National Health Bill: hearings

Meeting report

HEALTH PORTFOLIO COMMITTEE
18 August 2003
NATIONAL HEALTH BILL: PUBLIC HEARINGS

Chairperson: Mr. L. Ngculu (ANC)

Documents handed out
UWC School of Public Health Presentation
AIDS Law Project and the Treatment Action Campaign submission
COSATU and NEHAWU submission
Health Professions Council of South Africa (Appendix 1)
South African Registrar's Association (Appendix 2)
Western Province Blood Transfusion Service (Appendix 3)

SUMMARY
The Committee heard submissions on the National Health Bill from the Health Professions Council of SA (HPCSA), the Western Province Blood Transfusion Service (WPBTS), the Hospital Association of SA (HASA), the SA Medical Association (SAMA), and the SA Registrars' Association (SARA).

The Health Professions Council of SA (HPCSA) submitted that the Bill was not sufficiently clear on the laying of complaints with regard to medical treatment. They supported a certificate of need to eradicating unethical practices.

The Western Province Blood Transfusion Service (WPBTS) argued against the provision that a single national service should be established. They had a mandate from their donors that insisted on the independence of the service.

The Hospital Association of SA (HASA) submitted that the Bill lacked clear definitions. They were concerned that Section 41 (certificate of need) undermined the constitutional rights of licensed members of the private sector.

The University of the Western Cape's (UWC's) School of Public Health was concerned that the Bill was silent on human resource development in the health sector.

The SA Medical Association was concerned about a lack of protection for health care providers in the Bill. They were also concerned that the establishment of the various consultative bodies in the industry would lead to duplication of functions.

The SA Registrars' Association was pleased that both the public and private sectors were provided for in the Bill, but wanted to see the inclusion of rural areas. They felt that the HIV/AIDS issue should be included in Chapter 2 which relates to the rights and duties of users and health care providers.

In the afternoon, submissions were made by AIDS Law Project and the Treatment Action Campaign jointly as well as COSATU and NEHAWU.

MINUTES
Health Professions Council of South Africa
Adv. B Mkhize said that although the HPCSA generally supported the Bill, certain areas were potentially problematic:
(1) Section 18 provides for the laying of complaints about the manner in which a user is treated at a health establishment. The Bill does not indicate to whom such complaint should be made, or the sort of powers such a body would have in dealing with the complaint.
(2) The Council suggested an insertion into Section 51 which provides that private service providers should not be permitted to violate the ethical provisions of the Health Professions Act, No 56 of 1974.
(3) In terms of Section 77(f), It would appear that the same power vested within the Council to discipline those researchers who violate professional standards, is given to the National Health Research Ethics Council, which constitutes a duality of functions.

The Council was in support of Section 41, which calls for the issue of a certificate of need for health care establishments, especially in light of certain unethical practices in the health care field.

Discussion
Ms L Jacobus (ANC) (Select Committee on Social Services), asked whether, as provinces also legislated on health issues, would it be feasible that appropriate and necessary legislation be spelt out at provincial level.

In response, Adv Mkhize mentioned two types of complaints: (1) professional interventions that should be dealt with through a disciplinary framework and (2) complaints that would have to follow the normal course as provided for in the general operations of the hospital. Clear distinctions should be made between the two types of complaints.

The Chairperson asked for Mr Mkhize's view on the question of practitioners declaring their interests

Mr Mkhize responded that the Council had an ethical rule obliging practitioners to declare their interests in terms of shares. Those shares should not be acquired at less than the market value. He said it was essential to ensure that the private health care establishment was properly regulated.

The Chairperson thanked Adv Mkhize for the valuable presentation of the HPCSA.

Western Province Blood Transfusion Service
The presentation was made jointly by Mr N Parker (Chairperson), Dr A Bird (Medical Director), and Mr M Kahn (Administrative Director). The WPBTS is controlled by a Board of Donors and has about 80 000 donors. They reaffirmed that the WPBTS adheres to the key objectives of the National Blood Policy and argued that theirs was an effective blood programme.

Mr Kahn related that in early 1999, moves had been made towards an amalgamation by the WPBTS and the SA National Blood Service into one national service. However, in December 2000, WPBTS donor members overwhelmingly rejected the proposal, wishing for the organisation to remain independent. The WPBTS were subsequently assured by the Department of Health that their licence would not be revoked.

