The National Health Laboratory Service, Office of Health Standards Compliance, Council for Medical Schemes and Compensation Commissioner for Occupational Diseases presented their strategic and annual performance plans. The main highlights of the presentations related to suspended officials within the institutions who were undergoing disciplinary proceedings, changes in organisational structure and budget allocations, reorganisation of strategic objectives due to programmes being combined, redress of audit findings by the Auditor-General and the filling of critical and scarce skills in vacant posts.
Members noted the National Health Laboratory Service (NHLS) presentation has details of their performance for the previous year but not what they plan on achieving in the current financial year. It appears that the NHLS did not understand what was expected of them today. How does the NHLS perform its oversight responsibilities considering that most performance targets are annualised and not according to quarters? How does the NHLS track performance? How much of the budget is actually needed by the NHLS as there are different amounts presented in the budget? How is the NHLS going to manage the transition in public health in South Africa as a number of units are going to be lost in the process, so how will that loss be mitigated considering the challenges in management? There is a lack of qualified field epidemiologists in South Africa and the SADC region as a whole, so what is happening with the high failure rates? Members asked for the reasons the CEO and CFO were suspended and what is the progress with disciplinary proceedings. What are the indicators for the radical transformation that is being implemented? What is the percentage of laboratories with South African National Accreditation System (SANAS) accreditation? How has NHLS responded to the quadruple burden of diseases? How did NHLS achieve the costs that are cheaper than private laboratories? On the irregular expenditure the NHLS has been incurring in previous financial years, what is being done to obtain a clean audit? Its intention is to have more people on anti-retrovirals so does that mean the country has failed to combat the scourge of HIV/AIDS? Is Rietfontein still the Centre for Immunology and Virology? Does the NHLS still use external suppliers for their diagnostics and equipment? How many of the registrars in training are black? How far is the transformation process? Is research and development prioritised? Clarity was requested on the problem of provinces not paying on time and is this still the case? How many of the people on the training programme complete and get absorbed into the organisation? How does the NHLS retain scarce skills? What has been done about specimens found lying around at hospitals waiting to be taken to a lab and employees found not wearing protective gear?
Members asked the Office of Health Standards Compliance (OHSC) why the amount allocated to travel, subsistence and accommodation in 2016/17 has declined in 2017/18, considering the number of employees that are expected to be employed? How are they going to ensure efficiency of inspectors if the allocation of funds has gone down? Does the OHSC have intentions for outreach programmes to ensure awareness, and which language is used during such engagements? Are people in the rural areas made aware of the services offered by the OHSC? The time frames of accommodation of norms and standards by the Minister, when will they be completed? How many complaints have been received and resolved? Is there a direct link from communities to the Office? What is the nature of increasing public discontent about the health system based on their experiences? There is an almost one-to-one management per employer because there are 13 managers and 16 employees. Is it a specialist type of relation? The lease allocation is projected to go up to R16 million in the coming financial years which is too high, has the OHSC considered buying its own building? There is an amount for relocation expenses, is OHSC planning to move to new premises? How are the annual targets monitored and what mechanisms are in place to check the quarterly progress during the quarters? The target of 25 institutions per annum for inspection, what does that number represent? Does it include health establishments that are under local government? Can the complaints be disintegrated into provinces so that it can show from where the highest complaints are coming? There are people who have been pulled from pillar to post trying to lodge a complaint and they have not received help yet.
Members asked the Council for Medical Schemes (CMS) how it can assist with the increase in complaints about high medical aid contributions. What should happen if the savings account is depleted by June yet you still have to continue paying the contribution until year-end? What can be done about the unsustainability of medical schemes? How can the NHI assist in this process? Are the exorbitant increases in contributions fair? Are they not negating the implementation of the NHI? Are the schemes properly regulated and governed? Are beneficiaries informed and protected when benefits are exhausted six months into the year? Members noted that people have to cancel medical aid because they can no longer afford it. If the budget controlled by CMS was injected into the public health care system, would everyone not have access to healthcare considering the amount in question? The cost of the rented building by CMS and the amount spent on consultants - what is being done to reduce this? There was litigation against interventions, what is being done about this?
