The Western Cape Provincial Department of Health (the Department) briefed the Committee on the progress made in addressing and mitigating the potential impact of the risks identified by the audit committee during the 2018/19 Annual Report. This was a virtual meeting.
The presentation addressed strategic risks in the Department in 2018/19, ICT and fraud risks, TEXCO decisions and strategic risks for 2020/21.
Members questioned the significance of a low residual risk, fraud related to Personal Protective Equipment, the risk of water shortages and maintenance funds.
As part of its resolutions, Members requested the Department furnish it with a mitigation strategy report, further information on maintenance work at Tyberberg Hospital and a report on the state of health related infrastructure in the province.
Opening remarks by the MEC for Health in the Western Cape
The MEC, Dr Nomafrench Mbombo, said the Department received a clean audit for the first time in the 208/19 period. The mitigating strategies are aligned to when it must be implemented. The Department will not be able to table the 2019/2020 audit findings, as these will only be available after the end of the financial year.
Western Cape Department of Health Risk Management presentation
The Western Cape Provincial Department of Health (the Department) briefed the Committee on progress made in addressing and mitigating the potential impact of risks identified by the audit committee in the 2018/19 Annual Report.
The Department identified seven risks it faces.
One of the risks is budget constraints. The Department regards this risk as low, saying it is within its tolerance level.
At the close of the financial year under review, the Department underspent by R56m. The main reason for the underspending is the additional funds received for filling critical posts.
The Department has well developed financial controls, governance mechanisms, and monitoring systems.
A second risk identified relates to staff security incidents. The inherent risk remains extreme. The residual rating remains high. This is due to the nature of the risk, and societal contributing factors which require multi-departmental interventions.
Additional support is provided through the Department of Community Safety to the following facilities. This is because of security threats, which includes protest actions:
-Gustrouw Community Day Centre (CDC)
- False Bay Hospital
- Khayelitsha Hospital
- Helderberg Hospital
- Houtbay CDC
- Nomzamo CDC
Fraud is another risk identified by the Department. The risk for fraud, corruption, and theft is rated low and within the Department’s tolerance level.
The Department considers itself to have a high level of control over this risk. This is based on the support it receives from DoTP (Provincial Forensic Services).
Ms R Windvogel (ANC) wanted to ascertain what low residual risk means, given the Department’s equitable share decreased over the past few years.
Ms A Bans (ANC) asked the Department to furnish the Committee with a mitigation strategy report.
She also wanted to know why the risk in slide seven is so low. This question was posed in light of the continued incidences of fraud related to procurement of personal protective equipment (PPE).
Replies by the Department
The MEC said the mitigation strategies only relate to the 2018/2019 audit findings. It does not relate to the current financial year. The issue of PPE is not found in the 2018/2019 audit findings.
Dr Keith Cloete, the Head of the Western Cape Department of Health, said slide four of the presentation deals with questions pertaining to the impact on the Department’s performance, specifically in the absence of funding. The service risk is considered high. The Department underspent by R56 million.
Mitigating strategies for each of the seven risks are catered for under the comments section of the presentation.
The Department considers fraud to be a low risk factor within it. It implemented several controls making it difficult to commit fraud. In Dr Cloete’s opinion, the Department has sufficient controls in place to buffer against any risks of malfeasance.
Mr M Xego (EFF) referred to slide nine, which deals with water shortages. He recalled the inherent risk is considered high. He also recalled the Western Cape experiencing one of the worst droughts in recent memory. Based on this scenario, he wanted to find out if water shortages were a result of poor and aging infrastructure or climatic conditions such as drought.
Regarding aging infrastructure, he said he understood the allocation for maintenance work increased. He wanted to know if this increase means most infrastructure woes are attended to.
Mr L Mvimbi (ANC) said the Health Department is essential. It must run smoothly. He wanted to know if aging infrastructure referred to buildings or equipment, and how this will be addressed.
The Chairperson cautioned Members not to veer outside the subject matter at hand. She asked Mr Mvimbi to submit his comments as a resolution.
Mr Mvimbi agreed.
Follow-up replies by the Department
Dr Cloete said Mr Xego hit the hammer on the nail with his analysis. The Department drills boreholes, installs water tanks, and fixes broken pipes at some health facilities in the province. The Department was able to mitigate the risk of water shortages, but the residual risk is still high. This is because of climatic changes.
The budget allocation for maintenance was too little to service the entire backlog. The risk is partially mitigated. Tygerberg Hospital received the lion share of maintenance funds.
Closing remarks by MEC Mbombo
The MEC said it will be very useful to table the 2019/2020 Audit Report as well. It will show the level of improvements made since 2018/2019. Infrastructure challenges in the Province are myriad.
Ms Windvogel asked the Department to furnish the Committee with a report on the state of health related infrastructure in the province. She made particular reference to the GF Jooste Hospital.
Ms N Makamba-Botya (EFF) asked for a resolution to be included for information on maintenance work conducted at Tygerberg Hospital.
The Chairperson said the management of Tygerberg Hospital is scheduled to appear before the Committee. It might be prudent to raise all of these matters with the Hospital directly.
Ms Bans repeated her request, and asked the Committee to be furnished with a mitigation strategy report.
The Committee adopted the report of its meeting held on 12 August 2020.
The meeting was adjourned.
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