Minister and Department of Health briefings on 2012/13 Annual Report

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Health

15 October 2013
Chairperson: Mr B Goqwana (ANC)
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Meeting Summary

The Minister and Department of Health briefed the Committee on the 2012/13 Annual Report of the Department of Health (DOH). The Department had achieved significant objectives, particularly the reduction in mother-to-child transmission of HIV, managing to improve its image in the media and the general public, had managed to reduce non-compliance and irregular expenditure, and had made a tremendous reduction of preventable diseases like HIV and Tuberculosis (TB). The provision of primary health remained its main priority, as it was intended to prevent illness and promote healthy lifestyles. Although there were a number of complexities in the provision of National Health Insurance (NHI) for South Africans, they were not uncommon also in the rest of the world, but the significant point was that NHI would play a meaningful role in narrowing the gap between the rich and poor in getting access to the healthcare, especially relevant to the high income inequality situation in South Africa. The Department had essentially four main outputs, which were increasing the life expectancy, reduction in maternal and child mortality rates, combating HIV and AIDS and decreasing the burden of diseases and also strengthening health system effectiveness. These had been achieved. One major challenge remained as the lack of specialist doctors, especially gynaecologists, and this issue needed to be addressed promptly, although the training partnership with Cuba promised to solve the lack of specialist doctors. South Africa had made many strides in fight against the scourge of HIV/AIDS, as shown by the increased life expectancy. There was a need to transcend from the hospi-centric approach to one that focused on the provision of primary health, in order to fundamentally prevent communicable diseases. The Department noted that the reduction in number of HIV-related deaths was specifically because of extensive programmes on HIV/AIDS.

Members congratulated the Department of Health on its performance and improvement on many levels, especially on the reduction of HIV/AIDS and TB. They wondered to what extent the spending on programmes like loveLife and Soul City contributed to this. Their concerns related to the non-compliance and irregular spending as reported upon by the Auditor-General and several Members asked what was being done to ensure compliance and better management. They asked whether the interns employed in the financial sections had assisted in addressing issues, what steps had been taken to rectify the errors, and what control measures were now being introduced. They asked why the Department had not answered Parliamentary questions on litigation. Whilst they complimented the Department for promoting family planning in order to curb teenage pregnancy and abortion, they pointed out that not as many female as male condoms were made available. They wondered about the competence of managers and supervisors in the clinics and hospitals, noted that the problems cited around lack of leadership related mostly to the provincial level, and wondered if effective training was being offered. They also asked for clarity on how far the Department had gone with dealing with the social determinants of health, and questioned the involvement and financing of programmes in the Southern African Development Community. Finally, Members asked about the counting of Medical Male Circumcision, and whether traditional circumcisions were supervised and counted by the Department.
 

Meeting report

Department of Health 2012/13 Annual Report briefing
Chairperson’s opening remarks

The Chairperson gave a special welcome to the Minister of Health, the Deputy Minister, the Director-General and delegates.  He commended the Department of Health (DOH or the Department) for the sterling job it had done in this year, particularly highlighting the reduction in the number of those newly infected with the HIV/AIDS.

However, the Chairperson also mentioned that there were problems of irregular expenditure or non-compliance in three provinces, namely, North West, Limpopo, and Eastern Cape. He also commented on the existing conflict between the traditional and medical practitioners, and mentioned specifically the on-going complaints from the traditional practitioners about the disregard of the role of traditional practitioners in the health department.

Minister of Health  
Dr Aaron Matsoaledi, Minister of Health, appreciated the opportunity to address the Committee and pointed out that the key strategies, both for the achievements already made, and for addressing the constraints, were also outlined in the National Department of Health’s Annual Performance Plan for 2013/14. He appreciated the role of the media in keeping the general public informed about the accomplishments and also constraints experienced by the Department of Health. The Department of Health had improved its image in the media and the general public. He specifically mentioned the reduction in non-compliance or irregular expenditure, and a tremendous reduction of preventable diseases like HIV and Tuberculosis (TB). The provision of primary health remained the Department’s main priority, as this was to improve the health status of South Africans through the prevention of illnesses and the promotion of healthy lifestyles. In addition, there was a need to dispel the misconception that the provision of primary health care meant healthcare of lower standard.

The Minister also raised the issue of National Health Insurance (NHI) and the complexities involved in the provision of a national health insurance for South Africans, and emphasized that this was not only a South African problem, but affecting the rest of the world. NHI would play a meaningful role in narrowing the gap between the rich and poor in their access to the healthcare. This was especially relevant to a country like South Africa, where there were extreme income inequalities.

According to the National Health Sector Priorities, there were four outputs required from the health sector in terms of the Negotiated Service Delivery Agreement (2010 to 2014). These four outputs included increasing life expectancy, reduction in maternal and child mortality rates, combating HIV and AIDS, and decreasing the burden of diseases and also strengthening health system effectiveness. The Department of Health had managed to achieve the four outputs in the short period of time, but also emphasized that there was still a lot that needed to be done to ensure that South Africans were healthy and were living longer.

