Medical Research Council, Office of Health Standards, Council for Medical Schemes & National Health Laboratory Services Annual Performance Plan

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18 April 2018
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

The Portfolio Committee on Health met with the South African Medical Research Council (SAMRC),the Office of Health Standards Compliance (OHSC), the Council for Medical Schemes (CMS) and the National Health Laboratory Services (NHLS) for presentations of their annual performance plans (APPs) and budgets for the 2018/19 financial year.

The Medical Research Council described their goals, which included administering the health research sector efficiently and building capacity for long-term sustainable growth. They had experienced an average annual growth of 9.6% between 2014/15 and 2017/18. Their strategic objectives consisted of ensuring good governance, producing new scientific findings and providing funding for health researchers. Objectives to strengthen institutional research capacity at selected universities included leveraging funding for research projects and programmes in a collaborative method; creating an enabling research environment with essential infrastructure, gearing the universities for self-sustainability, and initiating, maintaining and growing a robust and sustainable research culture.

Members posed questions about the level of transformation within the organisation; the origin of its funding, and whether support from the Gates Foundation would continue; its support of the cancer registry; its relationship with the National Public Health Institute of South Africa (NAPHISA); the need for devices reduced maternal death to be available in ordinary public hospital maternity facilities; and SAMRC’s relationship with labour.

The Office of Health Standards Compliance said its goals were focused on demonstrating responsiveness and accountability for effectiveness, inspecting health establishments for compliance with norms and standards, and improving the quality of health and safety of health care through communication and collaboration. A Health Ombud had been appointed in June 2016 and a call centre had been launched in November 2016. The organisation investigated unresolved complaints by healthcare services, public and private, and made recommendations and referred complaints needing further management to other regulatory or public entities. The largest proportion of the budget would go to the Compliance Inspectorate Department.

Members wanted to know if the OHSC’s office accommodation problems had been resolved; why there was a large increase in the compensation for employees; when vacancies on the Board would be filled; how the OHSC were marketing themselves in the poorer areas so that people could easily communicate to report issues; why some of the performance targets remained the same as the previous year, and why some were constantly low. The Chairperson agreed that the expenditure needed to be reviewed, to try to reduce it. .

The Council for Medical Schemes said that overall membership of medical schemes had remained stagnant at 8.87 million, whilst their contributions had increased from R151.6 billion to R163.9 billion. The key focus for the next five years would be on strengthening of the CMS policies related to research and monitoring capacity, while simultaneously working on eliminating fraud, waste and abuse and improving technological conditions.

Issues raised included the challenges with regard to the budget; what was being done to educate and inform members of their medical aid options when making their choices; the lack of response by the CMS to complaints; where the most complaints had come from, and what types of complaints they were.

The National Health and Laboratory Services said it had a network of approximately 268 laboratories spread across all nine provinces. Between 2012 and 2017 it had trained an average of 234 registrars per year in collaboration with its academic partners. It had owed its suppliers approximately R833 million as at the end of October 2017, but for the current financial year, the NHLS had been invoiced for R1.2 billion worth of goods and services and had paid R1.4 billion to all its suppliers -- effectively eliminating R219 million of its prior year debt.

The NHLS was asked to respond to the statement that had been made, that non-communicable diseases would kill more people by 2030 than communicable diseases, and indicate what role it could play to prevent this from happening. Members wanted to know why targets were remaining static instead of showing progression, and how far the entity had gone in fulfilling transformation within the institution.

Meeting report

South African Medical Research Council (SAMRC): Annual Performance Plan

Prof Glenda Gray; President and Chief Executive Officer (CEO): SAMRC, led the presentation of the Council’s annual performance plan (APP).

The Council had four goals:

  • GOAL 1: Administer health research effectively and efficiently in South Africa. The goal was to strengthen the financial processes towards a clean audit opinion from the Auditor General. An indicator of this would be the compliance with legislative prescripts, reflected in the final audit report relating to the processes and systems of the SAMRC.
  • GOAL 2: Lead the generation of new knowledge and facilitate its translation into policy and practice. The goal was to promote the improvement of health & quality of life in South Africa through research. An indicator of this would be the number of published journal articles published by SAMRC grant-holders with acknowledgement of SAMRC support during the reporting period; as well as the number of book chapters and books by SAMRC researchers within intermural, extramural research units and collaboration centres at the SAMRC.
  • GOAL 3: Support innovation and technology development to improve health. The goal was to promote the improvement of health and quality of life (prevention of ill health, improvements in public health and treatment) in South Africa through innovation, technology development and transfer. An indicator of this would be the number of innovation and technology projects funded by the SAMRC to develop new diagnostics, devices, vaccines and therapeutics.
  • GOAL 4: Build capacity for long term sustainability. The goal was to provide research support in the broad field of health research. An indicator of this would be the number of new and renewals of SAMRC bursaries, scholarships and fellowships funded for postgraduate study at masters, doctoral and postdoctoral levels.

A focus was on the SAMRC intramural research programmes and investigating paediatric and adolescent mental health. Expanding the African footprint through collaborative projects with scientists in African countries would complement existing work.

The SAMRC’s transformation initiatives involved a transformation plan, diversity management, employment equity, succession planning, human resource management strategy and plan and representation of both women and African employees at the senior management level.

Risk workshops conducted at a strategic and operational level were initiated via risk mitigation plans had resulted in an improvement in SAMRC’s National Treasury Rating (NTR) for risk management. Audit, Rrisk and information technology (IT) Committees reviewed legal and regulatory compliance on a quarterly basis. SAMRC had received clean audits for five consecutive financial years.

In 2017/18, the baseline allocation had dropped due to the termination of the Economic Competiveness Support Package. In 2018/19, contract income was projected to drop when leveraged funding agreements ended, but there would be an increase in 2019/20 when new leveraged funding agreements would be concluded.

