Department of Health audit outcomes: AGSA, DPME & FCC input

This premium content has been made freely available

Health

09 October 2019
Chairperson: Dr S Dhlomo (ANC)
Share this page:

Meeting Summary

The Financial and Fiscal Commission (FFC) briefed the Committee on the provincial and national Department of Health spending patterns. The FFC said that as Health is a concurrent function across three spheres of government, this often creates coordinated planning problems. Inter-governmental fiscal review (IGFR) issues in the Health system include:
• Coordinated planning
• Multiple grant funding streams for same budget line item
• Skewed distribution of health facilities across provinces and within districts.
• Need for decentralisation of funding to hospitals.

The FFC made recommendations:
• National and provincial treasuries should develop criteria for determining serious financial strain that can be used to trigger automatic fiscal adjustment.
• National Treasury and the Department of Health should allocate  part of the health infrastructure allocations to gradually set-off expenditure accruals from unavoidable demands.
• National Treasury should ensure that the health infrastructure conditional grants accommodate flexibility during periods of protracted fiscal constraint so that provinces can be allowed to re-orientate their package of available capital allocations towards maintenance.

The FFC conclusions were:
• IGFR arrangements have a bearing on health care delivery and outcomes – health reforms must not undermine the integrity of IGFR
• Health spending is consistently positive and exhausted but performance show mixed results
• Long existing health conditional grants should be directly oriented towards rolling out of NHI
•IGFR institutional arrangements must be resolved before large NHI budgetary commitments are made.

Members said they did not agree with the FFC assessment that conditional grants were only meant to be temporary. They agreed with the suggested grant reforms but not that they should be time-bound. Members requested the FFC comment on the NHI Bill and be part of the Bill's deliberations. They said the FFC was not clear on whether the NDOH did or did not implement its recommendations.

Auditor General South Africa (AGSA) spoke about the audit outcomes of the national and provincial Department of Health and its entities. The audit outcome trends over the past ten years for national, provincial and local government. Irregular expenditure was R3 031 million, compared to R2 651 million in 2017/18, but 99% was incurred by National Health Laboratory Services for not following procurement processes. In 2017/18 fruitless and wasteful expenditure was R1 332 million for local government and R2 566 million for national and provincial government. Unauthorised expenditure stood at R12 851 million for local government and at R2 125 million for national and provincial government.

The AGSA completed six audits in the Health portfolio 2018/19: The Department, National Health Laboratory Services (NHLS), and Council for Medical Schemes (CMS) received unqualified opinion with findings. The Office of the Health Standards Compliance (OHSC) and the Medical Research Council (MRC) received an unqualified opinion with no findings. The South African Health Products Regulatory Authority (SAHPRA) received a qualified opinion with findings. The Compensation Commissioner for Occupational Diseases (CCOD) audit outcome was still outstanding.

Overall the portfolio improved as MRC and NHLS improved their audit outcomes. This was due to improvement of controls. The portfolio had an addition of a new entity SAHPRA, which received a qualified opinion. This was due to lack of controls over proper record keeping to ensure complete and accurate information for financial and performance reporting support as well a number of vacancies. Financial statement preparation remained a concern as material adjustments had to be effected to the Department and CMS financial statements submitted for audit. The OHSC had maintained a clean audit outcome from 2017/18 due to effective controls in place and oversight by the assurance providers.

Members were in agreement that placement of health facilities in various spheres often created coordination problems. However, concurrent functions were constitutional and a proper management of these concurrent issues should be found. They noted that decentralisation was something that the Department had been discussing, as it understood that more responsibility of the SCM needed to be given where services were provided. Members expressed concern about the irregular expenditure which increased from R2.6 billion to R3.3 billion and there were no apparent plans to curb irregular expenditure by the Department. Mechanisms needed to be found to work with law enforcement agencies so that transgressors were subject to the law.

