Questions and Replies

Reply:

According to the KwaZulu Natal Provinicial Department of Health, the response is as follows:

1. Please note that the waiting times on the table below is based on waiting time survey in 2021/2022 quarter four (04)

SERVICE POINT	AVERAGE ACTUAL TURN AROUND TIME (as per quarter 4 21/22)
Screening area	48 Minutes
OPD file registry	37 minutes

FACTORS CONTRIBUTING IN DELAYED WAITING TIME:-

• Head count: Manguzi District hospital see +/-458 clients per day
• Special clinic: mental health care user clinic and high risk clinic for maternity cases (every Wednesday), orthopaedic clinic, etc
• Incomplete record management system (patient registration using identity document) and limited record storage room.
• New normal (Covid-19 screening)
• Fast-tracking all emergency cases
• Border of Mozambique and Swaziland which increases influx of unplanned/ unreferred patients visits.

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

Challenges	Plan to improve
Non referred cases	The hospital management has identified designated area to see non referred cases so as to reduce overcrowding in OPD which will also improve OPD waiting time.
Special clinics	Strengthening of booking system to clients referred from different clinics.
Limited record storage room	Extra record storage area in a form of a container – The procurement process is in the advertisement stage.
Incomplete record management system	- Continuously educating the community about new system (use of identity document for registration) - noting unplanned/Unreferred visit of patients from Mozambique.
COVID -19 screening in waiting area	- Integration of services and educating community about the new normal. - ensuring community compliance in covid-19 precautionary measures
Improved communication with the public	Strengthen education to the clients on existing national guidelines for complaints, compliments and suggestion procedure.

END.

Reply:

According to the Western Cape Department of Health, the Department has taken a multi-pronged approach to prevent such incidents from occurring in the future. In line with the Departments security strategy, the department has commenced with the following:

1. Liaised with Western Cape Department of Police Oversight and Community Safety for a standard operating procedure to guide hospital CEOs with oversight and management of armed South African Police Service (SAPS) officials who access health care facilities including armed SAPS officials who are guarding patients requiring inpatients care.
2. Coordination by the Western Cape Department of Police Oversight and Community Safety for the implementation of a Provincial Memorandum of Agreement (MOA) between the SAPS Western Cape Provincial Commander and the MEC of Western Cape Health and Wellness. This MOA is to commit local resources for visibility and support of Health Facilities in the Province.
3. The implementation of complementary security measures such as the implementation security technology to bolster the security officer deployment.
4. A review of the current CCTV installations at health facilities and the procurement of CCTV systems on the approved tender since July 2021.

END.

Reply:

Honourable Member, the National Department of Health is consulting with the Mpumalanga Provincial Department of Health to source the full details of this matter. The Minister will provide the Honourable Member and Parliament with the response as soon as the details have been received from the Province.

END.

Reply:

Honourable Member, this information is not readily available at the National Department of Health but is with the provinces. The National Department of Health is therefore consulting with all the Provincial Departments of Health to source the full details on this matter. The Minister will provide the Honourable Member and Parliament with the response as soon as the details have been received from the Provinces.

END.

Reply:

1. According to the time periods stated by the question, the information is currently not available because it being handled by various bodies such as those that are responsible for population register and as such the department does not keep this information. Stats-SA which is the health entity supporting us in this area of work, has the report on the official statistics as regards to intentional self-harm (suicide) by gender and age up to 2018. This means that the report for 2019,2020 and 2021 is not yet available.

2. The Department is implementing a number of interventions in collaboration with other stakeholders to address factors that increase the risks for suicide including prevention, education and early intervention. Among others these include:

• The Department has established a training programme for professional nurses and medical doctors on clinical mental health since 2018/19 to enhance early detection, diagnosis, treatment, referral and rehabilitation of mental disorders at Primary Health Care.
• Screening for mental health has been included as part of health care package of services at primary health care to bolster early identification and intervention services
• The Department is continually educating the public on mental health issues using various platforms with special emphasis in July on mental illness and October on mental health, on annual basis to increase public awareness on mental health issues that can contribute to suicide as well as where the public can access mental health services.
• Mental health has been integrated into Integrated School Health Programmes to ensure early identification through screening and referral of learners that need further assessment and management.

• Mental health is being included in the package of services that are rendered by Community Health Care Workers to ensure integration of education, early identification and referral at community level
• The Department is funding the South African Federation for Mental Health to provide mental health advocacy and health promotion interventions. Since COVID-19 the organisation has utilised the funding to run a mental health information and support desk to strengthen access to information on mental health including how and where to access mental health services
• The Department if working closely with the Higher Education and Training sector through providing support to Higher Health organisation to strengthen mental health interventions among students in higher education institutions.

END.

Reply:

Spontaneous reporting of adverse events following immunisation (AEFI) increased significantly compared to pre-COVID-19 vaccine rollout. A total number of AEFIs reported between 17 May 2021 and 30 April 2022 (SAHPRA microsite) was 5893, this represent a reporting rate of 0.0172% of total number of COVID-19 vaccine doses administered for the same time period. The most frequently reported AEFIs were in line with the available product information. No safety concerns were raised based causality assessment outcomes conducted on severe and serious AEFI reported. Vaccine safety surveillance and monitoring trends of reported AEFI are vital measures to ensure that the benefits of immunisation are maintained in the interest of public health. Transparent communication with the public is important to maintain public confidence in vaccines and prevent all AEFI being misinterpreted as caused by the vaccine. The department in collaboration with SAHPRA, provide information on the process of AEFI reporting, investigation and causality assessment on the SAHPRA microsite. The AEFI reported should be investigated and causality assessed to maintain high levels of vaccine confidence in the immunisation programme.

END.

Reply:

a) The department reports the reported deaths of every person that has been diagnosed with COVID-19 at the time of death, whether the COVID-19 is the cause or incidental to a death from any other condition. There is no audit done on reported deaths in hospitals.

b) Deaths are reported by the attending clinicians at public and private facilities at the time of death, therefore on a daily basis, and the reports are captured into the national data base (DATCOV) as they are reported. A corpse may not be released to the undertakers without the death certificate. The deaths reported are available on a daily basis (https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/surveillance-reports/) and are reported in the national media daily. The department monitors which hospitals are reporting on DATCOV to ensure completeness of data.

