The Portfolio Committee on Health met to adopt the draft report on the Strategic Plan (2015/16 to 2019/20), Annual Performance Plan92015/16 to 2017/18) and Budget vote 16 of the Department of Health.
The Committee made a number of suggestions for changes to the wording, grammar and typographical errors in the Report. Members, when debating whether certain issues should be included, were very careful to only include matters directly discussed with the Department during the Committee's budget hearings. Particular recommendations and notes by the Committee included concerns that the Department needed to improve its communication with communities on HIV and AIDS and should be working with the Department of Education on its current curriculum, in order to enhance the quality of nursing. The Committee suggested that all the budget pressure highlighted by the Department should be indicated in the report. Dr W James (DA) commented that it would be useful for colleagues to come up with alternative formulations when raising issues. The Committee also stressed that the health sector had recognised the need to implement a comprehensive and inter-sectoral response to combat violence and injury, and significantly reduce the country’s injury and death rate. Members were concerned that the Office of Chief Nursing Services may create budget pressures, and suggested that all budget pressures expressed specifically by the Department should be captured. The Committee also noted its concern that the Provincial Health Departments were not performing well on their financial audit outcomes”. It also suggested that the entities cut down on the use of consultants and use the funding to train graduates instead. Other concerns were voiced around the slow establishment of the One Stop Service Centres in the feeder areas of towns and timeframes for review of the legislation. and the slow response rate of Emergency Medical Services, particularly in the rural areas. It was noted that the budget vote in the House would be held on 5 May.
The Committee asked Members to note recent media reports on, firstly, an application by a terminally ill patient that the Department of Health should assist him to die with dignity, and secondly, media reports about other assisted suicide, and said that this was an issue that all communities should be aware of.
Department of Health Strategic Plan, Annual Performance Plan and Budget 2015: Committee Report
The Chairperson noted that the Department of Health (DoH) budget vote was due for debate on 5 May. She tabled the draft Committee Report (the Report) and asked that Members focus on the last three pages
Mr A Shaik Emam (IFP) commented that the successes of the Department on the National Health Insurance Scheme (NHIS) were not included in the overview of the Department of Health.
Dr W James (DA) commented that it would be useful for colleagues to come up with alternative formulations when raising issues.
Mr A Mahlaela (ANC) agreed,and proposed that the last paragraph under "Introduction" on page 1 should be rephrased to read: “This report details the finding and recommendations of the Committee after engaging the Department and its entities, as well as receiving analysis by the Auditor-General and the Financial and Fiscal Commission on the Department’s Strategic Plan and APP”.
Ms C Ndaba (ANC) suggested that “Office of the Director General” should be used instead of just stating "Director General" in the paragraph under "Consideration of tabled strategic plan and APP and budget allocations".
Mr Mahlaela commented that that in the Department there was only one Office, which was the Office of the Minister so it should not be stated as the Office of the Director General.
Mr Shaik Emam commented that something on the achievements and successes of the Department should be added into the Overview.
Dr James disagreed with the proposal of Mr Shaik Emam as achievements and successes should not be in the Overview; he thought it more appropriate to put these with the strategic goals of the Department.
Mr H Volmink (DA) suggested that the sources of the critical indicators of the health sector achievement should be stated.
Ms C Ndaba (ANC) suggested that the observations and deliberations of the Portfolio Committee regarding Cosmetics and Food should be captured in a separate paragraph in the report.
Ms M Scheepers (ANC) proposed that the second sentence, under "Violence and injuries" (page 3) should be restructured to read: "The health sector recognises the need for the implementation of a comprehensive and inter-sectoral response to combat violence and injury, and significantly reduce the country’s injury and death rate.
Mr Mahlaela provided the source of the critical indicators in the first sentence on page 3 suggesting that it read: "Below are some of the health sector achievements in critical indicators as presented in the 2015/16 to 2020 Strategic Plan of the Department of Health."
Mr Shaik Emam asked if there was need to elaborate on the last sentence under HIV/AIDS and TB on page 3.
The Chairperson said the Committee was not elaborating on the reports, but was rather intending to make necessary corrections.
Ms Ndaba corrected a typographical error in the first sentence under Traditional Medicine (page 2).
Mr Mahlalela commented that the decrease in exchange rate would affect the set-up of Health Attaché’s Office in Cuba, as well as the annual contribution to the World Health Organisation and so he suggested that the bullet points under "Additional areas that could present budget pressure" (page 6) should be amplified to also capture the effects of exchange rate on both the Attaché’s Office and the contribution to the WHO.
Dr James corrected that it was a decrease in budget rate that could have implications, not increase in budget as stated in the Report.
The Chairperson suggested that Members should note their reformulations on paper, in order to save time.
Mr Volmink said "antenatal" should be written in lower case in the last bullet point of page 8t.
Mr I Mosala (ANC) proposed that the word "clients" (used for HIV positive antenatal clients) be replaced by the word "women" in bullet 4 of the Strategic Objectives (Programmme 3: HIV/AIDS,TB and Maternal and Child Health).
