I am very pleased that we were able to finally make this day happen after COVID-19 usurped our original plans to visit the train in March. Having said that it is co-incidental that the visit falls within Breast Cancer Awareness Month and I am pleased that you have requested me to focus on Breast Cancer awareness in this address.

1. Speaking Notes for Minister Mkhize
Phelophepha Health Care Train Visit
6 October 2020
Topic: Combating NCD’s as we focus on Breast Cancer Aware-
ness Month
Hon MEC Madoda Sambatha
MMC Health in Matlosana District Municipality Cllr N M Mendela
His Grace Bishop Victor Tlholo Phalana
Head of Transnet Foundation Mr Molatwane Likhethe
Leadership and staff of the Phelophepha
Distinguished Guests
Members of the Media
Ladies and Gentlemen
I am very pleased that we were able to finally make this day happen
after COVID-19 usurped our original plans to visit the train in March.

2. Having said that it is co-incidental that the visit falls within Breast
Cancer Awareness Month and I am pleased that you have request-
ed me to focus on Breast Cancer awareness in this address.
As a nation we have done extremely well in the fight against the
COVID-19 surge and, if we continue to stay vigilant and adhere to
non-pharmaceutical interventions we can, through our actions, miti-
gate a potentially devastating second wave. In the past few weeks
we have observing a rise in numbers and it’s important to say that
our behaviour is what will turn the tide. But now we need to turn our
attention back towards the implementation of the National Health
Insurance by building on the gains we have made as we imple-
mented our strategies for COVID-19.
The pandemic brought home the stark realities of the shortcomings
of our current system. Indeed, it emphasised the importance of the
tenets of the NHI and the fact that we have actually delayed imple-
menting a system that is absolutely crucial to enable us to respond
quickly and effectively to an onslaught such as the Coronavirus. In-
deed, on aspects such as strengthening of primary health care, ex-
panding domestic capability, building a capable workforce and in-
frastructure development, we realized that we did not have the luxu-
ry of time to spend debating on the merits of NHI. We, together with
the private sectors, immediately moved to pool resources and con-
solidate ourselves into one army, one health system with one co-
herent response. This is the very basis of the NHI.

3. We worked very well with the private hospital who availed beds for
public use. When we spoke of tests we didn’t take into account
whether it was public or private. This type of collaboration is what
we should be taking forward into the future. It now only remains for
us to learn from this critical lesson- that it is only by pooling re-
sources and through multi-sectoral collaboration that we can com-
bat any insult to our national state of health.
I am therefore extremely pleased to be here and celebrate the work
of the Phelophepha Health Care Train: an instrument of hope and a
shining example of effective primary health care delivery. And as we
have heard from MEC we have seen how this train has lived from a
single service initiative to now delivering multiple services across
the country.
To begin let me congratulate this institution for the sterling work
done in KwaZulu Natal, North West and Gauteng; screening and
testing citizens for COVID-19 and taking critical messages of em-
powerment to the people. You have buttressed the work of some 60
000 community workers who, along with yoursleves, provided a
ground force of troops who fought COVID-19 one person, one
household, one community at a time. Our community screening and
testing programme became a novelty for many around the world to
emulate as a shining example of primary health care applications to
a major public health threat. On behalf of your beneficiaries, I wish
to thank you for the critical work that was done on this train and
thank the staff for selflessly traveling across the terrain of our beau-

4. tiful and varied land for the sole purpose of bringing hope and heal-
ing to our people. It would have been possible to say that due to
COVID Phelophepha would delay their services. But this was not
the decision you made- you chose to respond to COVID-19, even at
personal risk to yourselves and in fact we know that over 30 000
health care workers acquired COVID-19. I salute all the health care
workers who make the sacrifices daily on this train.
As we all know, before the advent of COVID-19 we were already
faced with a triple burden of HIV, TB, and non-communicable dis-
eases and COVID-19 only served to quadruple this threat. And we
also know that another pandemic, Gender Based Violence, became
a rising phenomena which concerns us very much. As a result of
the massive uncertainty that came with the virus and the fear sur-
rounding its possible effect on our vulnerable populations such as
those living with HIV, TB and non-communicable co-morbidities, we
have been concerned to record drops in facility head counts of peo-
ple presenting for HIV, TB, Diabetes, Hypertension and Cancer
Screenings. I am now told that, since citizens have become more
confident to venture out and seek medical attention, that you have
noticed a rise in persons presenting with elevated PSA’s or clinical
evidence of breast cancer.
I therefore wish to take this opportunity to reassure the public that
we remain ready to serve you, our people, with services and tools
to protect yourselves from the complications of unmanned chronic

