• A Submission on A Green Paper for Public Discussion:
    Population Policy for South Africa?
    The Ministry of Welfare and Population Development

    from

    The National Progressive Primary Health Care Network (National Office)
    PO BOX 32095
    Braamfontein 2017
    (011) 403-4647 (phone)
    (011) 403-2517 (fax)
    Gauteng Province
    (The Network is represented in each province except the Northern Cape.)

    11 September 1995

    NPPHCN would be willing to present our views at a public hearing.

    1. Introduction/Motivation

    The National Progressive Primary Health Care Network (NPPHCN) is a national non-governmental health advocacy organisation promoting collaboration, participatory research and policy formulation, appropriate training and organisational development. Membership in the Network is comprised of more than 1,100 health and development programmes, projects, organisations and concerned individuals operating throughout South Africa. NPPHCN has regional offices in every province except the Northern Cape. The Network has no party political or religious affiliations, but affirms values and approaches that recognise universal human rights and support the promotion of health for all.

    NPPHCN congratulates the Ministry for Welfare and Population Development for presenting this important document to the general public for their comments. While we have serious concerns about the accessibility of this document, the drafting and circulation of A Green Paper for Public Discussion: Population Policy for South Africa? represents a significant step forward around this sensitive issue. Development policy is not just what you do about these issues but also the way you do it. This process must start with and be guided by full community participation.

    2. Definition and Governance Issues

    NPPHCN does not agree with the use of the term "Population Policy" in the document. Population policy is essentially about people. People should be viewed as valued resources, not as a problem. Thus, within the South African context, we believe that the focus should be on "Human Development Policy" (or "Human Resources Policy") rather than on "Population policy". Since the Primary Health Care (PHC) approach seeks to address the socioeconomic causes of poor health there should be an intersectoral approach to all development issues. The PHC approach does not advocate a population policy formulated in isolation from other human development issues.

    There were different views within NPPHCN about the correct governance structure to address human development issues. Some individuals believed that a separate Department of Human Development should be established. Others thought that a Division of Human Development within the RDP would be more appropriate. Whether either of these structures or another unit is created, there was general agreement on the principle that it must work intersectorally, have adequate staffing, and have clear authority to coordinate human development policies. (Throughout this submission, "Department of Human Development" is used to refer to this new proposed human development coordinating structure.)

    The Population Development Policy (PDP) staff and population units currently within the Ministry of Welfare and Population Development should be disbanded immediately. The moratorium on their activities should be enforced. Responsibility for these tasks should be transferred to a Department of Human Development with all due speed. Allowing the personnel responsible for the failed policies of the apartheid era to continue making these decisions is not acceptable. With the new philosophy and framework, there must be new personnel to carry out them.

    3. The Scope of Inquiry

    NPPHCN has serious concerns about the scope of inquiry presented in A Green Paper for Public Discussion: Population Policy for South Africa? The document is too narrowly focused. The report clearly states on page 6 in capital letters that the purpose of this report is not to question the policies and programmes of individual ministries within the Government of National Unity.

    Every department must be reviewed and evaluated to determine whether they are encouraging or discouraging human development. Although important, it is not sufficient to examine only the linkages between departments. If this exercise is to be valuable, it should present a systematic evaluation of the human development policies of all departments of the Government of National Unity to the South African people for their comments.

    The Green Paper lists the following two questions as the scope of the paper:

    • Should the Reconstruction and Development Programme (RDP) take population trends into consideration? If, so how?

      Population trends will be crucial to the ultimate success or failure of the RDP. For example, if the government is only able to meet the water needs of the current South African population by 2010, but the actual population of South Africa has doubled in that time, then the RDP will have failed to meet the needs of the people.

      The RDP has laid out a detailed vision to remedy many pressing problems facing South Africa. Now the government needs to develop a national policy to implement the RDP, using an intersectoral approach to address these issues. NPPHCN, therefore, challenges the individual ministries to convene an intersectoral committee to address human development. In addition to providing the framework, the RDP must incorporate human development and population analyses into the criteria used to evaluate government projects.

    • Do there need to be any institutional structures to ensure that population trends are taken into account?

      There are two potential institutional structures that would help to ensure that human development issues are seriously considered with each piece of legislation: an ad-hoc Human Development Committee within the National Assembly and a parallel human development committee convened from civil society. The primary functions of these structures would be to develop a set of criteria to assess the impact of proposed legislation introduced in Parliament on human development trends. Public evaluation of the human developmental impacts of proposed legislation will accomplish three goals: it will bring greater attention to human development issues, it will make the legislative process more transparent, and it will allow for greater participation on this sensitive issue by the public. These three goals coincide with the RDP's goals.

