The Director General reported on the performance of the Department’s six programmes: Administration; Health Planning and Systems Enablement; HIV/AIDS and TB / Maternal, Child and Women's Health; Primary Health Care (PHC) Services; Hospitals, Tertiary Services and Workforce Development; and Health Regulation and Compliance Management. The overall expenditure for all provinces was 70%. Conditional grant expenditure was also discussed. The National Tertiary Services Grant overall expenditure for all provinces was 73.8%. The Health Professions Training Grant reflects an under-spending of 77.9%. The Comprehensive HIV/AIDs Grant reflected an under-spending of 68%. The Health Facility Revitalization Grant had an under-spending of 64%. The National Health Insurance Grant the overall expenditure was 42% against the budget.
Members asked about serious maladministration in hospitals in some provinces about negotiating tenders for security in hospitals, medical waste removals, and gardening contractors; the turn-around times for toxicology and blood alcohol tests; National Health Insurance (NHI) expenditure and its ability to absorb its funding; the NHI funding paper; dental assistant regulations; dental care being largely absent from the quarterly reports; the leadership academy; the backlog on compensation claims for ex mine workers; combining legislation dealing with compensation claims of workers; drought plans; the school health programme; breast-feeding obstacles; delays in payment of outstanding invoices; delayed equipment delivery; austerity measures and the under-expenditure of conditional grants; accruals as a contributor of under-spending; missing data on MDR TB treatment by provinces not reporting on their results; provincial Annual Performance Plans; and provinces adhering to the list of non-negotiables.
The Director General noted that the central office of the Department of Health needs to have more authority and power so that it may be able to act against maladministration. Some of the tenders issued by the Department are transversal tenders which are coordinated by National Treasury and one needs to look at what the economies of scale will be for certain tender contracts, because if each hospital processes its own tender the costs may be too high. On delayed payment by provinces across the country, she said that the Department transfers monies to the provincial treasuries but the treasuries delay in transferring the monies to the health departments in the provinces. The treasuries withhold the money, so the Department is confronted with this dilemma. National and provincial treasuries need to deal with this matter.
Department of Health (DOH) 2nd and 3rd Quarter 2015/6 performance
Ms Malebona Matsoso, DOH Director General, reported on each of the six programmes: Administration; Health Planning and Systems Enablement; HIV/AIDS and TB / Maternal, Child and Women's Health; Primary Health Care (PHC) Services; Hospitals, Tertiary Services and Workforce Development; and Health Regulation and Compliance Management.
Programme 1: Administration
A strategic objective is to ensure effective financial management and accountability by improving audit outcomes. The annual target is to achieve an unqualified audit opinion, and the Department submitted the audit action plan progress report. All provinces have submitted financial improvement plans to address audit qualification matters. She cited that the Western Cape, North West and Limpopo provinces have received unqualified audit opinion.
A second objective is to ensure an efficient recruitment processes and responsive Human Resource support programmes. The target is bi-annual on this objective, being the average recruitment process turnaround time to be 4 months; in quarter 3 the department achieved a 71% (55/77) of vacancies filled within the target of 6 months, only 51% (39/77) were filled within the target of 4 months, and the Department persists to achieve this target.
Thirdly, the objective was to fully implement the Departmental Information Communication Technology Service Continuity Plan by 31 March 2018. She said the Department is currently setting up these information systems in departments. On the turnaround times on recruitment processes; the Department measures itself against a stringent 4-months target; however the DPSA target in the public service is 6 months. For this reporting period the Department met the 6 months target, even though there were challenges in meeting the 4 months target, and the Department is engaging the institutions responsible for the prerequisite verification of qualifications of selected candidates in order to improve the processes.
Programme 2: Health Planning and Systems Enablement
The strategic objective is to improve contracting and supply of medicines. The annual target of the Department is 350 000 in Q2 and 425 000 patients in Q3, and the preliminary performance was 246 320 and 322 121 patients, respectively. The annual target is 500 000 by the end of March, and the reasons the targets were not achieved is due to poor enrolment of Mpumalanga and North West provinces, and there is a team working on this. The Western Cape data is not included. DOH wants to work with other ministries to establish the implementation of the strategy to address antimicrobial resistance (AMR). In order to fast-track the implementation of improved patient administration and web based information systems at health facilities, the Department supplied the Department of Telecommunications and Postal Services with a list of health facilities in the NHI (National Health Insurance) pilot districts for broadband connectivity.
