Department and Deputy Minister of Health & Department of Home Affairs briefings on their 2014 strategic plans; Committee Programme

NCOP Health and Social Services

08 July 2014
Chairperson: Ms Dlamini (ANC; Mpumalanga)
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Meeting Summary

The Department of Health (DoH) presented its strategic focus and annual performance plans for 2014 to 2019, in the presence of its Deputy Minister, Mr Joe Phaahla. The Deputy Minister stated that the Department was committed to full implementation of the National Development Plan (NDP) goals 2030, Medium Term Strategic Framework (MTSF), and the National Department of Health (NDoH) Strategic goals 2014/2019. The departmental priorities were aligned with the NDP 2030. Nine priorities were identified that highlighted the key interventions required to achieve a more effective health system, which would contribute to the achievement of government’s desired outcomes. The DoH itself had eight strategic goals, but due to time constraints these were not presented in detail. The DoH budget for 2014/15 was R33.9 billion growing at an average of 9.3% to 39.4 billion over the MTEF. Of this R30.1 billion or 88.7% would go to conditional grants to provinces. R1.5 billion was retained as an Indirect Grant and was spent on infrastructure, NHI and human papilloma virus (HPV) vaccines. Employee Compensation would grow by an average of 7.7% over the MTEF and goods and services by 14.8%, mainly due to the addition of the HPV vaccine grant. The DoH was paying particular attention to evaluation and monitoring and the DoH had developed the norms and standards as a mechanism to determine whether the services were in conformance with quality healthcare. It was suggested that the Committee find time for a workshop on these norms and standards.

Members raised questions on improvement of health facilities, the decrease of budget and whether this meant that certain strategic goals would not be achieved under these line items, how the DOH intended to achieve improvement of access to disability and rehabilitation services, and wanted more detail on how the DoH would support the provinces, how it would address the medicine shortages, the early queues, and what were included in the “non-negotiable” items. They noted that if the budget was too low it would be difficult to achieve goals and objectives. Clarity was sought on the interventions related to piloting the National Health Insurance (NHI), improvement of human resources for health, improvement of health facility planning and infrastructure delivery. Due to time constraints, only brief answers could be given.

The Department of Home Affairs (DHA) presented the annual performance plans for 2014/15. He provided an overview of the DHA’s main mandates in respect of civic services and immigration. It was emphasised that the DHA played a key role in securing the nation, society and the State. The figures for employment equity were outlined, as well as some human resources strategies. A list was presented of the key challenges and how it intended to mitigate them, but again, due to shortage of time, not a great amount of detail was given. The budget allocations to the three programmes of administration, civic and immigration affairs were stated. There were allocations also to the entities of Independent Electoral Commission and Films and Publication Board.

Members asked questions around how the DHA intended to improve security on various borders, how it would address the flow of migration, what it was doing to improve access for the disabled, how it had improved queue administration, called for more detail on the smart card and asked about collaboration with other departments.  Few question on securitisation of the borders and the addressing the flow of migration. Due to time constraints, questions must be responded to in writing.

Meeting report

Chairperson’s opening remarks
The Chairperson welcomed the Deputy Minister of Health, Mr Joe Phaahla, and all delegates and Members. She raised concerns that certain documents had not been sent through in sufficient time to allow Members to go through them in detail, and this hindered their ability to engage fully on them. In future, this situation should be corrected.

She indicated that she was hoping that the Department of Health (DoH or the Department) would describe the alignment of the priorities with the National Development Plan (NDP). The Committee believed that the DoH should be able to reach its objectives with the resources given, and urged the Department to state whether it was ready. The Committee wanted to hear what achievements had been made on the 2013/2014 strategic plan, where the DoH stood, what were the challenges to be addressed, how the provinces were assisted, what had been the DoH improvements and priorities, and how the four provinces that were not doing well were assisted.

The Chairperson expressed deep concern about the state of health facilities and the long queues of patients at public clinics. She said that she would like to hear if the DoH had plans in place to address the issue of “early-morning queues” and suggested that the DoH could learn from the Department of Home Affairs (DHA) about queue management.

Deputy Minister’s briefing
Mr Joe Phaahla, Deputy Minister of Health, apologised that the DoH had sent through the documentation late. He also apologised on behalf of the Minister of Health, who was not able to attend the meeting due to other ministerial matters.

