The Department of Health briefly presented its Strategic and Annual Performance Plans for 2015 to 2019, in the presence of the Minister, Dr Aaron Motsoaledi and Deputy Minister, Dr Joe Phaahla. Prior to their presentation the Chairperson noted her particular concerns that whilst there were some good developments, the condition of clinics, and the long queues, remained a serious issue that would need to be tackled.
The Director General confirmed 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 Strategic goals 2014/2019.By 2030, South Africa should have achieved an increase in life expectancy, to 70 years, should have seen progressive improvements in TB prevention and cure, reduction of maternal and child mortality, prevalence of non-communicable disease reduced and injury and accidents and violence-related matters reduced by 50% on the 2010 levels. The health system reforms should have been completed, with primary health care teams deployed to communities and universal health coverage achieved, with skilled, committed and competent staff. The Department was tackling the link between alcohol abuse and health, including trying to curb advertising of alcohol - a difficult task, but pointed to its success in limiting tobacco advertising - and encouraging more awareness and healthier choices of food and drink by people. A number of specific aims were summarised for the next five years. These included efficient HR services, development of a full National Health Litigation strategy, and improved communication. The phased implementation of the National Health Insurance (NHI) would lead to universal health coverage. Prevention of mother to child transmission of HIV, mortality rates, antiretroviral treatment and more efficient emergency services were being prioritised. Overall the quality of health infrastructure, and infrastructure projects, were to be monitored. Mental health, non-communicable disease and environmental health were other important areas that would be addressed. To tackle queues, the Department had implemented dispensing and distributing points for chronic medication at public medical facilities and this would be expanded. Dual protection strategies for men and women were being encouraged to stop the spread of HIV / Aids and unwanted pregnancies. The new contraceptive implant had been used by 800 000 women, and work was ongoing to develop a five-year version. The Department was vaccinating school girls against cervical cancer. The budget was briefly noted as R36 billion, although shortage of time prevented a detailed explanation.
Members were pleased to note that dedicated staff were assigned to programmes, and stressed the importance of prevention. They questioned whether the billboard advertising was effective and whom it was targeting, as there should be more of a focus on youth, and also asked if anything had been done to address the youth's concerns about the quality of the condoms provided by government, and to encourage greater use. Members asked for more detailed reports and analyses on TB, and the criteria for grants. They asked whether brochures on post-natal depression were available in indigenous languages, asked when medical recognition of traditional healers would come into play, questioned the debt owing by hospitals for electricity, the service of the mobile clinics, and the prevalence of advertising by bogus "doctors" offering abortions and lucky charms and cures. Particular problems in Mpumalanga, with shortage of specialists and the condition of the Lupisi Clinic, were raised. Some questions would stand over for written responses.
Chairperson’s opening remarks
The Chairperson welcomed the Minister and Deputy Minister of Health, and the Department of Health delegation, and thanked them for their work and passion, but noted that there were still challenges needing to be tackled in the health sector. She requested that a debate should be held in the House on what would be ideal clinics, to help government and Parliament in moving forward to create better lives for all. She was particularly concerned about the state of health facilities and the long queues of patients at the public clinics, with some patients getting up as early as 03:00 to try to be first in the queues, only to still have to wait late in the afternoon to be attended to, or to get their medication. This issue would have to be addressed and resolved.
Department of Health Strategic and Annual Plan briefing
Ms Malebona Matsoso, Director General, Department of Health, noted that the Department of Health (DOH or the Department) was committed to full implementation of the National Development Plan (NDP) goals of 2030, the Medium Term Strategic Framework (MTSF), and the National Department of Health Strategic Goals 2014/2019.
The health sector derived its vision and mandate from NDP 2030. By 2030 South Africa should have achieved the following:
- Average male and female life expectancy at birth increased to 70 years
- Tuberculosis (TB) prevention and cure progressively improved
- Maternal, infant and child mortality reduced
- Prevalence of Non-Communicable Diseases reduced
- Injury, accidents and violence reduced by 50%, from 2010 levels
- Health systems reforms completed
- Primary health care teams deployed to provide care to families and communities
- Universal health coverage achieved
- Posts filled with skilled, committed and competent individuals
Dr Aaron Motsoaledi, Minister of Health, interjected that there was currently a strong correlation between poor health and alcohol abuse. There was a need for the Department to devise a strategy to work in the advertising industry, to promote good health and hygiene. The aim of the strategy was to break the barriers of advertising to warn the youth about alcohol and its side effects.
Ms Matsoso fully endorsed the Minister's statement and said that, for instance, the bottled water supplied during meetings encouraged people to drink plenty of water, instead of resorting to fizzy drinks for quenching thirst.
The Minister fully agreed with this statement and mentioned sugar as the biggest culprit causing obesity.
Ms Matsoso added that the Department had started a campaign of informing restaurant patrons better about what was on their menu, to make them more aware of the calories in each meal.