END.

Reply:

a) Due to a slow progress, both the Minister and Premier have agreed to transfer the project to the National Department of Health.

b) There is no additional budget. The estimated budget is R1 billion. The project will be completed within budget.

c) End of November 2023.

END.

Reply:

a) Following the National Health Laboratory Services’ insourcing of cleaners and security guards, the remaining entities have advised as follows regarding insourcing of cleaners and security guards:

• Council for Medical Schemes (CMS): The CMS insourced the cleaning personnel on 1 November 2016. The cleaning personnel enjoy employment benefits such as 100% subsidized medical aid, group life and disability cover as well as training opportunities. However, no decision has been taken on the insourcing of security personnel due to budgetary constraints.

• South African Health Products Regulatory Authority (SAHPRA): the SAHPRA is currently making use of outsourced security and cleaning services with contracts expiring in 2024. Going forward an analysis to review the current structure of the services will be conducted before expiry of the current contracts to determine the possible insourcing of the services.

• South African Medical Research Council (SAMRC): the SAMRC has evaluated in-sourcing and has been in discussion with labour. To this end, the in-sourcing of Patterson A and B staff has been included in the SAMRC. However, given the specialized nature of security, and the scope of business of research, the SAMRC cannot afford to develop this capacity to include security as in-sourced personnel since this requires in-depth situational analysis and specialized expertise of which the SAMRC does not have nor is able afford to acquire.

• Office of Health Standards Compliance (OHSC): the OHSC has two (2) contracts; (1) Cleaning Services for three (3) years ending 28 February 2024; and (2) Security Services for three (3) years ending September 2023. The OHSC will, prior to the expiry of the contracts, conduct an assessment and accordingly take a decision with regard to the future of cleaning and security services.

(b) This information is not readily available at the National Department of Health, it is with the Provinces and in municipalities as these are managed there. We are sourcing this information from provinces and municipalities and submit the full response as soon as such information is received.

END.

Reply:

The size and complexity of a project like Limpopo Central Hospital (LCH) requires a consolidated and concerted effort between various role players to eliminate risk and to keep the project on track, so that it can ultimately benefit the community and students it serves. Due to the impact of the COVID-19 Pandemic, the envisaged consultative processes for the LCH could not be undertaken between the relevant stakeholders due to the lockdown, lack of access to engagements with design consultants and the various Departmental Stakeholders. The consultative processes were thus delayed in finalising Stage Gate 3.

The project is however, currently in Stage 4: Design Documentation. The National Department of Health (NDoH) requested a Gateway Review process in line with the Framework for Infrastructure Delivery and Procurement Management (FIDPM) in December 2021 for this stage gate deliverables. The reviewal of Stage 4.1 was not a mandatory process but done to reduce the risk associated with the project during construction and eliminate any unforeseen costs. The objective of the review process was to ensure that the project delivers value for money, that any design related issues are appropriately addressed and that the overall project structure and governance is sound to take the project through construction. The Gateway review process have been concluded and the project is expected to go out on tender on approval of the Stage Gate 4 deliverables. The construction process is set to start in Q3 of this financial year.

END.

Reply:

The National Department of Health is consulting with the Gauteng Provincial Department of Health to source the relevant details in this regard. The Gauteng Provincial Department has been requested to provide the Ministry with the required information to enable the Minister to provide the response to the Honourable Member’s question. The response will be submitted as soon as information has been obtained from the Gauteng Provincial Department of Health.

END.

Reply:

The KwaZulu-Natal Department of Health treated 529 patients at our health facilities for flood-related incidents with 17 deaths reported during the acute phase of the flood disaster. There were no major disruptions to rendering of health care services in the affected health districts.

An additional 7 sessional pathologists were brought in to expedite the postmortems. A total of 429 post mortems were conducted, of which, 399 bodies have been identified by families.

Health care services continue to be rendered to 1 749 clients from displaced communities that are currently sheltered in community halls. This also includes ensuring dispensing of chronic medication.

Environment Health is monitoring water quality in eThekwini Municipality and Ugu District Municipality. Where water quality issues have been picked up in tanked water and Jojo tanks, these have been escalated to the relevant authorities. Health and hygiene education on small-scale water purification methods i.e., use of Jik and chlorine sachets by households is ongoing. Health awareness on Waterborne illnesses, Waste Management & COVID 19 Protocols is ongoing. Awareness on foodborne illnesses on soup kitchens and distribution centres has also been raised. Communicable Disease Control monitoring for water borne diseases is ongoing.

Water tankers were used and still continue to be used supply water to hospitals and clinics without piped water.

KwaZulu-Natal Department of Health has identified at least 87 projects at health facilities related to the flood damages at an estimated cost of R258 million and is currently addressing these together with the Department of Public Works.

KwaZulu-Natal Department of Health, together with the National Department of Health, continue to monitor the situation and are addressing the challenges accordingly.

END.

Reply:

The National Department of Health is still consulting with the KwaZulu Natal Provincial Department of Health on this matter, to enable the Minister to respond to the Honourable Member’s question. The response will therefore be submitted as soon as information has been received from the province.

END.

Reply:

The Department has investigated the matter with the Operational Manager of Stanford Terrace clinic and one of the reasons for the patient queuing outside the gate was due to inadequate space in the waiting area of the clinic as the clinic was implementing disaster management strategies and observing social distancing. The spacing of patients in mitigating the spread of COVID 19, resulted in queues that were outside the gate also because of large patient numbers.

Whilst the EC DOH acknowledges the basic conditions of employment of employees and nurses in particular, the locking of the gate with nurses enjoying lunch is regrettable, and investigations by labour relations office in this regard is underway. Should the findings of our investigation be found to be inconsistent with the EC DOH policies, consequence management will be instituted to those employees who failed to exercise the Batho Pele Principles whilst on duty.

PLANNED INTERVENTIONS

• Training of Stanford Terrace Nurses on Batho Pele Principles and;

• Procurement of a tent as a temporal measure for patients waiting to be served

As the National Department of Health, we will follow this matter closely to see to its conclusion.

END.

