CGE Reports on abortion in SA; Government’s Response Plan to GBV & Femicide and CEDAW Compliance

Meeting report

Opening Remarks by the Chairperson

The Chairperson opened the virtual meeting. She said that all three reports would be finalised in the meeting. She suggested the presenter skip through the introductory aspects of the presentation and highlight key points in order to end the meeting in time for the budget speech.

Ms Tamara Mathebula, Chairperson of the Commission for Gender Equality (CGE), introduced the various reports to be presented in the meeting. On the Report on an investigation into Choice of Termination of Pregnancies (CTOP) in South Africa, the Commission worked closely with the National Department of Health (NDOH) and provincial departments in collecting data that investigated the institutions providing TOP services in South Africa. The Commission was interested in the following: TOP services offered, issues of access and affordability, funding models and basic packages that the facilities offered – such as counselling, psycho-social support, public education, as well as referral systems with other units. The Commission also looked at staffing issues and training thereof. and the complaints management systems of these institutions. Regarding the data collected, the Commission was able to put together findings and recommendations.

Briefing on CGE reports

Ms Jamela Robertson, CEO of the CGE, presented on all three reports.

Report on an Investigation into CTOPA in South Africa 2021

Introduction

• The Choice of Termination of Pregnancy Act (CTOPA) is one of the most progressive pieces of legislation on women’s sexual and reproductive health and rights in the world. However, access to abortion services remains a challenge in South Africa, with approximately 50% of abortions occurring outside of designated health facilities.
• The right to safe, legal abortions in South Africa – especially for poor, black, and rural women – is still not a reality. Moreover, availability and designation of facilities for the provision of medical abortion do not exist nationwide.  

Methodology

• The CGE dispatched correspondence accompanied by a questionnaire relating to TOP services to the (NDOH) and Provincial Departments of Health, seeking information pertaining to variables such as access, funding model, assessment, and public education on TOP services.

Limitations

• National lockdown due to the pandemic placed certain limitations on the investigation process, and investigating officers were unable to visit sites identified as facilities rendering TOP services.
• As such, the CGE was reliant on information obtained by the national and provincial departments of health by way of a questionnaire dispatched, soliciting information in relation to TOP services. 

Key findings (NDOH)

• To date there are 350 facilities that provide termination services across the country.
• The Department acknowledged the unwillingness of health practitioners to perform TOP services as a barrier to service delivery; it runs values clarification and attitude transformation workshops, which include all categories of healthcare workers.
• When it comes to funding, the Department makes use of equitable shares. Further details in this regard were unfortunately not extended to the CGE, and it is therefore not clear what the budget allocation for TOP services entail and how it is calculated. (Slide 19)
• The Department highlighted that each facility has a complaints and compliments box (suggestion box) to register the complaints their clients may have. The Department did, however, report that seven cases were received regarding the failure of health workers to adhere to Batho Pele Principles.

Key findings (Provinces)

• Number of facilities providing TOP services:
  • Western Cape – 92
  • Free State – 12
  • North West – 26
  • Gauteng – 26 (and 34 community health centres)
  • Eastern Cape – 5 (31/65 district hospitals and 9/28 conduct deliveries)
  • Northern Cape – 4
  • Kwa-Zulu Natal – 53
  • Mpumalanga – 30

Key General Findings

• There seem to be limited and/or no monitoring by the NDOH on TOP services within the various provinces. This is deducted from the observation that NDOH could not provide any information on this service and how it is being managed. The number of facilities reported by NDOH differs from that reported by provinces.
• The Commission observed the lack of facilities and trained professionals across provinces that result in backlogs in many of the TOP facilities.
• The Commission finds that TOP services are not easily accessible, especially for those in rural areas.
• The Department acknowledged that the unwillingness of healthcare professionals to conduct TOP services due to conscientious objection is regarded as a barrier to rendering the services.
• It was observed that there is no standardised funding model for TOP services across provinces.

Key General Recommendations

• To promote access, all healthcare facilities in the country should conduct TOP service. The NDOH should provide an implementation plan to standardise access to TOP services and equip all facilities to provide TOP services inclusive of second trimester TOP services.
• Provincial departments to keep proper records of TOP services rendered within their respective areas, challenges identified and how they were addressed.
• The NDOH should consult National Treasury to standardise funding models for TOP services nationally.

