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Congress  |  COSATU Speeches

Speech of COSATU General Secretary, Zwelinzima Vavi, to the DENOSA KZN Congress,

1st August 2014

Comrades of DENOSA Kwa Zulu Natal, I am so very privileged to be here today in your presence. There is nothing more inspiring than a meeting of worker representatives who have come together determined to reach agreement on how to make a difference not only to the lives of the workers that they represent, but also to the lives of the people that they serve.

DENOSA has a proud record of being a focused trade union that serves its members well. But it also has a proud record of advancing the needs of the patient. DENOSA recognises the relationship between wages and working conditions and health service delivery. One side should never be neglected in favour of the other. Your union is a real role model in this, and has a lot to offer by way of example to other public sector unions.

It is not revolutionary to provide inferior service to other workers and the poor who rely on government services whilst providing best care when moonlighting in the private clinics and hospitals. It is not revolutionary to be anti-authority and create lawlessness that can only mean collapse of standards in public hospitals, for we all know this opens up workers to ideologically inspired assaults on the public services in favour of the private sector that marginalises the have-nots.

I am a very big fan of DENOSA precisely because you insist on professionalism, within an understanding that nursing is a calling not just ordinary work. There is no contradiction at all in being a revolutionary and at the same time being a professional. I was one of the student leaders who insisted that members of COSAS must distinguish themselves from others through conduct that wins society over instead of alienating the organisation from the society.

So in your context we insist that your conduct, humanity and professionalism in the wards should win members of society over to DENOSA so that when you campaign for improved infrastructure and conditions of employment that society throw its weight and support you.

In Kwa Zulu Natal you know the importance of linking the struggle for better wages and working conditions with the struggle for improved health care services.

You set an example by campaigning against the closing of McCord Hospital in Durban and must be congratulated for being instrumental in the victory that was won when the Province agreed to take over the hospital and keep its doors open in October last year. You are not wasting your time on theoretical talk and petty squabbles. You are not jumping to label everyone who is critical or who holds a different opinion as a reactionary or part of the "anti-majoritarian offensive". You work with and amongst those sharing your concerns about the need to invest in health infrastructure, quality training for nurses, and in quality service at the point of delivery. You are walking the walk. You must be commended for that.

Your national Positive Practice Environments campaign, which pulls together all these interests, and which you are rolling out jointly with SAMA, is an example to us all. Not only are you a role model in the manner in which you are taking up health service delivery, but also in the manner in which you are advancing co-operation between COSATU affiliates. The PPE campaign is surely a shining example to us all.

DENOSA stands at the centre of so many critical concerns facing our people. Many of these concerns you have already identified in your national PPE campaign. I would like to spend a little time elaborating on these concerns and making the link between your work in DENOSA and what we should be doing as a Federation to strengthen and broaden your own work on these issues.

The first big health sector challenge that confronts us all is ongoing health inequality or what we call the two-tier health system. The public health system currently serves 43.8 million people, while the private health system services only 8.5 million. And yet, when you take into account tax rebates and other sources of state funds that go into the private health system, we are actually putting MORE state money into the private health system than into the public health system!

This is unbelievable! Given that the overwhelming majority of private health care users are white, and that the overwhelming majority of public health care users are black, this is a new form of apartheid. And the inequalities go deeper, into a divide between urban and rural areas, even within the public healthcare system. Our rural areas across the country are currently only getting 35 new graduate doctors per year.

This is what we call maintenance of apartheid but now based on affordability or economic status instead of race as before. But we know that, based on the impact of 300 years of colonialism of a special type, the main victims of the economic apartheid will be those who were on the receiving end of apartheid - blacks in general and Africans in particular together with other vulnerable groups in society - the women.

The inequality in our health care system is why the introduction of a National Health Insurance system is so critical. We are still waiting for the details of the NHI, including proposals on the funding model, but we have already observed how the private sector is trying to muscle in on the NHI in a way that will take the guts out of the concept for their own selfish greed for profit.

We have to resist this at all cost. We have to do everything to preserve the integrity of a scheme that is supposed to bring equality to the health system. It is essential that when the detailed proposals are finally tabled, COSATU responds decisively with comments and proposals that ensure redress of the inequalities in the system.

We will need DENOSA to play a very active part in formulating the Federation’s response. But we cannot wait for the proposals to be tabled. We must engage publicly now to defend the concept of an NHI that is based on good public health care. We hope that DENOSA is actively involved in the three pilot sites in KZN – uMgungundlovu, Amajuba and uMzinyathi. I want to urge you to ensure that you ask your members in these sites about their observations. Their experience must feed into the Federation’s ongoing engagement and defence of NHI. If there are challenges, then we must all know about them.

The inequality in the health care system is also the reason why the Competition Commission’s current market inquiry private healthcare is important. Again, we will need the active participation of DENOSA in the formulation of a COSATU input on the matter. It cannot be correct that the private health system continues to charge exorbitant prices and reap profits such as Netcare’s 25% profit rate in 2013.

Related to this is the problem of patenting, which works to keep the prices of medicines high. We are generally weak in supporting transformative interventions such as inquiries. By now we should have conducted a campaign to get countless examples where our people have been taken advantage of and ripped off, with the sole intention of profit maximization instead of providing health care as our constitutional right.

COSATU in June established a Health Policy Committee to take up amongst others, the issues of NHI, the Competition Commission Inquiry into pricing and the issue of patenting of medicines. We hope that DENOSA will not only play an active role in the Health Committee, but that it will take the discussions into its structures to ensure that Provinces have a direct involvement, and are ready to mobilise for action when necessary.