Reply:

This information is not readily available at the National Department of Health, it is in the provinces. The National Department of Health is therefore still consulting with all the Provincial Departments of Health to provide these details, and this will enable the Minister to respond to the Honourable Member’s question. The response will therefore be submitted as soon as information has been received from the provinces.

END.

Reply:

The COVID-19 pandemic has had multiple adverse social and economic impacts on our people. The pandemic has created important lessons that should inform our policy actions and decision making going forward. The dissolution of the National State of Disaster by the President on 5th April 2022 necessitates that government retains the necessary mechanisms and levers that can be proactively utilised in the management of future COVID-19 and other types of similar future pandemics and notifiable medical conditions.

In this respect, and to ensure there are enough legislative and regulatory measures to manage the current and future outbreaks, the National Department of Health published the draft regulations under the National Health Act (61 of 2003) and International Health Regulations Act (28 of 1974). The objective of these draft regulations is to create transparent and structured measures which include the surveillance and the control of notifiable medical conditions; public health measures in points of entry; management of human remains; and regulations relating to environmental health. These draft regulations are not in any way intended to allow for the long-term replacement of the dissolved State of Disaster regulations as it pertains to the COVID-19 pandemic.

END.

Reply:

(a) The Department of Health actively promotes, protects and supports breastfeeding as a public health intervention to optimise child survival. This includes exclusive breastfeeding for a child’s first six month of life, followed by ongoing breastfeeding until at least two years of age together with introduction of good quality complementary household foods. The commitment is in line with the Tshwane Declaration which was adopted at the National Breastfeeding Consultative Meeting in August 2011.

In the years leading up to the Tshwane Declaration, the Department of Health provided free infant formula feed to infants whose mothers were HIV-infected. This policy and practice caused much confusion in communities and contributed to low exclusive breastfeeding rates in South Africa, which in turn contributed to high child mortality rates. One of the key Tshwane Declaration commitments was to stop providing free infant formula at public health facilities with limited exceptions for cases where breastfeeding is contraindicated.

(b) The Department has an RT-9 transversal contract in place which is managed by National Treasury. This contract includes all the necessary products or supplements that are currently required for use in people requiring specialised nutrition due to their disease conditions, and includes infant formula products. The products need to comply with the labelling, ingredient and other requirements as stipulated in the relevant regulations published in terms of the Foodstuffs, Cosmetic and Disinfectants Act, 1972 (Act 54 of 1972). Hospitals and clinics purchase the infant formula using the RT-9 transversal contract in accordance with their requirements. Where there are legitimate medical conditions as diagnosed by the medical practitioner, or when a mother is incapable for caring for her infant or young child, infant formula is provided for free by the hospital or clinic for up to 12 months.

END.

Reply:

This information is not readily available at the National Department of Health, it is in the provinces. The National Department of Health is therefore still consulting with all the Provincial Departments of Health to provide these details, and this will enable the Minister to respond to the Honourable Member’s question. The response will therefore be submitted as soon as information has been received from the provinces.

END.

Reply:

The National Department of Health is working with all the Provinces to collate this information and will provide the response to the question as soon as the information has been received from all provinces, in due course.

END.

Reply:

a) The National Health Laboratory Service (NHLS) insourced cleaners, gardeners and security officers starting from October 2017 and completed the process in April 2018.

b) The total number of workers insourced is (i) 430 however, (ii) the current total of insourced employees is 570 as the NHLS continued to recruit employees in the mentioned categories.

c) (i) Current remuneration: The cleaners and gardeners are graded at grade A on Paterson grading system. The salaries range from R96 051 per annum to R130 673 per annum. The security officers are graded at A3 on the Paterson grading system which ranges from R133 412 per annum to R179 198 per annum.

(ii) Worker Benefits: This cohort is part of the bargaining forum for employees within the NHLS. Their benefits include medical aid subsidy of 75%; 13th cheque which they receive in December each year, a living allowance of approximately R22 000 per annum and the pension fund. In addition, the NHLS implements a performance management and development policy which provides for annual performance assessment and criteria to qualify for performance awards or incentives in the form of pay progression and performance bonus. There are also bursary programs, and all employees complete a workplace skills plan for further skills development.

The NHLS also subscribes to the Basic Conditions of Employment Act No. 75 of 1997, which regulate hours of work and leave. Other benefits include an employee assistance program, where if an employee experiences personal challenges of any nature, they can call the NHLS’s 24 hours hotline and speak to a professional for assistance.

END.

Reply:

The National Department of Health is consulting with the Gauteng Provincial Department of Health to source the relevant details in this regard. The Gauteng Provincial Department has been requested to provide the Ministry with the required information to enable the Minister to provide the response to the Honourable Member’s question. The response will be submitted as soon as information has been obtained from the Gauteng Provincial Department of Health.

END.

Reply:

a) The National Department of Health did not conclude any commercial contracts with the government of the Russian Federation or any other entity based in the Russian Federation since 1 April 2017.

b) None of the entities reporting to the Minister of Health concluded any commercial contracts with the government of the Russian Federation or any other entity based in the Russian Federation since 1 April 2017.

END.

Reply:

As the National Department of Health, we are consulting with the provincial Departments of Health to collate the responses from those provincial Departments of Health to enable the Minister to respond to this question. The Minister will submit the response to the question as soon as the relevant information is received from the provinces.

END.

Reply:

No, the Department of Health does not keep a record of clinic and hospital visits of children who receive a Child Support Grant from the SA Social Security Agency (SASSA). The Department renders health services according to the needs of all clients, regardless of their social standing.

END.

Reply:

(a) All invoices for utility bills have been processed and paid, except for one invoice currently under dispute for Civitas building to the amount of R3,2 million for the period 01 October 2021 to 02 November 2021. The National Department of Health did not occupy the building during this period.

(b) We still await information from the provinces. This information will be submitted to Parliament as soon as it is received.

END.

Reply:

a) 80.7% of supplier invoices are paid within 30 days from receipt of an invoice.

b) A total of 44 suppliers have not yet been paid within the 30 days’ period.

c) The total amount not yet paid within the prescribed 30 days is R73,793,809.86.

END.