Programme 3: HIV/AIDS and TB; Maternal, Child and Women's Health (MCWH)
The Department planned on increasing the number of HIV positive people on ARVs. The target for Q2 was 3.4 million, and 3.6 million in Q3, the Department was only able to reach 3 265 037, and 3 331 122, respectively. However, the December figure is not included. DOH is also planning to increase condom distribution in the next financial year. With regards to TB, the Department wants to undertake a massive TB screening campaign, and the annual target is 50% and its Q2 and Q3 performance was 28.6 and 35.2%, respectively. The Department also wants to reduce the maternal mortality ratio to under 100 per 100 000 live births, and the neonatal mortality rate to under 6 per 1000 live births, in Q3 the target was 10.5 per 1000 live births and only 12.9 per 1000 live births was achieved. The Minister of Health Dr. Aaron Motsoaledi launched a dedicated health channel, and she encouraged the Committee to see it. With regards to cancer, the Department wants to protect girl learners against cervical cancer, its annual target was 80% and there were only 356 228 and 315 475 girl learners vaccinated respectively in Q2 and Q3. She lamented that the departments need to employ data capturers in order to reduce the pressure of nurses, because it is difficult to attend to patients and having to capture data at the same time.
Programme 4: Primary Health Care (PHC) Services
The Department wants to improve quality of services at primary health care facilities. The annual target was 500 primary health care facilities in the 52 districts qualify as Ideal Clinics, about 280 facilities should have been achieved by end of March 2016. She cited that the Department is calling for gym parks for members of the public for those who cannot afford gym, and it is currently working with the Department of Sport and Recreation to encourage partnerships. The annual target for the prevention of avoidable blindness was 1 500 operations per million un-insured population, in Q2 217 and in Q3 962.2 operations were achieved by the Department.
Programme 5: Hospitals, Tertiary Services and Workforce Development (see document)
Programme 6: Health Regulation and Compliance Management
The Department seeks to objectively establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance. The annual target in Q2 was 2 000 and 2 500 in Q3 for number of applications certified at Medical Bureau for Occupational Disease (MBOD) as compensable disease claims. In Q2 the Department achieved 965 and 1 014 in Q3. As for the number of compensable disease claims paid by Compensation Commissioner for Occupational Diseases (CCOD), other than pensioners; the annual target was 1 000 for both Q2 and Q3, the Department only achieved 416, and 411, respectively.
Financial report: Quarter 3 Expenditure 2015/16
Mr Ian van der Merwe, DOH CFO, said actual expenditure on NHI, the Health Planning and System Enablement sub-programme, as at 31 December 2015, amounted to R373 888 000 (62.66% of the adjusted budget amount) and the available funds amount to R222 758 000. The HIV & AIDs, TB, Maternal & Child Health sub-programme spent 74.03% of the adjusted budget amount. On Primary Health Care Services, the Department spent 68.48% of the adjusted budget. The CFO cited that the equipment purchased is currently being delivered.
The Department spent 71.99% on compensation of employees from the adjusted budget amount. For Goods and Services, only 51.36% was spent of the adjusted budget. The Server for Tracking System was recently procured; delays were due to delivery and correctness of the equipment and the first roll out will be within the next two weeks. The tender process for a Security Systems upgrade is underway and expenditure is expected to be incurred before year end. He said some funds will be rolled over to the next financial year.
On programme 1, the Department spent 70.10% of the adjusted budget, 62.66% of programme 2, 74.03% spent of programme 3, 68.48% spent of programme 4, 74.29% spent of programme 5, and 74.45% of programme 6.
Conditional Grants Report: Quarter 3 Expenditure 2015/16 as at 31 December 2015
The overall expenditure (schedule 4 and 5 grants) was 70% of the budget. The overall expenditure for all provinces was 70%, whilst the Mpumalanga province spent the most of its budget, 81.0%, and the Free State spent less of its budget with an overall of 70.9%.
The National Tertiary Services Grant total expenditure against the budget for all provinces was 73.8%. The under-spending is attributed to austerity measures on personnel expenditure, outstanding payments for NHLS in Gauteng, misallocation of transactions, and incorrect Persal linkages and outstanding accruals.
