I also want to thank the Brooklyn Chest Hospital, its brand-new Facilities Board Chairperson Mr Dawood Khan and Dr Moeti and all the staff at Brooklyn Chest Hospital for hosting us here today. It was an important step to actually come here as some of us may have wanted to hide the state of the hospital.
I think we have taken a bold step and are saying: Let us be right here and see what the challenges are that we think need to be dealt with. And then I really want to thank everyone who has taken the time to come, whether you come from an agricultural union, whether you are from the Treatment Action Campaign, or the Aids council or whichever structure you represent, thank you very much for coming to spend a few hours with us.
But more importantly, I want to echo what Minister Uys has said: Thank you very much for the constructive spirit in which I think this debate has occurred here today. I also want to thank our religious leaders for helping to set the tone of constructive reflective engagement, because we are all in this boat together.
The most important thing is that TB is back on the provincial agenda. Whatever differences we may have here, are differences amongst those who agree that maybe the de-emphasis of tuberculosis as a strategic challenge to the well-being of the Western Cape has been one of the big mistakes we have made over the past few years.
I think that often it depends on how specific symptoms within health, specific challenges within health and specific lobbies within health are able to organise themselves and to grab the attention of the public, the world and the media. And let us face it, for the past few years, the most successful lobby that has existed within health has been the HIV/Aids lobby. And I think to a large extent it has happened at the expense of highlighting the impact of a silent killer, tuberculosis. And if anything, there is a false divide between HIV on the one hand and TB on the other hand, because the two feed off each other.
It is as if scientists have predicted that when HIV and TB get together, we probably have one of the greatest challenges that one could have in Health in the Western Cape. And what I think we have done today is to say: TB is firmly on the agenda. We are dealing with it in combination with its twin HIV/Aids, and we have to move on the entire area of what the Health Department calls 'the burden of disease'.
If we are agreed on that basic premise, I think we have enormous agreement amongst us, and we have now got to solve the little differences on strategy, on tactics, we have got to solve the difference on emphasis, we have got to solve the differences of who gets the money and how we spend the money, those are the matters that we can negotiate.
As long as we do not have disagreement on the fundamental premise - that the burden of disease in the Western Cape has to be challenged - that within that, we have got to treat HIV and TB as two sides of a potentially devastating coin. And I believe that is where we have made a tremendous breakthrough in arriving at this imbizo.
What has awoken us from our complacency on the issue of TB is the manifestation of the MDR and XDR variants of tuberculosis. And I think we all stagger at its potentially devastating impact, but I think Dr Theron has confronted us today with a major proposal that hits us between the eyes: Can we lock up MDR and XDR patients in a former jail? Those who do not want to be disciplined and those who do not want to conduct themselves responsibly? Can we do that in a humane a way as possible?
We have never asked that question about any other disease in the Western Cape, not HIV or anything else. That an imbizo is confronted with that question begins to challenge Government, and to challenge society to think about the impact that these variants of TB have on us. We cannot answer that question here; no politician would want to answer that question a year before an election.
But the fact of the matter is, a responsible government and a responsible society have to unpack that question, and debate it, but to confront the fact that that question is the apex of a whole series of questions about the status of tuberculosis, its treatment and its prevention in a province like the Western Cape. That is the issue that has hit us between the eyes.
And so you can already begin to feel from the way in which all the questions have been asked and the questions have been answered - not perfectly, not everything you wanted to hear - but the indications are there, that having put TB back on the agenda is more than an academic matter. No one has said here it is on the agenda, let us discuss it.
Dr Vallahbjee has said that this Government and the Department led by Minister Uys and Professor Househam have concretised the idea of putting it on the agenda by applying for the 720-bed TB hospital on the site of the Brooklyn Chest Hospital, but nothing else suggests how seriously this has been taken.
What you can already begin to hear is that the budget to deal with tuberculosis has been increased so much so that the posts have been advertised, but the application rates are not as great as what we want. I am not sure whether it is because of a lack of expertise, or whether it is because of a lack of incentives to work in such an environment .
