Committee Reports on Mental Health & National Health Laboratory Services oversight

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

The Portfolio Committee on Health met to adopt its report the Committee’s report on the presentations made to it by seven Provincial Departments of Health: Eastern Cape, Western Cape, Free State, Limpopo, North West, Mpumalanga, Northern Cape and KwaZulu-Natal. It also adopted its report on the oversight visit made by the Committee to the National Health Laboratory Services (NHLS).

The bulk of the amendments to the reports were of a grammatical nature. The report on the status of mental health care services focused on reflecting the actual reports of each of the Provinces. The Committee also added to its recommendations the need to clamp down on illegal NGOs used for the care of mental health patients.

There was some disagreement on whether the report on the oversight visit to NHLS captured the objective of the visit, i.e. whether the Committee was meant to inspect the readiness of NHLS for the National Public Health Institute of South Africa (NAPHISA) Bill or inspect its capacity to carry out its mandate. After some deliberations the two reports were adopted with amendments. 

Meeting report

Chairperson welcomed all the Members and Mr A Shaik Emam (NFP) who had not attended Committee meetings for some time due to ill health. She also expressed her concern about the ongoing issue of Life Esidimeni and hoped that everyone will get closure in the end. She also encouraged everyone to learn from what happened. She emphasised the need for the sector to work harder to ensure that the health of all South Africans was well looked after. She briefed the Committee on the news of the death of the National Spokesperson of the Department of Health, Mr Joe Maila and requested that members observe a minute of silence. After a moment of silence she said the Committee would start by adopting the report on the state of mental health.

Adoption of the report on the state of mental healthcare services

Mr A Mahlalela (ANC) said on page 1, section 2.1.1 should read ‘150 beds for acute patients’ instead of ‘150 acute beds’.

Mr Shaik Emam said the same correction should be made to ‘700 chronic beds’ in the last sentence of section 2.1.1 such that it read ‘700 beds for chronic patients’.

Dr S Thembekwayo (EFF) added that ’30 acute beds’ should also be written as ’30 beds for acute patients’, and that the ‘s’ should be removed from the word ‘includes’.

On page 2, the Chairperson said the two findings combined in section 2.1.6 that related to high vacancy rates and infrastructure should be separated and written out as two different findings.

Ms C Ndaba (ANC) said the first sentence in section 2.2.8 should end on ‘traditional healers’ and the rest deleted. 

Mr Mahlalela noted a spelling mistake on page 3 and suggested, in terms of Ms Ndaba’s suggestion, that the two sentences should read ‘The Committee probed whether there was a working relationship between traditional healers and medical practitioners. The Committee was of the view that traditional healers may play a vital role in addressing mental health care needs.’ Section 2.2.9 stated that the report of the Western Cape Department of Health lacked details and this was not true since the province had been able to tell the Committee the location of the clinics.

Dr P Maesela (ANC) suggested section 2.2.9 should be deleted.

Ms Lindokuhle Ngamane, Committee Content Adviser, said it was captured in that manner to capture the question asked by Members and the answers had probably been provided and again captured in the report.

Ms Ndaba asked for clarity on 2.3.9.

The Content Advisor said the point made in section 2.3.9 was based on the presentation made by Free State Province. It was said that Free State was in discussion on the establishment of a Patient Electronic System.

Dr Maesela asked what was meant by Patient Electronic System in Section and that there was a need to explain what it was.

Mr Mahlalela said Committee Members are not in a position to answer the question asked by Dr Maesela, because it was a question that should have been posed to the province when they came for their presentation. He said the question that should be asked was ‘with whom was the Province in discussion’.

Dr Thembekwayo reminded the Committee that the report that was being adopted was based on the presentation made by the provinces.

Dr Maesela said his intention was not to ask a question that should have been asked during the presentation but rather to simply correct the sentence by including what the Patient Electronic System was meant for. He suggested using ‘Patient Registration Record’.

Ms Ngamane located where it was written in the Free State’s report and said no further details on whom the province discussed it with was provided and the ‘Patient Electronic Record’ was also written the same way in both the report of the province and the report that was being adopted.

Chairperson said since the question was not asked from the delegates from the province, it was too late to ask questions now.

Mr Mahlalela said there is no clarity on the meaning of the sentence in section 2.3.14 and there were too many points clustered together in section 2.4.9.

Mr W Maphanga (ANC) said it would be better to say ‘manage’ rather than use the word ‘run’ in section 2.4.11

Ms Ndaba said there was a need to reconstruct the way section 2.4.11 was written.

