Questions and Replies

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:

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:

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:

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 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 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 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 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:

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.

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:

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:

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:

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:

(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:

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:

(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 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:

(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:

1. (a)-(b) The attached Annexures provide the details in this regard.

2. Causes of foetal deaths

According to the Saving Babies Report 2017-2019 (pg 13-14) the following are the causes of foetal deaths

1. Hypoxia
2. Infection
3. Congenital abnormalities
4. Immaturity related causes

Causes of maternal deaths

According to the Saving Mothers Report 2017-2019 (Pg-20, 80-83), and Impact of COVID-19 on maternal health Report 2021 the following were the causes

1. Non-Pregnancy related infections related to HIV
2. Hypertensive disorders of pregnancy
3. Medical and surgical disorders
4. Obstetric Hemorrhages
5. Miscarriages and Ectopic pregnancies
6. Pregnancy related sepsis

Source: Saving Mothers Report 2017/19, Pages 20.

END.

Reply:

NDoH only has an accredited register of public service health care workers (HCWs) to use for determining the percentage of HCWs vaccinated/not vaccinated. The response therefore only reflects detail about public HCWs vaccinations as on 7 April 2022.

Province	Number of Public Sector HCWs	(i) Vaccinated Public HCWs	(ii) Public HCWs not vaccinated
		(a) Number	(b) Percentage	(a) Number	(b) Percentage
Eastern Cape	54 626	46 885	85,8%	7 741	14,2%
Free State	24 173	19 974	82,6%	4 199	17,4%
Gauteng	88 968	66 760	75,0%	22 208	25,0%
KwaZulu-Natal	83 852	72 513	86,5%	11 339	13,5%
Limpopo	42 949	38 048	88,6%	4 901	11,4%
Mpumalanga	28 986	23 688	81,7%	5 298	18,3%
National	1 570	1 001	63,8%	569	36,2%
North West	30 421	25 141	82,6%	5 280	17,4%
Northern Cape	9 776	7 988	81,7%	1 788	18,3%
Western Cape	37 734	31 331	83,0%	6 403	17,0%
Total	403 055	333 329	82,7%	69 726	17,3%

END.

Reply:

a) SAHPRA has considered all Clinical Trials and clinical data submitted in the application for emergency access and registration, as well as all periodic safety update reports received; Adverse Drug Reaction (ADRs) received as well as reports and information shared by other Regulators that SAHPRA aligns with such as EMA European Medicines Agency (EMA); USFDA (USA); PMDA(Japan); Health Canada; TGA (Australia); Swissmedic. Therefore, at the time of approval these are considered and that on an ongoing basis SAHPRA continuously receives and reviews safety updates as these are reported and hence the agency is constantly monitoring for safety and will update its report on any product based on these reviews.

b) SAHPRA is constantly reviewing safety updates and where there is a need for update and communicate such changes accordingly. SAHPRA approvals are based on clinical data submitted and these are done on risk benefit basis. The reports available at the time of review are considered. Note that SAHPRA approval of the Comirnaty vaccine for patients 12 years and older was done and communicated on 16 September 2021 and reviews and approvals were based on data available at the time. The date of registration is 25 January 2022 and is prior to the recently published reports. Thus, at the point of initial approval this report was not considered. This report now and based on the current PV data which is continuously monitored by SAHPRA there is still benefit exceeding risk in the populations this vaccine has been approved for and for the population the review was based on.

c) Yes, SAHPRA has received the clinical trial information as well as adverse events reported including those of trials and as published. All information regarding the side effects and adverse drug reactions as reported in various studies and as are adequately documented and validated are considered and SAHPRA is therefore of the view that as current information becomes available it is reviewed and the outcome of the regulatory decision would then be updated accordingly, however if there is no change in this decision it would mean that following assessment the risk benefit has not changed. SAHPRA convened webinars to educate the public on the side effects and adverse events of vaccines.

END.