5. conditions. We implore all our citizens to test for HIV and to screen
for TB, hypertension, diabetes, breast, prostate and cervical cancer.
This train, for instance, offers all of these screening and testing ser-
vices including pap smears and a special machine called Sure-
Touch which is like a mammogram that looks for potential masses
in the breast. I was also very excited to learn that there are also
dental, eye and psychology services that are carried out from this
train. Phelophepha means good, clean health- this is achieved most
effectively by preventative measures that will help those who are at
risk not to develop debilitating morbidity or lose their lives when it is
very possible to prevent death and disability by identifying and
managing chronic conditions early.
As I have mentioned, this month is Breast Cancer Awareness
Month and so I would like to spend a little bit of time talking about
the burden of Breast Cancer to our women and our nation and how
we, together, can beat Breast Cancer and save lives.
This year we commemorate Breast Cancer Awareness Month under
the theme “ Give Hope. Save Lives” We do so understanding that,
worldwide there are about 1.38 million new cases and
458 000 deaths from breast cancer each year. Breast cancer is by
far the most common cancer in women worldwide, both in the de-
veloped and developing countries. In low- and middle-income coun-
tries the incidence has been rising up steadily in the recent years
due to increase in life expectancy, increase urbanization and adop-

6. tion of western lifestyles. Our country is no different: breast cancer
is now the most commonly diagnosed cancer amongst women of all
races with a lifetime risk of 1 in 25 women developing breast cancer
according to the national cancer registry of 2016. The WHO has
warned that the incidence and mortality rate of breast cancer in low
to middle income countries, such as ours, is rising due to delayed
presentations as citizens struggle to access health care.
We must therefore re-enforce the message to women that is is ex-
tremely important that one knows the family history of all cancers in
the family as there are some cancers that put one at risk of having
breast cancer as well. It is also extremely important for women to
examine their breasts frequently at home and to take opportunities
to have their breasts screened by health professionals with a view
to test early if a problem is identified. It is very possible to be cured
of breast cancer and to save one’s breast, and life, if the cancer is
identified early. It is also important to examine your armpits (or axil-
lae) for unexplained lumps which could also be a sign of breast
cancer. Other signs that one can look for is abnormal discharge
from the nipples, skin changes and change in the elevation or size
of the breast or sometimes even an ulcer that can develop.
I recall many years ago as medical students who picked up a lump
at the age of 21- the following year we tragically lost year as the
cancer had advanced. And so self examination is absolutely crucial.

7. The Department of Health published The Breast Cancer Prevention
and Control Policy in 2017, which is an important document aimed
at prioritising breast cancer awareness, prevention, treatment and
care in South Africa. The strategic objectives outlined include:
• improving early detection rates by promoting community aware-
ness,
• educating communities and health care workers on breast health-
care and breast cancer management
• facilitating referral pathways for patients with breast healthcare
concerns
• providing guidelines for establishing appropriate facilities for the
management and care of breast conditions
• setting standards for optimal care and management of breast
conditions to provide a framework for auditing standards and out-
comes
A multilevel context of care is articulated in the framework for can-
cer prevention and control. This recognises the need to consider
nested levels of influence on care, from individual patients and their
families to provider teams, organisations, communities, provinces
and the nation. Therefore this policy recognizes opportunities and
strategies of intervention at every level to ensure that vulnerable
groups, and influencers are all empowered and enables to provide
support and advocate for behavioral change that leads to higher
levels of awareness and agency.

