The Compensation Commissioner for Occupational Diseases reported an increase in benefits as 1 April 2018 and a decrease in levies, which had resulted in a significantly lower surplus. The audited financial statements had moved from being a disclaimer opinion to a revenue qualification by the Auditor General of South Africa (AGSA). There had been no progress with the amendment to the Occupational Diseases in Mines & Works Act of 1973, and this had proved to be a challenge because of the flaws that were present in the Act.
Members asked about the treatment of controlled and uncontrolled mines; how the loss of earnings relating to occupational diseases such as tuberculosis and silicosis were funded; what measurement methods were used to determine if targets had been reached; reasons why there had been no progress with the amendments to the Act and issues with legal support; and whether there was any support that the Committee could offer to fast track processes.
The Department reported that it received an unqualified audit opinion. The reprioritisation process for critical vacant posts has been accomplished within the existing budgetary constraints. The National Health Insurance (NHI) final White Paper Policy was submitted to Cabinet before the end of March 2017 and published in the government Gazette on the 30th of June 2017. The Minister announced the establishment of seven NHI implementation structures which were also published in the government gazette on the seventh of July 2017. With the migration of data to the Web-DHIS (District Health Information System) for the first time 1 759 of 3 955 facilities were able to capture data at facility level.
The MomConnect programme launched in August 2014 to improve access to early antenatal services and empower pregnant women had reached a cumulative total of 1 888 918 pregnant women and mothers at the end of March 2018. Since the HIV Counselling and Testing (HCT) campaign was introduced in 2010, over 44 million people have been tested. A total of 13 872 315 people were tested for HIV exceeding the annual target of 10 million for the 2017/18 financial year. Fewer infants are being infected with HIV.
The first board of the South African Health Products Regulatory Authority (SAHPRA) was appointed by the Minister for a three-year term of office. The Acting Executive Officer of the Authority was appointed and following the first meeting about R254 million was paid to 10 409 claimants, of which R110 million went to neighbouring countries. Conditional Grants Expenditure [CG] as of 31 March 2018 was at 98.6% or R37.3 billion against a total adjusted budget of R 37.8 billion resulting in under spending of 1.4% or R516 million. The irregular expenditure within the Department stands at R77.5 million.
Members were concerned that non-communicable diseases were not being measured due to the lack of reliable information; and the underspending of 10% which was considered detrimental to the functioning and development of the Department. A further concern for Members was the incident at Baragwaneth Hospital where a lady was wrongly injected. There was no correlation between performance and expenditure as the Department has spent almost it entire budget with only a 60% achievement rate. Members heard that 4000 doctors and nurses had been trained to do liquid based cytology testing. This kind of testing is better than the convention Pap smear test as it is more sensitive and can detect cervical cancer better. Members also heard about the appalling conditions under which nurses have to sleep in hospitals.
Members asked what the role of the Department of Energy was in the Retlaphila Project; for a report on nursing training to be sent to the Committee; what was the Department planning to do about irregular expenditure; what is the status of the plan to train 18 master trainers for the cancer control policy; what is going to be done about the shortage of doctors in the country; why does there seem to be a fragmented system of health care; why the Department had not reached the goals of its school health programme; if the new Bill regulating tobacco included e-cigarettes and the Oka pipe; what interventions have been put in place to deal with under performance in Mpumalanga; is the Department going to review their organisational structure; whether there were clinic committees in the provinces and what was the Department going to do about the mismatch of staff internally.
The Committee expressed it intension to write a report on the Cuba programme as some students were saying that they were not okay overseas and there was talk of dispatching a psychologist to deal with their problems. The Committee felt that urgent attention had to be given to the situation currently at some hospitals where there were no EMS services and nurses had to transport emergency patients in their own cars because contractually hospitals were unable to do this.
Compensation Commission for Occupational Diseases (CCOD): Progress Report
Dr Barry Kistnasamy, Compensation Commissioner: Department of Health (DoH), said that previously the CCOD had had a backlog of annual reports and audited financial statements, which had been noted by the Committee. The DoH had therefore attended the meeting to provide an update in that regard.
He highlighted that benefits as at 1 April 2018 had increased by around 33% and at the same time, levies had decreased. This showed that the Compensation Fund was sufficiently solvent. The 2012/13 and 2013/14 financials had moved out of the disclaimer area and had had a revenue qualification, signed by the Auditor-General of South Africa (AGSA). A class action lawsuit against gold mining companies on silicosis and tuberculosis (TB), which had dragged on for about 10 years, was to be settled out of court due to the detrimental effects on the people affected. Information technology (IT) systems which were old and oput-of-date had resulted in a decrease in certifications.
Challenges faced included no progress on the amendments to the Occupational Diseases in Mines & Works Act of 1973, and this required legal support outside of the Department. The governance committee was functional, whereas the risk committee had proved to be problematic due to the flawed strict laws. Benefit medical examinations had reached a peak with regard to outreach activities, and the Department did not have adequate funding. Substantial backlogs still remained a problem.
The financial performance depended on revenue from the levies on the mining companies, and there had been a decline resulting from the shrinkage in the mining industry and a decrease in the levy as of 1 April 2018. The Compensation Fund sat at R4.281 billion, which had supported the decrease in the levies.
Dr P Maesela (ANC) asked whether they still had mines that were not yet controlled and if so, how many. If they were a sizeable number, what was being done with the no-go area mines. Secondly, who paid for the loss of earnings relating to the TB claims. Lastly, what role did the social partners play in the scheme of things?
Mr W Maphanga (ANC) wanted clarity on the management of the Compensation Fund, which had a target of 20% of new claims to be paid within three months, but the performance indicator stated that the tools to measure were still being developed. Therefore, what method was currently being used and what did they base their data on?
Ms E Wilson (DA) was concerned that the Department was not receiving legal support regarding the Amendments to the Occupational Diseases in Mines & Works Act, and wanted to know what the reasons for that were. She also wanted to know what had been done to ensure that the Chief Inspector and Deputy Inspector availed themselves to attend the risk committee meetings, as the legislation was flawed and meetings could not commence without them.
Dr Kistnasamy apologised that the report was in the form of a pamphlet, and not an audited annual report.
He said that there were approximately 1 600 entities registered with the Department of Mineral Resources (DMR), and there were 291 controlled mines and works from which the DoH generated revenue. Problems related to controlled and uncontrolled mines were partly linked to the risk committee, as well as the Mine Health and Safety Act, which in 1996 had which pulled out a number of the provisions for occupational diseases and placed the responsibilities with the DMR. The Department had not gone further in controlling more mines due to the policy decision to move under the same compensation legislation, and also the lack of resources.
Loss of earnings for tuberculosis was linked to the fact that a short term problem was coupled with a long-term one – silicosis -- in one Act. The Act was flawed and required a complicated calculation. The Department had provided a link on how it has overcome this issue, and mines, trade unions and ex mine-workers had been useful in the process.
Treasury had required a turnaround target on management of the Compensation Fund, to which the Department had agreed, but realised it was complicated to calculate. Therefore, the 20% target was based on 100 benefit medical examinations, of which 20 would have gone through the process. The prior method of measuring progress had not been successful as a result of it not being able to track documents. Currently, a new tool was being developed in the new IT system.
