National Health Insurance (NHI) Bill: Clause 40 to 42 deliberations

Meeting report

The Chairperson welcomed the members to the meeting. The members would deliberate on NHI Bill clause-by-clause After that, the Committee would adopt two sets of minutes.

The Committee Secretary read the apologies into the record.

The Chairperson read the rules of the meeting. The virtual meeting was deemed to be a precinct of Parliament and therefore constituted a meeting of the Committee.

The Chairperson noted that the Committee had completed up until clause 39 the previous week. The Committee was now at clause 40 of the NHI Bill.

Clause 40 Information platform of Fund

This clause said that:

“(1) The Fund must establish an information platform to enable it to make informed decisions on population health needs assessment, financing, purchasing, patient registration, service provider contracting and reimbursement, utilisation patterns, performance management, setting the parameters for the procurement of health goods, and fraud and risk management.

(2) Health care service providers and health establishments must submit such information as may be prescribed to the Fund, taking into consideration the provisions of the Protection of Personal Information Act, 2013 (Act No. 4 of 2013).

(3) The information in subsection (2) may be used by the Fund to—

(a) monitor health care service utilisation and expenditure patterns relative to plans and budgets;

(b) plan and budget for the purchasing of quality personal health care services based on need;

(c) monitor adherence to standard treatment guidelines, including prescribing from the Formulary;

(d) monitor the appropriateness and effectiveness of referral networks prescribed by health care service providers and health establishments;

(e) provide an overall assessment of the performance of health care service providers, health establishments and suppliers; and

(f) determine the payment mechanisms and rates for personal health care services.

(4) Information concerning a user, including information relating to his or her health status, treatment or stay in a health establishment is confidential and no third party may disclose information contemplated in subsection (2), unless—

(a) the user consents to such disclosure in writing;

(b) the information is shared among health care service providers for the lawful purpose of serving the interests of users;

(c) the information is required by an accredited health care service provider, health establishment, supplier or researchers for the lawful purpose of improving health care practices and policy, but not for commercial purposes;

(d) the information is utilised by the Fund for any other lawful purpose related to the efficient and effective functioning of the Fund;

(e) a court order or any law requires such disclosure; or

(f) failure to disclosure the information represents a serious threat to public health.

(5) The information architecture must include a fraud and risk management mechanism.

(6) In order to fulfil the requirements for dissemination of information and the keeping of records, the information platform must facilitate—

(a) the implementation of the objects and the effective management of the Fund; and

(b) portability and continuity of health care services available to users subject to the provisions of this Act.”

 

Ms A Gela (ANC) said that the ANC supported clauses 40(6)(a) and (b) for the following reasons. The Fund’s information platform and architecture must be designed and implemented in a way that ensured that users had uninterrupted access to needed healthcare services through the continuity of healthcare service providers that were appropriately accredited and contracted. The Fund’s information system must be robust enough to prevent any possibility of sabotage, information hijacking or hacking.

Mr E Siwela (ANC) said that the ANC supported clause 40(2) for the following reasons. The Fund must have the capability to request accredited and contracted providers to provide it with information that may be adjusted from time to time. The information to be submitted to the Fund will be prescribed in regulation. The requirement that the information requested by the Fund must take into consideration the Protection of Personal Information Act (POPIA) was supported. This would ensure that the Fund promoted and protected every patient or user’s right to privacy as outlined in the Constitution while at the same time protecting the flow of information and advancing the right of access to and protection of information.

Ms M Hlengwa (IFP) said that the IFP still supported the provision of universal healthcare, as it was defined. Although the IFP consciously supported the notion of the NHI it stressed that the current framework required serious reformation and reformulation. Many of the provisions in the current framework were not feasible at all. It had become very apparent from the many submissions received that a key criticism of the Bill related to the financial feasibility of the proposed NHI Fund. The public had a right to know how much the NHI Fund and the provision of service at all levels would cost. There had been no financial feasibility study provided which was a critical failure.

