Department of Health on its 4th Quarterly Performance Report

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Health

10 June 2015
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

The Portfolio Committee on Health was briefed by the Department of Health on its fourth quarter performance report. Comprehensive details were provided on the six programmes falling within the Department’s portfolio. Major areas covered included the development of a framework for integrated health services, progress with the National Health Insurance (NHI) pilot programmes, the country’s HIV/AIDS situation and the move towards medical circumcision, improved access to community-based primary health care facilities, and progress with the Medicines and Related Substances Amendment Bill.

 

The Department had recorded 9 566 097 HIV tests for the full year on clients ranging in age from 15 to 49 years, while medical circumcisions were performed on 508 404 males. A total of 3 103 902 clients remained on anti-retrovirals (ARTs) at the end of the period. 120 professional nurses had been trained to initiate multi-drug resistant (MDR) TB treatment, and 50 hospitals had been assessed according to the treatment criteria. 90% of correctional services centres were conducting routine TB screening. As at March 2015, aggregate pre-audited spending was at 98.4%, or R30.3 billion, against the total adjusted budget of R30.8 billion. There had been increased spending of 1.4%, or R2.9 billion, compared to the same period in the previous year, but overall spending was below the target by 1.6%, or R489 million.

 

Members asked why the Department was experiencing difficulty in filling vacancies, and what it was doing to attract doctors to work at the NHI pilot sites. They said it needed to improve its image by publicising the Department’s successes. Questions were raised about the prevalence of drugs for patients not being available, and steps being taken to overcome this problem. It was also suggested that there was a need to change the current school feeding programme, because children should not be served only soup and bread. A Member said it seemed the number of AIDS cases was increasing, and the Department conceded that there had been a rise in the incidence of HIV among women between the ages of 15 and 24. This was due to a variety of reasons, and the Department had started a project aimed at showing young women how to take charge of their lives, how to negotiate with older men, and how to take decisions.

 

The Department was asked to appear before the Committee again to provide details on the new nurses’ colleges and nursing curriculum, as well as on the status of the NHI pilot districts. The Committee also intended to hold a joint meeting with the Department, National Treasury and the Standing Committee on Appropriations.

 

The Committee extended congratulations to the Director General of the Department, Dr Precious Matsoso, on her election to the Executive Board of the World Health Organisation, an appointment which brought credit to her and the country.

Meeting report

Opening Remarks

The Chairperson congratulated Dr Precious Matsoso, Director General: Department of Health, on her appointment and invited her to inform the House on the health challenges facing the country. She commended the Department for doing well in the management of HIV/AIDS. The Portfolio Committee, irrespective of Members’ political affiliations, would work together with the Department to ensure accountability. In the course of doing oversight, the Committee might lock horns with the Department, but the aim was to ensure that the Department carried out its responsibilities. It was a credit to South Africa that Dr Matsoso had been elected as an Executive Board Member of the World Health Organisation (WHO), which showed the impact the country had in the Southern African Development Community (SADC) region, Africa and the world as a whole. The Department would be invited some time in July for a joint meeting with the Committee on Health and other committees.

She read apologies from the Minister of Health and Mr A Mahlalela (ANC), who were out of the country, and from the Deputy Minister, who was attending a Cabinet meeting. She informed the House that Ms Jenna Lowe had passed on and that a condolence message would be sent to her family on behalf of the Committee.

Dr Matsoso thanked the Chairperson for the kind words on her recent WHO appointment. It was a real honour to be asked to serve the world in that manner. The Department needed to be guided by the Committee about the three major conferences that would be hosted by South Africa for the first time. These were the World AIDS Conference, the Hospitals Conference, and the Regulatory Agencies Conference. She added that it would be good to have the South African Health Products Regulatory Authority (SAHPRA) in place before the conference as a host country.

Briefing by Department of Health

Dr Matsoso briefed the Portfolio Committee on the 4th quarterly progress report of the Department of Health’s annual performance plan (APP) for 2014/15, which had been designed to deliver on the medium term strategic framework (MTSF) commitments.

