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Successes and Challanges in achieving equity in  EC health
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Speeches and Media Releases
 Health

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EASTERN CAPE PROVINCIAL GOVERNMENT

SPEECH BY THE MEC FOR HEALTH

SUCCESSES AND CHALLENGES IN ACHIEVING EQUITY IN HEALTH IN THE EASTERN CAPE

24 FEBRUARY 2000

Chairperson, ladies and gentlemen it is an honour for me to come and share with you not the experiences of health service delivery in the 
Eastern Cape, but our vision of equitable, quality and sustainable health service. Our approach to equitable sustainable is informed by the 
following framework:-

* The Constitution of the Republic of South Africa bestows upon us as government organ a responsibility to ensure that our people have 
access to health care services, including reproductive health care.

* It is also a commitment of this government to ensure that the rural and the poor receive quality health service. Nothing more can be said 
by this commitment as President Thabo Mbeki and our leaders have constantly reminded us of it.

Defining the Eastern Cape

1.Economic Status

With population of  7 million, nearly 63% is rural.54% of the total population lives below poverty line. Being a labour reservoir for 
richer provinces, has not only robbed the province of its human resources, but also has further impoverished the province.We are the 
recipients of economically inept people from these provinces and this impact negatively on our health budget.Today most of the people with 
chronic diseases are those from the mines, the farms, the fishing industry, the chemical and other heavy-duty industries.

The province also shows a dichotomy of two worlds in one nation.With these two worlds emerged the legacy of the past.This explains why 80% 
of the people in Eastern Cape depend on Public Health for their livelihood.

Like other provinces, the Eastern Cape government inherited three different administrations, which were not only politically antagonistic 
to each other, but also had totally different cultures. That cultural identification has continued to exist despite attempts to inculcate 
new ethos.The situation has been worsened by the fact that one of the administrations had within itself not only racial segregated service 
delivery institutions, but also fragmented and duplicated services.

The legacy of the past is evident throughout the province. The neglected, underdeveloped and densely populated Bantustan areas had to be 
integrated with the wealthier and better serviced urban areas of the former CPA. Per capita expenditure in the former Transkei, which has 
about 54% of the population of EC, was only 35% of the health budget in 1994. Though this trend has been progressively reversed, the state 
of health service in those areas was near collapse forcing the department to pump a lot of money in the area without a significant 
improvement.

This balancing act also meant that the institutions which were in the former CPA areas had to reprioritise some of the services. This has 
been met with aggressive resistance. What became clear is that although we claim to have removed white supremacy there are strong elements 
who still live in the dark days. The Eastern Cape Department of Health falls within this ambit.

2.Health Status

Given the acute socio-economic conditions in the province, it is an undeniable fact that the Health Status of the province falls below what 
is considered to be measure of a developing country.The following statistics are an indicative of our health status.

    -High-recorded cases of TB. Nationally there are 362/100 000 people and in EC the recorded cases indicate that there are                  
504/100 000.
     -Infant mortality at national level stands at 45/1000 and in EC it is at 61.2/1000
     -Access to Primary Health Care is at 61% nationally and in EC it is at 52%.
     -Medical doctors  6/10 000 nationally whereas in EC we have 1/10 000
     -HIV/AIDS recorded cases in EC  18%.
     -Of the total number of 710 clinics, 167 have no electricity, 226 have no water, 197 have no telephones and 194 have accessibility       
problem due to bad roads. This excludes many of the hospitals in rural areas, which lack basic facilities.

Each year a significant percentage of the provincial budget of the Eastern Cape goes to three big social service departments i.e. Health, 
Welfare and Education. This is deliberate and in line with the policy of this government to invest in people and meet their basic needs. 
Since 1994 the Department of Health working within the broad national framework, sets itself very concrete tasks. These included unifying 
the fragmented and unequal services, setting up a new decentralised health model with particular emphasis on District Health System, 
improving access to essential services, especially in our most neglected rural areas, through building more clinics and health centres, 
better referral systems and good hospitals, developing relevant health programmes and, running through all these activities, improving the 
quality of life.

Since1994 the provincial health department has built a number of clinics and health centres. There is also number of clinics, which have 
been built by the private sector. Most of these clinics are in areas, which have been neglected by the previous administrations.

In South Africa we were given an impression that the only way to deliver health service is through secondary health care. The construction 
of clinics especially in rural areas marks the fundamental shift from this philosophy. Our emphasis is on Primary Health Care.This means 
that we shall do away with the notion that the hospitals are the places to go to when suffering from general illnesses.All general 
functions will be rendered at the local clinics with the nurses being the backbone of the services.

We envisage this process by ensuring that through training and orientation, nurses can investigate the cause of illnesses, analyse the 
extent of the problem and even prescribe treatment necessary where required.Some may argue that the nurse may never be able to replace the 
function of the doctor.This is not the intention.

What we are doing is simply to empower our nurses to a level where they can be equated with the general practice in the health service.In 
extreme cases, of course, patients can always be referred to bigger and more advanced institutions.

The most important aspect about primary health care system is that it is cheaper to implement, more accessible and affordable.With the 
shortage of doctors this also means that the services rendered by the doctors are going to be more focused or even specialised.

Our philosophy of Primary Health Care can never be functional unless the very buildings we keep on erecting are fully equipped and 
accessible. Water, electricity, roads and communication infrastructure, staffing and all the necessary equipment is a basic condition for 
the functioning of these clinics. There are many clinics in Eastern Cape, which do not have electricity, or water and some are not 
accessible. As a result of this most of our programmes have not met the required standards.

As part of the governments efforts to ensure that such essentials are available we have brought in all the relevant stakeholders. We are 
busy negotiating with the Department of Public Works and also Water Affairs so that water and roads are in good order. Apart from this 
initiative the Independent Development Trust has also approached us. They are giving us money so that our rural clinics can be electrified. 
There are also companies like Goldfields who are making their resources available to us.

Having said all this ladies and gentlemen, I must point out that apart from what the government can do there are other variables I feel 
have an important role to play in changing our misfortune. These include -:

Political willingness
Good understanding of each other
 Preparedness the limited resources of our province
 Ubuntu

We have two options, we can either sit down, criticise and watch allowing the situation to deteriorate which off course we will all be 
affected by the unhealthy environment or try to accelerate the upliftment of the underprivileged and get the whole province healthy.

The majority of the people of this Province mandated the ANC to deliver quality and sustainable health service to them. The Department of 
Health will therefore ensure that the citizens get the best out of their vote regardless of their race, creed, religious or political 
affiliations or their social status.

I am neither White nor Black, Rural nor urban, poor nor rich and Young or old. I am a South African dedicated to improving the lives of our 
people by making health accessible to our people. It is therefore an imperative that all of us, united in diversity, contribute positively 
towards the realisation of this noble vision. Destructive criticism both explicitly or implicitly will only worsen and prolong the 
suffering of our people. Those who still believe that equitable distribution of resources means the collapse of health service will find it 
hard to accept the reality that we have a constitutional imperative to eradicate our society of gross inequalities. We have a 
responsibility and we cannot fail our people.

Conclusion

The brief above was intended to highlight and give a picture of the health service delivery in the Eastern Cape. Delegates should not 
regard this as a lament but as an attempt to share our experience with you. As a young administration we are on a learning curve. While we 
recognise that the legacy of the past is still with us, we will be doing injustice to the people of the province not to what we can in the 
circumstances. We have commitment and the spirit to carry on. Not in the distant future these will be history.



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