The National Department of Health (NDOH) presented its 2016 Annual Performance Plan and budget to the Committee. The Committee was a little concerned at the timing as it was essentially considering the new targets without having been able to see the performance on the old ones. The Department set out the main points in each of its six programmes. It assured the Committee that despite the vacancy rate, the Department would not lower the bar on standards. There were certain areas of continuing concern in relation to the achievement of Universal Health Coverage through implementing the NHI, but the NDOH was now starting to hold meetings. One of the major challenges in Programme 2 was to reduce the maternal mortality to under 100 for 100 000 births, and to reduce neonatal mortality to under 7 per 1 000 live births. This was already being well monitored in Western Cape and Mpumalanga. The Department was encouraging breast feeding and discouraging traditional male-circumcision, was doing well with the HPV vaccines for girl learners, would like to improve on the lost-client follow up rate for TB and was starting TB programmes in correctional service centres. The various challenges and targets for strategies and areas of focus were set out for Primary Healthcare and the work done on provision of healthy meals and foodstuffs was outlined. In the Tertiary Health Services programme, a Chief Nursing Officer was appointed to give special attention to nursing services in the country., and a new curriculum was being drafted, to be phased in. All midwifery trainers would need special training. 26 hospitals were targeted to become fully compliant with National Core Standards. Accountability frameworks are sought for in ten other hospitals. Emergency Medical Services regulations had been published and the NDOH was hoping that ambulance services could become a provincial competency. R630 million to retrain all Basic Ambulance Assistants would be allocated in the next financial year. Backlogs in testing had been eliminated and a new laboratory for toxicology had been opened. The South African Health Products Regulatory Authority had been approved, and a board would be appointed. There was good interplay between the statutory health professional council, but the NDOH would like to see all board members perform well and was setting up systems so this could happen. The budget was briefly explained, including a drop in the baseline numbers of R380 million, provincial reductions for HIV, a once-off allocation for the South African Demographic Health Survey, of R30 million, and additional funds to the Medical Research Council. The NDOH was now engaging with National Treasury to have the HPV (Human Papilloma Virus) grant remain in place, until the end of the 2017/18 financial year.
Members appreciated the presentation. They asked for detailed information about performance by province, asked for more effort in indigenous languages in particular on traditional male circumcision campaigns, and were concerned about the Lindela Repatriation Centre clinic, suggesting that it may need more help. Members queried the progress of hospitals in Eastern Cape and Northern Cape mental hospital and suggested that more mental health wards were needed. They applauded the initiative for healthy food in Parliament and suggested it should be extended to the Department of Education. They questioned how nurses could be persuaded to stay in the country, and the progress on doctors trained in Cuba. Some Members were concerned whether the NHI was progressing and said that they would like to see the pilots converted to full projects. They asked for more information on the initiatives with mass gatherings. They questioned the figures for condom distribution and the suggestion that these were being used to ease arthritis. They wanted to know what Bills the NDOH intended to present, why the HIV awareness campaigns were not mentioned in the Plan, why TB budgets were reduced and questioned what informed the targets for HIV testing. Members were concerned about the conditions at the Lebombo Border Post, and encouraged the Department to try to ensure that all provincial departments could attain unqualified audits.
Chairperson's opening remarks
The Chairperson announced the apologies of the Minister of Health, Dr Aaron Motsoaledi, who was attending a Cabinet meeting and the Deputy Minister who had other commitments.
She introduced new Member Ms L Moshodi (ANC, Free State) who would replace the previous Member from the Free State, Ms M Tlake.
She said that the Committee had been put in a rather awkward position because this briefing on the new Annual Performance Plan had been scheduled before the Committee knew how the Department of Health (NDOH or the Department) had performed in the previous 2015/16 financial year, and it was difficult therefore to know how any non-achievements would be dealt with in the current planning.
National Department of Health on its 2016 Annual Performance Plan & Budget Department of Health
Ms Malebona Matsoso, Director General, National Department of Health, noted that the Department operated under six programmes that align with the National Development Plan (NDP) priorities. She outlined the programmes as follows: Administration, National Health Insurance (NHI), Health Panning and Systems Enablement, HIV/AIDS, TB and maternal and child health, Primary Health Care services (PHC); Hospital, Tertiary health services and human resource development, and Health Regulation and Compliance Management.
She then gave the highlights on each programme as follows;
Programme 1: Administration: There is currently a 5% vacancy rate in the NDOH, but Ms Matsoso assured Members that the Department was not lowering the bar on the standards.
Programme 2: National Health Insurance (NHI), Health Planning and Systems enablement: Ms Matsoso said that there were certain areas of continuing concern in relation to the achievement of Universal Health Coverage through implementing the NHI. The performance indicator of publishing the White Paper on the NHI was achieved but the Department will now have to go beyond the next indicator of waiting for public comments, and have meetings. Six workstreams had been identified and established.
