Questions and Replies

Reply:

a) The total costs that have been incurred since its opening in 2014 to transport patients to Pelonomi Hospital in Bloemfontein for operations is estimated at R 58 152 804. This is calculated based on Uniform Patient Fee Schedule (UPFS) rates applicable for externally funded patients for 5514 cases (High risk patients including 1521 maternity patient transfers that were to be operated at Senorita Nhlabathi District Hospital) at a cost of R 9 484 763, 65 transported since 2014 to 2024.

b) Senorita Hospital is based in the rural area, classified as a small district hospital and offers a comprehensive district hospital package of services. Due to challenges associated with the rural nature of the District where the hospital is placed, the district hospital experience difficulties in attracting and retaining medical professionals thus affecting consistency of conducting operations at Senorita District hospital. See table below comparing the cost of transferring patients from Senorita District hospital to Pelonomi Hospital.

The department remains committed to improving the health of the population being served by the hospital. More than consideration of the costs the Department is concerned about saving the lives of the users. According to the referral pathway the hospital should refer high risk patients to Dihlabeng Regional Hospital which is 200 km but due to longer distance and very poor condition of the road, the hospital refer their high risk patients and maternity cases to Pelonomi Tertiary Hospital which is closer by 130 km away. Additionally contingency measures put in place are that all the elective operations from Senorita hospital will be conducted by mainly community service medical doctors appointed by Senorita Nhlabathi District hospital on a shift basis at Moroka District Hospital which is 70km away and Botshabelo District hospitals which is 100 km away from Senorita district hospital.

Patients Transferred 2014-2024	Cost of Transport 2014-2024	Job Title	Notch	Cost
X 3993 High risk patients	R48 668 040,35	X 3 medical Doctors	R906 540.00	R3 725 879
		X3 Theatre Nurse(PNB1)	R431 265.00	R1 772 499
X 1521 maternity patients	R9 484 763,65	X2 Professional Nurse (PNA2)	R293 670.00	R804 656
		X 3 Staff Nurse	R199 725.00	R820 870
		X 1 Porter	R147 036.00	R201 439
Total transferred 5514	R58 152 804	X 1 Cleaner	R125 373.00	R171 761
GRAND TOTAL	R58 152 804.00		R7 497 104 p/annum

END.

Reply:

There are many testimonies from South Africans of excellent service received at both PHC facilities and hospitals, however there are pockets of incidents where our patients experience poor service delivery. The NDoH however takes every specific incident of poor service received seriously, and endeavour to provide redress and reduce such incidents in the future.

The Department is implementing various quality improvement interventions to ensure the provision of quality health care at health facilities which include the following:

• Ideal facility monitoring system which provides a platform for all health facilities to track the facility self-assessment progress, quality improvement interventions and the remedial actions taken to ensure compliance with standards.
• Implementation of Quality learning centres which is a cluster of facilities in a geographic area made up of hospitals, primary health care and private hospitals to facilitate an integrated approach to quality improvement through mentorship.
• Clinical Governance structures that are responsible and accountable for continuous improvement of the quality of care rendered at facilities and ensures best clinical outcomes for patient care.
• Patient waiting times are monitored and provinces support facilities to improve on waiting times.
• Patient safety incidence committees where adverse events are reported and analysed, and quality improvement plans are implemented.
• The National Department of Health has instituted a formal system of obtaining feedback on patients’ experience of care that they receive in public health establishments, through the patient experience of care surveys. Reports from these surveys guide continuous quality improvement of care.
• Office of Health Standards Compliance (OHSC) which monitor and enforce compliance by health establishments with norms and standards prescribed by the Minister of Health.

END.

