The Department of Health (DoH) appeared before the Committee to present a proposal for a Bill which will empower the creation of a National Public Health Institute of South Africa (NAPHISA). The Bill was proposed for the Institute to coordinate, conduct disease and injury surveillance, provide specialised public health services, interventions, training and research all directed towards the major health challenges affecting the population of the nation.
The Department outlined the reason for the formation of the Institution was to harness capacity that already existed with certain institutions that were buried under the National Health Laboratory Service (NHLS). NAPHISA will consist of three existing institutions, namely, the National Institute of Communicable Diseases, National Occupational Safety and Health National Cancer Registry, however, two additional institutes will be created, that is, the National Institute for Non-Communicable Diseases and the National Institute of Injury and Violence Prevention. Some of the institutions existed without mandates and the current funding process deprived them of the opportunity to function optimally, hence the proposal of NAPHISA. The clauses of the Bill were read to the Committee for its observation and questioning.
Committee Members engaged the DOH team in a robust discussion. Questions asked by the Committee included clarity on if NAPHISA had capacity to deliver proposed functions, cost of implementation, how the Department intended to raise funds for implementation, duplication of mandate, why the board consisted of only one community member, if there were African countries that had similar institutions and the effect of taking over these institutions by NAPHISA.
National Public Health Institute of South Africa: Department of Health Presentation
Ms Precious Matsoso, DG, DoH, stated that different institutions were under the National Health Laboratory Service (NHLS) that were in fact not supposed to be there. The National Public Health Institute of South Africa (NAPHISA) was therefore proposed as a separate institution with a separate law establishing it. She drew the attention of the Committee to the fact that countries agreed to comply and professed to have core capacities to abide by international laws but experience with the Ebola outbreak in West Africa showed these capacities were merely on paper and not strictly adhered to. The NAPHISA Bill was proposed to help the SA with epidemic preparedness and disaster management. NAPHISA was also proposed to monitor the trend of diseases in the world to identify places and types of outbreak so as to prevent transfer of diseases through migration of people. Ms Matsoso is the current chairperson of the independent oversight and advisory committee of emergency for the world and she knew the NAPHISA Bill is important to the SA.
Dr Anban Pillay, DDG: Health Regulatory and Compliance, DoH, outlined the purpose of the Bill was to establish NAPHISA as a defined organ of state. NAPHISA was to manage communicable and non-communicable surveillance systems which were currently managed by different institutions - there is currently no unification or collective umbrella. The intention of the Bill was also to provide coordinated surveillance data with the purpose of improving effectiveness in the health sector. Challenges that led to the creation of NAPHISA were:
(1) need for a coordinated surveillance data.
(2) finances of the Department unidirectional towards the treatment of infectious diseases
(3) evidence of inaccuracy of data due to disperse sources of data
(4) lack of coordinated human resources
(5) need to find a sustainable approach to funding methods by the Department
Dr Pillay then cited examples of institutions like NAPHISA that were created in countries like Canada, China, the USA and the UK. These included the Public Health Agency of Canada (PHAC), Centers for Disease Control and Prevention (CDC) in the USA, Health Protection Agency (HPA) in the UK and the Center for Disease Control and Prevention in China - these countries achieved better health services and these institutions had many benefits which included cost savings.
Ms Matsoso indicated the Medical Research Council (MRC) was a research institution while the NAPHISA would be involved in ongoing surveillance so as to identify when there was a need for different strategies in health interventions adopted by the Department.
Dr Pillay said the aim of NAPHISA was to provide integrated and coordinated disease and injury surveillance research, monitoring and evaluation services and interventions directly toward public health in SA. NAPHISA will consist of three existing institutions the National Institute of Communicable Diseases, National Occupational Safety and Health National Cancer Registry as well as the creation of two additional institutions, namely, the National Institute for Non-Communicable Diseases and the National Institute of Injury and Violence Prevention. NAPHISA will coordinate the burden of disease and injury under a single organisation.
The Committee was then taken through all the proposed functions of NAPHISA as highlighted in the proposed NAPHISA Bill. Members were also taken through the clauses of the Bill, namely,
-clause one: definitions
-clause two: establishment of NAPHISA of South Africa
-clause three: functions NAPHISA
-clause four – 20: governance and the control of NAPHISA, composition of the board, how members of the board would be appointed, chairpersons of the board, disqualification from membership or removal, meetings of the board, committees of the board and appointment of Chief Executive Officer (CEO), functions of the CEO, transfer and secondment of persons, intellectual property rights, finances of NAPHISA, delegation of function, limitation of liability, regulations, transfer of property belonging to the state, and transfer of employees, assets and liabilities from NHLS to NAPHISA
Ms P Kopane (DA) asked the DoH to explain why the board was designated as the accounting officer instead of the CEO. She asked the Department to clarify why the board members had five years tenure and not three years as applied to the NHLS. She also asked for the elaboration on the effect of incorporating the existing bodies into NAPHISA since the existing organisations had their own research mandates.
