Questions and Replies

Reply:

1. (a) Staff are tested normally during the activation of a quarantine site. Thereafter they are monitored for symptoms daily as per normal workplace protocols. Retesting only occurs when staff exhibit any COVID-19 symptoms.

(b) Staff are tested by the clinical team that forms part of the operationalisation of the site. The staff would be tested separately from the PUI (persons under investigation) testing.

(c) All rooms are deep cleaned and all surfaces disinfected as per the IPC guidelines. All linen, healthcare waste and medical equipment are removed and sent for disinfection or discarded. All spaces are cleaned with water and detergent and wiped with disinfectant.

2. Yes. The items below are monitored by the facility manager on site and implemented through the housekeeping structures of the facility.

(a) the floors of the sites are cleaned and disinfected three times a day in line with the guidelines, and floors to communal spaces are cleaned 2-3 times per day using water and detergent. The daily cleaning of the entire quarantine facility with disinfectants as specified in the IPC Manual is advised including surface mopping of all the floors, communal bathrooms and other shared spaces.

(b) rooms are being cleaned every third day in accordance with the guidelines. Residents should wherever possible be responsible for cleaning their own rooms. The facility however supplements this with cleaning of bathrooms, toilet facilities, undersides of beds and other related items placed in the rooms of quarantined people.

(c) separate groups within one site are kept separate and allocated separate staff. This is done where possible. As people are in quarantine they are limited mostly to their room. A roster is developed to allow people into common areas in small groups. This is done, taking into consideration the group they belong to. Staff however are not normally allocated per group as they have limited contact with residents. Those that do have direct contact would be limited to a certain set of people.

(d) staff members are quarantined.

(e) The adjustments to the approved guidelines no longer call for the clinical team to be on site due to the limitation of resources available. Clinical staff can now be given more than one quarantine site to service and can rotate between those.

Where possible, staff members that have direct access to those quarantined, would be encouraged to quarantine with the group that they service. However, staff members that have no contact, although encouraged to stay on premise, are allowed off site.

It is to be noted that sometimes new arrivals get to quarantine sites late in the evening or early morning after a long and tiring journey. The last thing that they are willing to listen to, is a briefing. Towards these we allow the facility to check them in as quick as possible to allow them some rest without a briefing. Alternative methods of briefing are explored in these cases e.g. through an information sheet in the rooms or briefed by the clinical team the next day during daily monitoring. Briefing normally entails what they can expect to experience during the quarantine period, the rules and protocols and basic questions they might have. It rarely deals with the number of people on site and the number of positive cases.

END.

Reply:

The National Department of Health (NDoH) and National Treasury have together estimated the quantity of oxygen required to meet the COVID-19 surge demands based on the SURGE modelling data. National Treasury has thus expanded the existing contracts to cater for the anticipated additional needs. The two Departments have also undertaken a process of engaging the suppliers to ensure that they can supply the demand and have measures in place to keep their skilled drivers safe from COVID-19. The NDOH has undertaken a process to review existing bulk storage capacity at identified hospitals and to review oxygen reticulation circuits by using qualified clinical engineers. Hospitals that do not have adequate reticulation will be fast tracked to improve their reticulation systems to ensure major respiratory support devices can be used effectively. Hospitals that do not have adequate bulk storage tanks will have alternate solutions devised for them as per the recommendations of the clinical and mechanical engineers. National Treasury has increased the capacity of supply by contracting Air Liquide as the second service provider for the supply of oxygen. Both Afrox and Air Liquide have written letters of undertaking to guarantee the sustainable supply of oxygen during the peak.

 

END.

Reply:

1. Despite the efforts to increase testing capacity in all provinces, the National Health Laboratory Services (NHLS) experienced an accumulation of unprocessed specimens (backlogs), since the beginning of May 2020 when provinces embarked on mass testing, due to the global shortage of test kits.

The NHLS initiated mitigation plans to try and reduce the backlog. The strategy the NHLS used was to prioritize the provinces where there was a high positivity rate, and clear the backlogs. The strategy implemented has successfully reduced the backlog in most provinces. The table below shows that currently three provinces have backlogs. The NHLS is working actively with the provinces to address this backlog.

 

The Western Cape, Free State, Limpopo, Mpumalanga, Northern Cape and North West currently do not have any backlogs.

Region	09-May-20	14-May-20	21-May-20	25-May-20	28-May-20	04-Jun-20	11-Jun-20	16-Jun-20	07-Jul-20
Eastern Cape	8 350	7 000	23 000	22 802	21 000	21 355	18 254	15 501	9490
Free State	200	4 300	6 000	8 800	1 767	0	0	0	0
Gauteng	15 000	13 000	23 000	24 076	24 000	28 395	20 978	27 000	13091
KwaZulu-Natal	12 000	18 000	28 000	22 802	22 000	20 751	14 802	12 400	3 500
Western Cape	14 000	16 630	21 000	18 000	15 000	10 568	3 000	0	0
Total	49 550	58 930	101 000	96 480	83 767	81 069	57 034	54 901	26 081

 

Reduction of Backlog

The reduction in the backlog has been achieved though the following:

• Re-prioritizing test kits to provinces with high positivity rates.
• A slightly improved supply of extraction kits.
• Utilizing innovative methods for extracting the RNA from the virus through lysis and heat activation, to reduce the dependency on extraction kits.
• Improved workflow in laboratories.
• Most importantly, the commitment and hard work of the staff.

(2) The reduction in the backlogs as well as prioritizations done by the laboratory and health facilities, and the turn-around time has improved in a number of provinces. Western Cape for example is currently processing specimens in less than 48 hours and in many instances in 24 hours.

