The Chairperson tabled the Committee’s draft Budgetary Review and Recommendation Report (the Report) for the Department of Health (the Department), and highlighted that health was a concurrent function, for although policy was developed at national level, most of the work was done at provincial level.
Members cited some matters that should be included in the Report, and also discussed the recommendations that the Committee wished to make. They wondered why, in this year, the Department had not appeared before the Standing Committee on Public Accounts (SCOPA), but agreed that comments from the Auditor-General’s report should be included. It was agreed that where questions had not been answered by the Department, this should be noted, as well as the fact that some stakeholders had complained of lack of budget, but the Chairperson noted that the Committee could not tell the Department how much budget it should give to the entities. Members felt that the failure to address certain issues linked directly to Millennium Development Goals, in particular maternal and child mortality, should be included, as well as references to Forensic Chemistry Laboratory, and the demographic and health survey, which had not been done. The reports on HIV/AIDS and malaria were also not included, nor were comments about nepotism and corruption. Another recommendation must be inserted in relation to equipment shortages and poor quality of procurement, and the issues of maintenance, and appointment of staff were further matters on which the Committee should comment. A Member suggested that norms and standards must be developed as a matter of urgency by National Government, to try to achieve standardisation of services at provincial level, and to ensure that community service workers were not working without oversight, which could lead to litigation. Timelines should be attached, and it was recommended that this be the end of the financial year. Members noted that improvements were needed in every programme. They recommended that the Department must brief the Committee every six months, and address outstanding issues from the previous year, as well as the patient satisfaction survey. More emphasis must also be placed on spending on infrastructure.
Health Budgetary Review and Recommendation Report (BRRR) 2010/2011
The Chairperson thanked the entire Secretariat for the compilation of the Budgetary Review and Recommendation Report (BRRR or the Report) on the Department of Health (DOH or the Department) in a short period of time. He noted that certain parts of the report may appear to be repetitive, but this was due to the prescribed format and certain matters that were repeated at every level. He outlined that the first part of the report consisted of introductions and a statement of how the BRRR slotted together. The second part of the report set out the strategies and priorities of the Department. This was followed by the analysis and budget, followed by the analysis of section 32 and the Annual Report. Human Resources, such as staff shortages, and the Auditor-General’s (AG) Report, finances and infrastructure were also highlighted. There was no report from the Standing Committee on Public Accounts (SCOPA) in respect o the Department for this year. Finally, the Financial and Fiscal Commission’s remarks, and recommendations were highlighted, as also the fact finding by the Committee, which included observations; conclusions and recommendations.
The Chairperson said that the Report would have to be amended or adjusted in certain areas. The Committee had to make recommendations and it should be clearly understood that Health was a concurrent function. The Department of Health was a national department but most of the work was done at provincial level, which made it slightly different from other departments.
Ms R Motsepe (ANC) asked for clarity on the acronyms DBT and PMCT, which she thought were not user-friendly.
The Chairperson explained that the acronyms would be explained at the beginning or the end of the Report in a glossary.
Ms M Segale-Diswai (ANC) asked for clarity on the reference to “Diphtheria Polio Tetanus (DPT3) to measles 1” vaccine, set out under the section dealing with Programme 2. She said that DPT3 and measles were two different things.
The Committee Secretary offered to check this from the documentation.
The Chairperson explained that the Department of Health was undertaking the measles vaccine and simultaneously had to continue with the DPT3. There were five districts that did not have the DPT3 vaccines, but they did have vaccines for measles.
Mr M Waters (DA) asked if the Department had given any replies to questions posed to it, and, where this had not been done, said that should be noted in the Report.
The Chairperson agreed with Mr Waters.
Ms E More (DA) asked if the Committee should include a statement that the Committee had not met with the DOH entities.
The Chairperson replied that the Committee should clarify why it would need to include entities. There were three entities in question – the Council for Medical Aid Schemes, Medical Research Council (MRC) and National Health Laboratory Services (NHLS). These entities were all making their own money, except for the MRC which was mainly funded by donors. There could be an argument made out for including the MRC, on the basis that it needed to be given extra funding.
Ms More explained that she was referring to entities that received government funding. There had been debates in the past around the low funding given to some entities that had accessed funding from private donors.
Ms Segale-Diswai asked for clarity on the requirements for dealing with BRRR, as she thought that the Report had been handled differently in the previous year.
The Chairperson explained that the recommendations made in the BRRR would not deal with the policies, although they might influence the next budget of the Department of Health.
Ms More asked for a recommendation to be placed in the Report to deal with the fact that stakeholders appearing before the Committee had complained of a lack of funding, and to some extent the Committee sympathised with them.
The Chairperson said that the Committee could place a recommendation in the Report to increase the budget to entities. However, this would not affect the BRRR directly. The Committee also could not make specific requests with regard to the budget.
Ms C Dube (ANC) asked who made the decisions about the amount of funding that entities would receive, and if it was not influenced by politicians.
