Department of Health Strategic Plan and Budget 2010/2011

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23 March 2010
Chairperson: Mr B Goqwana (ANC)
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Meeting Summary

The Minister and Department of Health delivered a comprehensive presentation to the Committee on the Strategic Plan for 2010/11. Health formed one of the five key priorities of government, and the Department of Health (DoH) had formulated a 10-point plan that attempted to meet the priorities, and a 20-point set of goals that detailed and attempted to address the challenges that health faced, over the medium term, up to 2014. The Minister noted that one of the most significant of the quadruple burden of disease in South Africa was HIV/AIDS, and several interventions were enumerated, including a campaign that would be backed by the President and involve Members of Parliament. The Minister also set out the increased attention to maternal and peri-natal mortality, which would focus on care during pregnancy and reduction of mother-to-child transmission. Other focus areas included the health needs of youth, including a focus on substance abuse, and integration of care for TB and HIV patients. Besides the testing and counselling for HIV campaign, a vaccination campaign would be running during the same three months of this year to vaccinate against measles, polio and H1N1.

The DoH briefed the Committee on the budget, noting that although this year’s budget had increased by 19% most of this related to the conditional grants allocated to provinces. Within those grants, the largest portion went to the HIV/AIDS grant. Within the conditional grants, the largest part of the budget went towards the HIV/AIDS programme. There was a sum of R140 million set aside for the improvement of forensic services, as well as R10 million for the audit of nursing colleges, and R4,02 billion for the hospital revitalisation programme. Funds were also available for the training of hospital management. R13 million had been allocated for the 2010 Fifa World Cup event's emergency medical services. The Chairperson and Members asked if the budget would be sufficient to meet the targets of the Department but did not generally have a problem with the allocations.

Members asked a wide range of questions, and a significant amount of discussion centred around values and attitudes, and how this affected patient care. A “disconnect” was detected between the feedback from staff, and the feedback from patients. A commissioned survey would have to be done to better investigate the reasons behind the disconnect, and would also look into questions of negligence that resulted in litigation against the Department. Related to this, there was also a discussion on Batho Pele. Members expressed concerns about the length of time it took ambulance services to reach patients in distress, partially through poor management and partially through unsuitable vehicles being used in some places. There was discussion on the local manufacture of generic drugs, as well as the absence of regulations for complementary medicines. The Committee heard that the fact that so many senior management position were filled by people in an “acting” capacity had been on Cabinet's agenda and was awaiting a decision. Members asked whether the Occupation Specific Dispensation had achieved its aims, and cited some problems which the Department confirmed it would investigate. Members asked about the appointment and evaluation of Chief Executive Officers of hospitals and the purpose and value of their training. The link between societal problems such as the continued use of the bucket system, and health problems was investigated.

Meeting report

Department of Health (DoH) Strategic Plan and budget 2010-2013
The Chairperson welcomed the Minister of Health, Dr Aaron Motsoaledi, members of the Department of Health (DoH) and Ms Mandisa Hela, Registrar of Medicines.

Dr Aaron Motsoaledi, Minister of Health, said that the vision and mission was clearly set out in the presentation, at slide 4. He noted that in the context of service delivery, health was one of the five key priorities of government. South Africa faced a quadruple burden of disease from HIV/AIDS, maternal and child mortality, non-communicable diseases; and violence and injuries. He quoted a report quoted in The Lancet of August 2009, stating that mortality rates of children under five years had increased since 1990. The context of this and other studies, coupled with the DoH’s own research, was being responded to by the 10-point plan (slides 8 and 9). He noted that two of these items were the implementation of the National Health Insurance (NHI) and the review of the drug policy. DoH had put in place an outcomes-based Medium Term Strategic Framework (MTSF) which set out 20 goals over the five year period ending in 2014. These goals included achieving a decreased maternal mortality ratio, improved tuberculosis (TB) outcomes, revitalisation of primary health care (PHC), and improved health care financing. He stressed that DoH would need a firm grip on achieving all its goals. However, he wished to place emphasis on two in particular. The maternal mortality ratio should be zero, but continues to be as high as 625 deaths per 100 000 live births. The number of children born HIV-positive should be zero, but this remained a challenge, partly due to poor adherence to ante-natal care. He also mentioned the goals for malaria, termination of pregnancy, post-natal care, the integration of care for TB and HIV, and the importance of exercise to help combat disease such as diabetes 2.  He challenged the Committee to lead by example and walk and exercise more. With regard to termination of pregnancy, it seemed that a trend was emerging whereby condoms were used less than expected, and pregnancy termination seemed to be used as a method of contraception. He said this was a very big concern for the DoH.