Programme 1 (Administration) had seen the information communication technology (ICT) service continuity plan approved to ensure that the Department could continue with critical functions in case of disaster. The communication strategy, which dealt with healthy lifestyle, TB, HIV and AIDS, safe sex, diabetes etc, had been finalised and approved. Internal Communication guidelines had been developed and an approved departmental language policy drafted and approved. 37.5% of vacant posts had been filled within five months and all four employee health and wellness (EHW) pillars implemented. The framework for integrated health service plans had been developed and implemented at national and provincial DoH. Nine provincial APPs were reviewed and feedback had been provided. One national and four provincial consultative forums had been convened – in Gauteng, KZN, North-West and Limpopo.

In Programme 2 (Health Planning and Systems Enablement), the draft white paper for the National Health Insurance (NHI) Bill had been revised and prepared for submission to Cabinet. Monitoring and evaluation had taken place in ten NHI pilot districts, and a consolidated fourth quarter report prepared. The DOH and National Treasury had continued their liaison to finalise the sections in the white paper on NHI that speak to financing arrangements. Treasury had also drafted a paper titled ‘financing NHI in South Africa’. The revised dispensing fee regulation had been published on 13 March 2015. The revised logistics fee regulation calculation had been published and the 2014/15 annual single exit price adjustment had been implemented. The Department had reviewed the Primary Healthcare Medicine Essential Medicine List (EML) and Standard treatment Guidelines (STGs), and published the 2014 edition. It was in the process of reviewing the hospital level pediatric and adult EML/STGs. A centralised chronic medicine dispensing and distributing system had been implemented in 77% of facilities in all ten NHI districts. A revenue retention model had been developed, and during the past three financial years, R1.3 billion had been collected by 13 hospitals. During the 2014/5 financial year, the total revenue collected was R450.6 million. Progress had been made with the reference implementation of architecture in the 700 primary health care (PHC) facilities in the ten NHI districts, and 3 337 computers and facility LAN equipment had been distributed and installed. A concept paper consisting of a proposal and business plan on the National Health Research Observatory (NHRO) had been established. The National Health Research Database (NHRD) which was part of NHRO, was being rolled out to provinces. The final draft Monitoring and Evaluation strategy plan had been submitted. An emergency operations centre for disease surveillance had been established at the National Centre for Vaccines and Immunology (NCID). The final 2013 national Antenatal Sentinel HIV survey report had been prepared and submitted. The provisions of international health regulations (IHR) (2005) and WHO Framework Convention on Tobacco Control (FCTC) had been implemented. The implementation of four cross-border projects of the SADC HIV and AIDS fund had been monitored. The Department had provided humanitarian assistance in response to the Ebola virus disease outbreak in some countries, and had provided financial assistance for the recruitment of Cuban doctors to provide health services in Sierra Leone. It had established a knowledge and information sharing platform on various areas of collaboration with Botswana, Uganda, Namibia and Ghana, and had continued to provide scholarship assistance for South African students to Cuba for medical training. Resources for the SA health system had been mobilized with the United Nations Industrial Development Organisation (UNIDO). There had been a handover ceremony of an additional ambulance by Turkey. Additional variable tranches for the Primary Health Care sector policy support programme had been released. A number of activities had been pursued within the ambit of bilateral projects.

Programme 3 (HIV and AIDS, TB and maternal child and women’s health) had recorded 9 566 097 HIV tests for the full year on clients ranging from 15 to 49 years, while medical circumcisions were performed on 508 404 males. A total of 3 103 902 clients remained on anti-retrovirals (ARTs) at the end of the period. 120 professional nurses had been trained to initiate multi-drug resistant (MDR) TB treatment, and 50 hospitals had been assessed according to the treatment criteria. 90% of correctional services centres were conducting routine TB screening. To reduce the maternal mortality rate, a 53.9% rate of antenatal first visits before 20 weeks of pregnancy had been achieved, against a target of 65%. The actual maternal mortality rate had been 132.5 per 100 000 live births. Statistics were also provided for the neonatal death rate, cervical cancer screening coverage, Human Papilloma Virus (HPV) first dose coverage, antenatal clients initiated on ARTs, infants’ polymerase chain reaction (PCR) positive test rate, child under five years diarrhoaea and severe acute malnutrition case fatality rate, confirmed measles case incidence, and immunisation coverage.

