Department of Health Quarter 1 performance

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29 August 2018
Chairperson: Mr A Mahlalela (ANC) (Acting)
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Meeting Summary

The Department of Health (DOH) presented the first quarter report on its performance and expenditure in implementing its six programmes, and indicated that there had been a general trend of under-spending.  

The e-health strategy had been revised, including the introduction of a new tradition where consultations would occur. The beneficiary registry had 2 994 facilities that were involved in the health patient registration system, and the DOH’s target at the end of the current financial year was to have 25 million South Africans registered on the beneficiary registry. These recipients could be followed with regard to where they were, and what services they were getting.

To avoid people having to stand in long queues when they needed access to medicine, the Central Chronic Medicine Dispensing and Distribution (CCMDD) system had been introduced. This system allowed patients to collect their repeat prescriptions at pharmacies.

A registrar had now been appointed with responsibility for traditional health practices in South Africa, who would drive the work of the Traditional Health Practitioners’ Council. A draft bill would go out for public comment, and thereafter go through the Cabinet process.

To implement the combination of prevention and treatment in the programme dealing with HIV/AIDS, tuberculosis (TB), and maternal and child health, the annual target for the total number of clients on antiretrovirals (ARVs) was five million. By the first quarter, just over 4.2 million had been reached, but the Department expected to catch up in the second quarter.

Other topics highlighted by the Department were the regulation of medicines through a single exit price, planning for the National Health Insurance (NHI) scheme, the collection of data on male circumcision, tracking down missing tuberculosis patients, the challenge of budget constraints in eliminating malaria, governance at primary health care (PHC) facilities, overcoming the shortages and lack of space at hospitals, implementation of the ideal clinics programme, and increasing the output of medical professionals from South African universities and colleges.

The Committee asked for the planning of the NHI scheme to be more clearly explained so that everyone could understand it. Other aspects raised by Members were the need for proper training and monitoring of PHC committees; the provision of more resources to PHCs, as the poor were suffering from the lack of services; more emphasis on health education at schools, with a particular focus on reducing teen pregnancies; how to address the understaffing at hospitals; why oncology and obstetrics programmes had not yet been implemented; what the status of “revitalized clinics” was; and why there were delays in procuring medical equipment, even when funds were available.

Meeting report

Department of Health: First quarter performance

Ms Precious Matsoso, Director General (DG): Department of Health (DOH) said audits were a key area in the administration programme, and this process was would be under way when the final annual report was tabled. The National Health Insurance (NHI) bill, which had been tabled with the Medical Schemes Amendment Bill, had been reviewed in November and submitted to the Cabinet in February.  The bills had been deferred until they were published in June for public comments. A major consultative meeting had been convened by the Office of the President last Friday to obtain input from different stakeholders on the two bills.

The e-health strategy had been revised, including the introduction of a new tradition where consultations would occur. The beneficiary registry had 2 994 facilities that were involved in the health patient registration system, but this had been slightly delayed due to the effects of an industrial strike. There would be an improvement in the second quarter. The DOH’s target at the end of the current financial year was to have 25 million South Africans registered on the beneficiary registry. These recipients could be followed with regard to where they were, and what services they were getting.

The DOH had met with different government departments, and had also collected data from learners and the Department of Basic Education (DBE). It was including data from the South African Social Security Agency (SASSA) so that the areas where SASSA beneficiaries were, would get adequate services. In the second quarter, the updates on the latest data would be shared.

Ms Matsoso spoke on the topic of surveillance, where there was supposed to be 3 625 facilities reporting on stock availability. The DOH was on target, with 3 500 facilities reporting. To avoid people having to stand in long queues when they needed access to medicine, the Central Chronic Medicine Dispensing and Distribution (CCMDD) system had been introduced. This system allowed patients to collect their repeat prescriptions at pharmacies. Two million patients should have been enrolled in first quarter, but there had been a deviation of 200 000. The DOH was monitoring the problem of resistance. It had signed memorandums of understanding (MOUs) with the National Health Laboratory Services (NHLS) and the National Institute for Communicable Diseases (NICD).