The Health Professions Training Grant reflects an under-spending of 77.9% of the budget. All provinces spent within the norm with the exception of Eastern Cape and Gauteng that spent 53.8% and 68.8% respectively. The reasons for this under-spending is because Walter Sisulu University posts not yet being absorbed on Persal due to delays in signing of agreement and slow recruitment process in Eastern Cape, and delays in payment of the NHLS account by Gauteng.
The Comprehensive HIV/AIDs Grant reflected an under-spending of 68% of the budget. Overall spending for all grants has improved considerably this financial year from 68% (2014/15) to 74% and spending is within the acceptable norm. All provinces spent within the acceptable norm with the exception of Free State, Limpopo, Northern Cape and North West that are under spending due to: delays in delivery of condoms ordered during Q2, late delivery of invoices by suppliers, and delays in recruitment process and delivery of equipment.
The Health Facility Revitalization Grant reflected an under-spending of 64% of the budget. Overall spending for all provincial grants has improved considerably this financial year from 64% (2014/15) to 76.9% and is within the norm. All provinces spent within the norm with the exception of Free State and Western Cape that spent 71.6 and 60.0% respectively, and the under-spending is attributed to challenges with implementing agents, delays in procurement of equipment for completed projects impacting on health technology. The overspending in some of the provinces is caused by acceleration of projects and improvement on performance of contractors and monitoring and evaluation.
The National Health Insurance Grant overall expenditure was 42% against the budget. However, overall spending for all provincial grants has improved this financial year from 42% (2014/15) to 53 53.8% but this is still below the norm. All provinces spent below the norm with the exception of Western Cape and the reasons for under-spending is attributed to: delays in payment of invoices, austerity measures at various provinces, delays in delivery of IT equipment (communication gadgets) and uniforms for Ward-based Outreach Teams (WBOT), and delays in supply chain management (SCM) processes.
Dr W James (DA) said that there is evidence of serious maladministration in hospitals in certain provinces across the country. He claimed that he knows the delegated authorities will speak to CEOs in hospitals in order to have the ability to negotiate the tenders directly regarding security in hospitals, medical waste removals, and gardening contractors. Secondly, he would like to know the turn-around times on the toxicology and blood alcohol tests as the Department claims turn-around times have improved and he would appreciate if it would furnish that information to the Committee. Finally, he asked how much is being spent on the NHI (National Health Insurance), and what percentage of that figure is actually being spent, and if there are any reasons for concern. As he understands, the Department cannot absorb that money, and asked for some clarification.
Mr H Volmink (DA) referred to the NHI funding paper and recalled in the previous year when the Minister of Health, Dr Aaron Motsoaledi, said that there would be a White Paper and a technical sort of funding paper from Treasury and that these two papers would have to be read together in order to understand the complete proposal. When is the technical paper going to be released in order to put the two pieces of the puzzle together? Secondly, he read in the media that there are regulations coming out that would make it difficult for dental assistants to function. Dental care as a whole is absent in the quarterly report being presented by the Department, he asked what impact will it have on service delivery when the Act comes down, and will there be a transitional period for those dental assistants who do not quite make it. On page 46 regarding the leadership academy, he asked where is the academy and when will it be fully established and functioning. On page 54, he lamented the backlog of compensation claims for workers, and noted that there have been bottlenecks for a number of years. Can there not be a dedicated focused plan to get rid of the bottlenecks for compensation claims and a long term plan on how to harmonise the various pieces of legislation dealing with compensation? On page 77, he asked for some clarity on how it has become the fashion to introduce austerity measures with such unfortunate consequences where service delivery is not fully functional because the money that should have been there, is not. Finally, with the drought currently persisting, the kind of plans outlined by the Department do not accommodate this kind of crisis that came the drought. He asked if the Department has enough resources and personnel to deal with some of the worst case scenarios that this drought can bring.
Dr P Maesela (ANC) asked how far is the school programme on health. Secondly, what is the major obstacle about breast-feeding as it appears that babies are not being breast-fed enough?