Reply:

a) The Department has received numerous responses from society to the published regulations.

b) The closing period for the submission of public comments has been extended by a further three months ending 5th August 2022. Consequently, the Department is not in position to furnish the numbers that are opposing or endorsing the adoption of the specified draft regulations.

END.

Reply:

The department has identified the following as areas needing urgent intervention to improve the quality of public health in the Republic, which is as a result of the lessons learned from Covid-19. All key pillars which were captured in the first surge and subsequent resurgence plans, have been identified as in need of attention and they are:

a) Key are of lessons	b) Steps taken to implement the identified improvements
Leadership and governance	The provinces are working on various interventions such as the process of conducting mortality audits across the country. This will assist us to know what were the underlying causes of high rate of deaths of many people during Covid-19 The department is also working on the improvement in the management of PHC services, through various interventions which will include the collaboration with school of government and other training institutions. The department is working with the provinces to integrate the Covid-19 management into the health systems management.
Infrastructure	The department is working on the capacity building programme for human resource capacity in the district hospitals where there is an infrastructure that was improved to cater for Covid-19 patients. The department has worked on the repurposing of the infrastructure to support the delivery of services.
Human Resources	The department is working on the process to increase number of nurses in the specialist areas to build on the capacity that was made available during Covid-19
Health Technology	The equipment that was procured for Covid-19 response will be made available for use in the hospitals. This is part of the Covid-19 legacy projects.
Diseases surveillance	The department has published the regulations that are preparing the health system to improve the surveillance and response to the notifiable medical conditions. The department has extended the closing date for the submission of comments by a further three months, meaning that the department is prepared to listen to as many voices and views as possible.

END.

Reply:

The department has worked with the provinces to do the following in order to ensure that the impact of Covid-19 is not as severe as the past four waves:

• Conducting the Intra-Action Review to identify the lessons learned from the previous waves and to develop plans to identified close the gaps, while also enhancing those areas that the department did well.
• The development of the resurgence plans which is based on the lessons learned from the four waves.
• The plan is working on the Integration of Covid-19 into the health system, so that it must be managed as part of the mainstream.
• The department is encouraging the South African Public to get vaccinated, as the best barrier to slowing down the impact of the pandemic while also minimising the severity in the event of infections.
• Integrating the vaccine into the PHC services, to avoid creating silos and vertical programmes.
• The plan is also to develop the Recovery and Rebuilding of the health systems for resilience.

END.

Reply:

As part of the Integrated Management of childhood disease services, two Data Elements are monitored for malnutrition deaths. These Data Elements are:

• Moderate acute malnutrition death under 5 years

• Severe acute malnutrition death under 5 years

a) The total number of children who have died nationally in public hospitals as a result of malnutrition in the past three years is as follows:

Data Element	FY 2019/20	FY 2020/21	FY 2021/22
Moderate acute malnutrition death under 5 years	166	207	238
Severe acute malnutrition death under 5 years	868	568	771
Total (National)	1034	775	1009

The above table shows a drop in malnutrition deaths in 2020/21, however, the 2021/22 deaths are similar to the pre-COVD-19 deaths of 2019/20.

b) The Total breakdown in each province is as follows:

Data Element	Province	FY 2019/20	FY 2020/21	FY 2021/22
Moderate acute malnutrition death under 5 years	Eastern Cape Province	24	20	20
	Free State Province	21	7	8
	Gauteng Province	34	45	45
	KwaZulu-Natal Province	33	83	81
	Limpopo Province	27	13	21
	Mpumalanga Province	11	24	29
	Northern Cape Province	0	8	11
	North West Province	14	6	19
	Western Cape Province	2	1	4
Severe acute malnutrition death under 5 years	Eastern Cape Province	149	72	127
	Free State Province	65	50	86
	Gauteng Province	94	75	120
	KwaZulu-Natal Province	176	164	187
	Limpopo Province	124	70	82
	Mpumalanga Province	60	52	59
	Northern Cape Province	38	21	33
	North West Province	154	56	62
	Western Cape Province	8	8	15
	Total (National)	1034	775	1009

END.

Reply:

This information is not readily available at the National Department of Health, it is in the provinces. The National Department of Health is therefore still consulting with all the Provincial Departments of Health to provide these details, and this will enable the Minister to respond to the Honourable Member’s question. The response will therefore be submitted as soon as information has been received from the provinces.

END.

Reply:

The Eastern Cape Department of Health has put together a Health Turn-Around Plan consisting of six pillars to address the administrative challenges of the EC DOH. The strategies outlined in the plan envisage collaboration with and seeking assistance from other government departments and the Office of the Premier as well as external stakeholders including private sector, communities and academic institutions. The plan gives a detailed outline of the strategies and the support required from each of these stakeholders. The pillars of the plan are summarised below.

PILLARS OF THE EC HEALTH TURNAROUND PLAN AND STRATEGIC SUPPORT

1. Financial sustainability initiative: This pillar addresses the EC DOH financial discipline and wellness; looking at strategies to take department beyond compliance and towards social entrepreneurship. Strategies to address this pillar include a) revenue generation, b) introducing efficiencies, c) management of cost-drivers and d) management of debt and unauthorised expenditure.

2. Medico-legal intervention: addresses the following strategic objectives i.e

a) Stopping haemorrhage of funds

b) Strengthening case management

c) Developing Medico-Legal litigation expertise

d) Manage unauthorised expenditure associated Medico-Legal (ML) settlements

3. Service delivery optimisation pillar focuses on:

a) Service Optomisation Implementation Planning

b) HR Intervention to promote SDO

c) Securing buy-in from key stakeholders

4. Digitalisation and eHealth: This pillar addresses issues of inadequate capacity to track all debts against the department, insufficient staff and budget to electronically capture and store of maternity medical records on HMS2 module. Support services are manual therefore labour-intensive, cumbersome and prone to human error and broadband to critical sites slow. Alternative solutions are required in the interim to gain last mile connectivity.

5. Clinical - Healthy Communities Initiatives: has four strategic objectives which are:

a) National Health Insurance (NHI) implementation through ward-based community outreach teams

b) Primary Health Care (PHC) Approach of inter-sectoral collaboration

c) Addressing Burden of Disease

d) Integrated Development Planning6. 

