Health Budget: Committee Report; Ministry/Department of Health on Covid-19 update


28 May 2020

Chairperson: Dr S Dhlomo (NA, ANC) and Ms M Gillion (NCOP, ANC)


Progress on COVID-19 Response

Meeting Summary

Video: JM: Portfolio Committee on Health & SC on Health and Social Services, 28 May 2020
Audio: Health Budget: Committee Report; Ministry/Department of Health on Covid-19 update                                        Part 2

Members welcomed the Committee Report on the 2020/21 Health Budget but requested the inclusion of demographic information on COVID-19 as it is not currently provided. The Chairperson emphasised the importance of the upcoming tabling of the 2020/21 Revised Budget. It is the duty of the Committee is to assist the Department of Health (DoH) and National Treasury to ensure that the revised budget is in alignment with the work that needs to be done to combat COVID-19 and strengthen the healthcare system. The Portfolio and Select Committees considered and adopted its Report on the Budget Vote.

Members from the Portfolio Committee gave feedback to the rest of the Committees on the recently conducted oversight site visits in the Western Cape and KwaZulu-Natal. Members noted the impressiveness of the Cape Town International Convention Centre (CTICC) as a field hospital that will be opened on 8 June 2020 with 862 beds available to receive patients on their road to recovery. Tygerberg Hospital is currently an operational facility that is experiencing shortages in staff, testing materials and kits, and Personal Protective Equipment (PPE) which must be addressed quickly. The General Justice Gizenga Mpanza Regional Hospital and the Netcare St Augustine Hospital were visited during the oversight site visit in KwaZulu-Natal. Social distancing was adhered to, and sanitation booths and checking of temperature were made available. Members were concerned that even though hotspots in the area have been identified and hospitals are doing well, there are significant delays in the test results of individuals.

DoH updated the Committees on its response to COVID-19, which included outlining the global and national situation of the pandemic, the hotspots of the disease, the weekly averages of new confirmed cases, the divide between public and private sector testing, and other crucial statistical information. The biggest challenge with the pandemic is to flatten the curve to reduce the number of people that are infected at one time to enable the healthcare system not to be overburdened. Members’ concerns centred on the prevalence and non-detection of asymptomatic cases that rapidly increase the infection rate, the quality of quarantine sites, the shortage of medical personnel in hospitals, the overburdening of the hospitals in hotspot areas, and the lack of effective communication with the people. Members emphasised the need for a breakdown of the confirmed cases according to race.


Meeting report

Ms M Gillion (ANC, Western Cape), Select Committee Chairperson, said the Committees would receive a briefing on DoH’s response to the COVID-19 pandemic, with an emphasis on the impact of lockdown alert levels on the increase in cases in areas designated as hotspots.

Dr S Dhlomo (ANC), Portfolio Committee Chairperson, noted that the Minister of Health is scheduled to join the meeting at 16h00.The Committees would also consider and adopt its Report on the Budget Vote. He asked the Members who were involved in the recently conducted oversight site visits to brief the Committees on the issues they have encountered.

Committee Report on the Health Budget Vote
Mr Dhlomo asked Members of the Portfolio Committee if they have any concerns on the allocated budget before there is a call to adopt the Report.

Ms M Hlengwa (IFP) welcomed the Report and commended it for being exceptionally clear. The IFP accepts the Report stating that the allocated budget will help the Department to achieve its goals.

Ms N Chirwa (EFF) stated the need to include demographic information (including race) in the COVID-19  reporting, as it is not currently provided to the Committees. DoH needs to explore the option of responding to and combating COVID-19 through a region-based approach, because the national ‘one size fits all’ approach is not working. She raised the issue of vaccines, testing kits, and medications available during the upcoming winter season, and requested an update from DoH on this. She noted the need for an update on the current capacity of hospitals and 24-hour clinics scheduled to be made available in response to the COVID-19 pandemic.

Chairperson Dhlomo asked Ms Chirwa to repeat her important concern about the need for demographic information to the Minister of Health when DoH presents its briefing to the Committees.

Ms S Gwarube (DA) the Committees had engaged with the content of the allocated budget. However, the Minister of Finance is scheduled to table a revised budget at the end of June 2020. Many of the targets will have to be revised. The duty of the Committee is to assist DoH and National Treasury to ensure that the revised budget is in alignment with the work that needs to be done to combat COVID-19 and strengthen our healthcare system. She referred to Auditor-General South Africa (AGSA)  which had raised some red flags on the DoH audit. It is important that the Committee fulfil its duty of ensuring that DoH performs its mandate and that the revised budget is in alignment with the work that must be completed.