Over the period 2014/15 to 2017/18, the SAMRC’s income grew by 31.6% (R237 million), with an average growth rate of 9.6% p.a. Over the medium term expenditure framework (MTEF) period from 2018/19 to 2020/21, the SAMRC’s estimated funding would increase by 16.9% (R166 million), with an average growth rate of 5.3% over the period. Over the period 2014/15 to 2017/18, the expenditure of the SAMRC increased by 39.5% (297 million). Over the MTEF period 2018/19 to 2010/21, the SAMRC’s budgeted expenditure was estimated to increase at an average growth rate of 3%. Only critical new posts would be funded from the reduction in vacant posts. Salaries would increase at an average rate of 7.2%, and goods and services were estimated to increase at an average rate of 0.3%

SAMRC’s strategic objective annual targets for 2015/16 to 2019/20 were:

  • Ensuring of good governance, effective administration and compliance with regulations. An indicator of this was the compliance with legislative prescripts, reflected in the final audit report relating to the processes and systems of the SAMRC.
  • Promoting the organisation’s administrative efficiency to maximise the funds available for research. An indicator of this was the percentage of the 2017/18 SAMRC total budget spent on salaries and operations of all corporate administrative functions.
  • To produce and disseminate new scientific findings and knowledge on health. An indicator of this was the number of journal articles published by SAMRC grant-holders with acknowledgements of SAMRC support during the reporting period.
  • To promote scientific excellence and the reputation of South African health researchers. An indicator of this was the number of published indexed impact factor journal articles with a SAMRC affiliated author.
  • To provide funding for the conduct of health researchers. An indicator of this would be the number of research grants awarded by the SAMRC.

Objectives to strengthen institutional research capacity at selected universities included leveraging funding for research projects and programmes in a collaborative method; creating an enabling research environment with essential infrastructure, gearing the universities for self-sustainability, and initiating, maintaining and growing a robust and sustainable research culture. Eight universities each received R1 million per annum for a five-year commitment agreement period. More than 20 research projects were performed and several masters and doctoral candidates and projects were funded. The first articles were published from 2016 and the first cohort of graduates in 2017.


Dr P Maesela (ANC) said he was proud of the work being done by the SAMRC. He was despondent about the fact that the transformation of people was classified according to race and not according to scientific demographic realities. He emphasised that innovation and scientific research made South Africa proud as a whole nation, not according to the race of the person involved in the research. He felt that the document not being readable and user friendly had been done deliberately to mislead the Committee. He expressed concern that the SAMRC’s funding was 60% from donations and 40% from government, whereas it should have been the other way round, as it could not keep relying on donations as a sustainable means of funding.

Ms S Kopane (DA) said more elaboration was needed with regard to the SAMRC-conducted studies and support of the cancer registry. She wanted to know how far or when feedback would likely to be available on the evaluation of the health information systems. She asked about the SAMRC’s relationship with the National Public Health Institute of South Africa (NAPHISA), and to what extent it was facilitating the change programme amongst universities across South Africa, as it was not made clear from the presentation.

Ms L James (DA) wanted to know whether the Minister of Health had agreed to extend the funding of the Gates Foundation, as it was coming to the end of its agreement period. She wanted it to be made clear to the Committee how easily accessible and user friendly the technological devices would be for ordinary human beings. She emphasised the need for these devices, especially the one which reduced maternal death, and wanted clarity as to when the devices would be in ordinary public hospital maternity facilities, as there was a huge challenge in the primary health care facilities and those devices would be of utmost help to make things more efficient.

Ms C Ndaba (ANC) asked what the SAMRC’s extramural targets were, as they were not mentioned in the presentation. She felt a lot of information had been a left out, such as what their impact was annually, and when the quarterly analysis would be presented.

The Chairperson wanted to know whether the technological devices were being used in public hospitals, and if the SAMRC had researched and found out about nurses who were trained and exposed to the devices. She wanted to know at what age children in paediatric wards who suffered from tuberculosis (TB), were given syrup or pills/capsules.  She also wanted reassurance as to the confidence of the SAMRC that the Gates Foundation was not determining its programme. She emphasised her discomfort with the statement made in the presentation that the first key business risk was the SAMRC’s relationship with labour, and wanted this explained. The Chairperson further explained that unpacking of the highly medical terminology was needed too. Having conducted her personal oversight with the Portfolio Committee, she did not understand how the Free State and Mpumalanga had improved their stock house, as indicated in the presentation.

Ms E Wilson (DA) said the presentation had not been as informative and it ought to have been. She said TB continued to be the biggest killer in South Africa, which related to factors such as the mining of asbestos, and bemoaned the shortage of qualified personnel trained in the proper use of spirometers for lung function tests. 

Ms Ndaba wanted to know whether labour cases had led to meetings being held with labourers and also within the board itself, as she was concerned that labour was considered a risk factor

SAMRC’s response

Prof Gray responded on the issue on transformation and said that the SAMRC wanted to create a vibrant, diverse environment and were committed to that and to creating a diverse workforce. She agreed that the presentation needed to be more user friendly, and apologised for that.

She said the National Cancer registry was within the National Health Laboratory Services (NHLS), and SAMRC was committed to funding it. Leveraged funding was an important aspect for the SAMRC as it allowed them to fund their ambitious projects. However, they had already walked away from the table when they felt that funders were not willing to address the issues that were pertinent to South Africa. They were a valued institution and were very hard to be pushed around and they negotiated ongoing renewals with funders regularly, and where they felt it was not to the advantage of South Africa then the funding was not renewed, and SAMRC was not afraid to leave the table. There was a new partner they were affiliated to now, and this intuitive focused on district level health care. Together with the DOH, the Clinton Foundation and the Alma Foundation, certain districts in the country had been identified as hotspots for neonatal and maternal mortality, and the partnership wanted to deliver interventions that were administered at the clinic level in an attempt to address those issues and work hand in hand with the team on the ground to turn around those clinics mortality rates. R2 million would be contributed from the SAMRC to that project, but they would be receiving R120 million in investment into South Africa at the district level for the health clinics. She emphasised that to leverage money they needed money, and that was why they were always looking for funds.

They had taken NAPHISA off their risk register for the year. However, it was not as a risk but as an important entity to engage and collaborate with, and to develop partnerships in a synergistic manner. They were excited to be working with them, as the National Cancer registry would go into NAPHISA and be funded by the SAMRC.

With regard to the paediatric formulations , syrup was administered to some, and tablets to others -- it depended on the size of the baby. For certain things, tablets had to be given, and in many cases children found them hard to swallow, but with syrup, they needed to take more millilitres. The syrups and tablets would need to be researched to make them easier to swallow or to make the medicine more palatable.

The issue of transformation was a big issue, as there were simply not enough black female scientists, and black scientists in general. Grants and funding had been received to be awarded to black female scientists and when looking for recipient candidates, none could be found. The question was whether to accept this situation or specifically develop programmes to build a pipeline of candidates. SAMRC could not be crucified because of that issue, as they had been trying their best to encourage and find candidates from institutions and universities.

The Chairperson interrupted that the fact that black female scientists could not be found was a reflection of the past injustices that had affected non-white females; as they had been told that a black child should never be taken to science institutions. The whole blurry image of blacks not being scientists was something which needed to be changed, and interventions and initiatives needed to be implemented to promote black scientists.

