National Health Laboratory Service Amendment Bill: Department of Health briefing

Meeting report

Briefing by Department of Health

Adv Micro Moabelo, Director: Legal Services, DoH, said that post 1994, the Public Health Laboratory Services were fragmented owing to historical developments and policies. Laboratory services were non-existent in former homeland areas, except for KZN. This resulted in provinces being dependent on the SAIMR for the provision of laboratory services. By 1998 the South African Institute for Medical Research (SAIMR) was insolvent due to poor payments from the provinces.

Following extensive deliberation, the Health MINMEC (now National Health Council), a Committee comprising the Minister of Health (as Chairperson) and the nine provincial MECs (political heads) responsible for health resolved that:

-Owing to the poor state of laboratory within the SAIMR and provincial departments of health;

-The need for greater equity in access to health care and thereby within laboratory services; and

-The need for a uniform and coordinated laboratory service

A provincial model of provision of laboratory services was not appropriate, and that all laboratory services comprising of SAIMR, provincial laboratories and homeland laboratories must be amalgamated.

Two major questions that delayed the amalgamation of all of these services and their reorganisation were:

-Whether to privatise, nationalise or manage the service as a parastatal; and

-The ownership of the SAIMR as an existing institution

MINMEC, resolved on 2 October 1998, that the National Health Laboratory Service (NHLS) would be a parastatal organisation.

The National Health Laboratory Service (NHLS) was established in terms of the National Health Laboratory Service Act, 2000 (Act No.37 of 2000), to provide quality affordable and sustainable health laboratory and related public health service.

The objects of the service are to:

-Provide cost-efficient health laboratory services to all public-sector health care providers and any other government institution inside or outside of the Republic that may requires such services; and

-Support health research; and

-Provide training for health science education

Whilst the NHLS has achieved certain objectives, such as consolidation and strengthening of laboratory services, infrastructure, improvement in access and offers high quality teaching, training and research structures, it is the overall leadership and governance of NHLS that has created problems and challenges.

Problems and challenges are summarised as follows:

-Leadership, management and governance;

-Service vs. Business – lab tests primarily conducted to generate revenue and not from a service perspective resulting in complications;

-Interface between NHLS and external stakeholders; including managing reconciliations, gate keeping and debt management

-Using fee revenue to Fund national functions; and

-Poor internal policies and controls

These problems undermine the good efforts made by NHLS since 2000 and has started to impact on the service delivery

The aim of the National Health Laboratory Service Amendment Bill is to amend the National Health Laboratory Service Act, 2000, so as to:

-Define certain expressions and to amend or delete certain definitions;

-Make the Preferential Procurement Policy Framework Act, 2000, applicable to the National Health Laboratory Service

-Adjust the objects and duties of the National Health Laboratory Service;

-Strengthen the governance and funding mechanism of the NHLS; and

-Provide for matters connected therewith

Adv Moabelo read out the proposed amendments from clause 1 to clause 18.

Discussion

Mr D Mitchell (DA) noted that clause 5 states that the Board is accountable to the Minister. In light of this, he asked if currently the Board was accountable to the Minister. Further, in reference to clause 10, he asked who the Board was and who on the Board can make the decision to grant a Board member leave to miss a Board meeting. Clause 9 referred to the total breakdown between the Minister and the Board, he wanted to know who determined that total breakdown and the level of the breakdown.

Mr Mitchell referred to clause 13 which provides that the Minister of Health in consultation with the Minister of Finance may prescribe a financing mechanism for the service. It also provides for the funds of the service. He wanted to know how a Bill could be introduced, amended and implemented when in the first place there should have been a financing method discussion in the first place already from the get go. Further, he wanted to know if there was even a financing mechanism in place. Lastly, he asked what the proposed commencement date for the Bill is as this had not been mentioned.

Mr B Kivedo (DA) wanted to know what the driving force was behind the amendment Bill and why only after compliance had the issue been brought forward for amendment.

Ms P Makeleni (ANC) wanted to know what the financing plan was. In reference to clause 5, she asked if the Board was currently accountable to the Minister. Lastly, she asked if a CEO and CFO had been appointed and if not, how that would be done.

Adv Moabelo responded that the Board was responsible to the Minister. He explained that there should be no confusion as to who the Board was responsible to and therefore found it best to legislate the decision around who the Board was responsible to.

About board meetings, he explained that the Board as a group empowered a member who could grant or dismiss someone from attending the Board meetings. The board as a group also followed and applied the rules of the company. The governance of the Board would be the same as the governance of any other Board. The person recording the attendance of the meeting would then submit to the Board that member a, b or c had not attended two consecutive meetings and then the member who had been appointed by the Board to appoint or dismiss the member would be informed of the specific members’ lack of attendance. The apologies and the minutes of the meetings were all recorded to keep track of administration and avoid excuses and problems that would arise.

Board members were protected under legislation if the Minister just decided to one day to dismiss the Board unnecessarily and therefore the provision that was included regarding this should not be an issue as well.

Mr Mitchell stated that when he looked at the provision regarding the aspect of the Minister and the decision to dismiss the Board and or members, it brought to his mind the example of when politicians took the oath of Office it was to the best intentions. The reality was that Ministers never remained the same throughout and while the current Minister may have appointed someone, when a new Minister came into power, they were granted the authority to hire and fire from the Board whom they wished based on their knowledge and information they held.

Advocate Moabelo stated that it had to do with the separation of powers...

Mr Mitchell interjected and stated that was exactly his point, and a Minister today may not necessarily be the same Minister tomorrow and that was why it was their power …

The Chairperson interjected and stated that the specific provision was one which they would need to go back to as it would be a back and forth discussion. For the sake of time, they would go back to that provision and continue forward with the discussion.

Addressing the last question, Adv Moabelo responded that the financial department would be best suited to answer questions around the financing mechanisms and financial aspects of the Bill.

The Chairperson noted that all aspects had been addressed.

The meeting was adjourned.