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Towards Equity in Health for the People of the Western Cape

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.


  • 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.


  • 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.