National Health Insurance Green Paper; Safety and Security in public hospitals: Departmental briefings

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Health

16 August 2011
Chairperson: Dr B Goqwana (ANC)
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Meeting Summary

The Committee received a briefing from the Department of Health on safety and security in public hospitals. The Department had conducted a safety assessment as part of the Core Standards of Health, which had demonstrated significant weaknesses, also proven by a number of incidents where staff or patients had been injured or killed due to poor security. The National Health Council (NHC) had conducted similar studies with the same conclusion. The NHC proposed several interventions. In the short term it would appoint a task team, improve physical security, including installation of closed circuit television, would conduct an audit on the status of facilities and develop an action plan. In the medium term, norms and standards would be developed, contracts enforced, and security officers would be upgraded. For the long term, the NHC aimed to develop a career path for security personnel, and to create new health establishments that were designed to have better safety. Some of the current challenges included lack of playback facilities by the cameras, lack of clocking to ensure regular patrols, and the need for proper fencing and pruning of gardens to ensure clear visibility. Security was generally not seen as part of the healthcare institutions’ core business, and was thus not included in annual performance plans, and no cluster existed for it at provincial level. Au audit of some provinces had revealed particular weaknesses and strengths, and it was decided that the system in KwaZulu Natal, which was operating effectively, would be shared with other provinces, and a security audit would be done, using a standardised approach. Terms of reference would be developed. Members asked about the use of private security companies in public health facilities, and questioned the viability of using private companies as opposed to establishing in-house security. They asked for statistical information on the number of safety incidents in public health facilities, asked whether armed or non-armed guards should be provided, and sought an explanation in regard to the role of police. They also highlighted instances where hospital management was linked to security tenders.  They sought an explanation on the role of police in public health facilities, and insisted that the problem of masterkeys must be addressed. 

The Department then briefed the Committee on the Green Paper on
National Health Insurance (NHI), saying that this would represent an innovative system of healthcare financing, with far reaching consequences to the health of South Africans. The NHI would ensure that everyone had access to health services that were appropriate, efficient and of good quality. The NHI would improve service provision, promote equity and efficiency, and ensure that everyone had access to affordable and quality services, regardless of their socio-economic status. The statistics for coverage by the private and public sector, and their funding, were outlined. It was noted that the public sector was under-resourced, relative to the size of population that it served and the burden of disease. The longer waiting times, and lower clinical consultation times occasioned by shortage of personnel brought risks of error. The current two-tier healthcare system was described as unsustainable, destructive, very costly, highly curative and hospital-centric. The key challenges included the quadruple burden of disease, quality of healthcare provided, the distribution of financial and human resources, high costs of healthcare and the out-of-pocket payments and co-payments. Other challenges were of an administrative nature.

The NHI aimed to provide quality healthcare for all, and to
pool risks and funds so that equity and social solidarity would be achieved through the creation of a single fund. It would try to mobilise and control key financial resources, and to strengthen the under-resourced and strained public sector, so as to improve health systems performance. The first steps towards implementation would be through ten pilot sites in 2012, and these sites would be selected using a number of criteria from the audits. Regulations would be drafted to define levels of hospitals and the appropriate skills requirements to manage hospitals and public health facilities. A Ministerial Task Team would be set up to advise on District Specialist Teams. An audit of Community Health Workers had been completed, and there would be retraining and re-skilling. It was intended to phase in the full system over 15 years.

Members noted that they had a number of questions to ask, but the Chairperson pointed out that this was only an initial briefing, that time was short, and that although questions could be asked now, the Members would have further opportunities to go into the issues in depth. It was agreed that written answers would be provided. Many Members indicated their support for the proposals, but others were dubious about its viability and asked how the
pooling of funds would be administered, why there was resistance in principle, to a two-tiered public health system, and whether dissenting opinions had been noted in the Green Paper. The independence of the Office of Health Standards Compliance was questioned, as well as the costing and what package of services would be provided. The position of the private sector and direct approaches to specialists was also questioned, as well as concerns expressed about how the fund would operate. Another Member pointed out that the public hearings would impact upon the policy and that it would be useful for Members to see comparative studies.  addressing gaps in the health system and in achieving equity in the sector.