      This public evaluation process could be modelled after the Environmental Consideration Act of 1989 (#73-89). Based on the best available information, the potential impact of legislation on human development would be estimated. This evaluation would become part of the public record and the criteria would be monitored over time to identify trends. The goal of the evaluation would be to ensure that human development issues are adequately considered before legislation is enacted and that the human developmental impacts of legislation are monitored over time.

    4. Monitoring Human Development Issues

    It is essential for the government to monitor human development and population trends. Some potential indicators are listed below as examples of the type of information that may be useful to track human development trends. Much of this information should be available from the Department of Health, as they move to implement the PHC approach.

    • Population Growth
      --Current population
      --Percent growth per year
      --Fertility rate
      --Birth rate
      --Death rate
    • Sentinel Life Indicators
      --Life expectancy
      --Infant mortality rate
      --Maternal mortality rate
    • Sexual/Reproductive Health Measures
      --Contraceptive prevalence rate
      --Teenage pregnancy rate
      --HIV prevalence
    • Public Health Indicators
      --Access to medical services
      --Malnutrition
      --Access to housing
      --Access to clean water
      --Access to electricity
      --Access to sanitation
    • Education/Employment
      --Literacy rate
      --Highest educational attainment
      --Unemployment rate
    • Economic Development
      --Economic growth rate
      --Average income
      --Distribution of income
    • Environmental Indicators
      --Level of air pollution
      --Biohazardous waste

    5. Role of NGOs and Human Development Issues

    Non profit making non-governmental organisations (NGOs) have a unique role to play in development. Unlike private sector companies that must concern themselves almost exclusively with issues related to their own firms, NGOs can and usually do concern themselves with social issues that extend far beyond their own economic survival and short-term interests. This is particularly important when it comes to dealing with economic externalities that impose costs upon society, where, though it is widely recognised that it would be beneficial to contain such costs, no individual firm would be prepared to get involved. For example, while most private sector companies recognise that poverty is damaging to society, as individual firms there is little they can do directly. Many NGOs, on the other hand, concern themselves exclusively with poverty and can operate synergistically with the private sector to channel some social responsibility resources to address these problems. In this way they provide a mechanism of dealing with such externalities.

    While governments can address many of the issues relating to economic externalities, they are bound by their representative nature to consider their public popularity and vested interests. They have to rely on large bureaucracies to implement policies and decisions. This limits their ability to move quickly, to experiment, to develop prototypes, and to innovate. They should therefore look to NGOs to provide the creative and flexible approaches to social development issues that they find it difficult to tackle. NGOs, including community-based organisations (CBOs), usually develop from spontaneous, voluntary efforts by citizens to get involved in activities that affect their society. Such organised group involvement helps to generate solidarity and ownership of community issues. Such phenomena generally operate strongly in favour of development and are one way in which NGOs strengthen the society.

    6. Responses to Specific Questions Posed in the Green Paper

    • 6.1 Does South Africa need to coordinate its policies and programmes in all departments in relation to resource usage, patterns of consumption, population trends, and environment management?

      • Appropriate taxation is one of the most potent means of regulating activities to achieve a balance between resource usage, consumption, and production. For example, if market distortions are leading to the overproduction of products that are damaging to society (for example, the production of cigarettes, alcohol, toxic waste, CFCs, greenhouse gases), then suitable application of specific taxes at the correct place in the production chain can operate both to curb the growth of damaging industries as well as to provide revenue to deal with the cost imposed. The guiding principle should be that taxation should be proportional to the degree of social damage caused by the product and the use of resources.

      6.2.1 Should South Africa set goals and time frames that are consistent with the international community?

      • While international goals and time-frames can provide useful yardsticks if they are realistic and the cost of achieving the goals has been carefully calculated, arbitrary international goals or targets can actually be harmful for measuring progress in South Africa. If they are too low, they may retard progress and create complacency. If they are too high, they may create despair and despondency. Thus, the achievement of sustainable human development must not be confused with the achievement of an arbitrary international goal. South Africa must develop its own formula for sustainable human development based on its own conditions.

      6.2.2 Should sectoral policies be incorporated into a development policy with population concerns?

      • The RDP offers a systematic development framework that is appropriate as a unifying theme into which human development policy can be integrated.

      6.2.3 Should South Africa set goals in relation to life expectancy, infant, child, and maternal mortality rates?

      • Specific goals in relation to specific indicators are necessary but not sufficient. To derive these indicators, detailed scenario planning and building of quantitative models must be done to ensure that they are realistic and achievable. Detailed time schedules must accompany the setting of goals to establish the exact path to achieve these goals. Goals that are unaccompanied by such detailed frameworks are detrimental to progress as they may be completely inappropriate. This implies that the development of goals occurs as the result of a lengthy process.