8. Like what we have seen in fighting COVID-19 wellness pro-
grammes and community screening and testing does depend a lot
on community structures like churches, youth organizations etc.
This needs to be taken as a social debate and discussion which
don’t need any health worker. These discussions should empower
community members to understand warning signs, access to health
care, early screening and prevention in order to save lives.
The National Cancer Strategic Framework for 2017- 2022 outlines
governments commitments to combating Cancer, including Breast
Cancer in South Africa. It provides an overview of cancer prevention
and control initiatives for the major cancers affecting South Africans
and is focused on the strategies to reduce the burden of cancer in
South Africa. It has identified the following limitation to be ad-
dressed in the management of cancers at large:
• Unacceptably long waiting times
• Lack of functional radiation equipment
• Lack of adequate staffing at cancer treatment facilities
• Poor awareness of cancer amongst community members- espe-
cially early warning signs
• Shortage of medical technologies
• Need to strengthen leadership and governance

9. At the same time it has acknowledged various key intervention that
government has implemented initiative and political will to combat
cancers and non communicable diseases- this includes numerous
efforts to curb smoking, a major risk factor, with the introduction of
the Tobacco Products Control Act in 1993, the Tobacco Products
Control Amendment Act No. 12 of 1999. In addition, the establish-
ment of tax and regulatory measures and health promotion inter-
ventions has been a critical national strategy. Ladies and Gentle-
men we saw for ourselves the dramatic effect of the alcohol restric-
tion in reducing the burden of trauma in this country. The National
Liquor Act No 59 of 2003 was an additional measure to curb the
bio-socio economic impact of alcohol abuse by regulating manufac-
ture, supply and distribution. COVID-19 has indeed taught us that
we were in the correct realm of understanding in this regard and so
we will be injecting some energy into further managing alcohol
abuse in the country, which is not only a risk factor for cancers, in-
cluding breast cancer, non-communicable diseases and accidental
trauma but also for interpersonal violence, including the scourge of
gender based violence.
Other interventions which I will mention for the sake of complete-
ness were programmes such as Hepatitis B vaccination, which was
included in the Extended Programme of Immunisation in 1999. The
regulations introduced in 2011 on the compulsory registration (notif-
ication) of cancer have led to the marked increase in the numbers
of patients reported to the National Cancer Registry. Vaccination
against HPV was introduced to the EPI as a population-based initia-

10. tive in 2014, while policies on breast cancer and cervical cancer
were finalised in 2017, as I have alluded to when I discussed the
Breast Cancer Control Policy of 2017
So what we want to say is that there is a huge Programme behind
cancer and we believe that the advent of the various vaccines will
be a real game changer in reducing incidence.
Many of you may not be aware that behind much of this work was a
highly committed and active Ministerial Advisory Committee on the
Prevention and Control of Cancer, which commenced activities in
2013. As a department we have also increased liaisons with various
stakeholders in the cancer arena. These include non-profit support
and research bodies, like yourselves, academic institutions and
pharmaceutical bodies.
I am taking the time to discuss these interventions because I want
to reassure you all here at the Phelophepha Train that government
shares your commitment and passion for bringing health care closer
to the people through a primary health care model and that this in-
deed does form the basis of the National Health Insurance we en-
visage as our tool for attaining Universal Health Coverage. We
stand ready to support you and enable you to continue and expand
your reach as this can only buttress our goals as outlined in the var-
ious intervention strategies.
So this is one of those contributions to Primary Health Care and as
we talk about the NHI we also speak of preventative care, aware-
ness and community agency to be able to know how to recognize

11. early signs, lifestyle changes that influence health and well being.
These issues if I attended become a cost to the state when citizens
become affected by disease, disability and death.
And when we speak of cultural issues and community mobilization-
we speak of taking health outside of the hospitals and clinics and
bring it into our homes, our churches, our schools and workspaces.
For instance what we saw is that this new normal of wearing masks
actually also caused a significant reduction in the seasonal flu
I therefore wish to conclude by sincerely thanking you all for this
wonderful opportunity to see the train and meet all the patriotic citi-
zens who ensure its sustainability and success. Long may this ini-
tiative live and may you all come to witness the fruits of this labour
of love.
I thank You