 

The average turnaround time, in days, is tabulated below 28 June – 04 July 2020:

Province Name	Average turnaround time in days
EASTERN CAPE	5
FREE STATE	2
GAUTENG	5
KWAZULU-NATAL	8
LIMPOPO	3
MPUMALANGA	4
NORTH WEST	4
NORTHERN CAPE	3
WESTERN CAPE	2

A reasonable time to clear a sample through the laboratory, if all reagents (test kits) and resources are available is 48 hours (2days)-72 hours (3 days).

END.

Reply:

a) Mortality data from the Civil Registration and Vital Statistics system permit the production of mortality statistics on a continuous basis and contribute to the understanding of the burden of disease at national, provincial and local geographic levels. The registration of deaths in South Africa falls under the mandate of the Department of Home Affairs. It is governed by the Births and Deaths Registration Act 1992 (Act No. 51 of 1992). The Act has been amended several times, with the last amendment made in 2010 [Births and Deaths Registration Amendment Act (Act No. 18 of 2010)]. The principal Act states that after a death occurs, notice of death should be given as soon as practicable. To better enforce the registration of deaths, the 2014 regulations of the Act mandate the registration of deaths within 72 hours (three days) from date of occurrence. The principal Act further states that a medical practitioner should prescribe the cause of death if satisfied that the death was due to natural causes. However, if there is doubt that the death was due to natural causes, such a death must be reported to the police. After an investigation as to the circumstances of the death in terms of the Inquests Act, 1959 (Act No. 58 of 1959), the medical practitioner shall certify the cause of death. Upon completion of death registration, a death certificate is issued.

(i) Natural Deaths by Province

A total of 137 816 deaths form Natural causes were recorded for persons 1 year and older for the period, 1 February 2020 to 16 June 2020.

Province	Natural Deaths
Eastern Cape	22 241
Free State	8 817
Gauteng	26 941
KwaZulu-Natal	25 212
Limpopo	14 306
Mpumalanga	10 091
North West	8 711
Northern Cape	4 416
Western Cape	17 081
Total	137 816

Source: SAMRC

(ii) Unnatural Causes

A total of 13 866 Unnatural Deaths were recorded for the period, 1 February 2020 to 16 June 2020 at national level.

Province	Unnatural Deaths
Eastern Cape	2 173
Free State	662
Gauteng	2 946
KwaZulu-Natal	3 143
Limpopo	1 005
Mpumalanga	950
North West	628
Northern Cape	323
Western Cape	2 036
Total	13 866

Source: SAMRC

b) All death notification forms are collected by Statistics South Africa (Stats SA) from Department of Home Affairs bi-weekly for capturing, processing, assessment, analysis and dissemination of statistical reports and datasets on mortality and causes of death. The last report released by Stats SA reported on deaths was in 2017, citing technical challenges as the reason. SAMRC sources only natural and unnatural causes of death data from the basic demographic information for all deaths registered on the National Population Register on a weekly basis for purposes of monitoring trends on behalf of the Department of Health. However, SAMRC is also not allowed to access detailed causes of death because it is confidential; and as a result the cause of death in each specified case cannot be provided.

END.

Reply:

Ekurhuleni Health District has employed fifty-two (52) Tracer Teams and one thousand and ninety-eight (1098) Community Health Care Workers. These teams are under the leadership of the District Health Management Offices of Ekurhuleni Health District. These teams assist the clinics to conduct screening and testing in the hotspots areas such as malls, informal settlements and hostels on a daily basis throughout the whole of the City of Ekurhuleni.

END.

Reply:

1. (a) (i) There is no list of the service providers that have been appointed in order to do deep cleaning at the clinics. Ekurhuleni Health District is using the Meridian Hygiene company to do deep cleaning at the clinics. A letter of appointment of Meridian Hygiene is attached as Annexure A.

(ii) Clinics they are cleaning within the City of Ekurhuleni are on the attached list (Annexure B)

(b) The clinics are fogged and deep cleaned each time there has been a positive case that has been reported in the facility. This is done in line with the guidelines issued by the Office of Health Standards Compliance (OHSC). The process of deep cleansing is being monitored by the Ekurhuleni Steering Committee Members and the Environmental Health Practitioners.

2. Yes. There are criteria that have been put in place in terms of the deep cleaning process guide. The attached document explains in detail the criteria that are being followed for deep cleaning. Please refer to part (iii) on the second page of Annexure B.

END.

Reply:

1. The Department of Mineral Resources and Energy has issued Government Notice No. 43335 on the 18 May 2020 covering the Mandatory Code of Practice on the Mitigation and Management of the COVID-19 Outbreak. As part of the code of practice, the mines have a contact tracing programme for contacts of COVID-19 cases identified on the mine and works with the district communicable disease coordinator on tracing of contacts beyond the mine. The National Institute for Communicable Diseases (NICD) contact tracing protocol is followed. The mines submit weekly reports to the Minerals Council South Africa, the Department of Mineral Resources and Energy and the Department of Health, on the number of miners screened, tested, those who have recovered and contacts traced for the index case;

2. The mines have a comprehensive programme on the Covid-19 response including risk assessments and public health interventions including social distancing. Communication materials and training is provided to the miners on the Covid-19 response and social distancing by the mining companies.

END.

Reply:

The following table reflects the details in this regard.