The Department of Planning, Monitoring and Evaluation (DPME) spoke on the progress towards government's Outcome 2: A long and healthy life for all South Africans. Key health outcomes in South Africa had improved over the five years of the MTSF 2014-2019. Evidence included life expectancy, maternal mortality ratios, as well as infant and child mortality rates. Average life expectancy declined over the first decade of democracy, due to the devastating impact of the HIV/AIDS epidemic, reaching a low of 54 years in 2005. Total life expectancy at birth was now estimated to have increased from 62.5 years in 2014 to 64.6 years in 2019. Infant mortality had improved from 39 per 1000 in 2014 to 23 per 1000 in 2017. Under-5 mortality declined from 56 per 1000 in 2009 to 32 per 1000 in 2017. The maternal mortality ratio (MMR) had improved from a peak of 302 per 100 000 in 2009 to 134 in 2016. The World Health Organisation (WHO) recently released data shows that MMR in South Africa decreased further to 119 per 100 000 in 2017.

The DPME stressed that health affected the quality of life and productive capacity of South Africans. It was a socioeconomic right of South Africans and impacts on their development and growth prospects. Health was not only an outcome of delivering health care services, but also of a multi-sectoral effort to address the social determinants of health. Poverty, unemployment and inequality impact negatively on health outcomes.

Members asked DPME why it had conducted a socio-economic impact assessment system (SEIAS) report for the NHI Bill  twice. What methodology did DPME apply to evaluate performance as neither AGSA or DPME was giving a clear picture on service delivery. A clinic had been without water for the past month and the shortcomings of other departments impacting on the Health sector performance was questioned. Technology should be used to monitor clinics and hospitals. Health challenges should be prioritised and be taken to a high level.

Meeting report

Financial and Fiscal Commission (FFC) submission on Department of Health
Mr Eddie Rakabe, FFC Program Manager: Fiscal Policy Unit, presented on health and the Inter-Governmental Fiscal Review (IGFR), health outcomes and national health budgets, national and provincial budget analysis, NHI in terms of progress, budget and policy, FFC recommendations.

IGFR issues in the Health system included:
• Implications of referral challenges on provincial health budget,
• Top slicing conditional grants to fund national health entities,
• Funding of municipal health services
• Challenges of vertical and horizontal coordinated planning persists
• Provinces occasionally held liable for undermining national policies – highlights weaknesses of intergovernmental forums
• Coordination problems were evident in the implementation of NHI pilots and grant – provinces were unaware of what to use the grants according to the NHI pilot review.

The Health sector has some of the oldest conditional grants in the system
• Conditional grants are only meant to be temporary - addressing specific priorities
• The NHI grant has undergone many changes in a short period of time. It has changed from being direct (with an indirect component) into an indirect grant
• Conditional grants underperform due to poor planning and poor consultation during introduction
• Government need to adhere to guidelines for introducing conditional grants with a 3 year lead period
• As a general rule indirect conditional grants should be avoided.

The rolling out of NHI had been on the budget program since the release of the Green Paper in 2011. A NHI grant was introduced in 2012 to finance 11 NHI pilots with an initial three year allocation of R1 billion. Planning was problematic from the beginning. The NHI pilot grant was intended to test the feasibility of new delivery models and had since produced mixed results. Full implementation of NHI was still years ahead but is scheduled to be operational by 2026. The 2017 budget announced an establishment of the NHI fund in 2017/18. This proposal was only allocated R64 million in 2018. No additional funding had since been announced. Several hurdles lie ahead before the NHI fund comes into operation. The 2026 timeline was too short a target to complete all the necessary steps. The NHI grant had undergone numerous iterations since inception in 2011. The continuous repurposing of the NHI grant was worrying given the imminent introduction of the NHI fund.

Mr Rakabe provided recommendations on health 2019/20:
• National and provincial treasuries should develop criteria for determining serious financial strain that can be used to trigger automatic fiscal adjustment.
• National Treasury and the Department of Health should allocate  part of the health infrastructure allocations to gradually set-off expenditure accruals from unavoidable demands.
• National Treasury should ensure that the health infrastructure conditional grants accommodate flexibility during periods of protracted fiscal constraint so that provinces can be allowed to re-orientate their package of available capital allocations towards maintenance.

