Department of Health 2014/15 Third Quarter Performance, with Minister

Standing Committee on Appropriations

22 April 2015
Chairperson: Mr N Gcwabaza (ANC) (Acting)
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Meeting Summary

The Minister said the Department of Health (DOH) was making inroads into the clinic and hospital maintenance backlog, working towards a universal national health insurance (NHI) system and developing holistic and integrated health care personnel that could deal with both HIV/AIDS and tuberculosis (TB). The DOH was busy outsourcing the management of GPs into the NHI system and the training of nurses for all types of scenarios. It had implemented technology in its communications, with sms messages on health care and reminders to pregnant women to visit their clinics. The Department had placed a moratorium on the procurement of different IT systems by the provinces to make sure that a national integrated system was used to gather information and speed up service delivery. Family planning was important. The implant in the upper-arm of women which prevented pregnancy was very popular. It was free of charge, and the DOH had reached 500 000 women from the beginning of August to today. Condom use in the country had gone down, even though condom production had gone up. Now the “cool” condom that was scented and coloured was being trial run at a few universities.

The Department reported that a large amount of work had been done in testing and treating HIV, TB, malaria and influenza. From over 70 000 mother-to-child AIDS transmissions in 2004, it had dropped to 7 000 children. The child mortality rate from malnutrition was an area of concern. On the budget front, the DOH had spent 73.47%, or R24.9 billion, of the budget of R33 billion. Goods and services expenditure had been R676 million, or 42.06% of the budget of R1.6 billion. There had been some under-spending due to the slow take up of health practitioners at the pilot sites for the NHI, and delays in finalising programmes.

Members asked what the DOH was doing about providing holistic training for nurses. They also asked why South African medical students were being sent to Cuba for training, and were told by the Minister that this was because Cuba had 27 medical schools, while South Africa had only eight. Furthermore, The Southern African Development Community (SADEC) did not have many medical schools, so they sent their students to South Africa, which reduced the capacity. 

Meeting report

Minister’s opening address

Dr Aaron Motsoaledi, Minister of Health, said the world was in transition and was leaning towards national healthcare systems. The future was universal health care. This would be discussed by the Director General. In 2004, there were 400 000 people collecting medicines from clinics in South Africa, but the number now was three million. South Africa had one-third of the world’s AIDS population, and this was a major challenge for the Department of Health (DOH). The big challenge was to have integrated health care personnel, where a nurse/doctor could deal with AIDS, diabetes, antenatal care and other conditions all in one go. At the moment, there were nine provinces running like separate countries buying new information technology (IT) systems. These provinces were told that they needed another system and so they went ahead and bought a new one. This kept going until they had spent R4.5 billion on IT. The DOH had slapped a moratorium on different systems to make sure that a national integrated system was used to gather information and speed up service delivery. He asked Parliament to support the DOH in implementing and monitoring this moratorium, as the provinces would come and complain about it.

23,000 nurses had been trained to provide AIDS treatment and to dispense drugs. They needed to do the same for nurses treating tuberculosis (TB). At the moment, there were only 372 nurses for multi-drug resistant (MDR) TB. Every Correctional Services facility needed to screen inmates. An inmate had taken the prisons to court for contracting TB, and had won the case. It was now a legal issue which needed to be dealt with. South Africa was a leader in the area of checking inmates and screening them and their families.

Many women waited until they were in labour before they went to clinics. This was a problem, as a mother needed to be put on HIV treatment by 14 weeks, and not at the birth. The DOH had created an SMS system to contact mothers once they had registered at clinics. Breast feeding was very low -- around only 8% of mothers -- which was one of the lowest rates in the world. Leaders needed to spread the message that women had to go early to the clinics. Family planning was important. The implant in the upper-arm of women which prevented pregnancy was very popular. It was free of charge, and the DOH had reached 500 000 women from the beginning of August to today. Condom use in the country had gone down, even though condom production had gone up. Now the “cool” condom that was scented and coloured was being trial run at a few universities. The DOH was hoping that dual protection would work, with the condoms and the free implant.  

General practitioners (GPs) needed to be encouraged to go to clinics, rather than hospitals. The plan for getting GPs to public clinics required a full-time unit to manage it. This had been outsourced and an improvement had been seen. The DOH had learnt from the errors through the pilot programme, and they would be spending more on national health insurance (NHI). 30% of the money that was appropriated for the DOH must be allocated to the backlog of maintenance, and only 5% to new facilities.

Dr Motsoaledi said that the President could be asked to fire him from the DOH if there were no changes going forward.

