National Health Laboratory Services Amendment Bill [B15B-2017]: Final Mandates; National Public Health Institute of South Africa Bill [16B-2017]: briefing

Meeting report

Briefing by the National Department of Health (NDoH) on the National Public Health Institute of SA (NAPHISA) Bill 
Dr Anban Pillay Acting Director-General, NDoH, explained that the Bill sought to establish the National Public Health Institute of SA (NAPHISA) as a legally defined organ of state. The aim of the Institute is to provide integrated and coordinated disease and injury surveillance, research, monitoring and evaluation of services and interventions directed towards the major public health problems affecting the South African populace.

Currently there is no integrated surveillance system in the country, different institutes deal with different aspects of surveillance and there is lack of institutional capacity for effective surveillance. There is a need for a single accountable authority and the lack of this accountability to date is a root cause of fragmented surveillance. The current evidence is subject to inaccuracies and may not sufficiently address national and regional needs. A higher cost could be incurred by the Department of Health due to the fragmentation and this will need to be substantiated by quantitative assessment. South Africa’s public health entities have different mandates and institutional arrangements. The lack of coordinated human resources puts an additional strain on very limited expertise. Funding for these functions is inconsistent and this jeopardizes sustainability of services.

NAPHISA will comprise of divisions dealing with the following:
-Communicable Diseases;
-Non-Communicable Diseases;
-Occupational Health;
-Cancer Surveillance;
-Injury and Violence Prevention; and
-Environmental Health

NAPHISA is governed and controlled by the Board, which will be the accounting authority of NAPHISA and is required to fulfill its responsibilities in terms of the PFMA. The Board consists of members, appointed by the Minister, taking into account, among other things, the appropriate representation of race, gender and disability.

NAPHISA is funded by:
-money appropriated by Parliament;
-fees received for services rendered;
-income earned on surplus moneys deposited or invested;
-grants, donations and bequests made to it;
-royalties; and
-money received from any other source.

The Committee was provided with insight into the specific clauses of the Bill.  

Discussion
Mr M Khawula (IFP. KwaZulu-Natal) was concerned that the National Department of Health (NDoH) was on a mission not to take provinces into consideration on the Bill. Provinces were being ignored. Of all the stakeholders represented on the NAPHISA Board provinces were not represented. In his view, this seemed deliberate. He pointed out that provinces were even included in the constitution. Provinces were responsible for health.

Dr Pillay explained that the NAPHISA structure was intended to be a technical body. Persons had to be experts in their respective fields to do their jobs. He noted that the Medical Research Council did similar functions as was envisioned by the NAPHISA and it too did not have provincial representation.
The National Institute for Communicable Diseases (NICD) also did not have provincial representation. NAPHISA’s key role was to do research, coordination and monitoring. Amongst its functions was to provide support and to advise the Minister of Health. This was done over the Listeriosis outbreak not too long ago. There was no implementation function.

Mr Madoda Sambatha, ANC member of the North West Provincial Legislature, asked what the operational outlook of the NAPHISA was in respect of provinces. NAPHISA could not be run nationally. He pointed out that the dominance of certain diseases differed from province to province. On the appointment of a Chief Executive Officer (CEO), he asked what was meant by the candidate having to be a “fit and proper person”. The understanding of what constituted a “fit and proper person” might be different for the appointing authority and for the lay person. There was no definition for “fit and proper person” in the definitions of the Bill. Did all CEO’s appointed by the NDoH have to be “fit and proper persons”? On the financing of the NAPHISA, he was concerned about the provision which provided for financing from “any other sources”. He noted that organised gangs could even fund the NAPHISA to gain leverage over the organisation. He asked that things be tightened so that funding should be from legally acceptable funding sources. 

Dr Pillay responded that “fit and proper person” was a legal requirement for most appointments. He explained that the use of the phrase, “any other sources” was a commonly used phrase in drafting.

Mr Micro Moabelo, Legal Director, NDoH, said that “fit and proper person” required that there be no impediment for the person to be appointed. The person should not have been convicted of a crime or should not have transgressed the law. Hence clearance checks were done. For instance where a person was applying for a job as Director of Finance a person should not have been convicted of an offence which involved mistrust.

Ms Kamy Chetty, Acting CEO, National Health Laboratory Service (NHLS), added that other disqualifying factors included an un-rehabilitated insolvent, an alcoholic or a person with mental health problems.

Mr Vishal Brijlal, Advisor to the Minister of Health, NDoH, said that “any other sources” would be covered by the Public Finance Management Act (PFMA). The PFMA had stringent requirements. 

Ms Chetty confirmed that funding would be guided by the PFMA. She explained that when NAPHISA is formed some structures would collapse whilst others would not. The Medical Research Council would not collapse.

A female ANC member from the Gauteng Provincial Legislature pointed out that there were no representatives from organised labour unions on the NAPHISA Board. She asked who appointed the Chairperson and Vice Chairperson of the Board. What was the funding model to be used for the NAPHISA? She also asked whether the NAPHISA would be a parastatal.

Dr Pillay stated that the Chairperson and Vice Chairperson of the NAPHISA Board would be appointed by the Minister of Health.

Ms Chetty confirmed that NAPHISA was a parastatal and not a government entity.

The Acting Chairperson said that if the NAPHISA was to perform a coordinating function around agencies that had different functions she asked whether after the formation of the NAPHISA the other agencies would collapse. What would happen to the staff members of those agencies? Would they be absorbed and integrated into the NAPHISA or would applications for jobs at NAPHISA be done afresh. She also asked what the financial implications of the Bill were. 

