National Public Health Institute of South Africa Bill: public hearings

Meeting report

The bill seeks to establish the National Public Health Institute of South Africa (NAPHISA) as a legally defined organ of the State in order to: coordinate surveillance systems that monitor diseases and injuries; provide training and workforce development; provide specialised reference laboratory and referral services; and conduct research and support public health interventions aimed at reducing the burden. The aim of NAPHISA 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 persons in South Africa.

Currently there is no integrated surveillance system in the country. Different institutes deal with different aspects of surveillance and there is lack in 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. South Africa’s public health entities have different mandates and institutional arrangements. The lack of coordinated human resources puts an additional strain on a very limited expertise. Funding of these functions is inconsistent and this jeopardizes sustainability of services. NAPHISA will comprise of divisions dealing with communicable diseases, non-communicable diseases, occupational health, cancer surveillance, injury and violence prevention and environmental health.

The functions of NAPHISA are listed in section 3(1) of the Bill. It provides, among many things, that it will promote co-operation between the Republic and the other countries with regard to the epidemiological surveillance and management of disease exposures and injuries, coordinate reference laboratory, referral services and strengthen the capacity of the workforce in the occupational health by developing curricula for occupational health, collaborate with relevant government departments and government agencies to implement communicating strategies on public and occupational health issues outbreak response and produce and distribute reports on health and disease profiles, injuries and violence and occupational health.

NAPHISA is governed and controlled by the Board, which will be the accounting authority of NAPHISA and is required to fulfil its responsibilities in terms of the PFMA. The Board consists of members appointed by the Minister, taking into account, 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 Public Finance Management Act applies to NAPHISA.

The Bill is summarised as follows:

Clause 1: provides for the definitions of words or expressions used in the context of the Bill.

Clause 2: provides for the establishment of the National Public Health Institute of South Africa as a juristic person and the 6 divisions it will be compromised of and states that the Public Finance Management Act applies to the institute.

Clause 3: provides for the functions that NAPHISA must perform and those functions the NAPHISA may perform.

Clause 4: provides for the governance and control of NAPHISA – NAPHISA is governed and controlled by the Board, which is the accounting authority of NAPHISA.

Clause 5: provides for the composition of the Board.

Clause 6: provides for the appointment of members of the Board – a member of the Board holds office for at least a period of five years as the Minister may determine at time of appointment, and is eligible for reappointment.

Clause 7: provides for the appointment of the Chairperson and Vice-Chairperson of the Board.

Clause 8: provides for the disqualification from membership of the Board, vacation of office by a member, removal of a member from the Board and the dissolution of the Board.

Clause 9: provides for meetings of Board

Clause 10: provides for the appointment of Committees of the Board

Clause 11: provides for the appointment of the CEO

Clause 12: provides for the functions of the CEO

Clause 13: provides for the accountability of and reporting s required by the PFMA

Clause 14: provides for the transfer or secondment of certain persons to or from employ of the NAPHISA

Clause 15: provides for the Intellectual Property rights

Clause 16: provides foe the finances if NAPHISA

Clause 17: provides for the Delegations of powers and assignment of duties of the Board and the CEO

Clause 18: limits the liability of certain persons liable in respect of anything done or omitted in good faith in the performance of any function in terms of the Bill

Clause 19: empowers the Minister to make regulations

Clause 20: provides for the transfer of immovable property belonging to the state to NAPHISA on conditions determined by the Minister with the concurrence of the Minister of Finance, in order for NAPHISA to perform its function

Clause 21; provides for the transfer of certain employees, assets and liabilities to NAPHISA

Clause 22: provides for the short title and commencement

 

Oral submissions

Ms Virginia Zweigenthal from the Western Cape Department of Health asked for a clarification of the definitions given, especially the definition of “surveillance”, noting that the definition is quite vague. The definition of “public health” is also not the definition that she (and her colleagues) is accustomed to, noting that the definition they are aware of is much broader than the definition given in the Bill. Clarification on accountability also needs to be given. On one hand it states that NAPHISA is accountable to the Minister while on the other hand it states that the entities are accountable to Parliament. Clarification on the different roles of the Department of Health and NAPHISA need to be given as well, as many of the roles seem to overlap. There are also overlapping functions of NAPHISA and the provincial departments of health. Will NAPHISA be coordinating the functions of the provinces or will they be taking over these functions from the provinces? It is also concerning that the composition of the board does not have any representation from the provinces especially because the provincial departments are going to be major players in NAPHISA. What provision has been made by NAPHISA for this?

Mr Usuf Chikte, a professor at Stellenbosch University, commends NAPHISA for including environmental health and occupational health in its clauses. He would like clarification on what is meant by workforce development, surveillance and public health, and agrees that the definition given for public health is quite narrow and can be broadened. There is also room to improve the role and function definitions of NAPHISA, needing to clarify them more. The Bill needs to be explicit on who develops the guidelines.

Mr D Mitchell (DA) asked if the legal drafting issues have been sorted.

Mr Vishal Brijlal, Advisor, National Department of Health, states that as the Department, they themselves cannot make any changes and that changes have to come through these processes that take place. This is in relation to the legal comment made by Mr Mitchell. On the overlapping of functions between NAPHISA and the provincial departments, the aim was not to have NAPHISA take over from the provincial departments but rather to force collaboration between the two. This goes to all the entities that will be working with NAPHISA. Furthermore, due to the available resources, NAPHISA would not be able to take over functions of other entities. He also emphasises the need for NAPHISA to have a relationship with the provinces. He gives an example of a cholera outbreak noting that if this were to happen, NAPHISA would have to find a way to engage with the communities and that would be done through their relationship with the different provinces.

He also clarifies the role of the Minister in appointing the board members and states that only one of the members is appointed directly by the Minister and the rest have to go through public nomination and interviews. The Minister, however, has to sign off on all board nominations, as part of their executive authority and duties.

The Chairperson then closes off by stating that written submissions will be due on 16 November 2018.

The meeting is adjourned.