The Department was committed to full implementation of the National Development Plan (NDP) goals 2030, Medium Term Strategic Framework (MTSF), and the National Department of Health Strategic goals 2014/2019. The departmental priorities were aligned with the NDP.

The health sector derived its vision and mandate from NDP 2030. By 2030, South Africa should have:
- raised the life expectancy of South Africans to at least 70 years
- progressively improved TB prevention and cure
- reduced maternal, infant and child mortality
- significantly reduced prevalence of non-communicable diseases
- reduced injury, accidents and violence by 50% from 2010 levels
- completed health system reforms
- provided primary healthcare to families and communities, and achieve universal coverage of health
- filled posts with skilled, committed and competent individuals.

In line with the NDP, nine priorities were identified that highlighted the key interventions required to achieve a more effective health system, which would contribute to the achievement of desired outcomes.

Department of Health Strategic Plan 2014
Ms Malebona Precious Matsoso, Director General, Department of Health, stated that whilst she would try to be as brief as possible, it would not be easy to summarise the presentation. She proceeded to present the NDoH Strategic goals, over the next five years, which included:
-  Making progress towards the universal health coverage through the development of the National Health Insurance (NHI) scheme, and improving the readiness of health facilities for its implementation;
- Re-engineering the primary health care (PHC) by increasing the number of ward based outreach teams, contracting general practitioners, and district specialist teams; and expanding school health services;
- Improving the quality of care by setting and monitoring national norms and standards, and improving system for user feedback, increasing safety in health care, and by improving clinical governance
- Improving health facility planning by implementing norms and standards
- Improving financial management by improving capacity, contract management, revenue collection, and supply chain management reforms
- Improving human resources for health by insuring appropriate appointments, adequate training, and accountability measures
- Preventing diseases and reducing its burdens, and promoting health through a multi-stakeholders National Health Commission (NHC)
- Developing an efficient health management information system for improvement decision making.

She took the Committee through each goal to explain, in more detail, the strategies to achieve each. However, she requested that the Committee should try to find time when a workshop could be conducted by the Department, to enlighten the Committee further about the priorities and strategies to be achieved. She believed that if the Committee understood the vision and goals of the DoH, the Committee would, when conducting oversight, be better equipped to do its own analyses and evaluation to determine whether the qualities of services were consistent with norms and standards.

The Minister had stressed that, for the NHI to succeed, two conditions had to be met, of affordability and quality. The Department would improve quality of infrastructure and accelerate delivery in the healthcare infrastructure.  There were no standards and norms in the past, but today these were in place and had to be adhered to for the improvement of and ensuring the quality of health care.

Ms Matsoso spoke to healthcare finances, and said that the Department had established a list of “non-negotiable” items. To allow the provinces to function sufficiently and effectively, funds would be allocated for those items. She gave an example of immunisation of children as one of non-negotiable items. The provinces would not be able to claim that they were unable to do the work on the basis that there was no funding.

The Chairperson interjected at this point, and said that, due to the time constraints, the budget should be presented.

Mr Ian van der Merwe, Chief Financial Officer, Department of Health, took the Committee through the budget presentation. The total budget for 2014/15 was R33.9 billion, growing at an average of 9.3% to R39.4 billion over the MTEF. Of this R30.1 billion (or 88.7%) represented conditional grants to provinces. R1.5 billion was retained as an Indirect Grant and was spent on infrastructure, NHI and human papilloma virus (HPV) vaccines. Compensation of employees would grow by an average of 7.7% over the MTEF, and goods and services by 14.8%, mainly due to the addition of the HPV vaccine grant.

He described the grants and provided the breakdown of the budget (see attached presentation for full figures), showing the amounts for each of the:
- Conditional Grants
- Conditional Grants Growth
- Health Professional Training Grants
- National Tertiary Services Grants
- Comprehensive HIV/AIDS Grants
- National Health Insurance Grants
- National Facility Revitalisation Grants

Mr Van der Merwe stated that the key components of the “non-negotiable” items, as mentioned earlier, would include:
- Infection control and cleaning
- Medical supplies, including dry dispensary
- Medicines
- Laboratory services
- Blood services
- Food services
- Security services
- Laundry services
- Essential equipment and maintenance of equipment
- Infrastructure maintenance
- Children’s vaccines
- TB

Ms Matsoso stated that more explanations would be provided in responding to questions.