Members asked the Compensation Commissioner for Occupational Diseases about funds that will never be claimed because the beneficiaries cannot be found. What those funds be invested? What is the current trend on the regional flow of pay-outs in Sub-Saharan Africa? Is there One Stop Service points in these countries? Members asked about the submission of reports and financial statements to the Auditor-General which have been outstanding. What are the findings from the Auditor-General, and how are the findings going to be redressed? Members were impressed by the One Stop Service points in Limpopo and the Northern Cape. Are there outreach programmes, and which languages are used during the outreach initiatives? What has the impact been in the areas in which they have been conducted? Was consideration made to change the name to “Prevention of Occupational Diseases”? What is being done about the dust in the Burgersfort area and how it is affecting community members? Questions were asked about unpaid claims as of 31 March 2015. Targeted payments are not satisfactory and should be increased. Why are the percentages of new claims being paid at a faster rate? If ex-workers do not trust the people who work at One Stop Service Centres, then where will they go to get help? There are improvements needed in management to ensure effective service delivery. Outreach programmes were previously not successful because there was no transportation for ex-mine workers. Have there been any changes to ensure the same challenges do not happen again? Why was the One Stop Service Centre in Swaziland not placed in an easily accessible area? What processes are in place to ensure that fraudsters do not take advantage of people? What is the role of trade unions in this process? How does CCOD trace people who have moved elsewhere?
National Health Laboratory Service Annual Performance Plan
Prof Eric Buch, NHLS Board Chairperson, said that both the CEO and CFO had been suspended and disciplinary hearings would commence on the 19 May 2017. He asked members not to request him to give more information on the matter so that he does not unduly prejudice the disciplinary proceedings. Prof Shabir Madhi is the Acting CEO and Mr Ben Wikner the Acting CFO.
He gave an overview of the presentation, and said that in the 2016/17 financial year test volumes increased by 4% mainly due to HIV related tests. Productivity has also increased by 15% over a period of seven years. This is largely due to responsiveness to the quadruple burden of diseases including AIDS and TB. The cost-effectiveness of services provided by the NHLS means costs of 25% less than a big private laboratory and 27% less than the smaller ones. The NHLS supports expansion of pathologists outside of academic centres, and aims to increase its accessibility through an extended laboratory footprint. The point-of-care testing will revolutionise services.
NHLS is using management information systems in the national mapping of multi-drug resistant tuberculosis. A national LIS is available to allow retrieval of patient results. A business intelligence unit is being established to deal with patient data, and consistent gate-keeping is being developed to prevent requests for unnecessary testing and reduce expenditure. NHLS is striving to ensure sufficient HR capacity and improved cash flow management. It is training pathologists, medical scientists, technologists and technicians. The current cohort consists of 243 registrars training to be pathologists. NHLS strives to continue to contribute to world leading research.
NHLS strives to ensure that 100% of hospitals at regional level and 80% at district level are provided with NHLS on-site services by 2020, all tests are performed within prescribed timeframes, that 85% of regional laboratories are accredited by 2020, that academic institutions produce highly competent pathology health professionals who will influence policy development, and improve turnaround times through the use of modern and advanced technology.
NHLS aims to build strong sustainable relationships with all stakeholders and improve customer satisfaction, have innovative laboratory medicine and state of the art IT that drives real-time digital laboratory services, attract and retain the right number of staff with the right skills mix at the right level, ensure compliance with all legislation, financial regulations and directives, and achieve clean governance by 2020.
The strategic objectives for Programme 1 are to improve the liquidity position, obtain a clean audit opinion through to 2020, build a robust IT infrastructure and innovative digital solutions to facilitate state-of-the-art laboratory services by 2020, ensure adequate and skilled human resources by 2020. NHLS aims to uphold communicable diseases surveillance at 90% by 2020 and beyond, maintain 100% of outbreaks responded to within 24 hours after notification, ensure that all National Institute for Communicable Diseases (NICD) laboratories remain SANAS accredited. NHLS aims to conduct 90% of all occupational and environmental health laboratory tests within specified turnaround times by 2020, increase the number of occupational and environmental health assessments, produce an annual surveillance report for the public domain, and audit 90% of targeted laboratories by 2020.
NHLS aims to increase the levels of quality tests performed within the laboratories by ensuring that laboratories are well equipped, resourced and maintained by 2020 and beyond, increase research outputs that translate into diagnostic practice by 2020, and increase articles published in peer reviewed journals to 653 by 2020. The infrastructure plan stands at R430 million for the 2017/18 financial year which includes buildings, laboratory equipment, computers, office furniture and fittings, office equipment and motor vehicles.
