Department of Health: budget briefing

Meeting report

SOCIAL SERVICES SELECT COMMITTEE
20 May 2003
DEPARTMENT OF HEALTH: BUDGET BRIEFING

Chair: Ms L Jacobus (ANC)

Document handed out:
National Department of Health Presentation to NCOP
National Health Department Cluster: Financial Management Budget 2003-2006
National Health Department Cluster: Financial Management: National Tertiary Services

SUMMARY:
The Department of Health briefed the Committee on their budget and programmes for 2003/2004.

MINUTES:
Briefing by Dr K Chetty (Acting Director-General, Department of Health)
Dr Chetty extended the apologies of the Minister, who was attending the World Health Assembly.

Dr Chetty said that the Department of Health (hereafter Department) had tabled their strategic plans for the next three financial years. They had chosen to present statistics on health that were often not discussed, but that the annual report had more detail.

The Department had no new figures on the infant mortality rate (IMR) and the maternal mortality rate (MMR) since the last South African Demographic Health Survey. The Department was hoping to repeat the exercise next year.

Intestinal infectious diseases, influenza and pneumonia and 'unspecified unnatural' were the top three underlying causes of deaths in 1997-2001 among children aged 0-14 years. The Department was aiming to lower the number of 'unspecified' deaths in order to get a better diagnosis on the specific causes of death. The previous survey showed a higher number of deaths in the category: 'unspecified'.

Dr Chetty said that key statistics had been selected to stress the vaccine preventable diseases and to highlight the effectiveness of immunization programmes. Immunisation programmes were still not operating at an optimum level.

For the period January to August 2002 only one case of Tetanus had been reported. During the same period five cases of Whooping Cough were reported compared to 24 cases for the same period in 2001. Of the 406 suspected measles cases reported in 1998, 27 were confirmed by laboratory tests and in 2001 the number of confirmed cases were even lower, only 8 of 1166 suspected cases were confirmed.

The overall HIV prevalence rate was 22.4% in 1999, 24.5% in 2000 and 24.8% in 2001. The prevalence amongst adolescents aged below twenty years declined from 21% in 1998 to 16.5% in 1999, stabilising to 16.1 in 2000 and 15.4% in 2001.

The sexually transmitted infections (STI) rate dropped. The Department was looking at public private partnerships in order to extend the treatment campaign.

Tuberculosis was to be a major priority area, as the incidence had not improved. Malaria cases have decreased due to the roll back malaria campaign which has been successful in the whole SADC region. Although there have been Cholera outbreaks in KwaZulu/Natal, the Eastern Cape and Mpumalanga, the rate was still low and the Department was handling the disease well in collaboration with the Department of Water Affairs who were monitoring water supply.

All provinces were implementing the Perinatal Problem Identification Programme (PPIP), which helprf provinces to identify causes of perinatal deaths. In 2000, 27 public sector facilities implemented PPIP, increasing to 91 in 2002. In addition the Baby Friendly Imitative had resulted in 58 out of 480 maternity units being declared as baby friendly. The number of functioning designated Termination of Pregnancy (TOP) facilities increased from 109 to 159 in 2002.

The number of female and male condoms distributed had been increased drastically. Since late 2000, Voluntary Counselling and Testing (VCT) sites for HIV were established in 691 clinics nationally.

R1.6 billion had been spent on hospital regeneration programmes and the Department was to move away from small projects in a range of sites and to concentrate on major projects in a few sites. The Nelson Mandela Academic Hospital in Umtata and the Pretoria Academic Hospital have been completed. Dr Chetty said that the Inkosi Albert Luthuli Academic Complex, a flagship project, was a good model of private public partnership.

Regarding the financing of health, Dr Chetty said that one of the key concerns raised in the Ministers Budget Speech last week was interprovincial equity. She said that there had been a process around the costing of services and the Tertiary Services Grant. For example the Eastern Cape had been funding the latter out of its own budget. The Department was finalising the costing of packages of care at all levels to ensure equity in resource allocation. In certain sectors of health the provinces had not been getting their concomitant increases in funding.