Noting the time constraints, Ms Matsoso said that she would summarise much of the presentation. She outlined some of the strategic objectives for the next five years, and said that the Department aimed to: included
-Ensure an efficient and responsive Human Resources Services through the implementation of efficient recruitment processes and responsive Human Resource support programmes
- Develop and full implement a National Health Litigation Strategy
- Provide support for effective communication by developing an integrated communication strategy and implementation plan
- Achieve Universal Health Coverage through the phased implementation of the National Health Insurance (NHI)
- Improve contracting and supply of medicines
- Expand the Prevention of Mother to Child Transmission for HIV (PMTCT) to more pregnant women by ensuring all HIV-positive antenatal clients were placed on Anti Retrovirals (ARVs) and reducing the positivity rate to below 1%
- Reduce the mortality rate for children under five to less than 23 per 1 000 live births, by promoting early childhood development
- Increase the numbers of HIV positive people on ARVs
- Ensure access to and efficient effective delivery of quality Emergency Medical Services ( EMS)
- Improve quality of health infrastructure in South Africa
- Strengthen monitoring of infrastructure projects
- Improve access to and quality of mental health services in South Africa
- Reduce risk factors and improve management for non-communicable diseases (NCDs) by implementing the Strategic Plan for NCDs for 2012- 2017
- Improve environmental health services in all 52 districts and metropolitan municipalities in the country
Ms Matsoso said that the DOH had implemented dispensing and distributing points for chronic medication at public medical facilities. She said that there were no queues for medication collection for patients any more. The plan was working well and the Department was working out a strategy to increase its outreach, as it helped to curb congestion at public clinics.
The Minister alluded to the dual protection strategy against HIV / Aids, which included using a contraceptive and a condom to curb Sexually Transmitted Diseases’ (STDs) and unwanted pregnancy. For females this included using a form of contraceptive and a condom. For males, it included medical circumcision and using a condom.
The Minister said that there were currently 800 000 women using the underarm contraceptive, which lasted for up to three years. The Minister said that this form of contraception was launched last year in February. He said it was available, free of charge, at public facilities. He added that work was being done on another form of the same contraception, which would last for up to five years.
He added that the Department was working on administering vaccines to school girls to prevent cervical cancer. The Minister informed the Committee that each year 6 000 women are affected by the disease and 80% of those affected were black women.
The Director General showed the budget for the 2014/15 year as R36 billion and noted that the breakdown was given in the attached presentation.
The Chairperson thanked the Director General and Minister for the presentation.
Ms T Mpambo-Sibhukwana, (DA, Western Cape) said that she was happy that the Department had someone dedicated to oversee the programmes. She said that the country, in her view, was spending too much money on healthcare and disability after it happened, rather than trying to prevent it earlier.
She noted the Minister's comments earlier on the advertising strategy but said that billboards in townships had nothing constructive on health, dedicated to the youth, but displayed things such as advertisements for Investec, closer to the suburbs. This was a political matter and did not help to build the youth.
Ms Mpambo-Sibhukwana asked that the Committee be given a detailed report and analysis on Tuberculosis (TB). She asked what criteria on grants in provinces had been followed.
She noted that no reports had been given on the quality of condoms, but related that people were not using government condoms because of the poor quality. She requested that the brochures on post natal depression be communicated in indigenous languages, to ensure better communication.
Mr M Khawula (IFP, Kwa Zulu Natal) asked when medical recognition of traditional healers would come into force, and noted that traditional healers were concerned about the lack of recognition.
Ms M Tlake (ANC, Free State) commended the presentation as informative but said that Members needed more time to deal with it fully. She asked for the Department’s stance on hospitals who owed huge electricity debts.
Ms P Mququ, (ANC, Eastern Cape) asked about the mobile clinics rendering services, diagnosing patients and referring them to hospitals. She wanted to know if the Department was aware of such clinics.
The Chairperson said that the issue of traditional healers was a very serious issue and it needed to be addressed. She also mentioned the pamphlets and stickers plastered across towns and cities, placed by foreigners, advertising abortions and lucky charms and cures, as if they were genuinely qualified doctors. She expressed her deep concern with these backyard “doctors” and their legitimacy, and said that it must be noted that she was not being xenophobic in mentioning these concerns, but was rather being entirely practical.
The Chairperson said that there were shortages of orthopaedic doctors in Mpumalanga, and said that it must be brought under the Department's attention. She said Lupisi clinic in Mbombela Municipality was in a chaotic state; the service was good but the environment was not conducive and was causing problems. In general, she was concerned about poor facilities at hospitals and clinics.
The Minister said that the alcohol billboards in townships were mainly targeting black women in the townships. He noted that this was a hard market to reach. Older black women upheld traditional values that a woman was not allowed to drink, but when the billboards in townships were advertising alcohol, their aim was precisely to reach that market. The Department was trying hard to curb advertising of any alcohol on billboards. So far, the alcohol industry had been resistant and it was "a hard nut to crack" but he was confident, and pointed to the Department's successful strategy to stop advertising of tobacco products.
The Minister said he had launched in February/March a newly improved tender for government condoms, based on what the youth wanted. The Department had held focus groups, in order to hear the youth’s grievances on The condoms now targeting University students and Further Education and Training Colleges (FETs) were flavoured and coloured.
The Minister said that the issue of African traditional healers was a problem across the whole African continent. He said that the AU declared that African countries must integrate traditional medicine in their health care system in 2000. After ten years, however, very little had happened. He said that there was only one expert in this whole African continent who truly understood all the issues - a Professor of Pharmacology in Tanzania - and she was the only person who could run the workshops and explain matters to people to get a better understanding.
The Minister responded, in relation to the pamphlets on post-natal depression, that the Department of Health had come up with a mobile application called MomConnect. The Minister said this application explained issues, and updated pregnant women on relevant details, every week.
Ms Matsoso noted the comment on Lupisi and agreed that the building of Lupisi showed major problems. She said that the electricity grid connection and domestic waste removal was infrequent, and the infrastructure was very poor. She said that when the Department allocated grant money, it would advise the staff on what problems had to be fixed.
The Chairperson thanked the Minister and Director General and said that any questions not yet responded to should be answered in writing.
Ms Matsoso confirmed that the Parliamentary Liaison Officers had communicated the date for the debate as 17 June 2015.
The meeting was adjourned.
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