Forensic Pathology Services Grant: assessment of grant

Meeting report

The Chairperson said the Forensic Pathology Services Grant was being phased out. The grant would now be accounted for in the provincial equitable share in 2012/13. National Treasury would give a status report on the third quarter spending, and both it and the Department of Health would reflect on the achievements of the grant.

National Treasury presentation
Ms Julinda Gantana, Chief Director Treasury, said the grant was introduced to facilitate the transfer of Pathology services from the South African Police Service (SAPS) to the provincial departments of health. When the grant started it was envisaged to last for five years to support the process of shifting the function. The end date was 31 March 2012 and Treasury. The function had now been successfully transferred and thoroughly upgraded and improved under provincial DOHs.

Ms Ogalaletseng Gaarekwe, Director Treasury, said the spending of the grant at the end of the 2011/12 financial year was 96% of the adjusted budget of R610 million. Only KZN and the North West had spent the entire budget. The Eastern Cape and Western Cape overspent their budgets; other provinces under-spent, with Gauteng recording a R23.9 million under-expenditure. Treasury had received a number of requests for rollovers from provinces. Gauteng was the only province that did not ask for rollover funds for the current financial year. Although the province had under-spent, its expenditure of the grant had increased significantly compared to 2010/11. This was the same for other under-spending provinces except Limpopo. Treasury was awaiting the fourth quarter report on the performance of conditional grants.

Ms Gaarekwe said the issues that the third quarter report raised as challenges included land availability, contract management, poor workmanship, and the general procurement process. Another major challenge related to human resources. The filling of vacant posts took long due to the lack of professional and technical staff in pathology services.

 The grant was being phased into the equitable share. The service was continuing - only the grant would now be funded through the equitable share. However there was no uniformity to say departments would budget a certain amount for certain services.

Spending on the grant had improved significantly compared to 2010/11 – spending almost 17% faster. Gauteng had improved spending on the grant by over 45%. The progress and success of the grant depended on provinces carrying on the mandate of building mortuaries beyond the lifespan of the grant.

Discussion
Mr M Makhubela (COPE, Limpopo) wanted to know if the under-spent funds by Limpopo would be incorporated into the 2012/13 equitable share.

Ms Gantana replied that unspent funds were R5.4 million. The province had applied for a rollover amount of R3.3 million. This was for committed funds. The balance of R2.1 million had not been committed to any identifiable projects. The R2.1 million would therefore constitute under-expenditure on the grant.

Mr Makhubela said the performance challenges highlighted looked as if they could be permanent challenges. The acquiring of land, contract management and filling posts were all challenges that could persist for a long time. It would be ideal if Treasury could share the plan it had to overcome these challenges.

Mr R Lees (DA KZN) sought clarity on the statement that the Eastern Cape had already been given a rollover funds as the province had already overspent. He wanted to know how it was possible that KZN and the North West could spend the exact amount as the budget. This was practically impossible to achieve unless the figures were manipulated.

Ms Gantana replied that the 100% spent was an issue of accounting. But it was possible that the two provinces might have overspent; that could not be reflected against the grant but the equitable share.

Mr Lees said the explanation was even more confusing. He sought clarity on the statement that provinces topped up the grant and it show on a separate account. He reasoned that the Eastern Cape and the Western Cape had overspent and it showed on the grant. This meant the two provinces got money from Treasury not the equitable share. This was not possible; Treasury could not pay more than the grant. He said he was confused.

Mr Ian van der Merwe, Chief Financial Officer DOH, replied the grant money was transferred to the province and one could not get more than what was in the Division of Revenue Act (DORA). The Western Cape and the Eastern Cape would have to show a 100% spend against the grant; the balance of that would go against the equitable share. He said this was how it would be reflected at the end of May 2012. Treasury figures were the actual spend. KZN and North West had netted their full expenditure against the grant and the balance would be taken from their equitable share.

Mr Lees said the explanation was not conclusive and therefore did not change his view. It was possible that the two provinces had spent more of that money but it was allocated elsewhere. Treasury should not treat provinces differently in terms of the figures, as it was not possible to have that 100% expenditure.

