National Health Laboratory Service Activities: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
13 September 2005
NATIONAL HEALTH LABORATORY SERVICE ACTIVITIES: BRIEFING

Chairperson: Ms M Madumise (ANC)

Documents handed out:
National Health Laboratory Service PowerPoint presentation
National Health Laboratory Service Strategic Plan 2004 - 2007

SUMMARY
The National Health Laboratory Service (NHLS) briefed the Committee about its statutory mandate to provide cost-effective health laboratory services, to provide training for health science education, and to support health research. Officials gave an overview of service provision, the NHLS model, the financial breakdown per province, their human resources strategy, and their programme for providing quality service. It was the first report tabled before the Committee since the inception of the unified NHLS in March 2001.

Members were concerned about the exclusion of KwaZulu-Natal from the NHLS provision, accreditation of tests, non-provision of annual reports, transport logistics to primary healthcare facilities, skills transfer, procurement policies, CD4 count statistics, training, transformation, and uniformity in remuneration.

MINUTES

National Health Laboratory Service briefing
Ms M Baloyi, NHLS Chairperson, gave a brief overview about the mandate of the NHLS in terms of providing cost-effective health laboratory services, providing training for health science education, and supporting health research. They had experienced many ‘teething problems’ because they had inherited state laboratories of different competencies and quality, but had ‘hit the ground running’ in setting up a new organisation.

Mr J Robertson, NHLS CEO, then briefed the Committee comprehensively about services provided to community clinics and hospitals, regional and tertiary hospitals, and to both the National Institutes for Communicable Diseases and Occupational Health. The premise for the NHLS model was based on the fact that they were the sole provider, charged a fee for their services, and provided training and research. A breakdown was given of the financial dimensions of provincial and per capita spend on laboratory services. The NHLS had developed a comprehensive human resource strategic plan for 2003-2006.

Mr Robertson elaborated on the programme for providing quality service, including:
- conducting quality assessment in all laboratories,
- measuring turn-around times of laboratory results,
- conducting training programmes,
- holding regular communication meetings with clients,
- conducting client satisfaction surveys and taking remedial action on poor performance areas,
- supporting national and provincial health programmes,
- providing an information resource to provincial co-ordinators, and
- focusing on tuberculosis (TB), cervical cancer screening, and HIV/AIDS CD4 counts and viral load management.

Discussion
Dr A Luthuli (ANC) was concerned about the exclusion of KwaZulu-Natal (KZN) from the auspices of NHLS. The exclusion posed a health problem as KZN had the highest incidence of HIV infection and TB. Tests relating to diagnosis were prohibitively expensive, which impacted on diagnosis and treatment. Mr Robertson responded that the laboratory information system ‘kicked in’ as soon as the specimen was taken. The turn-around time was based on empirical data. A Short Messaging System (SMS) cellphone system was used to disseminate TB results. The same could be done for other illnesses.

Dr R Rabinowitz (IFP) asked whether the NHLS was thinking of setting up partnerships between the public and the private sector to extend primary healthcare coverage. Mr Robertson answered that private general practitioners had participated in the roll-out.

Dr Rabinowitz was concerned that there was a six-month backlog for assessing patients for ARV treatment. About 60% of these patients were ‘lost’ while waiting for their test results. Were tests accredited like in the USA? How were tests controlled in South Africa? Were the tests used by doctors accredited?

Mr Robertson replied that the NHLS performed 30 million tests per annum. Their antenatal survey results were considered reliable. Mr B Schoub, Executive Director: National Institute for Communicable Diseases, explained that their quality control systems were affiliated to the those in the UK and US. There was a hierarchy of assessing quality. Tests did not have to be accredited. The NHLS had evaluated imported HIV test kits.

Dr Rabinowitz commented that the KZN Director-General for Health, Professor R Green-Thompson, had said that the NHLS should ‘stay out’ and that KZN was ‘doing fine’.

Ms D Kohler-Barnard felt that if centralisation was not speeding up delivery, why were they doing it. Ms Baloyi responded that legally, NHLS was responsible for laboratories in KZN. For the past three to four years, NHLS had held meetings with KZN to reach an agreement. A false perception had been created that NHLS did not want to integrate with KZN. Some laboratories in KZN were functioning, while others were inadequately resourced.

Ms Kohler-Barnard said that the NHLS found it difficult to present evidence and statistics in court. Mr Robertson replied that forensic laboratories did not form part of NHLS. The NHLS turn-around times for paternity testing were excellent.

Ms Kohler-Barnard mentioned that the NHLS had not provided its annual reports for the past two and a half years. Mr Robertson answered that the NHLS annual reports were audited by Price Waterhouse Coopers and Goboda companies, and not by the Auditor-General. The annual report backlog issue had developed because employees received no post-retirement benefits. The NHLS report had gone to Treasury in August 2004 and May 2005. Treasury had been kept informed all the time.

