Questions and Replies

Reply:

According to the Health Ombud:

a) Since the inception of the Office of the Health Ombud (OHO) in 2016, there have been inadequate investigative human resources to support optimal functionality. Commencing with two senior investigators in 2017, OHO had only five investigative staff between 2018 – and 2023 (Two senior investigators and three investigators). Due to the severe staff shortages, the two senior investigators were tasked with administrative, management, and operational responsibilities, in addition to their technical investigative responsibilities. Therefore, only three investigators were attending to the complaints lodged. During this period, the OHO received 307 high and extreme-risk complaints. Despite the enormous workload, 148 complaints were resolved during this period, and a total of 159 complaints remain unresolved.

b) The OHO budget constitutes an average of 13% of the OHSC overall budget from 2016/17 to 2022/23. The OHO's budget increased by an average of 7% per year. The provision of short-term relief in the form of surplus funding from 2018/19 to 2023/24 was made to remedy this predicament. This funding was used to enable the hiring of contract staff on 12-month contracts during the 2023/24 financial period. Although the ad hoc funding helped to reduce the number of backlog cases, there remains a large number of unresolved cases, in addition to new cases.

In 2024/25 the OHO will work towards converting the current contracted staff into permanent employment to boost the number of investigators from the additional R10 Million allocated over the MTEF. However, additional funding will still be required to appoint permanent staff to augment the capacity and ensure that the mandate of OHO is fulfilled.

c) In 2022 a Health Ombud Bill was developed to address the governance challenges experienced by the Ombud. The Bill sought to establish the Health Ombud Office as an autonomous entity.

The Ombud Bill served at the Social Protection, Community and Human Development Cluster (SPCHD). The National Treasury raised concerns with the financial implications of creating a Schedule 3A Public entity considering the current economic and fiscal challenges.

The National Treasury recommended that the Department explore alternative options that would establish the independence of the Ombud – one such structure recommended was the Tax Ombud or a shared service option.

While the two options are being explored, the department has earmarked the budget of the OHO for the 2024/25 financial year. This approach would provide greater financial certainty to the Ombud so that the budget for human resources, equipment and other goods and services can be effected.

 

END.

Reply:

a) Response teams in all the affected areas were activated and investigations commenced immediately to try and establish the type of food consumed by the affected people.

• Specimens were collected and sent to National Health laboratories to detect and identify the chemicals/organisms in the samples.
• The Gauteng Provincial Public Health Directorate further established the Incident Management Team that meets twice a week to monitor the progress of the outbreak and the response by each thematic area such as Environmental Health, Communicable Disease Control, Surveillance Officers, South African Police Services and Consumer Services.

(b)-(c) Steps and initiatives:

• Routine inspections are being conducted at food premises.
• Routine food and water samples are being taken for microbiological and chemical analysis.
• Joint operations are conducted with the following stakeholders: local councillors, consumer protection, metro police, border management, home affairs, and SAPS.
• Health education and awareness are provided to all formal and informal food operators and surrounding community on food preparation, storage, and handling, including chemical poisoning handling. This intervention is especially focussed on food vendors close to schools.
• Prohibition notices and fines are issued to owners of non-compliant premises.
• All suspected food samples are taken to the laboratory for analysis.
• All non-compliant foodstuffs were and will continue to be seized and disposed.
• Radio health talks are done on different community radio stations to create awareness.
• Health education and awareness campaigns are ongoing on food safety. This is being done on multimedia platforms e.g. TV, radio stations, social media and newsletters.
• Draft SOPs have been developed with all relevant stakeholders on how to deal with foodborne illness.
• Support visits are done to Early Development Centres to raise awareness.
• Information sharing with relevant stakeholders is ongoing.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

a) (i) Blood Alcohol tests are conducted at all four Forensic Chemistry Laboratories in Cape Town, Durban, Johannesburg, and Pretoria. These test requests comprise the bulk of services delivered by the FCLs (more than 80% of all test requests received). The blood alcohol tests are supposed to be tested within 90 days from the time the samples are registered in the testing laboratory. Any test that has not been completed and authorised within 90 days is classified as backlog. There are no backlogs recorded at the Durban FCL and backlogs that were previously reported at the Cape Town and Pretoria FCLs have been cleared. The remaining backlog in blood alcohol tests is recorded at the Johannesburg FCL and is currently at 35,176 cases.

(ii) The Measures taken to eradicate the backlog include the following:

• Additional space and analytic instruments have been acquired at the new Pretoria laboratory that accommodates the Pretoria Blood Alcohol section.
• New samples for blood alcohol testing are referred to the Pretoria laboratory to reduce the number of samples referred to the Johannesburg laboratory.
• Shift systems are in use for analysts at the Johannesburg FCL and a 30.5% reduction in the backlog has been achieved from 01 April 2023 to 31 January 2024.
• A new building has been identified that will accommodate further expansion of the Johannesburg FCL and the procurement of new analytic instruments is underway for the Johannesburg FCL.

(iii) Blood alcohol samples in the Forensic Chemistry Laboratories are processed in batches of 150 samples per week per analyst. Each test is processed on two separate instruments as required for quality purposes and additional fluoride analysis is performed to confirm the validity of the sample. On average, 4000 samples are completed per month.

 

b) The backlog is expected to be cleared by over 8 months from 01 March 2024, with the current staff and instrument capacity.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

1. The NHLS is currently working and communicating with the Provincial Departments of Health to collect all outstanding funds owed to the NHLS. Limpopo, Mpumalanga, Free State, and Western Cape have cleared the debt owed for the previous financial years and are paying their current debt timeously. North-West has cleared most of its historic debt and is paying towards the current debt. Gauteng has settled most of its historic debt and they are paying for the current debt but not in full. KwaZulu-Natal is paying its current debt in full. The NHLS is working closely with KwaZulu-Natal to come up with a solution regarding the outstanding disputed amount for the debt prior to the 2016/17 financial year. Therefore, most of the provinces are paying for the services rendered by the NHLS.

The NHLS acknowledges that fiscal constraints will impact negatively on the financial status of the provinces and the NHLS. However, the NHLS has implemented tight financial controls to maintain its financial stability.

(2) The National Treasury does provide funding to the National Institute of Communicable Diseases, National Institute of Occupational Health, Forensic Chemistry Laboratory Services (FCLS) and National Cancer Registry. However the funding is inadequate to meet the service demands so the NHLS has been cross-subsidizing the budgetary requirements for the Institutes and the Forensic Chemistry Laboratories to ensure an optimal staff complement and functional work environment to manage the current workload. The NHLS is not able to report on how challenges in service delivery experienced by the FCLs may have impacted the work of the SA Police Service.

END.

Reply:

a) The options are as follows:

1. Permanent method
2. Long-Acting Reversible Contraceptives
3. Short term hormonal contraceptives
4. Barrier methods
5. Emergency contraceptives

b) Name and method:

1. Permanent method Sterilizations (Vasectomy and Tubaligations)
2. Hormonal (Oral Contraceptive (OC), Subdermal implants and Injectables)
3. Barrier (Intra uterine contraceptive device (IUCD) and Condoms)
4. Emergency (Combined Oral Contraceptives and IUCD)

END.

Reply:

a) According to Gauteng Department of Health,

• South African Police Services (SAPS) has been alerted of the incident and the Department has also requested regular patrols along the hospital boundaries.
• Hospital security is also patrolling an additional 50 metre radius outside the hospital gates especially during shift changes.
• The local community policing forum has also been involved to assist with pro-active policing and community patrols in the hospital vicinity

b) The Local Community Policing Forum has been involved to assist with proactive policing and community patrols in the vicinity of the hospital.

c) The hospital management is investigating the costs of setting up a mobile police unit outside the main gate of the hospital. The hospital is also engaging companies on modern access and key control system. The hospital has CCTV cameras in strategic places inside and outside the hospital, to ensure that staff and patients’ privacy is not compromised.

 

END.

Reply:

(a) All hospitals have backup power in a form of generators to provide back-up electricity during outages. Some hospitals also have uninterrupted power supply (“UPS”) units inbuilt as part of their power supply backup. However, the generators and UPS units are not designed to run for longer periods of time than usually anticipated, as has been experienced in the recent frequent and longer instances of loadshedding.

(b) There are maintenance plans in place for all generators to ensure that they are operational and that there are diesel suppliers on standby to ensure that the generators are fully functional at all times.

END.

Reply:

According to Gauteng Department of Health:

1. Phahameng Clinic is one of the 40 clinics in the City of Tshwane (CoT) that is still owned and operated by COT. The provincial government through the Tswane Health District Office assists with the staffing shortage by seconding staff to some of these clinics. There has been a moratorium placed on the filling of vacant positions since 2019 to date, due to budget constraints. The CoT and the Tswane Health District Office are in the process of considering a list of critical positions to be filled during the 2024/25 financial year, within available budget.

2. (a) Facility Level: Phahameng clinic is resourced with personnel from both the City of Tshwane (CoT) and Gauteng Department of Health (GDoH).

The clinic has the following vacancies:

• 1 Chief Community Health Nurse (CoT)
• 1 Nursing Assistant (CoT)
• 1 Community Health Nurse (GDoH)
• The above positions have been vacant for less than 2 years.

b) Data is awaited from Gauteng Department of Health and will be provided as soon as we receive it.

3. Yes, budget constraints experienced by COT and the provincial government, impede the process of filling vacancies. The CoT and Tswane Health District are in the process of considering a list of critical positions to be filled during the 2024/25 financial year, within available budget.

END.

Reply:

The departmental statement referring to some medical doctors rejecting placement in rural facilities is based on historic trends that led to delays with recruitment for rural hospitals as well as the recent Internship and Community Service Placement (ICSP) statistics. During the 2023/2024 cycle, the Department received 109 appeals against placements for Community Services Medical Officer posts with majority being posts in rural facilities.

However, the Department can confirm that there are medical doctors in all hospitals and healthcare facilities that are designated to have medical doctors as part of the workforce, including those in rural areas.

END.

Reply:

The National Department of Health (NDoH) was aware of the shortages of biocides, hand sanitizer and hibiscus (hibiscrub) hand soap in the facilities across the Eastern Cape.

a) There are interventions that the NDoH implements to ensure that there are no supply shortages at facilities. These interventions are informed by the cause of the supply challenge.

• Where the supply constraint is due to operational matters, e.g. machine breakdown, labour unrest, theft, post importation testing, etc., the NDOH would source products from alternative local suppliers with registered products using the quotation process.
• Should the supply constraint result in a longer term supply challenge, such as regulatory matters including amendments to the dossier that requires approval from South African Health Products Regulatory Authority (SAHPRA), including a change/addition of an active pharmaceutical ingredient source and/or manufacturing site, the transfer of ownership of dossiers which results in a change of marketing authorization, delays in the issuing of the permits for imported medicines, manufactured products requiring additional quality checks by SAHPRA, etc. and no alternative local suppliers with registered products are available; an application would be made to SAHPRA for the acquisition of unregistered medicines for human use in South Africa Act use in terms of Section 21 of the Medicines and Related Substances Act.

b) Health facilities in the Eastern Cape place their orders with the depot on a weekly basis, and the depot processes these orders efficiently with a lead time of a week.

In most cases including the recently reported case, the medicines supply challenges are transient in that an item may be reported as out of stock and soon after the item is back on stock.

Currently, there are no the shortages of biocides, hand sanitizers and hibiscus hand soap in health facilities across the Eastern Cape. The table below shows the current availability of the items in the Eastern Cape health facilities including the depots:

Item Description	Quantity on stock	Stock Provision in Months
Hibiscus (Hibiscrub) Hand Soap 500ml	6 826	2.5 months’ supply
Hand sanitizer without emollient 500ml	8 590	4 months’ supply
Biocide 100s	6 060	2 months’ supply

Table 1. Stock on hand of selected items as at 12 February 2024

END.

Reply:

According to the Eastern Cape Department of Health (ECDoH):

The clinic supervisor that was overseeing seven (7) clinics in the local area of the Mhlonlo Sub-district of OR Tambo District in the Eastern Cape (EC), retired in 2021, and the appointed operational manager for Malepelepe Clinic who was the most senior professional nurse in the area, was delegated to oversee the seven (7) clinics as a clinic supervisor.