A registrar had now been appointed with responsibility for traditional health practices in South Africa, who would drive the work of the Traditional Health Practitioners’ Council. A draft bill would go out for public comment, and thereafter go through the Cabinet process. It was currently with the State Law Advisers, and the DOH was waiting for their opinion.

The Medicines and Related Substances Act provided for the regulation of medicines through a single exit price, and amendments stipulated that adjustments had to be implemented, based on currency fluctuations. The pricing committee had come up with a draft recommendation on single exit price adjustments, and the notices had been signed and were awaiting publication in the Gazette.

The DOH needed to know if users were satisfied with their services, which was why 1 500 primary health care (PHC) facilities were required to conduct surveys, so interventions could be made where there was dissatisfaction.  It had appointed eight provincial departments to conduct these surveys, and support had been rendered to four provinces. The DOH planned on making these surveys annual, and not once-off activities.

Ms Matsoso said that the Department aimed for an integrated monitoring and evaluation plan which would help them track their health outcomes. The assessment would start with the NHI evaluation, where fieldwork and data had been collected, as well as at NHI pilot sites. Usually appraisals and reviews would be done, but in this particular instance, it was about doing evaluations to measure impact, to see whether any differences were made at pilot sites.

She added that not all planned field work had been completed due to the delays in approval by provincial health research committees in five provinces, which had also delayed the commencement of data collection.

Ms Matsoso said that provincial consultative meetings had been scheduled. A workshop had already been conducted in the second quarter in this regard. The evaluation of fieldwork and data collection ought to be completed and the timelines revised. The DOH had also planned a big research meeting, where the results would be shared on 13 and 14 September. In addressing the industrial strike, the DOH would engage with a mediator and a bargaining council would convene with the Department. The Ministers of Public Works and Health had agreed that the DOH might have to relocate if the conditions in the building did not improve.

Programme 3 covered the treatment of HIV/AIDS, tuberculosis (TB), and maternal and child health.

To implement the combination of prevention and treatment, the annual target for the total number of clients on antiretrovirals (ARVs) was five million. The target by the first quarter had been 4.4 million, but only just over 4.2 million had been achieved. The Department expected to catch up in the second quarter.

The planned National Health Screening and Testing had had to be postponed because of the funeral of a member. The DOH had decided to continue with the provinces, although the campaign had not been launched formally. Medical male circumcision data would be completed only in the second quarter. Ms Matsoso admitted that the DOH had underperformed in both the testing campaign and the male circumcision data. However, the work had been started without any launches. The male circumcision issue was due to a delay in receiving data.

The DOH had been supposed to identify 15 000 missing TB patients, but when they looked at the data for the second quarter it had realised it had reached far more than that. The DOH needed reporting mechanisms, as these served as new indicators to set up systems for the purpose of reporting on data sets. She had looked at the data the previous day, and the numbers had stood at 45 000 for the identification of missing TB patients that the DOH had been able to track down. Reporting mechanisms for undiagnosed TB patients had been developed, to ensure that all provinces used a standardised data reporting tool. With the National Screening and Testing campaign, this was being done within the provinces, but the idea was to do it outside the Department. She said she was hoping to work with stakeholders, civil society and the private sector as a vehicle to reach out to other partners outside the Department.

Referring to Programme 4, Primary Health Care, Ms Matsoso discussed the elimination of malaria in the country, and said that the DOH was supposed to have had a strategic plan to look at the gaps where the problems were. From the DOH’s assessment, the provinces that were doing well were Mpumalanga and KwaZulu-Natal (KZN). The Department was struggling with Limpopo, and that that would be the place where it would be spending most of its time, especially with the malaria season coming up. The DOH had come up with a work plan for joint external evaluation (JEE), in which they also set up technical working groups to look at the packages. The DOH planned 10 district structures to meet minimum requirements. They had developed a tool on the basis which assessed whether districts were performing or not, as they were key to the delivery of primary health care. Tools had been developed, and stakeholders were still being consulted. The DOH would be meeting as a technical National Health Council (NHC) in this quarter to approve and use this tool to assess the districts.

