Special Audits on financial management of government’s COVID-19 initiatives; Update on COVID-19 vaccine roll-out, with Deputy Minister

Meeting report

Opening Remarks
Dr Joe Phaahla, Deputy Minister of Health, stated that the Department welcomed the opportunity to interact with the Auditor General’s Office. He wanted to assure the Committees of the Department of Health’s commitment to clean governance and to working together with Members of the Executive Council (MECs) and Heads of Departments (HODs) from the provinces.

The Department welcomed the work that was done by the Auditor General in assisting them, as directed by the President to audit on a regular basis – specifically in relation to the COVID-19 pandemic. Over the last 15 months or so, since the outbreak of the pandemic, they had all worked under tremendous pressure to institute the response by government to the pandemic. They acknowledged some of the indications in the AG report – that in the process of dealing with the response to the pandemic – there were a number of lapses and errors identified. They had meetings on a regular basis to ensure that they took steps to mitigate against those risks. Various steps had already been taken with their colleagues to rectify some of those mistakes and lapses. Many of those lapses happened as a result of time pressures. No one had planned for this and they all had to respond in an urgent manner. They had already undertaken a number of mitigating interventions through working together with their colleagues. They had been working on quality assurance, using the services of organisations, such as South African Health Products Regulatory Authority (SAHPRA), and providing assistance in terms of licensing and testing requirements. They also worked with National Treasury, which assisted them in setting prices. As indicated in the report, there were some areas that the AG had flagged, where some of the departments did not comply with the prices that were set. He wanted to take note, that a lot of interventions had already been instituted to address some of these matters. They were looking forward to a more intense interaction with their colleagues from various provinces, the Committees and the Office of the AG.

Chairperson Dhlomo stated that as a National Assembly Portfolio Committee, they had listened to the presentation already, there were certain things that had alarmed them and they were therefore listening to it for the second time. This time they were being joined by the Select Committee, led by Ms M Gillion. The Committees would likely have very little to ask, in terms of clarity seeking questions from the AG. They would probably prioritise the Members of the National Council of Provinces (NCOP). Thereafter, having finished the clarity seeking questions, excuse the AG and remain with the leadership across the whole country on this matter. There was a decision made at some point that if one had an HOD, who was trained in health, or health systems, one needed to support that HOD with a competent skilled finance person. The MECs would likely suggest that the faults resulted from not having a competent CFO to support and assist them. Some of the problems were basic violations of the Public Finance Management Act (PFMA). If there were problems that emanated from the report, the Committees should know about them. They needed to be able to pick up on things like tax non-compliance. They needed to be able to prevent this happening again in future. What could they do to prevent this in future and rather tackle ‘new’ problems? Change was not cyclical, one needed to move ‘spirally up’ to develop. They needed to be assured that this was happening.

First and Second Special Report of the Auditor General Presentation
Mr Andries Sekgetho, Business Executive, and Mr Eugene de Haan, Deputy Business Executive, presented to the Committee.

Three components of the COVID-19 Real-time Audit

Prevention:
-Building on our strong stakeholder relationships and processes, we had engagements with accounting officers/authorities and executive authorities on the need for preventative controls to be implemented or strengthened to address the increased risks and significant changes in operations.
-We are testing the implementation of the preventative controls (including automated controls) and report any remaining risks to accounting officers/authorities, with recommendations on closing the gaps.

Detection (audit):
-We identify high risk transactions, payments, procurement and processes using a risk identification process enabled through data analytics and a deep understanding of the environment.
-We audit the high risk items – the procedures are dependent on the nature of the matter being audited (e.g. emergency procurement or grant payments).
-We report any findings to the accounting officers/authorities as soon as they are identified so that they can address the finding and fix any control weaknesses identified before additional payments or distributions are made.

Reporting:
-We will be reporting on our work and the outcome thereof as well as the responses by the accounting officers/authorities to any weaknesses identified in special reports tabled in Parliament.