Chairperson said a Member of the Committee should reconstruct the sentences that were identified so that the Committee should address them towards the end of the process of adoption. The second sentence on page stated that there were no NGOs licensed to provide mental health services in the North West Province and asked if the information was correct.

Ms Ngamane said it was written as such in the report presented by the North West’s Province.

Mr A Mahlalela asked why the lack of NGOs was written in the observations and why the Committee was concerned by the lack of NGOs in North West Province.

Ms Ndaba said she could not recollect the Committee being concerned about the lack of NGOs for mental healthcare in the North West Province.

Chairperson said as a reminder that the Committee was aware that the use of unlicensed NGOs in Mpumalanga brought about a crisis situation in the province. This led the Committee to be concerned about the use of NGOs for mental health care in the provinces.

Mr S Jafta (AIC) said the word ‘does’ in the first sentence of Section 2.4.12 should be written as ‘do’ since it was used along with a plural noun ‘hospitals’.

Ms Ndaba said there was too much information in section 2.5.4 and proposed that the information should be categorised for consistency and that section 2.5.3 be reconstructed.

Mr Mahlalela said the phrase ‘a board mental health review board that consisted of four members’ should replace a ‘four membered mental health review board’ in section 2.5.3 and ‘probe’ should be replaced with ‘asked questions’. His understanding of the report by North West was that the province did not use NGOs and not that there are NGOs which were not licensed but are managing mental health patients.

The Chairperson said 2.5.6 should be deleted.

Mr Mahlalela said 2.6.2 should be reconstructed because the sentence implied that it was the use of general hospitals that resulted in the crisis. 

Chairperson asked if the report presented by North West Province was available so that the sentences could be corrected within the context of what was said in the report.

Ms Ndaba recalled that the decision by the National Department to integrate psychiatric patients brought about general hospitals dealing with psychiatric patients. It was not that there were no psychiatric hospitals in Mpumalanga.

The Chairperson said the integration of the hospitals was not the reason for the problem in Mpumalanga.

Ms Vuyokazi Majalamba, Committee Secretary, confirmed that the information was reported as it was presented by Mpumalanga Province and promised to check the report presented by the province to confirm.

Ms Ndaba said section 2.6.8 needed to be reconstructed.

The Chairperson said Members should work on it and that the Committee would return to it towards the end of the process. The phrase ‘a board mental health review board that consisted of five members’ should replace ‘a five membered mental health review board’ on page 10 and ‘queried’ should be replaced with ‘wanted to know’.

Dr Thembekwayo said the introductory part of the recommendation had a ‘should’ that covered all points listed under the recommendation and it would not be correct to repeat ‘should’ in each of the sentences.

Mr Mahlalela agreed and also proposed that the Committee should be specific on the names of the provinces that should prioritise the construction of the facilities, i.e. Mpumalanga and the Northern Cape. 

Mr Shaik Emam said it would be better to replace the word ‘should’ with ‘must’ because the recommendations consisted of the mandates of the Provincial Department of Health.

Chairperson said ‘must’ would be instructive. She asked how the sentence should be constructed.

Mr Shaik Emam said the Committee was allowed to instruct, but it would be alright if the Committee decided otherwise.

Members agreed that sections 3.2.2 and 3.2.3 should be combined into one recommendation.

Mr Shaik Emam noted that there were abundant beds in the Western Province while other provinces lacked beds. He asked if it would be appropriate for people to be sent from places with fewer bed spaces to other provinces since the patients are all South Africans.

Chairperson said the issue was beyond the patient, but also family members. There was a need to discuss this.

Mr Shaik Emam said there might be several patients who would be willing to accept the offer because of the stigma attached to them with their localities. It could be beneficial to patients who did not have families looking after them.

Ms L James (DA) said she concurred with the Chairperson because the there were complaints of loved ones being moved far away from family members in the Life Esidimeni issue and the Committee must consider the issue of budget and how to move budget within Provinces.

Mr Shaik Emam said the interest of the patient into consideration before the interest of their family members.

Chairperson said the movement of mental health patient was challenging. She concluded that the recommendation to move some mental health patients to other province would not be added to the report but it would be explored in future. She said the plan of government was to integrate mental health patients within their family’s reach. 

Chairperson said, in line with government’s plan, the Committee must try to ensure that mentally ill patients should be integrated within their family members. She concluded that the issue would be revisited at another time. She asked if the statements that were recommended for reconstruction had been fixed. 

Mr Mahlalela said he noted that there was no recommendation on the use of unlicensed NGOs for the treatment of mental health patients which was one of the issues that brought about the situation in Gauteng. There must be a recommendation because it was a fundamental problem.

Chairperson person said she expected Mr A Mahlalela to propose a recommendation

Ms Ndaba agreed that it was important to add a recommendation to that effect.