Meeting report

Safety and Security in public hospitals: Department of Health Briefing
Ms Malebona Matsoso, Director General, Department of Health, briefed the Committee on safety and security in public health facilities. The Department had conducted a safety assessment as part of the Core Standards for Health. That assessment had demonstrated weaknesses in the safety and security at health facilities. There had been a number of incidents where staff or patients had been injured or killed due to poor security provided in health facilities. In addition to that, Dr Aaron Motsoaledi, Minister of Health, had invited the South African Medical Association (SAMA) to make a presentation to the National Health Council (NHC) on safety and security issues affecting their members. These findings had concurred with the Department’s own audit findings, which led the NHC, after deliberations, to recommend that steps must be taken to address safety and security at public health facilities.
 
The NHC had decided, in the short term, to appoint a task team, to improve physical security, including the installation of closed circuit television (CCTV), to conduct an audit on the status of facilities, and to develop an action plan. In the medium term, the NHC had decided to develop norms and standards, enforce contracts, and upgrade security officers’ positions to appropriate levels. In the long term, the NHC aimed to develop a career path for security personnel, and to create new health establishments that were designed with better safety in mind.

In line with the NHC resolution, a task team had been convened in July 2011, and most provinces were represented on it, except the Western Cape, Limpopo and Gauteng. An external security expert from Passenger Rail Agency of South Africa had been invited to attend. The National Intelligence Agency, South African Police Service (SAPS) and South African National Defence Forces (SANDF) were also part of the task team. A follow up meeting was scheduled for August.

A number of provinces had conducted audits or assessments on safety and security. Mpumalanga had conducted its assessments with a focus on hospitals. KwaZulu Natal (KZN) had conducted a detailed assessment and followed it up with operational plans. The Free State had targeted known hotspots and developed improvement plans based on those hotspots. The North West had focused on certain facilities. The security measures that had been implemented in some provinces were reactive to incidents that had taken place.

One major problem was that the master keys of some institutions were still being held by unknown individuals. CCTV cameras in some institutions were not strategically placed, making it more problematic to provide effective security and safety. In addition, cameras in some facilities only played live footage, with no playback option for later viewing. Often, there were no clocking points to prove that patrols did take place as planned. Proper fencing was required, as well as cutting back of trees and grass to enable a clear view of the premises. Security functions were generally not seen as part of the core business of health institutions, and were not on most Annual Performance Plans. There was no line function or security cluster at provincial level. Some provinces did not have provincial security managers and security officers doing similar work in provinces were appointed at different levels.

However, there were some areas of good practice that had to be commended, and should be shared across all provinces.  KZN had had some success in enforcing service level agreements and imposing penalties for poor performance. Most provinces cited poor contract management and lack of enforcement, when highlighting the problems that affected security in their public health facilities. In other provinces, the reverse was true, and the awarding of contracts was decentralised to district level, with provincial officials not involved in the entire process yet having to supervise the district officials. There was sometimes a lack of skill around safety and security at district level. Contracts were not enforced. Sometimes the security guards were requested to play the role of porters, meaning they had to leave their stations unmanned when responding to such requests, and this then gave rise to other problems. Late payment or non-payment of security guards by service providers also put the security personnel into a vulnerable position, and made them easily susceptible to bribery.

To remedy the security situation, the NHC had decided that the KZN service level agreements and penalty clauses should be shared with all Head of Departments as an example of a good way to deal with security issues. A security audit would be conducted across all provinces, using a standardised approach and methodology. The NHC also decided to use the available provincial reports as a basis to develop a process for systematic and structured security audits directed at national level. The terms of reference for the consultant/s or team to conduct the audit would be developed and the Director General would sign off on these.

