Department of Health Annual Report 2005/06
Meeting Summary
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Meeting report
HEALTH PORTFOLIO COMMITTEE
29 May 2007
DEPARTMENT OF HEALTH ANNUAL REPORT 2005/06
Acting Chairperson: Ms M Madumise (ANC)
Documents handed out:
National Department of Health’s
Annual Report 2005/06 presentation
Department of Health Annual Report 2005/06 (available later at www.doh.gov.za)
SUMMARY
The Department of Health presented their Annual report for 2005/06. Improvement of Health Administration,
Strategic Health Programmes, Health Service Delivery and Human Resources were
discussed. The audit outcomes and
current adjustments were mentioned, as well as the strengthening of the systems
that were already in place. The challenges included those associated with poverty, unemployment, low
education levels, poor transport infrastructure and social cohesion. Other
challenges arose through the triple burden of disease (communicable,
non-communicable and trauma). lack of sufficient & skilled human resources
for health at both clinical and management levels, the poor health
infrastructure and community mobilization and patient adherence issues.
A report was given on the budget and financial performance. It was noted that
there had been both over and under spending but that overall across all
programmes there was a small under spend of 1,03%. There had been a qualified
Audit Report, resulting from the fact that business plans had not been approved
and there was therefore a discrepancy between the plans and the amounts
requested from the Division of Revenue Act, as well as late and non-submission
of monthly and quarterly financial reports. Matters of emphasis related to the
functioning of the Audit Committee,the failure to attend to the Environmental
Management Act report and the lack of full functioning of the Supply Chain
Management Unit. All of these issues were being addressed. The key priorities for the Department were to develop
provincial service transformation plans, to strengthen human resources, to
improve quality of care, to strengthen infrastructure and to strengthen
priority health programmes.
The discussion by Members centred on the Health Professionals and their
education as well as the lack of skilled professionals in the current health
system. This also included nurses
training and working conditions. The XDR
TB and treatment of TB was discussed and the treatment plans that were in place
to increase the cure rate of TB in SA.
The Human Resource issue was to be discussed in a more detailed meeting between
the committee and the NDOH focusing only on that issue.
MINUTES
National Department of Health briefing
Dr Yogan Pillay (Cluster Manager Strategic Planning, NDOH) introduced the
members of his team and proceeded to outline the presentation. This would cover the Legislative Mandates,
the key priorities of the National Health System for 2004-2009, a summary of
the key achievements and challenges per budget programme (comparing the progress between 2004/05 and 2005/06), as well as
the budget and expenditure report. The
key priorities as were reflected in the NDOH strategic plans for
2006/07-2008/09 and 2007/08-2009/10.
He reminded the committee of the vision and mission of the NDOH. The legislative mandates were covered and a
few were highlighted from the 2005/06 Annual Report. The budget programme structure was discussed
with regard to the current four programmes including Administration, Strategic
Health Programmes, Health Service Delivery and Human Resources. It was noted that the Budget Programme
Structure had changed between 2004/05 and 2005/06 with programmes such as
Districts and Development moving from Programme 2 to Programme 3.
The key priorities in the National Heath Plan for 2004-2009 were
mentioned. This included the improvement
of the governance and management of the National Health Strategy; the promotion
of healthy lifestyles; contributing toward human dignity by improving the
quality of care; improving the management of communicable and non-communicable
diseases; the strengthening of the Primary Heath Care (PHC), Emergency Medical
Services (EMS) and hospital service delivery systems; strengthening support
services; human resource planning, management and development; planning,
budgeting and monitoring and evaluation; preparation and implementation of
legislation and the strengthening of international relations.
Under Programme
1:Administration, comparison was made between 2004/05 and 2005/6 with
regard to all the programmes undertaken. In administration five bills were
processed during 2005/6 and the National Consultative Health Forum (NCHF) was
hosted in May, there were eight ministerial Izimbizo’s held and a range of
publications produced.
In respect of strengthening health sector planning Annual Performance Plans for
2006/07 and Annual Reports for 2005/06 were reviewed, eight of the nine
Provinces produced Service Transformation Plans for 2007/08, District Health
Planning (DHP) guidelines were published and used by 53 Districts to develop
District Plans for 2006/07 and the quality of most District Health Plans needed
further strengthening.
