Health Department Budget and Strategic Plan: briefing

Meeting report

SOCIAL SERVICES SELECT COMMITTEE
6 April 2005
HEALTH DEPARTMENT BUDGET AND STRATEGIC PLAN: BRIEFING

Chairperson: Ms J Masilo (ANC)(North West)

Documents handed out:
Power Point presentation: Department Strategic Plan and Budget 2005 – 2006
PowerPoint presentation: Department MTEF Budget Schedule 2004 –2008
Department Budget

SUMMARY
The Department of Health briefed the Committee on its Strategic Plan, key achievements, and Medium-term Expenditure Framework (MTEF) budget. The revised estimates for Conditional Grants were also tabled. The Department had faced many challenges in forward planning with the absence of a Director-General for sixteen months.

Members concerns included the reasons for the measles outbreak; the number of patients receiving antiretroviral treatment, which provinces would be building new hospitals, and how hospital boards were appointed.

MINUTES

Department Strategic Plan
Members of the Department delegation included Dr P Mahlathi, Deputy Director-General, Human Resources; Dr G Muller, Chief Financial Officer; and Dr Y Pillay, Chief Director, Strategic Planning.

Dr Mahlathi said his Department had faced many challenges in forward planning with the absence of a Director-General for sixteen months. He gave a summary of their progress, referring to key indicators in child, youth and adolescent health, voluntary counselling and testing, training primary healthcare providers, communicable diseases, the Hospital Revitalisation Programme and the National Health Laboratory Service.

The Department’s Medium-term Expenditure Framework (MTEF) Ten-point Plan until the end of 2004, had been revised and was being used as the major areas of focus for 2005 – 2008. Four programmes had been identified, namely Administration, Strategic Health Programmes, Health Service Delivery and Human Resources.

Discussion
The Chairperson, Ms J Masila (ANC)(North West) said the Committee had conducted some oversight visits and that questions would relate to these observations as well.

Mr M Thetjeng (DA)(Limpopo) asked if figures could be provided for the number of sites that had been accredited to provide antiretroviral (ARV) drugs for AIDS sufferers. In the previous financial year, there had been a lack of capacity in the Hospital Revitalisation Programme. Was capacity available to continue the programme? He also asked about the status of health services in district municipalities.

Ms A Qikani (UDM)(Eastern Cape) questioned how the outbreak of measles had been handled and why TB cases were again on the increase.

Mr J Thlagale (UCDP)(North West) asked which other groups of consumers besides schoolgoing children, were part of the Nutrition Programme. There had recently been controversies and public disagreements regarding the Blood Transfusion Services. To what extent had these issues been resolved?

Mr B Tolo (ANC)(Mpumalanga) said figures had been given for the increase in ‘youth-friendly’ health facilities. What were these increases being compared to? How many citizens were receiving ARVs from state institutions? As regards the increase in TB, he questioned whether patients were receiving sufficient information about their courses of treatment from the Department. He also asked in which provinces the multidrug-resistant TB hospitals had been established, and if the Department could please provide a list of the donor funders.

Mr M Sulliman (ANC)(Northern Cape) asked which provinces would be building new hospitals.

Mr Mahlathi said his Department was investigating the measles outbreak. It was a scientific issue and the Minister had ordered an in-depth investigation into why outbreaks had occurred in particular areas. As regards the increase in TB, he said community healthsorkers catered for all illnesses. They had obtained excellent skills in health promotion. They need to link nutrition programmes with anti-poverty programmes; entire communities needed to be targeted.

Referring to the multidrug-resistant TB hospitals in eight provinces, he thought the Northern Cape hospital was incomplete, but this did not mean there was no activity there. Other services still had to be linked to the hospital to finalise its operations.

Dr G Muller said the Hospital Revitalisation Programme would use R911 million in the coming year. A list of hospitals involved in this programme could be made available. Capacity was a problem in some provinces, but the Department had strengthened structures either from within or by outsourcing. The main problems were around the location of the hospital or the supply of services. A number of factors played a role in the rollout of the programme. He gave the example of the hospital in KwaZulu-Natal where the contractors had reneged on their agreements. He was confident that capacity would be developed.

Mr Muller said there were three major funding donors. The European Union had given R367 million to a Primary Health Care Programme and R200 million over five years for another programme. The Danish Funding Agency (DIFID) had given R100 million over three years. The United States’ Agency for Infectious Diseases (USAID) contribution was difficult to quantify because it funded programmes directly. There were other smaller donations from Australia, Canada, Japan, Italy and Belgium.

