Department of Health on its 2014/15 Annual Report, with Minister

Meeting report

The Chairperson commended the Department on the timeous submission of documents relevant to the meeting. This therefore meant that the Committee had sufficient time to read the documents before the meeting, and could therefore prepare adequately. Minister Mr Aaron Motsoaledi and the Director General Ms Malebona Precious Matsoso were welcomed to the meeting.

Minister’s Briefing

The Minister said that the NHI was the re-engineering of primary health care – it focused on preventive measures. Presently, the health system was a curative model, where one waited for people to get sick.

The Minister said the Chairperson had mentioned something very important and this Committee might have to do something about that. For the past four years the Western Cape Province and the North West Province were getting unqualified audits continuously [According to the former Western Cape Head of Health, Prof Craig Househam, Western Cape had received an unqualified audit for the past 11 years].  It was a battle to get the other provinces on the same level. What was worrying was that the North West Province had been put under administration. The Ministers were normally expected to deal with problems in their provinces; however what was forgotten was that the Premiers held power in the provinces. The Committee seemed to be calling Ministers and Members of the Executive Council (MECs) only, even though it had the right to call anyone. The MECs were too scared to expose the root causes of the problems in the provinces. The Minister no longer had confidence that the North West Province (NW) would continue in the vein of getting unqualified audits. It was not as if the MEC had done something untoward, it was just that they did not have powers as they were under instructions. He felt that those who instructed them should also be called to this meeting to be questioned. This had to be mentioned to the Committee because it had to help make the provinces work.

The Chairperson said that the Committee was concerned about NW being under administration, and were thinking about inviting them here to share information.

The Minister said that Limpopo Province was now under Section 100 and this was known. The entities that came to answer while Limpopo was under administration were those very entities like the Cabinet, especially the Minister of Finance, who had taken the initial motivation to Cabinet. He was the one who saw the media and the public and explained. The Minister’s concern was that if one called the Department of Health and asked them why they were put under administration, when they did not put themselves under administration, it would be very difficult to answer. He proposed that the Committee went to the source – to the people who put the North West Province under administration - just to explain. If one called the Department, no answers would be forthcoming, because they had been asked many times and had not provided any answers.

Briefing by the Department of Health on Annual Report 2014/2015

The Director General, Ms Matsoso, said the purpose of the presentation was to reflect on achievements and highlights in the Annual Report of the National Department of Health (NDoH) for 2014/15. The National Development Plan of the NDoH was outlined including its mandate for 2030.

The National NDoH Strategic Goals were as follows:

1. Prevent disease and reduce its burden, and promote health;
2. Make progress towards universal health coverage through the development of the National Health Insurance scheme, and improve the readiness of health facilities for its implementation;
3. Re-engineer primary healthcare by: increasing the number of ward based outreach teams, contracting general practitioners, and district specialist teams; and expanding school health services;
4. Improve health facility planning by implementing norms and standards;
5. Improve financial management by improving capacity, contract management, revenue collection and supply chain management reforms;
6. Develop an efficient health management information system for improved decision making;
7. Improve the quality of care by setting and monitoring national norms and standards, improving system for user feedback, increasing safety in health care, and by improving clinical governance; and
8. Improve human resources for health by ensuring adequate training and accountability measures.

The Minister said he had to communicate to the Committee that the previous week the Department had launched its very own health channel on television in partnership with Soul City. It planned to go on air on 1 December 2015. It would deal with, among other things, maternal issues, breast cancer, family planning, smoking, and how to cook healthy food. It was called the Good Life Network. 

One of the things that made the Committee very angry was the waiting times that people had to suffer through in the clinics. This was not happening in a vacuum – 10 years ago 400 000 people were on Anti-Retroviral (ARVs); today 3.4 million people were receiving ARVs from the same number of clinics. Hence the number of people receiving ARVs had increased 10 times in 10 years. Diabetes was very common now. So when one added this to HIV expansion, this was why waiting times were so long. This situation would not improve; in 2016 there would be 4.16 million people on ARVs. One solution was to have a programme where those with chronic illnesses just came to collect medication.

The DG reported:

 Programme 1:

• The vacancy rate was 6.6%; this performance remained below the DPSA’s target of 10%.
• Turn-around Time for recruitment process was within 5 months. This performance was within the 6 month DPSA benchmark.
• The National Department of Health (NDoH) has for the last 4 consecutive years obtained an “unqualified audit opinion” from the Auditor-General (SA), including for the 2014/15 financial year; and
• Three out of nine provincial DoHs obtained unqualified audit opinions for the 2014/15 financial year compared to two provincial DoHs for 2013/14

Programme 2: National Health Insurance, Health Planning and Systems Enablement
Most of the targets were met except for reviews of the hospital level adult Essential Medicine List/Standard Treatment Guidelines, where only 36% of the targeted 50% had been conducted. Most of indicators for children were looking very positive. The Tuberculosis (TB) death rate had gone down from 6% to 4.8%. One of the areas to improve was correctional services management.