The Chairperson agreed and said the matter would be alluded to when the Committee engaged provinces later in the month. The tendency in the past had been for provinces not to report on over expenditure as it would be taken from their equitable share. This was something that Treasury had to engage because other provinces used this tactic to justify an increase on a particular grant.

Mr Lees sought clarity on the Hospitalisation Revitalisation Grant. Where could the Committee get details on the expenditure on this grant? Nothing was being done to Madadeni Hospital in KZN and yet an indication was given that over R50 million had been spent on revitalisation of hospitals.

Ms Gantana replied that the Department of Health (DOH) would be more suited to answer this question.

Mr C de Beer (ANC, Northern Cape) wanted to know the procedures used by Treasury to monitor expenditure. He asked if monitoring was done through email communication or whether there were other methods like follow up visits. Under-expenditure by huge sums was annoying. He would confront officials in the Northern Cape about the details of under-spending.

Ms Gantana replied that there were other things Treasury did to monitor expenditure. There were visits to various sites in terms of infrastructure planned and the rollout of the grant. DOH evaluated spending on the grant; details were continually provided to Treasury in terms of assessment. There was also stipulation in the Division Of Revenue that prescribed how reporting should happen.

The starting point was with the Department as it was where the funds were allocated. The bulk of the monitoring would be from that angle. Treasury conducted infrastructure visits and interacted with provinces on where they foresaw problems. DOH was also restructuring and setting up a unit that would deal with provincial spending.

The Chairperson said he expected Treasury to have a sense of how the grant had performed since it was started. Going forward the Committee would expect provinces to sustain and budget within their own equitable share. Could Treasury indicate if it was satisfied with the achievements of the grant. He said it would be interesting to know the reasons for phasing out the grant if it had not achieved its purpose.

Ms Gantana replied that when the grant was introduced, it was agreed that it would facilitate moving the function of pathology service from SAPS to provincial health departments. When SAPS performed the function, the capacity was not fully developed. Key focus of the function was to develop the required human resource capacity. By August 2006, all SAPS staff had been transferred to the provincial departments of health. And since then the provinces had been beefing up their teams to fully align with the human resource plan. At the end of 2008/9 staffing levels were on track, but there were challenges in recruiting people with the necessary skills. She said the request to phase the grant into the equitable share came from the Director General of DOH. Parliament and the Cabinet had agreed to the request.
 
Department of Health (DOH) presentation
Mr van der Merwe said a capital decision was taken in 1998 to approve the transfer of mortuaries from SAPS to DOH. The transfer was important because it enabled and improved management of the function and handling of evidence. This was the major drive behind the move from SAPS to Health.

Section 27 (2) of the Health Act stipulated that provincial departments of health would be responsible for the entire pathology services. Forensic laboratories were still the competency of the national department.

The purpose of the grant was to develop effective pathology services, and ensure reduction of partial evidence for the criminal justice system. The deliverable that was agreed to was the transfer of the function from SAPS to DOH; and that well equipped mortuaries would be built. It was agreed that the old mortuaries would be refurbished, and also that the operational standards would be published and implemented.

The objectives were published in the grant framework, also published in the DORA. The four main areas were human resources, refurbishment of facilities, equipping the mortuaries and the information systems.

Mr Pakiso Netshiduvha, Chief Director DOH, said the achievements of the grant were based on the Unit. Personnel from the SAPS were now part of the staff at DOH. The pool of Forensic Pathology Officers was people who had matric and degrees. The spending by provinces had improved and all provinces had purchased fleet of vehicles. The information system was operational in the Western Cape and Gauteng.

There was an improvement in the number of bodies seen, and the turnaround time varied in provinces. This was the key service delivery indicator.

The challenge of fewer pathologists remained a challenge and as a result some provinces used medical doctors for the function. This was allowed in terms of the law. She said the Free State did not have any pathologists as they were still undergoing training. Gauteng had a considerable number of pathologists. During the allocation of the grant, Gauteng had produced four new black pathologists and one was a woman.