With regard to amendments to the Act, the Department had engaged with a range of other stakeholders, and therefore required the help of legal persons, economists and accountants to bring them forward to the Parliamentary process. It was currently in the process of obtaining legal counsel from the mining companies.
The DoH was frustrated with the risk committee as a result of the law, which did not allow any flexibility. It had tried persuasion, meetings and had sent support staff. It had suggested a change in the law for better accountability, and if law was changed, the Department did not see the need for a risk committee.
Dr Nhlanhla Mtshali, Director: National Department of Health, added that controlled and uncontrolled mines had been assigned a special task team. Unions had raised concerns and wanted action immediately, as they had no indication of when amendments to legislation would take place. Further, unions suggested that all mines be controlled, but the Department faced a lack of resources.
The Department had embarked on a process to rebuild a database of service providers. It was considering adopting vertical integration as a possible solution to the one stop centres, so that matters could be reported directly to the Department.
Dr Maesela commented on the issue of exclusion of workers in the uncontrolled mines. He hoped that the CCOD would push the Departments of Health, Mineral Resources and Energy, as well as Labour, to come together to solve the problem. If the Department needed some reinforcement, they should communicate what role they would like Members to play.
The Chairperson asked what was happening in Mpumalanga, and whether there were non-governmental organisations (NGOs) of ex-mineworkers there. The inspection and licensing requirements were worrying, as people were dying in the process. Further, in the Eastern Cape, there was an involvement of the executives, but it appears the focus was on the rural areas and not the urban areas. Lastly, were the general practitioners (GPs) who specialise in detecting silicosis being monitored?
Dr Kistnasamy responded that the Eastern Cape had implemented a strategic plan which was a programme on how they were going to deal with ex-mineworkers over the next five years, covering both rural and urban areas. The Department hoped that this example of a province taking leadership would encourage other provinces to do the same.
The licensing was a matter which should be dealt with by the Department of Mineral Resources. The DoH did not issue licences or inspect uncontrolled mines, as this was out of their jurisdiction and mandate.
The Department had faced issues with regard to quality control in the procurement process relating to GPs. A special task team had been assigned to deal with the ex-mineworker’s association in a legitimate process.
The Department has done work on the ground in Mpumalanga through outreach activities, but there had been no active involvement by the provincial government. The Department believed that the Eastern Cape’s bottom-up approach was a possible way forward
Dr Mtshali said that the GPs which were on their database were trained and had had their practices inspected, but the problem was that they could not pay now. The short-term solution was to mobilise through the mobile clinics, but they had faced an issue of overflow and some people were left unattended.
Dr Kistnasamy said it was impossible to get assistance by way of additional funds. Therefore, a new model of voluntary levies was being looked into with the mining Industry, and was due to be presented to the Chief Financial Officer, National Treasury and Minister. A push in the legal process and dedicated resources would be helpful to the Department.
The Chairperson concluded that the pressing issue was that of the legislation and its amendment, and said the Committee would look into the process.
The meeting was adjourned.
The Committee resumed in the afternoon.
The Minister of Health, Dr Aaron Motsoaledi started the meeting by apologising and asking if by six o’clock the meeting was still in motion he might be excused as he had a seven o’clock meeting the following day.
Department of Health 2017/18 Annual Report briefing
Ms Malebona Matsoso, Director General (DG), National Department of Health thanked the Committee for the opportunity to present the report for the year. She said that she will not focus much on achievements but rather on areas of performance. The purpose of the presentation was to reflect on the achievements and highlights of the 2017-18 financial years as reported on in the Annual Report for the Department of Health. The projects and programmes that were being presented formed part of the National Development Plan Vision 2030. These programmes were also a part of the Medium Term Strategic Framework (MTSF) which is government's strategic plan for the 2014-2019 electoral terms.
Under this programme the vacancy rate was a reported at 12.5%, which exceeded the Department of Public Service and Administration’s (DPSA) target of 10% due to budget cuts by the National Treasury. The Department has embarked on a robust reprioritisation process to ensure that critical posts are filled. For this the turn-around time for the recruitment process was within four months exceeding the DPSA’s 6-month benchmark. The Department has obtained an unqualified audit opinion from the Auditor General for consecutive years since 2011/12 financial years. The outstanding performance agreement was signed and filed with the DPSA after the stipulated deadline in 2017-18. The reprioritisation process for critical vacant posts has been accomplished within the existing budgetary constraints.
Health Planning and Systems Enablement:
For National Health Insurance (NHI) the final White Paper Policy was submitted to Cabinet before the end of March 2017 and published in the government Gazette on the 30th of June 2017. At the same time the Minister announced the establishment of seven NHI implementation structures which were also published in the government gazette on the seventh of July 2017. The implementation structures were:
- A committee on tertiary services;
- a committee on human resources for health;
- a committee on health care benefits for NHI; and
- national health pricing advisory programme
The following committees were established: a committee on consolidation of financing arrangements; a committee on health and technology assessment for NHI and; the National Health commission. With regard to Bills on this the NHI Bill and the Medical Schemes Amendment Bill were submitted and approved by Cabinet.
On medicine availability, the Centralised Chronic Medicines Dispensing and Distribution (CCMDD) programme continued to enrol new patients. Patients enrolled to receive their prescribed medicines through the CCMDD which enrolment increased from 125 2000 in 2015-16 to 216 6973 in the 2017-18 financial year. They received their prescribed medicines from over 855 pick-up points including occupational health sites, general practitioners (GP’s) and private pharmacies. And the use of the Stock Visibility System (SVS) increased to 3168 Primary Health Care (PHC) facilities. The SVS allows for the back code on the package or bottle to be scanned using a specially supplied cell phone and application. When nurses scan these at clinics, the stock level is reported automatically and in real time to an electronic map of all clinics at the central tower in Pretoria. Hospitals are using this electronic stock management system to strengthen demand-planning and governance increased from 228 hospitals in 2016-17 to 324 hospitals in the 2017-18n financial year.
eHealth and Information Systems
The Ministerial Advisory Committee on eHealth was appointed by the Minister of Health on 25 April 2017. The Committee completed a rapid review of the implementation of eHealth Strategy 2012-2016, and produced a report with recommendations in November 2017. With this in mind the Department migrated routine data from the stand-alone District Health Information System (DHIS) to Web-DHIS. As of 31 March 2018, 1 759 of 3 955 facilities were able to capture data at facility level, whilst the remainder of the facilities are capturing data at sub-district or district levels because they do not have internet connectivity at facilities. The implementation of the Health Patient Registration System (HPRS) was expanded from 1 854 PHC facilities in 2016/17 to 2 968 PHC facilities in 2017/18. As of 31 March 2018, 20 700 149 people were registered on the HPRS linked to a Master Patient Index.
