Gauteng Service Delivery: Department briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
23 August 2005
GAUTENG SERVICE DELIVERY: DEPARTMENT BRIEFING

Chairperson: Mr L Ngculu (ANC)

Documents handed out:
Department PowerPoint presentation
Department Strategic Programme, 2004 - 2009
Budget Speech, 2005 – 2006
Department Bana Pele (Chidren First) brochure
Department Youth-friendly Services

SUMMARY
The Gauteng Department of Health gave an overview of their strategic goals: to develop an effective HIV/AIDS strategy, to strengthen the district health system, to implement a ‘people’s contract’, and to operate smarter health management. Their budget allocation for 2005-2006 was R9.3 billion and included special projects and a discretionary equitable share.

Members were particularly concerned about the funding of community healthworkers, co-ordination and integration of Information Technology (IT) systems, the staff retention programmes, clarification of the school medical programme, the uniform allowance, the hotline service, the reliability of HIV/AIDS tests, accountability of non-governmental (NGO) funding, hospital revitalisation, and the erection of cellphone masts near schools.

MINUTES

Department briefing
Dr A Rahman, Department Acting Head, outlined their goals of an effective HIV/AIDS strategy, the implementation of a ‘people’s contract’, the operation of smarter health management, and the improvement of the district health system. Their main challenges were managing tuberculosis (TB) and HIV/AIDS cases, children’s and women’s health, ensuring the best clinical care with a risk management approach, reducing clinic waiting times, optimal functioning of the district health system, retention of professional staff, efficient capital expenditure, and implementation of a reliable monitoring and evaluation framework.

Ms T Majaja, Department Chief Financial Officer, then gave an overview of the budget allocation of R9.3 billion for 2005-2006. The budget baseline was underfunded. The budget needed to be increased to meet risks and pressures. However, the current budget still gave value for money in terms of health returns.

Discussion
Dr R Rabinowitz (IFP) stated that it was difficult to get funding from government for community healthwork. She mentioned Alexandra’s Haven and Aids for TOTS (Testing, Treatment and Support) as examples of community projects that needed more funding. Dr Rahman explained that 17 000 community healthworkers would be trained. Once they were trained, they would be given a stipend of R1 000 each per month.

Dr Rabinowitz wanted to know whether money from conditional grants covered the integration of IT systems in the medical health service in terms of the Millenium Development Goals. Ms Majaja said that tracking patients was difficult because patients changed their addresses so often. South Africa was still in the rudimentary stage of integration, but its IT systems compared to Singapore, the UK and Canada.

Dr A Luthuli (ANC) wanted clarity on the provision of spectacles in the school medical programme. Ms Majaja explained that the national conditional grants provided funding for specific priority and focused projects and programmes. Out of a health budget of R9.2 billion, R2.6 billion was earmarked for conditional grants. The Department provided affordable interventions like spectacles and hearing aids, but drew the line at cochlear implants for example.

Dr Luthuli asked how the Department was incentivising staff in the retention programme with regards to upgrading and certification. Ms Majaja said that the training of non-accredited staff with scarce skills was governed nationally. Scarce skills included high-end care and dialysis. Gauteng had a partnership with academic programmes in UK London hospitals where 14 nurses had just completed a year’s training. In this way, the nurses were not poached, but retained their jobs and their pensions. Many nurses left for financial reasons.

Ms D Kohler-Barnard (DA) queried whether there was a link between the police and the hospitals in the reporting cases of rape. Dr Rahman explained that there was a partnership with police in the crisis centre.

Ms Kohler-Barnard wanted to know whether there was a shortage of doctors in the province. Dr Rahman replied that there was more than a 23% shortage of doctors.

Ms Kohler-Barnard stated that the uniform allowance caused problems for nurses. How did the allowance compare to other provinces? Dr Rahman said that the uniform allowance was R2 000 per annum.

Ms B Ngcobo (ANC) asked whether the Department had mechanisms to account for funding given to non-government organisations (NGOs). Ms Majaja explained that all funding was accounted for. The Department needed business plans from the NGOs, and the Department did follow-up visits. They helped build capacity like financial management skills. The NGOs had to submit annual audited financial statements. Sometimes the NGOs received money from three different sources, for example the Departments of Health and Social Services, and the private sector.

Ms Ngcobo wanted to know whether there was a complaints hotline. Dr Rahman said that the Department had established a directorate of quality assurance, quality care and customer care, which was headed by a qualified nurse. The function of the unit would be to assist people in waiting areas with filling in forms, for example. The unit would look after complaints as well.