A major campaign to manage HIV prevalence would be announced in a media briefing by the Minister tomorrow and would be implemented in all State health facilities, as well as universities. The President would also be involved in making that announcement. He said the campaign would be one of the biggest to be undertaken by the DoH. The distribution of male condoms would be increased to 1.5 billion annually. The link between integrated care for HIV and TB would be strengthened by vigorous contact tracing of patients, which would facilitate early detection and treatment. This integration, it was envisaged, would be achieved by March 2011.

The Minister said that South Africa had perhaps not done enough to revitalise Primary Health Care (PHC). South Africa, as compared to the United Kingdom, had more patients seeking private than public health care, although the public service in South Africa had some of the most competent doctors. A contributing reason for people seeking private care was that public hospitals were collapsing. He noted that the DoH intended to achieve the improved delivery of infrastructure through Public-Private Partnerships (PPPs) which would achieve construction and refurbishment of five hospitals in various provinces (see Slide 25). Another contributing factor was the quality of patient care and satisfaction. He said the key lay in instilling positive and caring values and attitudes in every person involved in the running of the hospital, and ensuring cleanliness and availability of medicines, amongst other matters. These required good management. He asked members, in their oversight roles, to be vigilant about this aspect.

Dr Motsoaledi said that the National Health Act would be used to bring about amendments to address the improvement of health facilities. He said a quality management and accreditation body would also be established.

The DoH also needed to enhance operational management of health facilities, and a feasibility study was under way for the establishment of a Management and Leadership Academy for Health Managers. The business plan would be produced by March 2011 and it would be an accredited learning programme.

By the end of 2010/11, a human resources plan would be in place to address increasing the productivity of PHC workers, such as environmental health practitioners, infection control workers and other mid-level workers. The plan also aimed to recruit and retain other health professionals, including those who were surplus to requirements in other countries. It would also strive to seek a balance of the ratio between health professionals and administrative personnel. Long term, it was envisaged that the implementation of the PHC Information System in districts would be completed by 2012/13. This together with four other goals, formed part of the improvement of the Health Information System (HIS).

The Youth Health Strategy would be finalised by March 2011, and would address the specific challenges faced by youth, including HIV and drugs. This strategy would also implement the Mini Drug Master Plan (MDMP), since drugs, particularly in the Western Cape, were of huge concern. He said that it often seemed that those possessing small quantities of drugs would be arrested while the main dealers and in the illicit drug trade were not arrested and charged at all. He implied that urgent attention would be given to this problem.
Dr Motsoaledi noted that home based carers and community health workers, whether going under this or other names, were very active, working through non-government organisations (NGOs). However, problems arose when the beneficiaries were offered duplicate or conflicting services. A better coordinated and more integrated service was needed. Much had been learned from the example of Brazil, where the service was coordinated and managed in teams. DoH would be working with other departments (including Social Develop Local Government, and Traditional Affairs) to finalise a policy on these workers.

The campaign to vaccinate the population would receive focused attention over the next two to three months. There were a number of vaccines against TB, polio, measles, H1N1, coupled with counselling and testing for HIV. The Minister said there were many “quacks” espousing the virtues of natural (untested) cures, and others circulating stories to the media about the side effects of these vaccines. He urged members to be aware of these problems, and to note that the vaccines available from DoH had been thoroughly tested and had been successful world-wide.

