Provincial Budget Hearings: Limpopo and Eastern Cape

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Health

13 May 2002
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Meeting Summary

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Meeting report

HEALTH PORTFOLIO COMMITTEE
14 May 2002
PROVINCIAL BUDGET HEARINGS: LIMPOPO AND EASTERN CAPE

Documents handed out:
Limpopo Province
The following documents are awaited.
Eastern Cape
Northern Cape Province
Presentation by National Treasury

Chairperson: Mr L.V. Ngculu (ANC)

SUMMARY
The Committee was concerned about the meagre budgetary allocations made to Provincial Health Departments. The result of this under-funding was manifested in the rapidly declining health care services in the country.

The Committee noted that the Department of education carried received 44% whilst the Department of Health was allocated a mere 16%. The issue of equity was clearly lacking in budgetary allocations. There was an urgent need for correction of this situation.

MINUTES
Afternoon Session
Limpopo Province
Dr Manzini; the acting Health MEC outlined the expenditure trends for 1999/00-2004/05 and those of the period 2001/02-2004/05. Her Department is committed to providing comprehensive, integrated and equitable health and welfare services which are sustainable, cost effective and focus on the development of human potential in partnership with relevant stakeholders.

The Department's core functions were to provide regional and specialised services and academic health services. She noted that the Department's strategic priorities were the TB/STD/HIV/AIDS and other communicable diseases. Other areas are the maternal, child women, Youth & Adolescence health together with poverty alleviation programmes.

Dr Manzini spoke of the personnel and non-personnel expenditure trends and noted that the non-personnel expenditure for service delivery items had been declining in real terms whilst nominal increases had been below inflation rates.

Dr Manzini touched on fiscal equity issues and noted that the actual growth had been experienced in conditional grants but pointed out that equity within NP and between Provinces still needed to be improved. She explained the expenditure variances Analysis for 2001/02, which reflected a substantial increase due mainly to late transfer of rollovers of conditional grants and unspent budgets resulting from failure to get Tenders out in time for delivery of goods.

Dr Manzini outlined the achievements of the Department, which included the establishment of a fully fledged Directorate to deal with HIV/AIDS issues and the distribution of 8 million condoms. The main challenge facing the Department was the filling of the critical posts for clinics and the devolution of services to the various districts.

Discussion
Mr Nefolovhodwe (ANC) asked why there was a decline of staff yet there was at the same time an increase in personnel expenditure. Has the Department had undertaken any measures to revitalise its Hospital facilities?

Dr Manzini replied that the problem arises from the late allocation of the budgetary vote by the Treasury. She also attributed the shortfall to the problem of late back payment for earlier promotions that had been approved.

Dr Manzini said that the revitalisation exercise that was undertaken revealed that most hospital facilities were inhabitable but that due to scarcity of resources the Department decided to give them a facelift to keep them going for the time being.

Ms Mathibela (ANC) asked why it took the Department five years to construct a facility like a hospital. How does the Department handle the stress personnel experience due to their heavy work schedule?

Dr Manzini stressed that plans to revitalise health facilities were always good on paper but that budgetary constraints stood in the way of implementing such programmes. She admitted that her staff were greatly overworked hence stressful pressures set in. She said some of the reasons for such stress were late promotion, which gave way to low morale among the cadres affected.

Dr Luthuli (ANC) emphasised the central role equity issues played in the development agenda of the country. What plans did the Department have to address the huge Provincial disparity in budgetary allocations. Did the Department have any plans to fill the vacant critical posts it had? How was this personnel shortfall affecting the rest of the work force?

Dr Manzini explained that it was difficult for the Department to rationalise the issue of equity since part of the problem was at the National level. She attributed the inability to fill vacant critical posts to budgetary constraints.

Dr Cachalia (ANC) said that unless government takes firm and decisive steps to reduce unemployment, insufficient budgetary provision for health would persist. He asked if the Department anticipated budgetary allocations so as to utilise the funds as soon as they are released.