Discussion
The Chairperson thanked the Department for its presentation, and noted that the Committee had sought a progress report on safety and security because Members were concerned with the safety of medical staff at public institutions, given the number of incidents of violence at those institutions. There was also a concern that in some cases management in public institutions were involved in some of the security companies who had been awarded the tender to provide security services, and were not keen to replace them when something went wrong. He highlighted a case in Mpumalanga where a doctor had been attacked by a patient, and said that although it was difficult to have security personnel in a consulting room, due to patient / doctor privilege, he maintained that patients should be searched to ensure that they did not take weapons into a consulting room. He asked whether the use of private security companies in health facilities was necessary, and whether or not this could not be done internally.

Ms Matsoso responded that there was a need to look at the cost of outsourcing security against having the capacity to do this internally. The Department of Labour had called for the ending of outsourcing of provision of security. However, this issue was still being debated at Cabinet. 

Mr M Hoosen (ID) asked whether there were statistics available around incidents of violence in public health facilities.

Dr Itumeleng Funani, Technical Advisor, Office of the Director General, Department of Health replied that because that the task team had only held an initial meeting, and was yet to interrogate provinces on their statistics, the answer could not be given. However, these questions would be asked of the provinces, and statistics would be garnered as the task team conducted deeper investigations on safety and security.

Ms M Segale-Diswai (ANC) commented that the briefing on security was long overdue. She asked whether the security measures mentioned in the briefing would cover the clinics as well as major hospitals. She pointed out that n some cases there were aged security guards put to guarding public health facilities, and asked how this could be addressed. She wanted to see a pricing comparison for armed security as opposed to unarmed security companies. She also sought clarity as to which health facilities were focused upon by the North West Province.
 
Ms Matsoso replied that it was clear from the NHC report that all provinces needed to comply with safety and security standards, to reach uniform security levels in public health facilities. The norms and standards agreed to would ensure that security was provided to both patients and staff in public health facilities. Where construction was taking place at public health facilities, there was little delineation between security personnel and construction workers. The Department was of the view that public health facilities needed to have the capacity to manage private security company contracts.

Dr Funani replied that safety and security at clinics or primary healthcare facilities was a weakness that the Department had also identified. In some provinces, such as Mpumalanga and the North West, safety and security was only addressed at a hospital level, and that was problematic. Safety and security at primary healthcare facilities needed to be strengthened, and would be tackled in the assessment as the task team progressed with its work. The task team was also looking into the rotation of security guards, in order to prevent stagnation and ineffective provision of security. He further explained that the type of contracts entered into with the security companies would be geared to the nature of the threat, when determining whether armed or unarmed security personnel should be deployed.
 
Ms E More (DA) asked how the Department was going to maintain the functioning of CCTV equipment at health facilities, pointing out that this was costly. The issue of master keys needed to be addressed, as it was critical to addressing security. She asked if it would not be prudent for the Department to adopt a uniform approach to the use of security companies by public health institutions. She asked whether it was cheaper to outsource security. or to have an in-house security team for public health institutions. She wondered if the public hospitals were to blame for not paying security companies timeously. She also commented that it would be useful to add tracking mechanisms to hospital equipment, to stop theft.

Ms Matsoso responded that there was a need to look at the cost of outsourcing the provision of security against having internal capacity to provide security. She reiterated that the Department of Labour had called for the ending of outsourcing.

Mr D Kganare (COPE) suggested there was a need to assess whether it was more productive to have armed or unarmed security guards.

Dr Funani added that the issue of CCTV management was dependent on the budget, and whether it would be possible to extend those to include CCTV as an essential, not optional, item.

The Chairperson agreed that it was important to secure health equipment so as to prevent accidental use of needles or wrong medication.

Ms T Kenye (ANC) asked whether there were timeframes for the implementation of the task team’s short term measures to address security in public health institutions. She asked whether there were skills development programmes relating to security provision at public health institutions. She also asked why there was a lack of security managers at certain public health institutions. She asked what measures were in place to establish who was in possession of master keys of certain public health institutions.