Reply:

(a) (b) (i) (aa) (bb) (ii)

The table below shows public facilities with permanent pharmacists, permanent pharmacist assistants and those facilities without pharmacists and Pharmacists assistants

Province	Public Clinics (a)	Public Facilities (Clinics & hospitals)	Public Facilities with Permanent Pharmacists(b) (i) (aa)	Public Facilities with Permanent Pharmacists Assistants(b) (i) (bb)	Public Clinics without permanent Pharmacist &Pharmacist Assistants (ii)
Eastern Cape	777	867	139	236	490
Free State	219	251	43	170	38
Gauteng	373	409	67	210	132
KwaZulu-Natal	608	678	93	412	173
Limpopo	477	518	78	89	351
Mpumalanga	295	327	75	159	93
Northern Cape	161	176	47	85	44
North West	309	330	49	60	248
Western Cape	255	307	123	94	90
Total	3474	3863	714	1515	1659

Facilities without pharmacists and pharmacists assistants are supported by district pharmacists for monitoring availability of medication while nurses with dispensing course are dispensing their own prescriptions. Nurses without dispensing course are given authorisation to dispense medication in accordance with the Primary Health Care Standard Treatment Guideline and Essential Medicine List as per section 56(6), 33 of 2005. of Nursing Act .

END.

Reply:

The implementation of National Health Insurance (NHI) as a mechanism towards realizing universal health coverage (UHC) in South Africa is based on a structured, phased approach. A strategic part of the phased implementation includes proactive and ongoing engagements with various healthcare professional associations and groupings directed at providing them with clear information on the intentions of the policy and how the envisaged reforms are intended to contribute to overall health system sustainability.

The National Department of Health has undertaken study tours, including engaging with multilateral and bilateral partners, on the path that other countries, such as the United Kingdom, Thailand, Taiwan, and Canada, have taken towards implementing UHC reforms. Even in these countries there was anxiety among healthcare professionals concerned with changes around reimbursement mechanisms (i.e., changes from fee for service to capitation systems). To address such anxieties, it is specifically the reason why the Department is deliberately adopting a phased approach to the roll-out of NHI, as well as continuing to actively engage healthcare professionals through various channels and engagement platforms to provide all concerned stakeholders, not just healthcare professionals, with key information on the elements outlined in the NHI Bill and why they are important.

Emphasis is towards adopting a co-creation approach between the Department and stakeholders, including healthcare professionals. It is through this approach that the Department intends to address the perceived medical and specialist skills drain in the healthcare sector associated with the planned implementation of NHI.

END.

Reply:

The following table reflects the details in this regard:

NAME OF THE PROVINCE	1 (a) Total number of medico-legal claims filed	1 (b) Total number of the claims paid out	1 (b) (i) Total number of claims paid out as settlements	1 (b) (ii) Total number of claims paid out as court ordered payments	2 (a) (i) Total number of claims that were awarded based on lost patient files	2 (a) (ii) Total number of duplicate claims that have been filed	2 (b) (i) Total amount spent on legal cost	2 (b) (ii) Total amount of claim cost
Eastern Cape[1]
Free State	651	53	50	3	0	0	R37 259 798.24	R2 484 606 393.54
Gauteng	322	449	0	449	108	0	R634 637 738.31	R1 897 283 000.00
KwaZulu- Natal	779	94	0	94	0	1	R328 252 675.68	R8 677 266 708.80
Limpopo	903	30	2	28	0	1	R63 145 941.00	R266 804 823.43
Mpumalanga	569	62	32	30	15	0	R224 990 555.00	R245 485 320.00
Northern Cape	57	28	27	1	7	0	R24 670 478.26	R152 235 223.45
North West	241	22	15	7	0	0	R59 270 605.65	R99 136 357.41
Western Cape[2]
Totals	3522	738	126	612	130	1	R1 372 227 792,14	R23 637 317 204,63

1. Eastern Cape still verify the figures. ↑

2. Still waiting the information from WC. We have been advised that the responses have been forwarded to the HoD for approval. ↑

Reply:

According to the National Health Laboratory Service (NHLS):

a) (i) There is no backlog of toxicology cases at the Durban FCL.

The Durban FCL does not offer a full toxicology service. Postmortem cases referred from the Kwazulu-Natal and regions of the Eastern Cape provinces that require analysis for carbon monoxide testing only are processed and completed at the Durban FCL. These comprise a small number of samples and no backlog has developed.

(ii) There is no backlog of toxicology cases at the Durban FCL.

(iii) The Durban FCL receives on average 12 carbon monoxide cases for analysis per month and completes these cases each month.

b) There is no backlog of toxicology cases at the Durban FCL.