Mr Rakabe concluded:
IGFR arrangements have a bearing on health care delivery and outcomes
– Health reforms must not undermine the integrity of IGFR
• Health spending is consistently positive and exhausted but output and outcome show mixed results
– Parliament should focus oversight on under achieved performance targets with 100% expenditure
• Long existing health conditional grants should be directly oriented towards rolling out of NHI
– NHI grants should focus specifically on reforms that advance implementation of the Bill
• IGFR institutional arrangements must be resolved before large NHI budgetary commitments.

Discussion
Mr P van Staden (FF+), referring to the NHI, stated that there were provincial challenges that needed to be sorted out prior to rolling out the NHI. He remarked that the medical private industry played a crucial role in the reinforcement of the NHI and one would be careful to roll out the NHI in the private sector. He sought clarity on the statement that the private health sector was abusive.

Mr T Munyai (ANC) stressed that the NHI Bill was in Parliament and was still open for comment. He suggested that there should be a special meeting between the Department of Health, FFC and the Committee to have a common understanding on the rolling out of NHI. The concurrent function between the three spheres of government was constitutional. This could not be changed even though it was reported that concurrency in some instances presented challenges for effective health service delivery. The FFC should note that South Africa was a unitary and not a federal government. He expressed his concern that the private health industry did not want the NHI. It was against it. He did not agree on the role and function of FFC on slide 3. He did not understand the mandate of FFC. What he drew from the FFC presentation was that the NHI could not be rolled out unless the FFC recommendations were met. This position was incorrect.

Dr P Dyantyi (ANC) asked about the relationship between the Department and FFC and if the FFC report was submitted to the Department of Health (DoH). If yes, what was the DoH response to the FFC recommendations? She agreed that the health sector had some of the oldest conditional grants that ought to be revisited and reformed. However, she did not agree with the view that conditional grants should be temporary.

Dr S Thembekwayo (EFF) noted the mandate of the FFC included the making of recommendations. Recommendations on 2019/20 health service delivery were provided. She asked about the Health Minister's response to the FFC recommendations. There were a lot of acronyms in the report and no attempt was made to state what these stood for. She asked who failed to look at the FFC recommendations. Was it the Director General or Minister? Referring to slide 13 dealing on the national health outcomes, she asked if there was a comparative study with other nations, for example, Cuba. She reminded the FFC that South Africa was sending students to Cuba to undertake medical studies. It was very important to find out how Cuba was performing. Referring to national and provincial budget analysis, there was nothing in the presentation about irregular expenditure and asked why this was left out. The presentation talked about under and over spending only. She commented that the briefing could have more impact if the Department of Health, especially, the Minister, was invited to listen to the presentation. For example, the Minister could have responded to the points made on the NHI and if the FFC recommendations had been followed.

Ms S Gwarube (DA), referred to the challenge of decentralisation of funding to hospitals and asked how this was proposed to be addressed in the Bill. On the slow implementation of NHI, she asked about underlying issues of impasse between the Department and the National Treasury. Was there a discussion between the Department, FFC and National Treasury? Was there an agreement or a discussion on the 2026 implementation date of the NHI? She suggested that the Department be summoned to elaborate on the NHI and the impasse between the Department and National Treasury. The NHI review was released 10 days ago and the report should be tabled to the Committee for its analysis and discussion.

Mr K Jacobs (ANC) remarked that what the FFC was presenting was really different from what Members had heard. The presentation was an eye opener on how DOH worked. Members had to have a deep understanding of its financial performance. Referring to slide 7 on IGFR issues in health system, it was imperative for DOH to provide quality services to the people. Health facility allocations ought to be aligned to health needs, plans and priorities. For example, all people should have access to primary healthcare. He was worried that concurrent functions led to duplication of services at national, provincial and local level.

Mr M Sokatsha (ANC) remarked that decentralisation of funding to hospitals was a long outstanding issue. He felt that there was ambiguity on the role played by provincial and local departments in implementation of the NHI. However, the Constitution could be relied on to solve this matter.

