Department of Health + Compensation Commissioner for Occupational Diseases 2016/17 Annual Report

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Health

10 October 2017
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

Annual Reports 2016/17

The Portfolio Committee on Health concluded its Budget Review and Recommendation Report (BRRR) process with presentations by the Compensation Commissioner for Occupational Diseases (CCOD) and the National Department of Health (NDOH) on their annual performance for the past financial year.

The inability of the CCOD to provide an audited report since 2009/2010 financial year was blamed on the poor state of the Commission before the arrival of the current leadership. The Commissioner promised that the CCOD would clear its backlog of reports and meet its time frame targets by the 2018/19 financial year. In the current year, its achievements included the ownership of a centralised web-based database for the coordination of former and current mine workers. It had exceeded its target to inspect mines, achieved an increase in the number of beneficiaries who had received medical examinations by 21%, the payment of claims had increased by 58%, and outreach activities were up by 170%. One stop service centres had been established and strategies had been developed for tracking and tracing ex-mineworkers who were beneficiaries of the fund. The process of harmonizing the Compensation for Occupational Injuries and Diseases Act (COIDA) and the Occupational Diseases in Mines and Works Act (ODMWA) had been stalled because the Department of Labour did not agree on the collaboration. The CCOD had initiated a strategy called the ‘clean break transfer,’ which ensured that new mine workers were started off on COIDA, while former and current workers would be on the ODMWA. The challenges facing the CCOD were poor information technology (IT) infrastructure, and financial constraints which led to limited capacity.

The Committee expressed concerns over the compensation backlogs and the lack of collaboration and coordination among the stakeholders -- the Departments of Health, Social Development and Labour. Members asked questions about the one stop centre operations, the clean break intervention process, the working relationship between the Chamber of Mines, the union and CCOD, the harmonisation of the ODMWA and the COIDA Acts, and the tracing and tracking mechanisms for ex-miners.

The National Department of Health (NDOH) reported that it had received its sixth unqualified audit outcome in the year under review. Some of the achievements of NDOH were meeting its targets in four provinces and the submission of the final White Paper on the National Health Insurance (NHI). It had also exceeded its targets on improved access to sexual health, the provision of qualifications for primary health care facilities at ideal clinics, and coverage for spraying against malaria.

The Committee commended the NDOH for obtaining an unqualified audit opinion. It asked about its strategies to address issues that had led to a qualified opinion in some provincial health departments, and irregular expenditure in the provinces. It questioned the Department on its fruitless and wasteful expenditure, the disparity between funds spent and targets met, the status of interns, strategies to address the non-submission of annual reports by the CCOD for years, and timeframes for putting ex-miners on the CCOD database. Other matters debated included the NHI, targets, budgets for HIV testing and anti-retroviral (ARV) supplies, the accuracy of its reported performance based on the AG’s concerns, the poor state of Pretoria’s forensic laboratories, the status of hiring unemployed graduates and consultants in the Department, the draft Tobacco Products Control Amendment Bill, the patients’ experience care survey, measures to ensure that women in rural areas accessed care, the MomConnect maternal care programme, interim traditional health councils, efforts to stop malaria and new sexual infections, the strategy for retaining healthcare workers in rural areas, and assessments on Life Isidimeni centres.

Meeting report

Compensation Commission for Occupational Diseases (CCOD): Annual Report

 

Mr Barry Kistnasamy, CCOD, National Department of Health (NDoH), said the Commission had not presented any audited annual report to Parliament since the 2009/10 financial year. The CCOD was still building its base and had just been resuscitated after it almost died some few years ago, but he promised that it would move forward henceforth. The presentation was based on an unaudited report of the 2016/17 financial year.

He said there had been an increase in the number of beneficiaries for medical examinations by 21%, with increases in certifications, payment of claims and outreach activities by 60%, 58% and 170% respectively. The CCOD targeted inspecting 50 mines, but had been able to inspect up to 79. The Auditor General (AG) had given a disclaimer on the 2010/11 annual report, with a qualification on revenue. The report for 2010/11 was with the government printer and would be made available to the Parliament in a short time.

