Questions and Replies

Reply:

1. (a) The agreements with manufacturers contain a confidentiality clause which precludes the sharing of contract terms. This includes the price of the vaccines. We have approached manufacturers to highlight the transparency requirements as enshrined in our constitution for the purposes of oversight. We hope that our representation would allow the Department to be released from the non-disclsoure clauses of the agreement.

(b) the first phase of the programme involves healthcare workers and commenced on the 17 February 2021 while the second phase is scheduled to start on the 17 May 2021. The groups targeted in each phase may be vaccinated in subsequent phases hence nobody will excluded from vaccination.

2. Transport costs are dependent on the Incoterms contained in the contract. In these contracts the manufacturers will be responsible for transportation of vaccines to South Africa. Once in the country, the Department of Health is responsible for warehousing and distribution costs of vaccines.

END.

Reply:

The following information is as received from the Provincial Departments of Health.

1. (a) The overall percentage (%) rate for vacant posts in state hospitals in each province is 13%. The table below indicates the percentage (%) of vacant posts in Government Hospitals per Province as at end February 2021.

Province	% Vacant posts in Hospitals
Eastern Cape	13%
Free State	21%
Gauteng	11%
KwaZulu Natal	14%
Limpopo Province	7%
Mpumalanga	12%
North West	14%
Northern Cape	17%
Western Cape	15%
Overall Total	13%

2. The total number of Chief Executive Officers in acting positions is 64. The table below illustrates numbers per Province.

Total acting CEOs per Province
Province	Acting CEO's
Eastern Cape	14
Free State	6
Gauteng	10
KwaZulu Natal	-
Limpopo Province	11
Mpumalanga	7
North West	7
Northern Cape	7
Western Cape	2
Overall Total	64

The National Department of Health (NDoH) acknowledges the reported number of acting Chief Executive Officers (CEOs) as high. As a result, the Director-General has written letters to the Provincial Heads of Health Departments to prioritise the appointment of experienced eligible candidates permanently to the positions of CEOs at their earliest convenience to ensure stability and service delivery continuity in the affected Hospitals.

(2) A full report on the infrastructure upgrades of state hospitals in each province is herewith attached as Annexure 1.

END.

Reply:

In order to respond to this Question, information must be sourced from the provinces. The Department is still in the process of sourcing this information and as soon as all the information is received, the Minister will provide the response to the Question.

END.

Reply:

In order to respond to this Question, information must be sourced from the provinces. The Department is still in the process of sourcing this information and as soon as all the information is received, the Minister will provide the response to the Question.

END.

Reply:

(a)​  The overall percentage (%) rate for vacant posts in State Hospitals is 13%. The table below indicates the (%) rate of vacant posts in State Hospitals per Province as at end February 2021.

Province	% Vacant posts in Hospitals
Eastern Cape	13%
Free State	21%
Gauteng	11%
KwaZulu Natal	14%
Limpopo Province	7%
Mpumalanga	12%
North West	14%
Northern Cape	17%
Western Cape	15%
Overall Total	13%

(b) The recovery rate of COVID-19 patients without comorbidities reported as at 14 April 2021 is as below, please note that the comorbidities indicator is not covered as the current reporting classification does not include it:

 

PROVINCE	TOTAL RECOVERIES
	14 April 2021
Eastern Cape	184,064
Free State	79,579
Gauteng	405,110
KwaZulu-Natal	319,830
Limpopo	60,970
Mpumalanga	74,225
North West	61,631
Northern Cape	33,215
Western Cape	268,249
Total	1,486,873

END

Reply:

In order to respond to this Question, information must be sourced from the provinces. The Department is still in the process of sourcing this information and as soon as all the information is received, the Minister will provide the response to the Question.

END.

Reply:

The Electronic Vaccination System is built to be agile and responsive to the Vaccine Roll-out programme within the principles of inclusion – the system should not be excluding anyone that wants to be vaccinated. The registration system for beneficiaries is built to respond to the phases of the Vaccine Rollout programme and the sequencing of the population within the phases.

The enormity and importance of the vaccination programme requires that the administration of vaccines be appropriately captured and monitored. The Electronic Vaccine Data System (EVDS) has been developed to capture vaccination events digitally and provide data to its data analytics platform to monitor and report on vaccinations.

The EVDS, which is a web-based application accessible through multiple devices, including mobile and desktop devices, is critical to the success of the vaccine roll-out programme. It should be noted that although digital systems will be used and all vaccinations will be digitally recorded, those without access to digital technology must not and will not be excluded. All steps of the vaccination process will also be available through walk-in services where members of the public will be assisted for registration.

To streamline the vaccination, process a vaccination beneficiary register is required. A pre-vaccination registration functionality forms part of the EVDS., This pre-registration component of the EVDS is providing the public with two options for registration, i.e Self-Registration and Assisted Registration:

• The Self Registration will require the members of the Public as identified per phase and sequencing to log into a web portal and register themselves;

• For those members of the public that do not have the means and ability to do self-registration, the function of assisted registration will be made available in walk in centres and at vaccination sites.

END.

Reply:

The laboratory assessments indicate that the variant is more prevalent, now. The prevalence of the variant grew from 11% in October 2020 to 98% in February 2021.

a) The prevalence of the variant is consistent across all provinces sampled, KZN (>95%), EC (>95%), WC (>95%), NC (>90%), GP (>80%). Reports from neighbouring countries suggest that the prevalence of the variant is similar to South Africa.

b) (i) number of infections with the 501Y.V2 variant will be similar to the number of infections in the population, given that the variant has a prevalence > 90%.

(ii) There is no evidence to suggest that the variant is more deadly than the previous lineage. It is more transmissible hence more people are infected. Even though the proportion of people hospitalised (compared to being infected) has not changed - the number of hospitalisations and deaths has been higher due to a greater number of people being infected. There has been no reported difference in the clinical response to usual treatment.

The graph below provides the temporal emergence of the 501Y.V2 (B.1.351) variant

 

Table 1: The temporal emergence of 501Y.V2 (B.1.351) variant in SA over time

END.

Reply:

1. The UNEP (United Nations Environmental Programme) DDT Expert Group in its eighth meeting reaffirmed the continued need for DDT for IRS (Indoor Residual Spraying)-based malaria vector control in specific settings. South Africa is one of these settings in which DDT is indicated for malaria control owing to high level pyrethroid resistance in the major malaria vector mosquito species Anopheles funestus. Two factors support the continued need for DDT. Firstly, an anticipated resurgence in malaria cases and deaths, as a consequence of the Covid-19 pandemic and cyclone Eloise, necessitates the use of DDT as a highly effective insecticide with proven efficacy over a very long period. Secondly, in South Africa DDT plays a role in resistance management via a mosaic strategy that also utilizes pyrethroid insecticides. New vector control products and tools are on the horizon and are expected to provide new modes of action for IRS as supplementary methods, but continued financing will be essential to support the epidemiological trials necessary to inform international and local policy.

2. In 2011, the World Health Organisation (WHO) published a review on the human health effects of DDT and its metabolites in relation to DDT use for malaria control. The conclusions were that relevant exposure scenarios for the general population in countries using IRS are not of concern, because DDT and DDE (Dichloro-Diphenyldichloro-Ethylene) serum levels in sprayed households were generally below potential levels of harm. Recent findings showed weak associations between exposure to DDT and its breakdown product DDE and symptoms and diagnoses of allergies from an IRS area in Vhembe, Limpopo Province, South Africa. Another recent study reported that prenatal exposure to DDT, in Limpopo, a communitybased education programme was developed to reduce insecticide exposure from IRS. Community presentation through drama and song were implemented in 16 IRS pilot villages. The results showed an increase in the attendees’ knowledge of precautions to take before and after spraying, suggesting that the approach has promise to limit exposure to IRS insecticides.

It is especially important to note however that all insecticides have potentially harmful effects on human health, but their use is nevertheless necessary for the control of malaria, a potentially fatal disease. It should also be noted that malaria vector control via the use of insecticides, especially DDT, has reduced malaria incidence in South Africa by at least 95%, enabling South Africa to adopt an elimination strategy that will ultimately require fewer amounts of insecticide as malaria control becomes more targeted.

END.

Reply:

Please refer to Question 408 and its response.

END.

Reply:

1. We are currently providing healthcare workers with the Johnson and Johnson vaccine. Thereafter we will access the Pfizer vaccine for healthcare workers and persons eligible for phase 2. The commercial stock of Johnson and Johnson vaccines will become available in mid quarter two. Thereafter the rollout programme will be based on these two vaccines;

2. Johnson&Johnson Pharmaceuticals and Pfizer Pharmaceuticals;

3. A team has been investigating the cold storage capacity in South Africa and has been able to quantify the storage capacity across the country. The Johnson&Johnson vaccine is stored at fridge temperature for which there is adequate storage capacity. The Pfizer vaccine is stored at -70 degrees hence there is need for specialised storage facilities which we have secured. The team has been planning the logistics related to the storage, delivery and administration for each of the vaccines. South Africa has a vaccine programme that delivers close to 20m doses of vaccines annually so there is existing infrastructure, systems and human resources. This programme is on a much larger scale however vaccinations are not new for the department. 

4. The Department did provide an initial list of essential workers  that would make up phase two which included civil servants in particular sectors of the economy. Subsequently we have received representation from a number of sectors motivating for inclusion as essential workers. We are engaging with these matters and will provide a final list in the next couple of weeks.

END.

Reply:

1. The list of vaccination sites for the Sisonke phase 3b study is attached;

2. The vaccine has not been study in children hence we are not sure about the efficacy and safety of these vaccines in children;

3. We have good evidence from clinical trials  to support the efficacy of the Johnson&Johnson vaccine against the 501Y.V2 variant. In vitro studies suggest that the Pfizer and Moderna vaccines are effective as well against the 501Y.V2. We are awaiting the data relating to the effectiveness of the Sinopharm, Sinovac and Sputnik V vaccines against the 501Y.V2. In terms of Astra Zeneca and Novovax the studies to date suggest these vaccines have diminished effectiveness and the Ministerial Advisory Committee does not support the use of these vaccines at this stage.

END.

Reply:

The Department of Health has not been involved in the procurement of a “Cuban Covid-19 medicine” hence we cannot respond to this question. It must be referred to the Department of Defence.

END.

Reply:

According to the Acting Registrar of the Health Professions Council of South Africa (HPCSA), Dr. Wouter Basson is still on the register of medical practitioners in terms of the Health Professions Act, 1974 (Act No. 56 of 1974) (“the Act”). The Acting Registrar further indicated that Dr. Basson is legally entitled to remain on the register of medical practitioners until he is removed from the register in terms of section 19 of the Act.

The HPCSA charged Dr. Wouter Basson with, and found him guilty of, unprofessional conduct on 18 December 2013. Dr. Basson was, inter alia, charged and found guilty of the following charges – Coordination of the production of drugs.