Ms Matsoso stated that each clinic should have a committee that was functional in order to provide some level of governance. The DOH aimed to establish the level of performance in the clinics. It had been able to assess 2 208 clinics so far. If committees were dysfunctional, the DOH needed to set new ones up and follow-up. With these follow-ups, it would be able to see how regularly these committees met and what was discussed. The DOH had established the status of only 2 208 clinics, and still had to establish the status of 1 192 clinics, which would be achieved by the end of the year.

There were 1 178 PHC facilities that were accessible to people with physical disabilities. The initial target for the DOH had been 1 160. It had planned for all district hospitals to have ideal status, and had already completed the first framework for the ideal districts. The DOH visited 50 hospitals in eight provinces to establish what the key areas of concern were. It would sit with their provincial colleagues of those 50 hospitals each quarter to see how they would redirect resources, so that identified challenges could be resolved.

In 2012, the DOH had supplied a Limpopo hospital with chillers, boilers and other resources, but when they had revisited them in 2018, they had found they were no longer functional due to poor maintenance. She asked what methods could be used when the DOH intervened, and how they could sustain these hospitals. She questioned whether grants would be an appropriate way to respond. The DOH had discussed this with Treasury to try to find a suitable measure.

The DOH had also come up with a plan to improve environmental health services involving environmental health practitioners in all 52 districts and metropolitan municipalities in the country. The target had been for 15 district mental health teams to be established in each province, but three district teams had not been established. The DOH had created a fund so that if a district had not appointed a team, it could appoint teams itself, which would hopefully be an intervention.

The DOH aimed to establish two multi-disciplinary rehabilitation teams. For the programme, facility managers should not be the only ones driving the quality agenda -- district management teams should also be involved.

Programme 5 involved the hospitals, tertiary services and workforce development. With regard to the number of central hospitals with proper organisational structures, Ms Matsoso said that their visits to the hospitals allowed for the Department to come up with a proposal and a budget that they planned to implement, with the support and agreement of the provinces. She said that if vacancy rates were high, it would be a problem.

The DOH focused on casualties, and why hospitals were overburdened. They looked at the number of beds and their shortages, and had come up with plans to deal with the challenges at 50 hospitals. They were now at a stage where they were about to implement this strategy before they could take on another 50. They had set up targets for the improvement plans for oncology and obstetric services in public hospitals. Nine provincial departments were supposed to have plans for the delivery of quality emergency medical services, to comply with regulations that had been published. Each province had a committee that had to facilitate information exchanges. The DOH appointed people from one province to support another, so that a province that was well-performing could support another that was under-performing. The provinces would use a checklist to monitor compliance.

Ms Matsoso said that the DOH was supposed to establish 400 facilities compliant with infrastructure norms and standards. There had been 50 in quarter one. There were additional infrastructure assessments that had been conducted by the team. Each DDG had chosen a province which they supported. The 50 hospitals spoken about earlier also applied to this proposal.

The DOH had met their target of 20 clinics and community health centres that were to be constructed for revitalisation in quarter one. The target for the number of hospitals to be built had not been reached, as only two of the targeted 20 had been completed. The DOH had met the goals for refurbished facilities within the NHI district of 25 in the first quarter. The number of facilities refurbished outside the NHI district had also been reached, where the quarterly target had been 15.

The DOH had compiled draft human resource (HR) regulations for the workforce in terms of the National Health Act. The purpose of the regulations was to avoid vacancies. Medical interns, community service students and those who had qualified in the mid-year, had been allocated. When interns and students qualified in December, they would be placed at the beginning of the year. If students and interns qualified between January and May, they would be allocated in the mid-year. Those who qualified in the month of February and wanted to be placed immediately tended to disrupt the process. Two yearly intakes should be how the system worked.

The Department had conducted site visits at universities, worked with students and visited medical associations. The DOH’s strategy was due for review, and stakeholder consultations had been held. The strategy would be finalised in the second quarter.

Ms Matsoso spoke about the Mandela-Fidel Castro programme, where preparation had been done in the first quarter. The DOH had received 700 students back from Cuba, and they had been allocated to all eight medical schools in the country to finish their last leg of training. The difference with the programme this time around was that historically, the DOH received 100 to 180 students annually. This was the first time that 700 students had been received all at once. Next year, the DOH would receive 1 000 students. She explained that the DOH had signed an MOU with all eight universities, and had agreed that each university should make platforms for the finalisation of training. The Deputy Minister was driving the programme. She said that 2 100 South African students would qualify this year, as well as the 700 students who were finishing their training, and 1 000 students who were returning next year.