Ms C Ndaba (ANC) said that on the finances presented it appears that there are many outstanding invoices, she asked for the main reasons why the invoices are still outstanding. Secondly, with so much equipment shortages, how is the Department fast-tracking the delivery of this equipment because these can be outstanding for a long time. She gave as an example Natalspruit Hospital which was having complaints of outstanding equipment. She asked if DOH has a plan to ensure that equipment is delivered on time. She expressed a concern about invoices that are not being paid by the Department whether it is on national or province level and that she does not see any penalties or remedial actions implemented by DOH to ensure that they discipline officials who do not carry out their respective jobs whilst getting paid every month.
Ms Matsoso replied that the central office of the Department of Health needs to have more authority and power so that it may be able to act. At the moment they are testing in which areas that can be done. Some of the tenders are transversal tenders which are coordinated by Treasury and the Committee needs to look at what the economies of scale will be for certain contracts if done nationally, because if each hospital does its own tender the costs will be high, so they will have to identify specific areas. They have been looking mainly at those areas that in their opinion are necessary to make hospital operations more efficient and those have been identified and listed – such as the employment of a team that runs a hospital. They do not want CEOs of hospitals to go about employing people anyhow. There must be clear guidelines that will need to be adhered to, the Department will share the document with the Committee of what this systematic approach entails.
Ms Matsoso said that the Committee has noted problems with the current medical waste tender and reports were supported from the Western Cape and Gauteng provinces. The Committee has been in touch with the heads of departments of all the provinces to ascertain how the problem of medical waste can be addressed. She said, however, it is far more complex because the Department of Environmental Affairs coordinated some of the work on medical waste and, therefore, it is a dual problem. DOH is currently trying to sign an MOU with the Department of Environmental Affairs because this is where the problem emanated. The Department is in touch with the heads of department to address some of the problems that arose particularly in the Western Cape. The question on toxicology and blood alcohol tests will be handled by Dr Andreus at a later stage.
Ms Matsoso replied on the question about the consolidated expenditure figures for the NHI, saying there are multiple programmes and the funds are distributed across different programmes, but the DOH CFO will furnish the detailed information regarding the consolidated expenditure figures relating to NHI. On the question about the NHI funding paper, the cabinet’s decision was that there cannot be two papers because it will confuse the public, therefore, within chapter 7 of the White Paper is where the information from the funding paper can be found. The Department still needs to do further work, and there are certain implementation aspects of the White Paper that it still needs to deal with. DOH has come up with an implementation plan which is about 500 pages, and that implementation plan document needs to be collapsed into manageable components and the work streams are currently busy doing that including looking into the detail of some of the funding arrangements.
Ms Matsoso replied on the leadership academy question, saying there is a model which must be implemented, and there is a hub for CEOs and a hub that drives implementation, so the Minister will formerly announce the academy in due time.
On the backlog of compensation claims by former mine workers, Ms Matsoso said historically there were only two medical doctors that were employed to examine the former mine workers, now that number has increased to 21. With funding that the mining sector has made available, destitute former mine workers need to be traced by the Department so that they can access their benefits. She expressed her satisfaction about this new programme due to the fact that now these former mine workers can receive some sort of benefit. The Department has now set up One Stop Shops to avoid having people having to go all the way to Johannesburg and queue up only to find out that they perhaps do not have the relevant documents, so the system is now decentralized. For example, those who come from the Northern Cape can now go to the One Stop Shop in Kuruman. One Stop Shops have also been set up in the mining sending areas where there is a concentration of the people who have worked in the mines in the past. The Department will also set up a One Stop Shop in Limpopo. The Department is in partnership with the Department of Labour, through the legislation to establish a compensation mechanism, for instance, if the lungs are damaged as a result of previous mining employment the Department will compensate for that and if it is the other parts of the body the Department of Labour will compensate. Rand Mutual (Bank) handles the administration of the Department of Labour for this compensation mechanism; however, the Department has been considering making use of Rand Mutual to handle the whole administration for both compensation in terms of COIDA (Compensation for Occupational Injuries and Diseases Act) and ODIMWA (Occupational Diseases in Mines and Works Act), because these two separate pieces of legislation govern employees in the mines, and other workers outside the mining sector.
With regards to the austerity measures, Ms Matsoso said there are only three provinces that have imposed austerity measures: Gauteng, Free State and Mpumalanga. The problem with Free State and Mpumalanga is that they pay their employees through the grant, which is not acceptable, because the grant should only be made use of when finances are tight. On the question of the drought, that it is not the Department’s plan only, it is an inter-ministerial initiative that was established by Minister Pravin Gordhan, and there are multiple departments involved, such as DAFF (Department of Agriculture, Fisheries and Forestry) and COGTA (Cooperative Governance and Traditional Affairs) which coordinate all the other departments involved, and the departments submit inputs to COGTA.
