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SOCIAL SERVICES SELECT COMMITTEE
9 May 2006
DEPARTMENT OF HEALTH AND SA SOCIAL SECURITY AGENCY STRATEGIC PLANS & BUDGETS: BRIEFINGS
Documents handed out:
Presentation by the Department of Health on strategic plan and budget 2006/07
Presentation by the SA Social Security Agency on strategic plan 2006/07: Part 1, 2 & 3
Committee minutes of the 7th March 2006
Committee minutes of the 22nd March 2006
Committee minutes of the 2nd May 2006
The Committee was briefed by the national Department of Health and the South African Social Security Agency on their strategic plans and budgets.
The Committee raised questions about the lack of progress with the hospital revitalisation programme, insufficient infrastructure and human resources; grants fraud and corruption.
National Department of Health briefing
The Director General, Mr Thami Mseleku introduced Mr Muller (Chief Financial Officer) and Mr Z Dangor as his team members.
The Director General presented the vision and mission of the National Department of Health (NDOH). The NDOH was mandated by 49 acts, which included the Constitution of the Republic of South Africa, the National Health Act, the Mental Health Care Act, and the Medical Schemes Act. He outlined the key priorities for 2004-2009 highlighting improving governance and management of the National Health System, promoting healthy lifestyles, contributing towards human dignity by improving quality of care as well as strengthening the Primary Health Care, Emergency Medical Systems and hospital service delivery systems. The NDOH prioritised to strengthen international relations and preparation and implementation of legislation.
The Director General also mentioned priorities for 2006/07 highlighting the development and implementation of service transformation plans, implementation of the national human resources for health plan, strengthening physical infrastructure and improving quality of care. To develop and implement service transformation, all provincial DOHs had to finalise a service transformation plan by May 2006. The National Human Resources Plan had been completed and launched on the 7th of April (World Health Day). The scope of practice of mid level workers was also finalised. The Director General informed the Committee that hospital revitalisation was in its fourth year; four hospitals were completed in 2004/05 and forty-five hospitals were enrolled in the programme over the next three years.
In strengthening health programmes, all provinces would develop detailed, context specific implementation plans for the healthy lifestyles campaign including community-based health programmes, which would be implemented in all fifty-three districts. 60% of schools promoting health would implement the school health policy. The Director General concluded that despite many challenges the NDOH had seen progress in health service delivery in 2004/05 and 2005/06. With guidance from the Minister and the Deputy Minister, the NDOH would work hard to ensure achievement of 2006/07 targets
Mr J Thlagale (United Christian Democratic Party, North West) commented that it was interesting to see that the National Department of Health (NDOH) was taking part in preparations for the 2010 Soccer World Cup. However he was concerned about increases in the budget when there were no monies transferred to provincial departments.
Mr B Tolo (ANC, Mpumalanga) commended the Department for an informative presentation. He questioned whether or not the increases were nominal. Was the issue of inflation taken into consideration? He raised a concern that it had become a norm that the budgetary allocations of provinces were not in line with the funds allocated at the National level. He asked how the NDOH hoped to monitor and prevent that from occurring in the future.
The Director General responded that the increases were nominal even though it was possible that they would not match the need currently faced across the board.
Ms Madlala-Magubane (ANC, Gauteng) questioned how the NDOH hoped to ensure that all provinces submitted the Service Transformation Plan. She further asked the Director General to clarify the content of the Intermediate Worker Course that was to be introduced. Was it similar to the already existing primary health care course that was introduced a few years back?
The Director General concurred that there was a Health plan that was being implemented and it was hoped that it would improve as the scope of practice of mid level workers had been finalised.
Ms Madlala-Magubane wanted to know what was planned about the Natalspruit Hospital in Gauteng. Was it amongst the 43 hospitals to be revitalised?
The decision to include hospitals to be revitalised was a provincial responsibility; not that of the NDOH, said the Director General adding that it was possible that Natalspruit was amongst the hospitals to be revitalised.
Mr M Sulliman (ANC, Northern Cape) asked the Department to clarify why some hospitals were excluded from the revitalisation programme. Why were they excluded? He further questioned how the NDOH planned to ensure that under spending was avoided, as it had become a problem in the previous years.
