Department Strategic Plan: briefing

Meeting report

HEALTH AD HOC COMMITTEE
25 May 2004
DEPARTMENT OF HEALTH STRATEGIC PLAN: BRIEFING

Chairperson: Mr L Ngculu

Documents handed out:
Department of Health Strategic Plan 2004/05
National Department of Health Budget
Department Briefing on Strategic Plan

SUMMARY
The Committee was briefed on the Department's strategic plan for 2004/05; its achievements and challenges over the last decade, as well as plans for the next five years. Members heard specifics on programmes and a budget breakdown. The Committee expressed concerns over community involvement, human resource development and the Department's communication, and suggested they have greater interaction in the future.

MINUTES
The Department delegation was comprised of Minister Manto Shabalala-Msimang, Acting Deputy Director-General (DDG), Ms Nthari Matsau, the Chief Director of Strategic Planning, Dr Yogan Pillay, as well as the Chief Financial Officer (CFO), Mr Gerrit Muller.

Ms Matsau said that the Department was guided by the principles were equity, access, quality, sustainability and community participation. The successes of the last decade were attributed to following the 10 point plan, and had resulted in decreases in morbidity and mortality, improved resource mobilisation and management, and improvement of human resource development. These fundamentals meant that the rest of the 10 point plan would fall into place.

Ms Matsau also listed other achievements like improvements in immunisation coverage, no deaths from measles since 1999, the opening of 2000 Voluntary Counselling and Testing (VCT) facilities, the availability of 85-90% of essential drug list medicines at public health facilities; and the elimination of eliminate backlogs in assistance devices (wheelchairs and hearing aids) by the end of the financial year.

Ongoing challenges however included media reports over the lack of quality care, the emigration of health professionals, the increase in lifestyle diseases like diabetes and obesity (particularly in children), as well as spiraling non-natural causes of death like road accidents and homicides. Increased communication with communities was always a challenge.

Mr Pillay reported that the strategy comprised of three wide-ranging programmes: administration, strategic health and health service delivery. The strategic objectives of the programmes could be revised in the near future in order to keep it in line with the vision of the newly elected government.

Mr Muller made a comparative analysis of budgets from the financial year 2001/2002 until the projected 2006/2007. He explained the variations in budgets for different categories of spending. About 95% of budgets were allocated towards conditional grants.

Discussion
Ms C Dudley (ACDP) remarked on the notable increase in advertisements for alcohol on television, especially during sports broadcasts. She questioned why this had been allowed. She also asked for time frames on when social health insurance would be instituted and on how the Department's surveillance system kept track of the spread of HIV/AIDS.

Ms Matsau stated that the Department was considering guidelines for the advertisement of alcohol. Once such guidelines were in place, such advertising should decrease dramatically. Social health insurance was indeed complex. The Council of Medical Schemes had stipulated the minimum coverage needed. The Department was engaged in discussions and considering proposals of trade unions, etc.

Minister Msimang added that the social health insurance proposal would be finalised by January 2005 for presentation at the Cabinet Lekhotla.

Ms Matsau said that a comprehensive survey on HIV/AIDS was done every year during October.

Ms O Kasienyane (ANC) was concerned about the state of mental health services in rural areas. Many grants allocated to mental health patients were abused by family members.

Ms Kasienyane asked what the Department was doing to address the problem. She also asked for clarity on inequalities in public-private partnerships that the Department had concluded in the past.

Ms Matsau stated that the Department had done a survey on conditions in mental health institutions in the late 199's and had found appalling conditions. A policy decision was then been taken to do pilot studies to de-institutionalise certain mental patients. The burden of care would now fall upon communities so adequate support structures were needed. Some communities felt that government had abandoned its responsibility and had demanded compensation for the care of mental patients. Government consequently made grants available but on many occasions found that funds were being abused and patients were being neglected. The plight of mental patients was still a priority.

Ms Matsau said that the problem with the public-private partnerships was that the Department had not in the past set performance parameters for partners. The Department had i learnt from these past mistakes.

Mr I Cachalia (ANC) asked the Department to elaborate on the concept of telemedicine centres. He also asked whether there were enough psychologists and psychiatrists in South Africa.

Ms Matsau said that eight medical schools have been included in the telemedicine centres project. These schools would be connected to share information and knowledge. She could not comment on the numbers of trained psychologists and psychiatrists but noted that the Psychiatric Association of SA had reported that there were few black people studying psychology.

Dr Pillay added that psychology was predominantly studied by whites and that SA lost qualified professionals to the United Kingdom. There was a lack of trained psychiatrists and for black patients, the language barrier was a constant problem. The shortage necessitated the training of nurses in basic counseling.

Ms P Tswete (ANC) was concerned that although malaria was on the decrease in the country, there had been increases in cases in Limpopo province. She asked what specific provinces were receiving support from the Department on the management of tuberculosis (TB).

Ms Matsau responded that the intensity of malaria outbreaks was directly related to the environment, geography etc. The death toll depended on the responsiveness of the facilities. If the response was good, the fatality rate would be less than 1%. It was difficult to comment on the increase of malaria in Limpopo specifically. The Eastern Cape, Limpopo and Mpumalanga had received assistance in managing TB.

Mr R Coetzee (DA) asked if the Department had a strategy to keep doctors in SA. He asked if there was a written document on the subject that the Committee could read.

Mr Coetzee also asked for clarity on contentious drug pricing and doctors dispensing medicines.

Ms Matsau said she would forward a human resources document to the Committee as soon as possible.

The Chair asked Mr Coetzee to await responses on drug pricing until the Department could make a comprehensive briefing on the issue. Minister Msimang added that on the 31 May and the 1 June, the matter would be heard in court and was thus sub-iudicae. Mr Coetzee agreed.

