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The Health Systems Trust Response to the Minister of Health’s May 2003 Budget Speech
HST
2003-05-20
The Health Systems Trust (HST) is pleased to see that the Minister of Health has acknowledged the array of major public health challenges facing the country, including the need for improved management, and note with pleasure the establishment of the Arthur Letele Institute for Health Care Management. Specific reference to the continuing inequity within the health system is welcomed by the organisation. We are particularly pleased with introduction of free treatment for people with disabilities and the mandatory food fortification programme.
We acknowledge the recognition of the crisis around human resources (HR) and the additional budget allocation to this; the achievements in tobacco control and intentions re tackling abuse of alcohol; the increased budget allocation to HIV/AIDS/TB and malaria, the commitment to expanding PMTCT and the recognition that a functioning health system is necessary to offer treatment for AIDS; as well as the finalisation of several pieces of legislation. Whilst we applaud the intentions to improve the health care system we caution that unless these are accompanied by detailed plans of incremental implementation with realistic targets the intended progress will remain elusive.
The allocation of R500m for recruitment and retention of health workers particularly in rural areas is a necessary but insufficient response and we submit that we need a more holistic approach to retention. Issues such as human resource planning, appropriate training strategies and working conditions all need to be brought together within a comprehensive human resource strategy, and because of this we question the Minister’s assertion that it is ‘abrupt nature of these departures’ alone which are responsible for the current human resource crisis.
We note the intention to table proposals on Social Health Insurance and we hope that such proposals will make more resources available to those people who are unable to afford SHI, notably the unemployed and poor. However from an equity perspective we recommend further investigation into the merits and possibility of introducing a Comprehensive National Health Service funded through taxation.
It is regrettable that 10 years into our new democracy, gross per capita inequities across provinces persist. The Eastern Cape, Mpumalanga and Limpopo especially continue to reflect low expenditure, particularly in primary health care, relative to the other provinces. These low levels of spending undermine these provinces’ ability to address HR shortages and their ability to provide the basic services necessary to address TB, HIV/AIDS, maternal mortality and other priority diseases. For example, TB cure rates in the country, currently at 64%, are well below the target set by the national Department of Health of 85%, and as low as 49% in KZN. These provincial averages belie the fact that the cure rate in the poorest and most disadvantaged communities are likely to be even lower. Additional limitations that prevent TB and HIV/AIDS being effectively addressed are and the need to strengthen provincial planning and management capacity in order to implement effective programmes and interventions.
We urge the Minister to expedite the tabling of the National Health Bill which has been delayed for some time now. This Act, when promulgated, will not only provide the necessary framework for the establishment of the District Health System but will also allow for the roles of different spheres of government to be clarified and complete the structural transformation of the public health system.
Press Release, 13 May 2003: http://www.doh.gov.za/docs/pr/2003/pr0513.html
Budget Speech, 13 May 2003: http://www.doh.gov.za/docs/sp/2003/sp0513.html
The Health Systems Trust (HST) is pleased to see that the Minister of Health has acknowledged the array of major public health challenges facing the country, including the need for improved management, and note with pleasure the establishment of the Arthur Letele Institute for Health Care Management. Specific reference to the continuing inequity within the health system is welcomed by the organisation. We are particularly pleased with introduction of free treatment for people with disabilities and the mandatory food fortification programme.
We acknowledge the recognition of the crisis around human resources (HR) and the additional budget allocation to this; the achievements in tobacco control and intentions re tackling abuse of alcohol; the increased budget allocation to HIV/AIDS/TB and malaria, the commitment to expanding PMTCT and the recognition that a functioning health system is necessary to offer treatment for AIDS; as well as the finalisation of several pieces of legislation. Whilst we applaud the intentions to improve the health care system we caution that unless these are accompanied by detailed plans of incremental implementation with realistic targets the intended progress will remain elusive.
The allocation of R500m for recruitment and retention of health workers particularly in rural areas is a necessary but insufficient response and we submit that we need a more holistic approach to retention. Issues such as human resource planning, appropriate training strategies and working conditions all need to be brought together within a comprehensive human resource strategy, and because of this we question the Minister’s assertion that it is ‘abrupt nature of these departures’ alone which are responsible for the current human resource crisis.
We note the intention to table proposals on Social Health Insurance and we hope that such proposals will make more resources available to those people who are unable to afford SHI, notably the unemployed and poor. However from an equity perspective we recommend further investigation into the merits and possibility of introducing a Comprehensive National Health Service funded through taxation.
It is regrettable that 10 years into our new democracy, gross per capita inequities across provinces persist. The Eastern Cape, Mpumalanga and Limpopo especially continue to reflect low expenditure, particularly in primary health care, relative to the other provinces. These low levels of spending undermine these provinces’ ability to address HR shortages and their ability to provide the basic services necessary to address TB, HIV/AIDS, maternal mortality and other priority diseases. For example, TB cure rates in the country, currently at 64%, are well below the target set by the national Department of Health of 85%, and as low as 49% in KZN. These provincial averages belie the fact that the cure rate in the poorest and most disadvantaged communities are likely to be even lower. Additional limitations that prevent TB and HIV/AIDS being effectively addressed are and the need to strengthen provincial planning and management capacity in order to implement effective programmes and interventions.
We urge the Minister to expedite the tabling of the National Health Bill which has been delayed for some time now. This Act, when promulgated, will not only provide the necessary framework for the establishment of the District Health System but will also allow for the roles of different spheres of government to be clarified and complete the structural transformation of the public health system.
Press Release, 13 May 2003: http://www.doh.gov.za/docs/pr/2003/pr0513.html
Budget Speech, 13 May 2003: http://www.doh.gov.za/docs/sp/2003/sp0513.html
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