Mr Nick Buick, Chief Financial Officer (CFO): SAMRC, said the funding statement which had been mentioned earlier in the presentation had been a mistake. The funding which was being provided by Government made up 60% of the funding received by the SAMRC, while the donations made up the remaining 40% and not vice versa, as originally stated.

Prof  Gray referred to the spirometer issue, and said academic institutions’ curricula were comprehensive and included spirometry. This allowed students to perform the tests, read the results and interpret the information in order to ensure that hospital personnel were able to be efficient and comprehensive when working in private and public institutions. If one found personnel who could not do this, the reason would be that they were not fully trained, or were not refreshing their academic courses regularly, and these gaps could be addressed by adhering to the National Department of Health’s guidelines and creating regular course refreshers for medical personnel.

Regarding the issue of labour being a risk, there was a recognition agreement and a vibrant relationship with labour. The risk was not the relationship with organised labour, nor the membership of staff within organised labour, but rather the fact that the relationship had to be managed properly, because if this did not happen, it would lead to problems.  The current union membership was sitting at 58%, and on top of that there was an additional agreement with organised labourers. Quarterly reports were always sent to the human resources (HR) department in connection with all kinds of cases and processes, and engagements were in the form of regular scheduled monthly meetings, where the issues which needed to be addressed were brought forward. Currently there was no union representative on the Board, and that was due to the nature of the Act. It was not due to disinterest, but rather to the Act which determined Board appointments.

Dr Anban Pillay, Deputy Director-General: NDOH, responded on the issue of stock availability, saying there were two systems in place where the facility was required to report on the availability of the facilities on a weekly basis, and this was monitored regularly. An app had been developed so reporting could be done via the app, and any member of society could use it. This would help in the processes of the stock availability supply chain.

Dr Maesela told the SAMRC that transformation was not a favour, it was government policy and therefore it was law. If the SAMRC could not meet the requirements, then they needed to ask for help from the Committee to assist them.

Ms Wilson said that the spirometer initiative had only recently been developed, and was not always available as stated.

The Chairperson said Members could help the SAMRC with their oversight. She asked the SAMRC to compile a spreadsheet that the Committee and the community at large would be able to understand. It would need to contain the most common deadly diseases and sickness, and how and where they came from and was contracted. Secondly, she requested them also to conduct research on protective clothing, especially within the health sector. She said that empowering the Department of Health meant empowering the citizens of South Africa and the world at large.

Office of Health Standards Compliance (OHSC): APP

The Committee was told that the mandate of the Office of Health Standards Compliance (OHSC) was to protect and promote the health and safety of users of health services by monitoring compliance and ensuring consideration, investigation and disposal of complaints relating to non-compliance with the prescribed norms and standards.

Its strategic-oriented goals were:

  • To publicly demonstrate responsiveness and accountability as an effective and efficient high-performance organisation. The indicator of this goal would be that of the Auditor-General’s annual findings rating.
  • To inspect health establishments (HEs) for compliance with quality norms and standards. An indicator of this would be the percentage of compliant HEs certified by the OHSC within 60 days after the final inspector report.
  • To investigate and respond to patient and community complaints and situations of concern within a certain period. There were five indicators to this goal. They included the percentage of complaints that were resolved within the call centre within two months of lodgement; the percentage of user complaints resolved within 30 working days through assessment and screening; the percentage of complaints lodged with the OHSC instigated and responded to within six months; the percentage of investigations finalised by the Ombud within six months from the lodgement date; and the percentage of Ombud recommendations monitored and implemented by health establishments within six months of tabling to the OHSC.
  • To progressively improve the quality and safety of healthcare through effective communication and collaboration with users, providers and other relevant stakeholders. An indicator of this would be the number of public awareness initiatives that were executed.

Improving the quality of health was a critical component of the National Development Plan (NDP), with an outcome to “strengthen the health system’s effectiveness” through external assessments. The Health Ombud had been appointed in June 2016 and a call centre had been launched in November 2016. The Organisation investigated unresolved complaints by healthcare services, public and private, and made recommendations and referred complaints needing further management to other regulatory or public entities.

Circumstances surrounding the death of mentally ill patients in Gauteng Province had raised the visibility of the OHSC and the Health Ombud significantly. The complaints received by the OHSC had drastically increased and current trends indicated a further increase in volume and scope.

Changes in the performance delivery environment had given rise to the introduction of new programmes and the reallocation of performance indicators. The audited performance information for 2016/17 had identified some gaps in the strategic plan. This had led to a review of the strategic plan to align with the mandate and National Treasury guidelines for managing programme performance information. Challenges experienced by management in the implementation of the 2016/17 APP had limited the data available for benchmarking. Personnel appointed through the recruitment drive had achieved the target for filling vacancies in 2016/17 financial year. The promulgated procedural regulations would pave way for the inclusion of private sector hospitals and clinics in key performance indicators of the compliance inspectorate. The main changes to the strategic direction reflected in the 2018/19 APP were the exclusion of private health establishments in the indicators for compliance inspections and progressive enforcement in exercising regulatory power due to unavailability of promulgated norms and standards regulations, and the increase in the human resource capacity during the 2016/17 financial year was reflected in the current staff compliment.

There had been no significant changes to the OHSC’s legislative and other mandates, apart from the publication of the promulgation of the norms and standards regulations. The norms and standards for different health establishments had been promulgated by the Minister on 2 February 2018, and the regulations would come into effect on 2 February 2019.

The OHSC described its strategic objectives for the coming year.

Programme 1: Administration

The purpose was to provide leadership and administrative support necessary for the OHSC to deliver on its mandate and comply with all relevant legislation. The biggest indicator of this would be the Auditor-General’s (AG’s) annual rating. Their target was to receive an unqualified audit report. The mandate and objectives of the OHSC would be supported through memorandums of understanding (MOUs) with relevant regulators or other organisations. The target for the number of compliance inspectors accredited was not achieved in 2016/17 because the office had been busy with its training and setting up.

Large budget items were located within this programme. Implementation of the communication strategy was vital to increase the OHSC’s brand visibility and public awareness. There were Board and related costs to allow adequate oversight and corporate governance, and additional expertise as required. Other expenditure areas included support functions such as office space, audit costs, training and development and information technology, advertising for procurement, and recruitment to develop and employ skilled personnel.

Programme 2: Compliance Inspectorate, Certification & Enforcement 

The purpose of the programme was to manage the inspection of health establishments in order to assess compliance with the national health system’s norms and standards as prescribed by the Minister, to certify health establishments as compliant or non-compliant with prescribed norms and standards, and to take enforcement action against non-compliant health establishments.

The large OHSC division was to ensure the adequate staff required for inspection coverage of all health establishments across the country. The increased inspection coverage was accompanied by the requirements for the inspection teams, such as travel costs, subsistence and accommodation.

