Department’s Priorities For 2001: briefing by Health Ministry

Meeting report

HEALTH PORTFOLIO COMMITTEE
27 February 2001
DEPARTMENT’S PRIORITIES FOR 2001: BRIEFING BY HEALTH MINISTRY

Chairperson: Dr S Nkomo

Documents handed out:
Department’s priorities for 2001 (see Appendix)
Dr Chetty’s Power Point presentation
 
SUMMARY
The Department provided the Committee with a lengthy presentation on its programme and strategies for the upcoming year. Committee members were asked to submit written questions to the Department as all their questions could not be answered due to time constraints.

MINUTES
Presentation by the Minister
The Minister, Dr Tshabalala-Msimang, stated that the focus of the Department would be on filling the gaps to achieving the objectives of the Ten Point Plan which they introduced last year. This year they will consolidate their efforts to implement the plan. Many challenges face the Department and this was highlighted with the South African Demographic and Health Survey, which describes the occurrence of disease in relation to race and geography. The Department will concentrate on developing effective strategies to combat disease and find ways to decrease poor health in disadvantaged communities (especially in the African communities). The problem is that they do not have the budget to implement all their plans.

The Department’s strategy is outlined in their Ten Point Plan and their Strategy Framework document. Their vision is to promote a caring society where all South Africans have access to quality health care. It will be necessary for them to work with Local Government in order to implement their strategies.

The Minister stated that the Department would take into account the pointers given by the President’s in his speech at the Thirteenth International Conference on HIV/AIDS. She noted that the prevalence of sexually transmitted diseases has already decreased drastically and the Department aims to decrease it even further.

The incidence of women dying during childbirth was decreasing all over the country. The fact that women’s health is such a priority with the Department has led to screenings for breast and cervical cancers being made much more accessible to women. Immunisation of babies had increased from 63% to 70% and the Department is aiming to improve on this figure.

She admitted that the Department had not moved with the speed anticipated originally, as they still lack the capacity in the provinces to utilise the grants. They will also look at the admission of Black students to medical schools. This had been a sore point last year. Discussions have already been taking place with the Deans of the various institutions.

The Department aims to mobilise health workers in their efforts to transform South Africa into a caring society.

She referred to the Public Finance Management Act, which aims to establish a decentralised budget. However the effect in the disadvantaged provinces is however turning out to be the opposite of what had been expected as these places are experiencing a decrease in per capita expenditure. The Department aims to improve revenue collection and retention and to introduce uniform hospital fees in state hospitals.

The problem of the theft of drugs remains and the Department is working with security personnel in government in this regard.

With regard to food control and safety, she stated that the National Food Control Office performs tests in order to protect the public from toxic substances.

The Department has been taken to court by the Pharmaceutical Manufacturing Association and the Minister appealed to the Portfolio Committee to support the government.

A new Board will be appointed at the Medical Research Council. Nominations to the Board have been invited.

The media has traditionally communicated the Department’s messages to the public on its behalf. As the Department has learned its lesson in this regard, the Department will now communicate with the public on its own behalf. The aim is to improve communications between the Department and the public by developing its own communication policies and strategies.

With regard to the international health sector, the aims are to implement current agreements and manage donor funding more efficiently.

Presentation by Deputy Director-General, Dr Chetty
Dr Chetty read through the documents dealing with the following issues:
Anti-tobacco campaign
The Department is developing new guidelines for implementation:
- A Framework Convention for the Africa region will be taking place from 11 to 14 March 2001.The Portfolio Committee can play an important role here.
- Implementation and monitoring of the Act
- Anti-tobacco campaign for schools

Decreasing morbidity and mortality rates through strategic interventions                 
Health Promotion
– Health Promoting Initiative in schools: This is a programme targeting school children and emerged due to the cholera outbreak in KwaZulu Natal. This approach highlights personal hygiene.
- Healthy Cities guidelines: This approach is being implemented internationally. The treatment of diseases is dealt with holistically with a focus on the environment and not solely on prevention and cure, as is the traditional approach.
- Other health promotion activities include drafting guidelines for workplace health promotion as well as a community mobilisation programme for HIV/AIDS.

Chronic Diseases
- The Prevention of Blindness programme has been developed successfully. The most important project is the Tunisian Doctors Project in terms of which Tunisian doctors come to South Africa to assist with the backlog in cataract operations.
- There is also possible public-private partnership with St Johns Hospital. One of its areas of focus will be on cataract surgery.
- Primary focus is on containing the current cholera epidemic that arose in KZN. Advocacy for clean water and sanitation remains a priority and the Portfolio Committee could play an important role in this regard. The Department is following an inter-sectoral approach by working with other departments. The cholera epidemic highlighted the Department’s outbreak response preparedness. The Department has adopted a particular approach to its outbreak response which includes:
1  Policy guidelines on outbreak control
2  Epidemic preparedness on diarrhoeal, haemorragic and nervous systems infectious diseases
3  Co-ordinatation and management of disease outbreaks
4  Training of response teams
5  Development and maintenance of health information and promotion documents
6  Development of an Infectious Disease Control newsletter
7  Development of early warning systems

- Malaria control is taking place in certain provinces. The Department will focus on problems such as drug resistance and the affordability of drugs.

