Department Annual Report: briefing

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Health

18 February 2003
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Meeting report

HEALTH PORTFOLIO COMMITTEE
19 Feb 2003
DEPARTMENT ANNUAL REPORT: BRIEFING


Chairperson:
Mr. L. Ngculu (ANC)

Documents handed out
Health Department Presentation
Annual Report 2001/2002 (document awaited)

SUMMARY
The Committee was informed on the gaping disparity in health care resources allocated to South Africans living in different provinces. Differences were obvious in the wide range of per capita spending on health across provinces which translated into unequal service delivery on the ground.

MINUTES
Briefing by Dr. Kamy Chetty: Deputy Director General
Dr. Chetty informed the committee that there were signs that the various programmes initiated by the Department four to five years ago were beginning to bear fruit. She gave the example of programmes in immunisation, tuberculosis control, and management of illness, malaria control, STI treatment, children's and outbreak management as some of the areas the Department had performed well.

There was growing confidence at both management and service level about the approach adopted explaining that the scale of intervention which was becoming substantial enough for the Department to expect some influence on health indicators. Whilst much still had to be done in the area of mental health, disability and chronic care, new approaches had been instituted in this areas. Many of the new areas were patient-centred and developmental and cautioned that these measures would no doubt call for substantial investment of effort and resources in order to realise their potential.

Dr. Chetty admitted that the burden of HIV, AIDS and TB on society and on the Nation's health services was already a real factor. She warned that these developments had the capacity to stretch the National health system beyond its limits. She assured the committee that there was commitment across the Department's senior management team to stemming the tide of these epidemics and to containing their impact. She pointed out that all sections were expected to contribute their skill to this common endeavour.

Briefing by Ms Matsau - Deputy Director General
Ms Matsau acknowledged that tracking progress in view of the complexity of the delivery system, the disease burden and the variety of strategies employed was a major challenge in the health sector. It had not been simple to agree on key indicators and to establish appropriate monitoring systems that span local, provincial and national activities. She however assured the committee that the Department's ability to achieve its projected targets had significantly improved hence making it possible to get a sense of the pace and direction of management's collective work.

Ms Matsau noted that a grave concern was the gaping disparity in the health care resources allocated to South Africans living in different provinces. Differences were plain for all to see in the wide range of per capita spending on health across provinces noting that these differences translated equally plainly into unequal services delivery on the ground. She urged for urgent collective action in view of the guiding fundamental that equity was the absolute bedrock of the transformation agenda. The Nation could not roll back poverty when public services reflect the deprivation of the people that aim to assist.

Ms Matsau informed the committee that the priority goals and objectives of the Department for the period 1999-2004 were set out in a strategic Framework structured around ten main goals. Strategic Framework was used by the Department to organise its planning and monitoring processes and therefore was also the skeleton for the main body of the Annual Report. The Framework included health status and health system goals plus broader organisation targets and that while some of the strategic goals were specific to particular budget programme, very often the combined effort of sections funded different programmes was required to achieve the set targets.

Ms Matsau noted that the ultimate impact of many initiatives of the national department was mediated by the performance of provincial health departments and municipal health services that actually operated the hospitals, clinics and community and community health programmes. It was important to appreciate the complementary roles played by the various spheres of Government and pointed out that without this knowledge, it was difficult to evaluate the actions by the national Department, which might otherwise seem incomplete and dislocated from its goals.

Briefing by Mr. Muller : Chief Financial Officer
Mr. Muller informed the committee that overall the Department spent 99,6% of the funds allocated under its budget. He explained that the picture was somewhat less satisfactory when the Conditional Grants were taken out of the equation. The Department spent 96,9% of its own funds that were allocated and that if the Medical Legal allocation was disregarded, the Department spent 98,2% of the allocated funds for its own activities.

Mr. Muller pointed out that the Department's funding requirements were, by and large, catered for in the Medium Term Expenditure framework but that the recent slide of the value of the rand against hard currencies and the subsequent wave of inflation would impact severely on Health Sector budgets.

Discussion
Ms Malumise (ANC) asked why the committee was not taken on board before the National Health Bill was published.

Dr Chetty explained that the draft bill was published to solicit for public in-put and that the committee will in due course prepare a forum to interact with the bill during the public hearings. She added that copies of the published draft have been passed over to committee members.

Ms Malumise wondered why the issue of human resource deficiency continued without resolution. Were there policy mechanisms in place to address the problem once and for all.

Dr. Chetty explained that there was a policy framework in place to address this malignant problem and that what remained was the question of implementing the plans that were already on paper.

Ms Dudley (ACDP) wondered whether it was not the issue of salaries that was causing the massive exodus from the public health sector and referred to the vacant posts estimated at 29,000.