Mr Shaik Emam suggested corrections to typographical errors on page 5.
Dr James suggested that editorial points be noted and passed to the Committee Secretary in order to save time in the meeting.
Mr Mahlalela commented on the highlights made by the Department on page 10, which he felt was not well captured, as the Office of the Chief Nursing Services had been set up already and it may create budget pressure.
Dr James proposed that the sentence be restructured to read: "The Office of the Chief Nursing Services is in the process of being set up and it might create budget pressure".
Ms Ndaba suggested that the subtitle on page 11 be corrected to: “Selected targets under Programme 6 for the current financial year (2015/16)”.
Dr P Maesela (ANC) commented that the subtitle was incomplete.
Mr Mosala commented that there should be consistency with the subheadings that were set out on previous pages.
Ms Ndaba suggested that the first sentence be removed from the third paragraph on page 13.
Mr Mosala disagreed with the suggestion.
The Chairperson suggested that it should be a subheading: “Certain functions have also shifted”.
Ms Scheepers corrected the word "diagnosis" to "diagnostic2 in the last bullet point on page 13.
Mr Volmink suggested that the gap in page 14 be adjusted and numbered.
Ms Scheepers suggested that page 17 should be well numbered.
Mr Mosala suggested that all the budget pressures highlighted by Department should be indicated, and those that were not mentioned by the Department in the presentation should be removed.
Ms Ndaba corrected that it was additional budget "increase" not additional budget "cut", as stated in bullet point 1 of the paragraph on budget pressures (page 18).
The Chairperson proposed that the last three bullets under "Budget pressure" be deleted and that the Committee should add all the indicators of budget pressure as presented by the Department.
Mr Volmink commented that there should be consistency in the use of abbreviations/acronyms (page 20).
Dr James commented that the third bullet under "Findings of the Department (page 30) should be changed to: “The Committee expressed concern that the Provincial Health Department are not performing well in terms of financial audit outcomes”.
Ms Ndaba suggested that the policy gaps identified by the Committee, in relation to traditional medicines and other matters should be added under the "Findings on the Department/Committee Observations" section.
Mr Shaik Emam commented that the Committee had observed that the Department had failed in its communication to the public on HIV/AIDS and its prevention, so it should be added to the Committee Observations and Findings.
Dr James suggested that it should be stated that the Department can do much better in terms of communication on HIV/AIDS.
Mr Mahlalela corrected the last bullet point on page 30 to: “the Committee raised a concern around the lack of a system to measure the distribution and usage of condoms”.
The Chairperson suggested that the findings of entities should include the names of entities, and be made into subheadings (page 31).
Mr Mosala commented that the last bullet point on page 31 was not a true reflection of the Committee’s findings as the Committee had suggested that Office of Health Standards Compliance (OHSC) should cut down on the use of consultants and use the money instead to train unemployed university graduates.
The Chairperson corrected the ninth and tenth bullet points under findings of entities (page 31)to read: “the Committee notes the slow establishment of the One Stop Service Centres in the feeder areas of town.” and “The Committee was concerned about the timeframe set for the review of the SAMRC Act ..".
Mr Mosala commented that the last bullet on page 32 should be rephrased to: "The Committee was concerned about the excessive usage of consultants".
Dr James suggested that the fourth bullet point on page 31 be rephrased to: "The Committee was concerned about the slow response rate of the Emergency Medical Services and noted that the system was not working, especially in rural areas".
Mr Volmink suggested that it was important to add the need for better management of health care facilities.
Mr Mahlalela commented that the Committee did not raise the issue of health care facilities management with the Department so it should not be added into the Report.
Mr Shaik Emam commented that the Committee had identified the challenges with nursing and the quality of nurses ,and had also recommended that the Department of Health should be working with the Department of Education in order to introduce health care in its curriculum.
Mr Mosala proposed that the fourth bullet point under the recommendation should be rephrased to read: "Ensure the acceleration of the nursing training framework, in the context of the current curriculum, whilst working to develop a new framework".
Dr Maesela commented that there was an ongoing massive recruitment of nurses.
Dr James corrected some grammatical errors on page 33.
Mr Volmink suggested that the third bullet point under Recommendations should be restructured to capture the need for the Department to work in conjunction with National Treasury.
Adoption of the Report
The report was adopted unanimously, with amendments.
Ms C Ndaba (ANC) informed the Committee about a report that she had heard on the News, of a terminally ill patient who wanted the Department of Health to assist him to die, and had applied to Court that the Department should assist in terminating his life.
Mr Mosala commented that recently there had been a debate in the media on self-assisted suicide. He suggested that the Committee should note the case lodged by the patient, and reflect on the matter, and on the pros and cons.
The Chairperson suggested that the Committee should check with the radio stations what had been aired, as the entire community should be empowered on this debate.
The Chairperson commented that the Committee would be debating the budget vote on 5 May.
She also noted that the Committee had some documents from the Department of Public Service Commission, which would need to be reviewed.
She presented cards of sympathy from the Committee to the two Members who had recently suffered bereavements.
The meeting was adjourned.