Dr Yogan Pillay, Acting Director General, Department of Health, presented the budget to the Committee. National Treasury (NT) had requested all departments to reduce their budgets, and the DoH had made an “efficiency saving” of over R47 million in the current year. There were more savings over the Medium Term Expenditure Framework (MTEF) period. The total budget for the current year was R21,4 billion, representing an increase of 19% from the previous year, and rising to R23,7 billion and then to R25.8 billion in the next two years. This included funding for the conditional grants, and the increase was mostly accounted for by a rise in these conditional grants, the HIV/AIDS grant being the recipient of the largest part of that increase.

The budget was allocated across six programmes of Administration, Strategic Health Programmes, Health Planning and Monitoring, Health Human Resources Management and Development, Health Services, and International Relations, Health Trade and Health Product Regulation. Under the fourth programme, R10 million had been earmarked for the audit of Nursing Colleges project, while R160 million under the Strategic Health Programmes was allocated directly to the H1N1 outbreak. All the allocations, according to programmes, were further disbursed to the provinces.

In line with the President's State of the Nation address, new allocations would be made to give increased and better access to health, and the presentation set out how much of the R8.6 billion over the MTEF period was allocated to the HIV/AIDS conditional grant. The hospital revitalisation conditional grant amounted to R140 million for the Mitchells Plain Hospital. Another area of priority which would receive new allocations was the establishment of a Provincial Finance and Budget Support Unit. Other highlights in the priority areas allocations included the Forensic Chemistry Laboratories, the Measles and Polio Vaccination Campaign, and the Emergency Medical Services for 2010 (the FIFA World Cup event). He said the Forensic Laboratories had recently received quite negative media but some of those concerns would be addressed due to this new allocation, which would go towards the recruitment of additional forensic analysts. There was a shortfall in the compensation of employees (slide 47) but NT had provided an amount of R22 million in the current year, to make up the shortfall, and that would continue for the rest of the MTEF period.

Dr Motsoaledi noted that the task facing the DoH was an enormous one, but he was confident that DoH was equal to the task, and would be able to achieve its targets.

The Chairperson said that there was a very large sum of money that had to be approved. He was also concerned that this might not be enough to achieve all the targets that DoH had set. He noted the DoH's concern with the vaccine programme, which was negatively affected by media reports on the side effects of these vaccines. He said the Committee was fully supportive of the campaign. He also said that health promoters were key health workers and he was happy to engage with a group which had requested a meeting with the Committee. He noted that work towards most of the targets would be carried out in the provinces, where the conditional grants would be allocated. The provinces were not part of this engagement today and he felt that there should be a mechanism to monitor and receive input in that regard.

An ANC Member asked about performance management, noting that of the 100 managers, 63 had submitted their performance management audit (PMA). He asked how the DoH would encourage full compliance with submission requirements, since those not submitting should not be considered for performance bonuses.

He also asked how the problem of so many senior managers being appointed only in an acting capacity would be solved.

Ms A Luthuli (ANC) thanked the DoH for an invigorating presentation. She indicated that insufficient attention was being paid to the elderly, who were often bearing the brunt of caring for the youth, because of the impact of HIV/AIDS on their parents.

Ms Luthuli noted that there was a very high incidence of HIV/AIDS and questioned why, in light of this, the DoH seemed to be not in favour of notification.

Ms Luthuli said that the problem with home based carers was that they were not supervised.

Ms M Segale-Diswai (ANC) said she wanted to be positive about some of the DoH’s work but she was worried that the information about it might not be disseminated to where it was most needed.

Ms Segale-Diswai asked for clarification on Slide 12 and the reference to TB. She asked why, if the numbers of HIV positive patients were so high, it was said that there was less need to make this a notifiable disease, since she thought this was all the more reason why it should be notifiable.

Ms Segale-Diswai asked why it seemed that the electronic method, as opposed to the manual method, of capturing the data on TB was a problem, as referred to in Slide 20.

Ms Segale-Diswai asked what DoH intended to do about the mushrooming of new nursing colleges. These took advantage of poor people, who may get a qualification that was not accredited.