Province	Contracts	Reasons
Eastern Cape	95	95 holders of the contracts were community service doctors whose statutory one year-contracts (non-renewable contracts) were completed.
Free State	67	36 holders of the contracts opted to transfer to other Provinces after the contract expiry period due to personal reasons. The remaining 31 holders were community service doctors whose statutory one year contracts (non-renewable contracts) were completed.
Gauteng	130	128 holders were community service doctors whose statutory one-year contracts (non-renewable contracts) were completed, and 2 were sessional doctors positions converted to permanent appointments
KwaZulu-Natal	0	The Province did not have medical officers whose appointment contract ended during the reporting period.
Limpopo	34	5 holders of the contracts opted to transfer to other Provinces after the contract expiry period due to personal reasons. The remaining 29 were community service doctors whose statutory one year-contracts (non-renewable contracts) were completed.
Mpumalanga	45	14 holders of the contracts were foreign nationals appointed on three-year contracts. At the end of contracts, they were not renewed because opportunities are first given to South African Citizens in terms of the Immigration Act of 2002. The remaining 31 were community service doctors whose statutory one year-contracts (non-renewable contracts) were completed.
Northern Cape	72	72 holders were community service doctors whose statutory one year contracts (non-renewable contracts) were completed.
North West	81	46 holders of contracts were not renewed as posts were converted to Permanent Posts to reduce the vacancy rate. The remaining 35 were community service doctors whose statutory one year contracts (non-renewable contracts) were completed.
Western Cape	54	39 were Medical Registrars that completed their training and are replaced with new registrations. The remaining 15 doctors’ contracts terminated at the end of contract after completing specific tasks as per agreements.

END.

Reply:

(a) The clinics in Ekurhuleni Health District Municipality which are being provided with tents are on the attached list (Annexure A)

(b) There was no tender that was awarded for the erection of the tents. These tents are erected by the Gauteng Provincial Infrastructure team, as part of the expansion of the space for the patients.

END.

Reply:

a) According to the information available on the National Surveillance centre, there are three clinics in Ekurhuleni that have reported a stock-out of the first line ARV, Tenofovir/emtricitabine/efavirenz (TEE).

TEE was reported out of stock at the following clinics:

• Boksburg Civic Centre Clinic
• Dawn Park Clinic
• Palmridge Clinic

b) There is currently a supplier constraint with regards to TEE as the following suppliers have been unable supply the ordered quantities: Innovata Pharmaceuticals (Pty) Ltd and MacCleods Pharmaceuticals (Pty) Ltd. However, available stock in the district from other facilities has been allocated to these facilities based on expected patient numbers.

END.

Reply:

The joint Integrated School Health Programme Task Team (ISHP TT) between the Departments of Health and of Basic Education developed the Standard Operating Procedure (SOP) for COVID-19 Screening in South African Schools. This applies to all public and special schools in all provinces in the country.

The purpose of the SOP is to detect potential cases of COVID-19 and efficiently manage them to avoid further transmission and risk to other learners and school personnel.

There are four important aspects of the SOP:

• To provide guidelines to the School Health Team, composed of a Professional Nurse and Enrolled Nurses, and the School Screening Team (non-clinical) staff comprising of Youth Brigades, the School Based Support Teams (SBST) are trained to screen learners and school staff for symptoms of COVID-19 including daily temperature monitoring;
• To ensure that all learners who are identified as being symptomatic through screening are managed and referred appropriately;
• To ensure that contact tracing is conducted for all those who test positive. It is the responsibility of the professional nurse and the School Health Team to liaise with the appropriate contact training team within the district;
• The School Health Team and the School Screening team are required to work very closely with members of the SBST for co-ordination purposes within the school. If the school does not have an SBST, a member of the School Management Team should be nominated and designated to perform this role. Where there are insufficient school health teams to cover every school, a professional nurse from a local clinic may be nominated to provide support to the school (every school must have direct access to a named professional nurse).

All schools developed plans which were submitted to their District (Health and Education) to indicate readiness for school re-opening. These plans outline how they will manage the screening and testing including reporting and data management within the schools and districts.

Learner Health Questionnaires were also developed, translated into all official languages and distributed for parents to complete in order to identify children with comorbidities that put them at risk of contracting severe COVID-19. School principals are responsible to provide alternatives to face-to-face learning for these learners.

END.

Reply:

1. Yes, the following tables reflect the details in this regard.

No.	(a)	(b)	(c)
1	Mobility Solutions	R208,725-00	Procurement of 300 Infra-red Portable Thermometers for all ports of entry to mitigate Covid-19 risks.
2	Unicore Holdings	R353,527-83	Procurement of 350 Infrared Portable Thermometers for screening at exit points at Ports of Entry.
3	Mabhelonke Enterprise (Pty) Ltd	R233,000-00	Printing of 800 000 Travel Health Questionnaires for Covid-19 screening at the Ports of Entry.
4	Vision Projects 2020	R230,000-00	Printing of 800 000 Health Questionnaires for Covid-19 screening at the Ports of Entry.
5	Moetswadi Trading Projects	R 35,000-00	Decontamination, cleaning and disinfection of 10 pool vehicles allocated to Port Health at OR Tambo International Airport.

2. Yes.

(a) The deviations were due to health emergency as a result of Covid-19 pandemic outbreak;

(b) Details in each case;

No.	Supplier Name	Amount	Description of goods or services
1	Tammy Taylor	R115,000-00	Procurement of 2000 cloth face masks for NDOH employees to ensure compliance to Covid-19 regulations.
2	ExecuJet Aviation	R142,760-99	Emergency procurement of a charter flight for 4 officials to travel from Lanseria to East London to conduct contact tracing, attend to epidemiological issues and PPE supply during the surge of Covid-19 in Eastern Cape.
3	Libera Management	R132,298.53	Procurement of various sizes of hand sanitizers for use at entrances, boardrooms and laboratories of the NDoH.
4	Tammy Taylor	R 46,000-00	Procurement 800 additional cloth face masks for NDOH employees to ensure compliance to Covid-19 regulations.
5	Libera Management	R 79,524.16	Emergency Cleaning Services at Forensic Chemistry Laboratory in Johannesburg due to Covid-19.

