Department of Health 2022/23 Annual Performance Plan; with Minister

NCOP Health and Social Services

17 May 2022
Chairperson: Ms M Gillion (ANC; Western Cape)
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Meeting Summary


The Annual Performance Plan for the 2022/23 financial year is presented by the National Department of Health (NDOH) detailing some of its key responsibilities in monitoring at the provincial department level. The overall budget is R64.5 billion with 86% transferred to support provinces, across-the-board communicable diseases, support for vaccination and containment measures. The major challenge remains the depletion of the budget due to medical legal claims.

Committee Members asked about the status of the Charlotte Maxeke hospital; health facilities for foreign nationals and if the Home Affairs guidelines and international commitments are followed for registered asylum seekers and refugees entitled to services; the lack of community service and registrar contracts and the work in progress to ensure infrastructure funds and conditional grant adjustments to cater for damage to infrastructure by the KZN floods.

Meeting report

Minister of Health introductory remarks
Minister of Health, Dr Joe Phaahla, noted apologies for the Deputy Minister who is on official assignment outside the country. Due to Cabinet commitments, this virtual meeting has been brought forward so he is able to stay until the end of the meeting and will join the Cabinet meeting afterwards. He is looking forward to 2022/23 for Health programmes to recover and function at full strength. The pandemic still remains but they are hopeful and optimistic this will be the last difficult part of the pandemic so the year will usher in more intensive programme recovery.

The Minister thanked the support of Parliament and other spheres of government to reach where they are in the recovery process based on full cooperation from everyone. In the last 4-5 weeks we have witnessed a spike in Gauteng, Kwa-Zulu Natal and the Western Cape in the number of cases and the COVID positive rate. Easter weekend saw the rate of infection hovering at 3-7% however the last few weeks spiked to reach 35% at one point. While there has been a recent rise in infections what is encouraging is the hospitalisation rate that shows a similar trend as the Omicron variant in late November until January with a rise in infections but no steep rise in hospitalisation, ICU and deaths. They have now 4000 people in hospital compared to 2000 before Easter. It has not been very dramatic unless there is a backlog in the report on deaths. Admissions remain low therefore the Minister is optimistic 2023 will give enough breathing space that we can recover.

The 2022/23 programmes will be funded in line with the overall R64.5 billion budget with 86% of the transfer to support provinces, across the board communicable diseases, support for vaccination and containment measures. HIV/AIDS has been on the recovery in 2021 and will continue in 2022. Sexually transmitted infections (STIs), maternal and child health and TB have lost some ground but are regaining capacity. Human resources capacity building is also allocated towards community service doctors and the additional allocation can look after their employment before they start in January 2023. Infrastructure is another important area through health facility rehabilitation, new facilities and an upgrade in facilities at a district, regional and national level and the start of the major project of Limpopo Academic Hospital. The major challenge remains the depletion of the budget due to medical-legal claims. These will be approved based on capacity to manage this as it is depleting resources.

Department of Health (DoH) 2022/23 Annual Performance Plan
NDOH Director-General, Dr Sandile Buthelezi introduced the two presenters.

Ms Milani Wolmarans, NDOH Chief Director of Policy and Planning, noted one of the key responsibilities of the NDOH was monitoring at nine provincial health departments. The presentation detailed the activities and targets of the six programmes: Programme 1 Administration; Programme 2 NHI and improving access to health services through universal health; Programme 3 Communicable and Non Communicable diseases; Programme 4 Primary Health Care and District Health; Programme 5 Hospital System and Infrastructure; and Programme 6 Health System Governance.

Resource Envelope for Implementing NDOH Plans 2022-2025
NDOH Acting CFO, Mr Andre Venter, said the budget vote baseline has been increased to provide for the effects of a possible wage agreement and cash gratuity payments. The compensation of employees will follow the COE ceiling being reduced by 7% due to the shifting of the Forensic Chemistry Laboratories from the Department’s core budget to the National Health Laboratories Services (NHLS) transfer payment. The Goods and Services allocation for Covid-19 was reduced by 52% from 2021/22 to 2022/23 (from R4.3 billion to R2.1 billion). The allocation for the National Health Insurance (NHI) indirect grant was reallocated to the NHI and Human Resources and Training direct grants.

The transfers and subsidies increase in Conditional Grants is due to the reallocation of the NHI indirect grants to NHI and Human Resources and Training direct grants. An additional R758.684 million was allocated to Conditional Grants towards cash gratuity payments. The purchase of capital assets was increased by 19% (from R1.1 billion to R1.3 billion) and the capital funds of the Health Facility Revitalization and NHI indirect grants were increased by 65% (from R19 million to R53 million) from 2021/22 to 2022/23 (see document for details).