The revenue and expenditure overview shows that in 2012 the graph illustrates that expenditure was increasing higher than the revenue and a loss was experienced that year. In 2013 and 2014 there was a plateau of expenditure, which started to decrease in 2015 after efficiencies were created. In 2016 an accelerated decrease in expenditure was noticed, and in 2017 the relationship between revenue and expenditure is better managed. Revenue and expenditure are increasing due to volume increase. NHLS will require R628 million per month for 2017/18. Income is estimated at R7,6 million, which means that the NHLS can achieve a small surplus of 5.2% tariff increase with a volume of 2% increase if provinces pay their invoices on time. A three month reserve of R1,8 billion is needed in the bank to keep the NHLS running. By the end of 2016/17 the NHLS only had R329 million, which was R1.5 million short of the required reserve. There is still a backlog of R430 million for capital expenditure and suppliers are owed R864 million. The progress made in resolving KZN and Gauteng historic debts should address the backlog and a sizeable portion of the reserve shortfall.
The income and expenditure highlights show that the NHLS expects a 5.2% tariff increase and 2% volume increase. It anticipates an 8% increase in expenditure on goods and services, 12.7% on personnel increase which includes salaries and benefits and proficiency progression, 13th cheque and insourcing of gardening and services. Succeeding financially will depend on effective cost-containment.
The trends in performance show that there are good financial trends although the reserves are low, the creditor and debtor days will drop dramatically when KZN and Gauteng historic debts are resolved. There is a full board with more laboratory skilled members, new quantitative KPIs have been introduced, TrackCare is now operational but needs investment to achieve targets. New quantitative targets have been introduced for human resources. Coverage, response times and proficiency are moving positively.
Mr A Mahlalela (ANC) said that the presentation the NHLS has given deals with their performance for the previous year and not what they plan on achieving in the current financial year. Some of the slides were missing and not updated, and it appears that the NHLS did not understand what was expected of them today. What they have presented today will only be needed in August. How does the NHLS perform its oversight responsibilities considering that most performance targets are annualised? How does the NHLS track performance? How much of the budget is actually needed by the NHLS as there are different amounts presented in the budget?
Dr W James (DA) asked how the NHLS is going to manage the transition in public health in South Africa once the National Public Health Institute of South Africa (NAPISA) kicks in. A number of units are going to be lost in the process, so how will that loss be mitigated considering the challenges in management? There is a lack of qualified field epidemiologists in South Africa and the SADC region as a whole, so what is happening with the high failure rates?
Ms C Ndaba (ANC) asked for more information to be given on the reasons that the CEO and CFO were suspended and what is the progress with disciplinary proceedings.What are the indicators for the radical transformation that are being implemented? What is the percentage of laboratories with SANAS accreditation? How has NHLS responded to the quadruple burden of diseases?
Mr D Khosa (ANC) asked a question about the costs being less than private laboratories and how the NHLS achieved this. The budget shows an allocation for furniture which has not changed throughout the financial years. He asked about the irregular expenditure that the NHLS has been incurring in the previous financial years. What is being done to obtain a clean audit?
Dr P Maesela (ANC) asked about the intention to have more people on anti-retrovirals. Does it mean the country has failed to combat the scourge of HIV/AIDS? Is Rietfontein still the Centre for Immunology and Virology? Does the NHLS still use external suppliers for their diagnostics and equipment or are there plans to have an internal process to procure these things? How many of the registrars in training are black? How far is the transformation process? Is research and development prioritised?
Ms L James (DA) asked about the problem of provinces not paying on time. Is that still the case? How many of the people on the training programme complete and get absorbed into the organisation? How does the NHLS retain scarce skills?
The Chairperson asked about specimens that have been found lying around at hospitals waiting to be taken to a lab and employees who were found not wearing protective gear. What has been done about that? These were experienced through oversight visits by the Committee.
Prof Buch replied that the transition to NAPISA is being worked on and a transition workshop has been organised in the next month. The loss of skilled professionals may be a loss to the NHLS but not necessarily a loss to the country as they continue to contribute in various ways in their areas of employment. A re-assessment will be made when the time comes and the NHLS will continue to achieve its academic and research commitments through its academic partner institutions. The Field Epidemiologists Training Programme is producing a number of graduates which increases capacity in the country. The failure rates are being remedied through a number of measures which have increased the number of pathologists who are completing the programme.