3. The following table reflects the details in this regard

No.	Supplier Name	Reasons that the goods and/ or services were from the specified companies
1.	Mobility Solutions	Due to Lockdown, most of suppliers were not open for business, as a result there was a limited access to suppliers. The Central Supplier Database (CSD) was used to identify the suppliers to render the required services.
2.	Unicore Holdings
3.	Mabhelonke Enterprise (Pty) Ltd
4.	Vision Projects 2020
5.	Moetswadi Trading Projects
6.	Tammy Taylor	Due to the outbreak of the Covid-19 pandemic most companies were not operating as a result of lockdown. This supplier was willing to provide the department with the quotation of cloth masks in preparation for return of employees as per requirements of Covid-19 regulations.
7.	ExecuJet Aviation	Only this supplier was urgently available to execute the urgent task at the time.
8.	Libera Management	Since this supplier is currently providing cleaning services In-house, they were requested to urgently procure the required items in line with Covid-19.
9.	Tammy Taylor	Due to the outbreak of the Covid-19 pandemic most companies were not operating as a result of lockdown. This supplier was willing to provide the department with the quotation of cloth masks in preparation for return of employees as per requirements of Covid-19 regulations.
10.	Libera Management	The supplier was approached on an emergency basis to disinfect Forensic Chemistry Laboratory in Johannesburg due to the fact they are currently contracted to provide the cleaning services for NDoH.

4. No there will be no statement.

 

END.

Reply:

(1) The process for assessing and preparing quarantine facilities is properly defined in the approved Guidelines for Quarantine and Isolation Facilities. This process entails the identification of possible sites, the assessment thereof and the operationalisation of said sites. Apart from that, there are also a few state-owned facilities that were earmarked and prepared. This entailed basic maintenance to the sites, procurement of beds, linen and kitchen equipment and then the operationalisation of these sites again with staff, catering where necessary, PPE and medical waste management services;

(2) Yes. Sufficient water, electricity, clean beds, bedding and food is a prerequisite for a quarantine facility. Prior to activation, sites are inspected specifically related to the above and a list of criteria as contained in the approved guidelines. Where facilities were found to not comply to these requirements, they are decommissioned and will not be utilised again.

(3) Yes. Various inspections are done. There is the initial assessment to determine if a facility would meet the requirements as per the guidelines provided. All facilities need to be assessed for suitability. These assessments are done either by the National Department of Health, National Department of Public Works and Infrastructure or their provincial counterparts.

Once activated, there is a quality assessment that is done to determine if the operational side is in place and that subsequent infection control protocols are followed. This is a relatively new function and they are only now engaging in doing these on-site audits.

Where complaints have been received, various teams have been sent to these facilities and report on the status of these that were assessed.

(4) (a) The following quarantine facilities have been activated in the provinces:

(b) PROVINCE	NO OF SITES	NO OF BEDS
Eastern Cape	19	662
Free State	5	313
Gauteng	21	6236
KwaZulu-Natal	48	1098
Limpopo	6	313
Mpumalanga	6	434
North West	6	188
Northern Cape	9	497
Western Cape	16	2537
GRAND TOTAL	136	12278

(5) Yes. A statement will be made on the matter as part of media statements to update the country on the outbreak.

END.

Reply:

(a) As part of training, healthcare workers and contact tracers were sensitized on how to assist cases and contacts to deal with stigma and its impact on their mental health and well-being. Stigma, as a major cause of discrimination and exclusion, affects people’s self-esteem, disrupts relationships and contributes directly to human rights abuses. Recognising the need for mental well-being during this period of Covid-19 pandemic, the National Department of Health has developed Standard Operating Procedures (SOPs) on contact tracing in SA, which also include section on mental and psychological support to community during the Covid-19 outbreak.

The following aspects were covered during trainings:

• When referring to people with COVID-19, do not attach the disease to any particular ethnicity or nationality. Be empathetic to all those who are affected, in and from any country. People who are affected by COVID-19 have not done anything wrong, and they deserve our support, compassion and kindness.
• As part of health education, contacts are requested to seek information only from trusted sources and mainly so that they can take practical steps to prepare and protect themselves and their loved ones, should anyone in the household test positive for Covid-19.
• In other households, psychosocial support is offered to the family members who are not working and who need to take care of child or elderly dependents.

In addition to what is listed earlier in terms of combating stigma and discrimination, here is what the Department of Health has done to assist people to cope, in order to reduce anxiety, namely:

• Protect themselves and be supportive to others. Assisting others in their time of need can benefit the person receiving support, as well as the helper.
• Seek information updates at specific times during the day, once or twice. The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried;
• Gather information at regular intervals, from the Department of Health and NICD websites and local health authorities, in order to help you distinguish facts from rumours;
• Honour caretakers and health care workers supporting people affected by the disease in your community. Acknowledge the role they play to save lives and keep your loved ones safe.

National Contact Tracing Guidelines are currently being revised to emphasise the following issues that are covered during training:

• • Contact tracing should not be used punitively;
  • Contacts should be provided with details of how their information will be used, stored, and accessed, and how individuals will be protected from harmful disclosure or identification;
  • Contact tracing and associated steps, such as quarantine of contacts and isolation of cases, should not be associated with security measures, immigration issues, or other concerns outside the realm of public health.