Since, as per Department of Public Service and Administration Regulations, the post of operational manager of Malepelepe Clinic was still filled by the person who was appointed acting clinic supervisor, the acting operational manager for Malepelepe Clinic could not receive an acting allowance.

On 1 February 2024, the operational manager for Malepelepe Clinic, who was overseeing the seven (7) facilities, was appointed in the post of Clinic Supervisor, and the post of operational manager for Malepele Clinic became vacant. The person delegated to act as operational manager for Malepelepe Clinic will receive an acting allowance as from 01 February 2024 and the vacant post of operational manager for Malepele Clinic will be filled in line with government recruitment processes.

END.

Reply:

1. It is not a policy requirement to allocate ambulances to hospitals. Ambulances are allocated to EMS stations which are either stand-alone or co-located in hospitals, clinics, and other public facilities. The allocation is organized according to what is practically achievable within the budget allocation. The focus is on ensuring that these ambulances are accessible and respond on time when they are needed. Nationally, of the 483 public EMS Stations, 365 (76%) of are co-located at hospitals and clinics. The breakdown of EMS Stations per province is as follows:

PROVINCE	Total No. of Stations	No. of Stations Stand Alone	No. of Stations at Hospitals	No. of Stations located at Clinics	No. of Stations located at other sites
Eastern Cape	85	14	48	16	7
Free State	59	2	26	27	4
Gauteng	57	6	21	23	7
KwaZulu-Natal	71	22	26	19	4
Limpopo	57	10	26	18	3
Mpumalanga	37	7	16	5	9
North West	20	1	10	6	3
Northern Cape	48	4	8	36	0
Western Cape	49	12	25	9	3
TOTAL	483	78	206	159	40
PERCENTAGE	100	16	43	33	8
Other sites: Fire Stations, Local Govt Offices, SAPS

2. Access of ambulances to hospitals including emergency responses within the community are subject to demand and availability of ambulances at the time required. All calls, when received, are prioritized according to patient acuity needs, triaged and dispatched to the first available ambulance. This prioritization includes interfacility transfers.

END.

Reply:

(1) (a) The delegates are mandated to advance the interests of South Africa and of the Continent with regard to aspects that promote public health in relation to the control of tobacco and related products.

(b) South Africa is a signatory to the WHO Framework Convention on Tobacco Control (FCTC). The FCTC is a Global public health treaty which informs South Africa’s mandate in this regard.

(2) (a) Mandate on:

(i) combustible cigarettes

To ensure decisions made at COP will protect public health, reduce demand and supply and protect vulnerable groups and non-smokers and to identify new risk based on available scientific evidence.

(ii) non-combustible nicotine products

South Africa supports agenda items and decisions aimed at protecting public health. Our main objective to protect public health, reduce demand and supply and protect vulnerable groups and non-smokers against the harm caused by nicotine and to identify new risk based on available scientific evidence.

(iii) harm-reduction policies, technologies, and evidence led scientific findings

The Department of Health is not in support of the proposed promotion of harm reduction strategies and technologies, since what is proposed by the tobacco industry in this regard remain harmful to the public. The unregulated and uncontrolled use of nicotine poses a health risk and therefore, the Department is committed to the regulation of all tobacco and related products. The objective at all times is to promote public health and protect the vulnerable groups against the harm posed by the tobacco and related products.

(b) South Africa, in our pursuit to regulate all tobacco and related products, is guided by local and global studies that have provided significant evidence about the harm caused by both combustible and non-combustible tobacco and related products. These include the emerging products flooding the market worldwide.

END.

Reply:

(1) (a) The South African delegates were mandated to advance the interests of South Africa and of the Continent with regard to aspects that promote public health in relation to the control of tobacco products, electronic delivery systems and related products.

(b) The mandate is based on the fact that South Africa is a signatory to the WHO Framework Convention on Tobacco Control (FCTC). The FCTC is a Global public health treaty which informs South Africa’s mandate in this regard. The treaty is evidence-based and reaffirms the rights of all people to the highest standard of Health. In addition, South Africa is guided by local and global studies that have provided significant evidence about the harm caused by both combustible and non-combustible tobacco products.

(2) No, the public comment on the legislative process related to the Tobacco Products and Electronic Delivery Systems Control Bill has not been incorporated into the mandate, because legislative processes pertaining to the Bill has not been completed yet. Many of the COP issues are similar to the provisions of the Bill, and this is a justifiable coincidence since the two are dealing with the same subject matter at different levels. The Bill process is a law-making process at national level whilst COP deals with tobacco control and regulation at international level.

(3) The National Department of Health respects and values the legislative process that the Bill has to undergo and that includes the public participation process. The Bill before Parliament aims at regulating and controlling the tobacco and related products in the interests of public health. The WHO FCTC is a regulatory instrument on tobacco control at international level. Both WHO FCTC and the National legislation (Tobacco Products Act 83 of 1993), Tobacco Products and Electronic Delivery Systems Control Bill are dealing with the same subject matter namely the regulation and control of tobacco and related products, including electronic delivery systems. Therefore, you may find similar aspects covered in the Bill being discussed at COP as the body implementing the WHO FCTC. As a matter of course, the resolutions and recommendations of international bodies do influence the direction of national laws to the extent allowed by the Constitution of the Republic of South Africa, 1996.

END.

Reply:

1. (a), (b) (i) and (ii)

One official from the Department of Health was delegated to attend COP 10. No other officials from other entities were delegated by the Department to attend.

2. The cost for travel and subsistence for 1 person was R175 040.46. There was no other cost involved.

3. The cost is funded by the Department only.

END.

Reply:

According to the SAHPRA:

a) SAHPRA has the mandate of regulating the efficacy safety and quality of medicines and thus the information supplied in a license application does not include information about the financial implications of not having a license ;

b) There are various reasons licenses are not granted but in essence applicants must comply with the criteria for Good Manufacturing Practice (GMP) and Good Warehousing Practice (GWP). This is done in accordance with the General Regulations to the Medicines Act, Regulation 23(3) and Regulation 23(4). Noncompliance with the criteria for licensing will result in a license not being issued. In some cases applicants decline an inspection when they are contacted for assessment of their license application.

However, there were delays in finalisation of inspections due to capacity constraints in the Inspectorate unit.

c) In the 2022/2023 financial year, SAHPRA approved all new license applications that were evaluated however there are delays in the inspection of applicants due to limited inspection capacity.

END.

Reply:

1. All medical doctors eligible for community service have been placed as of January 2024. This number excludes those who lodged appeals against the areas that they were placed at.

2. National Department of Health can confirm that all medical doctors that were eligible to commence community service started work on 01 January 2024. Only those who are deemed as not eligible or are late starters (i.e., completing their community service later than 31 December 2023) have not been placed. They will be placed upon completion of their community service.

END.

Reply:

As reflected during the media briefing hosted on 05 February, fiscal challenges facing the country and also impacting on the health care system are acknowledged. The Provincial Departments of Health continue to actively engage their Provincial Treasuries to find ways of addressing the unemployment of health professionals, including medical doctors. According to the 09th February 2024 PERSAL print out, 425 Medical Officer appointments were captured for January 2024. Of these, 371 are Medical Officer Grade 1 category.

As reported in Parliament during the State of Nation Address (SONA) Debate on 13th February 2024, working with the Minister of Finance, a solution to address the current challenge of doctors wishing to stay in the public service is being worked out. The details will be furnished after the Minister of Finance’s Budget Speech on 21st February 2024.

There is no documented evidence that links the choice to emigrate with the delayed employment by the state. Contrary to that is the demonstration of aspirations to serve the South African Public Health system as expressed by the recent outcry by the “unemployed doctors”.

END.

Reply:

(a) The Provincial Departments of Health have advertised available funded posts for the various health professional categories including medical doctors and nurses. These are at different stages of recruitment.

(b) National Department of Health will provide guidance to provinces in line with the announcement that will be made by the Minister of Finance in his budget speech on 21 February 2024.

END.

Reply:

1. (a) COP 10 did not take place in November 2023 as scheduled. It was due to take place in Panama but has since been postponed and indication is that it will probably take place in the first quarter of 2024. Ordinarily the delegates include a legal representative responsible for drafting legislations and an official responsible for policy formulation, that is the programme manager for health promotion in the Department.

(b) The legal representative has experience in public service and working on health legislation and subordinate legislation and a health promotion official with experience in health policy formulation and application with both academic and professional health experience. Their experience and expertise place them in good standing to contribute towards development and alignment of the South African legislation and policies that promote public health.

2. (a) The delegates are mandated to advance the interests of South Africa and of the Continent on aspects that promote public health in relation to Tobacco Control and related products.

(b) South Africa is a signatory to the WHO Framework Convention on Tobacco Control (FCTC), which is a Global public health treaty. The treaty is evidence-based and reaffirms the rights of all people to the highest standard of Health. It aims to protect present and future generations from the devastating health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke.

Therefore, Government’s participation as a member state, is to learn, contribute, and adopt policy that may advance public health in South Africa.

END.

Reply:

According to the Health Professions Council of South Africa (HPCSA), the HPCSA underwent major organisational changes with substantive configurations that took effect in 2019/20. Regrettably, a lot of information from financial years prior to 2019 is still to be collated through the Knowledge Management Process. Currently, information as it relates to the question asked is available from 2017 as follows:

a) (i) The total number of foreign qualified graduates that applied to the HPCSA between 2017 and 2023 was 3836, and

(ii) of these 2056 applicants did not write the exams for various reasons outlined below. A total of 1780 foreign graduates wrote the exams, 1066 passed and thus qualified for registration.

b) Applicants would not proceed to registration for a variety of reasons, including, but not limited to the following –

(i) Failure to provide compliant documentation, including information on curricula, notarized documentation, hours of training, domains covered, etc.;

(ii) Non-recognition of qualification by the designated entity, in this case, the Educational Commission for Foreign Medical Graduates (ECFMG); and

(iii) Failing, either the theory and/or board examinations.

END.

Reply:

1.  A CAS number is generated by the South African Police Service (SAPS);

2. The postmortem was conducted, and the histology analysis has also been concluded to confirm the cause of death;

3. The postmortem report is ready for collection by the Investigating officer for release to the family.

END.

Reply:

(a)-(c) No, neither the Minister, the Deputy Minister nor any official of the National Department of Health attended the Rugby World Cup final in France in October 2023.

(i), (ii), (iii) (aa), (bb), (cc) Not applicable.

END.

Reply:

The National Department of Health organized an exhibition stand in collaboration with the South African National AIDS Council (SANAC) during the 11th SA AIDS Conference.

a) The exhibition stand was on display for three (3) days in line with the exhibition hall operational period.

b) The total cost for the stand was -

1. Total cost for three (3) days amounted to R1,055,951. The cost of the stand included booking of exhibition space at the Durban ICC exhibition Hall, Conceptualization, design, production and dismantling of an exhibition stand frame, panels, related items and Recording, production and editing of videography and photography of HIV/AIDS, STIs and TB interventions/programmes that were showcased during the exhibition.
2. Costs were not broken-down per day. According to the terms and conditions of the Conference Organisers, the Exhibition space is booked for the duration of the Conference, there are no daily rates applicable.

c) (i) The stand was utilised as a platform to popularise the current National Strategic Plan (NSP) for HIV, TB and STIs: 2023-2028, and showcasing the achievements of the country’s HIV response.

(ii) Return on investment is that the Department in collaboration with SANAC was able to provide a platform for engagement (dialogues) with various stakeholders on innovative interventions implemented to prevent new HIV infections. Furthermore, delegates had the opportunity to share lessons learnt, best practices and new scientific and behavioural developments in HIV response.

END.

Reply:

a) The total number of Environmental Health Practitioners (Health Inspectors) per Province is as outlined in the table below under column 4:

b) The vacancy rate per Province as listed below in the table under column 5.

c) The department is not responsible for filling the vacancies of Environmental Health Practitioners (Health Inspectors) because these officials are working directly under 44 Districts and 8 Metropolitan municipalities. The mandate to appoint EHPs lies with the Districts and Metropolitan municipalities.