Government’s ERAP on Gender-Based Violence and Femicide: CGE Review of ERAP Implementation

• ERAP implementation commenced in October 2019 for a period of six months, ending on 31 March 2020.
• The review/assessment was information-intensive and dependent on reliable and accurate performance information collected and compiled by government departments and related entities. Other alternative sources utilise, including a report from the Interim Steering Committee on GBV.

Key Challenges

• Access to government departments/officials for information affected by lockdown restrictions
• Reluctance/delays by officials from some government departments in providing information
• Issues of reliability and accuracy of information provided by departments.

ERAP: Overview of Implementation

• Overall, implementation of ERAP was characterised by inadequate operational coordination of departmental activities across thematic areas, interventions and targets.
• Many of the ERAP targets seemed not based on clear assessments of existing institutional capacity needs of responsible departments/entities. This resulted in many targets not achieved because the scope of the work involved exceeded existing institutional capacity.

Key Thematic Areas

• Access to justice for victims and survivors - Many targets under this thematic area were not achieved.
• Change norms and behaviour through high-level prevention efforts - This thematic area was characterised by claims based on inadequate information from some of the departments/entities.
• Urgently respond to victims of GBV - Many of the responsible departments provided insufficient information on their progress on ERAP target achievements. Many targets were only partially achieved.
• Strengthen accountability architecture to adequately respond to the scourge of GBV - Not a single target was met satisfactorily. Generally, there were many unrealistic targets and time frames set. Lack of interdepartmental collaboration/coordination and poor resource allocation played an important role.
• Prioritise interventions that facilitate economic opportunities to address women’s economic empowerment - The performance of departments under this thematic area was unsatisfactory (both in short-term and long-term interventions).
• Out of 80 targets in total, 17 were achieved, 12 partially achieved and 51 not achieved.

Conclusions and Recommendations

• The ERAP was a timely and appropriate response to an urgent national crisis but its implementation faced many obstacles on the ground: Problems of lack of effective coordination, ineffective oversight and accountability, lack of ongoing programme monitoring and evaluation mechanisms.
• Given that the Interim Steering Committee on GBVF was abolished in April 2020, it is recommended that in the short-to-medium term, the overall responsibility to drive government’s programmes of intervention to deal with GBV be placed under a competent institutional structure or department that will oversee such national programmes, including the process of establishing the national multi-stakeholder body on gender-based violence. It is recommended that priority, including the necessary resources, be given to the current process of establishing the national multi-stakeholder body on GBV.
• One of the key interventions identified in the ERAP was the implementation of the Gender Responsive Budget Framework introduced by the Ministry for Women in the Presidency and approved by Cabinet in 2019. It is recommended that this framework be widely disseminated and popularised across government (at national, provincial, and local government levels).
• As part of its constitutional and legislative mandate, the CGE should continue to assess government’s implementation of national policy and legislative frameworks, including national strategies (e.g. NSP,GRPB, etc.) and programmes of action (e.g. Presidential Summit Declarations, ERAP) to combat GBV.

CEDAW Report

• South Africa ratified CEDAW in 1995, which is aimed at fast-tracking gender equality globally, as the subject of gender inequalities is comprehensive and multi-dimensional.
• The report assesses the country’s progress in the implementation of the CEDAW committee’s concluding observations from the last country reporting during the 967th and 968th Session in 2011.

Methodology

• This study utilised published sources and other available information mostly from official government sources.
• The information was verified through direct contacts (via telephone calls and emails) with officials from the relevant government departments and other related organisations.

Limitations

• Much of the necessary information on government and departmental activities was not freely and easily available.
• Official government information relating to gender issues was not always and readily available in a sex-disaggregated format in line with the reporting indicators.
• Most of the departments' plans lacked specific data necessary for compiling this report i.e. budgets were not gender-sensitive, no clear gender-related performance indicators, etc.