The Chairperson apologised for rushing the presentation.

Ms L Zwane (KwaZulu Natal, ANC) thanked the Department for their presentation and remarked that it was very enlightening. With reference to the Department’s move away from an emphasis on curing and towards preventing diseases she asked whether this exercise was covered in the budget.  She sought clarification on whether the Department had mechanisms in place to educate the public about health. Noting that the number of the people suffering from HIV/AIDS seemed to be increasing, she asked what the Department’s plans were for addressing the matter and whether budget was allocated to address this issue, as well as to reduce prevalence of non-communicable disease.

Mr D Stock (Northern Cape, ANC) stated that some of the areas of priorities had been the centre of focus for 30 years, and it appeared from the presentation that the Department was doing well. He asked whether there was a plan to increase the numbers of clinics and hospitals in different provinces. He raised the issue of the young people who were sent to attend exchange programmes, but who, on completion the programmes, objected to being deployed in the rural areas, and asked what the Department’s response to that problem was. He further sought clarity on the non-negotiable items. He wanted to know what interventions had been made in terms of norms and standards compliance.

Mr B Mntomuhle (KwaZulu Natal IFP) sought clarification on the interventions related to piloting the NHI, improvement of human resources for health, improvement of health facility planning and infrastructure delivery. He remarked that the strategic focus 2014 to 2019 appeared to lean towards the areas that were already developed although he did appreciate the monitoring and evaluation approach. He asked the Department to elaborate on how it translated theory into practice. He asked for further comment on the Director-General’s comment about the graduates being deployed in other provinces except Eastern Cape and Kwazulu Natal, and the gap between the Department’s wish list and actual list.

Mrs T Mpambo-Sibhukwana (Western Cape, DA) sought clarification on the challenges faced by the provinces. She asked about money allocated to improve access to disability and rehabilitation services. She asked for more detail on what the intervention mechanisms to lessen the budget in the context of implementation of the framework and model for disability services were. She wanted more detail also on the interventions for the improvement of health and lifestyle in terms of reduction of, for example, TB and high blood pressure. With reference to re-engineering of Primary Healthcare (PHC), she asked the Department to give more information, and to clarify how it would address the issue of the medicine shortages in clinics and hospitals. Finally, she sought clarification on the strategic plan to engage the teachers of Grades 1 to 8 in schools, so they could contribute to health and well-being of learners. She remarked that it was not easy for the teachers to know if children were suffering from particular diseases.

Mrs M Tlake (Free State, ANC) stated that she was concerned with the timeframes. She wondered when the Department would air the Department’s plans and programmes on local and national media, for the people to be aware of the health services available.

Ms Zwane asked whether there were departmental interventions to help the Province of Limpopo to manage the finances, and if the strategic plans were implemented. 

The Deputy Minister agreed with the Director General that a workshop session was needed to equip the members of the Committee, particularly with knowledge of monitoring norms and standards, so they could evaluate the quality of care.

With reference to Limpopo province, the Deputy Minister stated that the Department was working with the province to address the issue raised. There was a team appointed to look into the financial issues and there was good progress.

The Deputy Minister spoke to issues around curable and preventative steps, and explained that spending on curable diseases in fact remained the Department strategic goal. The reality was that the Department could not sit with 5 million people suffering from HIV/AIDS, without doing something. The Department’s philosophy was grounded on measures for both curing and preventing diseases measures. The Department would, in the future, focus also on the preventative measures.

He further stated, with reference to the non-communicable diseases, that there were strategic plans to improve quality of health care with a particular focus on implementation of particular priorities. He said that the Department would, in the next presentation, provide a document containing the curative and preventative strategic measures.

The Chairperson sought clarification on a number of issues where the documents indicated that these were priorities, but where the budget had declined. They, for example, included PHC, HIV/AIDS and TB. If the budget was too small, that was an indication that it would be difficult to meet goals and objectives.

The Chairperson stressed again that the Department should find ways to address the queues at clinics and hospitals. Patients could not continue to wake up at 03:00 to go to queue for prescribed medicines. She expressed deep concern about meeting the standards and norms, saying that many clinics and hospitals still fell far short on this. She requested the Department to visit the PHC clinics in Mpumalanga to witness what she was referring to.

The Chairperson said, in regard to HIV/AIDS, that two provinces – Mpumalanga and Kwazulu Natal – were leading in the number of the people suffering from HIV/AIDS, and, in 2014, they were still leading. That was an indication that something was not right. 

