National Health Budget, Western Cape: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
9 March 2000
PROVINCIAL HEALTH BUDGETS

Documents Handed Out:
Briefing by Department of Health and Social Services: Western Cape
National Department of Health on Disease Prevention and Control Cluster

SUMMARY
The committee was briefed on the Disease Prevention and Control Directorate of the National Department. Committee members were concerned that materials used to disseminate information on HIV/AIDS in rural areas had been inappropriate. The Department replied that they had been working very closely with Churches and non-governmental organization to ensure more "culturally accurate" materials, such as audio and video tapes with black actors in rural settings, were being used.

The committee was also briefed by the Western Cape Department of Health. Discussion focused on why so many nurses had received voluntary severance packages. The Department stated that it was a result of a bargained contract that they had no control over. This was problematic because it created a situation where more nurses were needed and available, but there were not enough posts to hire them.

When questioned why more posts were not created, the Department replied that it was a matter of balancing the funding. It was expected that 200 nurses would be hired in 2000, and that another 200 nurses would be hired every year after for the next four years.

MINUTES
Disease Prevention and Control Cluster: National Department of Health
Drs van Heerden and Pretorius briefed the committee (see document).

Discussion
(Q) Dr Gous (NNP) asked who was involved in the HIV/AIDS vaccine program and who was funding the program?

(A) Dr van Heerden replied that the Medical Research Council, as well as various hospitals and universities were involved in the program. On funding, R5 million had been donated by the Department of Health, R5 million had been donated by Department of Arts, Science, Culture, and Technology, and approximately R18 million had been donated by private interests. At present, no international organizations had provided funding.

(Q) Dr Rabinowitz (IFP) asked if the vaccine would be preventative or curative, and what was the Department doing to ensure that educational information on HIV/AIDS was being dispersed into rural areas?

(A) Dr Pretorius responded that the HIV vaccine would be preventative. The Department had worked very hard to get information into the rural areas, but had found that the information was not always "culturally accurate" to each area. They were now focusing on using NGOs and traditional leaders to disseminate the information.

(Q) The Chair asked for clarification on what measures the Department was taking to make sure that the information was culturally accurate?

(A) Ms Kotzenberg stated that a study of two focus groups had revealed that the posters and pamphlets used in urban areas, were not useful in educating people in the rural areas. Instead, tapes and videos using black actors from rural areas were being used with much more success.

(Q) Ms Baloyi (ANC) asked how many dentists there were in South Africa?

(A) Professor Gumbi replied that there were currently 1493 dentists in South Africa, 90% of which were practicing in the private sector. It was expected that the 224 dental students graduating this year would commence community service in July 2000.

(Q) Ms Baloyi (ANC) then asked if the Department was aware of the lack of oral health personnel in the Eastern Cape?

(A) Dr van Heerden responded that they were aware of the problem, and were hoping that an increase in the number of community service dentists would help alleviate the problem. They were also looking into implementing other dental professionals, such as dental therapists to assist in reducing the problems. In addition, under the Decayed, Missing, and Filled Teeth (DFMT) program, surveyors had been sent to investigate the level of oral health in school children. The purpose of the program was to ensure that all school children in the province maintained a certain level of oral health. At present, the program was 60% complete.

(Q) Ms Malumise (ANC) asked why there had been a reduction in the number of district surgeons?

(A) Professor Gumbi replied that it was not cost-effective to have so many district surgeons on a full-time basis. District surgeons were now being paid on a part-time basis, with most of their powers being delegated to community doctors.

(Q) Ms Njobe (ANC) asked who is responsible for issuing hearing aids and wheelchairs? Why did it take so long to receive them, and what were the results of the elder-abuse poll?

(A) Dr Pretorius stated that each province had money within their budget allocated to wheelchairs and hearing aids, but that the national department was responsible for issuing them to the provinces. The delay in issuing hearing aids to elderly people was due to the priority being given to school children.

(A) Ms Kotzenberg said that elder-abuse poll revealed that 90% of those asked knew what elder-abuse was, 80% knew someone who had been abused, and 52% said they had been mentally or physically abused.

(Q) Ms Malumise (ANC) asked what mechanisms will be used to implement the home-based care program, and where will the workers come from?