Ms H Ismail (DA) referred to clause 40(1) and highlighted that medical schemes already collected significant member information. Rather than the NHI seeking to create its own database, would it not be more advisable and quicker to rather obtain an exemption from the provisions of the POPI Act and allow members’ information to be shared with the NHI and the Council for Medical Schemes? This would be an effective and quicker solution going forward. Where there was a proper sharing of patient data, subject to the protection of medical information which could still exist on a single database but only accessible by those healthcare practitioners who treated the patient. There would be an opportunity to render more efficient and effective healthcare services with enhanced patient care. It would be necessary for all public hospitals to be equipped with the health technology and information technology needed to connect to other hospitals across the country. She noted that some public healthcare facilities did not have all the tools necessary. This would be to the benefit of migrant workers, pensioners, and patients travelling between provinces seeking healthcare as some provinces did not have academic and specialised hospitals. This was necessary for everything to be stipulated. She noted that clause 40(5) said that ‘information architecture must include a fraud and risk management mechanism’. There needed to be more specifics. More clarity needed to be specified in the Bill with regard to it.

Mr N Xaba (ANC) supported what Ms Gela and Mr Siwela had said. The ANC supported clause 40(1) for the following reasons. For the Fund to be able to execute its functions and responsibilities in an effective, efficient, and sustainable manner it needed access to real-time accurate, valid information relating to all areas of its activities. This would allow the Fund to have cutting-edge capabilities in terms of data warehousing, analytics, and decision-making to ensure that the services it provided were relevant to users’ needs and it adequately addressed the health sector’s priorities and objectives. The ANC supported clauses 40(3), (a) to (f) for the following reasons. The information platform of the Fund would be critical for enabling improved collaboration and coordination among accredited and contracted healthcare providers. This would include streaming patient or user access to quality healthcare service within a geographical area. Improving cost efficiency in healthcare delivery arrangements and increasing accuracy and efficiently planning and management decisions. The clauses would assist the Fund to keep track of patients’ and providers’ experiences as it relates to its activities, including implementing measures to lower the cost of care and monitoring what impacts this had on quality performance metrics.

Ms X Havard (ANC) said that the ANC supported clauses 40(4), (a) to (f) for the following reasons. These provisions were consistent with the prescripts in the Constitution as well as POPIA. Furthermore, the conditions under which the personal information may be released to a third-party are listed. The Fund would strictly adhere to POPIA so that it protected patient user privacy and confidentiality. All its activities and interactions with third parties were under accredited and contracted healthcare providers. Furthermore, she supported the submissions of Ms Gela, Mr Siwela and Mr Xaba. 

Ms M Clarke (DA) discussed clause 40(1). She referred to her previous points on the national components overriding the powers given to the provincial components. If a province is more suited to determining its own needs, more effectively than any national component, how would this work practically given the condition of public hospitals, especially in rural areas that did not have access to internet, phones, and computers? She discussed clause 40(2)(d). What kind of consequence management would be put in place in terms of ensuring that medical staff were executing their duties effectively and that healthcare, in terms of patient needs, were being executed on a level at which patients deserved to receive healthcare? She discussed clause 40(4). It spoke about equipment etc. At many hospitals that she had visited there were no stock control procedures in place. It needed to be ensured that all those things were happening within the hospitals. She discussed patient confidentiality. It needed to be ensured that systems were in place so that these systems were not hacked and that people’s information, in terms of their medical care, was not at risk.

Dr S Thembekwayo (EFF) said that she rejected the clauses under discussion.

