Minister of Health & Minister of Human Settlements Progress Reports

Meeting report

Consideration of Executive Undertaking made by the Minister of Human Settlements During Policy Debate, 12 May 2015

Ms Lindiwe Sisulu, Minister of Human Settlements, outlined that the Department of Human Settlements (DHS) was responsible for providing houses in conjunction with the Department of Defence and Military Veterans – DHS provided the standard subsidy of a 40 square meter house however military veterans were provided for 60 square meter homes. The difference in meters is provided to DHS by the Department of Defence. DHS did not have a database of military veterans – this was provided by the Department of Defence and Military Veterans. Up to now, DHS did not have a full database provided by the Department of Defence. There was an engagement between the Departments and there was a workshop held with all military veterans in Birchwood earlier this year. DHS was given the impression that all was well. When the Minister arrived in the NCOP, on that day, another tragedy of a military veteran dying in a shack occurred. The number given to her of outstanding houses was 5 854 houses for military veterans. A decision was taken that morning to clear the number because DHS produced, in a year, approximately 260 000 houses so 5 000 houses would not take more than two months and there was assurance from the Department of Defence and Military Veterans that R177 million would be given over to DHS. The Minister was therefore quite certain when she made the promise in the Council that these houses would be cleared.

Unfortunately the Department of Defence and Military Veterans confirmed it did not have the database and without this the necessary resource could not be provided. The R177 million earmarked that year for military veterans was taken back by National Treasury. DHS established a task team comprising of the Chief Director, DDG and a number of other people, including from the Department of Defence and Military Veterans, to work through the recurring challenge. Currently there was still no final database from the Department of Defence and Military Veterans. At a meeting with the Deputy Minister of Defence and Military Veterans, she recommended he hand over the responsibility of providing housing to military veterans to DHS. There was agreement in writing.

Minister Sisulu said she made several overtures for DHS to take over this responsibility. She was extremely apologetic about the situation and she requested the Committee support her plea for DHS to entirely take over the responsibility of providing houses to military veterans. There was also a request for Treasury to ring fence the money intended for housing for military veterans and to be diverted to DHS. It would then not take the Department more than two months to work through the backlog.

When the legislation was negotiated, all military veterans were spoken of but when the Minister was in her first stint as housing Minister, she spoke of non-statutory military veterans – these were the most indigent and in need of resources and housing. Houses were handed over to military veterans in the Western Cape. These were the military veterans who served in the SA National Defence Force (SANDF). The Minister wanted to prioritise non-statutory veterans as these were people who did not have the opportunity to work or earn a salary.

Discussion

Mr S Mthimunye (ANC, Mpumalanga) found it problematic to hear that nothing was done to provide military veterans with housing when SA was more than 20 years into democracy, especially the non-statutory veterans. Why was it difficult to get the database from the Department of Defence? This database was needed for proper planning.

Minister Sisulu responded that houses were built for military veterans in every province and the Deputy Minister of Human Settlement was responsible for overseeing this. However, the Department did not build houses at the rate at which it had committed itself to. It was possible to clear the backlog of the number provided by the Department of Defence. There was the challenge of definition of military veteran and verification around this. The Minister herself was a military veteran. There was also the problem of the definition of the size of the house. The Department of Military Veterans was only established in 2010, by law. There were delays in processes requiring legislation, law and policy.

Mr D Monakaledi (ANC, Limpopo) asked whether DHS had some database it could work from in the interim. In engagements, was the Department of Defence willing and keen to work the DHS in terms of the approach to providing housing to military veterans? Or was there reluctance on the part of the Department of Defence?

Minister Sisulu answered that because the Department of Military Veterans was a new Department and so did not have the capacity to do what was required hence the DHS request to take over the responsibility. In terms of the database, DHS worked with what it could verify. So far for the 2017/18 financial year, in the Eastern Cape, 88 houses were approved and 34 were provided so far. In the Free State there were 199 houses approved and in the second quarter, 44 were provided. In Gauteng, 58 houses were provided in the two quarters. In Kwazulu-Natal, nine houses were provided. DHS was therefore providing houses to military veterans working off the database it currently had. If the Department had the entire database, the backlog could be cleared in two months. In total, 136 houses were provided to military veterans in the 2017/18 financial year but this was too slow for people who were aging and had been waiting for so long for houses.

