Members of the Portfolio Committee on Health were concerned at the inconsistencies between the Committee’s Budget Report and the Department of Health’s (DOH’s) annual performance plan (APP) on the implementation and objectives of the National Health Insurance (NHI) scheme. They cautioned against changing the meaning of the DOH presentation and documents, as the Committee’s report went out to the public.
The Committee decided to remove the section on the Department of Planning, Monitoring and Evaluation (DPME), as its presentation had not sufficiently addressed or analysed issues relating to the APP. It included the Auditor General’s (AG’s) analysis on human resources and expenditure management, as human resources could make or break the health sector.
Under the report’s findings and recommendation section, Members raised concerns over the DOH’s removal of 37 indicators from its overall programme plans. They were also concerned that the Department had not provided a clear timeline for tabling the National Health Insurance Bill. The Committee added an observation on the Office of the Ombudsman, noting that it received its budget funding from the Office of Health Standards Compliance, but reported to the Minister of Health. Members proposed that the Committee should invite the Ombudsman to account for this situation, and suggested that it receive funding from the DOH.
In addition, the Committee was deeply concerned about the excess accruals incurred by Provincial Health Departments, which used funds from the current financial year to pay for services rendered in the previous year. It suggested that the National Health Department assist the Provincial Departments to align their APPs with their budgets. The Committee raised the issue of unfilled vacancies, and several senior management positions in the Department having been filled in an acting capacity for a long time. It also suggested that the health professions bodies should form part of its solutions, as they were responsible for the conduct of their professions, and should be invited to Parliament to account for the attitudes and conduct of their members.
Committee Budget Report: Consideration
Mr A Mahlalela (ANC) was concerned about the second paragraph on page one of the Committee Budget Report. Even though the Committee had received a presentation from the Department of Planning, Monitoring and Evaluation (DPME), it was not related to the analysis of the Annual Performance Plan (APP), and was not relevant to the APP. The DPME had presented issues which were long overdue, but it was not the analysis the Committee had requested. He proposed that the Committee should not include the DPME in this section of the report.
The Chairperson asked if the Committee should remove the sentence, starting from "monitoring and evaluation" up to the word "sector".
Mr Mahlahela said that the Committee should rephrase the sentence to, “Briefing by Auditor General and Fiscal Financial Commission on their analysis of the APP”.
On page two, Mr Mahlahela noted the inconsistency between the Committee’s report and the Audit Development Programme (ADP) document on the objectives and implementation of the National Health Insurance (NHI). He said that Committee should not rephrase the APP documents or provide new meanings to the Department's presentation.
Ms C Ndaba (ANC) agreed with Mr Mahlahela, and said that the Committee should write according to the DPME presentation so as to not change the meaning of the presentation.
The Chairperson replied that concerns raised by the Members were important, as the Committee's report was a public document and should be a correct reflection of the DPME's APPs.
Mr T Nkonzo (ANC) noted that under programme three, on page four, there had been an omission of ‘AIDS’ in ‘HIV/AIDS.’
Ms Ndaba noted a repetition of the phrase "patient registration system" under bullet 3, and proposed that it be deleted.
Ms S Kopane (DA) said that there was another omission of ‘AIDS’ in ‘HIV/AIDS’ on page four.
On page four, under programme three, Mr Mahlalela asked if the number on male circumcision should be read as 60 0000 or 600 000.
Dr S Thembekwayo (EFF) referred to the different writing style in the report, and said there should be a consistent style of writing numbers. The report should start sentences with either the word or the figures of numbers throughout the Committee’s document.
The Chairperson reminded the Committee that the report was based on the APP document. It had adopted the writing of numbers from the Department’s presentation.
Ms Ndaba agreed with Dr S Thembekwayo’s point about consistency within the report. She asked if the Committee Secretary could explain why the report was structured in that manner.
Ms Vuyokazi Majalamba, Committee Secretary, said that if a sentence started with a number, it was written as a word. However, the error on page four would be corrected.
Ms Ndaba proposed that the section in page 39, on human resource and expenditure management from the Auditor General (AG) presentation, be included in the report.