Table depicting the total number of EHPs and the vacancy rate:

Province	Population as per Census 2022	Required EHPs (Inspectors) Per Ratio of 1: 10 100	Number of EHPs (Inspectors) per Province	Vacancy Rate per Province (vacant Funded Positions)
Eastern Cape	7230204	723	203	8.86%
Free State	2964411	296	71	21.13%
Gauteng	15099422	1510	437	14.42%
KwaZulu Natal	12423908	1242	287	10.45%
Limpopo	6572720	657	129	3.1%
Mpumalanga	5143324	514	81	3.70%
North West	3804546	380	76	28.95%
Northern Cape	1355945	136	55	50.9%
Western Cape	7433019	743	373	2.42%
RSA	62027499	6203	1712

END.

Reply:

South Africa’s representatives and negotiators working on the World Health Organisation (WHO) convention, agreement or other international instrument on pandemic prevention, preparedness and response (WHO Pandemic Agreement) have participated in the various iterations of the development of a draft negotiation’s text to prepare for the actual negotiations. The latest version of the document under discussion is titled the “Advanced unedited version of the WHO Pandemic Agreement” and is dated the 16 October 2023 (attached as Annexure to this response). The actual negotiations on the WHO Pandemic Agreement have not yet commenced as there is still no agreement on the negotiation’s text and there are divergent views on the language and contents of the WHO Pandemic Agreement by the WHO member states. The disagreements are on how the principle of Equity is to be operationalised throughout the Articles of the Agreement, to ensure that the mistakes made in responding to Covid-19 are not repeated as we move forward. The disagreements are based on developing countries requiring that lessons learnt for pandemic prevention, preparedness and response are provided for and that the provisions of the Agreement do not disadvantage member states from the global south. However, despite these divergent views, the following areas on sovereignty and conduct of pharmaceutical manufacturers are still being deliberated upon in developing a negotiations text for a future WHO Pandemic Agreement:

a) The “Advanced unedited version of the WHO Pandemic Agreement” has several articles addressing issues of protecting sovereignty of member states and on protecting members states against extortion by pharmaceutical manufacturers and other companies.

(i) On protection of sovereignty of state Parties to the WHO Pandemic Agreement, the Preambular section and Article 3 on General Principles and Approaches addresses these concerns.

1. The Preamble reaffirms the principle of sovereignty of States Parties in addressing public health matters.
2. Article 3 affirms that States have, in accordance with the Charter of the United Nations and the general principles of international law, have the sovereign right to legislate and to implement legislation in pursuance of their health policies.

(ii) On protecting members states against extortion by pharmaceutical manufacturers, other companies and member states, Article 10 on “Sustainable Production” and Article 13 on “Global Supply Chain and Logistics” is meant to provide for mechanisms that must be deployed by state parties to prevent extortionary practices by pharmaceutical entities and member states in which they are domiciled. It must however be noted that pharmaceutical companies are not state parties, but that member states in which they are domiciled will be the state parties to the WHO Pandemic Agreement and this is where the challenge of operationalising equity arises as the member states often invoke free market principles and their inability to intervene:

• 1. Article 10 makes provision for state parties to be self-sufficient in providing for health products by ensuring that in the inter-pandemic period, there is achievement of more geographically and equitably distributed global production of pandemic-related products, and that member states increase the timely, fair and equitable access to safe, effective, quality and affordable pandemic-related products, and thereby reducing the gap between potential demand and supply at the time of a pandemic.
• 2. Article 13 (3) makes provision for the establishment of the WHO Global Supply Chain and Logistics Network (the WHO SCL Network) which shall work with state parties to the agreement to ensure that it facilitates the negotiation and agreement of advance purchase commitments and procurement contracts for pandemic-related products; promotes transparency in cost, pricing and all other relevant contractual terms along the supply chain; and coordinates to avoid competition for resources among procuring entities, including within member states, regional organizations and/or mechanisms.
• 3. Articles 13 (5) and (6) further provide for each Party to the agreement to, at the earliest reasonable opportunity and in accordance with applicable law, make publicly available online the terms of government-funded purchase agreements for pandemic-related products in those instances in which the Party is directly entering into such purchase agreements and shall to the fullest extent possible and in accordance with applicable laws, exclude confidentiality provisions that serve to limit disclosure of terms and conditions of such purchases.

b) The provision for consequence management, including arbitration, should extortion occur, is described in Article 34 on “Settlement of Disputes” of the WHO Pandemic Agreement. This Article provides for parties to resolve disputes through diplomatic channels by negotiation or any other peaceful means of their own choice, including good offices, mediation or conciliation.

Failure to reach a solution by good offices, mediation or conciliation will not absolve Parties to the dispute from the responsibility of continuing to seek to resolve it. However, the pharmaceutical companies as previously stated are not state parties and will not be signatories to Agreement. This is where the drafting of the negotiating text has stalled as currently there are diverging views from advanced economies and countries of the global north where most of these pharmaceutical companies are domiciled on how to resolve challenges that may arise out of the conduct of these companies. This has resulted in the inability to reach consensus with the representative member states from the developed countries from the global north.

END.

Reply:

According to the HPCSA:

1. (a)-(b) The Scope and Guideline document for “Board Examination for Foreign Medical Practitioners wishing to practice in South Africa and for the purpose restoration” issued by the HPCSA’s Medical and Dental Professions Board dated July 2023 provides details on the content, length, and format of the Theory Examination. It is stated in the guideline document that the theory examination time is two (2) hours, as such the candidates were duly informed about the duration of the examination. In addition, the University (UKZN) created a special website from which candidates could access information and directly engage the institution on any matter as they prepared for the exams. The time period for each examination is determined when the examination questions have been finalised so there is no deviation from a three-hour examination period.

2. (a) Foreign-qualified medical graduates need to comply with the standards determined by the MDB for the purposes of registration and clinical practice. Both medical interns and medical officers will enjoy the same scope of clinical practice therefore it is appropriate that their assessment should be the same. There is no rational basis for separate examinations for the two groups.

(b) Based on what has been provided above, there is no need for rectification of any situation.

END.

Reply:

1. (a)(i),(ii) No Department within the Health Sector have blacklisted any company.

(b) Not applicable.

2. Not applicable.

END.

Reply:

a) (i),(ii),(iii) Donor funds

b) Total per each investment

a) (i) (ii) (iii)
DONOR'S NAME	2019/20	2020/21	2021/22	2022/23	2023/24	Totals
b) Total: Centre for Disease Control and Prevention	492,075,883,56	366,677,054,80	42,708,867,45	20,730,070,29	26,843,267,28	949,035,143,38
b) Total: European Union	4,613,092,16	-	-	-	-	4,613,092,16
b) Total: Germany	5,455,047,89	877 636,52	-	-	-	6,332,684,41
b) Total: Global Fund	616,153,230,05	571 301 660,14	1,411,879,026,50	922 803 142,86	930 804 645,72	4,452,941,705,27

(c) The Centres for Disease Control and Prevention (CDC) financial and technical support through the existing Cooperative Agreement, assists the NDoH to incorporate results of programme evaluations into operational disease prevention and control programmes.

• In Financial year 2019/2020, The CDC supported Community Services.
• In financial year 2020/2021 CDC supported procurement of HIV Pre-exposure prophylaxis drugs and TB Prevention therapy drugs. The drugs were distributed to provincial depots in 2021/2022. To date, in addition to the programmatic supports, the CDC Cooperative Agreement has been supporting the NDoH with key personnel within its directorates. Funded personnel are responsible for their respective areas of expertise, and all efforts contribute to the fight against HIV/AIDS and TB in the country. Additional funds were used to support payment of key personnel appointed in the HIV/AIDS and TB as well as Maternal Child and Women Health clusters.

END.

Reply:

The data as requested is drawn from the Persal System and was extracted on 30 November 2023. Unfortunately, records on the Persal System are not able to provide granule data of each specialization as Specialists are not captured per specialization but per Professional Category.

(a)-(b) The table below responds to question (a) and (b) which is the data available on the Persal system. We do acknowledge that the Professional Councils also keep data of all specialities but with a limitation of not being able to still distinguish between employment status (public or private) as well as current location of practice (Nationally or Abroad).

Row Labels	EC	FS	GAU	KZN	LP	MPU	NW	NC	WC
Medical Specialist	163	127	1026	569	81	51	113	29	749
Registrar (Medical)	97	186	1265	334	94	4	44	2	630
Senior Registrar (Medical)	1	0	10	0	1	0	0	0	48
Professional Nurse (Specialised)	1448	596	2834	3605	1539	775	1265	150	1416
Dental Specialist	0	1	60	2	3	2	0	0	5
Grand Total	1709	910	5195	4510	1715	832	1422	181	2848

(c) Not able to provide information of specialist currently in the private sector as the Department is currently not collecting the data but still improving our Human Resource Information System to be operable with private sector.

END.

Reply:

According to the records as presented to Parliament responding to a similar parliamentary question number 3511, the table below provides (a) data of graduates from each medical school in the country for the 2018-2023 period.

South African Institutions of Higher Learning	2018	2019	2020	2021	2022	2023	TOTAL
University of Free State	114	130	179	176	167	173	939
University of KwaZulu Natal	159	78	229	150	281	130	1027
University of Limpopo			24	41	89	75	229
University of Pretoria	225	291	351	366	335	343	1911
University of Stellenbosch	231	295	294	310	306	295	1731
University of Witwatersrand	274	277	425	397	436	466	2275
Walter Sisulu University of Science and Technology	86	99	195	156	156	151	843
Nelson R Mandela School of Medicine (University of KwaZulu Natal)	5	143	77	178	64	200	667
Sefako Makgatho Health Sciences University	201	255	333	254	309	290	1642
University of Cape Town	191	237	213	207	231	241	1320
Total	1486	1805	2320	2235	2374	2364	12584

(b) The Department has it on record that all these graduates were placed for the mandatory community service, after completing their medical internship and were declared registerable as community service doctors by the Health Professions Council of South Africa (HPCSA).

(c) The table below provide a breakdown of new Medical Officer appointments per province for the period 2018 to 2023. The appointments, includes doctors who post their medical community service applied for appointment in the public service.

Medical Officer's appointed from 2018 - 2019 in the Public Sector
	2018	2019	2020	2021	2022	*2023	Total
EC	329	323	364	298	275	252	1841
FS	103	109	158	110	196	170	846
GP	328	421	587	605	658	568	3167
KZ	493	511	656	489	514	515	3178
LP	110	224	183	215	261	239	1232
MPY	62	59	150	55	112	124	562
NW	83	88	85	95	48	144	543
NC	34	20	167	46	190	54	511
WC	249	283	345	275	360	235	1747
Total	1791	2038	2695	2188	2614	2301	13627

*2023 Data is only available up to November 2023.

(d) The Department does not keep records of unemployment doctors after completing community service as they register as independent medical doctors and can opt to practice in the public service or the private sector.

END.

Reply:

(a)-(b) According to the HPCSA they have no records of doctors employed and practicing in public hospitals or Clinics. It is important to appreciate that before a doctor can be employed in the public healthcare sector and paid in the public healthcare system he/she must be registered on the PERSAL system which would include a requirement that the doctor provides evidence of registration with the HPCSA as a doctor. Given that there are no reports of doctors without proper qualifications being employed in the public healthcare sector there would be no need to take action against any official in this regard.

END.

Reply:

In preparation for the busy festive season the following measures have been put in place in hospitals:

• Contingency plans for the festive season are in place for all hospitals and Emergency Medical Services as is done annually.
• Contingency plan is in place for extra personnel in Accident and Emergency units, surgical and orthopaedic wards throughout the festive period due to expected increase in the number of patients requiring surgical intervention.
• Elective, non-urgent surgical procedures are not booked during festive period and theatre space is provided on a 24hour basis for emergencies.
• Leave is strictly monitored, senior managers on call on a 24-hour basis to oversee operations in hospitals during this period.
• In case of disasters, all hospitals are in constant alert and the hospital disaster plans will be activated which includes recalling of staff on leave, at any given time.
• Interprovincial collaborations on transfers are arranged in case of disasters to respond appropriately.
• Stable patients on chronic medication have been given 2 months’ supply of medication to decongest the hospitals.
• Stable patients are discharged home to avail beds for acutely ill and emergency cases.
• Stable patients are given Pass-out should they wish so.
• The Medical Depot ordered buffer stock to accommodate any eventuality.
• Hospitals in the same or close geographical areas have a divert operational policy in place as a mechanism to ensure access to emergency medical services.