Dr Manzini agreed with Dr Cachalia that unemployment was a big problem area but pointed out that the Department had no wherewithal to address the malady. She said that the Department was unable to plan for what has not been allocated.

Dr Cachalia (ANC) enquired about the system the Department employs in its fee collection exercise.

Dr Manzini replied that the Department makes small collections, which it retained to contribute to the NP budget as a whole. She said the Department applied the billing system but that it was a big challenge to take collections from rural folks since most of the province is rural and far-flung.

Mrs Mnumzana (ANC) asked what the Department was doing to address the problem of underweight in schools. Were there any feeding programs in place for this kind of exercise? Was the mother to child HIV prevention programme being implemented?

Dr Manzini replied that the feeding programme was in place and that 1.7 children were currently participating. The mother to child HIV prevention programme was well managed in the province. She however said that due to the rural setting of the province the implementation of the programme was not as fast as one would have expected.

The Chair expressed his strong dissatisfaction with the capital expenditure noting that the 16% allocation to health against the 44% for education was unacceptable. He contended that the NP was poor yet received meagre resources for its many health provision needs.

Ms Mnumzana concurred with the Chair that the Department is badly under-funded but urged the Department to maximise services with whatever little they have at their disposal. She commended the Department for bringing down the rate of TB. Why does the Department not plan for conditional grants?

Dr Manzini (ANC) explained that conditional grant rollovers were not normally planned for. She said the NP Treasury allocated the money in late December when most people were out for the holidays and that in March the books were balanced and closed. She said the Department has now reached an understanding with the Provincial treasury to make advance plans for the budgetary allocation. She explained that success in TB reduction was achieved by the assistance of volunteers who have come out in full force to support the programme.

Ms Ngaleka (ANC) asked if the Department had moved to addressed the perennial problem of security at health service centres. She enquired if there were any programmes in place to mitigate the burden of Aids patients.

Dr Manzini admitted that the problem of theft and general pilferage had been rampant and that the Department is dealing with this urgently. She said security had been tightened at the clinics to stop the theft of stores and drugs adding that some staff members had already been charged in court for related offences.

Ms Twala (ANC) noted that there had been problems in the past in relation to the tendering system and asked what the current position was.

Dr Manzini replied that the Department is moving ahead with plans to decentralise the tender process. She clarified, however, that poverty alleviation programmes were exempted from the tendering process.

Mr Nefolovhodwe said that there was a problem with equity in budgetary allocation and that it would be important to interact with the National Department on this issue. How was migration of workers affecting delivery of services in the province?

Dr Manzini said that the real problem with migrant workers was that those who went to work in Gauteng come home old and penniless to claim social security grant and medical aid thereby putting pressure on the Provinces' already strained budgetary allocation.

Eastern Cape
Dr Stamper, the HOD said that primary health care constituted the core business foundation of the department. The Department had undertaken inter-sectoral programmes to deal with the dual epidemics of TB and HIV/AIDS. The Eastern Cape had the highest rate of child mortality in the country and that this phenomenon was fuelled by nutritional related ailments.

Dr Stamper revealed that the Department had set aside a sum of 2 million in the current budget to boost its immunisation programmes. He spoke on the Department's main priorities and said that the focus was on the availability of essential drugs in clinics and devolving primary health care programmes to the districts. The Department would put in place an outreach programme to bring services closer to the people.

Mr Mike Fraser, Chief Finance Officer, presented an overview of the Department's financial outlook and said that budgetary constraints were such that there was no room for expanding services to other deserving areas. He lamented that the budget vote had greatly curtailed the Department's expenditure at the expense of service delivery. He pointed out that newly renovated buildings were falling apart due to unavailability of resources to maintain them.

Mr Fraser noted that the Department was incapable of meeting its equity targets in the financial year due to the scarcity of resources. He informed the Committee that the Department was in the process of filling critical vacant posts and that restructuring plans were in high gear to improve the financial management services both at the head office and the districts.