The Department's strategic planning needed to be strengthened and that they were focusing on small, medium and long term planning and linking planning to the budget especially in light of the new National Health Bill. A chief directorate of Strategic Planning had been established.

Dr Chetty said that the legislation being prioritised at the moment was the National Health Bill and the Traditional Healers Bill. The Department was looking to create an overarching Professional Health Workers Bill, rather than catering for each health profession individually. The Termination of Pregnancy Amendment Bill recommended that instead of designated TOP facilities, TOP could be handled across a range of facilities.

Dr Chetty said that the communication of the Department needed to be strengthened. She said that they had received a lot of negative publicity but that there were positive aspects that could be highlighted.

The International Health Liaison's key focus was the NEPAD regional strategy and strengthening SADC agreements, for example the exchange of nursing staff to reduce outward migration of nurses.

Referring to Health Monitoring and Evaluation, Dr Chetty said that although as she had previously mentioned, they hoped to initiate another Demographic and Health Survey, StatsSA said that the funds the Department received from Treasury were not enough to cover the cost of the survey. The group that conducted the previous survey has said they can undertake the survey at a lower cost and the survey has thus gone to tender.

Dr Chetty said that at the moment the national patient complaint system was run on an ad hoc basis and needed to be strengthened.

Regarding mental health, Dr Chetty said that they had passed the Mental Care Health Act and now needed to look at implementation and regulations.

Referring to the PowerPoint presentation, Dr Chetty said that the counter advertising regarding tobacco had been successful and that they were extending this to deal with alcohol abuse. She said that in the Northern Cape for example the incidence of foetal alcohol syndrome was very high and that many road accidents across the county were the result of alcohol abuse. Counter Advertising would help to make people aware of what happens when women drink whilst pregnant.

Regarding HIV/AIDS and STIs the Departments priorities were to: expand the HIV Voluntary Counselling and Testing sites, to implement the courts decision regarding the roll out of mother to child transmission of HIV prevention drugs, to get general practitioners in the private sector to sue a syndromic management approach in dealing with these diseases and lastly to look at integrating all HIV grants to a single grant. Dr Chetty added that while there was underspending in many of the provinces with regards to these grants, there were reasons for this and the Department was looking to improve this.

Regarding Tuberculosis the Department aimed to increase the turnaround time for Sputa as it was low in many areas and to improve the first time care rate as this was linked to multi drug resistance.

Dr Chetty briefly mentioned the following areas:
-The Department was focusing on implementing the Pharmacy Act in the pricing of drugs and the licensing of pharmacies.
-The Department had been very successful in its cataract surgery project.
-The transfer of the South African Police mortuaries has been completed.
-There was a need to revitalise public hospitals and money had been allocated for this
-The strengthening of emergency services was needed
-Expanding non-personal health services

Dr Chetty said that they were concentrating on strengthening human resources particularly amongst mid level workers and community health workers. The Department was expanding recruitment and retention incentives to a number of health professions. In addition there would be a skills allowance for those skills that the Department had difficulty in recruiting.

Dr Chetty said that although the Department had achieved much they still had a lot of work to do. The Department had to concentrate on monitoring and strengthening the implementation of policies.

Discussion:
Mr J Thagale (UCDP) referred to the Department's distribution of condoms amongst the youth and said that due to the levels of poverty that many live in, some young women were resorting to having children in order to access the child grant. These girls were therefore indulging in unprotected sex. Mr Thagale said that if these stories were true, the control of the spread of HIV was affected. He asked the Department of Health to comment.

Mr Thagale said that the money allocated in the budget looked good but he was worried that it did not reach the rural areas but was concentrated around 'the glitter' of Cape Town or Pretoria.

