Health department director general Dr Olive Shisana has reaffirmed her Department's commitment to prioritise primary health care in the allocation of the country's health resources.
Shisana told a special session of NEDLAC's Executive Council late last year that her department was committed to lead the development of an effective national health system and to promote and monitor the health of all South Africans.
The NEDLAC executive formally approved the Department's policy, which was first published in April 1997.
Shisana said the bulk of the country's health resources must be allocated to primary health care. For the immediate future, the department has four key goals:
Nutrition is fundamental to health. Over four million people in 13 000 schools are taking part in a primary school nutrition programme, organised by communities, with small government grants. Since 1994, 393 new clinics have been built, and 2 298 have been repaired. However, in some cases, after the repairs, there were no funds left to pay staff until the next financial year. However, the government has now adopted a medium-term expenditure framework, making it possible to plan for a three-year period.
Free primary health care was introduced in April 1996. And doctors from Cuba, Germany and the United Nations volunteer programme are now working in rural areas, among poorest sections of the population.
Each year in South Africa, about 10 000 people are likely to die of tuberculosis. The health department has introduced a TB programme, with the help of the World Health Organisation, and 3 000 health workers have been trained in the management of TB. Of the 90 000 TB patients registered in 1996, 73% have successfully completed their treatment.
Immunisation as a preventive measure is vital to all health care. In 1995, 3l8 million children up to the age of four were immunised against communicable diseases; in 1996, 4.4 million and in 1997, 5 million. About 96% of children have been immunised against measles. A hepatitis B vaccine has been introduced for children born since 1995 and health workers have also been encouraged to be immunised.
To promote the rational use of drugs, the Department has issued a directory of essential medicines, to be used with guidelines on treatment, in primary health care clinics.
The prices of essential drugs in South Africa are among the highest in the world, and the Department is determined to reduce the price of medicines. This is a crucial part of making health care affordable, not only in the public sector, but also in the private sector. The private sector had failed to regulate itself in terms of prices, in spite of being asked to do so.
Three Bills have been introduced: the Medicine and Related Substance Control Amendment Bill; the Pharmacy Amendment Bill; and the Medical, Dental and Supplementary Health Service Professions Amendment Bill. These Bills allow for the following measures:
During the discussion on the health department's policy in NEDLAC, one speaker warned that, before we import cheaper medicines, we should look into labour conditions in those countries where the drugs are manufactured, in case prices are low at the expense of labour rights.
It is not difficult to see why Freda Sizani is an inspiration to her fellow workers. She speaks with the quiet confidence of a woman who has triumphed in the face of the many obstacles that life as a black working class woman has thrown in her way.
Sizani is a product of the union through and through, having risen from the shopfloor to become SACCAWU's second vice president.
She joined SACCAWU's predecessor, CCAWUSA, in East London 15 years ago. After a year she was elected a shop steward at OK Bazaars, where she still works.
Sizane herself drew inspiration from veteran unionist Emma Mashinini, who was the union's general secretary at the time. "When I first joined the union, women were not yet seriously involved in the struggle," says Sizane. "So it was strange to see a woman involved in the labour movement and in the struggle. But when I met Emma Mashinini, I felt that I could also do it."
Sizane served two terms as a shop steward Ñ a pioneer for worker rights at a time when racism was the rule and trade unions were still regarded as the enemy.
"Those years were terrible," she says. "Management suppressed black workers." There were no black people in senior positions. And where a token black person was promoted, it was to help management suppress black workers.
In those days it was difficult to convince workers to join the union. But Sizane drew support from CCAWUSA, which actively encouraged women's involvement.
Many of her co-workers were coloured, and had not yet been touched by the growing politicisation in African townships such as Mdantsane, where she lived.
"Workers in the store were not clear what the labour movement was all about. And they were scared they would lose their jobs if they joined the union."
But, with time, workers began to see the benefits of joining the union. "They started to welcome union officials in the stores and ask about the union. Especially when it came to wage increases, workers supported the union as they knew they would get something out of it."
Sizane's activities brought her under the scrutiny of the notorious Ciskei police, who raided her home, confiscating union documents and T-shirts. She was frequently detained and questioned about her union involvement.
Her first detention was during the 1983 Ciskei bus boycott, called in protest against fare increases. The boycott, led by the militant SA Allied Workers Union (SAAWU) was one of the first mass protest actions in the area. Hundreds of workers were detained in a massive clampdown aimed at smashing the boycott. Many were held at the Sisa Dukashe stadium and brutally tortured by Ciskei security forces.
Sizane's detention was a painful experience, particularly since she had a one-month old baby at the time. But she emerged from the prison cells determined to carry on.
Sizane speaks in glowing terms of the encouragement she and other women received from SACCAWU. This gave her the courage to take up leadership positions in the union.
She served as chairperson of SACCAWU's East London local and later did two terms as the union's Eastern Cape treasurer. She also coordinated union education in the region and played a leading role in COSATU's Eastern Cape gender forum and her local ANC Women's League branch.
When a number of SACCAWU office bearers were deployed as ANC candidates in the 1994 general elections, the union's CEC appointed Sizane as acting second vice president. In 1996 she was re-elected to this position at the national congress.
"I am very proud of what SACCAWU has done to me," she says. "I get all the support I need."