The suspension of the CEO and CFO were decisions which were not taken lightly. However at this stage no more information will be given on the matter until all the disciplinary proceedings have been completed. The indicators for radical transformation and SANAS are a complex process, where for example at Tygerbeg they would accredit the entire centre. However, if one laboratory out of the eight does not have enough staff then the whole laboratory loses SANAS accreditation. The indicators have to be adjusted to show a more accurate situation. NHLS is already providing the laboratory tests to deal with the quadruple burden of diseases. Other than the occupational diseases and cancer prevention, the NHLS is not mandated to provide surveillance for other non-communicable diseases. NAPISA will however be able to provide a database of surveillance.
The low costs are achieved through efficiency and not trying to make profit. A lot of the higher costs are due to the need to make profit. Due to the large number of tests conducted, the equipment used is such that more tests are conducted at a faster rate, and at a lower cost. The amount for furniture and equipment is not R10 000 but R10 million. The Board is continually tightening oversight on procurement to address irregular expenditure. The suspension of the CEO and CFO has had minimal impact on the institution and work has been increased substantially to deal with this. The Acting personnel are doing excellent jobs in the circumstances. There has been no drop in operational performance. The anti-retrovirals shows that the NHLS has succeeded in providing treatment to people infected with HIV as soon as it has been established that they are infected. This is as opposed to previous years when treatment only started when people had a CD4 count of 400. The test and treat approach recommended by the World Health Organisation has been adopted by South Africa.
South Africa produces amazing research and is considered one of the leading contributors to the field of research. The payment by provinces is improving dramatically and more revenue is expected in that regard.
Dr Mojaki Mosia, Executive Manager: Human Resources, NHLS, responded to the transformation question by saying that transformation in the NHLS broadly is on a positive trajectory. Registrars are 67% black, and this will contribute to the future transformation of black registrars. There are 245 pathologists of which 18% are black females and 4% are black male. The intake shows an intention to increase these numbers. The completion rate is a challenge as well as the recruitment of interested and committed professionals. Over 50% of the staff in the NHLS are critical and scarce skilled. The Board has improved the remuneration policy to ensure that salaries at the NHLS are competitive which will help to retain staff within the organisation.
Mr Andre Venter, NHLS Board Member, responded to the questions on supply chain and procurement within the NHLS. He said that the Board identified a number of gaps which led to the Head of Supply Chain being suspended. A revised organisational structure was approved and management is busy implementing that. A review of financial policies has been requested which will be dealt with in the coming month. A bid register will be implemented which will be handled by a Contracts Manager who has been appointed. This will ensure compliance with Treasury Regulations and legislation. The provinces experience budget constraints towards the end of the financial year and this makes it difficult to pay their suppliers on time. Provinces have not really received an increase in funding which affects their ability to meet set timeframes. He said many processes have been put in place to address handling of specimens and protective wear by staff.
Office of Health Standards Compliance Annual Performance Plan
Mr Bafana Msibi, Acting CEO: OHSC, said that the Office had to develop an annual performance plan for the 2017/18 financial year informed by the MTSF. The new indicators are in the areas of corporate services which has been reallocated under the administration programme, compliance inspectorate which now includes certification and enforcement as a new programme, and complaints management and Office of Ombud as one programme. The changes will contribute towards the OHSC’s continued support to reduce avoidable mortality, morbidity and harm within health establishments.
The changes in performance delivery environment gave rise to the need to introduce new programmes and reallocate performance indicators. These were the audited performance information results on predetermined objectives in the first year of independent operations which identified some gaps in the strategic plan; challenges experienced by management in the implementation of the first APP which was developed before appointment of the majority of users, using the limited data available for benchmarking; the promulgation of procedural regulations which will pave the way for the inclusion of private sector hospitals and clinics in the key performance indicators of the compliance inspectorate; the existence of systems and processes in other areas which will ensure delivery on the core business and support functions of the entity; availability of personnel appointed through the recruitment drive which saw the target of filling of vacancies in the first year of operations achieved in the first quarter.