Ms Ngcobo wanted to know whether patients were aware of their rights. Dr Rahman explained that a complaint would be lodged with the 24-hour hotline. The complaint would be acknowledged within 24 hours and investigated within six weeks. He admitted that the Department needed a more efficient way of handling patients’ complaints.

Ms Ngcobo asked whether the Department used doctors in private practice to alleviate problem situations. Dr Rahman replied that they used doctors in private practice but that the remuneration was different. Doctors were paid less in the public health sector. There was a partnership with private doctors for antiretroviral (ARV) roll-out.

Ms Ngcobo needed clarity on the term ‘kangaroo mothers’. Dr Rahman explained that the concept had been successful at Tygerberg and Groote Schuur hospitals. The term referred to skin-to-skin contact of under-developed babies with mothers so that the babies could develop better with breastfeeding and immunity. These babies did not need to be put into an incubator. The idea was to implement the concept in all regional and central hospitals.

Mr S Njikelana (ANC) asked about the Department’s approach to primary healthcare, as it should not only be only curative. Dr Rahman said that the strategic focus areas of the presentation covered rehabilitative and promotive aspects of healthcare. Ms Majaja said that primary healthcare was covered by local government. The Department strived to balance the health programme.

Mr Njikelana asked how the Department had handled crises like the recent Natalspruit situation. Dr Rahman replied that Natalspruit required focused action and should not be treated as an ordinary complaint.

Dr Rabinowitz wanted clarity on the foster care and child support grant. Ms Majaja explained that the answer would reside with the Department of Social Services.

Dr Rabinowitz needed to know how NGOs could access funding. Ms Majaja said that NGOs could respond to advertisements placed in newspapers. A committee would allocate funding according to certain criteria like adherence to the Public Finances Management Act (PFMA). There was also the issue of continuity for sustainable projects of three to five years. Some NGOs had been refused funding.

Dr Rabinowitz asked what body had accredited the HIV/AIDS tests. Dr Rahman responded that the tests followed international norms and standards.

Ms Ngcobo needed clarity on the term ‘farm areas’. Dr Rahman explained that the term included informal settlements and urban areas.

Ms Ngcobo asked whether there had been any cross-border flow problems. Dr Rahman said that patients from other areas were not refused treatment.

Ms Ngcobo wanted to know more about the role of traditional healers. Dr Rahman felt that traditional healers should work together with the primary healthcare system. There had been no finalisation of traditional healers working within the system.

Dr Luthuli queried how the Department was handling the ARV roll-out if doctors filled out time-consuming forms. The patients were frustrated. Dr Rahman admitted that it took 45 minutes to complete a form and that more interaction was needed between doctors and patients.

Mr Njikelana asked whether there was inter-sectoral collaboration between the Departments of Social Services and Health, and the Police, as this had implications for labour relations. Dr Rahman confirmed that there was collaboration.

Ms N Nkabinde (UDM) queried whether nurses had undergone dispensing courses and whether safety measures were in place. Dr Rahman replied that training courses had been carried over to the 2006-2007 financial year. Safety legislation covered dispensing medicines to the public.

Dr Luthuli wanted to know where the Department had obtained the money to create the post for the nurse in the Complaints Unit. Ms Majaja explained that the post was funded through conditional grants, which amounted to R2.6 billion.

Ms Kohler-Barnard asked whether 5 000 of the 12 495 babies delivered by 17 315 HIV-positive pregnant women, had died, even though they had been given Nevirapine born. Dr Rahman replied that that statistic was true. Mr Njikelana enquired whether the fatalities had been due to one cause. Dr Rahman said that there had been more than one cause.

Dr Rabinowitz asked who was responsible for cellphone transmitters in the municipal health services and who monitored the placement of cellphone masts near schools. Did this issue reside under the Department of the Environment? Ms Majaja replied that the national Municipal Health Act applied to local government.

Ms Kohler-Barnard wanted to know whether the Department had a problem with the Department of Public Works as 39% of the budget had been spent on hospital revitalisation. Ms Majaja explained that they had experienced a problem with the agencies that Public Works had used. The agencies had not delivered what they had promised.

Ms Kohler-Barnard asked why 11 million condoms had been given per month to men, while the distribution of female condoms had been downscaled. Dr Rahman said that the distribution of female condoms had not been reduced. 19 000 condoms had been handed out per month to women in the first quarter of the 2005-2006 financial year.

The meeting was adjourned.