END.

Reply:

The National Department of Health opened the Internship and Community Service Programme (ICSP) application site from 4 October until 23 October 2023. Applicants and all relevant stakeholders including students representatives by the form of Unions and Associations were informed accordingly.

As a result, it is appreciated that a total of 10 495 applicants headed a call and applied for medical internship and community service positions.

a) A total of 470 physiotherapist (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for community service positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

b) 463 applicants were eligible for placement based on the citizenship priority processes as mentioned above. Of those 424 have been allocated and notified, with the remaining 39 applicants still confirming their actual commencement dates.

c) The ICSP has two cycles, January and July intake, for allocation designed to accommodate applicants who complete and confirmed eligible at different intervals. As a result the department ensures that those that are eligible to assume duty on 1st January are duly allocated and appointed before commencing duty.

The department is considerate and mindful that the applicants need to make necessary arrangements, including travelling, hence ensuring that applicants are notified a month before the intake date.

The deadline to finalize all allocations cannot be specified as the process is not punitive, however it unfolds until all eligible applicants have been allocated to positions, and duly appointed by Provincial Departments of Health.

END.

Reply:

The National Department of Health opened the Internship and Community Service Programme (ICSP) application site from 4 October until 23 October 2023. Applicants and all relevant stake holders including students representatives by the form of Unions and Associations were informed accordingly.

As a result, it is appreciated that a total of 10 495 applicants headed a call and applied for medical internship and community service positions.

a) A total of 2 036 nurses (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for professional nurses community service positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

b) 2009 applicants were eligible for placement based on the citizenship priority processes as mentioned above. All applicants have been allocated and notified.

c) The ICSP has two cycles, January and July intake, for allocation designed to accommodate applicants who complete and confirmed eligible at different intervals. As a result the department ensures that those that are eligible to assume duty on 1st January are duly allocated and appointed before commencing duty.

The department is considerate and mindful that the applicants need to make necessary arrangements, including travelling, hence ensuring that applicants are notified a month before the intake date.

The deadline to finalize all allocations cannot be specified as the process is not punitive, however it unfolds until all eligible applicants have been allocated to positions, and duly appointed by Provincial Departments of Health.

END.

Reply:

The National Department of Health opened the Internship and Community Service Programme (ICSP) application site from 4 October until 23 October 2023. Applicants and all relevant stakeholders including students representatives by the form of Unions and Associations were informed accordingly.

As a result, it is appreciated that a total of 10 495 applicants headed a call and applied for medical internship and community service positions.

a) (i) A total of 2 403 medical interns (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for medical internship positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

(ii) A total of 2 391 medical doctors community service (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for medical internship positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

b) (i) 2 354 applicants were eligible for placement based on the citizenship priority processes as mentioned above and have since been notified of their placement outcomes.

Some outcomes were unfavourable to the applicants with reasons as follows:

• 113 have been declared not eligible for this Cycle by HPCSA
• 6 applicants to commence duty from 1 July 2024
• 1 applicant retracted his allocation due to other commitments

(ii) 2 387 applicants were eligible for placement based on the citizenship priority processes as mentioned above and 2 158 have since been notified of their allocation. The remaining 229 applicants to commence duty from 1 March 2024 and will be allocated in January 2024

(c) The ICSP has two cycles, January and July intake, for allocation designed to accommodate applicants who complete and confirmed eligible at different intervals. As a result the department ensures that those that are eligible to assume duty on 1st January are duly allocated and appointed before commencing duty.

The department is considerate and mindful that the applicants need to make necessary arrangements, including travelling, hence ensuring that applicants are notified a month before the intake date.

END.

Reply:

1. The Gauteng Department of Health (GDOH) requested the Gauteng Department of Infrastructure Development (GDID) to plan the renovation and refurbishment of the existing hospital infrastructure. The department was informed that the cost of renovations was comparatively too high as compared to the cost of building a new hospital. It was then decided that the existing hospital buildings should be demolished, site cleared, and a new hospital be built on the same site.

Further GDOH requested Gauteng Infrastructure Funding Agency (GIFA) to assist with the funding proposals for the demolishing and rebuilding of the new hospital. Currently GIFA is in the process of preparing Business Cases for submission to National Treasury to request alternative funding of the project under the Budget Facility for Infrastructure (BFI) Framework.

2. GDOH plans to reopen the hospital as a new district hospital to provide additional level 1 district beds needed within the Tembisa and Kempton Park area. Provision of additional district hospital beds at Kempton Park hospital will alleviate the pressure on the Tembisa Regional hospital and free bed space for level 2 and level 3 patients.

(3) The planning of the project was put on hold in 2019 to ensure funding is secured before the project can proceed. Consultations with local community were planned to take place once the funding of the project is secured and the project is ready to proceed.

4. The construction of a new level 1 Kempton Park district hospital will ensure that hospital aligns with the Departmental Long-Term Plan (LTP) to provide much needed level 1 district beds within the Tembisa and Kempton Park and the surrounding areas.

Tembisa hospital is a regional hospital with the proposed plan to increase the level of care to Tertiary and Regional levels. Currently Tembisa hospital is under severe pressure due to being the only government hospital catering for the uninsured population of Tembisa, Kempton Park and other surrounding areas.

Due to shortage of district beds in the area, Tembisa hospital is using level 2 beds for level 1 patients that are affecting the level 2 bed availability.

END.

Reply:

1. (a), (b) and (c) The Department is concerned about the growing number of people diagnosed with diabetes. Type 2 diabetes accounts for about 90% of all cases and is associated with obesity, unhealthy eating habits and a sedentary lifestyle. Type 2 diabetes can be prevented or better managed when people make healthy lifestyle choices. It is for this reason that the Department is acceleration implementation of preventive programmes.

2. (a) The Department has taken and will continue to take serious steps to prevent and control diabetes. The intensity of the Department’s intervention in this regard, is amongst others demonstrated by the fact that the Department has for the past two years, used part of the Health Promotion Levy to provide tools to provinces to facilitate increased screening and focussed health education in the community and in primary health care facilities for non-communicable diseases (NCDs), including diabetes, and promoting physical activity and healthy eating.

(b) The Department has a directorate for NCDs, and national managers work with managers in provinces and districts to pursue the objectives of the programme. The programme is currently achieving its screening targets. Outcome targets will be measured though the WHO STEP survey which is scheduled to commence during the 2024-2025 financial year.

(3) No, it is not necessary to make a statement.

END.

Reply:

a) Public Services employees are entitled to 36 sick leave days over a 3-year cycle as part of their basic conditions of services. In addition, the Annual Report of the National Department of Health publishes leave usage statistics on a year-to-year basis. These leave days are captured on the Transversal system that is administrated by National Treasury (PERSAL). The statistics are as follows:

Year	Total Sick Leave Days	Number of Employees using Sick Leave	Average Days per Employee
2019	7578	984	8
2020	1036	339	3
2021	2374	425	6
2022	5924	796	7

b) The Labour Relations Act (LRA) defines a strike as “the partial or complete concreted refusal to work, or the retardation or obstruction of work, by persons who are or have been employed by the same Employer or by a different Employer, to remedy a grievance or resolve a dispute in respect of any matter of mutual interest between the Employer and Employees.

Furthermore, the section 64 of the LRA stipulates two procedural requirements that should be met for a strike action by employees to be protected and they are as follows: -

• Firstly, it requires that the issue in dispute should be referred for conciliation to a bargaining council or the CCMA.

• Secondly, If conciliation has failed or (thirty) 30 days period has lapsed from date in which the dispute was referred to the council or the CCMA. the employees in the private sector are required give the employer at least a 48 hours’ notice to embark on a strike, while the employees of the state required to give the state seven (7) days’ notice.

In the Department there was no strike action, rather there was a work stoppage due to non-compliance of the infrastructure/ building to Occupational Health Safety legislative framework.

END.

Reply:

1. (a)(b) According to the PERSAL report as extracted on 31 October 2023, the table below is the data of health care workers in both health related and non-health related categories who are expected to retire due to attaining 65 years, which is the compulsory retirement Age in accordance with the Public Service Act 1994, as amended.

2. (a) Since the Department is unable to fill vacant posts due to budget cuts that have tremendously affected Cost of Employment (COE). Provinces have introduced systematic process of approving funding and advertisements of posts in consultation with Provincial Treasuries, to avoid exceeding available budgets.

• Developed and prioritised posts through Annual Recruitment Plan – where funding permits
• Prioritised filling of posts through conditional grant funding
• Filling of replacement posts considered and approved monthly
• Advertisements published National wide through print media
• A dedicated Registrar Programme to train and produce in-house Medical Specialists

(b) The Persal Age analysis information is used to influence our internal skills development program. When a retiring official is in a specialist posts, the Department grants study leavers who are interested in that particular speciality with the intention to appointment them when they qualify into that vacated post of the retire.

 

PERSAL Report as at 31 October 2023 - Staff retirements per year as at age 65
Province	Occupational Group Clasification	2024	2025	2026	2027	2028	2029	Total
Eastern Cape	Health Related	21	232	386	428	548	711	2326
	Non Health Related	1	25	62	73	86	110	357
Prov. total	22	257	448	501	634	821	2683
Free State	Health Related	32	100	140	154	223	273	922
	Non Health Related	5	17	24	28	50	60	184
Prov. total	37	117	164	182	273	333	1106
Gauteng	Health Related	69	309	393	531	696	880	2878
	Non Health Related	12	27	117	150	224	271	801
Prov. total	81	336	510	681	920	1151	3679
Kwazulu-Natal	Health Related	58	243	378	414	578	726	2397
	Non Health Related	4	66	114	143	216	308	851
Prov. total	62	309	492	557	794	1034	3248
Limpopo	Health Related	19	119	174	169	308	384	1173
	Non Health Related	4	43	70	56	103	174	450
Prov. total	23	162	244	225	411	558	1623
Mpumalanga	Health Related	20	50	70	97	139	192	568
	Non Health Related	1	12	38	57	78	84	270
Prov. total	21	62	108	154	217	276	838
Northern cape	Health Related	22	34	70	58	89	100	373
	Non Health Related	1	5	5	9	7	18	45
Prov. total	23	39	75	67	96	118	418
Nort- West	Health Related	80	69	125	110	188	270	842
	Non Health Related	1	10	16	28	41	64	160
Prov. total	81	79	141	138	229	334	1002
Western Cape	Health Related	64	163	166	197	272	355	1217
	Non Health Related	5	17	41	61	69	90	283
Prov. total	69	180	207	258	341	445	1500
Total	419	1541	2389	2763	3915	5070	16097

END.

Reply:

The Table below is providing a list of reports that were conducted since 1 January 2016:

DESCRIPTION OF THE REPORT	DATE OF THE REPORT	CONDUCTED BY WHO	LINK OF THE REPORT	STATUS OF THE REPORT
Occupation Health and Safety (OHS) Report	17 September 2017	Bigen Africa on behalf of GDID (Gauteng Department of Infrastructure Development)	Tambo Memorial Hospital - OHS Report.pdf	Contractor was appointed by IDT on behalf of the National Department of Health to address the non-compliance issues.
Condition assessment on the structure of the hospital regarding the damages caused by the gas explosion	29 December 2022	IDT on behalf of the National Department of Health	Report for Tambo Memorial Hospital structure.pdf	Contractor was appointed by IDT on behalf of the National Department of Health to address the findings.
Condition assessment on medical equipment/health technology equipment of the hospital regarding the damages caused by the gas explosion	29 December 2022	National Department of Health	Tambo Memorial Hosp Equipment Report.pdf	All the findings were addressed and resolved in January 2023.

END.

Reply:

a) The correspondence from NEHAWU refers to a forensic investigation that was instituted by the Health Professions Council of South Africa (HPCSA) to investigate the allegations levelled against the President of the HPCSA, Prof. M.S. Nemutandani.

