Health Budgetary Review and Recommendations Report

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Health

25 October 2016
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

2016 Budget Review & Recommendations Reports – BRRR

The Portfolio Committee on Health met to discuss the draft Budgetary Review and Recommendations Report that had been drafted for the Department of Health. The bulk of the meeting was mostly correcting grammatical errors which were made on the draft report. Members went through the report page by page picking up some errors and rephrasing some sentences.

A recommendation was suggested to be included in the report which reads “explain the reasons for the increase in neonatal mortality and prioritise interventions aimed at reducing the alarming trend” because an intervention is required.

Mr A Shaik Emam (NFP) had a problem he has with the observations made by the Committee in that all the emphases seemed to be around resources, whether money was spent or not and there was not enough emphasis on issues and given their practical experience there seemed to be a great challenge in terms of the state of health facilities in the country. He suggested that there should be more emphasis on monitoring and evaluation rather than the financial aspect. He further expressed concern with regard to Community Health Workers on page 25 of the draft report; mentioned there was lack of emphasis on the fact that the workers did not get benefits from working but only received stipends. It was important to emphasise the serious challenges that the workers faced and their issues must be addressed.

Another point raised and agreed upon was that there should be a balance in terms of money spent and what was being derived from the service at the facilities.

The report was adopted with amendments.

Meeting report

Opening remarks.
Ms D Senokoanyane (ANC) and Mr Shaik Emam (NFP) requested to be excused at the appropriate time because they had to sit in on a meeting with the Appropriations Committee.

The Chairperson mentioned that they would try to be quick and make sure that the important issues are discussed.

Budgetary Review and Recommendations Report of the Portfolio Committee on Health
Dr W James (DA) suggested Members look at substantive issues and leave editorial corrections to be taken care of by the staff who would be drawing down the final draft.

Mr A Mahlalela (ANC) mentioned that the suggestion was progressive and making editorial comments was just fixing he English on the report.

The Chairperson asked Dr James to inform her when they get to matters that he believed to be substantive. Members agreed with the suggestion made and proceeded with the discussion.

Dr James expressed his substantive issue on page nine of the report. Even though he was not at the Committee meeting when the table was discussed, he was struck by how poorly the table was presented. There needed to be far more nuance in the way the presentations described their achievements and try to avoid writing ‘not achieved’ on all of the targets that entities or the Department failed to meet.

The Chairperson said she hoped the Secretariat noted the suggestion.

Dr James said his second substantive note was on the Council for Medical Schemes (CMS) on page 19 of the draft report which described the Council as an organ of the state. Dr James said the CMS was a regulatory agency which must discharge its regulatory mandate, which was the Council of Medical Schemes Act. It was incorrect to say that it must discharge its legislative mandate in a coherent manner consistent with the national policies. The Council is an independent regulatory agency which must execute its legislative mandate. He suggested that the paragraph should read as “The CMS is a regulatory agency that is expected to discharge its legislative mandate in a coherent manner”.

Dr P Maesela (ANC) said there was nothing wrong with the way the sentence was constructed because the CMS is an organ of the state.

Mr Shaik Emam agreed with Dr James and explained that the Council is a not exactly an organ of the state but is more of a regulatory authority.

Mr Shaik Emam expressed concern with regard to Community Health Workers on page 25 of the draft report, which mentioned that there is lack of emphasis on the fact that the workers did not get benefits from working but only received stipends. It was important to emphasise the serious challenges that the workers faced and their issues must be addressed. The Chairperson asked Committee members if the issue of benefits was raised during presentations made by provinces.

Mr Mahlalela replied that members did raise questions on benefits, which was why there was an explanation on what was happening at each province on the draft report.

Mr A Shaik Emam said the problem he had with the observations made by the Committee was that all the emphases seem to be around resources, whether money was spent or not and there was not enough emphasis on issues and given their practical experience there seemed to be a great challenge in terms of the state of health facilities in the country. He suggested that there should be more emphasis on monitoring and evaluation rather than the financial aspect. There should be a balance in terms of money spent and what was being derived from the service at the facilities.

Mr Mahlalela made a similar observation because he noticed in the report that the Department achieved about 64% of its targets but spent almost the entire budget and there was no correlation between the service delivered and the money spent. There needed to be an understanding of the discrepancy and this issue should be taken into consideration.

Mr H Volmink (DA) agreed with the suggestion and mentioned that the Committee’s mandate spoke to the issue of the public value of public funds invested and planning. 

Dr Maesela agreed with Mr Mahlalela that it was unacceptable to spend all the money on 64% of work done.

Mr Volmink referred to page 29 of the report and suggested that Members add a point on its recommendations which was raised in a Committee meeting where there was an agreement between the Minister and Committee Members that the Nelson Mandela Children’s hospital should not be allowed to fail. He proposed to add a sentence which reads “There was a need for the Department in conjunction with Treasury to honour its commitment to support the operational functioning of the Nelson Mandela Children’s hospital”.

The Chairperson agreed with Mr Volmink and suggested that the point should be an observation as well as a recommendation on the report. He went on to propose that the last sentence in page 29 which read “The Committee questioned the role of the CMS in regulating medical schemes members’ contributions” be changed to “The Committee was concerned about how the CMS fulfils its mandate in terms of protecting members of the public especially in light of the substantial escalation of the monthly contributions” as it did not strongly capture what the Committee was saying. She asked if the bullet point did not explicitly reflect the role of the CMS in ensuring that members were protected.  She went on to ask if Committee Members had a problem with rewriting the bullet point that Mr Volmink suggested. Members agreed to the rephrasing of the sentence.

Mr Volmink said it was important to add a recommendation on neonatal mortality and suggested a recommendation which reads “explain the reasons for the increase in neonatal mortality and prioritise interventions aimed at reducing the alarming trend” because intervention was required. He was asked to craft a recommendation on the Nelson Mandela Children’s hospital and asked Members to include a point in the recommendations which reads “to ensure that the operational functioning of the Nelson Mandela Children’s Hospital is supported by the Department”.

Members also made minor grammatical corrections to the report.

The report was adopted.

Committee business
The Chairperson said the Committee was exercising its oversight and was improving. She commended the staff for the way the report was structured.

Mr Volmink agreed with the Chairperson and thanked the staff for the work it had been doing and for the great work on the preparation packs they produced for the Committee when the Committee was meeting with entities.

Announcements
The Chairperson announced that there was an international congress taking place in Durban on 31October to 3 November that the Minister of Health invited committee members to attend. The Minister invited two Committee Members and the Chairperson. the Chairperson chose Mr Mahlalela and Mr Volmink.

The meeting was adjourned. 

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