The number of pathologists had improved significantly in KZN as well. Although the Western Cape and Gauteng were leading on numbers of pathologists, there had been a general improvement in getting people into the forensic pathology services. Further improvement was needed.

She said all provinces had sufficient fleet stocks of 4X4 bakkies. The major area for the grant was to build new mortuaries and refurbish the old ones. The Department had planned to refurbish 65 but could only do 56. In terms of new structures, 66 were planned but only 34 were built. There was a challenge in this area.

The Department had not done well in the Information Technology area. The Western Cape had the system in all its facilities but it was functioning at only four facilities in Gauteng. The plan was to model the IT system in the Western Cape and then roll it out to all other provinces. There was a moratorium on information systems in 2010/11 so that was the reason the implementation of the system had been hampered.

Challenges and failures included failure to formalise the accredited programmes for the Forensic Pathology Officers so that they could qualify for the Occupation Specific Dispensation. Another challenge was SA universities being unable to produce pathologists at the desired rate.

There was a challenge of increasing number of unidentified bodies at their mortuaries. Sometimes there were issues with the police doing DNA, and Department of Home Affairs doing the fingerprinting.

The Northern Cape was the poorest performing province in terms of infrastructure. All the projects that were planned were only half complete. This was as a result of court cases surrounding the tendering processes. In most instances the Department had won these case, but the service providers had taken the matters on appeal.

There had been poor workmanship at some mortuaries and there were cracks in the new structures. The Department was looking to address those through the infrastructure programme. There were also issues of under funding because some provinces had capacity constraints, or had challenges with acquiring land.

Gauteng could not build its planned six new mortuaries because it struggled acquiring land. Whilst the challenges of constructing new mortuaries were there, the cost had also been escalating. Progress had been made in acquiring land for the Bronkhorstspruit and Springs mortuaries. There were pending cases in the Northern Cape and the matters were difficult to resolve. Mpumalanga could not complete all the facilities due to funding. The tendering process for the new mortuaries was very slow.

Monitoring and evaluation happened at two levels – provincial and national. At national level the capacity was minimal. Only two officers were managing the grant; previously it was monitored by a Director who resigned two years ago, and since then there had not been a director to monitor the grant. The grant manager was a deputy director who had to oversee all the performance areas of grant-like projects, human resources, infrastructure, and equipment.

The project manager had visited all provinces. Some facilities could not be visited due to construction problems, and some others have had to be visited more than once. Other provinces submitted quarterly reports late.

All the provinces had grant managers but there were challenges. In the North West, for example, the manager was suspended. This created a challenge in the monitoring of the projects at a provincial level.

The evaluation that DOH conducted mainly focussed on the building. Information regarding human resources was dealt with within procurement and equipment. Expenditure information was obtained through monthly reports from the provinces. Not all mortuaries were visited during the grant period. During the visits issues of occupational safety were also monitored. In some mortuaries the officials did not even wear protective clothing. They insisted that mortuaries needed to have in-house safety committees who could monitor the health aspect. There was a proposal on the table that environmental health officers should visit facilities at least twice a year.

Mr van der Merwe said once the grant had been moved to the equitable share there existed a possibility that the funds would not be spent on mortuaries, as intended. The conditional grant element would be lost. The Health Infrastructure Grant was now administered by DOH and there was room for Pathology Services to be included in that framework. The Department had a responsibility to ensure that provinces provided the required services.

There was a window that in future the refurbishment and building of the new mortuaries could be done under the existing Health Revitalisation Grant as well as the Health Infrastructure Grant.

Discussion
Mr Lees said he was confused as to whether the presentation was on state mortuaries and the functions that laboratories at these could handle. He asked if the forensic services were done on behalf of the SAPS.

Ms Alida Grove, Director DOH, replied that forensic mortuaries were responsible for autopsies. This did not involve the function of forensic laboratories, as these were a national function. Forensic laboratories were responsible for things such as drunken driving blood analysis, cause of death analysis (with information from the mortuaries), and analysis of food. SAPS forensic laboratories were responsible for DNA and ballistic analysis.

