Build a Working Class-Driven Momentum for a Quality Public Health System - With and For the Workers and the Poor
By: Blade Nzimande 20 September 2002
Introduction
The SACP is honoured by the invitation to come and address your 6th National Congress. This Congress comes at a very important moment in the national democratic revolution in our country, as well as in the midst of challenging working class struggles. It takes place just over a month after the 11th Congress of the SACP, and a few months before the ANC's 51st National Conference in December. We therefore hope that you will use your Congress to reflect on some of the key developments in the wake of the SACP's Congress, and also reflect on some of its resolutions. It is important, too, that you use this Congress to prepare your organisation to engage in the run-up to the ANC's Conference.
Your Congress also takes place at a time when we are battling to find one another within the Alliance on the issue of restructuring of state assets and privatisation. Given your own experiences of outsourcing in hospitals and the encroachment of private health into the fabric of our health system, you have a lot to say about this matter. This matter is also fundamental to the question of the struggle for a quality public health system in our country. You need to reflect seriously on the question of privatisation from the standpoint of your own experiences, and seek to contribute towards strengthening the working class in dealing with this matter.
Defeat the anti-working class offensive
Your Congress also takes place in the midst of what appears to be a concerted offensive against some of the leading working class formations, particularly some of the bigger unions of COSATU. There seems to be a concerted attack being directed at COSATU's biggest unions - SADTU, NUM, SATAWU and NEHAWU. The aim of this offensive is to weaken some of our prime worker formations, thereby weakening COSATU and ultimately the working class struggles as a whole. It is absolutely important that we defeat this offensive against the working class irrespective of its source and manifestation.
This is a matter that we will all have to seriously reflect on, without being conspiratorial. Your Congress thus comes at a time when there is an even more pressing imperative for the working class and all its formations to close ranks and unite. In this context it is important that we seek to accelerate a broad unity of health workers in general and nurses unions in particular. I hope your Congress will reflect on this urgent matter, as part of forging broader unity of the trade union movement and the working class.
But it is not enough to just close ranks, we need also to keep the working class mobilised and help it to strengthen itself politically, ideologically and organisationally in order to ensure that it is capable of stamping its authority and leadership over the national democratic revolution. Without a strong and politically conscious working class, our revolution will flounder. We need to remind ourselves that the historic mission of South Africa's working class is that of leading the national democratic revolution to its logical conclusion, the building of a socialist South Africa.
It is partly in the light of the above context and issues that our input today will focus on the following issues:
1. The political significance of the SACP's 11th Congress
The 11th SACP Congress, with 844 voting delegates from 337 branches around the country, was the largest Congress the Communist Party has held in its 81-year history. The Congress marked a significant moment in the Party's development, and it had an important political impact on our country. Despite very concerted attempts by sections of the media and other forces opposed to our vision and commitment to socialism to derail and distract Congress, it was a huge success and an important platform for further consolidation of working class and socialist perspectives and programmes.
The strategic slogan of the Congress was: "With and for the workers and the poor!" The message was clear - eight years into our new democratic dispensation, we have notched up enormous gains. However, our country remains on an accumulation path that is, fundamentally, unfavourable to workers and the poor:
The 11th Congress sent out a very clear message. The SACP, working very closely with its alliance partners (the ANC, COSATU, and the broad mass democratic movement) is determined to ensure that the aspirations, concerns, and perspectives of workers and the broader urban and rural poor become the dominant voice in our country. These are the core motive forces of our national democratic revolution. The SACP will do everything to ensure that these motive forces are not de-mobilised, displaced, or replaced. The workers and the poor are the bedrock of our struggle. Your Congress, its resolutions and programmes must further contribute to placing the working class firmly as the leading motive force of our revolution.
The success and confidence of the 11th Congress reflect many realities. The strategic slogan first advanced in 1995 - "Socialism is the future, build it now!" has, over the past 7 years, acquired greater substance and meaning. It has enabled us to engage actively and confidently on the terrain of the NDR as socialists. This should be the overall guiding programmatic slogan for the working class as a whole, and our own individual programmes and campaigns must be located within this framework. For instance, the struggle for a quality public health system must be pursued as part of the overall struggle to build elements and capacity for socialist education.
Since the Party's 1998 Congress, the SACP has, in its own right, more confidently led a series of campaigns and struggles, particularly around co-operatives and for the transformation and diversification of the financial sector. The 11th Congress provided an important forum in which to assess these struggles.
The 11th Congress re-affirmed, with greater emphasis, the SACP's conviction that the NDR itself requires the active propagation of socialist perspectives. In short, the 11th Congress was a moment in the Party's history in which we began to assert more positively and more consistently who we ARE. We deliberately avoided defining ourselves by what we are not, or through reacting to agendas of other class forces, outside of our socialist perspectives and goals.
