Questions and Replies

Reply:

(a) In the financial year 2021/22, there are no new irregular expenditure cases for the two quarters reported. 

There are 8 Irregular expenditure and 25 Fruitless and Wasteful expenditure cases registered from previous financial years. 

(b)  A total of 8 irregular expenditure cases are under investigations and 25 Fruitless and wasteful expenditure cases are pending investigation. 

(c)   None has been finalised to-date, but cases are reported to our Audit and Risk Committee on a quarterly basis to ensure regular oversight on irregular, fruitless and wasteful expenditure cases. 

Delays noted in finalizing cases are mostly due to Covid-19 and the move of the Department of Health offices from the Civitas building to Dr. AB Xuma building.  

 

END.

Reply:

Following receipt of the SIU Report (the Report) on 29 September 2021 the investigators appointed to assist the National Department of Health reviewed the Report and supplemented their legal opinion on proposed charges against implicated officials.  Charges were subsequently issued to all affected officials who are identified in the SIU and Ngubane Report’s and based on the advice from the investigators.  The Disciplinary Hearing for the affected officials has commenced and is currently underway. 

 

END.

Reply:

The details of the names and locations of the clinics are being collated in consultation with the Gauteng and the Eastern Cape Provincial Departments of Health. These details will be furnished to the Honourable Member and to Parliament as soon as they have been received from the provinces concerned.

 

END.

Reply:

a) Jane Furse Memorial Hospital started to experience water shortages following the illegal connections on the main line from De Hoop Dam by the surrounding communities. The Provincial Department of Health through Water Affair Department end up contracting a service provider drilled a borehole on site. Due to challenge with water table level around Jane Furse Hospital, the borehole ran dry. The Sekhukhune District Municipality left with no choice but to fill up the hospital water storage tanks through water delivered by the contracted service provider.

b) Jane Furse Memorial Hospital had been connected to De Hoop Dam from its existence and the borehole is also connected.

c) Jane Furse Memorial Hospital is not involved in any forms of contract but Sekhukhune District Municipality. The Hospital is responsible of paying monthly bills as per the meter reading to Sekhukhune District Municipality.

END.

Reply:

Yes.

a) The services provided by officials in the port of entry environment spans various areas, various legislation and some provided by the South African Health Products Regulatory Authority (SAHPRA). The nature of the various legislative mandates implemented in the border environment necessitated thorough assessment and engagements of the identified legislation to ensure relevant sections implemented within the border law environment are transferred to the Minister of Home Affairs. Engagements have had to be conducted with the Department of Home Affairs and the Border Management Authority office to ensure clear understanding of the intention so as to ensure BMA is adequately empowered with the correct provisions within the respective Acts. The SAHPRA has had to be engaged with respect to Acts enforced by the Entity and to receive their concurrence. Meetings between SAHPRA, Home Affairs and BMA have been facilitated by the department.

The department has been heavily involved in the Covid-19 response for the period under review, and that Port Health Service has been at the centre of the cross border monitoring and response to the pandemic in line with the Internaitonal Health Regulations. The Department has played a leading role in the response activities to mitigate against the spread of COVID-19 and strenghthening of our public health system in general. As we continue to respond to the COVID-19 pandemic, we experienced various challenges faced by ordinary South Africans and within our own work environment. It is my view that had things been normal, we would have responded much quicker to the section 97 proclamation as requested by the Minister of Home Affairs.

b) We await final response from SAHPRA, but are hopeful a response should be expected within the next month. It must be noted that SAHPRA has a Board and decisions are taken at the Board level. The meetings of the Board are scheduled on certain dates in a year. Fortunately SAHPRA is currently attending to the provisions of the Acts to be transferred to the Minister of Home Affairs.

 

END.

Reply:

The South African Nursing Council (SANC) as the regulator of nurses and midwives in South Africa, takes responsibility, amongst others, for –

• Setting and maintaining standards of education, training, and practice and

• Providing mandatory guidance and additional advice to people designing and developing education programmes

Gerontology Nursing/ Geriatrics is currently not listed as a Post Graduate Diploma (Nursing Speciality) programme. However, the content of Gerontology nursing/ Geriatrics is covered in the curricula of the legacy professional nurse qualifications, the new higher education 4-year Bachelor degree as well as the new 3-year diploma programme under the following exit level outcome:

• Provide nursing care throughout the lifespan in various healthcare settings of which the following criteria are evaluated:

• Preventive, promotional, curative and rehabilitative nursing care is provided to different age groups in various health care settings,

Based on the above information, all professional nurses trained whether through the legacy professional nurse qualifications and the new qualifications at higher education level are full capacitated to holistically nurse geriatric patients throughout the levels of care. All other categories of nurses work under the direct supervision of the professional nurse who guide the nursing process. Should there be specific gerontology nursing needs that have to be developed, the establishment can provide that by way of in-service training and continuous professional development.

END.

Reply:

1. The National Department of Health (NDoH) and the GCIS has worked together on a national information dissemination strategy, supported by a range of non-government partners. The strategy is informed through analysis of national and sub-national surveys and social listening, analysed by the Risk Communication and Community Engagement Committee of the NDoH and the multi-sectoral Demand Acceleration Task Team mandated by the NDoH. Together these structures have produced a variety of communication outputs, including:

• Mass dissemination of over 25 million information brochures in all 11 languages (distribution with the support of the PEPKOR group)
• Distribution of 300,000 posters in 14 languages through health facilities, retail stores and 40,000 spaza shops;
• Production and broadcast of radio public service announcements on 11 public radio stations and talk-shows and live reads on over 60 community radio stations;
• Production of videos for people with hearing disability and pamphlets in large print and Braille for people with visual impairment;
• Extensive use of social media through the use of both banners and voice clips in all 11 languages.

The use of this material has been mediated through partnership with trade unions, faith-based organisations, traditional and Khoi-San leadership, the business sector and community-based organisations. This is facilitated through the National Communications Partnership convened by GCIS. In addition, a number of other social partners have facilitated large-scale public communication and social mobilisation strategies, including the ‘Roll Up Your Sleeves” campaign and UNICEF outreach vehicles.

Working with these partners, the private sector and clinical operators of outreach programmes at SASSA queues, provincial departments of health have extended services to poorer, older people living in rural communities. It is particularly gratifying that the highest vaccination first dose coverage for people aged 60 years and older is in Limpopo (77%), closely followed by the Western Cape (70%), Eastern Cape (68%), Free State (67%) and KwaZulu-Natal (61%) respectively. It is of concern to the Department that the highest number of unvaccinated older people in fact reside in Gauteng, with over half a million people aged sixty years and older still to be vaccinated. This illustrates the fact that urban informal settlements and inner city areas should equally be regarded as national priorities.

 

The National toll-free COVID hotline is promoted in all communication as an accessible channel through which the public discuss/can get answers to questions and concerns re vaccination, registration/booking, side effects etc. In addition, Govt leads specific communication and engagement campaigns to maximise key moment uptake, or focus on key groups i.e. Vooma Vaccination weekend launched in October,  and Vooma III week scheduled for 3 to 10 December, linking pop up sites with Vooma media (community radio imbizos and talkshows and on the ground activation of community networks and stakeholders for imbizos and one to one discussions, Festive Season Noku Mashaba communication campaign launching on 13 December, through multiple communication channels: commuter TV, billboards, community and national radio PSAs,  digital banners, digital videos, posters and social media.

Zwakala #takeyourshot youth focused campaign led by community youth influencers, across multiple mass media channels and rapidly extending into community activations and micro level co-ordination around vaccination drives, TheTruck community engagement campaigns in collaboration with provincial departments of health, district health services and UNICEF,  a multimedia truck broadcasting local stories in local languages has visited multiple high risk areas in all provinces, to focus attention of local communities on real stories of COVID 19, and encourage them to engage with ground support teams and services around COVID prevention and vaccination  This adds to existing community engagement and door to door work conducted by provinces.

 

The national Vax Champs programme launched in November, invites everyone living in South Africa to sign up to become an ambassador for vaccination against Covid-19by by encouraging friends, family and neighbours to vaccinate. This will grow a network of local champions to lead the way to higher vaccination rates.

Vaccination of poorer, older persons living in rural communities:

• R200 Vooma Voucher (Checkers/Shoprite/USave) for every person over 50 who vaccinates for the first time during November/December
• Pop up vaccination sites activated through Vooma campaigns, in December will focus on shopping malls, taxi ranks and recreational areas, in addition to existing vaccination sites.
• NDoH campaign for youth to get older family members vaccinated.
• Young people in communities volunteering to assisting older persons to register/access vaccination e.g. Grandkids4Gogos.
• Involving the elderly tell their stories of vaccination in the stories broadcast on theTruck.