South Africa lacked specialist doctors, especially gynaecologists, and this issue needed to be addressed promptly. The partnership with Cuba for the training of South African doctors promised to solve the lack of specialist doctors.

South Africa had made many strides in fighting the scourge of HIV/AIDS. This was shown by the increase in the life expectancy, as HIV was the biggest contributor to the lowering of South Africa’s life expectancy. Moreover, the reduction in number of HIV-related deaths was because of an extensive programme on HIV/AIDS. Mother-to-Child HIV transmission had been reduced from 8% in 2008, to 2% in 2013, and there were plans to further reduce the number to 1% in 2015.  There was still a long way to go. The National Development Plan (NDP) clearly stated that by 2030 there should be fewer under 20s with HIV/AIDS, and this could be achieved through encouraging all the South Africans to do HIV testing at least once a year.

Discussion
The Chairperson commended the presentation and said that South Africans needed to be proud of the achievements by the Department of Health, although there was always a room for improvement, especially on the non-compliance of the three above-mentioned provinces.

Ms D Robinson (DA) also commended the Department of Health for the sterling job in the revitalisation of the Department in a short space of time. However, she asked whether the Department was doing enough to ensure the provision of adequate mental facilities, and psychiatric nurses. In addition, she argued that there was a need for the Department of Health to provide more nurses and social workers, considering that the country was ravaged by unbridled violence, abuse, and rape. She also questioned what the Department had done to ensure a full implementation of the control processes, to prevent health problems like HIV/AIDS, TB, and maternal mortality. To date, adequate monitoring and control had been problematic. What were the control measures to ensure compliance in the Department of Health so that effective and efficient monitoring could be ensured?  

Ms Robinson asked why the Auditor-General had not managed to access primary source information, and what would be done to rectify this for the current financial year. Since non-compliance or financial irregularities were caused by management failure, she asked if there was any review under way, or the possibility of instituting measures in the future, to ensure that this would not happen again.

Ms Robinson noted that the National Health Insurance had missed the stipulated targets and wanted to know what those new targets were. The targets were also not met regarding Medical Male Circumcision (MMC), and she asked what could be done to ensure an increase in the uptake of the MMC. She also expressed her disappointment of the fact that targets were also not met in HIV/AIDS testing, as only 50% of the targets reached. She finally wanted to know why the Department of Health had refused to answer Parliamentary questions on litigation against the Department.

Ms Precious Matsoso, Director-General: National Department of Health, responded that there was a proposal, for not only mental healthcare but also those with disabilities.

The Minister responded that the world of litigation was very complex in both the public and private sector, and not as easy as people suggested that it was, when it came to negligence in the public sector hospitals. He made an example of lawyers who never went to court but fraudulently made millions on the Road Accident Fund (RAF). Litigation could potentially destroy the healthcare system in the country, both in the public and the private sector.

Ms B Ngcobo (ANC) asked whether there was anything that could be done, either with or without the Department of Public Works (DPW), to resolve the major problems with infrastructure, particularly in provinces like Mpumalanga. She wondered if the under expenditure was going to be requested as a rollover. Ms Ngcobo asked if there were any measures to ensure compliance, especially in provinces like the Eastern Cape, where there were rampant cases of financial irregularities. She asked if the interns assisting with accounting played any meaningful role to the Department.

Ms Matsoso responded that the problem of infrastructural development had been scrutinised by the Department, especially in poor provinces like Mpumalanga, Limpopo and the Eastern Cape. The Department of Health had employed graduates from the FET colleges and other universities in order to deal specifically with the problem of infrastructure in clinics and hospitals; this included fixing broken toilets, drainage systems, broken pipes and so forth. She added that there were also engineers working with the team. The interns that were working in finance and accounting were only working in six provinces, excluding Eastern Cape, Mpumalanga and Limpopo, and there was a report on the outcomes of what the interns had done so far. In Gauteng the interns had done a wonderful job, as there was an improvement in the revenue collection. They had also played a significant role both in the administration and finances, and were involved in the programme where they had to physically count all the employees of a hospital, and employees had to produce an identity document during the process. 

Ms Ngcobo complimented the Department for promoting family planning in order to curb teenage pregnancy and abortion, but was concerned that female condoms were not given out to the same extent as male condoms.

Ms M Segale-Diswai (ANC) also asked the Department’s stance on the distribution of female condoms.

Ms Segale-Diswai argued that she did not see any significant improvement on the hospi-centric approach, introduced by the Department of Health, and also believed part of this appeared during the merge between the government clinics and local municipality clinics long ago. Some local municipality clinics, especially in the Western Cape, did not offer adult health care or 24 hour opening times. She wondered if there was effective training of managers, so as to improve supervision in the Department.

The Deputy Minister said that South Africa needed to move from a hospi-centric approach to preventative measures (primary healthcare); in order to win the fight against the burden of the diseases it was faced with. This made more sense as it prevented communicable diseases on the primary level.