The 11th Congress resolved that local governance and local economic development would become the "centre of gravity" for our Party in the years ahead. We will ensure that our growth and development strategy perspectives are implemented at this level. We will focus on local governance transformation through strengthening the delivery capacity of our municipalities by building people's power (community policing fora, ward committees, school governing bodies, strong party branches and districts, etc). We aim to achieve this by accelerating the elaboration and implementation of integrated development plans (IDPs), guided by our developmental perspectives of local economic development, industrial policies, mobilisation of domestic resources, and building people's power.
Our Congress resolution to focus on local governance also crucially includes the building of health committees and forums in the localities. This would include the very important task of building health brigades in the locality, which amongst other things need to focus on dealing with the HIV/AIDS pandemic. This is a very important area around which we can have joint concrete programmes with a union like SADNU.
The 11th Congress also adopted an important resolution on the re-establishment of a Young Communist League. In part, this responds to a powerful popular demand from thousands of young people. Young workers, young health workers, high school students, students in tertiary institutions and many others yearn for a socialist organisational home. Many young people are disgusted by the selfish dog-eats-dog, made-in-the-USA culture that proliferates in our country. The Congress has outlined concrete practical steps that must be taken to ensure that a YCL is launched by mid-2003. The socialist energies and aspirations of thousands of young South Africans, drawn from a generation that is carrying the burden of unemployment, the African underdevelopment crisis, and the HIV/AIDS pandemic, will become a critical factor in the unfolding NDR.
The 11th Congress of the SACP sent a powerful message to our country. The SACP Congress affirmed the finest traditions of our liberation movement - our commitment to non-racialism, our selfless positioning in the trench of the most marginalised, our preparedness to speak up critically and constructively. It was a message that even the liberal media could not fail to notice. The national prestige of the SACP has had to be acknowledged once more, even by our ideological opponents. In the coming months and years, the SACP and its cadres will take up the strategic perspectives, the programmes of action, and the resolutions of the 11th Congress…With and for - the workers and the poor!
2. The financial sector campaign and the 2002 Red October Campaign
The holding of the financial sector summit in NEDLAC on 20 August 2002, and the agreements reached therein, marked one of the most historic and significant gains for the workers and the poor of our country. Through the SACP-led campaign for the transformation and diversification of the financial sector, far-reaching agreements were concluded. This is indeed a major victory for the SACP and validates our line that building people's power through mass mobilisation - underpinned by democratic state power - is our most crucial weapon in deepening and consolidating the national democratic revolution.
Our campaign was launched as part of our year 2000 focus on the mobilisation of our people towards poverty eradication. Through this campaign, we were practically and concretely seeking to challenge the neo-liberal notion and orthodoxy that economic growth and development in our country will come mainly through adopting measures of liberalisation and privatisation in order to attract foreign direct investment. At the same time, we understood that without the mass mobilisation of our people, there could be no change from the dominant apartheid capitalist system and its financial institutions towards addressing the needs of the overwhelming majority of our people.
During our campaign, we had demanded and, at the NEDLAC Summit, got agreement on legislation and a policy framework for co-operative banks and other types of micro-credit, financial co-operatives. The building of co-operative banks came to be the major demand from our people. Related to this was an agreement on major banks working towards universal access to banking services for the poor, particularly the rural masses and those who receive old-age pensions. We will indeed continue to struggle for these services to be immediately made available and extended to all those who receive state grants, including child and disability grants.
Agreement on urgent steps towards the regulation of micro-lending and loan sharks is one of the most important achievements of our campaign, as well as an agreement on the regulation of the credit bureaux. These agreements form part of forging a developmental and affordable credit regime in our country. A commitment to exploring automatic insurance cover of up to a bond amount of R150 000 for all, including those of our people who are HIV-positive, is indeed a path-breaking achievement. This will go a long way towards ensuring AIDS orphans have a roof over their heads and towards ending unfair discrimination against the HIV-positive.
As SADNU, you have a very important role to play in taking forward this campaign. The trade union movement in our country needs to embark on massive mobilisation to control how, where and by whom your pension and provident funds are invested. What role are these funds playing in job creation and confronting the legacy of apartheid? We cannot leave these matters to asset managers alone. The owners of these funds, the workers, should guide these managers.
Red October campaign
The SACP has an annual Red October campaign to mobilise around specific issues within our programme of action. This year, our Red October campaign will focus on the need to develop a comprehensive social security system, as part of engaging and mobilising around the very debates that are taking place in government about this matter. This campaign is located within our struggles for poverty eradication.