Ms Segale-Diswai referred to slide 24, and said that there was a problem with District Management Teams around the Occupation Specific Dispensation (OSD), which had not really done what it was intended to do, but had instead created a situation whereby a lower-ranked person was earning more than a higher ranked person.

Ms Segale-Diswai asked how DoH was able to afford the refurbishment of dilapidated buildings and new equipment for the old clinics. Whilst she appreciated the PHC revitalisation programme, she wondered what the approach would be in view of this budget.

Ms M Dube (ANC) asked whether, in relation to the maternal deaths issue, referred to on page 17 of the Strategic Plan, the lack of appropriately trained staff was an identified weakness contributing to this situation. She said that discipline was very important. On the same page there was mention of knowledge management and she asked what was being done about this.

Ms Dube asked, in relation to page 21 of the Strategic Plan, what was being done about accountability and evaluation of hospital Chief Executive Officers (CEOs), after their management training. She also asked, in regard to page 29, how the structure of hospital boards would improve service.

Ms Dube asked for more detail on the implementation of the OSD.

Ms Dube noted the reference on page 42 to project management. This posed a challenge, in that there may be a shortage of human resources to fulfill that objective.

Ms Dube referred to page 44 concerning the overhaul of the health system, and suggested that the amount of litigation was suggesting that money was being lost due to negligence in the health service, and that it actually reflected on the issue of discipline. She asked how this problem would be overcome.

Ms Dube said that the reluctance of many doctors to use information and communication technology (ICT) could pose a threat to an efficient service, since this impacted on the time it took for the service to be completed, as well as impinging on a patient's confidentiality. She wanted to know how the Minister would approach such an obstacle.

Ms Dube questioned whether the disaster management policy, shown in the table on page 90, was a new policy or whether DoH was evaluating an existing policy.

Ms Dube was concerned that the principles of Batho Pele were not being met, that employees were not applying them, and there must be a fresh understanding that these should be applied throughout and as part of their daily work.

Mr M Waters (DA) was pleased to note that there had been a noticeable change in attitude from the previous DoH delegations coming to Parliament.

Mr Waters asked whether, in regard to the improvements in the HIV strategy, there had been provision made in the budget for the additional costs of counselling, since more counsellors would be needed. He was also concerned how the money would be raised for the testing of blood. He asked when there would be a shift to an HIV-prevention strategy since the use of anti-retrovirals (ARVs) became unsustainable in the long term. He said many ARV drugs were awaiting approval and if that were to be speeded up and made available it would bring down these costs.

Mr Waters asked how soon the recruitment and appointment of additional forensic analysts could be expected and whether the funding was readily available to deliver on this target.

Mr Waters said that each province was somewhat unique in the issues being faced with regard to the MDMP, but that other substance abuse such as alcohol was common across provinces. He asked whether any of the amendments or new legislation would address this matter.

Mr Waters asked when the NHI costing would be tabled, to give Members an idea of its sustainability.

Mr Waters indicated his full support for the vaccination programme.

Mr Waters asked whether CEOs of hospitals were equally competent. He commented on slide 27, with regard to patient satisfaction, and said that there would have to be assistance given to those facilities where there were complaints, to assist them to be raised to an acceptable standard. He asked what kind of assistance would be given.

Mr Waters asked for more detail on the location of the five new hospitals and how far patients would have to travel to obtain their medicine, even if this would involve using private pharmacies. There was a report commissioned on this, and he wanted to know the progress with the report.

Mr Waters said that the link between lifestyle and disease must be taken seriously, and MPs should lead the way by living a healthy lifestyle.

Mr M Hoosen (ID) congratulated the DoH on delivery of a good strategic plan, and especially commended the Minister's passion and energy, which he hoped would filter down throughout the system.

Mr Hoosen noted that the health care system was focused on being curative rather than preventative. He said the interventions for violence and injuries, as set out in Slide 5, were not sufficient. More  money should be made available for injuries causing loss of blood, such as stab wounds.