6. The Foundation Pillar purports to strengthen Leadership and Management Capability and improves stakeholder trust and confidence in the EC healthcare system. The key focus areas are valued employees, capable teams, effective leadership and communication & change management.

END.

Reply:

(a) (i) The current ratio of doctor to patient in public sector is 1:3198.

(ii) The current ratio of Nurse to patient in public sector is 1:357.

This is based on the following:

• The current total of Medical Doctors in the public health sector is 16 073.
• There are currently 144 090 Nurses appointed in the public health sector as of 31 March 2022. (This total includes all categories of nurses) (i.e., in all 9 Provinces including the National Department of health) recorded on the 31 March 2022 PERSAL System date set.
• Based on the Stats SA mid-year population estimates 2021, the current South African population is 60.14 million, with 4.05 million registered members, serving 8.94 million beneficiaries (i.e., insured population according to the 2021 Council of Medical Schemes data); and
• Approximately 51.4 million citizens are uninsured, and they depend on the public sector hospitals.

(b) From 01 April 2017 to 31 March 2021 the National Department of Health has supported 1356 Medical doctors to apply for critical skill visa with Department of Home Affairs.

END.

Reply:

Excess deaths refer to the number of deaths observed during the pandemic above a baseline of recent trends. Estimates of excess deaths provide information about the burden of mortality potentially related to the COVID-19 pandemic, including deaths that are directly or indirectly attributed to COVID-19.

The numbers of excess deaths in South Africa are estimated from the death registration data that the South African Medical Research Council obtains from the National Population Register maintained by the Department of Home Affairs.

Using all-cause deaths reported in the death registration system of South Africa (adjusting for late registration and incompleteness), the MRC developed estimates and monitors excess deaths experienced during the COVID-19 pandemic in the country. Weekly reports have been published, providing the total number of excess deaths from natural causes by province since 3 May 2020.

(a)-(b) Table A below provides the broad age break down of the numbers of excess deaths from natural causes in each wave of the pandemic and the figure shows the broad age band breakdown of the total excess deaths experienced during the period Week 19 of 2020 to Week 13 of 2022 (i.e., 9 May 2020 – 2 April 2022). 52 weeks are assumed per calendar year. The data is collected and presented by Epidemiological weeks which are used as a standard method to report excess deaths. Estimates of the numbers of excess natural deaths by province by age group are currently not available due to the fact that as you go lower down in population breakdown, variations may be marginal in comparison, which affects the confidence level of the estimates. The research team, comprising demographers, epidemiologists and statisticians are confident within a small range of uncertainty, with the numbers of excess deaths by broad age group (separate from provincial categorisation) at a national level.

Age group (years)	Wave 1 (2020 week 19 -2020 week 42)	Wave 2 (2020 week 43 - 2021 week 14)	Wave 3 (2021 week 15 -2021week 46)	Wave 4 (2021 week 47- 2022 week 13)	Total (2020 week 19 - 2022 week 13)
0-9	-3 399*	1 806	4 540	3 832	6 779
10-19	183	473	685	462	1 803
20-29	604	1 400	1 857	848	4 709
30-39	-533*	1 381	475	-452*	871
40-49	1 675	6 200	6 020	478	14 373
50-59	8 554	18 448	21 243	3 850	52 095
60-69	14 428	30 219	29 426	6 642	80 715
70-79	14 026	26 362	29 792	6 927	77 107
80+	13 107	20 010	26 600	7 766	67 483
Total	48 647	106 298	120 640	30 353	305 938

Table A

* negative values were reported where the deaths were lower than the baseline

(i.e., no excess death for that period)

Table B below shows excess death rates adjusted for differences in the age structure in each province. This data is from a peer reviewed publication scheduled for release in the May/June issue of the South African Journal of Science[1].

Province	Total excess natural deaths	Cumulative age-adjusted rate per 100 000 population	Annualised age-adjusted rate per 100 000 population
			Wave 1 (2020 week 19-2020 week 42)	Wave 2 (2020 week 43-2021 wee k14)	Wave 3 (2021 week 15 - 2021week 46)	Wave 4 (2020 week19-2022 week 4)	2020	2021
Eastern Cape	50 257	621	362	502	237	389	299	294
Free State	16 662	570	304	388	411	208	150	404
Gauteng	58 254	410	210	249	346	79	111	299
KwaZulu-Natal	60 942	610	233	651	300	253	178	416
Limpopo	31 758	467	100	440	353	222	419	384
Mpumalanga	22 795	509	132	467	396	183	444	410
Northern Cape	8 428	671	212	361	602	330	114	535
North West	16 569	422	117	322	395	124	63	352
Western Cape	30 559	379	154	272	249	154	130	237
South Africa	295 135	497	183	389	318	179	218	342

Table B

1. Bradshaw D, Dorrington R, Laubscher R, Groenewald P, Moultrie T. COVID-19 and all-cause mortality in South Africa – the hidden deaths in the first four waves. South African Journal of Science. (In Press).END.

    

Reply:

As of April 2022, 23 million doses of vaccine were available in South Africa. Given the continuing low uptake of vaccination, there is a high risk that a significant number of doses will not be utilised before their expiry date. In light of this situation, no vaccines are currently being procured.

1. The Department of Health continues to work with a range of partners to increase uptake of vaccination. These interventions include:

1. Continuing to provide consistent messaging around the importance of vaccination through a multiple media channels.
2. Ensuring effective liaison and collaboration for COVID -19 vaccination with community leaders and key stakeholders at ward-level
3. Strengthening platforms for participatory community dialogues, events, and activations
4. Improving community engagement and mobilisation for COVID-19 vaccination through the use of trained vaccinated Social Mobilisers
5. Providing technical assistance for localised communications that support COVID-19 vaccination mobilisation activities
6. Improving site marketing and build sustainable vaccine trust by advertising vaccination sites and using Social Mobilisers
7. Strengthening social mobilisation results-based management using Electronic Vaccination Data System (EVDS) and Geolocation Information System (GIS) generated data
8. Strengthening demand acceleration amongst vulnerable and hard to reach populations such as youth, undocumented persons and People Living with HIV thorugh community engagement strategies

(b) The National Department of Health is exploring opportunities for donating excess vaccines to other countries. If this is not possible, then excess vaccines that have reached their expiry date will be discarded.