The WPBTS was therefore not in support of the provisions under Section 58 (1) of the National Health Bill, which stipulates that the Minister must establish one national blood transfusion service. Their suggestion was to allow for two licences throughout the country to retain the present status quo that is working very well.

Discussion
Dr Cachalia (ANC) asked for clarification on WPBTS' statement on the National Blood Policy of 1998. He also asked if people were allowed to give blood for their own needs (auto-transfusion).

Dr Bird responded that the WPBTS viewed the National Blood Policy in terms of community needs. They strongly endorse blood as a national resource, but as one which could not be acquired under compulsion. Generally, people donate blood at routine times for their communities. It is therefore important that community and regional needs be in harmony.

Auto-transfusion is provided by both blood transfusion services in South Africa. The WPBTS actively promote the practice to those people who wish to avail themselves.

Ms Jacobus asked how the provisions of Section 58 (2) of the Bill would negatively affect the operation of the WPBTS, to which Mr Khan responded that those provisions did not accommodate the WPBTS at all. It would have the effect of the WPBTS losing their operating licence.

The Minister, Dr M Tshabalala-Msimang, explained that Section 58 was aimed at democratising and transforming the country. She asked what the WPBTS would advise in the event of another group emerging who was able to provide the same service. It was for this reason that the suggestion to create one national service, in which all role-players would pooled resources, had been made. Section 58 (2), in her view, accommodates all in society.

The WPBTS response was that in the event of another group emerging, that group could merge with either of the licenced operators.

The Chairperson suggested that nationalising blood transfusion services might actually have the effect of lowering costs. The blood transfusion framework in the country should benefit the entire nation, and not only one particular section of it. The fact that there is only one health laboratory service in the country is also a factor in favour of nationalising the service.

Mr Kahn responded that the WPBTS was bound to do as they were prescribed to by their donors, who did not want to merge.

The Chairperson felt an amalgamation could have the effect of drawing more donors if the public could be persuaded that nationalising the service was in the national interest.

Mr Parker stated that it was not possible at this stage to know which service would be awarded the licence. However, it was important to ensure that those who had a history of service, would continue to do so.

Dr Bird made a further suggestion that the Minister could decide to issue further licences.

Hospital Association of South Africa Presentation
Adv. K Warrall-Clare said the Bill was lacking in definitions and these should not only be dealt with in the regulations. Although HASA had no serious problems with the Bill, their most pressing concern was that it undermined the constitutional rights of licensed members of the private sector. HASA did not have a problem with re-application for licences, but it was concerned about the time it would take for the issuing of new licences.

Another concern was that legislation should more strongly protect health care workers. The private sector should be represented on the National Health Council.

Discussion
Ms L Jacobus asked who would be liable to pay compensation in the case of an unemployed person being admitted for emergency treatment.

Adv. Warrall-Clare recommended that the National Department of Health should establish regulations to address the issue. He suggested that if necessary, health care establishments could be prevailed upon to absorb the costs. HASA supports the process of independent arbitration on reasonable compensation. He mentioned that taking indigent persons to court would be a fruitless exercise.

Dr Cachalia (ANC) raised the problem of people who arrive at private institutions and are refused emergency treatment because they are unable to produce the medical aid card or finances. He said that affordable health care and the reimbursement system is open to a great deal of abuse and is not being addressed.

Adv. Mkhize responded that for this reason, clear definitions in the Bill were necessary. On affordable health care, he said that fragmentation in the industry should not be allowed.

The Chairperson agreed that definitions in the Bill need to be improved. The matter of private sector participation on the National Health Council would require further discussion.

The Minister could not see the motivation for such participation by the private sector as there were a number of consultative processes shaping policy. Even though the Ministry recognised the necessity for partnerships, Government must ultimately provide stewardship.

The Law Advisor stated that nobody could be denied emergency treatment. The term had not been defined in the Bill because that would places limitations on the instances in which treatment could be administered.

The Chairperson suggested that the Law Advisor study HASA's definition on page 7 of their submission.