Key Articles and Findings

• Article 2: National Gender Machinery (NGM)
  • The functions relating to ‘Children’ and ‘People with Disabilities’ were moved to the Department of Social Development, for the Ministry of Women to focus on the specific socio-economic needs and challenges of women.
  • General perception in the gender sector is that the Ministry has failed to live up to these expectations, as it remained one of the least funded Ministries in the country.
  • Later, the Ministry for Women was once again combined with other vulnerable categories, and this time with youth and persons with disabilities.
  • The 2013 CGE report generally agreed with the concluding observations of the CEDAW Committee, that South Africa’s NGM was weak, under-resourced and too fragmented to effectively promote gender equality and transformation.
  • The Department produced a draft Framework document on strengthening and reviving South Africa’s NGM.
  • According to a Framework, the NGM Forum has the responsibility for managing gender mainstreaming and its related processes in public and private institutions, and to broaden sectoral participation in the National Gender Programme. Given that the revitalisation of the NGM was still at an infancy stage when the report was compiled, a detailed analysis of the structure’s effectiveness could not be conducted.
• Article 5: Sex Roles & Stereotyping
  • One of the key policy and institutional developments introduced by the government in the wake of the CEDAW Committee Recommendations was the establishment of the National Council on Gender-Based Violence, which was formally launched on 10 December 2012. The NCGBV did not last for more than two years and ceased to exist after the 2014 general elections.
  • The first ever Presidential Summit on GBV and Femicide was hosted in November 2018.
  • Part of the summit resolutions was an agreement to establish an interim committee that would work towards the establishment of a permanent structure. The interim committee was established in early 2019. At the time of writing this report, it was still engaged in the process of establishing the ultimate structure.
  • In 2013/14, government did attempt to formulate an NSP to combat GBV, but these efforts did not bear results; thus prompting civil society organisations to embark on their own Shadow NSP, which was completed and disseminated. This was rejected by government.
  • A number of awareness-raising programmes have been initiated by government and civil society over the years.
  • Many of these interventions have obviously not yet borne much fruit as the country continues to face an unyielding or even escalating scourge of violence against women and children
  • In September 2019, President Ramaphosa announced an emergency plan to combat GBVF and allocated R1.6 billion towards that six months plan.
  • It is hoped that the NSP will also be costed and allocated budgetary resources accordingly.

• Article 12: Equality in Access to Health Care
  • The government has certainly made efforts to respond to the CEDAW Committee’s Concluding Recommendations regarding equality of access to healthcare. However, several challenges and obstacles continue to bedevil these efforts. Some of these challenges are around general systemic issues such as lack of funding, ineffective implementation, poor resource allocation and resource management, as well as lack of capacity and skills, negative attitudes of healthcare workers, prejudice and stereotypes towards people with HIV/AIDS or other health conditions - including prejudicial and discriminatory practices towards women’s sexual and reproductive health rights, which often fuel the scourge of violence against women.

Conclusion

• Based on this review, the country has, in many areas, made progress and advancements in meeting the obligations imposed by the CEDAW.

• Also, several institutional reforms, strategies and programmes aimed at dealing with gender-based violence, including discrimination and violence against women, have been put in place over the years.
• However, in many areas of compliance, the government has done the bare minimum of what was required in terms of the CEDAW Obligations. Much of the challenge has been at the level of administrative and implementation action.

Questions posed during the presentations

During the investigation into CTOP presentation, the Chairperson asked for clarification on slide 19, regarding whether the Commission saw concrete information from the NDOH on the use of equitable shares allocated for TOP.

Ms Robertson said no. The Commission was informed through the questionnaire but did not acquire anything when they followed up to get the actual information to analyse and see how the equitable share model is utilised. She highlighted the issue of unequal allocation of funds to different facilities, with the key problem being that the previously disadvantaged continue to be previously disadvantaged, hence they have pressed to see information on the actual allocations. Unfortunately, the Commission could not get this information during the study. The NDOH indicated that they procure equipment for facilities with full donations to about 285 of the facilities out of 350 facilities. For the Commission, it was important to ascertain the exact funding model used. It knew about the equitable share model but wanted to see the exact details of how provinces are allocated these funds. These were some of the issues that would help them improve in terms of equitable allocation as well as facilitating access to these services, especially for disadvantaged provinces.

The Chairperson asked if the Commission had asked questions such as how many times a patient had done a TOP.

Ms Robertson said that she would look at the questionnaire itself because the presentation only contains the headings of the questions that were asked. She acknowledged having come across the question in other research because women were using termination as prevention, hence some service providers would ask that question. 