It is important to appreciate the following:

• HESA appointed Prof Nemutandani to the Medical and Dental Professions Board (MDB) as per the Regulations relating to the Constitution of the MDB.
• As a Member of the MDB, Prof Nemutandani was one of those designated in terms of section 5(1)(a) of the Health Professions Act, 56 of 1974 (“the Act”), to be a member of the HPCSA Council.
• Prof. Nemutandani was thereafter elected as President of the Council by the members of the Council per section 7(1) of the Act, and that is how Prof Nemutandani became the President of the HPCSA.

You would appreciate that the President of the Council is appointed by the Minister after being recommended by members of the Council. You would consequently appreciate why the forensic investigation report makes findings and recommendations for consideration by the HPCSA and not the Minister. It is the Council that should consider the report and make recommendations to the Minister on any action against the President of the HPCSA.

b) According to the Registrar of the HPCSA, the matter is currently serving before the Professional Conduct Committee of the Medical and Dental Professions Board. The Committee is tasked with adjudicating whether the acts that Prof Nemutandani is accused of constitute unprofessional conduct as defined in the Health Professions Act 56 of 1974. This matter was first set down for 22 September 2023 but subsequently postponed to 15 November 2023 to allow the respondent to secure a legal presentation as he needed to brief counsel. The matter could not proceed on 15 November 2023 on account of a request for further postponement by the respondent as he had a bereavement in his family. The postponement was granted by the Committee to February 27,28, and 29, 2024. The Minister will be provided with a report upon the conclusion of the disciplinary hearing.

Notwithstanding the abovementioned disciplinary process, which is ongoing, the Department is also taking legal advice in terms of any further steps with respect to the individuals mentioned and the findings of the investigation report because of the nature of the matter and the level of Prof. Nemutandani at the HPCSA.

END.

Reply:

a) The National Department of Health raises awareness through various communication platforms such as social media, which includes Facebook and Twitter. There are also periodic webinars conducted, which are open to the public. There are national and local radio malaria campaigns conducted by both the National and Provincial Departments of Health. Community campaigns are conducted before and during the high peak seasons to sensitize and raise awareness. Key Malaria days, such as World Malaria Day, SADC Malaria day and Mosquito day are also commemorated across the country.

b) (i)(ii)(iii) South Africa’s strategy to prevent, detect and diagnose Malaria in high-risk provinces is implemented in Mpumalanga, Limpopo and KwaZulu-Natal. In each of the provinces, the Department has fully functional Malaria Control Programmes which oversee activities geared towards malaria elimination and consist of the following:

• The screening and testing of patients who show signs and symptoms of malaria is prioritized at facilities. This is to ensure patients are promptly diagnosed and treated with the recommended first line treatment to avert unfavourable outcomes and to disrupt ongoing transmission and/or spread.
• Subsequently, active case finding is implemented at community level, which entails screening, testing and treatment for any identified cases to avert further community transmission.
• Surveillance units deployed to the border areas to expand access to early diagnosis and treatment for border communities as well as mobile and migrant populations.
• Prophylaxis is also available in all public health facilities for those who are traveling from non-endemic areas to endemic areas.
• Vector control through Indoor Residual Spraying (IRS), supplemented by the treatment of stagnant water bodies, also called larviciding. This is timed to cover the peak transmission periods.
• Targeted Health Promotion and Risk Communication Community Engagement.

END.

Reply:

a) Table 1 below indicates the total number of Forensic Pathology Service(mortuaries) by province.

Table 1

 

Province	Number of mortuaries
Eastern Cape	22
Free State	11
KwaZulu Natal	33
Gauteng	11
Limpopo	12
Mpumalanga	21
Northern Cape	11
Northwest	7
Western Cape	17
Total	145

b) (i)) (ii) is indicated in tables below by Province.

EASTERN CAPE PROVINCE

District	Name of mortuary	Municipality	Number of Vehicles	Average response time and radius serviced
Chris Hani Health District	Queenstown FPS	Chris Hani	5 vehicles	Average response time ranges between 1 to 3 hours. Radius is 160 km
Joe Gqabi Health District	Molteno holding facility	Joe Gcabi	1 vehicle	Average response time ranges between 1 to 3 hours. Radius is 150 km
	Aliwal North FPS		2 vehicles	Average response time ranges between 1 to 3 hours. Radius is 250 km
	Mt Fletcher FPS		2 vehicles	Average response time ranges between 1 to 3 hours. Radius is 130 km
Nelson Mandela Bay Health District	New Brighton FPS	Nelson Mandela Metropolitan	3 vehicles	Average response time ranges between 1 to 3 hours. Radius is 70 km
Sarah Baartman Health District	Gelvandale FPS	Sarah Baartman	3 vehicles	Average response time ranges between 1 to 3 hours. Radius is 50 km
	Mount Road FPS		3 vehicles	Average response time ranges between 1 to 3 hours. Radius is 40 km
	Uitenhage holding facility		2 vehicles	Average response time ranges between 1 to 3 hours. Radius is 50 km
	Grahamstown FPS		2 vehicles	Average response time ranges between 1 to 3 hours. Radius is 100 km
	Graaf Reinet FPS		2 vehicles	Average response time ranges between 1 to 3 hours. Radius is 90 km
	Port Alfred Holding Facility		1 vehicle	Average response time ranges between 1 to 3 hours. Radius 80 km
	Joubertina Holding Facility		1 vehicle	Average response time ranges between 1 to 3 hours. Radius is 100km
OR Tambo Health District	Mthatha FPS	Ngquza Hill Port St Johns Nyandeni Mhlontlo King Sabata Dalindyebo	4 vehicles	Average response time ranges between 1 to 3 hours. Radius is 120km
Alfred Nzo District	Lusikisiki FPS	Matatiele Umzimvubu Mbizana Ntabankulu	3 vehicles	Average response 1-hour urban area and 3 hours rural areas Radius is 100km
	Bizana FPS		2 vehicles	Average response 1-hour urban area and 3 hours rural areas Radius is 150km
	Mt Frere FPS		2 vehicles	Average response 1-hour urban area and 3 hours rural areas Radius is 150km
Amathole District	Mdantsane FPS	Amahlathi Great Kei Mbhashe Mnquma Ngqushwa Nkonkobe Nxuba	3 vehicles	Average response time ranges between 1 to 3 hours. Radius is 40 km
	Bhisho FPS		2 vehicles	Average response time ranges between 1 to 3 hours. Radius 50 km
	Butterworth FPS		1 vehicle	Average response time ranges between 1 to 3 hours. Radius 60 km
	Adelaide FPS		1 vehicle	Average response time ranges between 1 to 3 hours. Radius 100 km
	Dutywa FPS		2 vehicles	Average response time ranges between 1 to 3 hours. Radius 60 km
Buffalo City Metropolitan District	Woodbrook FPS	Buffalo City Metropolitan	3 vehicles	Average response time ranges between 1 to 3 hours. Radius 70 km

FREE STATE PROVINCE

District	Facility	Municipality	Number Of Vehicles	Average response time and radius serviced
Mangaung Metro	Bloemfontein FPS	Mangaung	1 Vehicle	Average response time ranges between 1 to 3hours The radius is 400 km
	Botshabelo FPS		1 vehicle
Lejweleputswa	Welkom FPS	Matjhabeng	1 vehicle	Average response time ranges between 1 to 3hours. The radius is 260km
Thabo Mofutsanyana	Phuthaditjhaba FPS	Maluti A Phofung	1 vehicle	Average response time ranges between 1 to 3hours. The radius is 330km
	Bethlehem FPS	Dihlabeng	1 vehicle
Fezile Dabi	Sasolburg FPS	Metsimaholo	1 vehicle	Average response time ranges between 1 to 3hours. The radius is 85 km
	Kroonstad FPS	Moqhaka	I vehicle

GAUTENG PROVINCE

District	Name of mortuary	Municipality	Number of Vehicles	Average response time and radius serviced
Tshwane	Bronkhorstspruit	Tshwane Metropolitan	3 vehicles	Average response time ranges between 1to 2hours The radius is 78km
	Ga-Rankuwa		6 vehicles	Average response time ranges between 1to 2hours The radius is 48km
	Pretoria		7 vehicles	Average response time ranges between 1to 2hours The radius is 27km
Johannesburg	Diepkloof	Johannesburg Metropolitan	6 vehicles	Average response time ranges between 1to 2hours The radius is 50km
	Johannesburg		7 vehicles	Average response time ranges between 1to 2hours The radius is 80km
West Rand	Roodepoort	Merafong City Mogale City Rand West	7 vehicles	Average response time ranges between 1to 2hours The radius is 120km
	Carletonville		7 vehicles	Average response time ranges between 1to 2hours The radius is 100km
Sedibeng	Heidelberg	Emfuleni Lesedi Midvaal	3 vehicles	Average response time ranges between 1to 2hours The radius is 50km
	Sebokeng		8 vehicles	Average response time ranges between 1to 2hours The radius is 55km
Ekurhuleni	Germiston	Ekurhuleni Metropolitan	9 vehicles	Average response time ranges between 1to 2hours The radius is 42km
	Springs		9 vehicles	Average response time ranges between 1to 2hours The radius is 25km

KWA ZULU NATAL PROVINCE

District	Facility	Municipality	Number of Vehicles	Average response time and radius serviced
Ethekwini	Phoenix FPS	Ethekwini	15	Average response time is 2 hours. The radius is 98km
	Pinetown FPS	Ethekwini	8	Average response time is 1hour. The radius is 90km
Ugu	Park Rynie FPS	Umdoni	7	The average response time is 1 hour. The radius is 110 km
	Port Shepstone	Ray Nkonyeni	6	The average response time is 1 hour. The radius is 175
	Harding	Muziwabantu	5	The average response time is 1 hour. The radius is 50km
Ilembe	KwaDukuza	kwadukuza	3	Average response time is 2hours. The radius is 65km
Umgungundlovu	Pietermaritzburg	Msundusi	9	Average response time is 1h30 The radius is 50km
	New Hanover	Umshwati	2	Average response time is 1hour. The radius is 75 km
	Howick	Umgeni/Mpofana	2	Average response time is 1hour. The radius is 100km
	Richmond	Richmond	3	Average response time is 1hour. The radius is 75km
Uthukela	Ladysmith	Alfred Duma	9	Average response time is 1h30 The radius is 150 km
	Estcourt	Inkosi Langalibalele	4	Average response time is 2 hours rural area, 30 min urban area. The radius is 120km
Umzinyathi	Dundee	Endumeni, Nqutu	5	Average response time is 2 hours. The radius is 175 km
	Greytown	Umvoti	6	Average response time is 50min. The radius is 160km
Amajuba	Newcastle/ Dannhauser	Newcastle	2	Average response time is 1 hour in rural area, 30 min urban area. The radius is 105km
	Madadeni	Madadeni	3	Average response time is 30min. The radius is 120km
Harry Gwala	Kokstad	Kokstad	2	Average response time is 1h30 The radius is 100km
	Ixopo / Bulwer	Ubuhlebezwe/ Nkosazana Dlamini Zuma	4	Average response time is 2 hours. The radius is 150km
	Umzimkulu	Umzimkulu	4	Average response time is 30min. The radius is 100km
Zululand	Ulundi	Ulundi	5	Average response time is 30min. The radius is 40km
	Nongoma	Nongoma	5	Average response time is 45min. The radius is 75km
	Vryheid/ Paulpietersburg	Abaqulusi / Edumbe	5	Average response time is 1hour. The radius is 100km
	Pongola	Pongola	3	Average response time is 45min. The radius is 75km
Umkhanyakude	Mtubatuba	Mtubatuba	7	The average response time is 1 hour. The radius is 80km
	Mkhuze	Jozini	3	Average response time is 2 hours. The radius is 85km
	Mosvold	Jozini	3	Average response time is 2 hours. The radius is 150km
	Manguzi	Umhlabuyalingana	4	Average response time is 2 hours. The radius is 120km
King Cetshwayo	Richards Bay	Mhlathuze	7	Average response time is 1h30 The radius is 100km
	Eshowe	Umlalazi	6	Average response time is 2hours. The radius is 70km
	Nkandla	Nkandla	2	Average response time is 2hours. The radius is 60km

LIMPOPO PROVINCE

District	No Of Facilities	Municipality	Number of Vehicles	Average response time and radius serviced
Capricorn	Polokwane FPS	Polokwane Capricorn District Municipality	7 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km
	Lebowakgomo FPS	Lepelle Nkumpi Feta Kgomo Makhudu Mathamaga	5 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km however there are areas that stretches beyond 90km
Mopani	Letaba FPS	Greater Tzaneen	5 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km
	Maphutha Malatjie FPS	Ba Phalaborwa	1 vehicle
	Nkhesani FPS	Greater Giyani Collins Chabane	1 vehicle
	Kgapane FPS	Greater Letaba	1 vehicle
Waterberg	Mokopane FPS	Mogalakwena Mookgopong Lephalale	5 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km
	Bela Bela FPS	Thabazimbi Modimolle Bela Bela	4 vehicles
Vhembe	Tshilidzini FPS	Musina Thulamela	5 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km
	Elim FPS	Makhado Collins Chabane Greater Letaba	5 vehicles
Sekhukhune	St Rita’s FPS	Makhuduthamaga	5 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km
	Groblersdal FPS	Ephraim Mogale Elias Motswaledi	3 vehicles	30 min in an urban area and 60 min in rural. The radius for each facility is 90km however there are areas that stretches beyond 90km.