That therefore means that we have to go out and put this centrally on the agenda and make it the challenge of any health professional to want to crack the issue of tuberculosis in the Western Cape. We must all work together in order to get the skills that will deal with it. Alternatively, Minister Uys may have to make a case that professionals working in the field of tuberculosis should qualify as having a scarce skill. We need to find ways in which to deal with it.I think there is a whole range of questions which we are confronted with, having established the political and the administrative will to start dealing with it. We have crossed that little hurdle of infrastructure, maintenance, staff and budgets - not completely but I think it is a work in progress. We are dealing with it as much as we can manage at a particular time.
If I hear you correctly, those of you who work on the ground everyday, are saying to us that there is no way that we are going to crack the issue of tuberculosis and get the 75% cure rates that Minister Uys has promised Cabinet, that there is no way we will achieve 75% cure rates if there is no decentralisation. You are saying that the treatment has to be owned on the ground and it is going to be volunteer-driven, and it has to be based on patient involvement and buy-in. That is what I hear you saying about decentralisation.
The second thing I hear you saying as a necessary ingredient to confront tuberculosis is integration. You cannot have Chinese walls between HIV and Aids on the one hand, and TB on the other. Burden of disease issues are going to become more integrated, but particularly these two need to be dealt with together, so that you do not have to go to one site for ARVs and to another site for the handful of pills that you take for tuberculosis.
That is the challenge to all people who work in health to see. Dr Vallahbjee has already begun to show that bridges are being built between, for example, a hospital like this and Somerset, where on two days of the week you are able to cross over and begin the process of integration. What you can pick up from what we are saying is that we are beginning to hear you and the processes are in motion.
The third issue being raised is that a critical ingredient in fighting tuberculosis is the issue of information. People out there need to have positive information about tuberculosis so that we turn around issues of stigmatisation. The second thing you are saying about information is that every citizen needs to recognise the symptoms of TB and particularly symptoms associated with MDR and XDR. How do we promote the information campaign and involve citizens?
And the third kind of information that you are saying that you need, is information to guide you, once in your own lay mind you have identified someone who possibly has TB or MDR or XDR or whatever. What are the procedures? Who do you phone? How do you book someone in? How do you manage someone? How do you manage a defaulter? Who do you call? And I think that is the point that I hear from you that is absent, leaving us disempowered in the fight against TB because we do not have those basic bits of information that will empower us in the fight.
Then, the fourth ingredient which is absolutely indispensable is partnerships - partnerships, non-profit organisations, non-governmental organisations, volunteers on the ground, all health departments in whichever spheres of government. We are going to need all of them to work together, and these are absolutely critical.
The fact that we have someone like Mr Dawood Khan assuming leadership of the Facilities Board here at Brooklyn - and not only the much-publicised sexy easy-money Red Cross Hospital - begins to say that we are achieving something. Because now we have a champion who has helped with the re-development of Red Cross Hospital, who can possibly help us do the same for TB hospitals. So we have got to go and fetch all those people who want easy publicity and so forth, and say: Listen, we need you at this, we need you at that, we need you in the fight against TB, because this is critical.
That means that we have to make TB almost a commodity and sellable to the private sector so that they may know that an investment in TB is not only critical, but so good that the corporate body of their company must be associated with this. That is something very important that we have to do out of this meeting. The fact that we held a Health Imbizo on TB is Government's first deposit.
The pitfalls of partnerships would be if there is an expectation that Government is going to build a whole lot of organisations in different areas and that before the money reaches treatment on the ground, it is going to pay for three salaries, a car, two cell phones and a computer. Government is not in the business of building infrastructure which siphons off a third or half of the money that is needed on the ground.
The point is that partnerships must be based on maximum money reaching the ground. Therefore, other than the staff that we employ, volunteers are going to be very important. And we have got to understand the definition of a volunteer, because volunteers are not staff, but also people who need to put some food in their stomach and need to have some mobility. And that is where the notion of a stipend for volunteers come in.
It is understood that these are people who love their community, who want to do service to their community, who may not at this point need a job or have a job. While they are waiting to get a job or whatever, they can express their love for their community or for a particular cause, in this case TB, through volunteering to be the supervisors and the supporters of the DOTS programme.
Now I am making an undertaking to Minister Uys and to Professor Househam. As the Western Cape, we were given a target of 120 000 expanded public works opportunities, that the Western Cape had to achieve towards the President's score for a million such volunteers for EPWP workers. Before the end of our fourth year, the Western Cape was already on 118 000, meaning that with a year to go we have reached our target.