The CCOD had progressed to obtain a qualification on revenue in the 2011/12 financial year. 30% of the comments made by AG could be linked to challenges with Information Technology (IT) and some problems of missing documents. A collaboration between the Presidency, the Department of Mineral Resources, the Department of Labour, the African Union, the Southern African Development Community (SADC), the Ministry of Health and the CCOD had raised the profile of compensation and social protection reforms in national and international forums, including SADC. While the CCOD had R1.2 billion in unclaimed benefit for 100 000 ex-mine workers, the collaboration had brought about R45 billon as unclaimed benefits for about four million ex-mine workers in Southern Africa. The R45 billion was available, but the beneficiaries could not be found. The collaboration was working to carve out the mine workers’ social protection fund to get an integrated system for managing the fund. Mining companies had continued to support the CCOD by putting in about R100 million per annum, although this was insufficient because the payment did not cover the cost of the summation of the administration, care and income protection fund. The fund covered only the income protection fund.

There were one stop service centres based in provincial facilities. The internal environment had been problematic in the last year; with lots of work disruptions by organised labour. The CCOD had a declining budget because of inflation, challenges with IT and human resources. Although there was a new lung function machine, the x-ray machines were outdated. A process of integrating two compensation systems -- the Occupational Diseases in Mines and Works Act (ODMWA) and Compensation for Occupational Injuries and Diseases Act (COIDA) – had been led by the Deputy Minister of Mineral Resources, who had initiated a discussion among the Departments of Mineral Resources, Labour and Health. The integration process had stalled because the Department of Labour had declined owing to the backlog of the fund, which did not give a clear picture the current situation of the fund. The trade union felt that there were some benefits in COIDA that should be implemented by labour. He recommended a need to have a joint meeting with other Departments who were stakeholders in the compensation funds.

 He said the CCOD had introduced the clean-break transfer which stipulated that new mine workers would start on COIDA in the Department of Labour, while former and current workers would be on the ODMWA. There would be a new governance model, and they would be working with the legal department to initiate the process.

Ms Shireen Pardesi, Chief Director: CCOD, explained the progress made on the one-stop service centres to the Committee, and said that two centres would be commissioned within the next two months.

Mr Kistnasamy said the CCOD now had a web-based electronic database linked to The Employment Bureau of Africa (TEBA), unlike previously when it had relied on TEBA database at an access fee of R90 per record. It was expected that at the end of next year there would be 400 000 current mine workers in the database, eliminating the possibility of looking for mine workers when their claims were due. The CCOD would be meeting the Banking Association of South Africa (BASA) to negotiate a no-fee accessible banking package for ex mine workers. It was also working with TOMTOM, which had mapped out the 17 million households in South Africa, and a model had been developed on this information which was would be used for tracing ex-mine workers.

Claims had increased since the tracking of ex-mine workers began. 10 113 payments had been made, amounting to R322.6m. The CCOD could verify the 80% of the mines from which its revenue was generated. The financial evaluation was currently done in three years but there had been a request by the CCOD to evaluate its financial report annually.

Mr Maswadi Molawi, Deputy Commissioner: CCOD, National Department of Health (NDOH) said the AG’s comment had been that the CCOD did not have the knowledge of the entire population of the mines that it controlled, which led to an audit qualification in the 2011/12 financial year. Gazettes of ten mines were outstanding because the CCOD did not have sufficient capacity. The challenge with mine gazettes was the  change of ownership, hence the AG requested that the gazettes be linked to the trail of owners of the mines. He said 1 002 mines had been identified. He listed the number of mines that were closed and the number awaiting inspection.

