National Public Health Institutes of South Africa (NAPHISA) Bill: public hearings day 2

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Health

17 August 2017
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

The Public Service Accountability Monitor (PSAM) and the Health Promotion and Development Foundation Network (HPDNet) presented its comments and recommendations on the National Public Health Institute of South Africa (NAPHISA) Bill to the Portfolio Committee on Health.

PSAM was established in 1999 as a project for Rhodes University with the core mandate of improving service delivery and enhancement towards the progressive realisation of constitutional rights. It also seeks to enhance and strengthen accountability of various actors to ultimately enhance the sharing of knowledge on the use of public resources. Despite the progress in the provision of accessible and affordable health care, there are many who are still marginalised in terms of access to public health care information. The NAPHISA bill is vital for the realisation of the not only right to access to affordable health care but also the removal of other prohibitive obstacles.

PSAM said the Bill is not clear on the funding mechanism necessary for NAPHISA despite the current labour disputes of the National Health Laboratory Service (NHLS) regarding claims of corruption and poor working conditions. The Bill should find stronger remedies to prevent this. There should be stronger accountability structures between NAPHISA and the provincial departments to ensure that payments due to the NHLS are made. The Bill does not adequately articulate measures for South Africa’s open data commitments which should also be expressed in the Bill. Information Communication and Technology (ICT) needs are also not clearly expressed despite the apparent needs for modernisation.

The Committee observed that, although a large number of issues had been raised, there were no concrete recommendations made. PSAM was urged to get community input in the form of informed recommendations from the communities on the ground. There should be more clarity on the proposed recommendations to assist the Committee during their deliberations on the Bill.

HPDNet expressed the need for the establishment of a health promotion foundation. Health promotion will enable people to increase their ability and control over the improvement of their health. The NAPHISA Bill, however, does not mention health promotion and should at least recognise it in its preamble as a strategy to improve the health of populations and an expert in health promotion should be part of the Board.

Health promotion should include other sectors of society outside the health industry to reap optimal benefits. As a key example, recently the South African Breweries (SAB) launched a campaign called ‘Beers for Africa’ in partnership with the ‘Stop Hunger Now’ South Africa NGO, now rebranded as ‘Rise Against Hunger’. The problem with the campaign was that SAB had promoted the idea that the sale of beer would raise money to support students that are hungry and thereby ignored the relationship between poverty and alcohol. Alcohol reduces the amount of money available for basic needs such as education, food and health whereas alcohol consumption has been seen as a stress reliever for those suffering from poverty.

There was an initiative to make SAB stop promoting the sale of beer on the basis of feeding hungry children. SAB has since then withdrawn their campaign and have committed to donate money to ‘Stop hunger Now’, directly, without promoting the sale of beer.

The Committee said that there was a lack of specification with regards to the contribution to the NAPHISA Bill. There should have been specific proposed amendments made, if any, on the sections of the Bill.

Meeting report

Presentation by the Public Service Accountability Monitor (PSAM) on the NAPHISA Bill

Ms Zukiswa Kotwa, Public Service Accountability Monitor (PSAM), said that PSAM was established in 1999 as a project for Rhodes University with the core mandate of improving service delivery and enhancement towards the progressive realisation of constitutional rights. It enhances public dispensation and resource management by looking into budget and planning in relation to health, education, local government and human settlements. It also seeks to enhance and strengthen accountability of various actors so as to ultimately enhance the sharing of knowledge on the use of public resources. PSAM is in full support of the establishment of NAPHISA.

Despite the progress in the provision of accessible and affordable health care there are many who are still marginalised. The establishment of NAPHISA is vital towards the realisation of the not only right to access affordable health care but also the removal of other prohibitive obstacles.

On the proposed funding of NAPHISA, it states that funding to create new information and creation of new management systems has been provided by National Treasury in the 2015/16 financial year. In effect, this reduces the cost for transition through shared corporate functions within the service during the transition process and thereby reducing also the need for additional funding. Implications on the personnel budget have been reduced due to the decision to align the NAPHISA staff with the Department of Public Service and Administration (DPSA) remuneration scales and conditions of employment.

The Bill is not clear on the funding mechanism necessary for NAPHISA despite the current labour disputes of the National Health Laboratory Service (NHLS) regarding claims of corruption and poor working conditions. The Bill should find stronger remedies to prevent this from happening. There should be stronger accountability structures between NAPHISA and the provincial departments to ensure that payments due to the NHLS are made.

There is inadequate articulation of measures for South Africa’s open data commitments which should also be expressed in the Bill. ICT needs are also not clearly expressed despite the apparent needs for modernisation. It should outline, in relation to public health and surveillance data, the budgets and resources needed and also provide for open access to the data collected. The Bill should outline the technical support for the maintenance of the system that would be needed.

On environmental and occupational health, there is an omission on the National Health and Environment Policy and inadequate provision for the protection of the environment and the health of individuals under Section 24 of the Constitution. This may have an impact on the research and monitoring as well as the coordination the Bill seeks to enhance.