Programme 3: Complaints and Health Ombud 

The purpose of the programme was to consider, investigate and dispose of complaints relating to non-compliance with prescribed norms and standards in a procedurally fair, economical and expeditious manner.

In the strategic objective annual table in 2017/18, there had been two new indicators, which included the percentage of complaints resolved in the call centre within two months of lodgement, and the percentage of user complaints resolved within 30 working days through assessment/screening.

The budget for complaints management was expected to increase. Provisions had been made for expert panels to assist with investigations. The legal fees which related to the findings of the investigations were expected to increase. The budget of the Health Ombud was included, as required by the National Treasury Act.

The purpose of Programme was to provide high-level technical and educational support to the work of the Office in relation to research, development and analysis of norms and standards; and to support capacity building and the establishment of communication networks with stakeholders.

With regard to performance and expenditure trends, the remuneration of employees was the main budget item to support the OHSC’s technical work and plans to develop new norms and standards and measurement tools. The review of development norms and standards was of vital importance. Guidance and support at national and provincial levels necessitated budgetary provision for increased travelling and accommodation, as well as for consultative forums. Research would be undertaken by the OHSC. Additional external expertise would be required as needed.

The allocation per division in the 2018/19 budget estimates showed that majority of the allocation was given to the Compliance Inspectorate Department, keeping in the range of 38% to 39% annually. The second biggest allocation was given to corporate services. Allocations per programme showed that the majority of the budget was allocated to Administration, ranging from 38 % and 40%. In the budget allocation of core vs support functions, core functions were consistently allocated 60% to 62% of the budget allocated, with 38% to 40% going to support functions.

The compliance inspectorate programme housed the majority of employees, remaining constant at 52% of the total complement. This was followed by the constant 24% in the Administration programme. There was a general increase each year of the MTEF, from 63% in 2017/18, to 69% in the share of the budget for the compensation of employees. Goods and services would decline from 32% in 2017/18 to 27% in 2020/21. Board costs and capital expenditure were at 1% and 4% respectively in 2017/18, but both remained at a constant 2% for 2018/19 and 20120/21.

Key considerations of the budget were:

  • Over the MTEF period, the budget increased by an average of 5%, with compensation growing by an average of 8%.
  • The allocation for goods and services, and capital expenditure decreased over the MTEF to accommodate the differential rates between the overall budget increase and compensation costs.
  • The compliance inspection division receives the highest allocation, in line with the OHSC’s founding legislation of conducting inspections of health establishments.
  • There had been a significant increase in the number of complaints. Budgetary constraints limited the allocation of more resources to the complaints management division to accommodate the growing increase in the number of complaints received.
  • There was a need for increased guidance and support on norms and standards, as well as inspection tools, at both national and provincial levels, to increase compliance with norms and standards.
  • Consideration was given for a conducive working environment through the provision of adequate office space, tools of trade, as well as training and development.
  • Recent experiences indicated the potential for increased litigation pertaining to the decisions of the OHSC, thus a need for funding.
  • Due to the nature of the OHSC’s services, staff members were key to achieving the OHSC objectives, so personnel costs remained the highest cost element.
  • The staff complement remains at 121 over the MTEF period.
  • More staff members and budget were allocated to the core operations of compliance inspections, complaints management, standards design and the Ombud, with the remainder allocated to the CEO’s office, communications and stakeholder relations, the board, finance, human resource management, information technology, and administration.


Mr W Maphanga (ANC) said that in the previous report that had been submitted, it had been mentioned that the office accommodation was a problem. He wanted to know if the situation was the same or what had been done to change it. What were the cost drivers causing such an increase in fabrication and marketing to the extent of R2.5 million?

Ms Wilson wanted to know what the relationship was between the expenditure trends and the strategic outcome goals. She also wanted clarification on the increased compensation for employees, and on the lease situation involving R1.6 million.

Ms James wanted to know if the OHSC had moved from their old building, as they had complained previously it was too small to house their capacity. If they had, where had they moved to, and what was happening to the old building -- was it being rented out or had it been kept vacant? She wanted to know if there were any vacancies on the Board, and when would they be filled. She emphasised the need for good marketing skills and asked how the OHSC were marketing themselves in the poorer areas so that people could easily communicate with their phones, through calls or messages, to report issues and gain access.

Ms Ndaba (ANC) if the call centre had achieved its purpose or not. Had the OHSC recommended promulgation of the norms and standards to the Minister, and had all of them been promulgated? If not, what was the reason and when would they be promulgated? She wanted to know what the full component of the Board was, and how many vacancies still needed to be filled.

Ms Kopane wanted an explanation as to why some of the performance targets remained the same as the previous year, and why some were just constantly low. She asked for a breakdown of the staff complement.

Ms Wilson referred to the pending outcome of the inquiry that had been held, and asked whether the R1 million in legal fees would be recoverable. She pointed out that the performance target for the Ombud had been 80%, but only 30% had been achieved. She wanted clarity as to why that was the case, as it meant the OHSC were not resolving nor responding to cases. She also made it very clear that in terms of health, the targets were inadequately low.

Ms R Adams (ANC) wanted to know what measures were in place to reduce the OHSC’s expenditure. The budget did not allow for an increase of human capacity in skills and resources, and she wanted to know how that would be addressed.

The Chairperson agreed that the expenditure needed to be looked at and reviewed, to try to reduce it. She wanted to know what costs were related to the Board. Which provinces received the highest volume of complaints, and what types of complaints were they? She wanted details of where the OHSC’s “road show” would be going -- which provinces, districts, hospitals and clinics. She asked why it was involved in the legal costs, and wanted a breakdown of them. She also sought a breakdown of the number of inspectors, according to race, gender, age and skills, and what the inspectors were qualified to do.

OHSC’s response

Mr Julius Mapatha, CFO: OHSC, said the office space issue involved a procurement process, and at the point of selecting suitable premises National Treasury had advised the tender had to be revised in certain areas. Unfortunately, by the time that was done, the premises were no longer available. However, another option had become available. They were in the final stages of securing it, and would be able to move within the next three months.

The performance targets remaining the same was related to the volume and consistency of the entities they were dealing with. They were still a fairly young organisation, and were still training many members of staff, and therefore they had set realistic targets than aiming to overachieve and failing.

The high costs were a result of the rentals that were being paid while they could not acquire premises, as well as the call centre which had been established.

With regard to the recovery of legal fees, the regulations related to the Tribunal did not empower it to recover the costs. If they were to be awarded the costs, it would require a legislative amendment, and they would work with the Department to see what could be done about it.