Programme 3: HIV/AIDS, TB and Maternal and Child Health: One of the challenges is to reduce the maternal mortality to under 100 for 100 000 births, and to reduce neonatal mortality to under 7 per 1 000 live births. This will be measured over a period. Currently the Western Cape and Mpumalanga were performing well with their maternal mortality figures. The Department would like to see more HIV-babies reaching the HIV-free 24-month survival goal which means they should also not be dying from pneumonia or malnutrition. The Department wants to encourage breast feeding and discourage traditional male-circumcision. It is doing well with the roll-out of the Human Papilloma Virus (HPV) vaccines for girl learners. It would like to do better with its TB lost-client follow-up rate. It has started a TB programme in the Department of Correctional Services, and mine workers will also be screened.
Programme 4: Primary Health Care: The Department was satisfied with the target of 44 000 cataract operations that were done. There were challenges with the quest to have a malaria-free country by 2018, in some areas of Limpopo. The Department is striving for hand washing to become a norm, not only with doctors and nurses but also with mothers and ordinary people. Not only is this a way to prevent infection but also can cut out the use of antibiotics. Hand-hygiene strategy workshops were held in nine provinces. To ensure the provision of Port Health Services compliant with International Health Regulations (IHR), more investment was needed to deal with identifying chemicals and radio-active products. To reduce risk factors and improve management for non-communicable diseases, all government departments in the provinces of Limpopo, North West, Eastern Cape and KwaZulu Natal will be oriented on the national guide for healthy meal provision. On this same strategic objective, the target of taking random samples of each of the 13 food categories and reporting on the content was reached. The Department is waiting for the Minister’s approval for the drafted regulations for organ transplantation, dialysis and the National Policy Framework and Strategy on Eye Health, including provincial eye health centres for cataract surgery.
Programme 5: Hospital, Tertiary Health Services and Human Resource Development
A Chief Nursing Officer was appointed to give special attention to nursing services in the country. 26 hospitals were targeted to become fully compliant with National Core Standards. Accountability frameworks are sought for in ten other hospitals. The Department looked at the basic nursing qualification and a draft curriculum will be developed. The implementation date has been postponed so that nursing colleges have time to meet the set standards. It will also invest in educators for midwives, so that basically all the people who train midwives will need to be trained. That is a target for this financial year. As far Emergency Medical Services goes, a lot needs to be done after new regulations have been published, gazetted and approved by the Minister. The Department wants to see all ambulances in one colour and falling under provincial competences, so that they can go everywhere and not have jurisdictional restrictions. About R630 million is needed to retrain all Basic Ambulance Assistants, and this will have to be allocated in the next financial year. The Department reached its target of eliminating the backlog of blood alcohol tests, and a new toxicology laboratory was opened in KwaZulu Natal. There are now four in the country. The Department is looking into developing regulations for Care Centres at mass gatherings such as Moria. There, they will make sure of adequate water and sanitation.
Programme 6: Health Regulation and Compliance Management
Ms Matsoso thanked this Committee for the fact that the South African Health Products Regulatory Authority (SAHPRA) has been approved, and said that this body was now in the process of developing a board.
Dr Yogan Pillay, Deputy Director General, Department of Health, explained why statutory health professional councils were established. The six councils represented engaged with each other on cross-cutting issues. As an example he shared a problem between nurses and pharmacists regarding prescriptions, that were resolved at this forum.
Ms Matsoso said one of the challenges is that some people who are appointed to these boards do not engage during meetings. The NDOH was therefore looking into ways to develop a system to make sure these board members perform. These board members should be appointed by the Members of the Executive Council (MEC) and ideally there should be an existing template for them to feed their progress back to the MEC.
Mr Ian van der Merwe, Chief Financial Officer, NDOH, said that the Department had had some baseline increases in its budget, but that these increases were taken back again. For the next financial year there has been a drop of R380 million in the baseline numbers. The provinces were seeing a reduction on the HIV-programme. The Health Facility Revitalisation Grant was also cut, which forced the emphasis over to maintenance instead of to establishing new facilities. There was a once-off allocation for the South African Demographic Health Survey, of R30 million, and additional funds were also allocated to the Medical Research Council. The NDOH was now engaging with National Treasury to have the HPV (Human Papilloma Virus) grant remain in place, until the end of the 2017/18 financial year.
Ms Matsoso said that the Department’s performance plan is based on the National Development Plan (NDP) She expressed the hope that the National Health Insurance (NHI) will be a “game changer” in the country.
The Chairperson thanked the Department of Health and said that the Committee would be looking back to this document when considering how the Department had performed at the end of the financial year.
