The Committee met with the Department of Health, led by the MEC and Head of Department, to consider and adopt Vote 6: Health in the Schedule to the 2018 Western Cape Adjustments Appropriation Bill and consider and adoption of the Committee Report on Vote 6: Health. Members went through the Report page by page and posed a variety of questions to the Department based on the contents of the Report. The questions related to additional appropriation, rollovers under specific programmes, reallocation of funds and reasons for increased expenditure, and under sending, in specific programmes. Members questioned if the Department’s position on the Hout Bay community day centre had changed, circumcision numbers, programme on TB patients and where vehicles procured were distributed to. The Committee also probed the Department’s response to the growth of mental health illness, NGOs dealing with mental health matters and why services were outsourced under the HR strategy.
The Committee supported the adoption of Vote 6: Health as is. The minority opinion was noted.
The Chairperson noted the agenda of the meeting was consideration of Vote 6: Health in the Schedule to the 2018 Western Cape Adjustments Appropriation Bill and consideration and adoption of the Committee Report on Vote 6: Health. Members would go through the Report page by page and ask the Department any questions of clarity or to raise any other matter the Member wished to have a response to. There was however a time constraint as another Committee would be meeting in the venue at 14h00 so the Committee needed to move quickly. Whether the meeting was still ongoing or not, the Committee would have to adjourn its proceedings at 13h45.
Ms D Gopie (ANC) had a question regarding page 108 – she wanted to understand and wanted the Minister to respond to questions of additional appropriation. The budget for the Department is a lot. She wanted to understand the explanation given on page 108.
Ms M Wenger (DA) added that there was need for explanation for rollovers on page 109 under programme six.
Dr Nomafrench Mbombo, Western Cape MEC for Health, responded that those were just adjustments and if one looks at table 6.1, compensation of employees and goods and services made up the bulk of additional appropriation - approximately R22 million compared to the total of R23 million. On page 109, programme six, rollovers were estimated to be at R106 million - this was due to a number of factors. In terms of district health services, R30 million was directed at the global fund due to the late signing of the new grant given delays in filling posts and implementation of programmes. R1.3 million was used in respect of the Western Cape on wellness projects to promote health activities. There was also R38 million in respect of the national conditional grant which seeks to revitalise health facilities owing to slow progress on site, poor contractor performance, delays with procurement and outstanding final accounts.
Ms P Makeleni (ANC) had a question on page 114, sub-programme 2.9, district hospitals and reallocation of funds meant for compensation of employees – what is the reason for this reallocation? On page 115, sub-programme 4.3, which mental hospitals exactly were affected by the mental health rate?
Dr Mbombo responded that on page 114, with the district hospitals, compensation of employees is on one side and on the other side are goods and services. The Department is trying to do one thing at a time. The reallocation of funds was in order to realign it with budget and to alleviate service pressures due to an influx of patients at False Bay Hospital. Regarding page 115, if one looked at funding of R6 million, only R900 000 was taken from mental hospitals. There is no specific hospital targeted as the money is being adjusted generally.
Ms Gopie wanted to find out what programme six was for.
Ms Makeleni had a question regarding programme five and needed a more specific response so as to better understand it.
Dr Mbombo replied that under programme five, there is R8 million, under programme six there is R4 million and R2.2 million under programme seven. There were talks of turning colleges to CPUT but this was changed. Programme six concerned nursing training colleges – savings were realised due to CPUT and higher education institutions refunds due to termination of the agency agreement with CPUT. Programme five was on central hospital services - R8 million was appropriated to fund critically required assistive devices and medical equipment at centre hospitals.
Ms Gopie asked whether there was any detailed explanation for why expenditure was higher on page 121, under programme one.
Dr Mbombo replied that the projected expenditure was higher in the first month due to medico-legal claims that have to still be finalised and paid where merits have been conceded to the claimant. Many of the IT projects especially assigned to the IT entity have been gearing up hence low expenditure levels in the first quarter. There are also slow expenditure levels against tracing agents and debt collectors.