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

Province	District	Subdistrict	Total No of Individuals Vaccinated
Eastern Cape	Alfred Nzo	Matatiele LM	56117
Eastern Cape	Alfred Nzo	Umzimvubu LM	57755
Eastern Cape	Amathole	Amahlathi LM	37925
Eastern Cape	Amathole	Great Kei LM	10287
Eastern Cape	Amathole	Mnquma LM	68125
Eastern Cape	Amathole	Ngqushwa LM	19193
Eastern Cape	Amathole	Raymond Mhlaba LM	54348
Eastern Cape	Chris Hani	Emalahleni LM	35617
Eastern Cape	Chris Hani	Engcobo LM	40251
Eastern Cape	Chris Hani	Enoch Mgijima LM	80015
Eastern Cape	Chris Hani	Intsika Yethu LM	35129
Eastern Cape	Chris Hani	Inxuba Yethemba LM	21098
Eastern Cape	Chris Hani	Sakhisizwe LM	17292
Eastern Cape	Joe Gqabi	Elundini LM	36567
Eastern Cape	Joe Gqabi	Senqu LM	43327
Eastern Cape	Joe Gqabi	Walter Sisulu LM	25860
Eastern Cape	OR Tambo	Mhlontlo LM	48888
Eastern Cape	Sarah Baartman	Blue Crane Route LM	13550
Eastern Cape	Sarah Baartman	Dr B Naude LM	25911
Eastern Cape	Sarah Baartman	Kouga LM	34558
Eastern Cape	Sarah Baartman	Kou-Kamma LM	10512
Eastern Cape	Sarah Baartman	Makana LM	46295
Eastern Cape	Sarah Baartman	Ndlambe LM	16273
Eastern Cape	Sarah Baartman	Sundays River Valley LM	19808
Free State	Fezile Dabi	Mafube LM	10470
Free State	Fezile Dabi	Moqhaka LM	41052
Free State	Fezile Dabi	Ngwathe LM	28278
Free State	Lejweleputswa	Masilonyana LM	14156
Free State	Lejweleputswa	Matjhabeng LM	165221
Free State	Lejweleputswa	Nala LM	17612
Free State	Lejweleputswa	Tswelopele LM	17908
Free State	Thabo Mofutsanyana	Dihlabeng LM	98363
Free State	Thabo Mofutsanyana	Mantsopa LM	17315
Free State	Thabo Mofutsanyana	Nketoana LM	11677
Free State	Thabo Mofutsanyana	Phumelela LM	10440
Free State	Thabo Mofutsanyana	Setsoto LM	26445
Free State	Xhariep	Kopanong LM	24237
Free State	Xhariep	Letsemeng LM	9441
Free State	Xhariep	Mohokare LM	8126
Free State	Mangaung	Botshabelo SD	43328
Free State	Mangaung	Thaba N'chu SD	26697
Gauteng	Sedibeng	Lesedi LM	30662
Gauteng	Sedibeng	Midvaal LM	34739
KwaZulu-Natal	Amajuba	Dannhauser LM	15412
KwaZulu-Natal	Amajuba	Emadlangeni LM	5385
KwaZulu-Natal	Harry Gwala	Dr N Dlamini Zuma LM	31651
KwaZulu-Natal	Harry Gwala	Gr Kokstad LM	21176
KwaZulu-Natal	Harry Gwala	Ubuhlebezwe LM	28615
KwaZulu-Natal	King Cetshwayo	Mthonjaneni LM	11360
KwaZulu-Natal	King Cetshwayo	Nkandla LM	25250
KwaZulu-Natal	uMgungundlovu	Impendle LM	8758
KwaZulu-Natal	uMgungundlovu	Mkhambathini LM	13862
KwaZulu-Natal	uMgungundlovu	Mpofana LM	11545
KwaZulu-Natal	uMgungundlovu	Richmond LM	20912
KwaZulu-Natal	uMgungundlovu	uMngeni LM	37759
KwaZulu-Natal	uMgungundlovu	uMshwathi LM	19527
KwaZulu-Natal	Umkhanyakude	Big 5 Hlabisa LM	45860
KwaZulu-Natal	Umkhanyakude	Jozini LM	39606
KwaZulu-Natal	Umkhanyakude	uMhlabuyalingana LM	42313
KwaZulu-Natal	Umzinyathi	Endumeni LM	30232
KwaZulu-Natal	Umzinyathi	Msinga LM	29791
KwaZulu-Natal	Umzinyathi	Umvoti LM	25456
KwaZulu-Natal	Uthukela	Inkosi Langalibalele LM	45722
KwaZulu-Natal	Uthukela	Okhahlamba LM	22102
KwaZulu-Natal	Zululand	AbaQulusi LM	45325
KwaZulu-Natal	Zululand	eDumbe LM	15334
KwaZulu-Natal	Zululand	Ulundi LM	33722
KwaZulu-Natal	Zululand	uPhongolo LM	25392
Limpopo	Capricorn	Blouberg LM	56965
Limpopo	Capricorn	Lepelle-Nkumpi LM	67007
Limpopo	Capricorn	Molemole LM	34635
Limpopo	Mopani	Ba-Phalaborwa LM	44320
Limpopo	Mopani	Greater Giyani LM	74173
Limpopo	Mopani	Maruleng LM	44626
Limpopo	Sekhukhune	E Motsoaledi LM	82495
Limpopo	Sekhukhune	Ephraim Mogale LM	27245
Limpopo	Vhembe	Collins Chabane LM	61997
Limpopo	Vhembe	Makhado LM	139444
Limpopo	Vhembe	Musina LM	35627
Limpopo	Waterberg	Bela-Bela LM	24078
Limpopo	Waterberg	Lephalale LM	50594
Limpopo	Waterberg	Mogalakwena LM	111255
Limpopo	Waterberg	Mookgophong/Modimolle LM	42416
Limpopo	Waterberg	Thabazimbi LM	56965
Mpumalanga	Ehlanzeni	Bushbuckridge LM	150730
Mpumalanga	Ehlanzeni	Thaba Chweu LM	39159
Mpumalanga	Gert Sibande	Chief Albert Luthuli LM	39955
Mpumalanga	Gert Sibande	Dipaleseng LM	7464
Mpumalanga	Gert Sibande	Dr Pixley Ka Isaka Seme LM	12970
Mpumalanga	Gert Sibande	Lekwa LM	30997
Mpumalanga	Gert Sibande	Mkhondo LM	17138
Mpumalanga	Gert Sibande	Msukaligwa LM	46778
Mpumalanga	Nkangala	Emakhazeni LM	17010
Mpumalanga	Nkangala	Steve Tshwete LM	67574
Mpumalanga	Nkangala	Victor Khanye LM	18563
North West	Bojanala	Kgetlengrivier LM	15879
North West	Bojanala	Moses Kotane LM	64412
North West	Dr Kenneth Kaunda	JB Marks LM	80366
North West	Dr Kenneth Kaunda	Maquassi Hills LM	23957
North West	Dr Ruth Segomotsi Mompati	Greater Taung LM	36109
North West	Dr Ruth Segomotsi Mompati	Kagisano-Molopo LM	24018
North West	Dr Ruth Segomotsi Mompati	Lekwa-Teemane LM	14557
North West	Dr Ruth Segomotsi Mompati	Mamusa LM	16013
North West	Dr Ruth Segomotsi Mompati	Naledi LM	36651
North West	Ngaka Modiri Molema	Ditsobotla LM	60547
North West	Ngaka Modiri Molema	R Moiloa LM	53031
North West	Ngaka Modiri Molema	Ratlou LM	30624
North West	Ngaka Modiri Molema	Tswaing LM	26478
Northern Cape	Frances Baard	Dikgatlong LM	11806
Northern Cape	Frances Baard	Magareng LM	5917
Northern Cape	Frances Baard	Phokwane LM	19391
Northern Cape	John Taolo Gaetsewe	Gamagara LM	19338
Northern Cape	John Taolo Gaetsewe	Ga-Segonyana LM	43067
Northern Cape	John Taolo Gaetsewe	Joe Morolong LM	3410
Northern Cape	Namakwa	Hantam LM	9113
Northern Cape	Namakwa	Kamiesberg LM	3536
Northern Cape	Namakwa	Khai-Ma LM	6452
Northern Cape	Namakwa	Nama Khoi LM	19393
Northern Cape	Namakwa	Richtersveld LM	2749
Northern Cape	Pixley ka Seme	Emthanjeni LM	16908
Northern Cape	Pixley ka Seme	Renosterberg LM	350
Northern Cape	Pixley ka Seme	Siyancuma LM	7222
Northern Cape	Pixley ka Seme	Siyathemba LM	9357
Northern Cape	Pixley ka Seme	Ubuntu LM	6798
Northern Cape	Pixley ka Seme	Umsobomvu LM	9032
Northern Cape	ZF Mgcawu	!Kheis LM	221
Northern Cape	ZF Mgcawu	Dawid Kruiper LM	34303
Northern Cape	ZF Mgcawu	Kai !Garib LM	33835
Northern Cape	ZF Mgcawu	Tsantsabane LM	17278
Western Cape	Cape Winelands	Breede Valley LM	71510
Western Cape	Cape Winelands	Langeberg LM	35492
Western Cape	Cape Winelands	Witzenberg LM	48771
Western Cape	Central Karoo	Beaufort West LM	13220
Western Cape	Central Karoo	Laingsburg LM	2470
Western Cape	Central Karoo	Prince Albert LM	2950
Western Cape	Garden Route	Bitou LM	17872
Western Cape	Garden Route	George LM	72928
Western Cape	Garden Route	Hessequa LM	19894
Western Cape	Garden Route	Kannaland LM	8067
Western Cape	Garden Route	Knysna LM	31696
Western Cape	Garden Route	Mossel Bay LM	40162
Western Cape	Garden Route	Oudtshoorn LM	28566
Western Cape	Overberg	Cape Agulhas LM	13656
Western Cape	Overberg	Overstrand LM	44048
Western Cape	Overberg	Swellendam LM	13671
Western Cape	Overberg	Theewaterskloof LM	50439
Western Cape	West Coast	Bergrivier LM	23371
Western Cape	West Coast	Cederberg LM	26012
Western Cape	West Coast	Matzikama LM	20566
Western Cape	West Coast	Saldanha Bay LM	37267
Western Cape	West Coast	Swartland LM	39939
		Total	4969800

END.

Reply:

1. It can be confirmed that Pelonomi Hospital is maintained in accordance with a 5-year maintenance plan. The objective of the departments’ maintenance plan is to address maintenance backlog, user needs, clinical standards, and statutory requirements (as per the occupational health and safety act).

2. The department is reviewing the plan on an annual basis through the User Asset Management Plan and Infrastructure Programme Implementation Plan (IPMP). This is to allow for new activities that need to be added and escalation of costs.

3. (a) The hospital is experiencing shortages in beds due to the maternity ward not yet being complete. The contractor terminated when progress was still at 40% to complete due to poor workmanship. New contractor is expected to be on site by March 2022 for 14 months.

(b) Medicine Shortages experienced as per the table below:

Medicine Name	Suppliers
Amphotericin B	Waiting for Buy-Out
Acetylcysteine Vials	Equity not paid by depot
Ganciclovir 500mg vials	Waiting for Buy-Out
Nylon 3/0	Waiting for Buy-Out
Phenylephrine drops	Waiting for Buy-Out
Prontosan cleaning solution 350 and 1000ml	Waiting for Buy-Out
Tramadol 100mg ampoules	Waiting for Buy-Out
Sodium Valproate 400mg vials	Waiting for Buy-Out
Nylon 1/0	Waiting for Buy-Out
Soda Lime	Depot cancelled order and awaiting buy-out
AMIKACIN 100 MG	Waiting stock – Medical Depot (DDV)
Cefepime 1g and 2g	Waiting stock – Medical Depot (DDV)
SALBUTAMOL RESP SOL 5MG/1ML 20	Depot out of stock
FLUMAZENIL 0.5 MG/5 ML AMP	Waiting for Buy-Out
CARBIMAZOLE 5 MG TAB	Waiting Buy-Out
CLOTHIAPINE 40 MG TAB	Waiting Buy-Out
DIGOXIN 0.25MG 28'S 1 TAB	Depot out of stock
RINGER'S LACTATE SOLUTION 200	Waiting stock – B-Braun awaiting stock
Saline 50ml, 100ml and 200ml	Waiting stock – B-Braun awaiting stock
Paracetamol syrup	Barrs not being paid
Augmentin syrups	Sandoz not being paid
Aldactone tabs	Sandoz not being paid
Hydralazine 25mg	Sandoz not being paid
Hibiscrub and Steriprep	Barrs not being paid
Tuberculin PPD	Company out of stock
Actilyse	Awaiting buy-out
Artesunate	Equity not being paid
Midazolam 5 and 15mg	Worldwide problem

(c) Oxygen Shortages

There is currently no challenge with oxygen. All vacuum and oxygen points are serviced. The medical gas plant room was upgraded to provide the following capacity:

• Main tank = 19 500 Tons
• Standby tank = 8 500 Tons

Tanks were also furnished with sensors that are directly linked to Afrox supply chain platform. Afrox is thus informed when levels go beyond 50% and is then actioned to refill such.

(d) Theatre Beds Shortages:

There are currently 4 theatre beds shared between surgical and maternity. This shortage dur to the maternity Ward and its theatre still being under upgrade and renovation.

(e) Theatre Equipment Shortages:

The following equipment is required:

• Orthopaedic Drills = 6
• Operating Light with Camera = 6
• Anesthetic Machine = 3
• Dermatome = 2
• Tourniquet Machine = 4
• Autoclave for non-heat item = 2
• Mobile Suction Machine = 20
• Electrical Suction Machine = 10
• Theatre Chair = 18
• CMAC = 2
• Video System, Laparoscopic, General Surgery with Instruments = 1

1. f) General Medical Equipment Shortages

The following general medical equipment shortages exists:

• Cardiotocography (CTG) or Fetal Monitor = 15
• Transport Incubator = 3
• Hemodialysis Machine = 16
• Mobile Theatre Light = 2
• Dental Chair = 10
• CPAP Machine = 10
• Examination Light = 6
• Ultrasound (Sonar) Machine = 4
• Plaster (Cast) Cutter with Vacuum System = 6
• Defibrillator = 15
• AEEG Machine = 2
• Instrument Washer = 2
• Bronchoscope = 1
• Electrosurgical Unit Tester = 2
• ECG Simulator = 4
• Examination Couch, Paediatric = 4
• Electrical Safety Analyzer = 2
• Digital Bucky X-Ray Machine = 4
• Anesthetic Machine, MRI Compatible = 1
• Contrast Warmer = 1
• Injector Pump = 1

4. (a) Suppliers:

• Medical waste service provider is Buhle Waste.

• General waste service provider is Mangaung Metro Municipality.

• Recyclable waste: (e.g. white paper, card boxes and plastic cartons) the service is Waste Recyclers.

(b) Medical waste services are provided daily from Monday to Friday.

(5) No.

END.

Reply:

1. (a) (i) None

 (ii) None

(b) The total cost per student to date, depending on the Rand/Dollar Exchange Rate at the time of transfer, is reflected below and based on:

(i) Scholarship Programme, jointly funded by both Governments.

• Preparatory (one year) : $2000.00 per student
• 1st – 5th Year (per student) : $5000.00
• Stipend (per student per year) : $2400.00

(ii) Expanded Training Programme (ETP) is wholly funded by the South African Government is reflected in the table 1 below:

Table: 1

Level	Tuition Fees	Meals & acc.	Ave. cost Med. Ins.	Stipend
Preparatory	$6000.00	$6022	$450	$2400.00
1st – 2nd Year	$12, 500	$6022	$500	$2400.00
3rd – 4th Year	$11, 500	$6022	$500	$2400.00
5th Year	$13, 500	$6022	$600	$2400.00

(iii) Local Universities

Tuition fees at South African universities during the integration since inception until 2018 varies from one university to another. After the agreement signed with local universities, the cost of integration per student has been standardized since July 2018 and adjusted according to Consumer Price Index. Students have all to be in the clinical training platform for 18 months which translates into three (3) semesters. Additional costs included transportation of the final year students to local universities which depends on the mode of transport and distance to the university.