Having been found guilty of unprofessional conduct on 04 February 2015 and during the sentencing proceedings, Dr. Basson applied for the recusal of two of the members of the professional conduct committee arguing bias. The professional conduct committee which consisted of three members dismissed Dr. Basson’s application for recusal of two of its members. Dr. Basson thereafter applied to the High Court for the review and setting aside the dismissal of his application for the recusal of two members of the professional conduct committee.

The High Court dismissed Dr. Basson’s application for the review and setting aside the professional conduct committee’s refusal of his application for the recusal of the two members of the professional conduct committee.

Dr. Basson appealed to the Supreme Court of Appeal against the High Court’s dismissal of his review application, and the Supreme Court of Appeal upheld his appeal on 17 January 2018 and directed that the matter be remitted back to the High Court for a decision on the review application.

On 27 March 2019, the High Court granted the application for the review and setting aside of the professional conduct committee’s refusal of the application for recusal of two of its members.

The HPCSA unsuccessfully applied for leave to appeal the decision of the High Court. The HPCSA then unsuccessfully petitioned the Supreme Court of Appeal. The HPCSA applied for leave to appeal to the Constitutional Court, and on 05 February 2020, the Constitutional Court dismissed the HPCSA’s application for leave to appeal the ruling of the Supreme Court of Appeal.

Dr. Basson’s successful recusal of the two members of the professional conduct committee vitiated the entire professional conduct proceedings with the result that the professional conduct proceedings against Dr. Basson will now have to commence de novo (afresh) before the newly constituted Protecting the public and guiding the professions President: Prof M S Nemutandani, Vice President: Dr. S Sobuwa, Acting Registrar/CEO: Dr. MA Kwinda professional conduct committee and the HPCSA is preparing to commence these proceedings against Dr. Basson afresh.

END.

Reply:

Government is constantly engaging experts and scientists to keep abreast of any new variants that are emerging and the efficacy of the various vaccines that are currently available on the global market. This includes getting clinical and scientific advisories from relevant Ministerial Advisory Committees. Furthermore, part of our risk management strategy includes ensuring that we actively engage with various vaccine manufacturers and suppliers to ensure that the population has access to a diversity of vaccines as part of the vaccination roll-out campaign.

The South African Health Products Regulatory Authority (SAHPRA) has as its mandate, a responsibility to ensure that vaccines approved for use are efficacious. In this context SAHPRA requires that all vaccine manufacturers provide evidence of the efficacy of their vaccines against variants.  

END.

Reply:

a) According to the Gauteng Provincial Department of Health, (a) the number of vacant funded posts as at 25 February 2021 is 544 posts. The breakdown is as follows:

Row Labels	Number of Posts
Administration Staff	34
Allied Professionals	79
Allied Support Staff	6
Clinical Professionals	119
Management Professionals	1
Nursing Professionals	238
Support Staff	67
Grand Total	544

The process of replacing vacated posts is a decentralised function and the Hospital Management ensures that vacated posts are filled continuously on a monthly basis with priority given to core functions (i.e. health professions categories).

(b) Some of the reasons that the Hospital has struggled with to fill the specified vacancies include but not limited to a recurring challenge of limited skills of Specialised Nurses Categories in the Country (limited resources available). The recruitment of Clinicians is also a challenge as some of the candidates prefer to work in other Academic and Tertiary Institutions like Steve Biko Academic Hospital and Dr. George Mukhari Academic Hospital lose out because of their geographic area. The Hospital is also affected by the budget reductions under Cost of Employer (COE) experienced in the public health sector and the filing of most or all the 544 posts will result in over-expenditure.

(c) To mitigate this challenge, management appoints experienced Professional Nurses in those speciality areas who are capable of dealing with work demands. Continuous support is given to these nurses through training programmes and supervision. The Hospital has further put in place mechanisms to minimise the impact of vacant posts on service delivery through task sharing, overtime and rotation of staff.

END.

Reply:

According to the Mpumalanga Provincial Department of Health, the Department has noted water challenges in Kabokweni and Themba Hospital due to lack of / failure to provide bulk water supply from City of Mbombela municipality. The Department has subsequently installed two boreholes and procured two water tankers to supply the hospital with water in order to address water shortages at the facility. The Department of Public Works, Roads and Transport and City of Mbombela they are also assisting the Department with their own water tankers.

It must be noted that these tankers will remain in the hospital until Municipality bulk water supply is restored.

END.

Reply:

a)  On 29 January 2021 Johnson&Johnson released the results of their phase 3a clinical trial done in various countries including South Africa. The results of the trial indicate that the vaccine is 85% effective against preventing hospitalization and severe Covid-19 and 100% effective against death. The vaccine is also effective against the 501Y.V2 variant which is predominant in South Africa and was 57% effective in preventing moderate to severe symptoms.

b) The Johnson&Johnson vaccine has been approved by the Food and Drug Administration (FDA) for use in the United States of America. We anticipate that Johnson and Johnson will also submit a similar application to SAHPRA for consideration.

END.

Reply:

The current Covid vaccines assessed by SAHPRA and approved for emergency use do not contain any of these mentioned materials. In general, as part of the quality review of manufacturing, formulation and control of the vaccine, SAHPRA checks for all excipients and any possible impurities from these and from active substances used as well as their interactions and degradation products and establish if they are in acceptable safe limits, if not they are not approved.

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Reply:

a) Vaccines are approved for use after clinical trials are successful and the data is assessed by regulators. Regulators must consider claims of the efficacy of the vaccine as part of the market authorization. SAHPRA will perform this function in South Africa hence all vaccines we procure will be efficacious.

b) The regulator and research will conduct regular assessment of the vaccine against new and emerging variants. The timelines for the effectiveness of the vaccine is dependent on various factors including the type of variants that emerge and the rate of these mutations.

END.

Reply:

The COVID 19 vaccines were developed over 12 months in order to respond to the global crisis relating to the COVID 19 pandemic. The clinical trials that were done in the development of the vaccines did not identify cancer, seizures, heart disease, allergies and autoimmune disease as adverse events. There is also no data to suggest that vaccines in general cause any of these conditions.  Nevertheless we have implemented a pharmacovigilance programme to monitor any adverse events should they arise and will take the appropriate steps should they arise.

END.

Reply:

In 2020, a total of seven cases of human rabies was laboratory confirmed in South Africa, six of which originated in eThekwini District, KwaZulu-Natal (KZN) Province and one in Limpopo (LPP) Province. This compares to 10 laboratory-confirmed human cases in 2019.

In addition, three children were identified in 2020 who had dog bites/exposure and died of clinically compatible rabies disease. These cases could not be confirmed in the laboratory and were classified as probable cases in the provinces of KZN (n=1), LPP (n=1) and Eastern Cape (n=1).

To date, for 2021, 1 case of human rabies was reported from eThekwini, KZN.

The provinces that reported rabies cases during 2020 and 2021 have put in place prevention activities and plans. KwaZulu-Natal, Eastern Cape and Limpopo have put the following measures in place:

Actions taken in KZN

• A circular informing all districts was released;
• There are On-going health education and awareness campaigns, which is being among the affected communities;
• There is ongoing training of Health Care Workers;
• Rabies meetings were held by eThekwini District with role players;
• A One health approach is in place, in collaboration with Department of Agriculture, Land Reform and Rural Development (DALRRD);
• Alerts were sent out by DALRRD with real time surveillance maps and
• Animal rabies vaccination campaigns were completed in the affected areas.

Challenges identified by eThekwini District

• Patients presented late to health care facilities for medical help.
• Cultural beliefs resulted in delayed health seeking behavior by patients.
• Patients did not complete their vaccines according to the schedule given.
• There were delays in reporting on the notifiable medical conditions (NMC) system by health practitioners.

The DALRRD is responsible for controlling rabies in animals; most human rabies cases were as a result of dog bites. The DALRRD have also been experiencing challenges such as:

• too many stray dogs were roaming in the community;
• dog owners were not vaccinating their dogs on time;
• there was a need for further rabies education in the community and
• a high number of government vehicles were hijacked while rendering animal health services, including dog vaccinations.

Eastern Cape noted that despite the Covid-19 response having priority, the following were conducted:

• Routine surveillance of animal bites in humans were conducted (which was a proxy for suspected human rabies);
• Healthcare workers at the facility level were trained on case management;
• Treatment protocols were developed and distributed to health facilities;
• routine surveillance of rabies among animals by Veterinary Services are ongoing.
• Health promotion activities were conducted in high risk areas, especially when there were animal cases reported by Veterinary Services.

Rabies control in Limpopo are as follows:

• Health talks for the communities were conducted in collaboration with DALRRD.
• The DALRRD also vaccinated dogs; this is ongoing.
• Annual rabies awareness days were celebrated every year jointly with DALRRD.
• Politicians were engaged in promoting rabies prevention messages in the community.
• The province ensured that rabies post exposure prophylaxis was available in facilities.
• Refresher training for health workers were conducted and is ongoing.
• Health education on rabies were conducted for traditional healers.

END.

Reply:

(a) Data from the District Health Information System (DHIS) indicate that in the calendar year 2020, infant PCR test positivity rate is 0.51% at birth, 0.69% around 10 weeks and 0.23% at 18 months;

(b) Mother-to-child-transmission of HIV remains multi-factorial and thus interventions are developed at each possible point of infection. It could be (1) high viral load due to new infection during prenatal and post-natal period or pregnant women not virally suppressed, (2) pregnant women who are not aware of their HIV status, (3) women who develop drug resistance/ or treatment failure;

(c) The PMTCT guideline was revised in 2019 to address the mother to child transmission of HIV by introducing the following interventions:

• HIV negative pregnant women are retested for HIV at every basic antenatal care visit and at labour and delivery, and those who test HIV positive are initiated on ART immediately;
• Maternal viral load monitoring for pregnant HIV positive women done at ANC, at the time of delivery and another viral load monitoring at 6 months post-delivery to identify mothers who are at higher risk of transmitting HIV to their infants/babies;
• Enhanced infant prophylaxis where HIV exposed infants whose mothers has high viral load or the viral load is unknown receive HIV prophylaxis until their mothers are virally suppressed thus reducing the risk of transmission.

END.

Reply:

The Covid-19 pandemic disrupted the 2020 learning programs at Higher Education Institutions, resulting in Medical Students completing their final year studies late in December 2020. There was also a recorded delay for serving medical interns who were transitioning to community service: medical officer posts from 1 January 2021. The delayed completion, impacted on the finalization of the professionals registration with the Health Professions Council of South Africa (HPCSA), which is amongst others, one of the requirement for commencement of duty in a health facility.

Despite all these challenges, Provincial Departments of Health made provision to ensure viable appointments of health professionals (i.e. medical interns and community service doctors) are captured and finalized as soon as all the required documents are receipt.

The National Department of Health hereby confirms that Provincial Departments of Health across all Provinces, despite the challenges outlined above, managed to capture and finalize appointments of medical interns and community service and salaries have been paid successfully in this professionals bank accounts during the periods 31 January 2021 to 15 February 2021.