Ms E Wilson (DA) said that when one passed a Bill and used the word ‘must’ it meant that one had to. It needed to be delivered. She discussed clause 40(1) and what the information platform of the Fund was required to do. She said from the outset that Government would not be able to deliver it. There was already a province spending R1 billion just getting documents scanned that were stacked in toilets ‘and god knows where else just to get patient information’. At least a third of South Africa’s population lived in rural areas without access to wireless internet. There were hospitals with no phones, let alone a computer. It required tremendous training to get this type of information platform up and running. People with very little knowledge of any kind of IT infrastructure needed to be trained on this. She was wary of when Bills were passed, and the word ‘must’ was used when the government knew ‘damn well’ that it could not deliver. It made the Bill null and void from the outset.

Mr P Van Staden (FF+) said that he had the same concerns that he had when the Committee deliberated on clause 34. It would be good to have someone from the IT side explain to the Committee at some stage how the system would actually work and how the data would be protected in the POPIA.

The Chairperson said that the ANC supported clause 40(1) for the following reasons. The data and information capabilities that will be established as part of the Fund will also be instrumental in identifying possible fraud, corruption, and maladministration. The ANC also supported clause 40(5) for the following reasons. The Fund’s information architecture must enable it to prevent all forms of fraudulent, corrupt, or maleficent behaviour from employees, service providers, or other third parties. This would ensure that possible losses were minimised or eliminated, thus supporting the successful running of its operations. The inclusion of an effective fraud and risk management mechanism within the Fund’s structure and processes will effectively assist with achieving three interrelated and equally important outcomes. Namely, timeously preventing instances of fraud, corruption, or maleficence from happening in the first place, actively detecting all instances of fraud, corruption, or maleficence when they occur, and responding appropriately by ensuring that corrective actions are implemented to address any possible loopholes to prevent future breaches. He supported the submissions made by Mr Xaba, Ms Havard, Mr Siwela and Ms Gela.

Clause 41 Payment of health care service providers

It stated that:

“(1) The Fund, in consultation with the Minister, must determine the nature of provider payment mechanisms and adopt additional mechanisms.

(2) The Fund must ensure that health care service providers, health establishments and suppliers are properly accredited before they are reimbursed.

(3) (a) An accredited primary health care service provider must be contracted and remunerated by a Contracting Unit for Primary Health Care.

(b) In the case of specialist and hospital services, payments must be all-inclusive and based on the performance of the health care service provider, health establishment or supplier of health goods, as the case may be.

(c) Emergency medical services must be reimbursed on a capped case-based fee basis with adjustments made for case severity, where necessary.

(4) Without limiting the powers of the Minister to make regulations in terms of section 55, the Minister may make regulations to—

(a) provide that payments may be made on condition that there has been compliance with quality standards of care or the achievement of specified levels of performance;

(b) determine mechanisms for the payment of an individual health worker and health care provider; and

(c) provide that the whole or any part of a payment is subject to the conditions outlined in a contract and that payments must only be effected by the Fund if the conditions have been met.

(5) For the purposes of subsection (4), “health worker’’ and ‘‘health care provider’’ have the meanings ascribed to them in section 1 of the National Health Act.”

Mr Xaba said that the ANC supported clause 41(1) for the following reasons. Provider payment mechanisms must contribute to a responsive health system by incentivising improved quality whilst also making delivery of healthcare efficient, affordable, and sustainable. The Fund must be capable of accessing and deciding on alternative reimbursement tools that must be used for contracted and accredited providers and healthcare establishments at different levels of care. The NHI Fund would pay providers in a way that created appropriate incentives for the provision of effective, quality, and accessible care. The chosen reimbursement mechanisms must be reasonable taking into account budget impact and must ensure that the Fund remains effective, efficient, and sustainable in all its operations and contractual arrangements with providers. These clauses allowed the Minister to establish mechanisms to address measures such as these. Furthermore, the ANC supported clause 41(3)(b) for the following reasons. The ANC noted the concerns raised by the medical specialists during the hearings where they indicated that new provider payments that were all-inclusive and based on performance would impact their ability to make the same type of profitability that they were currently enjoying under the current dispensation, even threatening to immigrate to other countries. Another concern raised by some on this clause is that with the exception of emergency medical services, there was no provision for the purchasing of health care services from certified, accredited, and contracted private healthcare establishments. They further raised concerns that the Bill does not make provision whatsoever for payment of healthcare providers outside of the hospital context nor was there any mention of the payment of private healthcare providers despite the obligation of the Fund to actively and strategically purchase healthcare services for private healthcare providers. Therefore, it was concerning that as the Bill presently stood there was no provision for or mechanisms whereby private healthcare providers were paid directly. However, the ANC’s view was that the Fund must be capable of assessing and deciding on alternative reimbursement tools that may be used for contracted and accredited providers and healthcare establishments at different levels of care. This was the normal practice in many countries that these practitioners were threatening to migrate to, such as Canada, Australia, New Zealand and the UK. 