• July 2018 – June 2019 : R231 325.00 (R115 662.50 per semester).
• July 2019 – June 2020 : R241 734.63 (R120 867.31 per semester).
• July 2020 – June 2021 : R252 612.68 (R126 306.34 per semester).
• July 2021 – June 2022 : R260 696.28 (R130 348.14 per semester).

(2) Yes

This was a shortfall for the 2019/2020 academic period of students in Cuba. The shortfall was because the exchange rate baseline that was used in calculating tuition fees for students in Cuba was at R15 for the 2019/2020 academic period. Since the exchange rate escalated so much above the base line, this meant that the amount transferred to Cuba was lower than the amount received from Provincial Department of Health. The amount transferred to Cuba did not cover the total amount due.

(3) (a) (i)(ii)(iii) See Table 1 above

(iv) None known

(v) Additional costs include two return flight tickets per student during six years and/ or during a bereavement of next of kin.

(4) The department has just concluded an internal audit and reconciliation exercise from October 2021 to November 2021.The findings have been sent to Provinces for review and approval. Provinces have been requested to correct the findings by 17 December 2021.

 

END.

Reply:

The goals of the vaccination programme are to save lives by vaccinating those at highest risk of severe disease and death, and to vaccinate as many people as possible so that society and the economy can open up and resume full capacity, thus protecting livelihoods.

Herd or population immunity refers to a situation where a high enough proportion of the population are immune (as a result of natural infection or immunisation) that the virus is unable to circulate; as a result even those who are not immune are protected from infection. Whilst it was initially thought that herd immunity for Covid-19 was achievable, scientists now consider this unlikely because of factors such as vaccine hesitancy, the emergence of new variants and the delayed approval of vaccinations for children.

The immediate target of the vaccine roll-out is to ensure that at least 70% of adults have received at least one dose of vaccine. As of 2nd December, 41% of adults had been vaccinated. Sufficient vaccines and capacity to vaccinate are now available, and the main constraint to achieving higher vaccination coverage relates to poor uptake of vaccines. In response, a comprehensive Demand Acceleration Strategy has been put in place in an effort to generate demand and increase the number of individuals accessing vaccination. Key components of this strategy include:

Raising the profile of the vaccine roll-out

1. Vooma Vaccination weekends were held during October and November 2021. These included a national call to action led by the President, as well as other political, trade union, religious, traditional and other leaders. Events were also hosted by national, provincial and local leadership at vaccination sites.
2. Working with a range of stakeholders at national, provincial and local levels in order to mobilise communities through a range of activities including mobilisation at events (e.g. religious gatherings), in public spaces (e.g. taxi ranks) and through door to door campaigns.
3. Recognition of good performance at provincial and district level, and of outstanding performance by healthcare and other workers during Vooma Vaccination weekends.

Making reliable information regarding the safety and effectiveness of vaccines widely available

4. Increasing the availability of reliable information regarding vaccination through various media platforms including TV, radio and print media.

5. Improved signage at vaccination sites, and improving locally available information regarding location and opening times of local vaccination sites.

6. Monitoring and addressing misinformation circulating on social media.

7. Developing a network of local vaccination champions who volunteer to motivate those around them to vaccinate and report any problems with vaccination sites.

Providing incentives and rewards to vaccinated individuals

8. Limiting access to sports and other events to those who are vaccinated.

9. A pilot project whereby individuals 50 years and older can access a R100 (recently increased to R200) grocery voucher to offset any costs incurred through vaccination (e.g. transport costs).

10. Encouraging retail stores and other companies to provide rewards (e.g. entry to a lucky draw) for those who are vaccinated.

11. Consideration of making vaccines mandatory in some settings providing that these are implemented within the current legislative and regulatory framework.

Removing barriers to vaccination

12. Increasing the number of outreach and pop-up sites in an effort to take vaccinations as close as possible to people and communities.

13. Ensuring that as many sites as possible are open during weekends (especially but not exclusively during Vooma Vaccination weekends).

14. Pilot projects including provision of free transport to vaccination sites.

 

END.

Reply:

1. (a) Initially the National Department of Health (NDOH) anticipated that the adjudication and appeals process of the NFC Scheme would be complicated and onerous and that a retired judge would be better placed to oversee the scheme and adjudicate the appeals.  Upon re-assessment the NDOH has realised that the processes and caseload are not as complicated and burdensome hence the requirement for a retired judge and a Governance Oversight Committee has been done away with and this will reflect in the amended Regulations and Directions that will be published soon.  All oversight powers will now vest with the DG as the Accounting Officer of the NDOH.

(b) No committee members have been appointed on the basis that the Governance Oversight Committee will no longer be required.

(c) See (a) and (b) above.

2. (a)-(b) The disbursements will be done by the NDOH.  Disbursements will be made once claimants have been able to establish a causal link between the vaccine and the injury.  This will be assessed by the National Immunisation Safety Expert Committee and the Adjudication Panel will set the quantum.

3. The NDOH is not able to provide a list of nominated candidates for the Governance Oversight Committee since the Committee was never established based on the reasons outlined above.

END.

Reply:

Yes. The Department has the National Mental Health Policy Framework and Strategic Plan.

The number of people with severe mental disorders who do not receive the care, treatment and rehabilitation for their mental health conditions is not only high in South Africa but across the Low and middle-Income Countries. The Department of health has developed a plan to improve access to mental health services in the country and to ensure that people living with mental health conditions receive the care they need.

The plan is derived from the provisions of the Mental Health Care Act, 2002 (Act No 17 of 2002), which among others, aims to make comprehensive and quality mental health care, treatment and rehabilitation services available to the population equitably, efficiently, integrated at all levels, and in the best interest of mental health care users, within the limits of available resources.

The National Mental Health Policy Framework and Strategic Plan ,which is being updated and reviewed, further provides a blue print for strategic interventions to improve access to mental health services for the general population.

The details of the plan includes:

1. Mental health promotion and prevention of mental illness initiatives, which are not restricted to the Health Department, but integrated into policies and plans of relevant sectors, such as Social Development, Education, Correctional Services and other stakeholder departments.
2. Integration of mental health into all aspects of general health care across all levels of the health system to reduce the burden of untreated mental health conditions.
3. Ensuring that psychotropic medication as provided on the Standard Treatment Guidelines and the Essential Drug List (EDL) are available at all levels of health care.
4. Strengthening district based mental health services through establishment of district specialist mental health teams to ensure comprehensive services and integration at primary health care.
5. Enhancing institutional capacity and governance through establishment of Mental Health Review Boards in all provinces. These are quasi-judicial structures appointed by the Members of Executive Councils as prescribed in the Mental Health Care Act, 2002 (Act No 17 of 2002), to oversee that the human rights of mental health care users are upheld.
6. Improving human resource capacity for mental health services and training of health professionals including ongoing routine supervision and mentoring at all levels of the health system.
7. Strategic purchasing of services from health professionals through the NHI Conditional Grant to improve capacity for early identification, diagnosis, treatment and referral, at Primary Health Care including forensic mental health services.
8. Improving infrastructure for mental health services in Primary health care facilities, general hospitals and specialized psychiatric hospitals.
9. Development of community mental health day care and residential care facilities for people with severe mental illness and severe or profound intellectual disability
10. Strengthening Inter-sectoral collaboration to address the social determinants of mental illness
11. Ongoing surveillance and research on mental health services in the country. The Department recently conducted research on the evaluation of the health system cost on mental health services and programmes in the country; and on the mental health investment case to inform evidence based mental health plans and programmes.

END.

Reply:

10 In 2018, Ministers of Health and of Police met to discuss safety and security challenges emanating from the incident where a Dr was shot at in Limpopo at Letaba Hospital. It was resolved that an inter departmental task team should be established comprising SAPS, PSIRA, DLE, SSA and all Provincial Security Managers to develop a safety and security strategy to address security challenges.

2. In this regard, a Task Team through National Joint Operational and Intelligence Structure (NATJOINS) developed a plan with the following deliverables:

• Development of security infrastructure norms and standards
• Memorandum of Agreement (MoA) between SAPS and Department of Health
• Deployment of Reservist at identified hot spot hospitals
• Development of a Health Security Dispensation
• Physical assessment of hot spot hospitals
• Normalisation of hot spot hospitals and safety of EMS practitioners

Progress to date

The following table reflects progress to date

Deliverables	Progress
Development of security infrastructure norms and standards	Done: Infrastructure Unit Support Systems (IUSS) was developed and Gazetted. This is a document developed for health facilities and provides norms and standards, which include security services.
Memorandum of Agreement between SAPS and Department of Health	Done: MOA for collaboration was developed and signed by both the Director-General of Health and the National Commissioner of South African Police Services
Deployment of Reservist at identified hot spot hospitals	Work in progress: Costing for the development of police Reservists was done, waiting for provinces to request for deployment when required
Development of a Health Security Dispensation (in-sourcing of security)	Work in progress: Dependent on inputs from provincial in-sourcing strategy and/or hybrid model, which would then be consolidated into a nation strategy. These are still outstanding.
Physical assessment of hot spot hospitals	Done: Assessments were conducted at all hot spot hospitals and recommendations were submitted to relevant HoDs for implementation.

 

3. In addition to the establishment of the task team by both Ministers (Health and SAPS), NDoH has established a team to facilitate the implementation of safety and security strategy emanating from NATJOINTS comprising South African Medical Association (SAMA), Medical Women Association of South Africa (MWASA), Provincial Security Managers and Organised Labour.

4. The National Department of Health internal team came up with the following action plan:

• Expand membership of the Forum to incorporate other key stakeholders.
• The Forum will be the sub-committee to the Technical NHC
• Provinces must submit their needs for intervention and indicate hotspots hospitals for deployment of Reservists, number and period for deploying the Reservists and lastly indicate if funding is available.
• Health Care Workers and In-house Security Officers must be trained while Private Security should be retrained every six months.
• Provinces to provide copies of their current Service Level Agreement (SLA) to NDoH which will help the Forum to develop a universal SLA.
• The Forum will develop standardized security services specifications.
• Provinces to conduct and provide capacity and competency database audits and submit to NDoH.
• Provinces must report security breaches to NDoH promptly on a continuous basis.

5. CONCLUSION

Both NATJOINTS task team led by SAPS and internal stakeholder’s security committee are meeting on continuous basis with the view to ensure that all provinces implement the strategy.

 

END.

Reply:

The health system has limited capacity to provide vaccinations in people’s homes. Factors that contribute to this include the fact that the vaccine must be administered by a health professional, that open vials of vaccine (5 doses) cannot be transported between different locations, that the vaccinee must be observed for 15 minutes (or in some cases 30 minutes) following vaccination and that emergency equipment must always be available during administration of vaccines.

Local health services are however encouraged to assist elderly and disabled persons who are unable to attend vaccination sites, including through provision of vaccination in people’s homes. Community health workers who visit households play an important role in establishing linkage between such persons and local vaccination sites.

Additional strategies used by the Vaccine Programme to reach elderly people include:

• Vaccination of people in congregate settings especially in old-age homes.
• Setting up outreach and pop-up sites at locations where older persons congregate such as at SASSA pay-points.
• Encouraging younger people to assist elderly people to access sites.
• Ensuring that all sites prioritise the elderly to avoid long waiting times.
• Piloting the provision of R100 grocery vouchers for older persons to offset costs associated with vaccination such as costs associated with transport.

END.

Reply:

a) Plans to address the hospital’s

(i) Infrastructural problems

The Northwest Department of Health currently focus on statutory and day-to-day maintenance on health facilities in Lichtenburg. Statutory maintenance budget is ring-fenced to focus on Heating Ventilation Air-Conditioning and Cooling (HVAC) and maintenance of standby generators and boilers.

