Department of Health 2016 plans and budget: Financial & Fiscal Commission analysis; Medical Research Council on 2016 Annual Performance Plan and budget

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06 April 2016
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

The Financial and Fiscal Commission (FFC) provided an analysis of the budget and strategic plan of the Department of Health and its entities, providing some statistics on the spending and grants. It was noted that South Africa spent 8% of its Gross Domestic Product on health, on par with spending in Australia. However, this was divided into 50% for the private sector and 50% for the public sector, but because the former served only 17% of the population, this caused a skewed distribution of services. Although South Africa had consistently improved against all the key health indicators, the speed of improvement was not fast enough to meet Millennium Development Goals for life expectancy, child mortality and infant mortality, which was acknowledged in the National Development Plan. The main focus of the Department of Health over the medium term was to sustainably expand HIV/AIDS and TB treatment and prevention, revitalise public health care facilities, ensure specialised tertiary hospital facilities and facilitate the implementation of the National Health Insurance (NHI). The budget increase was at real annual average growth of 3.1% per annum, because of expansion of amounts for HIV and AIDS and TB treatment ad prevention, scaling up NHI activities and revitalising facilities. The Department had spent 97.7% and 97.8% of the budget respectively over the last two years, with the underspending linked to delays in appointment of GPs for pilot NHI sites, with a further 300 needed. DOH had 142 performance indicators, 40% more than the previous year, although its budget had increased by only 1%. The provincial health outcomes were poor and the Department should be asked what it was to do to support the provinces, where uneven spending was seen. The weak exchange rate was likely to mean that medicines were inflated. The NHI grant was to be phased out and its objectives transferred to the indirect National Health Grant. Poor spending of the Health Care Facilities Grant was of concern. FFC was recommending that provincial government must increase their allocations to Primary Health Care, and that inefficiencies must be minimised.

Members wanted clarity on the disparity between spending at 98% and achievement of targets at only 60%, and when provincial government might move to the recommendations of the FFC. They questioned why it was so difficult to attract GPs. They questioned whether there was any investigation into the apparent monopoly held by a few companies in the private health sector, and were told that a commission had been appointed. They questioned the cost of the NHI, and one Member made suggestions as to a possible phasing out of the tax benefits on medical aid contributions and putting the fiscal gains from that to alternative funding, as well as claiming from other countries when their residents were treated in South Africa. Other comments related to how other departments might assist with funding some aspects of health, whether the number of provinces should be reduced (a question that FFC could not answer), whether the health sector was being over-ambitious, how the Department could get greater buying power from the provinces, how donor funding was handled, the suggestion for a seriously independent body to evaluate the health sector, and said that internal self-evaluation is not effective enough, and question whether there was adequate communication between the National Department and the provinces. Finally, the FFC was asked to speak to its comment that both life expectancy and mortality rates were increasing and whether any research had been done into unequal social circumstances as a cause of ill-health.

The Medical Research Council (MRC) presented its 2016 Annual Performance Plan and budget. General observations were made that South Africans are living longer, with declines in the death rate in the 15-59 year old age group, largely believed to be due to the rollout of Antiretrovirals and the work around TB in the country. There was also a nine-year increase in life expectancy since 2005. There had been decreases in maternal and child mortality. There were concerns about the high rate of fatal prostate and breast cancer. A new South African Demographic Health Survey was to be launched this year which should produce critical knowledge. MRC had four major goals: to administer health research effectively and efficiently, directing money to where it was most needed, to lead the generation of new knowledge, to support innovation and technology development that would improve health and to build capacity for the long term sustainability of health research, including ensuring that graduates remained in the country partially by funding bursaries and scholarships. The new initiatives and collaborations were outlined, including collaboration into projects for HIV/AIDS,TB and malaria. .

On the financial side, there was a significant increase in government and non-government allocations, although the breakdown of government and private income was 40:60 and significant programmes would be funded through increases in government grants. MRC was financially sound and had obtained unqualified audits since 2012. Some of the highlights of current work were outlined. A significant finding, although the causes were not yet known, was that there was a high incident of cancer of the oesophagus in a belt running from Eastern Cape to the Great Rift Valley. MRC had released a Primary Healthcare App, used by health workers to find answers, exatype software was released that would determine a patient’s drug resistance very cost effectively, and Novel TB diagnostic was being developed that would be able to give TB results much faster than at present.