The majority of comments received on published draft regulations were constructive which indicates the entity is accepted by the public in bringing quality standards for health establishments. The review of comments on the draft regulations ensures that the final regulations take into consideration all the regulatory elements which may have been missing during the initial draft stage. There were confirmed concerns obtained through a national audit of all public sector healthcare facilities conducted in 2011 and 2012 which showed very low levels of compliance with standards in the six identified priority areas. Other identified health sector organisational problems include unacceptable poor quality and unsafe health services; high levels of inequality in per capita health expenditure between public and private sectors; public health system with poor outcomes or return on investment. The OHSC has been doing mock training inspections of public sector institutions since 2011. The total number of validated inspection results for health establishments by March 2016 was 1 386 or over 35% of public health care establishments. This is sufficient for analysis of challenges being faced and existence of the regulator.
The analysis shows large deficits as well as variations in the quality of health services. The broad strategies adopted by the Board of the OHSC during its first year in operation were designed to achieve the legislative mandate and strategic goals set for the entity. He gave an overview of the OHSC staff establishment.
The strategic objectives of Programme One include providing leadership and administrative support necessary for the OHSC to deliver on its mandate and comply with all relevant legislative requirements. This will be done through establishing a fully functional office suitably staffed to execute the mandate and goals of the OHSC, accredit inspectors after successfully completing approved training courses, implement good governance, oversight and accountability through appropriate delegations, including financial management and compliance with PFMA, leverage the IT to meet the needs of the OHSC and deliver services more efficiently, create public, provider and stakeholder awareness about the roles and powers of OHSC, support the mandate and objectives of OHSC through MOUs with relevant regulators and organisations.
The Administration programme comprises of staff in the corporate services division and office of the CEO. The programme will see an increase in staff members to support a growing organisation in the MTEF period.
The objectives of Programme Two are to manage the inspection of health establishments in order to assess compliance with national health systems and norms, certify compliant health establishments and take enforcement action against non-compliant establishments. This will be done through inspecting regulated public and private health establishments for compliance with prescribed norms and standards every four years; certify establishments which are compliant, effect enforcement action against consistently non-compliant establishments. This division has the biggest staff numbers to ensure coverage of establishments across the country. The increase in budget allocation will enable an increase in the number of inspectors. Certification and enforcement is dependent on promulgation of regulations so capacity can be built over time. The staff complement currently stands at 13 management/professionals and 42 employees.
The objectives of Programme Three are to consider complaints related to non-compliance and use of the Office of the Ombud to resolve complaints. The staff under this programme comprises of the Complaints management and Office of the Ombud. Provision has been made for additional staff members for the call centre, complaints assessments and investigations. The budget of the complaints management division is expected to increase from R12.9 million in 2016/17 to R16.9 million in 2019/20.
The objectives for Programme Four are to provide high-level technical, analytical and educational support to the mandate of the Office in relation to research, development and analysis of norms and standards and support capacity building and communication with stakeholders. The bulk of the staff in this division will be highly skilled individuals in the areas of standards development, data analysis and guidance and training programmes. The appointments over the next five years will ensure that the expertise and information of the OHSC is used strategically to enhance quality and safety improvements in the health system. The main budget item is the remuneration of employees in view of the division’s plans to conduct a review of and develop new norms and standards. This will include guidance and research at both national and provincial levels.
An overview of the 2017/18 budget shows a year on year increase of 25.04% in 2017/18, 5.80% in 2018/19 and 5.60% in 2019/20. The need to increase compliance inspection coverage in line with OHSC legislation requires the budget to be reconsidered. There is an envisaged growth in complaints lodged due to the promulgation of regulations for norms and standards. There must also be consideration for provision of adequate office space and training and development. The staff complement will increase from 108 in 2016/17 to 121 in 2019/20. More of the budget will be allocated to core operations of compliance and inspections.
Ms Ndaba asked about the amount allocated to travel, subsistence and accommodation in 2016/17 which has declined in 2017/18. What are the contributing factors for this decline, considering the number of employees that are expected to be employed? How are they going to ensure efficiency of inspectors if the allocation of funds has gone down? Does the OHSC have intentions for outreach programmes to ensure awareness, and which language is used during such engagements? Are people in the rural areas made aware of the services offered by the OHSC?