Ms Ismail noted clause 41(2) stated that the ‘Fund must ensure that health care service providers, health establishments and suppliers are properly accredited before they are reimbursed’. This Bill severely lacked specifications and this is what she had been highlighting throughout. There were no specifications again and there was no clarity on the process of accreditation. This needed to be specified at each clause, where necessary. Considering that there were major issues with suppliers or service providers not being paid on time, there needed to be more specifics on how the NHI was actually going to ensure because there was a lot of uncertainty. Looking at the NHI, and considering where the country was now, it needed to be specified how service providers would be compensated and how private practices would fit into the implementation of the NHI.

Mr Van Staden discussed clause 41(4)(a), ‘payments may be made on condition that there has been compliance with quality standards’. This had been deliberated on the previous week as well. The Office of Health Standards Compliance had a big problem itself, as was reported to this Committee. His concern is what is defined as quality standards and how would it be monitored. At this current moment, public institutions could not even provide such service of quality standards. It was known what was happening in public hospitals and clinics at this time. His concern was how this would be monitored in the first place if the relevant office that was in place, that was supposed to monitor it now, could not do that at this stage. He discussed clause 41(4)(c), it stated ‘as outline in a contract’. Would all current private service providers be contracted under the NHI Bill, like for instance private ambulance services? That was a matter that needed clarity as it was a big question mark at this stage. The people in the private ambulance service industry still did not know what their future would be under the NHI.

Ms Clarke discussed clause 41(1). Why was the Minister involved in the day-to-day running of the payment fund? She discussed clause 41(2) to (3). There were only a handful of healthcare providers who were actually able to be accredited. What would happen with these provisions now? Based on performance, what were these criteria? Will the supply be to hospitals that are understaffed or lacked supplies due to maladministration on behalf of the Department? Would it be based on the treatment success rate? Would this not deter facilities from offering these vital procedures? Would emergency services agree on a capped fee or offer emergency services at a lower price? She discussed clause 41(4)(a). This was open to massive abuse by the Minister who single-handedly could determine if a service provider should get paid. There should be no reason for the Minister to get involved in the payment of suppliers. Additionally, implementing such regulations would mean that almost every single public service provider would not be paid because they all did not have the required certificates for a sufficient level of standards. This should be the power of the board or the committee of the Fund. She discussed clause 41(4)(c). The Minister was again given excessive powers to determine who gets paid and who does not. This could lead to huge political influence or controversy. The Minister could dictate that cadres be paid in full immediately, while others must wait 30 days or more for payments. What would the criteria be when private healthcare was being paid for services provided? What would these criteria be and how long would private healthcare, which was providing services, wait until they were paid?