The only remaining challenge was in the Northern Cape where one medical intern and one community service doctor, who commenced duty from 1 January 2021 have not yet received salary due to the fact that at the time of capturing the appointment on the PERSAL System, the Northern Cape Provincial Treasury deactivated the appointment functionality in the Province for all Departments due to over expenditures encountered.

 

The Acting Head of Health Department (HoD) engaged the Acting Head of Provincial Treasury on the matter. The Province have since been given back the appointment function on PERSAL temporarily. The appointments have now been captured on the System and emoluments are due to be paid by 15 March 2021 backdated to January 2021 to the affected doctors.

END.

Reply:

As I had indicated previously the discussion held between Johnson&Johnson is subject to a non-disclosure agreement that government had to sign off on before discussions regarding access to them could be held. While we would certainly prefer to disclose as much information as possible this condition of non-disclosure is in place from all manufacturers. Nevertheless we can share some information with the Honourable Member.

(a) There were six formal meetings between Johnson&Johnson and the Department of Health between June 2020 and December 2020. In the period 1 January 2021 and 1 March 2021 there have also been six formal meetings. In addition, there has been significant exchange of email correspondence between officials and Johnson&Johnson.

(b) While there were various issues discussed in the meetings over the past 9 months the key issues are the following:

• • The characteristics of the vaccine-type of vaccine, storage, mechanism of action, dosing, administration requirements;
  • The anticipated date for completion of the phase 3 study;
  • The anticipated quantity of vaccine that can be delivered and the timelines for delivery;
  • The price of the vaccine;
  • The conditions in the advanced purchase agreement including liability, payment conditions, delivery dates, penalty clauses;
  • Access to the excess Johnson&Johnson trial doses following the pausing of the Astra Zeneca vaccine rollout;
  • Structure of the phase 3b study, logistics, reporting co-ordination, dose delivery dates.
  • The proposed contractual agreement from Johnson&Johnson has been reviewed by National Treasury and concurrence has been obtained. The agreement has been signed off for 11million doses with an option for an additional 20m doses based on availability of stock. The Johnson&Johnson vaccine is the most cost-effective vaccine for the following reasons:
  • it provides high level of protection against hospitalisation and death from clinical studies in South Africa;
  • It is effective against the 501Y.V2 variant;
  • Single dose vaccine;
  • It is stored at fridge temperature;
  • Price is lower compared to other vaccines

END.

Reply:

1. The terms sheet with the Serum Institute of India was signed on the 7th January 2021.

2. The terms sheet for Pfizer was signed on 15 January 2021. The terms sheet for Johnson & Johnson was signed on 05 January 2021.

END.

Reply:

1. (a) Yes

(b) Yes, information available from 2017/2018 – 2020/21

Financial Year	Applications Received	Applications Approved (i)	Job categories of approved applications (ii)
2017-18	12	1	Environmental Health
2018-19	7	5	Health Attaché’; Environmental Health, Supply Chain Management, Stakeholder Support and Liaison Demand and Acquisition (Supply Chain)
2019-20	9	5	Internal Audit (X3) Admin Clerk Intern
2020-21	6	3	Stakeholder Support and Liaison (HIV/AIDS) Demand and Acquisition (Supply Chain) Environmental Health.

2. Fourteen (14) applications were approved from 2017/18 – 2020/21.

a) Permission to perform remunerative work outside employment is granted in terms of section 30 of the Public Service Act, 1994, as amended;

b) RWOPS applications by employees at salary levels 2-14 are approved by the Director General. Applications by employees at level 15 are approved by the Executive Authority;

c) A total of 2 applications were found to have a conflict of interest in 2019/20 and 1 employee was found to have conflict of interest in 2020/21.

d) Disciplinary measures were initiated against the transgressors.

END.

Reply:

(1) It should be noted that HIV Prevention, Treatment, Care and Support services in public health services were not shut down during the hard lock down for Covid-19 restrictions. Health care facilities remained opened as essential services during this time. However, due to restrictions of movement, the performance for HIV testing subsequently decreased as community testing stopped.

Facility staff were deployed and assigned to do Covid-19 activities, HIV activities were not fully covered.

HIV and other PHC services were negatively impacted by deployment of facility staff as they were assigned to Covid-19 activities. The effect was noted in the delivery of services, which negatively affected the clinical assessment, registration of new HIV patients, and they could not be initiated on ART.

The staff members who contracted Covid-19, were not replaced and facilities were closed for decontamination over a period of time as prescribed by guidelines for decontamination. These activities affected delivery of services, as facilities were closed. Some of the reasons given were that patients were locked down as taxis were not available (not working) and law enforcement officials were stopping clients from moving around without asked for reasons (therefore couldn’t come to health facilities).

Lack of public transport and patients’ fear of contracting Covid-19 when visiting the facilities led to patients not accessing HIV services. There was a decline in new patients initiated on ART and total number of patients remaining on ART (TROA) during Covid-19. The programme experienced high missed appointments and high lost to follow up (LTFU) of patients.

Proactively, before the hard lockdown, the HIV programme enrolled all stable patients on ART in the external pick up points for collection of treatment at facilities closer to their homes and work.

In some areas, where there was support of development partners, medication was delivered to client’s homes.

(2) There were notable disruptions:

1. There was a shortage of drugs supplies in some facilities due to an influx of clients from other facilities (could have been closed due to Covid-19 or patients went to nearest facility as there were restrictions on traveling or could have moved to other province and were locked down in there). These actions affected the ordering of ARVs and planning of facilities as they received more patients than planned.

2. There was a notable disruption to the antiretroviral therapy provision in the country that resulted from failure of suppliers to deliver on time and courier services shut down due to Covid-19 restrictions.

3. The locking of international borders led to low production, due to lack of active pharmaceutical ingredient (API), this negatively affected delivery of ARVs to the country.

END.

Reply:

a) SAHPRA was informed of an alleged dispensing of Ivermectin tablets at Tayler Bequest Hospital. The Times newspaper issued an article dated 12 January 2021 that the Eastern Cape Department of Health will investigate a prescription for Ivermectin after it was allegedly signed at Tayler Bequest Hospital in Matatiele. It was also indicated that it carried the hospital stamp. SAHPRA was able to obtain information from the pharmacist at the Hospital on 03 March 2021. It was confirmed that one of the doctors had written a prescription for Ivermectin, however, it could not be dispensed by the hospital pharmacy as the pharmacy did not have stock. The patient left with the prescription. Management was not available to provide full information on what they were doing about this concerning matter, and it was requested to revert to SAHPRA with further action taken and progress. The response will inform the next step required.

b) There has been one case investigated where it was confirmed that Ivermectin was administered to humans for the purposes of prevention of COVID-19. SAHPRA inspectors conducted an inspection and halted further administration of the Ivermectin. The initial priority was the safety of the recipients, therefore SAHPRA requested the medical evaluation of the recipients. The medical reports received show no impact to the recipients. No case has been opened, however, SAHPRA will be making a follow-up visit to ensure that all commitments made have been met and will be requesting SAPS assistance in the follow up visit.

Cases involving illegal import of Ivermectin by persons into South Africa and illegal selling by South African persons or companies does involve SAPS and arrests were made. SAHPRA continues to investigate any tip-offs and information received.

END.

Reply:

The matter of the long queues at the Mayville clinic in ward 101 are known. This clinic is jointly managed by the Provincial Department of Health and eThekwini Metropolitan Municipality. This clinic operates for 5 days from 07h00 to 16h00. The clinic is managed in line with Ideal clinic programme, which has reduction of the long waiting times as one of its objectives. It is a known fact that long waiting times results in long queues in the clinics. Through the ideal clinic, Mayville clinic has been implementing the Integrated Clinic Services Management (ICSM), which directs that there be three streams. The streams are Acute Care; Mother child and Women’s health and the third stream is Chronic care. The implementation of the three streams has resulted in the reduction in the long queues because all users are seen at their own streams and thus avoid users waiting at wrong streams.

The clinic has indeed seen long queues in the past year due to the following problems:

a) All users that come to the clinic must undergo COVID-19 screening as part of the Covid-19 guidelines, and this leads to long queues as each user must be screened as part of the protocols.

b) The need for social distancing of 1,5 meters which adds to the long queues

c) Due to COVID-19 response, the clinic established CCMDD pick up points outside to avoid allowing many patients in the clinic. The outside pick point was closed when the country moved to lower lockdown levels. This led to the sudden increased number of patients who had been receiving their treatment remotely during the hard lockdowns.

The following steps have since been taken to address the situation:

a) The department has assigned 6 more COVID-19 screeners to improve efficiency and reduce the waiting times which lead to long queues

b) The department has implemented the fast queue for people with disabilities and the elderly so that they don’t wait longer hours.

c) There has an engagement with the local leadership to facilitate the reopening of the community halls as external pick up points for CCMDD. This will assist in that the patients do not have to queue at the clinic all at once for collection of chronic medication

The province has started to engage eThekwini Metropolitan Municipality regarding the provincialization of the Personal Primary Health Care Services. Once this clinic is provincialized, the province will be able to start with the extension of hours of services. These actions will address the long queues even after the COVID-19 pandemic.

END.

Reply:

(1) The impact of COVID-19 pandemic on human resources in health since the first positive case in the Republic has been enormous. As on 31 October 2020, there were 35 145 confirmed cases of health workers in the public sector of which 25% were in the Eastern Cape, followed by 24% in Gauteng and 18 % in KwaZulu-Natal. During this time 339 public sector health workers died in hospital. Of these 26% was from Eastern Cape, 24% from KwaZulu-Natal and 15% from Gauteng. As a result, as the Ministry, we developed a Strategy to protect the health and safety of health workers in the face of the COVID-19 pandemic.

The objectives of the Strategy amongst others include the following:

1. Protect the physical health of health care workers through prevention and mitigation of COVID-19 infections
2. Promote mental health of healthcare workers through psychological support
3. Provide social support for health workers
4. Education and training of health workers in screening, clinical management and care of Covid-19 suspect or positive persons and occupational health and safety, including training in Infection prevention and control in accordance with national guidelines
5. Maintain / establish ongoing communication with health workers.