Ms James thanked the OHSC for giving unemployed graduates the opportunity to be exposed to the work environment and get work experience. She asked a question about the time frames of accommodation of norms and standards by the Minister, when will they be completed? How many complaints have been received and resolved? Is there a direct link from communities to the Office?
Dr Maesela asked about the nature of increasing public discontent about the health system based on their experiences? There is an almost one-to-one management per employer because there are 13 managers and 16 employees. Is it a specialist type of relation? The lease allocation was R1.2 million and is projected to go up to R16 million in the coming financial years. The amount is too high, has the OHSC considered buying its own building? There is an amount for relocation expenses, what does the relocation mean? Is OHSC planning to move to new premises in the new financial year?
Mr Mahlalela asked about annual targets and how they are monitored. What mechanisms are in place to check the progress during the four quarters of the year? The target of 25 institutions per annum for inspection, what does that number represent? Does it include health establishments that are under local government? Can the complaints be disintegrated into provinces so that it can show from where the highest complaints are coming? There are people who were pulled from pillar to post trying to get help to lodge a complaint and they have not received help up to today.
Mr Msibi replied that the National Department of Health should respond to the question on the time frames for norms and standards.
Mr Julius Mapatha, Chief Financial Officer, OHSC, responded to the question on decreased allocated funds for travel and subsistence by saying that the funds have been redirected to the inspectorate to allow inspection services to be well-funded. The manager-employee ratio is due to the combination of the various programmes falling under one division. The lease payments are due to a much bigger space being required which will have to go through a competitive process. The benchmarking showed that the market-related fee showed that that is likely to be the going rate. The relocation expenses are because there is anticipation of a move to a new office space, so the amount caters for that possibility. Consulting and professional services are provided for because expert panels are required to resolve matters, as was seen in the Life Esidimeni investigation. There is also provision for translation of documents into the official languages, and legal drafting for the norms and standards, and actuarial skills for measurement tools for inspections. Outreach programmes have started since the launch of the call centre.
Mr Msibi said that the Office is always aware of tracking events that take place and the progress is reported on. The inspections include conversations with healthcare professionals to ensure that problems are noted and solutions are suggested. Nurses prefer to go to their unions to discuss matters of working conditions. The 25 inspected establishments include hospitals, clinics and facilities in municipal areas. The outreaches are conducted in the local languages.
The Chairperson requested that some of the questions be responded to in writing where detailed responses were required.
Council for Medical Schemes Annual Performance Plan
Prof Emeritus Yusuf Veriava, Council for Medical Schemes board chairperson, started the presentation by saying that the Acting CEO, Dr Sipho Kabane, has been approved by the Minister as CEO of CMS. The recruitment process for the post of Registrar has begun and eleven individuals have been shortlisted for interviews.
Dr Sipho Kabane, Acting Registrar: Council for Medical Schemes, said that the Council has collaborated with the National Department to ensure that all the targets are incorporated. There is unlikely to be an increase in memberships due to the numbers of unemployed. This will result in increased membership fees. The high number of deaths through HIV and communicable disease related causes has resulted in a high number of claims during hospitalisation and incapacitation periods.
There is a need for CMS and the Health Department to come up with a primary benefit plan to cover people who cannot afford high membership rates but still require medical aid. Industry trends which will affect the operation of CMS have been noted, which includes the decline in the number of members in medical schemes. The average expenditure per beneficiary per annum has increased by 9.04% to R15 824. A maldistribution of healthcare benefits has been noticed where hospitals and specialists remain as the main beneficiary of the pile.
The average increases in contribution proposed by schemes range from 10.2% to 11.9% which is significantly higher than the consumer price index. This shows that the industry is expensive, unaffordable and unsustainable. CMS has the capacity to deliver on its mandate, and a new Registrar will be appointed as the appointment processes are underway. The clinical expertise has been increased through appointment of panel experts to deal with prescribed minimum benefits. There are no vacancies in the Council, and it has been unionised since 2015 under NEHAWU.
The CMS has undertaken a process to map out its business performance to ensure it meets all the required targets in the APP.