Dr. Chetty disputed the 29,000 figure pointing out that indeed some progress had been achieved in this area in that a middle level cadre of workers had been created to ease pressure of work from senior personnel. The other intervention was the aggressive transformation of the health institution and the setting up of the institute of health managers by 17 March 2003.

Dr. Chetty noted that a team of officials from the Health, Treasury and Public Service and Administration had been set up to look into the issue of salaries for the health profession. She added that the other notable intervention was the introduction of community service programme for all health profession groups.

Ms Dudley asked if there were any plans to offer free health for all disabled persons.

Dr Chetty replied that the Department was working on the financial implication of the program and that it was critical to get the proper definition of who constituted a disabled person before rolling out any program.

Ms Dudley questioned the reliability of HIV/AIDS statistics that were obtained on the basis of the anti-natal section yet there were many undocumented cases of abortions.

Ms Matsau assured the committee that although the anti-natal program was not the ideal means of securing data on HIV/Aids, it was so far the most authoritative source that would give an indication of the prevalence rate among the populace. However, the survey took care of the deficiency that only a limited population sector was involved.

Ms Gxowa (ANC) decried the state of health facilities especially in far-flung rural out-posts and wondered what became of the hospital revitalisation program.

Ms Matsau explained that the hospital revitalisation program had two to three pilots per year and that it was expected that some health facilities would not be reached immediately.

Ms Dudley inquired why private doctors did not want to give treatment to certain segments of the disabled persons.

Dr. Chetty replied that it was mainly due to deficiency in training but that the Department was issuing guidelines for treatment and that there had been marked improvement in this scenario.

Ms Dudley wondered why death certificates did not disclose the status of the death as being Aids.

Dr. Matsau pointed out that disclosure in the death certificate was only made on the basis of consent and that where the diseased and/or family members object to the disclosure that information would remain privileged. She continued that disclosure was therefore made on absolutely voluntary basis but that in view of the awareness campaigns that were ongoing to remove stigma from Aids so that more people were opting for disclosure.

Ms Gxowa (ANC) lamented that home based community care givers were not fully equipped to carry out their functions effectively and that these people did not have the means to communicate their activities to relevant authorities.

Ms Matsau acknowledged that there were teething problems for home based caregivers. She said that the National Department had been forced to hire people to undertake support for these care givers after the provinces failed to give a better account of their activities. She assured the committee that there had been significant improvement in this area.

Ms Gxowa challenged fellow parliamentarians to go to the provinces and exchange ideas on this crucial matter in order to identify the source of the poor performance.

Dr. Luthuli asked about the type of training community care givers underwent and if the issue of payment had been streamlined.

Ms Matsau explained that there were three categories of home care givers - that is for TB, Aids and issues of Nutrition. There were training manuals and guidelines for these health workers. Due to intense pressure from the provinces the initial contractual terms were normally not adhered to accommodate sustained demands for increment.

Dr Luthuli expressed concern that the incidence of substance abuse was on the increase and asked what intervention mechanisms the Department had put in place to arrest the situation.

Ms Matsau acknowledged that indeed the Department was far behind this problem but she assured the committee that things were set to change with the passage of the new legislation on substance abuse and that the only major issue would be that of enforcement.

Ms Mathibela (ANC) lamented that the issue of human resource kept recurring and wondered if there were mechanisms to allow the National Department to step in where the provinces fail in their prime obligation of service delivery. She cited the case of the Eastern Cape which was a classic example of administrative structure going wrong.

Ms Matsau replied that the Department was well represented in the Presidential team that had been dispatched to the Eastern Cape and hoped that all these teething administrative problems would be addressed fully.

The Chair directed that the issue of human resource and foreign doctors was a critical one and that a forum would be prepared in due course to address these twin issues. Despite the committee's two previous visits to the Eastern Cape there had been no positive development. He asked members to design ways and means of addressing this issue in their oversight portfolio.

Ms Baloyi (ANC) asked if the Department had upgraded its financial management skills to be in tune with the PFMA requirement.

Mr Muller explained that upgrading skills was an on-going process and that in some cases donor funds were utilized to achieve this goal.

Ms Malumise (ANC) inquired if there were any developments on the outstanding issue of Sarafina II.

The Chair concurred with Ms Malumise that there was no point in the Sarafina account recurring in the financial budget of the Department when there was nothing to report on it.

Mr Muller replied that SCOPA was due to recommend to Parliament that the debt be written- off in view of the financial status of the principal debt.

The Chair wondered why the Department could not rely on internal auditors to conclude its audit activities.

Mr Muller explained that upon the introduction of the PFMA few people were qualified to undertake the standard audit required by the Act and that therefore the few auditors that were available in the Department could not effectively carry out this function.

Meeting was adjourned.




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