Mr Hoosen said that the patient satisfaction survey should be carried out in all hospitals, not only in the 30% mentioned.

Mr Hoosen queried whether the shortfall set out on Slide 47, which was to be made up by the additional allocation from NT, would cover the vacancies for health care workers as well.

Ms L Makhubele-Mashele (ANC) asked the Minister whether the DoH would be stressing and encouraging a better relationship between patient and nurse, and patient and doctor.

Ms E More (DA), in referring to Slide 27, asked what was being done about patient safety, particularly to ensure that patients did not die before reaching a health facility, as had happened due to the poor ambulance service in some areas.

Ms More asked how the complaints referred to on Slide 28 were being attended to.

Ms  More asked how the DoH could take control of disease when certain areas had problems such as the bucket system, which created conditions for disease to flourish. She said the source of the problem needed to be controlled before the issue of such disease could be addressed.

Ms More asked, in relation to the MDMP, how the increase in demand for cocaine mentioned on Slide 34 would be dealt with, especially in regard to control and seizure at points of entry such as airports.

Mr D Kganare (COPE) asked whether the construction of new facilities using PPPs would benefit the public, and how that could assist the alleviation of poverty. He, however, cautioned about the maximising of profits and the matter of labour broking.

Mr Kganare asked about the intake at the nursing colleges, which was not as visible as it could be, and therefore yielded a low percentage of new intakes. He therefore suggested that other kinds of health professionals could also be trained at these colleges.

Mr Kganare asked whether strategies were in place to assist managers who may not be perceived to be politically connected by the trade unions. This could create unnecessary problems for such managers, affecting their credibility and efficiency.

The Minister replied that the intake at tertiary institutions was also a concern for DoH, and was a point for discussion with the Minister for Higher Education. The colleges would be managed at the provincial level, but came with certain challenges, which were also to be addressed in conjunction with the Minister for Higher Education.

The HIV campaign would also include patients who may need a different kind of help, for instance with regard to conditions such as high blood pressure, and that could include the elderly.

The Minister noted the comment on home-based carers and said that many were being paid by their respective NGOs, which created a problem of accountability and supervision. The Cabinet decision on this point was to be reviewed.

The Minister said that the “mushrooming” of private nursing colleges had unfortunately happened when the State had not met the demand for this kind of nursing training. Nurses who trained at university later had to be trained “at the bedside” but this somehow had created a situation where those nurses entered into the workplace in a higher administrative position, thereby missing the opportunity of gaining the experience so central to good nursing practice. Nursing was a bedside experience, and it was a problem that the basic practical training was lacking in many university-trained nurses.

The Minister reported that in relation to the disciplinary hearing with regard to maternal and peri-natal deaths, a confidential enquiry had been conducted. A number of protocols had been developed and already existed. Those protocols were visible on noticeboards and other suitable places, but were being ignored. He cited an example that was raised in discussions with the MEC for Health in Kwazulu Natal. A baby who was healthy on discharge from the King Edward Hospital, known for its excellent standards, died three days later, because the baby had not passed muconium, which meant that a protocol had been ignored. This was carelessness.  In order to eliminate this kind of mistake, someone had to be made responsible. In the meantime, he reported that the number of midwives and gynaecologists was in decline, because of the issues related to maternal and peri-natal mortality. This was a concern.

The Minister noted that DoH was not reducing or removing Hospital Boards, because these served a very important function. Part of the reason for the huge improvement in the functioning of Baragwanath Hospital was because of the very good work of the Hospital Board. He said his impression had always been that the Hospital Board was the engine room which kept that facility in good running order. However, it was not enough to merely have the Hospital Board; it was also necessary to ensure that each individual serving on it was able to lead by example. He likened it to a school governing body, where the parents may not be highly trained, but that could function well with a good leader.

The Minister noted that the ICT system was crucial to the functioning of a good facility. Without it, patients, as in the past, could collect medicines multiple times without control, and could then sell the excess medicines through a money-making venture. The use of ICT therefore must be encouraged in order to control such practices.