Dr Maesela said the recommendation for NGOs was on page 8, but it was written under observations and findings for Mpumalanga. He proposed that it should be removed from that section and added to the general recommendations.

Ms Ndaba said the information should not be removed from that segment. There was no uniformity in Provinces concerning the criteria used to register NGOs. She proposed that the National Department should develop uniform criteria on the registration of NGOs, and specifically for those that would be licensed to deal with mentally ill patients.

Chairperson asked if the recommendation on 3.3.2 would be sufficient as a recommendation with respect to the NGOs.

Dr Thembekwayo said the sentence on page 13 should be sufficient, because the word ‘capacitated’ in the sentence was all encompassing.

Mr Mahlalela said licensing and capacitating NGOs were two different things, and proposed that the Committee must come up with a recommendation that all unlicensed NGOs must be closed down. 

Dr Maesela said the recommendation should read that ‘uniform criteria for the licensing of NGOs should be developed by the National Department of Health.

Chairperson said the recommendation proposed by Dr Maesela did not touch on the issue of illegality of some NGOs that are operating without license in some Provinces.

Mr Shaik Emman said the Committee must recommend that alongside the recommendation of 3.3.2, it must be stated that no NGO was allowed to operate illegally.

Ms C Ndaba said two bullet points must be added to the recommendations.

The Comiittee agreed that there would be two bullet points; the first is that the National Department should develop uniform criteria for licensing NGOs and the second for unlicensed NGOs to be closed.

Mr Mahlalela reminded the Committee that it must check the recommendation of the Ombudsman on issue of unlicensed NGOs, so that the Committee would be consistent with the recommendations of the ombudsman. 

Mr A Shaik Emam moved the motion for adoption.

The report was adopted with amendments.

Adoption of the report on the visit to the National Health Laboratory Services (NHLS)

Mr Mahlalela said the objective of the visit was not well captured. The Committee had not dealt with the National Public Health Institute of South Africa (NAPHISA) Bill and did not go to NHLS for that reason. 

The Chairperson said Mr Mahlalela had not been in the meeting when NAPHISA made a presentation to the Committee from which a decision to visit the NHLS was reached. 

Dr Maesela said the Committee cannot predict what will happen when the Act was promulgated. It should just be said that the Committee had gone to check if NHLS have the well withal to carry out its mandate.

Chairperson proposed that the report should be withdrawn for the day so that the Committee can refer to the minute to check for clarity.

Ms Ndaba said there was no need to withdraw the report. The Committee can deal with the report while checking on the minute. The content of the report will not change based on the purpose of the meeting.

Mr Mahlalela said he was part of the Committee that went on the visit and the Committee did not inspect NHLS’s readiness for NAPHISA during the visit.

Dr S Thembekwayo said the purpose stipulated in the invitation read that the committee would be visiting to see whether there was adequate capacity within the NHLS to carry out the mandate of NAPHISA.

Mr Mahlalela said regardless of the content of the invitation, the report must reflect what transpired during the visit and that the capacity of NHLS as an institution was considered. There was nothing in the report that related the visit to NAPHISA. There are certain activities that needed to be done before the Committee can be able to address NHLS’ readiness for NAPHISA. The report talked about the capacity of NHLS and its challenges and nothing was said about NAPHISA.

Dr Maesela recommended that the process of adopting be continued. He said the Committee would deal with the background afterwards.

Chairperson referred to page 2 and she said ‘is’ should be removed from the second sentence in the second paragraph.

Dr Maesela said the phrase ‘agreements that were agreed upon between themselves and NHLS’should be replaced with ‘agreements between themselves and NHLS’.

Chairperson observed that only Gauteng was reflected, but the debtors are Gauteng and KZN. 

Ms James said it was possible KZN was not included on the list of debtors because it made effort to pay some of the debt.

Chairperson said it should reflect Gauteng and KZN. The content of the report did not reflect any information on NAPHISA and proposed that the background should be changed. .

Dr Maesela moved the motion for adoption.

The report was adopted with amendments.

Adoption of minutes

Minutes dated 2 March, 9 March, 16 March, 6 April, 13 April, 20 April, 5th of May, 16 to 18 August; and 31 August 2017 were adopted with minor amendments.  

Chairperson reminded members of a joint meeting with Basic Education at 9.30am.

Mr Mahlalela asked if there was a plan for the joint meeting so that Members can be prepared. He proposed that the Department of Health should send its presentation to enable Members to prepare for the meeting.

The Chairperson asked the secretariat to get the necessary documents from the Department so that Members can preview them in preparation for the meeting.

The meeting was adjourned.



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