The Chairperson said that the NHI Bill was not complete, unless National Treasury supported it with a Money Bill that would cover universal health coverage expenses. He urged the FFC to sit with DOH and National Treasury and speak about NHI expenses and how the NHI could be implemented. The Department had educated the Committee on the NHI Bill with respect to how the NHI programme would be implemented. It seemed that the FFC was not educated about the NHI Bill and its implementation. On conditional grants, he asked what informed the thinking that conditional grant should be temporary. Why must grants have a lifespan of three years when they are important? Referring to slide 32, he remarked that FFC should not have used the word “regime.” The word regime had another connotation and was redundant.

Ms Gwarube said that the FFC mandate did not include submission of recommendations to the Committee, but to guide the Committee and show it how the business model of DOH was run. She reiterated that the FFC should have presented in the presence of DOH so that it could be given an opportunity to respond.

The Chairperson disagreed. He welcomed the FFC to respond.

Mr Rakabe responded that the term 'abusive' referred to abuse of market power in terms of ever changing power patterns. He understood that the concurrent functions were constitutional and that South Africa was not a federal state. However, concurrence should be well managed to avoid tensions and problems in the functionality of the health system. Inter-governmental forums were needed to address this. The FFC was conducting a research on how the concurrent function should be well managed to avoid duplication.

On the NHI implementation, Mr Rakabe replied that the FFC had presented the problems with the NHI which should be addressed, to avoid bigger problems in the future. He said that at local level, managers of clinics and hospitals complained that they did not have the power to take budgetary decisions. The FFC wanted to assist these managers. He explained that decentralisation would mean that funding was directed to hospitals. This had been successful in the education sector. On non-coverage of irregular expenditure, he noted that it was true that there was irregular expenditure and this was slightly covered in the budget issues.

The Chairperson remarked that DOH was not present, because it was meant not to be there. The Department would be coming the following week to brief the Committee. He requested that the FFC participate and make a submission on the NHI Bill, as it was out for public comment.

Health portfolio audit outcomes: Auditor General South Africa (AGSA) briefing
Mr Andries Sekgetho, AGSA Business Executive, noted that the Committee would be considering Annual Reports of the Department of Health and its entities, in preparation for the Committee's Budgetary Review and Recommendations Report.

Mr Sekgetho provided the Committee with the audit outcome trends over the past 10 years for national, provincial and local government and the history of irregular expenditure. Balances of irregular expenditure that were not yet dealt with were as follows: R38 534 million, R62 711 million and R71 107 million for 2015/16, 2016/17 and 2017/18, respectively, for local government. R95 197, R131 866 and R161 843 million for 2015/16, 2016/17 and 2017/18, respectively, for national and provincial government. The annual irregular expenditure and the balances were not complete as the disclosure of irregular expenditure was often qualified on completeness thereof. In 2017/18, fruitless and wasteful expenditure for local government and national and provincial government was R1 332 million and R2 566 million, respectively. Unauthorised expenditure stood at R12 851 million for local government and at R2 125 million for national and provincial government. Money recovered from irregular expenditure was R9 million (1%), from unauthorised expenditure R147 million (1%), and from fruitless and wasteful expenditure R60 million (1%).

Mr Sekgetho stated that the AGSA completed audits of six auditees in 2018/19. These audities(or portfolio) were Department of Health, the Council for Medical Schemes (CMS), Office of the Health Standards Compliance (OHSC), the Medical Research Commission (MRC), the National Health Laboratory Services (NHLS), the South African Health Products Regulatory Authority (SAHPRA), and the Compensation Commissioner for Occupational Diseases (CCOD). The CCOD’s audit outcome was still outstanding. MRC and OHSC received unqualified opinion with no findings. The Department, NHLS and CMS received unqualified opinion with findings. SAHPRA received a qualified opinion with findings.