The Chairperson asked for clarification as to whether the research was qualitative.

Ms Robertson said that the research was qualitative but quantitative in that the Commission also asked questions concerning the number of facilities. Disaggregated data gives the Commission quantitative information as well. The research was done through a questionnaire and telephone interviews.

Referring to slide 68, the Chairperson asked whether the case was that the district health services did not know how they fund TOP services.

Ms Robertson said the situation was that the district health services were told, for example, that they have a budget for maternal health or they will receive a budget through the equitable funding allocation mode, but they do not get a document that specifically states the allocated amounts. Allocation needed to be clearer.

Referring to slide 71, the Chairperson asked whether complaints handling was similar between provinces or in terms of how the Commission was dealing with complaints.

Ms Robertson clarified that she was referring to complaints handling of the facilities that provide TOP. The question for them was how they managed complaints. There were more similarities than differences in terms of their complaints management.

During the ERAP report presentation, the Chairperson asked whether the report depended on reports done by other people such as news. For example, did the Commission have a questionnaire?

Ms Robertson said that the Commission used different methods. The first source was getting government reports written in terms of their implementation of the action plan. The Commission looked at the report written by the Steering Committee. To cross-reference, they looked at other sources such as reports written by other interested institutions like the media. The information the Commission is providing states where the information was found.

The Chairperson asked whether Commission’s researchers verified the external information.

Ms Robertson said the external information was to verify the information across the reports. For example, they compared reports between Steering Committee, a department and what another source was observing. If they were different they asked why. The Committee reported those differences and what they found in the different sources and concluded. The findings in the presentation are based on what departments reported. It has the key information sources, while other sources are there to verify the information.

The Chairperson said the reason she was raising these questions was that she wanted to be sure that the information presented before the Committee is accurate, and that they know what they are dealing with.

Ms Robertson emphasised that the Commission’s report represents what it had and verified at the time of the study.

The Chairperson expressed concern over the Commission’s recommendation that a multi-stakeholder commission is established. There are already plans to establish a GBV council, and a secretariat has been appointed to ensure that there is infrastructure by the time the council is established. The secretariat does the administrative work for now. The Committee wanted to see the finalisation of the establishment of the GBV council and not another interim structure. The Commission needs to assess the developments and progress made in terms of the establishment of the council rather than establishing another interim structure that will take another year. Has the Commission monitored what the secretariat is doing currently?

Ms Robertson said that the current study observed the six-month action plan. In the Commission’s Annual Performance Plan (APP), they had targets that continued to monitor the interventions and had a project where they were monitoring the implementation of the NSP, GRPB, etc. Mid-year they had reported that they are still collecting data on this project. Upon finalisation this year, the report would report what the current status is on the Commission’s monitoring of what is happening. The Commission was open to the Committee’s recommendations on how they could move forward in terms of monitoring this work, such as what questions they should focus on.

Discussion

Regarding all three reports presented, the Chairperson asked what progress had been made to date insofar as the implementation of recommendations that the Commission had made. How did the Commission want the Committee to ensure that all the recommendations were being implemented by the respective departments?

On the CEDAW report, how did the Commission ensure ongoing monitoring of international obligations on a quarterly annual basis? What were the key challenges that hindered the domestication of CEDAW and reporting thereof? Had the Commission engaged with DWYPD on the outcomes of the CEDAW report? If not, why not? If yes, what were the outcomes?

On the ERAP report, the Chairperson asked: how did ERAP respond to the challenges that relate to women living in rural areas specifically? The report noted that there was reluctance by officials from some government departments in providing information to the Commission’s researchers. Which departments were these, and what reasons were cited for this reluctance? How would the Commission’s report findings be used, going forward? How would their methodology influence future studies, going forward?

The Chairperson disconnected from the online platform due to network issues.

Ms F Masiko (ANC) took over as interim Chairperson as per the Chairperson’s request via phone call.

Ms N Sharif (DA) said that it had been a very heavy day with news breaking out of the death of Riky Rick and expressed her condolences to his family. This had made it difficult to focus on the last report presented.