Mr Fraser pointed out that for the Department to be able to effectively meet its constitutional mandate, it required a budget vote of R6.5 billion, which was way far more than what was allocated to the Department currently. He added that despite the tremendous constraints on resources, the Department had adapted equity principles in its allocation of funds. He remonstrated with the Committee that education and social welfare were amply funded at the extreme expense of the provision of health care services to the populace. He said that the Department was closely consulting with the Provincial Treasury to avoid the incidence of rollovers due to late allocations.

Discussion
Dr Cachalia (ANC) said that when the Committee visited hospitals in the Province, most of them were dilapidatedand asked if poor management rather than scarcity of finance had anything to do with this sorry state of affairs.

Dr Stamper replied that he would not rule out mismanagement as a contributing factor in the stte of the physical facilities but he stressed that much of the blame lay on scarcity of funds to maintain the structures.

Ms Mnumzana (ANC) commended the Department for the improved presentation in-put from that of last year. She asked if the Department had plans to build capacity in management. Why had theTender Board not met for ten months and what happened during that period?

Ms Mnumzana said that budgetary allocations must be anticipated and planned for so that the allocated funds were disbursed to cover projects even if they came late.

Dr Stamper said that the Department was recruiting experienced financial executive officers to take charge of hospital cost centres. The Department was in the process of decentralising management to enable it to immediately utilise funds as they come in. Managers have been appointed to run programmes themselves so that they can fast track the implementation process. With regards to the Tender Board, he said that the Department was restructuring the Board to strengthen its capacity to manage and to put in place appropriate procurement systems.

Mr Fraser said that one cannot plan for allocations that were made late in the year adding that it is not possible to plan for what has not been allocated. He however noted that the Department was working closely with the Provincial Treasury to ensure that the last year's problem of huge unspent funds is not repeated.

Ms Mathibela (ANC) was unhappy about the run-down state of the Provincial theatres and the long wait patients were subjected to before accessing this facility. Why was it taking the Department such a long time to replace archaic equipment.

Dr Stamper replied that in view of the limited resources the Department had to contend with, the question of prioritising programmes became very vital. He explained that in such a situation of object scarcity priority is normally given to the procurement of non-personal items such as essential drugs and surgical equipment.

Dr Luthuli (ANC) asked why allocations for capital expenditure were not adequately applied to give hospitals a proper face-lift. She said facilities were 'appalling' and asked what role, if any, the Department of Public works played in this respect.

Dr Stamper said that the Department could only afford minor maintenance but that all major projects were undertaken by the Department of Public Works. He said that through the equity programme and some donor funding the Department had managed to refurbish some hospitals.

Ms Twala (ANC) expressed concern at the failing standards in public hospitals, which he said, had reached the point where patients had no food and asked what emergency measures, if any, the Department had put in place to remedy this unhappy situation.

Dr Stamper said that what compounded the problem was the non-allocation of funding to district hospitals putting pressure on provincial hospitals that had to cope with an influx of patients from these areas. Only specialised hospitals were doing well. He said there was a worrying trend where the public was shunning public hospitals for lack of confidence in their services. Public hospitals only admitte patients who were terminally ill since there was no medication readily available for deserving cases.

The Chair lamented the dismal performance in service delivery in the face of a huge deficit of R700m that was needed for the Department to function optimally. He said that there was need for budgetary allocations to reflect government priority which was not happening at present. He stated that the budget for the next financial year had not been approved yet the financial year commenced in February.

Afternoon Session
National Health Department
The National Health Department delivered a briefing aimed at informing the committee about the uses and criteria for various grants allocated to the provinces. Mr Muller started the briefing, drawing attention to the HIV/AIDS grant in particular which increased drastically this year from R34 million to R157 million, and the to R266 million in the next year and R380 million in the final year of the MTEF. This gave an idea of the importance with which HIV was being viewed. Two studies were conducted, one of which was on the cost pressures and structures related to HIV/AIDS, which convinced Treasury of the need for such an increase.