Dr A Luthuli (ANC) felt that lack of sanitation; low education levels and unemployment were key determinants of health. She asked how the Department could influence on these deliveries. She expressed shock over figures that showed that more rural women were affected with HIV/AIDS than their urban counterparts. She had always been under the impression that rural women would be more traditional and conservative.

Ms Matsau felt that sanitation was the major responsibility of the Department of Water Affairs. Departments often assisted one another in this regard. The cholera prevention programme was doing well. Expansion of public works programmes would alleviate the problems mentioned.

Ms Matsau attributed the high levels of HIV/AIDS in rural areas to the inequality that exists between men and women there. The subserviency of women was the major factor in the lack of use of condoms. The 'emotional lack of access' to condoms drove up the infection rate, even though condoms were physically available.

Minister Tshabalala-Msimang added that UNAIDS recently announced in Geneva that they wished to revise the AIDS figures in Africa. It was felt that the previous figures were hugely distorted.

Mr S Njikelana (ANC) asked whether the Department had learned any lessons from implementation of the ten-year strategy. He singled out community health centres and community participation as challenges. Regulatory bodies for skilled health professionals and medical aid schemes must have impacted on the work of the Department as well.

Dr Pillay said that over the ten years, more than 1 300 clinics had been established. In 1999, the Department had launched a primary care package delivered five days a week. Each clinic was required to have a Committee, but these often had a high turnover rate. Some provincial legislation had been a problem in providing a legal framework for the Committees.

Ms Matsau reacted that certain regulatory bodies had undergone transformations, however slowly, such as the Dental and Medical Council. Certain bodies that had been foes of the Department in the past, were now its allies, such as the Pharmacy Council.

Mr Muller added that the Department and the Medical Council had worked hard to stabilise medical aid schemes through regulation. Not a single medical aid scheme had gone bankrupt in the last five years. The Medical Council had also taken steps to ensue that medical schemes were competitive among one another.

Ms B Ngcobo (ANC) felt that the specific work of health professionals was not sufficiently communicated to potential patients, such as the specialty of paediatricians. The Department had released a Public Health Policy in November 2002 and she asked about progress. She also queried how the implementation of policy could be strengthened. She expressed concern over the state of school health.

Ms Matsau agreed that a large portion of the population was unaware of various health services, so professionals were not fully utilised. As social development increased, so would use and exposure. The quality of health care was not only about clinical management, but also about social management. South Africa offered top clinical quality but attitudes of professionals had to change. She continued that school health policy had not always been a priority. Stunted growth statistics were as high as 25% of black children. A new school health policy was in the pipeline.

Ms S Rajbally (MF) asked about interest and participation by communities in home-based health care.

Ms Matsau explained that community health workers formed a vital part of the Department's strategy. They were compensated, even though amounts had varied from province to province in the past. Community-based workers currently received the same remuneration. The Department had made guidelines available and new therapies were regularly distributed.

Ms M Manana (ANC) commented that people reject mentally ill persons because they were scared of them. Families had to be educated on how to care for mentally ill persons at home. She asked the Department to look into the complaints lodged by those on the TB 'DOTS' regimen. She further asked what was being done to educate persons about the prevention of non-natural causes of death, e.g. road accidents.

Ms Matsau agreed that families need to be educated and said a policy had already been put in place. Complaints from dot supporters would be addressed. All community workers would be compensated for services rendered. The Department was working closely with the Department of Transport to educate the public on road safety, such as through the Arrive Alive Campaign.

Ms R Mashigo (ANC) asked how widespread the Department's 2000 VCT facilities were. She felt that the indicators for district health facilities were too wide, and asked how they monitored such facilities.

Ms Matsau reacted that the VCT facilities were widespread. Dr Pillay added that each district health facility head had a checklist to complete. Each district would use the national checklist to rectify deficiencies.

Ms N Nkabinde (UDM) asked what programmes were in place to make health care accessible to the youth. She also asked how the Department intended to improve the availability of IMCI nurses.

Ms Matsau noted that even in developed countries the youth found it difficult to access health services. She listed campaigns like the 'lovelife' programme, youth and adolescent friendly facilities, and a life skills programme in conjunction with the Department of Education. She then conceded that IMCI trained nurses ratios needed to be improved in antenatal clinics.

Dr Luthuli was concerned about the lack of communication between the Department and the population as a whole. She asked what was being done to improve communication and whether the Department had a specific unit to deal with this.

The Chair answered that the Department had a Communications Directorate, but acknowledged that communication was still a great problem. The Department was continuously trying to improve it.

The Chair said he was pleased by the Department's ten point plan but nevertheless felt much more discussion was needed on the key indicators and benchmarks. He would appreciate information on what legislation would soon be dealt with by the Committee. Human resources, social health care insurance, and community health, were among the issues that needed to be discussed in detail. Ms Matsau agreed.

Minister Tshabala-Msimang asked for permission to address the Committee on statements made on television by Mr Richard Feecham from the Global Fund on TB, HIV/AIDS and Malaria. Mr Feecham had alleged that funds that had been donated to NGOs by the Global Fund had not been distributed in South Africa. The Global Fund had initially wanted funding to go directly to specific NGOs but the government had felt it more appropriate that the funds first go through the National Treasury. The latter route had been agreed on.

Minister Msimang said it had been discovered that funds had been distributed to both Soul City (a South African NGO), and to love life (a foreign NGO run by South Africans). Not all the funds allocated to love life had been released because they had not submitted all the required reports on accountability. Had this requirement been fulfilled, all the allocated funds would have been distributed. She strongly objected to the statements made by Mr Feecham. There had been no irregularities on the part of the government in the distribution of donor funds.

The meeting was adjourned.