Quality of care
There was a national survey to measure Patient Experience of Care in selected PHC facilities and hospitals. From this survey three guidelines were finalised: i) a Patient Experience of care survey Guideline ii) a National Guideline to manage Complaints, Compliments and Suggestions for the Public Health Sector of South Africa and iii) a National Guideline to manage Patient Safety Incident Reporting and Learning in the Public Health Sector of South Africa. Norms and Standards Regulations applicable to different categories of health establishments were finalised and gazetted in February 2018, and implementation by all health establishments will be expected from 1 March 2019. The country is participating in the Global Lancet Commission and has also established the Lancet National Commission consisting of 15 members from the public sector, Universities, the private sector, and Non-Governmental and Quality Institutions. The Lancet National Commission was launched in May 2017. The Lancet National Commission and the Lancet Global Commission hosted the Global Lancet Commission meeting from 11 -13 December 2017, attended by the Chairperson of the Lancet Global Commission and National Commissioners from South Africa, Mexico, Ethiopia, Senegal, Philippines, Argentina, Nepal and Tanzania. A depot manager has recently been appointed and a revised project plan has been developed to support the Provincial Medicine Procurement Unit (PMPU) functionality in the Mpumalanga Department of Health. NHI phase one evaluation is currently underway.
Child, Adolescent and Maternal Health
The MomConnect programme launched in August 2014 to improve access to early antenatal services and empower pregnant women had reached a cumulative total of 1 888 918 pregnant women and mothers at the end of March 2018. Integrated School Health Programme (ISHP) services have contributed to the health and wellbeing of learners as they are screened for health barriers to learning. The human papilloma virus (HPV) coverage for eligible girls in 2017/18 was at 82.6% for the 1st dose, and 61.3% for the 2nd dose.
HIV and TB
Since the HIV Counselling and Testing (HCT) campaign was introduced in 2010, over 44 million people have been tested. A total of 13 872 315 people were tested for HIV, exceeding the annual target of 10 million for the 2017/18 financial year. Fewer infants are being infected with HIV. In 2017/18, a Polymerase Chain Reaction (PCR) test done at around 10 weeks showed a 0.95% positivity rate for all babies born to HIV-positive women and; the new TB client treatment success rate reached 84.4%, while the TB client death rate was at 3.9% in 2017/18, the same as the rate in the previous financial year. For this project the development of the HIV Strategic Plan outlining key actions and strategies for the public health system will be done during the 2018/19 financial year. The District Implementation Plan to attempt to reach 90-90-90 targets for HIV and TB will be developed as part of the District Health Plans.
Primary Health Care Services
As of the end of March 2018, a cumulative total of 1 507 facilities qualified as Ideal Clinics. This achievement has been enabled by collaboration between the Department and National Treasury in resolving supply chain management challenges faced by clinics, especially with regard to equipment, essential supplies and infrastructure. Orientation workshops with government departments on the national guide for healthy meal provision in the workplace were conducted in all nine provinces to assist employees to adopt healthy eating habits.
In the near future malaria indoor residual spraying (IRS) will be increased and will commence earlier than usual in the endemic provinces. Killing of larva (where appropriate) will be strengthened and rolled out in the winter. Collaboration with neighbouring countries affected by malaria will also be strengthened and scaled up.
The DG made a special mention that when it comes to primary health care services; Early Childhood Development is still a problematic area.
Hospitals, Tertiary Services and Workforce Development:
A national core nursing curriculum was finalised for the new three-year diploma in general nursing and a one-year diploma in midwifery. The three-year diploma programme aims to enable graduates to function as clinically focused, service-oriented, general nurses able to manage low-risk health problems along the continuum of care. Eight of the 17 current public nursing colleges were supported to develop customised curricula in preparation for programme accreditation. In the 2017/18 financial year, staffing norms were implemented for the PHC levels. More than 2 000 PHC facility managers in seven provinces were trained on the concept and methodology for determining staffing needs based on workloads.
Under this national curriculum there are performance improvement strategies that have been implemented to make it more effective and comprehensive. Forensic Chemistry Laboratories will implement a targeted approach to analysis, in particular toxicology analysis which will significantly reduce the toxicology backlog. The 793 infrastructure projects that failed to reach practical completion by end of March 2018 will form part of planned projects in the 2018/19 financial year and; Provincial workshops are scheduled for 2018/19 to ensure that all managers access the already established knowledge hub, coaching and mentoring programme. The Minister added that after long deliberations and meetings there has been an agreement to go back to the curriculum that was used in the country before 1987 where training was more robust and it took around seven years for nurses to get the same accreditation they got in four years under the current curriculum. Under the new curriculum there will not just be any independent nursing school operating on its own. Nurses will have more practical experience in the hospitals at the bedside with the patients. Gone are the days where nurses will only be trained in the classroom and be expected to perform well in the field. The new training programme will have 60% of the work in the hospital and the remaining 40% will be taught in the classroom. For a Diploma, student nurses will do three years of school and after finishing these three years they will have to complete another year. When they come out of the programme they will have an epaulette with one bar of midwifery then they will become a nurse. The Department piloted this curriculum in three provinces Mpumalanga, Northern Cape and Kwa-Zulu Natal. A dossier has been put together and sent to the nursing council for approval.
For a degree the University will not be allowed to train students for four years. When they graduated they will still be given an epaulette with one bar. The Minister stressed that the reason for this is because in the past midwifery was being trained for over three months and this is not acceptable. Next year 2019 will be the last year for the intake of student nurses under the current curriculum. There is still an issue with universities as it seems as though they will only be able to do their first intake in 2023. This is war because some people in universities are still not happy with the new curriculum and they have even approached the President saying that the Minister has not consulted with them. They were lobbying and doing all kinds of things to prevent the new curriculum from being implemented. When the Minister first assumed his role as the Health Minister it was already known that the current curriculum had problems. So he decided to start everything from the beginning by having consultations and summits; the first big summit was in 2010, a summit that the Minister called the CODESA of Nursing. Provinces were urged to also have their own summits to get views from different stake holders. After this was done provinces were divided into seven commissions. It has taken eight years to get the curriculum including the piloting and consultation in motion.
The National Public Health Institute of South Africa (NAPHISA) Bill was also tabled for consideration at the Parliamentary Portfolio Committee of Health.
The Compensation Commissioner for Occupational Diseases and Occupational Health said that the Department did not take any short cuts when it comes to the piloting and it took three years. The Minister said it worries him that there are still stake holders who want the Department to have even more consultations when so much time has already been spent on the new curriculum. In fact he felt that this is unfair on the country.
The Minister said that on the state of medical schools if one is to take a closer look at historically black universities they do not have hospitals to practice in. All the universities in the Eastern Cape and Limpopo do not have hospitals in which to do their practical work. However, if one is to look at all the historically white universities like the University of Cape Town, Stellenbosch University and the University of the Witwatersrand all have well-functioning medicals schools that are situated next to hospitals so that they can make use of them for their practical education. The Minister had asked for money from the National Treasury but has not received these funds as the plan is to build hospitals for all these medical schools so that they can also produce competent medical schools. When these were applied for Treasury said it uses a new system for funding called the Strategic Infrastructure Procurement Development and Management system which meant that the Department had to start over with its application according to the rules of this new system. This new system would prevent corruption as no project would be given funds for the second stage of its building process until the necessary modules have been completed. The Minister agreed with this but said that when there is a new law it should not be applied retrospectively. The plan is to apply for these funds again and hopefully the Treasury will approve it so that the building process can be under way. The Minister said that it seems that the tender will be processed in December of 2018. This is the journey the Department has had in its process to revitalise hospitals. This has been difficult as the biggest problem for the Department has been the cutting of budgets. The Gauteng province had to write to the Department seeking permission to redirect their money from infrastructure for goods and services because they had huge accruals which meant stopping any infrastructure development happening. Of the President’s R400 billion budget for infrastructure, all the money that has been taken away from the Department over the past three years should be given back so that it can help with the revitalisation of hospitals.