The other study was on hospitals, with particular attention being paid to equity issues. This grant consequently was set to grow very rapidly in the next few years. The training and development grant was also set to grow at a steady rate. Mr Muller also said that the rehabilitation and revitalisation grant would grow more slowly, but this was because it had grown very rapidly since its inception. They had proved that they could spend the money, and consequently could use this as a way of reassuring Treasury that additional monies were needed. Mr Muller also briefly explained the Hospital Management Grant, saying that this was aimed at improving management capacity. The control of the grant had shifted from the provinces to the National Department.

Mr Sibeko, Chief Director of Hospital Services, delivered the briefing on grants related to hospitals. Previously, there had been two grants, the Training and Central Hospitals Grant was flawed, as was the Redistributive Grant. For this reason, a review had been conducted into where tertiary services were located and what volumes were handled. The data had been gathered from 529 specialised services, in 62 hospitals throughout the nine provinces.

The majority of tertiary services were delivered in the Western Cape, Gauteng and KwaZulu Natal, and they had historically received grants. However, it was also found that the Free State, the Eastern Cape and the Northern Cape were also delivering such services. He also pointed out that services were being rendered in line with the goal of increasing day visits and decreasing long-stay care. This situation meant that these provinces were using their own revenue to fund the tertiary services, and this was also true of KZN, but Gauteng and the Western Cape were not because of the size of their conditional grants. This led to the idea that the grants should strive to improve equity, since Northern Cape and Eastern Cape receive no funds, and the Free State and Natal receive insufficient funding. Thus all provinces now received some funding for tertiary services through the National Tertiary Services Grant. The Health Professional's Training and Development grant had been decreased to enable more funds to be devoted to the provision of tertiary services.

Discussion
Dr Cachalia asked whether, by shifting funds from tertiary level to PHC, there was not the risk that the components of human resource development and research development would be lost.

Mr Sibeko replied that the change was necessary, but the next part of the presentation would address what proportion of the funds were being devoted to tertiary care. He stressed that the idea was not to decrease the importance of tertiary care, but to look at where such services should be delivered and for how much.

Dr Baloyi said that, in addressing this about expertise the focus was on highly qualified people and academics, which ignored the expertise gained in everyday practice, in pockets of excellence around the country. If the research was refined, and assessments were made of who was doing what, he was sure that the finding would be that great work was being done by people without degrees. There was a need to recognise and reward such people.

Prof Segkunde said that, in principal, there was evidence that decentralised training would produce people with the skills and research ability. She added that there was the desire to have teaching at all the various levels, to expose professionals to more. In areas where this has been done, there were skilled professionals at all levels, in all areas of primary health care.

Mr Sibeko moved on to discuss the conditional grants for 2002/2003. Service agreements had been entered into with the provinces, for the National Tertiary Services Grant and the Health Professional Training and Development Grant. The requirements were that business plans be submitted, and approved indicators be developed. The provincial heads of health were also required to submit financial reports. There was also built in support and regular meetings with the National Department. It was accepted that transfers had to be regular. For the NTS and the HPTD grants, the transfers were monthly, with the Hospital Revitalisation Grant, it was quarterly and the Hospital Management and Quality Assurance Grant was transferred in three branches.

He then proceeded to explain the grants in more detail. The NTS grant was intended to facilitate equity between the provinces in tertiary services, while ensuring that there was national co-ordination of tertiary services so that nothing was planned in isolation. The monitoring of the grant was by means of service agreements which required monthly and quarterly reports on expenditure and quarterly reports on service level. The HPTD grant required quarterly reports on the number of students, by discipline, level and institution, and this was true of all categories, not just doctors. Quarterly and annual reports were similarly required on the practical placements, by discipline and facility as well as quarterly and annual reports from targeted provinces on the achievement of their specialist and teaching infrastructure. There was also the requirement that monthly reports be generated on transfers and expenditure. The Hospital Revitalisation grant required monthly reports on project implementation progress and cash flow. The Hospital Management and Quality Improvement grant required quarterly reports tracking improvements, as well as quarterly and monthly reports on transfers and expenditure.