Members asked how the MRC was seeking to prevent brain drain of PhD students and graduates, questioned the mismatch between government and private funding and questioned the implications for the type of research undertaken, and the conditions, and asked whether MRC was working with all universities. Thy asked for further details on the predisposing factors for cancer and gene therapy research, and asked its opinion on a possible sugar tax, and how this might be crafted. They wondered if there was any way to link poverty and ill health statistics, asked if the focus of the MRC was on research or education, asked about research into the drug Wonga, and wondered if the MRC was able to focus more on cures than prevention

Meeting report

National Department of Health and entities 2016/17 Strategic and Annual Plans: Financial and Fiscal Commission (FFC) analysis
Mr Bongani Khumalo, Acting Chairperson, Financial and Fiscal Commission, explained the role of the Financial and Fiscal Commission (FFC) for the benefit of those students from the Cornerstone Institute who were present in the meeting. The FFC is an independent constitutional advisory institution with the mandate to make recommendations to Parliament, provincial legislatures, organised local government and other organs of state on financial and fiscal matters, as envisaged in the Constitution and other national legislation.

Commenting on the 2016 Strategic and Annual Performance Plans of the Department of Heath (DOH) he noted that South Africa had consistently improved against all the key health indicators. However, the speed of improvement was not fast enough to meet Millennium Development Goals (MDG) for life expectancy, child mortality and infant mortality. The National Development Plan (NDP) acknowledged the huge health challenges facing the country and noted that key health indicators would take longer than initially predicted.

The country spends 8% of the Gross Domestic Product (GDP) on health. This is then divided into 50% for the private sector and 50% for the public sector. The private sector only served 17% of the population, which caused a skewed distribution of services. The main focus of the Department of Health over the medium term, in line with the NDP, included sustainably expanding HIV/AIDS and TB treatment and prevention, revitalising public health care facilities, ensuring specialised tertiary hospital facilities and facilitating the implementation of the National Health Insurance (NHI).

Mr Ghalieb Dawood, Programme Manager, FFC, said that the allocated budget increase represented a real annual average growth of 3.1% per annum, compared to 2.6% for the period 2012/13 to 2015/16. The higher growth in the budget allocation was a result of expanding HIV/AIDS and TB treatment and prevention; scaling-up NHI pilot activities and revitalising public health care facilities.

The Department spent 97.7% and 97.8% of its budget in 2013/14 and 2014/15 respectively. Under spending was related to the delay in the appointment of general practitioners (GPs) for NHI pilots. The Department intended to recruit 300 GPs to boost public health services across the country in 2016.

The Department was set to report against 142 performance indicators for 2016/17, an increase of 40% against the number of indicators of the previous year. However, the budget only increased by 1%.

The situation regarding provincial health audit outcomes remained predominately poor and it was not clear what action the Department intended to take to support provinces in this regard. Provinces were exhibiting uneven spending of their budgets. Kwazulu-Natal and North West, on average, had overspent while Gauteng, Northern Cape and Free State only managed to spend 98% of the allocation.

Mr Dawood mentioned the weak exchange rate resulting in higher medicine prices could lead to overspending of budgets.

Mr Khumalo noted that the NHI White Paper had been gazetted. Due to poor performance the NHI grant was being phased out and its objectives were carried over to an indirect grant (the National Health Grant). The FFC was concerned about the poor spending of the Health Care Facilities Grant because this grant could potentially address infrastructure related challenges in the sector.

Two recommendations were made by the FFC. Firstly, provincial governments should increase their allocation levels to Primary Health Care (PHC) to be in line with the minimum norms and standards for the PHC package set by the National Department of Health, and secondly, inefficiencies should be minimised to be in line with international best practices, particularly clinical, operational and behavioural waste.

Mr A Mahlalela (ANC) asked for clarity why expenditure of the budget came to 98%, but performance against targets was only at 60%. He asked if this discrepancy was due to lack of planning or wasteful expenditure. He asked when it was expected that the provincial governments would adopt and move towards the recommendations of the FFC, specifically bringing them in line with minimum norms and standards. He pointed out that government had already agreed that new norms and standards should be developed to replace those published in 2000.