(b) Stigma is associated with a lack of knowledge about how Covid-19 spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths. Stigma can also make people more likely to hide symptoms or illness, keep them from seeking health care immediately, and prevent individuals from adopting healthy behaviors. This means that stigma can make it more difficult to control the spread of an outbreak. As part of training of healthcare workers and contact tracers, the National Contact Tracing Team help prevent stigma by ensuring that contact tracers in provinces and districts:

• Always maintain the privacy and confidentiality of those seeking healthcare and those who may be part of any contact investigation;
• Quickly communicate the risk, or lack of risk, from contact with products, people, and places;
• Use of inclusive language and less stigmatizing terminology by sharing accurate information about how the virus spreads;
• Use of social media to spread facts about how the new coronavirus disease is transmitted and treated, and how to prevent infection, including speaking out against negative behaviors and statements, including those on social media;
• Engaging social influencers such as community leaders in prompting reflection about people who are stigmatized and how to support them, or respected celebrities to amplify messages that reduce stigma;
• All health promotion materials show diverse communities being impacted and working together to prevent the spread of Covid-19 and do not reinforce stereotypes.
• The use of news media and social media creates an environment in which the disease and its impact is openly and honestly discussed, to speak out against stereotyping groups of people who experience stigma;
• Suggesting resources for mental health or other social support services for people who have experienced stigma or discrimination;
• The contact tracers are expected to show empathy with those affected and make them understand the disease, and adopt effective practical measures to help keep themselves and their families safe.
• The Department carefully communicates with the public on Covid-19 to aid public/community implementation of the preventive measures and to avoid fuelling fear and stigma.

(c) The privacy of patients and contacts is protected by the following:

 

• Medical records of patients and contacts are subject to privacy and confidentiality. As part of training, healthcare workers and contact tracers are trained to better understand that patient information remains cordoned within the Prescripts of Protection of Personal Information Act (POPIA). All health care workers know that they are not supposed to divulge any information, of any patient in any media platforms. When such arise, there are legal implications to deal with the person divulging the information;
• The databases that are also used should be encrypted so that the information storage becomes secure. More work still needs to be done to ensure all data sources are aligned across all the provinces;
• All health care workers and contact tracers are expected to comply with Regulations Relating to the Surveillance and the Control of Notifiable Medical Conditions as outlined in the National Health Act, 2003 (Act No. 61 of 2003). Covid-19 is a category 1 notifiable medical condition (Respiratory disease caused by a novel respiratory pathogen). Confidentiality, protection of health records, and offences and penalties are dealt with in Chapter 4 of the Regulation.

END.

Reply:

a) Occupational therapy (OT) services for children are still running at Chris Hani Baragwanath Academic Hospital (CHBAH).

• Children who are admitted to the wards are still receiving in-patient therapy services as required. During these sessions, caregivers are trained in carrying out exercises with their children to ensure carry-over to the home environment. On discharge from the wards, caregivers are given follow-up appointments for OT should this be required, or they are referred to their closest facility for out-patient OT services;
• Out-patient OT services are still running as follows:
  • New patients who are referred to the OT department, are seen on the day of referral. During this session, caregivers are trained in carrying out exercises as well as given a home program to ensure carry-over to the home environment;
  • Caregivers of current patients are called telephonically and given the option of coming to the hospital for their appointment. Should they wish to attend their appointment, they are seen at the Hospital as normal. Should they not want to bring the child to the Hospital for their OT appointment, caregivers are given an option:
• They can bring their child for OT the next time they are at the Hospital for a Doctor’s appointment (four to six monthly), scan, collection of medication, etc. and the child will be seen by OT;
• The caregiver can attend without the child and bring their concerns (verbal or video) which will be addressed by OT (if the caregiver is at the Hospital for something without the child such as collection of medication);
• If a child has not been seen by OT for a month, their caregiver will be contacted telephonically to follow up on the home program as well as the child’s progress;
• Caregivers who have not brought their child to see OT for more than three consecutive months, are encouraged to bring their child in due to the rapid development of children so that they can be trained in new exercises and given a home program that is appropriate for their child’s current developmental level;

- Children who have sustained burn injuries receive follow-up with the doctors weekly at the Hospital. Should they require OT services, such as splinting or scar management, they are seen in the OT department weekly after their doctor’s appointment. Once they are discharged from the doctor’s clinic, they are followed up as above for scar management, ensuring that the child has the necessary pressure garments and resources (silicone, cream, etc.) to last them until their next appointment (every second month).

b) All caregivers of children who receive OT services, are encouraged to carry out exercises daily in their home environment as part of their home exercise program. To ensure efficient carry-over, during face-to-face contact sessions, caregivers are shown the exercises they will need to carry out with their child and then given a chance to practice these before they return home and are expected to carry out the program independently.

Pamphlets of different exercises have been developed and parents are given the relevant pamphlets as a reminder of the exercises they need to carry-out daily.

END.

Reply:

1. As the Minister of Health, one of my key responsibilities is to ensure the health and safety of all health workers. It is an obligation put on me not only by my conscience, but also by our own legislation regarding labour and occupational health and safety. We are also signatory to International Conventions on Labour, that underpin employee health and wellness management.

In terms of the Determination and Directive on Danger Allowance in the Public Service, dated July 2017 (PSCBC Resolution 1 of 2007 as amended by Resolution 4 of 2015) Part 2: PROVISION ON DANGER ALLOWANCE, employers pay standardized danger allowance to employees who in the course of their employment experience a genuine risk to their life because of exposure to psychiatric patients.

We are also fortunate as a country that over time we have established functional and effective structures and processes that involve both organized labour and employers whereby the labour and employment issues such as this call by the nurses should be presented and evaluated. In this regard I am confident that once presented to the Public Service Bargaining Council, the Department of Health will be advised accordingly.

2. (a) Chris Hani Baragwanath Academic Hospital currently has 165 acute gazette (approved) beds. The beds are sufficient for a Tertiary Academic Hospital. More beds need to be created in the Regional and District Hospitals and need to strengthen Community-based Psychiatric services.

