National Public Health Institute of South Africa Bill: Portfolio Committee amendments

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Health

23 May 2018
Chairperson: Ms M Dunjwa (ANC)
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Meeting Summary

The Portfolio Committee addressed amendments to the National Public Health Institute of South Africa Bill. The first matter was the request of the Portfolio Committee to incorporate environmental health in the Bill, but the concern was that there would be overlap with the Office of the Health Standards Compliance (OHSC).

Parliamentary legal services informed the Committee that the National Public Health Institute of South Africa was a co-ordinating body set up to conduct surveillance and to coordinate functions across both national and international levels. The Institute’s functions were more high-level functions compared to those of the individual offices, such as the OHSC which, specifically, advised the Minister in terms of the determination of norms and standards. It also inspected and certified health establishments. Section 83 dealt with Environmental Health investigations. That section empowered the Environmental Health Officer to investigate situations that constituted a violation in terms of section 24A of the Constitution, which dealt with environmental health.

The OHSC, the Environmental Health Officer and the Institute clearly had different functions and there would no overlap. The Bill could accommodate environmental health under clause 3(3)(i) which dealt with the functions of the Institute including strengthening of surveillance, provision of technical support for all spheres of government and coordination of research. The words “environmental health” were, therefore, inserted in the Bill, where appropriate. 

The legal services then presented the redrafted National Public Health Institute of South Africa Bill incorporating the amendments previously proposed by the Committee. The clause determining the composition of the National Public Health Institute of South Africa Board was amended and the community representative was removed. Members of the Board were required to have specific medical knowledge and skills. A new clause was proposed which determined disqualification from membership of the Board, vacation of office by members, removal of a member from the Board and dissolution of the Board.  The appointment, removal and performance agreement of the CEO, as well as the functions of the CEO and the Board, were extensively deliberated before being accepted by the Members.

Members sought clarity on the person responsible for vetting the Members of the Board, the distinction between the roles of the CEO and the Board, and the appointment and removal of the CEO.

Another amendment to the Bill was the substitution of the words “Minister of Health” with the words “Cabinet member responsible for health”. The reason given for the amendment was the possibility of a change of portfolio.

The Chairperson informed the Committee that the next phase of the process would be the line-by-line approval of the Bill.

Meeting report

Opening remarks

The Chairperson asked everyone to introduce themselves. Parliamentary legal services presented a re-drafted version of the National Public Health Institute of South Africa Bill in which the recommendations of the Portfolio Committee had been incorporated. The Chairperson reminded everyone of the rules and she encouraged Committee Members to asked questions based on the presentation.

Ms Gail Andrews, the Department of Health’s Chief Operating Officer, offered apologies on behalf of the Director-General of the Department of Health, Ms Malebona Matsoso, who was on an official assignment in Geneva. Ms Andrews was the Acting DG.

Presentation by the Parliamentary Legal Advisor

The Chairperson handed the discussion on the proposals of the Portfolio Committee over to Ms Suanne Isaacs, Parliamentary Legal Adviser. The consolidated amendments were presented to the Portfolio Committee for consideration.

Environmental health

The first matter for the consideration was the insertion of “environmental health” into the Bill. The Legal Advisor had been instructed to ensure that there would not be an overlap of the functions of entities in relation to environmental health. Ms Isaacs stated that there was an existing office that dealt with matters relating to environmental health. In terms of Section 78 of the National Health Act (NHA), the OHSC had been established to protect and promote health and safety in entities that utilised the health services as well to enforce and monitor compliance by health establishments and the national health system.

Ms C Ncube-Ndaba (ANC) interrupted the presentation. She was not satisfied that the Legal Advisor had not provided copies of the document under discussion. The legal unit of the Department should provide the Portfolio Committee with proper documentation for the sake of clarity. The Members of the Committee had to be able to relate to the contents of the Bill in order to ensure appropriate deliberations.

Mr A Mahlalela (ANC) concurred with Ms Ncube-Ndaba. Legal services should present appropriate documentation before the Committee so that Members of Committee could determine that there were no repetitions or overlaps with the current functions being performed in terms of the National Health Act (NHA), as amended.

The Chairperson agreed but suggested that Members refer to the NHA on their tablets or laptops, but asked Ms Isaacs to speak more slowly so that Members could absorb the points that she was making.

Ms Isaacs returned Section 78 of the NHA and the OHSC. The objective of the office was to monitor compliance with norms and standards in terms of the NHA. The Office advised the Minister in terms of the determination of norms and standards. It also inspected and certified health establishments. The Office investigated and monitored cases.