Programme 4 (Primary Health Care Services) saw the approval of the implementation plan for PHC facilities with functional clinic committees/district hospital boards. Ideal clinic software had been developed as a monitoring and evaluation system to measure functionality of clinic committees. The Department had completed the Workload Indicator of Staffing Needs (WISN) process and normative guidelines for PHC facilities. It had collaborated with other government departments on a range of matters affecting social determinants of health. The establishment of the formal forum would be guided by the National Health Commission. The roll out plan to improve access to community-based PHC services and the quality of services at PHC facilities had been approved and costed.1 748 functional Ward-based Primary Health Care Outreach Teams (WBPHCOTS) and 44 ports of entry had been compliant with the International Health Regulations. The DoH had developed an environmental health strategy and finalised health care waste management regulations. 169 418 people had been counseled and screened for high blood pressure, and 147 562 had been counseled and screened for raised blood glucose levels. Data elements for patients screened for mental disorders had been included in the rationalised PHC registers and District Health Information Systems (DHIS) survey indicator. Only one malaria endemic district had reported malaria cases within 24 hours of diagnosis, and a mobile sms application was being piloted in the three districts to improve reporting times. 837 645 high risk individuals had been vaccinated against influenza. A draft model for rehabilitation and disability services had been developed and was ready for discussion with stakeholders and presentation to the National Health Council. There had been 985 cataract surgery operations per million un-insured population. Emergency Medical Services (EMS) regulations had been finalised and gazetted. There was an average 2.3 months waiting time for blood alcohol results for all three forensic chemistry laboratories (FCLs). The turnaround times of toxicology tests and reports averaged 2.6 months, while for perishable food products tests and reports it was 56 days, and for non-perishable food products tests and reports it was 102 days. The draft policy on governance for central hospitals had been submitted for review by legal services. Four regional training centres had been established and were functional in Mpumalanga, Limpopo, Gauteng and North West. No public nursing colleges had been accredited, as consultation and discussions on accreditation was still ongoing.

In Programme 6 (Health Regulation and Compliance Management), the Medical Control Council (MCC) had published guidelines on Medical Devices and Invitro Diagnostics. A new definition had been published in the Complementary and Alternative Medicines (CAMs) regulations. The MCC had published guidelines on vitamins and minerals. Ten CAMs applications were under review. The Medicines and Related Substances Amendment Bill had been drafted and was going through parliamentary processes. The Portfolio Committee on Health had completed public hearings on the proposed amendment Bill. Consultations were ongoing to establish the extent of the capacity and capabilities to conduct testing of food samples. A governance framework and implementation plan had been developed for public entities and statutory councils. Amendments to the Traditional Health Practitioners Act had been proposed. Governance structures had been enhanced by convening regular meetings of the audit and risk Committee. One occupational health service facility had been established in the Eastern Cape and Gauteng province. A conceptual framework document and business case for the National Public Health Institutes of South Africa (NAPHISA) had been developed. 63% of health establishments had developed an annual quality improvement plan based on Office of Health Standards Compliance (OHSC) inspections.

Mr Ian van der Merwe, Chief Financial Officer: DOH briefed the Committee on the reasons for variance per programme.

In the case of Programme 1 (Administration), invoices for the Auditor-General, the Department of International Relations and Cooperation (DIRCO) and the State Attorney had not been received timeously to be paid before year end. Leave gratuity payments would be adjusted by means of virements at the end of the financial year. The replacement of the Minister’s and Deputy Minister’s vehicles had not taken place before the end of the financial year.