END.

Reply:

The department is responsible to make transfer payments to the Office of Health Standards Compliance (OHSC) as allocated from the national fiscus for the entity to conduct its operations in accordance with its legislative mandate. Requests for additional funds for the entity’s operations including compensation of employees would be made to the National Treasury by the entity with support from the department following due process (budget process).

The department supported the OHSC’s application to the National Treasury to retain accumulated surplus for the 2020/21 financial year considering the negative impact of COVID-19 and budgetary constraints to fund the following objectives as identified by the entity:

• Supplementing human resource capacity in the Complaints Management Unit, Certification and Enforcement Unit, and Legal Service Unit; 
• Additional budget for inspections and re-inspections, and certification and enforcement; 
• Replacement of old computer equipment/tools of trade (recapitalization); and 
• Development and/or enhancement of core systems – inspection, early warning system, certification, and enforcement.  

In addition, the Department during the 2020 MTEF process ensured that the OHSC’s budget was not reduced. National Treasury had proposed a reduction of 5.7% in 2021/22 and 8.5% in 2022/23 as a result of the tight fiscal envelope.

END.

Reply:

a) (i) Countries generally do not provide mechanisms for verification of vaccinations in other countries (other than their trading blocs as in the EU). It is not possible for South Africa to verify vaccination certificates from other countries in South Africa. The QR codes from most countries are also not readable outside of their own countries. This is for security reasons and to prevent fraud. As a way to accept other country vaccination certificates the Department of International Relations and Cooperation has taken responsibility for the negotiations of reciprocity for the acceptance of Vaccination Certificates through the individual country embassies. This will provide for the acceptance of the South African Vaccination Certificates by foreign countries and in return the acceptance of vaccination certificates from foreign countries within South Africa.

(ii) Where individuals are experiencing challenges with regards to entering another country, and the SA COVID 19 Vaccination Certificates are questioned, this is being handled through the embassies on a case-by-case basis.

(b) The are no common international standards for the COVID 19 Vaccination Certificate development or its technology use cases. This is an ever-evolving environment within different countries or regions’ specific policies. Within the above scenario a specific date cannot be confirmed.

END.

Reply:

The Nelson Mandela Fidel Castro Medical Collaboration Programme is a National Programme that was established through a Government-to-Government memorandum of agreement between the government of the Republic of Cuba and the government of the Republic of South Africa. Eight (8) provincial departments of Health are participating in the programme except one provincial department of health. The participating provinces fund the training of students that come directly from these provinces.

END.

Reply:

The National Department of Health is still working with the Gauteng Provincial Department of Health on this report. It will be shared with the Honourable Member as soon as it has been completed.

END.

Reply:

(1) In a 2013, the Department developed a Policy Guideline for Tertiary Services which provides guidance or a blueprint for the minimum health workforce categories required at each category of hospital. These category of hospitals ranges from the Regional, Tertiary, Central, National Referral Hospitals to Specialised Hospitals.

Regional/Secondary (R) hospitals require the permanent presence and input of a general specialist in each of the TEN core specialties listed below, or at least two full time specialists per core specialty:

• Medicine
• Surgery
• Psychiatry
• Obstetrics & Gynaecology
• Orthopaedic Surgery
• Paediatrics
• Anaesthetics
• Diagnostic Radiology
• Laboratory Medicine
• Emergency Medicine

Tertiary Hospitals (T1) provide services with more specialists than is generally available at Regional hospitals. T1 services are centred on a strong core of specialists in the main specialties, supported by other specialist and sub-specialists.

Central Referral Hospitals (T2) represents a set of highly specialist services, delivered by sub-specialists that require unique, highly skilled and scarce personnel.

 

National Referral Hospitals (T3) offer services that are provided by super-specialist at national referral units only, each linked to a Central Hospital.

Specialised Psychiatric Hospitals (SP) offer services that may be provided in general hospitals (usually acute psychiatric wards only) but are mostly provided at specialised facilities designed for care of mentally ill patients.

Further considerations:

• In all regional and tertiary hospitals, consideration is given to the number and complexity of supporting clinical departments and allied clinical support services required to deliver the service. For instance, cardiothoracic surgery requires the support of a cardiology service, intensive care, cath lab, Clinical Technology personnel, etc.

• The skills and competencies required to deliver the service will depend not only on the level and scarcity of skills and competencies of specialist doctors but on the level and scarcity of skills and competencies of all of the allied professionals whose inputs are required to deliver the service.

• The caseload required to sustain these skills and competencies must be optimal to ensure the patient’s safety and to justify the investment in the units.

(2) (a) Informal quality checks should be done on a daily basis in hospitals. According to the Norms and Standards Regulations applicable to different categories of health establishments (Feb 2018) all health establishments must conduct an annual self-assessment (formal quality assessment) against the Norms and Standards Regulations. The measures for District and Regional hospitals for the Norms and Standards Regulations were published by the Office of Health Standards Compliance in August 2021. The Central Hospital tool is in draft format.

(b) Currently the Ideal Hospital Framework is used by public hospital to conduct a self-assessment. The framework has been aligned with the published measures for the Norms and Standards Regulations and will come into effect in the 2022/23 financial year. The result of the assessments conducted by hospitals for the 2021/22 financial year is set out in the table below. From the 394 public hospitals, 257 (64%) hospitals have conducted an assessment.

Outcome of self- assessment for 2021/22 financial year	Number of Hospitals
Silver	116
Gold	6
Platinum	6
Not achieved	129
Total assessments conducted	257

(3) (a) The attached table indicates the (HR) component in each hospital recorded on PERSAL as at 31 March 2022.

(b) The current overall shortage of staff for all job categories, which provide both health related, and administration functions are 26 444 posts, in the public health sector (Hospitals) (i.e. in all 9 Provinces) recorded as on the 31 March 2022 PERSAL System date set.

(c) Due to general budget cuts introduced by National Treasury, the Cost of Employment (CoE) is negatively affected and therefore not all posts can be filled simultaneously. It is therefore impossible to confirm total funded vacancies as all posts are placed in the same pot and stringent measures are implemented to control filling of positions including key line function posts to avoid over expenditure on CoE.

