Department of Health on its 4th quarter 2015/16 report, in presence of Minister

Meeting report

2015/16 Quarter 4 report : Department of Health (DoH) briefing
Dr Aaron Motsoaledi, Minister of Health, thanked the Chairperson for the opportunity to present the 4th quarter (Q4) reports of the National Department of Health (NDOH).

Ms Malebona Matsoso, Director General, Department of Health, tendered her apologies as she was ill and not able to speak well.

Dr Gail Andrews, Chief Operations Officer (COO), National Department of Health (NDOH), presented the 2015/16 quarter four report.

Programme 1: Administration aimed to ensure effective financial management and accountability by improving audit outcomes. The targets for this objective were; to achieve an annual unqualified audit opinion from the Auditor-General (AG); three unqualified audit opinions from the provincial departments of Health; and for provinces to submit reports on a non-negotiable monthly basis. All the targets were achieved for this objective. The second strategic objective was to ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive HR support programmes. The targets were; to reduce the recruitment process turnaround period to be less than four months; to drop the vacancy rate down to 5%; for 98% of senior management services (SMS) members to conclude their annual performance reviews in line with the Disabled People South Africa (DPSA) timeline; and the implementation of the employee wellness programme. SMS members fell short by achieving 95%, and the other targets were achieved, with vacancies being filled within four months on average. The employee wellness programme was rolled out in Gauteng, KwaZulu Natal, Free State, Mpumalanga, and North West. The third strategic objective was to fully implement the Departmental Information Technology (ICT) services continuity plan by 31 March 2018. The aim was to establish the ability to access domain services outside of the NDOH premises. Tests were being conducted. The fourth strategic objective was to provide support for effective communication by developing an integrated communication strategy and implementation plan. The target was too have a communication toolkit developed to integrate messages. The Department achieved the development and implementation of 15 toolkits. The fifth objective involved a National Health Litigation strategy to be developed and implemented. The strategy was adopted from the Medico Litigation Summit Declaration.

In the 2016/17 financial year, the Department would be aligning its targets for recruitment turnaround period with the Department of Public Service and Administration target of six months.

Programme 2 dealt with the National Health Insurance, Health Planning and Systems Enablement. The first strategic objective was to achieve universal health coverage through the phased implementation of National Health Insurance (NHI). NDOH achieved the targets and the White Paper on NHI was finalised and published, and legislation for NHI was also finalised. The second strategic objective was to establish a national stock management surveillance centre to improve medicine availability. A review of the dispensing fee needed to be undertaken; an implementation of an electronic system to detect stock availability; and to establish a national surveillance centre to monitor medicine availability. This target was achieved and the system has been rolled in many hospitals nationwide. The third strategic objective involved the improved contracting and supply of medicines. Control towers were established in the Eastern Cape and Free State for the management of direct delivery of medicines; the number of patients receiving medicines through the distribution system 396  567 patients out of the targeted 500 000; and new contracts were drawn for pharmaceutical contractors eight weeks prior to expiry of the outgoing contract. The fourth strategic objective involved implementing a strategy to address antimicrobial resistance (AMR). The AMR strategy was developed. The fifth strategic objective was regulating African traditional practitioners. The target was to have a Council for Traditional Practitioners and registrar appointed. The process was currently under way for the recruitment of a registrar. The sixth strategic objective involved improving the management and control of pharmaceutical services. All the set targets were achieved. The seventh strategic objective involved strengthening the revenue collection by incentivising hospitals to maximise revenue generation. The aims were to develop and implement a Revenue Retention Model (RRM) at central hospitals; develop regulations pertaining to uniform patient fee schedule; and develop a central repository for the funded and unfunded patients. Significant progress had been made.