Mr Kistnasamy said services in neighboring countries had been setup. The CCOD would work towards electronic submission, occupational health, and the rights of workers. The Minister had allowed a research fund to be taken from the compensation fund. The CCOD would be going to Australia, Canada and Europe and would be going with members of the Portfolio Committee. A workshop to build on lessons learnt in the last five years would take place at the end of 2017.

The CCOD said it had covered about 20 000 households. 8 008 ex-employees were connected and 500 people that were already certified were currently in the process of being compensated.

Mr Kistnasamy briefed the Committee on the CCOD’s visit to Malawi and Angola. He said there was a collaboration of stakeholders of compensation funds to enlighten people across the continent.

Discussion

 

Ms S Kopane (DA) remarked that she became a member of the Committee ten years ago and the Commissioner sounded like his predecessor, but she commented that the new Commissioner was honest. He had said that without the financial statement, it was difficult to track transparency. The presentation showed that the CCOD was not close to solving the problems of people. She asked how the one-stop centre operated and for clarity on the mode of funding -- from the donor fund or from the Department. She also asked how many one stop centres had been planned, and how the needs of the ex-mine workers would be addressed on the clean break intervention. She asked him to state the process of harmonizing the two Acts and its mode of operation. What was the working relationship between the Chamber of Mines, the unions and the CCOD, and how did the relationships help to eliminate disruption to work? Why had it taken such a long time to decide to learn from countries that were doing better on the subject?

Dr P Maesela (ANC) said there was a need for the Commission to expedite its services, because justice delayed was justice denied. There was a need to provide a financial statement after so many years. The last one had been in 2012, and it was important to finalise and not make it a futuristic subject. He asked if the Commissioner did not think the delay in harmonising the ODMWA and the COIDA was becoming a human rights issue. He observed that if the Acts were not harmonised, the workers would be deprived. The faster the harmonisation was, the better. He asked if was not possible for the CCOD to become the custodian of the data, because it was the of core the CCOD's activities. He observed that some technologies were used in other countries to track mine workers during rockfalls to assist, so he asked the CCOD to explain why the mine owners in South Africa did not have such technologies. He said there was a need to work on the wellbeing of the mine communities where they lived. He asked if the communities affected by mining activities were covered by the CCOD.

The Chairperson said some of the questions may not fall within the scope of the CCOD, but it would need to work with other departments. She asked if it was limiting its tracing mechanism to places where there were mining activities. People were migrating. What part of the Eastern Cape had been covered in the tracing? The CCOD had limited human resource capacity for inspection, although she understood that it was working in a complex environment. She asked the duration for which the unemployed graduates were used, and until when. Were there financial constraints that prevented the CCOD from giving a stipend to the unemployed graduates to ensure that they were engaged for a longer period? She appreciated the breakthroughs that were noticeable, but she was worried that the sector would still have backlogs of compensation. There was a profound reason to demand integration, and she accepted that there was need for a joint meeting with the other departments. She was disappointed that the hope of harmonising the Acts had been dashed. She asked why there were outdated x-ray machines in the CCOD.

Ms Kopane asked who decided which mines were to pay the levies, and when last was the list updated for control purposes.

CCOD’s Response

 

Mr Kistnasamy said he understood the frustration of the Committee, and gave an insight into the history of the compensation of mine workers -- the segregation and other activities that led to the backlog in the Compensation. When he took over, he inherited a dysfunctional system and thought it would be possible to pull through the problems in two years, but unfortunately there were still challenges. The CCOD was doing two-yearly financial statements -- the one for 2010/11 and 2011/12 had been concluded, and was with the government printer. The AG was busy auditing the 2012/13 and 2013/14 one. It was working to make sure that other reports would be updated to the 2017/18 financial year. There were all accounting-type issues. Five chartered accountants had been provided and funded outside the organisation. R60m was given as vote to run a R200million operation providing decentralised services.

