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HEALTH PORTFOLIO COMMITTEE
15 November 2005
MEDICAL RESEARCH COUNCIL: BRIEFING; COMMITTEE REPORT ON NATIONAL DEPARTMENT OF HEALTH, MEDICAL RESEARCH COUNCIL, COUNCIL FOR MEDICAL SCHEMES ANNUAL REPORTS: ADOPTION
Chairperson: Mr L Ngculu (ANC)
Documents handed out:
Medical Research Council (MRC) presentation
Medical Research Council Annual Report
National Department of Health Annual Report [available at www.doh.gov.za]
Council for Medical Schemes Annual Report [available at www.medicalschemes.com]
Medical Research Council brochure
Committee Report on National Department of Health [available shortly at Committee Reports]
The National Department of Health was further questioned on its Annual Report which it had presented to the Committee in the previous week. The Members asked about progress on the hospital revitalisation roll-out programme which was costly. The business plans of Mpumulanga and North West provinces had not been received. Provinces were failing to provide their poverty relief programmes. The Committee was concerned about the roll-out of community health care workers, the stipend they received and their management/supervision.
The Medical Research Council conducted health research, development and technology transfer. With a budget of R350 million per annum, the Council focused on getting research results into policy, practice, promotion and product. The core business was to improve the health of South Africans. The transformation of the Council’s personnel would reflect the demographic profile of South Africa. The Council had produced a ‘wish list’ of priorities which involved additional expenditure of R403 million.
The Committee Report on the Annual Reports of the Department of Health and its two entities, the Medical Research Council and the Council for Medical Schemes, was adopted by the Committee.
National Department of Health (NDoH) Annual Report
Mr Thami Mseleku, Director-General, fielded questions from the Members. The Committee felt that the South African Medical Association (SAMA) Trust and the meeting of targets needed more discussion. The Members wanted to know the progress of the hospital revitalisation roll out programme. The Committee was concerned about the roll out of community health care workers, the stipend they received and their management/supervision.
Ms M Matsemela (ANC) enquired whether the Department had made any progress around facilities revitalisation or was the process stuck. The strategic aim of the revitalisation was to improve education and provide equitable health in rural areas. Mr Mseleku answered that the issue of hospital revitalisation needed to be revisited. Problems encountered related to the capacity of the Department of Public Works.
Ms D Kohler-Barnard (DA) asked how many hospitals were involved, which hospitals had been completed and what the final due date was in the hospital revitalisation programme. Mr Mseleku replied that the programme was a twenty to twenty-five year programme, which needed to be reduced to ten to fifteen years. Forty-four hospitals were involved. All projects were on track with the Department of Public Works in 60% of the cases.
Ms Kohler-Barnard wanted to know what was being done to clean up hospitals. In the nurses’ quarters in Umtata General, wires were hanging out of windows. Was the Department going to wait for twenty years before a new hospital was built? Mr Mseleku reiterated that the hospital revitalisation programme was a twenty-year programme for all hospitals depending on priorities. Some were national projects and some were provincial projects. Hospital revitalisation involved physical infrastructure, but not management revitalisation and quality care management.
The Chairperson cautioned that hospital revitalisation would be discussed later.
Ms M Madumise (ANC) queried where the 17 000 community caregivers had been deployed, especially regarding the Dots programme. The Dots programme in KwaZulu-Natal, Limpopo and Eastern Cape had not been implemented properly. Mr Mseleku responded that the Dot programme was a Social Development Department and Health Department initiative. The lack of integration had created problems for the communities. All entities had now been integrated in all provinces to strengthen the Dot programme. Out of 36 000 home-based caregivers, 17 000 were volunteers.
The Chairperson said that the human resource plan had not been forthcoming. Would the above-mentioned issues form part of the human resource plan? Mr Mseleku replied that the human resource plan had focused on the professional side and not really on this issue. The plan would focus on supply, demand, support, retention strategies, integration and extension in respect of health.
Mr A Madella (ANC) concurred with the Chairperson’s thinking on the human resource issue. He felt that if health care workers were poached by the private sector or found employment overseas, it would have an impact on service delivery in South Africa. The question was not answered.
Mr Madella asked whether there was uniformity regarding remuneration of community caregivers. Volunteers would be agitated if they got wind that other volunteers received more money. Mr Mseleku concurred that this issue could lead to problems. The extended public works programme (EPWP) focused on skills development and service delivery with a stipend given to workers. The workers would then be qualified to seek their own employment. The challenge was that the community care-based initiative could employ 100 000 workers/volunteers eventually who would need a stipend. The problem became a labour issue in terms of whether the non-governmental organisation (NGO) would be supported by government through a stipend.