Health Regulation and Compliance Management:
The first board of the South African Health Products Regulatory Authority (SAHPRA) was appointed by the Minister for a three-year term of office. The Acting Executive Officer of the Authority was appointed and following the first meeting about R254 million was paid to 10 409 claimants, of which R110 million went to neighbouring countries. One-Stop-Service Centres were opened in Burgersfort and Kuruman, one in Botswana, two in Lesotho, two in Mozambique and two in Swaziland to give ex-mineworkers increased access to decentralised services.
Dr Ian van de Merwe, Chief Financial Officer, National Department of Health, said that Conditional Grants Expenditure [CG] as of 31 March 2018) was at 98.6% or R37.3 billion against a total adjusted budget of R 37.8 billion resulting in under spending of 1.4% or R516 million (compared to 99.0% or R33.9 billion spent in same periods last year). However major contributors to under spending are:
* Health Facility Revitalisation Grant (HFRG) spending 94.1%;
* Health Professions Training Development Grant (HPTDG); and
* National Tertiary Services Grant (NTSG) and HIV/AIDS spent 98.1%, 99.6% and
99.6% respectively and thus far their spending is within the acceptable norm.
A rollover of R353 million was requested for unspent funds linked to committed projects. The overall spending of 98.1% this financial year is a decline from 99.6% of spending the year prior. All provinces spent within the acceptable norm with the exception of Mpumalanga Province and the Northern Cape. The underspending is attributed to delays in the delivery of equipment. A rollover amount has been requested and approved.
Dr van de Merwe commented on the irregular expenditure within the Department saying that as it stands it was R77.5 million. The Department has self-reported three of these incidents and the other one came from the AG. The first incident was with the Health Information Systems Programme (HISP); the R216 000 for infrastructure was another and the other one was a self-reported amount of R39000 where the Department had exceeded the designated amount for insurance costs. This is something that will be condoned through the accounting process. With the big amount of R39 million, the view of the AG was that it should have been used for the specific purpose it was set for as this was based on the Appropriation Act. These were the major items that came about as a result of the irregular expenditure. The CFO noted that there will have to be a number of applications sent to the Treasury like the condoning of some of the overspending and some needed clarifications.
The DG added that she personally wrote to the Treasury to request permission to use some of the funds allocated for infrastructure to pay doctors for services rendered because they were already rendering services. It was a choice of not paying doctors, not having services and not using infrastructure money and still being underspent. The application was declined. The other matter was on accounting principles where the problem that was brought to the attention of the Accounting General and the Auditor General was to issue a certificate of completion. The problem with this certification system is that it is tedious and takes time and it requires a certificate for every individual project in a bigger project. She would rather there be a certificate issued after the completion of a whole project. These letters will be shared with the Committee as they have implications for service delivery.
Ms Wilson expressed that she has quite a number of questions but wants to start with what was said in the presentations by the AG who raised a number of concerns that they regarded as important. The first concern was on non- communicable diseases that were not measured due to the lack of reliable information. This is a concern because if there are targets then one cannot measure if they have been met or not. The AG raised the concern especially with Programme 4 because among other things there are no supplementing documents on compliance and infrastructure. The other issue was on the underspending of 10% on the NHI. Considering where the Department wants to go with the NHI that kind of underspending is detrimental to the functioning and development of the Department. The provincial health budget for the provinces is being used on Chief Executive Officer (CEOs), no wonder the hospitals they visit often have no medicine or staff to carry out the work necessary because there is not enough funding for these to be there; the constant budget cuts are hurting the state of health care in many of the provinces. An even more severe impact is that there is an alarming shortage of specialist doctors in provinces like the Eastern Cape, North West and Limpopo as it is one thing saying that there is a moratorium but what is actually being done on the matter of a shortage of doctors in these provinces? What is happening to the Cuba programme, there seems to be knowledge that the programme is being closed and now it is being said that another agreement for its continuation is at play? It is confusing when there is contradicting information on the state of the programme. She said she has a number of questions but recognises that other members have questions as well so if there would be a second round of questions then she can perhaps ask those.
The Chairperson said that there will be a second round. She then requested that each member ask three questions and allow the Department to answer the questions and then there will be a second round of questions.
Ms C Ndaba (ANC) asked questions specifically regarding Project Retlaphila. It was stated that there is a collaboration between the Department of Science and Technology and the Department of Energy. What is the role of the Department of Energy in this programme? The Committee has been waiting on a report on nursing training, she said she would like for the Committee to be sent that report so that it could be engaged.
Dr S Thembekwayo (EFF) thanked the Department for the presentation. She said it has been highlighted that among others the Department of Health’s goal is to improve the quality of care and to improve patient care understanding that there exists a line for patient’s complaints. She wanted to know if the Department is aware of an incident that happened at Baragwaneth Hospital where a lady was wrongly injected. She wanted further action to be taken for that particular case. It was mentioned that there is an involvement of a project that deals with the detection of foetuses at risk of being still born. This is important and she asked if the Department was aware of the involvement of this group in this project. Mention was made that infrastructure is a huge problem, this maybe so but the workers inside hospitals who are not working under desirable conditions, as has been demonstrated through the nationwide protests is an issue that needs to be dealt with.
Mr B Maphanga (ANC) asked whether there has been any improvement in the performance of the new service provider. Irregular expenditure in the Department of Health has increased over the years, what is the Department planning to do to prevent this from continuing to happen? His third question was based on the matter of accruals; he said that accruals are one of the major issues in the health sector hence he wanted to know what is being done to deal with this problem particularly in the provinces. With regard to the audit outcome of the Department, he said it has been getting an unqualified audit status for seven years consecutively. He asked what the obstacles preventing the Department from getting a clean audit outcome were.
Mr Maesela asked are we still funding a fragmented system that has its challenges instead of amending the National Health Act to have one competency that complements the NHI especially in the view of the struggle that the provinces have? There are still no go areas, how is the Committee meant to tackle issues in these areas if they cannot be there? The program of students in Cuba is a problem because each province has its own approach. Perhaps the National Department could take over so that there is uniformity in the programme and there would be less confusion which would allow the Department to deal with things like students not having books.
Ms S Kopane (DA) thanked the Department for their presentation. In last year’s report the Department said it was going to train 18 master trainers for the cancer control policy. This year the achievement under this policy is zero, what is the status now? The other matter is that of students studying in Russia and it was indicated that these students learn under a curriculum that does not correlate with the South African health system, which essentially means that when they finish their studies they will not be able to find work here. Another matter was that of doctors who do not have employment even though there is a problem of a shortage of doctors in this country. Why have there been no vacancies open for them? Perhaps the Department could provide a report on this process. Finally, she expressed her concern over environmental health people in municipalities as vacancies tended not to be available for these people. She expressed concern about the NHI because in terms of contracting GPs, pharmacy assistants and other health professionals when the NHI was piloted there was a problem especially in the Limpopo Province where some of them resigned because they were not getting paid.
