Traditional Health Practitioners Bill: informal discussion

Meeting report

PORTFOLIO COMMITTEE ON HEALTH
11 August 2004
TRADITIONAL HEALTH PRACTITIONERS BILL: INFORMAL DISCUSSION

Chairperson: Mr L Ngculu (ANC)

Documents handed out
Traditional Health Practitioners Bill (B66 - 2003)

SUMMARY
The Committee met to informally discussed the Bill clause by clause, prior to a more formal reading planned for the near future. The Department Human Resource Director and two State Law Advisors assisted with questions. Members mainly focussed on definitions, minimum training for Council membership, practitioner registration requirements, and mental health exclusions.

MINUTES
The Chairperson recommended that the Committee work through the Bill clause by clause to achieve consensus on the terms and definitions. They would undertake an informal appraisal of the Bill, and then at a later stage formally consider the Bill. They would need a quorum of no less than ten members to approve the Bill.

Definitions
Members mainly interrogated the definition of 'master'. The Bill stated that this "means a person registered under any of the prescribed categories of traditional health practice who has been accredited by the Council to teach traditional health practice or any aspect thereof".

Mr R Coetzee (DA) inquired whether all persons engaged in instruction were male. If not, then the term could be construed as sexist. The Chairperson agreed that the term had a negative connotation as female instructors did exist.

Mr I Cachalia (ANC) proposed the term "tutor" would be more acceptable.

The Chairperson suggested that the Committee consider the more specific term of "professional traditional health practitioner".

Mrs N Dlamini put forward the term "principal" as trainers tended to instruct a group. The Chairperson countered that sometimes instruction would involve one person, therefore the term "principal" was inappropriate.

Mr Coetzee asked whether a specific African term existed to describe the role of "master" but suggested that such a term might prove difficult to translate into English. The term "tutor" was favoured. The Chairperson indicated that a number of terms existed in African languages but agreeing to one could be problematic e.g. a different term existed in Xhosa and Zulu.

Mrs Dlamini proposed the term "traditional tutor". The Chairperson reminded the meeting that "tutor" would automatically be associated with traditional practice. Mrs C Booysens (State Law Advisor) agreed that the "tutor" would be sufficient to determine specificity of the occupation.

Mr S Njikelana (ANC) recommended that "traditional tutor" was acceptable as "traditional birth attendant" was used in common parlance.

Mr Cachalia emphasised that the legislation made clear reference to traditional health practice in terms of the proposed "tutor" and further specification was not necessary.

Ms Ngcobo agreed that "traditional birth attendants" were in practice and "traditional tutor" would suffice.

Mr S Nxumalo proposed the term "traditional health tutor" to provide greater clarity.

Mrs T Mdlalose (Department) proposed that the term "tutor" could refer to other practices such as academia or nursing and contained a universal connotation. It was proposed that the Committee consider "traditional tutor" in order to make sufficient distinction.

Ms Ngcobo regarded the term "tutor" as too open-ended and required further specification.

The Chairperson proposed the term "traditional tutor" was acceptable and Members agreed.

Chapter 2: Establishment and Governance of Interim Traditional Health Practitioners Council

Clause 5 (f)- Standards of training of traditional health practitioners.

Ms M Manana (ANC) and the Chairperson enquired how the Council planned to enforce certain standards in training.

Mr Nxumalo stated that the Council was being established to create a framework for acceptable standards and requirements.

Mrs M Madumise (ANC) stated that "minimum requirements" did not refer specifically to academic standards but was related to standards as practised in the traditional context.

Mr M Motsapi (Department Legal Services) reiterated the need for practitioners to undergo sufficient training before registration.

Mrs Dlamini said that the Bill allowed traditional healers to undertake external training to improve themselves e.g. university training. Traditional healers were not opposed to the setting of minimum standards.

Mr Nxumalo suggested that the sentence under review contained two meanings, namely the need for prospective traditional students to have minimum standards prior to training, or that certain standards had to be achieved after completion of training.

Mr Njikelana said the sentence referred to standards after traditional training. The confusion arose when one considered relevant departments and assessment bodies to be involved. He recommended introduction of the term "peers". The Council would need to consult with groups that conducted quality assessment on a peer review basis to compare standards in different regions. It was proposed that "relevant Departments" be removed and replaced by "quality assessment groups".

The Chairperson suggested that the definitions of "accredited institutions" could serve as peer-review mechanisms.

Chapter 2, Clause 6 (i) - Training minimum requirements
Mr Coetzee had a problem with 'in' as it implied joint consultation. He proposed that they consider 'after' consultation instead, as the relevant Departments, bodies etc. would be consulted but this would not have to occur jointly. The Chairperson agreed and recommended that Members return to the issue at a later stage.

Mr Coetzee also recommended that the proposed Council publicise that avenues were available for complaints on treatment by traditional healers. The Act does not make adequate provision for this. The Chairperson agreed, as did Mr Motsapi who recommended that the provision be included under Clause Two.

Chapter 2, Clause 6 (2 c)
Mr Coetzee enquired about the issues of "matters of democracy and equity" on which the Council should advise the Minister. Could Members suggest an example?

Mr Njikelana responded that the intention of the present Bill was to incorporate traditional healing into the present dispensation governed by the Constitution and the Bill of Rights. Traditional groups were aware of their responsibilities within a democratic framework and acknowledged that criticism could be levelled where appropriate.

Mr Coetzee remained concerned about clarity but saw no harm in the Council advising the Minister on matters of democracy.

Mr Motsapi indicated that the intention of the clause was to place the Bill within the framework of the Bill of Rights and the Constitution.

Ms Mashigo (ANC) asked whether the three-year length of study proposed by the Bill was appropriate.

Mrs Mdlalose stated that the study period was referred to in the regulations as an apprenticeship and not formal schooling. It specified a minimum of three years and encompassed a system of tests.

Ms Ngcobo recommended that 'in consultation' remain as it referred to an ongoing process.

The Chairperson continued with the deliberation focusing on the Constitution of the Council.

Mr Coetzee felt that the Bill did not adequately cover the public' right to complain after receiving traditional treatment.

Ms Ngcobo agreed that communication was needed as the public was not aware of developments in legislation pertaining to traditional healing.

The Chairperson referred to the State Law Advisors to provide legislation compelling the Council to communicate such rights to the public.

Chapter 5, Clause 46 (4)(1a)
Mrs C Booysen referred to the requirement that the Bill t be published in the Government Gazette and inquired whether this was sufficient or whether an insertion was necessary.

The Chairperson asked that a clause be inserted that spelt out the duties of the Council in terms of communication.

Chapter 2, Clause 7 - Council membership
Mr Njikelana proposed that five years experience was inadequate for a practitioner to qualify as a Council Member.

Mrs Dlamini felt that five years was adequate as there was much interaction with learned and experienced practitioners.

Mr Nxumalo indicated that the process of selection and appointment to the Council would be conducted by experienced people mindful of adequate standards. A concern was raised with Clause 7 (f) and (g) that referred to medical practitioners and pharmacists. This appeared out of place in the context of traditional healing.

The Chairperson reminded the Committee that traditional healers had a role to play in the provision of health care and therefore there was a need for co-operation between Western and traditional practitioners.

Mr Coetzee raised a concern about the inclusion of a representative from each category of traditional healers. It appeared that the government wanted to include nine traditional representatives and nine non-traditional within the Council.

Ms Ngcobo said Councils were created in this manner as standard practice. It was necessary to include representatives from all aspects of traditional healing on the Council and the membership was determined following nominations from all provinces.

Mr Nxumalo indicated that the inclusion of all strands of practice would increase the membership beyond the 22 stipulated in Chapter 2, Clause 7.

The Chairperson stated that the intention was to ensure that all streams were represented but there remained doubt over the number of categories.

Mrs Dlamini responded that the four streams within traditional healing certainly needed to be incorporated: diviners, herbalists, birth attendants and traditional surgeons.

Mr Coetzee asked whether any bodies currently existed for traditional healers and whether such bodies could appoint representatives to the Council.

Ms Ngcobo reiterated that the composition of the Council was in accordance with prescribed rules.

Chapter Three - Registrar, Staff of Registrar and Registration Procedures

Clause 21 - Application for registration to practise
Mr Njikelana said the character reference requirement in Clause 21 (2b) (ii) was open to potential abuse.

Mrs Dlamini said the intention was to allow community members to support a particular applicant in terms of his/her ability and standing within the community.

Mr Dlamini supported the clause and emphasised the community-based nature of the requirement.

The Chairperson indicated that the Minister could, on recommendation of the Council, specify the minimum standards applied in the registration of practitioners in the various existing categories.

Mrs Dlamini agreed that the Council should determine the criteria for minimum standards.

Clause 23 - Removal from and restoration of name to register
Mr Coetzee said that Clause 23 (1l) referring to mental illness as grounds for removal of the practitioner, was too vague. Depression did not prevent other professionals from continuing in their occupations. The Chairperson responded that the term seemed appropriate.

Mrs Booysen indicated that this requirement could be linked to the inquiry of impaired registered persons in Chapter 4, Clause 40.

Ms Manana added that this requirement could fall under Chapter 2, Clause 9(d) indicating disqualification from the Council on the grounds of having a mental illness.

Mrs Mdlalose referred to the possibility of practitioners succumbing to drug or alchohol abuse that would render them impaired.

Mr Coetzee asserted that Chapter 2, Clause 9(d) was not appropriate as it could be construed as too punitive and discriminatory. Depression should not serve as adequate grounds for dismissal.

Ms Manana posited that a practitioner needed to be diagnosed seriously mentally ill before he/she could be removed from the profession.

Mrs Mdlalose proposed the introduction of a prefix to Chapter 3, Clause 23 (l) that indicated certifiable mental illness before removal proceedings were instituted.

Mr Motsepi suggested that before a practitioner could be removed, regulations under Chapter 4, Clause 40 should be followed.

The meeting was adjourned.