(ii) Staff Shortage

Due to funding constraints, the Department finds it difficult to fill vacant posts and continue to year-on-year overspend on compensation of employees. The Department continues to engage both Provincial and National Treasury in this regard.

b) Costs of the plans to the department

The estimated cost at present associated with the replacement of Lichtenburg Hospital amounts to R1.2 billion. This excludes costs associated with maintenance to maintain operability of the current facility and to where possible extend its life.

c) Update on the progress regarding the implementation of plans

The Maintenance plan, to do upkeep of the existing hospital, is an ongoing activity and funded for every financial year. The new Lichtenburg hospital will replace the old General de la Rey Hospital and the dilapidated Thusong Hospital which is too old for renovation at an estimated cost of R1,2 billion. The following tasks have been completed by the professional team since 2017:

• Accommodation Schedule – The number of beds (wards) including the pharmacy, operating theatres, trauma unit, kitchen, laundry, mortuary, mechanical workshops etc. have been agreed to and signed off by the stakeholders. This forms part of the project brief.
• Acquisition of land – The Ditsobotla Local Municipality has committed to making land available for the project (refer to attached letter from the municipality).
• Environmental Impact Assessment – A record of approval from the relevant authorities have been received.
• Traffic Impact Study – A preliminary study has been done.
• Geotechnical Investigation – A preliminary soil investigation has been completed.
• Land Survey – A topographical survey of the project site has been completed.
• Hospital layout and designs – A layout of the hospital and the detailed designs are expected to be finalized by the department in 2022/23 financial year

d) What steps will he take to address implementation of the plans.

There is an emphasis on strategic alignment of the project in the Infrastructure Unit of the National Department of Health and the appraisal and prioritization of this capital project undertaken has received quite a bit of attention over the past years. A concerted effort in alignment is thus underway for this project to ensure full compliance to the National Treasury Capital Planning guidelines.

The National Department of Health via the Direct-Health Facility Revitalisation Grant will continue monitoring the progress of implementing plans associated with this new hospital.

END.

Reply:

a) (i) and (ii) Following extensive investigation and consultation between the National Department of Health (NDOH) and National Treasury to find a suitable model to distribute the funds, these two departments have resolved that the Fund will be administered within the NDOH. Treasury will transfer the appropriate allocation to the NDOH. The NDOH is in the process of establishing a unit that will administer the Fund, in consultation with Treasury and the Department for the Public Service and Administration (DPSA). The Director-General of Health as the Accounting Officer will oversee the governance and administration of the Fund.

b) See (1) above.

c) (i) and (ii) The prescripts of the PFMA will apply. Treasury and the Auditor General will also continue to exercise oversight over the Fund.

d) The Director-General of the National Department of Health.

END.

Reply:

a) The Department has put the following interventions in order to promote awareness on the dangers of diabetes:

1. The department has developed Information, Education and Communication (IEC) materials on the signs and symptoms of diabetes, prevention measures and identification of risk factors. These materials have been shared with all provinces and are available in all the clinics. The materials are also used by the Community Health Workers as well as Health Promoters as part of the wider reach to the public. This is done as part of the routine services at all platforms, including during the commemoration of Health Events and at community campaigns. The target groups for these messages include vulnerable persons such as the youth, older persons, and persons with disabilities.
2. The Department has developed material which is used by nurses to educate patients and promote health and wellness when patients attend routine health visits.

b) Interventions which demonstrate how access to proper care for patients with diabetes is created, among others include:

1. Additional to the interventions listed above, he department is also conducting screening for chronic diseases including for diabetes at health facilities as part of the routine services in all our clinics, at mobile health facilities and is offered at the general Health Counselling and Testing Campaigns during all public events.

2. The department has further developed policies, strategies and guidelines including Primary Care Adult, Standard Treatment Guidelines and Essential Medicine List on the prevention, and treatment of diabetes including on preventing complications.

3. The Department promotes that diabetes risks and care are integrated in the policies, strategies, and guidelines of other health programs to address amongst others: gestational diabetes and diabetes among TB patients. The integrated approach for diabetic patients with co-, and multi- morbidities is implemented through the Ideal Clinic service delivery platform.

4. The department also introduced the Centralised Chronic Medicine Dispensing and Distributing mechanism which ensures that the medicines are available and reach the eligible diabetic patients at points where they live and work.

5. There has been training of health care workers at all levels to enhance knowledge of diabetes and risk factors as well as to improve competencies when treating patients.

6. The department has also strengthened home and community-based care and support of patients with diabetes by community health workers.

END.

Reply:

a) Beds

The Department has no plan to increase the number of beds from the current baseline that we have. This is based on the fact that even during the third wave, which was the highest, the country never had shortage of beds and oxygen that was required for the management of Covid-19 pandemic. As an example, between the 12 and 15 July 2021, which was at the highest point of the third wave, the country had the following hospitalisation breakdown:

• The total admissions in Non-ICU Beds was 14 319 out of total General 108 805 beds (13% bed occupancy)
• There 2423 admissions in the ICU beds out of 5615 total ICU beds (43% bed occupancy)

This means that we have enough capacity based on the lessons learned from the third wave, and as such there is no need to increase the number of beds.

b) Additional Ventilators

Both private and public sector hospitals have received 14 292 ventilators from Solidarity Fund. These devices are in the hospitals and approximately 7000 have been used. This has left us with a strategic reserve in the event of the increase in the number of patients. The department has further received 5708 of the additional ventilators which is the reserve that is kept in the National Department of Health for further deployment in the event of further pressure that may arise.

c) Additional PPEs

PPEs are in the main consumable and as such they are dependent on the rate of use. The Department has a system for monitoring the Stock On Hand, which alerts the department to the areas of acute shortages. The department has budget which will be used whenever the PPE reach less than 70% at aby given time.

END.

Reply:

The following responses are as received from the nine provinces

a) Safety precautions and/or plans have been implemented nationally in hospitals to manage fires

• In Eastern Cape, fire safety is managed at hospital level. Fire safety has several role-players including Infrastructure/ Facilities/ Engineering and Occupational Health and Safety units in most hospitals. Some hospitals have fire safety in their disaster plans and some have unit / ward – based action cards for response to fire and/or evacuation plans.

• All Free State facilities are fitted with fire extinguishers and fire hydrants. The smaller facilities have fire extinguishers and the larger facilities e.g. Hospitals have fire extinguishers and fire hydrants.

• Safety plans and emergency preparedness plans are in place but in many facilities in Gauteng there are no approved disaster management plans by the local authority for hospitals and also no occupancy certificates. Fire and evacuation drills are done sporadically or not done at all.

• All institutions in KwaZulu-Natal have fire fighting equipment i.e. fire extinguishers (10538), fire hose reels (2756) and depending on the size of the institution fire hydrants (1152). Internal disaster management plans, which include fire evacuation plans are available and reviewed as necessary. Fire evacuation drills are conducted internally and documented. Fire departments from local municipalities are involved in major evacuation drills and also institutions acquire their inputs when reviewing fire evacuation plans. Fire safety training has been conducted for staff and some institutions have fire and alarm detection systems.

• Limpopo has trained fire wardens in every facility with the Fire departments providing support and training. Fire drills are conducted at each facility.

• Mpumalanga facilities have approved disaster and emergency evacuation plans. Risk assessments are being conducted inclusive of fire hazards and risks and control measures put in place. Local fire inspectors conduct fire inspections at facilities on invitation.

• Northern Cape has no approved disaster plan but emergency plans are in place and bi-annual fire drills are conducted at facilities.

• All hospitals in North West have floor plans and evacuation plans with trained fire wardens and fire drills performed. Inspections of hospitals were done by the Fire Departments of local authorities in 2021 and the recommendations are used to enhance the plans.

• The Western Cape has adopted the MIMMS systems for hospital preparedness for managing Major Incidents. MIMMS (Major Incident Medical Management and Support) is an internationally accepted system to manage such incidents. Hospitals have Major Incident Plans that also include managing a fire incident. The Office for Disaster Medicine at provincial level and the facility manager signs off on the plan. The plan is reviewed annually or after a major incident at the facility.

(b) Servicing of fire equipment

• Eastern Cape has a provincial contract for the fire safety equipment which includes the servicing of fire extinguishers and fire hydrants annually.

• In Gauteng fire equipment are serviced once a year in line with expiry dates – however there is a dependency on the Department of Public Works and Infrastructure.

• The fire equipment are serviced annually in Free State, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape and North West.

• Fire equipment at all facilities in all districts of the Western Cape are serviced through service level agreement (SLA) contracts. Each district has its own SLA contract and all fire equipment are serviced every 12 months according to applicable regulations and requirements.

(c) Breakdown in each province in terms of fire equipment checks in each of the past five financial years

• Eastern Cape could not collate the information as it is kept at facility level.

• It varied in different hospitals in Gauteng with 27 facilities reporting annual checks; 5 facilities were last assessed in 2020 and 4 facilities did not report.

• Free State and Limpopo have annual checks on the fire equipment.

• In KwaZulu-Natal, fire equipment checks form part of the monthly inspections by health and safety representatives.

• Mpumalanga has spent on average R2m per annum on fire equipment checks and maintenance.

• Northern Cape conducts monthly checks on fire equipment.

• North West has monthly checks by Occupational Health and Safety (OHS) representatives with quarterly inspections by the provincial OHS forum.

• Western Cape has spent on average R8m per annum on fire equipment checks and maintenance.

 

END.

Reply:

1. The number of vacancies at the Pelonomi Hospital in Bloemfontein, Free State, as drawn from the Persal System and confirmed by the province are as follows (a) Nurses – 113, (b) Doctor – 22, (c) Cleaners – 33, (d) Maintenance officials – 5, Administrative Officials – 4 and (f) Management Personnel – 21.

2. These posts were vacated between the periods September 2009 to May 2021.

3. Due to financial constraints in the Free State Province, the priority of filling vacant posts is given to clinical posts. The Department does that to avoid unauthorised expenditure on Compensation of Employees (COE) within the budgetary allocation (VOTE), in accordance with Treasury Regulation 8.3 read with the PFMA section 76(4)(b) and Treasury Regulation 9 read with PFMA sections 38(1)g and 76(2)(e).” The Department is also busy with a process of reviewing the Organizational Structures of Hospitals including Pelonomi and the process is already at an advanced stage. It is anticipated that some of these posts might become redundant.

4. In order to ensure that the Hospital services are not compromised, as a temporary control measure, the Department has appointed a committee that focus in identify posts that are critical for filling. Based on the recommendation of the said Committee, those posts are urgently filled on a contract basis as when the need arise (i.e. While the Organizational Structural review is underway). The department also makes provision for approved overtime as one of the measures in ensuring that service delivery is not compromised.

5. The department will make a statement on the matter once the process of the Organizational Structure review is completed, defined in line with the service delivery requirements.

END.

Reply:

a) The Digital Vaccination Certificate is a digital version of the paper vaccination card that can be verified by a third party through the scanning of the QR code to establish the validity of the Vaccination Certificate. Government does not intend to use proof of vaccination to regulate access to public sector services and facilities.

b) Within the borders of South Africa, the primary use of the vaccine certificate could be used for third parties to allow vaccinated people to access certain rewards or incentives. This may include access to events such as sports, entertainment, and religious events, or to benefit from discounts or other rewards (such as entry into a lucky draw) offered by retailers or other private businesses.

The Department of Labour and Employment is responsible for regulating workplaces. Government's current position is that employees should be encouraged to vaccinate. However, employers may require employees performing certain functions, where not being vaccinated poses a risk to the employee, other employees, or members of the public, to be vaccinated. All existing legislation and regulations must be followed in dealing with situations where employees chose not to be vaccinated. 

END.

Reply:

The Department of Health is taking serious precautionary measures by prohibiting hospital visits by the families of the patients that are admitted within the facilities because the threat of Covid-19 virus is still real. While the country in alert level 1, we remain concerned about the possible increase in infections especially because there are still a number of cases on infections that are reported through our laboratories, although very low.

END.

Reply:

According to the report from the Northern Cape Provincial department of health, the clinic that is referred to as Bloemanda is Masakane Clinic.  Masakhane Clinic has been without immunisations for children. This clinic does immunisations daily and this has been verified through stock visibility system which has not shown any stock outs for vaccines.

END.

Reply:

(1) The minimum requirements/competencies for senior management in the Public Hospital are as prescribed by the DPSA directive on minimum entry requirements for Senior Management Service (SMS).