Mr A Mahlalela (ANC) also wanted to follow up on the matter of performance versus expenditure. He said the Department has spent almost its entire budget with an achievement rate of 60% and there is no correlation. This is something that has been happening over the years, where is the problem? The matter of infrastructure is worrying because the implication of that is that the Department comes to the Committee with a presentation that does not talk to the plan. It is the Department that has plans to refurbish all these hospitals – how do you do that if you do not have the money to do so? The other thing is that the annual report does not correlate with what the Minister is saying when comes to deviations. He expressed that he is not convinced about health facilities as all of them do not know their role. They say they are still waiting for training, how can the Department say that it is functioning well when workers do not know what they are supposed to do? This is so bad to the point where nurses have to buy their own stationary and some brooms because there is no equipment to keep facilities running. Under such circumstances clinic committees are helpless because if there is no funding, then there is nothing they can do.
The DG said the Department has prepared letters for the indulgence of the Committee so that they can see the technicalities that they have to deal with. With regard to targets, when the targets are being set it is a negotiation with provinces. As it stands there are two provinces that do not want to corroborate on the targets. What the Department does is that it uses the standard of professional bodies. The numbers of parties may not correlate because when he AG does its Audit it does not necessarily use the same facilities as the Department because for the sampling method it may choose facilities that do not necessarily represent the overall state of affairs as it uses different numbers.
Ms Wilson said that the DG was making a good point because if CEOs are 70%-75% of the required amount then how can facilities buy medicine and the equipment required; this confirms what Honourable Mahlalela was describing. There have been talks with the Treasury about what is the threshold for what is required for a hospital to run. She made an example of where in Limpopo there were two hospitals one with an oncologist and one with radiation treatment so there tends to be overlaps on these things. It was suggested that the oncologist move to the other hospital for various reasons. The point is it does not seem like there is a set standard on what hospitals should do or how they should look.
On the moratorium, provinces are saying that there is no moratorium. The DG expressed that the fundamental problem in South Africa is that doctors are educated to be trained not to be hired.
With regard to the safety of the Lancet building, only the Department of Labour can give a comprehensive report on that building. They issued a report to the Department which will be shared with the Committee. The Department has also invited the National Institute of Occupational Health to look and report on the occupational health standards of the building. The problem is the pace at which the Department of Public Works operates. None the less the Department will provide the Committee with a report when it finally comes through.
With regard to nursing colleges, the DG said that she would rather be invited to the Chief Nursing Officer because the problem was not just the development of training material; it was also about the readiness of these training colleges.
On irregular expenditure in provinces, the DG had said she will provide a document that deals directly with that and not just irregular expenditure but also accruals.
The DG said that about obstacles that hinder the Department from getting an unqualified audit report, for the past seven years if the Department did away with grants then that would happen but the question is whether that is something desirable. Policies had to be developed that would deal with these issues.
The Chairperson noted that since the Minister would be leaving earlier in the meeting then perhaps he should answer questions relating to him first so that by the time he has to leave he will have answered the bulk of the pertinent questions relating to his work.
The Minister expressed that it seems that in South Africa people want bad things to happen and he made an example of how people in hospitals use situations to get the same results as in the Life Esidimeni tragedy.
Many provinces are saying that there is no moratorium. In the budget speech in 2017 the Minister asked the then Minister of Finance Mr Pravin Gordhan to note in his speech that there will be no moratorium of core services. By this he meant that there cannot be a moratorium on doctors because they need to work. Maybe there can be one on management but not on doctors but if one were to go to the provinces you will see that doctors are not hiring doctors and this is why you will see strikes on Television. This is baffling and concerning because all the provinces have no moratorium on hiring doctors and this was in agreement with the Minister of Finance and it is in his budget speech. As a result, eight of the nine provinces, the one being the Western Cape, have been put under administration either under section 100 or under treasury administration. What this means is that their human resources are now under the Treasury, this also means that they will not be able to hire anyone without the approval of the Treasure. The issue here is that these approvals never really come.
On the issue of Compensation Commission for Occupational Diseases (CCODs) and no go areas, as it stands the country has two compensation mechanisms for occupational claims. One is the Compensation of Injuries and Diseases Act through the Department of Labour which compensates people who have any disease or injury except in case of the lungs or the heart. The other one is through the Department of Health where the CCOD deals only with lung and heart matters. Compensation from these two are not the same when it comes to the amounts for which it compensates.
On the matter of doctors who have passed exams but are struggling to be deployed, the Minister wanted to note that even with these doctors there are differences. First you have interns, these are none negotiable as it is a statutory duty for them to be placed in hospitals and the problem is the structural governance of the country Health Professionals Council as they are responsible for making sure that hospitals are best suited for interns and they set the number of interns going into hospitals. Nationally they accredit the Western Cape, Gauteng and KZN the most and one of the reasons why this is the case is because after internships provinces usually have to create jobs for these interns. Some provinces fall short in this area because they say that even though they have been accredited, they do not have the money to hire them. The second group of doctors is those that are doing community service, also statutory. The third group are those called Registrars. These doctors are doing a senior degree. The issue here is that even if a university agrees to train someone there might not be jobs for them after finishing. The fourth group of doctors are medical officers. What tends to happen in many provinces is that there are many vacancies for medical officers but fewer places for interns. What was proposed by the Minister was that the funds set for medical officers must be set for internships so that recent graduates can be trained.
When unions talk about unemployment what tends to happen is that the vast majority of these doctors are foreign nationals. The Minister said that he does not have problems with foreign nationals especially since it is a sensitive issue in South Africa. In looking at this matter he has had to ask himself if he is to give 100 jobs to foreign nationals when there are people in the country with degrees without work how would he justify that to the ordinary South African. The Department came up with a policy that for any job preference will be given to South African citizens. The next in line would be permanent residents who are not citizens. There is also a policy that states that at all universities in the SADC countries there must be at least five percent of students from other SADC countries.
The Cuban programme is actually in demand especially in developing countries; the reason for this is because Cuba has mastered the art of primary health care. There was a time when the United Kingdom (UK) wanted to evaluate the programme so the ministry with the MEC for Health out of paranoia denied this request and they still went ahead and took three students from KwaZulu Natal (KZN) to ask them about the programme. A problem with the Cuban programme is that when the doctors return they are placed in the curative system instead of being placed in primary health care like they were trained for in Cuba. KZN once did an experiment on this matter where they removed all doctors in curative care and placed them in primary health care and the result was that maternal mortality dropped and this is one of the reasons why this programme will not be stopped. Lately numbers of students being sent to Cuba have increased significantly but it was soon realised that provinces do not budget for these students and because provinces did not want to pay the programme had to be halted long enough to clear paying for the students whose provinces could not pay, and once this was done another group was sent. As for stopping the programme, it is not going to be stopped anytime soon. The fact that Cuba is the first country in the world to stop mother to child transmission of HIV is proof of how robust their primary health care programme is.
The Minister said that with regard to accruals as much as there is corruption, irregular expenditure and other detrimental things within the health sector, the country must also accept that if for three years the budget for health has been reduced by R9 billion in the public sector while the private sector is receiving an investment of R11 billion, what do people really expect to happen to health.
