Department of Health Annual Report 2006/7: briefing

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Health

05 November 2007
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Meeting report

HEALTH PORTFOLIO COMMITTEE
6 November 2007
DEPARTMENT OF HEALTH ANNUAL REPORT 2006/7: BRIEFING

Chairperson: Mr LV Ngculu (ANC)

Documents handed out:
Annual Report presentation
Department of Health (DOH) Annual Report 2006/ 07 [available at www.doh.gov.za]

Audio recording of meeting

SUMMARY
The Department of Health briefed the Committee on their Annual Report focusing on achievements in the 2006/07 financial year. In terms of improved governance, the National Health Council (INCH) was strengthened. Healthy lifestyles were promoted through awareness campaigns for breast cancer, cervical cancer and nutrition. A major contribution was made by the DOH towards the improvement of the quality of care. Sixty percent of revitalisation hospitals conducted clinical audits and a quality assurance-training framework was completed and sent to the Health Seta for approval. Challenges facing the DOH were lack of sufficient and skilled human resources for health, poor health infrastructure, intersectoral collaboration and community mobilisation and patient adherence issues.

Questions from the Committee focused on the audit performance of the DOH, funding of projects and why some projects were stopped, regulations for complementary medicine, the training of hospital managers, non compliance from the provinces regarding the submission of business plans, the National Aids Trust and foreign health professionals.

MINUTES
Department of Health presentation
Mr Thami Mseleku (Director-General) of the National Department of Health (DOH) briefed the Committee on the Annual Report of the DOH. The DOH reported on their achievements in 2006/07 against the background of their 10-point priority plan.

In terms of improved governance, the National Health Council (INCH) was strengthened. Healthy lifestyles were promoted through awareness campaigns for breast cancer, cervical cancer and nutrition. A major contribution was made by the DOH towards the improvement of the quality of care. Sixty percent of revitalisation hospitals conducted clinical audits and a quality assurance-training framework was completed and sent to the Health Seta (Sector Education and Training Authority) for approval.

An increase of 78% in immunisation was reported for 2007 and South Africa was declared polio free by the Africa Regional Certification Commission. A 2006 antenatal HIV survey showed a statistically significant decrease in HIV prevalence amongst pregnant women from 30.2 % in 2005 to 29.1% in 2006. Over 282 200 patients were initiated on antiretroviral treatment across the country in 2006/07. A national Strategic Plan for HIV and AIDS 2007- 2011 was launched in 2007 and nutritional packages were distributed to people living with AIDS. The World Diabetes Congress was held in Cape Town in December 2006.

The strengthening of support services was achieved through the transfer of forensic services from the South African Police to the DOH. Four provinces produced draft Human Resource Plans and a remuneration dispensation for all categories of nurses was also agreed on with National Treasury and the Department of Public Service and Administration.

With regards to planning and monitoring, the DOH reviewed all nine provincial annual performance plans and provided feedback to the provinces. The monitoring of the implementation of plans by the National and Provincial DOHs were strengthened, with four quarterly reports compile during 2006/07.

Two pieces of legislation had been processed: the Tobacco Products Control Amendment Bill and the Health Professions Amendment Bill.

Challenges facing the DOH were lack of sufficient numbers of skilled human resources for health, poor health infrastructure, intersectoral collaboration and community mobilisation and patient adherence issues.

With regards to HIV/ AIDS, a variance of R70 million in terms of under expenditure was reported. The DOH received a qualified audit from the Auditor General due to issues related to systems as opposed to mismanagement. The main issue was the reconciliation of fixed asset entries between the BAS (Basic Accounting System) and Logis systems had not been done. The DOH found that incorrect classifications on the Logis system resulted in inaccurate asset figures being posted in the Asset Register. A matter of emphasis in the audit report was that transfers were made to provinces without business plans

Discussion
Mr A Madella (ANC) was supportive of the work that the DOH was doing especially in the international field. The audit performance of the DOH left an ugly mark on the work it was doing. In order to improve audit performance, provinces should comply with the requirements to submit business plans and reports. Provinces should be assisted and guided in compliance and to improve inconsistencies between their monthly and quarterly reports.