Mr Lees sought clarity on whether the number of mortuaries in the Western Cape was 16 or 18.

Mr van der Merwe replied that the issue was with the new mortuaries that were supposed to be built as opposed to the IT facilities that existed within the Western Cape.

Ms Netshiduvha replied that the difference in the two figures was that the rollout was being planned for 16, but the extra two mortuaries were included at a later stage.

Mr Lees commented that there was a large number of vehicles that were targeted for Gauteng. He said that province was too small and did not need that many cars compared to a province like Northern Cape. He pointed out that the budget presented by the Department was different to what Treasury had presented earlier. Figures had to be the same; to be trusted, figures needed to be dealt with in a consistent manner. Errors should not happen when dealing with figures.

Mr van der Merwe apologised and said DOH presented the overall budget figures as opposed to the third quarter. The figures needed to reflect the adjusted budget.

Mr Makhubela said the presentation was very good. He wanted to know how many members were transferred from SAPS with the relevant qualifications. He asked what was done with those without the appropriate qualifications.

Ms Netshiduvha replied that most staff transferred from SAPS possessed a Junior Certificate (Standard 8) or a Matric for qualification. Those with Standard eight had either improved to attain Matric, or some had since resigned. The people employed at pathology services now had matric certificates or degrees.

Mr Makhubela asked if there were engagements with the Health Professionals Council of South Africa to recognise the pathology services profession.

Ms Netshiduvha replied that there had been progress on engagements with the HPCSA. The Minister had met his education counterpart, on the 240 credits and a request had been made that this be fast-tracked. Durban University of Technology had committed to training forensic pathology officers, but on condition that funding was availed. It was expected that by end of June the funding and 240 credits issues would have been finalised.

Mr Makhubela asked for the breakdown of paupers’ funerals per province.

Ms Netshiduvha promised to provide the information to the Committee. But said the number of unidentified bodies was mainly in the cities.

Mr Makhubela asked if there was a difference in the salary scales of specialist pathologists and doctors who performed pathology services.

Ms Netshiduvha replied there was a difference in pay, as pathologists were specialists in their field. Pathologists underwent intense training. A doctor might have a qualification in pathology but still that doctor ought to undergo training as per the guidelines.

Mr Makhubela asked that DOH provide a detailed report on service delivery of the grant during its entire life span, and the foreseeable shortfall that would be funded in the equitable share.

Ms Netshiduvha said the detailed report was available.

Mr Makhubela said DOH should clarify the statement that old mortuaries were refurbished and new ones built, in the context of an earlier presentation that there was a challenge due to the unavailability of land.

Mr De Beer asked why there was a difference in waiting times before bodies could be attended to.

Ms Netshiduvha replied that the workload of mortuaries was not the same and that had an impact on the times. KZN had a large number of autopsies hence it took up to a year to finish them. Also the process of waiting for a pathologist’s certification contributed to this in some other areas. The issue that influenced the waiting times was the number of bodies and the skill that was required.

Mr De Beer proposed that the Department looked at the condition of the vehicles especially given that the Northern Cape roads were largely untarred.

Ms Netshiduvha welcomed the input and said the Department would follow it up.

Mr De Beer commented that there were agreements with countries like Cuba and the UK in case SA universities did not handle the required number of students to be trained in the pathology field. DOH would have to explore where it could send students to get training.

Mr Siyabonga Jikwana, Director DOH, said becoming a pathologist was a specialised area, once one completed a medical qualification. Most universities struggled to register even five students in pathology. Given that the need was there for new recruits, the Department would have to influence some of the registrars. The suggestion of send aspiring pathologists abroad was worth exploring. Registrars were the people who would be supervising and the country's universities might lack expertise.

The Chairperson sought specific clarity and a breakdown on the figures presented for Western Cape, Limpopo, Free State and KZN on the number of practising pathologists.

