Department of Health Strategic Plan 2009/12 & budget briefing

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16 June 2009
Chairperson: Mr B Goqwana (ANC)
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Meeting Summary

The Department of Health briefed the Committee on its Strategic Plan 2009/10 - 2011/12. Much of the briefing consisted of a detailed elaboration on the National Health System (NHS) Priorities for 2009 - 2014, which entailed a ten point plan that was fully set out in the attached documentation. The Committee was also provided with detail on the Department's budget and its expenditure. It was evident from the presentation that the health sector was facing severe funding constraints. The availability of adequate resources was critical for the implementation of the key health priorities.

Members questioned what the Occupation Specific Dispensation was, what categories it would address and how the phasing in would happen. They commented that the budgetary constraints were disheartening, and asked what would be happening about the addition of more people to the antiretroviral programmes. Members asked how traditional medicine was being accommodated, whether the Department would train traditional healers and whether the immunisation coverage extended to the rural areas. They noted that often the essential drugs would not be held at primary health care centres and it was of concern that people were referred away or sent to other treatment centres through lack of planning. The Department was asked what strategies were in place for income generation and revenue retention, what plans there were to reduce expenditure, and what efficiencies could be introduced, particularly around lowering the costs of  drugs. Members also said that further attention must be focused on the National Health Information System, and the National Health Scheme, and questioned the dates for implementation. Questions were also asked about management training,  the opening of nursing colleges,  the accreditation system, the recent strikes, and why foreign health professionals were being recruited. Members indicated that the top-heavy structures needed to be reorganised,  whether the Department was being realistic, what was being done about poor infrastructure, and the necessity of research into mortality rates of young mothers.

Meeting report

The Chairperson welcomed Dr Molefi Sefularo, Deputy Minister of Health, to the meeting.

Mr Thami Mseleku, Director General, Department of Health, briefed the Committee on the Strategic Plan of of the Department from 2009/ to 2012. He provided background on the Department's planning processes and also touched on its mission and vision.

Mr Mseleku paid great attention to the National Health System (NHS) Priorities for 2009 - 2014. This  entailed a ten point plan, which he elaborated upon at great length (see attached document for full details). It was evident from the presentation that the health sector was facing severe funding constraints. The availability of adequate resources was critical for the implementation of the key health priorities. The National Department of Health was working with the Provincial Departments of Health to prepare an Integrated Implementation Plan for the NHS Priorities, which would also inform the Health Sector's Budget Bid for 2010/11.

The Chief Financial Officer, Department of Health, continued to give a breakdown of the Department's budget, providing specifics on expenditure especially as it related to the Department's programmes. The Department had not spent 4% of its budget. She also provided Members with a comparison of health sector expenditure as a percentage of government expenditure. The percentage seemed to fluctuate minimally between 13% and 14%.

The strategic plan was also outlined in detail in the attached document.

Ms A Luthuli (ANC) asked what OSD was, which had been used during the briefing.

Dr M Mathlati, Director (Human Resource Management and Development): Department of Health, said that Occupation Specific Dispensation (OSD) was a new system designed to retain health professionals and attract back those that had left South Africa. For most health professionals there was no performance management. The OSD system would address all the different categories of health professionals.

Ms Luthuli commented that the budgetary constraints of the Department were disheartening. This was especially true when it came to programmes dealing with HIV and AIDS and other serious illnesses. She stated that the citizens had high expectations from the Department to address health issues.

Mr Mseleku took heed of Members' concerns over the limitations of the Department's budget. However alternative ways to solve the Department's problems were also considered. Mr Mseleku said that budgets relating to HIV and ARVs were discussed vigorously. He pointed out that the Department would most probably always have over-expenditure. The Department was working on mechanisms to try to address the issue.

Ms M Segale-Diswai (ANC) asked what the Department was doing about traditional medicine and how was it accommodated within the Department's plans. She referred to the immunisation coverage, which was stated in the presentation as being 90%, in the presentation and asked whether it included rural areas.