The Director General said that the issue around budget allocation was a challenge to the Department. The NDOH made an effort to make sure that figures correlated, but could not monitor that effectively, because provincial departments operated in their own right with which the NDOH could not interfere. He added that it was important to note that the NDOH had very few cases of under spending and was engaging in a process of improving capacity to plan better.
Mr Tolo was concerned with the Doctor/patient ratio, indicating that there were insufficient doctors to deal with the huge number of patients in hospitals and clinics. He asked how the Department hoped to strike a balance between doctors and patients.
The Director General said that there was a need to produce more doctors in South Africa, however the strategy was unrealistic. As a consequence, the NDOH was considering the possibility of producing health professionals other than doctors who would be qualified enough to perform similar tasks despite having undergone a shorter period of training.
Ms H Lamoela (DA, Western Cape) posed a follow up question wanting to know how the Department would ensure that quality of health is not compromised by producing health professionals over a shorter period of time than was normal.
The Director General responded that many countries (including Canada) practiced that strategy and it had proven to be effective. There was no reason why South Africa could not do it.
Mr M Thetjeng (DA, Limpopo) asked if the NDOH had information indicating how the Department was progressing with recruiting health care workers. Was there a detailed plan indicating where human resources lacked and in what field of specialization training was a challenge? He further commented that there were instances in Limpopo where Mobile units proved to be unroadworthy. How did the NDOH hope to monitor licensing and monitoring of the mobile units?.
The Director General indicated that there was a Human Resources plan, which was hoped to assist provinces where resources were lacking. He said that the NDOH was in discussions with the SA military services to recruit from there for the 18-month course. These were some of the intermediate remedies that sought to deal with the challenges at hand. He informed the Committee that there were about 28000 ambulance assistants that would to be upgraded in their training and skills.
Ms Lamoela commented that there were no hospitals considered for revitalisation in the Eastern Cape. She also commented on the number of completed hospitals for revitalisation in 2004 indicating that four was insufficient. She urged that the process be sped up. Ms Lamoela questioned the role played by the Department to ensure that problems of long queues and insufficient doctors were dealt with, quoting a hospital in Ceres in the Western Cape.
The Director General indicated that the Eastern Cape had been allocated R140 million for revitalisation which meant that there would be hospitals revitalised at some point as well in the Eastern Cape; however much of the work depended on the availability of resources from the construction industry. Currently the industry was faced with challenges such as the shortage of cement.
Ms A Qikani (United Democratic Movement, Eastern Cape) was concerned that patients were not motivated to finish their TB treatment mainly because of poverty. Was there any role the NDOH could play to ensure that patients had access to food parcels in order to be motivated to undergo their treatment effectively? She also raised her concern around the manner in which the incinerators as well as the laundry facilities were utilised in hospitals and clinics.
The Director General responded that providing food parcels was part of the social development strategy and the NDOH was working closely with the Department of Social Development to look into the issue. He added that it was the Department’s plan to monitor the movement and progress of patients in hospitals, but provinces had a responsibility to ensure that their facilities were looked after.
Mr T Setona (ANC, Free State) commented that the Committee needed to move away from the manner in which it considered and dealt with some issues. He asked whether or not there was an integrated information technology system that could be used to improve communication amongst hospitals in dealing with issues such as patient referrals.
The Director General replied that the NDOH had embarked on a patient information system, which would ensure that patient records were kept and monitored. He added that this would also monitor the movement of patients from one health care facility to another.
The Chairperson was concerned that there were more male condoms produced and yet the number of female condoms remained limited.
The Director General echoed that the uptake of female condoms was low and part of the reason was that they were not user friendly and they were not cost effective compared to the male condoms. It was also interesting to note that the majority of people who purchased male condoms were females.