Dr Pillay - on financial implications - said that there would be a direct appropriation from Parliament to NAPHISA. He added that the NHLS also funded these structures. Staff from other structures would be transferred to NAPHISA. 

Mr Brijlal stated that the Memorandum on the objects of the Bill covered most of the issues raised by Members.

The Acting Chairperson asked why provincial representatives could not be included in the NAPHISA structure. She noted that there were structures that had provincial representatives from provinces on their boards.

Dr Pillay responded that the Council for Medical Schemes and the Office of Health Standards did not have provincial representatives. Persons serving on their boards had to have technical competencies. He pointed out that there was no hard and fast rule not to have provincial representatives serving on structures.

Ms Mihlosi Mushwana, Director: Public Entity Governance, NDoH, pointed out that the South African Nursing Council had provincial representatives.

The Acting Chairperson on the National Health Laboratory Service (NHLS) Amendment Bill as amended had concerns about provincial voices being heard. A compromise was made to have representation of some provinces but not all. She pointed out that provincial voices tend to differ. Provincial voices needed to be accommodated.

Dr Pillay responded that that there was provincial representation on the NHLS. He explained that the NHLS had a contractual agreement with each province and that was where engagement took place. He further explained that a board was a governance structure. The issue at present was around provinces not paying the NHLS but yet were still sitting on its board. The reason why they were not paying was because there were disputes around accounts. The matters unfortunately could not be resolved. Provincial representatives were sitting on the NHLS’ Board whilst doing business with the NHLS. There were therefore governance issues that came up.

Ms Chetty added that provincial representatives found themselves in an awkward position sitting on the NHLS’ Board when it came time to make decisions on tariff increases for provinces. There was always a balancing act at play. The compromise that was reached was for there to be three provincial representatives on the NHLS’ Board. She added that NAPHISA was to act as an oversight body.

Mr Brijlal said that the version of the NAPHISA Bill submitted to the NA had made provision for provincial representation. The Portfolio Committee on Health had removed the provisions. He felt it unfair for members to state that the NDoH was opposed to having provinces represented.

Mr Khawula said that the Bill was now with the provinces and provinces would be recognised. He added that with the NHLS Bill it was provinces themselves that had insisted that provinces be represented. It was not at the behest of the NDoH.  

Mr Sambatha said that he had asked about the provincial outlook of the NAPHISA. Would there be provincial offices? He felt that a definition of “fit and proper person” ought to put in all bills wherein it appeared. He was concerned that “fit and proper person” could be open to political and ideological interpretation. He felt the approach of the NDoH to be too centralist.

Dr Pillay explained that the way in which NAPHISA was structured it took over the functions of three institutions ie the National Institute for Occupational Health (NIOH), the Cancer Registry and the NICD. The three institutions would combine to form the NAPHISA. All three of the institutions had some sort of relationship with provinces. There was nothing stopping the NAPHISA to establish provincial offices. He added that “fit and proper person” was sufficiently defined in case law. It was up to the Committee to decide on including it under the definitions of the NAPHISA Bill.

Ms Chetty said that the NHLS had a national lobbying information system. There was a great deal of contact with provincial departments.

The Acting Chairperson noted that many of the issues raised by Members would be covered in the regulations to be issued by the Minister of Health. 

National Health Laboratory Services (NHLS) Amendment Bill: final Mandates
The Acting Chairperson stated that delegates from the provinces would present their respective final mandates on the Bill to the Committee.

Eastern Cape Province
An ANC male delegate from the Eastern Cape Provincial Legislature stated that Legislature was in favour of the Bill with amendments.

Gauteng Province
An ANC female delegate from the Gauteng Provincial Legislature stated that Legislature was in support of the Bill. The Legislature did emphasise that the funding model had to take into consideration the Province’s population growth and dynamics.

KwaZulu-Natal Province
Mr M Khawula (IFP, KwaZulu-Natal) stated that the KwaZulu-Natal Provincial Legislature supported the Bill.

Limpopo Province
Ms T Mampuru (ANC, Limpopo) said that the Limpopo Provincial Legislature voted in favour of the Bill.

Mpumalanga Province
The Acting Chairperson, in the absence of a delegate from the Province, stated that the Mpumalanga Provincial Legislature voted in favour of the Bill.

Northern Cape Province
No final mandate had been received from the Province.

North West Province
Mr Sambatha stated that the North West Provincial Legislature supported the Bill.

Western Cape Province
The Acting Chairperson, in the absence of a delegate from the Province, stated that the Western Cape Provincial Legislature supported the Bill.

Free State Province
The Committee was awaiting the final mandate on the Bill from the Free State Provincial Legislature.
               
The Acting Chairperson asked Ms Barbara Loots, Parliamentary Legal Adviser, if she had anything to add.

Ms Loots responded that it looked as though the provinces had voted in favour of the D-version of the Bill. She assured the Committee that everything seemed fine. Any conflict with the constitution was not foreseen but one could never tell whether there would be issues on implementation. At present everything seemed in order.

Voting on the Bill
The Acting Chairperson stated that the National Council of Provinces (NCOP) did not just rubber stamp bills that came from the National Assembly (NA). Provinces had made their own inputs on the Bill. She asked the provinces represented by delegates to vote on the Bill. Seven provinces voted in favour of the Bill. The Northern Cape Province abstained from voting as it did not have a final mandate. The mandate from the Free State Province was still awaited.

Report on the Bill
Given that the majority of provinces voted in favour of the Bill the Acting Chairperson read out the Report of the Committee which stated that the Committee agreed to the National Health Laboratory Services Amendment Bill [B15D-2017].
               
Committee Minutes
Minutes dated 9 October 2018 was adopted unamended.

The meeting was adjourned.