Minimum Qualifications for entry into SMS positions

For a Director and Chief Director - an undergraduate qualification (NQF Level 7) as recognized by South African Qualifications Authority (SAQA) in Public Health/Management.

For Deputy Director-General and Head of Department – an undergraduate qualification and a post graduate qualification (NQF Level 8) as recognized by SAQA.

Minimum Years of Experience as an Entry Requirement into the SMS

SMS Level	Relevant Experience (wef 01 April 2015)
Entry (Level 13)	5 years of experience at a middle/senior management level
Level 14	5 years of experience at a senior management level
Level 15	8-10 years of experience at a senior management level
Level 16	8-10 years of experience at senior management level (at least 3 years of which must be with any organ of State as defined in the Constitution, Act 108 of 1996)

Pre-Entry Certificate into the SMS

A further requirement for appointment at SMS level is a successful completion of the Senior Management Pre-Entry Programme as endorsed by the National School of Government.

Competencies

Strategic Capability and Leadership; People Management and Empowerment; Programme and Project Management; Financial Management; Change Management; Knowledge Management; Service Delivery Innovation; Problem Solving and Analysis; Client Orientation and Customer Care; Communication; Sound Knowledge of the Relevant Legislation such as National Health Act, Public Finance Management Act (PFMA), Public Service Act.

(2) (a) (i) See the attached list (Annexure A)

(ii) Kindly see the attached list (Annexure A)

(b) None

(c) Not Applicable

END.

Reply:

Conclusive evidence regarding the duration of immunity following immunisation against Covid-19 is not currently available.

Vaccine effectiveness has been shown to be maintained over time for severe/critical disease, but does diminish for mild-moderate disease. The durability of a particular vaccine is dependent on the variants of concern circulating at the time, and the durability of the immune response of the primary vaccine series.

It is also currently not known whether immunity induced by one vaccine will last longer than that induced by others. The vaccine effectiveness of the Moderna, Pfizer and Johnson & Johnson vaccines has remained relatively stable over time for protection against hospitalisation and death. There have been mild declines in effectiveness over time for hospitalisation and death for older people and those who are immunosuppressed. This has led to recommendations to provide booster doses to older people and those who are immunosuppressed and health care workers.

Such recommendations are country specific. Although vaccine effectiveness has remained durable over time for severe/critical disease, vaccine effectiveness against infection declined in the USA in the period when the Delta variant became dominant as compared to the pre-Delta period. This has led to the recommendation to provide booster doses as mentioned above.

It is difficult to extrapolate evidence of vaccine effectiveness from other regions to South Africa for the following reasons:

• their vaccine programmes started 4-6 months before the South African programme
• different variants have dominated in South Africa
• the high HIV prevalence in South Africa.

In South Africa, durability of effectiveness of the Johnson and Johnson vaccine against severe/critical disease during the Beta and Delta period was demonstrated in health care workers through the Sisonke study. The durability of the Pfizer vaccine during the Delta period has also been demonstrated. Ongoing monitoring is required to measure the duration of protection following immunisation with these vaccines.

END.

Reply:

a) The Council for Medical Schemes (CMS) issued circulars 80 and 82 in December 2019 based on two sets of research results at its disposal. The main message contained in these circulars was directed at the industry 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 primary insurance products and low-cost benefit options (LCBO). This was based on research conducted by a group of economists on behalf of Council, indicating the undesirability of these primary insurance products and the Low-Cost Benefit Option in the medical schemes industry. These research results indicated that:

1. 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
2. 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
3. The Low-cost Benefit option will also require some tax subsidies and credits and further burden the fiscus during a period of economic constraints
4. 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 primarily rely on the state for the provision of the greater part of their health benefits.
5. The burden of disease in the lower income groups is often higher than your high income earners, and providing a low benefit option is counter-intuitive

 

The second set of research results indicated that the primary health insurance products that were subjected to analysis had serious structural shortfalls in the following areas:

1. The greater part of the contribution made by policyholders was spent on broker fees and administration instead of the relevant health benefits
2. The marketing of these primary insurance products was misleading, promising unlimited GP consultations when in fact, the entitlements are no more than 3 per annum
3. These products were experienced a significantly low claims ratio due to members were not aware of the extent of cover or benefit entitlements
4. These primary insurance products are also unlikely to reduce the over-burdened public health system on the basis of lack of comprehensive cover

b) The impact of circulars 80 and 82 on the primary insurance products in the market has been minimal as no product has been discontinued as a result of these circulars:

1. The CMS undertook an extensive stakeholder roadshow following the issuing of circulars 80 and 82. The purpose of these engagements that took place in the more significant part of January and February 2020 was to ensure that these primary insurance products demonstrate a significant shift towards complying with the Medical Schemes Act
2. The agreement reached 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
3. 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
4. The engagements in these Advisory Committees are proceeding well and have included three workstreams:

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

Circulars 80 and 82 of December 2019 and Circular 56 of 2015 have 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. 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 Schemes 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 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.

END.

Reply:

The information provided is for the 2020/21 and 2021/22 Financial Years. The 2020/21 Financial Year is an update of the information that was submitted in March 2021. The information submitted in March 2021 was for Five Financial Years from 2015/16 Financial Year to 2020/21 Financial Year. The Information on 2020/21 Financial Year is now updated as when the information that was submitted in March was before the end of the Financial Year hence the submission of the updated information of the 2020/21

2020/21 FINANCIAL YEAR

PROVINCE	NUMBER OF NEW CASES RECEIVED	AMOUNT CLAIMED BY THE PLAINTIFFS[1]
Eastern Cape	Outstanding	Outstanding
Free State[2]	47 Cases	R 512 674 171.29
Gauteng[3]	77 Cases	R 873 785 433-55
KwaZulu Natal	329 Cases	R 727 706 522.00
Limpopo	215 Cases	R 1 764 652 099.00
Mpumalanga	132 Cases	R 1 058 442 000.00
North West	66 Cases	R 469 960 350.00
Northern Cape	15 Cases	R 531 716 811.04
Western Cape	65 Cases	R 529 995 591.10
TOTAL

 

2021/22 FINANCIAL YEAR

PROVINCE	NUMBER OF NEW CASES	AMOUNT CLAIMED BY THE PLAINTIFFS
Eastern Cape	Outstanding	Outstanding
Free State	21 Cases	R 246 850 920.00
Gauteng	53 Cases	R 560 370 586-90
KwaZulu Natal	205 Cases	R 1 578 054 150.00
Limpopo	167 Cases	R1 498 238 059.00
Mpumalanga	69 Cases	R 472 379 000
North West	31 Cases	R 215 496 610. 00
Northern Cape	11 Cases	R 169 616 789.42
Western Cape	39 Cases	R 319 202 451.00
TOTAL

END.

iThese are the amounts that the Plaintiffs think they are entitled to and they are not the amounts awarded by the Courts. Most of these cases are defended by the Provinces and the final payment or award if any will differ from the claimed amount. ↑

iiThe information from Free State has been revised from 2015/16 Financial Years after data cleansing as follows: 26 cases for 2015/16, 34 Cases for 2016/17, 42 Cases for 2017/18, 42 Cases for 2018/19, 44 Cases for 2019/20 and 47 Cases for 2020/21. ↑

iii.The information for Gauteng has been revised to 77 cases. ↑

Reply:

Gauteng Provincial Department of conducted the investigation about the allegations made about the Tembisa decuplets and produced a report in this regard, that confirms that Ms Gosiame Thamara Sithole was never pregnant. It is therefore not necessary for the national Department of health to conduct further investigations. The report is confidential in terms of the law.

END.

Reply:

a) Gauteng

(i) Occupational Therapy services

There are seventy-nine (79) clinics that are situated in the townships in Gauteng that offer occupational therapy onsite and forty-four (44) on outreach basis

(ii) Speech Therapy services for children with speech challenges

There are seventy-nine (79) clinics that are situated in the townships in Gauteng province that offer speech therapy onsite and forty-four (44) on outreach basis for children with speech challenges.

b) Eastern Cape

(i) Occupational Therapy

There are fifty-one (51) clinics that offer occupational therapy on outreach basis that are situated in the townships in Eastern Cape Province.

(ii) Speech Therapy

There are seventy-nine (79) clinics that are situated in the townships in Eastern Cape province that offer speech therapy on outreach basis for children with speech challenges.

END.

Reply:

The Human Papillomavirus vaccination programme was implemented in South Africa in 2014 with the aim of reducing the incidence of cervical cancer. A recently published study showed that women - now in their 20s - who were vaccinated against HPV in England at age 12 or 13 years experienced an 87% reduction in cervical cancer compared to the expected rate among unvaccinated women[1].

The World Health Organization (WHO) recommends that cervical cancer, which comprises 84% of all HPV-related cancers, should remain the priority for HPV immunisation programmes. For the prevention of cervical cancer, the WHO-recommended primary target population for HPV vaccination is girls aged 9-14 years, prior to them becoming sexually active[2]. The South African HPV vaccination programme targets Grade 5 girl learners 9 years and older in public schools, and is therefore aligned with these recommendations.

Vaccination of secondary target populations (such as girls 15 years and older, and boys) is only recommended by WHO if this is feasible, affordable, cost-effective and does not divert resources from vaccinating primary target population or from effective cervical cancer screening programmes.

Global cost-effectiveness analysis informed by country-based evidence suggests that vaccinating pre-adolescent girls is usually cost-effective, particularly in resource-constrained settings where alternative cervical cancer prevention and control measures often have limited coverage. However, if the HPV vaccination coverage in girls is greater than approximately 50% (as is the case in South Africa), then gender-neutral vaccination (targeting boys and girls) is unlikely to be cost-effective. [3],[4]

END.

1. Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. The Lancet. 2021. ↑

2. World Health Organization. Human papillomavirus vaccines: WHO position paper, May 2017. Weekly epidemiological record. No 19, 2017, 92, 241–268 ↑

3. Modelling estimates of the incremental effectiveness & cost-effectiveness of HPV vaccination. Available at http://www.who.int/immunization/sage/meetings/2016/october/07_Modelling_HPV_immunization_strategies.pdf?ua=1. ↑

4. Fesenfeld M, Hutubessy R and Jit M. Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review. Vaccine. 2013 Aug 20;31(37):3786-804. ↑

Reply:

a) The tables below indicate the vacancy rate percentages per province and for the last 3 years in Clinic’s (Reports as of September of each year)

Clinics - Medical Officer / Specialist Vacancy rate as at September 2019
Row Labels	Eastern Cape	Free State	Gauteng	KwaZulu Natal	Limpopo Province	Mpumalanga	North - West	Northern Cape	Western Cape	Grand Total
Filled	57	74	25	25	206	5	60	50	274	565
Vacant	0.0	1.0	0.0	0.0	1.0	0.0	1.0	0.0	1.0	3.0
% Vacancy rate	0.00	1.33	0.00	0.00	0.48	0.00	1.64	0.00	0.36	0.53

Clinics - Medical Officer / Specialist Vacancy rate as at September 2020
Row Labels	Eastern Cape	Free State	Gauteng	KwaZulu Natal	Limpopo Province	Mpumalanga	North - West	Northern Cape	Western Cape	Grand Total
Filled	57	38	24	22	193	5	58	46	225	668
Vacant	0	1	0	0	1	0	1	0	1	4
Vacant	0.00	2.56	0.00	0.00	0.52	0.00	1.69	0.00	0.44	0.60

Clinics - Medical Officer / Specialist Vacancy rate as at September 2021
	Eastern Cape	Free State	Gauteng	KwaZulu Natal	Limpopo Province	Mpumalanga	North - West	Northern Cape	Western Cape	Grand Total
Filled	60	45	30	25	184	5	60	50	277	736
Vacant	13	13	12	10	79	6	18	11	18	180
% Vacancy rate	17.81	22.41	28.57	28.57	30.04	54.55	23.08	18.03	6.10	19.65

b) The tables below indicate the vacancy rate percentage per province and for the last 3 years in Hospital’s (Reports as of September of each year)

Hospitals - Medical Officer / Specialist Vacancy rate as at September 2019
Row Labels	Eastern Cape	Free State	Gauteng	KwaZulu Natal	Limpopo Province	Mpumalanga	North - West	Northern Cape	Western Cape	Grand Total
Filled	172	529	383	2855	1288	957	443	70	1447	8144
Vacant	5	4	3	10	7	7	2	0	11	49
% Vacancy rate	2.82	0.75	0.78	0.35	0.54	0.73	0.45	0.00	0.75	0.60

Hospitals - Medical Officer / Specialist Vacancy rate as at September 2020
	Eastern Cape	Free State	Gauteng	KwaZulu Natal	Limpopo Province	Mpumalanga	North - West	Northern Cape	Western Cape	Grand Total
Filled	167	448	350	2567	1222	911	408	69	1029	7171
Vacant	5	4	3	10	6	7	2		6	43
% Vacancy rate	2.91	0.88	0.85	0.39	0.49	0.76	0.49	0.00	0.58	7.35

Hospitals - Medical Officer / Specialist Vacancy rate as at September 2021
	Eastern Cape	Free State	Gauteng	KwaZulu Natal	Limpopo Province	Mpumalanga	North -West	Northern Cape	Western Cape	Grand Total
Filled	167	470	445	2935	1325	1089	503	72	1166	8172
Vacant	29	121	32	296	523	166	65	16	48	1296
% Vacancy rate	14.80	20.47	6.71	9.16	28.30	13.23	11.44	18.18	3.95	13.69

END.