Chairperson Dhlomo emphasised the importance of Ms Gwarube's comment about the upcoming tabling of a revised budget. The Committee had been under the impression that there would be plenary session for the Minister to present the revised budget, but this arrangement has been rescinded in response to the COVID-19 pandemic.

Ms A Gela (ANC) welcomed the Committee Report on the Budget Vote and said that the ANC supports the budget allocation and the recommendations made.

Mr A Shaik Emam (NFP) stated that the NFP supports the budget allocation and the recommendations made. The former president made the announcement that all community healthcare workers would be made permanent employees and receive full benefits, which has been implemented by some provinces. When we look at the National Health Laboratory Services, the delay in test results for COVID-19 is spanning as much as 21 days. This delay is too long as it dramatically increases the amount of time that individuals who have not yet received a formal positive result can infect other members of society. He highlighted that over 20 clinics have been closed in Cape Town, which must be considered in the Report. He raised the concern of diseases such as HIV, AIDS, and Tuberculosis being neglected during this time.

Ms E Wilson (DA) stated that the DA reserves its position on the Report until such time as it has been discussed with her party.

Chairperson Dhlomo asked the Members of the Select Committee if there were any dissenting opinions about the Committee Report on the Budget Vote.

Ms A Luthuli (EFF, North-West) stated the EFF objection to the Report as none of the party's inputs were properly brought before the Committees.

Mr P van Staden (FF+) stated that the FF+ reserves its position on the Report until such time as it has been caucused by his party.

The Committee then adopted its Report on the Budget Vote.

Chairperson Dhlomo requested the Members involved with the recently conducted oversight site visits to highlight their experience and brief the Committees on the issues they have encountered. He requested the leadership from the Western Cape and KwaZulu-Natal oversight visits to give feedback to the Committees.

Feedback on Western Cape oversight site visit
Dr K Jacobs (ANC) provided feedback on the Western Cape oversight site visit. The delegation of Members who attended had the opportunity to engage with the management of the CTICC and Tygerberg Hospital which has been turned into an emergency hospital. The management was particularly open about the challenges they are experiencing. Members were able to view the tracking system of Tygerberg Hospital for its COVID-19 patients from diagnosis until recovery, which was impressive. There are seven wards designated for COVID-19 and other de-escalated wards have also been made available. On staffing capacity, the management is concerned with the possibility of the staff becoming infected which reduces the morale of the staff. There is a serious shortage of specialist nurses which renders 40 beds unusable due to this staff shortage. There is a shortage of PPE and testing kits to facilitate the continued diagnosis and testing of patients. The CTICC emergency hospital has an availability of 862 beds and it was impressive. Staff are screened upon entry and they have a separate entrance to the building. Staff members bring their own personal writing materials and all their possessions are deemed to be personal to them. Ablution blocks and showers were made available exclusively for use by staff members. The CTICC is not yet ready to receive patients, but it is estimated that the emergency hospital will be ready by early June.

Ms Gwarube said that the feedback by Dr Jacobs was comprehensive, particularly as it pertained to the Tygerberg Hospital. Their effort to recycle and sanitise PPE is a measure that DoH should investigate and rollout to other healthcare facilities to adopt a more sustainable approach. CTICC is an impressive facility and will go a long way to assist our healthcare system to extend the care needed for individuals. The same field facilities are in the process of being established in Khayelitsha and the Cape Winelands, which is a crucial step in our fight against COVID-19 and for the protection of our people.

Ms M Sukers (ANC) agreed about the impressiveness of the CTICC facility and the high-level engagement with the facility during the oversight visit. CTICC will be opened on 8 June 2020 with another 60-bed field facility nearby. The philosophy of care at Tygerberg Hospital ensures that the community will not be overwhelmed with the COVID-19 disease but see it as something that they are able to overcome. It is the duty of the Committee to ensure that staff of these facilities receive the support and encouraging communication that they require. Finally, she mentioned that the CTICC is a step-down facility and the patients admitted there are exclusively those who are on their way to making a full recovery.

Mr van Staden said that photographs of the oversight visit to the CTICC facility was shared on the Committee WhatsApp group, and restated the impressiveness of the facilities.

Dr Jacobs said that the Western Cape is having the surge of the COVID-19 peak. He enquired if it is possible to acquire staff from other provinces to assist the Western Cape during its peak and to address the staff shortages currently experienced at Tygerberg Hospital. Staff acquired from other provinces can be sent back once those provinces show a significant increase in their reported cases. He noted the importance of sharing information with the public on the availability of testing materials and kits and an explanation of when individuals will need to be tested.