The Deputy Minister of Health, Dr Joe Phaahla, commented on the Cuba programme and said that the desire is for the programme to be run nationally. This is a human resource development and deployment problem. It is a provincial competency issue and until the Department has the funding to make a provision for it to be provided for nationally, it is all tied down to the current funding formula. The management of the programme is national while the actual handling is provincial.
The Minister added that the Department is looking at the possibility of handing over the programme to the Department of Higher Education and Training since it functions nationally. This way the problem of Human Resources (HR) being provincial would be solved. He also commented on the reason why the Department has not received a qualified report opinion for the past seven years. If one is to look nationally there has only been two provinces that have been receiving an unqualified audit opinion and these are the Northern Cape and the Western Cape. The Minister approached a professor who advised him that there is no such thing as a clean audit in health because the AG does not audit solely on money as there are other things as well. If for example the Department claims to be providing ARVs to four million people, there is an expectation to provide evidence accounting for all of them; as everyone knows keeping track of all patients is not easy as some of them decide to stop treatment and disappear and this alone can prevent the Department from getting that clean report.
The Chairperson commented that the Committee wanted to write a report on the Cuba programme. There are students saying that they are not okay overseas and there was also a consideration of bringing a psychologist so that it can deal with issues that they might have as it is an urgent matter. She also commented on the matter of the functionality of hospitals, she stated that hospitals are not only dependant on specialists and residents, a key part of providing a service to people is human resources and clerks in hospitals are very important; general workers are also important to keep working environments clean and safe. In order for a doctor to work there must be a folder of the patient and they must work in a clean environment.
The Minister agreed with the sentiments expressed by the Chairperson. On the issue of cleaners, when he argued that there should be no moratorium he could only go so far when it comes to negotiating because it is a matter that involves money and only doctors could be negotiated for. He hopes that the recalibration of funds will help in bringing more money into the health sector to alleviate these problems.
With regard to the Cuban programme he said that he does not want to downplay it at all, there is a psychologist that has been sent there that perhaps should be permanent. He thinks that students when they go to Cuba they mistakenly think that they are going to a place like New York. He did not know why the orientation programme was stopped. Another issue was the composition of the students going to Cuba. When the programme was started it was meant for poor students and this does not seem to be the case lately. He was not sure if this was perhaps because they are not getting favours to enter the programme. Perhaps this could be why some of them are complaining, because they are used to more luxurious things in their lives. There was also an issue about students getting drunk. These are the same things that are happening in this country and it is not as though what the students are doing there is completely out of the norm. He reiterated that it is in fact advisable to have a psychiatrist and a psychologist that understands the social underpinnings of South Africa as a country so that in this way they would be able to relate to them and better understand the reason for the issues.
Mr Maesela felt that his question was not answered and asked why does there seem to a fragmented system of health care with everyone doing their own thing like some form of a federal state.
The Minister replied that on paper South Africa is a unitary state but practically it is not. Things like human resources are all provincial functions where provinces can do different things.
The DG answered some of the questions on the Russian medical school programme. Because she did not know much about this programme she did a bit of investigating to find out what was happening. She found out that the programme was being run by a Nigerian person. They wanted to talk to the children alone and did not have meetings with everyone when they were addressing them. It was also said that the students were told that there is a particular way that they should dress and this was an uncomfortable situation. A delegation from Mpumalanga went to see the students and as for now it seems like they will remain there.
Environmental health officers are very important because the job that they do is essential for ensuring compliance from companies. The cost of lives that emanates from none compliance is too much. The loss of lives is unnecessary and so the money that is invested in these officers is a worthy investment.
On the functionality of clinics, the DG explained the criteria used to assess the functionality of clinics. What is looked at is whether there is a committee, whether there are regular meetings, the existence of a structure, minutes and an agenda. In terms of training they are not trained as training was supposed to have started earlier this year but the person who was supposed to head that project was assigned to the North West province.
Dr Yogan Pillay, Deputy Director General: HIV/AIDS, TB, Maternal and Child Health at National Department of Health thanked Members for this opportunity. The Tshwane project is a Doppler programme that measures blood flow in the placenta for early diagnoses if there is still birth. It has been sent to various regions across the across the country and so far it seems to be doing very well. The programme is a South African invention that is cheaper as well so that makes it even better. Official data will be released in January 2019.
On the matter of the number of people trained to do liquid based cytology, the DG said that over 4000 doctors and nurses have been trained. This is a new programme being used as a departure from the old use of pap smears as it is more sensitive and can detect cervical cancer better. It is going to cost more than the current programme but it is a worthy investment.
On the matter raised by Mr Mahlalela on a ward based outreach team, work has been work done on implementing a policy that was adopted last year. To do this the Department has to know how many community health care workers there are, how many teams there are and where they are. This is important because it speaks to addressing the burden of disease. The second issue is that of remuneration. With an increase in the minimum wage last year this has to be factored in. With more than 26000 of them (community health care workers) having at least matric there has to be a way to push them all to the new minimum wage of R3500, but for this to happen more money is needed.
Given that historically the Department has faced a large number of things the next problem to deal with has been around changing the scope of work. So now the Department has policy that restricted certain things but also meant reorienting the work and a new structure of work which came with new training needs. Then there was a need for a new matrix system with a new form of monitoring and evaluation. Finally, what is needed is having a better management system in place.
Dr Anban Pillay, Deputy Director-General (DDG): Health Regulation and Compliance, National Department of Health, said he was also surprised about the involvement of the Department of Energy but the production of active pharmaceutical ingredients for ARVs is manufactured at a site that falls under the Department of Energy and perhaps this is the reason for their involvement.
The question about KZN and the Centralised Chronic Medicines Dispensing and Distribution (CCMDD) provider: the CCMDD provider is Pharmacy Direct. Previously the provider for KZN was Medi Post. The problem was that Medi Post came with a fee that is 25% higher than the one offered by Pharmacy Direct so the contract was given to them as they all had other contracts with medical schemes. The problem with KZN is not the provider but the management of medication in the province. Pharmacy Direct is quite strict on this and makes sure that the dispensation of medication is done properly. With Medi Post a number of medication supplies were borderline legal even though they knew that they were putting themselves at risk for doing that. A new dispenser does not take these risks. The province took the decision that they do not want insulin to be provided through cold chain via the CCMDD because it was said to be too expensive for them to do this, so the province not the Department or Pharmacy Direct took the decision to make these changes.
On the matter of the NHI and under spending: the underspending is mainly related to IT and the reason for this is because the National Treasury has a new system called the Strategic Infrastructure Procurement Development and Management system the intension of which is to have full sight of government warehouses which would show how the procurement of stock occurs. Having already done an overview of the warehouses the DG concluded that the IT systems that were in use were outdated and needed to be upgraded. The Treasury had said that they were developing a system that could be used in these warehouses so that instead of procuring one from outside they could use that one instead, but the system did not meet the required standards for it to be used. This system was used in the Northern Cape and it crashed. The Department did not want to make use of a system that obviously had problems so there was a waiting period while this new system was being fixed and being readied for use. This is why there is an underspending on the NHI and it is only now that the system will be used because it has been fixed and is competent to function for the NHI.