END

Reply:

A meeting was held on 9 November 2022 with Mountain City Community Leaders whereby the issue of the clinic was addressed at length. During the meeting, it was communicated to the Community Leaders that there are two clinics at close proximity to Mountain City, namely Thulamntwana clinic which is 2.8 km and Weilers Farm Clinic which is 3.4 km from Mountain City. The two facilities provide health services to the community of Mountain City, thus ensuring access to health services. Both health facilities are within the national norm of the 5km radius access to communities. The Department of Health will continue monitor the situation Mountain City area and respond appropriately.

END.

Reply:

The Deputy Minister of Health, Dr Sibongiseni Dhlomo, has made plans to visit the Lenasia South District Hospital, with the MEC for Health, to assess the state of affairs at the Hospital. This visit will take place on Wednesday, 13 March 2024 and the Minister will then provide the Honourable Member with a full report on the state of health services in that Hospital.

END

Reply:

(a) (b) There were no sponsorship, donations and financial transfers that were received from the State of Qatar and the Islamic Republic of Iran by the Minister, Officials and the National Department of Health.

(c) A mobile laboratory, various laboratory equipment and the associated consumables were donated to the National Department of Health by the Russian Government during COVID-19. The Russian government paid for the importation of both the laboratory and other items, but unfortunately the test kits were not approved by the South African Health Products Regulatory Authority (SAHPRA) and were not used. The vehicles (a large truck and a trailer) have been stationery and parked since importation while alternative applications are sought, either in South Africa or in another SADC country.

END.

Reply:

The Minister’s delegation included one technical official and one Personal Assistant.

1. (a)-(d) Yes.

(i) Total cost: R1 101 726.83

(ii) Daily allowance: R 57 390.94

Air Travel: R 211 876.63

Accommodation: R 827 461.51

Travel agent service fee: R 1 083.00

Service fees for accommodation: R 258.75

International handling fee: R 828.00

Back-office processing fees: R 828.00

Meals: R 2 000.00

2. As indicated in (1) above, the costs were born out of the budget of the National Department of Health.

END.

Reply:

1. The Department has, in terms of governance, developed and gazetted the “National Environmental Health Norms and Standards for Premises and Acceptable Monitoring Standards for Environmental Health Practitioners” in 2015. In terms of these Norms and Standards, the Department has since 2016 included the “Assessment of Municipalities” in its Annual Performance Plan (APP) to monitor the 1:10 000 ratio of EHP per population in the country. The reports generated from the assessments play a vital role in providing municipalities with evidence to use to motivate for additional human resources at their respective Municipal Councils.

2. The following table reflects the details in this regard.

YEARS	NUMBER OF VISITS TO ECDs
2019	48035
2020	29376
2021	39913
2022	52561
2023	54533

 

END.

Reply:

1. The employment of Foreign Health Professionals is subject to the conditions contained in South African employment legislation (including, for the public sector, those conditions contained in the Public Service Act, 1994, as amended and the Public Service Regulations, 2001), as well as the provisions of the Immigration Act, 2002 as amended in 2004 (Immigration Act) and the Refugees Act, 1998 (Refugees Act) where applicable.

In accordance with Section 19(2)(a) of the immigration Act 2002, as amended, the employment of Foreign Health Professionals shall only be allowed on condition that there is record that no South African Citizen or Permanent Resident was available or found suitable to fill the particular post. In addition, no Foreign Health Professional is allowed to initially take up employment in a professional capacity or continue with such employment without a valid Work Permit or Refugee's Permit or Treaty Permit and with the appropriate registration with the relevant Health Professional Council in South Africa.

In line with the above Regulations, the Policy on Recruitment of Foreign Nationals informs that posts for internship and community service will be offered to non-South African citizens and refugees within available resources only after all South African citizens and Permanent Residents have been accommodated. The policy further states that, once South African citizens and permanent residents are accommodated, priority will be given to the allocation of non-South African citizens who graduated from South African Universities and finally non-South Africans who have been recognised by the relevant statutory council as being suitable for practice in South Africa. The allocation algorithm will continue to place applicants in this order until all applicants have been allocated or available sites have been exhausted.

a) (i) Applications received for Foreign Nationals for ICSP in each year since 2019:

Non-South African Applications
Field of study	2019	2020	2021	2022	2023	2024
Audiologist	1	3	4	2	3	1
Clinical Psychologist	7	9	12	5	2	5
Dentist	18	6	10	11	18	11
Diagnostic Radiographer	17	23	33	13	13	12
Diagnostic Sonographer	0			0	1
Dietician	6	9	16	4	7	3
Environmental Health Practitioner	1	63	39	8	1	2
Medical Practitioner	83	27	38	13	11	5
Nuclear Medical Radiographer (Comm Service)	1	5	7	2	0	1
Occupational Therapist	8	7	11	6	4	2
Pharmacist	103	121	140	139	145	43
Physiotherapist	5	11	17	10	6	7
Professional Nurse	40	41	75	49	53	13
Radiotherapy	0	2	4	6	2	3
Speech Therapist	2	6	7	4	3	2
Internship	143	76	107	90	74	48
Grand Total	435	409	520	362	343	158

(ii) & (iii) In the reporting period of 1 January 2019 to 1 January 2024 only 2 foreign nationals were allocated in 2019 and 2023 on a self-funded accredited post or where resources permitted.

(b) There is no backlog of allocations as each Cycle is managed according to the number of applicants received against the number of available posts pertaining to the Cycle. Instead, applicants are always advised to apply in each cycle and treat that as a new application.

(c) Medical training offered across the 10 Medical Schools in South Africa has been accredited and accepted to fulfil the requirements to obtain Medical Degree. To register to practice as a Medical Doctor in South Africa as per the HPCSA Regulations, graduates are expected to undergo a two-year Internship Training programme. Accredited and funded posts for Internship programme are limited and as such unable to accommodate most Foreign Nationals.

It should be noted that the intention of hosting Foreign National African students to study in South Africa is to improve the human resources for health in the Region. Therefore, it is expected that foreign health professional graduates will return to their countries of origin to serve. Similarly, we expect our professionals to undergo Community Service before they can be recognised for independent practice registration.

2. Foreign students who study at various South African Medical Schools are continuously made aware of the above-mentioned processes and legislation throughout their duration of study. Furthermore, the Internship and Community Service Placement (ICSP) website clearly stipulates the allocation criteria. Lastly, the foreign graduates who would have applied still get reminded through the letter of decline the reasons for their ineligibility.

END

Reply:

1. (a) (i) The total number of Internship and Community Service applicants who rejected their allocation for the 2024 Annual Cycle is 70. The table below provide a breakdown of the total applicants who rejected per field of study.

2024 Annual Cycle - Medical Internship and Community Service - Allocation rejections
Community Service	61
Audiologist	2
Dentist	1
Dietician	5
Environmental Health Practitioner	1
Medical Practitioner - Community Service	29
Occupational Therapist	6
Pharmacist	2
Physiotherapist	8
Professional Nurse	4
Speech Therapist	3
Internship	9
Medical Practitioner - Internship	9
Grand Total	70

(ii) The total number of applicants who were not eligible for placement to commence duty on 1 January 2024 is 619.

(b) The table below provide a breakdown per field of study with reasons why they were not eligible to be placed

2024 Annual Cycle - Medical Internship and Community Service - Not eligible applicants
Row Labels	Can only register and commence duty between March to August 2024	Not eligible for Registration with HPCSA	Grand Total
Clinical Psychologist	-	2	2
Diagnostic Radiographer	4		4
Environmental Health Practitioner	15	8	23
Medical Officer Community Service	215	1	216
Pharmacist	-	177	177
Physiotherapist	-	5	5
Radiotherapy	-	1	1
Speech Therapist	-	72	72
Medical Internship	-	119	119
Grand Total	234	385	619

(c) Statutory placements are managed as replacements posts that requires applicants to commence duty on 1 January of each year to ensure that there is constant availability of health professionals to render health services at a certain required time including after-hour roster cover. As a result, the department targets to release allocation outcomes between October and November of the preceding. This allows allocated applicants enough time to make necessary arrangements to commence duty on time and avoid late start that affects health services and the Cycle management.

When applicants timeously declare their late start dates, due to various reasons, a provision is made to align their date to the allocation. However any applicant that has a date beyond 1st April is then expected to apply for the Mid-year Cycle which allocates for 1st July commencements.

2. The department continues to assist applicants who were unable to commence duty on the required date. However, this is done in consultation with Provincial Departments of Health where budgets permits.

In terms of the HPCSA regulations, medical interns has to comply with a three months rotation in one domain. Therefore there are 0 medical interns that can legally commence duty on 1 March 2024.