The Chairperson said that the Committee would appreciate a clean audit.

The Chairperson further remarked that the Department did not explain how it would be supporting the Offices of Premiers.

The Chairperson said that the Committee would find a day or two days for the Department to conduct a workshop that would enlighten the Committee about the Department’s standards and norms, and that would enable Members to conduct oversight visits.

The Chairperson said that generally, the Annual Performance Plan was designed to provide a clear indication of whether the Department had delivered or whether it met its priorities. In the next meeting, the Department should mainly focus on the provinces because that was the sphere of the government the Committee Members represented.

Referring to the ten central hospitals, the Chairperson said that the Mpumalanga was suffering because it lacked a central hospital. In the absence of that central hospital, the Department had organised the transportation of patients from Mpumalanga to Gauteng. As a result, Gauteng was disorganised and in chaos. She suggested that the Department should consider mitigating the costs of transportation and rather work on improving health care services in Mpumalanga, by establishing a central hospital in Mpumalanga and in other provinces where such services were lacking.

Department of Home Affairs Strategic Plan 2014/15
Mr Mkuseli Apleni, Director General, Department of Home Affairs, apologised on behalf of the Deputy Minister, who was on sick leave and the Minister, who was attending to other ministerial matters. The Chairperson responded by noting that the apologies were accepted, and requesting that the Committee’s good wishes be conveyed to the Deputy Minister.

The Chairperson noted that the Committee had time constraints and the Department might not have enough time to brief the Committee fully. However, what the Member wanted to hear about were the main challenges that the Department was facing and how they could be addressed. She reminded the Department to send the documents on time in future, saying that Members had received the documents only that morning and in future, if that happened, no meeting would be entertained since the Committee would be unable to give input. She urged the Director General, as accounting officer, to ensure that the documents were sent on time.

The Chairperson remarked that the Committee was happy to see the Minister of Home Affairs on the national TV, during NewAge Breakfast Brief, answering the most important questions. She commented that the Department did well in alleviating the ID and passport queue problem, and she intended to refer other departments to him, so they could take lessons in how they could similarly address these issues.

The Chairperson asked Mr Apleni to focus on the alignment with the NDP, the budget, how the Department was supporting the priorities of the provinces, and how it was aligning the resources to the priorities. The Committee was also interested in how the Department deal with securitising the border. She asked that he try to make his presentation concise but clear.

Mr Apleni said that his Department, unlike other portfolios, responded to 52 million citizens. Each individual needed the Department’s attention and care. He was aware that the documents ought to be sent to the Committee at least seven days prior to the meetings, otherwise the Committee would have insufficient time to prepare. He apologised and promised the Committee that he would adhere to the House’s rules in future.

Mr Apleni provided the content of the presentation and moved on quickly to providing an overview of two main mandates, namely the civics mandate and immigration mandate. In terms of civics mandate, the Department was custodian, protector, verifier of the identity and status of citizens and permanent residents in South Africa. This included issuing travelling documents that were recognised by other countries. In terms of its immigration mandate, the Department had to control, regulate, and facilitate immigration and the movements of persons through ports of entry. It also served foreign missions, enforced the Immigration Act, and determined the status of asylum-seekers and refugees in accordance with the international obligations.

Other mandates specific to the Departments included funding and oversight of the Independent Electoral Commission (IEC), Government Printing Works and the Films and Publications Board (FPB), administration of the Public Holidays Act, 1994 and funding of political parties through the IEC.

Mr Apleni stated that the civics system was stable and that the Department administered the national population register. The systems were critical and data was under consistent threat of fraud, errors, cyber-attacks and identity theft. The immigration system was dynamic. There was a need to empower the Department to effectively counter threats of crime and terrorism, and ensure the efficient and strategic facilitation of legal migration. He stressed that the Department played a key role in securing the nation, society and the State. That was done in collaboration with the other portfolios, such as Education, Health, Social Development and others.

Mr Apleni confirmed that the Department contributed directly to government outcomes in the 2014 to 2019 cycle, that:
- All people in South Africa are and feel safe
- Decent employment through inclusive economic growth
- A skilled and capable workforce to support an inclusive growth path
- An efficient, effective and development oriented service.
- Nation building and social cohesion.