About 40% of the claims were dated to before year 2000, and had been inherited by the present management. About R850 was needed for a single test, and it was more expensive in the rural areas. Each one-stop service centre cost about R10 million. He said there were no resources provided by the state. Although money had been raised, the sustainability of the Fund required changes in the levy, which could be done through changes in the legislation. In the previous Act, the state took responsibility for the problems caused by the industry. The levy paid by the industry should include the cost of administration, health care, service delivery and the cost of incapacitation, while the current levy covered only income protection.

The platform was set for CCOD to produce an up to date financial statement in 2017/18 financial year and to deal with all matters emphasised by the AG. It would get additional support for an IT system. There had been a discussion with the Chamber of Mines, as the CCOD was not up to date with mine closures. He spoke extensively about the need to work with other stakeholders such as the Department of Mineral Resources, and requested that a joint meeting with other Departments should be convened to address overlapping issues and collaboration.

He said there had been class action law suit against the mining companies which covered some diseases, in the lower and high courts. He had asked for intervention for an out-of court settlement with the two groups. The two groups were working towards an out of court settlement, and he informed the Committee of the categories of settlement. There were about 400 000 workers under the control of the CCOD, but 500 000 workers in the mining industry. The CCOD would work at ensuring all the mine workers were on its database by working with other stakeholders in the mining industry. Also, another source of revenue would be interest. Currently the interest of the Fund could not be used for administrative purposes, but this would change.

Mr Kistnasamy said there was a plan to set up a one stop centre per province. The concept of the one stop centrtes was to help with surveillance and remove the bottlenecks qt provincial health facilities. This necessitated the one stop service centres having to be located in the provincial health facilities. However, South Africa could get only four centres unless there was additional funding for the CCOD. There was a plan for seven in neighboring countries. He apologised for lateness in adopting the method of learning from other countries, but said it was never too late.

He said there was a good relationship with organised labour, external to the process, although there were a few difficulties with organisations like the Public Service Association (PSA) .He agreed that justice delayed was justice denied. About 600,000 mine workers had probably died without compensation. Environmental health issues and compensation were outside the mandate of the CCOD. Also, it was not involved in deciding the technological interventions to be used in the mines. It only covered people who got diseases from exposure while working in the mines.

He said there were social and cultural barriers to identifying and paying the benefits, and the CCOD was working at improving awareness. New lung function equipment had been delivered to Johannesburg. The X-ray machines would be changed when the procurement process was completed. The database was owned and managed by the Department of Health but available to every department and entity that might want to use it.

The CCOD recognised the issues and was working with the Department of Mineral Resources to address them. It was not neglecting any province, but it had to prioritise considering the huge backlog it had. The funding for the outreach activities came from the Chamber of Mines. The CCOD was concluding how to improve things. The social protection discussion with the Presidency was important. There was a need to have horizontal integration rather than the vertical silos that were currently in use.

Dr Nhlanhla Mtshali, Director: NDOH said a number of certifications had been done, but due to quality problems the CCOD had to target occupational health doctors and train them to understand the requirements. She indicated the areas that had been covered and the areas that would soon be covered.

Ms Pardesi said the CCOD outreach for 2016/17 had been completed, and indicated the other areas that would be covered in the outreach by the end of year 2017.

Mr Kistnasamy addressed the concerns regarding administrative inputs and described the integration in respect of the new workers. With the settlement fund, some administrative issues would be addressed and the levy changes would improve matters with the current fund. New workers in the mines would enter under COIDA and would not have a baggage under ODMWA. The Occupational Diseases in Mines and Work Act would deal with baggage legacy problems which had been declined by the Department of Labour. It would deal with the ex-mineworkers problems, and the current 400 000 workers. It would also absolve the government from having to provide funds for ex-mineworkers.

There had been a discussion with the Chamber of Mines, and the CCOD would need to take it to the industry. The Chamber of Mines and the working groups were putting in substantial resources to support the tracking and tracing of the one-stop service centres. There would be events to showcase the work that had been done through these partnerships. They were in contact with the Presidency which was very keen on looking at the use of unemployed graduates for tracing ex-mineworkers. There were 600 000 mineworkers to be found, which made it a sustainable programme for unemployed youths.

