Briefing by the Departments of Welfare and Health

Meeting report

SOCIAL SERVICES SELECT COMMITTEE
26 February 1999
BRIEFING BY THE DEPARTMENTS OF WELFARE AND HEALTH

Documents handed out
Department of Welfare Presentation
Department of Health Presentation

MINUTES
Chairperson Dr. Cwele (ANC) called the meeting to order. He apologized to the Department of Welfare for very few MPs being in attendance. He then reminded the members that the committee was on a strict time limit, and turned the meeting over to the Department of Welfare.

Department of Welfare Briefing
The Department of Welfare wants to be seen as a corporate institution with particular roles and responsibilities. The three prongs of government intervention within the anti-poverty sector are poverty alleviation, social grants, and welfare. Yet these are not individual strategies but need to be seen as a holistic strategy.

R50 million was allocated to 1133 development programs throughout the provinces, with the Eastern Cape managing most of the programs. Over 93,000 individuals have received benefits. The department is still assessing the allocations of the above projects. Development, however, cannot be achieved in a year or six months; the department is working on medium and long-term strategies. Financial Year 1998/1999 goals are divided into national and provincial projects, such as the Flagship Project and Spatial Development Initiatives. R24 million is designated to micro-saving pilot initiatives. This program will allow individuals already on grants to apply for small loans when additional financial resources are needed. R44 million is being transferred to social services, primarily for disabled persons. R12.5 million is spent on intergovernmental initiatives while R9 million is allocated for capacity building and administration.

Some of the projects which the department is extremely proud of are:
The Flagship Project for Women
Job Summit
Starfish 2000
Waste Management
Corporate Colors

R1.7 billion is allocated to welfare services. The Department would like to shift more financial resources into the number of services offered and decrease social services. Currently, there are 2.9 million beneficiaries.

Problem Solving
The Department recognizes that several problems hinder effectiveness. They are working on addressing the problem areas in the ways listed below.
Lack of bar-coded IDs: increases fraud potential. With the assistance of the Department of Home Affairs, the Department has identified the areas with a high concentration of non-bar-coded IDs. To reduce fraud and register voters, Home Affairs will be sending mobile units to these sites.
The re-register campaign involves physically placing individuals in the field to re-register beneficiaries. Although this is somewhat successful, it will achieve limited success unless the Department addresses other issues.
Data clean-up to avoid duplication
Decreasing the backlog of work.
In November 1998 the Department asked the private sector to write proposals that would better the Department. The private sector provided solutions to solving access to pensions, computer programming, and overall environmental changes to the Department.
The Y2K problem could cause significant problems, resulting in Departmental failures.
The Department continues to decrease fraud and increase customer service.

Social Welfare Services
Welfare is allocated by sector. Over 2.8 million South Africans are over the age of 60. Several problems exist with elderly facilities, and the quality of care. The Department hopes to alleviate these problems by passing legislation, and increasing funding to elderly care facilities. The HIV/AIDS problem is the scourge of the late 20^th century. The Department is holding a forum to better assess this issue on a train trip throughout the country. Ministers, MECs, and experts will conduct the conference, as the train travels from Johannesburg to Cape Town. Along the way the train will stop in various provinces to meet with constituents and discuss the issue of HIV and AIDS. Other social welfare services are outlined further in the Make A Difference Report, the Victim Empowerment Program, and continued legislative reform.

The Department thanked the committee for their time, and offered to return to the committee to discuss other salient issues as needed. The floor opened for questions.

Ms Tyobeka (ANC) asked the Department the following questions: what criteria are used to approve funding for these programs? To whom are the applications submitted, and who administers this at the provincial level? The Department replied that they would send the criteria to her via fax. The applications are submitted to a committee of individuals who represent the national and provincial departments that are involved in funding. Allocations are given by the national department, but the payment is done by an independent development trust, whose new mandate is to develop financing, disburse funding, receive and approve the report, and continue to pay-out. The Department of Welfare at the national and provincial level facilitates this development.

Ms Mothoagae (ANC) inquired why there was such a low conviction rate on fraud and corruption. She also asked how provinces spend the bulk of their grant monies. The Department responded that they have cleaned up fraud, however one can put a bucket underneath the stream, but the leak will not be solved until someone fixes the hole. The Department cannot be satisfied with a temporary solution. The low conviction rate is related to the amount of corruption within the system itself. It is difficult to solve these problems because unlike a bank or other major corporation, the Department does not have a stringent set of rules and guidelines regarding this area of concern.

