It was no surprise when health minister Zweli Mkhize told the national assembly on Thursday that the department’s urgent focus was to combat Covid-19, which has been allocated R9bn in the 2020/2021 financial year.
Mkhize said many government services had been pushed back to reprioritise resources to fight the pandemic.
He added that lessons had been learnt.
“The impact of Covid-19 has emphasised the necessity of investing in long-term resilience and sustainability of health systems to enable us to better respond to future health emergencies and crises,” said Mkhize, delivering his R62.5bn budget for the 2021/2022 financial year.
He said the pandemic had caused social and economic devastation globally.
“In our country, this resulted in 1,6 million positive cases, 10,9 million tests done and 54,968 associated lives were lost, although 95% of those affected have recovered.
“The Covid-19 positive cases have started to rise significantly and we may find ourselves in the third wave. Of concern has been the emergence of B.1.351 in our country, the importation of B1.617.2 variant from India and B.1.1.7 from the UK.”
Mkhize said it was citizens’ responsibility to continue to abide by non-pharmaceutical interventions to reduce the risk of infection.
On Monday the country is set to begin phase 2 of the national vaccination programme, which is targeting those over the age of 60 and vulnerable groups.
This week the government is pushing to conclude the Sisonke Johnson & Johnson (J&J) vaccination of 500,000 healthcare workers.
When the rollout gets under way, some members of the population will be inoculated with the J&J, others with the double-dose Pfizer vaccine.
“The Covid-19 pandemic caused significant health-seeking deterrence and various results have pointed to this challenge. The mandates set out in the performance agreement I signed with the president for the period of June 2019 to April 2024 indicate the need for innovation to close these service delivery gaps,” said Mkhize.
To meet President Cyril Ramaphosa’s demands, Mkhize needs to, among other things:
- Establish the NHI (National Health Insurance) Fund;
- Implement the recommendations of the Health Market Inquiry Report;
- Build human resource capacity;
- Improve quality;
- Expand health infrastructure;
- Uproot corruption; and
- Ensure clean governance.
Regarding the pandemic further, Mkhize thanked healthcare workers, saying the department developed surge capacity guidelines for human resources and a strategy to protect the health and safety of health workers in the occupational space.
“A key development over the Covid-19 period was the deployment of community health workers for the community screening and testing campaign. This programme is now a seminal case study for all countries seeking to strengthen their primary healthcare systems,” he said.
The minister added that at the end of March, 47,630 community healthcare workers received remuneration against the Medium-Term Strategic Framework 2024 target of integrating 50,000 community healthcare workers into the public health system.
“A committee was established by the National Health Council to attend to the various issues around the conditions of service for community healthcare workers. This work is still ongoing and the NHC is expected to finalise its recommendations and table these at the bargaining council.”
He said the government had undertaken key collaborative initiatives and investments to ensure SA could independently meet its biotech needs. This was in line with what deputy president David Mabuza told parliament on Wednesday — that the country was aiming to manufacture its own vaccines.
“These include attracting the Brics Vaccine Research and Development Centre for location in SA, fully capacitating our regulatory bodies and investing into academic and innovation institutions such as Biovac.”
Mkhize said SA had the expertise, including the precision guidance of genomic surveillance and the desired global partnerships, to grow its biotech capabilities.
To remain within the national aggregate expenditure ceiling, the minister said cabinet approved a more than R14bn reduction on the department’s baseline (R4.1bn in 2021/22, R4.9bn in 2022/23 and R5.1bn in 2023/24).
He said the backlog, current and future needs for health services far exceeded the current allocation of resources.
“All indications point to chronic underfunding of this sector. Despite the challenging reductions to the budget, I believe we have stretched our resources through strengthened relations with multilateral organisations such as UNAids and Unicef and key investment partners such as Global Fund, PEPFAR, the Clinton Health Access Initiative and the Solidarity Fund to ensure health services in this country continue to advance,” he said.
On NHI, Mkhize said its implementation remained one of government’s main objectives.
“Following the introduction of the NHI Bill to parliament in July 2019, the portfolio committee on health convened public hearings in all provinces during the latter part of 2019. These public hearings provided a platform for ordinary South Africans to be heard and contribute towards the shaping of the NHI Bill.”
In the medium term, R7.5bn had been allocated to the NHI unit to strengthen the system and contract service providers.
He told the sitting that Dr Nicholas Crisp had been appointed deputy director-general of the NHI.
“The NHI fund will be set up as soon as the NHI Bill is passed,” he said.
On infrastructure, Mkhize said the department had committed R20.6bn.
In the 2020/2021 financial year, 50,614 health-related and support posts were created to strengthen services in the public health sector.
The recruitment was enabled by combining the Covid-19 earmarked budget for human resources, funding from the presidential stimulus package and the Cuban medical brigade, he said.
“Despite disruptions to the academic year, 2,469 medical interns and 10,589 community service personnel, including, among others, medical doctors, nurses and pharmacists, were placed last year.”
On programmes for prevention and treatment of communicable and non-communicable diseases, Mkhize said R82.6bn had been allocated in the medium term to fund disease-specific programmes.
“Despite a difficult year, a cumulative total of 14,685,210 HIV tests were performed during April 2020 to March 2021,” he said, adding that the department had intensified community testing.
To address barriers to accessing healthcare, Mkhize said the department was developing a social and behavioural change communication strategy which aimed to mitigate stigmatisation and promote proactive health-seeking behaviour.
On malaria, he said the number of cases in the country decreased by 32%, while deaths had decreased by 48.5%.
He added that the department would be partnering with AstraZeneca to pilot a community-level screening project called the National NCD Campaign (NNCDC).
“At an operational level, the ward-based primary healthcare outreach teams will be deployed to find, screen and refer identified clients for further chronic care,” said Mkhize.
Services such as sexual and reproductive health services and paediatrics were affected due to the reprioritisation of resources towards the pandemic.
“There was an overall decline in childhood vaccinations in 2020. Immunisation coverage for infants (defined as children aged less than a year) was 78.5% in the months of April 2020 to March 2021, against the target of 90% by 2024.”
But Mkhize said the department was working on a “catch-up drive” with UN agencies, the private sector, NGOs and vaccine manufacturers.
The department had collaborated with other departments to address issues that lead to poor healthcare outcomes for children, he added.
In terms of medico-legal claims, the minister said: “We have appointed service providers to analyse the purported R100m liability. Their analysis has reduced the contingency liabilities by R32m and we believe that it could still be reduced further by conducting forensic audits into the claims.”
Mkhize used the opportunity to pay tribute to the Cuban Medical Brigade and the role that country had played in assisting SA to produce medical doctors.
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