Mr Sekgetho stated that overall the portfolio improved as MRC and NHLS improved their audit outcomes to unqualified with no findings and unqualified with findings respectively. This was due to improvement of controls over financial reporting and compliance. The portfolio had an addition of a new entity SAHPRA, which received a qualified opinion. This was due to lack of controls over proper record keeping to ensure that complete, relevant and accurate information is available to support financial and performance reporting as well a number of vacancies in the entity. Financial statement preparation remained a concern as material adjustments were effected to AFS submitted for audit for DoH and CMS. The OHSC had maintained a clean audit outcome from 2017/18 due to effective controls in place and oversight by the assurance providers.

Mr Sekgetho reported on irregular expenditure due to non-compliance in 2018/19. Irregular expenditure was R3 031 million, compared to R2 651 million in 2017/18. 99% of the irregular expenditure was by NHLS. The nature of the irregular expenditure in DoH, NHLS and CMS procurement made on expired contracts; DoH and CMS procurement from a panel not in line with Treasury Regulations; DoH, NHLS, CMS, and SAHPRA did not follow procurement processes, and to NHLS overspending on contracts. For 2017/18 restatement, NHLS restated their 2017/18 irregular expenditure amount from R598m to R2.5 billion. The restatement was as a result of management’s efforts in clearing the 2017/18 qualified audit.

Mr Sekgetho reported on supply chain management (SCM). There was an overall regression in SCM compliance. Most common findings on SCM arose from missing or incomplete information (SAPRA, NHLS); uncompetitive and unfair procurement processes (CMS, SAHPRA, NHLS) and interest not declared on some of the procurement contracts (SAHPRA, NHLS). The root causes for poor financial performance were threefold: Slow response to improving key controls and addressing risk areas; inadequate consequences for poor performance and transgressions, and instability or vacancies in key positions.

Mr Sekgetho stated the AGSA’s recommendations to the Department and its entities were:
• Leadership should: Exercise oversight responsibility regarding financial and performance reporting and compliance as well as related internal controls.

• Management should:
- Implement proper record keeping in a timely manner to ensure that complete, relevant and accurate information is accessible and available to support performance reporting.
- Prepare accurate and complete financial and performance reports that are supported and evidenced by reliable information.
- Review and monitor compliance with applicable legislation relating expenditure and procurement and contract management.

The Portfolio Committee should:
- Request management to provide feedback on the implementation and progress of the audit action plans to address poor audit outcomes during quarterly reporting.
- Ensure that officials are held accountable.
- Monitoring of appointments for key vacancies at the NHLS.
- List of action taken against transgressors should be provided quarterly to the Committee for follow up for all irregular expenditure incurred.

Discussion
Mr Munyai remarked that it was clear that there was disregard for compliance with laws and regulations. There was too much money which was not properly managed. Yet, there was no commitment to address this. There was no accountability. This was unacceptable. Poor financial performance was due to failure in implementing consequence management. AGSA should work with Hawks. Irregular and unauthorised financial performance could not be restricted to mere pronouncement. There ought to be criminal investigations and criminal accountability. It had become a trend that people were resigning and changing employment to avoid criminal consequences. He reiterated that criminals should be found and held accountable. Some entities did not have HR management so how could these entities determine the capacity of human resources needed. Irregular expenditure should decrease in that compliance with laws and regulations should be observed.

Ms Dyantyi remarked that DOH had not been performing as Members would expect it to perform. AGSA had now been given the power to refer material irregularities for investigation, but the salient question was what happens after carrying out investigations and finding the transgressors? Could AGSA take punitive measures against transgressors?

Ms Thembekwayo, referring to slide 31 on the status of internal control, asked AGSA if DOH and its entities have a proper and effective leadership. She asked if AGSA investigated the qualifications of DoH staff. She wondered if staff members in leadership were hired only because they were affiliated to the ruling political party. She suggested that all DoH staff members should be fired and recruit new people, and start with a clean plate. In principle, if AGSA found a problem, it ought to give 21 days to address the problem. Did they conform to this rule? If they did not, what alternative measures were taken?

Ms Gwarube asked what measures were taken to restore the irregular expenditure of 2017/18.

Mr van Staden asked when the law was going to be enforced as required by the PFMA.