In the Strategic Health Programmes the Integrated Strategy for Child Health
(ISCH) guidelines were integrated from the World Health Organisation (WHO) into
the Integrated Management of Childhood Illnesses (IMCI), which was expanded
into 136 of 284 local municipalities.
There had been a decrease in the
percentage of Health workers providing services to children, and trained in
IMCI, from 64% to 60% as there was a high demand and staff in hospitals had
also been rotated. The National
Immunisation coverage had increased to 82% and the district-by-district
coverage of immunization had improved.
72% of districts provided Phase 1 of school Health Services and 60% of approved
facilities provide Choice on Termination of Pregnancy (CTOP) services. There was an increase in condom distribution
and an increase in Voluntary Counseling and Testing (VCT) at facilities, as
well as Prevention of Mother to Child Transmission (PMTCT) services. The expansion of the comprehensive treatment
(CCMT) plan meant that 65% of people living with HIV&AIDS, TB and other
conditions were provided with nutritional support.
There was a drive to strengthen TB control with the Directly Observed Treatment
System (DOTS) however defaulting patients did not aid in the continuing
effective treatment of the illness.
There was ongoing collaboration with NGO’s in curbing HIV & AIDS and
International Health relations had been expanded.
Accessing of safe and affordable medicines included 70% of Pharmacy licenses
issued against applications, and dispensing fees were published but were under
challenge, and the medicine pricing regulations were reviewed. Malaria control had also been strengthened in
the three provinces most affected, namely; KwaZulu-Natal, Limpopo and
Mpumalanga.
In Programme 3:Health Service
Delivery, there had been an increase in utilisation of Primary Health
Care (PHC) services. There was expansion in the Hospital Revitalisation
Programme (HRP) and the delegation of authority was given to hospital CEO’s.
There were additional Telemedicine sites established in the Eastern Cape and
Mpumalanga, the transfer of Forensic Labs and Mortuaries to the Department of
Health was completed, the expansion of the cataract surgery project was
continuing and the report for UNGASS
(United Nations General Assembly Special Session) was completed.
Under Programme 4:Human Resources Management, more health workers were trained
in the implementation of the Comprehensive plan for HIV &AIDS Care,
Treatment and Management (CCMT). The
draft regulations for Community Health Workers, as well as a policy framework for
CHW were developed.
Dr Pillay noted that several challenges remained. These were largely attributed
to poverty, unemployment, low education levels, poor transport
infrastructure and social cohesion. Other challenges arose through the triple
burden of disease (communicable, non-communicable and trauma). lack of
sufficient & skilled human resources for health at both clinical and
management levels, the poor health infrastructure and community mobilization
and patient adherence issues
Mr Gerrit Muller, CFO: DOH, stated that there had been small under spend
in the DOH in the Administrative sector.
He pointed out the under spending of R4 million in Maternal, child and
women’s health was due to the vacancies of posts for Pediatricians. The under
spend in Programme 3 was due to the fact that the orders were received
late. The International Health Liaison
was dollar based and the World Health Organisation gave a discount to members
therefore there was an under spend in this area as well. There was a saving from the previous year of
R2 million from the Global Fund and Lifeline and this would cancel out the R6
million overspend on the non-communicable diseases. Therefore there was a break-even point
reached. When measured across all the
programmes the NDOH had under spent by 1,03%.
Mr Muller noted that the NDOH was given a qualified audit report. This was done
prior to the approval of Business Plans, and because of the difference between
the total amounts of Business Plans and Division of Revenue Act (DORA)
applications, as well as the late and non-submission of monthly and quarterly
financial reports the qualification had been noted. In addition, the quarterly
visits to the provinces had not always been conducted and the appointment of
monitoring staff had happened late in the year.
In addition to the qualifications there had been matters of emphasis. These
related to the fact that the audit committee had not been functional; the
internal audit was not effective, the National Environmental Management Act
report had not been done and the Supply Chain Management Unit was not fully
operational. All of these issues were being addressed. The key priorities for the Department were to develop
provincial service transformation plans, to strengthen human resources, to improve
quality of care, to strengthen infrastructure and to strengthen priority health
programmes.
Discussion
Mr G Morgan (DA) thanked the DOH for their report and commented that the
previous Auditor General’s report raised specific issues. He queried why the
report was qualified. With regard to the
delegation of CEO’s to hospitals, he questioned the level of delegation and the
variances between the provinces, as well as the implementation of this in the
hospitals. He asked as to why the
district level plans were so varied in quality.
