State of the Nation Address Debate Honourable Minister of Health, Dr MJ Phaahla

13 February 2024

The Speaker of the National Assembly, Hon Nosiviwe Mapisa-Nqcakula,
Chairperson of the NCOP, Hon Amos Masondo,
President of the Republic of South Africa, His Excellency Cyril Ramaphosa,
Deputy President, Honourable Paul Mashatile,
My fellow Cabinet Colleagues,
Deputy Ministers,
Honourable Members of Parliament

Good Afternoon, Dumelang

I wish to thank the Presiding Officers and my Chief Whip for this opportunity to participate in the debate of the President’s State of the Nation Address 2024. Thank you Mr President for a comprehensive report to the people of South Africa on the achievements of the 6th Administration while acknowledging challenges which are still being addressed. Indeed over the last few days many Tintswalos have come forward to say what the democratic state has done for them to open up opportunities for a better life. Shame to those who want to rubbish these lived experiences of many South Africans.

Mr President thank you for highlighting just a few key areas in the health sector, which shows the progress we have made and where we are going.

I wish to start by joining you in acknowledging the contribution of many South Africans in our fight against the Covid-19 pandemic which consumed a major part of the term of this government with devastating impact. We thank the galant health workers who carried the burden of looking after the sick even while may of us were staying home and later on came forward to administer life-saving vaccines. The cooperation between the public and private sectors especially during mass vaccination laid the ground for the implementation of the NHI.

Since the lifting of all restrictions in June 2022 the health sector has been on a recovery path and I am pleased to say that all key indicators show that we are well on this recovery path. Our key focus is to lay the foundation of Universal Health Coverage as envisaged by the Freedom Charter and Section 27 of our Constitution. This is a path which was laid by the founding President of our democracy President Nelson Mandela when he declared that all children under 6 and pregnant women should receive free services in all public health facilities. We are combining broadening of access to services with improvement of quality.

Deployment of appropriate Human Resources is key to both access and quality and this applies to multiple qualifications and skills within the health care teams. The medical profession is very key in the multidisciplinary teams and that is why we are doing everything to retain as many doctors, nurses, physiotherapists and other members of the teams in the public health system. I am therefore happy to announce that working with the Minister of Finance we have a solution to address the current challenge of doctors who want to stay in the public service but could not be offered funded posts. The details of how we are going to fund the posts will come out from Minister Godongwana’s Budget Speech next Wednesday. Our national team is working with National Treasury team to thrash out the details and working with provincial health departments to speed up the process so that by 1st April 2024 all those who will not be already in posts can be able to start. I am confident that with this certainty provinces will be able to start giving appointment letters even before 1st April 2024. I am sorry to disappoint all those political parties who were hoping to cash in on the disappointment of the doctors. The measures we are working on with the Minister of Finance will give us sufficient breathing space while we are working on long term solutions. This matter is a typical situation where the ANC-led Government is a victim of its own successes. Over the last fifteen years we have ramped up the training of doctors both in the local universities and the Nelson Mandela Fidel Castro programme in Cuba.

The number of graduates have almost doubled over the last ten years, in 2014 there were 1 338 graduates who entered internship while in 2022 there were 2 511 and this year there are 2 210 new medical interns, just around a thousand more graduates increase. We are committed to work with the medical association SAMA and the trade union SAMATU to look at more opportunities for doctors including in multidisciplinary group practices offering Primary Health Services in the community as we prepare for implementation of NHI which will contract such services.

As stated by President in the SONA, the other area of serious interventions to improve quality of health services is the upgrading of infrastructure including new facilities. I can confirm that the construction of Limpopo Academic Hospital is progressing well and should be completed on time and on budget by 2028. The construction phase of this hospital is creating just over 2 000 jobs in the province and when it is completed its operations will generate an equivalent number of jobs over and above the critical specialised clinical services which it will provide cutting down the need to refer patients to Gauteng.

In November last year 2023 the President opened the state of the art tertiary regional hospital in eThekwini, the Pixley Ka Isaka Seme hospital which will relieve pressure on Inkosi Albert Hospital and King Edward Hospital, now renamed the Victoria Mxenge Hospital.

Late last year I joined the Premier of Eastern Cape and MEC in opening the state of the art Siphethu District Hospital in Ntabankulu with modern equipment. Many similar projects have been completed in all provinces focusing on rural and township areas. Late in 2022 I joined the MEC of Limpopo and the Premier in unveiling modern equipment at a rural hospital, St Rita’s, where I worked as a medical officer together with Minister Motsoaledi who was part-time but spending more time there than at his practice. The equipments included a CT Scan, modern digital X-Ray and mammogram. All these equipments are backed up by Picture Archiving and communication system which allows doctors to receive the radiological images on their phones or laptops and the radiologist sitting anywhere in the world can interprete the images and feedback to the doctors on the patient’s bedside. In this way we are using technology to reduce lack of access to specialised skills. There are a number of other hospitals which are being constructed such as Siloam in Limpopo, Zithulele in the Eastern Cape, Dihlabeng in Free State, upgrading of Witbank Hospital in Mpumalanga and several CHCs and clinics which meet the standard which will be required by the NHI.