(2) (a) (i) The PERSAL table below indicates the total number of South African citizen doctors that have been appointed from March 2020 up until October 2020

Medical Officer (SA's) Appointed from March 2020 - October 2020
Job Title Description	Total
MEDICAL OFFICER	1863
MEDICAL OFFICER (COMMUNITY SERVICE)	233
MEDICAL OFFICER (INTERN)	276
MEDICAL OFFICER (SESSIONS)	3
MEDICAL SPECIALIST (SUB-SPECIALITY) GRADE 1	13
MEDICAL SPECIALIST	352
MEDICAL SPECIALIST (REGISTRAR)	1
REGISTRAR (MEDICAL)	185
Total	2926

(ii) The PERSAL table below indicates the total number of South African citizen Nurses that have been appointed from March 2020 up until October 2020

Nurses (SA's) Appointed from March 2020 - October 2020
Job Title Description	Total
ASSISTANT MANAGER NURSING (HEAD NURSING SERV)	2
ASSISTANT MANAGER NURSING (PRIMARY H CARE)	9
ASSISTANT MANAGER NURSING (SPECIALITY UNIT)	9
ASSISTANT MANAGER NURSING AREA	12
CLINICAL NURSE PRACTITIONER (PRIM H CARE)	194
DEPUTY MANAGER NURSING (LEVEL 1 & 2 HOSPITAL)	3
LEARNERSHIP (NURSING)	2
LECTURER NURSING	52
MANAGER NURSING (LEVEL 3 HOSPITAL)	14
NURSE STUDENT	72
NURSING ASSISTANT	3574
OPERATIONAL MANAGER NURSING (PRIMARY H CARE)	75
OPERATIONAL MANAGER NURSING (SPECIALITY UNIT)	28
PRINCIPAL NURSING COLLEGE (SINGLE NURSING CA)	1
PROFESSIONAL NURSE (COMMUNITY SERVICE)	649
PROFESSIONAL NURSE (GENERAL NURSING)	4887
PROFESSIONAL NURSE (SPECIALITY NURSING)	365
STAFF NURSE	4284
Total	14232

(iii) The PERSAL table below indicates the total number of South African citizen Community Healthcare Workers that have been appointed from March 2020 up until October 2020.

Community Healthcare Workers (SA's) Appointed from March 2020 - October 2020
Job Title Description	Total
COMMUNITY HEALTH WORKER	31203
Total	31203

(iv) The PERSAL table below indicates the total number of South African citizen other healthcare professionals have been appointed from March 2020 up until October 2020

Other Health Related Professions (SA's) Appointed from March 2020 - October 2020
Job Title Description	Total
ARCHITECT PRODUCTION GRADE A	1
ARTISAN PRODUCTION GRADE A	18
ASD: PHARMACOVIGILANCE	2
ASSISTANT DIRECTOR ENVIRONMENTAL HEALTH GRADE 1	2
ASSISTANT DIRECTOR MEDICAL TECHNOLOGY GRADE 2	1
ASSISTANT DIRECTOR RADIOGRAPHY GRADE 1	1
ASSISTANT DIRECTOR: CLINICAL SUPPORT L9	2
ASSISTANT DIRECTOR: EPIDERMIOLOGICAL RESEARCH	1
ASSISTANT DIRECTOR: TECHNICAL SUPPORT L9	1
ASSISTANT DIRECTOR-SENIOR: CLINICAL SUPPORT L10	1
ASSISTANT DIRECTOR-SENIOR: HEALTH L10	27
AUDIOLOGIST (COMMUNITY SERVICE)	2
AUDIOLOGIST GRADE 1	12
BOARD MEMBER	5
BOARD OF SURVEY COMMITTEE: MEMBER	18
CARE GIVER	164
CASE MANAGER	2
CHIEF AUDIOLOGIST GRADE 1	1
CHIEF DIETICIAN GRADE 1	1
CHIEF DIRECTOR: HEALTH FACILITIES L14	1
CHIEF OCCUPATIONAL THERAPIST GRADE 1	1
CHIEF PHYSIOTHERAPIST GRADE 1	4
CHIEF RADIOGRAPHER GRADE 1	8
CHILD MINDER	2
CLINICAL ASSOCIATES	64
CLINICAL ENGINEER TECHNICIAN ASSISTANT	1
CLINICAL MANAGER (DENTAL) GRADE 1	1
CLINICAL MANAGER (MEDICAL)	14
CLINICAL PROGRAMME COORDINATOR GRADE 1	21
CLINICAL TECHNOLOGIST GRADE 1	13
COMM LIAISON OFFICER	1
COMMUNITH HEALTH COUNCELLOR	96
COMMUNITY CARE CCG(SUPERVISOR)	15
COMMUNITY CARE GIVER	1106
COMMUNITY LIAISON OFFICER	60
COUNCILLOR	15
COVID 19: SCREENER	7
COVID-SPRAYERS	159
DD: COMMUNITY OUTREACH SERVICES	1
DENTAL ASSISTANT GRADE 1	39
DENTAL PRACTITIONER	1
DENTAL SPECIALIST	7
DENTAL TECHNICIAN	2
DENTAL THERAPIST GRADE 1	2
DENTIST (COMMUNITY SERVICE)	3
DENTIST GRADE 1	69
DEPUTY DIRECTOR DQIM	1
DEPUTY DIRECTOR: WOMENS HEALTH	1
DEPUTY DIRECTOR: CLINICAL PSYCHOLOGY L12	1
DEPUTY DIRECTOR: HAZARDOUS SUBSTANCES POLICY DEVELO	1
DEPUTY DIRECTOR: HEALTH PROGRAMMES L11	1
DEPUTY DIRECTOR: HOSPITALS L11	2
DEPUTY DIRECTOR: LSA MANAGEMENT (HEAD OFFICE) L11	1
DEPUTY DIRECTOR: SPEECH THERAPIST & AUDIOLOGIST L11	18
DEPUTY DIRECTOR: TB HOSPITALS L12	22
DEPUTY DIRECTOR: TB SERVICES L11	3
DEPUTY DIRECTOR- SENIOR: CLINICAL SUPPORT L12	1
DEPUTY DIRECTOR- SENIOR: HEALTH L12	1
DEPUTY DIRECTOR- SENIOR: ORTHOTIC & PROSTHETIC L12	1
DEVELOPMENTAL YOUTH	1110
DIAGNOSTIC RADIOGRAPHER (COMMUNITY SERVICE)	7
DIETICIAN	40
DIETICIAN (COMMUNITY SERVICE)	2
DIR: COMMUNITY OUTREACH SERVICES	1
ECM SCANNING OPERATOR	4
ELECTRO ENCEPHALOGRAPHIC ASSISTANT GRADE 1	1
EMERGENCY CALL CENTRE AGENT	5
EMERGENCY CARE OFFICER	841
EMERGENCY CARE TECHNICIAN	24
EMS COURSE CO-ORDINATOR GRADE 4	1
EMS LECTURER (PARAMEDIC)	11
EMS SHIFT LEADER GRADE 4	1
EMS STATION MANAGER GRADE 3	1
ENGINEER CANDIDATE	1
ENGINEER PRODUCTION GRADE A	1
ENGINEER PRODUCTION GRADE C	1
ENGINEERING TECHNICIAN CANDIDATE	1
ENGINEERING TECHNICIAN PRODUCTION GRADE A	3
ENGINEERING TECHNICIAN PRODUCTION GRADE C	1
ENGINEERING TECHNOLOGIST PRODUCTION GRADE A	1
ENVIRONMENTAL HEALTH PRACTITIONER (COMMUNITY SERV)	292
ENVIRONMENTAL HEALTH PRACTITIONER GRADE 1	76
EPWP WORKER HAST	1
FORENSIC PATHOLOGY OFFICER	97
FORENSIC TOXICOLOGIST	2
GISC TECHNOLOGIST PRODUCTION GRADE A	1
GRADUATE	6
HEAD CLINICAL DEPARTMENT (MEDICAL) GRADE 1	2
HEAD CLINICAL UNIT (DENTAL) GRADE 1	1
HEAD CLINICAL UNIT (MEDICAL) GRADE 1	14
HEALTH CARE WORKER ASSISTANT	1
HEALTH PROMOTERS	12
HOME BASED CARER	7259
HOSPITAL BOARD MEMBER	54
HTS COUNSELLOR	209
INDUSTRIAL TECHNICIAN GENERAL ENGINEERING PROD	2
INDUSTRIAL TECHNICIAN SUPERVISOR CLINICAL ENGINEER	1
INTERN - LEARNERSHIP	598
INTERN (COMMUNITY DEVELOPMENT GRADUATE)	2
INTERN: EPWP OPERATOR	232
INTERNSHIP (CARPENTRY) L6	2
INTERNSHIP (PLUMBING) L6	4
INVIGILATOR	1
LAY COUNCELLOR	1590
LEARNER	84
LEARNERSHIP (CARPENTRY) L2	16
LEARNERSHIP (ELECTRICITY) L2	2
LEARNERSHIP (PHARMACY) L4	4
LEARNERSHIP (PLUMBING) L2	7
MALARIA SPRAYER	386
MAMMOGRAPHY RADIOGRAPHER GRADE 1	1
MEDICAL ORTHOTIST & PROSTHETIST GRADE 1	10
MEDICAL PHYSICIST GRADE 1	3
MEDICAL TECHNOLOGIST	6
MEMBER OF HOSPITAL BOARD	7
MIDDLE MANAGER (SOCIAL WORKER)	1
MIDDLE MANAGER CLINICAL SUPPORT L11	1
MMC TRADITIONAL COORDINATOR	44
MORTUARY ASSISTANT	20
MORTUARY ATTENDANT	4
NUCLEAR MEDICINE RADIOGRAPHER	4
NUTRITIONIST GRADE 1	4
OCCUPATIONAL HEALTH AND SAFETY OFFICER	1
OCCUPATIONAL HYGIENIST GRADE 1	2
OCCUPATIONAL THERAPIST	40
OCCUPATIONAL THERAPIST (COMMUNITY SERVICE)	10
OCCUPATIONAL THERAPY TECHNICIAN	3
OPTOMETRIST	7
ORAL HYGIENIST	10
ORTHOPAEDIC FOOTWEAR TECHNICIAN	2
PARAMEDIC	31
PATIENT CARE ASSISTANT	2
PATIENT TRACER & HEALTH AWARENESS MOBILISER	265
PHARMACIST	123
PHARMACIST (COMMUNITY SERVICE)	82
PHARMACIST (INTERN)	45
PHARMACIST ASSISTANT (BASIC)	39
PHARMACIST ASSISTANT (POST-BASIC)	276
PHARMACOLOGIST(CLINICAL)	1
PHARMACY SUPERVISOR GRADE 1	4
PHYSIOTHERAPIST	58
PHYSIOTHERAPIST (COMMUNITY SERVICE)	6
PHYSIOTHERAPY ASSISTANT GRADE 1	2
PHYSIOTHERAPY TECHNICIAN GRADE 1	3
PODIATRIST GRADE 1	7
PSYCHOLOGIST	59
PSYCHOLOGIST (COMMUNITY SERVICE)	26
PSYCHOLOGIST (INTERN)	3
RADIATION ONCOLOGY RADIOGRAPHER	7
RADIOGRAPHER	140
REGISTRAR (DENTAL)	5
REVIEW BOARD MEMBER	6
SAFETY OFFICER SENIOR L8	1
SOCIAL AUXILIARY WORKER GRADE 1	9
SOCIAL WORKER	106
SPECIAL ADVISOR	1
SPECIALISED AUXILIARY SERVICES OFFICER	2
SPECIALISED AUXILIARY WORKER (DENTAL)	12
SPECIALISED AUXILIARY WORKER (LABS)	1
SPECIALISED AUXILIARY WORKER (MORTUARY)	2
SPECIALISED AUXILIARY WORKER (PHYSIO)	1
SPECIALIST FORENSIC INVESTIGATOR	1
SPECIALIST PSYCHIATRY PRINCIPAL L13	1
SPEECH THERAPIST (COMMUNITY SERVICE)	1
SPEECH THERAPIST AND AUDIOLOGIST	18
SPEECH THERAPIST AND AUDIOLOGIST (COMMUNITY SERV)	1
SPEECH THERAPIST GRADE 1	19
SPEECH THERAPY ASSISTANT GRADE 1	2
SPRAY OPERATOR	354
STERILIZATION OPERATOR PRODUCTION	8
STERILIZATION OPERATOR: SUPERVISOR	1
STOMATOLOGIST	2
STUDENT: RADIOGRAPHY	1
TECHNICAL SPECIALIST	1
TECHNICIAN/TECHNOLOGIST(IT)	1
THERAPEUTIC & MEDICAL SUP SERV PROGRAMME CO GR1	1
TRADESMAN AID	20
ULTRASOUND RADIOGRAPHER GRADE 1	7
VOCATIONAL COUNSELLOR PRINCIPAL L8	1
WORK INSPECTOR INFRASTRACTURE	5
Total	16995

(v) The table below indicates the total of Foreign National healthcare and related professionals that have been employed since from March 2020 up until October 2020.