Department of Health Presentation

Dr Malebona Matsoso, Director General, DOH, gave details of the Department’s six programmes.

Programme 1: Administration

The DOH had achieved an unqualified audit report. All nine provinces had submitted reports for the third quarter against a defined set of non-negotiable items. On IT, an information, communication and technology service continuity plan had been approved. An integrated strategy had been approved to communicate on issues like health, lifestyle, TB, HIV AIDS, safe sex and pregnancy. Private communication companies had been invited to prepare mass communication proposals. Pregnant women received an SMS to come into natal care as part of this. On human resources (HR), 58% of vacant posts had been filled within five months. Three out of the four Employment Health and Wellness pillars had been implemented up to December 2014. Nine provincial annual performance plans had been developed and reviewed, and feedback had been provided. One national and nine provincial forums had been established.

Programme 2: NHI, Health Planning and systems enablement

The piloting of the NHI in selected districts had begun. Ten districts had been involved in discussions. A consolidated Q3 report had been prepared and submitted in January 2015. The DOH and National Treasury were collaborating to prepare a White Paper on NHI that addressed financing arrangements. Treasury had drafted a paper entitled “Financing National Health Insurance”. Recommendations on the final dispensing fee for pharmacists had been submitted for approval. Legislation on data fees had taken precedence over logistics fees in this case. Industry had requested more time to go over the technical aspects of the pricing systems. The DOH needed to continue to review what treatments were published. On the adult essential medicines list, only 26% of hospital levels had been reviewed, against a target of 45%. Seven medicine reviews had been conducted on a super speciality list of medicines. Chronic medicine and distribution was now to be centralised to assist with distribution, and 61% of facilities in pilot districts were running with this.

The DOH had developed a revenue retention plan using unemployed finance, and HR and IT graduates who were trained with EU money. R1.3 billion had been collected over three years, where people used public hospitals and money was tracked down and collected from private medical schemes. Hospital CEO’s should be able to use the money to fix issues straight away with this extra money. This plan should be rolled out to central and tertiary hospitals. Progress had been made with reference to the implementation of IT architecture in the 700 provincial health centres and ten NHI districts to gather information on patients. A total of 3 337 computers had been distributed and installed in local areas in order to capture data on patients. A web-based electronic health research database had been launched in October 2014 in an observatory.  The DOH had data on every single health professional in the country. A final draft monitoring and evaluation (M&E) strategy plan had been submitted. An integrated surveillance system had been developed for diseases. A national antenatal HIV survey dataset had been finalised and analysed. The problem age was 15 to 24 in women, where they were infected with HIV by older men and passed it on to younger men. The DOH had launched a new colourful and scented condom to try deal with this. Ebola and yellow fever were areas that had been discussed with international parties and treaties.

Programme 3: HIV, AIDS, TB and Maternal, Child and Women’s Health

2 365 533 HIV tests had been conducted on people aged between 15 and 49, against a target of 2 500 000. Male circumcisions conducted were 84 791, against a target of 250000. Anti-retroviral (ARV) treatment was 2 904 153, against a target of 2 800 000. The new client treatment success rate was 80.9%. The TB MDR treatment success rate was 46.6%. The DOH had targeted mining and Correctional Service areas to deal with TB, as they had a high contraction rate. The DOH wanted to reduce the maternal mortality ratio to fewer than 100 per 100 000 live births. At the moment, it was 127.5 in Q3. The DOH wanted to reduce the neonatal mortality rate to fewer than six per 1 000 live births, but in Q3 it was 14.1. From over 70 000 mother-to-child AIDS transmissions in 2004, the number had dropped to 7 000. The malnutrition child mortality rate was an area of concern.  The measles case incidence was now 0.9 per million people.

Programme 4: Primary Health Care Services

An implementation plan and monitoring and evaluation system had been developed for primary health care facilities with functional clinic boards.  Clinic committees had been established.  A clinic model had been developed for small, medium and large clinics. Broad-based community health care teams had been developed, with about 17 000 trained.  44 ports of entry had been assessed for compliance with international health regulations, and were ready for designation. The target was to have a malaria free SA system by 2018, and the only problem was the border with Mozambique. For influenza, 818 908 high risk individuals had been vaccinated. Non-communicable diseases were a priority, with 140 146 being counselled and screened for high blood pressure and 108 476 for high glucose levels. A new information system had been developed for mental illnesses. The DOH was improving access to disability and rehabilitation services. An Emergency Medical Service plan had been developed to speed up ambulances, and to make them the same colour and easily identifiable.  A new toxicology laboratory had been launched in KZN.

