Department Budget Briefing

Meeting report

HEALTH AD HOC COMMITTEE
31 May 2004
DEPARTMENT BUDGET BRIEFING

Chairperson: Mr L Ngculu

Documents handed out:
National Department Budget 2003/04 and 2004/0
Pharmaceutical Policy and Planning
HIV-AIDS and TB Programme
Districts and Development

SUMMARY
The Committee was briefed by four directorates within the Department. The directorates outlined their functions, their budgetary allocations, their strategic plans as well as some of the challenges faced.
Much discussion ensued over specifics lacking in the briefings as the Committee was intent on obtaining detail from the Department.

MINUTES
Deputy Minister Nosiviwe Madlala-Routledge was present at the meeting as were representatives from the Department. The Acting Deputy Director General, Ms N Matsau noted that the briefings were intended to provide the required detail that Members had wanted on the performance of the Department. Due to time constraints only the following four cluster briefings could take place.

Financial Services
Mr G Muller, the Chief Financial Officer reiterated the comments that he had made on the Department's budget at the briefing on 25 May. However he concentrated on the comparisons and variances for the financial years 2003/2004 and 2004/2005.

Pharmaceutical Policy and Planning
Mr H Sokufa, Cluster Head: Pharmaceutical Policy and Planning, said that food control and safety as well as accessibility to affordable medicines were amongst the goals of his cluster. He highlighted some of the cluster's strategic plans which included the implementation and monitoring of all aspects of the medicine pricing regulations, consolidating the licensing activities related to pharmacies and health professionals who want to dispense medicines as well as pursuing the establishment of the New Integrated Food Control System. He pointed out that revising the National Drug Policy of 1996 and the State's compliance by July 2005 to the requirements of the Pharmacy Act and the Medicines and Related Substances Act of 1997 were amongst the challenges that the Department had to face.

HIV-AIDS and TB Programme
Dr N Simelela, Head of the Programme, provided the Committee with budgetary information on the programme. She set out specifically how the total budget had been allocated for 2004/5 and how it had been spent the previous year. She made particular reference to the conditional grant expenditure in the provinces especially since it made up a great deal of the expenditure. She concluded by highlighting the programme's achievements in HIV prevention, community based care projects and voluntary counseling and testing.

Districts and Development
The Head of Districts and Development, Dr T Wilson, briefed the Committee on the responsibilities of this cluster. Amongst the responsibilities were the district health system, monitoring the implementation of the public health package as well as rural development and urban renewal. He set out the strategic objectives and the operational plans that had facilitated the meeting of these responsibilities.

Discussion
Dr I Cachalia (ANC) asked Mr Muller for clarification on why there had been a small decrease in the budget for the District Primary Health System.

Mr Muller answered that the budget for the district health systems was for the national Department. The funds should be made available at provincial level where the actual work was being done.

Ms M Manana (ANC) asked for specifics on the Department's donor funders. She made reference to a previous statement about a report on health monitoring and evaluation being available. Ms Manana asked for the report to be furnished to the Committee.

Mr Muller stated that there should be a balance between the usage of the Department's own funds and that of donors for various activities. He was not concerned about the slight decrease in donor funding. He agreed to forward a report on donor funding to the Committee. He pointed out that a five-yearly survey had been done on health monitoring and evaluation. The cost of the survey had been R26m and asked a colleague, Dr Makobalo when the results of the survey would be available.

Dr Makobalo answered that the results would be available within the next few months.

Mr Y Wang (Independent Democrats) said that he had done research in the USA and Taiwan on pharmaceutical systems. He asked what the budget was for the system to be used, whether it would be implemented in phases and what type of technology would be used. He felt that the system should also allow for the tracking of doctors. He picked up on the importance of tracking doctors during discussions in the Home Affairs Portfolio Committee meeting.

Mr Sokufa conceded that a costing of the pharmaceutical system had not yet been done. He noted that discussions were taking place on what was needed. The Department together with the provinces was considering possibilities.

Mr Njikelana (ANC) asked why District Health was so dependant on donor funding. He asked how public-private partnerships were financed and to what extent did the private sector make any inputs. To what extent did public forums influence the budget of the Department? Lastly he asked if there were any budget allocations for partnerships on HIV-AIDS.

Ms Matsau emphasised that heavy dependence by the Department on donor funding was undesirable. She noted that donor involvement had been by default as their assistance had been required in the early days of capacity building and skills development. She felt that greater donor involvement often leads to consequences that were undesirable. That is, the focuses of provinces would be dislocated from what the national Department expected from them.

Ms Matsau reiterated the inequalities that had existed in public-private partnerships in the past. She said that the Department was embarking on a new approach of having well articulated management accountability contracts in place. The Department had in the past always funded the partnerships.

Ms Matsau noted that people's forums did make recommendations to the Department. She pointed out that a great deal of work was being done in this regard by both the national Department and the provinces. Ms Matsau conceded that there could be greater interaction between the Department and people's forums. She said the Department often appointed co-coordinators to report on activities in the provinces and as a result there were budgetary implications. It also came to light that R5m was available for HIV-AIDS.

The Chair referred to the Pharmaceutical Policy and Planning presentation and noted that the Committee had been informed that the directorate had a budget of R28m, but no information had been provided on how it was being spent or whether it had been sufficient. The presentation came across as a to-do list. It failed to provide information on what had already been done. It gave the impression that the Directorate was still being established.