Response
Mr Sekgetho, referring to slide 14, replied that the expanded mandate of the AGSA includes (i) referring material irregularities to relevant public bodies for further investigation, (ii) taking a binding remedial action for failure to implement AGSA’s recommendations for material irregularities, and (iii) issuance of a certificate of debt for failure to implement remedial action if there is financial loss. However, the AGSA recommendations did not have the same power as the Public Protector recommendations in that AGSA could not take remedial action. AGSA recommendations could only be implemented by the accounting officers of the department and its entities. AGSA did not deal with criminal investigations. Firstly, it was incumbent to the accounting officers, in terms of the PFMA, to act on AGSA findings  (as evidence) to deal with wrongdoers. The audit report of AGSA could not be reviewed because it was an opinion. The AGSA report could be submitted to another relevant public body to carry out further investigation and institute criminal proceedings against wrongdoers.

Mr Sekgetho replied that in many cases of irregular expenditure, the wrongdoer had left the organisation. In some cases the irregular expenditure is condoned by National Treasury or it is written off as irrecoverable if it is confirmed that no person is liable in law.

The Chairperson noted that the AGSA report would assist when the Committee engaged with the Department next week, to understand the nature of the irregular expenditure and what plans were in place to curtail it. Mechanisms needed to be found to work with law enforcement agencies so that individuals who misuse public funds were subjected to the law. He was concerned about the irregular expenditure which had increased from approximately R2.6 billion to R3.3 billion.

Department of Planning, Monitoring and Evaluation (DPME) briefing
Mr Thulani Masilela, DPME Chief Director: Health Information, said the Committee would be considering annual reports of the Department of Health and its entities, in preparation for its Budgetary Review and Recommendations Report. DPME would brief the Committee on the performance outcomes of the Health Sector for 2018/19. The presentation focused on performance against the NDP Vision 2030 and Medium Term Strategic Framework 2014-2019. It reflected the national picture and provincial variations in performance and incorporated findings from DPME visits to health facilities across provinces.

Mr Masilela said that key health outcomes in South Africa had improved over the five years of the MTSF 2014-2019. Evidence included life expectancy, maternal mortality ratios, as well as infant and child mortality rates. Average life expectancy declined over the first decade of democracy, due to the devastating impact of the HIV/AIDS epidemic, reaching a low of 54 years in 2005. Total life expectancy at birth was now estimated to have increased from 62.5 years in 2014 to 64.6 years in 2019. Infant mortality had improved from 39 per 1000 in 2014 to 23 per 1000 in 2017. Under-5 mortality declined from 56 per 1000 in 2009 to 32 per 1000 in 2017. The maternal mortality ratio (MMR) had improved from a peak of 302 per 100 000 in 2009 to 134 in 2016. The World Health Organisation (WHO) recently released data shows that MMR in South Africa decreased further to 119 per 100 000 in 2017.

Mr Masela spoke to the key health challenges and noted the dual and unsustainable health care system, which was characterised by high costs of care in the private sector (covering 16.4% of the population with medical aid) and a public sector that provided for care for the majority (84%), with a resource envelope almost similar to that of the private sector. There was a decline in quality of care in the public sector, articulated by various independent sources. Challenges included urban-rural inequalities, characteristic of broader socio-economic inequality in South Africa; escalating medico-legal costs (including fraudulent claims from some sectors of the legal fraternity); dwindling financial resources (including effects of accruals from previous years); inadequate distribution of human resources for health, relative to population growth and migration patterns (national and international, research institutions, PERSAL); insufficient infrastructure (Ideal Clinic reports); health management and leadership; the burden of non-communicable diseases, such as diabetes, hypertension and cancers had increased; and increasing levels of violence and injury.

Mr Masela concluded by noting that health affected the quality of life and productive capacity of South Africans. It was a socioeconomic right of South Africans and impacts on their development and growth prospects. Health was not only an outcome of delivering health care services, but also of a multi-sectoral effort to address the social determinants of health. Poverty, unemployment and inequality impact negatively on health outcomes. South Africa had a Gini-coefficient of 0.68, with stark racial, gender and geographic inequalities. The lower levels of progress in meeting MTSF 2014-2019 targets in provinces that were predominantly rural, under-resourced, unable to attract the best talent in the country, and which provided health services mainly to communities of lower socio-economic status, were a case in point. DPME had also found management capacity and capability to be an important factor. It was a major difference between a well performing health facility and a poorly performing one – even within the same environment, with equivalent resource levels.