We are also rolling out digital Health Information system with the Health Patient Registration System (HPRS) having registered more than 60 million individuals.

We are building the system using also the benefit of the Electronic Vaccination Data System (EVDS) which was very successful for Covid-19 vaccination but we are also leveraging on inter-operable systems developed in provinces which are owned by the State. The IP of these systems belong to the State not private companies.

Honourable Speaker and Honourable Members, all these interventions are laying the foundation for the implementation of the NHI. We thank members of both the National Assembly and the NCOP who have passed the Bill. As stated in the Bill, it will be implemented in two remaining phases from 2024-2026 and then 2026-2028 focusing on establishing the institutions key amongst which is the Board and CEO and several key committees of the NHI Fund. Simultaneously strengthening of the health delivery platform will be speeded up.

We are confident that the innovative funding of infrastructure as stated by the President will also contribute to health facilities. In the meantime the National Department of Health (NDOH) is strengthening the NHI Branch which is focussing on key delivery areas such as Health Care Benefits design, Digital Health Systems and Risk Identification and fraud prevention, just to mention a few areas of preparatory work.

Honourable Speaker and Honourable Members indeed as stated by the President, key indicators show that we have recovered well from the impact of Covid-19 pandemic with examples of improved life expectancy approaching pre-Covid at 65 year and continued reduction in maternal mortality in pregnancy and reduced infant and under 5 mortality rates. Backlogs in planned surgery procedures including in orthopaedics, general surgery, eye operations such as removal of cataracts are being attended to through mobilisation of key specialists to spend time in under-served areas with many doing it free of charge, the surgery marathons e.g Limpopo, Mpumalanga, Gauteng, etc.

Honourable Speaker some of our hospitals have also focused on improving their expertise in areas which are part of our burden of disease. In 2023 Steve Biko Academic Hospital was the first hospital in South Africa to receive the World Stroke Organisation (WSO) Angel’s Diamond Award in recognition of their excellent work in acute stroke care, the highest level set by the WSO. They use cutting edge technology that supports physicians and the decisions they make daily.

In addition to this the Steve Biko Hospital is the most advanced in the use of nuclear medicine in the diagnosis and treatment of various cancers, under the leadership of Prof Sathekge.

The procurement and distribution of medicines has stabilised with the result that we have a stock availability of 85% with the result that over the last few years there has not been complaints of shortage of commonly used medicines on our Essential Medicines List except where provinces had not paid suppliers.

Our Centralised Chronic Medicine Dispensing and Distribution (CCMMDD) through which chronic medicines are brought closer to patients at pharmacies, shops and other pick-up points has also gained traction. In 2019 there were 3.4 million clients participating in this programme and by the end of 2023 there were 6.5 million participants.

This helps to reduce congestion and queues at clinics and hospitals as stable patients pick up their medicines at several pick-up points closer to where they live.

Honourable Members we have male significant progress in the fight to defeat HIV and AIDS as the country with the largest burden of this epidemic. We are making steady progress towards achieving the UNAIDS target of 95% of people knowing their status, 95 % of them on treatment and 95% virally suppressed. In 2014 we had 2.9 million people on ARVs and today that number stands at 5.8 million people who are on a one pill a day, living healthy, productive lives, and 94% of them being virally suppressed which means that they will not transmit the virus to their partners.

Even more impressive is the prevention of passing HIV from a pregnant mother to her child, in 2003 the risk of this happening was 23% of children being born HIV positive, today in 2024 the risk is 0.3%, thanks to the women of our country who attend Antenatal clinic before 20 weeks of pregnancy for 8 times before delivery.

Honourable Members the fight against TB is also making good progress. In a recent Global TB Report, the World Health Organisation (WHO) indicates that South Africa is meeting its SDG targets. All countries committed to reduce TB cases by 80% in 2030 compared with 2015 figures and reduce deaths by 90%. New TB cases were 552 000 in 2015 and reduced to 280 000 in 2022. In 2015 988/100 000 South Africans got TB and in 2022 the number declined to 468/100 000, again more than 50% decline. In terms of reducing deaths by half by 2025, the report indicates South Africa had already achieved this by 2023.

Honourable Members as they say numbers don’t lie. The progress this government led by the ANC has made before, during and after Covid-19 speaks for itself. What is left now is to create a Universal Health Coverage where citizens will not have to worry about money when they need an ambulance on the road, when they get admitted to a hospital and when they require ICU services. That is where we are going and in a nutshell that is what the NHI will achieve when it is fully implemented.

I thank you, Ke a leboga!