There is an under representation of members of the public on the Board and also health promoting civil society organizations who work on the ground with communities. The Bill is silent on the specification for the eligibility of the community representatives on the Board and also their geographical diversity. The Bill should outline the eligibility criteria to avoid ambiguity.

Reports on the reporting and accountability mechanisms on health, decease profiles, injuries and violence and occupational health should be produced more regularly. The institute should make recommendations to government on health measures for decease outbreaks and mitigating risks and hazards of injury and violence. There is a need for clarity on the binding nature of these recommendations and the feedback mechanism, if any.

Discussions:

Mr A Mahlalela (ANC) noted that although a large number of issues had been raised, there were no concrete recommendations made. On the funding structure, he asked what practical recommendations and additional measures could be incorporated into the Bill to enhance and strengthen existing structures. What measures could be taken in order to prevent wastage in addition to measures provided under the Public Finance Management Act (PFMA)? With regards to accountability and reporting, he asked what measures could be adopted if the current reporting mechanism is inadequate to provide for more public access to information and enhance accountability. He referred to environmental and occupational health and asked whether PSAM was suggesting it to be an additional division to the five divisions already existing in the Bill. On the composition of the Board, he asked for clarity regarding the proposal to include an additional member of the public as a community representative, specifically why one representative is insufficient and also why a separate category for an ICT representative on the Board should be included. On the binding nature of the Board’s recommendations, he asked whether they should be binding under the Office of the Public Protector (OPP) and under which specific section in the Bill it should be expressed.

Mr P Maesela (ANC) asked which types of funds PSAM was addressing in particular and whether they were referring to government funds. He also he asked whether PSAM had engaged any government departments while conducting their research or if their research was purely academic in nature.

The Chairperson welcomed the presentation, but said it too academic and proposed that PSAM should try going and getting the issues on the ground.

Ms Kotwa replied and said that although PSAM was part of Rhodes University, it was not a purely academic project. It also engages with policy makers and government departments. Despite its research having an academic perspective, it is evidence-based. There remains a need for greater representation on the Board, for example, women and or youth, so as to provide access. Representation should be guided by some eligibility criteria of which the Bill, as it is, is silent.

The Chairperson said the Director-General, at an appropriate time, will respond to all issues raised. PSAM’s submissions should have informed recommendations from the communities on the ground. There should be more clarity on the proposed recommendations to assist the Committee during their deliberations on the Bill.

The Health Promotion and Development Foundation Network (HPDNet) on the National NAPHISA Bill

Ms Gonda Perez, Associate Professor, UCT, Health Promotion and Development Foundation Network (HPDNet), said that their institution was a network of individuals and institutions that believed in health promotion as a vehicle to achieve healthier communities. Their aim is to lobby for the establishment of a health promotion foundation and the realisation of constitutional health rights. Health promotion is the process of enabling people to increase their ability and control over the improvement of their health. It focuses further from individual behavior and more into the socio-political environmental interventions. Other countries such as Australia and Thailand have established health promotion foundations.

The NAPHISA Bill does not mention health promotion and should at least recognise it in its preamble as a strategy to improve the health of populations. In addition, an expert in health promotion should be part of the Board. One of the functions of NAPHISA should be to work with civil society in the establishment of a health promotion foundation. Health promotion should be regarded as an ongoing activity and be looked at in a broader sense to programs that go beyond prevention.

Health promotion should include other sectors of society outside the health industry to reap optimal benefits. As an example she said recently the South African Breweries (SAB) launched a campaign called ‘Beers for Africa’ in partnership with the ‘Stop Hunger Now’ South Africa NGO, now rebranded as ‘Rise Against Hunger’. The problem with the campaign was that SAB promoted the idea that the sale of beer would raise money to support students that are hungry and thereby ignored the relationship between poverty and alcohol. Alcohol reduces the amount of money available for basic needs such as education, food and health whereas alcohol consumption has been seen as a stress reliever for those suffering from poverty.

There was an initiative to make SAB stop promoting the sale of beer on the basis of feeding hungry children. SAB has since then withdrawn their campaign and have committed to donate money to ‘Stop Hunger Now’ directly, without promoting the sale of beer.

Discussions:

Ms S Thembekwayo (EFF) said that there is a lack of specification with regards to the contribution to the Bill. Most of the issues addressed in the presentation are meant for a discussion on another occasion and not in the agenda of the Bill.

Mr Maesela said that poverty is the greatest cause of ill health and therefore any organisation contributing towards its alleviation should be welcomed.

Ms C Ndaba (ANC) asked whether HPDNet was looking for the Committee’s endorsement as one of the organisations that are part of NAPHISA.

Ms Perez responded and said that, with regard to specifications, health promotions should be mentioned in the preamble as a strategy to improve health. HPDNet does not wish to be part of NAPHISA since it is an independent organisation. An independent health foundation should promote good health in the population.

The Chairperson said that any proposed recommendations should specifically address sections in the Bill which should be amended or added.

The meeting was adjourned.

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