The level of travel costs was due to their inspection units having to travel to areas outside of Pretoria and hire bakkies, as the roads were not suitable for normal cars, and they would usually be away for a few days. They were trying to see how much they could reduce their costs.

The legal costs were due to the investigations and tests done at private institutions, as many of them did not agree with reports and referred them to the courts, so the OHSC had to go to court and defend them. The costs of the Board were carried by National Treasury, which described what costs may be allocated to the Board. On average, the costs had increased by 8% year on year.

Dr Siphiwe Mndaweni, CEO: OHSC, referred to the increase in marketing and publication costs, and said the head of the department had raised a concern that the OHSC was not known to the public. As a result, an accelerated campaign lasting three months had been conducted which was meant to make the OHSC known to the communities and public institutions at large. The focus of the OHSC was mainly on rural areas, and they had also translated their materials and information into local languages so that they could be easily reached and inform the public. The road show’s focus was to visit public places such as taxi ranks and hospitals, and they also went to the rural areas and to tertiary institutions to inform them.

The call centre had been established in November 2017, and within three months it had received over 700 complaints. On average, the call centre had now received about 300 complaints per month and therefore served as a tool for community members to report on incidents, which made it a vital function for the OHSC. The types of complaints received, and from which provinces they mostly came from, would be shared with the Committee.

She added that the recommendations had been made to the Minister, and one had been promulgated on 2 February. The other, however, was not yet promulgated due to the public participation process, which was under way.

Ms Oaitse Audrey Montshiwa, Acting OHSC Board Chairperson, explained that the minimum number of Board members allowed was seven, and the maximum was 12. Currently there were nine Board members. The one vacancy that urgently needed to be filled by the Minister, was the position of the Chairperson, as the previous Chairperson had taken up other responsibilities. The OHSC could only wait on the Minister’s decision.

Ms Wilson said that there was an outstanding claim of R20 million, and wanted to know if it affected the OHSC. Why was so much money spent on consultation costs, as it led to her questioning the skills and professionalism of the staff and Board of the OHSC if they kept on outsourcing for consultants.

The Chairperson suggested that the OHSC should read the report made by former President Kgalema Motlanthe on the health sector, and should use it to develop ways to deal with their weak aspects.


Council for Medical Schemes (CMS): APP

Part A: Strategic Overview

The CMS reported that its overall annual performance had improved from 86% in 2014/15 to 94.4% in 2016/17. Other specific performance successes that the CMS would continue to build on and achieve at an accelerated rate in 2018/19 included:

  • An unqualified report by the Auditor General (clean audit);
  • Maintaining information communications technology (ICT) systems up-time of more than 99%;
  • Improvement in the recruitment and retention of staff;
  • Improved turnaround times for complaints and clinical reviews;
  • Increased Prescribed Minimum Benefit (PMB) definitions, reviews and code of conduct;
  • Increased stakeholder interactions, training and empowerment;
  • Increased presence and awareness about CMS and its programmes;
  • Increased turnaround times for is investigations and enhanced enforcement capacity;
  • Improved turnaround times for registrations and rule amendments;
  • Strengthened legal compliance and a reduced backlog of appeals;
  • Improved financial compliance, and monitoring of non-compliant entities.

The major development in the policy sphere was the promulgation of the National Health Insurance (NHI) implementation policy and its gazetted implementation advisory committees. CMS would be playing a key role in these implementation advisory structures, and some of the specific activities related to this role would include:

  • Consolidation of options and schemes that were non-compliant with the requirement of 6 000 members;
  • Consolidation of government employee schemes;
  • Alignment of the PMBs with the NHI single service benefit framework;
  • A beneficiary registry; and
  • Legislative and governance reform.

The medical scheme industry trends had not changed significantly in the past two years. The number of schemes had decreased, and the overall scheme membership had been stagnant at 8.87 million in 2016/17. Member contributions had increased from R151.6 billion to R163.9 billion. There had been an increase in the inability of schemes to settle claims in line with contributions, without relying on investment income. There had been a total deficit of R2.4 billion before investment income for 2016/17. Member complaints had declined from 5 089 in 2015, to 4 823 during 2016.

Some of the interventions that CMS was working towards, to ensure affordable private healthcare for all, were recommendations on contribution increases; solvency ratios; consolidation of risk pools to lower costs; a recommendation for a health market enquiry, to establish a pricing authority/regulator; and measures to counter fraud and wastage.

The CMS had aligned its goals to that of the NDOH and the NDP. Its mandate included collaborating with the National Health Ministry on various strategic policy initiatives in order to ensure that the health sector achieved its vision of a “healthy life for all” in South Africa. The CMS was currently collaborating with NDOH on the following policy initiatives, whose duration was expected to extend beyond 2018/19:

  • National Health Insurance (NHI);
  • Health market inquiry (HMI);
  • Low cost benefit option (LCBO) framework;
  • Beneficiary registry list;
  • Prescribed minimum benefits (PMBs);
  • Demarcation;
  • Solvency framework.

The CMS had four strategic goals. These were to promote access to good quality medical scheme cover; to ensure medical schemes and related regulated entities were properly governed, responsive to the environment and beneficiaries were informed and protected; that the CMS was responsive to the environment by being a fair, transparent, effective and efficient organisation; and to provide strategic advice to influence and support the development and implementation of National Health Policy.

The CMS described is programmes and sub-programme plans.

Programme 1: Administration

The CEO was the executive officer of the Council for Medical Schemes delegated with the mandate of exercising overall management of the office, and as Registrar, exercised legislated powers to regulate medical schemes, administrators, brokers, and managed care organisations.

The purpose of the Office of the CFO was to serve all the business units in CMS, the executive management team and Council by maintaining an efficient, effective and transparent system of financial, performance and risk management that complied with the applicable legislation. The internal finance unit also served the audit and risk committee, internal auditors, the NDOH, National Treasury and the AG, by making available to them information and reports that allow them to carry out their statutory responsibilities. By doing this, it helped the Council to be a reputable Regulator.

The purpose of the Information and Communication, Technology and Knowledge Management sub-programme was to serve the CMS business units and external stakeholders by providing technology enablers and making information available and accessible.

The sub-programme on human resource management was to provide high quality service to internal and external customers by assessing their needs and proactively addressing those needs through developing, delivering, and continuously improving human resources programmes that promoted and supported the Council’s vision. This mission would be fulfilled with professionalism, integrity, and responsiveness by treating all its customers with respect, providing resourceful, courteous, and effective customer service, promoting teamwork, open and clear communication, and collaboration, demonstrating creativity, initiative, and optimism. By doing this, it would support its administration and staff through HR management advice and assistance, enabling them to make decisions that maximised its most important asset -- its people -- and to continue the development of CMS as an employer of choice.