The eighth strategic objective involved implementing a health strategy of South Africa through the development of the system design of patient information systems and implementation. Continued testing of the basic health information exchange was under way; new IT hardware had been purchased for 1200 primary healthcare clinics (PHC); and 657 PHC facilities were implementing the web based health patient registration system. The ninth strategic objective was developing and implementing a national research strategic plan. The plan was under way and the draft integrated national research strategy was developed. The tenth strategic objective involved the development and implementation of an integrated monitoring and evaluation plan aligned to health outcomes and outputs contained in the health sector strategy. The target was to identify a fully defined comprehensive list of indicators and data elements approved. The list was currently in the process of being drafted. The eleventh strategic objective was the domestication of international treaties and implementation of multilateral cooperation on areas of mutual and measurable benefit. Three international treaties and multilateral frameworks were implemented. The twelfth strategic objective was the implementation of bilateral cooperation on areas of mutual and measurable benefit. The target was five bilateral projects, and this was achieved. The thirteenth strategic objective involved implementing the patient quality care survey tool.  The tool was piloted, and awaiting preparation for roll out into the provinces. The fourteenth strategic objective tool was conducting a national survey to measure patient quality care. There was no target set and the study was being planned and protocols developed.

The performance improvement strategies for Programme 2 were to improve the number of patients receiving medications through the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme. Patients were identified for the programme in eThekwini, Alexandra clinic, RK Khan Hospital, Potchefstroom Hospital and patients who participated in adherence clubs.

The NDOH, together with the Council for Medical Schemes (CMS) was working with the Council for Industrial and Scientific Research (CSIR) to ensure that the repository patients would comply with the National Health Normative Standards for inter-operability. The purchase of IT equipment took place in the last quarter of the 2015/16 financial year and the process would be rolled out during the 2016/17 financial year once the infrastructure and systemic challenges were resolved.

Programme 3 dealt with HIV/AIDS, TB, Maternal, Child and Women’s Health. The Department set 14 strategic objectives under this programme. First, the expansion of the ‘Prevention of Mother To Child Transmission’ (PMTCT) coverage to pregnant women by ensuring all HIV+ antenatal clients were placed on ARVs and reducing the positivity rate to below 1%. The target was 88% of women, and the Department managed to cover 93% of women. Second, to expand the availability of contraceptives by developing a training manual for the implementation of contraception and fertility planning policy; develop pharmacovigilance system for adverse events for contraceptive implants; develop cervical cancer control policy, and develop a breast cancer policy. Most of these targets were achieved and final draft policies were been presented to the tech NHC. Third, to reduce under-5 mortality rate to less than 23 per 1000 live births by promoting early childhood development. All targets were achieved in monitoring diarrhea, pneumonia, acute malnutrition, and measles as causes of death. Fourth, to contribute to health and wellbeing of learners by screening for health barriers to learning. Grade 1 and 8 learners were screened annually and all targets were achieved. Fifth, to protect girl learners against cervical cancer by giving HPV doses, convening with the Minister's Portfolio Committees, and setting guidelines for the common childhood illnesses in district hospitals. All targets were achieved. Sixth objective was undertaking a massive TB screening campaign, and the targets were to reach 50% of TB patients over 5 years old; 75% of inmates screened for TB; 60% of mines to conduct routine TB screening; and at least 462  000 people screened for TB in communities annually. The Department was able to reach 36.1% of TB patients over 5 years of age; achieved their screening of inmates; 97.3% of  mines conducted routine TB screening; but unfortunately only 183  631 people were screened for TB in communities. Seventh, NDOH aimed to improve access to treatment. The Department set a target of 85% and managed to achieve a 92.4% success rate. Eighth, strengthening patient retention in treatment and care. The Department met all its targets for new client success rate, follow up rate, and client death rate. Ninth, TB/HIV Co-infection. The target was to reach 75% of infected clients on ART, and the Department reached 87.5%. Tenth objective was to strengthen patient retention in treatment and care, and all the targets for the TB MDR client loss to follow up rate, TB MDR client death rate, and TB MDR treatment success rate were achieved. The eleventh objective was to scale up combination of prevention interventions to reduce new infections. 464  731 medical male circumcision procedures were conducted; the target of 2.5 million HIV tests was achieved with 11.89 million tests being conducted; 839. 87 million male condoms distributed, and 27.05 million female condoms also distributed. The twelfth objective was to increase the numbers of HIV+ people to receive ARVs. The target of 3.8 million people on ARVs was exceeded by 3.4 million. The thirteenth objective was to reduce the maternal mortality ratio to under 100  000 live births, and targets for antenatal visits, postnatal visits and maternal mortality ratios were achieved. The last objective was to reduce the neonatal mortality ratio to under 6 per 1 000 live births. The target had not been achieved, and the mortality rate currently sat at 10.5 per 1 000 live births.