Foreign Citizenship Health Related Professions: Appointed from March 2020 - October 2020
Job Title Description	Total
ADMINISTRATIVE OFFICER SENIOR	1
ASD: BIOMEDICAL ENGINEER	1
ASSISTANT DIRECTOR ADMIN RELATED	5
ASSISTANT MANAGER BIOMEDICAL ENGENEER	4
ASSISTANT MANAGER MEDICAL PHYSICS	1
BIO MEDICAL ENGINEER	3
BOARD OF SURVEY COMMITTEE: MEMBER	2
CLINICAL ENGINEERING TECHNOLOGIST	3
CLINICAL MANAGER (MEDICAL) GRADE 1	6
CLINICAL TECHNOLOGIST	3
COMMUNITH HEALTH WORKER	17
CONSTRUCTION PROJECT MANAGER PRODUCTION GRADE A	1
CONSULTANT	1
DD: BIOSTATISTICS	1
DD: BIOSTATISTICS TECHNOLOGY	1
DD: EPIDEMIOLOGY & DISEASE SURVEILLANCE	3
DD: EPIDEMIOLOGY TECHNOLOGY	3
DENTIST (COMMUNITY SERVICE)	2
DENTIST GRADE 3	1
DEPUTY DIRECTOR FINANCE	1
DEPUTY DIRECTOR INFORMATION TECHNOLOGY	2
DEPUTY DIRECTOR MEDICAL TECHNICAL SERV GRADE 1	1
DEPUTY DIRECTOR: INFORMATION MANAGEMENT	3
DEPUTY DIRECTOR: INFORMATION MANAGEMENT (BIOSTATICS	3
DEPUTY DIRECTOR: INFORMATION	1
DEPUTY DIRECTOR: INFORMATION MANAGEMENT(EPIDEMIOL)	1
DEPUTY DIRECTOR:IT MANAGEMENT L11	2
DEPUTY DIRECTOR_ADMIN RELATED	2
DEPUTY MANAGER HYGIENE&EPIDEMOLOGY	2
DIAGNOSTIC RADIOGRAPHER (COMMUNITY SERVICE)	1
ENGINEER	3
EPIDEMIOLOGIST	1
EPIDEMIOLOGY TECHNOLOGIST (NON-OSD)	4
FAULT MANAGEMENT CONTROLLER	1
FORENSIC TOXICOLOGIST	1
HEAD CLINICAL UNIT (MEDICAL)	2
HEALTH TECHNOLOGIST	4
HEALTH TECHNOLOGY (NON-OSD)	3
HYGIENE AND EPIDEMIOLOGY	1
INFORMATION MANAGEMENT (BIOSTATICS)	1
MAMMOGRAPHY RADIOGRAPHER GRADE 2	1
MANAGER ADMINISTRATION	1
MEDICAL OFFICER (COMMUNITY SERVICE)	14
MEDICAL OFFICER (INTERN)	10
MEDICAL OFFICER	519
MEDICAL SPECIALIST (SUB-SPECIALITY) GRADE 1	1
MEDICAL SPECIALIST	30
MIDDLE MANAGER(ADMINISTRATION)	4
MIDDLE MANAGER(HEALTH)	1
MIDDLE MANAGER (HUMAN RESOURCE)	2
NA1 NURSING ASSISTANT GRADE 1	4
OCCUPATIONAL THERAPIST GRADE 1	1
OPTOMETRIST GRADE 1	1
PHARMACIST (COMMUNITY SERVICE)	21
PHARMACIST (INTERN)	2
PHARMACIST ASSISTANT (POST-BASIC) GRADE 1	3
PHARMACIST GRADE 1	13
PHARMACY SUPERVISOR GRADE 1	1
PHYSIOTHERAPIST (COMMUNITY SERVICE)	1
PHYSIOTHERAPIST GRADE 1	2
PNA1 PROFESSIONAL NURSE (COMMUNITY SERVICE)	5
PROFESSIONAL NURSE (GENERAL NURSING)	25
PNA5 OPERATIONAL MANAGER NURSING GRADE 1 GENERAL	1
PNB1 CLINICAL NURSE PRACTITIONER GR 1 PRIM H CARE	1
PNB1 PROFESSIONAL NURSE GRADE 1 SPECIALITY NURSING	5
PND1 LECTURER NURSING GRADE 1	1
PROVISIONING ADMINISTRATION CLERK GRADE II SENIOR	1
PSYCHOLOGIST (COMMUNITY SERVICE)	1
PSYCHOLOGIST GRADE 1	2
QUANTITY SURVEYOR CHIEF GRADE B	1
RADIOGRAPHER GRADE 1	2
REGISTRAR (DENTAL)	1
REGISTRAR (MEDICAL)	16
SN1 STAFF NURSE GRADE 1	3
STUDENT NURSE	1
Grand Total	797

(b) At the time of reporting, the Provinces were not in a position to upfront indicate the numbers of health care workers who will be retained as that is reliant on the service delivery needs and availability of budget.

END.

Reply:

The question asked by the Honourable Member is acknowledged. However, given the nature of the details required in terms of (a) cost of (air tickets, (ii) transport, and (iii) VIP transport for the officials that travelled including (b) total subsistence and (c) cost of the accommodation for the trip, the National Department of Health is still in the process of collating this detail from the relevant provincial Departments of Health. Once fully collated, the information will be submitted for the Honourable Member’s consideration.

END.

Reply:

1. The details of the dates and names of persons that travelled are outlined in the table below. However only nine Members of the Executive Councils (MECs) attended and not 12 as stated in the question.

	TURKEY	THAILAND	UNITED KINGDOM	TOTAL
DATE	2nd - 6th Dec 2019	27th Jan - 3rd Feb 2020	25th -29th Nov 2019
MEC	Dr Bandile Masuku (GP) Ms Sasekani Manzini (MPU) Dr Phophi C Ramathuba (LP)	Ms Nomafrench Mbombo (WC) Ms Montseng Tsiu (FS) Ms Nomagugu Simelane- Zulu (KZN) Mr Madoda Sambatha (NW)	MEC Mase Manapole (NC) MEC Sindiswa Gomba (EC)	9
HOD	Ms Jeanette Hunter (NW) Ms Priscilla Monyobo(FS) (Acting) Dr Sandile Tshabalala (KZN)	Dr Thobile Mbengashe (EC) Dr Keith Cloete (WC) (Acting HoD) Dr Steven Jonkers (NC)	Prof. Mkhululi Lukhele (GP) Dr Beth Engelbrecht (WC)	8
DISTRICT MANAGEMENT	Ms Puleng Malefakgotla (NW) Mr Papi Maarohanye (FS) Mr A Hlongwane (KZN) Mr Simon Kaye (WC) Dr Alastair Kantani (NC)	Ms Nomathemba Mazibuko (NC) Dr Zolela Ngcwabe (GP) (Travel cancelled and replaced by Dr Adiel Chikobvu) Ms Sindiswa Gede (EC) Ms Nanana Hlatshwayo (MPU) Dr NM Ndwambi (LP) (Travel not approved at last minute by HoD)	Dr Ariel Torres ( Free State) Dr Lenyatso Modisane (GP) Dr David Leburu (NW)	13
NDOH OFICIALS	Mr Mbulelo Cabuko Ms Nellie Malefetse	Dr Aquina Thulare Ms Nellie Malefetse Mr Mbulelo Cabuko (Health Information System)	Ms Nellie Malefetse	3
SPECIAL ADVISORS		Dr Qiniso Langisa (Special Advisor to KZN MEC)	Dr Bayeni Special Advisor to MEC Eastern Cape	(2)

(ii) The programme and plans were considered by the National Health Council on the 25th July 2019 and finally approved for implementation on 15th August 2019.

(2) The study tour report was submitted to the National Department of Health as per standard operating procedures. The report is of an operational nature and still has to be fully considered by the National Health Council. It will be shared with the Portfolio Committee as soon as it has been presented to the National Health Council.

END.

Reply:

1. DATCOV data provides us with Case Fatality Ratio among Covid-19 admissions with chronic cardiac disease, by province, South Africa, 5 March-28 November 2020, n=2097

Province	Died	Total admissions	CFR (%)
Eastern Cape	132	294	44,9
Free State	64	208	30,8
Gauteng	175	531	33,0
Kwazulu-Natal	169	482	35,1
Limpopo	8	32	25,0
Mpumalanga	15	37	40,5
North West	27	94	28,7
Northern Cape	26	67	38,8
Western Cape	113	352	32,1
SOUTH AFRICA	729	2097	34,8

*Note*: The surveillance platform does not include fields on myocardial infarction (heart attacks) as a complication of CovidD-19.

2. Assessment of cause of heart attack, and association of medication as a contributing factor would need to be done on a per patient basis. Many clinical considerations around the patient’s condition, history, and medication management would need to be considered. It is thus difficult to comment broadly on this issue.

South Africa has an adverse drug reporting process, whereby medication associated adverse effects are reported to a central point and important trends are captured to inform future use of products.

Cardiotoxicity is the occurrence of heart electrophysiology dysfunction or muscle damage. The heart becomes weaker and is not as efficient in pumping and circulating blood. Certain medications can cause cardiotoxicity. On the question of whether there was a specific medication administered, that she is concerned about, the Honourable Member is requested to supply this detail for us to investigate.

The Clinical Management Guidelines, version 5, August 2020 outlines the management of Covid-19, as well as, medications that can be used. These can be accessed at: http://www.health.gov.za/index.php/component/phocadownload/category/628. Management of Covid-19 is generally supportive, however key medications used in hospitalised Covid-19 patients with specific indications are: dexamethasone or heparin, which are not associated with known Cardiotoxicity.