Ms S Thembekwayo (EFF) asked for clarity on the composition of the board. She wanted to know what guided the decision regarding the board especially considering the anticipation of non-attendance of board members and the need for more involvement by the community as a major role player.
Dr P Maesela (ANC) asked if the intellectual property right, which specified the research conducted by employees belonged to NAPHISA, would not deter innovation or findings because scientists always preferred to own the right to their findings. He asked the DoH to state how liability could be removed from the staff of NAPHISA while performing service to the people. He also asked for clarification on how the function of NAPHISA would align with the function of the Commission of Occupational Diseases.
Ms L James (DA) asked the Department to speak to the effect NAPHISA would have on the other institutions since NAPHISA was expected to strengthen advocacy. She also asked for clarification on how NAPHISA would be facilitated under the Presidency or under the municipality.
The Chairperson asked the DoH to explain the strategy it would use to create awareness for NAPHISA in communities and how people would be made to understand the NAPHISA Bill. She noted that the numbers of meetings of the board were too few and suggested the number be increased to three instead of two as indicated in the Bill. Would NAPHISA incorporate only the institutions mentioned or were more institutions to be incorporated?
Ms Kopane noted there was a lot of responsibility on NAPHISA – she asked if NAPHISA was taking over the responsibility of other institutions.
Ms Matsoso said there were a number of institutions that existed, in their own right, before the National Health Laboratory Service (NHLS) Act was formulated, but the NHLS was made an umbrella for some of these institutions. The specific provision abolished all laboratories. The SA Institute of Medical Research, SA Medical Research Council, SA Institute for Virology Forensic Chemistry Laboratory and all provincial health laboratories were all put under the NHLS. These institutions themselves did not have their functions written anywhere in the law. NAPHISA will be working as a coordinating body to put the institutes to better use. The institutions with functions that did not lead to clinical care were removed and put under the umbrella of NAPHISA. In a situation where there was chemical or nuclear spill or terrorism attack, the institution that would respond to these challenges would be NAPHISA. It is an institution that must be protected under government control and must be funded directly. NAPHISA would still conduct a certain level of research but it would not conflict with the provisions of the Medical Council Act. The observation of the Members on the number of community members represented on the board was valid and will be looked into. Information to the public would be done by NAPHISA - every institution that had a mandate to protect the public also had a mandate to inform and educate the public. Three years tenure of board members was relevant. As she was an advocate of open source information, she felt no employee should claim ownership of research finding conducted using public funds - there must be open source to advance knowledge and science but there must be a way to compensate owners of the information.
Dr Pillay stated government structure for public entities was that the board appointed the CEO and the board was responsible for the institution. When employees were employed, they have to adhere to the rules and regulations of the organisation and, in case of transgression, appropriate measures will be taken to deal with the employee.
The Chairperson asked if there was capacity for NAPHISA considering the magnitude of work proposed and the shortage of professionals in the sector as this could create delay in the area of delivery of NAPHISA’s mandate. Was there any country in the African region that used a similar institute as proposed? She asked the DG to put the explanation on the purpose of NAPHISA in a written report so as to empower the Committee.
Ms Matsoso responded that capacity for carrying out these functions already existed in the Department but it was not empowered and not referenced in the Act because they were buried under the NHLS. The proposed institute is meant to give a mandate to the institutions that were buried under the NHLS. There are 21 similar institutes on the African continent which had such associations. The situation in SA was different because SA has capacity to have highly infectious pathogens. Due to funding model challenges, the nation had compromised on institutions that should be protected.
The Chairperson asked how the Department will ensure that South Africans understood the institution was not for the high and powerful. Although the proposal needs to be academic and technical, it was the responsibility of the Department of Health to ensure the presentation was conducted in a user friendly way for the sake of ordinary people. She asked the Department to state how many submissions were received concerning the NHLS and NAPHISA to empower the Committee as it prepared for the public hearing. She also instructed the Committee secretariat to carry the House of Traditional Leaders along as the work on the Bill progressed.
Mr N Matiase (EFF) found it encouraging knowing there were 21 countries in Africa that had a similar institution.
Ms Kopane needed clarity on the funding modules. She asked the DoH to state the cost implication of implementing NAPHISA and explain exactly how NAPHISA would be funded.
Ms Matsoso replied that SA was undergoing the Joint External Evaluation (JEE) in terms of the international health regulation – the Committee would be provide with the International Health Regulations (IHR) and examples of countries that did their JEE including Uganda and Tanzania in Africa. The financial implication was not contained in the Bill as it already existed but there was the risk of uncertainty if the money was channeled through the NHLS. Financial needs will arise after SA did it’s JEE to ensure the institute was able to achieve capacity to comply with international regulations. The body would ensure that tradition, science and environment relate together. She also emphasised the institution was very important.
The Chairperson remarked the briefing was the beginning of the processing of the NAPHISA Bill.
The meeting was adjourned.