Issues raised by the Committee during discussion on the findings in the report on the Department of Health budget, included the training of paramedics, whether emergency services were being effectively rendered in rural areas, the basic training of nurses, and the opening of new nursing colleges.
Under recommendations, Members discussed the filling of vacant posts, the need for appropriate skills for the posts, and the filling of posts in rural areas. On the latter, there was discussion about incentives to attract and retain staff. On the issue of breastfeeding, it was established that a stumbling block was the ready supply of baby milk formula.
The burden on the health system of patients from the SADC region and neighbouring countries was huge. There was mention of suitable vehicles – 4 x 4s rather than mini-buses -- being allocated to service rural areas. There was discussion on environmental health services within municipalities, and the creation of a single public service. Other issues raised included the need for a publicly-owned pharmaceutical company, tele-medicine, and harmonisation of legislation under the Department of Health and the Department of Labour insofar as it affected compensation to workers for occupational injury and disease.
Apologies for Dr W James (DA), and Mr A Shaik Emam (NFP) were received.
The minutes of the previous meeting were tabled. An amendment was made to page 2, point 4 of the minutes of 2 July, where it was noted that the Director General was omitted as being part of the briefing to the Committee. With these amendments, Mr N Matiase (EFF) moved that the minutes be adopted. This was seconded by Mr I Mosala (ANC)
The minutes of 3 July, page 2, point 1, should record that the word “receive” must replace the word “receiving”. The word “Committee” must replace the word “communities”. With these amendments, Mr A Mahlalela (ANC) moved that the minutes be adopted. This was seconded by Dr P Maesela (ANC).
Committee Report on Department of Health 2014 Budget
The Chairperson established that the draft report had been circulated and received by all Members. The report was taken page by page. She said that the most important page was the last page, containing the recommendations.
Dr H Volmink (DA) asked that the word “ration” be amended to the word “ratio”, on page 5, goal 7. He also asked the Committee to consider changing the wording on page 15, third last bullet from the bottom, so that it reflects that maternal mortality rates were used as an example of the “accuracy and quality of data”. He was asked to provide the wording to the secretariat so that it could be captured properly. The rest of the pages were unchanged. A discussion on the findings on page 15 and the recommendations on page 16 followed.
Mr Mahlalela stated that on page 15, bullet 7, the outsourcing issue did not apply to phamaceuticals. Rather, the matter that arose there was prompt delivery and turn-around time.
Ms C Ncube-Ndaba (ANC) agreed with Mr Mahlalela on the pharmaceutical matter issue
Secondly, the Committee’s finding on emergency services was that paramedics must receive proper training so as not to affect the quality of service adversely. The Chairperson said this concern about quality of service was located on page 16 under “Recommendations”, second bullet, and concluded that this matter must appear under findings as well.
Dr Volmink, on the same point, stated that paramedics should not be taken out of the service for the purpose of training for too long, as an undue interruption could interfere with service provision.
Mr Mahlalela said that the response time when there is a call out must be prompt, especially in rural farming areas,.
The Chairperson said that Mr Mahlalela raised an important point. She therefore proposed that a request be made to the Department to furnish the Committee with the facts about the situation in the farming community with regard to emergency services. She added that farms are privately owned land and farm workers may be affected by what the farmer feels is important or not important when it comes to emergency services. The Committee should also consider whether this becomes part of its oversight responsibility. Emergency service rendering was in addition challenged, in some cases in the rural areas, by a lack of infrastructure. The Department must say whether there is a system in place to ensure that services are being rendered to people in the rural areas.
Ms Ncube-Ndala said that, under bullet 8 on page 15, it had been agreed that the old “basic” nursing training should be re-introduced at training colleges. This was discussed against the backdrop of the length and years of training of nurses. It was felt this would produce a better quality of service from nurses. There were too many nursing sisters and too few nurses trained in basic care. The Chairperson said that the opening of nursing colleges addressed quality of nursing as well as the need for an improved curriculum.
On the same point, Mr Matiase said that the opening of new nursing colleges must not be delayed.