Revitalisation of hospital services
The Department will look at Emergency Medical Responses and work toward developing effective response strategies. Uniform norms and standards would be necessary to accomplish this effectively. They will also aim towards commissioning at least the following hospitals: Alfred Ntuli (Durban) , Nelson Mandela Academic Hospital (Umtata) and the Pretoria Academic Hospital – ensuring they are equipped so that they would be ready for opening.

The Hospital Revitalisation Project encompasses the Hospital Rehabilitation Project and the Hospital Reconstruction Project. Whereas the latter focussed on the physical infrastructure of the hospital, the Revitalisation Project is more comprehensive as it also focuses on areas such as information systems and management. The Department is working with other departments to implement this within this year.

The Integrated Planning Framework aims to introduce uniform norms and standards and strategic planning. It will also focus on human resources, affordability and the ratio of beds to the hospital population.

With regard to the conditional grants, the Department will monitor compliance and refine reporting. The Health Professionals Training Grant will cover the extra cost of training hospital personnel. There is also a Central Hospitals Grant and a Redistribution Grant. The latter aims to build up special services in peripheral areas of the provinces as opposed to the central hospitals. The Hospitals Management Grant aims to encourage effective management in the hospital sector.

Improving human resource development and management
To achieve this aim the Health and Welfare Bargaining Chamber and the Health and Welfare Sector Education and Training Authority have been established. Both public and private sectors will contribute to these. The Department will have to determine their training needs and requirements. A five-year plan will be used in order to fulfill resource requirements.

The Pick Report emphasised that one had to concentrate on private health care in order to strengthen the development of mid-level workers.

In accordance with Batho Pele, a strategy has been developed in order to deal with staff attitudes.

There will be a renewed focus on postgraduate and undergraduate training. The Department will attempt to get the postgraduate training required to meet the needs of South Africa.

Improving communication and consultation
A Chief Director has been appointed. Internal communication within the public health system will be improved. To facilitate this a Communicators Forum will be established and sustained. There will be an audit of publications. In addition, a departmental newsletter will be produced and key departmental events will be organised. There will also be improvements in the external communication of the Department. This will take place via the media, publications, stakeholders and the development of a website.

Reorganisation of certain support services
- Strategies to deal with medical waste will be finalised.
- With regard to Port Health Services, the focus will be on food and animal control, the revision of International Health Regulations and the regulation of environmental health hazards.
- The National Health Laboratory Service Bill has been passed and the Act is now on its way.

Legislative Reform
- Mental Health Bill
- National Health Bill (will be passed this year)
- Nursing Bill
– Two amendment Bills will be the Medical Schemes Amendment Bill and the Medicines Control Amendment Bill.

Strengthening co-operation with their partners
The Department will focus on public-private partnerships in order to enhance financial management and make overall improvements in the hospital sector.

Presentation by Deputy Director General (National Health Information Systems)
Ms Matsau read the document entitled “Branch: Strategic Health Programmes” and highlighted certain issues in particular.

Pharmaceutical and Food Services
-   Legislative Reform
The regulations governing labelling of food from Genetically Modified Organisms is a new development which has occurred as a result of South Africa becoming part of the Codex Commission. This is because the EU set certain standards for countries exporting to them and with which South Africa therefore had to comply. Labelling has to be in line with these standards.
-   Pharmaceutical Services
Guidelines for the drugs system have to be developed as they are lacking. The Essential Drug List has not provided the expected benefits, as there are still problems to be dealt with.
-   Food Control
The Department is working with the Department of Agriculture on this issue.

Health information, research and evaluation
-   Monitoring
The World Health Organisation has already evaluated how effective the South African health system is. The Department hopes to continue this practice.

-   Research management
Although there has been much research on health issues it has often been unrelated to any other research. The Department aims to co-ordinate research to make it more effective.

- Quality of care
The department will focus on implementation of the following four areas now that the policy stage has been completed:
-Implementation of Policy on Quality in health care

-Base-line survey of quality in public health facilities

-Packages of care for different levels of care

-Implementing Telemedicine Phase II. Telemedicine was started three years ago and there has been a pilot project that has highlighted the deficiencies. Telkom is one of the partners involved in the project.

