The Committee convened on a virtual platform to adopt its 2020/21Budgetary Review and Recommendations Report (BRRR) for the 2020/21 annual performance of the heath portfolio. The report was adopted with amendments.
The Committee discussed a range of matters related to the performance of the Department of Health (DoH) which they had expected the findings and recommendations within the report to reflect. An issue that was strongly emphasised was the need for consequence management systems within the DoH to indicate early warning signs, and to handle the internal containment of problems before they escalated.
Members asked that the Minister provide a written response regarding the shortage of staff -- doctors and nurses, as well as medical interns. They urged that there should be a workshop, or broad discussion, with the Minister and DoH regarding the Cuban doctor programme and the staffing of the Department in respect of nurses and doctors, especially interns and community service doctors.
Members commented that the annual breakdown of the provinces' performance had not been received from the DoH, and asked the Committee secretary to write to the DoH to request that this report be submitted timeously.
Regarding the National Health Insurance (NHI) public hearing process, Members agreed to meet on Wednesday mornings to hear presentations by organisations in order to address the matter without wasting further time. It was recommended that the Committee reconvene earlier at the start of next year in order to address all the outstanding matters
Budgetary Review and Recommendations Report (BRRR) of the Portfolio Committee on Health
The Chairperson took Members through the Budgetary Review and Recommendations Report (BRRR) for 2020/21.
Mr T Munyai (ANC) said the Department of Health (DoH) should have early warning systems to advise of any irregularities, process deviations or failure to obtain the documents necessary to complete the audit on time. He said that consequence management should be in place before the Auditor-General’s (AG's) audit or the Special Investigating Unit (SIU) report were received by the Committee. Consequence management would prevent problems from escalating.
The Department should praise the individuals involved in the Dr Mandela and Commandant Fidel Castro student programmes upon their return. He expressed concern that the students of these programmes often became collaborators with entities trying to overthrow the government of Cuba. He suggested that these students should be placed within the South African government systems instead.
Ms N Chirwa (EFF) said that the assertion that the Department and the executive of the DoH had failed, was excluded from the BRRR.
Engagements with the other health entities, aside from the DoH, were not captured in the minutes.
She expressed strong concern at failure of the executive and the health entities of the DoH. The Department had failed to provide cogent consequence management tools and methods to deal with deviations from legislation, which had been raised by the AG.
Concerns regarding the Forced Sterilisation Commission had been were excluded from the minutes and the BRRR.
Ms Chirwa added that there was a civil case against the DoH regarding surgical mesh which should be reflected in the minutes and the BRRR, as this had been raised several times with the Department and its entities.
Ms E Wilson (DA) said that the Committee had failed to receive a breakdown from the provincial departments on their performance. These reports were necessary in order to understand where the DoH stood in fulfilling their duties and goals.
Ms H Ismail (DA) agreed that there were insufficient consequence management systems in place, which should be highlighted in the BRRR.
How nurses were fed into the government system should also be included. This was important, as many nurses were waiting to be recruited, while nursing colleges were closing and there were shortages of staff in the government health departments.
Referring to the Cuban doctor training programme, she said the report should reflect those medical students who were being mistreated in Cuba.
Ms Ismail said that the corruption being investigated should be highlighted, as looking into the deviations was depleting budgets. Accountability on this topic should be emphasised.
Mr P Van Staden (FF+) reiterated that consequence management systems should be included in the report to encourage the Department to incorporate it in their workings.
He supported Ms Wilson's statement that the Committee should receive a report on the provincial health departments soon.
On the Cuban doctor programme, he said the Minister of Health should explain to the Committee how the programme works, the financial implications, whether it was functioning as expected, and whether it was having a positive impact on the DoH.
He asked why the shortage of doctors and nursing staff was not being resolved. Last year, the Minister of Health had issued regulations calling on doctors at home, without appointments with the Department, to help with COVID-19 relief, but nothing had come of this. He questioned why the Department was looking for doctors from outside of South Africa for assistance when this problem existed.
Mr M Sokatsha (ANC) said that the BRRR reflected problems with the training of nurses, provinces unable to retain doctors after training, and the issue involving Cuban doctors. He agreed with Mr Van Staden that the Department must account for how the Cuban doctor programme works, and whether it was effective.
The Chairperson thanked the Members for their recommendations and discussion. He said the report should reflect that the Committee had expressed concern that investigations into transgressions and irregularities were not initiated promptly to enable consequent management, and early warning systems needed to be developed. The Department and its executive ought to develop cogent tools, including analytical tools, to assess their progress and follow through with consequence management when required.
On forced sterilisation, the Chairperson commented that the reports which had not been discussed by the Committee would be addressed at a meeting later that day. He asserted that this matter should be dealt with later.
It was not necessary to note the matter on reports from the provincial departments, as the provinces would be presenting to the Committee in January.
Ms Wilson clarified that the DoH usually gave a breakdown of the provincial departments in brief as part of their presentation, but this was not received this year.
The Chairperson said that the report must reflect that the report on the breakdown of the provinces was not received, and that the Committee wished to receive the report after the Committee secretary had written to the DoH.
He agreed with Mr Van Staden that there should be a written reply from the Minister regarding the shortage of staff -- doctors and nurses, as well as medical interns. He suggested that the Committee should express the need for a workshop or broad discussion with the Minister and the DoH regarding the Cuban doctor programme and the staffing of the DoH in respect of nurses and doctors, especially interns and community service doctors.
Ms Chirwa referred to the Council for Medical Schemes (CMS), and said that the two circulars released should be recalled and not be implemented until the process of engagement with stakeholders had been implemented.
The Chairperson said that the Committee had requested a letter calling for a meeting with the Office of the Health Ombud (OHO), the Minister, the DoH and Members concerning the Health Ombud Bill. The letter had been forwarded to the Minister, and the Committee was awaiting a response.
Mr Sokatsha expressed concern over Members stating that the Department had regressed, as the AG had reported an improvement in the performance of the DoH.
The Chairperson noted the matters Members had raised, and said they would be included in the report in the way they were raised.
Ms A Gela (ANC) moved the adoption of the report, with amendments.
Mr Sokatsha seconded the motion.
The Chairperson took Members through the minutes of 9 and 10 September, 1 October, 10, 12 and 17 November 2021.
The minutes were adopted.
NHI public hearings
Regarding the resumption of the National Health Insurance (NHI) public hearings, the Chairperson asked which organisations were available to attend these meetings, in order to finalise the meeting schedule.
The Committee Secretary indicated that there were dates available on 1 and 8 December.
Ms Wilson said that the DA would be available to sit in Wednesday morning meetings.
Mr Van Staden said that he would be in attendance insofar as possible.
Ms Wilson suggested that the Committee meet earlier on Wednesdays to cover two presentations, or to thoroughly discuss the presentations.
The Committee Secretary clarified that three stakeholders had been invited to speak on each day.
The Chairperson pointed out that the Committee had four outstanding reports due. He stressed the urgency of completing the NHI public hearings to attend to this report.
Ms S Gwarube (DA) suggested that the Committee reconvene after the State of the Nation Address (SoNA) to ensure that there was sufficient time to address all outstanding matters.
Mr Van Staden supported this statement.
The meeting was adjourned.
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