In Programme 2 (NHI, Health Planning and System Enablement) the compensation of employees budget had come under pressure due to the appointment of a Health Attaché in Cuba, and the cost of living expenditure for officials at the missions was much higher than had been budgeted for. The recruitment of the health practitioners for the NHI pilot hospitals had been slower than anticipated. The SA Health & Demographic Survey budget of R30 million, which had been received as a special allocation for this purpose, had been requested to be rolled over to the 2015/16 financial year (FY).

In Programme 3 (HIV and AIDS, TB, Maternal and Child Health), under payments for capital assets, the fridges for the Human Papilloma virus vaccines were still to be procured due to the lengthy tender procedures to be followed.

Programme 4 (Primary Health Care Services) had seen over-expenditure in the compensation of employees due to the appointment of 25 environmental health practitioners as a response to the Ebola virus outbreak. The project on Regulatory Impact Assessment on the Control of Marketing Alcohol Beverages Bill had not been finalised yet, and the printing of the road-to-health booklets could not be finalised before year-end. The transfer of funds to the National Kidney Foundation could not be processed due to difficulties experienced with the banking details. The amount of R350 000 had been requested to be rolled-over to the 205/16 FY. Leave gratuity payments would be adjusted by means of virements at the end of the FY.

In Programme 5 (Hospitals, Tertiary Health Services and HR Development), compensation of employees had been affected because some vacant posts had not been filled during the year. An amount of R86 million for the refurbishment of clinics managed by COEGA and the Development Bank of SA had been spent before year-end. A tender for specialised laboratory equipment had been awarded, but not all orders had been received and/or paid before the year end. The construction of new clinics and relocatable doctors’ consulting rooms had involved outside partners to procure what was needed, and the same was the case with the refurbishment of older clinics.

In Programme 6 (Health Regulation and Compliance Management), compensation of employees was affected by the fact that the recruitment of officials for the OHSC and SAHPRA was taking longer than expected. Additional funds of R8.3 million had been received during the Adjustment Budget for the set-up of SAHPRA. Due to the short period of time before year end, not all processes could be finalised.

R9.77 million had been received during the Adjustment Budget to upgrade the IT system in anticipation of the SAPHRA establishment during 2015, and the tender had been issued.

As at March 2015, aggregate pre-audited spending was at 98.4%, or R30.3 billion, against the total adjusted budget of R30.8 billion. There had been increased spending of 1.4%, or R2.9 billion, compared to the same period in the previous year, but overall spending was below the target by 1.6%, or R489 million. Main contributors to the under-spending were NHI (71.8%) and the Health Facility Revitalisation Grant (94.8%). There had been an overall improvement in spending and compliance, and tightened monitoring and evaluation both at national and provincial level.

Discussion

Mr A Shaik-Emam (NFP) asked about the status of the country in terms of HIV/AIDS -- the number of people identified and if there had been a reduction in the number of cases. At the SADC Conference held in Botswana on HIV/AIDS he had asked why SADC countries could not get together to fund research on HIV/AIDS, as the cost impact was too much for a country to bear alone, and resources was part of the challenges faced. Elaboration was required on the municipal monies that were outstanding. He asked for the number of vacant posts that needed to be filled, the challenges in terms of filling the vacancies, as 37.5% of the posts had been filled. He commended the increase in the number of GPs to 200, which was still far away from the 900 that had been targeted, and asked what needed to be done to attract GPs for the NHIS. There was a need to strengthen communication on the successes of the Department as its good works were not heard by the public, and he suggested that the Department come up with health magazines to publicise its good works. The Department should access global funds for researchers and attract quality nurses at the school level. Under-spending needed to be addressed. He congratulated the Department on the good work it was doing.