There were a number of managers who needed to be trained. There should have been 30 hospitals and 300 PHC managers who should have been trained through the PHC management hub for coaching and mentoring. So far only 21 hospital managers, two CEOs, 19 management hospital teams and nine PHC managers had been trained. There needed to be an investigation as to why there had been such a poor uptake of training coverage.

For nursing education and training, nine out of 17 colleges should have been customised for the new three-year diploma that had recently been introduced. The new courses would commence in 2019. So far, only five of the nine nursing colleges had customised their nursing programmes in order to be ready for 2019. A draft of standard norms and guidelines for clinical training programmes that had been developed.

Programme 6 covered health regulation and compliance management.  Ms Matsoso said that the National Public Health Institutes of South Africa (NAPHISA) Bill had gone through the National Council of Provinces (NCOP). Bi-annual governance reports had been produced for all health entities and councils. A handbook would be developed so that board members could be trained for all entities to comply with them, as well as statutory professional councils.

First quarter financial expenditure

Ms Matsoso stated that as of 30 June, the DOH’s expenditure was R11.435 billion, which was slightly below the linear projection of R25%. Areas of under-performance were administration and the NHI, Health Planning and system enablement, which had started late due to disruptions. For primary health care services, the DOH had had to reorganise the functions in the Department to work within the budget.

Mr Ian van der Merwe, Chief Financial Officer, DOH, said the reasons for deviation in Programme 1, were because the DOH still had to increase all the salary notches from April till the second quarter. With the South African Institute of Chartered Accountants (SAICA), the DOH had approved the business plans for the provinces, and expenditure would commence in the second quarter. His biggest problem was the issue of the lease agreement on the Civitas building worth R24 million. Payment had not been made due to outstanding repairs by the Department of Public Works.

There was a transversal agreement with Microsoft which had to be paid for by the second quarter. The DOH had negotiated the quantum of the contract downwards in terms of what licences were needed.

With the compensation for employees, the invoices for health attaches had not been received yet, but would be processed as soon as they were available. On goods and services, there would be an annual contribution to the World Health Organisation (WHO) which would be payable in the fourth quarter of the financial year.  There had also been a Vodacom billing error which had been rectified. A contract for a software licence for the medicine stock system was in the process of being finalised.

Mr Van Der Merwe said that some service level agreements still had to be signed. The DOH was having issues with the auditor general (AG) in terms of the auditing of financial statement from institutions. Those statements needed to be available in order to transfer funds. He added that labour issues had severely impacted the DOH in terms of having staff available to place orders.

Expenditure in Programme 4 had reached 17% of the annual allocation. A number of goods and services payments were in process in respect of the printing of malaria health promotion flipcharts. There were also other promotional materials in process. The allocation for mental health from the Treasury was still in the planning phase. He added that transfer payments could be effective only when the service level agreements had been signed and audits had been provided from the institutions and NGOs.

Mr Van rer Merwe said that Programme 5 had reached the targeted expenditure level of 24%, with the issue of transfer payments. Pre-payments had been made to entities, but the DOH needed to reconcile the actual expenditure before they were able to reflect it in their books. Labour action had greatly affected the finance documentiation.

In programme 6, the DOH would be purchasing an X-Ray machine for the Medical Bureau for Occupational Diseases (MBOD), which would be paid in the second quarter or early in the third quarter.

Mr Van der Merwe said the conditional grants expenditure report showed that the DOH was sitting at 23% with grants, against 23.7% in the previous financial year. Overall spending was still within the norm of 25%, although there might have been issues of under-spending between the grants. The spending on the Health Facility Revitalisation Grant (HFRG) had been 18.3% due to the poor performance of contractors and slow procurement processes. Spending on the Human Papilloma Virus (HPV) was at 2.2% due to the seasonal nature of the grant. The spending on the grants for HIV/AIDS and the National Tertiary Services Grant (NTSG) was within the acceptable norm.