According to the ICSP records, only 11 Medical Community Service doctors have proclaimed that they will assume duty on 1 March 2024. Provinces have been requested to assist with their appointment to 1 April 2024.

3. They have not accepted posts as yet.

END.

Reply:

a) The National Department of Health requirements is that each facility should have clean running water. All clinics that are constructed in the Northen Cape province, particularly around Kimberley are having water, and also provided with back up water system through boreholes. Most of the old facilities are getting water from municipalities and those that don’t have borehole are prioritised in 2024/25 to get back up water.

b) No clinics have been closed as a result of poor water supply or quality.

c) Provision of water is the competency of municipalities, the Department interacts with other departments like Water and Sanitation and municipalities to ensure that communities have access to safe clean water. The challenges of unsafe water negatively impact on the health of communities. Random samples are taken to check safety of water at laboratories if there is a sudden increase of diarrhoea cases at certain areas as a precautionary measure.

The tap water in Carnavon was tested and results were positive faecal organisms and therefore not fit for human consumption. Information from District Health Information System (DHIS) for Carnavon CHC and Carnavon clinic for the past six month showed only 1 new case of diarrhoea reported. The matter is dealt with Water and Sanitation Department and outbreak response team has been activated for health education in the community.

END.

Reply:

As a standard practice, staff submit their annual leave plans to their managers in the beginning of the year. Managers analyse the plans and allocate the leave days in such a way that there will be service coverage at all times. Managers discuss the allocations with the staff, reach agreements and finalise the unit or section leave plans. Any unavoidable deviation from the agreed upon plan is managed by seconding staff from other facilities so that service coverage is adhered to.

END.

Reply:

1. Health sector relies on employment of doctors, nurses and other critical posts hence most of the budget is allocated to compensation of employees. Currently in 2023/2024 about 63% of total budget has been allocated to compensation of employees and 64% in 2024/2025 financial year.

2. As reflected during the media briefing hosted on 05/02/2024, we do acknowledge fiscus challenges the country is facing and the impact in the health care system. 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. The ongoing provincial engagements will allow provinces to get leverage of activating the posts that were previous unfunded due to the budget pressures and subsequent austerity measures encountered last year.

Indeed the “several bilateral engagements” with National Treasury have yielded very positive results and become a confirmatory expression that government departments work together to better the lives of the people. On 21st February 2024, the Minister of Finance announced allocation of R848 billion for the health sector which is inclusive of the following obligations:

• Payment of current employees and the impact of the wage bill agreement
• Provision of the health services in all facilities
• Medical equipment
• Maintenance and construction of new facilities

Included in the budget above is an additional budget of R3.7 billion has been allocated towards compensation of employees in the sector for the financial year 2024/25 to address the wage bill increase and recruitment of additional staff including nurses and medical doctors.

As a result of the provincial inter-departmental engagements, Provincial Departments of Health have already advertised 823 since December 2023 and have reported projections of 1103 Medical Officer appointments by 1st April 2024. According to the 09th February 2024 persal print out, 425 Medical Officer appointments were captured for January 2024 of which 371 are Grade 1 category.

END.

Reply:

The Department of Health does not keep a database of unemployed health professionals including the nurses. However, all health professionals, including nurses, whether employed or unemployed, are required to remain registered with their relevant statutory health councils, this being the South African Nursing Council in the case of nurses.

END.

Reply:

a) The National Department of Health requirements is that each facility should have clean water. New clinics that are constructed in the Northen Cape province, particularly around Kimberley since 2011/12 are provided with water supplied though municipality line and back up water system through boreholes. Facilities that were build prior 2011/12 that does not have back up water system are attended to through Borehole Water Programme.

A service provider has been appointed during 2003/24 financial year in Robert Mangaliso Sobukwe Hospital (RMSH) in Kimberley to build a 2 Mega Liters (2 million litters) water tanker as additional water capacity to the current 360,000 Liters.

b) All facilities around Kimberley have electricity and some also have back up generators. There is a program running to provide generators to facilities that don’t have any back up system. The province is also benefiting from People Republic of China donated generators. Robert Mangaliso Sobukwe Hospital is also equipped with GenSets in case of electricity went off during loadshedding.

c) Ideally the Department of Health wishes to fill all health care worker posts in order to improve the health outcomes of the population. Due to current financial constraints, annually, the Provinces appoint Employment Recruitment Teams led by Heads of Health Departments or delegated officials at senior level to develop recruitment plans, prioritising the filling of critical posts with required skills mix. However, they must guard against overspending on provided / available budgets.