Ms Matsoso responded that the Department of Health intended to focus specifically on the provision of primary health care, as the statistics indicated that most of maternal mortalities in South Africa happened in the primary health sector. She also mentioned the importance of school health as one of the examples of services being offered in the primary health sector.

Ms Segale-Diswai asked also for comment on whether the Department was winning with provision of sufficient transport, its relationship with the Auditor-General, what specifically was being done around  inadequate monitoring and evaluation, lack of leadership stability, inadequate skills and insufficient leadership? 

Ms Matsoso responded that there was data on the training of managers, and most managers were trained to address the shortcomings included in the report. She agreed that the issue of transport was still a thorny issue in the Department, especially the provision of mobile clinics in rural areas or areas in the periphery. The Department had a policy of zero tolerance of wasteful expenditure nationally. For example, money was collected for computers or laptops lost by staff, and if hotel bookings were not cancelled on time the Department took the money back from the individuals. There was an instance where 50 computers could have been written off, but the Department had decided to collect all the money, ranging from R10 000 to R15 000 per computer. The Department still had a problem with the engagement with the non-government organisations (NGOs).Comments about leadership instability applied to the provincial level rather than the national level. She said that she did not have an appropriate answer for the question regarding leadership instability.

Ms M Dube (ANC) complimented the Department of Health for the sterling job and the overall performance and commented that most people seemed overly-preoccupied with the shortcomings in the Department, instead of recognising its significant achievements, especially in the fight against the scourge of HIV/AIDS.

Ms Matsoso welcomed the compliment to the Department of Health and emphasized that the achievement could had never happened without the teamwork, hard work and dedication of her entire staff.

Mr D Kganare (DA) was concerned that the increase in the Gross Domestic Product (GDP) spent on health would affect the delivery of a quality health service. He specifically commended the Department’s plan to curb irregular expenditure by ensuring that workers would pay for their lost laptops and accommodation. He asked, with reference to the amount of money being pumped into programmes like loveLife and Soul City, whether any assessment had been done of whether these programmes were effective. Mr Kganare asked how far the Department had gone on the social determinants of health in terms of the NDP.

Ms M Matsoso indicated that the GDP allocation to health of 8.5% was inadequate, but emphasised that money could not be attached to the value of human life, whether there were any improvements in the life expectancy, maternal mortality and infant mortality.

The Deputy Minister said that the Department was not generally in favour of the consultancy approach, but sometimes the Auditor-General audited NGOs as a consultancy. It must be recognised that it was impossible for the health system to run effectively and efficiently without assistance from NGOs. For example, the HIV testing programme, where 18 million South Africans were tested, would have been impossible without the assistance of NGOs. NGOs like loveLife played a crucial role in healthcare.

Commenting on the provinces, Mr Kganare said that the problem of irregular expenditure in the Eastern Cape was more political than administrative. He asked if South Africa was financing the many regional health projects that it was involved in, especially in countries within the Southern African Development Community (SADC). He wanted to know the capacity of the Kimberley hospital.

Mr Barry Kistnasamy, Compensation Commissioner for Occupational Diseases, DoH, mentioned that South Africa was funding the projects in SADC, and this was to help other poor nations, but also more importantly to limit the influx of immigrants seeking healthcare in South Africa.

Mr Kganare asked about the compensation of panellists.

Mr Barry Kistnasamy, Compensation Commissioner for Occupational Diseases, DoH, responded that the panellists were found both in the formal and informal sector workers, and they essentially focused on the clinical examination of the mineworkers, to check their fitness for work, and they also dealt with claims for compensation for the injuries that occurred in the workplace. Generally, there was insufficient rehabilitation for the mine workers.

Ms R Motsepe (ANC) complimented the Department of Health, especially on the provision of mobile clinics in rural areas, as this had greatly increased the accessibility to health-care. However, Ms Motsepe was concerned that the mobile health service vehicles provided by the Department of Health might not be suitable for poor road conditions in rural areas.

Ms Matsoso responded that indeed the roads in most rural areas were extremely bad and inaccessible, and therefore, the Department was going to provide 4x4s as mobile health service vehicles.

The Chairperson asked if circumcision performed by a medical doctor in the bush or traditional setting was included in the statistics and considered to be Medical Male Circumcision.

The Deputy Minister responded that MMC was clear, simple and less complex than the traditional circumcision. Every circumcision was recorded and counted. In KwaZulu Natal, traditional circumcisions were performed by medical doctors and counted, as opposed to the Eastern Cape where there was less acceptance of this practice. The United Nations Programmes on HIV/AIDS (UNAIDS) clearly emphasized that MMC should be counted as a proven measure in the reduction of the HIV/AIDS pandemic.

The Chairperson thanked the Departmental delegation for the presentation, and emphasised that the Department of Health had done a sterling job.

The meeting was adjourned.
 

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