Performance improvement strategies for this programme included the implementation of the adherence strategy, which aimed to assist in retention of patients on TB treatment. The target for the medical male circumcision had been realistically determined for the 2016/17 financial year, based on the 2015/16 report. The country operational plan and the district level micro-plans included a demand creation strategy that would address social mobilisation at the local level by employing social mobilisation teams.

Dr Motsoaledi intervened to draw attention to page 23 of the report dealing with HIV/TB/Maternal health. He said the numbers and figures referred to a bigger problem facing society and the rest of Sub-Saharan Africa, where babies were being found in dustbins on a regular basis, and HIV/AIDS was on the rise.

Family planning was a societal issue that many people ignored. Abortion was more prevalent, especially among young people. The biggest issue that the Department was fighting related to illegal practices advertising all kinds of medical procedures dealing with abortion, which tended to be unsafe procedures.

Dr Motsoaledi addressed the issue that was currently in the media of an 11 year old girl who was impregnated by a grown man, and society was asking why the man had not being arrested because sex with a minor was illegal. The problem was that if the parents were not reporting the crime to the police then the offender could not be arrested. Another issue was that of ‘blessers’ – a term used to refer to older wealthy men having sex with young women against the promise of money and gifts. The Department had no control over but it was a contributing factor to the high rate of young girls falling pregnant.

The Department was in a process of adopting a policy that aimed to target girls and young women in the age group of 15-24 since this was the group at a higher risk of contracting HIV/AIDS, or falling pregnant. The policy would propose five initiatives;
-Reduce level of HIV/AIDS of girls in the age group
-Reduce pregnancies
-Fight gender violence
-Keeping the girls in school as long as possible
-Linking them to skills and economic opportunities so as to reduce dependence on ‘blessers’.

Dr Andrews continued with Programme 4 which dealt with Primary Health Care Services (PHC). The objectives were to improve district governance and strengthen management and leadership of the district health system; and improving access to community based PHC services. Job profiles for district health management structures were finalised and 2 590 functional Ward Based Primary Health Care Outreach Teams (WBPHCOTs) established.  The Department had set a target of 500 PHC facilities in the 52 districts to qualify as ideal type clinics, but were able to achieve 322 facilities qualifying as ideal types. The objectives to improve environmental health services in the 52 districts and metros, as well as establishing an intersectoral forum that would oversee the implementation of interventions across all sectors, were both achieved. The objective to reduce the risk factors and improve the management for Non-Communicable Diseases (NCDS) by implementing the strategic plan for NCDs 2012-2017 was achieved.

Dr Motsoaledi added that tobacco companies had been complaining since the Tobacco Act was amended, stating that tightening the tobacco laws would negatively impact the economy of the country by reducing job creation. However, he requested the Portfolio Committee on Health to assist the Department in pushing for the Bill to be finalised because the main concern is health, and not the profits gained from sales of tobacco products.

Dr Andrews said another objective was to improve the access and quality of mental health services by increasing the percentage of people screened for mental disorders, increasing the number of people treated for mental disorders, mental health patients attached to designated district and regional hospitals, and mental health teams established in each district. All the targets were achieved and a strategy to establish mental health teams was approved by the Tech NHC. A study was commissioned to determine the readiness of districts to implement a framework and model for rehabilitation and disability services. The Department had an objective of preventing avoidable blindness, and set a target of 1 500 operations per million uninsured population. It had fallen just short of their target and achieved 1 064 operations. Another target the Department was working towards was the elimination of malaria cases in South Africa by 2018.
           
The performance improvement strategies included the provision of support and assistance to provinces, districts, and facilities to improve quality by facilitating assessments and the procurement of essential equipment for individual facilities. The testing of salt content in foods would be done in the 2016/17 financial year.