Mr A Shaik Emam (NFP) said it had been repeatedly said that the GPs were causing delays in the rollout of the NHI. He wanted to know why it was so difficult to attract GPs. At a recent conference in Mauritius there was apparently much interest from GPs to come and work here. He urged those present at the meeting not to forget the circumstances that aggravated ill health, such as poverty and violence. Other role players like the Departments of Education and the Department of Sport and Recreation should also assist, as he felt that a major part of the problem was the silo approach where work was being done in different spheres and with different budgets instead of trying to combine and work smarter. He also raised a query whether there might not be a case to be made out for a reduction in the number of provinces. He said that the government was not judged by what it did do, but what is did not do. He wondered if the health sector was not trying to take on too much.

Mr Shaik Emam said he was recently shocked at the food tins being sold on the streets in and around Cape Town, which was expired but had simply had the labels removed. The idea behind the NHI -that a person should not have any lesser chance of health merely for being poor – brilliant, but it would be unachievable unless all the challenges were first identified. He raised concern over attracting people into jobs in the health care system, not because they had a passion for the work but simply because they needed any job. He called for suggestions of how the Department of Health could get greater buying power from the different provinces so that people would appreciate it for what it did.

Dr H Chewane (EFF) asked where donor funding was placed. The Western Cape used the same model that government had used to attract doctors to primary health care facilities, and he wanted to know why the same model was not used all round. He also asked what the budget for the NHI was.

Dr W James (DA) asked about the statistic that the private health care sector was using half of the GDP spend on health, but only serving 17% of the population. This simply could not continue, and he asked how that could be changed before the NHI was introduced. Dr James suggested the establishment of a Risk Equalisation Fund for the NHI, into which money could be channelled from Medical Aid Schemes. Another suggestion was to loosen the boundaries of which facilities could be used, between the private sector and the public sector. As an example he used Groote Schuur Public Hospital, which was renowned for its work on liver transplants, but currently was not being used by those with medical aid. That would require upgrades in the Public Health sector. Another suggestion would be to withhold tax credit from medical aid users. In his calculation, R2 500 per medical aid user would then be made available to the fiscus. That would double the amount of money distributed to the provinces and lead to universal care coverage. These were steps that could be taken now. He asked for comment on these from the FFC.

Dr James further asked if the Southern African Customs Union could not be used to reimburse the country when foreigners came to South Africa for medical treatment. There was also no reimbursement for cross-province utilisation of health care. He suggested that there was a need for a seriously independent body to evaluate the health sector, and said that internal self-evaluation is not effective enough.

Ms D Senokoanyane (ANC) asked why there was such a drastic increase in performance indicators, if the provinces found their budgets to be a challenge. She also asked if there was adequate communication between the National Department and the provinces. She was also concerned over the small national budget for Primary Health Care (PHC), especially by comparison to the Australian figures.

Mr H Volmink (DA) fully supported that comment, and said that the explanation given was that PHC did not form part of the national budget but the provincial budget. Taking their huge mandate into regard, he asked if PHC indeed suffered from under allocations in the budget. He also asked if having 142 performance indicators was not perhaps “obsessive compulsive” or could be seen as a normal increase. He also asked if the expenditure reviews had already been done to affect baseline reductions to grants not performing. In regard to the NHI, he asked the FCC’s opinion on possible constitutional challenges.

Dr P Maesela (ANC) asked the FFC to unpack the comment that both life expectancy and mortality rates were increasing. He asked since when his increase had been noticed and how it looked on both sides. He raised concern over the decrease, instead of increase, in health professional numbers. He asked the FFC to research unequal social circumstances as a cause of ill health, as poverty caused ill health and ill health causes poverty.

Mr Khumalo responded that the discrepancy between the expenditure and performance outcomes was a critical question. He served on the Presidential Remuneration Commission, which looked at these matters. Certain norms and standards had to be developed so that these could be met, and value for money could be measured. In theory, increases in allocation should lead to increases in outcomes. Therefore the increase in performance indicators did not necessarily mean that these were geared towards having more objectives, but it should be that the objectives were broken down to make them more measurable.

Mr Khumalo said that PHC was primarily a provincial function. In the design of the provincial equitable share formula, there was an allocation that must go to health, currently around 27%. The priorities identified should be reflected in the way allocations were made, and this was the type of information could be obtained from National Treasury.

He noted the comment on possible reimbursements through SA Customs Union (SACU) from countries whose residents used our medical services, but pointed out that not all countries were members of SACU and outside of the formal agreements quite a number of these users had either legal or illegal South African identification. He agreed with Dr James that more needed to be done about the nature of the challenges involved.