School of Public Health, University of the Western Cape
Prof. D Sanders submitted a three-point presentation on the following: (1) Human resources Development; (2) Equity in Health Service Delivery; and (3) Health Information Systems.

Human resources account for 70% of recurrent expenses in the industry. This includes facilities, technology, equipment, drugs, transport, communications, and human resources.

Although the School of Public Health had no serious problems with the Bill, it was concerned that it gave no direction to human resource development; did not clarify the division of human resource functions between different levels of government or provide for decentralisation to district level.

Prof Sanders cited the Health White Paper of 1997, which although it now required updating, provided visionary principles. Its strategies could be adapted to give the Bill substantive direction.

Furthermore, Prof. Sanders felt that there should be specific representation of academic health institutions on the bodies for which the Bill makes provision.

Discussion
Ms Jacobus stated that the Bill provides the broad framework within which specific concerns could be addressed. The suggestions made by Prof. Sanders could not be included.

Prof. Sanders accepted this, but felt that certain provisions could bring more clarity. It was very important for a few key phrases to be inserted.

Dr Cachalia asked how Prof. Sanders would address the hampering of research capacity and the development of research, to which Prof. Sanders responded that the responsibility should be shared by the Departments of Health, Education, Science and Technology, and ultimately, National Treasury.

The Minister commented that Prof. Sanders' presentation was a reminder of the problems that exist. The current Executive is attempting to address these in an equitable manner.

South African Medical Association
Dr S Mazaza said that although SAMA supported the National Health Bill, they were requesting certain amendments. SAMA was concerned that there was a "total lack of protection of the rights of providers" in the Bill. SAMA was also concerned that the Bill requires the various consultative bodies to only meet at least once in every two years. They urged that more attention be given to the functions and purposes of these forums.

South African Registrars' Association
Dr M Sonderup explained that a registrar is a qualified medical practitioner in the process of specialising. SARA was pleased that the Bill sought to regulate health in both the public and private sectors. They would like to see the inclusion of rural areas in the Bill.

SARA felt strongly that HIV/AIDS should be included in Chapter 2 ("Rights and Duties of Users and Health Care Providers").

Discussion
SAMA and SARA were questioned jointly.

Dr Rabinowitz asked if doctors belonging to SAMA and SARA would follow in the footsteps of other doctors who had taken the government to court over certificates of need.

Dr K Letlape (SAMA Chairperson) said it was regrettable that the matter had come to court. It was to prevent this that SAMA was in consultation with the Department of Health. He said that young professionals needed to be encouraged to be dedicated to the industry. As an individual, he would not choose to take the government to court, but rather to engage with it.

The Chairperson asked in which way the presenters thought the certificate of need would undermine professionals in the industry.

A SAMA representative responded that this provision deals with medical practices and so would affect people's livelihoods in a major way.

AIDS Law Project and Treatment Action Campaign Joint Submission
Mr Jonathan Berger presented a summary of submissions produced three weeks ago on the National Health Bill B32-2003. These submissions were made on behalf of both the AIDS Law Project and the Treatment Action Campaign represented at the meeting by Thembeka Majali.

In the light of still worsening situation of the HIV/AIDS epidemic, Mr Berger called for the transformation of the SA health system as the epidemic exacerbates inequality and puts unsustainable pressure on delivering appropriate care. Mr Berger drew attention to the Joint Committee to certain aspects of the Bill that undermine the right of access to health services. There appears to be an unnecessary and problematic overlap of functions and memberships of various bodies. He then suggested a number of remedies that could be found in the document below.

The issues were categorized into three groups (1). Placing unjustifiable limits on access to health care services, (2.) Rights to privacy and bodily and psychological integrity, (3.) Academic freedom and freedom of scientific research.

Mr Berger did not believe that constitutional guarantee can be limited by a manner proposed by the Bill. He concluded by expressing hope that the transformation of the health care sector will respect human rights.

Discussion
Ms R Rabinowitz (IFP) asked about guidance on the issue of academic freedom in the area of genetic engineering of tissue or cloning. She asked for advice on best practice models.

Mr Berger did not have a definite answer. He said there should be powers exercised but this was a policy decision. The parliament could to decide that no human cloning is to ever take place but the Bill was right to state that certain types of tissues cannot be removed, with certain exceptions. Debate should take place on who has the right to exercise these powers.