The Minister said that the principles of Batho Pele were widely known by everybody. People in public service were aware and enthusiastic about it but were often tardy in practising it. The Minister said this issue required leadership from the top, and people must set an example, in order to make it successful.

The Minister noted that conditional grants to provinces for HIV were mostly being used for the purchase of ARVs, whereas the national budget was mostly used for the cost of testing. However, it would be sufficient to cope with the demand, because other conditions which previously required blood tests would not be necessary any longer. DoH was aware that there were tests for HIV available over the counter from pharmacies, and stressed that this could be dangerous without an intervention from a health professional, as it posed the risk of negative implications for that patient. In comparison, the State used a thorough, reliable method of testing.

The Minister noted the comment about PPPs and said that an example of good collaboration could be found with the Department of Correctional Services. These partnerships were good but DoH needed to be very careful, because it could become very expensive.

The Minister challenged the Committee to form a club which could meet every day and walk. He said he was glad that a healthy lifestyle was mentioned here, because a successful example would encourage others to follow suit. He noted that in Giyani some 60 year old women had started a soccer club, and in Khayelitsha some older women were walking together in a club.

The Minister would be writing a letter to the Committee and to CEOs stressing the need for them to be at the forefront of campaigns for counselling and testing. They should be the first to voluntarily test for HIV/AIDS. The most important gain from that exercise would be to reduce the stigma, since MPs would be joining the queue along with others coming for the test. The Minister said he had a lot of work ahead for the Committee in this campaign.

Dr Pillay answered further questions. He said that there was much activity around health promotion, but it was not well coordinated. More resources would be needed.

Dr Pillay noted that in regard to the “acting” senior positions, the Minister had appointed a panel to finalise the matter, and this was currently awaiting a decision from Cabinet.

Dr Pillay noted that both chronic disease and the elderly were receiving attention, and the details of the programmes would be forwarded to the Committee.

Dr Pillay expanded on the issue of HIV being a notifiable disease. This had been a debate for several years but over the last 15 years, DoH had not taken a decision on the point. The matter had been raised with the South African National Aids Council (SANAC), where it hopefully would receive broader attention that would lead to a decision being made.

Dr Pillay said that there had been improved case-finding in relation to TB, which enabled more treatments to be undertaken, and therefore decreased the incidence of TB. He said that prophylactics for TB also helped significantly to decrease the co-infection rate.

Dr Pillay noted that an audit was under way in respect of the PHC human resources and equipment, which should identify and help with an understanding of the gaps, in order to determine whether a grant was needed to complement existing facilities. The provinces may have to re-prioritise in this case.

Dr Pillay noted that German Government funding was being used to address the major reasons for avoidable maternal deaths. An intervention was being used whereby a team of retired gynaecologists and midwives would observe and give feedback and recommendations to DoH. This programme was under the supervision of Dr Moodley in Kwazulu Natal.

Dr Pillay said that there would be benefits to including project management skills training in the programme of training for managers, because often the challenges faced by managers were of a technical nature.

Dr Pillay noted that there were three ways in which the costs of ARVs would be reduced: namely by restructuring the tender, by having better task management that would in future enable nurses to diagnose, prescribe and dispense, and by decreasing laboratory costs.

Dr Pillay noted that the appointment of more forensic analysts would be enabled by better managing the existing service. The R140 million allocation was less than what was requested for infrastructure and posts, but the intention was to move fairly quickly to implement this goal.

Dr Pillay said that in regard to substance abuse and regulation of alcohol, the new labelling on bottles would assist with the problem. In collaboration with Dr Charles Parry of the Medical Research Council, other ways were being found to combat this problem.

Dr Pillay noted that a collaboration with Virgin United (an international company and funder) on disease control had been implemented. A Section 21 company was established to collect data from the public. This data would provide guidance to the DoH in effecting better disease control in compromised situations, such as those where the bucket system was still being used. He noted that poverty impacted as one of the key drivers of ill health. In district and sub-districts, good local government Integrated Development Plans (IDPs) ensured better outcomes.