As part of the overall management of the patient, the clinicians and team balance risk and benefits of all treatments used to ensure the patient, based on their clinical state, has the best expected outcome.

3. A detailed of assessment of individual patients will be needed to assess any drug causality, and any similarity of traits.

END.

Reply:

1. The Department has observed the increasing Covid-19 positive numbers in the two Provinces, as you may be aware I have personally visited Eastern Cape and Western Cape, met with the leadership in both Provinces, jointly agreed on measures to be taken.

The Department has placed WHO experts in the two Provinces to assist with the resurgence. I have also deployed teams from National to work with the various provinces including Eastern Cape and Western Cape to develop resurgence plans.

 

In Eastern Cape additional doctors and nurses were employed to address Human Resource shortages. Further in Eastern Cape, specifically in Nelson Mandela Bay and Sara Baartman, community testing sites have been established, and these have increased access to testing for many communities.

Compliance monitoring has been strengthened including Environmental Health Practitioners and other law enforcement agencies are monitoring non-compliant outlets and closing down those found to be non-compliant.

• Curfew between 10pm and 4am
• Alcohol sale has been restricted to Monday to Thursday.

Additional measures

Evidence is showing us that gatherings provide an opportunity for the virus to spread, with social gathering recorded as super spreaders.

Drastically reducing numbers or stopping social gatherings should be considered to ease the pressure in our hospitals.

All patients on chronic medication are urged to adhere to their treatment to reduce emergency admissions due to non-adherence to treatment.

Stricter measures are being taken in Taxis or busses and trains if passengers and drivers are not wearing masks. Passengers also have a responsibility to demand a safe environment.

2. A decision on whether or not to reintroduce a hard lockdown is taken after careful consideration and in consultation with the relevant stakeholders, keeping in mind the health of the nation as a priority, as well as the socioeconomic impact such a decision would have to the country.

END.

Reply:

The medicine supply chain is long and complex, with interruptions at any point in the supply chain affecting medicine availability at the facility. These interruptions may relate to, inter alia, the shortage of the active ingredients, regulatory issues affecting formulation, logistical challenges, inadequate volumes produced relative to the ordered quantity and inadequate quantities being ordered. Medicine shortages is a global problem affecting all countries for the reasons outlined above.

South Africa has experienced constrained supply of psychiatric medicines. The challenges precede the outbreak of the Covid-19 pandemic. The reason for the shortage of each drug differs and includes a shortage of the active pharmaceutical ingredient, the manufacturer is unable to supply ordered quantities within the contracted timelines, production problems, and industrial action at local production facilities.

(a) The shortages are considered to be very serious.

(b) Steps taken in mitigation include sourcing of stock from alternative suppliers, where possible, as well as the issuing of circulars recommending use of available alternative agents that are considered to be therapeutically equivalent. Where partial deliveries are made by contracted suppliers availability is managed at the district level through stock rotation among facilities.

The supply issues related to the availability of Citalopram and Fluoxetine; have been resolved. However, South Africa is experiencing shortages of four drugs (Amitriptyline, Chlorpromazine, Haloperidol and Olanzapine).

END.

Reply:

1. Yes currently there are three research studies that have been conducted through collaboration between the Department of Health research sectors and universities.

a) Parker et al (2020) study findings suggested that PLHIV with COVID-19 might have a high probability of admission to hospital, but had similar presentations, comorbidities and outcomes when compared with the HIV-negative study population.

b) Boule et al. (2020) Collaboration between Western Cape Department of Health and the National Institute for Communicable Diseases (2020) study suggested consideration of people with HIV and tuberculosis as being at elevated risk of severe COVID-19. Additionally the study also suggested that HIV was associated with a doubling of COVID-19 mortality risk.

c) Pillay et al (2020) analysis showed that HIV and TB were not the most common comorbidities in individuals who died from COVID-19.

2. It should be noted that HIV is not a notifiable condition, it is not reported in the death certificate. The National Department of Health currently is not collecting any COVID-19 related co-morbidity details. All deaths are reported to the Department of Home Affairs; the cause of death is recorded in the death certificate.

References

a) Parker A, Koegelenberg C.F.N, Moolla M.S et al. 2020. High HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town, South Africa. S Afr Med J 2020; 110(6):463-465. https://doi.org/10.7196/SAMJ.2020v110i6.14809

b) Boule A, Davies M, Hussey, H et al. 2020. Western Cape Department of Health & NICD. 2020. HIV and risk of COVID-19 death: a population cohort study from the Western Cape Province, South Africa. Clinical infectious diseases, ciaa198. https://doi.org/10.1093/cid/ciaa1198. Published 29 August 2020.

c) Pillay-van Wyk,V, Bradshaw D, Groenewald P. 2020. COVID-19 deaths in South Africa: 99 days since South Africa’s first death. S Afr Med J 2020; 110(11):1093-1099. https://doi.org/10.7196/SAMJ.2020.v110i11.15249

END.

Reply:

According to the Gauteng Provincial Department of Health –

a) The treatment of the patient was as a result of miscommunication between the patient and the junior doctors. The patient presented at J Dumane clinic on 18 October 2020 with a history of diabetes, hypertension, chronic kidney disease and cerebral atrophy. The patient is on chronic medication for the medical conditions stated above. He was transferred to Thelle Mogoerane Hospital through an ambulance. The paramedics who transferred the patient reported that the patient was unable to walk at the date of admission at Thelle Mogoerane Hospital. The patient was admitted at the Hospital and was seen on a daily basis by the internal medicine team. The patient was discharged on 09 November 2020 with a follow-up date for medical outpatient department of 25 November 2020 and was given medicine to take home.

b) (i) Following a complaint which was lodged, a team of clinicians from the province and the district held a meeting with the family of the patient on 02 December 2020. During this meeting, the doctor provided clarity to the family about the diagnosis and the condition of the patient including interventions that were made. During the discussions it was discovered that there was miscommunication between the junior doctor and the family and an apology was conveyed to the family through the doctor. This was done as part of redress for the patient and the family.

(ii) With regards to the treatment given to the patient, the department has since appointed a social worker to ensure that the patient is placed at Steppingstone Hospice in Alberton. The Social Worker discussed this arrangement with the family. The doctor and the social worker have planned for the patient to be transferred to the hospital for medical review on the set date. The district has provided the patient with a wheelchair. The province and district have identified the need to strengthen communication between families and clinicians and to ensure that there is an adequate patient discharge plan which includes district services of this nature to ensure appropriate continuity of care. From the discussion between the family and the clinical team including with the Social Worker, the family accepted the intervention made by the Department and therefore there is no need for compensation.

END.

Reply:

1. The table below reflects the details in this regard:

	Forensic Chemistry Laboratory Cape Town	Forensic Chemistry Laboratory Johannesburg	Forensic Chemistry Laboratory Pretoria	Total
(a) the total backlog of toxicological reports at the laboratories at present	5474	10335*	12 372	28,181
(b) total number of reports outstanding for (i) more than 10 years,	1030	6333	526	7,889
(b) total number of reports outstanding for (ii) 10-9 years,	139	842	1294	2,275
(b) total number of reports outstanding for (iii) 9-8 years,	376	854	1519	2,749
(b) total number of reports outstanding for (iv) 8-5 years,	430	2370	2925	5,725
(b) total number of reports outstanding for (v) 5-1 years;	2484	4132	6108	12,724

*As at 30 September 2020

2. (a) The reasons for the backlogs are:

(i) The number of unprocessed samples indicated in the table above, include approximately 12,315 cases (multiple samples per case) without SAPS CAS (Case Administration System) numbers. The mandate of the Forensic Chemistry Laboratories (FCLs) is to analyse only samples with SAPS CAS numbers – these cases will thus only be tested upon request of the SAPS Investigating Officer or relevant Forensic Pathologist.

(ii) Of the 28,181 unprocessed cases as at 30 November 2020, only 16,550 cases contain CAS numbers.

(b) The following measures are employed to address the backlog:

• The laboratories are working overtime on weekends in order to decrease the backlog.

• Cases are prioritized for Court purposes, to assist families of the deceased to finalize insurance claims, or when children are involved.

• In terms of the Toxicology samples without CAS numbers, another engagement with Pathologists will take place to further discuss this matter with them. It should be seriously considered to destroy the toxicology cases that do not have CAS numbers.

• Urgent filling of crucial vacancies.

• There will be an engagement with the National Treasury to source additional funding for a building for the Pretoria Forensic Chemistry Laboratory. There were discussions with the CSIR which has space, however, the issue is lack of funding.

3. I will make a statement at the appropriate time.

END.

Reply:

a) The emergence of the COVID-19 pandemic necessitated the need for a concerted societal response to design and implement innovative, quick and practical solutions to address the impact of the pandemic on the national health system. A key element of this response was the interactions between the public and private sector stakeholders of different kinds (most importantly private healthcare professionals) to collaborate with Government at various levels. This collaboration and open engagement allowed for some innovative solutions, such as the Private Laboratory network (22 Laboratories) agreeing to work with the National Health Laboratory system (27 Laboratories) to scale up testing capacity; the private health facilities availed their beds and ICUs for the management of cases; as well as establishing platforms for the coordination and sharing information with the private sector which was essential in monitoring ICU capacity and where additional patients could be referred particularly during periods of the pandemic peaks in some provinces.

b) The National Department of Health continues to cooperate and regularly engages the private health sector on a variety of matters pertaining to priority programmes for the sector. This engagement and cooperation will continue to be followed through as we make progress towards the implementation of National Health Insurance (NHI), through ensuring a coherent and sustainable plan as outlined in the White Paper on NHI and the NHI Bill. Some of the core areas for continued engagement with the private sector include how best to incorporate the skills and clinical insights of the private sector into both the primary and hospital-based health care services, the role to be played by the multidisciplinary district health teams; and the development and implementation of alternative reimbursement strategies. Equally important is the aspect of digital integration of private health information platforms into the Health Normative Standards for Interoperability with the systems that are being designed and implemented as part of the NHI Fund’s information system.

END.

Reply:

1a)  Actions and/or measures has he and/or his department taken to address the

 

(i) Availability of PPEs

The National Department of Health developed an Infection Control and Prevention (IPC) Guideline that identifies in detail what PPEs are required in by health care and support personnel require in the different health care service delivery settings. This document formed the basis of determining what PPE’s and in what quantity each health care worker and support personnel will require.

(ii) Quantity of PPEs

The IPC Guidelines informed the PPE demand forecast, initially projected for a 6-month period and subsequently the PPE forecast was projected until March 2021. The PPE demand forecast projections are utilised to identify resources required to procure PPEs, finalise transversal contracts with National Treasury, secure and negotiate availability of PPEs with suppliers.

A PPE module was also added to the stock visibility system (SVS) used to monitor medicines. This enabled health facilities and depots in provinces to report PPE stock on hand against forecasted demand and identify shortfalls and surpluses. The SVS system is used by provinces to monitor PPE availability and to address shortfalls at a health facility level.