Ms T Mpambo-Sibhukwana (DA, Western Cape) asked for detailed information about the Department's achievement per province. In relation to traditional circumcision, she expressed her opinion that more effort should be made, with more campaigns, especially in all indigenous languages. She asked for detailed information on how cervical health workers will be selected and their training. She expressed great concern over the Lindela Repatriation Centre in Rustenburg. There were huge needs at the clinic there, where a lot of HIV patients are being treated, and she wanted to know what the progress was in responding to the needs of that clinic. She noted further that during a visit to the Eastern Cape, the Committee Members had seen a great need for the building of a missionary hospital, but nothing had been said about that yet and she wanted therefore to know whether the budget would accommodate the building of that hospital, for which there are already plans in place. She liked the initiative on healthy food in Parliament and wanted to know if that initiative could also be extended to the Department of Basic Education. She said she was sure that positive results would be seen, in the lowering of the risks of diabetes and high blood pressure. She said she knew that unhealthy snacks were being sold at Model C schools in the Western Cape. She asked how nurses could be persuaded to stay in the country instead of being lured to go and work in countries such as Saudi Arabia. She wanted to know what happened to the doctors who were training in Cuba.
Mr M Khawula (IFP, KwaZulu Natal) said he had a problem with all the pilot programmes in the country that are not going beyond being pilots only. He also asked if the NDOH was getting where it wanted to get with the model clinics. He said he would like to see these model clinics also in his area. He asked what the definition of a “mass gathering” was and whether the services at those gatherings were going to be offered for free.
Mr D Stock (ANC, Northern Cape) wondered if the “baseline targets” were departmental targets. He noticed a significant reduction in all the programmes’ targets and wanted to know why, and whether these had been adjusted by reason of actions by National Treasury. He was very concerned over the state of a project of a mental hospital in his province and asked if there had been progress on that.
Ms P Mququ-Samka, (ANC, Eastern Cape) asked her questions in an indigenous language, and no translation was provided.
The Chairperson asked if the Department of Health indeed have a unit dealing with communication and, if so, why the country did not know more about the NDOH achievements. She felt that the NHI is taking too long; she understood that that it wanted to be cautious, but said that because ordinary people were going to benefit, the pace must be fast tracked. She was upset that the Committee had had no word on the project of the mental hospital in the Northern Cape even though money was continuously being pumped into this project. She was also worried about the Lindela Repatriation Centre, especially the congestion there, and noted that this topic had been raised previously with the Department. She was concerned over the figure on condom distribution. The Committee had heard that these were also used to ease the pain in elderly people’s arthritic knees, and asked how significant that problem was. She was concerned at the number of hospitals with no mental health wards, particularly in view of the increasing problem of drug abuse in the country, which cannot be ignored. She also asked for “mass gatherings” to be defined.
The Chairperson asked how many Bills the Department intended to present in this year. She wanted to know why she does not see the HIV awareness campaign mentioned anywhere in the Annual Performance Plan (APP), although it was mentioned by the President in his State of the Nation address. She was also concerned that the budget for TB has been reduced, but in view of the close relationship between TB and HIV she wondered how a better balance could be achieved on that. She would like to see all provinces receiving unqualified audits and asked the Department not to fail in this. She noted the comment that for three years, 10 million service users had been tested for HIV, and asked what informed that figure. She was very concerned about the conditions at the Lebombo border post between South Africa and Mozambique, which was visited by the Committee, who found that there were only two workers there, who were not wearing uniforms and who were trying to work with malfunctioning computers.
Ms Matsoso answered Mr Khawula that it was possible for DHA to make all of the reviews on the pilot programmes available. The NDOH was able to assess exactly what is happening on each NHI Pilot programme. She assured the Members that the NDOH did conduct reviews every year and that the reports can be sent on
The Chairperson asked if the Committee and NDOH could agree now that all reports would be sent through and that would be set as a standardised procedure.
Ms Matsoso agreed, and said NDOH would send the previous reports immediately and the current one as soon as it has been finalised.
Ms Matsoso also said that the NDOH would make the information available as to where the NHI budget, has been spent so far. Mostly, the funding had been used to buy equipment and prepare for the creation of the Fund. The Department would now prefer if that budget just went into creating a universal health fund.
The NDOH aimed to have about 1 000 clinics that could be considered “Ideal Clinics” and she said that the NDOH had now come up with a tool to classify clinics in terms of Gold, Platinum, Diamond. Those are “Ideal Clinics”. Those that are classified Bronze or Silver are still aspiring. So far the NDOH had 500 “Ideal Clinics” that will now be branded as such and she would be able to point the Committee Members to some of them.
She commented that the NDOH would ideally like to see the shake up of EMS and happening immediately but that the NDOH had resource constraints. This must also happen in the private sector and should be coupled with a communication campaign. She confessed that the Department had not reached that target, and importance was now placed on getting municipalities to relinquish their control of ambulances over to the province. She hoped it would become easier to do this after elections.