The Chairperson asked how the human resources goals would be achieved, given the size of the budget and the small overall increase.

Ms Nthari Matsau, Deputy Director General: International Relations, DoH, said that the DoH and Department of Health had a sectoral plan in place to deal with injuries arising from motor vehicle accidents. There was also a training programme on home injuries and domestic violence. Another successful programme was in the Northern Cape, where forensic nurses had been trained in sexual assault cases. She wanted to allay the Committee's fear that such substantive programmes would not be abandoned.

The Chairperson said a team from the alcohol industry had engaged with the Committee, acknowledging the problem of alcohol abuse, and indicating their willingness to help and advise the Committee.

Mr Andre Venter, Acting Chief Director and Deputy Chief Financial Officer, said that there were processes under way in terms of the Annual National Health Plan, which would be forwarded to the President by the end of April.

Mr James Cornwall, Acting Deputy Director General: Employment Relations, DoH, said that he was aware of the disparity in the hierarchy as queried by Ms Segwale-Diswai. He said that it needed to be investigated to establish whether this was an isolated case, or whether it was a generic problem with the OSD implementation. He said some audits into the matter had already been completed. There was a sectoral agreement, but it was waiting for the last of the negotiations to be concluded before it could be signed and implemented. The number of posts that were vacant and unfilled would have to be established.

The Chairperson said that the DoH's human resources plan was never tabled to the Committee. He wanted clarity on the OSD budget, with notes on whether the items were a national or provincial budget.

Ms V (Tiny) Rennie, Acting Deputy Director General: Corporate Services, and Chief Financial Officer, DoH, clarified that the OSD budget was a national resource, but the amount requested from NT was less than the amount allocated. The funds would only be released to provinces once the OSD had been finalised.

Ms Rennie noted that DoH was aiming to get full compliance and returns on the PMAs. Where there had not been compliance, the managers would not be considered for performance remuneration. In addition, their names would be forwarded to the Minister for further action.

The Chairperson asked whether the remuneration for health professionals whose skills were in high demand would be reviewed, since these were the professionals who generally left for reasons of better pay.

Dr Carol Marshall, Acting Deputy Director General: Health Planning and Monitoring, DoH, said she was addressing the reports of negligence by staff and how that could lead to litigation. A change was needed, and would come about through leading by example. She said that it was necessary to instil values and ethics from the top, and that there must be accountability, so that actions would lead to consequences. This principle, however, would not only be applied in a negative way, as positive recognition would be given for good deeds.

Dr Marshall noted that the survey on staff satisfaction gave a positive result. However, the complaints from patients gave a different picture. There appeared to be a disconnect between staff satisfaction and patient complaints. An independent agency would be contracted to do the survey. There would be a cost implication. It was a challenge to develop and implement the protocol. International studies showed that this was also a problem experienced elsewhere in the world.

Dr Marshall noted that there were also problems with regard to ambulance services, and the waiting times at hospitals. There were too many unnecessary steps in this process. DoH was committed to mobilising partners to help increase mentoring and working towards better management. Systems for monitoring medical errors were needed, but should be assistance-based rather than punishment-based. This turnaround in approach was far more successful.

The Chairperson commended the presenters on the answers given so far.

The Chairperson noted that ambulance services operating in some rural areas were using vehicles that were not suitable for the roads. DoH could consider changing to heavier vehicles like 4x4s to reduce delays in getting to patients in distress, and thereby reduce litigation costs.

Ms Hela acknowledged the slowness in registrations of new medicines. However, she said that in order to maintain a sound reputation, the processes involved were quite technical and thorough, although she could not, for ethical reasons, give specifics on how the testing and registration process was done. She gave the Committee the assurance that she was giving the matter full attention and would work towards speeding up registration, especially of ARVs. These had already gone through the first stage, and would become available on the market very soon. This would benefit the public because these were cheaper than the present ARVs.

The Chairperson said that many so-called experts or people who had developed medication could be heard on radio. He had a problem with that, as they were held out as being credible. Many desperate people were willing to purchase these remedies.