On the first report, it was great to point out how progressive South Africa is beyond the CTOPA. South Africa generally has progressive laws and policies that look at bringing equality closer to reality. However, even though the Act has been in place for over 20 years, there are still cases today of back-street abortion centres operating unabated. If one walks through Johannesburg, the CBD and populated areas, one is inundated with signage and messages of illegal abortions. This is something that South Africa needs to look into shutting down. The truth is young women are being turned away from abortion facilities and having to find alternative ways to terminate their pregnancies. This is a massive issue despite legislation that should be making access for women easier. It would be important for the Commission to start doing investigations into these back-street abortion facilities and identify gaps in terms of our law that allow these facilities to operate in unabated silos. It is a massive issue when university students, high school students, and, in some instances, primary school students are turned away when seeking assistance. It is important for the NDOH in provinces to publicise a list of facilities to inform people on where to get assistance. Marie Stopes has been operating in South Africa for a long time. She was uncertain as to whether it was a public or private facility. The resources they get are limited given the number of women that need access to TOP. It was disheartening to see provinces like the Free State only have 12 facilities. This takes away the importance of opening up the space for women all across the province and country to get much-needed assistance. Funding models are a massive issue that speaks to the lack of resources and capacity that many facilities have.

On the ERAP report, the DWYPD in a previous joint sitting said that the ERAP was done and needed to be forgotten about so that focus could be on the National Strategic Plan (NSP). The DWYPD did not come with enough information to present to the Committee on their plans for the implementation of the ERAP. In that meeting, she had said that the targets are impossible to achieve within a six-month period. She felt that, even though the plan was needed, it felt unattainable, particularly the targets set. Government set itself up for failure when doing the ERAP. Even though the ERAP had good intentions and good interventions, there was simply not enough time, capacity, coordination and resources to implement and achieve the targets. They will now have a GBVF secretariat that has been appointed and work within the Department to facilitate the workings of the GBVF council once the GBVF Bill has come back to Parliament and been approved. Everything seems to be taking so long and it leaves the Committee wondering what is actually happening. In the previous meeting, she suggested to the Chairperson that the Committee get the GBVF secretariat from the Department to report to the Committee and tell them what they were doing, what was their scope of work and what their day-to-day work looks like. The Committee needed to look closely at the GBVF secretariat and hold the Department accountable for not implementing what they were supposed to be implementing, specifically looking at the NSP. The NSP is a good document because it is the brainchild of civic organisation in collaboration with government. But implementation had to happen. She recommended that the Commission monitor key departments, like the SAPS, Department of Justice, and the Departments of Social Development and Human Development to ensure that they were doing the work that they were meant to be doing. Having webinars and talks did not make as much of a difference in people’s lives as implementing interventions and strategies that they know can work to make lives safer for women.

Mr S Ngcobo (DA) asked whether the reports had been shared with the relevant stakeholders, particularly the TOP report.

Ms T Masondo (ANC) asked what progress had been made with the implementation of the recommendations contained in the reports. What challenges had the Commission experienced in the development of the CTOP report in this regard? Had the funding model for TOP services been standardised? If not, why not? Had the functional monitoring and evaluation system been implemented to assess the rendering of TOP services?

Ms Masiko said that one of Ms Masondo’s questions had been covered by the Chairperson’s questions. On the CTOP report, she reiterated Ms Sharif’s comment that when one walks around the streets of Johannesburg and other places around the country, there are posters everywhere advertising illegal abortion. Given that the report said approximately 50% of abortions occur outside designated health facilities, this was a huge concern given the fact that poor and marginalised communities are struggling with issues of healthcare. When these people find services easily accessible in and around cities, they have access to unsafe abortions. She was reminded that she had a dialogue with a number of young women in her province weeks ago where one young woman stood up and spoke about having three kids at the age of 25. This young woman said she had given birth to her last child last year.