Reply:

a) When new information is shared with SAHPRA either by the applicants or by reports shared from other regulators and/or also published journal information it is reviewed considering existing approval. Therefore, the report received in respect of the Pfizer vaccine is being reviewed to establish whether changes will be required in the current approved status. If there are changes required, these will be communicated to the applicant to provide details of the findings and recommendations. Following the applicant’s inputs/response, SAHPRA will then pronounce on changes to be effected and if it severely impacts on the safety and efficacy and affects the risk benefit of the vaccine, this will then be given conditions under which it can be used and if so deemed it may be withdrawn from market and for use.

b) Yes, SAHPRA still holds the view that vaccines are safe to be rolled out. This is based on the outcome of the safety reports which indicated that the benefit-risk ratio of these vaccines remains positive.

END.

Reply:

a) The delivery of the Johnson & Johnson vaccine was delayed in April/May 2021. The reason for this delay is related to an FDA inspection at Emergent BioSolutions Bayview facility, one of the manufacturing partners of Johnson & Johnson.

This had an impact on the global supply of Johnson & Johnson vaccines, including for South Africa.

b) The current delivery is 63% of total contracted volume. However, it should be noted that the NDOH requested that deliveries be delayed because demand has reduced and there is limited storage at the central warehouses. The advantage of this approach is that new doses when they do arrive have better expiry dates and the risk of wastage is reduced.

END.

Reply:

a) Water sampling testing is conducted by 2 authorities in Municipalities, i.e. the (1) Water Services Authorities in line with their mandate to provide water that is safe for human consumption, and (2) by Environmental Health Practitioners (EHPs) in municipalities in line with their role of water quality compliance monitoring, prescribed in the National Health Act, 61 of 2003, as amended. The Department of Health (DOH) has developed and has in place Norms and Standards for Health-related Water Quality Monitoring, as part of the National Environmental Health Norms and Standards, which aim to standardize the provision of Environmental Health Services in the country, including water quality monitoring. These standards provide clear protocols, proper techniques, preservation and transportation standards to be adhered to nationally when conducting water quality sampling in various water sources. The norms and standards further provide recommendations on frequencies of water sampling, in line with the SANS code 241: Drinking Water. The norms and standards further outline the requirement for Municipalities to develop Water Quality Monitoring Plans that are implemented across the country and these include waterborne disease monitoring plans to ensure that water consumption is safe for the communities. EHPs have been trained/capacitated on their responsibilities on water-related outbreak response and ensure reporting in accordance to the National guidelines on Notifiable medical conditions. The DOH also collaborates with other Ministries, i.e. Ministry of Water and Sanitation, Ministry of Basic Education and Ministry of Human Settlements to also ensure that identified gaps at community or municipality level are addressed at policy making level.

Practitioners were capacitated and will continue to be capacitated on water sampling and testing standards to ensure credible water results.

b) The link between good water quality and credible testing and analysis is critical for protection of public health. This can only be achieved through a high national standard of testing by laboratories. The current regulatory environment for water testing laboratories lies with the Department of Water and Sanitation (DWS) and accreditation body, the South African Bureau of Standards (SABS). Only test results from approved laboratories are accepted by DWS, as necessary element to be awarded Blue Drop and Green Drop Certification and for uploading data in the National water Information System.

The same requirement stands for water testing conducted by EHPs to ensure credible water quality results. Accreditation bodies such as the South African National Accreditation System (SANAS) assess factors relevant to a laboratory’s ability to produce precise, accurate test and calibration data, including the technical competency of staff, validity and appropriateness of methods, traceability of measurements to national standards, suitability, calibration and maintenance of test equipment, suitable environmental conditions, handling of test items, quality assurance of test and/or calibration data. The DOH has not taken any measures to ensure testing labs that are controlled by the state, as this is outside of its mandate. However, the independence of testing labs needs to be protected and separated from the water providers. However, there is also acknowledgement of the importance of laboratories for Municipalities that may be used regularly for provisional sampling.

END.

Reply:

According to the Limpopo Provincial Department of Health, the Department procured and has received delivery of 25 new fully equipped ambulances which will be distributed throughout the province. The handover of the ambulances to the province took place on 11 April 2022. Bela-Bela will receive 2 ambulances by the end of April 2022 to address the operational needs of the sub-district.

END.