The Chairperson said that the Department presented programmes and plans, with a budget, to the Committee. The Committee voted on this budget as a whole. However, it did not dictate to the Department how much funding it should give to the entities. The Committee’s role was one of oversight and it could make recommendations, based on the history of spending in other entities, on where to increase the funding, as well as on priorities set out in the State of the Nation Address.
Mr Waters said that his understanding was that the Committee was dealing with the Annual Report and money that was underspent had to be returned to the National Treasury. The Committee had no power to move money around.
The Chairperson replied that the Committee could make recommendations, via Parliament, in respect of the BRRR.
Mr Waters asked if the Committee could, for instance, say in the Report that investigations into maternal mortality needed more money, because the country was failing to meet the Millennium Development Goals (MDG).
The Chairperson said that the Committee could not change policies but that it could influence the budget by making recommendations. The Minister formulated the policies.
Mr Waters asked if comment could be included on measurable objectives which had not been reached from the previous year.
Ms Segale-Diswai said that if the same components appeared in the Annual Report and other reports she would not have a problem with it.
The Chairperson said that Members should compare like with like. He noted the concerns of Mr Waters. The Department had changed around some programmes.
Mr Waters noted that the references to the Forensic Chemistry Laboratory, which had been mentioned in the Annual Report, was missing from the section on Programme 2, and reference to the demographic and health survey were also missing from Programme 3. There had been no improvement in the programme, and this should be noted.
The Chairperson agreed that it could be added. He added that the Report stated that the survey had not been conducted due to budgetary constraints. He asked what was meant by “no national adverse reporting system was in place”.
Mr Waters replied that patients could report nurses who did not wash their hands, or could report problems such as incubators are not working. This was a form of accountability in the system, which had not been implemented.
Mr Waters asked why the Department had not appeared before SCOPA, pointing out that it had to appear before SCOPA in the previous year.
The Chairperson replied that he was not sure why the Department had not appeared before SCOPA.
Ms Segale-Diswai said that the Department had appeared before SCOPA the previous year, and asked where were the recommendations were. There were still outstanding matters even if it was not discussed.
The Chairperson suggested that the Committee should check the last Report for recommendations.
Mr Waters asked why the MDGs were not included, such as child mortality, pointing out that meeting those goals was vitally important for the Department. The reports on HIV/AIDS and malaria were also not included.
The Chairperson asked if this was a comparison between the AG’s report of last year and this year.
Mr Waters replied that it was, but some points may be under the recommendations.
Ms Segale-Diswai asked where the reference to the asset register appeared. She noted that the infrastructure findings were omitted.
Mr Waters replied that that would be listed in the AG’s report.
The Chairperson noted that there was nothing on corruption and nepotism in the Report.
Ms More recommended that something should also be included about equipment shortages and the quality of procurement. The issue of maintenance also had to be addressed. The long process of appointing staff, and human resource shortages, must be included as well.
Mr Waters recommended that norms and standards must be developed as a matter of urgency by National Government. There were no norms and standards and as a result provinces allocated money as they wished. The imposition of standard procedures would ensure that provinces accessed the same amount of money with no disparities in service.
Ms Segale-Diswai asked if only the negative aspects of the Committee’s oversight visit would be highlighted. She asked if the positive aspects would be highlighted, noting that there had been some progress in the
The Chairperson replied that there were good aspects, but that the Committee was still in the process of analysing the report and could say something positive at the end of it.
Ms More asked if the issue of doctors and community service workers would be addressed. Community service workers were working without oversight. This could become a litigation issue. This would impact on the budget if something went wrong.
The Chairperson agreed with Ms More and noted that it had to be established whether the Department had received a qualified audit.
Ms More noted that the Department needed improvement in most programmes.
The Chairperson said that the Department had to find a strategy that would help the provinces to work together with the National Department.
Mr Waters suggested that the Report should include a statement that there were no norms and standards across the country, and that timelines should be put in place for this to be implemented. The deadline should be the end of the financial year. There had been increased underspending in every programme, and this should be noted as of concern to the Committee.
Ms More said that the Committee would need further to talk about a draft policy.
Mr Waters said that the Acting Director General (DG) had developed guidelines about the appointment of Chief Executive Officers and how to improve audit qualifications. The Department needed to brief the Committee every six months. Members had not still received any documents from the previous year. Women and children were dying unnecessarily and the patient satisfaction survey was meant to be done every four months. These objectives had not been achieved.
Ms Segale-Diswai noted that there was underspending and that more emphasis should be placed on infrastructure. She recommended interaction with the Department of Public Works and said that an action plan should be developed.
Ms Dube suggested that Mr Waters should list all his recommendations and send them through to the secretariat for inclusion in the Report.
The Chairperson agreed that the Department should appear before the Committee every six months. The onus was on the Committee to ask the Department to appear.
The Report was adopted, with amendments and additions.
The meeting was adjourned.
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