Ms Wilson said that once the members got into these sections, then the Bill fell apart in its entirety. There was no stipulation as to how people would be paid, when they would be paid, and what timelines there were. It spoke about only paying accredited providers. The Bill was taking away the provinces’ mandate to manage health in the respective provinces. Now the Bill was only paying accredited providers, what happened to the rest? When would they get paid? How do they get paid? If they were not accredited, do they close their doors? Was the Government going to close the doors of 70 to 90% of hospitals and clinics in the country because they were not accredited? What happened to the provincial mandate? What happened to the health budget? Was the entire health budget going to be ploughed into the NHI Fund and thereafter there would be no funding for anything else? The Bill was so broad, so wide, so open to manipulation, and very hard to understand. She had looked at provinces in their current accruals year on year and it ran into millions, in most provinces. They could not pay their Bills. They were underfunded. They were under-budgeted. The Bill was complicating a system that was going to ‘crash around our ears’. There was nothing in the Bill that spoke about the other healthcare service providers. It only spoke about accredited facilities. What was happening to the rest? How were they going to get funded? How were they going to survive? If the Fund ran out of money and would only pay the accredited companies first, then money would be taken from other budgets. It would put the provinces in severe problems because they would not get immediate access to their funds because their budgets were suddenly being used to fund this NHI Fund that had no money. It had no money and would not get off the ground in any way. She had a big concern, and this was where the entire Bill started to collapse.

Ms Havard said that the ANC supported clause 41(4) for the following reasons. The Fund, in consultation with the Minister, would determine its own pricing and reimbursement mechanisms. This clause ensured the reimbursement mechanism was not legislated but was prescribed in regulation to provide flexibility for required changes. The ANC supported clause 41(5) for the following reasons. This provision ensured legal and regulatory cohesiveness. Applicable definitions within PEU must be consistent with those provided for by the other existing Acts. She also supported the submission of Mr Xaba.

Ms Gela said that she supported the submission of Mr Xaba and Ms Havard. The ANC supported clause 41(2) for the following reasons. This provision is very well articulated in clause 39 with the amendment as proposed. The Fund must ensure that it was at all times dealing with providers, health establishments, and suppliers that meet clearly stipulated criteria. These criteria should be clearly communicated to all parties with a clear knowledge that appropriately accredited healthcare providers will be reimbursed according to predetermined criteria. The ANC supported clause 41(4)(c) for the following reasons. In alignment with clauses 39(3) and 39(5), the Fund, through its performance monitoring and assessment processes should ensure that only providers that have met the service provider criteria were reimbursed. Any provider or health establishment that failed to meet contractual criteria and obligations must not be paid. This would ensure that the Fund eliminated its exposure to fraud or maleficence and prevented the occurrence of fruitless and wasteful expenditure. The clause removed arbitrariness in payment.

Mr Siwela said that the ANC supported clause 41(3)(a) for the following reasons. The contracting unit of primary healthcare is a key structure representative of the Fund at the subdistrict level. However, the intention of the NHI Bill was to create a legal framework for the introduction of a single purchaser. There would be a single purchase thus eliminating the fragmented funding tools currently characterising the health sector. In this regard, the CUPs could not be expected to remunerate healthcare providers as this would by default introduce a multiyear payer NHI Fund. The ANC supported the following amendment to clause 41(3)(a). An accredited primary healthcare service provider contracted through a contracting unit for primary healthcare will be reimbursed by the Fund using a capitation strategy. The ANC supported clause 41(4)(a), as the primary purchaser of healthcare services on behalf of the population the Fund must ensure that it implemented and actively monitored and assessed the various reimbursement mechanisms it implements. This would ensure those payment mechanisms that contribute to realising the Minister’s priorities and programme for the health sector. One of which should be improved population health outcomes by accrediting and constructing with providers at health establishments that meet with stipulated qualities and other requirements and actively monitoring their performance against agreed criteria. The Fund will be able to contribute to utilise the available resource to achieve desired health sector performance targets. One of which was the realising the progress to universal health coverage. He supported the submission of Mr Xaba, Ms Havard and Ms Gela.