Dr A Luthuli (ANC) commented that volunteer workers were poorly managed. Where did the problem lie? Mr Mseleku responded that the Mathisson hospital in KwaZulu-Natal was a TB hospital and had a 99% cure rate, while the Port Shepstone hospital had a 65% cure rate. Even though the hospitals were 25 kilometers away from each other, the difference lay in supervision and organisation. Home-based caregivers were under the supervision of NGOs. This needed to be strengthened.
The Chairperson needed clarity on timeframes for business plans. Mr Mseleku said that timeframes had overtaken adjustments of the issues in question in the report. If provinces did not hand in their business plans, their funds would not be transferred.
The Chairperson felt that the problem around the audit committee had not been attended to. Mr Mseleku replied that he had been appointed in January 2005. He had informed the audit committee members that they could be dissolved and a new committee established. The challenges were that meetings did not have quorums or senior officials had not been present when meetings had been convened. There had been misunderstandings and he (Mr Mseleku) was trying to resolve them.
Ms Madumise needed clarity on whether the money used by provinces when their business plans had not been approved, would be authorised. Mr Mseleku answered that should provinces’ business plans not be approved, they would be overspending their budget. They thus overspent at their own risk. If business plans were approved, the overspend would become a journal entry to balance the books.
Ms Kohler-Barnard said that the names of the provinces had not been supplied. Mr Mseleku replied that they would supply it.
Mr Madella enquired what proactive measures were in place to assist provinces with providing a business plan to access funding for projects. Mr Mseleku responded that funds were available to assist with project management in provinces, for example, hospital revitalisation, AIDS, etc. Proactive action had been taken and not a ‘Pontius Pilate’ approach.
The Chairperson commented that 96% of the Department’s budget had been spent. Mr Mseleku replied that it was a ‘saving’. The Chairperson rejected that answer. He needed 100% expenditure.
The Chairperson thanked Mr Mseleku for a good report. There had been a marked improvement.
Ms Kohler-Barnard asked that the names of the two provinces be given to the Committee by tea time as the Department had been asked to forward these two weeks previously.
Medical Research Council (MRC) Annual Report
Prof A Bewu (President: MRC) gave an overview of the mission, strategic objectives and a list of research achievements. More scientists needed to be trained to increase capacity. The MRC had produced a ‘wish list’ of priorities which involved additional expenditure of R403 million. (See presentation document).
Dr Luthuli asked when there would be a vaccine for the HI virus and how was the vaccine going to work. Did research understand viruses in general? Dr P Manyike, Interim Co-Director: Scientific & Clinical Affairs: South African AIDS Vaccine Initiative (SAAVI), replied that that was a challenging question. They would have an effective vaccine in five years’ time. Phase I had started already. Phase II would start before the end of 2005. The life definitive studies of Phase III would start in two years’ time. Small components of the vaccine had been used so as not to cause disease. Research undertaken understood viruses. Prof Bewu added that the MRC had a comprehensive research portfolio to empower young people to abstain or practice safe sex. A preventive or therapeutic vaccine would unlikely be 100% effective. Viral evolution meant that viruses mutated/changed. The HI virus mutated continually.
Dr Luthuli commented that circumcision was a possible tool to reduce HIV infection. Was research being done in this regard? Prof Bewu responded that circumcision provided some protection against HIV transmission. It was not 100% certain. Research evidence was not strong enough.
Dr Luthuli noticed that the MRC was underfunded. What was the reason for this? They were doing good work. They even raised more money than what they received from government. Could the Committee assist them to raise more money? Prof Bewu replied that they received generous government funding. Between 1997and 2000, their funding had doubled. Their wish list would treble their budget.
Ms C Dudley (ACDP) asked whether research had been translated into relevant policy. Prof Bewu answered that South Africa needed an indigenous biotechnology industry and pharmaceutical manufacturers to develop drugs and vaccines. There had been behavioural changes, because young people changed their behaviour regarding abstinence and condom usage.
Ms Madumise said that crystal methamphetamines were harmful. Which part of the body did it affect? Most youngsters under the age of twenty were using it. How many were getting better? Prof Bewu replied that crystal meth/’tik’ usage was increasing, especially in the Western Cape and Johannesburg. The physiological effects were racing pulse, altered consciousness, etc. Drug abuse had to be seen in context. Reducing the supply of drugs would not solve the issue. The public health approach should focus on the social context, education and rehabilitation.
Ms Madumise commented that TB patients required more toxic and costly drugs. Prof Bewu conceded that drug-resistant TB was more expensive to treat, took longer to treat, was more toxic and was less successful. The primary strategy to improve the TB control programme was through controlling primary TB. Compounds from South African plants could be developed and marketed.
Ms P Tshwete (ANC) asked what was meant by nurses being ‘gatekeepers’. Prof Bewu said that research had shown that the care of health professionals during and after was important to patient behaviour. The public trusted the information disseminated by health professionals more than that of the media. Nurses were the primary point of contact. They were informed about HIV. They welcomed the patient. They encouraged the patient to remain in care and treatment. Nurses should therefore be properly trained.