Feedback on KwaZulu-Natal oversight site visit
Ms Hlengwa said that the General Justice Gizenga Mpanza Regional Hospital and the Netcare St Augustine Hospital were visited during the oversight site visit. She commended the large presence of young women at the facility. Social distancing was adhered to, and sanitation booths and checking of temperature were made available. Hotspots in the area have been identified, and while the hospitals themselves are doing well, there are significant delays in the test results of individuals. Members were impressed with the reports they received from the two facilities. Netcare St Augustine Hospital was impressive on testing and sanitising. The staff members undergo sanitising and testing processes daily, and masks are used continuously.

Chairperson Dhlomo added to the feedback with two points. First, he noted that the training in using PPE was innovative and particularly necessary at the KZN facilities. Second, President Ramaphosa announced that all metropolitan areas are designated as hotspots for COVID-19. Surprisingly, there are some additional districts close to the King Shaka International Airport that are hotspots, as well as surrounding areas. Within these districts, it was commendable that the efforts were centred on the problematic areas through a highly focused approach. Netcare St Augustine Hospital released a useful report giving recommendations to other facilities on how to improve their responses and strategies to COVID-19.

Chairperson Dhlomo  said the next oversight visit is scheduled for the Eastern Cape and he asked Ms Gela if the oversight visit to Gauteng would be taking place the next week.

Ms Gela replied that Members submitted the information on the areas that they would like to conduct oversight site visits but they are still waiting for approval to proceed.

Mr Dhlomo said that the Committees received a blanket approval for the provincial oversight visits, and Ms Gela and other Members should inform when they are ready to start so logistical support can be provided.

Ms Gela thanked him and said that the Committee will be informed of the readiness of the Members for the Gauteng oversight site visit.

COVID-19 pandemic response: Director General update
Dr Anban Pillay, Acting DoH Director General, gave an outline of the global and national situation of COVID-19, the hotspots, the weekly averages of new confirmed cases, the divide between public and private sector testing, and other crucial statistical information on the pandemic.

He outlined the global, African region, and the national status of the pandemic and its spread. There are currently 5.4 million confirmed cases worldwide, and 343 000 reported deaths. This translates to a 6.4% fatality rate, which must be compared with the South African situation. South Africa currently has the most confirmed cases on the African continent, but not the highest number of reported deaths. Our recovery and death figures are noticeably lower than other countries. The Western Cape and Gauteng are the main hotspots as they have reported the most infections.

There is an exponential increase in infections during the COVID-19 pandemic. In April 2020, the average new cases reported in a week were in the 600s, but in May 2020, it increased to the 1000s. The number of deaths has also increased weekly. The number of laboratory tests done by 26 May 2020 were 634 996, and the split between public and private sector testing was 49%  and 51%. Recently, the private sector has been undertaking more tests, increasing the divide to 62% private sector and public sector 38%. The challenge with the COVID-19 pandemic is to flatten the curve to reduce the number of people that are infected at one time to enable the healthcare system not to be overburdened.

Ms Wilson raised the concern of asymptomatic cases and their detection. Are there any signs or trends from the World Health Organisation or from other countries on the number of such cases that we can expect? It is extraordinarily hard to get exact data on this, but it is crucial to gauge the problem to determine how it will impact the number of infections reported. She asked DoH to update them on the setting up of quarantine sites and if there are set protocols for this.

Dr Jacobs said that there are many challenges in the COVID-19 pandemic and made recommendations. In terms of medical care, our doctors are very well trained. In the Western Cape, the hospitals in the hotspots are overburdened. The biggest challenge is the shortage of staff, which renders beds unusable because of this staff shortage thus making healthcare less accessible to infected individuals. DoH needs to address the staff shortage and their ability to fulfil their duties during these challenging times. In terms of the community, an effective communication strategy is required to inform people who must be tested and who does not need testing due to the shortage of tests. It is important to  share information with the public on the availability of testing materials and kits.  In terms of recommendations and concerns, DoH needs to address the availability of medical practitioners who are not yet registered. He asked if staff from other provinces can be utilised in hotspot areas such as in the Western Cape. Staff acquired from other provinces can be sent back once those provinces show a significant increase in their reported cases. Solidarity between National and Provincial Departments of Health is paramount to effectively combat COVID-19. The shortage of oxygen in hospitals is a key concern that DoH must address for effective treatment.