Personal Protective Equipment for Healthcare Workers Special Report 1
-PPE items not ordered at prices regarded by the National Treasury as market related  Seven of the nine provinces ordered PPE items from suppliers at prices in excess of the maximum prices prescribed by National Treasury. (EC, GP, KZN, MP, NW, NC, WC)
-Specifications not indicated on awards and submissions: When we assessed the awards, submissions and delivery notes in relation to goods delivered, we noticed that no mention was made of the actual specifications that had to be complied with for the goods to be delivered, as required by instruction note 8 of 2019-20 paragraph 3.7.6. (KZN, GP).
Goods received and accepted other than those ordered:
-PPE of inferior quality accepted other than those ordered and paid for (KZN).
-Goods were received and paid for by the department that were not the same as the ones specified in the original order documents (GP).
-Same price paid for smaller units delivered and accepted than those ordered (KZN)
-Transactions noted with tax-related discrepancies
-Transactions entered into with suppliers who are not tax compliant at order date (KZN)
-Transactions entered into with suppliers who are not tax compliant at order date (GP)

Personal Protective Equipment for Healthcare Workers Special Report 2
-Reasons for deviation from supply chain management prescripts, not recorded and/ or approved as per the approved delegation of authority, as required by treasury regulation 16A6.4 (EC, GP, NC, NW)
Goods procured at prices higher than National Treasury Instruction Notes (GP, KZN, NW, WC):
-As reported in the first special report, departments did not always adhere to the instruction notes issued by the National Treasury, as they continued to order PPE items at prices in excess of the maximum prices prescribed by the National Treasury. (GP, KZN, NW, WC).
Non-compliance with local content requirements:
-The winning service providers did not submit a declaration on local content. (KZN, MP, NC)
Specifications not indicated on quotations and submissions (EC, GP, KZN):
-As reported in the first special report, when we assessed the awards, submissions and delivery notes in relation to goods delivered, we noticed that no mention was made of the actual specifications that had to be complied with for the goods to be delivered, as required by instruction note 8 of 2019-20 paragraph 3.7.6
-Limitation of scope – procurement information requested not submitted for audit (FS, GP, KZN, MP).

Key audit observations:
Systems and/or controls to account for PPE not in place or not effectively used at bulk storage and healthcare facilities (EC, KZN, MP, NC, NW):
-We identified that, at nine bulk storage facilities and nine healthcare facilities in five of the nine provinces, systems and/or controls to account for PPE were not in place or, where they were in place, were not used effectively based on the requirements of the respective departments.
PPE not distributed in a complete and/or timely manner to healthcare facilities (EC, FS, GP, KZN, LP, NW):
-Ten of the bulk storage facilities in eight of the nine provinces fulfilled some of the requests for PPE from the healthcare facilities in reduced quantities or not at all.
Poor storage practices at bulk storage and health care facilities (EC, FS, GP, KZN, LP, MP, NC, NW):
-PPE stock was not always stored according to the respective departments’ requirements to ensure efficient and effective storage. We found poor storage practices at 12 bulk storage facilities and 23 healthcare facilities in eight of the nine provinces
Limited security controls at bulk storage facilities (EC, FS, NC, NW):
-At seven of the bulk storage facilities in four of the nine provinces, PPE stock was not always stored securely
-Ineffective quality assurance over PPE during receipt (EC, FS, GP, KZN, MP, NC, NW):
-Some items of PPE received by the healthcare facilities in seven of the nine provinces did not meet the minimum required standards and/or specifications.

Poor Storage at bulk storage and healthcare facilities
-PPE stored in the walkways, outside the boxes and on top of each other in a disorderly manner.
-PPE stock was stored at a temporary bulk storage facility and some healthcare facilities where the infrastructure was not well maintained and therefore in a poor condition. Instances were identified where the ceilings were not in a good condition due to water damage. Some of the PPE was damaged by water
-PPE stock was stored outside a temporary bulk storage facility. Sanitisers were stored outside the facilities that were exposed to the sun and rain. Some of these items were damaged due to exposure to direct sunlight, therefore its integrity/quality was compromised.

Key Audit Observations

Special Report 1:
-No provision for data backup management process in the service level agreement
-No provision for change management process in the Service level agreement

Special Report 2:
-PPE procured at prices higher than National Treasury instruction notes
-The NHLS procured some PPE items at prices in excess of the prices regarded by the National Treasury as market related
-IT project management governance and system implementation controls deficiencies resulted in incomplete and inaccurate data
-Systems were implemented without clearly defined business and functional requirements.
-Project governance was not adequate for overall oversight and monitoring, including managing risks as they arose
-We were not provided with any evidence that some form of systems testing was performed before systems went live.