Ms E Gouws (DA) said that they had done much to improve the environment with the anti-smoking legislation. However she said that alcohol abuse was in the same category as HIV in its impact and she worried that simply putting warning labels on bottles of alcohol would not deter people sufficiently. She added that the saying "naughty is nice" described the way young people were attracted to attractive labelling. They had experienced a lot of trouble due to alcohol abuse along Port Elizabeth' beachfronts and as a result drinking alcohol was banned on beachfronts, which helped with the problem. Alcohol abuse warranted drastic action such as banning alcohol at sports events and other public places.

Dr P Nel (NNP) asked how bad the backlog of cataract patients was and whether the shortage of ambulances in all the provinces would improve. Referring to the conditional grants for HIV/AIDS he asked what success had been made in monitoring.

Ms Jacobus asked if any legislation was not being implemented due to lack of funding as she had found was the case in other departments. What kinds of assisted devices were backlogged in delivery? Lastly she asked if the Department was functioning at full capacity and whether there were vacant positions.

Mr G Muller (Chief Financial Officer, Department of Health) said that they had spent R70 million last year on distributing condoms and would be sending R108 million this year. He said that whether this would solve the problem, time would tell. The money allocated was related to the changing exchange rates as some condoms were imported and all had imported materials in them.

Answering Ms Jacobus's question, Mr Muller said that he was not aware of any legislation not being implemented due to lack of funding.

Regarding Ms Jacobus's question on assisted devices, he said that they had been unsuccessful in asking Treasury for more funding.

Mr Muller said that the monitoring of HIV conditional grants was an ongoing battle. He said that a province might do well in one year but not in another as personnel in the Departments change. He said they tried to remedy fallbacks in performance and delivery as quickly as possible.

Dr. H Zokufa (Chief Director, Pharmaceutical Policy and Planning, Department of Health) said that the Pharmacy Act and the Medical Act were to be implemented this year and though there was available funding at the moment his concern was that the legislation applied to state standards, norms and guidelines and that there was a huge backlog and the state still needed to get its house in order to provide for this.

Dr Zokufa said that the fact that rural areas were not able to deliver was a constant thorn in their flesh. He said that the well to do areas could align themselves quickly to gain from legislation but the rural areas could not get their acts together in terms of human resource management. He added that they were trying to support the provinces. He added that most facilities newly legislated for are those relevant to the rural areas.

Ms A Marshall, HIV unit, Department of Health said that the since the conditional grants for HIV had been implemented three years ago there had been a huge increase in expenditure of approximately 91%. All provinces have to submit monthly compliance reports regarding the grants and there has been a big improvement.

Dr Pillay (Advisor, Director General's Office, Department of Health) said that he was happy that the Department was prioritising the rural areas. The European Union grant had all been spent on the thirteen rural nodes identified by the president. The Human Resources grant was specifically for focusing on issues of lack of capacity especially in rural areas.

Referring to Mr Thagale's concern about young women becoming pregnant to access child support grants, he said that it was problem and they had volunteers and youth workers addressing these issues.

He said that the backlog in assisted devices was in wheelchairs and hearing aids, however they had bought 3621 new wheelchairs and approximately 3000 hearing aids, which were in addition to those bought by provinces.

Dr Chetty said that R500 million was allocated to help recruit and retain skilled staff; this was to increase to R1 billion in the third financial year, two-thirds of which was a rural allowance.

Regarding teenage pregnancies she said that it was not only a health issues but a social development issue and that they needed to ask questions such as: are they creating perverse incentives? What environment exists for young women?

Regarding counter advertising of alcohol, Dr Chetty said that she noted Ms Gouws's point and that they were working with the drug authority to help with the problem.

Dr Chetty said that she could fax the details of the cataract patient backlogs and programmes to Dr Nell. She said that they had had many successes in dealing with the backlogs with the help of Tunisian doctors and a national cataract surgery day on which many operations were carried out.

Dr Chetty agreed that much work had to be done in addressing the backlogs in the emergency services, such as ambulance provision as well as maintenance and improvements in patient referral systems.

Lack of human resource capacity was a problem but they were addressing these issues. Dr Chetty said that meetings were held with the Director General in which all competing claims were put on the table and they decided what needed to be prioritised.