Dr Matsoso replied that the Department had made a joint submission to the global fund to fund activities for the SADC region, and hoped it would be successful. She said that a lot of GPs were lined up for contracting outside the NHI pilot district, so there was a need to change the NHI framework. The Department had appointed a Chief Nursing Officer in charge of nursing related issues, and she requested the Committee to invite her to present on the changes made in nursing in terms of colleges and institutions. Pilot colleges had started in four provinces, as all colleges must be part of Higher Education now, and this required some investment to prepare in terms of human capital, as teachers at those colleges needed to be trained.

Ms Tiny Rennie: Head, Corporate Services: DOH, said that the percentage of vacancies were often calculated from the date of advertisement until the letter of offer. The Department was often challenged when it had to re-advertise some posts, for not getting the appropriate people and so would have to head hunt and would therefore fall outside the five months period. Some people would accept the letter of offer and drop out at the eleventh hour. The percentage was also calculated from the beginning of a year to the end of the financial year. In this current financial year, there were 1 085 vacancies that were intended to be filled in the course of the financial year. She acknowledged the gap in communication, as the Department had been communicating in silos. It was now working on an integrated communication strategy that would start working in August 2015.

Dr Terence Carter, DDG: NDOH commented that no municipality owed, and there was an 8% adjustment between the economic classification and across programmes.

Dr P Maesela (ANC) suggested that the Department developed a campaign on circumcised neonates as done in some countries, as it was easier and more cost effective. This had to be legislated and the campaign should be the starting point before conceding to traditional or cultural norms. He suggested the legislation of strategies to combat malnutrition, rather than depending on some manufacturers. Referring to eye-testing, he said majority of children had not been screened while some had been screened. After screening they still had to buy spectacles themselves. These were unaffordable for them, which defeated the purpose of screening. He suggested publicizing environment health regulations, as the municipalities should make the communities aware of these regulations. Norms and standards should be publicized and accessible by everybody. He asked why pharmaceutical companies had to renovate their facilities at the same time and suggested that they should be made to renovate in rotation, one after the other. He asked if mines had paid in order for the miners to be paid compensation. He said that SAHPRA should be given priority in view of the upcoming conference. An explanation required on the R48 million released in Gauteng and the request for its roll-over.

Dr Matsoso agreed that the proposed campaign was a good move, as it was cost effective and would save lives. The Minister was having a discussion with traditional leaders and she advised that the issue of circumcision be taken up at that level as it was a culturally sensitive issue. The department was not relying on the pharmaceutical industries, but was only asking them to change their certification model. It was important to change the school feeding programme, as children should not be served only soup and bread. There was a need to look at whether the nutrition at ECDs, crèches and pre-schools was appropriate. Over 200 000 learners had been screened. 54 000 had problems and the issues had to be dealt with, as failure to deal with the problems would affect basic education, as students would not have good matriculation results. It was not enough to publish the norms and standards, but also important to train and educate the people. The Department was on track with the mines. At the moment, companies paid retention fees, registration fees and so on, but the monies were not retained by the MCC as they went back to National Treasury. However, with SAHPRA they could retain the money and employ more people. She added that SAHPRA must employ their own staff and set up their own system to avoid further delays. She added that the four to five months timeframe for SAHPRA was quite tight, as people needed to be trained -- there were no readymade people for the job. SAHPRA needed holders of PhDs and Masters degrees -- people with analytical minds that needed to be trained.

Mr I Mosala (ANC) commented that there had been continuous lamentation about provinces in respect of audit reports, and asked whether it would be in the interests of the Department or country to put in systems that ensured that provinces’ performances were monitored quarterly, rather than at the end of financial year. He asked if the Department had considered employing unemployed graduates to be deployed to all Provinces in order to achieve a clean audit report. He commended the Department on its communication strategy, as the Deputy Minister had announced at a conference the strategy of dealing with stigma from 1 July. Elaboration was required on the Department’s actual target on human resources, as 37.5% had been achieved. He asked whether the obstacles arose in the provinces. He requested that the Department provide the systematic survey on the dispensing fee at its next presentation to the Committee. He added that 77% of the central chronic dispensing and distribution facilities had been achieved, as all 10 pilot systems were running well and efficient, but he asked for the status of the 23% unachieved health facilities, as the challenges had not been stated. He referred to mental health care and asked if the country was slowly graduating to a situation where there would be a single test that covered all health areas and gave a holistic picture of the situation in the country. He requested that the presentation report given by the Department to the Appropriations Committee be provided also to the Health Portfolio Committee in order for them to have a clear picture of the pilot sites.