Mr Apleni touched on the issues of human resources strategies, including the employment equity status. The breakdown of employees was 86.58% Africans, 5.75% coloured, 0.82% Indians and 6.85% whites.

Mr Apleni stated that the Department supported the priorities of government; inter alia, the electoral mandate, the State of the Nation Address (SONA) and the NDP. He proceeded to highlight the implications of the NDP for the Department and the Department’s contribution to the MTSF 2014-2019 (see attached presentation for full details).

The key challenges that were identified were:
- Asylum seeker/Refugee management including relocation of refugee centres to borderlines;
- The need to overhaul the permitting system and border management;
- The continuing dependency on the Departments of Public Works and State Information Technology Agency (SITA);
- Non integration of IT systems;
- Records management;
- Lack of capacity in critical areas;
- Fight against unlawful activities;
- The need to achieve improvement of administration, especially financial management
- Ensuring that the Department had staff that were appropriately trained, professional and caring.

In terms of the 2014/2015 priorities and commitment, the Department had identified six goals or strategic objectives that it would achieve over the next three to five years. These goals were further elaborated on (see attachment).

Mr Apleni briefed the Committee on key programmes and campaigns impacting on provinces. He set out some significant achievements 2013/2014. The achievements include registration of a total of 650 682 births and issuing a total of 125 112 smart ID cards.

Mr Apleni explained that the annual performance plan (APP) was grounded on three outcomes, namely secured South African citizenship and identity; (secured and responsive immigration system; and services to citizens and other clients that are accessible and efficient. The outcomes were obtained through implementation of further strategic objectives.

Ms Josephine Meyer, Chief Director: Finance, presented the budget. The Department has three programme budget structures, for administration, civic affairs, and immigration affairs. For the 2014/15 budget, R1.75 billion was  allocated to administration; R2.274 billion was allocated to the civic affairs whereas R730.9 million was allocated to immigration affairs. The two Departmental entities – the IEC and FPB – received R1.675 billion and R78.9 million respectively. There was a decrease in the budget from 2011/12 financial years to 2012/13 financial year due to the once-off passport funding the Department received from the National Treasury.

The Chairperson noted that some Members of the Committee now had to attend another meeting, and excused three. She asked the remaining Members to ask their questions.

Ms Mampulu, referring to slide 9 and slide 47, asked the Department to unpack the re-issuance of ID smart card and state how the Department intended to manage the movements of the Zimbabweans.

Mrs Zwane stated that she did not hear the Department stating how it would make it more easier for people with disabilities to have access to services. Furthermore, she commented that the presentation should have primarily focussed on the performance, and not on the strategic plan.

Mr Mntomuhle expressed a deep concern about the securitisation of the border between South Africa and Swaziland and the border between South Africa and Mozambique.

Mr H Groenewald (DA, North West) also raised the issue of security of the Musina border. He remarked that the presentation lacked timelines.

Ms Mpambo-Sibhukwana said that numerous shacks had caught fire, people had lost all their items, and nothing had been provided to them. Secondly, she wanted to raise questions about a certain child, now 19, who was born in Mitchells Plain, and was disabled. His sex was wrongly recorded at birth. He was now unable to access social benefits because of this wrong recordal and was being compromised. She also wanted more detail on the securitisation of the borders. Lastly, she asked what mechanisms were place to safeguard the South African children, when one parent was a foreign national who had entered into the marriage simply to get South African citizenship, but who soon thereafter divorced.

The Chairperson again noted the time constraints and asked that these questions be responded to in writing.

The Chairperson noted that the Department should quarterly inform the Committee on its progress. She noted the importance of collaboration with other departments, and said that this Committee wanted to know how that collaboration would be improved for the Department to meet its priorities.

Mr Apleni illustrated how collaboration was prime, by giving a quick example. The DHA, free of charge, was providing the ID Smart Card to those over 60, had communicated with the Department of Social Development (DSD) that such services were launched, and had requested the DSD to send people falling in that age group of people to DHA to obtain smart cards. If the DSD did not encourage this, the work of the DHA would be more difficult. He emphasised that the smart cards were crucial because they were electronically protected, and another person would not be able to use them to steal the rightful owner’s grant entitlement.

Adoption and consideration of Committees 1st term programme and Committee Minutes
Due to time constraints and lack of quorum, the Committee’s first term programme and Committee minutes were not tabled for consideration.

The meeting was adjourned.

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