In rural areas, there is limited access to prevention pills or injections at local clinics. Women have mainly resorted to drinking Coca-Cola mixed with Grand-pa or Disprin every time after they engage in sexual activities, due to the lack of access to prevention methods within clinics. Therefore, these unwanted pregnancies also relate to the unavailability of pills and injections in local clinics, and this was something that needed to be paid closer attention to. She drew attention to the issue of uniformity in the number of clinics per province, as raised by Ms Sharif. In the Western Cape, the report stated that there are 109 sites, whereas in the Free State there are 12, North West 26, Gauteng 26, Eastern Cape 34, and Northern Cape only had four. This is a concerning matter, and it speaks to the issue of uniformity in terms of the NDOH. How come provinces smaller in size have a larger number of facilities but larger provinces have a less number of facilities that can perform TOP services? This also speaks to the issue of the uniformity of the standard operating procedures (SOPs) for the DOH. In the presentation, the Commission refers to one department, regardless of the fact that the SOPs are for different sites in different provinces. How are the provinces not standardised? The issue of uniformity also relates to the issues of the referral system as well as the funding model. The Commission must have a serious meeting with the DOH to address these issues of uniformity and accessibility, especially to women in rural areas and those coming from poorer backgrounds. It is important to ensure that lives are being saved because the unavailability and inaccessibility of a free choice to terminate a pregnancy will result in women resorting to illegal abortions, which places danger on their lives.

Where the CTOP report noted that the Commission could not visit sites, there has been the easing of lockdown regulations, movement has been allowed and the Commission could visit the sites. Sometimes what is provided on paper cannot be trusted. It is better to physically visit the sites to see the problems that are raised on paper. One will find that most of the time, the reports do not reflect what is happening on the ground. It is thus important to physically visit the sites and see what their processes are. The management of cases and complaints as well as public education is very important. It is important to look at public education on TOP because it is also what leads to young people drinking Coco-Cola and Disprin to avoid falling pregnant. When this concoction does not work and they do fall pregnant, they then resort to illegal abortions as they do not have access to public facilities. Regarding the regulatory body for medical officers who refuse to perform abortions because of their own beliefs: were there any medical officers that have been held to account for their refusal to perform such abortions?

The Chairperson reconnected to the online platform. She noted the four important points raised by Ms Masiko and said that the Committee will have to make a recommendation to the Portfolio Committee on Health, particularly on the standardisation of services in all the provinces. They needed to have a meeting with the DOH and Portfolio Committee on Health to address the findings of the Commission’s report. What assistance did the Commission need from the Committee to ensure that their recommendations were being implemented? She thanked Ms Masiko for continuing with the meeting during her brief absence.

Ms Mathebula requested that some of the questions that had been asked by the Members be sent in writing to the Commission, as they had struggled to hear them all. The Commission would respond comprehensively in writing.

On the Commission engaging with the DWYPD and the newly established GBV council: page 24 of their ERAP report stated that the Commission is more than willing to engage with the council due to the urgency to address GBV. The Commission is willing to monitor all the departments and work that has been done to date. The Commission will also be waiting on the processes of the GBV Bill and full establishment of the National Council of GBV. The Commission will share the report with the established council and look at the enabling legislation, together with the council and the Department. Based on the information received, it will look at how the bills and legislation provide enabling environment to address GBV and femicide. This would not only be limited to the council, but they would also look at other structures such as the South African National Aids Council, the DOJ, the NPA, the SAPS and the Departments of Basic and Higher Education.

An example of follow-up work the Commission was conducting based on the ERAP report and five key thematic areas was the work they are currently doing with SAPS. A key question that they ask regarding the SAPS is whether law enforcement is being conducted along with the enforcement of current legislation – for example, law enforcement relating to alcohol, including the withdrawing of licenses from alcohol outlets that do not comply with legislation. The Commission was also looking at the DoJ, and the NPA in terms of the granting of bails and imposing sentences, enforcing legislation and looking at the national registrar for sex offenders. These were the kinds of work that the Commission was doing in monitoring and following up on the ERAP report.

On what the Committee can do to ensure that the recommendations made are implemented, for example with the CTOP report, the Commission would request and recommend that the Committee assist them in engaging the Committee responsible for health or the NDOH. This could be a joint meeting. The Commission was willing to return and present and based on their presentations. The Committees could look at how they can monitor the implementation of the recommendations; the same went for the ERAP report. The Commission requested that they look at the 22 government departments that were given the responsibility to implement the 39 interventions based on the 80 targets and determine what the challenges were. Ms Sharif was correct in her concern that the targeted times and resources were constrained in terms of fully realising the implementation of ERAP.

Ms Mathebula agreed with the Members’ concerns regarding the advertisement of back-street abortions and emphasised that this issue had to be looked into. Some people who accessed these illegal abortions would come back with perforated uteruses or sepsis and would still be referred to healthcare facilities for care for those complications. There is a need to engage the NDOH to ensure that there is an expansion of the number of facilities in provinces and investigate issues of access to these facilities, particularly for women in hard-to-reach areas or rural areas.