Programme 5 dealt with hospitals, tertiary services and workforce development. The objective of increasing the capacity of central hospitals to strengthen local decision making and accountability to facilitate semi-autonomy of 10 central hospitals was currently in the process and an assessment on the current capacity was conducted. With regard to the target of improving compliance with national core standards at all central, tertiary, regional, and specialised hospitals, two hospitals had obtained overall scores of 91% and 80% but did not meet 100% compliance on extreme measures and more than 90% compliance on vital measures. Significant progress had been made with regard to developing and implementing health workforce staffing norms and standards. Five regional training centres were established, 1 000 facilities were benchmarked against PHC staffing normative guidelines, and the WISN methodology was used to develop guidelines for HRH norms and standards. Other objectives were to improve management of health facilities at all levels of care through leadership and management academies; to professionalise nursing training and practice implementation of the objectives of the nursing strategy; improve quality of health infrastructure in South Africa; ensure access to and efficient effective delivery of quality Emergency Services (EMS); to eliminate the backlog of blood alcohol and toxicology tests by 2016; and to provide food analysis services. The Department achieved most of these objectives and fell short of some of the targets by small margins.

Performance improvement strategies included increasing the capacity of central hospitals. In relation to toxicology, equipment failures (that had now been fixed) at the Pretoria laboratory contributed to non-achievement of targets. The Pretoria laboratory was scheduled to move to a new facility in the 2016/17 financial year, and capacity at the Joburg laboratory was being expanded in order to address backlogs. The sub-programme of developing staffing norms would be used to mobilise resources from partner organisations to support the work done at both provincial and national levels.

Programme 6 dealt with health regulation and compliance management. The objectives of establishing the South African Health Product Regulatory Authority (SAHPRA), and establishing the Institute of Regulatory Science were both achieved. SAHPRA was opened by the State President on 24 December 2015. Draft amendments were being developed in line with policy on integration of compensation systems. The objective to establish an occupational health cluster was in the policy process of implementation. The objective to establish one stop services centres in provinces was achieved in Kuruman, Northern Cape and Burgersfort, Limpopo. The objective to establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance was approved and legislation for NAPHISA was gazetted. The Department achieved its objective to improve oversight and corporate governance practices by reviewing the governance framework and implementation plan.

Performance improvement strategies included the Institute of Regulatory Science (IRS) being implemented as part of the MM/SAHPRA initiative. The Minister approved 24 additional medical doctors as members of the certification committee and they began working in December 2015. A track-and-trace project was in place at the Compensation Commission for Occupational Diseases (CCOD) to find claimants and update documents, and change management support interventions were introduced at the CCOD.

Conditional Grants Expenditure, 31 March 2016 – Fourth Quarter Expenditure
Mr Ian van der Merwe, Chief Financial Officer, NDOH presented on the Conditional Grants (CG) expenditure.

Mr van der Merwe said the spending performance on all Conditional Grants was shown up until 31 March 2016. Schedule 4 and 5 was related to direct grants and schedule 6 was related to the indirect grants. The total CG spending sat at 99.1%, or R31.9 billion, against a revised budget of R32.2 billion. The indirect grant spending sat at 95.3% for the fourth quarter.

The Health Professions Training Grant (HPTG) had a total budget of R2.374 billion and an expenditure of R2.373. Limpopo used up 98.9% of its allocated budget and was the only province that underspent. Underspending was due to outstanding invoices for medical equipment and rollover had been requested. The Northern Cape overspent due to accruals. Expenditure would be journalised to equitable share to keep it within the norm.

The National Tertiary Services Grant (NTSG) had a budget of R10.41 billion and an expenditure of R10.37 billion. Eastern Cape, Gauteng, Limpopo, Mpumalanga and North West had underspent their budgets, while the Northern Cape was the only province that overspent the budget. The reasons for underspending were lack of contracts for medical equipment, and delays in the delivery of medical equipment. A rollover had been requested by all the provinces underspending for unpaid invoices and awaited delivery.

The Comprehensive HIV/AIDS Grant had a budget of R13.7 billion and an expenditure of R13.6 billion. Limpopo and North West were the only Provinces that underspent their budgets. The reason for underspending was  outstanding invoices for medicines and consumables.

The Health Facility Revitalisation Grant (HFGRG) had a budget of R5.6 billion and an expenditure of R5.4 billion. All the provinces underspent their budget allocations with the exception of Eastern Cape, Gauteng, KwaZulu Natal, and Limpopo. The reasons for underspending were: delays in appointments of staff in Free State under Organisational Development; challenges with implementing agent in the Western Cape; and outstanding invoices, for which rollover had been requested.

