Policy Documents

1. Introduction

Since the country’s first democratic elections in 1994, the African
National Congress-led government has made great strides towards the
reconstruction and development of this country. Not only have the
disenfranchised majority been given a real say in the running of this country,
but there have also been tangible benefits to people’s lives. The basic living
conditions for many people have improved significantly.

Examples of this are:

• services are now reaching many previously disadvantaged people for the
  first time.
• fresh water is now being supplied to 23 million people.
• telephones are being supplied to over 6 million households.
• electricity is being supplied to 4,9 million households
• almost one-third of our population is now in schools, universities or
  colleges.
• approximately 400 000 new houses have been built and 700 000 housing
  subsidies have been allocated.

2. Major achievements of the National ANC-led Ministry of Health since 1994

Since 1994 the ANC-led Ministry of Health has achieved many successes. The
effect of these policy and legislative changes are keenly felt at provincial and
local level.

Some of these successes are:

• Switching from institutionalised hospital care to primary health care.
• Adoption of the Primary Health Care Approach as the basis for the District
  Health System for South Africa.
• Improved access to health care, particularly in rural areas and small
  towns.
• An additional 5 million people are obtaining health care
• Since 1994, 567 new clinics have been built. 106 mobile clinics were
  purchased.
• Allocation of 100m in 1998 to repair dilapidated hospitals, with R200m
  being allocated in 1999 with further annual increases.
• Improved distribution of drugs, equipment and personnel to clinics.
• Free health care for pregnant women and children under 6 years was
  introduced in 1994.
• In 1997, free health care was extended to all attending primary care
  facilities.
• Collaboration with Cuban, German and other foreign governments to employ
  doctors in rural areas.
• Implementation of community service for new doctors.
• Emphasis on activities promoting health care, especially heightening
  awareness of the dangers of smoking.
• Currently the Primary School Nutrition Programme is feeding approximately
  5 million school children in 14 001 primary schools.
• An inter-sectoral government plan to the combat the HIV/AIDS epidemic has
  been launched.
• Since January 1997, achievements in reducing the backlog in assistive
  devices for the disabled include the provision of 4 275 wheelchairs.
• During 1997 alone, 25 440 cataract operations for sight restoration were
  performed.
• The government has prioritised occupation health, with 40 000 persons in
  the mining industry undergoing medical benefit examinations. Of these, 22
  000 were certified as having occupational lung diseases, and qualify for
  compensation.
• The government embarked upon mass immunisation campaigns against the major
  vaccine preventable diseases. In particular campaigns have been initiated to
  fight measles and polio, and measles has been virtually eradicated in South
  Africa. The number of measles infections dropped from 22 000 in 1992 to 684
  in 1998.
• In an effort to reduce maternal deaths, these have been made notifiable as
  of December 1997. An important intervention has been termination of
  pregnancy service, which is now accessible to increasing numbers of women.
• The development of an Essential Drugs List in line with World Health
  Organisation (WHO) policy. In November last year, three books were published
  listing drugs used at each level of care (primary, secondary and tertiary).
• Introduction of a system of “rational prescribing” whereby
  patients are assured that when they visit a clinic the basic medicines will
  be available.

Important Acts passed in Parliament 1994 – 1998

• The Nursing Amendment Act
• Pharmacy Amendment Act
• Medical, Dental and Supplementary Health Services Professions Amendment
  Act
• Dental Technicians Amendment Act
• Previously fragmented health professions councils of the republic and
  homelands are replaced with single national bodies.
• New transformed South African Nursing Council, Pharmacy Council and Dental
  Technicians’ Council are established.
• The Health Professions Council fundamentally changes the power
  relationships between medicine and supplementary health professions, for
  example physiotherapy. Legislative changes allow for compulsory community
  service.

• • The Choice of Termination of Pregnancy Act
    • This Act allows women the right to choose whether to terminate a
      pregnancy or not.
    • The effect of this Act will be to save 400 women who die annually or
      suffer serious complications due to back-street abortions.