Among the experienced union leaders who helped groom her was SACCAWU general secretary Bones Skhulu, who is also from East London, and national treasurer Alina Rantsolase.
"If you listen to her, you won't get lost," says Sizane, "especially when it comes to union policy and procedures."
Sizane is all too aware of the obstacles women workers face in taking up leadership positions. Her long years in the union means she has learnt the ropes and offers other women advice on how to make their voices heard in union structures.
"That inferiority complex in women is always there, until you convince yourself, I can do what they (men) can do.
"If you feel inferior, you will run away and then you won't get up there," she says. "So it is important for women to start to engage men on issues, socialise and discuss with them where they are free to talk and give you advice.
"In meetings, men want to show that they are men. But outside the meeting they will open up and go deeper into politics. And if you hold a position, they will assist you.
"One thing I have realised," she adds, "is that women are very strong. Women can make it. We just need to fight this inferiority complex."
Women's activism in the union is also undermined by male chauvinism. Meetings after work were poorly attended as women would have to rush home before their husbands came home. So SACCAWU started holding lunchtime meetings, rotating between the different stores. Women would take turns to bring tea, cake and snacks.
Congress resolutions to develop women leadership are worth little without concrete programmes to develop women, Sizane says. She is against the quota system and says women should rather develop and emerge through the union's structures to occupy positions in the union.
She is full of praise for COSATU's role in putting gender issues on the agenda. "If it were not for COSATU, affiliates wouldn't be prioritising women's issues. But COSATU has done very well in encouraging affiliates to come on board."
Thanks to these efforts, men's attitudes have gradually begun to change. "Today even male comrades are gender coordinators. And it gives women courage when a man speaks the language of women. We are all workers."
Sizane says SACCAWU is building women leadership beyond the national level. Women are becoming increasingly visible in regional and local structures and as shop stewards.
"When we hold shop steward elections, male comrades say we must be gender sensitive. In the past, women would vote for men. But those days are gone and now women know what they want.
"Especially with the new government, women want to be heard and to see the government dealing with issues of importance to women. During the Basic Conditions of Employment negotiations, women were very interested and were even prepared to go out and fight.
"These days women are going for it!"
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SACCAWU plans to arm its negotiators to vigorously take up the rights of working parents
Mary Mahlangu, a factory worker, lost her job after she stayed at home for three days to look after her sick three-year old. Her boss was not interested in why she had been absent.
When domestic worker Sally Jantjies took off three months after the birth of her first baby, she returned to find that her "madam" had given her job to someone else. A single mother, Jantjies was left penniless and jobless.
Today mothers like Mahlangu and Jantjies have some protection under new labour laws Ñ the Basic Conditions of Employment Act and the Labour Relations Act. But these provisions are far from adequate.
COSATU's September 1997 congress resolved to campaign for parental rights at all workplaces and to include demands for maternity leave, child care leave and child care facilities on unions' collective bargaining agenda.
SACCAWU has already begun planning to step up its parental rights campaign this year.
The campaign aims to ensure that women Ñ and men Ñ can combine a secure working career with a healthy, enjoyable family life; that women receive the necessary pre- and post-natal care and that children's needs are met.
The majority of SACCAWU's members are women and the problems facing working women with children have been on the union's agenda since its launch in 1975.
Struggles initially centred around individual dismissal cases, but later moved to maternity agreements and parental rights.
SACCAWU won its first maternity agreement at OK Bazaars, way back in 1983. In 1985, the first agreement on the rights of men and women workers was won at Metro Cash and Carry, followed by a comprehensive parental rights agreement at Pick 'n Pay in 1988. Since then many such agreements have been won at other companies.
SACCAWU says apartheid's legacy means that the lives of most pre-school children are still dominated by poverty and the lack of basic necessities. High infant mortality rates and inadequate educare facilities persist, as do high unemployment and low wages.
Child bearing and rearing in this situation poses daunting challenges for South African parents.
While parental rights should be a social responsibility, most parents bear the burden alone. The socialisation of childcare remains a distant prospect. The lack of funding for health and welfare and the overall neo-liberal orientation of government policy points to childcare remaining an individual, family responsibility for the foreseeable future.
Winning parental rights therefore falls heavily on the shoulders of parents and their organisations, says SACCAWU gender coordinator Patricia Appollis.
The union has made important breakthroughs in negotiating parental rights, especially in large national chain store groups. But much work still needs to be done.
"All agreements need revision and consolidation and there are still many workplaces without agreements, especially small businesses," says Appollis. Sectors such as hotels, restaurants, fast-food outlets and banks need particular attention.
SACCAWU's campaign will centre on collective bargaining negotiations and the union plans to train an army of negotiators for this. Since the union faces strong opposition to centralised bargaining, negotiations will have to take place at company level. This places an even greater burden on the union's resources and the campaign's success will depend on capacity-building.
Many SACCAWU negotiators are male, and there is a tendency to make parental rights a secondary issue, often due to a lack of information on the issue.
SACCAWU negotiating teams will be given special training, information and support. Along with NALEDI and ILRIG, the union will conduct research and produce a parental rights manual and booklet and a discussion paper to help stimulate debate on key issues. The union is aiming to have these completed by June this year. Watch this space!
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