The conditions for awarding the grants were also outlined. The NTS grant was bound by the agreement that the provinces signed, specifying the number and type of services to be rendered. The HPTD grant was designed so that there would be support for the training of health professionals, the development and recruitment of specialists and the funding of the costs of remedial students. There was also emphasis on a process of shifting teaching from central to the regional and district hospitals. The conditions were that information be supplied and that additional registrars and specialists be deployed to the gaining provinces. There was also the desire that support be provided as quickly as possible. the training component of the grant was meant to fund the five provinces providing training for undergraduates.

The development component, which made up 10% of the grant, was for the purpose of developing specialists and registrars that were needed in level II service in the remaining provinces. The Hospital Revitalisation Grant was for the purpose of transforming and modernising hospitals in line with the national planning frameworks, to achieve sustainability. The conditions for the allocations were compliance with the provincial priorities contained in the strategic position statements. The various components were human resources, infrastructure and equipment, and Mr Sibeko stressed that all three components needed to be present for conditions to have been met. He said that the provinces were required to implement their pilot projects as identified in their project business cases. The Hospital Management and Quality Improvement grant includes the development of cost centres accounting systems. Its other aims are to improve PFMA implementation, by enhancing financial management skills in particular and supporting quality of care interventions. The conditions were that there be demonstrable progress towards decentralisation, that cost centres be implemented and that all hospitals implement quality improvement plans, as defined by national policy.

Mr Sibeko concluded by saying that, in terms of the amounts of the grants, the Tertiary Grant saw massive increases going to the Eastern Cape and the Northern Cape. He also said that the Hospital Management grant was also aimed at addressing the issue of equity.

Mr Ngculu said that it seemed that they were beginning to address the need, and asked for questions.

Ms Molelekwa asked whether the new process started this year, to which Mr Sibeko replied that it did.

Ms Chetty, the Deputy Director General said that revitalisation was an attempt to get away from the situation of a patchwork approach to maintenance, and to look at both these types of repairs but also the more longer term upgrades.

Mr Ngculu said that he was still struggling with conceptualising real examples where the NTS grant would come in.

Mr Sibeko said that tertiary services were for example transplant operations. He said that there was a need to fund such services through, for example the NTS grant. But he pointed out that such services did not only happen in the larger central hospitals, and these other facilities were, until now, not funded.

Ms Chetty gave an example from the Western Cape, where the central hospitals such as Tygerberg, Red Cross Children's Hospital and Groote Schuur were funded. Yet Conradie Hospital had a specialised spinal care unit, which could be defined as providing tertiary care.

The Chairperson asked if they would be able to request funds, to say that they would be able to perform a certain service.

Ms Chetty said that the review showed that the services were already being performed, but were not recognised, due to the lack of a medical school.

Ms Dudley said that 'Carte Blanche' had shown hospital after hospital where services were inadequate. She asked if this would address these needs. She gave an example of a hospital in Mpumalanga that the committee had visited, where there was a significant amount of technologically advanced equipment, but no staff and no patients. She cautioned that real needs might not have been addressed.

Mr Sibeko replied that the business case identified the services and catchment areas etc. He said that such business plans led to an understanding of the recurrent expenses, and this would prevent the building of hospitals for which there were no funds for staff etc. He also said that the strategic priorities would also help to identify where and what services were needed.

Ms Chetty said that she hoped it was also recognised that this would not mean that other areas were underfunded. Quality of care was part of the national priorities, and this was linked to human resource.