The Chairperson said that the human resource (HR) section was highlighted in yellow, but the Committee may not be comfortable with this as there were challenges in the HR sector. It would be important to include the HR area in order to establish what was making or breaking the sector.
Ms Ndaba said that the Committee had agreed to delete the DMPE section on page 40.
The Chairperson replied that since the Committee had removed the section on the DPME in the earlier pages, the report’s numbering would change. The Committee's ‘Observations and Findings’ would now be numbered as seven. The Committee would go through its ‘Observations and Findings’ bullet by bullet from page 41.
Ms Ndaba noted a grammatical error in the first bullet point on page 41, and proposed that an “s” be added to ‘provincial department(s).’
Ms L James (DA) noted a grammatical error in the third bullet point on page four.
On the second bullet point, Ms Ndaba proposed inserting human resource management, as stated in the AG's report.
The Chairperson noted a minor grammatical error in the third bullet point from the bottom.
Ms Ndaba said that the Committee needed to have an insert in the third bullet, to indicate its seriousconcern at the lack of planning.
The Chairperson proposed that the last bullet point of page 41, be written as ‘irregular, wasteful and fruitless expenditure,’ as the Department continued to increase this figure.
Mr Mahlalela pointed out that as soon as one added the word ‘irregular,’ the last portion of the sentence had to change as well, as its addition changed the meaning.
Ms Ndaba said that the AG's report included irregular expenditure of more than a billion rands. She proposed that the bullet point should end at, “ the Department continues to increase".
The Chairperson proposed that on page 42, the Committee remove the repeated word "service" in the sentence “challenges to services of Emergency Medical Services (EMS)” in the first bullet point and elsewhere in the report.
Ms James corrected a grammatical error in the second bullet point on page 42.
Dr P Maesela (ANC) pointed out a grammatical error in bullet four.
Mr Mahlalela proposed that the Committee divide bullet point 4 on page 42 into different points, as it contained multiple observations on the National Health Insurance (NHI). These observations included the outstanding NHI phase one report, which did not reflect the objectives of the second phase. He added that he was not sure which changes the Committee report spoke of under the performance indicators.
He said that another observation made under this bullet point was the Committee’s concerns over the lack of a timeline for tabling the NHI Bill in the Department of Health's plan, which was in contrast to President Ramaphosa’s statement in his 2018 State of Nation Address. The President had committed to this Bill being tabled in the upcoming weeks. Mr Mahlalela proposed that the Committee should also deal with the performance indicators of the DOH, as the Department aimed to streamline the implementation of the NHI.
The Chairperson said that Committee’s report would end the fourth bullet at the word “implementation". The fifth bullet point will start from the word “Committee”. The sixth bullet point would address the lack of timelines for the NHI Bill tabling.
Ms Kopane said that in the third bullet point on page 42, the Committee had raised concern over the sizeable number of indicators removed by the DOH. The Committee should indicate its seriousness on the matter and spell out how many had been removed.
The Chairperson said she noted Ms Kopane’s comment, but cautioned that the Committee should take into consideration that the Department was streamlining the NHI. She asked Mr Mahlalela if this point should be incorporated under his proposed new bullet structure.
Mr Mahlalela agreed with Ms Kopane, but said that the Committee should not limit this comment to programme two, as indicators had been removed from programmes three and five. In total there were 37 performance indicators which had been removed by the Department. He proposed inserting “That the Committee was concerned that the Department removed 37 indicators," and state how many indicators were removed from each of the three programmes.
He said that ‘observations’ should also address non-communicable diseases (NCDs), which the Committee acknowledged was a problem. Even though the Department had a budget for NCDs, it had not stated that NCDs were a focus area. He was concerned that the Department may not be able to use this budget properly, as there were no indicators for this area.
Mr Mahlalela proposed that the second bullet point on page 43 be removed, as the issue had been clarified by the Board. The Committee should add a third bullet stating its concern over the impact of increased fees on poor and ordinary people.
The Chairperson proposed that the Committee add its observations on the Office of the Ombudsman in its report.