On the professional training grant, most provinces were on track, except for Mpumalanga and the Northern Cape. The issue with most provinces was that they loaded their budgets very late in the first quarter, which meant that expenditure was not properly reflected. There was also the problem of alignments of business plans to the grant. The DOH encouraged grant programmes, to allocate budgets to their business plans. The HIV and clinic services grant was at 24%, with the Western Cape, North West and the Northern Cape being the slowest spenders. The Western Cape had been awaiting the delivery of ARVs and condoms. Other provinces seemed to be on track.

Mr Van der Merwe discussed the revitalisation grant, where expenditure stood at 18%. The slow spending provinces, such as Mpumalanga, were the same as the previous year.  Northern Cape had had severe pressure, and was presently at 49.4%. They had not been able to access incentives from the last financial year, and the DOH had had to see how to address it with an indirect grant. Contractors had expedited the deliveries.

Ms Matsoso referred to the teams that were led by each DDG to different provinces to solve the problems in hospitals. They spent time with the facility managers, doctors and the various teams in the hospitals. She asked for the report on the 50 hospitals to be shared.


Mr S Jafta (ANC) asked how the Department was trying to address the issue of the shortage of doctors in hospitals. How would they retain those who were currently rendering their services? He asked the department for an update of the roll-out of ideal clinics, and what support the DOH was giving to the ideal clinics to conform to the standards. How was it assessing the PHC committees? Was any training given to committees immediately after the members had been elected to serve?

Ms L James (DA) spoke about Programme 2 (Health Planning and Systems Enablement), saying she had a problem understanding it, and hoped that the government would explain it properly. On Programme 3 (HIV & AIDS, TB and MCWH), she urged fast-tracking on the infrastructure spending. She said that clinics were the only options for her people.  Primary health care had to be sorted out in respect of staff, nurses, doctors, materials and all other resources. If PHC was not sorted out, the poor would continue to suffer.

She asked how the Department was dealing with teen pregnancies. Health education was important, and could not be a once-off event -- like 1 December was World AIDS Day, and that was it. There should be a continuation of education of the youth. If the Department did not empower communities, the youth would struggle with the battle of diseases. Health education had to happen at clinics and churches. The Minister should not be the only one speaking to the communities. There should be people who sat with communities to explain how they could lead longer lives within their means. People should be given the power to take care of themselves. She asked if the clinic committees were also being empowered to perform what was expected of them. Did TB patients’ families know that they also ought to get tested?

Dr P Maesela (ANC) asked why there was an overall under-expenditure in all the programmes when there was so much that was needed to be done with the money. The procurement management system did not seem to be working in the health system, or in government in general. As long as procurement system management were not included in the decision-making group and they were just implementers, the system would not work because contradictions would arise. If procurement managers were upgraded into the decision-making sector, it would work.

He said that there was a chronic shortage of health practitioners, and Treasury had said they would not be able to fill all the vacant posts. He asked how this would happen, with the chronic shortage. He also asked if South Africa would be able to produce its own practitioners, instead of sending them away. He asked for a focus on producing health professionals internally. The DOH needed to expand if they were to cope with the NHI, but there appeared to be blockages and the Department was contracting. He asked for an explanation. He said the Committee was looking for the ideal clinics and was struggling to find them, and asked for an  update on their roll out.

Mr T Nkonzo (ANC) also sought clarification on Programme 2. If 80.2% had been spent, what had been the under-spending on the other programmes? The Department had not mentioned where the other under-spending had been, and should have been consistent. In Programme 3, the spending on HIV/AIDS appeared to be on track. He asked what was being done to improve the turnaround time for blood and toxicology tests. Were there any programmes to up-skill the staff at PHC facilities? The Committee needed an update on the health professionals for the school health programmes. He asked about 1 192 clinics that had not yet been assessed, their functionality and the implications of their not yet having been assessed. He wanted to know about the understaffing at hospitals.

Mr W Maphanga (ANC) wanted to find out whether it was the provincial or national Departments which were responsible for providing shelter for patients, and how the DOH was going to rectify the situation. Why had the malaria programme, which was planned to commence in July 2018, had not happened? He also wanted clarity on why both the oncology and obstetrics improvement plans had not been drafted yet, and when they would be drafted and presented to the Committee.