(d) The period that the positions has been vacant for is immaterial as on a monthly basis, Provinces are pprioritizing filing of posts in accordance with the Annual Recruitment Plan, where funding permits.

(e) Each hospital in each Province does have a Human Resources capacity plan compared to the population capacity, however, as mentioned above, due to budget cuts, it is not always possible for the hospital to employ to full capacity but mechanisms are in place to ensure that service delivery is adequately provided at all times.

To mitigate the above, the Department has introduced several interventions to address the shortage of health workers in health facilities, which amongst others includes:

• Prioritisation of the posts in the Annual Recruitment Plan – where funding permits
• Prioritisation of the posts for conditional grant funding
• Filling of replacement posts considered and approved weekly
• Advertisements published National wide through print media
• A dedicated Registrar Programme to train and produce in-house Medical

Specialists

• Provision of internship and community service programmes.

END.

Reply:

The information requested by this question is not readily available at the National Department. The Department is working with all provincial departments of Health to source this information. As soon as the information is received, the Minister will furnish a full response in this regard.

END.

Reply:

The information requested by this question is not readily available at the National Department. The Department is working with all provincial departments of Health to source this information. As soon as the information is received, the Minister will furnish a full response in this regard.

END.

Reply:

The information requested by this question is not readily available at the National Department. The Department is working with all provincial departments of Health and the Health Professions Council of South Africa (HPCSA) to source this information. As soon as the information is received, the Minister will furnish a full response in this regard.

END.

Reply:

(a) The department has reviewed its Supply Chain Management (SCM) policy and aligned it with the National Treasury SCM Instruction Notes and Circulars that are issued from time to time by National Treasury. Currently NDOH SCM is also reviewing its Standard Operating Procedure of SCM to be also in line with the new with the intension to workshop rework shop all their internal stakeholders (different branches and clusters in the department). With these workshops is the enhance compliance with prescripts and bring everyone on board with the latest developments in SCM space.

(b) Section 38 of the PFMA and Chapter 8 of the Irregular Expenditure Framework issued by National Treasury direct that disciplinary steps must be taken against officials responsible for irregular expenditure. In adhering to these requirements, some of the officials implicated in irregular expenditure cases had been suspended and disciplinary hearings are in progress.

END.

Reply:

It is our considered view that in view of the Government Employees Medical Scheme (GEMS) being an entity falling under the responsibility of the Department for the Public Service and Administration, this question would be best be answered by that Department and not Health.

Parliament is therefore requested to divert this question to the Ministry for the Public Service and Administration accordingly.

END.

Reply:

The National Department of Health is working with all provincial departments of Health to source the information requested by this question. As soon as the information is received, the Minister will furnish a full response in this regard.

END.

Reply:

The Department is working with all provincial departments of Health to source this information. As soon as the information is received, the Minister will furnish a full response in this regard.

END.

Reply:

The National Department of Health engagements has been on the issues highlighted in the following Commission on Gender Equality (CGE) report.

1. Report on the consultative hearings on the status of shelters in South Africa 2020.

(a) (i) Total number of recommendations is six (6) and 1 of the recommendations has six (6) sub-recommendations.

(b) (i) Total number of recommendations not implemented is two (2).

Table below responds to details of the recommendations and indicate those implemented and not implemented

Table:

Recommendations	Implemented	Not implemented	Reason for not implementing
(a) The NDOH must develop norms and standards for the provision of services to domestic and GBV survivors, including: (i) The creation of an area-relevant shelter referral list (ii) The sensitive treatment of survivors of GBV. (iii) The required services for survivors and their children at shelters and duties of care.	List received from the Department of Social Department Front line workers are trained on treatment on sensitivity to survivorsrs and children implemented by all health facilities using the Sexual Reproductive and Health Rights policy and guidelines		Plotting of the shelter list to health facilities still needs to be concluded.
(iv) The prioritisation of survivors of GBV at clinics and hospitals. (v) Transport for survivors to health facilities and the provision of primary healthcare at shelters. (vi) Clear, sensitive norms for the provision of services to the LGBTIQA+ community and PWDs and other vulnerable survivors.	Ambulances are provided when needed. Front line workers are now trained for gender sensitisations in the Sexual Reproductive and Health Rights Module Adapted the The South African National LGBTI HIV Plan, 2017-2022 that define norms and package of care also to survivors.		After the process of plotting shelters, we will be able to know proximity of shelters to health facilities. Where there are no fixed structures, we will look at the option of mobile clinics.
a) The NDOH is to issue a circular by the end of December 2019 on the prioritisation of GBV survivors at health facilities at all levels. A copy of the circular is to be provided to the Commission.		Director General of Health to still approve Circular	Director General of Health to still approve Circular
b) The NDOH is to develop a programme on harmful social norms and myths that facilitate the spread of GBV, rather than to focus only on a legislative approach. The Commission welcomes engagements on this development		This Programme is a social phenomenon and Ndoh will not be able to prepare a Programme, however, will collaborate with other social stakeholders guided by the National Strategic Plan doe Gender Based Violence and Femicide.
c) The NDOH is to make mental health services as well as detoxification facilities more accessible to shelter residents. The NDOH must revert with the proposed roll-out plan.	Mental Health services are established in terms of the National Mental Health Policy Framework and Strategic Plan 2013-2020, which is being updated and founded on the provisions of the Mental Health care Act 2002 (Act No 17 of 2002). Access for all citizens including shelter residents is ensured, among others, through the following initiatives: Integration of mental health in the core package of district health services. Routine screening for mental illness and a stepped approach to management and referral for mental conditions from PHC. Establishment of district specialist mental health teams to plan and coordinate mental health services in districts. Strategic purchasing of services from health providers to render mental health services at Primary Health Care. These includes psychiatrists, Psychologists, Registered Counsellors, Social Workers and Occupational Therapists. Regarding Detoxification, Substance abuse prevention, treatment and rehabilitation services are provided in terms of the Prevention of and Treatment of Substance Abuse Act, 2008, which is led by the Department of Social Development (DSD). Substance abuse rehabilitation centres are subsidized by DSD. The Department of Health screens for and manages substance abuse across all levels of the health system in line with the Adult Primary Care guidelines and the Essential Medicines List, Standard Treatment Guidelines. Detoxification is provided to all community members in general hospitals, when required.
(e) The NDOH must provide a report on the training that frontline staff, managers, and senior managers have received on GBV.	Report was provided for frontline staff provided in 2020.
(f) The NDOH has a duty to educate communities around issues of health and it must engage the community around the stigmas surrounding survivors, and where to seek help.	Community mobilization is done on this issue by the Department and partners such as Love Life and Soul City.

