Social Assistance Amendment Bill: Negotiating Mandates & Department of Health Strategic Plan & Budget

NCOP Health and Social Services

03 June 2008
Chairperson: Ms J Masilo (ANC)
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Meeting Summary

The Negotiating Mandates in respect of the Social Assistance Amendment Bill (the Bill) were read out. Each of the provinces supported the Bill, with the exception of Gauteng, who indicated that it was still to hold public hearings and its position would only be contained in the final mandate. Certain suggestions were made by the Provinces, mostly on technical matters. Eastern Cape had received an objection to the incremental roll out of the older person’s grant. Kwazulu Natal called for the deletion of clause 2(b) as this repeated section 18(b) of the principal Act. It suggested that the payment of older person’s grants be paid retrospectively from 01 April 2008. It recommended clarity on the setting up and operation of the Tribunal. Northern Cape was of the view that the powers of the Minister would be diluted if an independent tribunal considered all appeals, not only those specifically referred to it.

The National Department of Health presented its budget and strategic plan for 2008 to 2011. The priorities for the next five years would be promotion of healthy lifestyles, the implementation and preparation of legislation, the strengthening of support services and the improvement of governance. Specific priorities for 2008/9 included the strengthening of human resources, infrastructure, key health programmes and the Provincial Service Transformation Plans, and increased quality of care. The achievements for 2007/8 were described across the programmes. The Department touched on the enquiries in maternal deaths, noting that the ten recommendations had been implemented at about 85% of health facilities. Immunisation coverage had increased, malnutrition in children under five had decreased, and there were strategic plans for TV and Aids. 32 hospitals were under construction. Tunisian, Cuban and Iranian doctors were being given permits to practice in South Africa. Challenges were listed as including the public service strikes, safety in hospitals, and the longer internship programmes. Specific strategies for 2008/9 would include reduction of the costs of pharmaceuticals, strengthening of international relations and communication, fast tracking the filling of vacant posts, increasing polio surveillance and reduction of TB defaulter patients. A clinical associates programme would be implemented with three universities. Three new hospitals were planned and nine were to be upgraded. The budget was fully described, with breakdowns across programmes and a description of the conditional grants.

Members raised questions on the revitalisation project in de Aar, which seemed to have stalled, the voluntary counselling and testing, the categories of nurses who would receive Occupation Specific Dispensation payments, the action against hospital contractors who failed to complete the work on time, and unpaid fees due to hospitals. Further queries related to the recommendations on material deaths, the prices of pharmaceutical products, the quality of generics, the statistics on HIV prevalence of women using ante-natal services, where the funds budgeted for the Deputy Minister would go, the need to strengthen emergency services, and whether the budget catered adequately for foreigners using hospital services.

Meeting report

Social Assistance Amendment Bill [B17-2008]: Negotiating mandates 
The Negotiating Mandates in respect of the Social Assistance Amendment Bill (the Bill) were read out.

Eastern Cape Provincial Legislature indicated that its Portfolio Committee was briefed on the Bill by the legal officials No public hearings were held due to time constraints. However input had been requested from the public via the print media and radio stations. The Committee supported the Bill but raised comments on clauses 1 and 2. It was noted that the Committee had received an objection to the incremental roll out of the older person’s grant.

Kwazulu-Natal Provincial Legislature noted that it supported the Bill, subject to the deletion of clause 2(b) as this repeated section 18(b) of the principal Act. It suggested that the payment of older person’s grants be paid retrospectively from 01 April 2008. It also recommended clarity on the setting up and operation of the Tribunal.

The Limpopo Province Legislature supported the Bill and had wanted to conduct public hearings to ensure effective consultation, but noted that due to time constraints, advertisements were placed in newspapers for objections and comment from the public.

Mpumalanga Provincial Legislature stated that public input was made at radio slots on 23 and 26 May. It supported the proposed Bill and gave authority to negotiate to support the Bill. It noted that the public had suggested that the qualifying age for the older person’s grant be brought down to 55 for men and 50 for women.

The North West Provincial Legislature stated that it had advertised at radio stations due to the station’s extensive coverage. An advertisement was also placed in a newspaper. The Province did not hold any public hearings, as there had been no objections from the public through the newspaper and radio advertisements. This Province supported the proposed Bill.

The Western Cape Provincial Legislature confirmed that this legislature was in support of the proposed Bill. 

Gauteng Province Provincial Legislature indicated that it was  not in a position to present a negotiating mandate, without having first solicited the views of the stakeholders. Therefore it reserved the position until its final mandate, which would by then have been informed by inputs from the public..

Northern Cape Provincial Legislature indicated that it supported the Bill. However, it was of the view that the powers of the Minister would be diluted if an independent tribunal would be allowed to consider all appeals, not only those specifically referred to it. Some further technical points were raised.

The Free State Provincial Legislature noted that its delegates were mandated to vote for the adoption of the Bill. It noted that it had invited public input by placing advertisements on national and local radio stations, and national and local newspapers.