Ms Makeleni wanted to understand the cause of shifting R500 000 from Vote 6 to Vote 12.
Dr Mbombo replied that, as indicated, this amount was shifted to Vote 12 (Department of Economic Development and Tourism) in order for the Western Cape economic development partnership to expand its output and to support other departments through its learning initiatives. There were certain services and maintenance contracts coming into place, statutory increases for identified industry sectors as well as bulk medical and surgical equipment.
Ms Makeleni had a concern on page 137 on the community day centre in Hout Bay where the community had originally been given two options – upgrade or replace the day centre. She however saw the budget was only R1.352 million – does this mean the position has changed?
Dr Mbombo replied that there was a river affecting zoning – environmental matters would be solved. An Environmental Impact Assessment (EIA) was conducted and approval was granted so this has to be complied with. There are however a number of challenges to first overcome. For example, now that the EIA has been done, certain financial aspects have had to be factored in. There was thought of just refurbishing the hospital itself but this is not a feasible option.
Dr Beth Engelbrecht, Western Cape Head of Department of Health, added that the Department was working closely with the City of Cape Town. The Department was doing procurement, funding, as well as construction. It is very challenging because of environmental issues of the site along with waiting for official responses from the City of Cape Town.
Ms Makeleni wanted to find out whether Members could have access to the environmental report and better understand the challenges.
Dr Mbombo replied that this was of high priority to the Department - even the Department of Public Works is involved. It is considered a standing project. The environmental report would be furnished to the Committee.
Ms Gopie wanted to find out what the reason was for the delay in expenditure on page 131.
Ms Makeleni questioned page 145 - she could not tell what has been done.
Dr Mbombo replied that on page 131, delays in capital and equipment expenditure were caused by financial leases for transport equipment. It is expected that there would be a spike in expenditure to accommodate claims of daily tariffs for emergency medical services. Mitigating factors have been put in place to accelerate this.
On page 145, there was just a shifting from one place to another – funding shifted and capital plans were adjusted resulting in capital expenditure being higher in the second half of the financial year. This was done for replacement of obsolete equipment and implementation of the picture archive communication system and radiology information system which are all aimed at rehabilitation of the centres. Theatre management services as well as addressing the backlog in assistive devices of procurement will only be finalised in the coming six months.
Ms Engelbrecht added that capital and maintenance was shared with transport but only in emergencies. All activities done by roads and other departments were not published in the budget but the definitions are in capital.
The Chairperson had a question on page 125 in terms of the decrease of revenue in the 2018/19 Financial Year by R54 million.
Dr Mbombo replied that the R106 million rollover was a total accumulative rollover and not just related to the Global Fund. She reminded Members that initially the Global Fund initiative was implemented in a way that it was to be done to last for years. However R30 million was the rollover due to late signing of the new grant given delays in filling posts and implementation of programmes.
The Chairperson asked the Department to leave the venue for a few minutes to give Members the opportunity to deliberate on Vote 6 and the way forward.
Members were asked to either support adoption of Vote 6 as it is or reject it.
Mr D Mitchell (DA) supported Vote 6.
Ms M Wenger (DA) supported Vote 6.
Ms Makeleni stated that she represented the ANC minority opinion which was to reject the Vote.
The Chairperson noting the minority opinion held but that the Vote was supported by the majority.
At this point the Department returned to the venue.
Ms Makeleni asked why there was a loss of patients and whether it was because they were not being given medicine to the end. With the circumcisions on page 57, the numbers are dropping especially for the Xhosa and Zulu. What is the status of the traditional healers, or initiators, issuing certificates so these problems do not occur? One is merely seeking to understand and get clarity on the matter – it might be that there is not a crisis in circumcision. When will the programme on TB patients, on page 58, be fully implemented? What is the reason for not achieving the target on page 60?