Reply:

Following receipt of the parliamentary question, the Gauteng Provincial Department of Health conducted the investigation to verify the allegations. The investigation revealed the following:

Members of staff in the Mandela Sisulu Clinic deny any knowledge of such a practice. The staff members indicated that they actually have to forego their morning tea break in order to serve patients, as a result of the high volumes of patient numbers in the morning on a daily basis. The staff members further stated that they take their lunch on rotational basis, so that there are always staff members that continue to assist patients. There may be times where some patients may have preference with regard to a particular staff member. It is in times such as this that patients may have to wait for that staff member, although this is not a common practice in this clinic.

Remedial action:

The staff members will continue to communicate with the patients on any developments and their actions as necessary. This will include announcements to patients when they take breaks as provided for within their conditions of work employment, as this may leave a reduced staff compliment for that time.

The Supervisors will also undertake unannounced visits to ensure proper compliance to continuity of service delivery and where necessary ensure adherence to Departmental policy prescripts. In this way, there will be some certainty of continuity of provision of the services.

END.

Reply:

The National Department of Health (NDoH) met with the Department of Home Affairs (DHA) to discuss the implementation of biometric identity verification in the health system in South Africa.

Provision has been made for the development of the functionality in the existing Health Patient Registration System during the 2022/2023 financial year.

Once the development is completed, the solution will be deployed in a small group of facilities for testing. Lessons learned will be used to enhance the biometric identity verification before it is deployed to the remainder of the health facilities in the country.

For successful implementation, the NDoH is working on overcoming the following:

1. A detailed, integrated solution needs to be planned and implemented in collaboration with DHA - DHA to provide guidance on which of their systems is the most appropriate to interface with.
2. Funding to source biometric equipment in facilities - although some funding has been made available it will not cover all facilities.
3. Broadband connectivity needs to be resolved as this solution will not work with the current connectivity solution in most public sector facilities.

END.

Reply:

The following tables reflect the details in this regard:

a)  Catering

https://pmg.org.za/files/Catering.pdf

b) Entertainment

https://pmg.org.za/files/Entertainment.pdf

c) Accommodation

https://pmg.org.za/files/Accomodation.pdf

END.

Reply:

(a) The Post-Exposure Prophylaxis (PEP) is available in all 3,465 public health facilities (Primary health Care and Community Health Care facilities) and 54 Thuthuzela Care Centres (TCC) countrywide. These services are available for everyone who may have been exposed to HIV within 72 hours of exposure, however, those who are exposed through sexual assault and are eligible, are offered PEP at an entry point then referred to the TCCs for further management.

Out of the 37 441 sexual assault cases seen in the current financial year, 21,026 were offered PEP through the following eligibility criteria:

Eligibility criteria:

• PEP must be given to persons with a negative HIV status (Meaning an HIV test must be conducted);

• Must be given within the first 72 hours of exposure.

The Post-Exposure Prophylaxis is not disaggregated by age and gender.

(b) Oral pre-exposure prophylaxis is currently provided at 2,700 facilities (including 2,224 public PHC facilities). Since 2016, a total of 450,606 individuals (males and females of all ages) were initiated of oral pre-exposure prophylaxis.

During the period 1 April 2020 to 31 December 2021, 161,910 persons, males and females, ages 15-24 years were initiated of oral pre-exposure prophylaxis of which 140,837 were females.

END.

Reply:

1. The department has always adopted a true, genuine and consequential approach to abusive behaviour within our health facilities. This can be demonstrated by several policy documents and guidelines that were published and are available in the public domain. These include the establishment of the Office of Health Standards Compliance (OHSC) as a standard setting body supported by the Health Ombudsman. The department has demonstrable evidence where people that were found to be at fault were taken to task in various health facilities. One such example is the steps taken in the unfortunate situation around Life Esidimeni where those that were found to be at fault were made to take responsibility for their acts or omissions.

2. (a) SA Medical Association (SAMA)

South Africa Medical Association is a private association that represents the interests of its members, being the medical doctors. This organisation is not part of the department and as such the department is unable to comment on how it handles matters related to its members.

(b) The South African Medical Research Council (SAMRC)

This entity is a research institution which does not get involved in service delivery issues and most importantly in the behaviour of the health care workers. However, if requested the SAMRC can could conduct behavioural research in an institution noted to be an issue to understand root causes and address interventions.

(c) Health Professions council of South Africa

The role of Health Professionals Council of South Africa (HPCSA) is to ensure that where such acts or offences were committed by practitioners registered under the Health Professions Act 56 of 1974, disciplinary action will be undertaken by HPCSA by investigating the allegations in line with the Act.