Mr Waters said that the DA had laid criminal charges against such a person operating in Kwazulu Natal, who claimed that his medicine could cure HIV. He said the police later withdrew the case and he felt stronger action, by way of legislation, was needed to deal with the problem.

The Chairperson asked if Ms Hela could provide a list of such medicines which may already have been tested.

Ms Hela said that complementary medicines were unfortunately not regulated, and the Medicines Control Council (MCC) was looking into ways to strengthen the regulations. She pointed out that anyone with any suspicion about any medicine could report such a matter to the Minister and call for  its evaluation. She said the problem was further complicated by the fact that dispensing to one patient did not constitute a trespass of the law or regulations. The matter would only be followed up if the remedy was being dispensed on a large scale.

Mr Waters said that the provinces had overspent on the OSD, and that Kwazulu Natal was R3.5 billion in overdraft. He asked how much the OSD had contributed to that overdraft.

Mr Waters asked what the role of the Department of Social Development was in relation to assisting with the awareness campaign, including assistance with the budget for this function.

Mr Waters asked whether the MCC would consider putting drugs on the market which had already been properly tested and registered in other countries, thus saving time and money, instead of duplicating the process.

The Chairperson said that he agreed with Mr Waters on the matter of drug testing.

Ms More asked about senior management training, and whether these managers were trained simply for the sake of training and having something on their curriculum vitae, or whether they were serious about implementing their skills to improve hospital management.

The Chairperson said that discussing style of management was very subjective, because individuals with the same medical degree many not approach the management of tasks in the same way. He added that the qualifications of doctors varied, and this too perhaps contributed to the success of management of their hospitals.

Ms More said she was referring to training for hospital management, not for the medical profession.

Ms Luthuli asked if there was a concerted effort by the DoH to solve the high incidence of diarrhoea, and whether inter-sectoral assistance was being pursued.

Ms Luthuli said that producers of alcohol were clearly targeting youth, as some of the drinks were disguised, but had a high alcohol content. She was in favour of the Committee receiving the team of producers from the alcohol industry.

The Chairperson said that he agreed that the Committee should be part of the solution and wanted to remain informed on this kind of substance abuse.

Ms Luthuli said that drugs were expensive, and felt government should produce more generic drugs. If these were produced locally this might require substantial capital outlay initially, but would result in savings over the long term.

Dr Pillay said the OSD did have an effect on the deficit in provinces, and could be brought down by increasing efficiency. This could be done by DoH and NT working together. The bail out to some provinces was quite significant.

The MCC was an independent body and therefore the DoH could not impact on its operations but some cooperation did exist and he would use that to help speed up the change to the regulations.

Dr Pillay said that the hospital management training was costly, but necessary. Of the 400 disaster managers, 140 had already undergone training. Disaster management was province based, not facility based, but over the next three years a sector-specific plan would be put in place for this service.

Dr Pillay conceded that inter-sectoral collaboration on the issue of diarrhoea was a challenge, and was partly due to a constraint in the budget. He said the PMAs would reflect further on understanding this challenge.

Dr Pillay noted that in regard to the production of generic drugs locally, some cooperation between the Department of Trade and Industry, NT and DoH would be required, together with a good knowledge of waste management and technology management. A task team was following up on this.

The Chairperson said assistance must be given to the pharmaceutical manufacturers. Many drugs were still being imported, resulting in a neglecting the development of local manufacturing capacity. He asked whether this made economic sense, and noted that a complaint about it had been made to the Committee.

Other business
The Chairperson noted that the Committee’s report would be adopted on the following Wednesday. Mr Waters asked that the Auditor General's office be invited to the meeting.

The Chairperson read out a letter from HIV Free Generation thanking the Committee for the visit on 4 March.

The Chairperson noted that some Members would be involved in the FIFA Oversight Committee activities, which would impact on their availability over the next few weeks. He wanted members to note the new regulations related to oversight in that regard.

The meeting was adjourned.


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