South African Social Security Agency briefing (SASSA)
The Chief Executive Officer of SASSA, Mr Makiwane introduced his delegation as the following: Mr H De Grass, Dr W Terblanche, Ms R Alley, Mr D Plaatjies, Mr H Radebe, Ms M Mosheshe, Ms C Colaal and Mr Z Dangor
The CEO presented the Agency’s establishment and operationalisation, outlining progress and the challenges experienced thus far. He indicated that the Agency had progressed well with setting up the infrastructure, appointing key and critical personnel while appropriate policies; processes and procedures were being implemented. The following are some of the critical topics the CEO covered: the head office executive management team was in place; Human Resource policies and processes were approved and implemented; financially the accounting practice and guidelines were in place; the Agency implemented its Information and Technology strategy while Information and Communications Technology was being rolled out in the regions.
The CEO highlighted that the South African Social Security Agency Act, 2004 as well as the Social Assistance Act were the legislation that informed the Agency and the priorities including improving service delivery and enhancing grant process integrity. The Agency experienced a challenge in improving application processes for grants with the varying and lengthy turn around times across and within provinces; the proposed solution included implementing improved business processes as well as designing streamlined business processes for grant administration to reduce turnaround time in relation to grant applications. Moreover the Agency piloted the turnaround time in three provinces, the Eastern Cape, Western Cape and Mpumalanga.
SASSA reported that to date, forty mobile vehicle units were to be rolled out in areas where no infrastructure existed. Blueprints for service offices and pay points were being drafted. Regarding the 2006 Medium Term Expenditure Framework, the social assistance system was financed through social assistance transfers and the social assistance administration. The 2006 strategic plan showed that the social assistance administration funds comprised the SASSA establishment and operational funds, social assistance administration and grants administration integrity. (See presentation for budget allocation)
Mr Sulliman asked if SASSA was aware that there were loans signed out to pensioners. He was concerned that the money for grants was not being used effectively as service providers deducted money from pensioners, thus decreasing the actual amount pensioners received.
The CEO said that the issue was complicated, but the Agency preferred to monitor the manner in which service providers interacted with pensioners. It was not up to the Agency to pass a law against deductions; however the Agency was engaged in a process of reviewing and managing new contractors to provide services. There was a possibility of finalising a tender with banks, which would ensure that deductions were monitored and regulated.
Mr Thlagale commented that he was impressed with the progress the Agency was making as a new organ. He asked what steps had been taken to prevent people from receiving childcare grants and yet use them for their interests and not those of children. Was it possible to educate them on how to use the grant and what role did it play in the well being of the child?
The CEO commented that the Agency hoped to educate people on what it wanted to accomplish with grants and what role the money played in the well being of a child. He agreed that the process was challenging, as there were a number of various departments and entities involved.
Ms Qikani asked if the Agency felt that the forty mobile units were enough to cater for the Eastern Cape, which needed the services urgently. Was it not possible to increase the number of mobile cars?
The CEO explained that the mobiles were not enough for any province in the country and it was important to understand that introducing the mobile units was part of the initiatives by the Agency to speed up service delivery. It was hoped that the process would be sped up. He concluded that there was a possibility to purchase more mobile units in the future.
Ms Madlala was worried about corruption in South Africa especially at the border crossings. It was possible that there were people who had false identity documents and using them to gain funds through the grant systems. She asked if the Agency had any system in place to ensure that such eventualities were monitored and prevented.
The CEO indicated that they hoped to verify the authenticity of identity documents working in collaboration with the Department of Home Affairs. All other departments were expected to "own" the process to ensure that corruption was rooted out. He added that part of the work depended on society and the manner in which they reported cases to Home Affairs and other institutions.
Mr Thetjeng asked if the Agency had a unit that focussed and dealt with cases of fraud. He further commented that he often found it difficult to get assistance when calling on behalf of pensioners in his constituency. He asked if there was any mechanism in place to assist legitimate people calling on behalf of pensioners and others members of society.
Ms Mosheshe responded that there was a unit dealing with cases of fraud. However there were challenges in checking irregularities in identity documents. The Agency had resolved that whoever was involved in fraud would be charged and would have to pay back the money.
The CEO responded that enquiring on behalf of someone had its shortfalls because it was possible that people would use the information gathered to further their own interests.
The meeting was adjourned.
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