HIV/AIDS and STDs
The Department will look at ways to encourage home-based care to discourage the practice of families simply abandoning patients at hospitals.

Maternal, Child and Women’s Health
-   Immunisation
As previously stated, there has been an increase of coverage from 63% to 70%. The Department is hoping to see a further increase.
- Contraceptive Services
The fact that there have been no guidelines until now has presented many problems in the past. The Department hopes that the development of guidelines will solve some of these problems.
- HIV/AIDS
The Department will focus on orphans in general.

TB control
Traditionally the government, SANTA and Lifecare have together dealt this issue but they have not been very successful. The Directly Observed Treatment Shortcourse (DOTS) programme has been evaluated by WHO as being successful and will be expanded.

Due to time constraints, the briefing had to be cut short. Members were requested to read the document entitled Branch: Strategic Health Programmes.

Discussion
Dr R Rabinowitz (IFP) praised the Department for always being willing to admit its problems and deal with them. She felt that many of these problems have to do with the failure of the Department to work together with Local Government. She asked why the negotiations on pharmaceutical services and drugs are still floundering.

The Director General, Dr Ayanda Ntsaluba, replied that the distribution of medicines to peripheral areas has increased significantly and emphasised that these had been the problem areas. Some of the contracts had stipulated that medicines should be delivered to the hospitals first and from here it would then be delivered to the clinics. The Department now wants to ensure that delivery takes place directly to the clinics from the depot. With regard to the involvement of Local Government, he stated that the Department recognised the need to work together more effectively but that it was difficult to do so in reality.

Ms Rabinowitz agreed that privatisation was a positive step. She asked if the Department intended to look at involving South African or international companies. How would the Department release work to non-governmental organisations that were working on the same issues and how could these NGO apply for funding? She asked if it could also include the Health Systems Trust.

The Director General replied that the companies involved would include profit and not-for-profit organisations as well as trusts. It would include anyone who is willing to help.
 
Dr E Jassat (ANC) referred to a recent case where a child had been assumed to be retarded due to lack of academic progress. However, it was subsequently discovered that the child was in fact poorly sighted. An NGO in America has offered to donate an instrument with which it will be possible to test eyesight even in the most remote rural areas.

The Director General noted that the same problem is experienced with hearing disorders. As a result there is a pilot project to determine the extent of hearing disorders in the North West.

 Dr Jassat referred to a paper by Dr Schultz on how to improve Human Resources planning. He suggested that the Committee engage with the doctor on this issue.

The Director General said that the Department would do this. Mr Mabope, Special Advisor to the Minister, stated that he had received an e-mail from her and would respond to it.

Ms C Dudley (ACDP) asked what has been done to ensure the availability of the drug Nevirapine.

The Director General responded that the registration of the drug has not yet been completed as new questions have emerged from the Medicines Control Council (MCC).

Ms Dudley also asked if the Department was considering the use of mosquito nets in the prevention of malaria.

Dr Ntsaluba replied that the pros and cons of using these are being investigated.

Ms Dudley wanted to hear more about what is being done about the issue of medical waste.

The Director General stated that the Department of Environmental Affairs and Tourism would publish the draft regulations later this year for public comment.

Ms F Marshoff (ANC) asked what was happening with the Cuban doctors’ project. She asked whether there was still a need for them and if agreements between the two governments had been renewed.

The Director General replied that these doctors are here in terms of a community service project. The Department has not reached the point where they can do without these doctors yet. Although there will be no significant increase in the number of the doctors brought in, they will replace those who leave by using other doctors from Cuba.

Ms Marshoff also asked how successful Batho Pele is in ensuring improved service delivery.

Mr R Mabope said that it would only be possible to answer this question once the results of the implementation of the Patients’ Rights Charter and the Quality Assurance Policy had been evaluated. The Department could then report back to the Committee.

Ms Marshoff asked if the conditional grant was a new grant or if it was locked into the Rehabilitation Grant.

Dr Ntsaluba replied that the Rehabilitation grant was not new. The focus however is on the Revitalisation Grant that is fairly new and encompasses the Hospital Rehabilitation Grant.

In answer to a query by Ms M Njobe (ANC) on immunisation statistics, the Director General stated that the target is to increase the immunisation figure to 80% by the end of 2004.

Mr M Ellis (DP) referred to the Minister’s comments on theft and corruption. He asked what is being done to prevent corruption before it occurs.

The Director General replied that in accordance with the Public Finance Management  Act, all government institutions have to have anti-corruption measures in place by 30 March 2001. One of the pilot projects being implemented by the Department is a system of bar-codes.

The meeting had to be concluded due to time constraints. The Chair pointed out that members could submit written questions to which the Ministry and the Department would reply in writing.