Ms Malumba delivered the briefing on the Conditional Grant for HIV/AIDS. She started by tracing the history of the grant, saying that cabinet had approved funds for the fight against AIDS in 1999, with the first grant being made available in the 2001/2002 budget. 70% of these funds had been spent by March 2002, which the National Treasury had deemed a reasonably good performance. Ms Malumba proceeded to trace some of the key features of the expenditure patterns. She said that Mpumalanga and the Eastern Cape had spent the least. She also said that the funds for PMTCT had only arrived in November last year, yet that program had spent the most, in terms of the percentage of its allocation. Home-based care was the program which spent the least, with the other program being voluntary counselling and testing. She also said that KZN had the most funds allocated, reflecting its situation as the area with the highest infection rates, and Mpumalanga received the least.

She broke down the figures even further, saying that the Northern Cape had spent the most in terms of its allocation for VCT, with 100% of its allocation having been spent. The Eastern Cape however, only spent 42%. She also said that the Free State and the Western Cape had spent their allocations well. She also said that the VCT program was the backbone of the HIV/AIDS program, and it was essential to get it functioning, as the other programs could not function without effective testing. The community and home-based care program (CHBC) had started to address the training of carers, to research the needs and to set up pilot projects. The PMTCT program was made a reality during 2001/2002, as 18 pilot sites were set up, one rural and one urban in each of the provinces. This had also had an impact on the provision of PHC. Some of the problems encountered in the PMTCT program were the late transfer of funds, the lack of infrastructure and skills and the need for more active community involvement, particularly around the issue of breastfeeding. There was also a need for greater inter-sectoral participation. Ms Malumba said that AIDS was still seen as a health issue, when there was a need to involve Water Affairs, Social Development and the Department of Transport, for example.

She explained the criteria for the budget allocations. She said that the criteria were based on prevalence, the issue of whether the appropriate training had taken place, the issue of whether clinics offered antenatal care and finally the population of the province concerned. in order to ensure greater expenditure, an NGO unit had been set up in the national department, with the purpose of strengthening service delivery with NGOs. There was also a process of programme management training, which included components addressing financial management. There was a requirement that quarterly reviews of each program's implementation be submitted, according to the business plans and there were national program co-ordinators who were going to play an increasingly supportive role for the provinces. There was also the need to ensure that functional integration structures were in place, to ensure that there was accountability between the sectors. All these measures were aimed at achieving the goal of better evaluation and monitoring.

Discussion
Ms Dudley asked for elaboration on the NGO unit, in terms of where it was based, how it could be accessed and how was it being publicised.

The reply was that it had been in operation since 1 April, 2001. Ms Malumba said that they were launching a communication initiative on the 30th of May to showcase the units links with LoveLife. This was the first of several communication exercises. It was located within the Chief Directorate of HIV/AIDS. It also acted as a repository for donor funds, in order to cut out some of the bureaucracy while preserving mechanisms to ensure openness, for example the agreed-upon tender processes. It was also involved in capacity building, because smaller NGOs struggled to access funds due to a lack of capacity.

Ms Twala said that the Eastern Cape was particularly worrying. She asked why the allocation was voted in November, and loaded in December - she wanted to know what the problem was here.

Ms Malumba said that the Cabinet decision had only been made very late. This led to a late identification of specific needs, as research had to be done. This situation was multiplied in the Eastern Cape by other structural problems, such as the absence of a Head of Department.

Ms Twala asked what happened in the Western Cape, where they did not use their allocation for PMTCT, but funded the program out of another budget. She asked whether they were now allowed to use those funds at their own discretion.

Mr Muller replied that the Western Cape may surrender the money back to the National Treasury, or roll it over into the coming year.

Ms Twala said that earlier, the Northern Province had explained that part of the problem was that they were a very rural province, and therefore struggled to monitor whether or not HIV positive mothers were breastfeeding their babies or not. She asked what mechanisms could be put in place to monitor this.