(A) Ms Kotzenberg replied that they were looking at a finalized list of home-based care models to see which would be best suited for South Africa. The new system was expected to rely on community health workers and the individual's family members.

(Q) A committee member asked who was accountable for the disability grants, and how accessible were the grants?

(A) Mrs Kotzenberg responded that disability grants were the responsibility of the Department of Welfare, but was aware that many of the 3 million people with moderate to severe disabilities still had not been addressed.

Department of Health and Social Services for the Western Cape
(see document for presentation)

Discussion
(Q) Dr Rabinowitz (IFP) asked what percentage of the province's budget was allocated to health, and what chance does a person have of surviving an accident, in terms of emergency transportation by ambulance, and will the Public Finance Management Act (PFMA) sort out last year's procurement problems?

(A) Dr Blecher replied that health accounts for approximately 29% of the budget, which includes conditional grants.

(A) Dr MacMahon said that ambulatory services in the province were exceptional, and that ambulance stations had been located in the communities rather than at hospitals to ensure quicker response times.

Dr MacMahon stated it was too soon to tell if the PFMA would alleviate last year's procurement problems.

(Q) Dr Rabinowitz (IFP) asked for clarity on the current situation for nurses?

(A) Dr Lawrence responded that most nurses had received voluntary severance packages as a result of bargained contracts, which the Department had no control over. Most of the nurses left voluntarily because of downsizing, and that they could not be re-employed because the posts no longer existed. This was problematic because it created a situation where more nurses were needed and available, but there were not enough posts to hire them.

(Q) Dr Rabinowitz (IFP) then asked who was responsible for designating these posts?

(A) Dr Abdullah replied that it was a matter of balancing the funding. In 1999, there were 350 graduates from nursing college, but only 10 were employed because of insufficient funding. It was expected that 200 nurses would be hired in 2000, and that another 200 nurses would be hired every year after for the next four years.

(Q) Ms Marshoff (ANC) asked how many people were suffering from tuberculosis, and what programs were in place to ensure that tuberculosis levels were at an acceptable rate, and what was the cost of these measures?

(A) Dr Abdullah said that there were approximately 27,000 people suffering form tuberculosis. The cost of treating these individuals was between R110-R120 million, which included the total spending from all six tuberculosis hospitals, as well as the cost of the related medicines. The establishment of the community Directly Observed Treatment Shortcourse (DOTS) program in six areas of the province had shown marked progress in lowering the number of tuberculosis cases. The cure rate had risen from 65% to 68% over the last year. The focus of the program was on health education, and ensuring that patients continue to take their medication.

(Q) Ms Marshoff (ANC) then asked what percentage of tuberculosis patients also had AIDS?

(A) Dr Abdullah replied no data was available, but that tuberculosis was the most opportunistic infection in people with AIDS.

(Q) A committee member asked for clarity on the AZT project in Khayelitsha, and whether the trials were being monitored for clinical ethicacy?

(A) Dr Abdullah responded that it was not the task of the department to monitor the ethics of clinical trials. The purpose of the project was to determine the willingness of women to participate in these types of trials, to test the operational capacity of these clinics in areas such as Khayelitsha, and to see whether the community could sustain this type of program. He added that it was too early to determine what the results of the trial would be.

(Q) Ms Baloyi (ANC) asked why Khayelitsha had been chosen?

(A) Dr Abdullah responded that Khayelitsha was the area in the Western Cape with the highest prevalence of HIV/AIDS.

(Q) Dr Jassat (ANC) asked for comment on the fact that the National Department was getting rid of district surgeons?

(A) Dr Lawrence replied that the Western Cape was also decreasing the role of district surgeons in favor of a nurse-based service, and putting a limit on salaries of district surgeons.

(Q) Ms Baloyi (ANC) asked what was being done about fetal-alcohol syndrome?

(A) Dr Abdullah responded that their efforts were on early diagnosis, but that not enough had been done to prevent the disease.

(Q) Ms Baloyi (ANC) asked what was the theft rate of medicines in the Western Cape?

(A) Dr Abdullah stated that R1.5 million had been allocated to hospitals to improve security, but that what was needed were information systems that track the movement of medications from the warehouse right through to when the patient receives it. These information systems are expected to be in Groote Schuur and Tygerberg hospital shortly.

The meeting was adjourned.