This entity does contribute towards the genuine and consequential approach to abusive behaviour within our health facilities.

Secondly, the HPCSA has a responsibility in guiding the practitioners. It also has interventions such as symposiums and roadshows where these ensure that ethical rules and ethical guidelines are communicated to the practitioner.

(d) South African Nursing council.

Just like with the Health Professions Council of South Africa, this entity, is a statutory health professional body for nurses and its duties include upholding and maintaining standards of nursing practice in order to serve and protect the public. In cases of complaints against any person registered with the SANC, an investigation is conducted in accordance with the Chapter 3 of the Nursing Act, 2005 (Act no. 33 of 2005), and applicable regulations. The Council is empowered by the Nursing Act, to establish specific committees to institute an enquiry into any complaint or allegations of unprofessional conduct and to undertake appropriate disciplinary action against any person registered under the Nursing Act. In the event that there is a complaint against any person registered with the SANC, The Preliminary Investigating Committee investigates the allegation to establish if there is a case against the practitioner. Should there be evidence that there is, the matter is referred to the Professional Conduct Committee to institute disciplinary action. If the nurse is found guilty of such misconduct, the Council imposes any of the prescribed penalties.

END.

Reply:

1. The Kwa-Zulu Natal Department of Health has not planned to close St Francis Hospital, a decision was made to merge the management of St Francis Hospital and Nkonjeni Hospital as far back as 2013.

2. St Francis Hospital has not been closed and consultation with various stakeholders was done regarding the merging of management to be stationed at Nkonjeni Hospital.

END.

Reply:

The National Department of Health does not provide/pay allowance and/or stipend when allocating health professionals to perform the required medical internship or community service for relocation when allocated outside their ordinary place of residence nor does it provide a standard policy regarding this provision.

As a result, a Province utilize its own discretion in accordance with each Provincial Resettlement and Relocation Policy and to date, all Provinces do not pay an allowance and/or stipend when appointing health professionals to perform the required medical internship or community service for relocation when allocated outside their ordinary place of residence.

END.

Reply:

According to the Mpumalanga Provincial Department of Health, the incident happened on the 12 November 2021 at Oakley Clinic, Mpumalanga and the person who committed the assault was not a nurse but a support staff (cleaner). The Mpumalanga Provincial Department of Health then followed the procedure by placing the accused on precautionary suspension pending the finalisation of the case on the 09 March 2022, in terms of clause 7.2 of the Disciplinary Code and Procedure for the Public Service (Resolution 1 of 2003).

END.

Reply:

The Gauteng Provincial Department of Health informed that contract workers from the Expanded Public Works Programme (EPWP), employed by the Gauteng Department of Health for over three years cannot be absorbed and/or offered permanent employment because they are employed in fixed term contract under the Expanded Public Works Programme (EPWP) that is in terms of section 198B (4) (g) of the Labour Relations Act, 1995 (“the LRA”) which is permitted by clause 2 of the Ministerial Determination 4: Expanded Public Works Programmes promulgated on the 4th of May 2012, in terms of section 50 of the Basic Condition of Employment Act, of 1997 (“the BCEA”). Copy of the Ministerial Determination is attached as an annexure to this response, for ease of reference.

It is essential to be cognisant of the fact that in the Public Service, the creation, grading and filing of posts is regulated in terms of the Public Service is the Public Service Act, 1994, as amended and the Public Service Regulations, 2016, as amended contrary to the Regulations that support the EPWP above.

In terms of Section 3 (5) (b) of the PSA, the authority to create, grade and abolish posts vest on the executive authority and the EPWP, does not occupying an existing post created and funded by the Department.

END.

Reply:

(1) (a) The province does not regard this as a failure to ensure availability of sufficient facilities as situational analysis was conducted and several reasons were identified for not being able to expand the Termination of Pregnancy (ToP) services in the province:

1. Infra–structure challenges in some institutions, no space to establish new or additional services including TOP services;
2. Clinicians (professional nurses and doctors) left the services due to various reasons (retirement, transfers, promotions and self-advancements);
3. Health systems pressures such as the need for continuous frontline support service and increasing demand for the services.