He noted the comments on the grant but said that between the provinces, movement and health demands were less of a problem, because there was a National Tertiary Services Grant built into the system. If people were moving around from province to province for medical treatment, on the basis of referrals, it should be by and large only an administrative challenge for reimbursements to take place. Inter-provincial emergency health care would be another matter. The grant was conflated and was traditionally used when medical students from one province might damage equipment in another province.

Mr Khumalo said that work had been done in meeting with the Minister to discuss intergovernmental and fiscal relationship models, but as of yet no specific thought had been given to the constitutional and legal questions involved in the NHI.

Over the years there had been an expansion in the country to the access of services, as would be expected from a growing economy. Among the factors were more clinics built in rural areas. There were still other challenges, such as the upkeep of roads leading to the clinics, and the maintenance of the clinics' equipment.

Mr Khumalo said it was not for him to answer the question whether there were too many provinces. A commission was to be established to look into the matter, but as yet there was no certainty on when this would be done.

Mr Khumalo noted the question about what the budget would be at the roll out of the NHI. At one stage a “back-of-the-envelope calculation” figure had been mentioned, but the conversation was now around whether the tax system would be used to fund the NHI (an idea that was not very popular) or whether an alternative vehicle would be found. The FFC was aware that money would have to be injected into the fiscus. Whenever the country had to make a choice on the tax handle to use, it would have to look very carefully at the impact it would have.

Mr Dawood said there was a problem maintaining the new assets continuously being created. More conditions should be set when funds were allocated, because the life span of assets was also being reduced.
He added that in line with the Estimates of National Expenditure, each department was expected to report on all donor funding received, but on the receipts side of the table of the Department of Health, there was no specific line that spoke to donor funding. He suggested that Members should raise this with the Department of Health and ask how and where donor funding was recorded.

He said that South Africa’s spending on health was at the same level as other developed economies and for this reason the comparison to Australia had been chosen. No research had been done by the FFC over increased life expectancy but it was possible that the effective targeting of HIV/AIDS and TB could shift life expectancy.

The Chairperson thanked the FFC and suggested that the Committee should go through the situation province by province. She asked Members not to be hark back to the past, but to draw lessons from it and move on.

Dr James had a follow-up question about the possibility of removing medical aid tax deductions, asking if it might work if that was put on the budget and distributed to provinces, to spend as a conditional grant for health funding.

Mr Khumalo answered that in principle, this made sense. Many people had very basic medical aid coverage,, and there was very little tax clearance on that. Another problem was that taking that money for that purpose was very obvious ear-marking of certain types of funding.

Mr Shaik Emam asked what was being done over the monopoly held by a few companies in the private health sector.

Mr Khumalo responded that a commission chaired by retired Chief Justice Sandile Ngcobo was currently looking into that.

Medical Research Council (MRC) 2016/2017 Annual Performance Plan and budget briefing
Professor Mike Sathekge, Board Chair, Medical Research Council, outlined the importance of the work of the Medical Research Council (MRC or the Council), saying that its research and innovations led to prevention strategies and treatments to address South Africa’s major health challenges, thus reducing the burden of disease.

The MRC was making strides in the transformation of Human Resource management. Some top posts were still held by white people, but would be filled by people with colour when they retired.

Ms Glenda Gray, President, MRC, shared the MRC’s four strategic goals in line with the National Service Delivery Agreement (NSDA), as follows:
- To administer health research effectively and efficiently. She explained this meant the MRC did not want to keep the money from those who needed it
- To lead the generation of new knowledge
- A new goal developed in recent years was to support innovation and technology development, to improve health. For every year of life saved, a region’s GDP was increased by 4%
- Another new goal was to build capacity for the long-term sustainability of the country’s health research and to make sure the diversity of the sciences was increased. Part of this would be trying to ensure that graduates stayed in the country, to help with clinical research and development. A number of bursaries, scholarships and learnership programmes were funded to achieve this.

These strategic goals were being further developed into objectives and indicators to measure the MRC’s performance.

Statistics South Africa (StatsSA) and others would be launching a new 18-month programme – the South African Demographic Health Survey – in this year. With this launch, more critical knowledge would be gained. For the first time a TB prevalence survey would also be launched.