Mr van Staden enquired about the accuracy of testing data coming from communities. What is the DoH response to the announcement by Western Cape Premier, Mr Alan Winde, there is a backlog of 100 000+ test results in South Africa? When will DoH provide the Committee with a full list of quarantine sites around the country? DoH was requested to update the Committee on the readiness of the mortuaries and other bereavement facilities for the upcoming peak period of deaths? How was the additional R20bn spent that President Ramaphosa announced as part of the COVID-19 relief package? How many confirmed cases involved people who are smokers and how many deaths were related to smokers? Are our hospitals and clinics ready for the peak?

Ms Chirwa condemned the violation of protocol about the Minister of Health not being available at the scheduled time to the Committee, which indicates his disregard for accountability. The Committee needs to know the racial breakdown of the COVID-19 confirmed cases. This information must be sourced in the same way DoH obtains the breakdowns on age and co-morbidities. Can the Committee receive clarity on the test backlogs and the procurement of PPE stock? In the previous meeting, DoH said that it procures 10% of PPE locally and that they are planning to increase this procurement as 90% are imported. What is the progress on this? What mortuaries are used by DoH and what are the criteria used to select these facilities? How does the backlog of test results impact the information received by the Committee and by the larger public? How can a clinic be ready for a surge of COVID-19 patients when people must line up in long queues to get medical attention? DoH needs to reconsider how it determines the readiness of hospitals and clinics.

Chairperson Dhlomo noted that technical problems are part of conducting virtual meetings and the Health Minister should not be singled out in this regard.

Chairperson Gillion welcomed the DoH presentation. Members of the Select Committee have sent a list of questions to DoH for them to respond in writing. She raised a concern about the farms in the Cape Winelands as most confirmed cases are farm and factory workers. Does DoH have a specific focus on the farm workers? She emphasised Ms Chirwa’s point on the need for a demographic breakdown (specifically for race) of the confirmed cases. Has there been an investigation on the growth of cases in the Western Cape and what is its preliminary findings? Is there a strategic approach to attempt to mitigate these infections? The shortage of staff and available beds are a critical concern in the Western Cape.

Ms A Luthuli (EFF, North-West) requested clarity on the healthcare response in KwaZulu-Natal to the clinics and hospitals that are struggling with lack of PPE stock.

Ms D Christians (DA, Northern Cape) asked about chronically ill patients who are forced to forfeit their medications by avoiding clinics due to the fear of police harassment or infection. There can be many fatalities because of this. What is DoH doing to combat the mental health deterioration in our society due to the pandemic and its social and economic effects? She asked DoH to comment on the concept that allows for the spraying of chemicals through tunnels to aid in disinfection. Has research been done to provide information on its feasibility?

Mr M Bara (DA, Gauteng) appreciated the presentation. He raised a concern about PPE. In different hospitals in the Eastern Cape there are protests by healthcare professionals who are not at ease performing their jobs because they are at a risk of infection. How does DoH aim to address these concerns? There were individuals demanding a COVID-19 allowance as essential service workers. How is DoH responding to this? The number of test results outstanding is unacceptable. What is the reason for this backlog and how does DoH plan to address this challenge?

Ms Gwarube said that it is important to constantly pay tribute to the healthcare workers who put their lives on the line to combat the effects of the COVID-19 pandemic. A closer management of provinces are required. What is the breakdown per province on quarantine sites, beds available, the building of field hospitals, the staff available, and the Intensive Care Unit (ICU) facilities available? It is important to know if other provinces are ready for their surge of infections when it is coming. Is there any movement to obtain more test kits and materials (such as reagents) to address the shortfalls? The Committee needs an update on the national figure or percentage of the backlog of test results. The definition of an area deemed a hotspot is any area that has 5 positive tests out of 100 000 tests conducted. It seems like a small number of tests, and DoH is requested to provide clarity on how this was determined. What role is DoH playing in advising the National Command Council (NCC) in drafting the Regulations of the lockdown period?

Ms Sukers highlighted the need for DoH and the Committees to involve the society in its response to the COVID-19 pandemic. What approaches are DoH taking in involving communities in their self-containment measures to utilise its leadership and uniquely established networks? How will DoH raise awareness and enhance compliance in high-density areas? Is there a drive to raise awareness to ensure that individuals comply with their treatment campaigns? What other support (referring to mental and emotional support) are given to our essential workers, particularly to the healthcare professionals?