The National Health Insurance (NHI) Grant had a budget of R70.4 million and an expenditure of R63.4 million. All provinces had underspent, with the exception of Eastern Cape, Free State, and Mpumalanga. The reasons for underspending were; inefficiencies in supply chain management; delays in the delivery of the Ward Based Occupational Training uniforms (WBOT) and other equipment; and the inability to contract Health Professionals (HP) in Western Cape as indirect funding was converted to direct funding for HP contracting.

Looking at the provincial overview of direct grant spending, the Eastern Cape received R3.22 billion and spent R3.21 billion. All the grants received were used to capacity with the exception of the NTSG and NHI. The reason for underspending of the NTSG was due to challenges with specifications for equipment. NHI overspent due to application of section 22 of the Division of Revenue Act (DoRA). Unspent funds not returned from the previous year were charged against the current budget allocation.

Free State received R2.59 billion and spent R2.56 billion. All the grants spent 100% with the exception of the HFRG. The main reason for underspending here was non-filling of posts under Organisational Development component of the grant. Funds were only made available to the province during the adjustment budget. A rollover had been requested.

Gauteng received R7.6 billion and spent R7.5 billion. All the grants spent 100% of the budget except for NHI because the outstanding invoices for the WBOT uniforms.

KwaZulu Natal received R6.888 billion and spent R6.885 billion. All the grants spent 100% with the exception of NHI due to an IT project that was not completed and would be paid during the first quarter of the 2016/17 financial year.

Limpopo received R1.89 billion and spent R1.86 billion. All the grants underspent with the exception of the HFRG. The main reason for underspending was supply chain inefficiencies; outstanding delivery of medical equipment; outstanding invoices for condoms ordered in the third quarter; and the examination equipment for patients not delivered. A rollover had been requested by all grants underspending.

Mpumalanga received R1.47 billion and spent R1.46 billion. All grants spent 100% with the exception of NTSG and HFRG. The main reasons for underspending related to  equipment not  delivered. NHI overspent due to implementation of section 22 of DoRA.

Northern Cape received R1.39 billion and spent R1.36 billion. The NTSG and HIV/AIDS grant overspent their budgets, while HFRG and NHI underspent. The reasons for underspending were supply chain inefficacies; delays in delivery of WBOT uniforms and other equipment; and outstanding invoices for health technology. Mr van der Merwe said Northern Cape would require assistance in the following financial year because its need was much bigger than its budget allocation.

North West received R2.08 billion and spent R2.04 billion. All the grants underspent their budgets except for HPTDG. The main reason for underspending was due to outstanding invoices for infrastructure projects, NTSG equipment for hospitals and WBOT equipment.  A rollover had been requested.

Western Cape received R5.1 billion and spent R4.9 billion. All grants spent 100% of their budgets with the exception of HFRG and NHI. Reasons for underspending were linked to challenges with implementing agent because the province was only using one implementing agent; delays in implementation of projects; inability to contract HP in the Province as indirect funding was converted to direct funding for HP contracting; funds for conversion were only allocated during adjustment budget. A rollover was requested.

Indirect Grants under Schedule 6 comprised of the NHI component of CCMD and HP contracting; Health Facility Revitalisation component of machinery and equipment, and infrastructure development; and the HPV component. The adjusted budget for indirect grants was R1.1 billion and the expenditure was R1.05 billion. The main reason for underspending was due to HPV in submission of claims by provinces and outstanding invoices of which rollover had been requested; and NHI contracting of HPs including pharmacy assistants.

Mr van der Merwe said the NHI framework had been reviewed to include the ‘ideal clinic’. Most activities relating to ideal clinics would accelerate the expenditure for the 2016/17 financial year. Strengthening of monitoring and evaluation for infrastructure projects would ensure spending efficacy.

Discussion
Dr W James (DA) said that he was in support of the initiative to target the high risk women in efforts to reduce HIV/AIDS and pregnancies

Dr James said control on the sugar tax should be reviewed so that companies are charged.

Dr James asked what the Minister thought on the issue of medical marijuana.

Dr James complimented the Department on the report and the work it was doing

Mr H Volmink (DA) asked how the Department could tighten implementation to make sure its targets on TB could be fully achieved.

