring new medicines rapidly to those who
need it?

How can we get patients to be involved in making decisions about their health care?

How can we use new technology to improve diagnosis, treatment, and care, especially in
the area of telemedicine?

How can we use technology to close the gap between urban and rural residents?

How can we reduce the cost of healthcare using technology?

These are the questions we need to answer as we work towards introducing National
Health Insurance.

South Africa, like the rest of the Sub-Saharan Region, has inadequate number of skilled
people. But the few who are there, need an enabling environment to work optimally for
the whole population, and not for a selected few.

Here is an opportunity for the public and private sectors to work together to bring
technology to all our people.

More importantly, all of us, as citizens, must be at the centre of improving our health
system by taking full responsibility for our own health through the pursuit of healthy
lifestyles.

Today, we are happy to officially launch the National Wellness Campaign, which focuses
on testing and treating people who have HIV, TB, sexually transmitted infections and
non-communicable diseases such as diabetes and hypertension.

The focus of the campaign will be on the provision of comprehensive health and wellness
services targeted at men, adolescent girls and young women as well as key and
vulnerable population groups.
The campaign reinforces the implementation of prevention strategies, linkages to care,
management, treatment and support.

The success of such a massive campaign largely depends on coordinated collaboration

among all social partners in respect to planning, implementation and monitoring. We call
upon all our social partners to join us in implementing this programme.
This national wellness campaign will be known as “Cheka Impilo” – a call to action for
South Africans to move from a curative response to health to preventative approaches
and the adoption of healthy lifestyles.

As various stakeholders, we are committing that we will be taking the services to the
people.

As part of the package of services for the “Cheka Impilo” campaign, we will focus on
increased information, education and communication activities, promotion of HIV
testing, widespread distribution of condoms, and provision of pre- and post-exposure
prophylaxis against HIV.

All of us must, therefore, go out in great numbers to test for HIV and screen for STIs, TB
and non-communicable diseases such as diabetes and hypertension. Within 24 months of
this campaign, we must have found and put 2 million more people on ARVs. We must
also have found and put at least 80 000 more people with TB on anti-TB treatment. We
must also have identified thousands more with Diabetes, High Blood Pressure and
Cancer, and put them on treatment.

In conclusion, Ladies and Gentlemen, we should use this Presidential Health Summit to
begin to find solutions to the challenges of our health system.

Let us together transform health in this country so that our people can feel immediate
benefits and ensure that we sustain and expand these benefits for decades to come.

This is a historic moment to make our health care the best that we want it to be.

With these words, I formally open this Presidential Health Summit

I thank you.

Issued by the Presidency

Pretoria