Ms Matsoso said DOH is making substantial progress in school health, and very soon audiologists and optometrists will be employed and deployed to the schools as part of the school health programme. The Department will report to the Committee in due course on the progress of the programme.
On the question of breast-feeding, it is an ‘exclusive’ matter, because babies must not consume any other liquids but only breast-feeding milk alone. So there are some inherent cultural issues with this situation because women must attend to their menial duties, and when they go back to work from maternity leave, breast-feeding becomes a challenge and the logistics in their homes who do not allow for breast-feeding to be as smooth as it should be for the baby. The Department must try to encourage a paradigm shift of society’s perception about breast-feeding. She alluded to the sensationalised breast-feeding incident that occurred on an SAA flight a few years back.
On outstanding equipment and invoices, Ms Matsoso said she will do a follow up with the team in the Natalspruit Hospital to ascertain the causes of the equipment delivery delay. It is a new hospital, however, by now it should have already received equipment because when it was commissioned the equipment should already exist.
With regards to delayed payments, the National DOH has not had a delayed payment since last year April and May because it reports to Treasury on a monthly basis as a statutory requirement. An investigation was done and the individual who caused the delay was caught and dealt with appropriately. With the provinces lagging behind on payments, she writes to every Head of Department in the provinces, informing them on how much is outstanding. Likewise with pharmaceutical deliveries, she furnishes them with detailed information on how much is owed, an age analysis of the debt, delivery details and so forth. In dealing with this problem, the National Assembly stated one must fire people who are not adhering to the prescribed standards, but the Department came up with much harsher course of action of holding back the salaries of those who do not pay suppliers. As a result, there was a positive response from the provinces.
Dr Gail Andrews, DOH Chief Operations Officer, said the turn-around times for blood alcohol tests is 6 weeks, for toxicology tests it is 3 to 6 months, and for food tests it is 1 month.
Mr van der Merwe, DOH CFO, replied that the consolidated expenditure for 2015/16 has three streams, which include the NHI direct grant, the indirect portion and the infrastructure portion. The consolidated figure for all three streams amounts to R974 million. By 31 January 2016, expenditure was at R750 million, which is 70% of total expenditure if the three streams are consolidated. Under NHI there are five grants, which include; Professional contracting, Revive grant, HPV Vaccines, Information Systems and Are-U-Clinic grant. In 2016/17, the budgets will range from R1, 2 billion; R1.4 billion and R1.3 billion and the idea is to put them into one expenditure stream in the upcoming financial year. If the Department does that in the current year it will be sitting at 77% expenditure of the total amount.
On austerity measures, the DOH CFO said the difficulty was that provinces tended to look at their compensation line item on their budgets and if that line item was under pressure, they would make provision for compensation from the grant. When the Department transfers funds as complementary to the equitable share like the tertiary grant and training grant, it is always affected by that. The idea is for provinces to link the doctors specifically to the grant, so that expenditure can reflect immediately and the province would not have to go back to their books and process journal entries. There are mixed reactions by some provinces to this proposal. Provinces such as the Eastern Cape only catch up their expenditure in February/March when they do their journals to catch up with the expenditure already in their books. On underspending, he said that when the Department undertakes visits to provinces, they do encourage them to move the funds in the business plan to have some kind of expenditure to avoid under spending. On outstanding equipment, DOH has negotiated the equipment budgets with Treasury during the adjustment stage, and it was discovered that suppliers have excessive lead times on delivery. There is also the need for asset management of equipment by administration as they need to be bar-coded and registered and only then distributed to the provinces. So there might be an overlap in the new financial year to carry out all of that work. When it comes to equipment, the first round was delivered last year to the head office and administrative issues persisted. Now the Department is delivering directly to the clinics and Heads of Departments need to sign for these deliveries and so that lead time leaves the Department a bit of an audit risk because the Auditor-General would say that at the time the audit was carried out, the equipment was in the possession of DOH and so it should be able to account for it which is not always possible because they would now be in the district. Computer equipment is being warehoused and gradually distributed to the clinics. Some equipment payments that will affect the expenditure may appear immaterial in terms of the bigger budget but are actually material in the cluster budgets. Further, some clusters delay in putting out their requirements for equipment until the fourth quarter.