The purpose of the legal services programme was to provide legal advice and representation to the CMS and business units, to ensure the integrity of regulatory decisions.

Programme 2: Strategy Office

The purpose of this programme was to engage in projects to provide information to the Ministry on strategic health reform matters, to achieve the government’s objective of an equitable and sustainable health care financing system in support of universal access, and to provide support to the office on clinical matters. The purpose of the clinical unit was to ensure that access to good quality medical scheme cover was maximised and that regulated entities were properly governed, through prospective and retrospective regulation.

Programme 3: Accreditation

The purpose of the programme was to ensure brokers and broker organisations, administrators and managed care organisations were accredited in line with the accreditation requirements as set out in the Medical Schemes Act, including whether applicants were fit and proper, had the necessary resources, skills, capacity and infrastructure, and were financially sound.

Programme 4: Research and Monitoring

The purpose of the programme was to serve beneficiaries of medical schemes and members of the public by collecting and analysing data to monitor, evaluate and report on trends in medical schemes, to measure risks in medical schemes, and to develop recommendations to improve regulatory policy and practice. This would help the CMS to contribute to the development of policy that enhanced the protection of the interests of beneficiaries and members of public

Programme 5: Stakeholder Relations

This programme was to create and promote optimal awareness and understanding of the medical schemes environment by all regulated entities, the media, Council members and staff, through communication, education, training and customer care interventions.

Programme 6: Compliance and Investigation

The purpose of the programme was to serve members of medical schemes and the public in general, by taking appropriate action to enforce compliance with the Medical Schemes Act.

Programme 7: Benefits Management

The purpose of this programme was to serve beneficiaries of medical schemes and the public in general by reviewing and approving changes to contributions paid by members and benefits offered by schemes. The CMS analysed and approved all other rules to ensure consistency with the Medical Schemes Act. This ensured that the beneficiaries had access to affordable and appropriate quality health care. This helped the CMS to ensure that the rules of medical schemes were fair to beneficiaries and were consistent with the Act.

Programme 8: Financial Supervision

The purpose of the programme was to serve the beneficiaries of medical schemes, the Registrar’s Office and Trustees by analysing and reporting on the financial performance of medical schemes and ensuring adherence to the financial requirements of the Act. By doing this, the CMS was able to monitor and promote the financial performance of schemes in order to achieve an industry that was financially sound.

Programme 9: Complaints Adjudication

The purpose of the programme was to serve the beneficiaries of medical schemes and the public by investigating and resolving complaints in an efficient and effective manner, ensuring that that beneficiaries were treated fairly by their medical schemes.

There had been a general trend of an increase in the levy amount, with it rising from R27.80 per month in 2014/15, to R33.99 in 2017/18 and R36.13 in 2018/19.

Expenditure on goods and services had gone from R48.6 million in 2016/17, to R52.4 million in 2017/18, and R54.5 for 2018/19. Compensation of employees over the same period had risen from R90.1 million, to R98.2 and R106.7 million. Capital expenditure had increased from R2.4 million, to R3.5 million and R3. 8 million.

The compensation of employees made up 65% of the expenses for 2018/19 because the CMS was a a service driven-entity, which required specialised skills and expertise such as actuaries, accountants, researchers, clinical analysts and medical experts.

The CMS concluded with observations, which included the view that members were choosing benefit options that did not suit their healthcare needs, there was a lack of understanding of the nature and extent of benefits, and they were not reading medical schemes’ material, including monthly statements.


Mr T Nkonzo (ANC) wanted to know what the challenges were with regard to the budget. The statement that there had been an overall decrease in the number of complaints seemed to contradict information which was mentioned earlier in the presentation. He wanted to know why over R7 million to consultants – what services were they providing, what measures were in place to reduce reliability on them?

Mr Maphanga said the CMS always produced progressive results regarding performance, and was confident that they would achieve their 100% target. He wanted to know what was being done by the CMS to educate and inform members to choose medical aids that met their needs.

Dr S Thembekwayo (EFF) said a pharmacy owner had sought help from the CMS after receiving a letter from a medical scheme in May 2014, and had not yet received a response. The scheme had suspended direct and indirect payments into her account, abd she wanted to know if CMS was aware of the situation and why no response had been given yet.

Ms Wilson said that CMS received only R5.6 million from the Department of Health, although its budget was R106 million, which was a substantial gap to fill. Did it have a plan for a sustainable budget, especially as more and more people were moving off medical aids due to the high costs that were associated with them?

Mr A Mahlalela (ANC) said It was worrisome that medical aid rates were the direct key to providing health care. Affordability was what the CMS ought to be addressing, and playing the role of regulator of prices. There had been a substantial increase in the number of complaints, and he wanted to know the reason. How was CMS mitigating against these issues that affected people?

The Chairperson said she wanted clarification of which medical schemes were the culprits who were responsible for the most complaints.

Dr Sipho Kabane, Acting CEO and Registrar: CMS, referred to the issue of accreditation numbers, and said the target figures would have been difficult to understand if people did not know the background. There were a lot of variables that were taken into account, and they therefore reflected the areas that were taken into consideration as well, and were not just one-sided.

With regard to the inability to settle claims versus contributions, and the link that was between them, he apologised if the numbers came across as misleading, suggesting that there had been a significant drop in the number of complaints. When looking at how many complaints there were, it was still relatively high.

It was important for CMS to rely on its consultants, because it required clinical and specialised experts for project-inclined type of work. It did not see a benefit in hiring consultants on a full time basis, as the work done took merely a few days at most. In order to improve compliance, reduce backlogs and increase efficiency, CMS needed more capacity -- additional resources would lead to increased efficiency.

He said CMS would love to be given the regulating authority for the health care sector’s tariffs in order to manage and lead to a more accessible and efficient health sector for citizens and reduce exploitational costs for citizens. Currently CMS was busy improving on its new five-year plan and would incorporate the recommendations given in the reports and from the Committee and the public.

Mr Daniel Lehutjo, CFO: CMS said that the monthly rental payments were related to the monthly rental and operational costs for the premises. The reason CMS had not bought premises was due to the fact that they had agreed to lease with the intention to buy, and during the interim period they had wanted to purchase it. However, what the land lord was asking compared to the actual market price evaluation, indicated the amount was just not reasonable -- the difference had been R70 million over the market value. The lease would expire in 2023, and the major part of their expenses went towards that. They paid about R11 million per year.

The other expenses involving consultants included auditing, banking and accounting services, all of which were related to functions which the CMS could not do or did not have the capacity to do.

