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SOCIAL SERVICES SELECT COMMITTEE
8 June 2004
DEPARTMENT OF HEALTH BUDGET: BRIEFING
Chairperson: Ms J Masilo (ANC)
Documents handed out:
Presentation of National Department of Health Strategic Plan 2004/05
National Department of Health Budget 2004-2007
National Department of Health Budget Vote
A delegation from the National Department of Health briefed the Committee on their strategic plan and budget for the year. They discussed their performance over the past ten years and their proposals for the future. Questions and answers followed with the migration of health-workers, particularly nurses, a recurring theme of the discussion.
The Department's delegation consisted of Dr Kamy Chetty, the Deputy Director General, Dr Yogan Pillay, the Chief Director of Strategic Planning and Mr Andre Venter, the Director of Finance. Dr Chetty gave an overview of the Department's achievements, reached via its "ten-point plan", over the past ten years. For further information on their achievements, the Committee was advised to consult the Department's "ten year achievement" booklet. Dr Chetty itemised each point of the "ten-point" plan, emphasising those which were pertinent to the future. She also discussed challenges facing the Department.
Dr Pillay briefed the Committee on "Financing Health Services", dividing his presentation into three "programmes", viz. administration, strategic health programmes: districts and developments and health service and delivery. When he gave his budget presentation, Mr Venter broke the budget down to these categories, specifying expenditure within them. He compared the previous budget with this year's, explaining variances between them.
Dr Pillay noted that the Department's strategic plan had been drawn up before the elections. Since then they had been issued with a new mandate, requiring some modification of the plan.
Due to time constraints, Ms Masilo requested that each Member be allowed one verbal question and that other questions be submitted in writing to the Department, which would have to answer them within the week.
Mr T Setona (ANC, Free State) asked whether any research had been conducted on the actual costs of public sector personnel and international employment opportunities for health professionals and whether the Department had made any interventions to stop the outflow of these professionals.
Mr Buthelezi (a delegate from KwaZulu-Natal) asked whether the province had received its share of the Global Fund for HIV/IDS, Tuberculosis and Malaria funding.
An MP requested more information on environmental health services and its accompanying infrastructure.
Dr Pillay responded that environmental health was a municipal function, although the Constitution did not clearly define their role. The National Health Bill would address this issue. Ms Masilo requested that the document be sent to all Members to which Dr Pillay agreed. The Department had a number of activities which needed separation, including environmental health on which they collaborated with the Department of Provincial and Local Government.
Rev E Adolph (ID, Western Cape) asked the DDG about the Department's intention to get rid of the backlog on assistive devices by the end of the financial year and whether the Department had the resources to do so.
Ms M Madlala-Magubane (ANC, Gauteng) asked about the youth and substance abuse and whether the Department was working with the Department of Social Development on this issue.
Mr M Thetjeng (DA, Limpopo) commented that the Department had not presented enough specifics and their performance as a whole could thus not be properly monitored. His main complaint was that targets were not tangible enough. He also said that in certain provinces there were clinics that were not operating.
Regarding the closure of clinics, Dr Pillay noted that this had come to the Department's attention and that some provinces claimed a lack of human resources responsible. This was especially so in disadvantaged areas. Security was a big issue as staff often felt unsafe. The Department was hoping to encourage communities to play a larger role. Ms Masilo added that the government also had a responsibility and perhaps better policing was necessary.
Mr A Sulliman (ANC, Northern Cape) asked about communicable diseases and how the Department interacted with SADC countries and the world at large in dealing with them. Dr Chetty replied that co-operation with SADC countries was superb. Regarding malaria and the use of DDT, they were co-operating with Zimbabwe and Mozambique as they shared the Lubombo Special Development Initiative. There was a rollback malaria campaign, as there was for polio.
Mrs Noel (a special delegate from Durban) commented on the "braindrain" of nurses from SA stating that a lack of respect for and recognition of the work nurses did was a major factor in the outflow. The assumption that nurses left because of salaries and working conditions was inadequate.
Ms Masilo congratulated the Department on trying to increase the use and distribution of femidoms, and asked if there was a roll-over regarding conditional grants. She also asked about the relationship between the Departments of Health and Public Works...
Ms H Lamoela (DA, Western Cape) asked if SA had enough nurses and health workers in training, especially given the present outflow. Apparently, she had heard that 7000 nurses were leaving every year and that only 1 000 were in training.
The DDG responded that there were many issues around the migration of health workers, and a lot of research had been done on it. The World Health Organisation had carried out a six-country research project on this issue. Accurate accounts of where workers were moving were important, but this was not always possible as some nurses were still registered in South Africa while working overseas. The six-country report showed that a key reason for migration was a desire for international exposure. Obviously, though, poor working conditions, remuneration and family needs were also factors. There were a number of push-pull factors. The pull factors were very difficult to compete with, particularly the desire to earn foreign currency. Push factors were more under the Department's control. The DDG noted, too, that South Africa had been instrumental in instituting the Commonwealth Code with its Ethical Recruitment Code. The code was globally relevant and served to protect our workers. Regarding intervention, agreement had been reached with the United Kingdom about the placement of their workers in rural areas.