She noted that some quite remarkable health gains, including huge gains with HIV/AIDS, were being made in the country. Gains were also made in decreasing child mortality, maternal mortality and in increase in general life expectancy. This was consistent with the roll out of Antiretroviral treatment (ARVs) and the strengthening of the TB control programme. Prime concerns, however, were the high death rates from prostate and breast cancer.

Some new initiatives included the establishment of the Scientific Advisory Committee for strategic oversight, improved funding of intramural units and the National Health Scholarship Programme that was set to help deliver 1 000 PhDs to the Ministry of Health in the next ten years.

MRC collaborations included TB Implementation Science with the Newton Fund, interventions to impact on neonatal mortality rates and maternal health with the Gates Foundation. and the nanotechnology CSIR project with the World Health Organisation (WHO)

Ms Gray listed several intra- and extra-mural research units currently active. Their respective researchers were all prolific in their work. Other centres included TB and HIV/AIDS and Malaria Collaborating Centres that also helped support the huge amount of work done for the problem of malaria that was also very prevalent outside South Africa.

The MRC received unqualified audits on all the annual strategic objectives targets. The Council took working with public money very seriously and was a “lean and mean” team, not ceremonial and everyone was expected to work very hard. It was thoroughly committed to building the pipeline of new scientists.

Mr Nick Buick, CFO, MRC, briefed the Committee on the financial figures. The Council’s expenditure was broken down into the four key objectives. There was a significant increase in government and non-government allocation (almost double since 2012/13), which was encouraging, although it also seemed to be plateauing. He following key observations were also made:
- A decrease in spending on administration was foreseen
- The breakdown between government and non-government income was 40/60
- Significant programmes would be funded through an increase in government grants
- Even though the revenue would only increase by 0.1%, 59% of that increase would go into research.

He noted that MRC used the funds it already had to leverage more additional international funding. It was financially sound.

Ms Gray shared some of the highlights of what the Council was doing. She tabled demographics about race and gender involved in the different projects regarding the new generation of scientists. The National Health Enhancement Fund, into which private companies contributed partners, and which was a particular vision of the Minister, aimed to develop 100 PhD students per annum.

Through a surveillance system based on numbers of deaths recorded on the National Population Register a Rapid Mortality Surveillance Report was compiled. This had shown a decline in the death rate for the age group 15 – 59, believed to be due to the rollout of ARV’s. There was also a nine-year increase in life expectancy since 2005, for men of 60 years old and for women of 65.8 years old. Since 1997 interpersonal violence as a cause of death had dropped on the ratings, from number 3 to number 7.

The MRC had isolated a “Cancer of the Oesophagus-belt”, starting in the Eastern Cape and going all the way up to the Great Rift Valley. The high incidence of cancer was first noticed amongst the Xhosa-speaking people of the Transkei in the early 1950s. Scientists were struggling to understand the cause of this.

Ms Zoleka Ngcete, Programme Manager, MRC, described three of the current projects for the Committee.

The Primary Health Care (PHC) App, which was funded by the MRC with help from the Department of Health, could be downloaded by anyone with a smart phone, and this was launched in the last quarter of last year. Since then it had been downloaded more than 10  000 times. Through this the Department was being made aware what answers health care workers were looking for, and where. Currently the top ten searches were on hypertension in adults, and vaginal discharge symptoms, which were not expected.

The Exatype™ software was the next project. She noted that it had been noted that of the 3.1 million South Africans currently on ARV treatment, nearly 10% would not respond adequately to the first line of drugs given to them. Thus money was wasted on inappropriate drug usage. There were some other developments that could determine a patient’s drug resistance but these came at a cost of around R2  000 per patient. However, the exatype™ software could be used much more cost effectively, because it processed several patients’ information at once, to give a report showing the clinician which drugs would be most effective. Prof Simon Travers developed the platform together with his team of researchers based at the South African National Bioinformatics Institute (SANBI) at the University of the Western Cape.

The third project was Novel TB Diagnostic, which was being developed at the University of North West as a device able to give a diagnosis in 30 minutes instead of two hours. It could also determine if a patient was taking medication and getting better.

Mr Volmink asked what the MRC was doing to prevent a leaking pipeline of PHD production, which he described as PhD students either dropping out, or pursuing careers elsewhere once they qualified. He said that he was going to ask his “perennial question” - which was what the situation was now with the TB vaccines. He described the MRC's revenue breakdown, and particularly the amount of money that it was relying upon from outside the fiscus as “a scary situation” because this posed a risk to its sustainability. He asked whether the MRC had enough money to fulfil its basic mandate.