The Chairperson noted news reports reflecting badly on the Charlotte Maxeke Hospital on the issue of xenophobia and the treatment of foreign nationals in hospitals. He requested an update from the Minister about why this is happening, how to accommodate foreign nationals and the impact on health services rendered to South Africans. There are outrages countrywide – if the Minister could brief on why and how?

Ms A Maleka (ANC, Mpumalanga) asked about the reduction in compensation of employees in the Department. She asked about the reduction and doctors not being placed timelessly. Will increases in the grant assist with such issues?

Ms D Christians (DA, Northern Cape) asked about the yearly allocation of medical interns and community service doctors given recent media reports of their contracts being suspended or terminated. Why are they being terminated and what support will be provided for those with incomplete service? Will the grants prevent this happening?

Ms Christians referred to Programme 3 and the disturbing media reports about severe malnutrition and children dying. What is the strategy to combat this and how do you assist mothers with children with severe malnutrition? What is the cross-sectional approach with the Departments of Basic Education and Social Development?

Ms Christians referred to Programme 6 and the disturbing report of the forensic chemistry lab backlogs. Is there a timeframe for when the backlogs will be addressed?

Ms Christians requested a report on Charlotte Maxeke Hospital since the fire and cancer treatment was shifted into the background. She asked for the timeframe for cancer treatment restoration. How are provincial healthcare personnel going to be safe given the recent shooting at Somerset Hospital where lives were lost. A Mpumalanga ambulance was robbed of R300 000 in vehicle parts while paramedics were held hostage. How will the Department ensure medical personnel remain safe when working?

Finally, oncology and mental health are not supported in the budget. They were put into the background due to the pandemic and now the budget has been decreased. Will targets be reached? What is the update on the registrar posts – is the budget sufficient?

Ms N Ndongeni (ANC, Eastern Cape) asked about the NDOH database equipment being moved and how it will be accommodated. She asked for a report on the state of medico-legal claims and their definition. She asked about lease payments in the budget. What has NDOH learned from the Covid pandemic and from the NHI in particular? Can it update the Committee on the Health Patient Registration System (HPRS) and if it is linked to Home Affairs? Please provide an update on the spending of the NHI grant.

Mr M Bara (DA, Gauteng) asked about the media coverage of doctors and nurses leaving the country and applying elsewhere. What are the reasons and the action NDOH will take to ensure that does not happen? With the Covid 19 numbers growing, what could be the reason and what will NDOH do to ensure the country does not go back to the initial pandemic?

The Chairperson raised the KZN floods and applauded the NDOH response. He asked the Minister how it will ensure services in KZN are not too severely interrupted for Oncology, TB and HIV patients and malnutrition concerns. In Gauteng, how will NDOH intervene and assist with the budget constraints and retrenchment of staff?

Ms Maleka also raised oncology and mental health as missing in the budget and the broader NHI grant. Government has not indicated any specific money to be allocated to unsupported services. How much will be allocated for these?

Minister response
Minister Phaahla replied about the Charlotte Maxeke Hospital fire that matters had taken some time as the fire safety division had to give the go ahead about the building being safe and agreements reached on what needs to be done and further fire prevention. The Minister had agreed with the Gauteng Premier to come in and fast track the intervention agreement with the Solidarity Fund as initiated by the President’s Fund. Agreement was reached for the infrastructure team to work with the Solidarity Fund to accelerate the first part of rehabilitation. After refurbishing they were able to recommission the Accident and Emergency section of the Charlotte Maxeke Hospital. It is not functioning at 100% but the majority of sections in the hospital have been restored for operation. It is functioning at 75% capacity in various sections. Oncology has not fully been restored but it is functional. The project has been handed over to the Development Bank of Southern Africa to ensure the programme developed reduces the projected 2026/27 timeline for rehabilitation completion and by the end of 2023, the hospital rehabilitation should be done.

On health facilities for foreign nationals, Health follows the Home Affairs guidelines and international commitments on asylum seekers and refugees entitled to services once registered. What causes a challenge are undocumented migrants and people from neighbouring countries who come specifically for health services such as maternity services which puts a lot of pressure on the Department. Tshwane, Limpopo and Gauteng have up to 40-60% deliveries of undocumented babies as people come in at an advanced stage of pregnancy then have to be attended to without antenatal service records which lead to complications in labour wards. A formal assessment is being requested to be able to report on these labour wards and for the recommendation to give the bill to the embassy to pay. This has not been finalised but may be presented to Cabinet for consideration on what should be done.

