Budget Hearings: Department of Health

Meeting report

HEALTH PORTFOLIO COMMITTEE
30 April 2002
BUDGET HEARINGS: DEPARTMENT OF HEALTH

Chairperson: Mr James Ngculu (ANC)

Documents handed out:
Achievements and Budget Priorities 2002/3
Expenditure per Sub-programme 2001/2
HIV/AIDS Conditional Grants 2001/2

SUMMARY
The Department of Health continued their presentation on their achievements and budget priorities. They began with their ten-point plan for the years 1999 - 2004. This plan covers the improvement of resource mobilisation, dealing primarily with the strategy on utilising PPP's and how exactly this was going to be done. It covers the improvement of human resource development and management, the gender issue arose as a problem for the Department of Health. Furthermore, it deals with the re-organisation of certain support services, legislative reform, with improving communication and consultation within the health system and with strengthening co-operation with partners internationally.

In their questions Members raised the issue of the use of PPP's, the cutting of funding to tertiary institutions, the registration of births and finally, the establishment of a tele-media network.

MINUTES
The Department presented their budget and priorities for 2002/3, beginning with point five of their ten-point plan for the years 1999-2004. Each point was discussed in detail. Point five deals with the improvement of resource mobilisation dealt primarily with the strategy on utilising PPP's and how exactly this was going to be done. On point six, the improvement of human resource development and management, the gender issue arose as being a problem for the Department of Health. Point seven deals with the re-organisation of certain support services, point eight with legislative reform, point nine with improving communication and consultation within the health system. Point ten deals with strengthening co-operation with partners internationally.

Discussion
Dr E Jassat (ANC) asked what would happen now that the Department of Health has taken over the mortuaries from the South African Police Services. He also asked about the sixteen-day campaign of no violence against women and whether or not it was successful.

With regard to the mortuaries, the Department of Health stated that nothing much will change, the staff will merely be transferred across to them.

The 16-day campaign was a joint effort by a few Departments. Last years campaign was not as successful but they have learnt from their mistakes, will try to correct errors and maybe even have a whole month campaign.

Dr O Baloyi (ANC) was concerned about whether or not the Department could effectively map the impact of HIV/AIDS holistically and not just concentrate on its immediate effect. He brought up various factors that would affect such an impact assessment. They are the following: the issue of safety and protection of health professionals, the decreasing number of new entrants into the health services, and its effect on more complicated diseases. Such issues should be recognised as being a part of the impact of HIV/AIDS and wanted to know whether the Department is planning to focus on such issues.

The Department responded that the impact of HIV/AIDS not only affects the health-service. In light of this, there have been inter-departmental Committees involving Health, Social Welfare and Education that have worked on the AIDS question and the problems it poses. They stated that the study they have carried out is complete and that it is meant to cover every aspect of HIV/AIDS on both individuals and families.

Dr SC Cwele (ANC) asked how much is being spent on the tele-medicine campaign and whether the Department has adequate funds available for this.

The Department's answer was that the first government tender for the tele-medicine campaign cost R12 million and that this included training. They were not however quite satisfied with the training given. With regards to the second tender, they stated that the cost must be looked at in relation to the opportunity costs, which would be missed out on, if they did not install this technology. Such a programme would save money on transport costs since it provides access to medicine for those people who live in remote areas. With regard to the satellite stations at universities, the expense would not be that great since the proposed satellite stations already have many of the facilities required. Such a program will also be of immense benefit to universities, students and health-practitioners. The prices of the required technology have also dropped. When the project first began, a hub cost R700 000. Today, a new one costs R 200 000. Although it will cost money, there are huge benefits to be gained through such a campaign.

Dr Cwele asked about the public/private partnership and their proposed vaccine production programme. He asked whether it was a general public private partnership (PPP) or whether it was vaccine specific.

The response was that the PPP will start off with an incremental process involving labelling, packing, filling and production. This will take a while and there is a great deal of work to be done.

Dr Cwele asked if the Department of Health was sending out any guidelines to the hospitals on what they should do when returning terminally ill patients home. He stated that often such patients were under the impression that once they left the hospital they were unable to return.
The Health Department stated that they do have guidelines and that every effort is made to ensure that people are trained on these guidelines. They did however state that the pace of covering the whole country is very slow and so the guidelines have not reached everyone.

Dr I Chachalia (ANC) expressed concern that funding to secondary and tertiary level services was being decreased. He believed that this would ultimately filter down to levels of primary health and so have a negative effect on this area. Important services offered these tertiary institutions offer are of benefit to the public sector who need the expertise offered by such institutions.

The Department of Health stated that they want to ensure that there will be adequate funding in the area of primary health care. However, they recognise that the whole health system must be integrated and seen as a whole and as such, the tertiary institutions will not be ignored.

Dr A N Luthuli (ANC) highlighted the problem of registration of births and wanted to know how the Department goes about ensuring that children are registered.

The Health Department stated that before 1994/95, births could only be registered at Home Affairs and at hospitals. This has changed and now births can be registered anywhere. Since this change, registration of births has increased by 60%. They have, however, still experienced problems especially in the Eastern Cape where mothers cannot get their children registered because they themselves have not yet registered. They also raised the possibility that some people are still unaware of this change in the registration procedure.

Dr Essop Jassat asked a question about the usefulness of establishing an ethics council to monitor research. Research is normally done through an institution of some kind and these institutions, in order to maintain their integrity, impose their own ethical guidelines on potential research projects.

The response of the Department of Health was that different institutions have their own ethical guidelines and as such there is no conformity. Thus there needed to be a centralised ethics committee.

Dr Baloyi then commented on the strategy around PPP's. He was wondering why, if primary health care was going to be the focus of the Department of Health, they had not entered into PPP's with the low level general practitioner. He suggested that this could be because the health services are driven by people from the academic field and such persons were in a better position to check in with PPP's at this level, but that no attempt was being made to check in at a lower level.

The Department of Health responded that PPP's have been initiated at a primary health care level. The problem is purely one of perception. Work at the primary health care level does not attract much attention unless it deals with HIV/AIDS. There are many PPPs with NGO's and other bodies especially around diseases such as TB. These bodies however work on the quiet and as such not much is heard about them.

Dr Baloyi questioned the process of communication between the Department and themselves. He was interested to know if a relationship between the two even existed. Could the Department communicate and formulate the end product in such a way that the Legislature could understand and evaluate it.

The response of the Department of Health was that they do communicate on a mass basis. They have a Management Health Brief, which would be useful to Members of the Legislature, and they also have a web-site which they update regularly. This information, although useful, is not confidential and so problems of individualised information needs to be worked out between the Chairperson and the Department.

The meeting was adjourned.