Dr Chewane asked if donor funding came with certain pre-conditions on the focus of the research topics. He also asked whether all universities, including historically disadvantaged universities, were involved in research projects. He asked what the constraints would be if MRC was not working with all universities yet and what government could do to help that to happen if this was a problem.

Dr James asked what were the predisposing factors for the oesophagus cancer in the Eastern Cape, and what results the MRC was getting from gene therapy research. He noted the rise in hypertension and asked the MRC for its opinion on the possible imposition of a sugar tax. He explained that possibly it was a tax on the manufacturer and not on the consumer side but that it could provide the incentive to produce new products for the tax free zone. This could be a way to find revenue, an estimate of R8 billion, but research would have to be done to develop the tax model. He asked if the MRC would be interested in doing such research.

Mr Khosa asked for which year the clean audit was awarded. He also asked why the MRC had not mentioned collaboration with African countries.

Dr Maesela asked how rapidly TB screening could be done, and whether the MRC could think of a way to screen sex workers to stop the spreading of HIV/AIDS. He also asked if there was a way to incorporate, into statistics, the ways in which poverty affected ill-health. He asked if the MRC was prioritising research or prioritising education.

Ms Ndaba asked for progress on the TB vaccine. She was concerned over a drug called “Wonga” and asked if the MRC had done any research on that. She was also concerned over what she called managing diseases instead of curing diseases. She urged the MRC to find cures. She also asked why women, especially in Gauteng, were experiencing high rates of breast cancer. She asked what preventative measures could be taken.

The Chairperson also asked what the cause of the rise in oesophageal cancer was. She asked whether the low numbers for people in the Western Cape being treated might be that people tended to attend hospitals in Gauteng for treatment.

The Chairperson also asked whether intensive research into a particular topic such as HIV or AIDS, could in any way create the idea or belief that a situation was worse than it really was – for instance, that South Africa might be perceived as having the highest percentages of those with HIV in the world.

She too was concerned over donor funding and the influence the donors had on the use of the funding. She finally asked the MRC whether it would feel more comfortable in reporting to the Department of Health or the Department of Science and Technology.

Mr Sathekge replied that when the Council received donor funding it was not entirely on the donor’s terms and the Council made sure that the research being funded was relevant to South Africa. A lot was being done to make sure all universities, including the historically disadvantaged universities, were involved in research programmes, and that this figure would improve.

He compared the Department of Health and the Department of Science and Technology to “a mother and father” of the MRC and said MRC would like to keep ties with both, but it would certainly help if the MRC was able to meet with both simultaneously.

Ms Gray said the MRC needed to look at how to manage the burden of disease. The South African Demographic Health Survey was going to help with that. National Health Insurance (NHI) was important and information received from clinics would help to manage the burden of disease.

The MRC had a better outcome with PhD students working for it, than students studying alone at universities. Key elements in that were the time spent with the students, the mentoring and quarterly reports they had to submit to the MRC.

Ms Gray noted that the MRC was in a translational space with TB vaccines. The vaccine on which its researchers were currently working with was not the one it would take to the market, but it helped them to understand more about TB. Even though South Africa had the highest TB incidence figure in the world the MRC was not quite sure what protected or what made one more susceptible to the disease. The Council did not understand the micro bacteria involved yet but foresaw that soon the MRC would leapfrog into understanding more.

Ms Gray agreed that the budget for the MRC, which was the biggest funder of medical research in Africa, was not adequate, particularly given the kind of work that it had to do. The Council spent a lot of time negotiating with donors, but basically was not interested in working with donors who were not prepared to fund in areas where the funding was needed. All the donor fund processes were very visible and there was a lot of good governance in the way the Council worked with donors.

The Council spent two years unlocking potential at previously disadvantaged tertiary institutions and had some excellent work going on at Walter Sisulu University, and opened an HIV/AIDS research site in Umtata. The MRC would be doing a lot more in the Eastern Cape.

The oesophageal cancer rate was a fascinating and interesting story. There were a lot of theories about it, for example the soil, the maize, the way toxins were stored, smoking, and the way sorghum beer was made. The MRC, because it was at the epicentre of the discovery, could well become world experts on this. It had always been thought that there were many socio-economic factors causing breast cancer, but recently there was a gene identified that had a strong influence on whether a person was likely to get breast cancer or not.