END.

Reply:

1. Based on the current Occupational Specific Dispensation (OSD) salary scales of 1 April 2023, the appointed medical officers will be remunerated as follows:

 

Category	Salary Structure
	Basic Salary	Commuted Overtime (8-12 hours weekly)	Total Cost of Employment (per capita)
Medical Officer Grade 1	R 906 540	R 253 135	R1 159 657
Note: Designated facilities may also offer Rural Allowance at R 148 740

2. The Department is not reviewing the approach of employing medical doctors. Instead, the review is on conditions of service and relatively all employment categories will be included in the process. The envisaged outcome of the review is to optimize the retention of health care workforce in the public health sector and for the department to remain the employer of choice.

END

Reply:

a) The disclosure/ declaration of financial interests by employees in the public service is regulated by Regulation 18 of the Public Service Regulations, 2016, which requires designated employees to submit particulars of their financial interests to their respective heads of departments and non-compliance in this regard is handled in line with the provisions of Section 16A of the Public Service Act, which require the head of the department to take appropriate disciplinary steps against an employee who does not comply with a provision of a regulation.

b) Some of the reasons for failure to comply with the disclosure processes include forgetting the personal log-in details (usernames and passwords). In some instances, it is with regard to properties that employees acquired a long time ago and are no longer in possession of, but those properties are still registered in their names. As a result, they are of the view that they are not required to disclose such properties, while that is not the case.

c) Ethics Officers inform designated officials that are required to disclose their financial interests timeously before the period of disclosure starts and they are constantly reminded about the process of disclosing their financial interests. There are also dedicated officials who are responsible for providing assistance and technical support to all officials who are experiencing challenges in accessing the e-disclosure system.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

a) Toxicology tests are conducted at three of the four Forensic Chemistry Laboratories namely, Cape Town, Johannesburg, and Pretoria. The toxicology tests are supposed to be tested within 90 days from the date the samples are registered in the testing laboratory. Any test that has not been completed and authorised within 90 days is classified as backlog. Multiple factors have contributed to the backlogs that developed at the three laboratories, including incomplete information on the request forms, inadequate infrastructure, aging analytic equipment, interruptions in power supply, inadequate water supply, the COVID-19 epidemic, and shortages in human resources.

The current backlog at the Cape Town Forensic Chemistry laboratory is 6,792 cases with Johannesburg and Pretoria laboratories at 15,358 and 16,824 cases respectively

 

b) The measures taken by the NHLS to eradicate the backlog include:

• • Increasing laboratory processing capacity to analyse samples and ensuring the optimal use of resources within the laboratories.
  • Acquiring additional laboratory space in Pretoria to process both the toxicology and blood alcohol samples.
  • New posts for toxicology analysts were created for the new laboratories in Pretoria.
  • The new toxicology laboratory will analyse new cases and the old laboratory will focus on the backlogged cases only.
  • Similar plans are in process to increase laboratory capacity for toxicology cases at the Johannesburg and Cape Town laboratories and to offer a toxicology service at the Durban laboratory.
  • The NHLS, in conjunction with the Forensic Pathology Services (FPS) in the Department of Health, is developing strategies to address ageing samples in the backlog and how to best manage these samples.

c) Each toxicology case that is registered in the laboratory may include a varying number of biological specimens that were taken during the autopsy and each specimen may require to be tested more than once or on different sets of instruments, depending on the test requirements. In the pre-analytic stage, specimens may require specialised preparation, depending on the tests that will be conducted.

As a result, it is difficult to quantify the number of toxicology tests that are processed in a day as tests run concurrently and completion periods differ vastly between cases. Hence, Toxicology cases are allocated in batches of 15 cases per analyst per month.

d) It is difficult to estimate when the backlog will be eradicated, however, the NHLS remains committed to improving service delivery at all four Forensic Chemistry Laboratories and to accelerating the reduction of the toxicology backlogs at these laboratories.

END.