Dr Anban Pillay, DDG: Pharmaceutical, NDOH, replied that in order for a patient to be recruited for chronic medicine supply, there should be a person at the facility to explain to the patient how the programme worked. Currently, the Department’s facilities were geared mainly to treat patients rather than explaining to them how the programme worked. The Department currently had capacity to deal with the programme in 77 facilities, and then it would move to other facilities. The Department would also like to go to facilities outside the NHI districts but Treasury had insisted that patients should go only to NHI facilities. The survey relating to the dispensing fee and how it was calculated could be provided to the Committee. He said a standard survey was regularly used to get the information on costing and the maximum price a pharmacy could charge when dispensing.

Dr Matsoso said that the Department had developed a non-negotiable tool as an early warning system for provinces which could show a province that was already in red or amber, and on quarterly basis provinces had to inform the Department how they were fixing those problems. She added that a few years ago the department had employed unemployed graduates for audit purposes and they had been chased away in Mpumalanga and KwaZulu-Natal. The Western Cape had not wanted them also. Only six provinces had accepted them and they had been redistributed to those provinces to assist. She said there was a stigma problem, but the Department would reinforce its efforts to educate the public and its health workers on the stigma issue. The Department was introducing integrated care management which was being piloted and rolled out in all the clinics across the country, such that a user would not visit a facility multiple times. The Department was redesigning its services in order to reduce the burden on users, and she advised the Committee to check during oversight whether the provinces were implementing this. She added that the appraisal reports would be made available to the Committee.

Ms Jeanette Hunter, DDG: NDOH said that the Department would start monitoring municipalities to see whether they complied with the norms and standards as stated in the regulations. It had started a process to motivate municipalities to be able to capacitate themselves to deliver against these norms and standards by prioritising four areas: water safety and sanitation, food safety, vector control and medical waste management. The Department had done a detailed study across all municipalities to look at the capacity for managing those issues and would come through with the report through the technical Committee of the National Health Council, for it to be taken forward at Ministerial level, for municipalities to be capacitated to deliver in those four priority areas.

Mr H Volmink (DA) thanked the Department for the presentation and congratulated the Director General on her appointment to the WHO Executive Committee, which was a huge achievement for the country. He thanked the department for the Emergency Medical Services (EMS) and asked that the Committee be provided with copies of the regulations. He commended the excellent work done by the young African scientists with nanotechnology on communicable diseases, specifically on malaria and humbly requested that the Committee write a letter of support to the young scientists to encourage them. The Prevention of Mother To Child Transmission (PMTCT) rate of 1.5% achieved in six months was huge, and the vision of an AIDS free generation needed to be communicated to the public. He advised the Department to go back to the drawing board to review all the logistics before the white paper was finalized. He asked them to look at countries like Tanzania and Ghana to see how NHI/universal health coverage was working over there. He added that there were elements of the value chain that were outside the Department’s control, such as manufacturing. He asked whether there was an early warning system that should have alerted the Department. An explanation was required on stock outs and buffer stock. He asked if the supply chain problems were external or internal issues that needed to be remedied.