Dr Luthuli felt that costs for laboratories were higher in KZN because they were not part of state laboratories. Mr Robertson responded that it should be cheaper if there was high utilisation of the facility.

Ms P Tshwete (ANC) congratulated the delegation for their 50:50 representation in terms of gender and for the fact that a woman was the Chairperson. She remarked that 55 000 tests had been performed per month at 18 centres on CD4 counts. Was this data from all the centres in the country? Mr Robertson replied that the statistics showed growth on a monthly basis. Information had been gathered into the database. They had a unique identifier to facilitate the process of data gathering. About 260 tests were performed per day for viral load and 230 for CD4 count. The sites were operating at 50% capacity. The sites were expensive to maintain if they were not used optimally.

Ms Tshwete asked about the transport logistics to primary healthcare facilities. Did they use mobile clinics to extend the service to communities? Mr Robertson responded that they were servicing 4 000 primary healthcare centres. Metro and urban areas used their own transport. They used subcontractors in rural areas. Some clinics operated one or two days per week while others operated five days per week. Ambulances were used to take specimens to laboratories on specific routes on specific dates.

Ms R Mashigo (ANC) enquired whether skills transfer was taking place when staff retired. Did they extend the employee’s contract to transfer skills to specific employees? Ms Baloyi replied that they had reduced the fixed-term contracts to empower employees. They did not employ anybody after retirement. They developed managers through training and mentorship programmes.

Ms Mashigo commented that their buildings and infrastructure was old and in need of renovation. How did their tenders work in their procurement system? Ms J Mogale, NHLS: Executive Manager, answered that they had inherited dilapidated buildings. They followed preferential procurement policies in the allocation of tenders. For instance, women-owned companies received 15%, while men-owned companies received 10%. It was rare that tenders were awarded outside the province. This initiative was to empower local suppliers.

Ms Manana questioned whether there had been a CEO since the inception of NHLS. Ms Baloyi answered that the Board had been appointed by the Minister. They were a constituency board and did not select members. They had had no SALGA representative initially as no-one had availed themselves. Mr N Crisp had been the acting CEO before Mr Robertson was appointed.

Mr S Njikelana (ANC) stated that the report and presentation were ‘thin’ in terms of the experiences of the NHLS. What were the key aspects of transformation, policy changes and operational strategies?

Ms E Greyling, NHLS: Executive Manager Human Resources, explained that state laboratories had previously been run by various provincial administrations. Between June and December 2002, payroll data had been inaccurate. There had been two different payrolls. By March 2003, staff had not been classified in terms of race, gender or disability. In April 2003, they had implemented a consolidated payroll. They had established a Labour Relations Forum to consult and negotiate with labour. As the staff had come from various organisations with different conditions of employment, they had established a uniform set of conditions by 1 April 2003. They presented a strategic plan for human resources to the board in 2003 regarding skills development, employment equity, recruitment and selection, a code of conduct, and disciplinary codes. They had also established a uniform remuneration structure. They had a workplace skills plan for education and training for all employees. There was wide consultation with recognised labour.

Dr Luthuli asked whether it was financially viable to train specialists who then left to go into the private sector. Did the NHLS have a plan to deal with this issue? Mr Robertson said that registrars trained for 4-5 years and then often left for the private sector. The NHLS had introduced a contract system that bound the registrar to stay for two years after he/she qualified. NHLS would also pay any student debts incurred. They offered competitive salaries. These incentives were offered to attract prospective employees to NHLS.

Dr Luthuli enquired what was being done to ensure that measles did not resurface as an epidemic. Mr Schoub replied that measles had been brought under control before 2003. It could be efficiently controlled with vaccination if high coverage was sustained. Routine coverage implied vaccination for infants at nine and eighteen months of age. Measles could spread rapidly when there was overcrowding, and this needed to be addressed. A global programme to eliminate measles was needed, as had been the case with polio. Surveillance and control of measles pinpointed deficiencies. There was a tendency to become complacent because measles ‘came in waves’. It was necessary to maintain high immunisation levels across society, and to be vigilant in surveillance.

Dr Luthuli enquired at what percentage would measles be considered ‘under control’. Mr Schoub responded that this would be when there was 90% routine immunisation and 95% mass immunisation.

Mr Njikelana needed clarity on the procurement process for Information, Communication and Technology (ICT) software. He nominated himself and Dr Rabinowitz to visit the NHLS during recess. He still had a litany of questions that needed to be answered, and would forward these questions to the NHLS.

Ms Baloyi replied that she would be happy to share ideas. She admitted that they had not addressed some areas adequately due to lack of time. They needed guidance on certain issues.

The meeting was adjourned.