Mr Volmink asked what would be the focus on the National Health Commission, and if the Department would involved in any advisory role.

Mr Volmink asked how movements such as #feesmustfall and others would affect medical students' training, and what the Department was doing to prevent ill effects on the training of students.

Mr Volmink asked if independent students studying abroad would have the same opportunities for employment upon returning back to South Africa, or if they would have to go through rigorous re-application processes.

Mr Volmink asked for more detail on the disease control under Programme 6.

Mr Volmink asked how was the restructuring of the NHRS going to be managed.

Mr H Chauke (ANC) asked how many paramedics were required on particular roads, because at present there was a shortage of paramedics and this presented an issue with many road deaths perhaps being avoidable.

Mr Chauke asked what the Department had to say about providing security for mental health facilities.

Mr Chauke asked what was being done to implement NHI.

Mr Chauke asked what would be the best approach to place managers in health facilities.

Mr A Mahlalela (ANC) was pleased that the unqualified audit opinion from provinces was achieved, but he worried that this was not stable and did not show good progress if provinces were fluctuating one year to the next, so he asked if this was sustainable.

Mr Mahlalela asked what the Department was doing about handling the different issues facing provinces.

Mr Mahlalela asked what the progress was on the White Paper.

Mr Mahlalela asked what the key pillars were of the strategy for Programme 3.

Mr Mahlalela asked why the Western Cape was excluded from the programme to distribute condoms.

Mr Mahlalela asked how the Department measured functionality of clinics.

Mr Mahlalela asked what the state was of hospital boards and their functionality as a whole.

Mr Mahlalela asked how clinics were measured to determine if they were ‘ideal clinics’.

Mr Mahlalela asked for clarity on NAPHISA. He did not remember the process being ratified. He asked the Department if NAPHISA was a Bill or if it had been legislated.

Mr Mahlalela asked if there was a reason why the Department did not have a CCOD that produced annual financial statements.

Mr Mahlalela asked if it was practical for provinces to receive money when they had overspent their budget, especially when stabilisation of the provincial department was not guaranteed.

Dr P Maesela (ANC) asked if the Department was preparing for the required staff complement for the NHI when it is implemented.

Dr Maesela asked how far the process of establishing nursing colleges was.

Dr Maesela asked how successful the screening campaign for TB was.

Dr Maesela asked how successful the prevention of HIV/AIDS was.

Dr Maesela asked what was being done to tackle the effects associated with consumption of genetically modified chicken.

Ms D Senokoanyane (ANC) asked for clarity on the figures and achievements associated with Programme 3.

Ms Senokoanyane said that healthy eating and lifestyle needed to be strengthened.

Ms Senokoanyane said that issues of 11 year olds falling pregnant needed to be seriously addressed.

Mr S Jafta (AIC) asked if the Department was planning to train their staff in using new IT equipment.

Mr Jafta asked if the Department was planning to secure health facilities, especially in remote rural areas.

The Chairperson asked for a breakdown of the provinces that had functional health facilities.

The Chairperson asked where the hospitals constructed or revitalised were situated, and where the hospital that was completed was situated.

The Chairperson asked in which hospital, and in which province, WISN was a success.

Dr Motsoaledi agreed with Dr James about the readjusting of the sugar tax. In the schools, the Department was trying to roll out a plan that did not provide sugary snacks in school vending machines and shops.

Dr Motsoaledi said the issue of medical marijuana needed to be specific. If it were for medical purposes and it was registered, then permission had been granted. The issue was not with the Department but with the doctors who had discretion to apply for marijuana licenses on behalf of patients.

Dr Motsoaledi said the National Health Commission was specific about health, and in the NDP the Department was required to deal with social issues of health.

Dr Motsoaledi said that with regard to medical training, the only time the Department of Education became involved was in the dispensing of bursaries to students coming from disadvantaged schools.

Dr Motsoaledi said that the practice of medicine was not a uniform practice where the standards were the same everywhere. In some countries the level of training received was different to what was offered in South Africa. He said even though two people applying for a job might have the same qualification, their training might have been different and therefore a person trained out of South Africa and not into any of the Commonwealth countries might not pass the South African board exam. South Africa, as a former colony of Britain, uses the British system.