According to Dr Pillay, 121 clinics and community health centres, had been accredited to deliver ARV drugs of which 113 were active. The quarterly report to end February 2005 stated that 30 000 patients received ARVs from such institutions. The number of non-defaulters was important, not the number of starters.

Certain local municipalities had entered Service Level Agreements with the Department. These agreements enabled the Department to work through these municipalities in delivering health care. However, the Department did not want to burden municipalities that were already finding it difficult to deliver basic services such as water and sanitation. The Department did also not want to see primary healthcare services being fragmented even further.

Dr Pillay said there were two parts to the Department’s Nutrition Programme. One consisted of the Integrated Nutrition Programme and the other involved the feeding of patients with chronic diseases. Both programmes were run through clinics. The Department of Education ran the Nutrition Programme for school children.

Meetings had been held with the Blood Transfusion Service to develop a new model for the identification of high-risk blood. The new model would remove race as a risk factor.

The baseline for progress shown in the Youth Services Programme was the last financial year i.e. 2003 – 2004. The National Adolescent Friendly Initiative involved training staff who could deal with issues and problems facing the youth. NGOs had been given accreditation in this area.

Ms H Lamoela (DA)(Western Cape) asked when the Healthy Lifestyles Programme would be starting in schools and communities, and what measures were being taken to ensure there was an improvement in the quality of primary healthcare.

Mr Thetjeng asked which provinces lacked capacity.

Mr Tolo asked when they would be able to say that the shortage of professionals had been overcome. Rural areas experienced huge problems due to staff shortages. The lack of medicines was also ridiculous in primary healthcare clinics.

Ms Masila wanted to hear more about the R1 200 uniform allowance for health professionals. She commented on the backlog in the maintenance of hospitals and mortuaries in North West and Mpumalanga. She was not sure if the latter was a South African Police Services (SAPS) problem. She asked about the progress with the Primary Health Workers Programme and with the Primary Health Charter.

Ms J Vilakazi (IFP)(KwaZulu-Natal) added that he maintenance of hospitals in her province was also extremely bad.

Ms Masila said the number of men’s condoms being distributed had been mentioned, but what about condoms for women? She asked who was responsible for the monitoring and evaluation of mortuaries.

In reply to the questions concerning human resources. Dr Mahlathi agreed this was a major challenge. The largest loss of staff was to the private sector. Staff left for monetary reasons, unhappiness with the work environment, lack of equipment and management problems. Strategies were being developed to stem the flow and opportunities were being explored, such as scarce skills development, meetings with the Democratic Nursing Association of SA (DENOSA), and better human resources planning and development. The increase in the uniform allowance to R1 200 had been agreed upon in principle after a meeting with the Heads of Department and the nursing profession, but the Department still had to work out the implications of such a cost increase.

Dr Mahlathi said the Department was also trying to standardise the training of health workers. This would be finalised by the end of May. Work had been done on the Health Care Charter. The Task Team had to report to the Minister and the final consultative process had still to be undertaken.

Dr Muller said the Hospital Revitalisation Programme and maintenance were linked to capacity in provinces and the personalities of staff. The Department wanted to create more depth in terms of planning in the provinces so that responsibility did not remain with one person. Hospital maintenance was a problem as the Department funded small maintenance items and large-scale maintenance involved the Department of Public Works. In some provinces, the Department of Health had concluded service level agreements with various Departments of Works. It was as a result of the lack of maintenance that the Revitalisation Programme was needed. The latter also included improvements in management and the provision of equipment.

Mortuaries fell under the budget for ‘medico-legal services’, and both the SAPS and the Department provided this service. These services were being consolidated under the Department but not all provinces wanted to come ‘on board’ with this. Money had been transferred to provinces as a Conditional Grant for planning and maintenance. He hoped to have R90 million in 2005/2006 to complete this process.

Dr Pillay said 120 million female condoms had been issued and 365 million male condoms. The price difference was because female condoms were more costly.

The Healthy Lifestyles programmes were ongoing and would be accelerated. Dr Pillay said there would be a March for Health in Cape Town and a Walk for Health in Limpopo Province for World Health Day this month. The Healthy Lifestyles campaigns had also been expanded in schools.

Dr Muller said the monitoring and evaluation of mortuaries was a split service falling under the SAPS, the national Department and the provincial departments, but a decision had been taken to consolidate these functions.

Ms J Vilakazi (IFP)(KwaZulu-Natal) commented on the poor conditions under which nurses and doctors had to work and the way some patients were "tipping" staff to avoid having to use a bed on the floor.