Regarding resources for wheelchairs and other assistive devices, R13 million had been allocated for this year, and R4 million for the following year. There were also donated funds that could be used. On substance abuse, the DDG indicated that there a programme targeting the youth and a counter-advertising strategy was planned. Substance abuse was linked to violence and suicide.
Regarding the lack of respect for the professional role of nurses, Dr Chetty noted that this had been shown by surveys. Rural allowances had been extended and conditions of employment had been examined. Surveys by the Democratic Nurses Organisation of South Africa (DENOSA) had showed that a lack of respect from patients was also a problem.
On hospital services and maintenance, Dr Chetty noted that the Department of Public Works was responsible though a number of provinces were looking at how these could be transferred to the control of the Department. Regarding human resources, Dr Chetty said a prominent issue was the distribution of nurses across the urban/rural, and public/private divides. Certain categories were in short supply. There was supposed to be a ratio of one professional to every two staff nurses, but this was the other way round. She was not aware of the figures quoted by Ms Lamoela and thought that they might be an inversion of the last count from the Nursing Council. There had been a decrease in the number of South African nurses in the UK since June last year and there were now fewer than 2000. She emphasised the need for caution when dealing with statistics.
Mr Venter said there had been a misunderstanding regarding the Global Fund donation due to reporting by the media. He thought there had been a public apology from the media. At issue was the Department's capacity for dealing with funds, but at present no funds needed to be disbursed.
Dr Pillay added that 60% of the Department's budget was spent on human resources. They were very serious about this and had created an entire branch devoted to it.
Mr J Thlagale (UCDP, North West) thanked the DDG and Director-General, but pointed out that the responsibility of the members of the NCOP was their provinces. However, the debate so far had not been focused on provincial matters. This was difficult in the absence of specific information from the Department. He wanted to know whether the provinces were given separate allocations.
Mr Pillay responded that the Public Finance Management Act (PFMA) required the Department to account for its expenditure, but not for provincial expenditure. He noted that when the National Health Bill becomes law, a national expenditure plan would be required.
Mr A Sulliman (ANC, Western Cape) asked for clarification on intended expenditure.
Ms M Madlala-Magubane (ANC, Gauteng) asked if the Medical-Legal insurance extended to mortuaries and wanted to know more about the upgrading of the Pretoria Academic Hospital and other academic hospitals. She also asked for a departmental organogram.
Mr Venter responded that mortuaries were included in the insurance cover. The Department had had to fight for funding for the Pretoria Academic Hospital project as it had a history going back to the last dispensation. Other hospitals were catered for under the revitalisation programme. Mr Venter told the Chairperson that they would make an organogram available. There would be some changes to this organogram as the Minister was very sensitive to gender issues.
Mr Thetjeng (DA, Limpopo) asked for more information on the Department's staff composition. He also asked about the social security grants and whether they related to the Department of Social Development. He noted that a doctor was required to recommend whether or not a person should get the grant. People with epilepsy did not seem to get grants and were often fired from their jobs.
Regarding disability grants, Dr Chetty said there was a need to work more closely with the Department of Social Development and that a single tool to work with the grants and services of both Departments was to be created. He acknowledged that there had been abuse of disability grants and that their growth was unsustainable. In the last year, for instance, grant payments had grown by 40%.
Mr Buthelezi, a special delegate from Kwazulu-Natal, asked when the department would get a Director-General and also about the employment of district surgeons. Dr Chetty responded that the post of Director-General was a concern; the post had been advertised last year, but it had been deemed sensible to hold interviews after the elections. Regarding district surgeons and the National Health Bill, he pointed out that the Department was awaiting a response from the President's Office. An evaluation of district surgeons had shown that there had been much abuse of their offices and a need for them to be monitored was identified. Consequently, the position had been made redundant and contracted doctors provided services to the public sector.
Rev Adolph (ID, Western Cape) asked about delivery programmes and for more detailed budget information.
Regarding buildings, Mr Venter said that funds were allocated in the Department's budget and they then negotiated with the Department of Public Works that put services out to tender. Ms Masilo asked if the Department monitored the Department of Public Works and received reports from them. Mr Venter replied that this was the case and that the Department was closely involved.
Ms Masilo noted that there were still many outstanding issues and suggested that the Committee plan a one-day workshop for a broad presentation before the Winter Recess. She also noted that she would like to see Ministers and Deputy Ministers at Committee meetings in future.
The meeting was adjourned.
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