Ms Rabinowitz asked about the certificate of needs. This should not be arbitrary but rather based on objective criteria.

Mr Berger said the certificate of needs is not comparable to any other powers. The issue there is not so much on the discretion exercised, because ultimately somebody needs to make decisions. He believes the Department must be regulating that.

The Minister Manto Tshabalala-Msimang commented on the section 47C around research and said that the co-ordination function is critical.

Mr Berger agreed with the Minister on the need for more research co-ordination along with the Medical Research Council (MRC), as an important statutory body. His main concern was that the Bill does not make clear the relation between various committees.
Coming back to the issue of certificate of needs, he suggested that the process of certification should be simple and done by the Department.

The Chair asked how the Bill undermined the independence of the MRC?

Mr Berger said that it undermines it only potentially. It is largely due to the fact that the Bill does not deal with the relationship between the Committees and various other statutory bodies.

The Chair was concerned with the separation of powers. The presentation suggests that there must be a role for the parliament whereas in fact the Minister has the power.

Mr Berger said that Parliament's guidance is required. It is in providing the kinds of factors that come precisely from the separation of powers. The parliament has an obligation to ensure that when it grants powers that it gives a kind of guidance as to how this power is to be exercised.

COSATU and NEHAWU
The key problem that faces South Africa health system today is the massive inequality associated with low-quality care for the poor at both primary and tertiary levels. Other problems include: substantial under-budgeting, co-existence of public and private health sectors that push up national spending, high cost of patented medication and medical aids, poor management at local levels plus lack of understanding of national policies, and the existence of a single blood transfusion service.

Discussion
Dr Rabinowitz that there is a need to set a minimum standard for emergency care. On the issue of penalties, she asked how to bring about accountability of health care providers in the absence of penalties?

Mr Sweet (NEHAWU) said that the South Africa health system is not static but evolving. There are legal as well as financial implications rising from the Bill. One has to confront the appropriate social responsibility of the private health industry in the period of transition. On the question of penalties, he said that this matter has to be discussed between the two departments.

Mr Paulus (COSATU) said that there is an unhealthy situation on the issue of limited resources prior to any attempt being made to progressively realise rights. The concern about private partnerships is that the restructuring of the sector will lead to job losses.

Minister Tshabalala-Msimang, on the issue of penalty, pointed out that sometimes there are cases of negligence and people must pay the cost. She then referred to chapter 12 and said that there is, however, a need to formulate the rights of health care providers.

Christian Science Committee on Publication
Louis Benjamin said his colleagues supported the Bill fully and the ethos enshrined in its intent. Their request was that the Portfolio Committee consider accommodations for spirituality to be included in future Health Bill provisions to assist health care practitioners. Spiritual healing functions are both a self-care as well as an administered activity, and can sustain healthy consciousness and a healthy body.

Oral Submission: Mr Ray Llale
Mr Ray Llale, a banker from Gauteng, related his experience of spiritual healing of muscle spasms. This spirituality was explained in a non-denominational book entitled "Science and Health with Key to the Scriptures" by Mary Baker Eddy. He had learned how the power of prayer could be channelled to support other people mentally and physically.

The meeting was adjourned.


Appendix 2 : Health Professions Council of South Africa
The Health Professions Council of South Africa (HPCSA) hereinafter referred to as the Council, is a statutory body established in terms of the Health Professions Act, No 56 of 1974, with a mandate to, inter alia, set and enforce compliance with educational, training, ethical and professional practice standards for all health professions registered under the auspices of this Act.

The purpose of this submission is to highlight those areas in the National Health Bill, 2003, hereinafter referred to as the Bill, which impact on the processes and/or mandate of the Council. Otherwise the HPCSA supports this Bill subject to the issues listed hereunder being clarified and/or addressed.

The submission does not attempt to address all aspects raised in the Bill but rather focuses on the areas considered pertinent to the Council.

Comments on the Bill
The Council supports the overall purport of the Bill and that which it seeks to regulate and achieve.