• Sterilisation Act
  • This service will be more accessible at primary and secondary levels.
  • More stringent criteria will be used in the assessment of
    learning-disabled women and girls before a sterilisation procedure can be
    performed.
• The Medical Schemes Amendment Act
  • A controversial aspect of this Act is the proposal to disallow the
    medical aids from risk rating in favour of community rating. This
    progressive concept means that open medical aids can no longer choose the
    clients they wish to serve, but that all people will have an equal
    opportunity to belong to a medical aid.
  • The Act also makes allowance for a single system of administration of
    medical aids.
  • The Act prevents medical aid schemes from arbitrarily relinquishing
    responsibility for its members.

Current legislation to be passed by the Portfolio Committee includes:

• • The Medicine and Related Substances Control Bill
  • The Medical, Dental and Supplementary Health Professions Bill
  • The Pharmacy Amendment Bill
  • The overall effect of these Bills is to:
  • Encourage the use of generic medicines which are cheaper but which do
    not comprise quality.
  • Allow parallel importation of drugs to ensure that branded medicines are
    more affordable to people both in the public and private sectors.
  • Regulate licensing of doctors to dispense medicines.
  • Extend the ownership of pharmacies beyond qualified pharmacists.
  • Ban sampling and bonusing of medicines to discourage inappropriate
    prescribing.
  • Introduce a single exit price as a means to reduce the price of
    medicines by removing mark-ups and replacing them with handling fees.
  • Introduce a system of community service for medical graduates as a means
    of enhancing the training for doctors before they enter independent
    practice.

• The Tobacco Products Control Amendment Bill
  • This Bill has been controversial in that the powerful tobacco companies
    have been lobbying against the introduction of this Bill.
  • The main thrust of this Bill aims to ban both the advertising of
    cigarettes and the promotion of sports sponsorships associated with
    tobacco use.
  • By discouraging the use, promotion, and advertising of tobacco products,
    this Bill aims to reduce tobacco-related illness and death.

• National Health Bill
  • The bill establishes a broad framework for governance of the health
    system and attempts to delineate an appropriate distribution of powers and
    functions between national, provincial and district health authorities.
  • One chapter is devoted to the protection of the rights of health service
    users.
  • Other chapters addresses issues including, e.g. the establishment and
    operation of public and private health facilities, regulation of public
    health programmes and services, control on use of human tissues, health
    laboratories and health surveillance, research and information.

• Proposed Statutory Council for African Traditional Doctors
  • The Portfolio Committee on Health has approved the creation of a
    statutory council for African traditional doctors. This will enable
    traditional doctors to play a much greater role in the public health
    sector while regulating their training and practice.

• Complementary Health Disciplines
  • The Portfolio Committee has also approved the use of a greater number of
    complementary health disciplines such as ayurvedic medicine and
    acupuncture

3. Highlights of the ANC-led Provincial Ministry of Health 1994 – 97

• The development of a Provincial Health Plan outlining a strategic vision
  for the Department of Health for this province. This was based on the
  Primary Health Care Approach of the WHO, and included extensive community
  and role-player consultation. The plan identified such priority areas as
  Tuberculosis (TB), HIV/AIDS, Malnutrition, Communicable Diseases (measles
  etc) and maximisation of the role of traditional and complementary healers.
• The creation of a management structure for the Department which would
  enhance the delivery of the programmes outlined above. Appointments were
  made to ensure greater representativeness.
• Significant attempts have been made to overcome apartheid fragmentation
  through initiating the development of health districts offering
  comprehensive health care
• Emphasis on development and training of personnel and community members to
  ensure improved service provision.
• A strong clinic-building programme was instituted. A total of 36 new
  clinics were built, while 16 were upgraded.
• Services were extended to 24-hour care in Retreat, and Gugulethu.
• Specialist health services were improved in the upgrading of hospitals in
  George, Worcester, Paarl and Karl Bremer in the Metro.
• GF Jooste Hospital was opened as an acute and trauma hospital.
• Proposals were finalised for the rationalisation of the four nursing
  colleges into one. The Nico Malan Nursing College at Athlone was to be the
  primary centre of learning for undergraduate nurses.
• Free health care increased access for those who traditionally were
  excluded.
• The Primary School Nutrition programme was extended to feed in the order
  of 400 000 children every day.
• The declaration of TB as a provincial emergency. The programme has been
  given a significant boost with the introduction of the Directly Observed
  Treatment Shortcourse (DOTS) strategy. This programme is significant in that
  the Western Cape has the highest incidence of TB in the world.
• A multi-faceted programme to combat HIV/AIDS was instituted. Programmes
  include a life-skills programme aimed at youth, strengthening of counselling
  services, strengthening the treatment of sexually transmitted diseases at
  clinics, and the provision of both male and female condoms, with a focus on
  high-risk groups.
• The promulgation of the Health Facility Boards Bill which formalised the
  establishment and functioning of hospitals boards and community health
  committees.
• The commissioning of an investigation into the rationalisation of the
  Academic Hospitals by the Kings Fund. The recommendations in this report
  have been utilised as the basis of the ongoing rationalisation process of
  the Associated Academic Hospitals and the Associated Psychiatric Hospitals.
• The average number of ante-natal visits per pregnancy in the Western Cape
  has increased and this compares favourably with the WHO requirement is at
  least 3 visits per pregnancy