Mr A Mahlalela (ANC) said the austerity measures are very worrying because it is one of the areas that is cited as the biggest contributor to under-expenditure of grants. He asked is it legal for a province to declare a moratorium on conditional grants without having engaged and agreed with the Department, because it is a conditional grant and it should be spent according to how it has been conditioned. Why is this allowed?
Secondly, year in and year out one of the biggest contributors of under-spending on conditional grants is listed as payment delays, what explanations are provinces giving for payment delays? Money is being released in time and money is received but they continue delaying payments even when invoices have been issued by suppliers, it has been a recurring matter.
He referred to accruals as another contributor of under-spending. It means that the accruals have exceeded a period of 30 days and that is a violation of the PFMA and Treasury regulations. Accruals should have been cleared in the first quarter to avoid having accruals un-cleared in the third quarter. He asked for clarity on how this occurs. In the presentation, DOH is citing audit costs which is reflected for payment in the last quarter of the financial year. He asked how it is going to be paid in the last quarter (but not actually budgeted in the year the audit is carried out) to avoid the issue of accruals and under-spending. He said when you are planning to procure at the end of the financial year, the Department is literally planning for accruals. He asked if it is allowed to do that. On page 67 under capital payment, there is communicable diseases cluster equipment valued at R1 million and the Department does not have that R1 million currently available. Where is DOH going to get the difference? On page 69, for capital payment there are invoices to the value of R174 million, laboratory equipment valued at R7 million and IT equipment of R50 million which amounts to R254 million in total, but the funds available are sitting at R169 million. This automatically means that the Department is planning to over-spend. He asked if it is allowed to overspend and from where the money is coming to balance out the over-expenditure.
He pointed to Programme 6 under CCOD and asked if the failure to certify and the failure to pay former mine workers is as a result of the unavailability of IT equipment, yet how did DOH manage to pay the others, because the Department has managed to pay 416 in quarter and 1, 411 in quarter 2 and certify 965, but there is no correlation between the certification and payment. Why is there a delay in payment for those who have been certified?
On page 43, he asked for clarity on the central hospital delegation, he asked if DOH is only looking for delegation for human resources because it does not seem as if anything is being communicated about financial, logistics and supply chain delegation. If these other delegations are being dealt with, how are they being processed and how far is the Department on processing this. On page 34, he asked for a detailed list of the idle clinics to see at what stage each idle clinic is and if they are still at that level.
He referred to the MDR TB treatment, the DG had said that the un-captured data is due to clinic or provinces not reporting on the results. So if people were reporting, the number would probably be higher than the one being reported? On medical male circumcision, the annual figures seem worse than the quarterly figures, and is therefore, very confusing, there is no correlation between 2010 and 2015 and he asked for an annual performance.
On page 18 under the APPs (Annual Performance Plans), he asked if the Department is reviewing APPs that have already been adopted and implemented. What is the purpose of that review? He thought that the Department would be working with provinces in their preparation so that by the time they are ready to table their APPs, they can table APPs that the Department is in agreement with.
Lastly, is it possible to clarify what the stance of the Department is on the submission of the provinces for non-negotiable matters. Are the provinces adhering to these non-negotiables? What is the observation of the Department?
Mr Volmink said his question on dental assistants has not been answered. On compensation claims, the three steps conducted by the Department include: identifying the former mine workers eligible for compensation, their applications must be adjudicated and approved, and lastly there is payment of compensation. With regards to the first step, the Committee undertook an oversight visit to the Mthatha One Stop Shop but they found that there was no one there. This raises a question about identifying those who are eligible for compensation. On the second step, pointing to page 54, he said 2000 applicants were targeted in the second quarter and only 965 were reached and in the third quarter the number dropped by 41% in terms of processing and certifying the applications, so there is a huge backlog. Therefore, the urgency is pivotal. He asked if it is possible to have delegation of the director’s duties to a number of different committees to speed up the process of these applications so that the backlog can be eliminated given the sensitivity of this matter. He asked if it is possible to have a single Act that will bring together the entire compensation system in the country. Is it that something we could see happen any time soon? Lastly, on page 29, on child malnutrition, he expressed gratitude on the work that the Department has carried out to reduce the number of fatalities due to child malnutrition.