Dr Matsoso thanked the Committee for raising these questions. At the Department’s presentation to the Appropriations Committee, she had premised her presentation with a letter addressed to the National Treasury with regard to the under-expenditure on NHI grants. National Treasury had agreed with her that the planning approach was very rigid, as the Department had written in June (third quarter of a financial year) for Treasury to approve some changes to the grant framework -- as it already had data of screened children -- in order for people to get coverage and access to care. Treasury had responded after three months in September, which had delayed implementation. NHI/universal health coverage was important and should be seen as a means to improve the lives of South Africans. She said a grant could not be used for an important programme like universal health coverage, as grants came with restrictions. The Department had decided to use donor funds, as Treasury had stated that grants could not be used. The amount of money spent using the grants, was exactly the equivalent amount of money under-spent. By using donor funds, grant funds had not been spent, hence another vehicle was needed for this purpose.

She commented that the EMS personnel were not employable, as they were trained by the institutions that trained basic ambulance assistants for six weeks at a cost of R9 000. There were 54 000 EMS candidates who needed to be upgraded and provided with further training in order for them to be employable. The department was dealing with the NHI-white paper issue.

Dr Pillay said stock outs could be supplier problem. There had been a time when suppliers were unable to supply 168 items, and in order to identify the 168 items, there had been an early warning system. The early warning system was such that when a manufacturer received an order, he was expected to indicate to the Department if there was a problem in the factory and he could not deliver within the six weeks expected. When supplies were not received within six weeks, then the Department would know that there was problem. There was a contractual agreement requesting suppliers to advise immediately when they anticipated problems.

Dr Matsoso commented that the 168 items that suppliers were unable to supply were not available in either the private or public sectors. The Department had approached the WHO for a list of pre-qualified suppliers outside South Africa that could be considered.

Dr Pillay commented that stocks like Benzylpenicillin and Atropine were unavailable in both the private and public sectors and had had to be flown in from other places.

Cr Matsoso said that countries like the U.S., Canada, Australia, Europe and the U.K. had a list of common stocks that were unavailable to them, indicating there was a general stock out problem.

Dr Pillay added that stock outs could be a problem between the depot and the facility, as sometimes a facility might forget to order a particular drug or might predict an amount it needed for the next four weeks, then find it was less than what it needed and would run out in between. The Department had implemented a number of strategies to deal with the problem. With clinics, cell phone technology ws used, working with Vodacom. A nurse would scan the barcode of the medicine which would be uploaded to a central saver, and the provincial administrator would see how much stock was left in the facility at that point in time. The system could also generate orders for the clinic based on historical utilization. A special solution was in place for hospitals too. Also available was a call-free line for patients (0800012322) to alert the national Department that a patient could not get drugs from a particular clinic. Civil society could also report on a daily basis that a clinic had a problem with its drug supply. The system of monitoring between clinics and districts had happened manually before, but the cell phone technology was expected to take over the manual system. Currently, 600 clinics were linked to the system and over the next six months there would be other clinics linked to the system. The department had ARV buffer stock stored in Centurion and from time to time, when needed, it was deployed as there could be a supplier problem. Over 20 000 items were kept, and some could expire, so they needed to be managed.

Ms L James (DA) said the presentation had brought a lot of relief and answered a number of questions. She expressed concern over the fiscal dumping, especially towards the last quarter and asked what the Department was doing to prevent it. There had recently been information that HIV infection was increasing, especially in young girls, and she asked what the Department was doing to prevent the rise. Did the Department have backup generators to support connectivity in Limpopo during load shedding?

Dr Matsoso replied that the HIV incidence among women between the ages of 15 and 24 was increasing which could be attributed to a number of factors. The prevalence was high, as more people were on ARV drugs. The Department had just started a project, a young women’s club, targeting young women and as at May over 900 women had been recruited out of about 12 000.This project was to educate women on how to take charge of their lives, how to negotiate with older men and how to take decisions. It was also targeting women’s prayer group and society in general. She argued it was not actually fiscal dumping, considering the whole budget process, as money from the adjustment budget was released only in December and spending could take place only from January. She added that Parliament should reconsider when adjustments were done and when approval should be made. Analysis would have to be made in terms of load shedding, as the Department could not make assumptions.