Ms Thembi Phaswane, General Manager: Complaints Adjudication, CMS, gave an overview of the trends in complaints received by the Council. She said that the first deals with administrative matters where claims are funded from the incorrect funds. Customers complained about customer services where they do not receive the necessary help. Other complaints relate to authorisation for hospitalisation being denied, sometimes due to funds being depleted. Some claims were rejected incorrectly and the cases were resolved. The main complaints were on the increases in contributions. The prescribed minimum benefits are sometimes not paid in full, and when adjudication is made then medical schemes are ordered to re-process the claims and pay the claims in full. Medical schemes can only enforce a co-payment if the customer voluntarily consulted a non-designated service provider. Some medical schemes only pay a claim up to a certain limit which is incorrect.
Dr S Thembekwayo (EFF) asked how CMS can assist with the increase in contributions as noted in the complaints trends. What should happen if the savings account is depleted by June of a financial year, and you still continue paying the amount of money? How can that matter be dealt with?
Dr James asked about the unsustainability of medical schemes and what can be done about it. How can the National Health Insurance (NHI) assist in this process?
Mr Khosa asked about the exorbitant increases in contributions and the unaffordability by people. Are these increases fair? Are they not negating the implementation of the NHI? Are the schemes properly regulated and governed? Are beneficiaries informed and protected when benefits are exhausted six months into the year? This is especially for people who have to choose the lowest package because of unaffordability.
Ms James asked about the number of people who cancel medical aid because they can no longer afford it. If the budget controlled by CMS was injected into the public health care system, would everyone not have access to healthcare considering the amount in question?
Ms Ndaba asked about the rented building and the amount it is costing CMS. The answer regarding the purchasing of a building is not satisfactory, why is CMS not trying to find other property?
Dr Maesela asked about the amount spent on consultants and what is being done to reduce this amount? Why are people not employed to do this job? There was litigation against interventions, what is being done about this?
Mr Mahlalela asked about the consultants who are more than the actual employees at a cost higher than all the programmes. Why do they not have a single indicator to track performance?
Prof Veriava replied that the questions by members highlight shortcomings within the Council which will be dealt with accordingly. The shortcomings will not be defended. The high amount of rental is due to the landlord of the current building inflating the selling price above market price. Negotiations are underway to try and reach an agreement, and the reluctance to move is based on the investments CMS has already made towards the building.
Ms Phaswane said that depending on the scheme package, the savings account amount is agreed upon and determined by the amount in contributions. The scheme notifies the customer on which services can be paid for through the savings account. Once that amount has been depleted, a member continues paying because the amount was determined by the monthly contributions. This means that only half of the savings amount had been paid for and so the rest must still be received by the medical aid. It is improper for medical aids not to inform its customers about depleting funds and such matters should be raised with the Council.
The detailed responses will be provided in writing.
Compensation Commissioner for Occupational Diseases (CCOD) Annual Performance Plan
Dr Barry Kistnasamy, Compensation Commissioner, provided an overview of the mandate of the Commission. He said that the CCOD covers compensation of cardio-respiratory diseases of miners in controlled mines and works. It also provides medical assessments every two years, provides access to post mortems and provides services in South Africa and neighbouring countries.
There is a total of around R1.2 million ex-mine workers from South Africa, Lesotho, Mozambique, Malawi, Botswana and other African countries, who mostly suffer from TB. An amount of R308 million still needs to be paid to 61 310 ex-mine workers, who are TB sufferers. In South Africa, the largest percentage of ex-mine workers comes from the Eastern Cape, at 31%.
Business reforms of the CCOD are supported by its stakeholders, and there has been an alignment of compensation systems and enhanced services in provinces and neighbouring countries. There have been policy and legislative changes, and administrative changes in database, certifications, track and trace and payments. There has been an increase in certifications per month, and an increase in payments per month. The SADC region receives R 75.64 million in payments and R50.53 million goes to the Eastern Cape.
The financial statements and actuarial valuation of 2010-2012 have been signed by the Auditor-General, the website is up and running, the logistics coordinating centre is functional as well as a call centre, mapping is underway and One Stop Services are fixed and mobile. The advisory and audit committee are functional, as well as the distressed mining communities and SADC community forums. The risk committee is non-functional. There is no Director of Medical Bureau for Occupational Diseases, there is a lack of health, finance, legal and information technology professionals, work stoppages have affected operations, there are inadequate physical facilities and equipment, the IT system is outdated and 22 professional technical service officers were lost, and a nominal increase in budget are some of the challenges faced by the CCOD.