Reply:

(1) (a) All four (4) forensic chemistry Laboratories are functional. There is one (1) laboratory each in Cape Town, Durban, Johannesburg and Pretoria.

(b) None.

(2) (a)-(b) Total number of laboratory tests still to be conducted (including the backlog) as at 30 September 2021 refer to Table 1 below.

TABLE 1
Test to be conducted as at	Ante-mortem drunken driving	Post-mortem drunken driving	Toxicology testing	Food Testing
30 September 2021	38,111	10,648	30,669	1,745

(c) Monthly demand for laboratory tests nationally refer to Table 2 below.

TALBE 2
	Ante-mortem drunken driving	Post-mortem drunken driving	Toxicology testing	Food Testing
Average number of test requests received per month (5-year average)	5,046	1,617	411	229

END.

Reply:

1. The Department is working against the target of reaching 70% of adults (28 million persons) vaccinated with at least one dose by end of December 2021. The number of vaccinations is dependent on the number of persons vaccinated with Pfizer, which is a two dose vaccine. As of 16 November, the Department has vaccinated 16 million persons; however there have been 24.2 million vaccinations. The Department is confident that it will reach 70% coverage in all age bands; and in all provinces and districts. The coverage in the 60+ population is highest (just below 64%); while it is lowest (25.5%) among youth (18-34 year) population. We have a large youth population in South Africa. 17.8 million of 39.8 million adults are in this age group and therefore, our overall vaccination coverage is going to be heavily dependant on our collective ability to convince youth to be vaccinated.

The Vaccination coverage is a function of both supply and demand side factors. The forecasting done by the Department is largely from a supply side (looking at both health system capacity; and availability of vaccines). The lower coverage we’re observing currently is driven by demand side factors.

2. One million doses of the AstraZeneca vaccine (Covishield) were delivered to South Africa on 01 February 2021.

 

Attached is the vaccine arrival report detailing the receipt of the shipment in South Africa.

Furthermore, attached is the vaccine arrival report detailing the receipt of the shipment in South Africa.

END.

Reply:

According to the Scope of practice of nurses, only professional nurses registered with the South African Nursing Council (SANC) are allowed to administer vaccinations. Enrolled nurses, also registered with SANC, may administer vaccinations under the supervision of a professional nurse, on condition that they receive the relevant training.

Currently, there are no nurses registered with SANC in the “community nurse” category. For this reason, the Department of Health (DoH) may not use nurses who are not registered with SANC.

END.

Reply:

1. According to Section 4 (Application for registration) of the Health Professions Council of South Africa (HPCSA) Regulation R101, An application by any foreign qualified person for registration as a health practitioner in any of the professions registered under the Act shall be made on the prescribed application form obtainable from the professional board concerned, and shall be accompanied by - (e) in the case of an application for registration in a profession for which internship training is a requirement, a certificate of completed training as an intern or of similar training or experience obtained elsewhere and the Programme for such training; (g) an original certificate of good standing, which shall not be more than six months old, issued by the foreign registration authority where the applicant is or was registered”.

Most of the South Africans who study abroad in institutions not recognized by the HPCSA are unable to meet these requirements. The pathway was intended to assist such applicants by providing an opportunity for clinical exposure and registration as student interns so that they could then be able to undertake formal internship. Unfortunately the pathway, which was approved by the National Health Council (NHC), has not been fully implemented because of the outstanding issues between HPCSA and medical schools, in terms of providing this opportunity for these students interns training.

(2) All applicants who are eligible and/or have submitted compliant documents have been allowed to sit for examinations. It should however be noted that, because of the COVID19 pandemic and subsequent lockdowns, there were no exams held in 2020. This led to a backlog that has, since the beginning of 2021, been attended to. The HPCSA is currently processing new applications that are currently being received for future examinations.

END.

Reply:

1. No, Government does not intend to make COVID-19 vaccinations mandatory by law. the government approach is to invest in persuading in people seeing the life-saving value of vaccination.

2. As stated above, government wants to emphasis on rather convincing people of the value of vaccination.

3. While the state has no intention to make vaccination mandatory, we also have no intention to interfere in internal policies of private and independent institutions, including on the public health policies.

4. Not applicable.

5. As stated in (3), government has no intention in interfering in internal policies of private and independent institutions in this regard.

END.

Reply:

(1)and (2)

(I) CONSTRUCTION OF A NEW JOUBERTON CHC

1.1 STATUS SUMMARY

The project status summary is highlighted in the matrix below.

Table 1.1: Project status summary: Construction of a new Jouberton CHC

No.	Item	Description
1	Contract Number	DoH/020/PS/11
2	Date of Site Handover	19 September 2016
3	Original Contractor	JV Group Five & ENM
4	Implementing Agent	NWDoH
5	Principal Agent	Tiki Architects
6	Contract Commencement Date	19 September 2016
7	Contract Duration ( Original )	410 Calendar days
8	Practical Completion (Original )	3 November 2017
9	Revised practical completion date (As per EoT 8)	21 May 2019
10	Cost of EoT	R 4 358 562,97 Excl VAT
11	Contract value before EOT 8 (with EOT 7)	R 205 320 122, 91 Excl VAT
12	Revised contract value with EOT 7 & 8 awaiting Approval by Provincial treasury	R 209 678 685,88 Excl VAT
13	Original Contract Amount	R 146 622 724,20 Excl VAT
14	Progress to Date	100 %
15	Expenditure to date	R 222 217 461.09

​1.2 PROJECT SCOPE STATEMENT

The project scope includes the following health units amongst others:

CTOP, Dental, Emergency, Maternity, Theatre, Outpatients, Crisis Control, Radiology, Sputum Booth, TB and appurtenant works.

The following service units are also included:

Guardhouse, Main Reception and Administration, Pharmacy, Service Building, Generator and Gas Control, Medical Waste and refuse Deposit, Pump Station, Carports. Staff accommodation comprising of six (6) two bedroom flats and four (4) one bedroom flats and appurtenant works also forms part of the scope of works.

​1.3 PROGRESS TO DATE

The project is at 100% completion, with final completion achieved. The clinic is currently operational.

(ii) CONSTRUCTION OF A SEKHING chc

​1.4 STATUS SUMMARY

The project status summary is highlighted in the matrix below.

Table 1.1: Project status summary: Construction of a new Sekhing CHC.

No.	Item	Description
	Contract number	NWDOH/PS/019/11
	Contract sum	R 84 026 731.26
	Commencement date	4 October 2012
	Original Contractor	ENM Trading Pty Ltd
	Principal Agent	Phitlhelelo Properties Pty Ltd
	Project Period	22 months
	Practical completion date (original)	31 August 2014
	Revised practical completion date	21 February 2019
	Progress to date	89%
	Revised contract amount (Incl approved V.O’s)	R 130 686 350.69
	Expenditure to date	R 121 557 456.64

​1.5 PROJECT SCOPE STATEMENT

Community Health Centre with Administration Building, OPD, Male and Female Medical Wards, CTOP, EMRS, Crisis Control, Pharmacy, Dental Unit and Services Building. Residential Accommodation with parking Bays, Water storage tanks, Generator and Diesel Tank Rooms, Boundary Fence for both developments and parking for visitors.

​1.6 PROGRESS TO DATE

The contractor has currently abandoned the site citing financial difficulties, and further requested settlement on the project. The Department has appointed an external investigator on the project, of which the finding on the report shall provide a way forward on the project as the Department is considering termination.

iii) Information about the Mathibestad CHC is still being verified by the Province, it will be submitted as soon as it is completed.

(3) According to the North West Provincial Department of Health the current breakdown of the vacancy rate of health care workers in each hospital are as follows (a)-

HOSPITAL / HEALTH CARE WORKER CATEGORY	FILLED	VACANT	TOTAL	VACANCY RATE
Bophelong Psychiatric Hospital	220	34	254	13.4
Brits District Hospital	377	72	449	16.0
Ganyesa District Hospital	96	27	123	22.0
Gelukspan District Hospital	142	37	179	20.7
Gen De La Rey District Hospital	44	14	58	24.1
Job Shimankane Tabane Hospital	792	113	905	12.5
Joe Morelong Memorial Hospital	289	40	329	12.2
Klerksdorp Tertiary Hospital	1032	144	1176	12.2
Koster Hospital	91	11	102	10.8
Lehurutshe District Hospital	74	25	99	25.3
Mafikeng Provincial Hospital	593	56	649	8.6
Moses Kotane District Hospital	426	119	545	21.8
Nic Bodenstein District Hospital	94	23	117	19.7
Potchefstroom: Hospital Primary	457	98	555	17.7
Schweizer-Reneke Hospital	72	16	88	18.2
Taung District Hospital	330	39	369	10.6
Thusong District Hospital	136	32	168	19.0
Tshepong Primary Hospital	121	26	147	17.7
Witrand Regional Hospital	509	130	639	20.3
Zeerust District Hospital	67	17	84	20.2
Grand Total	5962	1068	7035	15.2

(b) Position in the North West

The North West Provincial Department of Health has an overall health care workers vacancy rate of 15.2%. The North West Provincial Department of Health’s budget baseline for the financial year 2020-2021 is reduced over R400 million and therefore the department is mainly filling critical replacement posts and some priority posts which were identified in the beginning of the financial year. The posts are being filled as and when the budget is available and confirmed by the Chief Financial Officer.

The Province ensure that health care service are continuously provided in the Province and not compromised through payment for overtime for additional hours worked by health care workers.

END.

Reply:

EASTERN CAPE

1. The province had allocated sufficient budget at the beginning of the financial year for the settlement of outstanding accruals for medicines in the Depots. The interventions also included a process of ensuring that all invoices are received and processed on time from the suppliers to the payment stage.

2. The Eastern Cape depot had a total of R847 461 million on accruals at the end of the financial year. The high level of accruals was due in part to the cash flow challenges faced by the department as a result of the high medico legal claims.

The department prioritized the settlement of accruals in the first quarter of the current financial year. At the end of August 2021, the department had settled R689 042 million of the accruals. This is equivalent to 81% of the total accruals on medicines and medical supplies. The balance is expected to be settled in the month of September.

FREE STATE

1. The Free State department of health does not experience problems in paying the claims of medical depot. The strategy we use is that of prioritizing medical depot and making sure that they remain afloat to enable it to pay suppliers on time. The arrangement is that they submit their claims at the beginning of every week.

2. The total accruals amount to R542,443,773 and total paid amount to R443, 963,155 which translate to 82% of the total payment made to date. The outstanding amount R97,267,083 was settled by 31 August 2021 and R1,213,534 by 09 September 2021.

GAUTENG

1. The department and the depot had agreed to submit claims at least twice a month as opposed to once a month. This has helped to keep the depot afloat so that it is able to pay its suppliers on time while procuring more medicines as may be required by health facilities. The GDOH is now able to process payments for submitted claim within 30 days on receipt of a claim. The Medical Supplies Depot is able to fulfil its mandate of procuring Medicines that are mostly delivered direct to health facilities and to pay its creditors.