To this end, our 2002 Red October campaign will, amongst other things, focus on the following:
Your union has a very important role to play in this campaign, which also coincides with an intensified focus by the Department of Social Development to speed up the registration of those who qualify for state grants but are currently outside the system. It is important that as part of this Red October campaign SADNU mobilises its members to ensure that applications for medical check ups for the disabled are promptly processed in order to facilitate receipt of the necessary state grants by those of our people who qualify. All indications currently point to serious inadequacies in our public health system to promptly deal with these examinations. SADNU needs to take this up together with government and the SACP to deal with this matter.
Another crucial issue that we, together with SADNU, need to take up is that of general access to health care by the majority of our people. In our Red October campaign we regard the establishment of a national health insurance scheme as a critical component of the provision of comprehensive social security and access to health care by working people and the poor. Let us together take up this issue energetically.
For instance two-thirds of our country's health resources are in the hands of private medical aid schemes. This private medical aid industry is serving less than 7 million people, of whom less than 9% are Africans. This is a reflection of not only the location of the bulk of health resources in the private sector, but a highly skewed distribution of health resources, excluding the overwhelming majority of our people. This is in fact scandalous and a national disgrace. Even worse in a situation of high levels of poverty and the HIV/AIDS pandemic - two challenges that require the maximum possible mobilisation and availability of health facilities and resources for the majority of our people. We need to embark on a massive campaign for the transformation of the very medical aid schemes such that they are harnessed to serve a broader public health purpose.
We urge SADNU to mobilise in support of this campaign, using the fact that you are health workers and therefore strategically located to make a difference through the mobilisation of your members in particular and health workers in general.
2. Defeating the HIV/AIDS Pandemic
The impact of the HIV/AIDS pandemic in our country and on the continent is already devastating; that millions of people will suffer poor health. There are indications that the death rate in our country is rising and that our Human Development Index is declining. Women face an increased burden of care and support and are most vulnerable to HIV infection as a result of patriarchal practices and attitutdes in society.
A fundamental challenge in arresting this pandemic is to bring down the rate of new infections by a mass campaign and public education promoting awareness about the imperative to change behaviour. The success of such a campaign is inextricably linked to the struggle for human development, including a radical improvement in literacy, housing provision, a strong and effective public health system and employment. Such an effective prevention campaign needs to be complemented by an appropriate treatment programme that can extend the lives and improve the quality of life of persons living with HIV/AIDS and give hope to millions of infected and affected people.
Importantly, the private sector in South Africa is manifestly failing to contribute effectively to combating this pandemic. There are resources available in the private sector that can be mobilised to fight this pandemic. Private appropriation of knowledge in the form of patent and intellectual property rights can be a barrier to making available affordable medicines
Therefore we need to strengthen and intensifying our collective contribution to the fight against HIV/AIDS, including by:
3. The challenge of building a quality public health system
One of the key challenges facing our country at the moment is that of building a quality public health system that is able to comprehensively respond to the health needs of the overwhelming majority of our people. This is a critical component of the overall struggle for poverty eradication. There can be no poverty eradication whilst millions of our people currently do not have access to health facilities.
Indeed our democratic government has laid a foundation for a comprehensive health care system to respond to this challenge. Clinics and other primary health care centres have been built to cater for millions of our people, including in the rural areas. Government also introduced a school feeding scheme, which goes a long way in combating malnutrition amongst children, despite enormous problems, obstacles, and corruption that we still face in the delivery of this programme.
However, during the ANC's Letsema campaign focus month on health in April this year, the SACP launched the Chris Hani Health Trail to visit hospitals and other health care centres. We had named it after Chris guided by one of his famous sayings that "Socialism is not about big concepts. It is about safe drinking water, health care and a life of dignity". This health trail was in many respects an eye opener to us. We found that fundamentally our public health system is in dire straits. There is an increase in tuberculosis caseload and mortality, an increase in HIV/AIDS cases, lack of adequately trained health workers, staff shortages, problematic attitudes amongst some of the health workers and generally the incapacity of the system to respond to the health needs of our people.
For the SACP the challenge of building a quality public health system is the single most important challenge and campaign that a union like SADNU needs to take up. This is a multi-faceted challenge, and I will only highlight some of the key challenges in this regard.
The first and foremost campaign that you need to take up in this regard is to assert that health is a right and not only a privilege for the minority that has access to medical aid. This is important in that socio-economic rights, like health, only tend to be relegated to the private sphere, which inevitably, given our capitalist economy becomes a right enjoyed only by the few. We need to mobilise for adequate financial and human resources to be allocated to the health sector.
Secondly, we need to develop hospitals that are able to comprehensively respond to the health challenge in our country. This means amongst other things that we address the serious staff shortages in our hospitals. From the Chris Hani Health Trail it is clear to the SACP that there can be no talk of downsizing the public service generally, particularly in the health sector. Instead we need more health workers if we are to adequately respond to this challenge.
