Address by Deputy President Kgalema Motlanthe 04 November 2011
Programme Director; Dean of Harvard School of Public Health, Dr Julio Frenk; Minister of Health Dr Aaron Motsoaledi; Executive Director of Harvard Ministerial Leadership in Health Programme, Dr Sinclair; Distinguished Guests; Ladies and Gentlemen:
It is a great honour for me to deliver this inaugural address at this special occasion to launch the Harvard Ministerial Leadership in Health Programme. Given the current global economic crisis this programme could not have been launched at a more appropriate time.
As you are aware, many countries have been implementing austerity measures and budget cuts in order to service their debts. Unemployment is also increasing, leading to many citizens having to depend more on the state. In this situation health care, like any other public service, is likely to suffer reductions in already limited resources, while those who depend on state provided health care will invariably increase because of unemployment. This has, in turn, exacerbated the anomalies that exist in health system reform and management.
Developing nations that have been dependent on aid for bolstering their health care budgets are the hardest hit as donors begin to reduce on aid spending. Thus this programme is crucial in assisting governments to reform their health systems through better leadership, skills training and the setting of priority health outcomes. Strong political and senior public service leadership is therefore critical in steering the transformation of health systems to ensure that they are efficient and sustainable. To this end, the ruling party in South Africa has taken a view that all health portfolios, at both provincial and national levels, should be led by health practitioners with executive management training and experience. This way we hope to further professionalise the public healthcare system with the view to overcome the attendant challenges.
Throughout the history of strengthening health systems, I have not come across a better programme aimed at enabling, supporting and empowering health ministers to provide stewardship. We are extremely honoured that the institutions that came together to design this programme found it appropriate to launch it in South Africa. For that, I would like to express our government’s gratitude. Leaders need support of competent and highly skilled teams able to manage and add value to complex and nuanced systems. These skilled teams need to be able to inculcate a culture of excellence and to transfer their ethos and skills across a multiplicity of often challenging environments. Supported leadership can eventually firmly institutionalise the enlightened organisational culture into the health system as a self-perpetuating norm.
Ladies and Gentlemen; The World Health Organization in its constitution describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Closer scrutiny of this statement reveals the weighty responsibility of those tasked with the mandate of providing health services. From it, we begin to fully understand what governments and in particular, the health ministers, are expected to do as part of their mandate and responsibility to their citizens. This definition also includes the need to attend to the social aspects of health, thus bringing into this critical role ministries that are tasked with responding to the social determinants of health and addressing these in a comprehensive manner. It is my view that the definition puts government at the centre of the issues we are reflecting upon this evening.
Returning to the matter of health care and the provision, when assuming power in 1994, the African National Congress led government of national unity was driven by a vision of building a united, democratic, non-racial, non-sexist, just and prosperous society. Accordingly, our country’s constitution gives everyone the right to health services, sufficient food and water, and social security. By so doing, we have made certain that in South Africa this obligation is constitutionally framed as the right of every citizen to access appropriate health services. In order to understand and therefore evaluate our performance in discharging our constitutional mandate, we are following the World Health Organisation’s (WHO) guide in identifying the key functions of health systems and what member states ought to do to ensure the provision of quality health care to their citizens. As a result, occasions like these provide us with an opportunity, however limited, to reflect on how well we have performed against these standards as stipulated by the WHO.
In reflecting on our progress as a country, our point of departure has to be defined by our history and the journey we have taken to arrive where we are as a young democracy. In this regard, our journey has taken us away from the pre-1994 health system that was based on apartheid and characterized by racial and geographic disparity. This system consisted of fourteen health departments which were separated according to the apartheid policy. With the dawn of the democratic government, in1994, we have sought to embark on a process of integrating these systems under a single national Ministry of Health whilst decentralising the management and delivery of health services through a district based system and a primary health care approach.
Unfortunately efforts at rebuilding our health system were set-back by the emergence of the HIV and TB epidemics, reversing some of the gains we had made through such reforms as free maternal and child health care and others. Be that as it may, these pandemics attracted both domestic and international resources to the country and this is an investment we intend to continue maximising for the benefit of our people. We have made significant progress in addressing the burden of ill health due to co-infection HIV and TB.
We are also in the process of re-engineering primary health care and preparing for the implementation of the National Health Insurance. This is precisely why the new Harvard Ministerial Leadership Programme in Health, which is a joint initiative of the Harvard School of Public Health and the Harvard’s Kennedy School of Government, is a most welcome, timely and critical intervention. We are confident that this will put us in a better position to measure progress, identify and address bottlenecks, and achieve better integration in our work as government.
Programme director, In conclusion, I once again want to draw focus towards the issue of stewardship by drawing your attention to the words of Dr Gro Bruntland, the then Director General of the World Health Organisation who at the turn of this millennium said: ‘…Ultimate responsibility for the performance of a country’s health system lies with government. The careful and responsible management of the well-being of the population− stewardship− is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent.’ Heading to this call for stewardship and political will we are confident that this forum will go a long way in providing quality health care to all. I once again thank you for this exciting initiative and wish you all success in its execution. I thank you. Website: www.thepresidency.gov.za