(iii) Quality of PPEs

The National Department of Health in collaboration with South African Bureau of Standards (SABS) the South African Health Products Regulatory Authority (SAHPRA), the National Regulator for Compulsory Specifications (NRCS) sets the quality standards for the various personal protective equipment items. Each province is responsible for ensuring that the quality standards of PPE’s procured are maintained.

The National department of Health has also supported the provinces with availing a Policy on Respiratory Protective Equipment and a list of PPE specifications that provinces can utilise to guide the PPE procurement process. In addition, PPE quality assurance training was conducted for provinces. The Department of Trade and Industry also provides support to local manufacturers and distributors in respect of compliance with applicable standards and conformity assessments to assist them to prepare for the licensing and approval process.

Meetings with provincial PPE coordinators, depot managers and PPE supply chain officials are convened bi-weekly to monitor and address availability, security of supply and quality assurance of PPE.

b) The labour unions participate in the weekly Project Management Office meetings chaired by the Director-General where updates are given on personal protective equipment (PPE) availability and quantity at facility level through analysis of data on the Stock Visibility System (SVS). The SVS also allows for access to trade union representatives to sign-off on the quantity of PPE at the facility level. I have convened meetings with the trade unions to update them on PPE availability and quantity. In addition, PPE and Occupational Health and Safety are standing agenda items on the Tech-NHC and NHC meetings.

END.

Reply:

1. The approved Health Compact raised a pillar that required the execution of an infrastructure plan to ensure “adequate, appropriately distributed and well maintained” health facilities. The Public Health Infrastructure Refurbishment Programme identified as the vehicle to do so and executed within the legislative framework of government facilities. This framework guides the maintenance of government faculties that includes health facilities and infrastructure as guided by strategies and guidelines driven from the national department of public works as the mandated department for all public properties in the country.

The National Department of Health (NDOH), together with National Treasury (NT) implemented a system which requires Provincial Departments to develop and submit what is called an User Asset Management Plan (U-AMP). This plan details the condition of each health infrastructure asset per province and their equipment. From the U-AMP, provinces are required to draw a three-year priority plan called an Infrastructure Programme Management Plan (IPMP). This is the plans that are submitted to the Implementing Agents (i.e. Public Works, Development Bank of Southern Africa (DBSA) etc.), who should provide the Provincial Health Departments with an Infrastructure Project Implementation Plan (IPIP). The IPIP indicate the readiness of the Implementing Agents to execute the projects listed and all of these plans are submitted to NDOH and NT for review and approval.

Provinces are allocated three-year Medium-Term Expenditure Framework (MTEF) budget based on the needs identified and the money available and required to adjust their plan to fit within the approved budget. These adjusted plans are presented to Provincial Executive Committee (EXCO) for endorsement and implementation.

From a systems perspective thus, strides have been made to ensure that the programme is well executed and prioritised facilities where refurbishment is most needed. In addition to this, the National Department in partnership with the various Provincial Health departments and supported by DBSA, initiated not only the development of a Health Maintenance Strategy, but also appointed contractors to develop a 10-year Infrastructure Plan.

The Maintenance strategy developed under the aegis of the Department of Health, seeks to establish a consolidated maintenance management approach, that is specific to health infrastructure and includes the specialist field of health technology equipment that is vital for the effective and efficient health services across the country. On the other hand, the 10-year infrastructure plan aims to provide a development window to ensure that the distribution and planning of infrastructure refurbishments are in alignment with the needs of the provinces as identified through the various communities they serve.

2. COVID-19 has elevated the need for properly maintained and adequate health facilities and have thus contributed towards a reprioritisation of projects in order to facilitate the curbing of the spread. Towards this end the various maintenance projects related to oxygen and ICU wards were brought forward and expedited.

In the Eastern Cape for example eighty-five (85) contract awards, amounting to R578,902,253 million have been made to contractors for refurbishment of 67 Health Facilities across the province for COVID-19 purposes. Of these 85 projects, forty-eight (48) have now been completed at a total cost of R123,809,915.06 and have yielded 1259 Covid-19 isolation beds. A total of thirty-seven (37) projects are currently at advanced stages of construction within the province with a combined cost of R466,618,721.25. Upon completion, these projects will yield a total of 1179 Covid-19 isolation beds. The total cumulative expenditure to date on the 85 projects is R248,507,116.

For the primary health care facilities in terms of clinics and community health centres, various movable units were targeted for space augmentation to improve service delivery as part of the COVID-19 Treatment Surge and Resurgence. Post COVID-19 the units will be utilized for the HIV Treatment Surge in line with the project identified during the 2018/19 financial year under the auspices of the PEPFAR Facility Infrastructure Improvement Project.

In the hospitals, these units will be used to complement the screening and testing spaces needed during this COVID-19 Surge and Resurgence. Post COVID-19, the units will be mainly utilized for records storage. Currently patient files and general records are highly paper driven resulting in volumes of files that need to be appropriately kept for ease of retrieval and maintenance.

In Gauteng a Rapid intervention programme was launched to assess 32 hotspot facilities in the province to increase its COVID-19 surge capacity. This included the provision of P1, P2 and P3 level care related to administration of oxygen, especially high flow oxygen, provision of beds in terms of high and critical care beds and to identify problems in dealing with capacitation at these sites. As a result of these assessments, various projects were identified and now in planning, procurement and implementation to facilitate the improvement and refurbishment of surge capacity at these priority facilities.

END.

Reply:

a) 946 hours over 6-month period.

b) R1,740,632.26 over 6-month period.

c) R13,234.26 as reimbursement for use of private vehicle to and from the airport at a rate of R3,61 per km over a 6-month period.

d) A departmental tender (NDoH20/2019/2020) was awarded to the supplier.

END.

Reply:

1. According to the KwaZulu Natal Provincial Department of Health, there is a total of 153 Nurses which is inclusive of nurses employed on contract basis and permanent employees. Nurses were from the following sites:

• Inkosi Albert Luthuli Central Hospital
• Greys Tertiary Hospital
• King Edward Hospital
• Prince Mshiyeni Memorial Hospital
• RK Khan Regional Hospital
• Mahatma Gandhi Regional Hospital
• Port Shepstone Regional Hospital
• Newcastle Hospital
• Madadeni Hospital
• Addington Regional Hospital
•  Ladysmith Regional Hospital
• General Justice Gizenga Memorial Regional Hospital
• Ngwelezane Tertiary Hospital

2. These nurses have been employed on contract up until 31 March 2021. No decision has been taken regarding the retention of these healthcare personnel on permanent basis after Covid-19 pandemic. The decision will be based on need and availability of budget.

3. The Department intends to prioritize appointing post-community service personnel into permanent existing posts of clinical psychologists and physiotherapists. Plans are also in place to advertise more bursaries in these professional categories. The Department also intends to target students who are pursuing Honours and Master’s Degree to address the shortfall.

END.

Reply:

1. The model that South Africa used to determine the red list of high-risk countries from where persons are permitted to travel to the Republic is based on a scientifically robust and tested approach that was benchmarked with other countries. The benchmarking process assisted the country to understand how best other countries are implementing interventions to enable proactive risk categorisation processes. The model and the criteria applied were based on globally accepted standards taking into consideration the guidelines as set by the World Health Organisation (WHO). Several criteria and scientific data are utilised to design, develop and refine the RSA risk categorization model. The primary considerations include the following:

a) the number of new cases per 100,000 persons over 14 days;

b) the number of new deaths per 100,000 persons over 14 days; and

c) the total number of accumulated cases in the given country since the first case.

Furthermore, the model also considers sensitivity analyses to assess the tolerance level rate to the RSA baseline. Other parameters such as testing data and active cases are considered. However, due to the absence of sufficiently updated data across different countries, it was recommended that these factors are not significantly relied upon. Based on all these factors, countries were classified according to three distinct categories: “Low Risk”, “Similar Risk” and “High Risk”. The “High Risk” category is what is used to create the red list of high-risk countries.

Therefore, the methodology outlined above is what was used to determine (a) China as a low-risk country and (b) the Maldives as a high-risk country. It must be noted that due to recent global developments and trends, the Cabinet resolved that the strategy of using the red list of high-risk countries should be changed and instead use the 72-hour PCR test and the screening of incoming passengers to determine if they should be allowed into the country or not.

 

Based on recent global developments and trends, the Cabinet resolved that the strategy of whether (a) non-residents, (b) persons employed abroad and (c) persons who will be relocating will be allowed to travel to identified high-risk countries should be based on the use of the 72-hour PCR test and appropriate screening interventions at both the departing border and those implemented in the destination country to which all individuals are expected to comply as per those countries’ COVID-19 prevention and screening protocols. This decision takes into consideration the WHO’s guidelines on public health considerations while resuming international travel as published in June 2020 and subsequently updated advisories.

END.

Reply:

According to the KwaZulu Natal Provincial Department of Health, the following tables reflects the details in this regard:

(a)

Mortuary	number of (i) women admitted	number of (ii) men admitted	number of (iii) children admitted
	Jan-Dec 2019	Jan-June 2020	Jan-Dec 2019	Jan-June 2020	Jan-Dec 2019	Jan-June 2020
(i) Pinetown,	263	94	1 148	542	134	45
(ii) Gale Street,	452	74	1 872	340	129	36
(iii) Phoenix,	256	159	1 265	652	121	70
(iv) Park Rynie	92	34	426	196	41	9

(b)

Mortuary	number of (i) women admitted
	African	Asian	Coloured	White	Other
	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020
(i) Pinetown,	221	70	23	10	3	2	16	11	0	1
(ii) Gale Street,	338	55	41	8	20	2	31	4	22	5
(iii) Phoenix,	190	124	49	30	3	2	14	3	0	0
(iv) Park Rynie	89	30	2	2	0	0	1	2	0	0

Mortuary	number of (ii) men admitted
	African	Asian	Coloured	White	Other
	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020
(i) Pinetown,	986	464	116	45	4	9	41	24	1	0
(ii) Gale Street,	1 563	292	135	25	65	8	93	15	16	0
(iii) Phoenix,	1 031	536	193	83	11	5	30	28	0	0
(iv) Park Rynie	403	189	9	4	0	0	14	3	0	0
Mortuary	number of (iii) children admitted
	African	Asian	Coloured	White	Other
	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020
(i) Pinetown,	132	43	1	2	0	0	1	0	0	0
(ii) Gale Street,	120	35	8	1	0	0	1	0	0	0
(iii) Phoenix,	106	62	12	6	1	1	2	1	0	0
(iv) Park Rynie	35	9	0	0	0	0	0	0	0	0

(c)

Mortuary	number of (i) women admitted with gunshot wounds	number of (ii) men admitted with gunshot wounds
	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020
(i) Pinetown,	31	13	292	160
(ii) Gale Street,	42	3	391	82
(iii) Phoenix,	26	12	320	133
(iv) Park Rynie	9	2	76	65

(d)

Mortuary	total number of victims admitted with (i) stab wounds	total number of victims admitted with (ii) soft tissue injuries suggestive of trauma inflicted and
	Jan-Dec 2019	Jan-Jun 2020	Jan-Dec 2019	Jan-Jun 2020
(i) Pinetown,	157	59	181	91
(ii) Gale Street,	282	33	223	73
(iii) Phoenix,	188	81	148	104
(iv) Park Rynie	68	24	69	44

(e)

Mortuary	total number of victims of motor vehicle accidents
	Jan-Dec 2019	Jan-Jun 2020
(i) Pinetown,	232	67
(ii) Gale Street,	490	80
(iii) Phoenix,	280	136
(iv) Park Rynie	130	27

END.