A major concern was that 65% of women in South Africa were obese and 31% of men.

The Minister emphasised that obesity was not the same as being overweight, and South Africa had the highest rates for obesity in Africa. This included the rates for HIV.

There was a need to really take this seriously so TB and blood pressure screenings had to be done regularly.

Programme 3 dealt with increasing life expectancy
Plans and results were the following:

• The Ward-based Primary Health Care Outreach Teams were following-up new mothers within six days of giving birth. At the end of 2014/15, 74.3% of mothers received a postnatal visit.
• The Integrated School Health Programme (ISHP) had a 23.2% coverage rate for 2014/15 in Quintile 1 and 2 schools, and 463 School Health Teams screened a total of 709 396 learners; and
• The Human Papilloma Virus (HPV) immunisation campaign was largely successful, with 91.8% of the targeted number of girls reached for the 1st dose HPV immunisation

Programme 4
Some of the results and outcomes for Programme 4 were:

• A draft Policy Framework and Strategy for persons with disability was developed
• Cataract surgeries were performed for 43 742 older persons.
• The Minister of Health convened a summit for kidney care in January 2015. The outcome was a Declaration which forms the basis for improving future kidney care from primary to tertiary health levels
• To improve oral health in children the Department provided fissure sealants, toothbrushes and toothpaste to 12 000 children in Quintile 1 and 2 primary schools.
• The Oral Health programme received fully equipped Mobile Dental Units in all National Health Insurance (NHI) pilot districts for oral health services at schools.

Cabinet had just passed two Bills. One was on the National Health Laboratory Services Bill and the second one was the National Health Public Institute Bill. The Institute was mainly from entities that resided in the NHLS, so the NHLS dealt mainly with laboratories. A framework was established and the Bills were passed.

The Minister said that two One Stop facilities were set up in areas to cater for those with Silicosis and Asbestosis. Each centre saw close to 4000 ex-mine workers.

In conclusion the DG said that key milestones were achieved during the financial year 2014/15, in relation to the objectives and targets set in the National NDoH Annual Performance Plan for this period. 69% of the planned targets in 2014/15 were fully achieved, and 31% of the targets were partially achieved.  Challenges were experienced, but these were addressed in the National NDoH Annual Performance Plan for 2015/16.

Ms Valerie Manamane Rennie, Head: Corporate Services: National Department of Health, said the vacancy rate was at 6.6%, 10% below the DPSA target.

Mr Ian van der Merwe, Chief Financial Officer (CFO): National Department of Health said 98% of total budget had been spent. There was major under spending on Programme 2 due to negotiating funds for the National Health Survey, and the processes involved in appointing a GP contractor in terms of the NHI. There were some mitigating factors there and a request was made to National Treasury for permission to use some of the funding outside of the NHI pilot site. This was not approved so some donor funds were used. On Conditional Grants, close to 99% of the total budget for these grants were spent.

Discussion

Mr D Stock (ANC Northern Cape) applauded the Department for the comprehensive presentation and for the unqualified opinion for four consecutive years. With regard to Programme 2 and the NHI, he asked if the DG could provide a provincial breakdown of the NHI.

The Minister replied that he would answer this question in a general way to illustrate that the differences and problems between provinces and National could be located in four areas; and in those areas the Department had no authority, only responsibility. If problems in these four areas could be solved then the health care system would improve tremendously.

1. Human Resources – training, development and management of human resources;
2. Financial management; 
3. Procurement; and
4. Infrastructure maintenance

He was attending lectures at Harvard University who were running lectures on Health Leadership in Africa. The course dealt with the same four problems mentioned above.

Mr Stock asked when the NHI White Paper would be released. 

The Minister replied that in the White Paper on the NHI, primary health care had to be the heartbeat of this policy.  The White Paper was going through the Cabinet process at the moment. The Department met with National Treasury the previous day. The next meeting would be held on Friday.  The Department’s approach to change was to start at the bottom. There were 1212 elements required to create the ideal model for clinics. 10 clinics were chosen out of 3500 clinics.

Mr M Khawula (ANC KwaZulu-Natal) said that last year the DG had promised an appraisal of the NHI, but this had not been provided as yet.  He asked when this would be provided. 

The DG? Said the documents were sent to the Committee. She asked the Committee to please check to see why the promised documents, even though they had been sent, had not reached them. 

Mr Khawula referred to page 22 of the Report and asked if the PhD studies spoken of were only for health related studies or if management studies were included as well. 

The Minister explained the history of the PhD studies. With the NHI and the Public Health Enhancement Fund R40 million was made available to help build human capital. The approach involved three steps:

1. Get 100 medical students who would not normally be accepted into medical school due to their disadvantaged backgrounds;
2. Pledge that from the launch in 10years time there would be1000 PhD students involved in research in TB and HIV; and
3.  That there were mostly women involved in the process. At the moment there were 55 women who had received the scholarship.