Mr Mpho Ndaba, Executive: Department of Planning, Monitoring and Evaluation (DPME), said the CCOD would use the children of ex-mine workers to track the people because they knew the ex-mineworkers better.

Dr Maesela said it would be advantageous for CCOD to write down all its recommendations and forward them to the Committee for further submission to the Treasury.

Ms Kopane said the presentation showed that there was no collaboration among the stakeholders -- the Departments of Health, Social Development and Labour. Without coordination between the stakeholders, it would be difficult to make landmark achievements. She asked the CCOD to give clarity on the process being shared by the three Deputy Ministers.

Mr Kistnasamy said the NDoH was not responsible for social protection, but just a technical aspect of social protection, such as occupational exposure limits. The Department of Labour was responsible the preventive aspect of exposure. The Deputy Ministers of the three departments were entrusted with the process of integrating the two Acts.

The Chairperson commented that the Commissioner had said the state took the responsibility for ex-mineworkers where the industry did not take the responsibility. He had said the sector was dealing with a legacy that had been present for years. She said it was often forgotten that this was a legacy from which some people had not benefited. There were people who were getting away with murder. The mine owners were rich from the work of people who were perishing. There was a need to coordinate the unemployed youths so that the mineworkers did not lose hope. She also hoped that the communications in the outreach programmes were done in the languages understood by the audiences. It was important that districts were specified when reporting training and payment, so that the Committee could be empowered to perform its oversight. The Committee was happy on the issue of the fund, and she thanked the Chamber of Mines for its assistance. She requested more detailed information and asked for the location of the quarries. The CCOD still had more work to do, and the Committee would still engage with it.

National Department of Health (NDOH): Annual Report

 

Dr Anban Pillay, Deputy Director General: Regulations and Compliance, NDOH, highlighted the performances of the Department and compared them to the targets set for each indicator in the annual performance plan. It had received the sixth unqualified audit outcome at the end of the 2016/17 financial year.

Program One (Administration) had a vacancy rate of 8.1%, which was below the DPSA benchmark of 10%. Four of the nine provincial offices of the NDOH had demonstrated improvements in their audit outcomes. The Free State had received an unqualified audit after 13 years.

On Program Two (Health Planning and System Enablement), the final White Paper for the National Health Insurance (NHI) was submitted for Cabinet’s consideration at the end of March 2017. The Minister had announced seven NHI implementation structures which were published in a Government Gazette Notice on 7 July 2017. The NHI draft bill produced in 2016/17 was scheduled for submission to Cabinet for approval and would be presented to Parliament in March 2018. More than1.25 million patients were receiving prescribed medicine through the centralised chronic medicine dispensing and distribution programme. 3 121 primary health care facilities were implementing an electronic system for early detection of stock-outs of medicine. The Department had conducted a demographic health survey to track the health status and progress of the people of South Africa against the National Development Plan. The survey had covered 15 000 households and was completed in November 2016.The Key Indicator Report was released in May 2017. The Health Patient Registration System (HPRS) had been designed in partnership with the Council for Scientific and Industrial Research (CSIR) and the Department of Science and Technology (DST) for the development of personal health records. 1 849 facilities were implementing the web-based Health Professionals Council (HPC) registration. The NDOH was participating in the development and implementation of various regional health initiatives to combat the cross-border spread of diseases.

On Program Three (HIV and AIDS, Tuberculosis, Maternal, Child and Women Health), the NDOH had tested 14 233 123 people for HIV, which exceeded the target of 10 million. A reduction of diarrhorea and pneumonia cases in children below the age of five had each recorded a 2.0% improvement. The Basic Antenatal Care Plus (BANC Plus) strategy for eight antenatal visits was implemented in April 2017. The Department also recorded improvement in the access to reproductive health services and an increase of TB/HIV co-infected patients on anti-retroviral (Arv) treatments.