Ms Ndaba agreed with the Chairperson, as the Office of the Ombudsman used the budget of the Office of Health Standards Compliance. However, the Office of the Ombudsman reported to the Minister of Health. She proposed that the Committee state this observation, as the Ombudsman was not reporting to the people it got its money from. It would be better if the Ombudsman received its funding from the Department, as that was to whom the Office reported. The Committee had never called the Office of the Ombudsman to come to account for this occurrence, and it should do so at a future date.
Ms Kopane agreed with Ms Ndaba, as she had previously suggested that the Office of Health Standards Compliance should be given a legal mandate and account to Parliament. The Ombudsman did not have the legislative power to investigate, but only to report on matters. She proposed that the Committee should consider making an amendment to the Bill so that the Ombudsman reported its investigations directly to Parliament.
On page 43, Dr Thembekwayo pointed out what appeared to be a typographical error in the third bullet, referring to emergency health services.
Ms Kapano replied that ‘EM Health’ was a new app which assisted with healthcare services.
Mr Mahlalela proposed that the Committee remove the bullet on page 44 as a whole, as the Department’s APP had targets. He suggested that the Committee add a new bullet point which expressed its concern over vacant positions: “It was concerned that the positions of CEO and CFO have been vacant for more than 12 months. In addition, the position of the Head of Technology, Head of Internal Auditing and Risk Management had been vacant for more than nine months". There were mainly people in acting positions in senior management, and this should the Committee's biggest concern.
Ms Ndaba proposed that the Committee raise concern over the long outstanding cases in the Department.
Mr Mahlaela said that the first recommendation on page 45 should include the National Health Department assisting Provincial Health Departments to ensure the alignment of their APPs to their budgets, given the huge accruals observed by the Committee. He said that Provincial Departments stopped paying for services in November and accrued all the services rendered from November to March. The Departments would pay for these accrued services from April to June, using money from the current financial year. The Department’s APPs and budgets would not be aligned because the money was used to pay for the previous year’s services. The National Health Department should assist the Provincial Departments, taking into consideration this accrual system. The Provincial Departments had these accruals to avoid unauthorised expenditure, and did not seek money from Treasury to pay for the services rendered to them.
The Chairperson proposed that the Committee recommend the elimination of accruals by provincial departments.
Mr T Nkonzo (ANC) said it was concerning that accruals were rolled over to the next financial year. It was important to monitor how they recovered.
Ms E Wilson (DA) agreed with Mr Nkonzo, and said that the departments begin the financial year with a deficit, and this impacted on their ability to provide services. The situation was escalating, and accruals existed had to be justified.
Ms Mahlalela replied that ‘accrual’ should be qualified, as financial accruals would always exist. However, the accruals faced by the departments were a problem and they had to eliminate their current accruals amounting to more than R60 billion.
Dr Maesela said that the issue of accruals should be addressed before it grew any further, as the departments may reach a stage where they could not do anything about this problem. General accruals were legal methods of dealing with accounting, but the identified accruals were not and were illegal methods.
Mr Nkonzo suggested that the Committee should add ‘wasteful and fruitless expenditure’ to the second last bullet of page 45.
Ms Kopane purposed that Committee’s third last recommendation should incorporate the Health Professions Bodies, as they were responsible for the conduct of their professions, and they should form part of the Committee’s solutions to identified problems.
The Chairperson noted Ms Kopane’s comment, but said that the Committee had not raised this issue when the DOH gave its presentation. The Committee had not reflected on the Health Professions Bodies in its findings either. It would be a bit unfair to put this point in the Committee’s recommendations, as the Committee had not given the Department time and space to explain its perspective on the role and responsibilities of the Health Professions Board. The Committee should note this point and engage it when the Department presented its annual report.
Mr Mahalelal suggested that the Committee should invite the health professions bodies to address and account for the concerns raised by Committee Members.
Mr W Maphanga (ANC) suggested that the Committee should add ‘fruitless and wasteful expenditure’ to bullet nine.
The Chairperson said that the Committee would delete the recommendation on page 47, as a new finding had been inserted in the report.
The amendments and deletions of the report were adopted.
The meeting was adjourned.
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