Ms C Ndaba (ANC) gave credit to the Department on the VENBE connectivity, which reflected their support towards rural development. The Department should take the good stories of its successes to the public through publication in newspapers. She agreed that the Department should do a campaign about the importance of circumcision in reducing sexually transmitted infections (STIs). She expressed concern over the under-spending and over-spending in the Department. The status of the programmes must be provided to support the under-spending and over-spending of budgets. She agreed that the Committee should be provided with the NHI report.

Dr Matsoso replied that the majority of the NHI pilot districts were rural, except for one or two in urban areas, as the Department likes to make investments in rural-based pilot sites because if they succeeded in rural sites, it would be easier to do it anywhere else. The Department was still waiting for its audit report as it had no fruitless expenditure, no unauthorized expenditure, and irregular expenditure of R108 000.

Ms M Scheepers (ANC) congratulated the Department on the presentation, which reflected progress and good work done. She commended the Department on its revenue retention and requested a list of the 13 hospitals.

The Chairperson commented that it was important to see an improvement in the number of unqualified audits from Provinces, and matters of emphasis needed to be addressed. It would be proper to get detailed information on MomConnect for the districts in the Eastern Cape where it was or not doing well. She asked if young women in rural areas were connected. She added that the stock out sms application was not compatible with some phones, and this should be checked.

Dr Massoud Shaker, DDG: Infrastructure, NDOH, said that the Department was improving in terms of expenditure for infrastructure, as last year the expenditure was around 85% and this year it was close to 95%.The main element for this improvement was a capacitating programme in collaboration with the National Treasury and the departments in the provinces. 44 professional positions were being filled in each and every province with the grant money. He added that quality and quantity control at the project level was an element, as last year local supervisors had been appointed along with oversight and monitoring professionals assigned to every province, to make sure that the quality and quantity expended improved. He agreed that the Department was a bit behind, as 50% of its budget had been spent last year: The supply chain management and delivery mechanism was a challenge but by the end of the financial year there would be 548 projects in 375 health facilities in NHI districts, and based on the cash flow analysis, before September there would be 1 000 projects.

Dr Matsoso said that the Department was just rolling out MomConnect and would check or negotiate the connectivity with the service providers.

Dr Maesela wondered whether the mechanism for delivery was difficult, as the same issues were often presented before the Committee. He hoped that next time it would be different.

The Chairperson reminded the Committee that the national Department itself was facing difficulty, as it transferred funds to provinces, and these were used depending on the circumstances in the provinces. In exercising oversight, the Committee would be able to relieve the frustration. She hoped the Department would improve on supplying information, as she was yet to be provided with information on nursing colleges. It was the Department’s responsibility to communicate to the people about what the government was doing, as people did not understand that health had its ideological challenges. The Committee had the responsibility of playing its oversight role to ensure that the Executive was held accountable. She added that the DG should be specific when giving information in order to ensure that it was aligned with the NDP vision. It was important for the Committee to know why some provinces had refused to be assisted by graduates. She reiterated that a health magazine be introduced to inform the public of the success stories in the Department. She agreed that the Chief Nursing Officer should be invited to present to the Committee, along with the Department of Higher Education, in order to discuss changes to the curriculum of the nursing course.

She acknowledged the good work done by the Department, and thanked the team for its engagement with the Committee.

Adoption of Minutes

The Chairperson proposed that the minutes be adopted at the next meeting.

Members would be informed in advance about the oversight that would take place and advised them to indicate their availability, as Parliament was very strict now.

She welcomed Dr H Chewane (EFF) to the Committee.

On behalf of the Committee, she presented a sympathy card to Mr Mosala on the demise of his father.

Mr Mosala appreciated the sympathy card and proposed that the Department should present to the Committee on the status of the NHI pilot districts.

The Chairperson agreed to the proposal.

Mr H Volmink suggested a meeting between the Committee, the Appropriation Committee and National Treasury.

The Chairperson agreed to the suggestion.

The meeting was adjourned.

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