2. As at 31 March 2021 the balance owed to the Medical Supplies Depot was R925 million, the outstanding amount was settled in full in the first quarter of the current financial year (2021/2022). At the end of quarter one of 2021/2022 financial year amount owed to the depot was R664 million and was paid in full in the month of July and August. The new current balance owed is R412 million but is still within 30 days.

KWAZULU-NATAL

1. The Medical Depot is continuously engaging with the facilities to submit payment packs on time in order to be able to process them to pay suppliers. Monthly account reconciliations are done in order to identify old outstanding payments. Strict turnaround times to process the payments on time once all necessary supporting documents are received from the facilities.

2. The actual total accrual amount at the end of August 2020 (excluding less than 30 Days) was R1,053,308,923 and the current outstanding amount August 2021 (excluding less than 30 Days) is R455,859,740.

LIMPOPO

1. Limpopo pharmaceutical procurement is partially centralized with the exception of the Regional and Tertiary institutions that are on direct delivery system. Total budget allocation for the 2020/21 financial year was R1,6 billion whereas the accruals as at the end of the financial year was R96 million which translate to 6%.

2. Total Medical depot accruals amount to R96 million. Accruals are expected to be in line with the monthly expected percentage expenditure equal to 8,3%. The department in the year under review managed to contain the accruals to remain under the acceptable percentage of 8,3%. All the accruals have been paid in the 1st quarter of the current financial year.

MPUMALANGA

1. Mpumalanga Department of Health does not have any outstanding invoices not paid as all accruals have been paid during the first quarter.

2. Total accruals outstanding as at 31 March 2021 has been R195,813,681 and all the invoices have been processed during first quarter and currently invoices not paid are within 30 days of been received.

NORTHERN CAPE

1. The department is currently experiencing cash flow constraints, thus a number of invoices cannot be paid within the 30 days of receiving the invoice, as determined in terms of Treasury Regulation 8.2.3. There is continuous challenge to settle the accruals which mainly affects the Equitable share. The payments are prioritised in terms of the source of funding, contractual obligations, non-negotiables items and other payments.

2. Total Medical Depot accruals & payables as at 31 March 2021 amounts to R96.512 million, which results mainly from cash flow constraints affecting the provincial equitable share funding. Currently, there is no intervention from the oversight departments.

NORTH WEST

1. The North West Department of Health could not pay all of its invoices for goods and services for the 2019/2020 financial year, starting from the third quarter. In the main, the challenge has been inadequacy of goods and services budget allocation over the years as opposed to the ever increasing burden of diseases and price escalation on non-negotiable items such as medicine and medical supplies.

2. At the beginning of the intervention, the North West Department of Health had accruals amounting to R236,649,308 relating to the medical depot and at the end of 2020/2021 financial year an amount of R265,928,108 was disclosed as accruals. As at 31 August 2021 accruals totaling R215,568,490 which is 81% has already been settled and the intention is to pay in full all in the invoices which are not disputed by end of September 2021.

WESTERN CAPE

1. The Cape Medical Depot (CMD) procures Goods and Services on behalf of the whole Western Cape Health Department via its MEDSAS procurement system. Once the CMD issues stock to a particular health institution the relevant budget of that institution is expensed. Once invoices are received, payments are effected and paid within 30 days, so there is no need for Medical Depot accruals payment strategy.

2. CMD’s accruals are significantly below the accepted threshold and will not be prevented from continuing to procure the relevant goods and services on behalf of the department. In terms of payment days, the department is well within the 30-day payment threshold.

END.

Reply:

(1) (i), (ii) The NWDOH has not conducted any forensic investigation related to any of the Buthelezi entities. However a case was opened with the SAPS (Hawks) and the case number is: Mmabatho Case Number: 89/02/2018.

(2) (a) Services

The service is currently managed provincially with services decentralized to the sub-district level within Districts. The NWDOH has developed a Policy Framework and Strategy which details a number of interventions that the department is implementing to ensure improvements in EMS delivery. Key to the strategy is the centralization of EMS Command to the EMS district and provincial offices, moving away from the current decentralized command where district health services were responsible for management of EMS. However before vertical reporting of EMS could be implemented, a need was identified to capacitate both the districts and provincial EMS offices particularly with administrative support staff to enable the office to function. Critical vacant positions have been identified after funds were secured for this financial year and the department in process of advertising, and recruitment currently. Plans are that the centralization of command would be effected within the next financial year as the department continues to prepare accordingly.

Two other main objectives in the policy framework entails centralizing the 4 existing district call centres which are working on manual systems into one highly digitalized central communication centre and the establishment of the Planned Patient Transport (PPT) sub-program. The Infrastructure Development and Technical Services unit of the department has been allocated funds and has recently appointed consultants to refurbish and furnish the building identified for the Emergency Communications Centre. With regards to Planned Patient Transport the sub-programme responsible for budget (financial planning) within EMS is utilized to procure red fleet and does not have any staff attached to it. The function of PPT is currently done with the same EMS resources and this negatively impacts EMS operations. The revised EMS staff structure includes PPT and the entire ideal departmental structure is awaiting approval.

The primary response times of EMS in both rural and urban areas continue improving in order to meet the national norms and standards. The revised national standard for EMS response time is that Priority 1 (P1) patients should be reached within 60 minutes in rural areas and within 30 minutes in urban areas for 75% of the cases. EMS in the province over the previous financial year (2020/2021) registered an improved 76 per cent of rural patients and 70.9% per cent of urban patients serviced within the national norms. The target set for P1 urban and P1 rural in the current Annual Performance plan is ≥60% and ≥70% respectively given the resources available. EMS currently attends to 67 per cent of urban P1 patients in 30 minutes and 73 per cent of rural P1 patients within 60 minutes.

Currently there are 37 operational Paramedics and Emergency Care Practitioners (ECP) appointed across the districts which has helped reduce the reliance on private services. A number of ambulances are also upgraded to be utilized as Advance Life Support ambulances for ICU related cases.

(b) Challenges

The NWDOH is experiencing a shortage of ambulances. In addressing the gap the department has been using outright purchasing by procuring red-fleet using National Treasury approved RT57 contract. In 2018/2019 final year, the Department of Community Safety and Transport Management’s (DCST) Head of Department issued a circular instructing all provincial departments to cease procuring any fleet directly from RT57 as it results in unwarranted audit findings. DCST further indicated that they will no longer assist any department that procure their own fleet with any support from their Transport section, which is responsible for registration on e-Natis, licensing, e-fuel installations and maintenance/repairs of vehicles.

Following the circular, the Department transferred funds to DCST for procurement of red-fleet. However in January 2020, DCST returned funds to the Department proposing that the Department apply for roll-over of the same funds from Treasury. This was because the delivery period as per contract was going to overlap into next financial year whilst vehicle manufacturers were experiencing production challenges. As a result, the Department could not procure red-fleet in 2020/21 financial year. The Department applied for roll-over of funds to this financial year but the provincial Treasury did not approve the roll-over of funds.

For the 2021/22 financial year the department has already transferred R33 million allocated for motor vehicles to DCST to procure 41 ambulances and the DCST have committed a purchase order and is currently awaiting conversion of panel vans to ambulances before delivery to the NWDOH. The department is internally identifying funds which needs to be re-prioritized towards implementing an alternative strategy of procurement of red fleet through full maintenance leasing (this alternative procurement model is currently undergoing consultation processes). A further R30 million is estimated as the required budget for this initiative as part of the first phase.

(c) EMS Shortfalls

The lack of efficiency in the current manual based district call centers is affecting service delivery as well as management of resources and information management. The introduction of a comprehensive emergency communication solution which is technology based will greatly assist and also improve public access to these services. As already indicated above, a building has been handed over by the Department of Public Works and IDTS has appointed consultants to establish the central Emergency Communications Centre.

The inability to inject new fleet in the previous financial year has contributed adversely on the prevailing shortages, most specifically of ambulances. Furthermore, the current turnaround time for repairs (1 – 365 days) as well as replacement and repairs of red fleet is not responsive to the needs of the department, hence the department is pursuing leasing of vehicles as an alternative.

(3) (a) The SAMRC has a collaborative research agreement with Aurum Rustenburg to be a clinical trial site for Sisonke, the phase 3b open-label study of the Ad26 SARS-CoV-2 vaccine administered to health care workers.

(b) SAMRC entered into a collaborative agreement with Aurum to provide for funding to Aurum sites to participate in the Sisonke clinical trial. In terms of the agreement, Aurum is required to implement the study at its sites in accordance with the approved protocol and good clinical practice.

(4) There are no senior officials at the SAMRC that have been suspended.

END.

Reply:

(a) and (b) When samples are taken from individuals the laboratory must complete the biographic data name, surname, ID, date of birth, address etc. This information is then captured into an electronic data system which is then used to analyse and publish statistics. Unfortunately biographic data is often not fully completed by the patient and health care workers consequently we do not have a full data set of biographic data in all cases. In the case of race specifically this data is often not reported at source. Consequently we have not been reporting COVID infections and vaccinations by race, since there is also no evidence that race is a significant risk factor.

END.

Reply:

a) Our goal must be to vaccinate at least 70% of adults in South Africa, and especially to ensure that all people over the age of 50 are vaccinated before Christmas 2021. If we do that, the number of people who are hospitalised or die from COVID-19 will be substantially reduced.

(i) In terms of vaccine hesitancy, the South African population falls into three main groups:

• Those who are eager or willing – this is the biggest group, roughly two thirds.
• Those who are uncertain and need to be supported to get them over the line by providing them with information and reassurance and making it easy for them to get vaccinated – a quarter of the population.
• Those who are opposed to vaccination (roughly a sixth).

This is encouraging, because it means that the vast majority of South African adults may come forward for vaccination if their concerns are addressed and if it is easy for them to access the service. The challenge is likely to be due to lack of urgency to be vaccinated rather than being unsure of whether to vaccinate or not.

Extent of vaccine acceptance

The Department of Health has drawn on a number of national studies to understand the extent and reasons for vaccine hesitancy. They include:

• The NIDS-CRAM series of panel surveys (which found that vaccine acceptance has increased from 71% in Feb/Mar to 76% in Apr/May 2021. Half of those who were vaccine hesitant in Feb/Mar 2021 had changed their minds were now willing to vaccinated.
• HSRC/University of Johannesburg survey (Dec/Jan 2021: Two thirds of the SA adult population say they will definitely or probably get vaccinated.
• Ask Afrika Survey: 62% of South Africans willing to get vaccinated.
• African Response (May 2021): 74% of South Africans are willing to get vaccinated and are confident of government’s efforts to manage the vaccine rollout.
• Afro Barometer (May 2021): 43% say they are willing to get vaccinated; 64% approve of government’s performance and 78% say government has done a good job of keeping public informed).
• SAMRC VAX-scenes (April 2020): 62% willing to get vaccinated.

All surveys with the exception of the Afrobarometer survey find that the majority (about two-thirds) of South Africans are willing to get vaccinated. Another quarter are open to persuasion. Only about one in six say they definitely won’t get vaccinated.

Reasons for acceptance.

The main reasons for accepting the vaccine are to protect themselves or family from contracting the virus (~75% of those who are willing).

Reasons for hesitancy

The main reasons cited for hesitancy include:

• Concern over side effects (about ¼ of those who are vaccine hesitant)
• Distrust of the vaccine (about ¼ of those who are vaccine hesitant)
• Unsure of its effectiveness

b) The Department’s response on communication measures put in place:

• The NDoH and GCIS work together on a national communications strategy to tackle the reasons for vaccine hesitancy. This includes a social media strategy, radio PSAS in all 11 languages as well as printed material in all 11 languages distributed to all districts. Over the past months, over 20 million information leaflets have been printed and are being distributed.

• The NDoH and GCIS also leverage the communications and social mobilisation capability of civil society organisations, labour and the business sector through the National Communications Partnership which has produced and disseminated contents through their networks.

• The private sector has also come on board, with the PEPKOR group of companies distributing over 10 million of the NDoH leaflets through their stores. Posters have been placed in 30,000 spaza shops encouraging people to get registered.

• A national Demand Acceleration Strategy has been developed and a National Task team established to direct its implementation. These activities will be accelerated over the next three months, even as efforts are expanded to make it easier for people to get vaccinated through mobile outreach and other access strategies.

END.