Recommendations

PPE:
-Accounting officers must focus on the implementation of robust preventative controls. These preventative controls must be enforced and there should be zero tolerance for transgressions and consequence management in order to affirm accountability.
-Departments must investigate unjustifiable awards of contracts fully and hold transgressors accountable. They should also fully disclose such instances as it relates to irregular expenditure and recover potential losses.

Community testing and screening, Case management:
-The accounting officer should ensure that governance and contract management of the case management system is strengthened.

Temporary quarantine sites and field hospitals:
-The accounting officer should ensure that there is more accountability with regards to the temporary quarantine sites and field hospitals.

Conclusion
-Overall, we have identified several control weaknesses and related findings throughout the health sector that materially impacted the quality and value for money of the services or products delivered, and communicated these to management.
-These had a significant impact on whether the funds allocated had actually been spent for the intended purpose, by the institutions involved.
-A majority of the findings reported in the second report, were in progress at the time of tabling the first report.
-Repeat findings noted, were as a result of the slow response by management to implement the recommendations and commitments made, with appreciation that management were occupied with responding to the pandemic.
-The accounting officers have committed to implementing a number of internal controls to address the significant deficiencies identified, with most accounting officers committing to suspending emergency procurement and reverting back to normal procurement processes, as well as ensuring that matters reported are followed up.
-These follow up actions should include investigations and consequence management, where applicable, for transgressions.

(See Presentation)

Discussion
Ms A Maleka (ANC, Mpumalanga) stated that the Accounting Officer should ensure that governance and contract management relating to the case management system was strengthened, so that they could properly do their work. What were the issues identified by the AG with regard to COVID-19 related expenditures by the Provincial Health Departments?

Ms S Lehihi (EFF, North West) noted that as per the report of the AG, the following provinces specifically had a price-hike on PPE: Eastern Cape, Gauteng, KwaZulu Natal (KZN), Mpumalanga, North West, Northern Cape and Western Cape. At the beginning of the pandemic, they were warned against Supply Use Tables (SUTs), government was asked to be cautious – but they never listened. Have there been any cases of corruption open against people who facilitated the price hike? If not, why not? Were there any plans to recover the taxpayers money which was stolen, if not, why not?

Chairperson Gillion raised some issues for consideration by the Select Committee, as they were doing oversight over the provinces. It was really imperative that they needed this question to be answered by the AG’s Office or by the Director General (DG). Had there been implementation of the recommendations made by the AG’s Office, in terms of the findings in the report? Which provinces still fell short in terms of implementation of the recommendations made by the AG’s Office? The AGSA had said that there was follow-up being made when the first report came out – but she requested that they still wanted feedback on the progress after the second report.

As a Committee, they also needed to follow-up on issues raised pertaining to the procurement and contract management by the provincial health departments. The provincial heads should provide clarity on the issues raised by the AG. In delivering the COVID-19 initiatives, if officials, leaders, sectors implementing agents and institutions did not do their part and actively partner to strengthen the delivery value chain, it would undermine the effectiveness of the programme and lead to losses, abuse and costly investigations. Although an effort was made to develop appropriate controls to prevent the weaknesses reported in the first Special Report, those controls were not fully implemented or effective. This resulted in repeat findings on matters such as hotels charging rates above the allowable limits, the use of sites that had not been approved by the Department of Health and overpayment. It was concerning that some of the initiatives did not achieve the desired results and were even abandoned due to failed coordination, monitoring and relationships across the three spheres of government - where implementing agents were involved. The AG found weaknesses in coordination and monitoring which compromised delivery, transparency and accountability.

Mr M Sokatsha (ANC) stated that based on state of the report, given the powers that the AG had, were there any irregularities that were reported to the law enforcement agencies? The AG had powers to make such recommendations.

