Department of Health Strategic Plan & Budget 2007/08 briefing
NCOP Health and Social Services
23 May 2007
Meeting Summary
A summary of this committee meeting is not yet available.
Meeting report
SOCIAL SERVICES SELECT COMMITTEE
23 May 2007
DEPARTMENT OF HEALTH STRATEGIC PLAN & BUDGET 2007/08 BRIEFING
Chairperson: Ms J M Masilo (ANC, North West)
Documents handed out:
Presentation
on strategic plan & budget 2007/08 – 2009/10
National Department of Health budget and report [available at www.health.gov.za]
SUMMARY
The Chairperson announced that the Health Professionals Amendment Bill was
still being finalised and proofread and it should be ready by 29 May.
The Department of Health briefed the Committee on its strategic plan and budget
for 2007/08. The major goal of the DOH in promoting healthy lifestyles
remained. Ten key priorities for 2004 – 2009 were outlined, which included also
governance and maintenance of the National Health System, improvement of
hospital quality care, improvement in management of disease and strengthening
internal management issues. The achievements across all programmes were
detailed. Five hospitals had been completed on the hospital revitalisation
programme. Primary health care visits had increased. A countrywide human
resources plan had been developed. Challenges included poverty, unemployment,
low education levels, poor transport infrastructure and social cohesion. The
triple burden of disease, lack of skilled and sufficient human resources at
both clinical and management levels and inadequate health infrastructure were
further challenges. The priorities for the forthcoming year under the national
health scheme were described. The budget for health was increasing at 11.9%
average. The allocation for 2007/08 was R734,7 million
and conditional grants of R12.6 billion were anticipated. The budget included
provision for the new remuneration structure for health professionals, 30 000
additional personnel, emergency medical services, hospital revitalisation and
modernisation of tertiary services for radiology and cancer.
Members asked numerous questions, only some of which were answered in the
meeting, and the Department was asked to produce written responses by 30 May.
These questions included the exchange of nurses, training of nurses,
remuneration issues, schools’ health programmes, monitoring of HIV and
drug-resistant TB, service delivery in some provinces, human resources planning
and skills shortages, the plans for further oncology units, plans for rural
hospitals, hospital revitalisation programmes and per capita spending across
provinces. Further issues were raised around medication pricing, the lower
budget for cervical cancer, regulation of circumcisions, and the number of
vacant posts and staff holding acting positions.
MINUTES
Finalisation of the Health Professionals Amendment Bill
The Chairperson stated that the final copy of the Health Professionals
Amendment Bill had been delayed as it still needed to be finalised and properly
proofread. Clarification on clause 12 and other clauses was still needed. It
was decided that a meeting would be arranged between the Health Professionals
and the State Law Advisor to finalise any changes. The Bill needed to be
finalised by the 29 May 2007.
Strategic Plan 2007/08: Briefing by the National Department of Health (DOH)
Dr Yogan Pillay, Chief Director: Strategic Planning, DOH, apologised for the
absence of the Director -General, Mr T Mseleku, who was attending a
summit. He emphasised that the goals of
the DOH since 2004 in promoting healthy lifestyles had not changed.
Dr Pillay outlined the DOH’s Ten Point Plan key priorities for 2004-2009. These
included the governance and management of the National Health System, promotion
of healthy lifestyles, improvement of hospital quality care, improvement of the
management of communicable and non-communicable diseases and the strengthening
of various internal management issues as well as international relations.
Dr Pillay described the achievements in each of the programmes. With regard to
the Administrative Programme, Dr Pillay emphasised that five new pieces of
legislation were processed. All the
provinces had produced Service Transformation Plans (STPS) and this
strengthened the culture of planning. On the National level strategic plans
were reviewed and the Draft Bill reviewing the Medical Schemes Act been
submitted to Cabinet. Communication on the National and Provincial level had
improved, 18 imbizos were held and a range of publications produced. Key Cabinet decisions regarding Social Health
Insurance were also made.
With respect to the Strategic Health Programmes the Integrated Management of
Childhood Illnesses (IMCI) project was taken to 136 of 284 local
municipalities, and 60% of health workers seeing children were trained in IMCI.
Choice of Termination of Pregnancy Services, was
provided by 60% of approved facilities and 88% of facilities offered Voluntary
Counselling and Testing. 72% of districts were providing phase 1 of School
Health services. Medicine pricing regulations were being reviewed. 24 000
applications for compensation for ex-miners were processed.
The Health Service Delivery Programme achievements were detailed. Primary Health Care (PHC) visits by the
public had increased and all nine provinces had delegated authority to Hospital
Managers. The transfer of forensic laboratories and mortuaries to Department of
Health was now complete. The National Infection Control policy was finalised. Five hospitals on the Hospital Revitalisation
Plan were completed, and further hospitals were added.
The Human Resources Management Programme of the DOH had developed a countrywide
HR plan. The Skills development Policy was adopted and draft regulations for
Community Health Workers (CHWS) were developed.
11 958 Health Workers were trained to implement the comprehensive plan
for HIV & AIDS. The interim Traditional Health Practitioner Council was
established.
Challenges faced by the DOH included poverty, unemployment, low education
levels, poor transport infrastructure and social cohesion. The triple burden of disease (communicable,
non-communicable, injuries and trauma) as well as the lack of sufficient and
skilled human resources for health at clinical and management levels, and inadequate health infrastructure were further
challenges.