On contracting matters, the DG said that the Department contracted General Practitioners (GPs), pharmacist assistants and other medical practitioners. The contract was for a fixed period and the agreement that was reached was that for the duration of the contract pharmacy assistants would be hired and thereafter the provinces would be responsible for the rehiring of them. After the contracts ended they decided that they do not want to continue with the contracts anymore so this is why there were terminations of contracts. When it comes to GPs the Department wanted to continue contracting them so through the grant the Department transferred money to the provinces so that they could continue with the contracts. However, as soon as the provinces received the grants they decided that they do not need as many GPs and that they did not like where they were stationed and so the position of GPs also changed significantly as soon as provinces were given the grant.
Dr Gail Andrews, Health Systems Integration and Human Resources for Health, National Department of Health thanked Members for the opportunity and commented on the manner in which targets are set within the Department. The Department works closely with provinces on setting the targets. As the DG has said it is all in agreement with the provinces. With regard to none communicable diseases in particular there had never really been outcome or impact indicators for this so she did not really know what the Financial and Fiscal Commission (FFC) is referring to because the Department does surveys to check none communicable diseases to have good data to track communicable diseases. The actual outcomes are targets to improve management and reducing risk factors all of which are far from the ambit of the FFC.
Dr van Der Merwe added that although it is independent, the FFC does not really take time to check facts. The AG is also independent but they take time to check their facts. Some of their reporting is not really great as last year they reported the wrong targets.
On the matter of irregular expenditure as the Minister had said if one reduces fiscal expenditure then the outcome of that cannot be expected to be great. There is research that has been done on the provinces which found that many of them run out of funds on the tenth or eleventh month of the year which means that they carry accruals of around 90 days. Provincial CFOs developed a cost containment strategy to deal with accruals.
On the obstacles preventing the Department from getting a clean audit, the DG said that as long as there is infrastructure on the indirect grants, the accounting audit comes at a huge risk. It is quite complex and has a myriad of requirements. For now the Department depends on bodies like the Development Bank of South Africa (DBSA) to account for that.
Mr Mahlalela asked why the Department had not reached the goals of its school health programme. There needs to be more emphasis on HIV/AIDS prevention as there are more and more teenagers getting pregnant at school even though the government spends a lot of money on condoms. Perhaps they are throwing them away so there needs to be a re-strategisation on the prevention of HIV/AIDS and teenage pregnancies. He then asked why the government was building NHI clinics instead of building community care centres. He expanded on this point and said that with the rapid increase in population clinics will run out of capacity and as time goes by they will need to rebuild to comply with standards, but if these were to be clinics they would be serving people in their communities and improving the current state of affairs.
Dr Thembekwayo wanted clarity on the new Bill regulating Tobacco. She wanted to know if the new Bill also includes e-cigarettes and the Oka pipe.
Ms Wilson expressed her approval of what the Minister had said regarding moving the Cuba programme from the Department of Health to the Department of Higher Education and Training. She had always expressed how effective this would be and it is great that the Minister is considering it as a viable option.
With regard to the rebuilding of Nursing Colleges the Minister had expressed how the Department has been getting reports on how nursing colleges needed to be rebuilt. Ms Wilson said that as much as the actual colleges needed to be rebuilt, their accommodation spaces also needed to be rebuilt because they are appalling. The conditions that nurses have to sleep under are not conducive to having a good night’s rest at all and no human being should be forced to live under those conditions. She then followed on with what Dr Thembekwayo was saying regarding the availability of medicines. She had recently done oversight at clinics where there were shortages of critical medications. On the recent visit to Cuba she was amazed by the clinical outcomes it had on the prevention of cancer and diabetes. In Cuba some of the cancers have now become chronic diseases instead of being killers. She wanted to know why there has been no interest shown in adopting some of these strategies for South Africa because it could be a tremendous score for the country especially since these are major killers in this country too.
Ms Wilson said that there have been reports about an NHI task team and a Ministerial task team. She asked if these teams had been established and who sits on them.
Ms Wilson said that there needs to be more plans in place on malnutrition and joblessness. Child Care Grants cannot feed families as they should feed the child. At the moment Child Care Grants are being used to feed families. If it is something that does fall under the Department then it is something that needs to be dealt with efficiently because if not, then children are going to be stunted from birth.
Mr Mahlalela wanted clarity on what sets an ideal requirement versus the cost standards; he raised this in the context of the report that was submitted by the Office of Compliance Standards which stated that all primary health care facilities are not functioning well and were performing below 60%. However in terms of an ideal status this is totally different. So based on which standard must one rely?
The second issue was that of Emergency Medical Services (EMS). He asked if the monitoring system that has been developed is going to be applied nationally. He has observed that the systems employed in some parts of the country are basically none existent. After an oversight visit what he observed was that sometimes nurses transport patients outside with their own cars because there is no EMS available to transport them.
On finances Mr Mahlela said that he has observed that where there is under performance in grants the Mpumalanga Province seems to be the common denominator. What seems to be the problem there and what interventions have been put in place to better this problem? It seems that there are no consequences in the province for this especially regarding wasteful expenditure. The AG has raised this as a contributing factor for underperformance in the province.
Ms S Kopane (DA) said that in the morning the Committee was briefed by the Compensation Commission of Occupational Diseases on their progress. Unfortunately, there was no annual report that was produced to account for this. But it was also said that the Commission had a meeting with the Minister so perhaps the Department could inform the Committee about subsequent developments. What was apparent from the presentation is that there seems to be a problem of a shortage of staff. Is the Department going to review their organisational structure?
Ms Kopane said that many Departments use consultants to figure out their problems but no skills transfer happens in the process. She wanted to find out if any skills transfer happens during the process of consultancy. They just come and leave with their skills.
Ms Kopane expressed dismay around the situation regarding condoms. Condoms are everywhere and are dispensed quite a lot by the Department, but is there any measurement of the impact that they have because there cannot just be a dispensation when there is nothing to account for the impact that they have in the country.
Mr T Nkonzo (ANC) wanted clarity on the Cuban doctors that have finished training because mention was made that when they returned they were not placed in primary health care which was their area of speciality.
Mr Nkonzo said that there were many committees in the country like for example the Police Community Forum at a provincial and national level. He wanted to know if the same occurs for clinic committees. Who in the provinces can one talk to about this? He knew that the national department is talking to the provinces but does not know who to turn to.
The Chairperson said that in Cuba when the Committee visited the Centre for Molecular Immunology and asked if they had any relations with South Africa the answer was that essentially there was no relationship between the two countries in that regard. The country was said to be dragging its feet when it comes to those matters. Why is it that the government is dragging its feet when the country is sending its student there?
At the beginning of the term in 2014 there was hype about dealing with the mismatch of staff within the Department. In the presentation there was no mention of this. What is the Department doing with regard to this?
On the matter of fake foods, the Chairperson said she understands that there will be health inspectors dealing with the problem. Is there a report on this, if not perhaps the Department should brief the Committee on this?
The Chairperson asked which provinces are refusing to negotiate on setting targets.
The Chairperson also noted that the reason why Ms Ndaba left the meeting is because she had a family emergency that she had to attend to immediately.
The DG said that yes e-cigarettes and Oka pipes as alternatives to smoking cigarettes were covered by the Amendment bill.