The Chairperson asked why Limpopo had not performed as expected on malaria. What were they not doing that they were supposed to be doing?  What interventions were being put in place for malaria control? Were there no systems to track areas that were infested with malaria? Malaria control should be more proactive, and people should not wait for deaths to happen and then react.

He asked for the lists of revitalised clinics, and said that he had never seen one. He asked for the list of 20 revitalised clinics that had been constructed from the previous quarter. This also applied to hospitals. The committee needed to know where they were located, and be able to claim victories. Communities could not be told about revitalised clinics that did not exist, as this just became a story to them.

He said that the priorities for the provinces seemed to be upside down, as they did not understand that primary health care was a priority. Mpumalanga was demolishing hospitals and building new ones. There were areas which did not have proper health care facilities, which did not make sense to him. Something had to be done about it, otherwise targets would not be achieved.

The Chairperson asked about the delay in procurement of medical equipment, and whether this was because it was not available in the market. This was a challenge, as there was money for medical equipment in health facilities, yet there was a delay in its procurement. He asked if the equipment was not procured because it was not available in South Africa.

He referred to the low spending on infrastructure at ideal clinics, and indicated that in some provinces the conditions of the clinics were not up to standard. In June, the Committee had reached out to clinics which had said they did not have budgets for infrastructure. The clinics had some funding which was not being spent at the required level, and he asked what interventions were being put in place to deal with that.

He said the DOH had to explain its planning to lay the foundations for the introduction of the National Health Insurance programme, otherwise it would indicate that it was not yet ready.

DOH’s response

Ms Matsoso said that there were always complaints from the places the Committee had done their oversight visits. The outcome from the first survey among the doctors, nurses and CEOs had indicated stated that there were not enough beds. In Gauteng, hospitals had resorted to buying “Lazy-Boy” reclining couches. There were situations where patients had to stay on the beds for days because the theatres were closed. Upon investigation, hospitals would respond that there were not enough funds for beds.

There was a challenge of referrals, as people would walk from a clinic straight to the hospital. They would go to clinics and if they did not receive the service they wanted, they went to a hospital. If the clinics were dysfunctional, the hospitals would be dysfunctional. At some facilities, equipment was broken and at others there were staff shortages. There were some cases where there were two or three staff members who were doing their best but could not cope. The DOH’s appeal was that because there were existing grants for expenditure, Parliament and Treasury should allow the Department to redirect the funds to these problems. The DOH did not want to focus on a specific province, but to look at all the facilities.

Ms Matsoso said that 88 mobile clinics had been bought. Some were parked and some were never used, with the provinces thinking they were the national Department’s responsibility. There was a “national-provincial” attitude. Anything to do with national, people did not touch. These problems needed to be resolved. There was an organisational culture problem, and the report would highlight that.

She said the DOH would redirect money and fix the problems. It had wanted to use the presentation as a test, and give the Committee the planning which would be jointly shared with the provinces. The planning would also be shared with the provincial legislatures, and be closely monitored. This would be done for clinics and hospitals, and a very aggressive programme would be followed.

The DOH was cooperating with other provinces, such as Limpopo. It had divided the responsibilities so that Dr Pillay would be leading a KZN team, Ms Rennie would be leading the Limpopo team, Dr Andrews would lead Mpumalanga, and she would be doing the Free State because of the two facilities which spent a lot of money. The DOH would also be focusing on Upington, as it also had another state of the art facility. She added that a state of the art facility did not equate to health care, and that what was what the DOH wanted to fix.

The DOH would not respond just to the needs of a hospital, but also the clinics surrounding it. The under-expenditure would be corrected by those funds being redirected to revitalising facilities and tackling infrastructure-related problems.

Ms Matsoso said that with regard to the staff shortages and the retaining of employees, the DOH had worked with the provinces and Treasury, and had done an HR analysis across the country to get a breakdown of the staff shortages by province. Gauteng was the worst placed with staff shortages. Hopwever, Treasury had put a cap on spending, because hospitals were already at 65% of the HR budgets, which would leave very little money for activities to bring employees through the system to render services.