The CCOD aims to make policy and legislative changes, have fully functional committees, and provide efficient service delivery and clear backlogs in claims management and revenue collection. The CCOD has R 61.6 million in voted funds for 2017/18, which is inadequate as R200 million is required per annum. It is working with mining companies and social partners to enhance business reforms, have a register of controlled mines and put together a new model of governance, management and service delivery.
Some of the highlights for the 2016/17 financial year include approval of the actuarial valuation report, sign-off of annual reports and financial statements by the Auditor-General on 2010/11 and 2011/12 financial years, consultations for setting up a Compensation Authority, 1 710 certifications a month, 425 payments per month, fixed and mobile One Stop Service centres in neighbouring countries and files in database include records of service from TEBA. CCOD aims to finalise auditing of previous financial years by the Auditor-General.
Dr James asked about funds that will never be claimed because the beneficiaries cannot be found. What will be done with those funds, will they be invested? What is the detail on the regional flow of pay-outs in Sub-Saharan Africa and what is the current trend? Is there a One Stop Service point in one of these countries?
Ms Ndaba asked about the submission of reports and financial statements to the Auditor-General which have been outstanding. What are the findings from the Auditor-General, and how are the findings going to be redressed? She said that she is impressed by the One Stop Service Stops in Limpopo and the Northern Cape. Are there outreach programmes, and which languages are used during the outreach initiatives? Which models are being used and what has the impact been in the areas in which they have been conducted?
Dr Maesela asked whether there was consideration to change the name to “Prevention of Occupational Diseases” instead of what it is now because a healthcare professional’s job is to prevent illness. What is being done about the dust in the Burgersfort area and how it is affecting community members in the area?
Dr Thembekwayo asked about service delivery prioritisation by the CCOD and the unpaid claims as of 31 March 2015. The targeted payments are not satisfactory and should be increased because it prejudices the large majority of claims which are not being paid on time. Why are the percentages of new claims being paid at a faster rate? If ex-workers do not trust the people who work at One Stop Service Centres, then where will they go to get help? There are improvements needed in terms of management to ensure effective service delivery.
Mr Mahlalela asked about the outreach programme and how such activities previously arranged were not successful because there was no transportation for ex-mine workers. Have there been any changes to ensure the same challenges do not happen again? Why was the One Stop Service Centre in Swaziland not placed in Manzini or other area which is easily accessible?
The Chairperson asked about the processes which are in place to ensure that fraudsters do not take advantage of people? What is the role of trade unions in this process? How does CCOD trace people who have moved to other provinces?
Dr Kistnasamy responded that a demonstration of the reference database will be given, which will be made accessible to the constituency offices after a non-disclosure agreement has been signed. The CCOD has come a long way to resolve some of the issues that were a huge challenge in previous years to date. The CCOD does not have a benefits committee and investments committee, which means that it will not at present be able to make a decision to invest the funds which have not been successfully claimed. The plan is to have governance structures which will ensure that these options will be effected and the reserve funds can be invested.
The actuarial valuation report will assist to ensure that proper planning is made to look at the liability of the fund and levy setups. There are centres planned for Zimbabwe and Malawi, although there has not been an active flow of mineworkers from these areas. The regional flow of funds will be broken down and submitted to the Committee in writing. Submissions of reports have been delayed because of the challenges within the organisation. They are unaudited but members are more than welcome to have access to them when they so require.
The audit qualifications were mainly on revenue which is linked to the registrar of controlled mines, which is something that is being addressed at present. There were no strategic plans or annual performance plans in previous years and that is why the Auditor General disqualified the CCOD. The outreach programmes have indeed been affected by lack of funds but the Deputy Minister of Mineral Resources has committed to provide funds to assist with this. The outreach programs are presented in the local languages of the areas and not in English. The database of ex-mine workers is being updated, which includes mineworkers who were on the TEBA database.
He gave a live demonstration on how to search for ex-mineworkers on the database to show how to see which claims are outstanding for patients, and when they are due for medical examinations. He said that the requested reports will be made available to the Committee.
The meeting was adjourned.
- Office of Health Standards Compliance 2017 Annual performance plan presentation
- NHLS 2017 Annual performance plan presentation
- Compensation Commissioner for Occupational Diseases 2017 Annual performance plan presentation
- Compensation Commissioner for Occupational Diseases 2017 Strategic plan presentation