Mr Sekgetho stated that in terms of attempts to recover taxpayers’ money – they had done the audit from a regulatory point of view. They identified a number of indicators that indicated that a potential loss was suffered by government – they had reported in terms of the non-compliance aspects that were picked up. Those were included in the Special Report. If one considered the Special Report that was tabled by the AG, one would note that in terms of the findings, where they could indicate some element of loss, they tried to indicate that. As it was a legal process, they did need to ensure that they were being administratively fair and just. It required them to engage in a number of steps – which included notification that must be indicated to the accounting officer and providing the accounting officer or HOD with sufficient opportunity to respond to the matter that was raised. They then needed to evaluate, assess and conclude based on that response that was received before they made a determination in terms of the follow-up action. A lot of the expenditure was being incurred for the 2020/21 financial year; those audits were in the process of being undertaken by their teams. Hopefully they would have better insight in the not-so-distant future in that regard. They identified instances where it was easy to quantify the laws. There were some of those instances that required them to do a little more work to quantify whether there was a loss. Once those processes were finalised, they would provide feedback in terms of the material irregularity process. There was a process that needed to be undertaken to open up cases of corruption – the question would be better answered by the accounting officers in terms of the PFMA – who needed to investigate any form of transgression which were reported and needed to ensure that in the event where there were such cases – they needed to be taken forward with the relevant police authorities. That went hand-in hand with what he had indicated earlier regarding material irregularity.

In terms of the COVID-19 related expenditure, they were approached by the Minister at the beginning of the year who provided them with full context, with regards to what was then government’s plan in terms of dealing with the vaccine roll-out. In so far as the COVID-19 vaccine audit was concerned – that was still underway because of the number of changes in government’s plans and approaches. It had hampered their ability to do their audit work timeously. The AGSA could not audit money that had not been spent. They had provided the Department and Minister with key risks that needed to be taken into consideration as they were busy with the roll-out as well as some high level preventative controls that they needed to ensure were at least at a minimum in place to ensure that they were not exposed unduly or unnecessarily. The COVID-19 audits were still ongoing. A lot of the expenditure was incurred from 1 April up 2020 to 31 March 2021 for which the PFMA audit was currently underway.

For the Special Report 1, they tried to follow-up on some of the commitments, as mentioned for the purpose of providing some feedback in the Special Report 2. The MECs and HODs might be in a better position to outline and provide feedback as to how it was implemented. They gave them the report, but they had not done any follow-up work, they were now busy with the PFMA audit and then they would do some follow-up work once they received the financial statements for the 2020/21 financial year.

Mr de Haan stated that what was most important was that the progress between the two reports had been shown in the presentation. It was now important for all MECs to take note of the current audits underway. The audits underway would follow-up on the commitments made in the Special Report 2. They would report it in the management report and audit report that should be signed at the end of July 2021. The Committees could then request those follow-ups to be provided to the specific oversight structures so that they could remain informed of the progress that was made regarding the specific matters identified. It was also important to note that the whole purpose of the report was to strengthen the accounting officers’ oversight and to empower them, so that they could see upfront, before the end of the year, if there were any specific non-compliance issues or irregularities.

Ms H Ismail (DA) asked what preventative control measures were put in place in terms of procurement processes – so that they could avoid unnecessary issues next time. There were many irregularities with regards to tender processes. What would be done to ensure this did not happen again? What was the Ministry going to do to hold people to account – so that they could avoid unnecessary issues? With regard to preventative measures, if they did not follow the requirements stipulated in the PFMA, what would be done to ensure that this did not happen again? It seemed that every time the HOD came, they had the same situation. Nothing constructive was being done to make sure there was an accountability mechanism in place. What would the Ministry do to streamline and improve monitoring within procurement processes? They knew already there were many Special Investigating Unit (SIU) investigations taking place – what would the Ministry be doing constructively to ensure that these things did not occur again? There was no transparency across all the provinces. Besides the AG report, the Ombudsman had stated, that when PPE was procured and stored – it was stored under circumstances where it got damaged. With COVID-19 in the country, when losing so many healthcare workers lives, this was unacceptable and negligent. What would the ministry be doing to those provinces to ensure that there were some accountability measures in place? Who would be held responsible for the PPE damage due to negligence?

Mr Sokatsha stated that it was a management issue and an issue with the health systems. He asked a question around the irregularities. He highlighted all the issues that were centred around PPE – around storage and mis-management. In terms of the poor storage, did the MEC or HOD – did they go and play an oversight role over where the PPE was stored? He thought it was irresponsible for PPE to be stored outside the facility. It clearly showed that no one was overseeing the storage of PPE outside – let alone those inside with leakages etc. He asked the MECs what the problem was in implementing the commitments.

