The Secretariat made a presentation to the Committee on the processing of the budget vote, an overview of the health sector, and policy priorities. Members’ questions included the budget allocation to primary health care (PHC), the National Health Insurance (NHI) pilot sites, the co-infection rate of HIV/AIDS and TB, and maternal mortality. There were also questions on infrastructure and conditional grants.
There was some discussion on the burden of disease in the mining sector and whether the mines contributed to a fund for this purpose. Members also asked about the establishment of a pharmaceutical company to source medicinal products. A matter of concern was the accuracy or inaccuracy of the data provided by the Department, particularly on maternal mortality.
Apology and opening remarks
An apology for Dr W James (DA) had been received.
The Chairperson said that the work of the previous committee would be taken forward, and the work that had been done was noted. On the topic of health, she said: “… It is not about what you want, or what I want, it is about the citizenry of this country.” By its nature, health was an emotive subject. A legacy report had been handed to all Members. This document would assist in the understanding of the previous work done and how it fitted in with the work commencing today.
The Members and visitors introduced themselves.
The minutes of the previous meeting were tabled.
Mr A Mahlalela (ANC) said that on page 2, the word “elected” must be replaced by the word “nominated”.
Ms C Majeke (UDM) asked whether the names of Members should be preceded by “honourable” when referred to in the minutes.
The Committee Secretary, Ms Vuyokazi Majalamba, responded that during committee meetings, names were preceded by “Mr”, “Ms”, Dr”, as the case may be.
The Chairperson noted the amendment.
Mr Mahlalela moved that the minutes be adopted. This was seconded by Dr P Maesela (ANC).
Briefing by the Secretariat
Ms Majalamba said that according to the Public Finance Management Act (PFMA), the Minister tabled the annual budget in the National Assembly at the beginning of the financial year. Thereafter each department presented its programme objectives. This was called the Strategic Plan. The budget vote and Strategic Plan were then referred to the relevant committee by the Speaker. The work of the committee involved producing a report, and this was followed by a debate in the House. The debate took place in the Extended Public Committees (EPC). The Committee would process and finalise their work by 11 July, 2014. The EPC commenced on 15 July, 2014.
The work of the committee was done in three phases. The first phase was administrative support, which included developing a programme for processing of the vote and outlined the interaction with the department.
Ms Lindokuhle Ngomane, Content Adviser, presented an overview of the health sector, with a background to the constitutional mandate of committees, which was to pass legislation, approve annual budgets and perform an oversight function.
She said that currently South Africa had two types of health systems – public and private. There was an increasing demand for health services. One of the challenges facing the health sector was under-performance, seen in the light of its expenditure. In order to enhance its performance, the sector was aiming, among other objectives, to increase life expectancy from 60 years to 70 years.
Mr Zubair Rahim, Parliamentary Researcher, dealt with policy priorities.
The health sector was guided by the National Development Plan (NDP) and contained nine goals for health. One of the goals of the Health Department’s Strategic Plan was the re-engineering of Primary Health Care (PHC) services. The largest portion of its budget (56%) was allocated to hospitals and human resource development. He elaborated on its various programmes’ budgets and said the key issues to be considered were maternal health, PHC, non-communicable diseases, National Health Insurance (NHI) and tuberculosis (TB).
Ms R Capa (ANC) requested that the Secretariat compile a glossary of the many abbreviations. The small font made the document very hard to read.
Mr Rahim responded that a glossary was being prepared as part of the orientation paper for Members. In research papers it was typed out in full the first time the abbreviation appeared. A request that the printing of the documents be done in larger fonts would be made.
Ms Capa asked whether any grants were allocated in the programmes.
Ms Ngomani said one of the functions of the Department was to monitor NHI primary health care sites. These sites received grants specifically for school-based programmes. A breakdown on pilot sites should be provided to show how those grants had been disbursed. A number of conditional grants had been significantly restructured and reduced due to slow spending. This matter had to be addressed with the Department, which must explain to the Committee what was being done about it.
Mr H Volmink (DA) said there had been a decrease in the budget for PHC, which was surprising. In the NHI green paper, the re-engineering of PHC was a key facet of that reform. He wanted to know whether the elements around re-engineering fell under programme 2, or if it was part of the NHI budget.