Mr Khawula referred to page 28 of the Report, which dealt with the Integrated School Health programme, and asked how it would be mentored because he did not see anything related to it on the ground.

The Minister replied that last year 700 children had been screened for problems with their eyesight, hearing and oral hygiene. 201 000 were referred because they had either one of those problems.

The DG replied that mobile units were available to assist with the Integrated School Health Programme (ISHP). The President had actually launched the programme. Mobile units for the pilot phase of the Integrated School Health Programme would be distributed to 10 districts where the NHI system was also being piloted.

Mr Khawula referred to Programme 4 where the Department of Home Affairs had stated that there were many unofficial entry points in the country. He asked how that could be dealt with.

The DG replied that scanners had been bought for airports with OR Tambo being the priority port of entry.  Because people were coming from West Africa via the airports scanners were prioritised for airports. For land, the very busy ports of entry like Lebombo and Musina were prioritised. The Department had started processes for the other ports of entry this year. Mr Morewa was responsible for the work that dealt with port health services and would come and give a report.

The Chairperson said that border posts were creating a challenge. Uniforms were not always visible. The Committee would visit border posts to see where performance could be improved.

Mr Khawula said, on occupational health issues, the Report had stated that planning was happening in this regard. The Report should say whether implementation had happened or not. 

Ms T Mpambo-Sibhukwana (DA WC) complemented the Department on its Good Life Network television station, as this was an important part of service delivery. The new television channel promoted a new lifestyle.

With regard to Sub programme 4, Severe Profound Disability, Ms Mpambo-Sibhukwana asked what preventative measures had been taken to lessen intellectual disability; because as it stood it did not seem to deal with the problem in terms of prevention. The Department funded Severe and Profound Disability, so one expected to see what preventative measures had been taken.

Ms Mpambo-Sibhukwana said that getting medicines in hospitals was working well. Programme 3 had shown that service delivery included getting medicines to churches; she asked if service delivery included reaching out to synagogues and clinics as well.

Ms Mpambo-Sibhukwana said that Programme 3 dealt with expediting service delivery to the elderly. She asked if the Department could include the youth using the bicycle delivery system. This had worked in Khayelitsha. It had also helped to keep the youth away from crime because they were kept busy.

The Minister replied that bicycles for the delivery of chronic medication were welcome.

Ms Mpambo-Sibhukwana asked what was done to improve the situation when the six provincial departments received qualified audits. What was being done to improve this situation?

The Minister replied that it had already been explained why six provinces could not get clean audits. The bottom line was that one had to go and look at who was the CFO or rather who had to do the job.

Ms Mpambo-Sibhukwana said that the Auditor General had raised issues about the quality of data presented in annual reports for the past three years. She asked what the Department was doing to rectify the situation.

The DG replied that she had the very report on mobile units and data that came out of here. It had been sent to the Committee but they had not received it.

Ms Mpambo-Sibhukwana asked the Department to update the Committee on the use of interns in the field of finance and administration.

Ms Mpambo-Sibhukwana asked why were the legal invoices for the external auditors not paid in the financial year, and why was there under expenditure in capital goods?

Mr Khawula said that the Department had been getting an unqualified audit for the past four years. He asked why there was no improvement. There was a difference between an unqualified audit and a clean audit.

Ms P Mququ (ANC Eastern Cape) asked for clarity about the situation in the Limpopo province.

The Minister replied that Limpopo had received an unqualified audit opinion. They had been placed under Section 100. In this case Human Resources (HR) had affected the finances. Four people had been appointed to deal with the situation and matters had improved there.                               

Ms Mququ asked how many mine workers in total had benefited from the One Stop facility in total.

The Minister replied that the One Stop facility was not only a plan. Two of them were working already with approximately 8000 ex- mine workers receiving treatment. 

The Committee hoped that the Bill would be finalised soon as all nine provinces supported it. No challenges were anticipated.

The Chairperson asked on what levels the vacancy rates were located.

She said that it would useful to find an IT system that interfaced with the Department of Home Affairs’ IT system.

The systems for collecting medication should be improved. It would be good to have other places to collect medication. SMSs could be used.

With regard to healthy living and eating, the Department had to empower the Committee in this regard.

The issue around long queues put the Committee in a bad light. There were attitudinal issues at play and it might have to do with understaffing. Elderly persons came to hospitals and clinics very early and were not attended to immediately even if there were staff members present.

The Minister replied that attitudinal problems were being looked at. The office of Health Standards and Compliance was about to appoint an ombudsperson to help deal with these issues.

The Chairperson said that the Committee was flagging the issue of performance vs spending, because it had to be clear how money was spent.

The Chairperson said that due to time constraints and the venue being booked for another meeting at this time, the Department would have to forward written responses to the remaining unanswered questions.

The meeting was adjourned.