Ms Malumba explained that the rural areas presented an intersectoral challenge. There was the need for water to be provided, so that mothers could make formula to feed their babies. She said that the department was working with Social Development. She also said that the separate programs were not necessarily so vertical, but that there was overlap. She also pointed out the change in terminology of one of the programs, from home-based care to community and home-based care. There was a need to involve women in the villages who acted as leaders, to empower them to play a role. Public Works was also involved, since roads were needed to ensure that home care could be provided.

Ms Ngijima provided the briefing on the Primary School Nutrition Program (PSNP). The allocations throughout the country were decided on based on the population figures, but also on the provision of business plans. These business plans contained the requirements that quarterly and monthly reports were to be provided. She traced the expenditure patterns over the year, saying that the percentage of funds spent increased from 54% to 87% in 2000/2001, but that for the year that had just passed, 2001/2002, this figure decreased to 78%. This was largely attributable to a drop from 83% to 44% in the Eastern Cape. This in turn was blamed on human resource problems, with staff having to be constantly retrained to fill vacancies. The North West Province had also dropped from 75% to 58%, again due to human resource problems, where the deputy directors position was vacant for a long period of time. She did point out that KZN had achieved 100% expenditure of its allocation. She also pointed out that the figures were affected by the fact that some provinces were spending inconsistently throughout the year, and some provinces were not submitting their documentation in time, which led to skewed figures.

Some of the challenges identified were the delayed transfers from Provincial Treasuries, as well as incorrect coding at these treasuries, which increased delays. The human resource capacity in the provinces remained a problem, with vacancies not being filled, substitutes not being adequately trained and restructuring in some of the provinces, such as the Northern Cape, the Eastern Cape, the Northern Province and Gauteng. Another problem was that the role of the Department of Education in the program had not yet been formalised. The Free State had changed its procurement system in mid-year, which had caused some problems. There was also the problem that there was a long chain of command, from National to Provincial to Regional and from there down to various CBOs and NGOs. This meant an overburdened administration, with difficulties in meeting timeframes, and assessing accountability.

The remedial action which had been taken included designating national officers to particular provinces, the development of a food safety monitoring system (in response to the problem with peanut butter that had occurred). The development of reports on capacity which had assisted in the speeding up of filling vacant posts, and the drafting of service level agreements to formalise working arrangements between the Departments of Health, Social Development and Education. Water Affairs also had an existing agreement with Education, which fostered more rapid service delivery.

Discussion
Dr Baloyi said that he appreciated the attempts at remedial action, but pointed out that the long chain of command and the delays in the transfer of funds had not been addressed.

Ms Ngijima agreed that the long chain of command remained a problem but said that, in relation to the transfers, that the National and Provincial Treasuries had met with the Department of Health and were trying to find solutions.

Ms Gxowa (ANC) asked what the problem was in relation to Human Resources. She asked why there was constant training and retraining, and whether the people were untrainable.

The response was that high staff turnover meant that people had to constantly be trained to fill positions.

A Member of the ANC asked how the process was monitored. She said that at times the menu was unsuitable, and the children would not eat the food, no matter how hungry they were.

Ms Ngijima said that their research indicated similar results. The report had been presented to MinMec and from there it went to Cabinet. The proposal had been that, where previously provinces had been given an RDA rating for the food they were required to provide, this had now been translated into four costed menus, which six of the provinces had already agreed to make use of.

Dr Luthuli said that there had been reports of lots of corruption, and asked whether this had been dealt with.

The Department representative replied that this was a problem, and that, when she had been trained in Food Service Management, it was accepted that 10% of the budget had to be devoted to food being stolen, this was a feature world-wide. She stressed however that they had striven for a degree of containment, and that it had been minimised, but not eliminated.

Mr Ngculu thanked the Department for their input. He said that the blockages around conditional grants were something that the Committee would watch closely, and said that the Committee should also look at adopting various provinces, in particular the Eastern Cape, Mpumalanga, the Northern Province and the North West Province, and monitor their progress closely.

The meeting was adjourned.

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