As a result, the President has allocated 40 000 additional ones from other provinces, which may have not achieved their targets, to the Western Cape. Now everyone is standing in the queue for it. The people building the roads to Gansbaai, they want so much. Bambanani wants so many thousands. Home-based care wants so many thousands. Early childhood development wants so many thousands ? and they are all important.But Minister Uys, I think that if we all understand each other correctly, about what a partnership is and what a volunteer is, then I believe that we should be making a major bid to get that same energy back into communities on the DOTS programmes, on following up on defaulters and so forth. And how do we enrol people in the Winelands onto an EPWP programme like this?
Maybe we should aim at being able. Now we give some training because at the end of it you may become something else in health. But many Bambanani workers just volunteered. Today, when any security company needs to employ people, they come to Bambanani because they recognise discipline, they recognise training and they recognise a willingness to work.
The last thing I want to speak about is the issue of prevention. I have walked the streets with Santa, I have walked the streets with many other organisations. We have gone into shebeens, we have been shown what some of the problems are, we have gone into houses, we have seen what it is and we have agreed absolutely about the prevention issues that we are talking about. Everything depends on living conditions. If I tell you we will sort out the living conditions of people within five years, you have the right to call me a liar because I know it is not going to happen.
We have dramatically increased our budget for housing, doubled it from R500 million to R1,3 billion. At the same time, the population has increased. In five years, the population of the Western Cape shifted from 4,5 million people to 5,2 million people. Only a few of them are rich.
So we are dealing with housing as a moving target. But we have begun to see our determination to start implementing housing standards so that they are not like the apartheid houses that you have seen. There has been a big stand-off between Minister Dyantyi's Department of Housing and Lord Laidlaw, who came with a bit of money to help build houses, but he wanted to build houses that are too small according to our standards.
Many people may think who is this ungrateful Dyantyi who does not want to take the money and build houses? It is because we no longer want to build houses and then the Health Department has to spend the equivalent of what Lord Laidlaw has put in on helping TB cases afterwards.
The point that I am making is that we are beginning to build in housing specifications about sizes. We do not want a house that is less that 40 m2. We have now compromised with Laidlaw to go to 36 m2, based on issues such as ventilation and privacy, proximity of toilet to kitchen and all of those kinds of things. We all know that generations of houses were built with the toilet door opening up right into the kitchen.
In the Western Cape we have attained some of the best figures in the country. More than 90% of our people have water that comes to their house. That was not there seven or eight years ago. More than 90% of the citizens have electricity. We are currently dealing with sanitation programmes in the informal settlements, but we have over 90% sanitation levels. If you cannot build a house for everyone, it does not mean a family should not have access to sanitation, water, electricity and waste removal and such basic services. I think that we are trying to move through all of those things.
I want to end off not only by thanking you for being here and for remaining committed, but I want to say that we need to get that energy back for tuberculosis that we had when in 1995-1996, we declared TB a provincial emergency. Now we are not going to use such dramatic language any longer. But the fact of the matter is, we need to get people back on the radio speaking about TB. We remember how we took over parks, how we took over District Six on World TB Day. Everyone knew it was World TB Day because the volunteers and the organisations were together and we were out there.
If we do the kinds of things we are claiming to be doing again, then I think we can make TB take its rightful place in the consciousness of our people in the Western Cape. I want to say to you: I believe that our department led by Minister Uys is ready for that challenge, otherwise we would not have stuck out our necks today with a TB imbizo.
I hope that all the organisations are ready for it on the basis of what I have said and I am hoping that as we go towards World TB Day and so forth, we will be able to regain that energy, that movement and you will be able to feel some of the impact of the funding streams that are moving on, some of the commitments and some the private sector involvement which I think we should be eliciting.
Thank you very much, Minister Uys, for being brave enough to convene the TB community, and hopefully to re-energise it. We may have far more common ground than differences amongst us and I think all we need to do is to harness this energy. I am very happy that the HIV lobby understands that we need to work together on both HIV and Aids. I think this is the powerful partnership that has eluded us for a long time.
Thank you very much and enjoy the rest of the day.