Reply:

According to the Provincial Departments of Health, the responses to these questions are as follows:

1. Eastern Cape

The Eastern Cape Department of Health does not have a hospital administrator (CEO) that is currently under investigation leading to temporal suspension. In 2018, the CEO of Livingstone Hospital was suspended and subsequently resigned and left the service. He was on a precautionary suspension and investigated on allegations of fraud and corruption.

2. Free State

NAME OF EMPLOYEE	RACE	SALARY LEVEL	GENDER	NAME OF THE INSTITUTION	DATE OF THE SUSPENSION	DATE SUSPENSION LIFTED	REASON FOR SUSPENSION	TYPE OF TRANS-GRESSION	REASON FOR DELAY / FINALISATION	HIGHLIGHTS / CHALLENGES OR TRENDS
Noge SR	A	7	F	Bongani Regional Hospital	27 March 2019	10 May 2019	Misconduct	Irregular Expenditure	Charge sheet is complete the role players to be appointed	N/A
Tau LW	A	11	M	Bongani Regional Hospital	27 March 2019	10 May 2019	Misconduct	Irregular Expenditure	Charge sheet is complete the role players to be appointed	N/A
Mfanta X	A	12	M	Pelonomi Regional Hospital	27 April 2019	23 October 2019	Misconduct	Sexual Harassment and Irregular Expenditure	The case was set down for the first time on the 27th November 2020.	N/A

NAME OF EMPLOYEE	RACE	SALARY LEVEL	GENDER	NAME OF THE INSTITUTION	DATE OF THE SUSPENSION	DATE SUSPENSION LIFTED	REASON FOR SUSPENSION	TYPE OF TRANS-GRESSION	REASON FOR DELAY/ FINALISATION	HIGHLIGHTS/ CHALLENGES OR TRENDS
Kgaile P.I	A	11	M	Mangaung Metro	20 May 2019	30 August 2019	Misconduct	Irregular Expenditure	Investigations has been Finalized and the charge sheet is still being Formulated	N/A
Christou A	W	10	F	Mangaung Metro	30 May 2020	30 August 2020	Misconduct	Irregular Expenditure	Investigations has been Finalized and the charge sheet is still being Formulated
Ramodula BS	A	14	F	Pelonomi Regional Hospital	31 March 2020	29 May 2020	Misconduct	Failure to put measures in place for management of COVID-19 ward	Case Finalized and Final Written Warning issued on the 29 May 2020.	N/A
Molefe M	A	11	F	Pelonomi Regional Hospital	31 March 2020	29 May 2020	Misconduct	Failure to put measures in place for management of COVID-19 ward	Case Finalized and Final Written Warning issued on the 29 May 2020. The appeal of the Final Written Warning was upheld.	N/A
Seboko JM	A	13	F	Free State Psychiatric Hospital	16 May 2019	19 July 2019	Misconduct	Gross negligence	Waiting for the Investigations to be finalized.	N/A
Marefeka MJ	A	12	F	Free State Psychiatric Hospital	16 May 2019	19 July 2019	Misconduct	Gross negligence	Waiting for the Investigations to be finalized.	N/A
Moshao IN	A	11	F	Free State Psychiatric Hospital	16 May 2019	19 July 2019	Misconduct	Gross negligence	Waiting for the Investigations to be finalized.	N/A

3. Gauteng

INSTITUTION	FINANCIAL YEAR	DATE OF THE INCIDENT	SURNAME & INTIALS	JOB TITLE	SALARY LEVEL	RACE	GENDER	TYPE OF MISCONDUCT	SANCTION	STATUS
Dr Yusuf Dadoo	2018/2019	19/02/2018	Maanwane KM	Session Doctor	Session	African	male	Rape	contract expired	Closed- the perpetrator left the Department

4. Kwa-Zulu Natal

There are no investigations that are currently being conducted on hospital administrators for alleged maladministration.

5. Limpopo

There are no investigations that are currently being conducted on hospital administrators for alleged maladministration.

6. Mpumalanga

1. The Mpumalanga Department of Health has not experienced any case of violence and or rape between patients and therefore, there are no Hospital administrators who are being investigated or temporarily suspended regarding this matter.
2. As stated in paragraph (a) above, none of the Hospital Administrators are under investigation nor suspended, therefore there are no investigators taking place for the past five years up to the current financial year.

7. North West

 

The North West Department of Health does not have such cases. The only CEO currently under investigation and on suspension has not relationship whatsoever with security concerns, violence and/or rape.

8. Northern Cape

The Northern Cape Department of Health does not have CEOs that are currently suspended from the hospitals for any of the allegations as contained in this question.

9. Western Cape

The Western Cape Department of Health does not have such cases for the last five years neither do we have current or pending cases.

END.

Reply:

a) (i) The model that South Africa used to determine the red list of high risk countries from where persons are permitted to travel to the Republic is based on a scientifically robust and tested approach that was benchmarked with other countries. The benchmarking process assisted the country to understand how best other countries are implementing interventions to enable proactive risk categorisation processes. The model and the criteria applied were based on globally accepted standards taking into consideration the guidelines as set by the World Health Organisation.

(ii) Several criteria and scientific data are utilised to design, develop and refine the RSA risk categorization model. The primary considerations include the following:

(1) the number of new cases per 100,000 persons over 14 days;

(2) the number of new deaths per 100,000 persons over 14 days; and

(3) the total number of accumulated cases in the given country since the first case.

Furthermore, the model also considers sensitivity analyses to assess the tolerance level rate to the RSA baseline. Other parameters such as testing data and active cases are considered. However, due to the absence of sufficiently updated data across different countries, it was recommended that these factors are not significantly relied upon. Based on all these factors, countries were classified according to three distinct categories: “Low Risk”, “Similar Risk” and “High Risk”. The “High Risk” category is what is used to create the red list of high risk countries.

b) The list was updated fortnightly, that is, every 14 days. Given the nature of the pandemic and the evolving data dynamics in every country, the model that was utilised could not be static as the baseline was expected to change over time. The considerations include the 10% tolerance level on the South African baseline which are used to compare against other countries. Countries with an estimated baseline of +/-10% to South Africa were considered “Similar Risk”; those with a score that was higher than the baseline + 10% were classified as “High Risk”; and all other countries with a population of less than 1 000 000 people were classified as low risk (or ignored). All countries in Africa were classified as low risk (or their high scores are ignored).

c) Taking into account recent global developments and trends, the Cabinet resolved that the strategy of using the red list of high-risk countries should be changed and instead use the 72 hour PCR test and the screening of incoming passengers to determine if they should be allowed into the country.

END.

Reply:

1. Yes, the costs in question were incurred by Department, however it serves to be mentioned that the total cost of R 5000.00 was incurred by the Department as a result of Chapter 8 paragraphs 2.9 and 7 of the Guide for Members of the Executive that came into effect on the 20th of November 2019 which states that:

2.9 “Where a Member moves from a State-owned Residence to a Private Residence to be used for official purposes in the same seat of office, personal effects may be packed and transported at the expense of the relevant Department. This is a non-recurring concession and cannot be utilised more than once during the Member’s term of office”.

7. “The relevant department shall be responsible for the costs of installation and maintenance of fax, internet/wifi facilities, computer equipment and relevant television subscription services for official use by the Member at the Official Residence”

2. The service in question was initiated and sanctioned by the support staff in the Office of the Minister and it took place based on the call out fees and diagnostic services. Once the service provider has submitted the invoice, proper procedures will have to be undertaken through Supply Chain for the purpose of processing the payment. It also serves to be mention that services of this nature are not easy for three (3) quotations to be sourced due to the fact that a diagnosis to determine the nature of work to be done must be concluded prior to rendering a service. Sourcing three (3) quotations will require that three providers must go on site of which they will all charge a call out and diagnostic fees which may result to fruitless and wasteful expenditure, hence one (1) quotation was sourced.

3. Based on Chapter 8 paragraphs 2.9 and 7 of the Guide for Members of the Executive, the Minister is not liable for the cost but it for the account of the Department.

Lastly, this transaction has to be subjected to a determination process which includes an investigation to determine the cause, the impact of the transgression and who must be held accountable in terms of Irregular Expenditure Framework issued by National Treasury.

END.

Reply:

a) Malaria is a seasonal disease, transmission increases during the summer months, and is exacerbated when there is higher rainfall. The COVID-19 pandemic started in March and peaked in July this year- when the malaria transmission period was waning.

There was a timely start of the Indoor Residual Spraying (IRS) programme this year despite the COVID-19 pandemic. Spraying started as planned in September 2020 in each of the malaria-endemic provinces. As 18 November 2020, a total of 1,112,637 structures (624,365 structures in Limpopo; 410974 in Mpumalanga and 77298 in KwaZulu-Natal) have been sprayed of the targeted 2 059 979 structures for the 2020/2021 financial year. The current national spray coverage is 54% (51.94%, 54.29% and 76.53% in Limpopo, Mpumalanga and KZN provinces respectively), noting that spraying will continue into the early part of the new year.

Community testing and treatment was adopted as part of the malaria elimination strategy for South Africa and cross-border collaboration with eight malaria eliminating countries (E8) that form the SADC Elimination 8 countries. It mostly targets the border districts to prevent secondary transmission from malaria cases imported from the high malaria-endemic countries bordering the Republic of South Africa. The screening process was slow with only a few cases reported during the initial days of the COVID-19 pandemic due to level 5 Lockdown and border closures when travel was limited. The screening gradually improved and will continue in the border areas over the festive period. During the 2020/2021 financial year a total of 66 162 people suspected to have malaria have been tested in the community and a total of 517 have been found to be positive through active case detection. All the positive cases were treated with the recommended treatment for malaria.

b) The holiday season (Christmas and New Year) coincides with the malaria transmission season hence the Malaria programmes embark on spraying in September 2020 to protect the communities at risk in the three malaria-endemic provinces of Limpopo, Mpumalanga and KwaZulu-Natal. The provincial Malaria Programmes have updated their Epidemic Preparedness Plans to ensure that there are adequate stocks of diagnostics, treatment and insecticides.

In addition, health promotion and awareness campaigns are essential interventions for the prevention of malaria morbidity and mortality and were enhanced during the first week of November 2020 when the SADC Malaria Day was event was commemorated in the endemic provinces. These interventions will continue during the peak season covering December to April.

END.