Mr Matiase said that with regard to the last bullet point, under “Recommendations” on page 16, the filling of vacant posts must not be delayed. The recruitment of non-professional workers had increased in number to about 45 000 in two provinces. The Minister had raised his concern about the manner in which provinces recruited. In light of that, the Committee recommended that a guideline be given to provinces not to do so.
Ms Ncube-Ndala said the Committee had advised the Department that before it made recommendations to hospitals, it should consider factors such as the capacity of the institution and the population of the area in which the institution was located. It had been the case that posts were approved without considering whether they were an appropriate number in relation to the population of the area.
Mr Mosala said that he was aware of a system called Workload Indicator of Staffing Needs (WISN) -- a method to determine the number of posts required in relation to the population. He said this point was not reflected in the report.
The Chairperson said that the posts must be filled by people who had the appropriate skills for their particular posts, since in the past the Department had quite a problem with this.
Mr S Jafta (AIC) added that there was also a problem with the issue of staffing especially in remote areas, where the institutions were sometimes deserted by the staff who did not want to work there. There must be a strategy to attract people to work there.
Mr Mahlalela identified five findings which had no recommendations:
1. The burden of neighbouring countries as a result of an overflow of South African Development Community (SADC) patients. However Treasury’s argument was that the budget was informed by the data being collected, and the data being collected did not specify the region from which the patient was coming. The Department did not dispute this, but it remained a problem and therefore the Committee should debate the matter.
2. On the issue of breastfeeding there should be “vigorous” public education. The problem was also due to the ready supply of baby milk formula.
3. On the issue of accreditation of 220 nursing colleges, the Department should provide its strategy for dealing with it.
4. An urgent intervention is needed to address the lack of contribution by the mining sector with regard to tuberculosis.
5. On the issue of the indicators being mainly on an annual basis, not on a quarterly basis, the target for the annual performance plan (APP) needed to be revised.
Ms Ncube-Ndala said the point on nursing colleges should also include nursing curricula.
On the issue of the overflow of SADC patients, she said the Committee must recommend that the Department devise ways of monitoring and evaluating those patients and gather the data so that there was a basis for making a claim from the SADC fund.
On the breast feeding issue, the Minister had put in place a project for starting milk banks in hospitals.
Mr Mosala said that South Africa was not utilising the fund within SADC for the health care of SADC patients from neighbouring countries. South Africa was highly affected by the financial demands on the Department, and the Committee should pressurise Treasury to claim its share from the fund.
Dr Maesela wanted to know what the Constitution said about this issue.
Mr Mahlelela said the Constitution is very clear – that health care must be available to all, regardless of the country from which the patient is coming. Not all members of SADC belonged to the fund and it was not practical to get a share in the fund. The important matter is to focus on making sure the Department gets a sufficient allocation to provide services to all. The size of the allocation must be based on the data.
The Chairperson reminded the Committee that an important point had been raised by Mr Jafta on the filling of posts in rural areas, and that Members should address this issue as well.
Dr Volmink said that on the last point on page 16a, a line must added “… to develop and implement appropriate incentivisation strategies aimed at retaining staff”. With regard to the overflow of patients from SADC countries, the Department and the Committee need to be very sensitive in terms of human rights and social justice on the issue of providing unbiased health care. There were already certain measures in place which addressed this issue, for example, the inter-ministerial forum.
Mr Mahlalela said the Department had tried various options, such as incentives to nurses and doctors who were prepared to work in clinics in rural areas, but these did not work. The Department had been doing its part, but the Committee needed to make recommendations on how to retain and attract staff to the rural areas. Community service and providing housing for staff, were other options used. The concept of sessional doctors, who make up the majority of doctors running an institution, needed serious attention.
The Chairperson said what Mr Mahlalela had raised should be addressed to the Department, which must give the Committee a breakdown of the areas affected province by province. She recommended that Members refer to the NDP and read the chapter relevant to this issue. Health workers were not only doctors and nurses, in terms of clinical staff. In the next quarter, the Department would provide the Committee with all the categories in the health sector. She reminded Members that this was one of the challenges they needed to address.