He also asked as to why there was a change in vacancy rate in the
hospitals and if NDOH was downgrading or changing posts.
Mr B Mashile (ANC) queried if NDOH were aware of the impact of under spending
on service delivery and if there was an improvement in the accountability of
the managers and in the monitoring of service.
Mr A Madella (ANC) asked why there was a breakdown of the sub-districts and why
not all of the sub-districts had not been reached in the immunization
process. He queried as to why the
bargaining council employee relations were not being considered, as this would
benefit the health workers. He queried
the general vacancy rate of 30% and noted that it would have a great impact on
Public Health Service delivery.
Mr Muller referred to the questions on the audit and stated that the payments
had been paid prior to the business plans been submitted, that the quarterly
reports were not fully under control and the monitoring staff had been
appointed late in the year. The
bargaining council was paid by Human Resources and the current vacancy rate was
previously the same or worse.
Dr Pillay drew a parallel between the vacancy rates and the under spending and
pointed out that those positions that were unfilled were for technical
specialists who would earn less in the DOH than in private practice and that
pharmacists were also affected in this way.
In the clinical services it was difficult to acquire certain
professionals. Some of the work was outsourced to other academic institutions
and specialists outside the DOH.
In relation to the perceptions of managers and their role in running the
hospitals. Dr Pillay emphasised that they were essentially CEOs, but their
skills and training varied widely. This
included their skill to do the allocations of budget and decide what budget was
needed in the particular hospitals. This
also had implications for service delivery.
The managers did not know of or could not properly exercise their
authority to handle and order according to the needs of the hospital and the
budgets allocated. However, he noted that there There was a management grant
available to improve the hospitals and 50% of the staff had been enrolled in
formal courses.
Dr Pillay said that the National Health Council definitions of level of care
had changed and had come into effect in February 2007. At regional and tertiary levels there was not
only one level of care and the level of service also differed as to the needs
of the population that it served. The
specifics of the Health Promotion were not understood and the Health plans
submitted from the regions varied in their degree of competency.
in regard to vacancies, he noted that there was currently an ongoing exercise
of “right sizing” of the staff as to the needs of the population and levels of service
required.
Mr Muller added to the issue of the vacancy rate, commenting that this also
depended on the services that were offered by the hospitals. He said that there were only two hospitals
that offered tertiary care.
Mr Muller said that with regard to the governance, an audit committee had now
been appointed and with regard to the internal auditing this was now done by an
internal audit team and co-outsourced as well.
Dr Pillay noted that the data for the quarterly reports had come in late and
the quality of the data received was not always of a high standard.
Ms N Mathibela (ANC) enquired as to why the funding of NGO’s had been reduced
from 74 to 70. She enquired why the quarterly reports were not
also given to the committee, and why more money was issued to the DORA projects
Mr Mashile enquired as to the cataract aftercare and the training of the health
professionals with the budget that is available. He enquired as to the interventions done with
the CEO’s of the hospitals and what was done in coaching them on their
responsibilities and on service delivery.
With regard to the district plans he enquired how those plans were put
into action.
The Chairperson enquired as to why the NGOs had not complied with the audited
financial statements.
Mr Muller replied that the NGOs applied to National government to be funded and
that the provinces reviewed this and also gave allocations, so that the NGOs
were not funded twice in government.
In the previous financial year there was a support programme to assist in the
DORA applications and this meant that they needed Management and Auditing as
line items. Two business plans were not
submitted.
He noted, in response to a previous questions, that condoms were manufactured
in South Africa by at least one firm, but that the raw material is imported.
Mr Muller noted that the Health Professionals' training grant would remunerate
the province for the training given to the students in the medical field. This development grant would be allocated
according the skills needed in that province.
Dr Pillay explained that the UK Development Agencies assisted in funding;
however there was a need to make this sustainable. The National Health Council did take
monitoring land grants very seriously.
He stated that the Health system had been significantly under funded for
the requirements it needed to meet.
With regard to the Cataract surgery he noted that professional and specialised
staff were needed and follow-up appointments to check the eye had to be
arranged.
The need for on site training with regard to TB was apparent and those skills
needed to be efficient as well as effective.
The districts needed assistance in planning and implementation of their plans,
as well as technical support, and the aid from the USA assisted in this.