Ms Netshiduvha replied it was difficult to source information from provinces on their pathologist services. The Western Cape recorded the highest number, with 13 specialist pathologists and 6 doctors. There was a challenge with getting the information from the Free State and Limpopo. Whilst Limpopo had not provided information on pathologists for the whole year; Free State relied on Gauteng as it was closer. She said it was difficult to source information from Limpopo, but a team from the national office would be headed to the province to assist. KZN operated on 93 doctors and 1 pathologist.

The Chairperson said the fact that only two people had been overseeing the grant indicated there was a lack of monitoring of the grant. If that was not corrected the Department would remain with the challenges it faced. The Department had failed to do the proper monitoring and, in fact, this was the reason it failed to visit all the facilities. The report did not contain factual information with regards to what was happening on the ground. When the Committee visited those sites earmarked for the Hospital Revitalisation Grant, it could not find a single structure, and yet millions were sucked from Treasury. If DOH accepted there were monitoring challenges before, what guarantees did it have that it would be able to monitor now. This could only get worse, with provinces administering this as part of the equitable share.

Mr Jikwana replied that there were managers for all the grants. Remaining without a director for the past three years, meant this grant was impacted on. The staff who were there to manage the grant did a good job, given the demands of DORA. A unit had been established to conduct oversight and coordinating within the Department. The Unit would provide support to all managers to ensure support in the management of the grants. A mechanism of understanding had been developed on whether there would be continuity with the projects. DOH was still gathering the information from provinces on projects in the pipeline and those planned. Some of these were included in the infrastructure grant and DOH was analysing the implementation plan for revitalisation. Some of the mortuaries would be taken through that process.

The Chairperson asked if provinces had budgeted sufficiently for Forensic Pathology Services.

Mr Jikwana replied that the Department was still collecting the information from provinces on their equitable share expenditure.

Mr De Beer said the team from the national office could contact Mr Tom, who was the coordinator of the intervention team for the five departments that were put on administration under Section 100(1)(b).

The Chairperson asked if his understanding was correct that the grant was being phased out but the money would still be availed under equitable share. He was concerned that funds for pathology services could also be availed through the revitalisation grant. Other provinces would want to exploit that.

Mr Mark Blecher, Chief Director: Health and Social Development, Treasury, replied that provincial treasuries had been asked to oversee that health departments allocated funding for the purpose of pathology services. The budget for 2013 was R676 million and in addition to this, some provinces would be using some of the Health Infrastructure Grant. He agreed that the Hospitalisation Revitalisation programme was not an appropriate funding mechanism for the Pathology function. The programme would remain permanently on the provincial budget and Treasury could monitor the spending.

Ms Gantana replied that the departments could not change appropriated amounts unless they went to their respective legislatures. There was no way health departments could change the budget after it had been tabled. She said the Committee needed to rest assured that the money was the amount that was there.

The Chairperson asked the specific mechanisms that were there to ensure that the money would strictly be used for mortuaries refurbishment. At provinces anything was possible, and misuse of these funds would be very easy.

Mr Lees said he shared the concern and the grant should not have been created as it was more geared to a function. This was set-up in a way that was unfortunate. The function had moved, therefore that operation was finished. This should never have been a grant; it should have been allocated in the equitable share. He said there would be nothing stopping provinces from using whatever money was left in the grant for other purposes. This was easy with a transfer function as opposed to a conditional grant.

Mr Blecher replied that when the function was under SAPS it was in an extremely poor condition. The reason why the grant was established was because provincial treasuries had refused to accept the function, as it was so messy. A lot had been done in the transition period especially in the areas of staff appointments, vehicles, and capital projects. The service was much better than the condition it was in seven years ago. The purpose of the grant was to ensure transition.

Mr van der Merwe added that departments would not be allowed to shift funds mid-year, but a lot of work was needed around developing strong monitoring mechanism for this specific grant.

Closing remarks
The Chairperson thanked the departments and said the Committee would interact with both ministries. He said the Parliamentary Liaison Officer of the health department needed to be more visible in Committee meetings. This would facilitate the interaction with the meeting, but the Committee would prefer to see the PLO more.

The meeting was adjourned.