Ms Matsoso responded that the Department recognised that it could not divorce management issues from the security issues that affected public health facilities. The Department welcomed the comments and suggestions on management and how to address these issues.

Dr Funani replied that the task team had to submit a report to the Minister of Health by the end of November 2011. There were clear indicators for each aspect of the assessment to take place, to assist with reaching the time targets.

The Chairperson said that part of the responsibility of security personnel at hospitals included preventing the theft of hospital equipment and medication. Some security officers colluded with people who stole drugs from hospitals, and that was another problem for the Department to consider as it went forward in its work. 

Ms Matsoso responded that she was aware of such cases or incidents where the management was in cahoots with security companies.

Mr Kganare commented that the Committee was digressing from the main issue, which was the security of patients and hospital staff.

The Chairperson commented that the Committee needed more information from the Department, and Members should ask as many questions as they wanted, and these could address a broad scope, because Members would need to feed back the information to the communities they represented.

Mr Kganare thought that private security companies had to be included in any assessment of public safety and security at public health institutions. In some cases, private companies underpaid their staff and a strike would result, which again had a negative effect on safety and security. If CCTV technology was to be broadly introduced in public health institutions, then technicians would be needed to monitor the equipment. He suggested that better use be made of the Sector Education Training Authorities (SETAs), who could assist in providing such technicians.

Mr G Lekgetho (ANC) noted that this presentation had not mentioned police involvement, and  that may be helpful in addressing safety and security issues.

Ms Matsoso replied that a policy decision would need to be taken whether to involve private security companies in public health facilities. The Security Cluster had made it clear that it was not possible for the police to be available, on a fulltime basis, to provide security in hospitals.

Dr Funani responded that the Department had taken note of the concerns raised by members over the lack of involvement of the police. South African Police Services (SAPS) were part of the discussions, at a task team level, and the Department would be guided by their opinions. Certain functions in the provision of security could not be carried out by security guards and police involvement may be needed.
 
Ms M Dube (ANC) commented that the provinces that had not participated in the task team review needed to provide reasons for their failure to do so. She asked whether there were policies to replace security personnel who arrived at work drunk.

Ms Matsoso replied that, in line with the KZN model, fines would be imposed on guards who were drunk, and further punitive measures would be pursued. Dismissal was the ultimate measure, should there be repetitive disorderly conduct.

Ms B Ngcobo (ANC) asked who was responsible for creating career pathing for provision of security in public health institutions. She asked whether the Department of Health had a statistical record of incidents relating to safety and security in public health institutions. She asked whether the Department conducted forensic audits of security companies to assess their ability to provide security. She asked how medicine could be stolen from hospitals if there was effective security in those hospitals. She also asked to what extent the Department could safeguard the security of clinic personnel working after hours.
 
Ms Matsoso replied that the Department was in the process of conducting audits on 4 210 public health facilities, and by the end of July, the audit on 876 had been completed. At an appropriate time the Department would brief the Committee on the outcome of those audits.

Dr Funani said that career pathing was mainly addressed at the public level by management, but once a formal decision had been taken on whether to outsource or use in-house security, more could be done to ensure that career pathing was taken up seriously. Due to the fact that the task team had only held an initial meeting, and was yet to interrogate provinces on statistics, including whether there had been a decline in incidents, it could not yet comment in depth.

Ms H Msweli (IFP) commented that more needed to be done to prevent the theft of drugs from hospitals, and agreed that CCTV technology would be a key way in preventing that theft.

The Chairperson said that the Committee had held an oversight visit to Limpopo, where it had assessed security, and had been generally satisfied with what it had seen. People in communities with clinics should take responsibility for looking after the well-being of those clinics, as they benefited their community.

Ms Segale-Diswai asked what was meant by “hotspots”.

Ms Matsoso replied that hotspots were areas where incidents of violence at public health facilities were high.