Section 83 dealt with environmental health investigations. That Section empowered the Environmental Health Officer to investigate situations that constituted a violation in terms of Section 24A of the Constitution, which dealt with environmental health. The Officer could investigate cases of pollution and other conditions that might be harmful to environmental health. The Officer could investigate cases of violation of norms and standards in terms of environmental health.

According to Ms Isaacs, the National Public Health Institutes of South Africa (NAPHISA) was more of a co-ordinating body set up to conduct surveillance and to coordinate functions across both national and international levels. NAPHISA’s functions were more high-level functions compared to those of the individual offices. The individual offices dealt with specific complaints, while NAPHISA dealt with national and international matters. According to that section, the functions of NAPHISA included strengthening of surveillance, provision of technical support for all spheres of government and coordination of research, where appropriate. Ms Isaacs reiterated that NAPHISA dealt with national and global matters, whilst individual offices dealt with more localised complaints.

The OHSC, the Environmental Health Officer and the Institute clearly had different functions and there would no overlap. The Bill could accommodate environmental health under clause 3(3)(i) which dealt with the functions of the Institute including strengthening of surveillance, provision of technical support for all spheres of government and coordination of research. The words “environmental health” were, therefore, inserted in the Bill, where appropriate. 

National Public Health Institute of South Africa Bill

Ms Isaacs turned to the National Public Health Institute of South Africa Bill and presented the amendments made to the document in accordance with the request of the Portfolio Committee.

Preamble

The specific amendments were then considered. Most of the amendments dealt with the insertion of the words “environmental health”. Ms Isaacs said that “environmental health” would be inserted in the first page of the Preamble. The Preamble recognised communicable and non-communicable diseases, occupational health, environmental health, injuries and prevention of violence and other challenges in South Africa. Those words would be inserted in line with the recommendations of the Portfolio Committee.

Ms Ncube-Ndaba sought clarity on the placement of environmental health and injury.

Ms Isaacs replied that the insertion of the word “environmental health” was merely a technical amendment.

She then went on to discuss the contents of the Bill.

Clause 1

The “Minister of Health” on page 2, in line 5 was substituted with “Cabinet member responsible for health”. The reason for the amendment was the possibility of a change of portfolio.

The Members agreed with the amendment.

Clause 2

On page 3, in line 24, to omit “and”. On page 3, in line 25, to omit “.” And to substitute “; and”. On page 3, line 25, to add the following paragraph: “(f) Environmental Health.”

Clause 3

On page 3, from line 47, to omit paragraphs (i) and (j) and to substitute:

Strengthen cross-border, regional and international collaboration on communicable diseases, non-communicable diseases, occupational health and safety, cancer, injury and violence prevention and environmental health. Environmental health was inserted at the end of the sentence. 

On page 3, in line 54, to omit “government” and to substitute “the Department of Health”. On page 4, from line 4, to substitute the words in (n) and (o) with:

 “(n) provide technical support for all spheres of government and other regulatory bodies on surveillance of communicable diseases, non-communicable diseases, occupational health and mitigation strategies for occupational exposures, cancer, injury and violence prevention and environmental health;

(o) coordinate research, and where necessary conduct research to inform policy and guidelines on communicable diseases, non-communicable diseases, occupational health, cancer surveillance, injury and violence prevention and environmental health, and must develop processes for dissemination of research findings to key stakeholders.

Members agreed to the amendment.

Environmental health was also inserted on page 2 of the proposed amendment in terms of NAPHISA’s functions. Members agreed to the amendment.

On page 4, from line 15, to substitute the words in paragraph (q) with:

“(q) strengthening advocacy, social mobilisation and partnerships in order to address communicable diseases, occupational health, non-communicable diseases, cancer surveillance, injury and violence prevention and environmental health,”.

Mr Mahlalela suggested that non-communicable diseases should come immediately after communicable diseases in paragraph (q).

Clause 5

The clause dealt with the composition of the Board. The clause was rejected.

The following was proposed as a new clause:

The Board consists of the following Members, appointed by the Minister, taking into account, amongst other things, the appropriate representation of race, gender and disability:

(a) an official from the national Department of Health;

(b) two Members, each with special knowledge in one of the following areas:

  (i) economics, financial matters or accounting; and

  (ii) legal matters;

(c) seven Members, each with the knowledge in one of the following areas:

  (i) communicable diseases;

  (ii) non- communicable diseases;

  (iii) occupational health;

  (iv) cancer surveillance;

  (v) injury and violence prevention;

  (vi) environmental health; and

  (vii) field epidemiology

The community representative in Clause 3 of Sub-Section D was removed because there was no provision for such in the proposed amendment.