Reply:

Infant deaths are defined as deaths occurring during the first year of life, and are divided into newborn deaths that occur during the newborn period (0 – 28 days) and post-neonatal deaths that occur between 29 days and one year of age. The majority of infant deaths occur during the newborn period.

The thirty public sector hospitals with the highest number of infant deaths recorded thus far in 2021 are shown in the table below[1]. The hospitals with the highest number of infant deaths are predominantly national central, tertiary and regional hospitals – this is primarily due to the fact that these are large, referral hospitals which provide care to many newborns and other infants who are at highest risk of death.

Hospital	Level of care	No. of newborn deaths	No. of post-neonatal infant deaths	Total infant deaths
gp Chris Hani Baragwanath Hospital	Tertiary hospital	299	62	361
ec Nelson Mandela Academic Hospital	National Central Hospital	139	67	206
gp Dr George Mukhari Hospital	National Central Hospital	168	29	197
lp Mankweng Hospital	Tertiary hospital	159	27	186
gp Tembisa Hospital	Tertiary hospital	166	18	184
gp Rahima Moosa Hospital	Tertiary hospital	156	23	179
ec Dora Nginza Hospital	Regional Hospital	126	40	166
gp Thelle Mogoerane Regional Hospital	Regional Hospital	149	17	166
kz Queen Nandi Regional Hospital	Regional Hospital	116	41	157
fs Bongani Hospital	Regional Hospital	135	22	157
kz Prince Mshiyeni Memorial Hospital	Regional Hospital	129	20	149
wc Tygerberg Hospital	National Central Hospital	118	31	149
nw Mahikeng Provincial Hospital	Regional Hospital	126	11	137
nw Job Shimankana Tabane Hospital	Tertiary Hospital	119	17	136
gp Sebokeng Hospital	Regional Hospital	101	18	119
gp Steve Biko Academic Hospital	National Central Hospital	68	49	117
kz Mahatma Gandhi Hospital	Regional Hospital	95	17	112
fs Pelonomi Hospital	Tertiary hospital	92	17	109
kz Port Shepstone Hospital	Regional Hospital	87	21	108
kz General Justice Gizenga Mpanza Hospital	Regional Hospital	91	16	107
kz RK Khan Hospital	Regional Hospital	84	13	97
mp Witbank Hospital	Tertiary hospital	72	21	93
gp Kalafong Hospital	Tertiary Hospital	71	18	89
mp Rob Ferreira Hospital	Tertiary Hospital	65	22	87
gp Mamelodi Hospital	Regional Hospital	76	11	87
gp Leratong Hospital	Regional Hospital	67	18	85
ec Mthatha General Hospital	Regional Hospital	79	2	81
kz Newcastle Hospital	Regional Hospital	62	18	80
fs Universitas Hospital	National Central Hospital	69	11	80
gp Jubilee Hospital	District Hospital	77	3	80

END.

District Health Information System. Extracted 2nd September 2021. ↑

Reply:

This question is unfortunately beyond the scope of information that is available to the Department of Health. The determination of rape requires a conviction in a court rather than an allegation or complaint. The SAPS may be in a better position to provide information regarding this question. Rape is not recorded as a cause of death in any health statistics and deaths associated with sexual assault will usually be recorded as death due to unnatural causes, most frequently recorded as ‘blunt trauma’ or ‘sharp trauma’, etc.

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Reply:

No. The Department is not aware of any deaths or severe illness reported that are directly connected to the use of hookah in South Africa.

However, studies conducted in other countries on the chemistry of waterpipe smoke had shown hookah smoking contained seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants (Pratiti, R., & Mukherjee, D. (2019). Water-pipe smokers are found to have significantly higher carbon monoxide in blood which reduces tissue oxygenation, than cigarettes smoking (Theron, Ansa, Schultz, Cedric, Ker, James A, & Falzone, Nadia. (2010).

The main ingredient used in waterpipe is tobacco, and its use has both acute and long-term harmful effects on the respiratory and cardiovascular systems. Hookah users tend to also add other substances to it such as alcohol and drugs. (Theron A et al: Carboxyhaemoglobin levels in water-pipe and cigarette smokers Original Articles122 -124.)

Waterpipe use is associated with an increased risk of transmission of infectious agents, including respiratory viruses, hepatitis C virus, Epstein Barr virus, Herpes Simplex virus, tuberculosis, Helicobacter pylori, and Aspergillus. WHO had raised concerns about waterpipe use and its risk of transmission of diseases, also indicated that it could also encourage the transmission of COVID-19 in social gatherings.

All innovative tobacco products, the related products, including the waterpipe should be strictly controlled in the country. The demand and supply of such products need to be reduced to ensure that we do not get more young people addicted to the products. Young people need to be continually made aware of the harm that goes with using these products and the tobacco industry needs to be controlled by, for example, development of the Control of Tobacco Products and the Electronic Delivery Systems Bill of 2018, which seeks to address all loopholes pertaining to these harmful products flooding our country as most countries are strictly regulating them or not permitting them at all.

Hookah/waterpipe, they uses molasses or moist tobacco. There are two types of waterpipes (hubbly bubbly, hookah pipes), the electronic (non-combustible) and those that cause emissions. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used.

A study conducted in South Africa found that while the tobacco was the norm in smoking hookah, significant numbers also reported using marijuana and/or alcohol-based products in combination with tobacco even among children as young as 13-15 years (Combrink, A., Irwin, N., Laudin, G., Naidoo, K., Plagerson, S., & Mathee, A. (2010). Results indicate that the hookah pipe is a gateway drug, as participants appear to use the hookah pipe with other substances like marijuana and alcohol. (Jacobs, L., Roman, N. V., & Schenk, C. (2015).

END.

Reply:

a) Covid-19 Vaccines are widely available across all provinces and there are vaccination sites, fixed or mobile in every local municipal area.

b) (i) Two vaccines are presently in daily use

(ii) Pfizer and Johnson & Johnson

c) (i) Sinovac has been conditionally approved by SAHPRA for use in adults. The conditions primarily relate to evidence of efficacy and safety for use in people with HIV & AIDS and evidence of efficacy against Delta variant in a real-life setting (not laboratory Based). The NDOH has conducted an economic assessment and is presently engaged in the preparatory procurement process to obtain a price and availability information from the applicant.

(ii) The regulator has received two applications for Sputnik V vaccine but neither has been approved for use yet..

END.

Reply:

Yes, the Department did make payments to Digital Vibes.

a) Digital Vibes was appointed on the 15th of November 2019 through a deviation process, which was approved by National Treasury, to provide communication services in relation to the National Health Insurance (NHI) Bill as released by the Cabinet for Parliament consideration. On the 25th of March 2020, the Department extended the scope of work of Digital Vibes to include Covid-19. This was done in accordance with the Emergency Procurement rules issued by National Treasury for COVID-19 Procurement.

b) The following table reflects the details in this regard.

END.

Reply:

1. The reference date of 2 May 2021 was before the start of the National Vaccination rollout programme on the 17 May 2021. As of 31 August 2021, at 14h50 a total of 3,567,652 individuals older than 60 had registered for vaccination on the EVDS;

2. The response is as follows:

• There are three options to self-register at no cost to the individual namely:
• • • Through the internet at vaccine.enroll.health.gov.za
    • Through WhatsApp by sending a Whatsapp Message – Register to 0600123456
    • Through USSD by dialling *134*832#

    Two options for assisted registration exist namely:

• Registration points at vaccination sites
• Dial the National Call Centre Toll free numbers 0800029999, the call centres agents will assist the individual to register while on the call.

3. Yes.

 

END.

Reply:

(1) The Gauteng Health Department reported that immediately after the fire, the City of Johannesburg inspected the facility and found out that the hospital was not compliant in several aspects. The hospital has more than 1500 fire doors, which are at the back of the wards and lead to the fire escape routes. The hospital had to remove burglar doors next to the fire doors and this meant wards were left with no protection on access to the wards. This meant that the risk of criminals entering the wards was high in the wards using the back side of the wards without being detected. Plans are in place to review different options of securing the units without compromising fire regulations policies, including extending the CCTV installation to the fire escape routes.

(2) The hospital entered into a Service Level Agreement (SLA) with the security company. The SLA under schedule of penalties give guidance to parties on handling of violations to any terms contained in the agreement. It has been difficult to apportion the liability to the security company as all hospital staff had to vacate the building due to the uncertainty on the safety of the building, including security personnel.

During the temporary closure of the hospital, the Department of Infrastructure Development (DID) took advantage of the situation and invited contractors to do fire remedial work and some maintenance work in the wards. This meant that the hospital had several contractors on site.

(3) Most of the hospital walkways are covered by camera surveillance except for the fire escape routes as per a response to question number 1. The fire escape routes did not have CCTV coverage, they had bugler proofs. As a result, it was not possible to review that footage in the areas where equipment was stolen.

The monthly payment of R450 000 is for repairs and maintenance of CCTV equipment. The monitoring/surveillance of cameras is done by physical security.

CCTV’s have assisted before in identifying and investigation of criminal activities within the hospital. Where criminals are identified the hospital submitted footage to SAPS and had successful prosecutions before. It is for this reason, that the hospital is now exploring the latest technology to have surveillance in fire escape routes.

END.

Reply:

According to the reports from the DATCOV, in South Africa, children make up a smaller proportion of those tested for SARS-CoV-2, confirmed cases, hospital admissions and in-hospital deaths, despite comprising 37% of the population. The picture here below shows the low rate of infections among children including the data for the third wave, which is why the department has adopted an attitude of alert and caution on the infection and admission rate of children.

Figure 1: Incidence risk of SARS-CoV-2 cases per 100,000 persons, by age group and epidemiologic week, South Africa, 5 March 2020-14 August 2021

Hospital admissions

The records from the DATCOV show that Covid-19 hospitalisation rate is low among children in all three waves, compared to adults. However there was a 44% increase in admissions in children <19 years, in 3rd wave compared to the 1st wave peak. Among individuals under 19 years, the highest rate of hospitalization is in children < 1 year. The reasons for this increased admission is likely testing for non-COVID indications, because clinicians were likely admitting them as a precaution in this younger population group.

Figure 2: Incidence risk of COVID-19 admissions per 100,000 persons, by age group and epidemiologic week, South Africa, 5 March 2020-14 August 2021

Although there have been slightly more children admitted during the third wave compared to the first, the delta virus doesn't seem to be causing more severe infections in children. It is for this reason that it is unlikely that paediatric hospital bed capacity and critical care capacity will be overwhelmed as has been seen in adults.

Despite these low numbers, the health system has made adequate provision for the increased hospitalisations for all age groups during all various waves of Covid-19 pandemic. With the information having come to our attention, the health system will pay special attention to this possibility during the review of the implementation of the third wave resurgence plans, which will include planning for the fourth wave.

Of the 11 129 COVID-19-associated admissions among individuals aged ≤19 years, 688 (6.2%) were admitted into ICU and 252 (2.3%) were ventilated at some point during admission. Children are generally managed in line with the guidelines on Covid in Children contained in the National Essential Medicine List Standard Treatment Guidelines. A more detailed guideline (Managing Maternal, Neonatal and Child Health during the COVID-19 pandemic in South Africa: A clinical guide for health workers and clinical managers) provides additional detail. Children and adolescents with mild disease should be managed at home, whilst those with moderate or severe disease should be admitted in the health facilities. From the previous waves, it has been shown that children and adolescents rarely required admission to ICU.

The public sector has approximately 11,000 paediatric beds and 3,000 neonatal beds (DHIS data). To date there has been sufficient capacity to accommodate the additional workload resulting from the Covid-19 pandemic. Adolescent beds are generally only available in central hospitals, with the result that many adolescents are cared for in adult wards in most hospitals, which are in good supply. Whilst the number of adolescents requiring admission and ICU care in particular remains small, these numbers have been included when planning for surge capacity during all waves.

Afrox, as the service provider for oxygen supply and support, has made provision for all means of supply ranging from different kinds of cylinders to the reticulated bulk oxygen supply. This includes coverage of paediatrics wards.

END.

Reply:

Ketlaphela SOC Ltd was established as a subsidiary of Pelchem SOC, a subsidiary of South African Nuclear Energy Corporation. These SOCs are part of the Department of Energy and Mineral Resources.

The Department of Health is not the responsible Department for Ketlaphela, the Department can therefore not comment on the current operational status.

 

END.