Ms Kenye recommended that audits and assessments be done in rural areas as well.

Ms Matsoso replied that the audits would incorporate rural areas. 

National Health Insurance: Department of Health (DOH) briefing
Ms Matsoso and Dr Yogan Pillay, Chief Director: Strategic Planning, Department of Health, briefed the Committee on the main highlights of the recently released Green Paper on the proposed National Health Insurance (NHI).

They noted that the
NHI represented the introduction of an innovative system of healthcare financing, which would have far reaching consequences on the health of South Africans. It would ensure that everyone had access to health services that were appropriate, efficient and of good quality. The NHI would improve service provision, and would promote equity and efficiency, to ensure that all South Africans had access to affordable, quality healthcare services, regardless of their socio-economic status.

The South African health system in its current form was inequitable, with only the privileged few having disproportionate access to health services. The current system was two-tiered, with a private health insurance sector for those who could afford it, and a public sector system for those who could not. The private sector covered 16.2% of the population, with a relatively large proportion of funding allocated through medical schemes, various hospital care plans and out-of-pocket payments. The private sector provided cover to private patients who had purchased a benefit option with a scheme of their choice, or who were covered as part of their employment conditions. People were subsidised by their employers in both the State and the private sector. The public sector covered 84% of the population, and was funded through the fiscus. It was often plagued by poor management systems and oversight, especially in hospitals. The public sector was under-resourced relative to the size of the population that it served, and the burden of disease. There were less human resources than in the private sector, leading to longer waiting times and lower clinical consultation times, which increased the risk of error.

Four key interventions needed to happen simultaneously to successfully implement a healthcare financing mechanism that covered the whole population, such as the NHI. There needed to be a complete transformation of healthcare service provision and delivery. The entire healthcare system would have to be totally overhauled. There must be radical change of administration and management. Finally, there should be provision of a comprehensive package of care, underpinned by a re-engineered Primary Health Care.

South Africa’s two-tier healthcare system was unsustainable, destructive
, very costly, highly curative and hospital-centric. The key challenges in the South African health sector were the quadruple burden of disease, the quality of healthcare provided, the distribution of financial and human resources, the high costs of healthcare, and the out-of-pocket payments and co-payments. The public health sector also faced other challenges, including cleanliness, safety and security of staff and patients, long waiting times, staff attitudes, infection control and drug stock-outs. Meantime, the cost of private healthcare was out of control, at the expense of members of medical schemes, and the cost of public healthcare was escalating at the expense of the fiscus.

The public sector costs were driven by the compensation of employees, pharmaceuticals, laboratory services, blood and blood products and equipment. A number of medical schemes in the private sector had collapsed, had been placed under curatorship or had merged. Schemes had reduced in number, from over 180 in 2001, to about 102 in 2009. To sustain their financial viability, schemes tended to increase premiums at rates higher than the Consumer Price Index. 

The NHI would aim to provide improved access to quality health services for all South Africans irrespective of whether they were employed or not. It aimed to pool risks and funds so that equity and social solidarity would be achieved through the creation of a single fund. It would procure services on behalf of the entire population, and would efficiently mobilise and control key financial resources, and strengthen the under-resourced and strained public sector so as to improve health systems performance.

The socio-economic benefits would include an increased output. A healthy person worked more effectively and efficiently, and could devote more time to productive activities. There would be a broader knowledge base in the economy, and the gains to education would increase as life expectancy increased. This in turn would increase work life and savings, as a result of increased life expectancy, which may result in earning and saving more for retirement.

The NHI would cover all South Africans and legal permanent residents. Short-term residents, foreign students and tourists would have to obtain compulsory travel insurance, and produce evidence of this upon entry into South Africa. Refugees and asylum seekers would be covered in line with provisions of the Refugees Act, 1998 and International Human Rights Instruments ratified by the State.

