Questions and Replies

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:

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.

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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.

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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:

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:

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.

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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.

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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).

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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.

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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:

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%

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

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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.

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Reply:

Vaccines are intended to prevent infection or reduce the severity of infection when it occurs. Most vaccines used in the prevention of illnesses are injectable.

In contrast, oral antiviral therapies are generally indicated for the treatment of infections when they occur. Therefore, the purpose of the vaccine compared to oral antiviral therapies are different, and they should not be considered as alternatives.

The role of the National Department of Health is to identify medicines which are safe, effective, cost-effective and affordable for inclusion in the Essential Medicines List. Medicines on the list are then procured for use in the public sector. To date, no antivirals against Covid-19 have met the criteria to be included on the Essential Medicines List.

Manufacturers are responsible for decisions regarding where medicines are manufactured. One of the key considerations that will inform the viability of local manufacturing is the volumes that may be intended for use that will produce the economies of scale leading to affordable prices. The required volume is informed by the size of the population that will benefit from a particular therapy.

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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.

 

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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:

The National Department of Health is still trying to get the necessary information from the Gauteng Provincial Department of Health. The response by the Minister will be furnished to the Honourable Member as soon as the report has been received from the Gauteng Health MEC on this matter.

END.

Reply:

The National Department of Health is working with the National Health Laboratory Service (NHLS) to obtain the details that the Honourable Member is requesting. This information is being finalised and will be furnished to the Honourable Member as soon as it is finalised, in the next week or so.

END.

Reply:

(1) (a) (i) The National Department of Health has followed and conducted all due process required in the disclosure of financial interests by designated categories of employees and found no one doing business with the Department.

(ii) Information related to Provinces is not readily available and will be submitted once received.

(b) (i) Not applicable.

(ii) Still awaiting information from Provinces.

(2) Yes, all SMS members submitted their declarations of interest during the regulated time (01 – 30 April 2021).

(a), (b), (c) Not applicable.

(3) (a) The National Health Department completed ninety five (95) investigations.

(b) National Health Laboratory Service completed Eleven (11) investigations.

(4) Yes, NDOH 91 cases - employees issued with final and written warning and 4 cases disciplinary action to be instituted against the employees. NHLS recommendations for ten (10) out of eleven (11) investigations were implemented. The outstanding one is still in progress as outlined below:

No	Investigation	Outcome	Recommendations	Implemented recommendation
1.	Allegations that the Area Manager in Eastern Cape Region was appointing her relatives (Nepotism)	Substantiated	Disciplinary Action against Area Manager and implicated staff	Disciplinary Action is in progress

 

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) There are five (5) vacant Professional Nurses posts which are in the process of being filled, to mitigate the understaffing, namely: three (3) vacant General Nurses posts and two Clinical Nurse Practitioners posts.

(b) Gauteng Department of Health did prioritize the project of constructing a new Stanza Bopape Community Health Centre on the current site. The design or layout plan, however, requires additional land. There is land available behind the current structure. Submissions were made to City of Tshwane Metropolitan to acquire additional land and this process is still not finalized.

END.

Reply:

a) (i) The National Health Insurance (NHI) Pilot Programme took place over a five year period starting in the 2012 / 2013 financial year and concluding in the 2017 / 2018 financial year. The 1% decrease in the budget has no effect on the programme that was concluded four(4) years ago.

(ii) Any budget decrease reduces the amount of care that the health sector is able to provide. The NHI is a reform that will take time and that is to be phased in. The reduction of allocations will not impact the rollout of the NHI programme but it will negatively impact health care for those who use the public health system.

b) (i) Programme 3: Communicable and Non-Communicable diseases is the most affected by the decrease.

(ii) The decrease is mainly due to a reduction in the allocation to procure COVID-19 vaccines because sufficient stock were obtained during 2021 for the vaccination programme.

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.

Reply:

The following are names of Primary Healthcare Facilities that will be completed by end 2021/22 financial year.