Dr Motsoaledi said that the biggest solution to solving the problem of ambulances was to make them all have one national number and have the same colour code.

Dr Motsoaledi said the contracting of General Practitioners (GP) had been resolved so that GPs could be “on loan” to provinces in need of doctors.

Dr Motsoaledi said that a manager of a health facility needed to be someone who had a background in health.

Dr Motsoaledi said in order for clean audits to be achieved constantly, there needed to be good leadership and those leaders must be left to do their work uninterrupted. Audits were not the function of the Minister of Health, but rather were the function of the Premier of the particular province. Dr Motsoaledi said conflict between the hospital board and the CEO could arise when the CEO of the hospital is a good manager and the Chairperson of the Board is of poor quality. Here the CEO would not blindly give into the board's demand. However, if the CEO and the Chairperson of the hospital board were on the same page then the hospital would be managed well and provide quality care. If, however, the CEO and the Chairperson were both of poor quality but were on the same page, then there would be no conflict, but the quality of service offered would be poor.

Dr Motsoaledi said it was not the Department that decided the functionality of hospitals, but rather, the workers overseeing the hospital.

Dr Motsoaledi said the issue of CCOD was progressing. Mines and unions had put their forces together to address the issue.

Dr Motsoaledi said large numbers and percentages over 100% for achievements were indicative of the amount of screening that took place. 500% equalled the process being done five times over.

Dr Motsoaledi said that the campaign of healthy eating would be strengthened.

Dr Motsoaledi said when new IT equipment was supplied, workers were trained on how to use it, but many reverted back to old practices once training was over.

Dr Motsoaledi said that security in health facilities was a big challenge that the Department was fighting to improve.

Dr Motsoaledi said that a hospital in Ladybrand near the border of Lesotho had been completed and the facilities were first class.

Dr Motsoaledi agreed that the data for clinics receiving medication in the Western Cape was not presented; this was not because the NDOH did not cater for the Western Cape, but rather that the Western Cape was the only province using a different system for the dispensing of medication.

Dr Motsoaledi said WISN was a formula that determined the need for staff in specific clinics and hospitals.

Dr Andrews said South Africa was part of the anti-microbial resistant strategy group.

Dr Andrews said that for the national laboratory service and funding model, there was a new funding model being discussed.

Dr Andrews said South Africa had taken a leadership role on outbreaks of diseases. The Director General of Health was appointed Chairperson of the Committee reporting to the DG of the World Health Organisation and the Secretary General of the United Nations, Mr Ban Ki Moon.

Dr Andrews said the Department was making progress on increasing the number of ambulances so that rapid response was readily available.

Dr Andrews said where ever computers were installed, training was provided. The NDOH would ensure security was available to secure the equipment.

Mr van der Merwe said there was stability in management and progress was evident. Gauteng was an example. The Department would be assisting provinces who were lacking behind.

On the issue of conditional grants, Mr van der Merwe said that if the Provincial Health Departments did not spend their money then they could keep it or surrender it back to the National Department. When the province did not surrender the money back, then National Treasury withheld funding in the following year so that the province would use up the grant.

Dr Yogan Pillay, Deputy Director General: DG HIV/AIDS, NDOH said the Department was looking for a cohort to treatment for MBRT because treatment was prolonged. The three pillars were social behaviour, structural  and medical.

Dr Pillay said that if some of the numbers  did not make sense, if must be remembered that those figures fluctuated in most cases between quarters, and also the final figure.

Ms Jeanette Hunter, Deputy Director General: Primary Health Care, NDOH, said patients in mental health facilities were placed with NGOs, and the Department picked up that the NGOs had capacity issues to deal with what was expected.

Ms Hunter answered the question on GP contracting, and said that whether doctors came into the facility or not, they got paid. The initial start-up was slow because doctors were reluctant to get involved.

Ms Hunter said functional committees were defined by having appointment letters from the MEC of the Province and had biannual meetings.

Ms Hunter said functionality of PHCs was measured by the WBPHCOTs.

Ms Hunter said the NDOH had a target of ideal clinics of 500 in 2015 and achieved 300. For 2016, the Department had 320 ideal clinics, which was far better than the previous year.

The  meeting was adjourned.