Individual and specific comments on the Bill follow hereunder:

Section 18
This section provides for the laying of complaints about the manner in which a user is treated at a health establishment. Save for the provision of establishing procedure for laying complaints by the MEC, there is however no indication as to whom such complaint should be lodged and who will investigate the said complaint. There is also no indication as to what powers or sanctions such an investigative body or person will have in relation to the handling and dealing with such complaints as may be lodged by the users.

Secondly, it would seem that the powers regarding the handling of complaints as same emanate from interventions by professionals registered with the Council, vest with the Health Professions Council of South Africa (HPCSA). The duality of these powers may therefore create practical difficulties if a clear mechanism or relationship between the two structures is not clearly defined or established. Perhaps the question to be raised is at what level of the provision of health care services is the procedure for laying complaints going to be prescribed? Is it at institutional level or at professional level because if it is at professional level, that might conflict with the already established responsibilities of the Council. This area needs clarification in order to avoid unnecessary duplication.

Section 41 (3)(h) & (5) read with Section 44(2)(f)
Council supports the issue of the certificate of need for health care establishments in relation to the yet to be established institutions but more so supports the idea of revalidating through the certification process of the existing institutions. This is particularly against the backdrop of perverse incentives and schemes that a number of establishments have perpetrated thereby inducing practitioners registered with Council to act unethically, without a mechanism of ensuring control of the activities in these institutions. Secondly, and more importantly, the issue of adequacy of human resources in these establishments is critical as Council has had instances where some institutions actually operate emergency and trauma units with one practitioner who is even not properly trained in handling trauma cases. Council therefore fully endorses and supports this initiative.

Section 51
Given the corporate involvement in the provision of health care services in the country and the ethical implications that flow therefrom, it is suggested the following insertions be added onto this section:-

Private Health Establishments should refrain from or not be permitted to introduce a practice, administer, manage or maintain a scheme(s) or arrangement(s) with any practitioner registered under the HPCSA Act, that would directly or indirectly conflict or violate or undermine the upholding of ethics and good professional practice as established in the Health Professions Act, No. 56 of 1974 and its subordinate regulations.

For the purposes of (a) above, should the Council have reasons to believe that a private health establishment has introduced or intends introducing or is maintaining a scheme or arrangement with the practitioners registered with Council which conflicts with its ethical codes, the Council shall have powers to conduct an investigation into that practice, scheme or arrangement as it may deem appropriate, as if such power was specifically assigned to it in terms of its own Act.

Where the scheme or arrangement envisaged above has an effect of not complying with the Council ethical rules, Council will have powers to recommend to the Minister/DG for appropriate sanctions to be imposed as may be prescribed.

These proposals are informed by what has become commercial exploitation of practitioners in the performance of their professional practices with the result that undesirable business practices are perpetuated to the detriment of the user of health services. Typical example is the issue of over-servicing and perverse incentives in terms of the payment of commissions for more referrals. In certain instances, practitioners are required to admit a certain number of patients against which certain incentives flow to them. Obviously, for the incentives to flow or for the practitioner to retain free or cheaper consulting rooms in a particular private health establishment, they would have to direct for admissions when they are not called for or even direct performance of certain tests and procedure which may not be indicated just to meet a particular target.

Section 77(f)
The Council has established norms and standards for clinical/health researchers registered with the Council with the implication that such researchers may be disciplined by Council should they be found to be in violation of the research ethical standards and norms. This same power seems to be vested with the National Health Research Ethics Council in terms of this section. As a result, there may be a duality of functions again on this aspect where provision is made in terms of this section, for institution of disciplinary action by the National Research Ethics Council, against any person found to be in violation of established norms and standards for conducting research.

Section 82 read with Sections 83 & 86
A clear definition of roles needs to be spelt out between the Inspectorate envisaged in terms of Section 82; the Office of Standards Compliance in terms of Section 83 and the Health Officers in terms of Section 86, as it would seem that the similar powers are vested in these three structures. Section 82(2)(a) empowers the Inspectorate to monitor and evaluate compliance with this Act by health establishments and health agencies in the province for which it is established, while Section 83(2)(f) also makes provision for the Office of Standards Compliance to monitor compliance with prescribed health standards by health establishments, health care providers and health agencies and Section 86 also empowers Health Officers to monitor and enforce compliance with this Act. Besides this seeming overlap in roles between these three structures, it seems that the responsibility for monitoring and enforcing compliance with health standards specifically, by health care providers, is an area of responsibility assigned to the HPCSA by law. This area will need clarification of roles and responsibilities.