Ms S Gwarube (DA) stated that there were a number of problems that the AG had highlighted. One of the reasons they had asked for this meeting was that they had wanted the provinces to come and account in terms of what the report had shown, which was the ‘abhorrent and inexcusable’ inability for some of the provinces to actually adhere to proper governance systems. During the pandemic there were a number of deviations that had to take place and there were many provisions that had to be made in order for there to be speedy procurement. Ultimately, there were a number of problems where the provinces had a complete disregard of good governance models. Where were the HODs, in terms of understanding what had gone on in each of the provinces and working with the AG in that regard? What was the progress in terms of holding people accountable and responsible for the mis-management of public money? Where were they in terms of being able to recuperate the money? The AG now had powers to take this directly to the doors of the HODs. It would be quite interesting to note what the HODs had done. It would also be interesting to note and get a sense from the MECs themselves. Ultimately they had political oversight over the Department. The fact that those things could happen under their watch was in itself inexcusable. She directed her question to the Deputy Minister; they were not going to get rid of COVID-19 and some of the urgencies around it. What did the NDOH envision their role to be in provinces to curb the corruption and mis-management? Ultimately, they needed to put systems in place. The fact that they did a ‘post-mortem’ and were bewildered about the money lost – did not help anyone. They needed to figure out what their role was as a portfolio committee – in terms of holding them to account. What were their plans to prevent this from happening again?

Chairperson Dhlomo echoed the issues highlighted by the other Members. He highlighted that it was inexcusable to pick a service provider that was tax non-compliant and then state that ‘they were fine with that.’ The issues around storage and tax non-compliance should not be happening at this level.

Deputy Minister Phaahla stated that they appreciated the assistance of the AG’s Office as directed by the President. When the Budget adjustment, the President announced that there would be a live audit process to assist rather than just after the fact – which had been happening. The AGSA had ensured that this took place both at national and provincial levels. That was why it had produced the two reports. They appreciated that there had been improvements from the first to the second report. There were some areas where improvements had not taken place. There were areas highlighted in the report – including those mentioned by the Members. They reflected overall weaknesses of management and consequence management. Some of the shortcomings were of a basic nature in relation to the supply chain management processes i.e tax non-compliance of one of their suppliers. One could not blame that on the emergence of COVID-19. It meant that there was some basic lack of management in part of their administration – including the matters related to PPE. They interacted on a regular basis with their colleagues, sometimes on a fortnightly basis – depending on the emergency situations – sometimes late at night. In those meetings they addressed specific issues and areas of weakness and ensured that they could support each other. From that point of view, there had been a supportive relationship in order to respond comprehensively as a national team to COVID-19. When it came to very specific implementation, National Treasury had ensured that they be guided by compliance requirements relating to procurement – even in cases of emergency relating to COVID-19. National Treasury amended or withdrew some of the deviations that were made available – when there were issues. They tried to ensure that they could support one another, the Director General and HOD Offices, through regular discussions and formal meetings. This was done through the Technical National Health Committee and the CFOs Forum. Compliance differed at the level of implementation.

Mr Ian van der Merwe, Chief Financial Officer (CFO), Department of Health, stated that they had been working with the AGSA on this matter and other matters. Initially they requested, together with National Treasury, to set certain prices which they benchmarked. There were a number of instruction notes, of which some were repealed. They tried to suggest that a central procurement plan was better than a decentralised one. That was withdrawn. Provinces were allowed to make use of the central supplier database to procure PPE. At the time they reported that the number of suppliers on the system, was anything between 8000 – 12 000 suppliers, that were willing and able to provide PPE at certain prices. Many provinces complied with that prescript and found that many suppliers were not able to supply as they had promised. Even at a national level, they put out orders that they had to cancel because of non-delivery or because they could not deliver at certain prices. Those were some of the challenges that they had experienced. The implementation was mostly at provincial level. Together with the technical team, they had set up certain systems which went through a number of teething issues but they got the stock visibility system up and running. The system showed what was available at provinces in terms of stock and alerted provinces what and when to order. They had a CFO Forum that tried to meet regularly. They discussed some of the matters that pertained to supply-chain management. They also had a number of discussions in relation to budget availability, what grants could be used for PPE procurement, for instance. From a national perspective, they had worked with provinces and National Treasury to mitigate many of the issues and the commitment was still to improve on them and the findings from the AG.