On Programme Four (Performance Improvement Strategies), technical support was provided to Mpumalanga for the development of implementation plans for the national policy framework and strategy for Disability and Rehabilitation Services. The surveillance and treatment of malaria along the border areas through regional and cross-border interventions was improved.

The achievement in Program Five (Hospitals, Tertiary Services and Workforce Development) was the development of a new basic nursing qualification programme and curriculum in line with the national nursing education and training policy.

On program six (health regulation and compliance management), the South African Health Products Regulatory Authority (SAHPRA) was listed as a public entity, and the National Public Health Institute of South Africa (NAPHISA) Bill was approved by Cabinet for tabling to Parliament. CCOD and Occupational Health produced an electronic database of 600 000 records of claimants, and hosted the integration of compensation systems summit.

Mr Ian van Der Merwe, Chief Financial Officer: NDOH, said the Department had obtained an unqualified audit opinion for the sixth year running. It had spent 99.7% of its budgeted expenditure. There was no unauthorized expenditure. Deviations had occurred because payments to non-profit organisations were not made owing to service level agreements (SLAs) that were not concluded before the end of the financial year. Also, the planned expenditure for infrastructure projects did not occur. A roll-over had been requested from National Treasury for unspent funds linked to committed projects.

Discussion

 

Dr Maesela (ANC)asked what had been done to address the prevalence of irregular expenditure that had increased in the provincial departments of health over time. What had been done about fruitless and wasteful expenditure of R402 000 incurred by the Department? The NDOH should explain why there was a disparity between the money spent and the target that was achieved. The NDOH should be commended for obtaining an unqualified audit opinion, but what was being done to get a clean opinion? He asked for strategies to address issues that had led to qualified opinions in provincial health departments. What was the Department doing on interns—had they been absorbed by the Department? He asked for strategies to address the non-submission of annual reports by the Commission for Occupational Diseases (CCOD) for years.

The NDOH should provide details on the contracting of general practitioners, pharmacy assistants and other health professionals who worked in the NHI pilot. He said proper funding of the first implementation of the NHI would be critical to its success and asked what the current funding was and when it would be increased. He asked why the Department included other sectors, like private and traditional sectors, in its figures. He observed that the target for HIV testing had been exceeded, and asked if the extra cost had been budgeted and who paid for it. The NDOH had not reached its target on ARV, yet it had utilized 99.9% of its budget, and asked if this meant that the indicator was under-budgeted. He also asked what steps the Department was taking to reduce the cost of ARVs.

Mr T Nkonzo (ANC) said that given the AGs findings on the lack of reliability of the performance data, how was the Department sure that the reported performance was accurate? He asked for an update on the state of forensic laboratories, given the media report on the poor state of the Pretoria facility and the AG’s report. Why had three provinces failed to report on the management of sexual health, given the increasing rate of sexual crime in the country? The Department should report on how much was spent on consultants, if there was value for money, if the Department had a skills transfer plan and if the consultants were providing specialised services or routine tasks. He also asked for the number of unemployed graduates that had been hired by the Department.

Ms Kopane (DA) asked how much had been spent on male and female condoms and why the NDOH had performed below target on male circumcision. She asked it to update the Committee on the draft Tobacco Products Control Amendment Bill, and indicate when it would come to the Committee. One of the key strategic objectives of the Department was to improve the management of health care at all levels. She observed that only two hospital CEOs had been coached out of a target of 40 hospital CEOs, and only 16% of the toxicology tests were achieved, and she asked the NDOH to give the reasons for this performance.

The Chairperson asked if the NDOH was in a position to indicate to the Committee when all patients would be on the CCOD database. She asked what the findings from the health survey were. The AG had raised concerns on the reliability of the information supplied by the NDOH, and she asked it to explain the reasons for the concern. She noted that there were conflicting figures on the total expenditure of the Department, as indicated in two different pages of the report.