On the termination of intern contracts, NDOH has requested additional funding from Treasury as internships require training and interns are designated to certain hospitals. They are allocated based on capacity to be supervised by resident doctors. The province creates and budgets for internship posts. Provinces have not been able to cope with the budget reduction as only a certain number of interns can be catered for. The province will advise it can only budget for six interns although the demand is higher. To cover the deficit Treasury is approached to provide additional funding for three years. The difficulty remains rather once they finish community service. Once fully qualified, provinces are not able to retain them.

Dr Nicholas Crisp, NDOH Deputy Director-General: NHI and COVID-19 vaccine rollout coordinator, noted the four very clear Covid-19 variants that caused havoc as each has different genetic makeup but is still Coronavirus. There are currently a set of subvariants of Omicron with some difference in genetic makeup but they cannot be classified differently but not acting as a variant of concern currently. South Africa has three subvariants where two are becoming dominant, BA.4 and BA.5. They are causing increased infections and are different now from how the virus holds onto our cells. While subvariants get past the immunity and can still make a person sick. Therefore the increase in numbers currently reaching up to 10 000 infections a day. This rate changes from province to province but it stabilised this week. However, the subvariants are causing people to be sick and need hospital admission with some deaths. To prevent transmission, wear masks and follow regulations on crowding. They are pleading for vaccinations to avoid people getting sick; therefore they are spreading awareness. They are sustaining vaccination stations and continuing the vaccine distribution to provinces. They are also extending availability of vaccination into other services including HIV.

The community service (ComServ) and registrar challenges were due to budgets being reduced for COVID-19 which meant not being able to fill all posts. They recently used conditional grants to aid this; however, there is now double the number of graduates than previously. The Mandela/Fidel Castro Medical Collaboration Programme doctors are coming back from Cuba in large numbers and need to do their internships. The programmes are producing more graduates when we need them but the South African economy is weak and is unable to employ them. Treasury’s commitment for three years is aiding with the process of allocation. NDOH tries to make it fair with allocation based on computer allocation. Registrars are needed to train the young doctors. The challenge is insufficient funding to maintain those posts. Therefore they have to reduce the training posts and start cutting back. This will mean a problem in the next 4-6 years.

The Health Patient Registration System (HPRS) implemented in health facilities allows one to generate one unique case file with a Master Patient Index number as a single patient file which is a personal portable record. Our medical history will go with us as we move around in the public and private health care sectors. The verification of records is done against Home Affairs and national healthcare records. The structure and rules of the system is in compliance with the POPIA Act by the Department of Health. We as individuals own our record. It is a work in progress but it forms the foundation of storing our records electronically.

Ms Valerie Rennie, NDOH Head: Corporate Services, replied about security concerns that the National Department is really concerned about the frequent crime incidents at the provincial level and personnel are now losing their lives. NDOH has a safety and security forum to benchmark with the provincial head of security to follow the path National has followed in having an MOU agreement with SAPS. They have requested provinces to collaborate with SAPS as National has. The challenge remains the implementation as seen with the incident in Western Cape. Provinces have a hybrid model of security of both insourcing and outsourcing and they are expected to be able to handle to the situation on site for now – that is the best alternative to curb the issues at hand.

Minister Phaahla replied about the KZN flood disaster. Fortunately, the damage to health facilities was not enormous. The main issue was the water supply interruption to a number of facilities, key amongst those was Prince Mshiyeni Memorial Hospital in Umlazi in Ethekwini. Its water supply had been washed away. It had to depend on tank water which was not conducive for a hospital that sees up to 1000 outpatients a day which reached 1500 outpatients on the day of the Minister's visit. This issue has fortunately been resolved with the bulk of the remaining challenge being the flooding of the clinic and some health centres. Despite this only one hospital was affected by the flooding which should be resolved once the area has been cleaned up. There is quite a number across the province like the Ugu, uMgungundlovu and Ilembe District Municipalities where a number of facilities were damaged; however, not too extensively as was the main area of Ethekwini. There is work in progress with the provinces to ensure infrastructure funds and conditional grants adjustments to cater for the damage.

The Chairperson thanked the Minister and his team. If there were any follow up questions, Members were to put them in writing and send them to the Committee Secretary.

Committee programme
The Committee Secretary shared the second term programme and noted the meeting postponed the previous week for not having enough Members. Meeting with the Department of Women on 24 May 2022; informal briefing by the Department of Social Development on the Children’s Amendment Bill on 31 May 2022. On 7 June 2022, there will be an informal briefing that has not yet been shared by the Department of Health. On 14 June 2022, the Children’s Amendment Bill formal briefing will take place as the Bill should have been referred to this Committee by then. On 21 June 2022 a formal briefing by NDOH on the National Health Insurance Bill which is followed by a constituency period from 27 June 2022 with the joint study tour to Korea.

The Committee adopted the programme.

The Chairperson thanked everyone for the significant meeting with NDOH and adjourned the meeting.

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