Dr Sandile Buthelezi, DG, Department of Health, assured the Committees that they had a very good working relationship with Treasury, such that with the vaccine roll-out they met every week to go through the issues. They had dealt with a bit of complicated procurement in this regard in terms of the vaccines. Treasury provided guidance as they moved forward, in relation to those issues.

In terms of consequence management, as accounting officers, they were implementing this moving forward, with provinces. There were some contracts flagged by the AG – they would finalise investigations – some of these documents had been handed over to the SIU because they had requested that they work hand-in-hand with them. They had a good working relationship with the provinces and dealt with the matters as they came up and as they moved forward.

Presentation on COVID-19 Epidemiology and Vaccine Roll-Out
Dr Buthelezi presented to the Committee.

Overview
-There has been sustained increase in the daily new cases for the three consecutive weeks in all provinces.

As of 26 May 2021:
-Cumulatively of 1 645 555 cases, recoveries 1 546 583 (94 percent)
-There are 56 077 deaths (CFR 3.4 percent)
-Test positivity rate is tending toward 10,1 percent.
-Lessons from our second wave response highlighted the importance of early response to sustained increase in new cases.
-Lessons from other countries underline the need to slow down transmission, facilitate vaccine penetration and thus allow for the benefits to take effect – to avoid overwhelming the health system.

Hospitalisation and death trends per province (as of 21 May 2021)
-In last 7-day hospitalisations increased in all provinces except KZN and the Western Cape (WC).
-Hospitalisations in the Northern Cape (NC) have surpassed the peaks of both the first and second waves in the province.
-Hospitalisations in the Free State (FS) and North West (NW) province are steeply trending upward with Gauteng beginning to show similar trends.
-Hospitalisations are gradually increasing in the Eastern Cape (EC), Limpopo and Mpumalanga.
-Deaths increase in six provinces in the last seven days.

Justification for urgent change in the restrictions

Epidemiological Rationale:
-Sustained increase in new cases in last 14 days.
-Increased admissions
-Increased positivity rate (almost 10 percent at a national level).

Drivers of the recent spike in case transmission
-Social gatherings without NPIs or following guidelines on numbers
-Funerals and after tears parties
-Clusters in schools (matric camps, sport camps).

Health system capacity
-Increasing admissions in 8 provinces
-Increasing demand for oxygen in the hospital
-ICU capacity in NC already at stress levels.

Behavioural and social
-Increased complacency (low risk perception)
-No adherence to non-pharmaceutical interventions (NPI) (not wearing masks, increased crowding)

South African COVID-19 Vaccination Programme registration Portal
-Total registered: 3 044 907
-Healthcare workers: 957 380
-Over 60 population: 2 087 527

Discussion
Ms Gwarube stated that she was dissatisfied by the response from the Department regarding the matter of consequence management. The DG and the Deputy Minister highlighted that the provinces and NDOH met regularly, they had a good relationship and were interacting with National Treasury. This was clearly not stopping the issues at the various provinces – even at the National Department – in terms of people looting public funds. They were not adhering to even the most basic procurement processes. She asked the AG what could be done in terms of consequence management. What more could the Department be doing? Meetings upon meetings and committees were clearly not working – not that they had no place – but they clearly were not working. If they were not careful they would be sitting there in a similar meeting the following year – talking about the vaccine procurement. It would be the dereliction of their duty, if they did not get to the bottom of what could be done to stop that kind of thing.