What are some of the other health policy and implementation challenges that we need to work on, both within DENOSA and across the Federation?

While we have seen significant slowing down of HIV infection rates, the opposite is true for tuberculosis. The incidence of TB in South Africa has increased by a staggering 400% in fifteen years. It is now the leading cause of death in the country. This is scary, because along with an overall increase in ordinary TB rates, we are facing the devastating threat of a rapidly increasing rate of drug resistant TB. This is alarming because the current treatment for DR TB is not only very, very expensive, but the chances of cure are as low as 20%.

The hotspots for DR TB are our prisons, our mines and our hospitals. This means that nurses are seriously at risk. Of course you know this because you see it in your daily work. And DENOSA must be commended for taking the issue up through a project to train nurse educators on MD TB. But we are not educating our membership across the Federation. We need your help to do so! We need to step up our long standing campaigns and education work on HIV to incorporate the issue of TB.

And while we focus our attention on TB, we must remain vigilant in our continued focus on HIV and AIDS. While KZN has made a dramatic difference to mother to child transmission, with the rate now lower than 3%, infection rates amongst pregnant women remain unacceptably high. In Ugu district as many as 44% of all pregnant women are HIV infected, and in eThekwini the rate is 40%. We are not making enough impact on reducing rates of infection. DENOSA has a critical role to play – including amongst fellow COSATU members.

Another area where DENOSA could play a significant role in raising awareness across the Federation is cervical cancer and breast cancer. 6000 women a year contract cervical cancer in South Africa and half of those do not survive. We welcome the Health Minister’s intervention to introduce HPV vaccinations to young girls to help prevent cervical cancer. But many parents, including those who are members across COSATU’s unions, are ignorant of the importance of this vaccination. We need to raise the awareness of all COSATU members, but in particular our women members.

The COSATU Health Committee and our gender structures would be a very good place for DENOSA to motivate this. The challenge of breast cancer is just as huge – with one in 33 women in this country contracting breast cancer at some point in their lives. We have to radically step up our rates of screening and treatment of both cervical and breast cancer.

As nurses you also deal on daily basis with the effects of non communicable diseases, including the so-called lifestyle diseases. You deal with the results of high alcohol consumption, of smoking, of a high salt diet and so on. The consequences are rampant diabetes and heart and lung diseases. Hundreds of thousands of members across the Federation are privately battling with these non communicable diseases, and yet we never ever talk about them!

We do not have education and awareness-raising in place. We do nothing to help our members overcome these diseases. In fact we make things worse for many of our members when we provide unhealthy meals in our meetings! You as nurses in DENOSA have a role to play in lifting us out of our complacency in the Federation and forcing us to bring information to our people.

We still have a shockingly low life expectancy of 59.6 years in this country, and an infant mortality rate of 47 per 1000 before the age of 5. The statistics for KZN are even lower than this. We often forget that for a nation to be healthy and to live long, it takes more than treatment in the health system. We will remain a nation of the unwell and dying as long as poverty persists.

How can it be that diarrhoea, a totally preventable and treatable conditions remains the biggest killer of children under the age of 5? Lack of access to clean water is the primary cause. And how can it be that the second biggest killer of young children is treatable pneumonia – with 8 out of the ten worst hotspots in the country being in KZN? Ugu has the very worst incidence of death of under fives due to pneumonia.

It is absolutely unacceptable that 13 million people go to bed hungry every night in this country, and that a further 14.8 million are at risk of hunger. Malnutrition is actually expanding, resulting in stunted growth, blindness, incomplete mental development, and other health problems. In uMungundlovu you have the second highest rate of severe malnutrition amongst children in the country. So the problem is right at your front door.

How can this be in a land where there is more than enough food produced and imported to feed the whole nation? It means that the wealthiest segments of our population are eating in excess and wasting vast quantities of food. So we see that poverty’s twin – inequality – is also to blame. The problem of food poverty is not just about quantity of food, it is also about dietary diversity.

The notion that poor people should survive on a starch-loaded diet needs to be challenged head-on. We need a campaign against food poverty – a campaign that promotes the right to access to affordable food that is both fresh and diverse. Such a campaign will bring us up against the food giants who keep prices high through price collusion. The case of the bread producers is only the tip of the iceberg.

So you can see that as nurses, you are right at the centre of our core demand for an end to poverty, inequality and unemployment. We need you to play a leading role in our campaign for a REAL radical economic transformation. You need an independent and militant fighting COSATU to engineer what we have called our Lula moment working together with organs of people`s power under the leadership of a transformed alliance. You need a transformed alliance not the one which only comes to life on the eve of elections. That`s why you have joined a call that a Special National Congress of COSATU be convened to take forward our 11th National Congress resolutions and to put an end the current paralysis.

I would also like to throw out an organisational challenge to you. There are over 70,000 community health care workers in this country who live on inadequate stipends and who suffer appalling working conditions. They live in a twilight world of vulnerability, at the same time as providing a critical support service in the health system. They are largely invisible and unorganised. Should DENOSA not be seriously considering organising these workers? Or at least encouraging and guiding them to organise themselves?

Last month COSATU has launched a national campaign to organise vulnerable workers. I want to seriously challenge you to think about reaching out to community health care workers or health counsellors as some of them seem to be called in KZN, as a highly exploited group of vulnerable workers. I am aware of an inter-union initiative lead by PAWUSA in KZN to address the needs of health counsellors. I hope very much that DENOSA is actively involved in this initiative.

Comrades and friends, keep on growing the good work that you are doing as a union. And all the best to you in your Congress deliberations