Funds were raised in terms of the Levies Act of 2000, and were the main source of revenue in the organisation. Plan B would be to amend the legislation in order to find alternative revenue sources. The CMS appreciated the grant which was given by National Treasury.

Ms Thembekile Phaswane, General Manager: Complaints, CMS, referred to medical scheme members who did not choose the right options to suit their needs, and said that brokers were the ones who dealt with helping individuals choose the best options. The role of the applicant was to understand the medical scheme which they chose to suit their needs, and what they were going to be getting in exchange for their monthly payments. What CMS was advocating was that individuals needed to understand what they were getting from their schemes and what they would be covered for and for what they would not, and CMS tried to educate them on the basics of what should be included. The Office had a dedicated team and department which held educational drives and initiatives where they went to institutions and communities advising what they needed to do about understanding their medical schemes. It was found that in some cases, members were given all the information but, chose to ignore it, and therefore they remained liable for any shortfalls that had been communicated to them at the time. Communication had been made to the schemes to simplify the language in order to allow members to understand it more.

Regarding the pharmacist’s complaint that the CMS had not responded, it had been dealt with and the pharmacist had been unhappy with the outcome, it related to fraudulent claims that had been submitted to the scheme, which had then withheld payment and paid members directly instead of to her pharmacy -- they were allowed to do that according to the Medical Schemes Act. The pharmacist now had to go to members to receive her money, and not to the CMS. T

The reason behind the complaints increase was due to the unpaid accounts from Liberty and COMED medical schemes. Corrective measures had been taken, and Liberty had amalgamated with Bonitas medical scheme and therefore members were protected -- members had been transferred and Liberty had been closed. The same had been done for COMED, so no members had been affected negatively in the long run.

National Health Laboratory Services (NHLS): APP

The National Health Laboratory Services (NHLS) said that according to Stats SA, the country’s population had grown from 53.7 million in 2014 to 56,52 million in 2017, thereby exerting increased pressure on the country’s public health care system. HIV and TB remained priority diseases which required significant volumes of testing to support their management. Over seven million South Africans were HIV-infected, with approximately 4,3 million individuals on anti-retroviral therapy. By 2030, it was predicted that non-communicable diseases (NCDs) would kill more people than communicable diseases.

The NHLS had a network of approximately 268 laboratories spread across all nine provinces. There were 10 national central laboratories, 17 provincial tertiary laboratories, 42 regional laboratories and 199 district laboratories. The National Institute for Communicable Diseases (NICD) continued to deliver on its mandate for the reporting and management of outbreaks, the recent one being Listeriosis. The National Priority Programmes (NPP) unit continued to support the NDoH in managing the country’s top two priorities – TB and HIV.

The Board of Directors was the accounting authority of the NHLS in terms of the NHLS Act (Act 37 of 2000). Members of the Board were appointed by the Minister of Health, and the CEO was appointed by the Board. The Board also appointed the executive managers, who were accountable to the CEO.

The current situation and HR challenges facing the NHLS were:

  • The recruitment and retention of skilled professionals.
  • The migration of skilled professionals to the private sector and internationally.
  • In the first decade of the NHLS, from 2003 to 2013, the total staff complement grew from 3 509 employees to 7 087, while its total cost of compensation shifted from R 489.4 million to R2,1 billion. This represented a staff increase of about 49.5%, and staff personnel expenditure of 42%,
  • This situation could be attributed to the expansion of its services across the country, as well as the incorporation of the KwaZulu-Natal Provincial Laboratory Services into the NHLS.

Between 2012 and 2017, the NHLS trained 234 registrars on average per year, in collaboration with its academic partners. Between 2014/15 and 2016/17, it had offered in-house training to 64 intern scientists, 43 laboratory assistant students, 498 medical technician students and 737 medical technologist students.

Key players in the private sector included Ampath, PathCare and Lancet, which comprised about 90% of the market. In total, the private market employed approximately 10 295, of whom 295 were pathologists, 50 medical scientists, 3 000 medical technologists, 1 000 medical technicians, 200 phlebotomy technicians and 3 000 nursing disters. On average, the private sector performed over 3 000 tests per day.

At end of the 2016/17 financial year, the NHLS employed 7 101 employees, which included 203 pathologists, 224 medical scientists, 1 473 medical technologists, 859 medical technicians, 248 phlebotomy technicians and 42 nursing sisters.

The NHLS described its goals:

Goal 1

To provide 100% of hospitals at the regional level with pathologist cover by 2020 and make optimal use of technology to improve turn-around times.

Goal 2

To produce highly competent pathology health professionals to spearhead service delivery and locally relevant research.

Goal 3

To increase communication with all stakeholders and ensure sound corporate governance.

Goal 4

To ensure effective management of the NHLS through efficient use of resources, integrated systems and improved monitoring and evaluation.

Goal 5

To improve the efficiency of financial practices, including procurement; in order to generate sufficient revenue to ensure financial viability and sustainability.

Goal 6

To ensure adequate resources within the organisation.

The strategic objectives were embodied in five programmes and sub-programmes:

Programme 1: Administration

Sub-Programme: Financial Management

  • Develop systems and policies which would govern effective financial management and good practices.
  • Develop a revenue collection plan and produce comprehensive invoices that meet acceptable standards.

Sub-Programme: Government and Compliance

  • Clean audit outcome by ensuring continuous management practices through compliance with standard operating procedures and systems within the NHLS.
  • The Board had a basic responsibility to ensure sustainable improvements in corporate valuations by providing strategic guidance and oversight.

Sub-programme: Information Communications and Technology

  • Invest in modernised, innovative and efficient IT systems that were patient-centred.

Sub-programme: Human Resource Management

  • Provide effective services through efficient processes and adequate human resources. To improve the motivation and performance levels of all employees.          
  • Ensure that the laboratory service and supporting services have adequate number of staff necessary to provide service.

Programme 2: Surveillance of Communicable Diseases

  • Maintain comprehensive communicable diseases surveillance programmes for leading infectious diseases, and maintain an effective response time.
  • Conduct relevant public health-related research and train qualified professionals in communicable diseases.

Programme 3: Occupational and Environmental Health and Safety

  • Provide and improve occupational and environmental health services, including laboratory testing, hazard and health assessments surveillance reports, and NHLS occupational health and safety (OHS) audits.
  • Promote and conduct research on occupational and environmental health, including gender issues, in South Africa; and advance capacity building to strengthen human resources in occupational and environmental health and safety.            

Programme 4: Academic Affairs, Research and Quality Assurance

Sub-programme: Quality Assurance

  • Improve total quality management systems within laboratories, and support departments to increase certification of support structures and accreditation of laboratories.