(b) the Annual Strategic Plan and Annual Performance Plan for the Department talked about 80 hospitals to be revitalized or constructed over the MTEF. All these hospitals will have a dedicated mental health ward.

END.

Reply:

a) Clinics and hospitals across the country receive water from the municipal water reticulation system. These facilities do however have back up water supply to assist when the municipality is unable to supply. A total of 2 908 (94%) clinics have piped water, and 2 568 (83%) have backup water supply in case of emergency. Those that do not have piped water and backup water receive water through municipal tanker supply system. All hospitals are connected to the municipal water reticulation system and also have backup water reservoir for the days that there is no supply from the municipality.

b) Chris Hani Baragwanath Academic Hospital does not have water shortage. It has the main Reservoir supplying Laundry and the Boiler and numerous tanks around the Hospital. There is, however, a need for two more reservoirs to be devoted to supply Maternity and Accident and Emergency Areas. The project for water reservoir to expand the water supply for the Hospital is planned for during this 2020/2021 financial year. Whenever there is a shortage of water from the municipality, the Hospital is able to supply the affected sections from its reservoir.

END.

Reply:

1. No, the Scooter Project that was launched by the Eastern Cape Department of Health (ECDOH) does not meet the basic criteria for patient transport as an ambulance. The purpose of this project by ECDOH is mainly for widening access to primary health care and delivering of chronic medicine for the most remote areas of the Eastern Cape Province.

2. The National Department of Health was not consulted on specifications before procurement of the scooters. However, the Province has been advised that none of these scooters will be used as ambulances because they do not meet the specific requirements as provided for in the EMS Regulations, such as, minimum patient compartment space and equipment requirements.

END.

Reply:

The total number of field hospitals that have been built in each Province since 1 March 2020 have been provided in the table below. The construction of the field hospitals is at different levels of completion, from site hand over to the completion of the construction of the hospital, and also includes utilization of the hospital. Most of these are the modification of the space in the existing hospitals.

PROVINCE	FIELD HOSPITAL	COMMENTS	Total Number per province
Eastern Cape	Port Elizabeth VW field hospital	The hospital is 35% complete and the completed section is being used for COVID-19 admissions.	1
Free State	Intra-Health Care Facilities for Surge	a) Universitas has converted the underground management parking to create a space for 110 beds. The contractor is currently on site. b) House Idahlia has been identified for 60 High Care Beds. The contractor is currently on site. c) Pelonomi hospital has been approved for 296 beds. The contractor is currently on site d) Bongani hospital Nurses has been identified for 150 beds. Waiting for the awarding of the contract. e) Itumeleng CHC has been approved for 200 beds. Waiting for the awarding of the contract. f) Manapo Hospital Hall has been approved for 53 beds. Waiting for the awarding of the contract. g) Albert Nzula Hospital in Trompsburg has been approved for 95 beds. The contractor is on site	7 hospitals with
Gauteng	NASREC Field hospital	The department has approved and completed 500 beds and it is currently being used	1 with 500 beds
KZN	Royal Agriculture Showground field hospital	The field hospital in Pietermaritzburg is operational with 254 beds. Ngwelezane hospital has been approved the construction of 113 beds, which are under construction. General Justice Ginzenga Mapanza has been approved for 113 beds which are under construction. Clairewood hospital has allocated 226 beds which are still under construction.	4 with 706 beds
Limpopo		Limpopo has not built any field hospitals as yet.	0
Mpumalanga		Mpumalanga has not built any field hospitals as yet	0
Northern Cape		Northern Cape has not built any field hospitals as yet	0
North West	Maseve Field hospital	This hospital has been approved for 200 beds in Rustenburg and it is 90% ready.	1 with 200 beds
Western Cape		a) CTICC has been approved for 870 beds and it is completed b) Thusong has been approved for 68 beds and it is completed c) Brackengate has been approved for 330 beds. The portion of the existing warehouse, design for the facility has been completed. Planned first patient admission will start on 7 July 2020.	3 with 1268 beds

END.

Reply:

The View of the Ministerial Advisory Committee on the Prevention and Control of Cancer

a) The Ministerial Advisory Committee on the Prevention and Control of Cancer (MACC) sees no reason to withdraw the Johnson and Johnson talc-based baby powder from the South African market as long as it is asbestos free.

b) The relevant details are as follows:

1. Talcum powder is made from a substance called talc whose components are magnesium, silicon and oxygen.
2. Talcum powder is used in cosmetic products such as baby powder, adult body and facial powders, as well as in a number of other consumer products
3. In its natural form some talc contains asbestos which is known to cause cancer and it was linked to ovarian cancer in 1958.
4. Globally, guidelines inform that all cosmetic products which contained talc in them had to be free from detectable amounts of asbestos.
5. Johnson and Johnson’s talc powder is no longer being used in the USA following a class action court case where Johnson and Johnson were ordered to pay billions of dollars’ compensation to women with ovarian and other genitourinary cancers allegedly caused by the use of talc powder on their genitalia. Although this judgement went against Johnson and Johnson, the evidence that talc powder is carcinogenic is very limited as confirmed by the National Cancer Institute.
6. Talcum powder used to contain asbestos which is a known carcinogen but is no longer the case

END.

Reply:

1. (a) South Africa appreciates the help from the Cuban Government. The Cuban health care workers will stay as long as needed and the current arrangement is for a period of 12 months, and reviewed quarterly;

(b) It is expected that if all goes as planned the Cuban brigade will travel back to Cuba on the month of May 2021;

(c) The salaries for the Cuban health care workers will be paid to the health care workers individual bank accounts, like any other employee employed in the South African Public Health Sector;

(d) In accordance with the signed Government-to-Government Agreement between the Republic of South Africa and the Republic of Cuba, the air transport at the end of the contract will be at the expense of the receiving Country.