Mr Mseleku said that traditional medicines were discussed and that there were programmes in place. He noted that the 90% immunisations coverage included rural areas. All 18 districts were covered.

Ms Segale-Diswai also pointed out that the essential drug list was of importance at primary health care centres. She noted that often doctors had to refer patients away or to other hospitals as required drugs were not available. Perhaps the system needed to be reviewed.

Mr Mseleku said that service delivery was the key issue and he confirmed that medicines should be available at primary health care centres. He suggested that perhaps a better information system would allow for better stock keeping records.

Mr S Pillay (ANC) said that the presentation had been quiet on income generation. He asked what strategy the Department had in place to ensure income generation and revenue retention. Mr Pillay asked what the potential was to earn income. He further asked how the Department intended to reduce expenditure. It was felt that efficiencies needed to be introduced within the Department.

Mr Mseleku responded that income generation and revenue retention issues were in the hands of the provinces themselves. Different provinces had different policies over the issue. This was part of the Department's fiscal arrangement. There was no broad national policy on the issue. The concern was that a national policy might encroach upon provincial matters. He stated that the registration of medicines was the Department's only income.  

Mr Pillay pointed out that the cost of drugs in SA was much higher than in many countries. He asked what plans the Department had in place to reduce the cost of drugs.

Mr Pillay stated that it was almost impossible to measure outcomes due to lack of information. He noted that at some point the issue of the National Health Information System needed to be looked at. Reference was made to cost-benefit studies, and Mr Pillay suggested that this be done in relation to substance and alcohol abuse as causes of motor vehicle accidents, violence and similar occurrences.

Mr M Waters (DA) referred to reductions in the budgets for OSD and Antiretroviral (ARV) treaments,  and

asked whether deserving persons who qualified for this would be turned away.

Mr Mseleku said that the programme remained with people already within the ARV programme. He noted that the issue was a difficult one. He said that not too many people could be added as there were financial constraints, but on the other hand everybody had the right to medical treatment. New persons were therefore being added to the programmes. The Department was trying its utmost to manage the situation.

Mr Waters asked, in light of the fact that OSD was apparently to be phased in, what categories would be prioritised.

Dr Mathlati said that there was a phasing in of OSD over a 3 year period. There would be allocations of R500million during the first year, R1 billion in the second, and R1.5 billion in the third year. Detail on the OSD would be presented to the Committee at a later time.

Mr Waters asked whether the 37% of hospital managers who were to receive management training would be getting refresher courses or training afresh. He questioned whether these persons had qualifications and said that if they did not, it was costly to the taxpayer.

Mr Mseleku noted that those to receive management training would be trained in order to improve their quality. It did not mean that these individuals did not have qualifications. The Department would focus on  service development.

Dr Mathlati added that persons who manage hospitals must have competencies. He added that the health sector was diverse and complex.

Mr Waters referred to the National Health Insurance Scheme and noted that the planned final process for consultation was March 2010. He asked on what basis was the date set.

Mr Mseleku noted that the Department worked on the basis of legislation. He noted that public comment usually took about three months, and there would need to be another three months allowed for comment from the Executive, provided that there were not any interruptions. Therefore, he suggested that by March  March 2010 the policy proposals should be done. This did not, however, mean that this would also involve the implementation. Mr Mseleku said that there would be a draft White Paper, and that the process would follow its normal course.

Ms L Ludwanga (ANC) referred to the opening of nursing colleges and asked when the process was to start. She said that there were high expectations on the matter and that timeframes needed to be set. Ms Ludwanga asked how nurses were recruited. She said that often times vacant posts were advertised in newspapers and hence possible candidates who lived in rural areas were disadvantaged as they did not have access to newspapers.