Province Owner	Facility Asset Name	Project Name
Gauteng (GT)	Greenspark Clinic	Greenspark Clinic-Construction of new Clinic-ID
KwaZulu - Natal (KZ)	Chwezi Clinic	Chwezi Clinic: Supply, Installation and Commissioning of Park Home Unit
Mpumalanga (MP)	Pankop Clinic	Construction of new Pankop Clinic and 2 x 2 accommodation units at Pankop in Masobye Village
North West (NW)	Gateway Clinic	Gateway Clinic Parkhome
Northern Cape (NC)	Bankhara/Bodulong Clinic	Facility Replacements: Bankhara Bodulong Clinic
Western Cape (WC)	Avian Park Clinic (NEW)	Worcester - Avian Park Clinic - New
Western Cape (WC)	Khutsong South Clinic	Khutsong South Ext2 Clinic-Construction of new Clinic-ID
Western Cape (WC)	West Rand District Clinics	West Rand District Clinics - Electro
Western Cape (WC)	Ekubungazeleni Clinic	Ekubungazeleni Clinic - Re-route existing sewer line & upgrading the existing septic tank
Western Cape (WC)	Hlathi Dam Clinic	Hlathi Dam Clinic: Replacement of Existing Sewer System
Western Cape (WC)	Impilwenhle Clinic	Impilwenhle Clinic (Imbal)- New borehole.
Western Cape (WC)	KwaMashu Poly CHC	KwaMashu Poly CHC - Replacement of Fencing
Western Cape (WC)	Mazabeko Clinic	Mazabeko - Replacing of Existing Sewer system
Western Cape (WC)	Ndwedwe CHC	Ndwedwe CHC - Construction of medical waste area
Western Cape (WC)	Nondweni Clinic	Nondweni Clinic - Replacing of Existing Sewer system
Western Cape (WC)	Ntabeni Clinic	Ntabeni Cinic - Replacement of perimeter security fencing
Western Cape (WC)	Oqaqeni Clinic	Oqaqeni Clinic - Replacement of Fencing
Western Cape (WC)	Underberg Clinic	Underberg Clinic (Pholela CHC)- New borehole
Western Cape (WC)	Heuningvlei Clinic	Replacement of Heuningvlei Clinic
Western Cape (WC)	Gansbaai Clinic	Gansbaai - Gansbaai Clinic - Upgrade and Additions (Alpha)
Western Cape (WC)	Laingsburg Clinic	Laingsburg - Laingsburg Clinic - Upgrade and Additions

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 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:

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:

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:

a) (i) (aa) 1

(ii) 0

b) (i) 1

(ii) 0

(c) The accused was due for retirement when the case was finalised at the CCMA which was in favour of the employee, therefore the disciplinary hearing did not happen as he was already out of the system. The department paid the compensation to the employee to the value R160 118.88 as result of the arbitration outcome.

END.

Reply:

The Honourable Member is advised that as this information is not readily available at the National Department of Health (NDOH), the Department is still working with the provinces to source this information. The full response will be furnished to Parliament as soon as we have obtained such from the provinces.

END.

Reply:

All viruses, including SARS-CoV-2, change over time. Most changes have little to no impact on the virus’ properties. However, some changes may affect the virus’s properties, such as how easily it spreads, the associated disease severity, its ability to evade the immune system, or the performance of vaccines, therapeutic medicines, diagnostic tools, or other public health and social measures.

1. The following variants of concern (as defined by the World Health Organization) of the SARS-CoV-2 virus have been found in South Africa during the Covid pandemic: Alpha, Beta, Delta, and Omicron. The Beta variant was dominant during the 2nd wave, Delta during the 3rd wave and Omicron during the 4th wave. Other variants, which have not been classified as variants of concern, have been detected in South Africa e.g. Eta, Kappa and C.1.2.