Ms Ford (IFP) commented that the low conviction rate could be attributed to a lack of management training. What worries her is the auditor-general’s report that individuals within the department who are found guilty of fraud are given a suspension with full pay which she found ridiculous. With regard to the AIDS/HIV information provided to the public, she understands that students are targeted to receive this information; however, listening to adults speak on the topic for several hours is not the way to educate our youth, nor spend the finances. The Department needs to come up with inventive and innovative ways to educate the youth about this growing problem. Finally, reregistering patrons has worked exceptionally well in KZN; however, there is some insensitivity at ground level, especially with the illiterate, elderly population. She hopes the Department can alleviate that problem. The Department noted the member’s concerns.

Mrs. Tyobeka (ANC) asked about the long waits for the elderly at pay points. Oftentimes, pensioners must sleep in line a day before the pensions are given out. She asked what measures the Department is taking to solve this problem. Also, there was a failure over the holiday season with checks not being cashed. This resulted in hardship for many poor families - what is being done to correct the situation? The Department said the reason for the delay in payment was because the tender was for January of next year. The Department is currently working with Transnet and Telkom to provide containers for water, and provide a connection for operation centers to solve the problems and the queues. The National Operation Center will now be replicated throughout the provinces.

The Chairperson inquired what was the Department’s target for percentage of services within the budget? He also questioned the frequency of the payments. The Department responded that they would like to spend 20% on welfare services; payments are made once a month to individuals.

The Chairperson thanked the department for their thorough presentation and asked the Department of Health to begin their budget presentation.

Department of Health Briefing
The Director-General stated that he would be sticking to the document handed out. Overall, there has been an increase in the allocation to the health budget. The Department is pleased with this turn of events, because it is in line with the Department’s policy to increase the number of primary health care services, and to maintain integrated services. The Department believes that there is not a lack of resources; rather inefficiency that they hope to correct throughout the system. To legitimize the health care infrastructure, four broad elements need to be addressed. These are:
The physical infrastructure
Appropriate human resources
Reliable pharmaceuticals
Quality of Care discussions

The achievements of the Department of Health are outlined on page two of the document. Page three outlines the provincial breakdown of health services as of 19 January 1999. Page four highlights the number of primary care clinics that can be found throughout the provinces as well as the shift of personnel (nurses) from hospitals to clinics.

The Hospital Reconstruction Plan
Health Facilities have a tremendous backlog
The increase in funding throughout the next five years is an investment to better our hospitals. Prior to this, there have been no significant developments/investments in South Africa.
On page seven, the Department outlines the new academic hospital in Durban. This project is on track, and the Department is fast-tracking the commissioning of this hospital. Currently, there is a job opening for a CEO.
After a scathing report from this committee regarding the Umtata Community Hospital, a new hospital is currently being built to replace it. This new hospital will not only assume the duties of the former, but also serve as the regional hospital for 34 other Transkei facilities.

The Department has instituted District Management Teams that will coordinate health services throughout the provinces. The demarcation of districts has occurred throughout the provinces, and training district managers is the next operational phase. Pages nine and ten of the document illustrate the duties of district managers and provides examples of their functions. The success of this program depends on the strength of primary health care infrastructures.

The South African Drug Agency Program is an essential program within the Department. A working drug list is essential, to maintain a current list of all drugs coming in and out of the country. This agency prioritizes drug distribution in a similar fashion as private suppliers. It also makes it easier to track drug flow throughout the country.

The Department believes that a turning point has been achieved regarding the awareness campaign for HIV/AIDS/STDs. The Department has successfully made this a central issue throughout the country, and hope to continue with these measures. The LifeSkills program has been moderately successful. The teenage pregnancy rate, however, has increased 65%, and the Department recognizes the need to target specific youth to ensure greater success. The Department of Education is training secondary teachers for sex education, and that is a tremendous step. The department plans to increase the number of private general practitioners and to discuss health issues with traditional healers to ensure all areas of the nation receive correct health information. With regard to mothers transmitting HIV to children and AZT treatment, the Department said that it recognizes there are several departmental problems that it would like to discuss later. It is pleased that the primary school nutrition program is giving finances to a national nutrition program that is beginning to be a successful structure.