Ms Gopie, on page 64, questioned the poor performance of the agents. What are these agencies tasked with specifically and what is the way forward after their poor performance? Has the Department met with them or rather what are the mitigating factors that have been to in place to improve their performance?
Dr Mbombo replied that first patients have not been abandoned. Once on medication, they received medication to the end. The system had become easier because of patient ID and thus it is easier to monitor movements in the Western Cape especially for those people who move around. However, there are also immigrants in the Western Cape. With resistance, sometimes the patients do it willingly and disappear.
On circumcision, there is a reliance on service providers but one would also need to look at demographics. There is a reliance on the fact that those with problems will come to the facilities. In some places traditions guide circumcision. In other areas it is not that there is negligence. The Department is willing to work with traditional healers to train and licence them.
Ms Engelbrecht added that monitoring movement of people was becoming easier due to the growing number of NGOs aiding the statistics by monitoring and keeping in contact with patients. On TB patients, the programme is supposed to be rolled out as from January 2019 – the Department is ready for this. Progress will be reported once achieved.
Ms Makeleni found that some of the responses given were a bit short and light on detailed description. There were vehicles procured but at the same time it is not known to which centres they were distributed. The Department should explain this so that Members can really get a sense of understanding. Is the Department making any impact? On page 67, there needs to be explanation for the back pay of R7 million. Is the Department also in charge of matters related to mental diseases?
Ms Engelbrecht replied that there might be a challenge with the structuring of the report because all details are contained therein. The vehicles were circulated generally to areas where they were required such as Mfuleni, Khayelitsha, Hout Bay and other general areas where there was a need. The vehicles were not procured for certain areas but for wherever the need was. With the R7 million back pay, this was as a result of implementation of a Department of Public Service and Administration (DPSA) directive where the stipend for youth programmes interns increased – the increase was supposed to come into effect from October 2018 but it would now only start in April 2019 hence the back pay.
Dr Mbombo added that the psychosocially ill fall under the Department of Social Development (DSD) – DSD is responsible for these individuals and keeping statistics. Mental health diseases have been growing over the years.
Ms Gopie asked the Department what it was doing or measures it was putting in place to prevent or deal with the growth of mental health matters. With the HR strategy objective on page 77, why are services outsourced?
Ms Makeleni wanted to know the reason for under spending on the Cape Medical Report as noted on page 105.
Ms Wenger questioned the strength and state of the ICU.
Dr Mbombo replied that the Department was working closely with stakeholders and its experts in coming up with ways of mitigating mental health related diseases. NGOs have been quite helpful but at this time the Department is in the process of accessing all patients and databases to try and contain this. While it is however challenging to try and prevent it, the Department is doing a lot of civic education.
On the HR strategy, services were outsourced because the particular service required expertise which could only be outsourced. This has to do with the computer-aided dispatch system.
Under spending on the Cape Medical is not actually the case – orders are made in the first half of the year where payment and delivery only occurs in the second. Orders were made but the payment has not be effected so it created the impression of under spending.
The Chairperson wanted to know which NGOs were dealing with mental health.
Dr Mbombo replied that the NGOs are registered by DSD. They deal with many matters including mental and psychiatric problems. One would find that when looking at a group of, let’s say, five cases, for example, one of these cases would be related to use of drugs. Users are licensed. A detailed report could be tabled.
Ms Engelbrecht added that as the NGOs deal with many matters, at times it was hard getting handy information as sometimes an NGO might just bring one case or might bring one user who is suffering from a mental health problem. However the Department would liaise with DSD when tabling the report.
Ms Makeleni wanted to know what is happening at the Western Cape Hospital and progress made in this regard.
Ms Engelbrecht stated that originally the community had come to consensus that the hospital needed replacement entirely as it was not modern and had a problematic design. However before this can actually be fully implemented, in the meantime, the hospital needs to be maintained as it is being refurbished. The plan is still on course and once the phase reaches that point it will be dealt with accordingly.
The meeting was adjourned.