Ms Matsoso explained that Mass Gatherings are internationally described, and the NDOH would be following the general understanding. The NDOH would like to ensure that there was no spread of disease at such gatherings and that that would be done by NDOH looking carefully at sanitation and access to water. It would also be looking into preventing heat stroke.
Ms Matsoso explained the problems with malaria and said that the mosquitoes from South Africa did not transmit the Zika virus, and the main transmission risk thus came from sexual transmission. A gentleman from the Caribbean who has the Zika virus was monitored when he came to watch a cricket game in the Eastern Cape. Another virus that was of concern was now Yellow Fever and everyone entering the country who came from a high-risk area must present a Yellow Fever certificate.
She agreed that communication, in local languages, about the dangers of traditional male circumcision is important.
Ms Matsoso reported that the Lindela Clinic is currently under the Department of Home Affairs in West Rand District. The NDOH would investigate how it was doing and if it needed support.
She answered that she would follow up with the infrastructure provider on the progress of the hospital in the Eastern Cape, and then submit a written report to the Committee.
Ms Matsoso agreed fully that the NDOH would have to .reintroduce the guidelines on nutritious food to the Department of Basic Education.
In relation to the shortage of nurses she said that the UN’s General Secretary has identified two heads of State, President Zuma and Francois Hollande, President of France, under whom a commission will be formed to investigate the issue of Human Resource for Health. This is basically looking into how Health Workers can shift from being viewed as expenditure (for their training) to being viewed as an investment. In Africa alone there is a shortage of 80 million health workers, but that number is much smaller in South Africa. Nursing has been identified as a key game changer by the established commission that includes parliamentarians, including from Japan. One of the identified issues is that it is a profession that is traditionally viewed as female driven. The question was raised whether, for instance, a country such as Saudi Arabia should pay a levy to a country whose health workers were going to work there. The flip side of that, however, was that South Africa was also a recipient of health workers from other countries and would have to pay levies for that also
There is s a programme for doctors who return for Cuba. Currently there is a process to also identify doctors from the Western Cape, because historically they did not send students to Cuba.
Ms Matsoso spoke to the baseline targets and said the NDOH had lots of influence and suggestions from stake holders about their targets, and had followed their advice to make the indicators more in line with SMART targets.
Ms Gail Andrews, Chief Operations Officer, NDOH, noted that the targets have not been reduced other than in those specific cases where budgets had been reduced. The NDOH did want to make its objectives achievable.
Ms Andrews answered questions about the Northern Cape mental Hospital and said that an investigation was commissioned by the Office of the Accountant General, and a report had been produced. During that week, the Minister would be going to the province to discuss that report. There is indeed a concern.
She added that over 100 000 mine workers who should have been compensated for sickness due to mining could not manage the burden of travelling to Johannesburg to check their lungs. Therefore there are now four “One Stop Shops” established around mining towns such as Carletonville.
The NDOH had been around the provinces to investigate whether the Premier is housing a Provincial Aids Council. The KwaZulu Natal Council was found to be the best, but the Free State is active and Mpumalanga has improved.
Ms Valerie Rennie, Head: Corporate Services, NDOH, responded to the question about communication and said that the NDOH did run communication, especially with newspapers, and it would monitor social media daily. She said the NDOH had noted the concern that it was not visible enough. She noted that the communications portfolio for y HIV/Aids awareness had been awarded to a communications provider.
Ms Matsoso agreed that the NDOH would be sharing the report on the mental hospitals. The NDOH would be working with the Medical Research Council (MRC) whether there was any basis to the claim that condoms could be used to relieve arthritis
Ms Matsoso noted that the NDOH would like Parliament to become involved in the development of a strategy to address drug abuse, saying that the country would be “doomed” if it did not develop a strategy for this problem. It was a crisis that would require both attention and investment.
She noted that NDOH was expecting to table two Bills in the financial year: one on the National Public Health Institute of South Africa, and one on the NHI.
She said that the budget for TB is not reduced as such, because the NDOH was getting international funding, especially for TB in schools, mining and Correctional Services centres.
She agreed that provincial audits were needed and said that she agreed that no province should be allowed to lag behind the others.
A figure of 10 million was the target for HIV-testing, because the NDOH had realised that it could not simply maintain the previous target.
She noted that there was a procurement process in place for the Lebombo Border Post and very soon she hoped that this would make a substantial difference.
The Chairperson thanked the Department of Health, and was particularly appreciative of the “hands on” approach that Ms Matsoso was taking. The Committee would be monitoring what had been presented here, during its oversight. She urged the NDOH to push itself to achieve, instead of lowering their targets, such as had been done on the HIV testing.
The morning session was adjourned,
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