Reply:

a) The position of the department is to implement the recommendations of the Public service Commission (PSC).

b) The department has implemented some of the recommendations which have no financial implications, the implicated employees are still in the employ of the department and the findings have not been challenged by the implicated employees and/or the PSC reports have not been taken on judicial review.

 

END.

Reply:

Responses as received from the provincial departments of health.

a) (i) Gauteng Department of Health underspent the total allocated budget with R2.7 billion of which R937 million was for provincial equitable share and R1,7 billion for conditional grants,

The reasons for underspending are -

• Late receipt of invoices and claims from suppliers that are subjected to a verification process.
• The reduced number of nursing students enrolled for the academic year and delays in the submission of Non-Profit institution's claims.
• Claims for the South African Cuban Doctor programme was received and subjected to reconciliation and review and could not be processed for payment at year-end.
• Slow construction and contractors abandoning sites due to poor contractors performance.
• Underspending on conditional grants was due to the unavailability of contracts, and probity audit processes towards procurement of high-value medical equipment that could not be delivered and paid at year end.
• Underspending was also incurred due to price reductions of antiretroviral drugs, non-contracting of general practitioners performing voluntary medical male circumcision (VMMC) and shortage of condoms within the country.

Rollover application of R582.2 million was submitted and R279 million was approved as follows;

• National Tertiary Services Grant R515.8 million requested and R226.8 approved
• District Health Services Grant (HIV/AIDS component R38.4 million requested and R32.8 approved and
• Statutory Human Resources component R27,9 million requested and R19.4 approved

b) (i) (ii) The following table reflects the details in this regard:

Name of the province	Underspending in 2022/2023 FY R’million	Reasons for underspending
Eastern Cape	R62,2 R31.7 Conditional grants R30.5 Voted funds	Delays in the payment of medico-legal settlement due to Trust registration delays by plaintiff attorneys. The rollovers amount to R24,8 million for the National Tertiary Services Conditional Grant and R6,1 million for the District Health Programme Conditional Grant (Comprehensive HIV Component) has been approved.
Free State	-R’4.4 R85 Conditional grant -R89 voted funds	The underspending on the grant totalling R85 million was as a result of the process of reconciliation for payment at year end and could not be finalised. The roll over amount of R84 million on Health Revitalization Grant was requested and approved to be spend in 2023/2024
Kwa Zulu Natal	R’000	The Province spent the total allocated budget in 2022/23 financial year.
Limpopo	R103,5 R49.3 Conditional grant R54.2 voted funds	The unspent budget of R103 million is attributable to delayed deliveries of medical equipment caused. The Department successfully secured R78 million through roll over request to be paid during 2023/2024 financial year.
Mpumalanga	R25,3 R12.8 conditional grants R12.5 Voted funds	Department experienced delays in the procurement of equipment due to revised Public Procurement Regulations.
Northern Cape	R141,4 R131.3 conditional grants R10.1 Voted funds	Underspent funds due to delay in the supply, delivery, installation and commissioning of the linear accelerator. National Health Insurance grant rollover amount was requested and R47,484 million was approved to be spent in 2023/24 financial year. National Health Revitalisation Grant underspent by R82,211 million, attributed by the delay in the monitoring and implementation of infrastructure projects.
North West	R4.8 R200.6 conditional grants -R209 voted funds	Delays in submission of invoices by service provider, late delivery of medical equipment (Catheterization and Lab Thyroid Stimulating Hormone). Rollovers were requested and approved to be spent in 2023/24 financial year, Health Facility Revitalisation Grant - R178,9 million, National Tertiary Services Grant - R1,9 million and National Health Insurance Grant -R15 million
Western Cape	R180 R14.4 conditional grants R165.6 voted funds	Savings on approved post list due to delays in the filling of funded vacancies and in-year attrition rates. Delayed in the implementation of contracts with training providers resulting in training that could not be implemented as planned. The use of covid-19 rapid ag tests instead of the more expensive laboratory based PCR tests and decrease in audit fees and legal fees.

END.

Reply:

According to information received from the Provincial Departments of Health, the responses are as follows:

EASTERN CAPE

a) One robbery and two-armed robberies.

b) (i) Empilweni TB Hospital, Helenvale and Zigidlo Clinic.