2. COVID-19 tests identify anitgens that are common to all variants, and the tests do not differentiate between different variants of the virus. Genomic sequencing is required to identify the variant of the virus which has infected an individual, and is only conducted on some of the specimens.

a) It is not usually possible to be certain as to which variant has infected each individual, although inference may be drawn based on the dominant variant at the time of infection. From a clinical perspective, this does not matter as the clinical management of the patient is the same, irrespective of the variant causing infection.

b) No

3. Not all viruses are sequenced, and therefore the number of persons infected with each variant is not known. However, based on genomic surveillance, whereby both routine specimens from all provinces and specimens of special interest are sequenced, it is possible to identify new variants as well as shifts in the variants causing COVID disease over time. Each of the waves of COVID infection has been associated with emerging dominance of a new variant. The first wave was associated with the alpha variant, the second with the beta variant, the third with the delta and the fourth with omicron.

4. The Network for Genomics Surveillance in South Africa, which includes the National Institute for Communicable Diseases, KRISP at the University of KwaZulu-Natal, University of Cape Town, Stellenbosch University, the University of the Free State, the University of Pretoria, the University of the Witwatersrand and the National Health Laboratory Service, continue to monitor and assess the evolution of SARS-CoV-2. Updates are published on a weekly basis on the NICD website (https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/sars-cov-2-genomic-surveillance-update/).

END.

Reply:

According to information obtained from the Provincial Departments of Health, the following Table reflects the details in this regard.

Province	All Surgical Operations
Free State	1718
Kwa-Zulu Natal	15395
Limpopo	5312
Mpumalanga	2687
Northern Cape	3830
North West	4871

We still await information from the Eastern Cape, Gauteng and Western Cape Provinces. This will be furnished to Parliament as soon as it is received.

END.

Reply:

The Honourable Member is advised that as this information is not readily available at the National Department of Health (NDOH), the Department is still awaiting specific details from the North West Provincial Department of Health to enable me to respond to the question. The full response will be furnished to Parliament as soon as we have obtained such from the Province.

END.

Reply:

The following table reflects the details in this regard, as received from the Limpopo Department of Health

NAME OF THE PROVINCE Limpopo	total cost of medico-legal claims Question 475 (1) (a)
2018/19 FINANCIAL YEAR
Limpopo	253 Cases R2 329 565 300.00
2019/20 FINANCIAL YEAR

Limpopo

249 Cases R2 537 110 500.00

2018/19 FINANCIAL YEAR
Limpopo	157 Cases R1 155 510 500.00

(2) Number of payments made for the period 2016 to 2021 is (a) 67, amounting to (b) R249,388,504.

END.

Reply:

The following table reflects the details in this regard, as received from the Limpopo Department of Health

Sekhukhune
Dilokong	4
Groblersdal	6
Jane furse	4
Matlala	1
Mecklenburg	2
Philadelpjia	7
St Ritas	2
PHC	2
Total	28

Mopani
Dr CN Phatudi	3
Evuxakeni	1
Kgapane	7
Letaba	10
Maphutha	2
Nkhensani	15
Sekororo	2
PHC	2
Total	42

Capricorn district
Botlokwa	4
Helen Frans	6
Lebowakgomo	8
mankweng	8
Pietersburg	21
Seshego	12
Knobel	3
Zebediela	1
PHC	3
Total	66

Vhembe
Donald fraser	2
Elim	11
Louis Trichard	8
Malamulele	7
Messina	5
Siloam	7
Tshilidzini	17
PHC	3
Total	60

Waterberg
Ellisras	1
FH Odendaal	4
Mokopane	7
Thabazimbi	1
Voortrekker	4
Warmbaths	4
PHC	4
Total	25

• (2) what steps is his department taking in terms of human resources, training and upgrading of infrastructure and equipment to ensure that there are no further medico-legal cases?
• Ans.
• The Department in conjunction with the University of Limpopo has begun to produce well trained health care professionals and doctors on annual basis to enter the job market and contribute in providing healthcare particularly to many rural communities in the Province. There is also training of specialists within the province through the many HPCSA recognised sites; these practitioners will be contributing actively in the improvement of services rendered.
• Infrastructure upgrades are currently being under taken in various healthcare facilities throughout the Province. New equipment is being procured e.g. MRI machine to be in stalled in the Pietersburg/ Mankweng Complex. These measures are anticipated to increase the overall quality of care which in turn will reduce future claims against the state.
•  

END.