Mr Mseleku said that the DOH was aware of the non-compliance by some provinces and that they alerted the Auditor-General (AG) to this problem. In some cases transfers to provinces was stopped because of non-compliance with procedure. A balancing act was required because stopping fund transfers had an impact on service delivery. Compliance regarding reporting by provinces was improving.

Mr Madella wanted more information on why it was reported that several projects had stopped, given the importance of hospital revitalisation for the DOH.

Mr Mseleku replied that in the past provinces would start projects when funding was approved. They however had to wait until funding was secured, before they started with projects. Meetings with provinces were held in order to remedy this problem. A 2002 audit indicated that health infrastructure was aging. Bigger construction companies were concentrating on big projects in anticipation of the 2010 World Cup and the DOH was exploring Private and Public sector Partnerships (PPPs) in order to deal with capacity problems related to construction.

Mr M Walters (DP) asked for clarification on the regulations for complementary medicines.

Mr Mseleku said that the Minister had asked an independent Council to look at this issue. A lack of capacity for regulating and inspecting was identified as a serious issue. It would be easy to make regulations but there should also be the necessary capacity to enforce these regulations. An audit was done to identify the complementary medicines already in the market. Currently complementary medicine did not require registration.

Mr Walters referred to page 26 of the DOH Annual report. He wanted further information on the implementation of systems for licensing and inspectors.

Mr Mseleku replied that pharmacists preferred to work outside government because of the better salaries that they received. The job levels of pharmacists were raised in order to attract the required expertise within government.

Mr Walters indicated that there was a skills shortage at the hospital managerial level and wanted more information on this. He also requested clarification on the performance contracts of hospital managers. According to the DOH 100% of all hospital manager performance contracts were to be finalised.

Mr Mseleku said that the training of hospital managers was a priority and that the department did provide support to hospital managers. Comprehensive training was required and it might be necessary to develop a Health Management Academy.

Mr Mseleku said capacity was a major problem. The DOH had a range of discussions with provinces where undertakings were made. Provinces however did not always implement and the National DOH could only probe and ask questions. The relationship between the National Department and the provinces was based on co-operative governance. Non–compliance by the provinces was considered to be a serious issue and significant efforts was made to address this problem.

Mr Walters wanted to know in which provinces the hospital revitalisation programme was stopped.

Mr Mseleku said that projects were stopped in the Western Cape, Northern Cape, Kwazulu Natal and in Gauteng.

Mr Walters asked what steps were taken to ensure that hospitals implemented monitoring.

The DOH representative said that the monitoring of grants was a major issue and that a range of committees were attending to this. The National Co-ordinating Committee and the National Chief Finance Officer Forum focused on grants on an ongoing basis.

Mr Walters referred to the requirement that all provinces had to submit human resource development reports and that only four reports had been submitted. He wanted to know why not all reports were submitted to the National DOH.

Mr Walters referred to the AG’s audit report and the DOH’s explanation that the qualification was because of incorrect classification of assets. Given that the incorrect classification was a human error, he wanted to know what steps the DOH was taking to rectify this situation.

The DOH representative indicated that the problem identified by the AG was a result of systemic reasons as well as human error. The auditing of assets was identified by DOH as a growing concern. Reconciliations would be finalised in December 2007 and duplication would be reduced within the system.

With regards to conditional grants, Mr Walters wanted to know what undertakings were received from provinces that they would submit their business plans.

The DOH representative said that even if provinces did not submit a business plan the national office could not with hold transfers.

Ms M Manana (ANC) wanted more information on the forensic pathology service. There were rumours that some people pay for this service but while the service was still under the South African Police Service it used to be for free.