Sub-programme: Academic Affairs 

  • Promote capacity building of health professionals to strengthen a business case for sustained development for the NHLS through the development of pathologists and medical scientists.  Ensure an adequate and relevant contribution to diagnose laboratory services outside academic centres, by access and clinical interaction.
  • Laboratories should be encouraged to participate in relevant health research to improve patient management, laboratory performance and disease control.

Sub-programme: Research and Innovation

  • Increase the knowledge base on diseases and influence the decisions taken to diagnose, treat and care for these diseases through research outputs and articles published, and explore opportunities for innovation.

Programme 5: Laboratory Service

Sub-programme: Operational Efficiency 

  • Increase the overall turnaround times of all tests within every laboratory across South Africa.
  • All laboratories should have appropriate functional equipment and adequate supplies to support uninterrupted delivery of service.       
  • The laboratory service needed to have at least a three-year resource plan to maintain continuity in service delivery.

Turning to the expenditure estimates, the NHLS said that expenditure had increased remarkably in 2016/17 due to provisions made for the KwaZulu-Natal and Gauteng historical debt. The projection for 2018 to 2020 indicated that expenditure in relation to revenue would be managed better.

The NHLS owed its suppliers approximately R833 million as at the end of October 2017. However, for the current financial year, it had been invoiced for R1.2 billion worth of goods and services and had paid R1.4 billion to all its suppliers. It effectively meant it had paid R219 million towards its prior year debt.

Goods and services expenditure would increase from R1.56 billion in 2017/18 to R1.8 billion in 2018/19.  The volume would increase by 1% overall due to gate keeping initiatives by the provincial departments of health. A tariff price increase of 5.7% had been requested.  Personnel expenditure would increase from R3.3 billion in 2017/18, to R4.1 billion in 2018/19 because of in-sourcing, the back payment of salary adjustments as agreed with labour, and the filling of critical posts which had not been filled due to funding constraints.


Ms Wilson referred to the statement that by 2030, non-communicable diseases would kill more people than communicable diseases, and asked how the NHLS’s work and research would affect this. In what way could they help prevent this from occurring? What percentage of hospitals had pathologists currently; in order to reach their goal of having 100% of hospitals with pathologists covered by 2020? How understaffed was the NHLS? She wanted to know if the doctors that had trained under the doctors of the NHI had increased their skills and knowledge. Were the laboratories accredited by the South African National Accreditation System (SANAS) and if not, what accreditation did they have?

Mr Maphanga wanted to know why the targets in programmes one to five were remaining the same, when they should be showing some progression. Currently there was severe pressure due to the listeriosis outbreak, so what lessons had the NHLS learnt thus far about the outbreak and how would it help them to prevent a situation of the same sort recurring?

Ms Ndaba said the NHLS performance indicators all seemed “copy and paste,” and she was not convinced. There could not be a performance indictor which was stated as new in 2014, but in 2018 it was still new, as that meant that there was no performance at all. She also wanted to know what practical steps had been taken for the integration with NAPHISA.

Dr Maesela asked how far the NHLS had gone with transformation, and if they could actually show some discernible evidence that there had been any sort of proper transformation. It had been indicated that there was gate keeping by provincial departments, and he wanted to know what type of gate keeping it was. The NHLS had mentioned that people resisted change, but he countered that by saying that resistance was what would bring about change -- if everything was in equilibrium, then there would be no need for change. It was that resistance which would start change and bring about development and growth. He added that it would serve no purpose to have a laboratory if the scientists there just wanted to work on exotic procedures, but could not even tackle the basics.

NHLS’s response

Prof Eric Buch, Chairperson: NHLS, said that last year they had included some of the historic data, including the provisional 2018 figures. However, the Committee had stated that those figures should be kept back for when the NHLS reported on its performance later in the year, which was why the data on non-communicable disease was absent.

The NHLS was not a static organisation, and therefore they had undertaken strategic exercises in the pathology discipline that anticipated future demand as the development in technology evolved, and would adapt to those situations. As more South Africans got access to medical and health care, the need and demand for tests would grow, and that led to the question of equipment and capacity. The message here was that the field of laboratory medicine and services was not a static one.

They were constantly investing in new and improved equipment technology to improve efficiencies in order to get better value for money. Historically, the NHLS had a capacity of about 50 tests per day, but the listeriosis outbreak had served as a way to show that many more tests were needed, and therefore an amount of R10 million had been invested in a new piece of equipment so that staff could do more than 400 tests per day, thereby increasing efficiency and also reducing the unit costs.

He referred to the performance indicators, and what “new” meant, and said certain performance indicators were not a good measure of performance and therefore new measures had to be developed, so when there was “new” written it meant that a new method had been introduced which was not linked to the previous year.

He apologised that there should have been a footnote to explain properly that. IT infrastructure had been invested in, as a Board, to develop and evolve. The bandwidth was being expanded in order to extend the sustainability of the NHLS. The nature and the structure of the “SWOT” analysis had been looked at and evaluated as a Board. The quarterly targets were not in the APP presentation, but they were in the APP document handed out. The extra R219 million was historic debt that had been invoiced, and the aim was to remove the entire debt over the next two years.

Dr Timothy Tucker, NHLS Board member, said that training had been identified as a problem in terms of the pass rate, and the Board had taken specific steps and appointed a Committee to put in place mechanisms to face and combat the challenges and ensure that there would be progress. The NHLS had also made changes to allow for increased contact time with the learners, and at the latest exams there had been an improvement.

Issues of race and gender were very sensitive, and the exact numbers would be reported back to the Committee. 

Regarding the NHLS’s development, there had been significant progress. A strategic research plan had been created, and where possible and where cost effective, it was investigating strengthening the innovation side of things. In collaboration with the Department of Science and Technology, there would be an innovation summit this year to look at innovation within the organisation and how improvements could be made. He stressed that research and alignment with national needs were indeed being taken care of . 

Dr Karmani Chetty, CEO: NHLS, referred to the issue of non-communicable diseases, and said a pilot programme had been started which involved looking at a system where general practitioners (GPs) became contracted to supply medications and diagnostics where provided by the NHLS. They were the only institution big enough to take care of the majority (80%) of the population, and the private sector did not have the capacity to support the majority, or even close to it. The private sector could not compare to the NHLS with regard to affordability. The effectiveness of the pathology had not been done as yet, but was being worked on. Exercises were being carried out to check the workload in the different facilities and how they could utilise the staff they had. Pathology vacancies took priority when they needed to be filled. The turnaround time was also something which needed to be looked at.

The meeting was adjourned.

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