She appreciated the update given regarding the vaccine roll-out. In terms of the uptake relating to registration – there had been a much slower uptake from the over 60s in terms of being able to register. She knew that certain provinces, like KZN, had opted to side-step the system by saying that they would accept walk-ins and walk-throughs, so that they could get as many over 60s vaccinated as possible. What was the situation with the Electronic Vaccination Data System (EVDS)? Why was it ineffective? Why were people not being given sufficient time to get to the various vaccination sites? Had they considered decentralisation of the system to the provinces to manage their sms and appointment systems? Was the problem that it was centralised? If they would eventually end up not having an appointment system – did it not defeat the purpose of having the system to begin with? They needed to get to a point where they were vaccinating 250 000 people per day. The numbers were still relatively low considering that they started phase two a week before. Did it mean that they would not meet their deadline of vaccinating the over 60s by June 2021? If so, did this mean that they would be taking a longer time to get to vaccinate the people with co-morbidities? Considering the numbers that the DG had spoken about, they needed to get people living with co-morbidities vaccinated as soon as possible. If they were delayed in getting through healthcare workers and the over 60s – how did it affect the overall timeline?

Ms Ismail highlighted that they had not received any specific replies to their questions. All of them had asked questions relating to accountability measures – such as consequence management. Did they have a minimum compliance framework that tender reporting needed to abide by? Did they have an independent regularity body to ensure that due processes were followed? How were they going to ensure the proper implementation of PFMA was actually adhered to? They did not want to be there in another year or two wishing they had done something better.

In terms of the vaccine presentation, she was really concerned that they were not reaching their targets as a country. She had been inundated with calls from senior citizens saying that they applied but were still waiting for registration sms’s. Some said they received the first sms but not the second stating which vaccination sites they could go to get the vaccinations. This was slowing the process going forward. People 60 and over received a follow-up sms stating that they needed to go to vaccination sites in other towns or provinces that were far away from them. First of all they were ‘old,’ secondly they got stressed out very quickly. She had been told of a person in Gauteng whom had been told to go to a vaccination site in KZN. It was still ongoing; she had highlighted the matter. These were issues that needed to be attended to. She was concerned that the timeframe was delaying the process of the actual vaccinations to the phase 2 residents. Why did they not consider a hybrid approach for people 60 and over to be received as walk-ins? Obviously, the vaccination sites were adhering to the COVID-19 protocols and sanitising etc. That would mean that the 60s and over could go in as walk-ins – if they were on the system. It would be a quicker process; if they were not on the system they could immediately do the application. They could then reach their targets much quicker. She was worried for the people with co-morbidities. They were getting a lot of queries from people with co-morbidities stating that they felt at risk – asking how long this would take. Obviously, the way they were looking at things going on the country at the moment – it looked like it would take much longer than they had anticipated to reach the next phase. They needed a more streamlined approach to the vaccinations.

Chairperson Dhlomo suggested that the Deputy Minister might have to make a follow-up appearance to the Committee. They did not want to receive a ‘post-mortem’ again. In terms of the vaccines, he appreciated that they had the foresight to appear before the Committee on another matter but had this update ready to present. There were some provinces providing updates on a regular basis.

He had heard a caller on a particular radio station state that they registered on behalf of their grandparents. The grandfather had since been called and the grandmother had not been called. The response that came from Dr Crisp was that maybe there were too many people registered between the first and second entry made. They said they would have to take one and wait. Those delays in the system were creating a challenge for some of the citizens. The couple would probably go in together and hope that they both got attended to. He asked whether they could check up on the system in this regard. There was a hope that they were working on the Johnson and Johnson vaccine that would augment the Pfizer, because its limitations had been noted. Unless Pfizer was no longer deemed to be that limited and could reach the most rural part of the Country.

Deputy Minister Phaahla stated that the Members needed to take into account the ‘architecture’ of the country in terms of its functioning. The National Department provided the policy framework and implementation frameworks. Where necessary they also provided more detailed procurement structures. That was why they emphasised the support – making sure that they functioned together. There were particular areas at national level where they had – in the final implementation and management stages - set responsibilities that they needed to take accountability for. When those things went wrong, they had a direct responsibility to implement. There were a lot of other areas, where their role would be what he had outline in terms of guidelines, policy frameworks, support coordination and day-to-day implementation at a local and provincial level. They wanted to make sure there was a streamlined level of accountability. They needed to take account of the fact that it needed to happen within the framework of their architecture – at all levels. This was not an attempt to evade accountability and responsibility. He was just stating how the system worked.