2. As the statement was made when the Cuban brigade arrived in South Africa, it will be necessary for the government of the Republic of South Africa to make a statement when they leave, to thank them for their selfless service in assisting the Republic in its fight against COVID-19.

END.

Reply:

1. The Department of Health has been implementing the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme. The CCMDD programme is a National Department of Health (NDoH) initiative to improve access to chronic medicines to stable patients by enabling them to collect their repeat medicines from a convenient collection point near their home or place of employment thereby decreasing the patient volumes in health care facilities.

• (a) Eligible patients collect their diabetes, hypertension, ARVs and other chronic medication for free from a convenient pick-up point like Dis-Chem, Clicks, Pick n Pay or even a local spaza shop. Majority of these service providers have been open during the National lockdown, allowing clients to collect their treatment without interruption.
• (b) The majority of these service providers have been open during the National lockdown, allowing clients to collect their treatment without interruption. However, lockdown restrictions created a confusion around availability of public transport services to access these service outlets.
• (c) In health facilities, before and during the lockdown patients were given 2-3 month Tenofovir + Lamivudine + Dolutegravir (TLD) supply and 2 months Tenofovir +Emtricitibine + Efavirenz (TEE) supply;

2. The Department of Health has also strengthened in-facility processes and support to People Living with HIV (PLHIV) on ART in order to maintain adherence. Tracking and tracing (telephonically and then in-person) of clients lost to follow-up is ongoing in majority of our facilities during lockdown;

• (i) The Department of Health has developed messaging for PLHIV and people living with TB regarding the importance of treatment. These various messages have been sent to clients through SMS and social media;
• (ii) The Department of Health in partnership with the SABC and other partners, have initiated COVID-19 radio programme. This communication is cutting across all health programmes in relation to the pandemic through daily pre-recorded interviews in all SABC radio stations, to address what needs to happen during the lockdown period regarding treatment adherence and access to services.

(2) The registered deaths from the civil registration system are maintained by the Department of Home Affairs (DHA) and the Department of Health is not in a position to provide the requested information.

(3) The Department of Health is not able to provide the requested analysis because of access restrictions to the civil registration system data, which is hosted by the Department of Home Affairs.

END.

Reply:

1. (a) The suppliers that the Department of Health have used to supply Personal Protective Equipment (PPE) are as follows:

No.	Supplier
1.	BARRS Pharmaceutical Industries
2.	Unicore Holdings (Pty) Ltd
3.	Mr First Aid (Pty) Ltd
4.	Biologica Pharmaceuticals
5.	X-Business Resources
6.	SciProfs
7.	Tammy Taylor Nails
8.	Lora Medical Supplies
9.	Libera Management Services

(b) The total number of PPE that has been supplied is depicted on the table below as follows:

Item / Commodity	Quantity
Masks Respirator N95/FFP2/KN95	40 715
Masks Surgical / Medical	54 900
Masks Cloth	3 400
Face Shields	15
Gloves Examination Sterile	12 000
Gloves Examination Non-Sterile	8 000
Gloves Surgical	12 000
Safety Goggles	2 000
Boot Covers	2 000
Aprons	3 000
Coveralls	2 000
Hand Sanitizers	78 522
Infrared Thermometers	350
TOTAL	218 902

 

(c) The total monetary value of PPE cost is R 6 853 123.44.

2. All PPE were sourced from local suppliers as depicted on the table under the response to question 1. (a).

 

END.

Reply:

The Chief Executive Officer (CEO) Dr Lesia confirmed that as at 31 May 2020, the vacancy rate of the Hospital stood at 11,77%, since the process to fill the vacant posts is ongoing.

The details are as follows:

1. Management

One post of Senior Manager: Nursing was filled; and the successful candidate assumed duty on 01 June 2020. The processes are underway to fill the following posts:

• 1 Quality Assurance Manager: 01 July 2020
• 1 Senior Clinical Manager: 01 January 2021

2. Administration

As at 31 May 2020, vacancies for Administration cadre stood at 171 reduced from the 202 number as mentioned above.

• 31 Administration Clerks were appointed and commenced work on 01 June 2020.
• 34 posts are in the process of being filled for 01 July 2020.
• 21 posts are in the process of being filled around August and September, respectively.

3. Allied Support

Only 1 Specialised Auxiliary Services post has been filled because the department is prioritising the critical l posts.

4. Support

41 support staff have been appointed; and 26 Cleaners have assumed duty on Monday 15 June 2020.

5. Medical

Medical posts are filled on a continuous basis.

• A replacement process is adopted for vacated posts in the Hospital for clinicians. It is for this reason that the 95 vacant posts were reduced to 68 as at 31 May 2020, with 27 appointments confirmed.
• The Department/Hospital has a generic open advertisement that allows recruitment of medical staff as and when it is required.

6. Nursing

Like with Medical posts, there is an open advertisement for nursing positions. 10 posts from the 253 vacant posts will be filled from 01 July 2020 as applicants received offers, and they have confirmed start date.

The National Department of Health will engage the Gauteng Department of Health to further assist Chris Hani Baragwanath Hospital to access the Disaster Management Funds in order to fill the outstanding critical vacant posts.

END.

Reply:

We are not aware of the oversight visit conducted by the Portfolio Committee on Health from Parliament. However the response is as follows:

a) The number of children under five years of age admitted to public sector hospitals during 2018/19, 2019/20 and the first quarter of 2020/2021 is shown in the table below. It should be noted that in line with World Health Organisation recommendations, children with kwashiorkor are classified as having Severe Acute Malnutrition and are not counted separately.