Members agreed to the amendment.

Clause 6

Clause 6(c) was deleted based on the recommendation of the Portfolio Committee because community representatives were no longer required.

Members agreed to the amendment.

Clause 8

The Clause was rejected.

The following new clause was proposed:

“Disqualification from Membership of Board, vacation of office by Members, removal of member from the Board and dissolution of the Board

8(1) A person may not be appointed or remain as a member of the Board if that person-

(a)   is not a South African citizen and ordinarily resident in the Republic;

(b)   is not fit and proper;

(c)   is an unrehabilitated insolvent;

(d)   has at any time been convicted in the court of law-

  (i)  of any offence and sentenced to more than 12 months’ imprisonment without the option of a fine; or

  (ii) of an offence involving financial dishonesty, whether in the Republic or outside the Republic if the conduct constituting the offence would have been an offence in the Republic and sentenced to imprisonment without the option of a fine.

Disqualification could also arise if the person committed offences like violence and assault.

Members agreed to the amendment.

Ms E Wilson (DA) expressed satisfaction with the Board. However, she sought clarity on the person responsible for vetting the Members of the Board.

Ms Isaacs said vetting was not included in the Bill, but it was a qualification requirement. The appointing authority with the Minister had to vet nominees.

Mr Mahlalela sought clarity on why 2(e) was removed.

Ms Isaacs said 2(e) was omitted because it had been covered in 2(a), which spoke to the disqualification of the CEO in terms of subsection 1. She said 2(e) was a repetition of 2(a). Non-citizenship of the Republic was automatic disqualification. The changes were covered in clause 2(a).

Ms Wilson asked about clause 8 (2), (4) and (5). Clause 11(3) should have read “the appointment of a person as the CEO is subject to written performance agreement entered into by that person and the Board in collaboration with the Minister.”

Mr Mahlalela cautioned that Ms Wilson’s recommendation could lead to complications in terms of accountability if the agreement is entered into “between the person and the Board in collaboration with the Minister.” The agreement should be between the person and the Board. The Minister could then consider the agreement and approve the performance agreement of the CEO.

Ms Wilson said that the Minister had to be involved so that there was a political will to remove the CEO, where necessary.

Mr Mahlalela maintained that the roles of the Minister and the Board had to be separate. The Minister appointed the Board which, in turn, appointed the CEO. The Minister could remove a member of the Board, but he could not remove the CEO since he was not responsible for the appointment of the CEO.

Mr Brijla attempted to clarify the role of the Minister in terms of appointment and removal of the CEO, but he was eventually corrected by the Portfolio Committee.

Clause 12

The clause spoke to the functions of the CEO. The clause now included additional functions for the CEO. The clause ensured that the CEO and other responsible persons acted in conformity with the Public Finance Management Act (PFMA). There were also technical amendments to clause 12 in terms of punctuations.

Clause 13

The Department proposed that the following be a new clause:

Annual report

“13.       Subject to the PFMA-

(a) the CEO must, in consultation with the Board, prepare and submit an annual report, financial statements and the report of the auditors on those statements to the Minister; and

(b) the Minister must table the annual report and statements referred to in paragraph (a) in Parliament within one month of receipt thereof.”

Members agreed to the amendment.

Mr Brijla sought clarity on Clause 13(a). “It was the duty of the CEO to prepare the report and submit it to the Board. The Board in turn submitted the report the Minister”.

The Chairperson said that the CEO in consultation with the Board submitted to the Minister.

Mr Mahlalela said that the CEO, as the accounting officer, had the responsibility and obligation to submit the annual report to the Minister after the report had been adopted by the Board (the accounting authority). That was in line with legislation, including the PFMA.

A member of the public said that the Board had to ensure that the CEO did what was right in line with the PFMA.

The Chairperson reiterated the importance and distinction of the function of the accounting officer and accounting authority. The Portfolio Committee could not alter the role, as that might conflict with other legislations.

Mr Mahlalela stressed the importance of collaboration between the CEO and the Board.

The Chairperson said that the clauses following clause 13 would have to be altered in terms of numbering.

Clause 22 (in place of Clause 21)

On page 10, in line 49, it was necessary to omit “2017” and to substitute “2018”.

Members agreed to the amendment.

Ms Isaacs said other technical amendments would come up if the Portfolio Committee agreed to the proposals presented.

Closing remarks

The Chairperson expressed satisfaction with the presentation. She said the next phase would be the line-by-line approval of the Bill.

The meeting was adjourned.

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