The key National Health Scheme (NHS) priorities for the coming year were
stated. These included developing
provincial service transformation plans, strengthening human resources as
related to the National Skills Development Strategy, improving the quality of
health care, strengthening infrastructure and strengthening priority health
programmes, which included the implementation of mass media campaigns to
promote nutrition, to ensure that 60% of health districts had staff trained to
implement the Reach Every District (RED) strategy, to strive for 5% reduction
in smoking by adults and youth, and to support 85% of the institutions with
maternity beds. Full details of each programme were explained.
Mr Gerrit Muller, Chief Financial Officer: DOH,
highlighted that the Health budget grew by 11.9% over the period. He tabled new
allocations for 2007 with respect to the rebuilding of the Department of
Health’s Civitas building. Allocations for LoveLife (including evaluation),
hospital revitalization, HIV & AIDS and for the National Tertiary Services
Grant (NTSG) were tabled. The total allocation for the 2007/08 year was
R734.7million and the total conditional grants were R12.6 billion. Full details
were given of the breakdown across programmes, provincial health expenditure,
personnel expenditure and capital expenditure. The budget made provision for
the new remuneration structure for health professionals, 30 000 additional personnel,
emergency medical services, hospital revitalisation and modernisation of
tertiary services for radiology and cancer.
In conclusion, Dr Pillay stated that the Department faced a range of
challenges. Adequate resources and
changes in the social contexts for the Health System were vital to the success
of the implementation of the plans and intersectoral collaboration across
government and with key stakeholders was crucial. The National Treasury would be engaged for
further resources.
Discussion
Ms N Madlala-Magubane (ANC, Gauteng) raised a number of questions, namely:
-How far the agreement between the exchange of nurses programme was progressing
-The earnings related to local and government clinic nurses
-How the schools Health Programmes were being run
-How the HIV levels of infection were being monitored
-Why the benchmarked countries for comparing medical prices were only the UK,
Canada and Australia
-Why there was a difference in the amount of doctors on the Hospital Boards
from province to province
-Why the committee were not receiving quarterly reports from the DOH
-Why the service delivery in the Gauteng area was so poor, as reported on the
slide dealing with the service and infrastructure audit.
Mr M Thetjeng (DA, Limpopo) enquired why there were not more oncology units and
what plan was being formulated to deal with this. Detailed results and figures
were requested with regard to Human Resources planning and skills shortages,
particularly on specific skills and qualifications. He also enquired as to how
the more damaging strains of the drug-resistant TB were being dealt with.
Mr B Tolo (ANC, Mpumalanga) enquired as to the hospital policies on the bodies
of stillborn babies and enquired as to why qualified nurses’ remuneration was
not increased. He asked if there were sufficient nurses trained over the last
year and if there was a plan to eventually acquire a building for the DOH as
rental could become expensive.
Ms J Vilakazi (IFP, Kwazulu Natal) enquired as to the plans for the rural hospitals.
She also enquired as to the rural allowances for nurses and the hospital
facilities in the rural areas.
Dr Pillay responded to the questions on remuneration generally by stating that
a different plan was in the process of formulation with regard to rural
allowances, and this would include a new grading system for nurses and health
workers. The exchange of nurses to the UK was a Gauteng specific pilot project.
Mr M Sulliman (ANC, Northern Cape) stated that clarity was needed on those
hospital revitalisation projects that were stopped. Uniformity in the per
capita spending in each province was needed.
He asked whether the qualified refugees from the surrounding African
states could be absorbed into the nursing staff of this country.
Ms H Lamoela (DA, Western Cape) enquired if there were any imposed penalties on
the delay in the revitalisation of some of the hospitals. She requested a break
down of the schools per province that were involved in Health
Promoting Schools programmes.
Ms Madlala-Magubane enquired as to why the benchmarked countries for medication
prices did not include any African countries. She noted that the adjustment of
the budget for cervical cancer was lower, and she asked the reasons. She
enquired as to how far the DOH was on the regulation of traditional
circumcisions.
The Chairperson expressed concern with regard to the vacant posts and the fact
that those positions were filled by people that had been “Acting” directors for
a number of years.
Dr Pillay replied in general to some of the questions. He made a general
comment on government leverage of national policy, stating that the
decentralisation, autonomy and the provincial treasuries did not all have the
same priorities as the National government.
The Human Resources National Plan included what the plan of DOH was in the
coming years. The pull and push factors were different for nurses. The push
factors taking the nurses away from SA were that the management and
remuneration were not adequate. Health professionals experienced
“Irresponsible” behaviour by patients but health workers reported that they
were not respected by their patients.
Dr Pillay stated that with regard to the hospital revitalisation programme, the
budget bid was R3,6 billion over three years, but only
R1,9billion had been allocated. One
third of the budget had been allocated for the rebuilding of hospitals,
one third of the budget had been allocated for the rehabilitation of hospitals
and the final third for maintenance of hospitals. The lack of infrastructure arose through the
shortage in building skills, a shortage of cement and a lack of capacity. Other contributing factors included
corruption and the projects could not be brought forward until the legal cases had
been finalised.
Mr Muller replied that the per capita funding was R1,451
billion for 2007/08 and the report (slide 13 of financial presentation) showed
that Limpopo, Mpumalanga and North West were less than the average.
Dr Pillay (DOH) stated that there were two major goals for the country; a 50%
reduction in HIV incidence and by 2011 to have care, support and treatment
available to those that need it.
Ms Mazibuko suggested that the detailed answers to the other questions asked be
put in writing.
The Chairperson concurred and asked DOH to submit the answers to the questions
by the following Wednesday.
The meeting was adjourned.
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