The DOH was drawing up a proposal to address the challenges at ideal clinics. In most of the DOH’s reports, there was always the problem of infrastructure involving most facilities across the board. The provision of shelter was also a common problem, whether from sun or rain. There were also space problems – such as space for health workers to assess patients, or spaces to wait. She had argued with Treasury that there should be no talking about building new hospitals, but that money should be used to fix the existing ones.

Ms Matsoso said that the DOH wanted to assess the committees, to establish whether they had been appointed, when they met and what they did when they meet. The DOH wanted to take over and shape them. Its intervention was that they would work with the provinces and if they did not get a response, they would be more aggressive than they already were.

One of the reasons for the under-spending and the delays in signing off was the need for redirecting funds. The DOH was perhaps too ambitious when it started a project.

Programmes such as “Love Life” and “Soul City” were supposed to be helping the DOH to educate the youth about teenage pregnancies. “Love Life” had spent R64.3 million alone annually, and that needed to be reviewed to see if they were delivering what the DOH wanted. The DOH had also spent R20.2 million on “Soul City.” These grants amounted to almost R100 million annually. She asked the Committee to help with these problems.

Ms Matsoso said that the Minister had launched a new initiative called “She Conquers”, a three-year national campaign that aims to improve the lives of adolescent girls and young women in South Africa. Donors had funded R3 billion to empower young women to take charge of their lives. This programme ran parallel with an international programme called “She Decides”. It would not help if it was just the DOH running all these programmes -- it had to be all of society’s responsibility so that there would be a much broader dialogue about youth and young women.

The DOH also encouraged communities to take responsibility for their facilities and to take care of them. There were training programmes which recognised prior learning. There would be 20 000 formalised health workers in this financial year.

The Department had made considerable progress with school health. It had sent audiologists and optometrists to schools to treat young learners so they could know about those people and what they were doing. The Department of Education had been wonderful in sharing data with the DOH.

Ms Matsoso explained that to combat malaria, the DOH used to have seasonal workers who sprayed at specific times. South Africa was one of the E8 elimination countries that were supposed to eliminate malaria. It had been included because it was one of the closest to eliminating malaria,. This programme was monitored very closely in South Africa to assess whether it was still close to eliminating it, but with the budget cuts, the DOH could not keep up with the necessary preventative measures.

Dr A Pillay, Deputy Director General, DOH, referred to the low spending on the NHI indirect grant, and said the Department’s intention was to contract health professionals, and had advertised to do that. It had also involved the universities as well so that it could deliver services in the areas where they were needed. The DOH was looking for optometrists, speech and hearing therapists, oncologists, ophthalmologists, etc. When the DOH had advertised these opportunities, they had found that there were more people that were interested than they had expected. There had been a lot interest outside the private sector for service delivery.

He said there had been significant spending on oncology, and in the school health services and the mental health services. The DOH was waiting for the signing off from the State Information Technology Agency (SITA) on the procurement of software, so there would be huge expenditure there.

The problem of space in KZN had been found to involve general practitioners needing additional rooms for consultations. A request had sent to all provinces to get their feedback so that a standard structure could be provided for all provinces, as this was needed to be done quickly.

Mr Van der Merwe spoke about the health facilities’ procurement issues. The DOH had seen during oversight visits that in many instances, provinces at district levels had delegations of authority. The turnaround time for the approval of equipment took time. The budget allocated for equipment to some institutions was quite low. There were also instances where provinces had to do procurement through Treasury, which would take even longer.

Ms Matsoso stated that there were hospitals in KZN that had created their own delegation policies for procurement, where they set thresholds on the purchase of equipment. If there was overspending, the provincial department would be contacted, and the DOH would have to reverse all those transactions. The DOH therefore did not know if hospitals were implementing or not.

Mr Van der Merwe referred to compensation issues in Programme 5, and said there were some payment backlogs to be settled and also some vacancies to be filled. 

Ms James asked if there were any consequences for offending service providers, or blacklisting of them by the Department.

The Chairperson asked the DOH to audit of all primary health care services in the country so that it was able to understand the infrastructure challenges. He said this was a warning about the problems that were affecting facilities.  The provinces also had to indicate what plans they were putting in place to replace those structures. A follow-up audit had to be done on the primary health care services, and the DOH would also have to give a status report on all the facilities. Some problems did not need money, but management.

The meeting was adjourned.

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