Primary healthcare services would be delivered according to the following three streams:

-
District-based clinical specialist support teams, supporting delivery of priority health care programmes at a district
-
School-based Primary Health Care services
-
Municipal Ward-based Primary Health Care Agents

The healthcare benefits emanating from the NHI would be prevention, promotion, curative, and community outreach, and there would thus be community-based services as well as school-based services. In-patient and outpatient hospital care would be provided for, including specialist and rehabilitation services. Prescription drugs, emergency care, mental health services, oral health services, basic vision care and vision correction would be further benefits of the policy.

As part of the overhaul of the health system and improvement of its management, hospitals in South Africa would be re-designated, so that they would fall into categories of district, regional, tertiary, central or specialised hospitals. Each level of hospital designation would be managed at a newly defined level with appropriate qualifications and skills as defined by the National Health Council.

A d
raft Bill on Office of Health Standards Compliance (OHSC) would soon be tabled in Parliament. This aimed to establish an independent OHSC, which would have three units dealing with inspection, an ombudsperson, and the certification of health facilities. The District Health Authority would be given the responsibility of contracting with the NHI. This Authority would be supported by the NHI Fund’s sub-national offices, to manage the various contracts with accredited providers, and would also monitor the performance of contracted providers within a district.

The NHI’s principal funding would come from a combination of sources, including the national fiscus, employers and individuals. The NHI revenue base would be as broad as possible, in order to achieve the lowest contribution rates and generate sufficient funds to supplement the general tax allocation to NHI. Private medical schemes would continue to exist side by side with the NHI, and they may also provide top up cover. No one would be allowed to opt-out of the NHI.
 
The first steps towards implementation of National Health Insurance in 2012 would be to run pilot schemes, when ten districts would be selected for piloting. The Department of Health would conduct audits of all healthcare facilities. Criteria for the choice of these ten districts would be set from the results of the audits, as well as the demographic profiles and key health indicators. The selection of the ten districts would be based on the several factors, including health profiles and demographics, the health delivery performance, management of health institutions, income levels and social determinants of health and compliance by institutions with quality standards.

Regulations would be drafted to define levels of hospitals and the appropriate skills requirements to manage hospitals / public health facilities. A Ministerial Task Team would be set up to advise on District Specialist Teams, led by the Chairperson of the Confidential Inquiries into maternal, neonatal and deaths of under-five year olds. An audit of Community Health Workers had been completed, and retraining and re-skilling would be undertaken.

In 2010 there were 150 509 registered health professionals in South Africa. These numbers had remained static between about 1996 and 2008, when there was also a decline in key categories such as specialist and specialist nurses. There was inequity, between rural and urban areas, in the ratio of health professionals to each 10 000 people. The ratios also differed between public and private sectors. There were various ways to assess the “shortage” of health professionals. The counting of vacancies in the public sector was neither an accurate nor realistic indication. It would cost billions to fill the public sector vacancies that existed at present. Instead, s
taffing requirements should be based on service plans informed by norms and needs. It was evident that South Africa had a nurse based health care system, as 80% of health professionals were nurses. South Africa had considerably less doctors, pharmacists and oral health practitioners (and other health professional categories) per 10 000 people than other comparable countries.
 
District and provincial profiles had been developed, with districts ranked from best to worst-performing  over the 26 selected indicators. A score of between 1 (the best performing) and 52 (worst performing) was allocated. Where districts had the same value, the same score was given, resulting in the last value actually being reflected as lower than 52. The attached presentation showed districts with the lowest scores as performing well, and those with the highest scores as performing poorly.

It was reported that the
NHI would be phased-in over a period of 15 years. This would include piloting and strengthening the health system in the following areas:
-Management of health facilities and health districts
-
Quality improvement
-
Infrastructure development
-
Medical devices, including equipment
-
Human Resources planning, development and management
-
Information management and systems support
-
Establishment of the National Health Insurance Fund

Discussion
The Chairperson said that because this briefing by the Department was an initial report back on the Green Paper on the NHI, Members should comment, but not ask questions, as there would opportunity for that at a later date.