Ms M Matsemela (ANC) enquired about the lack of skills in TB research. Prof Bewu replied that the MRC had world class, cutting edge TB research, yet South Africa had a rising TB epidemic, which was not only due to the prevalence of HIV. There were health system issues. There was a bias towards biomedical research because it was more interesting. Health system research was neglected. The emphasis should be on diagnosis, prevention and then treatment.
Dr Luthuli felt that the sensitivity/reaction to drugs was problematic. How did health professionals know which drug the patient was reacting to? Prof Bewu responded that they used a fixed drug dose combination in TB treatment over a six-month period. They were hoping to reduce the time to four months and then to two months. The procedure would work well if the drugs were taken properly and there was no toxicity. Fifty percent of TB patients were also HIV positive. Research was being conducted to look into the effects of using drugs for TB and HIV at the same time as this was a ‘huge problem’.
Ms Matsemela asked where the problems were in telemedicine. Dr M Molefe, MRC Director: Telemedicine Research answered that there was no e-health policy plan or strategy. The problem thus lay in implementation. It had become a ‘connectivity issue’, because ISDN lines were expensive to use. A solution was to use affordable connectivity by using a different technology like YMAX. The other problem was that healthcare workers were not computer literate. They had developed touch screen telemedicine technology to address the problem. There had been a suggestion to centralise the service and use retired doctors to do research in these areas. Telemedicine could also be classified as a tertiary service. It could become a reinvestment issue, because no money would be paid. Telemedicine also involved medical legal issues, because there was no policy to protect health professionals. Patients signed a consent form for treatment and preventative care for rapid response telemedicine. The information supplied was confidential.
Ms R Mashigo (ANC) queried whether any research had been done before projects had been undertaken. Dr Molefe replied that health professionals were unable to use equipment in hospitals during project management.
Ms Mashigo enquired at what level would the MRC start funding new self-initiated research. Prof Bewu responded that they had 507 scientists in 47 research units. One hundred research projects could use about R120 000 – R250 000 per annum. The MRC evaluated the projects according to anonymous or international peer review.
Ms Kohler-Barnard requested that the wish list be forwarded to the Committee so that they could motivate it. Prof Bewu replied that the list would be submitted.
Ms Kohler-Barnard queried the MRC’s readiness for avian flu. Prof Bewu admitted that South Africa was not ready for avian flu. The MRC had developed childhood vaccines to reduce pneumonia after influenza. No country had enough drugs stockpiled. Citizens could live or die depending on their immune response.
The Chairperson commented that lay health workers had been effective in the reduction of TB, but he had found no correlation in the figures. Prof Bewu said that in a random control trial research, farms where lay health workers had worked had an 8.7% higher cure rate than farms where no lay health workers had worked. This was called responsive health research.
The Chairperson commented that indigenous knowledge systems were knowledge- and science-based research. Dr M Matsabisa, MRC Director: Indigenous Knowledge Systems remarked that indigenous knowledge systems were needed for health. Medicinal plants held benefits for communities.
Prof M Ramashala, MRC Chairperson, commented that the MRC ran a ‘tightly managed ship’ regarding governance. The three committees (financial, audit and risk) ensured appropriate usage of funds. The research and development committee oversaw research and priority strategies which they then reported to the board. As for the wish list, South Africa could face a personnel or HIV crisis. The bulk of white males were retiring. The MRC needed to develop new scientists. Capacity development was thus at the top of the wish list. In three to five years, they could be faced with a serious crisis in human resource development in South Africa.
Ms Kohler-Barnard commented that 74% of MRC staff was black. The MRC were hoping for a complete transformation in three years’ time. She believed that the MRC had a policy of only hiring black people to the exclusion of Indian and Coloured students. What were the MRC’s recruitment policies? Prof Ramashala believed that the question raised two issues, viz. personnel representivity and employment equity at the MRC. She felt that the MRC was well-represented regarding Indian staff members, but not so well-represented by Blacks and Coloureds, as these had previously been marginalised groups. The MRC operated on the basis of looking at an employable pool of applicants and then looked at statistics to upgrade staffing before they made a selection.
The Chairperson intervened by saying that the discussion should not be diverted to employment equity. The definition of employment equity should be looked at. South Africa should develop its own indigenous capacity.
Prof Ramashala added that employment equity spelled representivity in the workplace and labour distribution in South Africa. Blacks had always been at the bottom of the pyramid. Thirty percent of senior positions had been filled by Blacks and women. There should be a move to enable South Africa to function and compete globally.
Committee Report on Annual Reports of Department of Health, Medical Research Council and the Council for Medical Schemes
The Committee Report on the Annual Reports of the Department and its two entities, the Medical Research Council and the Council for Medical Schemes, was adopted by the Committee.
The meeting was adjourned.
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