4. What has happened since the end of the GPU?

There are a number of indications that the New National Party has drawn back
from implementing the widely-canvassed and support Provincial Health Plan based
on national and international policy. These are

• The process and decision of placing the combined nursing college at Nico
  Malan in Athlone has been reversed. This effectively takes the education of
  our students away from the communities who would benefit the most by it.
• Personnel appointments do not reflect the demographics of the province.
• The Health Facility Boards Bill was been by the NNP-led provincial
  government.

Furthermore, the National Party does not even have a strategic plan or vision
for the provision of health care to the people of this province. It is a party
governing on the same principles of discrimination that it maintained during the
apartheid era.

5. The approach of an ANC-led Government

An ANC-led provincial government would prioritise:

The District Health System

• The establishment of a district health system based on the primary health
  care, with effective referral procedures.
• Improved access to health care with particular emphasis on the provisions
  of services in rural areas and small towns. This would include improved
  distribution of personnel, drugs and equipment.
• Improving the infrastructure of hospitals to ensure the maintenance of
  effective secondary and tertiary levels of care.
• The creation of greater representation from communities on Hospital Boards
  and legal recognition of Community Health Committees, consisting of elected
  local representatives and ordinary community members.
• The increased commitment to developing communities’ capacity for
  involvement in health.
• Greater inter-sectoral collaboration with departments such as social
  service, education, housing and community safety.

Programmes

• Comprehensive and inter-sectoral programmes to deal with major public
  health threats such as TB, HIV / AIDS, violence & trauma and foetal
  alcohol syndrome.
• Strengthening of comprehensive programmes, in Child Health, Nutrition,
  Women’s Health, Chronic Care, Disability and Rehabilitation.
• Emphasis on activities promoting health care.
• The strengthening of the role of complementary health practitioners and
  traditional healers.
• Sufficient resources to ensure the delivery of high-quality emergency
  medical services.
• In line with international trends, comprehensive programmes, including
  nutritional support, life-skills training and developmental screening will
  be available to children attending crèches.
• Emphasis on training of health workers to ensure rational prescribing of
  drugs.

Human Resources

• Greater progress in transforming the management of the Health Department
  through further appointments in the areas of Programme Development, Human
  Resource Development and at district level.
• The development of skills and competencies of all categories of health
  workers will be given priority, as will the development of effective
  managers in the Health department.
• The provision of a client-friendly service by public servants who are
  conversant with the principles of the Batho Pele (People First) campaign.
• The release of a patient care charter which will outline the standard of
  care which should be offered to patients at all public hospitals and
  clinics.

Finances

• The realignment of the budget to place emphasis on social spending –
  education, health and welfare.
• Improving competitiveness of the Public Health Sector to attract revenue
  from paying and medically-aided patients.
• Freeing up resources through planned rationalisation of the Academic
  Health Centres.
• Implementation of cost-saving measures, for example, decreasing the number
  of drugs available on tender.

Partnerships with Communities and NGOs

• Partnerships with communities and NGOs to harness resources effectively.
  This would be underpinned by financial support, capacity development and
  training, particularly in the areas of health promotion and nutrition
  development.
• The training of volunteers as highlighted in the Victim Empowerment
  Programme led by the National Welfare Department will be given priority. All
  victims of violence and trauma will be given the necessary support in a
  non-judgmental manner that also ensures confidentiality and respect for
  their human dignity.