Mr Sokufa conceded that the aim of the presentation had been to inform on what was still to be done. He noted that a great deal of work had already been completed and that the budget for 2003/04 had been sufficient. Mr Sokufa agreed to present a comprehensive breakdown on work done within the Directorate in the near future.

Members commented that much detail was still needed from the Department on various issues. The Committee agreed that the Department would in the future present on matters that were outstanding.

Ms R Mashigo (ANC) felt that cross border services should receive more attention.

Dr Wilson said that the fragmentation and duplication of services across borders was being addressed. He noted that once a single public service was in place, proper interaction would be achieved.

The Chair asked how Dr Wilson felt about the 14% decrease in his budget. The Chair felt that the district health system was not being optimally used. There should be greater focus on the shift towards a single public service. He asked Dr Wilson to comment. The Chair also asked how the reclassification of municipal health services to environmental health services would affect the delivery of primary health care.

Dr Wilson answered that the decrease might seem small to many but it was being felt, given the great dependence on donor funding. He agreed that the shift to a single public service would see great improvements in district health delivery. By January 2005 a framework should be in place and by January 2006 legislation would be enacted for a single public service. He added that rationalisation was currently taking place within local government.

Dr Wilson stated that the change to a narrower definition from municipal to environmental health services was required to prevent the further fragmentation of budgets. The recommendation had been that most of the responsibility of primary health should lie with the provinces. Budgets should thus lie with provinces as it was implied that local government no longer had budgets for primary health care. He stated that National Treasury had been advised to fund provinces so that they would be able to take over the function.

Dr Wilson ventured his opinion that politicians should make a decision as to whether municipalities could be allowed to contribute funds towards primary health care if needed. He remarked that some metros were well funded and could easily assist provinces in the provision of health care.

Dr Cachalia noted that budgets for mental health and substance abuse treatment seemed small. He got the impression that mental health was being neglected. He asked if SA had enough psychologists, psychiatrists and the facilities to meet the demands of mental health.

Ms Matsau agreed that the budget on mental health was small. She explained that work on policy and legislation was being done. She emphasised that the bulk of the work on mental health was done at provincial level. The Department was engaged with a policy to deinstitutionalize certain mental health patients. However communities were not yet ready for the task of caring for mentally ill persons.

The Chair asked why there had not been total expenditure of conditional grants by the provinces with regard to HIV-AIDS and TB Programmes. He also asked why the SANAC Trust was not yet operational.

Dr Simelela pointed out that it was not that provinces were not spending their funds. The problem was that provinces experienced difficulties in journalizing and publishing their spending activities. The Department was engaging in efforts to assist provinces on this. Dr Simelela said that assistance had been ongoing but that it remained a challenge.

She explained that the SANAC Trust had been established as a public entity by politicians. State law advisors however cautioned that politicians were not allowed to do this and nor could they sit on the board of the trust. The trust was to be dissolved and this recommendation was to be put to Cabinet.

The meeting was adjourned.

Appendix:
KEY ISSUES FROM 2004 BUDGET HEARINGS

1. ISSUES RAISED BY MPs

• Community involvement: how are we involving communities at all levels (not just clinic committees and hospital boards)?
• How do we deal with volunteers especially with regard to HBC?
• How are we training volunteers re: HBC
• DOTs supporters not happy that HBCers are getting stipend - how are we dealing with this issue
• How are we educating communities re: non-natural causes of death e.g., traffic accidents (this is not only a Dept of Transport issue)
• How accessible are VCT services?
• There are many complaints about lack of drugs in clinics
• How are we monitoring the DHS implementation?
• What are we doing about youth and adolescent health?
• Need to train more nurses in IMCI (5000 not enough)
• Referral systems don't work - esp referral back from hospitals. What are we doing about this?
• DOH is doing a lot but still not communicating this effectively. Do we have a communication strategy?
• Need special sessions on: HR; SHI; DHS
• Committee wants legislative programme for 2004
• Have been hearing about water fluoridation for years - what progress?
• What progress on mental health? Too few psychiatrists and psychologists; too many chronically ill patients roaming about uncared for in communities
• What progress regarding labelling of bottles (alcohol)?
• When will SHI proposals be tabled?
• Need better surveillance systems
• Need to improve rural health
• What progress on PPPs?
• Do we have a comprehensive HR strategy?
• Need to ensure better sanitation
• Need more details on DHS development, including clinic networks & community participation
• What is being done regarding regulatory and statutory councils - to further transform them?
• Need to expand health professionals to include podiatrists
• How are we dealing with the exodus of health workers?
• What are we doing to improve quality of care?
• Need to improve school health services

1. ISSUES FOR MANAGERS TO CONSIDER WHEN DEVELOPING PRESENTATIONS FOR NEXT ROUND OF PRESENTATIONS

• DOH needs to learn from imbizos held during the elections: this is the key strategy to consult with communities
• Presentations must clearly say what resources both funding and HR the cluster has (2003/4 and 2004/05) and what
• Budget for last 10 years by cluster must be presented which shows how budget has changed to reflect changing priorities
• How are we empowering communities & what resources are we putting in - including funds allocated for partnerships
• Following clusters to present next time: IHL; communication; Strat Planning; hospitals; HR; Maternal child and womens health; Disease Prevention and Control; HIER; Health Financing and Economics; Non-personal health services