      6.2.4 Should South Africa set strategies to influence internal migration?

      • Migration into urban setting is an international phenomenon that South Africa cannot be wished away. However, urbanisation should be encouraged in the numerous small towns that cover the country rather than into the large metropolitan cities. Our development should be towards the development of small towns as service centres in every district of our country to strengthen rural development. In the Health Sector, the concept of the District Health Authorities requires that at least one small town in each peripheral district should be developed in such a way that enough resources are available to attract health and other professionals.

      6.2.5 Should South Africa set strategies to influence international migration?

      • International migration can only be influenced in the long-term by the equitable development of all nations. Limiting international migration by regulation is ineffective. South Africa must provide positive internal policies that discourage excessive emigration and positive external policies that facilitate develo

      6.2.6 Should South Africa set goals and time frames in relation to fertility rates?

      • People should decide for themselves whether they want children, how many to have and when to have them. The state should not tell people how many children to have. Instead it should provide information and the means and services (including contraception) necessary for people to act on their own choices.

      6.2.7 Should South Africa have a coordinated strategy on integrating population trends into development policy and planning?

      • The role of the Department of Human Development should be to help each sector to understand the implications of human resource trends for their activities.

      6.3.1 What is the most effective and appropriate way to gather data on population trends for development planning?

      • Each department must gather and collect data from district and regional level and send it to a central data collection centre. In addition, it is necessary that a coordinating unit (Department for Human Development) develop a research agenda, in discussion with all other relevant departments, which ensures that research is done, covering all the needed insights into the interrelationships between human development programmes and population trends. This structure could commission research and gather research done by other institutions. This unit must work in an intersectoral manner.

      6.3.2 How can the government ensure use of data on population trends for development planning and monitoring?

      • Departments would perform their own interpretation of the data, but the Department of Human Development would serve as a resource centre when necessary. It is essential to make all relevant data available and accessible to communities at regional and district level regularly to encourage them to participate in the process of planning and evaluation.

      6.4.1 Should the interrelationships between population trends and the empowerment of women be spelled out by the government?

      • It is essential that these interrelationships are spelt out in an overarching policy because they are so important for influencing women's position in society. Women should have control of their bodies. In addition, they should have access to information and free family planning services to carry out their individual choices.

      6.4.2 Should there be a mechanism for coordinating services aimed at women's empowerment?

      • A Department of Human Development closely linked with the RDP should coordinate this programme.

      6.4.3 Should there be a structure that is responsible for empowering women by giving them information, which is separate from other departments?

      • Each line department needs to be responsible for the empowerment of women. The Department of Human Development should monitor these processes to ensure that the Ministries are actually providing these services to women.

      6.4.4 Should a development policy propose means to involve men in taking responsibility to equalise power relationships between women and men?

      • Yes, a human development policy with an integrated approach to population trends should propose means to support men to take responsibility for equalising power relationships between men and women. This policy should reorient men about their role in a society that focuses on the empowerment of women.

      6.5.1 Should the government provide ongoing information about population-related matters?

      • There is a need for government to provide information and education about human development trends. The present value-laden approach needs to be questioned. Trying to persuade people to curb excessive fertility should not be part of this mission.

        Thus, there is a need for a review and evaluation of the current IEC efforts within the government. There also needs to be a renewed commitment to advocacy work around health promotion. Participatory research methodology involving researchers, policy makers and the community (through NGOs and CBOs) should be used first to evaluate the current impact of IEC and to create a new curriculum. It is essential to involve communities in the development of any advocacy material because of the real fear that information can be manipulated to perpetuate ideological prejudices and biases.

      6.5.2 Which sections of the government should be responsible for IEC?

      • IEC needs to be related to service provision within line departments. The Department of Human Development should coordinate these efforts. The government should use NGOs and CBOs to inform, educate, and communicate to the population. These structures have already developed networks within communities and have expertise providing these services. It is not necessary to rely only on government structures to carry out IEC.

      6.5.3 If the government decides to launch a campaign on population issues, with NGOs, communities, and others, how should this be coordinated?

      • Before any campaign is launched, a thorough re-evaluation of the PDP and its information strategy needs to occur. Once the review has been completed and the necessary changes made, the initiative should rely on intersectoral collaboration between many departments. The Department of Human Development should coordinate nationally in support of all line departments within the framework of the RDP. In addition, the campaign must develop a mechanism to contract with NGOs and CBOs for their participation.

      6.6.1 How should population trends be institutionalised?

      • Human development management should be institutionalised in the coordinating functions of the Department of Human Development that would conduct its activities in an intersectoral manner relating both to other line departments and non-governmental organisations within the framework of the RDP as the overarching development strategy.

      6.7.1 Is it necessary to have a population forum representing the interests of organisations of civil society?

      • It is useful to have a specific forum to represent the interest of civil society regarding human development issues. The government should make financial and other resources available to enable this to occur.


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