Reply:

a) The Department of Health does not handle nor collect data of persons who have committed suicide. They are handled by the South African Police Service.

b) There are 19 976 beds available nationally to cater for mentally ill patients. This consists of 14 246 beds in public sector and 5 730 in the private sector.

c) (i) The Department of Health does not collect data on persons who have committed suicide.

(ii) Beds available for mentally ill patients in the public and private sector in each province are distributed as follows:

Province	Public Sector	Private Sector
Eastern Cape	1 864	1 088	2 952
Free State	920	298	1218
Gauteng	2 547	2 787	5 334
KwaZulu-Natal	3 200	385	3 585
Limpopo	1 492	38	1 530
Mpumalanga	258	0	258
Northern Cape	344	74	418
North West	1 256	186	1 442
Western Cape	2 365	874	3 239
Total	14 246	5 730	19 976

END

Reply:

(1) Urgent measures

a) Despite the known challenges of a strained fiscus associated with austerity measures in place to curb public spending; the Limpopo Department of Health has continued to prioritize appointment of,

(i)  Nurses especially midwives in high-risk areas such as maternity wards.

(ii) The Department has further attracted and appointed various Medical Specialists including paediatricians and paediatric surgeons to the Tertiary Hospital Complex.

b) Each facility in the province has adequate Oxygen supply which is routinely monitored and refilled. There were some Oxygen challenges during the peak of COVID-19 second wave however same was swiftly attended to and resolved.

c) The number of theatres currently available throughout the province remains a challenge and measures have been put in place to increase capacity which include a new Central Hospital which is in the pipeline.

d) The delivery rooms require appropriately trained staff to operate optimally. The Department is addressing this by prioritizing appointment of Midwives and appropriately qualified professional nurses in various institutions across the Province.

(e)-(f) Every child in the Province has a right to access to health care, the province however prioritizes all disabled children whether as a result of fault on the part of the Department of not. Furthermore, cases of proven malpractice by the Department results in such children receiving compensation to assist such children with further care including modification of family housing to accommodate a child with a disability.

(2) Intervention

Medical Malpractice claims have become a National crisis. A multipronged approach is required to adequately deal with this problem. It necessarily involves improving the quality of care throughout the country by having proper healthcare infrastructure supported by adequately trained healthcare professionals and a functional healthcare system. Limpopo Department of Health envisage the NHI to be a step in the right direction to address some of these challenges.

The Department has also called for an investigation into the rise of medical negligence cases through the South African Law Reform Commission with a view to introduce legislation that will prevent the collapse of the Health Care System because of uncontrollable litigations against the state.

 

The recently established intergovernmental national litigation forum is also envisaged to assist the Department in dealing with these cases appropriately.

END.

Reply:

a) The SA Health Products Regulatory Authority standard operating procedures and/or measures in place to strengthen controls relating to the preparation and review of financial and performance reports are as follows:

• Finance reporting standard operating procedure has been developed and implemented with standard excel templates to facilitate ease of capture and recording of information
• Business units are required to report on financial and performance management information on a monthly basis by the 7th of each month including upload of supporting evidence
• Supporting evidence is uploaded on an online share drive to prevent loss of information
• Consequence management has been implemented against officials not submitting within specified timeframes
• Internal audit performs quarterly audits on performance information for accuracy and completeness
• A project has been initiated to develop supporting records for audit purpose relating to unavailability of historical records. Listings are created from the bank statements for the 2018/19 and 2019/20 financial years to support the financial statement figures previously reported on. Application numbers are to be listed against the listings derived from the bank statement which will be linked to supporting evidence. The project is planned for completion before submission of the financial statements for audit purposes. Internal audit has been tasked to track progress made against the clearing of the remaining qualification.