Ms B Engelbrecht (DA, Gauteng) did not understand why DHS had R177 million from the Department of Defence and the backlog figure 5 854 houses but the houses were not provided.  Given the large number of requests, why were more houses not built if the money was there?

Minister Sisulu explained that the number for the backlog was an indicative number provided by the Department of Defence and Military Veterans. The DHS system also experienced some challenges where the applications of some military veterans were rejected by the system – a decision had since been taken that the Minister would override the requirements. The total was 4 900 – if DHS had permission to take over responsibility of providing houses to military veterans, it would complete this total within the first two quarters of next year.

Mr Mthimunye pointed out that the Department of Defence did verify applications of military veterans – if the DHS was also doing this, was it not duplication? Was it also not a waste of time and resources when houses should be delivered?

Minister Sisulu explained that before the Department built houses, it had to ensure the application was approved and verified by its own system. A decision had since been taken that this verification would be overridden so that there was no rejection by the system. For example, if a military veteran was employed and earned a salary higher than the threshold on the system, the application would naturally be rejected. The criteria on the system could now be overridden so that some of the challenges could be bypassed with military veterans on the DHS system.

Mr Mbulelo Tshangana, DG, DHS, added that if the military veteran who received housing in 1999 wanted to reapply, the DHS system would kick the veteran out immediately. The criteria from the Department of Defence and Military Veterans was that the qualifying veteran must earn less than R125 000 per annum. Considering all military veterans, there was a figure of about 16 000. The figure of 4 900 was from those who qualified – the non-statutory (or destitutes) figure was about 1 400. Some of the applicants were kicked out by the DHS system because they received houses in the past therefore there was a need for deviation. With the budget, the unit cost for a 50 square meter house was about R180 000, if geo-tech variances and other matters were excluded.  The top up from the Department of Defence and Military Veterans was around R78 000, for each unit, while the remainder was funded by DHS. DHS may therefore not be able to build the 50 square meters for everyone due to budget constraints by the Department of Defence and Military Veterans. It was also important to note the military veterans themselves, who were not working, did not want to be passive recipients but were in active in meeting their needs, for example, bringing in their own companies and labourers – this made the process slow sometimes although it was encouraged.

Minister Sisulu noted that there were internal dynamics and differences when different companies were used so a decision was taken for DHS to build the houses themselves. Last year, between R170 000 and R190 000 was returned to Treasury from the Department of Defence because it was not used – DHS felt that if the money was directed toward it, it would have been able to utilise the money. Sometimes with military veterans, people waited until the primary beneficiary had passed on and the system would then need to be overridden to ensure the family home was built – this was however not catered for in the policies of military veterans. DHS wanted to ensure the children of the veterans also benefitted – if the task was centralised, action taken would be much faster.

Ms Engelbrecht asked what criteria DHS would use to override the system, how it would prevent people from getting double benefits and how it would ensure only real military veterans benefited. 

Minister Sisulu responded that a task team was established to investigate matters when the system needed to be overridden to ensure the veteran was not a previous beneficiary or was not cheating the system – such an investigation must be done before the system was overridden.

Ms T Wana (ANC) was pleased to hear that the families of military veterans would also be covered – many veterans had died but their families were still suffering. She would support the idea of deviation to ensure those in the rural areas received part of the beneficiation – rural people did not need a large share of the beneficiation but an appreciation of a roof over their families.

Minister Sisulu said she was Minister of Defence in 2007 when the Department of Military Veterans was established – legislation was needed because resources could not be seeded to a department if there was no founding legislation. This legislation was only concluded in 2011 – it took Parliament four years to pass the legislation and in this time not a single house could be built. One of the reasons was the definition of military veteran – now a military veteran was defined as any South African citizen who (a) rendered military service to any of the military organisations, statutory and non-statutory, which were involved in all sides of the South African liberation war from 1960 to 1994, served in the Union of Defence Force or became a member of the new South African Defence Force after 1994. It be might be useful to amend the definition of military veteran because the people who were considered military veterans before 1960 were only those who served in the Union Defence Force. With the way that the law was put together, it was causing much delay. Because government was caring, it could look at encouraging those that fell outside of the definition to build their homes and a subsidy could be provided.