Dr Maesela said the Department must be more specific when referring to “human resources”. It must specify which category of practitioner, and how many of each post was filled -- that is, it must be quantified.
Ms M Scheepers (ANC) gave an example of rural areas of Qwa Qwa, which were provided with vehicles fully equipped as mobile clinics, but these were not suitable to access remote areas because they needed 4 x 4s, not mini-buses. So the mobile clinics were standing idle. The Committee must recommend that in the planning stage, the Department should get adequate input from provinces on what was needed.
Dr Volmink said there were three matters which he could relate out of his personal experience as a new doctor working in rural areas, which could assist the Committee in making its recommendations. These were basic working conditions, mentoring and supervision, and further training and specialisation.
Mr Mosala said that doctors who had experienced conditions in rural areas must give their input to the Department and in so doing, inform new incoming doctors. He said that it could be a topic for research.
The Chairperson said that the Committee Researcher was here to note this.
Ms Ncube-Ndala raised two issues. Under findings, bullet 2, there was no recommendation with regard to community health workers (CHW). The second was on Human Papilloma Virus (HPV). The Department had launched a good programme on HPV, but this was not enough. It should go further, and encourage and educate our communities and schools so that it was promoted at a primary school level.
Ms L James (DA) said with regard to the provincialisation of clinics, all the metro clinics were currently serviced by the municipalities. Moving the clinics to the provinces had not happened yet. This had led to local governments abandoning their duties in environmental health. In terms of the budget, the DG had said there should be measures in place to focus much more on environmental health, and the budget should be increased accordingly.
Mr Mahlalela agreed with Ms James that the budget should be adequate for environmental health services. There should be discussion with the Department on this.
This prompted him to speak on a related issue - the creation of a single public service. He said the problem with this was the discrepancy in salaries of a director in a municipality, for example, and a director in provincial structures. There was legislation around this, but it would take time to realise.
On the pharmaceutical company issue, he said there was a process underway that would create a company that is publicly owned for the purpose of direct delivery of medicinal products.
The Chairperson asked whether there were any more recommendations that needed discussion.
Dr Volmink said with regard to compensation for occupational injury and disease, the Minister had said that the two-tiered system of compensation was causing workers problems in getting access to compensation. One tier is legislation that falls under the Department of Labour, while the other tier falls under the Department of Health. A legislative review was needed to harmonise the claiming of compensation. The Committee in the current term should strive for harmonisation.
The Chairperson proposed that there should be a joint portfolio committee meeting between Health and Labour, so that the work of harmonisation could be expedited.
Dr Maesela said the service rendered by community health workers (CHW) was not integrated. They should be integrated in health services and be properly trained.
Ms Ncube-Ndala agreed that they must be properly trained. The Department must use the data and clarify their role and their work.
Dr Maesela agreed that data must be gathered and also capture the creativity of CHW, for example, to deliver medicines to people’s homes by bicycle. There should be a discussion with the Department on the issue of the integration of CHW as a part of primary health care (PHC).
Mr Matiase said that it was time that private health care contributed to PHC.
The Chairperson said the Committee would encourage the Department to highlight its collaborative work with other departments which were also involved in the burden of ill health, and how it was working together with the Department of Science and Technology in making sure their mandate was being implemented. She said tele-medicine was a way in which science and technology could help with health care. It was being practised effectively and was thereby easing the burden. Members should consider whether this could be a recommendation.
Dr Maesela said for this to work successfully, a broad-band system was needed. Groote Schuur was doing tele-medicine with doctors in Namibia.
Dr Volmink stated that his party was in support of universal health care. The challenge was to find the most practical route to achieve that goal.
Mr Mahlaselela moved to adopt the report with the amendments. Ms Ncube-Ndala seconded its adoption.
Dr Volmink reserved his right, since he wanted to discuss it first with his party.
The Chairperson said that Members who had made recommendations should forward these on paper to the secretariat. The report would then be adopted with the corrections done and recommendations amended. After that, the secretariat would forward it to the office of the Chairperson, after which it would be tabled. She reminded Members to read their documents in preparation for when the entities did their presentations to the Committee.
The meeting adjourned.
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