Members were concerned that no social payments could be made available until the proposed Bill became an Act of Parliament. They were also concerned about back pay of money due to accrued non-payments. They felt that the Bill needed to be adopted as soon as possible so that the poorest of the poor could start to benefit.

National Department of Health (DOH): Budget and Strategic plan 2008/09-2010/2011.
Dr Yogan Pillay, Chief Director:Strategic Planning, National Department of Health, presented the Department’s budget and strategic plan for 2008 to 2011. The Department’s vision was to have a high-quality health system, with its key focus areas being access, sustainability, equity, and efficiency.

49 pieces of legislation were reflected in the 2008/09-2010/11 strategic plan for the next years. Priorities for the five-year period were the promotion of healthy lifestyles, the implementation and preparation of legislation, the strengthening of support services and the improvement of governance.

Mr. Pillay then highlighted the Departments’ priorities for 2007/08. These included the strengthening of human resources, infrastructure, key health programmes and the Provincial Service Transformation Plans (STPs). Quality of care was also noted as a key priority for the 2007/08 period.

Mr Pillay described the Departments’ achievements for 2007/08. The achievements pertained to the four programmes of Administration, Strategic Health, Health Service Delivery, and Human Resources. Six pieces of legislation had been passed in 2007/08. The Annual National Health Plan 2007/08 had also been promulgated. Included in the administrative programme were health related multi media campaigns. The campaigns were done through the SABC African Language Radio Stations, community and commercial radio stations.

Programme 2 dealt with the certain health programmes, and the ten recommendations of the Confidential Enquiries Into Maternal Deaths (CEMD) were implemented at approximately 85% of
health facilities. Immunisation coverage had also increased to 84% in 2007 from 78% in 2002. Dr Pillay noted that malnutrition in children under the age of five years had decreased since 2001. The country’s annual update report on polio-free certification was submitted to the Africa Regional Certification Committee. The National Strategic Plan for TB was produced and promulgated and the National Strategic Plan (NSP) for HIV/Aids had also been launched.

With regards to health service delivery,  Dr Pillay noted that 32 hospitals, in compliance with the Hospital Revitalisation Project, were currently under construction and that 11 were in the planning phase. 22 Tunisian doctors had commenced work in South Africa’s hospitals and of the 312 being assessed by the HPSA, a further 258 had been selected to be deployed to South Africa. Cuban and Iranian doctors had had their treaty permits extended and community service for nurses had been implemented since January 2008.

Some of the challenges highlighted were the strikes that had taken place in 2007/08, and the safety in hospitals, which had attracted great public interest. The move from one-year medical internships programmes to two years also  posed a challenge as it placed a greater burden on hospital staff.

The Strategic Plan for 2008/09 aimed to further reduce the cost of pharmaceutical products, and to reduce the cost through international standardisation. The Department had as a priority the strengthening of international health relations, management and communication. With regard to administration the Department had a plan to produce and incorporate a policy to fast track the filling of vacant posts. The Department wanted to update the Polio Preparedness Plans by strengthening surveillance. It was also hoping to reduce the rate of
TB patients defaulting on completing their treatment from 10% down to 7%. The rate had already decreased to 8.9%. The Department wanted to reduce malaria-related deaths by
10% in their planning phase.

With regards to health planning and monitoring he added that the Department would be appointing 1 110 data capturers to improve the quality of health information.

 With regards to the 2008/09 programme for human resource management the Department planned to implement the Clinical Associates Programme in collaboration with the Universities of the Witwatersrand, Walter Sisulu and Pretoria. Dr Pillay noted that the programme was a three year degree course and that some were already doing the course.

It was intended to complete three new hospitals; two in Limpopo Province and one in the Northern Cape Province. It wished to implement another nine hospitals into the Hospital Revitalisation Programme. The appointment of Health Information Officers in 286 hospitals was also planned for 2008/09.

Dr Pillay indicated that the Department also provided international support for reconstruction processes in Sudan, Burundi and the Democratic Republic of Congo (DRC).

Mr Gerrit Muller, Chief Financial Officer, DOH, then briefed the Committee on the budget for 2008/9-2010/11. He said that there had been a significant increase in conditional grant funding for the 2008/09 budget. He discussed the Hospital Revitalisation Grant as well as the Comprehensive HIV and AIDS Conditional Grant, setting out comparative figures. He noted that the National Tertiary Services Grant was budgeted at R10 million that was earmarked for nursing college plans for refurbishment. 

Mr Muller explained that the Department now had a new six- programme Organogram, which
comprised an additional two programmes. He listed the budgets for each of the programmes and also tabled the budget for the conditional grants (see attached presentation for full details).

Mr M Sulliman (ANC Northern Cape) was concerned about certain projects that were in the Revitalisation Programmes. He was specifically concerned about a project in his home town of De Aar where the building of the hospital had just stopped. He wanted to know why there were periods of stagnation in the building of the hospital. He added that the economic spin offs of having the hospital completed would be phenomenal.