Discussion
Ms Gwarube noted that the DPME conducted a Socio-Economic Impact Assessment System (SEIAS) Report for the NHI Bill  twice. What were the differences in findings between the two reports? On monitoring and evaluation, AGSA looked at financial performance so what were the substantive aspects looked at by DPME? What methodology did DPME apply to monitor and evaluate performance. Neither report was giving a clear picture on service delivery.

Ms Dyantyi asked if DPME had interactions with other departments on challenges that might have a negative impact on Health performance outcomes. She visited a clinic in her constituency and was told that it had not had water for the past four weeks. On health budget allocations, she asked if DPME had ever considered that money should be allocated to prevention of early pregnancy.

Mr Munyai welcomed presentation. He commented that a new technology should be used to support the current monitoring and evaluation system. The e-health and e-government should be supported. The fourth industrial revolution was spoken about by the President, but nothing was being done to promote it. In South Africa, there was no spectrum to monitor hospitals and clinics, technologically. There was no need to visit clinics and hospitals when they could be monitored whilst sitting in the office. They needed to approach MTN to ensure that they stayed connected. They could learn from how Rwanda applied this new technology spectrum. Medical records and data required new technology to be developed. Safety was important and could be monitored. Patients and doctors were being raped in clinics and hospitals.

Mr van Staden referred to slide 20 and said that the number of public healthcare facilities surveyed did not correlate with the number provided by AGSA. He asked why people felt more secure working for the private rather than the public health sector.

Mr Masilela replied that in the first SEIAS report DPME was quite harsh. DPME felt that it had rushed to release the report. DPME had said that there should be further consultation. DPME was a department of government. It ought to be outside government to carry out its mandate of monitoring and evaluation of government. DPME ought to be impartial, fair and unbiased. DPME had to send DOH back to reconsider its report. There had been a report on e-connect. A private entity had been hired to carry out an extensive evaluation of the White Paper policy and the Bill. The report was produced. The DPME responded that there were eight critical issues that e-connect raised and DOH had to illustrate how it could deal with these issues as they could not just be ignored. The majority of provinces supported the Bill. Some provinces gave a conditional support. DPME wanted to know how these conditional supports would be addressed. One of consensus was a public consultation.

On the DPME methodology used, Mr Masilela replied that DPME worked on a test basis and that a feasibility study was conducted. Two clinics or 10 clinics could be visited and their performances compared to come up with findings. A simple sample was used to come to accuracy in findings. DPME also looked at the WHO and UNICEF data to ensure accuracy in findings. They also followed performance indicators and data reported on by clinics and hospitals. The DPME interacted with other departments responsible for social determinants of health. There was the National Food and Nutrition Security Committee which consisted of 12 departments, including, amongst other, Agriculture, Social Development, Health, and National Treasury. DPME tried to play the role of advocacy to promote public good. For example, water was very important for health in general and for people who were sick or in hospital, in particular. It was very important for children and people who could contaminate their hands. Water delivery could promote a public good. There were many factors that promoted ill health which included poverty, which might be connected to early pregnancy. The Department of Basic Education did not allow distribution of condoms as a part of their health policy. This was supported by legitimate reasons. The main question was how DPME could bring these two departments together to find a common ground on early or teenage pregnancy.

Mr Masilela agreed with Mr Munyai that technology should be used to monitor and evaluate clinics and hospitals and monitor progress in general.

The Chairperson remarked that health challenges should be prioritised and be taken to high level. The Committee should work to contribute to promoting a healthy nation. The Committee should evaluate itself on whether it was doing what was required in promoting health. South Africa was known to develop good policies, but most of problems and challenges were due to their implementation. The Committee must do its work of oversight and monitoring.

Meeting was adjourned.

Share this page: