Protocol on health in South African Development Community: briefing

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Meeting report


27 October 1999

Documents distributed :
Protocol on Health in the Southern African Community
Presentation document : Protocol on Health

A Member of the Department of Health and representative of the South African Development Community (SADC) briefed the Select Committee on the origin, timeframe, status and content of the Protocol on Health. It has been drafted in the terms of the SADC Treaty and is aimed at promoting cooperation and harmonisation among SADC Member States in health related matters. It includes provisions for the promotion of health education, development of information systems and measures for treatment of HIV/AIDS. Consultation is scheduled for February 2000 with the Protocol to be tabled in March/April 2000. It is hoped that it will be ratified in July 2000.

Historical Background
Catherine Makwakwa of the Department of Health introduced the Protocol by explaining the background to SADC. She explained that the health sector was established under the SADC Treaty in 1997 when, during WHO AFRO 47, the SADC Ministers of Health decided on the establishment of the health sector. The decision was relayed to the SADC Council of Ministers meeting in Blantyre, Malawi, at the same time, which allocated responsibility for the health sector to South Africa. The health sector unit is based in Pretoria and is headed by Dr Thuthula Balfour and a team of four staff. Ms Makwaka stressed that at no stage did South Africa lobby for coordination of the sector.

SADC Profile
Ms Makwaka explained the institutional framework to SADC. Formerly known as the South African Development Coordination Conference (SADCC), the organisation was developed in Lusaka, Zambia on 1 April 1980. In 1992 the South African Development Community (SADC) replaced the SADCC. Its Member States are Angola, Botswana, Democratic Republic of Congo, Lesotho, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, Seychelles, Tanzania, Zambia and Zimbabwe. Its headquarters are in Gabaronne, Botswana. Each Member State has a responsibility to coordinate a sector or sectors on behalf of the other Member States.

Allocation of Sectors
Ms Makwakwa explained that sectors are allocated in consideration of Articles 21 and 22 of the Declaration of the Treaty and Protocol of SADC which stipluates that member States shall cooperate in all areas necessary to foster regional development and integration and harmonise macro-economic strategies.

Dr Thuthula Balfour, Director of the SADC health sector unit, confirmed that the Protocol has already been signed by the Minister on behalf of South Africa but it is only effective in any country once it has gone through the constitutional requirements of that country (resolution by both chambers of Parliament in South Africa). The Protocol must then be approved by two thirds of all Member States before it will come into effect.

Development of the Protocol
Dr Balfour explained that Member States had agreed on the need for the Protocol in 1997 and a draft document was subsequently produced. Member States then consulted with stakeholders and convened at a 3 day workshop in February 1999 at the end of which the Protocol was accepted and submitted to the Council of Ministers in August 1999.

Main Provisions of the Protocol
Article 1 : definitions
Article 2 : sets out the principles on which the documents are founded. Its aim is to produce an acceptable standard for all.
Article 3
: sets out the objectives of the Protocol. Dr Balfour highlighted epidemic preparedness including communicable and non communicable diseases, utilisation of health personnel and facilities within SADC, work with external partners such as UNICEF, harmonisation of policies, collaboration with other SADC sectors.
Article 4 : sets out the institutional mechanisms of the sector so as to legalise them and confirms that the health sector unit is funded by South Africa.
Article 5 : deals with the financial provisions and states that Ministers should fund themselves to attend meetings therefore Member States should budget for this.
Article 6 : health systems, research and surveillance for both communicable and non communicable diseases.
Article 7 : deals with health information systems to ensure good quality health data.
Article 8 : deals with health promotion and education
Article 9 : is a very important provision which provides that parties are to cooperate to harmonise policies. For example, WHO guidelines in respect of polio are not followed in all member States. This provision would enable the identification of certain laboratories as reference laboratories which other countries could then use.
Article 10 : deals with the standardisation of policies aimed at the prevention of HIV/AIDS
Article 11 : Malaria control. Dr Balfour stated that this provision was less important for South Africa and Lesotho. The protocol provides for the establishment of efficient mechanisms for the effective control of malaria in the region.
Article 12 : TB control. Dr Balfour stated that due to the seriousness of the disease and the increasing rate of resistance to treatment the Protocol aims to standardise treatment and so facilitate cross border treatment.
Article 17 : Reproductive and adolescent health. Provision is made for Member States to formulate coherent strategies and procedures for reproductive health, including fertility control.
Article 18 : Health Human Resource Development. The Protocol provides for the standardisation of curriculae and exchange programmes to train doctors in other Member States. The provision is to be read in conjunction with the Protocol on Education and Training but defines further areas of cooperation.
Article 19 : Health care resources. Member States shall share experience relating to the mobilisation of funding resources.
Article 20 : Traditional health practitioners. Member States shall endeavour to develop mechanisms to regulate traditional practices. Dr Balfour explained that this provision was drafted in largely open terms as it was recognised that the issue of traditional health healers was a polarised one which divided Member States. It had therefore been phrased in such a awy as to try to cater for everyone's needs.
Article 27 : Health Technology Equipement. This provision provides for the sharing of information, training and skills relating to the maintenance and procurement of equipment.
Article 28 : Referral systems. Dr Balfour stressed the importance of this provision to promote the cooperation between Member States in the harmonisation of policies, strategies and procedures regarding tertiary care services.
Article 29 : Pharmaceuticals. Member States must cooperate in harmonising procedures for registration of pharmaceuticals. Dr Balfour explained that this was a big issue as currently registration was not obligatory for all Member States.

Dr Balfour outlined the proposed timetable. It is proposed that consultation will take place in South Africa in February 2000 and the Protocol will then be submitted to Parliament in March/April 2000. Dr Balfour stated that it was hoped the Protocol would be ratified by July 2000 and would then be submitted to the summit on September 2000. Dr Balfour stated expressed her hope that the South Africa would approve the Protocol as, as host of the health centre, it would give valuable impetus and confidence to other Member States.

Questions by committee members
Ms S Ntlabati (ANC) : The Department of Health in South Africa recognises violence as a public priority. Should this not be included?
Response : Violence is very important but there is a provision relating to the prevention and treatment of trauma which incorporates violence in its ambit.

Ms S Ntlabati (ANC) : In relation to Article 10, should there not be a means of facilitating negotiation before July 2000 at local level as in the Free State in particular it is not an easy task to negotiate with neighbouring countries ?
Response : The health sector has identified HIV/AIDS as its first priority and has already established a task force to lead activities for all Member States. Therefore, SADC cooperation on the issue is on-going even during the ratification process.

Ms S Ntlabati (ANC) : But my concern is primarily relating to devolving planning in this area to the provinces without having to go through the cumbersome route of international agreements
Response : There are instances where the national council can delegate certain matters to local level. The task force is still working on mechanisms to ensure collaboration between neighbours but it is necessary to start from a broad framework and filter responsibility downwards.

Ms S Ntlabati (ANC) : I take issue with your comment that the issue of malaria is of little importance to South Africa. There is a significant amount of malaria in Northern Natal and we do not know whether this will spread.
Response : I was speaking comparatively. It is true that malaria is a problem in South Africa and has increased from some 10,000 to 30,000 cases. We must ask ourselves how far the liberalisation of borders has contributed to this increase. This increases the importance of implementing measures in other Member States.

Ms S Ntlabati (ANC) : In relation to Article 18, health human resource development, currently countries such as Lesotho send patients to Europe or the USA for treatment. Yet they have no common problems with these countries. They do have problems in common with South Africa and in my view should receive training from South Africa.
Response : I agree.

Mr P Qokweni (UDM) : It is often necessary to amend local law to give effect to international treaties. How far has this process gone? Have lawyers looked at this document?
Response : The Protocol was drafted by the Department of Health legal unit which then met with the legal unit of the Foreigh Affairs Department to scrutinise the Protocol and ensure it is in line with current policy.

The Chairperson, Ms L Jacobus, (ANC) : are you in a position to say whether any new pieces of domestic legislation will flow from the Protocol?
Response : The Protocol is not prescriptive. There remains a great deal of discussion to take place to finalise the detail of many of the policies. It is not possible to say whether any amendment will be necessary until those details are finalised.

The Chairperson : Are the provisions in the Protocol relating to training and education compatible with the SADC Protocol on Education and Training?
Response : The Health Protocol was finalised in Botswana and so recognises the Protocol on Education and Training. Because the Protocol on Education and Training has already been ratified it will be implemented before the Health Protocol.

The Chairperson : What has taken place already by way of consultation?
Response : The National Health Consultation Forum has consulted with provinces, universities, NGOs and relevant private sector organisations. Further consultation is scheduled in March 2000.

Dr P J C Nel, (NNP) : I am encouraged to hear that South Africa will be able to share its policies and experience on issues such as notifiability of diseases. Do you have an idea of the number of SADC countries in which HIV/AIDS is a notifiable disease?
Response : It is in areas such as HIV/AIDS that we would like to see a greater interchange of information on the pros and cons of notifiability. Currently two Member States are in the process of making HIV a notifiable disease, these are South Africa and Namibia. However, the implications of notifiability are uncertain.

ANC spokesman : Have all the countries signed the Protocol?
Response : The Protocol has been signed by all the countries and we are now in the process of taking it forward to ratification. The first countries will do so in February 2000. It appears that Tanzania will be the first to ratify the Protocol.

ANC spokesman : How is the extra funding to be accessed?
Response : It is the duty of the unit to raise the necessary funds with assistance from the Minister.

ANC spokesman : How is health data compiled?
Response : The compilation of accurate data is critical. A sub-committe will be set up to ensure data is accurately complied.

ANC spokesman : In relation to the provisions on prescriptive healing, what does it mean if one party chooses to standardise its policies and another decides not to?
Response : The Protocol tries to be non prescriptive and to accomodate all countries. It is very difficult to make harmonisation obligatory as evidenced by the problems experienced in Zimbabwe, a country which was having severe difficulty in doing so.

The Chairperson : Does the Protocol represent a move towards the recognition of degrees of other Member States?
Response : This issue is dealt with under the Protocol on Training and Education which provides for the transfer of credits between Member States.

Ms Ntlabati (ANC) : In the final analysis, however, recognition of qualifications is not the sole responsibility of the Department of Health. The key party is the councillor.
There was no response to this comment.

The Chairperson then thanked Ms Makwakwa and Dr Balfour for their enlightening input and stated that the Select Committee was in the best position to interract with the provinces. She stressed the importance of keeping the timetable in mind and suggested the Protocol be discussed again by the Committe when it reconvenes in 2000.

The Chairperson confirmed that there would be no formal consideration of the Pharmacy Amendment Bill as the National Assembly was still considering it. It was due to be debated in Parliament on 16 November 1999 and would come to the Select Committee after that.

The Chairperson then explained the programme until 19 November 1999 :
1-8 November 1999 : Constituency week. Members of the Committee were expected to use this week to look at the quality of welfare in their own constituencies, concentrating on regional offices, the procedure relating to border visits and community doctor services. The Chairperson recognised that for some members of the Committee it would not be possible to touch on every area but every member was expected to touch on some of them.

10 November 1999 : Meeting with the Department of Health. Neither the Minister or the Deputy Minister would be able to attend as there was also a cabinet meeting on the same day. The Pharmacy Amendment Bill would also be discussed on that day.

12 & 13 November 1999 : Health summit. All members of the Select Committee were expected to attend.
17 November 1999 : it was planned to arrange for the Director General of Home Affairs to brief the Committee on the White Paper on Migration.

29-31 November 1999 : Health visit, Kwa-Zulu Natal.

The Chairperson reminded the Committee of the importance of regular attendance.


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