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HEALTH PORTFOLIO COMMITTEE
10 October 2000
NATIONAL HEALTH LABORATORY SERVICE BILL: BRIEFING AND VOTING
National Health Laboratory Service Bill [B 52B-2000]
There was a clause-by-clause reading of the Bill. Many questions came from Mr Ellis (DP) who challenged the practicality of making health laboratory services public. He said his party favoured privatisation. The Committee voted in favour of the Bill, with the ANC voting for and the DP and NNP voting against.
The meeting was briefly attended by Minister Manto Tshabalala-Msimang.
Briefing on the Bill
Mr Ray Mabope of the Department took the Committee through the Bill clause-by-clause.
Mr Ellis (DP) asked how the transitional provisions will work and how long they will be in place.
Mr Mabope answered that the amalgamation of existing medical laboratories will be complex in that many bodies must cease to exist (see clause 2 of the Transitional Provisions, listing the South African Institute for Medical Research, the National Institute for Virology, the National Centre for Occupational Health, state-owned forensic chemistry laboratories and all provincial health laboratory services). He ventured the process would take from between 12 to 18 months, considering there would be complicated legal processes with staff, etc.
Mr Ellis asked if there were deadlines set for the final amalgamation.
Mr Mabope said there was no commitment to a date as of yet, but that he would consult with the Minister and perhaps have an answer by the following day.
Dr Rhoda (NNP) asked about expected job losses from the change.
Mr Mabope said they did not foresee massive job losses, but did admit there would probably be some retrenchments. He did not know how many there would be, but said retrenchments are part of any amalgamation process. He said that there was some "fat" in the system, but did not know how much. He said a complete audit of staffing was taking place now. Some members of staff, he added, may choose not to come into the service in favour of pursuing careers in academia.
Mr Ellis asked to what extent the bodies listed above were involved in the process of amalgamation.
Mr Mabope replied there had been a long process of consultation and negotiation from the very beginning. They had chosen from the options of a public, private or parastatal entity. The public option was rejected since everything could not be rationalised. They did not feel they were competitive enough to go private, so the parastatal entity was seen to be the best compromise.
Ms Baloyi (ANC) asked for clarification of clause 16, "Rendering of laboratory services to foreign countries".
Mr Mabope answered that South Africa can be seen as a "resource" for other Southern African Development Community (SADC) countries and that South Africa wants to provide services to its neighbours, within protocols and with allowances for ventures and partnerships. He said South Africa has been doing this on an ad hoc basis, such as during the Ebola virus outbreak in the DRC, but without protocols.
Mr Ellis asked why they were determined to move away from privatisation in terms of health care. He asked why going public is seen to be better?
Mr Mabope answered there had been a lengthy debate around the three options of public, private and parastatal. Stakeholders had had concerns around privatisation. Privatisation would also curtail academic and research interests. He added it would be hard for government to privatise and meet its own policy of providing affordable health care.
An ANC member asked that the functions of the Board, its Chairperson and Vice-Chairperson, in terms of clauses 7 and 9, be clarified.
Mr Mabope explained that the CEO runs the organisation, is responsible for the management of services and is accountable to the Board. The Board is appointed by the Minister. The CEO becomes a member of the Board and can offer the Board clarifications, especially at the policy framework level. He added the Board is expected to be representative of the whole country as a whole in that it must have members from each province.
The Chair announced it was time for the Members to vote on the Bill. He read the Motion of Desirability which was agreed to unanimously. Mr Mabope then embarked on a more detailed clause-by-clause reading of the Bill, taking more questions from Members.
Clause 2, "Exclusion from application of this Act"
Mr Ellis asked why the South African Police Service and Military Health Services had been excluded.
Mr Mabope answered they were governed by a different Act and that some services, such as those pertaining to criminal law, are highly confidential.
Mr Ellis asked if they might come under the Act at some time in the future?
Mr Mabope said negotiations would continue.
Clause 4, "Objects of Service"
Mr Ellis asserted that clause 4 is representative of his party's difference of opinion with the ANC. He said the DP cannot believe a big nationalised health service can provide "efficient and cost-effective" health laboratory services, as clause 4(a) sets out as an object of the Services. He asked if they were creating another parastatal that would be able to meet the objectives of its Bill.
Dr Jassat (ANC) said a centralised system is more efficient than a private one.
Mr Mabope said you can only centralise what it makes sense to centralise. For example, staff appraisals can't be done centrally, so they will have to be done at a lower level. There can also be particular areas of specialisation around the country, for example, pathology. In this way, everything will not be completely centralised.
Clause 7, "Composition of Board"
Mr Ellis asked if there were enough members of the Board with specific technical experience.
Mr Mabope said they had been uncertain as to whether or not to make requirements that specific professions be represented on the Board but ultimately had decided not to. This was because it might have raised questions as to the representativeness of certain professions.
Mr Ellis asked if the Minister can override a province.
Mr Mabope responded by referring to the "gel" that makes government work. This gel cannot be touched, he said. It is based on goodwill and co-operative governance. He commented that, in this context "override" is a harsh word.
Clause 15, Purchasing of services
Mr Ellis asked for clarification of this clause.
Mr Mabope answered that the NHLS should be able to do work coming from the private sector, as set out in clause 7, and also drew attention to clause 5(2)(e) which allows the NHLS to purchase a service from the private sector. He added if a test is not done frequently, it may be cheaper to have it done privately and locally rather than sending it to Johannesburg.
Clause 18, "Finances of Service"
Dr Rhoda (NNP) asked if any budget problems between central and provincial governments were anticipated.
Mr Mabope said there would be no big reserves left or surpluses.
Mr Ellis asked if this surplus would be allowed to rollover.
Mr Mabope said he would investigate how rollover funds would be dealt with.
Mr Ellis insisted he be informed as to what will happen to these funds. If there was no rollover, how would the money be spent? Would it just be spent recklessly so the budget would be used up?
The Chairperson interjected and said Mr Ellis's questions were for information, not for voting purposes.
Voting on the Bill
The Committee voted on the Bill.
The ANC voted in favour whereas the DP and the NNP voted against.
The tally was 9 to 2, so the Bill was passed by the Committee.
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