NDOH’s Response

 

Mr Van der Merwe said irregular expenditure had been reduced at the NDOH, but the problems were with the provinces. Chartered accountants had been placed in most of the provinces to help with their accounting processes. It had assisted the Free State to achieve an unqualified opinion. The next province that would be assisted was Limpopo.

Most of the consultants reported were service providers and project managers who rendered specialised services.

He said R160m was spent last year and R133m in the current year on condoms. The 93.8% was the percentage of the budget spent, while the 90.2% spent was the comparison to the expenditure in the three-year financial plan.

Ms Jeanette Hunter, Deputy Director General: Primary Health Care, NDOH, said she was unable to answer the question about the time frame on the Tobacco Products Control Amendment Bill, but would send the response in writing to the Committee.

Ms Valerie Rennie, Deputy Director-General: Corporate Services, NDOH, said the interns were in the service for one year after which they exit the system, when there was an advertised position those who applied were recruited. He said five years ago interns were contracted for four years at the end of their internship.

Dr Gail Andrews, Chief Operating Officer: NDOH, referred to the reliability of performance information, and said the NDOH had gradually improved on the quality of its indicators and aligned its targets with the provinces. The indicators were included in the NDOH’s operation plans and were monitored. The NDOH had been in touch and worked hard with the AG, and there was now a better understanding of the requirements of the AG. The NDOH and the AG had also designed the protocols together to improve understanding.

The final result on the patients’ experience care survey would be released on Friday, 13 October 2017. The outcomes were favourable.

The service provider that was to oversee the coaching and mentoring programme had been delayed because the funding organisation’s funding had only been confirmed in October 2016.

The forensic laboratories had staffing issues which had now been sorted out. The other problem was that the laboratories had been testing for all toxins, but had now moved to a more targeted approach.

Mr Van der Merwe said the NDOH would be on track to achieving a clean audit in the current financial year.

The Chairperson asked if it was possible to get a clean audit in the sector.

Mr Van der Merwe said it was possible, and the NDOH was quite close to achieving a clean audit.

Dr Pillay said there was a difficulty in attending to all chronic patients because of financial constraints. The NDOH was engaging with National Treasury (NT) to address theses constraints. NT had been very supportive of the programme, but the funding had been low. The NDOH was putting pressure on the CCOD to ensure it finalised its report.

Ms Hunter said there had been mobilisation for male medical circumcision, but it seemed that saturation of the number of people that were interested had been reached, and NDOH would change its strategy to encourage people to participate.

Ms Rennie said that when the contract of the unemployed graduates expired, there was a plan to retain them, but the provinces -- except for Limpopo -- said they could not absorb them due to financial constraints. Some applied for vacant positions and had been employed.

Ms Kopane expressed concern about the transfers to the NGOs, as most of them were involved with HIV/AIDS, and she asked why cancer was not included. She asked when the Office of Health Standards Compliance had done awareness campaigns in six provinces, and when the other provinces would be targeted for awareness.

Ms R Adams (ANC) also expressed concern about the reliability of the data reported in some of the indicators in the report. She asked if there were measures to ensure that women in the rural areas could access care. She asked if the impact of the MomConnect maternal health care programme had been assessed. She asked if there were interdepartmental challenges and when the goal for the eradication of mother to child HIV transmission would be achieved. How many sanitary towels had been distributed to date?

Mr Nkonzo asked for an update on the interim traditional health council, and asked for the number of doctors’ rooms it had constructed in the pilot stage of NHI in the district. What was the Department doing on malaria and assisting the neighboring states. He observed that there were 786 additional facilities and asked if the facilities were qualified as clinics, and if the clinics that qualified were re-assessed or if it was just a “once off.” He said the screening of inmates for TB had been stated as 83%, but the AG could not verify the report, and he asked the delegates to provide clarity.