The Chairperson said that the ANC supported clause 41(1) for the following reasons. The ANC had considered inputs from stakeholders such as the South African Private Practitioners Forum (SAPPF), in their oral and written submissions. They raised concerns on behalf of medical specialists where they indicated that the provision of payments that were all-inclusive and based on performance would impact their ability to make the same type of profit that they were currently enjoying under the current dispensation, even threatening to emigrate to other countries. SAPPF further proposed that there must be a regular review of the reimbursement rates and prices assigned to the services delivered. In response to this concern, the ANC noted that one of the main challenges that the South African health system faced was that of cost escalation, which was predominantly driven by a lack of a regulatory framework guiding providers and health establishments on reasonable rates that should be charged for health care services. This was also because in the private health sector, primarily as a result of the actions of medical specialists and private hospitals which were dominated by fee for service as the prescribed reimbursement mechanism of choice. This has contributed to the high and unsustainable costs as shown by the health market inquiry findings. The ANC supported clause 41(3)(c) for the following reasons. Given the constitutional obligations that one may be denied access to emergency care, it was important that the Fund actively implemented mechanisms to ensure that patients and users can have access to emergency services and that these were reimbursed using a case-by-fee structure while taking into account budget impact analysis. This is because such fee structures have been shown to effectively assist purchasers of health care services to control their cost and where necessary adjustments were included for the severity of cases they have also been shown to improve efficiency and effectively assist in the control of the quality of care. The ANC supported this clause aligned to the minor amendments which have been suggested to clause 35(4)(a) of differentiating between mobile emergency services that will be provided by public and private ambulances and also in terms of mobile and facility-based emergency services. The ANC also supported clause 41(4)(b). The NHI Fund will pay providers in a way that creates appropriate incentives for efficiency and also for the provision of quality care and accessible care, as a strategic purchase of personal healthcare services for the population the Fund must be capable of determining the most appropriate, effective, efficient and sustainable reimbursement mechanisms that it would use accredited and contracted providers and health establishments. This will ensure that the Fund was able to effectively utilise the resources allocated to its function and operations and that it generates the greatest value in terms of population health gains. Healthcare workers and providers who wish to contract with the NHI Fund must comply with the stipulated reimbursement mechanism as per regulation.  

Ms Wilson discussed private hospitals and private healthcare facilities. They were for-profit organisations. When the Bill spoke about reimbursement and at a capped fee, what then happened to their right to be for-profit organisations. The Bill would go against their constitutional right to be a for-profit organisation. She noted the role of the Minister, without limiting the powers of the Minister to make regulations in terms of section 65. The Minister may make regulations and then provide that payments were made on the condition that there was compliance with quality standards etc. There was no discussion about consultation and who the Minister was going to consult. It was going to be a situation where the Minister was the judge, and he appointed the jury. This would come into problems. She was concerned by the part that said, ‘may provide in whole or any part of a payment is subject to the conditions outlined in a contract and that payments must only be effected by the Fund if the conditions have been met’. With all due respect, health was a moving target. It changed continuously. No one knew what would happen tomorrow. Covid was a prime example of this. The norms and standards, in principle, went out the window because the entire health system had to be adjusted to deal with the pandemic. She noted the implication of the inclusion of clause 41(4)(c). Where in this clause did it say, ‘subject to’ or ‘if’? It does not. People had to readjust after covid. People acted outside of the norms and standards after the country was hit by covid. Now all of a sudden, Government would not pay those people. Health was a moving target. Things changed in health all the time. The country could face a problem of hepatitis, and this was raised in the oral questions last week. The country could get hit with covid. Health was a moving target and she believed that clause was going to restrict people and make excuses for people not to be paid because they worked outside of the norms and standards, because they were forced to.

Ms Ismail said that clause 41(1) stated that the ‘Fund, in consultation with the Minister, must determine the nature of provider payment mechanisms and adopt additional mechanisms’. However, looking at clause 23 (c), it placed the function of setting up a unit of providing payment in the jurisdiction of the CEO. There seemed to be a clash there. The clauses were very vague and left a lot to the discretion of the Minister. Somewhere in this Bill, the two clauses were not speaking to each other or were not aligned. There needed to be more specification on that matter. She discussed clause 41(3)(b). It was unclear and not aligned with other related provisions. What did ‘all-inclusive’ mean? There needed to be more clarity and specification on that in this particular clause.