Compiled by: Adv. B Mkhize, HPCSA Registrar/CEO

Appendix 3 : South African Registrar's Association

COMMENTS ON THE NATIONAL HEALTH BILL, 2003
BY THE SOUTH AFRICAN REGISTRARS ASSOCIATION (SARA)
(a special interest group of the South African Medical Association)

Introduction
The South African Registrars Association (SARA) is the representative body of registrars (medical specialists in training) in South Africa. We welcome the opportunity to comment on the Bill and present our proposals to the Parliamentary Health Portfolio Committee. We note that in the preamble, importantly, the Bill acknowledges the need to urgently address the socioeconomic injustices, imbalances and inequities of the health services of the past. SARA fully supports this initiative however wishes to take this opportunity to highlight the needs and aspirations of young medical professionals in South Africa that may be negatively influenced by certain aspects of the Bill. This may ultimately be detrimental to the objectives of the Bill.

As a special interest group of SAMA, we share many of the sentiments expressed in their submission but wish to emphasize aspects of the Bill that are of critical concern to registrars and other junior doctors.

Chapter 1
We support and note the acknowledgement of both the private and public healthcare sectors and wish to reiterate that the two sectors are both vitally important role-players in South Africa. They are not mutually exclusive and need to coexist in the broader healthcare arena. In addition we trust that the central constitutional tenet of the progressive realization of the right of access to health care services remains the principal on which regulations are enacted in terms of the Bill.

Chapter 2
An area of concern is the lack of reference to the rights of health care providers in the Bill. We would strongly support the expansion of this chapter to include the rights of both patients and healthcare providers. With reference to the laying of complaints, it should be emphasized that the HPCSA is the statutory body regulating doctors and complaints and discipline should remain within their statutory ambit and control.
We support the notion by other stakeholders to specifically include a provision for the non-discrimination of patients with HIV/AIDS in this chapter of the Bill.

Chapters 3, 4 and 5
We are extremely concerned that the proposed Health Councils would constitute an enormous bureaucracy with the probable duplication of functions and the inevitable costs involved. In addition, in chapter 3 [clause 20 subsection 2(c)] makes reference to medical training. We wish to emphasize that this should remain within the statutory ambit of the HPCSA and the various training institutions.

Clause 35 and 36 introduces District Health System and District Health Councils. We would hope that public sector doctors are incorporated into these councils and would avail ourselves to be involved in any council in an area where registrar training occurs.

Chapter 6
Of the entire National Health Bill it is the proposed Certificate of Need (CON) that is cause for most concern to the SARA. It is our sincere opinion that it will be junior doctors and registrars who stand to be most affected by the introduction of the CON. It is our understanding that the intention of the CON is to regulate medical professionals in terms of the location and length of time they may practice in a specified area. The intention is clearly for an equitable distribution of doctors but it is our belief that this will exponentially intensify the insecurity and demoralization felt by most junior doctors.

The reality of the healthcare sector for young professionals is that one is faced with three possible career options. A first option would be to continue your career in the public sector. The unfortunate reality is that despite several attempts, career pathing in this sector remains woefully inadequate and virtually non-existent. The levels of frustration felt by doctors, nurses and other healthcare providers because of major problems in the public health sector at all levels is almost unquantifiable. The public sector as a career option is therefore dwindling in popularity.

Private medicine is another possible career option but the spectre of the CON has cast huge doubts over this sector. The proposed structure of the certificate of need would serve to markedly disadvantage and disenfranchise a young doctor or specialist wishing to enter practice.

Our members feel that they are unable to safely invest in an area in South Africa as the reality of a CON and all its implications as defined in the proposed Bill dawns upon them. Unfortunate as it may be, many more young doctors and specialists will feel the need to exit the country or the profession. This is not an option we would hope our members ought to take.

The CON, in our opinion, unjustly targets doctors in an attempt to apply inappropriate regulatory measures. Market forces ultimately determine whether a doctor will be able to adequately function in a given area or not. The measures proposed by the CON restrict freedom of economic activity and are potentially challengeable, both legally and constitutionally.