MPUMALANGA PROVINCE

District	Facility	Municipality	Number Of Vehicles	Average response time and radius serviced
Ehlanzeni	Themba FPS	Mbombela	4 vehicles	Average response time is 1 hour to the furthest point. Radius is 7263sqkm
	Barberton FPS	Mbombela		Average response time is 2 hours to the furthest point. Radius is 3774 sqkm
	Tonga FPS	Nkomazi	2 vehicles	Average response time 1 ½ hours across service points Radius is 4787sqkm
	Mapulaneng FPS	Bushbuckridge	4 vehicles	Average response time is 2 hours to the furthest point. Radius is1587 sqkm
	Tintswalo FPS	Bushbuckridge
	Lydenburg FPS	Thaba Chweu	2 vehicles	Average response time is 1 ½ hours to furthest point. Radius is 5719sqkm
Nkangala	Witbank FPS	Emalahleni	3 vehicles	Average response time is 1 hour across service points. Radius is 2678 sqkm
	KwaMhlanga FPS	Thembisile Hani	2 vehicles	Average response time 1 hour time across Radius is 2384sqkm
	Middelburg FPS	Steve Tswete	5 Vehicles	Average response time is 1 hour to the furthest point. Radius is 3976sqkm
	Mmamethlake FPS	Dr JS Moroka	1 vehicle	Average response time is 1 hour across service points. Radius is 1416sqkm
	Delmas FPS	Victor Khanye	3 vehicles	response time 1 hour across service points. 1568sqkm
	Belfast FPS	Emakhazeni	1 Vehicles	Average response time is 1 hour to the furthest point. 4736sqkm
Gert Sibande	Bethal FPS	Govan Mbeki	4 vehicles	Average response time is 1 hour across the service points.
	Evander FPS	Govan Mbeki
	Piet Retief FPS	Mkhondo	2 vehicles	Average response time is 1 hour to the furthest point. Radius is 4868sqkm
	Carolina FPS	Albert Luthuli	2 vehicles	Average response time is 1 hour across the service points. Radius is 5559sqkm
	Embhuleni FPS	Albert Luthuli
	Volkrust FPS	Pixley Ka Isaka Seme	2 Vehicles	Average response time is 45 minutes across the service points. Radius is 1104sqkm
	Ermelo FPS	Msukaligwa	1 vehicle	Average response time is 1 hour across the service points. Radius 2616sqkm
	Balfour FPS	Dipaleseng	2 vehicles	Average response time is 1 hour across the service points. Radius is 2955sqkm
‘;	Standerton FPS	Likwa	2 vehicles	Average response time is 1 hour to the furthest point. Radius is 4585sqkm

NORTHWEST PROVINCE

District	No Of Facilities	Municipality	Number of Vehicles	Average response time and radius serviced
Dr. Kenneth Kaunda District	Potchefstroom FPS	JB Marks Municipality	4	Average response time is 2hr 40min. The radius 6 398 km2
	Klerksdorp FPS	Matlosane and Makwasi - Hills Municipalities	5	Average response time is 2hr 20min. The radius is 8 204 km2
Dr. Ruth Segomotsi Mompati District	Vryburg FPS	Naledi, Greater Taung, Lekwa-teemane, Mamusa and part of Ratlou local Municipalities	3	Average response time is 3hr. The radius is 28 941km2
Ngaka Modiri Molema District	Lichtenburg FPS	Ditsobotla, Tswaing and part of Ratlou Municipalities	5	Average response time is 2hr 2 min. The radius is 14806,7km2.
	Mafikeng FPS	Mafikeng, Ramotshere - Moiloa and part of Ratlou Local Municipalities	04	Average response time is 2hr 1 min. The radius is 13 333km2
Bojanala District	Brits FPS	Madibeng, Moretele and part of Rustenburg local Municipalities	03	Average response time is 2hr 30 min. The radius is 6 972km2.
	Phokeng FPS	Rustenburg, Kgetlheng and Rustenburg local municipalities	03	Average response time is 1hr 30 min. The radius is 13 115km2

NORTHERN CAPE PROVINCE

District	Facility	Municipality	Number Of Vehicles	Average response time and radius serviced
Frances Baardt	Kimberley FPS	Sol Plaatjie	6	Average response time is 1hour The radius is 100km
	Hartswater Holding Facility	Phokwane	1	Average response time is 30minutes The radius is 30km
ZF Mgcawu	Upington FPS	Dawid Kruiper	3	Average response time is 1hour and 30minutes The radius is 300km
	Postmasburg Holding Facility	Tsantsabane	1	Average response time is 1hour and 30minutes The radius is 200km
Pixley KaSeme	De Aar FPS	Emthanjeni	5	Average response time is 2 hours The radius is 200km
	Prieska Holding Facility	Siyathemba	1	Average response time is 1hour and 30minutes The radius is 150km
	Victoria West Holding Facility	Ubuntu Municipality	1	Average response time is 1hour and 30minutes The radius is 150km
	Douglas Holding Facility		2	Average response time is 1 hour The radius is 150km
John Taolo Gaetsewe	Kuruman FPS	Gasegonyama	3	Average response time is 2hours The radius is 200km
	Springbok FPS	NamaKhoi	3	Average response time is 2hours and30minutes The radius is 300km
Namakwa	Calvinia FPS	Hantam	2	Average response time is 1hour and 30minutes The radius is 150km

WESTERN CAPE

District	No of Facilities	Municipality	Number of Vehicles	Average response time and radius serviced
Western Cape, West Metropol	Observatory Forensic Pathology Institute	City of Cape Town	5	Average response time is 23 minutes. The radius 2446sqkm
Western Cape, East Metropol	Tygerberg FPS	City of Cape Town	5	Average response time is 34 minutes. The radius 2446sqkm
Western Cape, Cape Winelands/ Overberg	Paarl FPS	Drakenstein Stellenbosch	2	Average response time is 56 minutes. The radius is 2369sqkm.
Western Cape, West Coast / Winelands	Vredendal	Cederberg Matzikama	2	Average response time is 77 minutes. The radius is 20988 sqkm.
	Malmesbury	Swartland Bergrivier	2	Average response time is 51 minutes. The radius is 8114sqkm.
	Vredenburg	Saldanha Bay	2	Average response time is 37 minutes. The radius is 2015sqkm.
Western Cape, Cape Winelands/ Overberg	Worcester	Breede Valley Langeberg Swellendam	3	Average response time is 76 minutes. The radius is 12187
	Hermanus	Overstrand Cape Agulhas Theewaterskloof	2	Average response time is 74 minutes. The radius is 8401sqkm
	Ceres	Witzenberg	2	Average response time 36 minutes The radius is 10753sqkm
Southern Cape/ Garden Route/ Karoo	George	George	2	Average response time is 29 minutes. The radius is 5191 sqkm
	Laingsburg FPS (Holding Facility)	Laingsburg Prince Alfred	2	Average response time is 25 minutes. The radius is 16937sqkm
	Mossel Bay	Mossel Bay	2	Average response time is 26 minutes. The radius is 2001 sqkm
	Knysna	Knysna Bitou	2	Average response time is 34 minutes. The radius is 2101sqkm
	Oudtshoorn	Oudtshoorn	2	Average response time is 78 minutes. The radius is16458 sqkm
	Beaufort West FPS (Holding Facility)	Greater Beaufort West	2	Average response time is 27 minutes. The radius is 21917sqkm
	Riversdale Holding Facility	Hesssequa	2	Average response time is 33 minutes. The radius is 5733sqkm

END.

Reply:

The National Department of Health has the National Recruitment Plan, which is the tool used by all the Provincial Departments of Health to guide and facilitate the recruitment and selection processes of the new students for the Nelson Mandela/Fidel Castro Medical Training Programme to ensure, uniformity, transparency, and fairness.

a) An advert for the recruitment to the programme is published and managed by the Provincial Departments of Health. The Provincial Departments of Health use various methods of advertisements that include print media, social network platforms, websites. Adverts are also placed in radio adverts, schools, and hospitals. The minimum duration for the advertisement, is one month.

b) The admission process is informed by the selection criteria that are outlined in the National Recruitment Plan. Potential new recruits must have passed Grade 12 (matric) with full University exemption. They must have passed four key subjects which are, English, Mathematics, Life Sciences and Physical Sciences with the minimum of achievement level of 50% in each. The Provincial Departments of Health also ensure that all the districts are represented when selecting potential recruits.

Table 1 below indicates the number of students recruited for the programme by year and province.

Table 1:

Provinces	2016	2017	2018	2019	2020	2021	2022	2023	Total
Eastern Cape	0	0	0	0	0	0	0	0	0
Free State	0	0	0	0	0	0	0	0	0
Gauteng	1	0	0	0	0	0	9	0	10
KwaZulu Natal	0	0	0	0	0	0	0	0	0
Limpopo	0	0	0	0	0	0	0	0	0
Mpumalanga	10	0	0	0	0	0	0	10	20
Northern Cape	0	0	0	0	0	0	0	10	10
Northwest	0	0	0	4	0	0	20	20	44
Total	11	0	0	4	0	0	29	40	84

END.

Reply:

(a) All the Provincial Departments of Health are recruiting forensic personnel to increase the number through their recruitment policy and plans. Where necessary medical officers do sessional work to ensure that provision of service especially in mortuaries is adequate. There is a drive to send medical officers for specialisation in Forensic Pathology based on availability of funds and intake by the universities.

(b) There are various mechanisms in place related to training and development of forensic health professionals in all provinces. This is done through workshops, attendance of seminars, clinical professional development and in service education and attendance of short courses.

Health officials also receive debriefing sessions by the Counselling and Clinical Psychologists and Psychiatrists where necessary to improve their well-being.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

1. (a) Toxicology tests are conducted at three Forensic Chemistry Laboratories (FCLs) in Cape Town, Johannesburg, and Pretoria. The factors that contribute to the backlog include inadequate infrastructure, equipment breaking down, loadshedding, inadequate water supply, the Covid-19 pandemic and shortages in human resources.

Toxicology backlogs as at the 31 October 2023:

FCL	Toxicology backlog	Completed during October 2023
Cape Town	6 825	58
Johannesburg	14 700	206
Pretoria	16 437	101

b) The NHLS has implemented strategies to address the backlogs in toxicology testing at the FCLs. In this regard the blood alcohol testing backlog has been cleared in all laboratories except the Johannesburg FCL.