Ms Gray thought South Africa needed the sugar tax, and that the income from that should come to research. There were many possible ways to do the research needed on hypertension and so forth, in order to assist in drafting the tax model.

Ms Gray was pleased to note that the MRC's suggestions were being taken very seriously. There were many bilateral agreements with African countries, although these were not specifically mentioned in the presentation. She cited examples of work being done with Sudan, Uganda, and Zimbabwe, and informal arrangements to work in Mozambique, Zimbabwe and the Congo. The Council was committed to developing both formal and informal programmes in Africa. It was also working in Rwanda on intimate partner violence, and in Kenya, and working with the African Institution of Science.

She noted that home testing for TB had been approved in South Africa and there was a new innovation under way where a person could order a test that would be delivered to the door by scooter.

She noted that some doctors were dying through contracting TB at Groote Schuur and that should certainly not be happening. Education and research was a cycle and both had to be prioritised. Both were imperative.
Ms Gray said there was a situation last year where the country ran out of the Bacillus Calmette–Guérin (BCG) vaccine because manufacturers stopped making it, because it was cheap and did not have a high profit margin. This had, however, been a TB vaccine that worked. There was re-activation and re-infection and many things that had not been solved. There was a need to start looking at how the country's population could all be protected against TB, and increase its health generally. This would include interventions such as not smoking and being aware of Diabetes.

Ms Gray said that she personally felt comfortable with the MRC being the research unit for the Department of Health.

She commented that in order to prevent neo-natal deaths, the MRC would have to keep chipping at the block by doing things such as making sure to prevent congenital syphilis and introducing interventions that nurses could do once certain signs had been identified, and managing asphyxia properly.

Mr Nkosinathi Bhuka, Legal Department, MRC, added that the MRC was very happy with the attention received from the Department. He touched on the subject of institutional capture, when a number of institutions had a role to play on the same subjects.

Mr Buick made the point that it was quite correct that the MRC’s external funding was not sustainable and it could do with additional fiscus funding. It was very difficult for MRC to undertake research programmes that took five to eight years, without knowing how predictable the funding was.

He clarified that the MRC had received clean audits since 2012 and would continue to strive for that. He said that actually the correct wording would be “unqualified audits without emphasis of matter”.

Prof Kelebogile Mokwena, Board member, MRC, said that “Wonga” was the same as Nyaope; it was a cocktail drug of psychoactive substances. The ingredients used were common but that there was also variation, especially from region to region. It was a uniquely South African phenomenon and needed South Africans to research it. A programme was going to be launched with the Institute of Health that would be looking at mental health problems including addictions.

Prof Zodwa Dlamini, Vice Chairperson, MRC, said there was a lack of research about genetics and she hoped that next time the MRC would have more information about research in genetics. As an example she mentioned micro toxins in certain kinds of beer that interacted with certain genes and created conditions that led to cancer.

Ms Ngcete said the TB test she had mentioned was an improvement on the current one recommended by the World Health Organisation, and that it would be quicker. There was still a need for improved point-of-care tests. The MRC could not produce a cure for diseases, because this was very complex and difficult. The root causes of diseases could often change when, for example, metabolism, genetics and the environment came into play. It was also not only about genetics, because one person with the same genetic make-up as another could, for example have diabetes while the other did not. A project on prevention of diabetes was under way but it was in its early stages. It would use biomarkers that could predict susceptibility to diabetes, and be incorporated into point-of-care tests, almost like pregnancy tests, which could be purchased privately and used at home.

Ms Ndaba raised the point of Imbaba beers sold in townships, into which battery acid was apparently mixed. She asked if the MRC could research that.

Ms Gray said it was crucial to highlight these issues so that the MRC could try to prevent these kinds of instances. The way beer was made a long time ago caused haemochromatosis (iron overload), and because the research was able to highlight the dangers, that had been changed.

The Chairperson thanked the MRC and emphasised that knowledge about health issues was important. One example might be that it could highlight the dangers of re-using cooking oil, whilst also realising that economic factors such as poverty due to the high unemployment rate would influence matters. However, it was the responsibility of the Department of Health and institutions such as the MRC to empower the people with knowledge. Now was the time to also reach future generations. She urged that myths about science being a difficult subject should be dispelled and all knowledge disseminated at the correct level for full understanding. This would build the ideal of a strong and healthy society.

The meeting was adjourned. 

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