The chairperson interrupted the meeting at this juncture to point out that they had another meeting at 12h30 and that the presentation needed to be sped up, so Programmes 5 and 6 would have to be rushed through. Due to time constraints, Members were asked to pose questions and the Department would respond in writing to those not covered.

Programme 5: Hospitals, Tertiary Services and workforce development

Five public nursing colleges accredited to offer the new nursing qualification was the target, but to date there had been zero achievement.  Five new Community Health Clinics (CHCs) in Mpumalanga and three new hospitals had been peer reviewed during the clinical briefing phase in line with gazetted norms and standards.

Programme 6: Health regulation and compliance management

The Medicines and Related Substances Amendment Bill had been drafted and was going through the Parliamentary processes, with a view to establishing the SA Health Product Regulation Authority (SAHPRA) a public entity. The DOH was also looking at strengthening food safety through expanding testing capabilities.

Quarter 3 Financial Report

Mr Ian van der Merwe, Chief Financial Officer, said the DOH had spent 73.47%, or R24.9 billion, of the budget of R33 billion. Goods and services expenditure was R676 million, or 42.06% of the budget of R1.6 billion. There had been some under-spending due to the slow take up of health practitioners at the pilot sites for the NHI, and delays in finalising programmes. The transfer payments expenditure was R23.6 billion, against a budget of R31.1 billion.  For the national health grant, 23% of the budget had been spent, or R271 million against a R1.1 billion budget. The cumulative cash flow was on the rise.  The DOH had improved the facilities at 104 units. GPs wanted better conditions, better compensation and good infrastructure before committing to the NHI.  On schedule 4 and 5 grants, 97.8% had been spent on the budget, or R30.1 billion out of a budget of R30.7 billion.

Discussion

Mr M Figg (DA) said that the hospitals were in quite a bad state, and people were dying there. He asked how this situation was going to change. SA had a shortage of doctors -- why were students being trained in Cuba, and why was SA using Cuban doctors in their hospitals? How did the DOH encourage students to study medicine here? There was a lack of facilities. He asked the Minister if he visited hospitals frequently. Could the new fancy condoms be made locally? Promotion of circumcision was often discussed, and people believed they were safe when they were circumcised -- this was a big problem. Had the supply chain problem been resolved? What was the ideal family size in family planning? The CFO must please comment on the shot gun approach mentioned in slide 64.

Ms M Manana (ANC) said that the Minister had asked the Members to help with communicating the message about antenatal clinics. However, there were no records at these clinics, and they needed to inform women to go back to clinics. Why had circumcision been slow? The Minister had mentioned that nurses were not trained in a holistic way -- what were they doing about it? Could the DOH come up with a new organogram to accommodate the new GP structure? The DOH was not in charge of building new houses and clinics -- it fell under the Department of Public Works. The Members would assist in helping with a document to control this. The documents for these meetings must be sent in advance.

Ms R Nyalungu (ANC) asked what the human papillomavirus (HPV) discussed during the presentation was? What criteria did the DOH use for the 400 graduates in the collection of revenue?

Mr A McLoughlin (DA) asked if Members could get a copy of the invitation letter that was sent to the Department in the future?

The Minister responded that the DOH was looking to improve hospitals. It had sent out teams to review hospitals and check on compliance with rules and regulations. In the past, anyone could manage a hospital, but now it had been determined that only health professionals could be CEOs. At the moment, Public Works handled maintenance and fixing, and this needed to change. There had been sewage in one of the hospitals and they were waiting on Public Works to fix it. Cuba had 27 medical schools, while SA had only eight. That was why the DOH sent medical students to Cuba, as they had the spare capacity to train them. The DOH was looking to increase the number of facilities and increase the capacity of the current schools. The Southern African Development Community (SADEC) did not have many schools, so they sent them to SA which reduced the capacity.

The number one AIDS province in SA was KZN. King Shaka had promoted no circumcision, but now King Goodwill was promoting it and this was slowly turning the tide. The Minister did not agree that people did not use condoms once they were circumcised. There were new opportunities with implants for penises. When social economic conditions were poor, families were normally big. When times were good, families tended to be small. Male circumcision was seasonal, so that was why it had been small in Q3. The foundation that trained nurses for HIV was the same one training nurses for TB, and was incorporating GPs into the system as well. HPV leads to cancer, so the Department was going to schools to stop this from spreading. An advert had gone out to students and schools for the position of tracking down outstanding revenue.

The meeting was adjourned.

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