Mr Mseleku said that if there were instances where people paid for forensic services, that one would need to look at the specifics and investigate. People should only pay if they went to a private practice.

Ms Manana wanted to know what the new targets were for water supply, sanitation and clinics. She mentioned that the old targets for December 2005 were not achieved by the DOH.

Mr Mseleku said that a project was being initiated to look at the supply of free water to clinics and schools. Targets for health service delivery were being reviewed.

Ms M L Matsemela asked whose fault it was that there was a lack of monitoring and governance as stated in the AG’s report.

Mr Mseleku said that where problems were identified, a letter would be written to the Premier of the Province to ask him to address the problems. Capacity was however a major problem in improving monitoring and governance.

Ms Matsemela asked if there was the need for a rollover, what had been done about the situation.

Mr Mseleku replied that rollovers were required for certain funds, for instance, DOH asked for a rollover in order to buy computers. Rollovers could be requested from Treasury who could grant the rollover or refuse it.

Ms S Kalyan (DA) wanted clarification on the monthly and quarterly inconsistencies and also asked whose line function it was to check these inconsistencies.

Ms Kalyan referred to the environmental plan, which has not been tabled and asked what the reason was. She also wanted to know how this would impact on the disposal of medical equipment.

Mr Mseleku said that the environmental issue would not affect the disposal of medical waste.

Ms Kalyan also referred to the National Aids Trust and asked if funds were dispensed to this institution, given that they have not had a meeting since its inception.

Mr Mseleku said the National Aids Trust presented a difficult situation. There was an undertaking to close the Trust and bring the money back to the fiscus. There was also no money being raised by the trust. The Trust was supposed to be dissolved but
South African National AIDS Council (SANAC) had approached the Trust and said that when restarting SANAC, they would require the Trust.

Ms P Tshwete (ANC) wanted more information on security problems at hospitals.

Mr Mseleku said that security in hospitals was becoming a serious problem. The matter was being investigated by the DOH.

A committee member asked how many foreign health professionals applied for work in SA and how many were employed. She asked if the remuneration packages for nurses were finalised and when it was going to be implemented. Further, who had developed the ‘constitution’ for clinics.

Mr Mseleku replied that foreign health professionals were employed in SA due to bilateral agreements between SA and other countries. Health professionals came from Tunisia and Iran as well as from an organization called Doctors without Borders. As a rule SA did not recruit health professionals from Africa especially SADC. Unfortunately this led to the misperception that SA prefers to employ other foreign health professionals but not those from Africa. The system for nurses was in place and the DOH was looking at qualifications and years of experience. Implementation would start in January 2008. Mr Mseleku said that there were guidelines for clinics provided to provinces.

Mr Ngculu was very concerned about the problems identified within the AG report for the DOH. He requested feedback from the DOH Director General about the issues identified by the AG.

Mr Mseleku said that the national department had a control framework in place. In previous financial years capacity and information was not adequate in the DOH. An internal audit focusing on the national and provincial provinces was done to interrogate problematic issues. The DOH required the capacity to monitor. The national DOH required guidelines from the AG regarding what it considered to be adequate visits to the provinces. Mr Mseleku indicated that it was only the conditional grants, which were considered to be problematic.

Mr Madella said that the National DOH should determine what they need to do in order to provide training and capacitate provinces to comply with requirements. It was important to take note of issues raised by the AG and ensure that something was done about these.

Mr Madella referred to the State of Nation address of the President where it was mentioned that nursing colleges would be closed. He also wanted to know how many student nurses were in training.

Mr Mseleku replied that colleges were closed only in two provinces while in other colleges, training was continued.

Mr Mseleku proposed that the Committee request the provinces appear before it to discuss problems related to quarterly reports before considering legislative measures.

Mr Ngculu felt that more discussion on issues was required, but given time constraints it was agreed to discuss issues at a later time.

The meeting was adjourned.

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