The Chairperson said that compensation is a complex matter. She asked if public institutions are empowered enough to pick up when an ex mine worker is being examined and that the result of their health condition is due to working in the mines without him or her expressing that. Secondly, she asked if it is possible to have one piece of legislation that will be able to administer compensation.
Ms Matsoso replied to the question on conditional grants and whether provinces can have moratoriums on spending these. She said that the Department has met with the Select Committee and Standing Committee on Appropriations. The money is transferred by the Department and it sits in provincial treasuries and is not being transferred to health departments in the provinces. The treasuries withhold the money, so the Department is confronted by this dilemma - the failure of treasuries to transfer monies to health departments in provinces. The provinces that are always affected are Free State, Gauteng and Mpumalanga. Eastern Cape in the past was also affected but they have improved. Those provincial treasuries also hold back the money for the grant. Then the provinces use available money for other things and when the grant money is finally transferred, it is also used for other reasons so it is a matter that provincial and national treasuries need to deal with.
On audits, the AG conducts interim audits during the course of the financial year and the Department must pay for those interim audits, so those interim audits are then finalised by AG in the next financial year when conducting the final audit. After the interim audits, the department engages with AG on their findings as a prerequisite for the final audit.
On the procurement of IT, when the Department approached Treasury, Treasury suggested that the procurement of IT equipment must be included as part of the adjusted budget and the only time the adjusted budget is finalised is in December, and by then factories are closed so the Department cannot order the equipment. So the Department essentially only has the last quarter to order, purchase and have the equipment delivered. When the Department suggested to Treasury that it has planned for the IT equipment, Treasury said that IT equipment cannot be viewed in the same light as medical equipment, therefore, must only be included in the adjusted budget.
On the compensation claims, in terms of the Public Finance Management Act, Ms Matsoso said the power she has as an accounting officer is to provide administrative support to the Commissioner who is governed by the ODIMWA and all these questions should actually be directed at him. The Commissioner sits with the compensation money, and so the relationship between the Director-General and Commissioner is purely administrative, whatever the Commissioner needs the DG’s office must provide. For instance, the 19 new medical doctors appointed to assist in examining ex mine workers, the need for security to ensure that fraudulent files and applications are detected. So in the process of setting up security systems there was labour action, the staff of the Commissioner requested that they want internal not outsourced security. The security systems are the ones that reflect how much money is available to compensate, as the Department cannot go and find ex miners and the system reflects unavailability of funds. The Commissioner must then get the inspector of mines to inspect the mines to determine which mines that should be paying compensation, so all the money received will then be used for compensation. However, there is an evaluation that needs to be conducted as well to determine if the mine is sufficiently liquid to pay for the compensation. The system is one of the reasons the Auditor-General has given the Department a disclaimer because the data is not sensible. On the other hand, the mines claim that they do not know if the data that the Department has is sufficient for them to pay compensation; this debate has been ongoing. So the Department agreed to do the evaluations, and provide the support to the Commissioner to do the valuation and to ensure that all the files are in order. The Department employed previously unemployed graduates to go through over 500 compensation claim files which were otherwise not processed at all. The Department has set aside R55 million in order to provide administrative support to the Commissioner so he can process R1.5 billion of funds. The solution DOH has provided is that the Rand Mutual has capacity and has been providing administrative support to the Department of Labour. The Department is in discussion with the Department of Labour to achieve a solid way forward.
On the question of delegations in the central and tertiary hospitals, Ms Matsoso said the Minister has stated there are four things which if not addressed the NHI will not be a success. These include: Human Resources, Finance, Supply Chain, and infrastructure. The Department is trying to address all of these areas. The Minister has set up teams of former HoDs that ran hospitals in the past, and they will be working with the Department starting with the central hospitals. Additionally, guidelines need to be compiled and provided to CEOs so they can use these, including the development of the hub. On page 34 on idle clinics, the detailed lists will be furnished to the Committee in due time, along with the break-down of each province.