Mr Mseleku said that the issues around the re-opening of the nursing colleges were at present focusing upon how exactly to re-establish them. He noted that this needed to be looked at in broad terms as there were many different considerations. A clear policy framework was needed and the Department was working on it. By 2010 something should be available. Mr Mseleku pointed out that the training of nurses was no longer based on salary but rather on bursaries.

Dr Mathlati added that two years ago an analysis of the nursing colleges issue was done and it was found that not many had in fact closed, but some had amalgamated. It was found that not only was physical infrastructure lacking but that nursing teachers were also lacking.

A COPE representative asked whether the old accreditation system would be replaced with a new one. She said that there should not be a recurrence of the same problems.

The COPE Member asked who the CEOs of hospitals should ideally be - whether these should be appointed on the basis of their background in finance and management, or their background in medicine. She asked whether perhaps lack of suitable people was the reason why under spending was happening.

Mr Mseleku said that the Department did not have its own accreditation system. The accreditation of hospitals was done by an independent institution. Accreditation was not a policy. An accreditation system was needed by the Department. It had to be formal and legislated.

Ms T Kenye (ANC) referred to the recent strikes by doctors and asked what was happening on the issue.

Mr Mseleku said that strikes did happen. He said that the Department did not accept that the rights of doctors violated the rights of patients. The Department was finalising a new proposal on the matter but had deferred it for now. Perhaps by the following week the proposal would be tabled. There were some technical issues that needed to be sorted first. It was believed that the proposal would be a reasonable one.

Ms Kenye asked why foreign health professionals were being recruited, seemingly in preference to local health professionals.

Mr Mseleku stated that it was not only foreign health professionals that were being recruited by the Department. Locals were also being recruited. He also said that in fact many African health professionals from South Africa's neighbouring countries complained that the Department refused to hire them, but, he explained, the Department was merely adhering to a Southern African Development Community (SADC) agreement not to poach doctors and other health professionals from its neighbours; those neighbouring countries would do the same for South Africa. Mr Mseleku said that the recruitments were only done from those countries that the Health Professional Council proposed should be targeted. There was by no means a blanket recruitment. It was only done to fill gaps that existed.

The Chairperson asked why Priority 5 was allocated the largest portion of the Department's budget. He felt that the bulk of the budget should be used to monitor provinces.

Mr Mseleku responded that Priority 5 dealt with conditional grants to provinces and hence it contained the bulk of the funding.

An ANC Member asked whether the Department trained traditional healers. She also referred to the Office of the Ombudsman and asked what its function would be. 

Mr Mseleku said that traditional leaders were a priority and that they would be trained. A traditional council was to be established. The Office of the Ombudsman would be national and its function would be to develop capacity.

Ms Segale- Diswai stated that many structures were top heavy and lean at the bottom. Given the shortages of staff she wondered how the Department was going to ensure 100% delivery of primary health care. She asked whether the Department was being realistic.

Ms Segale Diswai also referred to the deterioration of health infrastructure, such as buildings and access points, and asked what the Department was doing to engage with the Department of Public Works Department on the issue.

Mr Mseleku said that the issue of top heavy structures would be handled at National Health Council level. It would be addressed.

Ms Kenye commended the Department on the research and development that was taking place on the infant mortality rate but asked what was being done to address the issue of the mortality rates of young mothers.

Mr Mseleku said that research was being done on various programmes. Some were prioritised over others. The Department was engaged with the issue of mortality rates of young mothers.

An ANC Member asked what the Department was doing to lobby more funding for its budget from National Treasury. She referred to HIV AIDS donors and asked how oversight over them was going to be done. She asked also whether the funding that was not being spent by the provinces would be used to help the Department to fill gaps.

Mr Mseleku noted that there was constant interaction with National Treasury on budgetary issues. He said that the Department did not have a specific policy on HIV AIDS donors. There was however a National Co-ordination Forum on Donors. In regard to the provinces, he said that if the provinces under spent funds these would be referred back to the Department.

The meeting was adjourned.

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