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Media Centre  |  COSATU Speeches

Speech of Zwelinzima Vavi, to the DENOSA National Congress

30 October 2014

Comrades of DENOSA, I bring you revolutionary greetings from the COSATU NOBs and indeed the entire membership of the Federation. I am extremely honoured by your invitation to address this august and historic congress of your union.
You are meeting at the time when our movement in general and our federation in particular is facing challenges like nothing it has faced before in its 29 year history. Those of us in leadership are extremely exhausted and frankly stressed by the palace politics and boardroom shenanigans that that have sidelined the interests of the general membership. As a result of this unending leadership war, the Federation has never been this weak and so paralysed. The risk we face is that our movement becomes irrelevant to a growing number of workers, and particularly irrelevant to young workers who have no historic attachment to the federation and will judge its relevance only in terms of the problems they face as workers and citizens today.

This is the reason why I am so happy to be amongst you today in a gathering where for a change we can speak about our real challenges as workers. I am happy to be amongst you, the nurses who occupy such a strategic layer of professionals in our struggle to build a better life for all. 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.
In the run up to this congress I have addressed your provincial congresses in the Eastern Cape and KwaZulu Natal. We want to elaborate and emphasize key points we made in these two provinces.

Our central message is this:- DENOSA is an organisation of nurses. It calls itself the Democratic Nurses Organisation of South Africa. The name reflects the character of your organisation. We want you to retain that character not rhetorically but as revolutionary practice that is felt by members in every health institution and every meeting of the union, including this very congress. We want you to remain a union that advocates revolutionary transformation – that teaches its members that whilst they join the union to protect their interests at each workplace, ours is also an agenda to transform all the colonial and apartheid vestiges that still sit with our society, and to replace them with a new agenda centred on the needs of our people. In your case these needs of the people are for a country that has a health system that provides service to all irrespective of their colour, financial or class status, gender or creed.

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. To date you have struck the correct balance between fiercely fighting for better wages and working conditions and the need for improved delivery of health services. Your union is a real role model in maintaining this balance, and has a lot to offer by way of example to other public sector unions.
Revolutionary trade unionists deliberately seek to win over ordinary masses to the cause of the revolution. They do not through their actions alienate the public from the unions. Our task is to multiply revolutionaries not only amongst our members but amongst those we treat through our professional work in the wards and clinics in both the public and private sectors. In doing this we should promote the centrality of the state in delivering decent health care, and not act in ways that further open up the country to private market oriented solutions to our health care challenges.

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. We see no contradiction between being revolutionary and being a professional at the same time. Being a revolutionary is to treat our people with dignity, is to be humane, is to care sincerely, is to make our people comfortable as they face whatever pain, is to make them feel cared and loved and it is to make them confident about the future of the country. Being professional is exactly the same things.

We have to teach these values in particular to the younger generation. We also need to avoid passing on our own mistakes. Most of us together with our fore fathers and mothers were born in the struggle against the apartheid authorities. Defiance of authority became engrained in us and a we have often applied this defiance inappropriately. We know of many examples where our people are humiliated and belittled by public servants. The task of a COSATU nurses union must be to protect health workers from abuse (including at times from their very patients) but also to protect patients from abuse and to advocate humane health care.

A revolutionary trade union also extends its hand to others outside of the trade union movement who are struggling for a better life for all. We wish to commend you for actively putting into practice COSATU’s policy of building alliances with civil society organisations by acting together with organisations such as the Health Crisis Coalition in the Eastern Cape, the TAC, and Section 27.
You have set an example by taking up such critical but practical matters such as the collapsed ambulance services. 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 collapsing public health care and the need to invest in its infrastructure. You are walking the walk. You must be commended for that.

We have also observed how you are walking the walk in your national Positive Practice Environments campaign, which you are rolling out jointly with SAMA. So 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.
Many of the issues and concerns that you have been taking up are ones that we should be taking up more broadly as a Federation.

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 are those who were on the receiving end of apartheid – black people in general and black women in particular.

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.

The inequality in the health care system is also the reason why the Competition Commission’s market inquiry private healthcare is important. 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. We eagerly await the report of the Competition Commission, and hope that action will be taken to control prices.
Related to this is the problem of patenting, which works to keep the prices of medicines high. How can it be that there is no generic alternative to the R12,000 a month drug called linezolid produced and patented by Pfizer for the effective treatment of XDR-TB? How can it be that the drug entecavir which has been developed for the treatment of Hepatatis B costs R4700 per month in South Africa? There is no generic alternative and so only 8 patients in the whole country currently have access to it, despite the fact that Hepatitis B is such a big killer.