(b) Eastern Cape implemented the following interventions to ensure availability of services at facilities:

1. In 2021 Eastern Cape conducted training targeting clinicians (professional nurses and doctors) from facilities not providing the ToP services;
2. Provincial support visit for ToP providers conducted in 2020/2021.
3. Debriefing workshop are conducted (excluding disruptions during Covid-19 pandemic) and for the current financial year it is currently underway (23- 25 March 2022) which will be followed by value clarification workshop in August/September 2022, targeting managers of the facilities not providing ToP services.

National Department supports provincial efforts through the Deputy Minister’s awareness campaign where Eastern Cape will be visited in April/May 2022, sensitizing public on the availability of ToP services and package of Sexual and Reproductive Health (SRHR) services as a whole.

END.

Reply:

The National Department of Health is still collating this information from the provinces. As soon as information is received from all the provinces, the Minister will consolidate the response and submit to the Honourable Member and Parliament.

 

END.

Reply:

a) The current status of the specified circulars, as provided by the Council for Medical Schemes (CMS) is as follows:

(i) The Council for Medical Schemes issued circulars 80 and 82 in December 2019 based on two sets of research results at its disposal at the time. The main message contained in these circulars was a message to the industry that was indicating that the exemption that had been granted to the primary insurance products that had applied to the CMS, previously may not be granted again at the end of March 2021, if there were no significant improvement and changes made to them. The exemption that had been granted to these products at the time was done in April 2017 and was expiring in March 2019. The responsibility for the granting of these exemptions lies with the governance body of the CMS upon advice from the Registrar and team and is based on the Exemption Framework that was developed between the Council for Medical Schemes, National Treasury and the National Department of Health.

(ii) The first set of research results is based on a study that was commissioned by the CMS and was conducted by a group of economists. The results of this study were released by the CMS in a circular at the end of March 2019 indicating the undesirability of these primary insurance products and the Low-Cost Benefit Option in the medicals schemes industry. These results can be briefly summarised as follows:

• These products are targeting individuals that are already tax-exempt based on their low income. Expecting these individuals to spend more of their remaining disposable income contributing to health products with thin benefits did not make sense;

• The introduction of the Low-Cost Benefit Option and related products will be adding yet another set of benefit options in an industry with too many options that are already making rational purchasing choices difficult for the consumer. This goes against the Health Market Inquiry recommendations;

• The Low-Cost Benefit option will also require some tax subsidies and credits and further burden the fiscus during a period of economic constraints;

• There is no evidence that these options will ensure that relief is provided to the over-burdened public health system, given the fact that their beneficiaries still largely rely on the state for the provision of the greater part of their health benefits.

(iii) The second set of results indicated that the primary health insurance products that were subjected to an analysis had serious structural shortfalls. These can be summarised as the following:

• The greater part of the contribution made by policyholders was spent on broker fees and administration instead of the relevant health benefits;

• The marketing of these primary insurance products was clearly misleading, promising unlimited GP consultations when in fact the entitlements are no more than 3 per annum;

• These products were experienced very low claims simply because their members were not aware of the extent of their benefit entitlements.

(iv) The impact of circulars 80 and 82 on the primary insurance products that are in the market has been minimal as no product was discontinued as a result of these circulars. The facts are:

• The CMS undertook an extensive stakeholder roadshow following the issuing of circulars 80 and 82. These engagements took place in the greater part of January and February 2020;

• The agreement with the key stakeholders was that further engagements were necessary and that a Low-Cost Benefit Framework will need to be developed that will assist these primary insurance products to migrate into the medical schemes’ environment;

• There was also an appreciation that the regulator cannot perpetually exempt these primary insurance products from complying with the Medical Schemes Act and its Regulations as this is the only legislation that is at its disposal for regulatory purposes.

• The engagements in these Advisory Committees are proceeding well and have included 3 workstreams:

• Schemes and administrators
• Insurance providers and brokers
• Service providers, policyholders and consumers.