Dr Pillay noted that the hospital in De Aar had not been allocated extensively for in former years but that it a substantial amount would be allocated towards it this financial year and that it should be largely completed in this financial year.

Mr Sulliman raised a concern regarding Voluntary Counselling and Testing (VCT) that
was provided in 90% of the public health care sector. He wanted to know in which provinces the VCT had been provided.

Mr Sulliman asked which categories of nurses were eligible to receive the Occupation Specific Dispensation (OSD).

Dr Pillay said that over the next few years it would be the Departments’ objective for all professional and staff nurses who had the experience and qualifications to benefit. He added that OSD was largely dependent on variables such as experience and qualifications.

Ms H Lamoela (DA Western Cape) was concerned if there were any penalties imposed on contractors who did not complete building projects within the designated time frames.

Dr Pillay responded that these would be dealt with in the procurement processes and contracts, and that the people who were responsible for procurement would take action if necessary against the contractors.

Mr Muller added that the onus was not on the National Department of Health to penalise contractors as it was the responsibility of the Provincial Government Department who had entered into a contract with the contractors.

Ms Lamoela also was concerned about unpaid fees due to hospitals by patients. She raised a concern pertaining to hospital asset registers.

Dr Pillay said that with the implementation of the National Health Insurance System the Department wanted to remove all user fees for the poor and concentrate on claiming for outstanding fees through the medical aid schemes. He added that it was futile to expend resources and time on trying to recover money owed by poor people who simply could not repay.

Ms Lamoela questioned what the ten recommendations of the Confidential Enquiries into Maternal Deaths (CEMD) were.

Dr Pillay said that the recommendations had included the use of specific types of sonar scans that needed to be taken by expectant mothers. He added that women were not utilising services adequately. The provision of transport for mothers to facilities would reduce mortality and that more blood needed to be made available if a transfusion became necessary after a caesarean section was performed. He added that the monitoring of possible bacteria on common objects like keyboards and cell phones in hospitals also needed to be taken into account.

A Member raised a question on the reduction of the prices of pharmaceuticals, asking also about the scarcity of medicines and the quality of generic medicines.

Dr Pillay explained that generic medicine was of the same quality as originals. He explained why it was cheaper. He said that generics were the same products with just a different name. All patented medicines could not be copied for a certain number of years. Once the patent expired, the exact formula could be copied under the generic name. The generic would be cheaper because there were fewer costs involved – for instance there would be fewer costs as the product would have been extensively tested in its original form.

Ms Lamoela disagreed with Dr Pillay on certain parts of his explanation.

Dr Pillay said that the fact that testing had been done in the past was the reason why the generics were not required to go through clinical trials.

A Member asked how the Department was intending to reduce the TB defaulter rate from 10% to 7%.

Dr Pillay noted the committee members’ concerns on the reduction of the TB defaulter rate from 10% to 7%.

A Member questioned the reliability of statistics referring to the 2006 HIV antenatal survey. The Department was questioned on whether the statistics were taken from the public health sector only, noting that many women utilised private hospitals.

Dr Pillay said, in regard to the statistics that showed a 29% reduction in HIV prevalence of women using ante natal services, that the statistics were based on the public health sector. He added that the statistics were based on figures derived from Statistics South Africa and surveys. He added that South Africa still had a long way to go with the reduction of maternal and infant mortality.

Ms F Mazibuko (ANC Gauteng) questioned the Department as to how and why specific universities were targeted for the implementation of the Clinical Associates Programme.

Dr Pillay responded that the Department had assessed eight universities and that other universities, including the University of Limpopo, would be implementing the programme soon.

Ms Mazibuko questioned how the allocations by way of the National Tertiary Services Grant would strengthen tertiary services.

Ms Mazibuko referred to the Administration Budget for the Deputy Minister and wanted to know where the funds would be going as that post was currently vacant.

Mr Muller noted that the allocated money was not to be spent if there was no incumbent.

The importance of strengthening resources for Emergency Medical Services (EMS) was emphasised. It was noted that EMS service was generally poor.

Dr Pillay responded that the Department was generally not happy with the response times of Emergency Medical Services (EMS). He added that the response time in rural areas should be 40 minutes and that the response time in urban areas should be 15 minutes. He noted that additional funding would have to be allocated for EMS for 2010.

The Chairperson raised issues pertaining to maternal deaths and infection control. The importance of effective service delivery was discussed and the Chairperson suggested that unannounced oversight visits needed to be made.

Ms Lamoela asked the Department who was responsible for the monitoring of hospital registers as she had heard of a horrifying incident where six disabled people had been killed due to an overdose of medication in a hospital.

The Chairperson raised a key issue as to whether the programmes being budgeted for made provision for all the foreign nationals currently in the country. She added that there was corruption on a large scale, with foreigners duplicating their identities in order to be able to access extensive amounts of medication, which they would then take home with them to their own countries.

The Chairperson wanted to know if the Department had budgeted according to South African statistics and if they had included foreigners in their statistics for the budgets.

Mr Muller noted the need for an additional budget to cater for foreign nationals

The meeting was adjourned.


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