Dr Maesela said irregular and fruitless expenditure was not acceptable. It should not continue every year while there were hopes for improvement. There should be consequences, because if annual performance plans were followed there would not be such occurrences. He asked why so much money was spent on condoms while new infections continued to exist. The NDOH should think of a more strategic way to stop new infections. It was not only a problem of health, but there were societal and national problems. There was a need to find out the reason for challenges at the forensic laboratories. He said accruals could be stopped, and it was not compulsory that it should be reported.

The Chairperson asked if the NDOH had a strategy for retaining healthcare workers, because the shortage of health professionals was a common challenge, especially in the rural areas. She asked if there was a monitoring mechanism. The NHI was dependent on the improvement of the facilities and availability of healthcare professionals, especially in the rural areas. She observed that performance in infrastructure was low, while the spending was high, and asked why this was so.

Mr Van der Merwe said irregular expenditure was spending contrary to any law. Sometimes expenditures were declared irregular because provinces did not challenge the AG’s decisions. Another problem was instability in the staffing at the provinces. He said the NDOH could move the provinces towards achieving a clean audit. Provinces grew accruals because of budget constraints. Accruals were technical matter and they may not be totally eradicated, but the NDOH would try to keep accruals within 30days.

Ms Hunter said after the Life Isidimeni issue, the NDOH had conducted a rapid assessment of all nine provinces, and a report on the assessment could be made available to Parliament.

There had been no fund transfers to any cancer association, because the NDOH did not have an agreement with any cancer association.

The Department of Women was responsible for the distribution of sanitary towels, and worked with the provincial Basic Education Departments.

Consulting rooms had been added to 264 existing clinics.

She said South Africa worked with seven other countries and with the neighboring countries. Operation MOSASWA (Mozambique, South Africa and Swaziland) had been launched to eradicate malaria especially in the rainy season, when mosquitoes were prevalent.

Monitoring was not once off -- the NDOH always went back to recheck the facilities. The disproportionate staffing was communicated to the Provinces. She said there was a report for each facility on the cadres of staff. It would be nice to get resources to grow the number of health care professionals in areas where there were shortages.

Ms Rennie said every time the National Health Council met there was a report on critical posts. The process had now changed, so that each Head of Department (HOD) would give reports on their critical posts so that they could be interrogated on their short term and medium term plans.

Ms Andrews said the NDOH was working on new strategy on human resources (HR) in the health sector. There were a variety of health strategies for HIV/AIDS intervention.

She explained that the numbers provided for screened inmates at correctional facilities used to be the rate which compared the screened inmates to the total number of inmates. The number of inmates given by the Department of Correctional Services was not always reliable. The NDOH therefore now reports on the number of inmates screened, rather that the rate.

She said the impact of MomConnet had not been measured, but there had been a decline in the maternal mortality rate and the infant mortality rate was also reducing. As with all data, there were chances of error but there was a data improvement strategy in place by the Department. There was a strategy for the prevention for mother to child transmissions. The NDOH had a packaged programme for the prevention of HIV which included educating people, and the distribution of the of condoms was only one of the measures that the package contained.

Dr Pillay said the NDOH had appointed a registrar for the interim health traditional council. He said when infrastructure targets were set, they were not linked to the budget. The financial implications of the facilities were not collated and linked to the budget, which was always the assumption of the AG. The AG’s assumption was wrong.

The Chairperson said the health sector was about the ordinary people who went to clinics with expectations. There were allegations that there were clinics where health workers stopped work at 2pm when there were still patients to be attended to. She observed that it was not about the work that had not been done, but the small things that were omitted which had serious impacts on service delivery in the clinics. She highlighted the importance of the community’s behaviour. She was aware of what the sector was doing, considering its history. She encouraged the Department to strategically map out lasting solutions to the challenges of health in South Africa. The NDOH had the responsibility to ensure that it took care of the health of the citizens.

The meeting was adjourned. 

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