(v) Circular 56 of 2015 provides a summary of input received on the classification of managed care services. This circular has no bearing on the ability of low-earning households to have access to quality medical care other than providing a guide for medical schemes to report better-managed services. However, a more relevant circular to low-earning households' affordability of care is circular 56 of 2020;

(vi) The objective of Circular 56 of 2020 was to provide an overall update regarding establishing the LCBO Advisory Committees and developing the Low-Cost Benefit Guidelines and notice of extension of exemption period to 31 March 2022. The Advisory Committees were tasked with addressing the challenges faced by primary health insurance providers in complying with the Medical Scheme Act:

• The need for medical schemes to develop options for low-income earners;
• They would also develop a roadmap leading to the end of March 2022;
• Provide inputs on the LCBO framework before the CMS submits it for approval to Council and final approval by the Minister of Health;
• The Charter and Code of Conduct were issued to nominees during June/July 2020;
• A regulatory workshop with the National Department of Health, National Treasury, Prudential Authority, Financial Sector Conduct and the Council for Medical Schemes was held on 29 September 2020;
• Introductory workshops were held with interested parties and nominees during October 2020, whereafter the Charter and Code of Conduct was adopted.

(vii) The Advisory Committee's work entailed the establishment of four technical workstreams that provide technical support to the advisory committees in the development of an LCBO framework and guideline. The scope of work for each workstream is summarised below:

• Workstream 1 - Market / Affordability

• Needs assessment/Quantity market/affordability issues;
• The market needs assessment report issued on 8 September 2021 for comments by committee members

• Workstream 2 - Benefit, Product and Pricing

• Benefit design, package and price;
• Key discussions on the minimum products considered against the GEMS Sapphire option has been started as a reference point; key factors need further discussion: Direct access to healthcare nurse with GP, mediation EDL approach or diagnostic definition conditions, dentistry, and optometry are significant affordability constraints and the question on whether private honour should be excluded.

• Workstream 3 - Compliance & Legislative requirements

• Enabling environment and legal framework;
• Key policy considerations: Medical Schemes Amendment Bill; Health Market Inquiry; NHI
• A legislative comparison indraft has been done to identify which legislative framework would be the best outcome for insurers conducting the business of a medical scheme

• Workstream 4 - Implementation Plan & Risk

• Development of a risk matrix/roadmap for LCBO
• Risk framework discussion, Timeline and Risk matrix discussion workbook developed

(b) Herewith the summary of engagements that took place between 2020-2021:

1. February 2020- LCBO Engagements with Industry
2. March 2020- Engagements with NT on LCBO & Demarcation
3. October 2020 - 1st Joint Advisory Committee meeting
4. December 2020 - 2nd Joint Advisory Committee meeting
5. January 2021 – 3rd Joint Advisory Committee meeting
6. June 2021 – 4th Joint Advisory Committee meeting
7. November 2021 – 5th Joint Advisory Committee meeting

All the above stakeholder engagements and Advisory Committee consultative processes emanated from the concerns raised by stakeholders following the publications of Circulars 80 and 82.

• The current engagements on the LCBO stem from the regulatory non-compliance with the provisions of the MS Act, section 20(1), given the implementation of the Demarcation Regulations;

• The technical workstreams have developed position papers that will form a basis of an LCBO framework and guidelines and will be submitted to the Registrar and Council once finalised;

• The exemption period of insurers conducting the business of a medical scheme, which was granted from 1 April 2019 to 31 March 2022 will terminate on 31 March 2022. Input from the National Department of Health, National Treasury, Financial Sector Conduct Authority, and the Prudential Authority was sought to allow for extending the exemption period by a further two years, from 1 April 2022 to 31 March 2024. Further details are contained in Circular 9 of 2022;

• This extension was granted to ensure continued cover for members currently covered by the existing exempted insurance products. Furthermore, to allow for the finalisation of the LCBO framework and recommendations.

The recommendations will be submitted to the National Department of Health for final approval.

END.

Reply:

Molnupiravir and Paxlovid® (ritonavir-boosted nirmatrelvir) are oral antiviral agents that have been reviewed by the National Essential Medicines List (NEML) Ministerial Advisory Committee (MAC) on COVID-19 Therapeutics for the treatment of COVID-19 in ambulant patients.

The current rapid reviews or advisories, based on available published evidence at the time are accessible from the National Department of Health website. As evidence on COVID-19 therapeutics is emerging rapidly, the MAC on COVID-19 Therapeutics reviews are routinely updated when new evidence becomes available. The MAC on COVID-19 Therapeutics considers a range of factors apart from efficacy and safety when making recommendations.