In terms of the Ketlaphela project the reason behind the use of China really has to do with the volumes they produce. Cuba is one of the leading countries in biomedical research so it would make sense to make use of them. But one other option that was being considered is producing ARV treatment in the country; this would make sense since South Africa is the biggest consumer of ARV treatment.
The DG said that with regard to the student programme being part of higher education, talks have already been happening between the two departments to see the feasibility of this happening.
On the question posed by Ms Wilson on accommodation at nursing colleges, the DG said that she agrees with this, in fact at some of the colleges in the North West lecturers did not even have offices to work in. When she visited there she realised that not only do nurses sleep in appalling conditions, lecturers are in that position too and it is a key concern.
The DG said that with vaccine capacity there are challenges to up their skills in the areas of medical technology. If one could recall a while back there was a Cuban engineer who came to South Africa with plans to educate South Africans about fixing broken equipment. The South African system for registration of learners did not allow them to do this which was unfortunate because they could have been used to fix equipment problems.
On EMS the DG said that there perhaps needs to be a national system where monitoring the performance of provinces could be a lot easier. When she visited the Free State, she was shocked by the nature of the agreement that was reached there. The agreement stated that EMS only covers transportation of patients from one province to another and if a patient was in a critical condition this would not be covered by the contract. So there is evidence that nurses are basically being forced to use their own cars to transport patients. This has been reported to the province.
On the root causes that the AG identified, the DG said that the Department actually has a basic system that it uses. If the audit outcomes are a ‘no show’ then the DG takes back the money. If it is gross, then the Department starts disciplinary action. There was an official who was supposed to refund the Department R2 million. There are very specific processes in place to deal with the situation.
When it comes to irregular expenditure, there are two issues that were raised by the AG; one was related to Human papillomavirus (HPV) and one to Henoche-Schonlein purpura (HSP). She said she does not think the response is linked. The DG has written a letter to the Accounting General about this matter. The situation appears to be about a balance of compliance and non-delivery.
Dr Y Pillay said he first wanted to respond to the issue of malnutrition. The indications that are there show that malnutrition is on the increase and so is stunting. There was a meeting with the Presidency last year to deal with malnutrition in families and children. When it comes to children in particular the Department has been working with the DJ Murray Trust based in Cape Town to look at innovative ways to get nutrition to children. One of the key things about stunting is that it starts prenatally which means that pregnant women must have access to nutrition.
On the matter of the Home Information Systems Programme (HISP) the DG has already outlined this clearly. The programme has been used to record every child that has been vaccinated. The HISP has been helping with the collection of data using tablets to assist nurses in this regard. . It is a worthwhile investment when looking at what it can do. The way in which Dr A Pillay explained it earlier is what led to it being irregular expenditure.
Dr Gail Andrews, COO, Department of Health. said that she does not know if there is anything to add except that the Department had a history with the HISP. It was an investment from the Danish government. There is a service delivery agreement with them. They provide technical programming support.
The Chairperson highlighted that the letters she was talking about raised these problems. Even though it is a finding for them (AG), the Department cannot take that to heart because it will affect service delivery, where young children might find themselves not being immunised because of a faulty system.
Dr van de Merwe said that in looking at what the AG found, the root causes were for the entire portfolio so the National Department was not flagged by the AG in terms of the lack of competency but definitely for consequence management. The other part was the slow response by management. The Department does have weekly sessions, so he is not exactly sure why the AG flagged the Department on this one in particular. The Department tracks responses on a weekly basis and this was why he does not understand the reason for being flagged for this part. He understands the issues around consequence management. Perhaps there has to be better monitoring of supply chain management.
Ms V Rennie, Head of Corporate Services: National Department of Health, said that in the AG report the numerous repeat findings was why Information Technology (IT) had a f grade. The root causes for these findings were capacity issues nationally. The IT environment changes all the time and staff do not want to be reassigned new duties based on new technology. All these repeat findings have been improved; most of them have been because of the old infrastructure for IT. Funding has been transferred to deal with this issue.
On the matter of the shortage of staff for CCODs, Ms Rennie said that two years ago the Commissioner created a new organogram but it was a bloated and unaffordable structure. At the moment there is no revised structure for CCODs because it was too expensive.
The Chairperson wanted to deal with the Cuban situation. She said that provinces appointed people based on the availability of posts. This might be because when they returned they still had a year of training that had to be done in hospitals. This is something that has to be changed because having them work in hospitals is a waste of investment because they will not be utilising the skills that they learned in Cuba. The plan is for the most recent group to be placed in primary health care facilities so that they can do what they are trained for.
On the matter of clinic committees and their availability the DG said she will make Mr Morena available to give details on whom to contact in the provinces.
With regard to contact with the Centre for Molecular Immunology there was an agreement with South Africa to come and fill vacant posts the majority of which were family doctors. The second agreement was for their training. The third was supposed to be for clinical engineers to be trained in fixing broken equipment but unfortunately this never happened because an engineering body had said that they would not meet engineering standards. As a result this part of the agreement was halted.
Ms Aneliswa Cele, Chief Director Environmental and Port Health Services, National Department of Health commented on the issue of fake foods and said that after the social media chaos in August there was a huge health scare. Environmental officers were sent to report on the matter. There were no fake foods found. In the Northern Cape however there was a factory that was making counterfeit products of Robertson spices valued at R77 million. As of the end of September the Department has been able to do 281 joint operations with the South African Police Services (SAPS). The biggest problem is with shops working without licences. Notices have been handed to those facilities for them to close down.
Dr A Pillay said that with regard to the stock of medicines and supplies there have been supplies coming in so it is not that the country has completely run out. In November new stocks will be coming from a Danish company that used to supply South Africa. This company is a global supplier and especially reliable to satisfy the much needed Bacilli Calmette-Guerin (BCG) vaccine. It also must be mentioned that BCG drug supplies have been slow worldwide and the World Health Organisation has also been struggling to get hold of supplies, so this problem was not limited to South Africa.
With regard to NHI Committees Mr A Pillay said that given that the bill has been sent out for public scrutiny IT committees would probably be established after the legislator has fully drafted the bill. They will then know what their mandate is.
On condom usage Dr Y Pillay said that in terms of how the Department monitors condom usage it is done in three ways: 1) reported usage; 2) through the transmission of HIV/AIDs and STIs and 3) through HIV/AIDs incidents. The data showed that among 15-24 year olds condom usage has increased. Where monitoring was through transmission it was evident that in some provinces the rates were increasing. A study was found that showed that the overall incidents of HIV/AIDs have decreased in all age groups.
The DG then commented on the two provinces that do not want to comply and said that it is mainly KZN and the Western Cape provinces. Other provinces sometimes did not respond at all which meant that they were accepting the situation. The two above-mentioned provinces responded but they just wanted fewer indicators.
The Chairperson thanked Members for their attendance and the Department for their presentation.
The meeting was adjourned.
- Department of Health & Compensation Commissioner for Occupational Diseases 2017/18 Annual Reports, with Minister 1
- Department of Health & Compensation Commissioner for Occupational Diseases 2017/18 Annual Reports, with Minister 3
- Department of Health & Compensation Commissioner for Occupational Diseases 2017/18 Annual Reports, with Minister 2
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