Mr Thetjeng requested the criteria for the appointment of members to Hospital Boards. He asked which provinces had hospitals completed in the 2004/2005 financial year.

Dr Pillay said Ms Vilikazi had raised alarming issues about the hospital in KwaZulu-Natal and the Department would investigate this. He added that the Hospital Boards would be strengthened by the National Health Act. The Department would provide the names of the hospitals and the Provinces in which they would be built.

Department budget briefing
Dr G Muller, Department Chief Financial Officer, showed the actual figures for expenditure for 2001/2002, 2002/2003, 2003/2004 and the revised estimates for 2004/2005. The Medium-term Expenditure Framework (MTEF) budgeted amounts for the period 2004/2005, 2005/2006, and 2007/2008 were also documented.

The revised estimates for 2004/2005 for the four programmes were Administration R124.17 million, Strategic Health Programmes R270.27 million, Health Service Delivery R138.30 million and Human Resources R47.34 million. Figures were also given for specific items such as the Medical Research Council R167.89 million, Condom Purchases R132 million, Lovelife R23 million, the Global Fund R20 million, NGO funding R40.25 million, the Comprehensive Plan against HIV/AIDS R93 million and Medico-Legal expenses R47.5 million. The revised estimates for Conditional Grants were also tabled.

Discussion
Ms Masilo said no figure had been given for the funding of the Pretoria Academic hospital.

Mr Tolo asked what percentage of the previous year’s budget had not been spent. He was concerned about Conditional Grants as it seemed it was the norm not to spend them. He also commented on national versus provincial tenders, stating that the national Department did not adjudicate on tenders in time. A a result, provinces could not spend their money. Rollovers caused a postponement of delivery that lengthened the suffering of the public.

Ms Masibuko (ANC) asked if the Committee could have the figures Dr Muller had mentioned when he compared total health expenditure to the Consumer Price Index (CPI) and Gross Domestic Product (GDP). She also requested a pie chart showing how the Conditional Grants and the budgets for each programme were distributed. She further asked for clarity on tertiary hospitals and their allocations. Dr Muller had stated that the Primary Health Care used to rely on donors but now it was budgeted for. However, money was not necessarily transferred to provinces. What was the purpose of having that money nationally? She asked about other organisations that were given funding for home-based care and ‘step-down beds’.

Ms N Madlala-Magubane (ANC)(Gauteng) asked about vaccine production that was no longer being budgeted for. If the Lovelife Programme had been moved to the Department of Sport and Recreation, why did it still appear in the budget? She asked what the money from the Global Fund Against HIV/AIDS, TB and Malaria was used for? She then asked for clarity on the amount of money going to the Nelson Mandela Hospital in Umtata.

Ms Masilo inquired about the payments to NGOs. Most Provinces had only spent about 54% of their budgets by December 2004, the result of delayed transfers by the national Department. This meant that many NGOs could not continue their work.

Mr Muller said the Pretoria Academic Hopital upgrade had been budgeted for under the Revitalisation Grant of R911 million, so it was not a separate line item. Other hospitals had been funded over a number of years. Pretoria Academic had been co-funded by the provincial and the national Department. He would provide more information on the expenditure on hospitals in a written report to the Committee.

As regards Conditional Grants, he explained that problems that had arisen because of the change from FMS to Bass computer systems at the provincial level. Interfacing between these systems had become a problem and this had resulted in slow spending patterns. By the end of February, 91% of the budget had been spent nationally. In KwaZulu-Natal, there had been problems with contractors on site and the grant had been returned.

Dr Muller said the Department had been criticised for continuing to transfer money to the provinces, despite spending not having taken place. By the time the transfers had been stopped under order from the Auditor-General, there was enough available for the provinces to carry on. NGOs had been very slow in providing annual audited financial statements, and these were required before funds could be transferred. This would have led to disruptions; NGOs needed to ‘get their houses in order’.

He continued that the only tenders that were sent out nationally were those for pharmaceuticals. The tenders for the building of hospitals were provincial tenders. He could provide a pie chart and the figures relating to the CPI and GDP, and the total health expenditure. He would send a list of all the hospitals funded by the tertiary grant.

Ms Masilo asked for a list of NGOs funded by the Department. Dr Muller agreed to send the list of those funded by the national Department and those funded by the provincial departments. Only R2 million had been allocated to Lovelife and hence R23 million stayed with the Department. The Step Down Beds Programme was funded by the Global Fund. Vaccine production would take a while to explain, so he would include this in the written report.

The meeting was adjourned.