Mr Madella enquired as to why the care rate of TB patients was not higher as
opposed to the higher rate of defaulting patients. He also enquired as to whether the newly
qualified graduates were welcomed into the DOH.
Mr Mashile enquired as to the interventions taken for under performing CEO’s of
hospitals and the dispensing fee for those areas that only had one chemist
where medicines could be collected. .
Ms M Manana (ANC) stated that the provinces needed to be held accountable for the
way they spent their budget. The new
definitions also needed to be made available to the Members. She also enquired as to why there were now
more training colleges for nurses even when there was a shortage of nurses in
the country.
The Chairperson enquired as to why the Directly Observed Treatment System went
wrong.
Dr Pillay replied that the National Health Council and the National Department
had an advisory role to make sure that all norms and standards were followed.
The Hospital Improvement Plans were developed by the hospitals with the support
of the Province and National oversight.
The National Committee would meet four times a year. Plans for strengthening and monitoring of
hospitals and pharmacies would continue and a report by the National Health
Council would be given.
With regard to power failures and other problems in hospitals an early warning
system or indicator needed to be given so that problems like power failures
could be dealt with as quickly as possible.
The Department of Public Service and Administration guidelines needed to be
revised.
The TB cure rate was lower as the patients would not return for their final
smear or would not complete the whole cycle of treatment. The patient needed to be free of TB for two
months to be able to be declared “cured”..
Three different measures needed to be taken and employees were being
trained for capturing TB data and following up on those that had not finished
their treatment.
Health professionals trained were not in one specific field and there were
about 1200 graduates every year.
The nursing colleges were available to accommodate the students and the
colleges in each province were either amalgamated, new campuses built or closed
down according to the need of the province.
The new Definitions of Health Service Providers would be made available to the
Committee.
With regard to the dispensing fees, Dr Pillay suggested that the consumers
needed to compare prices to get the best value.
Ms F Batyi (ID) commented that as the dispensing fee was so expensive in some
cases the patients would use each other’s medication, especially if they did
not have a medical aid. She commented
that in Beaufort West there was only one hospital and the doctors were not on
duty during the weekends. She asked how
this was going to be dealt with.
Mr Morgan enquired as to the current status of internships for doctors and the
current details for community service for nurses.
Mr Madella enquired as to why those suffering from the Extremely Drug Resistant
(XDR) TB were being turned away from hospitals.
The output by doctors for the needs in the hospitals did not meet the
health systems requirements.
Ms M Tlake (ANC) stated her concern of the brain drain from SA of qualified
health professionals while new nursing colleges were also being opened and she
suggested a more integrated approach in education in this regard. The nurses that received degrees were at a
lower risk than those that chose to study in nursing college. She queried the disparity between the salaries
of those nurses, who did the same work but did not receive the same
remuneration.
Dr Pillay replied that the dispensing fee was based on a court ruling for a
minimum fee to be charged to clients for medication.
There was a drive to encourage private sector doctors to support the rural
clinics and communities, as well as the country-to-country doctors support
programme.
With regard to Human Resources there would be a special session with the Health
Committee dealing with this issue.
In dealing with the XDR TB the patient needed to be isolated and treated.
However the patient results were usually available later, so the patient could
not at first necessarily be isolated.
Additional beds were needed as well for these patients. The XDR TB strain had developed because the
patients had not finished their treatment and so the TB would adapt to the
medication.
The Human Resource matters would be further discussed in the report and meeting
concerning that specific matter with the Committee.
In the preceding year too many pharmacists and dentists were trained. For the
nurses a normative planning model had not been helpful and it was now suggested
to follow with workload based assessments for the nurses, as most nurses had to
attend to about 40 patients a day and this included those that were chronic, to
the more treatable illnesses.
With regard to the “brain drain” experienced, this had been a long ongoing
debate and would continue to be as other countries were experiencing this as
well. The issues were also around the
skills need of the country.
In regard to the other debate of whether to issue a stipend or use the bursary
system, Dr Pillay noted that both of these were currently being maintained as
historically the State employed and trained nurses as well. It had to be accepted that training
university graduates in nursing was also contributing to the international
market.
The access to Choice of Termination of Pregnancy (CTOP) was always limited in
expansion in that health workers could choose to do this or refer clients to a
different hospital or clinic. However
this had resulted in fewer abortions.
The meeting was adjourned.
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