In terms of vaccinations, they were monitoring the situation on a regular basis. They had experience of eleven days – from the 17 May to the 28 May 2021. They had discussed with the Minister that it was probably high time that they convened with their colleagues to review and evaluate and look at the experience of the last 10/11 days. They had noted various things in relation to the roll-out at different levels – over the past weeks. They had agreed that community health workers should be given the instruments to go out and register people in their homes – especially in outlying areas – also to the extent possible – they could actually bring people into the sites so that they could be registered and vaccinated – to the extent that it could be manageable. In terms of the situation outlined by the Chairperson, they had received feedback from their facilities of such cases. When the couple went in together, they would both be vaccinated. The partner would not be sent back. The problem was that people did not necessarily know that it was wise to go together. They would propose adjustments over the coming week – they hoped that the Johnson and Johnson vaccine would be released sooner – in which case they would immediately get two million additional doses which would be suitable particularly for outlying areas. That would mean that they would need to be able to activate many of those outstanding 3 000 sites that the DG mentioned.

Dr Nicholas Crisp, Head of EVDS and Consultant, Department of Health, stated that the questions had all been raised with them on other occasions and there were plausible explanations for all of them. In terms of the decentralisation of the system to the provinces – they had already done better than that. That system was entirely decentralised to the vaccination sites. Each province managed their own vaccination sites. There had been training of the vaccination site managers. They were the ones who did the scheduling of the numbers of people that they were able to see on a day-to-day basis. Already, they were seeing the patterns changing as they got more confident – and were confident about the vaccine availability and were scheduling them not only one day ahead but more days ahead.

With respect to the issue of wrong locations, they were aware that this had happened. It was the way in which the data was provided and captured in the beginning. There were two problems that had occurred and they were tidying them up as they were brought to their attention. The one was the recording of the geographical location of the vaccination site. In some cases, no matter how hard they tried to verify the actual geographical location (to a 10 metre distance), it had happened that the physical location was incorrect on the system. When it was brought to their attention they corrected it again. The other problem they had experienced was that there were many of the same addresses in different parts of the Country. If a postal code was not included, the computer system – which was picking people from the registration list – did not know whether it was one province or another province or the same address. There were those sorts of technical things that they were trying to tighten up and see whether there were other ways that they could ensure that the correct location and sms was sent.

The other question raised was ‘why they were not moving faster.’ They had nearly vaccinated as many people since Monday the previous week, as the whole of the Sisonke study – he was not sure that they were ‘not moving fast.’ They were moving as fast as the vaccine distribution was able to roll-out. This week had been a substantial increase over the week before. As the health workers on sites were getting more confident they were able to vaccinate faster and schedule more people. There were more sites that were being brought on. They had just over three million people registered on the system, of those three million about half a million were vaccinated during the Sisonke Trial. Since then, close to 350 thousand, in the last ten days. That was over 800 000 people – closer to 850 000 people that had been vaccinated. That still meant that there were 2.2 million people over the age of 60 – or bonafide healthcare workers – who were still in an existing queue to be sent to a vaccination site for vaccinations.

The system was supplying the amount of vaccines that it could – it was monitoring the distribution of the vaccine and monitoring the number of people who went to those vaccination sites. As they received more data – it was easier for the people who were handling the logistics, placing the orders and scheduling the sites – to be seeing one another’s data and make more accurate projections and distributions. It meant that they could track the actual vaccine dose. They could track the type of vaccines, actual batch and lot number to an individual. They knew when they were given the dose, how they were given the dose, by whom they were given the dose and they were able to make sure that there was equity in the distribution between uninsured and insured populations and between the public and private providers. They could account for who was paying for it. The system was doing what it was supposed to do. They needed to give it a chance to settle down. They needed to recognise that healthcare workers were extremely tired and he was impressed with the number of compliments healthcare workers were being given by those vaccinated about how polite people had been to them. They should be glad for that, despite the many challenges that they still needed to resolve.

Dr Buthelezi clarified that they were not turning people away from the vaccination sites. They had developed a guideline on how to deal with that, with the understanding that some people might have difficulty in accessing the system as the Deputy Minister previously mentioned. They were cognisant of the fact that they did not want to create havoc at the sites. They were dealing with the over 60s. They were hoping to move as quick as possible with the system.

Closing Remarks
Chairperson Gillion thanked everyone in attendance. She thanked the DG for providing answers as well as the road map for the vaccination process. This was a very informative meeting and she was looking forward to the next engagement.

The meeting was adjourned.