Mr Xaba said that in other meetings Mr Munyai did indicate the importance of the Committee respecting the constitutionality of the Minister. Through this Bill, the Committee was supporting the work that the Minister was currently doing. He supported what the Chairperson had submitted. It was in line with what the ANC said.

Ms Clarke asked what would happen if the private healthcare system did not accept the tariffs that were set. Would they close up shop, leading to even worse healthcare services? If they did not accept what was put into this Bill in terms of those tariffs, what happened?

Ms Wilson said all of this was dealing with hospitals and facilities that were contracted into the NHI. What happened when a facility did not want to contract into the NHI?

Clause 42 Complaints

It stated that:

“(1) An affected natural or juristic person, namely a user, health care service provider, health establishment or supplier, may furnish a complaint with the Fund in terms of the procedures determined by the Fund in consultation with the Minister, and the Fund must deal with such complaints in a timeous manner and in terms of the law.

(2) The Investigating Unit established by the Chief Executive Officer in terms of section 20(2)(e) must launch an investigation to establish the facts of the incident reported and must make recommendations to the Chief Executive Officer as to the way in which the matter may be resolved within 30 days of receipt of the complaint.

(3) The complainant must be informed in writing of the outcome of the investigation launched in terms of subsection (2), and any decision taken by the Fund, within a reasonable period of time.

(4) If the Fund has made a decision in terms of subsection (3), the Fund must—

(a) provide the health care service provider with a notice of the decision to provide the health care service provider with a reasonable opportunity to make representations in respect of such a decision;

(b) consider the representations made in respect of paragraph (a); and

(c) provide adequate reason for the decision to withdraw or refuse the renewal of accreditation to the health care service provider, as the case may be.”

Mr Xaba said that the ANC supported clause 42 for the following reasons. The ANC noted the concerns raised by the stakeholders that this clause must not limit those persons who may make representations to healthcare service providers only. Instead, it was proposed that the term should be replaced with an affected party so that complainants of any nature, including those persons who were subject of the complaint and affected third parties may rely on the section to make representation to the Fund. They can have their representation considered by the Fund and be provided with adequate reasons for the Fund’s decision. The ANC supported this clause because it clearly stated that the Fund must develop and implement protocols and procedures for dealing with complaints raised by various stakeholders, including users, patients, providers, and suppliers. This needed to be clearly communicated and readily accessible. This will ensure that the und processes around addressing complaints and complies with the Constitution and provisions of Promotion of Administrative Justice Act. The Fund must endeavour to deal with all complaints in a fair, lawful way, and the protocols and systems implemented to achieve this constitute reasonable administrative action. Furthermore, the ANC supported clause 42(2) for the following reasons. The Fund must be capable of speedily investigating any incident reported to it and it must exercise its investigating powers in a fair, non-prejudicial, and transparent manner. The outcomes of such investigations must be speedily reported within stipulated timeframes. Where deemed necessary, the investigation unit should be able to forward and furnish relevant information about specific incidents to other bodies such as the Health Professional Council, the National Consumer Commission and the South African Police Services.  

The Chairperson said that due to technical difficulties the Committee would continue with its clause-by-clause deliberations next week Wednesday. Any other discussion the Committee wanted to have and the minutes it wanted to adopt would be held over to the next meeting.

Ms Wilson raised a concern that the Committee was not seeing the political office-bearers. The Deputy Minister is not in the meeting. The Committee had not seen the Minister for a long time. At the end of the day, they would be the ones who would be held accountable. There came a point where the Committee needed to see their faces. That was what the members were there for and whom they held to account. The Committee was not seeing them at all. She had issues with that. They needed to be present on a more regular basis.

The meeting was adjourned.