On the matter of how regulatory bodies deal with healthcare workers that do not want to perform abortions or TOP in the facilities: beyond the DOH, the regulatory bodies include the South African Nursing Council (SANC), the Democratic Nursing Organisation of South Africa (DENOSA), and the Hospice Palliative Care Association (HPCA). These are the bodies that need to be engaged so that they can be informed about possible refusal of some healthcare providers to provide TOP services based on their personal beliefs. This should be coupled with training and monitoring thereof.

Ms Robertson addressed the Chairperson’s question regarding progress to date of the three reports. On the CEDAW report, in terms of regional and international instruments: the Commission generally reports periodically. When the country is reporting, they also monitor from the perspective of the Commission. As they are busy with plans to 2022/23, the conversation they are having with researchers is what is up for country reporting for that period. The researchers are working on plans for that and research instruments so that the Commission can begin the compilation of information and report accordingly. The Commission would not necessarily have quarterly targets, as they report periodically unless there are specific issues that relate to the conventions that the Commission needs to monitor and report on. The next reporting period for CEDAW will be informed by the overall country reports and other activities. In the research and investigations, the Commission has presented so far, one can see that they have already done work that shows how the country is responding. These reports will form part of their cross-referencing when monitoring. The CTOP report was produced for the year March 2021. The Commission’s recommendations, as a matter of practice, relate to the targets in their APPs; they state that they will follow up on recommendations from the previous year or other important information. That would include issues of ERAP, which there are aware no longer exists. However, GBV still exists and the NSP is addressing the same issues that all other structures and instruments that seek to address regarding GBV.

On the issue of GBV and gender-responsive budgeting, teenage pregnancies and access to TOP services: the Commission’s recommendations form part of the projects, going forward, in terms of follow-ups. When the Commission reports for 2021/22, it will have an updated report that will address the progress around the implementation of the NSP-related activities and the progress related to the implementation of GBV national programmes. At the end of 2022/23, the Commission will have a full report that has conclusions based on the information that they will have at that time.

On the challenges regarding the ratification of international instruments: generally, from other readings and reports, South Africa does not encounter many challenges. The country does object to certain things here and there but is has mainly ratified instruments – particularly instruments that seek to address issues of gender equality.

On the ERAP report and how it addressed the problems of women in rural areas: when the Commission monitored the implementation of ERAP, it was found that services do not reach people equally. It was found that there was a differentiated focus in terms of addressing the issues of those previously disadvantaged. Generally, they found that those people are still disadvantaged – in terms of access, availability or resources. Looking at major cities in which generally black people did not live in in the past, they tend to come across as more resourced than other areas like Mpumalanga. This emphasised the need to place focus on some areas to address inequality, and this applies to all the reports. It also related to fund allocation and equitable share issues. There must be evidence-based resource allocation.

On the unwilling healthcare providers to carry out TOP, the Commission is implementing the Constitution and emphasises that this issue is about basic human rights. There is also the right to cultural practices and personal views. The challenge is how competing rights are balanced. Laws get challenged when people feel that their religious beliefs are, for example, being eroded by the Constitution. This is a quagmire that must still be addressed nationally. It also relates to the advert streets and to the fact that there are complex factors that lead certain people to prefer those services rather than public services. These nuanced challenges need more research. Hopefully, all the questions were answered in the lumped response, as the questions speak to the same root causes.

The Chairperson accepted Ms Mathebula’s request for outstanding questions to be sent and responded to in writing. When the Committee convenes with other portfolio committees, they will invite the Commission to follow up on issues that have been raised in the reports. Ms Robertson was advised to share the reports with the departments so that, when they do convene in future, they will have read the reports. She thanked Ms Robertson and Ms Mathebula. They have dealt with all the reports that were outstanding. The Committee will provide reasonable recommendations to be implemented by departments. Members will see whether, in the next term, they can have joint portfolio committee meetings and invite the relevant departments to account to the Committee on the recommendations to be implemented by them.

Ms Mathebula thanked the Committee for giving the Commission the opportunity to share their reports.

The meeting was adjourned.