Financially, the FY 1998/1999 conditional grants are voted to the budget. In the out-years of the MTF the Department sees extensive growth. Salient increases in the conditional grants are:
Redistribution of hospital services
Rehabilitation of hospitals
HIB Vaccine
Government AIDS plan

The HIB (Hepatitis B) Vaccine will be introduced in July 1999, to complement current polio and measles vaccinations. South Africa is currently scheduled to eradicate polio by the year 2010. There has also been a significant decrease in measles. The HIB vaccine will build onto the continuing success of the National Immunization Program.

The Redistribution of Specific Health Services grants rose from R53 million to R112 million. This effectively moves funding to provinces to build facilities within community areas currently lacking necessary health facilities.

Health Professional Training and Research increased by five percent this year. Traditionally, this money is allocated to the five provincial medical schools. In the Minister’s White Paper, she outlined greater goals for further training not only to go to medical schools, but for outreach programs as well. This funding can now be given to such programs.

The operational budget of the national department is R380 million. The conditional grants add up to R5 billion, making the total allocation R5.44 billion.

The Chairperson opened the floor for questions:
Ms Mothoagae (ANC) inquired about training policies and upgrading for PHC. She wanted to know about drug depositories and tracking methods discussed by Dr. Zuma. Also, she asked if there was any way to mark AIDS patients, so costs could be saved when they travel from one hospital to another to receive similar treatments. What stage would the Department introduced the vaccine? Finally, where are the implementation costs located for abortion and other legislation? The Department replied that the training for PHC needs to be compiled so there are no barriers to legislation. The member is correct in saying that the Minister is touting a tracking system – it will track and differentiate between private and governmental drugs. Due to anti-discrimination laws, there can be no flagging of AIDS patients. However, better education of these patients needs to occur in order to prevent duplicity in treatment. Since implementing the abortion act of 1998, roughly 6,000 terminations were completed and successful. Although health professionals are not forced to perform the procedure, they are required to refer patients to physicians who will.

Ms Tyobeka (ANC) asked what is being done to increase the quality of care, especially the lack of staff and flight of skills? She also inquired about the lack of hospital security, and access issues for average South Africans. Finally, she asked about the number of facilities currently not utilized, staffed, or equipped, but are built and otherwise fully functional. What is being done to make these facilities operational? The Department responded that the Quality of Care shortage is a problem within the provinces and with cash flow. South African skills are being lured away for better wages, packages, etc. In the White Paper, Dr. Zuma outlined a policy, which would require voluntary service within the country after receiving one’s degree. With regard to security, it is improving; Examples in Gauteng and Port Elizabeth are proof that the Department is concerned with the safety of health professionals and are attempting to solve the problem. They are working with the South African Police Force on creative solutions to this problem.

Ms Ford (IFP) questioned the HIB vaccine. What was the problem last year? Apparently mothers and children who went to the clinic were then sent to the pharmacy, where they were required to pay for the vaccine. Also, is it not correct that one needs two doses of HIB to be effective? Finally, how much of the budget is allowed to roll over? The Department responded that HIB does not officially go into effect until July 1999. Parents could purchase the vaccine last year, if they wished. HIB is effective after 3 doses. The National Immunization Plan reaches amazing success levels when a one-time vaccination is issued. However, the success rate decreases when another vaccination must be issued. A rigorous education program must be implemented to ensure success.

Ms Mothoagae (ANC) inquired how much money South Africa loses on world health programs and foreign affairs, with lack of invoicing. The Department responded that 90% of the international budget paid to health attachés and foreign problems. The Foreign Affairs Department usually processes these claims at the end of the fiscal year, resulting in massive bills. But the money is accounted for and will be used up before the end of the current fiscal year. The issue of treating patients from other countries has also been an increasing cost issue that the Department will look into further.

The Chairperson thanked the Department of Health for their presentation on behalf of the committee. He then announced that the Budget Vote would occur the following Tuesday. Five minutes would be allocated to both Departments. Parties would receive five minutes as well; however, the committee would like to include opposition parties in the discussion, and asked that the ANC note their time would be shorter to accommodate other interests. In addition, the Chairperson asked that the parties take the amendments agreed on to their respective provinces for approval. Although the Bill has not yet come through to the NCOP, this will allow the provinces ample time to formulate their policy on the matter.