The rapid review of molnupiravir, issued on 20 December 2021, was based on the available published evidence at the time which was a single randomised controlled trial by Bernal et al. (2021). Based on this data, a conditional recommendation was proposed by the MAC on COVID-19 Therapeutics that molnupiravir not be used for the management of COVID-19 in ambulant unvaccinated patients.

However, in March 2022, more information has been released by the World Health Organization (WHO) in the form of a supplement to the published WHO living guidelines: Safety and efficacy of molnupiravir compared to standard care/placebo. The NEML MAC on COVID-19 Therapeutics will thus be reviewing this additional evidence to update the rapid review. Based on this new data, the recommendation may or may not be revised.

Similarly, for ritonavir-boosted nirmatrelvir (Paxlovid), a conditional recommendation was proposed against it’s use for the treatment of COVID-19. The evidence base for the rapid review report dated the 14 March 2022, was a single randomised controlled trial of ambulatory unvaccinated adult patients with confirmed COVID-19, who were at high-risk for progression to severe COVID-19. This antiviral has the potential for many drug-drug interactions (including anti-epileptic and anti-diabetic medicines, protease inhibitors amongst others) and therefore given the potential safety risks associated with its use patient and healthcare worker- education would be required.

Products have yet to be registered in South Africa, and the NEML MAC on COVID-19 Therapeutics will be updating the review, when there is more information on the availability and pricing of generic products.

Both antivirals requires rapid access to definitive diagnosis and initiation within five days of the onset of symptoms and is contra-indicated in pregnancy, requiring women of childbearing potential to take effective contraception.

However, it is important to note that these oral antiviral formulations do not replace vaccination for prevention of COVID-19, but as treatment, once infection occurs.

END.

Reply:

The oral antivirals, Molnupiravir and Paxlovid® (ritonavir-boosted nirmatrelvir), are indicated for use in the treatment of COVID-19 infections. These antivirals are indicated for use in ambulant patients and not in patients with more severe disease. Therefore the benefit of these agents for widespread use requires careful consideration as not all patients would be eligible to receive these traetmnets. Furthermore, the clinical trials for both agents were conducted in the unvaccinated population.

Additionally, Paxlovid is associated with significant drug-drug interactions with many commonly used agents in the management of comorbidities such as diabetes, epilepsy and HIV, i.e. high risk populations for COVID-19 infections. Significant training will be required to ensure its safe use in the target populations.

The aim of vaccination is to prevent morbidity and mortality. Vaccination has been proven to be a key intervention to prevent infections, or the severity of infections, in order to reduce the loss of life and to mitigate the public health and economic impact of the pandemic and end the acute phase of the global pandemic.

END.

Reply:

The National Department of Health is still sourcing this information from the provinces. As soon as this information has been collated, it will be furnished to the Honourable member and Parliament.

END.

Reply:

According to the information received from the Free State Provincial Department of Health, Pelonomi Hospital has a total number of 2 053 approved posts in their Establishment/Organogram. Currently, 1 573 posts are filled and 484 posts are vacant bringing the vacancy rate to 23.6%. The Province has processed and finalized the filling of 108 posts in various occupational classes from 1 April 2021 to date, as steps to bring down the vacancy rate at the Hospital to enhance service delivery.

Further to the above, through a process of prioritising posts; Management of in the Hospital, has identified 116 critical posts in various occupational classes (i.e. Ranging between administrations to clinical posts) to be filled during the 2022-2023 financial year.

The process of filling these critical posts has commenced and submissions are underway to approve advertisements and administrative processes to fill the posts.

 

END.

Reply:

The National Department of Health is working with the North West Provincial Department of Health to obtain the details that the Honourable Member is requesting. The full response will be provided to the Honourable Member as soon as it is finalised with the North West Provincial Department of Health.

END.

Reply:

The clinic in Mabeskraal is functional. The cleaning materials have been provided and the monitoring system put in place to ensure continuous supply and availability.

The facility has a total of 43 toilets, 15 non-functional toilets have been attended. The remaining toilets process will be completed by the 15th of April 2022. The delay was due to replacement of the old plumbing system (complete flush master units) as they are worn out and problematic to repair. The current process is to replace the whole plumbing system.

END.