b) Internal controls in place to review and/or monitor compliance with legislation relating to:

(i) Supply Chain Management (SCM) include the following:

• Review of SCM policies and alignment to applicable legislation
• Review of the delegation of authority specifically relating to procurement thresholds
• Development of a SCM standard operating procedure detailing step by step actions that must be performed during the procurement process accompanied by various standardized evaluation and compliance templates
• Development of an irregular, fruitless and wasteful operating procedure detailing step by step actions that must be performed to detect, report and corrective actions to be taken
• Filling of SCM vacancies
• Establishment of a panel of experts
• Internal workshopping of SCM process and SCM training provided to key role players
• Establishment of a loss control function and implementation of consequence management

(ii) Regulations regarding contract management include the following:

• Development of a contract management standard operating procedure detailing step by step actions that must be performed during the procurement process accompanied by various standardized evaluation and compliance templates
• Implementation of a contract register and checklist
• Review of the delegation of authority specifically relating to contract approvals and variations
• Weekly contract expenditure management implemented to update contract managers in advance of total spent
• Establishment of a panel of experts

END.

Reply:

1. (a)(i)(aa) The total number of doctors who were confirmed as having met the requirements of completing their degrees in December 2021 that made them eligible for medical internship for January 2022 are 2 419;

(a)(ii)(aa) The total number of Nurses who were confirmed as having met the requirements of completing their degrees in December 2021 that made them eligible for community service for January 2022 are 3 196;

(a)(bb) The total number of Interns who have completed their medical degrees and were eligible to be placed for medical internship in the Annual 2022 cycle are 2 419;

(a)(cc) The total number of community service doctors who have completed their medical internship and were eligible to be placed for community service doctors in the Annual 2022 cycle are 2 155.

(b) A total of 43 Medical Community Service doctors, 10 Medical Interns and 12 Community Services Nurses were placed, respectively into positions. However, they have since rejected their placements due to various reasons and therefore remain unemployed.

(b)(i)(ii)The budget for placing Interns and Community service Doctors and Nurses in the healthcare system have since increased from the year 2016 baseline with 75%, making the budget demand to be R 4 898 440 063.00 p/a. The increased numbers demanding additional positions for placements, are due to returning medical students who studied in Cuba through the Nelson Mandela Fidel Castro (NMFC) Programme and additional intakes by local Universities, (b) the National Department of Health, had to approach National Treasury to introduce new funding as Human Resources Training Grant (HRTG) to cover the shortfalls as Provincial Departments of Health were unable to the shortfalls demands within their equitable share budgets.

END.

Reply:

The National Department of Health is indeed the custodian of Health Services in the country, the Constitution has, in Schedule 4B, assigned some of the Health Services to Municipality later defined in section 1 of the National Health Act, 2003 (Act No 61 of 2003) as Municipal Health Services. The District Municipality is therefore responsible for the services but monitored and supported by both the Provincial and National Departments of Health.

The matter was investigated through the King Cetshawayo District Municipality lead by the Air Quality Management Unit in collaboration with the Environmental Health Unit (Municipal Health Services) thereof.

(a) The results of the investigations are as follows: There was no substantive or adequate information provided on the type of gas that was inhaled by the pupils during the interviews with the affected school (Richards Bay High School) and their neighbouring schools. The authorities could not access the main complainants through the Richards Bay Clean Air Association (RBCAA) Arboretum Station that would have provided adequate information on the type of fumes/smell experienced, times, duration and the areas (location). In addition, the available ambient monitoring data and emission data does not provide a conclusive source of emissions due to the reported symptoms not related to the monitored sulphur dioxide.

(b) The authorities to conduct a further investigation until the root cause is identified; availability of public awareness posters on how to log air quality complaints; conduct awareness in local schools on air quality. Fire, rescue and disaster management as well as the community are urged to log complaints through the authorities’ (City of uMhlathuze and King Cetshwayo District Municipality). The available complaints systems telephone numbers are 035 907 5000 and 080 011 1258 respectively).

END.