Government is currently developing a new patent policy which we all hope will result in a sharp increase in the availability of affordable generic drugs. But the pharmaceutical companies are lobbying hard to ensure that our patent policy remains as it is and that their profits are protected. By now we should have a Federation wide campaign to counter their influence. The high price of medicines is not only bad for the individual citizen and consumer of health services, but it is bad for our economy as a whole. The high cost of medicines is the 5th biggest driver of our trade deficit. Why are we not marching in large numbers to put pressure on the DTI while it develops its policy on patenting?

COSATU established a Health Policy Committee in June this year to take up amongst others, the issues of NHI, the Competition Commission Inquiry into pricing and the issue of patenting of medicines. However the discussions in the committee have not yet gained traction across the Federation, largely because of our state of paralysis. The Central Executive Committee, comprising the leadership of all our affiliates, has not entertained any of the issues reported to it by the Committee.
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 a significant slowing down of HIV infection rates, the opposite is true for tuberculosis. As you will have witnessed in your work, 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 DRTB is not only very very expensive, but the chances of cure are as low as 20%.

The hotspots for DRTB 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 DRTB. 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.

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, so that they feel comfortable to give consent for their children to be vaccinated.

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.
The issue of medicine stock-outs in our public hospitals and clinics is also of major concern. Just last month the Soweto Mofolo Clinic on our doorstep in Gauteng experienced a stock-out of nevirapine, the drug critical for defending babies born to HIV positive mothers against HIV infection. And yet our presence in the TAC lead campaign against stock-outs has been negligible.

Talking about TAC we are saddened by the news that this Organisation that has played such a historic role in the battle against denialism, for treatment of those infected and in broader education on health issues may be forced to close its doors due to drying up of funding. We join all those calling on previous and potential funders to assist the TAC so that it can not at this critical moment scale down or worst close down its doors.

Going back to our message, we should also be making a national noise about the skewed allocation of resources within the health care system. While we have a high vacancy rate in key positions such as district pharmacists, the ranks of management are being excessively swelled. A recent study conducted by the Foundation for Professional Development found an example of one municipal HIV unit where 94% of the entire budget goes to management salaries! This cannot be right. How can a service be delivered by non-existent or underpaid front-line staff, especially nurses?

As nurses you also deal on daily basis with the effects of non communicable diseases, including the so-called lifestyle diseases. In the words of the Heart Foundation “South Africans eat too much, drink too much, and don’t move enough”! We have moved away from a traditional diet to one of excessive salts, fats, sugar and refined grains. As nurses you deal with the results of high alcohol consumption, of smoking, of a high salt diet, obesity 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. 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.

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. Our people are coping by skipping meals, cutting the size of meals and reducing the variety of foods eaten. Malnutrition is actually expanding, resulting in stunted growth, blindness, incomplete mental development, and other health problems.

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. A report on hunger in South Africa published by Oxfam this month shows that an unbelievable 30% of all agricultural produce is wasted every year. This amounts to 9 million tons of food every year! 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.
Hunger is not only hitting the unemployed, it is also hitting many workers whose wages are so low that they cannot afford to adequately feed their families. This is why our campaign for a National Minimum Wage set at a decent level is so critical. The hunger question also talks to issues of access to water and access to land.

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?
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, working together with organs of people`s power to bring about real change.
That is why you joined the call for a Special National Congress of COSATU to be convened to take forward our 11th National Congress resolutions and to put an end the current paralysis, wherein COSATU’s Central Executive Committee is not using its time and efforts to strategise on a comprehensive campaign challenge to poverty and hunger and related policy issues. You have supported a call to put the future of the Federation in the hands of its owners – the membership.

You have built a powerful and influential union in DENOSA. You have kept it free of corruption and have prevented it from becoming a stepping stone for political ambition. Just as you need a militant, independent and accountable COSATU, you will continue to need a militant, independent and accountable union. I urge you to guard and enhance your good tradition of internal democracy, transparency and accountability. Make sure that you continue to train your shop stewards, to communicate with your members, and to service them well. Work hard to ensure that in your general meetings and all meetings of union structures you keep open the space for critical debate and discussion.

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