The NHLS will expand the toxicology capacity in the three laboratories that currently offer toxicology testing to ensure an increase in the processing capacity at these laboratories. To this effect, additional laboratory space has been acquired from the CSIR that will accommodate a new toxicology section for the Pretoria FCL. Similar solutions are being explored for the Johannesburg and Cape Town FCLs. The NHLS have invested significantly in ensuring laboratories are equipped with functional analytic instruments through the replacement of ageing and obsolete equipment and the procurement of additional instruments for the planned expansion in services. Plans are underway to source additional laboratory space that would allow the Durban FCL to expand its service offering to include toxicology testing.

c) Toxicology cases are time-consuming, and this is mainly related to the complex nature and variability of the cases and testing processes as well as the requirement for special reference materials to complete cases. For these reasons, toxicology cases are allocated in batches to each analyst at the beginning of each month and laboratory outputs are measured on a monthly basis. Each toxicology analyst is allocated at least 15 cases per month.

2. The NHLS is determined to implement strategies to clear the backlogs in toxicology testing at the Forensic Chemistry Laboratories. At this stage it would be difficult to determine when the backlogs would be cleared. As can be seen from the various efforts that have been made, the NHLS is working towards clearing the backlog as fast as possible.

END.

Reply:

EASTERN CAPE

(1) (a) (i) (ii) (aa) (bb)

Number staff attacked/ threatened by patients in hospitals	Number staff attacked/ threatened by patients in clinics	# Attacked by patients
0	4 Circumstances Zwide Clinic Patient threatened Security guard with a gun. Soweto Clinic Staff member in Pharmacy threatened with a firearm by the patient New Brighton Clinic Patient attacked dentist Tshangana Clinic Clerk assaulted by the patient inside the clinic	4
Number Staff Attacked/ Threatened by other Assailants in Hospitals	Number Staff Attacked/ Threatened by other Assailants in Clinics	# Attacked by Assailants
0	10 incidents Circumstances Nomangesi Jayiya Clinic Security Guard attacked by 4 thugs. He ran into clinic and locked himself in. Thugs took the exterior security gate with them Staff robbed of personal belongings inside the clinic     Mabandla Rehab Staff Robbed at gunpoint Max Madlingozi Clinic Security Guard and driver of vehicle collecting/delivering of blood samples robbed of personal belongings Service provider (repairing plumbing) robbed of personal belongings inside facility Security guard robbed of personal belongings on 1st day of work at clinic staff robbed of their personal belongings Kwadwesi Clinic Staff Robbed at gunpoint    West End Clinic Security Guard robbed of cellphone at the guardhouse Middle Street Clinic 3 x gangsters chased rival gang member into clinic where they stabbed him inside the clinic.	10
Total Hospital 0	Total Clinic 14 incidents	Grand total 14 incidents

(2) Measures put in place to address the p

• Staff counseled at Wellness clinic
• Security enhancements

FREE STATE

(1) (a) (i) (ii) (aa) (bb)

The Free State Department of Health reports that they have had no cases except for the following:

Pax clinic, two groups from township were fighting each other and the fight ended up at the clinic where one group wanted to finish the member of the other group.

(2) The police were called and positively calmed the situation down. The department increased the security personnel and instructed the district to utilize the hybrid security model to strengthen the security service by appointing the private security company for the clinic to work on Fridays, Saturdays and Sundays supplementing the departmental security service.

GAUTENG

1. (a) (i) (ii) (aa) (bb)

Number staff attacked/ threatened by patients in hospitals	Number staff attacked/ threatened by patients in clinics	# Attacked by patients
3 Tembisa 1 x staff member attacked by patient 2 x staff members attacked by patient at Charlotte Maxeke	1 Circumstances Lillian Ngoyi. Staff member attacked by patient at the clinic	4
Number Staff Attacked/ Threatened by other Assailants in Hospitals	Number Staff Attacked/ Threatened by other Assailants in Clinics	# Attacked by Assailants
4 Tembisa Hospital A police officer (boyfriend) shot a nurse assistant. The boyfriend entered the facility with a police vehicle flashing light, a case was opened at the local police station case 203/03/22 The father to a patient assaulted a nurse in the ward at Tembisa Hospital. The matter was reported to Tembisa police station case 650/3/2023. Charlotte Maxeke hospital 2 x security officers were assaulted by Psychiatric patient	0	4
Total Hospital 7	Total Clinic 1	8 Grand total

(2) Approved Security Policy and Access Control Policy were distributed across Gauteng Health facilities. The department is also conducting security assessments on the current status of CCTV cameras.

The Gauteng department of health is in a process to procuring the new security contract for all the department of health facility with the Hybridge model to address all security concern within the province.

KWAZULU-NATAL

(1)`(a) (i) (ii) (aa) (bb) and (2)

Facility	(ii) clinic staff have been attacked and/or threatened by (aa) patients on the premises of health facilities in each province	(b) were the circumstances of each incident in each Province;	what are the relevant details of the measures that have been put in place to address such incidents in each province?
Fort Napier Hospital	08	1 x case of sexual assault (A female Staff was touched inappropriately by a Patient.) 7x cases of physical assault on staff members by the patients.	In the wards staff members are issued with mobile panic buttons, to use in emergency cases. Cleaners are encouraged to work in pairs as much as tasks allow. Staff members are trained on de-escalation techniques. Security officers are allocated in the wards to assist on security issues. Patient risk assessment is ongoing and risk mitigation is implemented as risk changes are noted.
Niemeyer Memorial Hospital	01	The mentally ill patient attacked the nurse with a drip stand whilst under 72hrs observation.	Investigating Officer appointed to conduct investigation with effect from 23 November 2023. Referral of violent /disruptive mentally ill patients immediately to designated psychiatric facilities.
Greys	01	A Female Nurse who was separated from her husband at the time was assaulted by her husband on the hospital parking lot. Security was called to assist but the perpetrator was armed and threatening verbally.	Local SAPS was called but unfortunately arrived after the perpetrator had left. The wife was assisted by security to the Emergency Dept.  the wife completed a J88 in the Emergency Department.   A court order was obtained, and the husband can only access the hospital property as a patient.
Townhill	09	5 x Staff injured while restraining MHCU’s. 3 x Professional Nurses sprayed with fire extinguisher by MHCU. Security officer assaulted by enrolled nursing assistant at the main gate	More staff will be sourced to monitor psychotic patients. Ongoing staff re-training on seclusion of psychotic patients. ENA seconded to another hospital while labor relations investigation proceeds
Northdale	07	All cases of staff being attacked by patients involved acute psychosis exhibited by the patients.	Installation of live CCTV cameras to specific wards. Upgrade security patrols around wards to do crowd control during visiting hours.
Richmond	01
Nkonjeni/ St. Francis Hospital	01	A patient brought by relative jumped and kick the window while the OPD clerk was retrieving his file	Strengthened security at OPD.
Vryheid hospital	14	Nursing staff attacked by psychiatric patients	Assistance by Security Guards. Seclusion of psychotic patients. Staff referred to EAP for grief counselling.
Addington hospital	01	Casualty Staff were threatened by a relative demanding urgent attention.	Security strengthened at Casualty.
KEH & ST. Aidan hospital	01	Staff threatened by a Patient who was intoxicated.
Mahatma Ghandi Memorial hospital	05	DR assaulted by MHCU patient in casualty and the Dr’s cell phone was taken and smashed by patient in male medical ward and had her arm twisted Security and Nurse bitten by MHCU in casualty when restrained nurse trying to administer medication Nurse attacked by MHCU that was refusing admission. Security Officer attacked by MHCU from casualty. The patient pulled the security hair.	Security posted inside casualty and another at entry od casualty. Each security has been provided with two way radios to call for backup.
Wentworth hospital	03	Relatives demanding attention	Installation of CCTV cameras. Security guards are posted to all service point areas.
KwaMashu CHC	01	A security guard was hit by a patient who had requested assistance and the Security had a negative attitude towards the client	PRO attended and cautioned patient. Security was subjected to disciplinary action.
St. Mary’s hospital	03	MHCU patient in OPD and another on one the ward threatened staff. MHCU in ward Confused Patient in the ward. Security attack by patient’s relatives Relatives brought in an assaulted patient and were demanding to be seen immediately. Attacked Security and broke the hospital boom gate.	Matter discussed in OHS Committee Meeting, relevant department to keep in stock soft restrains and improve communication with other relevant stakeholders during hand-overs to ensure that status of all patients is known to the new shift employees. The matter was discussed in the OHS Committee Meeting and information cascaded to the relevant ward. SOP of handling confused Patients developed. Ward strengthened communication during handover between shifts should status of patients change. SOP in place to ensure one relative accompanies the patient that is unable to assist themselves.
G.J. Crooks hospital	02	Staff Member was assaulted by a patient Verbal assault of a Doctor and a Nurse.	Access control was intensified and Security was added.
Phoenix CHC	01	MHCU that had defaulted his treatment punched a staff members in the face.	Security personnel are placed throughout the facility at strategic points to ensure the safety and security of patients, community, staff and the facility.
Thonjeni clinic	01	A Security Officer was shot and killed outside the clinic while on duty.	It was an isolated incident as it was nothing to do with work, except that on the day of incident he was on duty.
RK Khan Hospital	05	All were attacked by Mental Health Care Users in Casualty Department.	An additional 7 beds have been added in the Male Psych ward to avoid keeping patients in Casualty.
Port Shepstone hospital	01	Security Officer assaulted while assisting Nurses to control a MHCU.	More than one Security in assisting to control the violent patient
G.J. Crookes hospital	03	Staff Member was assaulted by a patient. Verbal assault of a Doctor and a Nurse.	Access control was intensified. Priority is given to transfer of mentally ill patients to mental health wards. Staff members were referred to EAP.
Murchison Hospital	02	Staff members attacked by a MHCU.	Provided better measures and counselling of handling the mentally disturbed patients.
Isithebe Clinic	01	Armed robbery by five unknown men.	Investigation conducted by the District Security Coordinator. A case was open at Nyoni Police Station and a Team came to take fingerprints.
KwaMashu CHC	01	A Nurse was assaulted by unruly patient. Security deserted post during incident	Security was dismissed and an additional security was posted
Umkhontokayise clinic	01	Armed robbery by two unknown men who had made a hole in the parameter fence.	Investigation conducted by the District Security Coordinator. A case was open at Nyoni Police Station and a Team came to take fingerprints.
Thokozani clinic	01
Ndulinde clinic -	01	A Nurse was attacked by her boyfriend.	Security guards intervened. No physical injuries were sustained.
Sundumbili clinic	02	Break-in where two staff vehicles were taken at gunpoint. Staff members were threaten by the relatives who were accompany the critical ill patient. Staff members were told to pay a special attention to their patient at gunpoint, if a patient dies staff members will be killed as well.	Additional of security personnel and one roving/ patrol vehicle has been made to check all clinics. A case was open at Nyoni Police Station and a Team came to take fingerprints.
uNtunjambili Hospital	03	A staff member suspected to be intoxicated attacked his colleague	A formal investigation was done which resulted in dismissal. Reported to early warning signs system, PSI was discussed in the meetings Nurses were referred to psychologist
GJGHM	02	Patient was aggressive and he wanted his baby to be discharged	Security guards were trained to handle aggressive patients Nurses were capacitated to identify patients showing signs of aggression and how to manage aggressive patient Explained to the father the cause of child’s admission.
Ndwedwe CHC	01	Doctor was attending to a patient with a gunshot wound with fatalities and the relatives were questioning the doctor.	Security guards were instructed not to allow multitudes to accompany patients to service areas.
Nkandla Hospital	03	Psychiatric patients were aggressive to Staff.	Security bars were installed in the ward.
Eshowe Hospital/Clinics	01	Attacked by intoxicated relative of patient in casualty	Reduce number visitors per patient to one Increased security patrols in casualty backup especially during weekends and after hours Stakeholder engagement with local SAPS Revived security committee, inclusive of SAPS representative
Ndlangubo Clinic	01	Robbery	Security do frequent patrols especially at night. Revived security committee inclusive of SAPS. Community leadership engagement for support.
Greytown Hospital	02	Both staff members were attacked by mental health care users.	Both assaults reported as incidents during PSI Meetings and maximum doses recommended for psych patients especially at night.
Church of Scotland Hospital	02	All staff members were physically handled by the psychiatry patient.	Increased security guards in the wards
Mseleni Hospital	02	The Mental Health Care User became violent slapped the Nurse and attacked the security guard who sustained soft tissue injuries.	Staff members were seen by the medical officer in OPD and referred to the psychologist for psychological support. Staff in-service on the handling of a violent MHCU.
Bethesda Hospital	01	A Nurse was assaulted by a MHCU.	Risk assessment of the work environment done by Safety Officer and risks identified. Staff members referred to Occupational Health doctor.
Madadeni Regional Hospital	09	08 Staff members were attacked by MHCU’s. Stray bullet went through the window at the clinic.
Ladysmith Regional Hospital	07	MHCU’s assaulted staff members on separate incidents. A Medical Officer was pushed and fell in an iron bar.	Emergency Medical care for injuries Health Risk assessments done, quarterly. EAP counselling and debriefing Ongoing Staff training and on management of aggressive patients. Increase security in MHC wards.
Eg &Usher Memorial Hospital	03	In casualty a mental health care user attacked a Nurse with a drip stand. A Nurse in casualty was attacked by an aggressive patient believed to be intoxicated. Professional Nurse was attached by patient relative
Estcourt Hospital	03	Two Security Guards and a Nurse were assaulted by a Mental Health care user who was brought in for admission.