(ii) 1

(c) At Empilweni TB Hospital, the Security Company on-site decided to re-imburse its own personnel for the loss of their belongings (Security Officers). The criminal cases were opened at SAPS with CAS Number 11/09/2023 and 16/2/2024.

FREE STATE

a) The Department has not experienced any robberies in the past six months.

GAUTENG

a) Three robberies.

b) (i) Zola Clinic, Sebokeng Clinic and Rahima Moosa Hospital

(ii) 1

c) All robberies were reported to law enforcement agencies for further investigation.

KWAZULU NATAL

a) One-armed robbery.

b) (i) Ndlangubo Clinic

(ii) 1

(c) SAPS was contacted and called to the crime scene and the criminal case was opened at SAPS with CAS Number 222/09/2023.

LIMPOPO

a) One-armed robbery.

b) (i) Zebediela Hospital.

(ii) 1

c) The criminal case was opened at SAPS with CAS Number 97/09/2023. Furthermore, the physical infrastructure of the guard house is being improved to include bullet proof and one way mirror from the inside only and the Hospital has been included in the SAPS patrol list.

MPUMALANGA

a) One-armed robbery.

b) (i) Nkangala District, Empumelelweni CHC

(ii) 1

(c) The criminal case was opened at SAPS with CAS Number 135/11/2023. Furthermore, the Infrastructure Unit fixed the palisade fence that was broken.

NORTH WEST

The Department has not experienced any robberies in the past six months.

NORTHERN CAPE

The Department has not experienced any robberies in the past six months.

 

WESTERN CAPE

a) One armed robbery. (b) (i) Khayelitsha CHC in Site B (ii) 1 (c) Immediately after the incident, the Department deployed the Provincial Security Team to safeguard the facility to provide additional support to the onsite security officers. Counselling Services and wellness debriefing were made available to staff based at the facility. The CCTV camera system at the facility is currently undergoing upgrade and maintenance to include remote monitoring capabilities. The Department is in the process of re-constructing the entrance into the facility. The new entrance will include a double gate vehicle lock system as well as turnstiles.

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 in the process of procuring additional analytical equipment and all vacant positions are being filled to ensure an effective staff complement.

a) Cape Town: the NHLS is in the process of procuring additional instruments to increase testing capacity;

​b) Johannesburg: 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; and

c) Pretoria: new positions have been created in the new Pretoria laboratory, toxicology section, and the posts are currently being filled. All new toxicology samples will be referred to the new facility while the existing one focuses only on processing backlogged toxicology samples only.

2. (a) The NHLS is still in the process of identifying a suitable facility for the Durban Forensic Chemistry Laboratory that would accommodate a new toxicology section;

(b) the Durban FCL will start with toxicology testing as soon as the laboratory has relocated to a new suitable premise.

END.

Reply:

Infrastructure and capacity to treat adults with cancer are variable throughout the country and thus Gauteng Province has the additional responsibility of rendering oncology services to its neighbouring Provinces. However, comprehensive oncology services in the Gauteng Department of Health (GDOH) are currently only rendered by Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Steve Biko Academic Hospital (SBAH). This places a huge burden on service delivery for these two centres which according to the 2020 National Cancer Register (NCR) of South Africa are estimated to ensure that the 23 634 new people with cancer in the public health facilities in Gauteng Province are treated. With only two Central Hospitals rendering a comprehensive oncology service, long waiting times for diagnosis and treatment leads to disease progression and poorer cancer related outcomes. Lack of infrastructure and lack of human resources are also additional contributory factors to the extreme waiting times. The Department is thus outsourcing radiation oncology services to reduce the current radiotherapy waiting times at both CMAJH and SBAH.

END.

Reply:

The details of the food contract is as follows:

Tender Number: HEDP021/19/20

Duration: 01/07/2023 to 31/04/2024

Contract description: Supply and delivery of perishable provisions at all hospitals in the Limpopo Department of Health for 36 month.

Items covered in the tender:

• Fresh fruits and vegetables
• Bread
• Chicken Breast and Wings
• Fish
• Full Cream Milk/ Low-fat milk
• Eggs
• Cheese
• Yogurt plain low-fat
• Mageu

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 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:

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) 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) 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:

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:

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. (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:

(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) 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. 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:

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:

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:

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:

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:

(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:

(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:

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:

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. (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:

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:

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.