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Speech at the opening of the 4th RUDASA  Annual Congress
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 EASTERN CAPE PROVINCIAL GOVERNMENT
SPEECH BY DIRECTOR GENERAL DR ME TOM
AT THE OPENING OF THE 4TH RUDASA ANNUAL CONGRESS,
21 SEPTEMBER 2000



Chairperson,
The MEC Health,
 Director General Health,
 Colleagues,
Ladies and Gentlemen,

I must say that I was greatly surprised when Vincent approached me to address you on this day.I feel very privileged and honoured to be 
here and make this humble contribution to the discipline and profession so close to my heart.I looked at the programme this week and 
realised how much I am missing since my departure from the health field in 1997.

For one who thought that he would spend the major part of his career in the rural health arena your theme strikes a rhyme in my soul. The 
Rural Practitioner: An Integrator in Service Delivery.What a challenging topic! How elusive integration and service delivery are!

You could not have chosen a better part of the country than the Eastern Cape for this congress especially with the theme.Nor could you have 
chosen a better time than now when the Stats SA poverty report has just been released and when we are talking about the transformation of 
local government which extends to be wall-to-wall including rural areas. The model of that local government as outlined is a developmental 
one. Your deliberations are going to feed into that process.

THE EASTERN CAPE

This is a rural province with a very rich history but faced with abject poverty. More than 60% of our population is in the rural areas.Most 
of those rural households are led by women. Poverty, ignorance and disease are a well-recognised combination by any public health 
worker.Systematic deprivation and underdevelopment of the rural areas dates back to the colonial times. Being the entry point for 
colonisation of South Africa the Eastern Cape bore the brunt of the violent rape of our land, which continued under apartheid. It is no 
wonder then that the fight against apartheid was also championed in these shores. However, it is also here that the first schools and 
university for Africans were founded by the missionaries.Therefore, the oppressors were also sharpening the spear that would in the end 
reverse that oppression. It does not matter that later the oppressor learnt to give just a dose of education that would perpetuate 
slavery.The seeds were already sown. We must remember though that the spear was sharpened and used even before that education - in the 
frontier wars.

The province is, therefore, still characterised by poverty, landlessness, huge infrastructural backlogs, economic stagnation and 
unemployment. This is clearly indicated in the Stats SA report which could make good reading for a rural practitioner who would like to be 
an integrator.

The provincial administration has a vision of  An Eastern Cape which is devoid of the inequalities of the past, unified through integrated 
and sustainable economic, social and cultural development; thus providing acceptable quality of life for all its people in the context of a 
united, non-racial, non-sexist and democratic South Africa

In order to realise this vision the province identified eight pillars as follows:-

* Rural development
* Meeting the basic needs
* Investment in people
* Sustainable use of resources
* Effective and efficient civil service
* Job creation
* Crime prevention
* Redistribution of income

These themes especially the first five are directly linked to the issues appearing in your programme. They are for the rural practitioner, 
they are about integration and they are about development and service delivery.

Once more, your timing and your choice of venue has been excellent.

PRIMARY HEALTH CARE AND INTEGRATION

There is no other useful document that I always refer to when I have to refer to integration of health care than the Alma Ata Declaration 
of 1977 on primary health care. It is so instructive and so informative for a health worker who would also like to be a development worker. 
As we go through the topics in your programme this weekend I would like you to reflect on the particular issues raised in that declaration. 
Critical are the linkages made there with development. Right from the definition of primary health care to what should be contained in that 
system you find the thread of development.Primary health careforms an integral part both of the countrys main focus, and of the overall 
social and economic development of the community.South Africa having defined itself as a developmental state has no option but to focus on 
all other sectors related to health and aspects of national and community development amongst which we can mention education, public works, 
housing, agriculture, communications, electricity etc. It is not only on the health sector that the health status of the people has to 
rely. It relies on the other sectors that Ive just mentioned above. There is no other champion of that intersectoral collaboration than 
the Alma ata Declaration.It demands coordination and it demands integration.

It is a well-known factor that the socio-economic status of people determine the disease patterns in that society. Infectious diseases are 
particularly known to affect the poor with no access to clean water, sanitation, food etc. What better example than that illustrated by the 
resurgence of tuberculosis in the poor societies of rich Britain and the United States of America? Poverty and ignorance breed disease.If, 
indeed, the theme of the congress is such that you are looking at a generalist who goes beyond seeing the patients and clinical care you 
cannot avoid addressing issues of development, poverty, resources etc.It is, therefore, unavoidable that you will refer to depression not 
as it just affects the mind but what the ills of our society, past and present, have done to breed a generation that is so violent.You 
cannot avoid to link sexual abuse and rape to that type of society and its violence.Sexually transmitted diseases thrive in that 
environment. Can we then avoid the link of the spread of the HIV/AIDS epidemic to these factors?It is an infectious disease, it spreads 
mainly by sexual contact and it spreads faster in the presence of other sexually transmitted diseases.

Many a health activist has never dissociated the health status of a society from the allocation of resources in that society.The allocation 
of resources is linked to priorities identified.Having an understanding of the fundamental causes of disease plays a big role in the 
determination of those priorities. It is the responsibility of the health worker and professional to identify those causes and, therefore, 
priorities. We all agree that the major thrust of public health, and, indeed, individual health is prevention. Whether you read Family 
Health in McWhinney or Stott, or Public Health publications you will find the theme of prevention cutting across. McWhinney defines every 
contact with a patient as an opportunity for prevention or health education. The importance of data for the rural practitioner plays a big 
role in determining allocation of resources because the policy-makers need to be confronted with that accurate data in decision-making.It 
is not enough to talk about bed-occupancy or lack of drugs. What is important is to link that with the conditions that are filling those 
beds and consuming those drugs.Once that is done we go back to ask ourselves why those conditions are common and what can be done to reduce 
their incidence. We may need to divert the resources from the disease to the contributing factors in order to reduce the health 
expenditure. Then the generalists will be going beyond just seeing patients and clinical care to dealing with developmental issues. They 
will direct the transformation process with redirection of human resources and determining what additional training and type of health 
worker is required. They will participate in determining the integrated sustainable rural development strategy that can assist in 
addressing the incentives for rural practitioners.

This is in line with what McWhinney again says about generalists. They have a perspective of the whole organisation - its history and 
traditions, its general structure, its goals and objectives, and its relationships with the outside world. They understand how each part 
functions within the whole.Having identified the problem, they may either deal with it themselves or refer it to a specialist.I would like 
you to remove your minds from identifying the problem referred to as just a medical or health problem.It may be any of the sectoral 
problems we referred to in Alma Ata as having a bearing on the health status of the population. That is in line with what this congress is 
about - focusing on the generalist nature of services in the rural areas, and going beyond just seeing patients and clinical care.

The rural development strategy I have referred to is a national priority. It is based on the Reconstruction and Development Programme aimed 
at improving the quality of life of the rural people. It also entails access to affordable services one of which is health. It is our hope 
then that this congress as it deliberates will deal with how you see yourselves participating in that process not only in the Eastern Cape 
which will hold its rural summit on the 5th and 6th of October but throughout the country.

You have a rich programme and I hope you will be able to assist us in the challenge of improving the quality of lives of our people.I wish 
you all the best in your deliberations.

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