LIMPOPO

(1) (a) (i) (ii) (aa) (bb)

Number staff attacked/ threatened by patients in hospitals	Number staff attacked/ threatened by patients in clinics	# Attacked by patients
4 Circumstances Kgapane Hospital: Patient threatened a Nurse with a knife, demanding to be injected with a small injection. Hayani Hospital: A MHCU patient attacked 1x Security Guard. Maphutha Malatjie Hospital: MHCU Patient assaulted Security guard. Patient assaulted a Nurse	3 Circumstances Morutji Clinic: Assault of 2 x Nurses by a Patient Relela Clinic: Patient assaulted a Nurse.	7
Number Staff Attacked/ Threatened by other Assailants in Hospitals	Number Staff Attacked/ Threatened by other Assailants in Clinics	# Attacked by Assailants
9 Circumstances Pietersburg Hospital: NEHAWU Members threatened 8 members of management with violence and disrupted services Lebowakgomo Hospital: A political party leader of an organization called Defenders of the People (DOP) forced entry and verbally abused the PA to the CEO.	2 Circumstances Sambandau Clinic: 1 x Male Nurse assaulted by armed robbers and robbed of a Car, Cellphones and Cash (R100- 00) Same robbers proceeded to rob 1 x Security Officer of a cellphone.	11
Total Hospital 13	Total Clinic 5	Grand total 18

(2) For all incidents of assault against Nurses and Security, criminal cases were opened, security increased in vulnerable areas and counselling arranged for the affected persons.

Material loss is covered by the SLA with Security company(s) and the Service Provider replaced the lost materials.

Threats and disruptions of services by organised labour are handled through negotiations and where there is no agreement court interdicts are applied for, as it was the case with Pietersburg Hospital.

A court interdict was obtained against the Defenders of the People (DOP)for Lebowakgomo hospital.

MPUMALANGA

(1) (a) (i) (ii) (aa) (bb)

Number staff attacked/ threatened by patients in hospitals	Number staff attacked/ threatened by patients in clinics	# Attacked by patients
0	0	0
Number Staff Attacked/ Threatened by other Assailants in Hospitals	Number Staff Attacked/ Threatened by other Assailants in Clinics	# Attacked by Assailants
1 Circumstances Carolina hospital Staff member was assaulted by a group of young men. Case No 59/06/2023 was opened	5 cases Circumstances Mayflower CHC Staff member were attacked by a group of young men Pholansikazi CHC Three young men robbed and shot an EMS crew member. Case number 147/06/2023 was opened. Dwarsloop clinic Armed robbery and Theft of equipment. Case No 55/7/2023 was opened Jim Brown clinic Intruders came and discharged firearm in the clinic at night. Security was robbed of their belongings. Armed robbery case number 24/07/2023 Empumelelweni CHC Four young men entered the facility through the palisade fence and robbed staff and security officers cellphones and stole computers	6 cases
Total Hospital 1 case	Total Clinic 5 cases	Grand total 6 cases

(2) The MDoH has opened police cases with regard to these incidents.

MDoH, has already at some facilities at is in the process at others of improving physical and electronic security. Amongst these measures are increasing security officers, installed walkthrough metal detectors and a bullet proof glass on guard houses.

NORTHERN CAPE

(1) (a) (i) (ii) (aa) (bb)

Number staff attacked/ threatened by patients in hospitals	Number staff attacked/ threatened by patients in clinics	# Attacked by patients
2 Circumstances Galeshewe Day Hospital (GDH maternity) female patient slapped the nurse NMH Hospital Security guard was assaulted by Mental patient who was trying to escaped	6 Circumstances Pichard CHC security guard was assaulted by a Patient Wega CHC Assault Fight between patient with visitor and nurse Pampierstad CHC patient threatened to stab the nurse with a sharp object Aggressive patient threatened a nurse Valspan Clinic Aggressive patient threatened a nurse Dr Winston Torres Clinic a nurse was threatened by the patient.	8
Number Staff Attacked/ Threatened by other Assailants in Hospitals	Number Staff Attacked/ Threatened by other Assailants in Clinics	# Attacked by Assailants
3 Circumstances Hospital not mentioned Patient’s father assaulted security guard alleging that security man-handled his son. RMS Hospital Unhappy visitor threatened the nurse De Aar Hospital security guard was assaulted by police officer. Police officer refused to be searched	1 Circumstances Ritchie Clinic a nurse was assaulted by her boyfriend	4
Total Hospital 5	Total Clinic 7	Grand total 12

(2) Increased security and involved SAPS

NORTH WEST

(1) (a) (i) (ii) (aa) (bb)

Number staff attacked/ threatened by patients in hospitals	Number staff attacked/ threatened by patients in clinics	# Attacked by patients
8	4	12
Circumstances	Circumstances
Witrand Hospital, Mental patient assaulted the staff member Mental patient assaulted the staff member	Park Street Clinic Mental patient attacked 2 staff members.
Job Shimankana Tabane Hospital Arson at Mental Health Care Unit by Mental Patient. Case 554/11/2022 was opened HRT (Refusal of Hospital Treatment) by mental patient who threated nurses. Case 447/04/2023 was opened	Jouberton Clinic Patient who refused to queue threatened staff members
General De La Rey Hospital (v)Patient attacked security guards at the gate Case 282/10/2022 was opened.	Grace Mokhomo CHC (iii)Verbal abuse to a Doctor by a patient under the influence of alcohol.
Mafikeng Provincial Hospital (vi)Patient threatened a doctor (vii)Security Officer was assaulted by an aggressive patient	Botshabelo CHC (iv) Mentally sick patients attacked security officers on duty
Bophelong Psychiatric Hospital (viii)Male staff cleaner was assaulted by Psychiatric patient
Number Staff Attacked/ Threatened by other Assailants in Hospitals	Number Staff Attacked/ Threatened by other Assailants in Clinics	# Attacked by Assailants
13	8	21
Mafikeng Provincial Hospital Health workers were attacked by gangsters at hospital casualty.	Tswelelang CHC (i)Local gangsters were fighting and one got injured and threatened the staff to attend the injured speedily
Job Shimankana Tabane Hospital Group of males (8 in number) forced entry at Ward 5 to check their patient. Group threated the nurses that they must assist their patient fast	Tigane CHC (ii)MMC for Safety and Security threatened staff and attacked patient inside the facility
Koster Hospital Nurse received death threat call from unknown caller. Case 1/4/15-185/2023 was opened,	New Jouberton (N12) CHC (iii)Community members forced entry into emergency unit and threatened nurse on duty needed assistance for their partner who was stabbed,
Tshepong Hospital Doctors were attacked and robbed their cellphones and belongings at gunpointDoctors were threatened by family members due to long waiting time	Orkney Clinic (iv)Job seekers (community members) attacked health worker. Case opened with SAPS,
Bophelong Psychiatric Hospital Staff members on duty were intimidated by community members. Case 497/07/2023 was opened,	Alabama Clinic (v)Nurses were verbally attacked by members of community. Case opened with SAPS
Moses Kotane Hospital Male patient threatened the nurses at Casualty to be assisted first	Empilisweni Clinic (vi)Operational Manager assaulted by officials from legal firm demanding a patient record.
Taung District Hospital Family accompanying patient refused to follow department procedure by opening patient file instead they became violent and threaten nurses and doctors	RB Nzima Clinic (vii)Staff member attacked by unemployed community members demanding removal of personnel not from their area
Taung District Hospital Community members fight outside the hospital premises and followed the one who was taken to hospital for medical attention	Top City Clinic (viii)Staff members were threatened by the local business forum during a site briefing meeting for the renovation of the clinic.
Taung District Hospital Community members fight outside the hospital premises and followed the one who was taken to hospital for medical attention
Joe Morolong Hospital Community members fight outside the hospital premises and followed the one who was taken to hospital for medical attention One of the group was in passion of Firearm threatening Dr, Nurse and security Officers
EMS Station Emergency staff on night duty attacked at gun point. EMS Staff attacked at Jacaranda Informal Settlement by a knife EMS personnel on night shift were chased by a car.
TOTAL HOSPITAL 21	TOTAL CLINICS 12	33 GRAND TOTAL

(2) For some incidents police cases have been opened.

Increased security and involved SAPS

END.

Reply:

According to the Compensation Commissioner for Occupational Diseases in Mines and Works:

1. The CCOD is responsible for the administration of the Mines and Works Compensation Fund under the Occupational Diseases in Mines and Works Act, 78 of 1973. The Tshiamiso Trust is an independent trust set up through the class action settlement in 2018. The CCOD is not processing claims on behalf of the Trust as the Trust has its administration for claims processing.

(a)-(b) The CCOD is not involved in the processing of claims lodged with the Tshiamiso Trust. The details relating to the current backlog in the processing of the specified claims and the date on which the backlog will be eradicated can be obtained from the Dr M Kwinda, the Chief Executive Officer of the Tshiamiso Trust at [email protected].

2. (a) The MBOD/CCOD interacts with the Tshiamiso Trust in areas of common interest. Additionally, the Commissioner (Dr Kistnasamy) is a member of the Board of Trustees of the Tshiamiso Trust.

(b) (i)-(ii) During the period 1 April 2023 to 31 October 2023, Dr Kistnasamy attended three Benefits Committee meetings; two meetings of the Governance, Human Resources and Remuneration Committee; two Trust Advisory Committee meetings; three Board of Trustees meetings and the Annual General Meeting of the Trust. Regular meetings are also held between the operational teams of the MBOD/CCOD and Tshiamiso trust regarding the exchange of information to assist with the tracking of claimants with unclaimed benefits; outreach activities for ex-mineworkers (Eastern Cape (April 2023) and Free State (September 2023) and discussions with service providers who provide the call centre inputs and the compensation claims management system across the MBOD/CCOD and the Trust.

END.

Reply:

a) Total number of the assessed clinics and community health centres that have satisfied the criteria of an Ideal Clinic is 2046 (59%) to date. This is from 0% in 2014.

b) Interventions implemented to support the clinics to meet the standards of Ideal Clinics Programme are as follow:

• A team of national managers provide technical support for Ideal Clinic Realisation and Maintenance (ICRM) programme. One manager support two or more provinces.
• The department developed the ICRM framework in the form of ICRM Manuals and Assessment tools for clinics and community health centres which are used as standard operating procedures for reference and guidance.
• Where budget limitations prevent provinces from meeting Non - Negotiable Vital (NNV) elements which focuses on emergency room equipment and accessories, the NDoH assist where possible, within its own budget constraints, to procure the required equipment.
• The NDoH, introduced a dedicated program under the Health Facility Revitalisation Grant which aim to respond to infrastructure challenges highlighted by the Ideal Clinic assessment tool.
• Facilitates orientation sessions for new facility operational managers and to all managers when updates have been done to the ICRM Framework.
• National Department of Health developed:
• guidelines and schedules for managing patients waiting times, handling of complaints and compliments
• health commodity catalogue for ordering supplies
• guidelines and training manuals for governance structures

• The NDoH organizes and provide resources for the annual peer reviews

END.