Ms P Dyantyi (ANC) pleaded to DoH to enhance the compliance of facilities. Has DoH prioritised the areas deemed hotspots to ensure they are given adequate test kits and materials? Can DoH source more PPEs to address the shortfall thereof? DoH needs to engage with the private sector to ensure that public facilities are not overburdened with testing responsibilities.

Mr Shaik Emam said that DoH regarded the lockdown period as a time for the country and the healthcare system to be prepared. What does DoH mean by becoming prepared? There is a significant backlog of test results, low percentages of quarantine sites are ready for commissioning, and many people have been infected. This is not what prepared means and DoH needs to reassess how it determines its readiness. Clinics that have been closed due to infections place greater burdens on other healthcare facilities. What was DoH’s view when the NCC took a decision to introduce children back to school during this time? We are now entering the winter season and children are vulnerable to many diseases. What has DoH done to ensure that the Department of Basic Education complies with the health standards imposed? How are compliance monitored in factories and store outlets? Workers are not granted leave or paid for time off from work because of infection or testing of COVID-19. DoH needs to reconsider the way it monitors and implements its standards and Regulations, because while its strategy looks good on paper, it is ineffective and wasteful in practice. How will DoH dispose of the bodies and potential deaths that will soon be upon our society?

Ms Hlengwa said that President Ramaphosa announced that following consultations with religious leaders, places of worship may open under lockdown alert level three. What has DoH done to contain the possibility of this allowance increasing infections? Does DoH have the capacity to conduct health inspections at places of worship to ensure compliance? On the issue of 200+ Cuban doctors being deployed in South Africa during the pandemic, DoH are requested to provide information of the number of South African doctors who were not trained domestically have been enlisted to help?

Mr T Munyai (ANC) said that the Minister of Health has been at the nucleus of the COVID-19 pandemic and has been working together with essential service workers. He thanked the Minister and DoH for the work done so far. It has been proven that during winter the number of infections increase rapidly, including influenza. How does DoH aim to combat the COVID-19 infections alongside the increased number of patients with other seasonal diseases? What will be the mitigating strategy to avoid the rise in infections?

Ms N Ndongeni (ANC, Eastern Cape) asked for an update from DoH on the number of public health facilities that have been closed in the Eastern Cape due to COVID-19 infections.

DOH Response
Dr Pillay, Acting DoH Director General, replied that gauging the number of asymptomatic cases is an unanswered scientific question. Studies have reported that between 50% and 75% of people who get infected do not develop symptoms. It is a crucial factor as asymptomatic infected individuals can infect other people. Therefore, it is paramount to use PPEs such as cloth masks and to adhere to principles of social distancing.The Department of Public Works and Infrastructure has earmarked properties to be used as quarantine sites. DoH is only responsible for providing health services, such as healthcare professionals and equipment for screening and testing of individuals. The Department of International Relations are responsible for the repatriation of South Africans who will be subject to quarantine. DoH has noted the recommendations made by Dr Jacobs. The Western Cape has indicated that it requires additional nurses, and DoH has been in contact with other provinces to acquire staff members to assist in the surge of COVID-19 infections there. However, this is a voluntary process as healthcare professionals cannot be forced to go and help in other higher-risk provinces. DoH is in the process of dealing with unregistered medical practitioners that could be valuable in freeing up other medical staff in the response to COVID-19. The screening tool is valuable but may be redundant when used on people who are asymptomatic. There are 80 000 tests in the backlog because of a shortage of test kits and materials that are limited in their production and distribution to South Africa. The Department of Science and Technology is investigating the feasibility of producing test kits locally which is a lengthy process. DoH is in the process of expanding its mortuary capacities. DoH has not yet received money from the R20bn fund announced by President Ramaphosa but DoH has put in a request at National Treasury to be allocated some of the funding. DoH will need to conduct a study on the number of smokers infected with COVID-19, but it is established that smokers are more vulnerable to a severe infection.

Dr Zweli Mkhize, Minister of Health, commented that DoH appreciates the essential workers, healthcare professionals, and front-line fighters doing their part to combat the effects of the COVID-19 pandemic. South Africa’s mortality rate is only at 2%. While it is unfortunate that we had to suffer any deaths at all, we must be thankful for the comparative small number of fatalities compared to other countries. On the demographic racial information, the data is not ready, but the Committee will be informed when it is made available. The DoH information is transparent, credible and accurate. There have been delays in delivering test results because of the high number of tests being done, especially in areas deemed as hotspots. DoH is dealing with serious challenges and is working to curb the spread of infections as much as possible.

Chairperson Dhlomo requested that DoH to respond to the unanswered questions in writing.

The meeting was adjourned.