Related to the need for more health workers we need to address the impending crisis in shortages of qualified nursing staff. The emigration of nurses and their taking up of employment in places like the UK and the Arab world is a matter that requires serious attention. We are in fact losing some of the best trained and skilled nurses - like senior nurses, theatre and ICU nurses, whose experience take a very long time to replace. This calls for a comprehensive strategy including urgent review of the conditions of service and remuneration for particularly skilled nursing personnel.
But for us to realise the goal of comprehensive hospitals requires that we challenge the practice and scale of outsourcing that we are seeing in our hospitals. Frankly there can be no comprehensive hospitals that outsource practically everything that seems unconnected to the immediate medical functions - eg cleaning, laundry, cooking, etc. We cannot have a handle over our health institutions when some of their critical functions are controlled by the private sector, whose goal is not to see clean and hygienic hospitals, but profit, profit and profit. Let us take up this campaign against outsourcing as a critical component of building a quality public health system and against privatisation.
Thirdly, we need to intensify our campaign in cheaper medicines and drugs by challenging multinational pharmaceutical companies. The passage of the Medicines Control Act and our subsequent victory in court against the pharmaceutical companies is a victory that we must build upon to struggle for cheaper medicines and drugs. Related to this struggle is that of fighting for our right to manufacture, produce and import cheaper generic drugs as part of challenging the highly monopolistic patent regime that is holding the health rights of our people at ransom. SADNU needs to throw its weight behind, and even for that matter lead, this struggle.
Fourthly, the establishment of a community service for doctors is a very progressive stance by our government and it should be strengthened. But given the fact that the challenge of health care is essentially a challenge of poverty eradication and extension of basic services to our people, serious consideration should be given to extending community service to all graduates, not just in the health sector, with a particular deployment in the rural areas as part of the overall offensive against poverty. We need newly qualified water engineers to do community service to enhance sanitation, commerce graduates to assist in building co-operatives, social science graduates to attend to the various social needs of our people. Let SADNU debate this matter as part of a comprehensive response to the health needs of the nation.
Lastly, but not the least we need to be hard on ourselves as health workers. We need to promote the highest levels of dedication and service to our people. In short we need hard work. We need to fight against the laxity that we still see amongst our health workers and nurses. We need to challenge those who are making a bad name for your profession by ill-treating the sick and the elderly in our institutions. Let SADNU embark on a campaign to treat patients with dignity, to stop shouting at our sick people in queues. This is a critical component of building a quality public health system. We can only defeat the privatisation of health if we prove in our daily work that the public sector can deliver better than the private sector. Indeed we must embark on this struggle as we simultaneously embark on the struggle for better resource allocation by government including the employment of more health workers.
We would also like to take this opportunity to call upon SADNU to take up the question of solidarity with the Palestinian people. The struggle for Palestinian independence has now reached a stage where unless international solidarity is deepened there might be some serious roll-backs. In Sharon and Israel we are dealing a brutal apartheid and racist regime whose actions needs to be challenged by all revolutionaries and democrats throughout the world. It is important that SADNU can start linking up with Palestinian health workers and nurses as the first step towards concrete solidarity with this oppressed people. We also need to highlight the extent to which the Israeli regime, backed by the US government, is destroying the health facilities and means of livelihood of the Palestinian people.
Your Congress will be a success only if it can take concrete resolutions and emerge with a concrete plan of action around these issues. Our unions should not only deal with collective bargaining matters - fundamental as these are to any union - but should also take up concrete socio-economic campaigns. We need to mobilise workers on a sustained basis around socio-economic campaigns in the sectors in which we operate. We can build a strong COSATU only in so far as its affiliates are strong and also are embarking on a sustained basis on socio-economic and political campaigns. Your campaign is that of building a quality public health system! It is through such campaigns that the working class will come to lead society and be the driving force of our Alliance and the revolution as a whole.
4. Building a strong trade union movement and the Alliance
The question of strengthening trade unions as a systematic focus has once more become even more urgent. As I pointed out at the beginning the unity of health workers - mental and manual workers - is a critical challenge. The SACP hereby commits itself to work with SADNU around key concrete campaigns, including joint political education. It is important that we intensify political education programme among workers in order to ensure that unions are strong and understand their role within the broader context of the challenges of NDR and the struggle for socialism. Let us concretely work towards a joint programme in this regard.
Such work is also important in order to ensure that our Alliance as a whole is strengthened. The political centre of gravity of the Alliance is the working class. It is the only class that has the muscle, organisational power and revolutionary traditions to carry the national democratic revolution to its conclusion - the true emancipation of black people, women and the working class - socialism.