Ms Wana noted that the people who petitioned the grievances to Members were the ones who could not benefit in terms of the definition – the Committee was not there to oversee the Department but to hear about certain practices of the Department.

Minister Sisulu replied that the people who the Member referred to were indeed the ones who did not benefit from the definition currently – perhaps the definition needed to be reviewed and the legislation amended. In the meantime, DHS could assist those people, by virtue of them being indigent, with some kind of subsidy or assistance however, they were not entitled to the full benefits due to them due to the currently legislation which only recognised liberation movements. The legislation did not include the veterans from colonial struggles – the cut off date was 1960 when the ANC formally established uMkhonto we Sizwe and the only people considered before 1960 were those in the Union Defence Force. The suggestion of the Minister was to amend the legislation.

Ms Wana appreciated this answer which Members could communicate to those who had brought the petition to them.  

Minister Sisulu hoped that the Committee supported her decision for DHS to take over the role of providing houses to military veterans as it was most embarrassing that people who fought for the liberation of the country still did not have housing.

Consideration of Executive Undertaking Minister of Health Made During Policy Debate: Health on 07 May 2015

Mr Aaron Motsoaledi, Minister of Health, noted that when the undertaking was made, more than two years ago, SA was undergoing loadshedding and at the time, the Department of Health (DOH) tried to communicate with Eskom that when it did the loadsheddding, it must exempt hospitals but Eskom declined. Ordinarily, hospitals must have standby generators. It was also the broad narrative that Ministers were solely responsible for whatever went awry in their portfolios but because health was a concurrent function, there were purely provincial competencies such as Human Resource (HR) matters, procurement, financial management and maintenance of equipment and infrastructure.

The Minister then outlined the case of the generators in the specific hospitals in question.

Ms Wana asked how the national Department linked with the authorities in the provinces to ensure discrepancies were fixed or repaired. The hospital in the Free State indicated it took a long time to get the assistance from the national Department on these issues – what strategy did the national Department have to monitor provinces in this regard?

Minister Motsoaledi asked what assistance the province alluded to.

Ms Wana responded that it was in relation to the generators but she was not sure what exactly the province was referring to in terms of assistance – it could be procurement or assistance with the service provider.

Minister Motsoaledi noted that it was exactly what he was referring to earlier – provinces often pointed to national when they were in trouble. In August, he approached the Portfolio Committee to request that Parliament look into the issue as health was supposed to be a concurrent function. An example was Life Esidemeni and the oncology challenge in KZN –such incidents occurred because the pillars of the health care system were purely provincial competencies, i.e. not concurrent, such as HR, financial management, procurement and maintenance of equipment and infrastructure – these were the cornerstones of a health care system. Listening and analysing to the complaints from patients and the public, complaints stemmed from problems with these four pillars yet they remained purely provincial functions however when there was a problem, responsibility lied with the Minister – essentially the system meant the Minister was set with the responsibility but did not have the authority. There was a National Health Council, which was chaired by the Minister, and comprised of MECs for Health, Heads of Department, Head of the SA Military Health Services and the SA Local Government Association (SALGA) – this was the only structure where the Minister had access to the provinces. The matter of the loadhsedding was brought before the Council where the Minister indicated the decision by Eskom meant trouble and meant hospitals would have to be self-sufficient when it came to generators. It was agreed by the Council that more generators must be procured and a team was put together to assess and audit whether generators already there could carry the hospitals if Eskom cut the power for 24 hours , from province to province. Some hospitals took extra steps by establishing Uninterrupted Power Supply (UPS) especially for areas like the theatre and ICU. If the audit found the generators were insufficient at a hospital, it was to job of the province to procure and install the generators. Part of the responsibility of installation fell on the departments of Public Works and it was no secret that many Public Works departments, starting from national, were dysfunctional. However when these systems did not go according to plan, no one approached the Minister of Public Works – they came straight to the Minister of Health. It was also an issue of tender and who won the contract.