We are not in support of proposal of a grandfather or a sunset clause with respect to the certificate of need. This would merely serve to advantage existing practices and would clearly be to the detriment of the junior members of the medical profession.

We suggest that the issue of the CON be removed from the Bill and a system of accreditation of practices rather be introduced. In addition regulatory measures for technologies and therapies could be considered rather than measures to regulate individual doctors.

We cannot stress strongly enough the dissatisfaction felt by our members in this regard and we trust that the portfolio committee would equally appreciate our serious concern.

Chapter 7
We share the concern of other stakeholders with regard to the proposed mechanisms by which the Minister may, in consultation with the Minister of Education, establish academic health complexes. As the Bill reads at present, this can be done without any consultation with other relevant role players. We propose that Clause 56 be amended to allow for consultation with other relevant role players prior to the establishment of an academic health complex. In addition a suitably constituted forum that specifically focuses on academic health complexes would prove invaluable in the planning and functioning of the academic health sector. This would serve a critical function in creating a stable environment in which registrar training could occur.

The regulations pertaining to human resources are critical to the optimal functioning of the healthcare sector. We believe that the management of human resources cannot occur in the absence of the involvement of the health care providers. We formally request to be involved in the planning of any regulations in the future.

Chapter 8
We support the broad principles in this chapter.

Chapter 9-12
SARA is in support of the establishment of a National Health Research Committee and a National Health Research Ethics Council.

SARA suggests that clause 95(b) and (c) should be deleted or amended as it is not in keeping with the spirit of democracy. As a general principle, all regulations should be published for comment with a 3 month period set aside for comment.

Conclusion
The Bill contains many laudable principles that serve to address deficiencies in the healthcare sector. However, it is our belief that the certificate of need as proposed in its current format will be devastating to newly qualified doctors and specialists.

In addition we are willing to be available to provide any input or comment with respect to any regulations that may be considered.

COMPILED BY THE SOUTH AFRICAN REGISTRARS ASSOCIATION
14 August 2003

Appendix 4 : Western Cape Blood Transfusion Service

Press release: 18 August 2003

WP Blood Transfusion Service asks for independence.

Today (18/08) WP Blood Transfusion Service had the opportunity to
present its case to the Parliamentary Portfolio Committee for Health in
a bid to remain an independent Blood Service.

According to Chapter 8, section 58 of the Draft Health Bill, the Department of Health
(DOH) wishes all the Blood Transfusion Services in RSA to form "one single service".
In response to this wish, Western Cape blood donors have voted against this proposed
amalgamation on two separate occasions, in 2001 and 2002. Since the Service is a
Section 21 Company, formed by association of voluntary, non-remunerated blood donors,
the members retain the right to object to this seemingly unconstitutional bid to strip them
of their autonomy.

Our reasons for objecting to "one single service" are based on the following:

No real technical/medical benefit can be derived from this amalgamation:
WPBTS presently complies fully with the National Blood Policy. In addition it is
the first Service countrywide which to attain SANAS accreditation. We will continue, as always to participate in maintaining national clinical standards of blood transfusion practice countrywide.

No real financial benefit will be forthcoming for the patients and hospitals in the
Western Cape. (The price of blood is more than likely to rise as a result of increased
operational costs of a "single service" and this will affect Provincial hospitals and
health departments)

No real national benefit can be gained, since we already co-operate on many
levels: we contribute blood to other regions when needed, and co-operate in media
and promotions activities, contribute to haemovigilance reports, co-author Clinical Guidelines and update Standards of Practice.

All major requirements which should be met by a transfusion service, are
comfortably met by WPBTS already.

It just does not seem that there will be any really tangible benefits to gain from a
potentially expensive and administratively cumbersome new structure. The donors feel
that they are best able to serve both national and regional interests under the present
structures.

WPBTS proposes that DOH:

Recognise and respect the wishes of the blood donor community of the Western
Cape to remain independent.

That the Department will under Chapter 8, Section 58 of the Draft Health Bill
grant two licences.

That we may continue to be part of the National Blood Committee and be allowed
to contribute, as always, to maintaining good standards of blood transfusion practice in RSA.

Issued by: Marika Champion Public Relations