On MDR TB, Ms Matsoso said the Department has reported on hospitals that have a hefty burden and more cases. The Department has just put people on MDR TB treatment and its being rolled out to the rest of the country, and therefore, it needs to know if there are success rates in the provinces as a result of the treatment. The data that is missing is if these hospitals do not report as the Department solely wants to know if the patients are getting treatment.
On medical male circumcision, the Department’s target is a much longer-term target and so it would have been more workable if the Department was reporting on an annual basis. The Department requests data from their private sector and NGO (Non-Profit Organisation) partners on an annual basis, so quarterly reports are not requested but a correlation as requested will be done and provided to the Committee.
The process of the Annual Performance Plans (APPs) is a regulated process in terms of Treasury regulations. The process commences early in the year and by the end of February the Department is ready to submit. What is reflected in the report is to show the Committee that the Department has actually gone through all those processes. The Department has a team headed by Dr Andreus which is tasked to visit all provinces to work on the development of the plans, but the Department insists on that there must an agreement on indicators on provincial and national level. DOH also insists on having the district plans, because having provincial plans alone is not adequate and these plans must be submitted to the Presidency. The National Health Act prescribes this, and imposes that the planning be conducted in the manner reflected in the report.
With regards to the dental assistants, there have been problems perhaps stemming from the interpretation of the law because SADC (South African Dental Council) has taken DOH to court twice as the Department prescribes the scope of practice for oral hygiene and dental assistance. DOH has won both cases in court. The reasons for being taken to court perhaps includes expansion of the scope of dental assistants by the Department and so SADC feels the Department is encroaching on their role as dentists. The view of the Department is that the regulations promulgated by the Health Profession Council is that the scope of practice that has been determined was to expand access to dental practice, because there are not enough dentists in the country, so all oral workers and dental skilled workers are needed to be able to respond to all the oral health problems existing in the country. The legal team will prepare a summary of the cases for the Committee in due time.
On the capacity of public institutions to detect former mine workers, the DOH has prepared a document to see if this service can be rendered at primary health care level in order to integrate and broaden the access.
Mr van der Merwe spoke to security measures, saying there are two grants which the Department transfers to supplement the equitable share and provinces tend to take a view on total compensation and make a call on that when they employ austerity measures. On late payments, many provinces cite the cash flow of that province, referencing page 74 of the report which shows the amounts that were not transferred by provincial treasuries to the provincial departments. Some of the issues they raised included that they are delaying payments because of cash flow. Some provinces do not differentiate between the conditional grant cash flow and the equitable grant cash flow - they treat it as one amount which they can use for payments. Gauteng just recently started splitting the grants and it proves to be effective.
Mr van der Merwe said the accruals are worrisome to the Department as well, and provinces still deal with legacy issues when it comes to accruals. Unfortunately, these are just some of the reasons the Department receives from the provinces. He added that audit is a year round cost; hence it is reflected in the report. Improvement can be made on invoices, particularly with infrastructure. Some of those invoices are outstanding because the infrastructure projects take time to complete and invoices are issued at later stages.
He said the laboratory and IT equipment hopefully will be delivered this year based on the adjusted budget that DOH will receive. When it comes to rollover funding, Treasury will only consider rollover funding if it is a capital commitment or a capital expenditure and the funds have been committed. On the communicable diseases cluster payments, he will review the amount, and he agreed with Mr Mahlalela that it is indeed correct the amount reflected on the financials exceeds the amount in the explanatory notes. A review will be conducted and the variance will be amended. It could be that some of the funds were received in December and have not yet been reconciled to the financials.
With regards to the non-negotiables, he said the Department has established a culture of reporting, but some of the provinces ring-fence aspects of the non-negotiables within the total budget and so the expenditure on a monthly basis shows that that is some of the reasons for overspending. The Eastern Cape for example will show big potential for overspending in a total basket, and Free State for example will show a total of under-spending. So they try to continue to reconcile that with the conditional grant and with cash flow expenditure. The Department continually tries to encourage provinces that if certain items of non-negotiables reach overspending, the funds can be moved within the Goods and Services items as the non-negotiables essentially fall within the Goods and Services items. For instance, if there is prevalence for overspending in medical supplies and there is an under-spending in equipment, the adjustment can be made in the accounting books to balance them out.
The Chairperson said that when the Committee conducts its oversight visits, a much clearer view of what is really going on will be prevalent because the real work occurs mainly at a provincial level.
The meeting was adjourned.
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