Ms Engelbrecht congratulated the Minister on his incredible passion for the sick people of SA. It was clear that provinces were not taking accountability- it seemed the only way this would occur was through the national and regional health council. She asked how the Minister suggested the system be changed so that provinces were accountable.

Minister Motsoaledi proposed to the Portfolio Committee that laws be changed – what happened with Life Esidemeni showed the National Health Act and Mental Health Act needed to be changed and reviewed to prevent current lacunas, challenges and weaknesses. It was also emphasised that Parliament needed to call the Premiers to account – often in the national health councils, MECs placed the responsibility on Premiers. The Minister was always mentioned when there was failure in the Department and the Premiers felt no heat. It was the Premiers who appointed MECs and Heads of Department, not the Minister – these officials were accountable to the Premier and not the Minister. There was however no legal mechanism for the Portfolio Committee to call Premiers to account – only the NCOP had the power to so. The Portfolio Committee then endeavoured to meet with the Select Committee. It was stressed that when conducting oversight, Committees should focus solely on HR, financial management, procurement and maintenance of equipment and infrastructure – Premiers were responsible for these four areas.

In 2015, the Minister put together a team consisting of retired senior health sector workers such as the former Head of the Department of Health in KZN, a former Head of Department in the Western Cape, the first Head of Department in Gauteng and previous chair of the Public Service Commission, the SA Revenue Service (for procurement matters) and National Treasury. The team was presented with a list of the 100 most problematic hospitals. The team visited 25 hospitals – it had not yet visited Gauteng, the Western Cape and the North West but from what was already seen, they had the full picture where it was clear problems lied with the provincial government. There were problems of CEOs not having delegated authority in some hospitals to even repair a broken window. The report from the team was sent to the Portfolio Committee to assist in guiding its oversight. Since 2013, the Minister had been attending leadership courses at Harvard University, in the USA, for Ministers of Health in Africa, the Far East, Caribbean and Latin America i.e. underdeveloped areas, to assist in health leadership. In 2015, a global health unit was established and research was done on underperforming health care systems. It was found that such poor performing systems had challenges relating to HR, procurement and supply chain – the two were taken to be distinct because it was found there could be procurement but supply along the chain was problematic. These were the exact areas identified by the team the Minister put together in 2015. The Minister emphasised that he alone should not be summoned – those who had the authority should be included. Since the inception of the NCOP, the Minister could not recall it summoning a single Premier – why would these authorities change their ways if they knew someone else would be held accountable? Premiers were also not present at NCOP debates – it was clear the system needed to change. If the Premiers were not summoned, many of the challenges would continue.

There was also a need to change the laws – when the White Paper on the National Health Insurance (NHI) was compiled, it was discovered 12 Acts needed to be amended to ensure the NHI was rolled out nationally. Among the Acts to be amended was the relationship between national and provinces on these matters. He emphasised that Parliament should not only summon Ministers but all those with the authority to ensure the bottom of the problems were reached.

The Chairperson appreciated the wise insights of the Minister which assisted Members.

Minister Motsoaledi pointed out that Premiers were responsible for hiring Heads of Departments and Ministers did not even have the authority to suspend these Heads – this was experienced in the Section 100 intervention in Limpopo. Section 100 was not a panacea because while national would have the responsibility, those with the authority and power would still remain.

Mr Mthimunye suggested a joint sitting of the Portfolio and Select Committees, in the new year, on the issue of concurrent functions between national and provinces to find a common way of dealing with the matter and where expression could also be found in the Rules of Parliament. It was not only the job of MPs to make legislation but to make active interventions when necessary.

Minister Motsoaledi said there was no doubt that certain Acts needed to be changed. The main intervention would be to call those who had the authority instead of those who were responsible – this added to the attitude of those officials that they were above accounting to Parliament.

Ms G Oliphant (ANC) thanked the Minister. She agreed that all Premiers should be called in the new year in a joint meeting. Then the Heads of Departments and MECs could be called.

The meeting was adjourned.