Mr M Waters (DA) said that he had lots of questions to ask.

The Chairperson said that there would be a platform for questions to be asked at a later date, but stressed again that this briefing was an initial engagement.

Mr Waters disputed that assertion, and said that it was normal procedure to ask questions after a presentation.

Ms C Dudley (ACDP) said that the Committee should be permitted to ask questions of the Department.

Mr Hoosen asked the Chairperson why he was restricting the questioning of the Department.

The Chairperson responded that the Committee was running out of time and again said that the briefing was an initial one, with plenty of room for comment and questions allowed at a later stage. He proposed that he and the Director General should decide which questions the Department could respond to on the day, and which would be responded to in writing by the Department.

Mr Waters raised a point of order, and said that the Chairperson had no right to arbitrarily decide which questions could be answered and which would not. The questions he would ask had nothing to do with the Chairperson. He expressed his view that an open debate on the NHI was necessary.

The Chairperson said that it was his duty to guide the Committee with a view to time constraints; he was not trying to impose his will on the Committee or muzzle debate.  

Ms Kenye shared Ms Dudley’s view.

Ms Segale-Diswai said that the Committee should be permitted to ask clarity seeking questions.

The Committee agreed to ask questions of the Department with the possibility of getting answers from the Department in written form at a later date.

Mr Waters asked what criteria the Department would use in delineating the different hospital districts under the NHI pilot project. He asked why the Department had removed the media review from its website, and enquired if the Department was opposed to debate on the NHI.  He asked whether the OHSC would be independent from the Department, since it would be appointed by the Minister. He commented that there was no definitive way of assessing the costing for the NHI, but the Department should present what package of services would be provided in the NHI. He asked why the Department was opposed to a multi-tiered system. He asked whether there had been opposing views to the NHI recorded in the Green Paper. He asked what methodology was used when the costing for the NHI was done, and whether private costing was taken into consideration. He sought clarity on whether there would be a restriction on the quantity of services the private sector could provide when the NHI came into full operation. He asked how the centralised fund operated by the State would function, and whether there would not be a conflict of interest if it reported to the Department of Health.

The Chairperson commented that people should not become paranoid when addressing the issue of the NHI. This was a policy that was initiated principally in order to provide healthcare to the majority of the country. The NHI was not cut and dried, and there would be further opportunity to comment and debate the policy.

Ms Dudley asked how the reality of the United Kingdom’s healthcare system had impacted upon the Department’s thinking on the NHI. She commented that direct access to specialists would be difficult, and sought an explanation on how the Department would approach that.

Mr Kganare commented that the NHI was an emotive topic, because universal coverage was the basis for the policy. Some people were opposed to the NHI simply as a matter of ideology, based on their class origins. He supported the NHI because he represented the working class. When people quoted authority-based on comparative studies they disadvantaged their fellow members, because not everyone was privy to those comparisons. Public hearings on the NHI were yet to be held and these would be important in developing the policy. 

The Chairperson suggested that the Committee researchers should put together all comparative studies, to assist members in deliberating on the NHI.

Ms Dube agreed with Mr Kganare that certain people represented a particular group and were personalising the NHI debate, which she thought they should not do.

The Chairperson commented that the NHI was a broader issue and the health sector currently was not sustainable.
 
Ms Kenye expressed her satisfaction that the NHI had been presented to the Committee. She sought clarity on the pooling of funds and the revenue stream, and how it would be administered. 

The Chairperson said that in the two and a half years he had been in Parliament, the NHI debate had been the most interesting debate in which he had participated.

Ms Segale-Diswai also thanked the Department for its briefing and said that the NHI was a very important policy, which would bridge a large gap. 

The Chairperson said that another date would be set aside for the Committee to discuss the NHI. He asked the Department to respond to the questions asked in writing. He pointed out that there were still severe disparities in South Africa, seventeen years after democracy. The NHI would be vital in addressing gaps in the health system and in achieving equity in the sector.

The meeting was adjourned.



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