 

2. Report into the investigation on the forced sterilization of women living with HIV/AIDS in South Africa 2020.

(a) (i) Total number of recommendations is nine (9) only 5 applicable to the Department of Health

(b) (i) Total number of recommendations not implemented is one (1) and in process.

Table below responds to details of the recommendations and indicate those implemented and

not implemented

Table:

Recommendations	Implemented	Not implemented	Reason for not implementing
1.The Commission will refer this report and its findings to the Health Professions Council of South Africa (Health Professions Council of South Africa) and the complaints contained herein. The HPCSA guides and regulates health professions on all aspects pertaining to professional conduct and ethical behavior. Thus, they ought to engage with this report on this matter as they have the necessary capacity to investigate the professional conduct and behavior of the implicated health care practitioners.		Responsibility of CGE
2. The Commission will refer this report and its findings to the South African Nursing Council (SANC) and the complaints contained herein. The SANC guides and regulates nurses on all aspects pertaining to professional conduct and ethical behavior. Thus, they ought to engage with this report on this matter as they have the necessary capacity to investigate the professional conduct and behavior of the implicated health care practitioners;		Responsibility of CGE
3.The NDOH, upon receipt of this report must interrogate and scrutinise the provisions of the Sterilisation Act and interrogate consent forms for sterilisations to ascertain whether the provisions contained therein provide for and protect the principle of informed consent in all respects. The NDOH must report to the CGE within 3 (Three months) of receipt of this report as to what concrete steps the Department will take to ensure that the eradication of the harmful practice of forced sterilization.	Implemented, and there was no need to change the Act however, clarification on Sterilization Act was provided in the National Contraceptive guideline updated in 2019
4. The NDOH, upon receipt of this report must facilitate dialogue between themselves and the complainants to for them to find ways of providing redress to the Complainants.	Done on the 3rd and 4th June 2021 in Durban.
5. The Commission will present this report as part of its petition to the SALRC for amendments to legislation that ensure consent is properly obtained such as counselling prior to consent, the timing of obtaining consent and compulsory information that must be provide.		Responsibility of CGE
6. The NDOH must revise consent forms to bring them into conformity with the guidelines provided by International Federation of Gynaecology and Obstetrics and standardised for all sterilization procedures. The NDOH should also print consent forms in all official languages, and the explanation around the procedure,particularly its irreversible nature should be given in the patient’s language of choice. This must be executed and attested to;	Implemented. Translation to 10 other languages completed and the process is in the process of acquiring tender to print the revised consent forms.
7. The NDOH must make it an operational policy requirement that where a patient agrees to sterilisation, they must be given a “Cooling off” period to fully appreciate the risks and consequences of their sterilisation procedure.	Implemented as documented on the revised Maternity case record
8. Standard timeframes should be put in place in relation to when the discussion around sterilisation should take place. Patients cannot be informed about this process minutes before going to theatre. Patients must also be informed that they are at liberty to change their minds at any time before the procedure takes place;	Implemented as documented on the revised Maternity case record
9. The DOH must ensure that their filing systems, both manual and electronic are standardised for ease of coordination. Feedback to the latter must be provided within 3 months from date of this report.		Not implemented however the process of filing systems are being addressed through the NHI configuration systems.

3. Report on the Government's Emergency Response Action Plan (ERAP) on Gender-based Violence and Femicide, Review of implementation 2020.

No recommendations in the report specific to the Department of Health.

4. Report on the gender transformation on procurement 2018/19

No recommendations in the report.

5. Report on the Victims Charter: Assessing the Effectiveness of Implementation by Departments of Health and Correctional Services 2012.

No recommendations in the report.

 

END.

Reply:

a) The following progress has been made:

PROGRESS FOR THE EMERGENCY UNIT

The technical work for the Emergency Unit is 99% complete. The Certificate of Occupancy has been issued by the City of Johannesburg. The clinical operations will be executed in phases starting from the 6th May 2022.

PROGRESS FOR THE REMEDIAL WORK FOR ALL THE BLOCKS

The remedial work covers the following milestones:

(i) THE IMPLEMENTATION OF THE NEW STORES FACILITY

• Construction works will start on the 25 May 2022
• Practical handover of the News Stores Facility is scheduled for the 10 November 2022.

(ii) CONDUCTING OF A DETAILED ASSESSMENT

Construction works will start on the 4 April 2022 until 13 June 2022

(iii) THE IMPLEMENTATION OF A TEMPORARY ACCESS TO PARKING

• Construction works will start on the 13 April 2022

• Practical handover of the News Stores Facility is scheduled for the 15 May 2022.

(iv) THE IMPLEMENTATION OF THE MAIN WORK FOR BLOCK 4 AND 5 REMEDIAL WORKS

b) Practical handover and completion is December 2023

END.

Reply:

a) The root cause is related to the following factors:

• Some of the delays were caused by the COVID-19 restrictions including the unavailability of material. CORRECTIVE MEASURE: Due date for completion has been extended until end of September 2022.
• There was a poor application of the design standard to be used for example: IUSS (Infrastructure Unit System Support) matters. CORRECTIVE MEASURE: Training has been arranged to unpack the IUSS requirements.
• There was a lack of bulk infrastructure on site. CORRECTIVE MEASURE: The National Department of Health has provided a team of technical engineers to the Mpumalanga Province to address the issues related to the lack of bulk infrastructure.
• Insufficient yearly budget allocation due to COVID-19 requirements and priorities.

b) Further remedial activities:

Department has allocated budget for 2022/23 financial to install the bulk infrastructure services (sewerage, bulk water supply, storm water drainage and access road) because municipality does not have the funds and these charges will be deducted from the municipality bill payment of the services.

END.