Mr Rahim said the Department’s budget consisted mainly of transfers (to provinces). Just over R1 billion went to capital assets, R30.9 billion went to transfers and subsidies (provinces, municipalities etc), and current payments were R2.1 billion, giving a total of R33.9 billion. Health was a provincially-led mandate and budgets would be spent accordingly, but the national department should be setting the priorities. Re-engineering was going to be very costly and the question was where the money would come from.
Mr I Mosala (ANC) asked for more detail on the budget -- for example, underfunding. He wanted the Secretariat to address process issues, of which there were three: administrative support; Departmental inputs; and the Committee’s deliberations. He asked for clarity on how these interfaced with each other.
The Chairperson responded that it was an ongoing process,,and referred Members to the Committee’s work programme.
The Chaiperson asked for clarity on infrastructure, under the heading National Development Plan (NDP) mentioned on page 2 of the research paper: Vote 16: Health.
Ms Ngomani said the Department should be asked how it was fulfilling its mandate of revitalising its facilities, seen in the light of its budget being underspent.
Mr Mahlalela wanted to know if the pattern of expenditure had been captured. This would show how the Department was performing on expenditure and what expenditure trends were emerging. The Committee had to be convinced that the money was needed, taking into consideration that the Department had previously failed to spend its allocation. What measures would be put in place so that it did not overspend.
Ms Ngomani said the Budget process was ongoing, so the Committee will be monitoring the trends as it went along.
Mr Mahlalela said that in the strategic plan, the life expectancy for men was different to the life expectancy for women. What then would be the age used, or was it generalised? This needed to be clarified.
Mr Rahim said this should be raised by the Committee.
Mr Mahlalela wanted to know why, if TB was identified as a challenge, the increase for that sub-programme was only very small. Why did the Department not allocate more resources to it? What did the Department intend to do about the problem of TB, and why did TB continue to be resistant?
Mr Rahim said that TB was being addressed provincially. Whether it was getting the priority it deserved, and why it received only a small increase, must be raised by the Committee. TB co-infection rates with HIV were high. The budget for HIV and AIDS was huge, but for TB it was miniscule. The Department needed to clarify this.
Ms Ngomani stated that other indicators included an increased number of TB tracers and facilitators, as well as an increase in facilities for multi-drug resistant (MDR) TB. It was significant that TB spending was very poor (R7 million underspent), while the cure rate is not being met. The procurement of the Gene Xpert machines had been shown to improve outcomes.
Mr Mahlalela, on the issue of maternal health, said the Committee needed to establish why the increase for this budget was so minimal (R100 000).
Mr Rahim responded that maternal health was a critical factor in the prevention of mother-to-child HIV. It was one of the underlying factors contributing to maternal mortality. The targets and outcomes in this sub-programme had not been achieved.
Mr Mahlalela noted some errors in the strategic plan. For example, he asked if the errors on page 5 (ii) affected its content, or were the errors minor? Some sub-headings were missing under some programmes and sub-programmes, and not in others -- for example, “Purpose”. It needed to be kept consistent.
The Chairperson commented that these errors would be addressed to the Department in terms of its thoroughness in the presentation of documents, especially if it was found that the errors affected the content substantially.
Ms Majeke asked whether there was any difference in TB rates for rural and urban areas.
Mr Rahim said that the TB figures obtained did not distinguish whether they were gathered separately for rural and urban areas. TB was found in both rural and urban areas, and significantly found among miners.
Dr P Maesela (ANC) asked, on the issue of the sourcing of medicinal products, whether it would be feasible to establish a company for this purpose.
Mr Rahim said that the establishment of a pharmaceutical company was a possibility.
Dr Maesela asked whether the NHI pilot sites which were successful, could be made known.
Mr Rahim said that the list of the NHI pilot sites could be provided to the Committee by the Department.
Mr Mahlasele asked whether the mining sector contributed to a fund, or whether the burden of dealing with TB was entirely with the Department.
Mr Rahim said that the main factor was the spread of TB because of movement between the mines and miners’ homes. The Compensation Commissioner for Occupational Diseases (CCOD) was responsible for the care of miners contracting an illness on mines. No annual report had been submitted, but it was not performing very well.
Ms Ngomani said that the Minister had set up a task team last year to look into mining areas and try to help miners and their communities. Currently the mining sector was not contributing or participating.
Mr Volmink asked whether statistics on maternal mortality were accurate, and which documents were sourced for the data on maternal mortality rates.
The Chairperson commented that it would be more appropriate for the Department to respond to this. The secretariat had said that the data was not always accurate, and this must be taken up with the Department.
The meeting was adjourned.