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Speech delivered by the MEC for Health and Welfare Mr. Seaparo Sekoati on the occasion of Bohlabela District Health Council Launch Bohlabela District24 November 2004Programme Director On the 26th June 1955 peace and democracy loving people converged in Kliptown and adopted the Freedom Charter. An ideal that inspires us this morning is one of the clauses of the Charter: The people shall govern. Over the past ten years government has sought to give meaning to this noble ideal. Organs of popular participation have been created and those once banned made lawful. This has been so because of the shared belief that our development to be sustainable has to be people- driven and centred. Indeed the advent of democracy in our country in 1994 provided a platform for the acceleration of social and economic transformation. We are confident that we will seize the opportunity and together contribute to the betterment of the lives of our people. Primary Health Care, as an essential part of the broader reconstruction and development of the country had to be allotted its proper share in that process. Without comprehensive Primary Health Care the dream of a “ Better life for all” will remain illusive, particularly for the majority of our people living in rural areas. Since then, policies and structures have been put in place to reduce the fragmentation that characterised the public health system. Prior to this, the country’s public health services were unequally distributed in terms of
Services were curative in emphasis and primarily hospital based. Our government, since its inception committed itself to and ratified many international conventions and declaration all of which were geared towards the creation of a new world order. In this way South Africa joined other nations of the world in a common struggle to build a better world for all. In its quest to protect and promote the health for all the people, our government adopted the 1978 Declaration of Alma-Ata on Primary Health Care. Among others the declaration “reaffirms that health … is a fundamental human right and that the attainment of the highest possible level of health is a most important …social goal, whose realization requires the action of many other social and economic sectors in addition to the health sector.” Our important response to the challenge of transforming our health system has been the adoption of the core package of Primary Health Care services. This concept of Primary Health Care, codified in the Alma-Ata Declaration, explicitly outlines a strategy that would respond more equitably, appropriately and effectively to basic health care needs and also address the underlying social, economic and political determinants of poor health. The understanding is that health care must be accessible. The comprehensive and integrated package of essential primary health care services will provide a solid foundation for a single unified health system in our country. The package recognises the role and centrality of the communities and individuals to the delivery of health care services. In fact in the past many of the initiatives to promote community participation in health have concentrated on inviting communities to participate in activities established and largely controlled by the health services personnel. A recent WHO report uncovered a wide range of community groups or organisations that play some role in promoting health. The majority of these organisations owe their origins to the age-old community traditions of mutual support and co-operation and have a long history of community action. In our own country and province such organisations include the clinic committees, hospital boards, social grants committees, the Home and Community Care groups and of utmost importance the district health councils, one of which we are launching here today. These are the organs for people’s power that we have always spoken about and it is through these that we as communities are able to determine the sort of services we require. An immediate challenge of this district health council is to ensure that many of these structures are coordinated, consolidated and capacitated to discharge their responsibilities. The vehicle for the delivery of integrated and comprehensive primary health care services package is the district health system. The clinics, both fixed and mobile, community health centres, and district hospitals where access to clinics and community health centres is limited, form the platform for the delivery of this package. Fortunately this infrastructure has been provided for in the past ten years of freedom. In this region we have 42 clinics, 2 Health centres and 1 regional hospital, 2 district hospitals and 1 district hospital under lifecare management (Matikwane hospital). A major challenge remains the extension of these services to inaccessible parts of our district. The mobile units are doing a great deal of work in this regard. However we need to ensure that they are provided with the necessary equipments and appropriately adapted vehicles. Currently they are using conventional transport to offer services. Very soon we will receive the Cappilanos that have been designed specifically for these services. Obviously they will not be enough and the challenge remains with this council to find other ways to provide and broaden access of our services to the previously marginalized. Given the scarcity of resources for the provision of comprehensive primary health care services, it is essential in the pursuit of equity that services like the Home and Community Based Care services be planned at a district council level. Like other organisations working in the health sector, these groups are available, but are uncoordinated and highly fragmented, often competing to get a share of government’s funding, and plagued by the problems of inefficiency due to lack of ongoing training and capacity building. In short the integrated primary health care package, for its successful delivery requires and promotes maximum community participation in planning, organisation, operation and control, making fullest use of local, national and other available resources. Currently there is still confusion about our referral systems, often leading to traumatising situations. The system basically means from clinic to district hospital to regional hospital and then to a tertiary hospital. In this area, for example, it means our patients must start at the health centre, then to Tintswalo hospital before going to Mapulaneng hospital and ultimately to Polokwane/ Mankweng Hospital Complex. The lack of understanding of our referral system has proven to be an important factor in the bypassing by our people of primary health care institutions to hospitals. This is a matter that as the district health council we must deal with, engaging in a concerted marketing campaign to raise awareness on this issue. In order to strengthen our health team and to respond to the expressed health needs of our people, we will have to mobilise and ensure maximum participation of traditional health practitioners, suitably trained socially and technically to deliver primary health care services to our people. The Traditional Health Practitioners’ Bill of 2003 is currently under scrutiny to finally institutionalise the practice. We must fully contribute to its evolution and final enactment. Overall, these are some of the challenges that we must deal with as government and as the district health council. We are mandated to do all these things by the National Health Act of 2004, which among others, establish district health councils charged with the responsibility to advise the government on any matters regarding the health of our people. Given the historical legacy of a wide range of inequalities in health, our government is facing increasing public pressure to provide resources and quality services. We are however confident that this burden will be lessened through proper planning by the district council. We urge you not to fail in your endeavour to address the main health problems in the communities, providing promotive, preventative, curative and rehabilitative services accordingly. I wish you all success and wisdom in your work as you carry out your obligations. Thank you
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