	No of children under-five years of age admitted with Moderate acute malnutrition (MAM)	No. of children under five years admitted with Severe acute malnutrition (SAM)
2018/19	6,057	11,280
2019/20	6,159	11,089
Feb 2020	534	1,129
March 2020	479	991
April 2020	272	596

The reduction in cases during April may be a reflection of level 5 lockdown regulations. The shift in focus to COVID-19 activities did not allow for active case finding of children at risk of severe acute malnutrition, and caregivers of children may have lacked access to transport to the facilities. Data may also be incomplete if data capturers were not on duty.

b) All children with severe acute malnutrition admitted in health facilities are managed according to standardised guidelines and protocols. The Department has also prioritised nutritional assessment and classification of all children who are admitted to ensure that cases of malnutrition are not missed.

All provinces have been requested to draft response plans focusing on addressing the prevention and management of children with acute malnutrition in the context of COVID-19 during and after the lockdown.

A draft national guidance framework has been developed and shared with provinces to ensure that key issues such as ensuring the availability of key commodities and supplies is ensured.

c) The national guidance framework on nutrition response in the context of COVID-19 shared with provinces to guide development of province/ district response plan has outlined key priorities including:

• Ensuring that Community Health Workers screen, identify and refer children with severe acute malnutrition – this is part of their routine activities, but was not done during lockdown as Community Health Workers were focussed on community screening and testing for COVID-19;
• Prevention strategies e.g. breastfeeding promotion and support, promotion of appropriate complementary feeding;
• Forecasting the need for essential nutrition supplies (e.g. F-75, F-100, Ready-to-Use Therapeutic Food (RUTF), micronutrient supplements, MUAC tapes, etc.) for 2-3 months, and ensure adequate storage conditions;
• Increasing the amount of nutritional supplements provided to outpatients to reduce the frequency of follow-up visits;
• Consider task shifting for community health workers to provide nutrition supplements during home visits for follow-up patients with missed appointments or hard to reach areas;
• Ensure linkages and referral systems to the Department of Social Development of SAM cases through social workers to benefit from social protection measures such as social relief for distress and food parcels.

END.

Reply:

The strategy for curbing infections in communities is in keeping with the World Health Organisation’s recommendations, which is to undertake contact tracing, community screening and testing - which has now evolved into targetted community screening, especially in the hotspots (where there is greater than 5 cases per 100 000 population). The National Department of Health is also working closely with its provincial counterparts to also ensure hospital readiness for COVID-19. Moreover, community messaging on social distancing and hygiene practices are being stepped up in provinces, especially where the hotspots have been identified. A revised testing strategy will prioritise those persons who are at very high risk and are symptomatic.

The lockdown has been effective in managing new infections. The mathematical models have shown us that we would have had a five times higher mortality if the lockdown was not implemented.

Additionally the lockdown provides the health system an opportunity to plan for the surge of infections. The lockdown has achieved both these objectives reducing new infections and providing the healthcare system with more time to prepare for the surge.

The new strategy is a risk adjusted model of alert levels based on the level of infection and the health system capacity in an area. The health system must focus its energy and resources on these areas where there are high levels of infection. These areas are different from other areas where there is little or no infection. The areas with low risk do not require the stringent restriction that areas of high risk require. There is little value in a generalised lockdown when the reality is that there are specific areas of the country that are of high risk (Hotspot). These areas require intervention to curb the spread of infection. The risk adjusted approach is intended to focus our attention on areas that are at high risk. This is a much more efficient approach to responding to COVID-19.

END.

Reply:

1. As at 15 June 2020, a total of 1138 ventilators have been procured through Provincial Health Departments as well as National Department and they are all imported with a lead-time of minimum of 3 months and maximum of 9 months. Eastern Cape and Limpopo received 15 of the 60 and 3 of the 133 procured ventilators, respectively. The remaining 1120 ventilators are still to be delivered. Table below give a full illustration of all ventilators procured and the numbers that were delivered.

Province	Current ventilator capacity	No of Ventilators Procured	Supplier	Date of delivery
National Procurement		300	SSEM Mthembu	Delivery expected on 1st week of August
EC	68	30	Mbuso Medical	15 delivered. 15 will be delivered on 31-Jul-2020
		30	SSEM Mthembu	5 on 30-Jun-2020, 10 on 31-Jul-2020, 15 on 31 Aug 2020
EC Total	68	60
FS	200	50	Phoenix Neomed	15 -31 July 2020
			Mbuso Medical
			SSEM Mthembu
			Drager
			Marquet
			Medhold
			Respiratory Care Africa
FS total	200	50
GP total	409	145	Drager	An incorrect order was placed for 145 circuits instead of ventilators. This will be amended & an order for 145 ventilators will be processed on today (15 June 2020)
KZN	164	18	Drager	26-Jun-20
			SSEM Mthembu	3 on 7 Jul 2020
		11		8 on 5 Aug 2020
		6	Marquet	05-Aug-20
KZN Total	164	35
LP	78	3		Only 3 delivered
		30	SSEM Mthembu	30-Jun-20
		100	Mbuso Medical	27 on 25-June-2020
				73 on 21-July-2020
LP Total	78	133
MPU	130	75	SSEM Mthembu	31-Jul-20
		50	Drager	31-Aug-20
		75	Marquet	31-Aug-20
		75	Mbuso Medical	31-Aug-20
MPU total	130	275	SSEM Mthembu	Awaiting delivery
NC total	17			No ventilator ordered
NW total	59	40	Drager	Jan-Mar 2021 - They are currently looking for another supplier who can deliver earlier
	125	70	Respiratory Care Africa	31 July 2020
		30	SSEM Mthembu	15 July 2020
WC total	125	100
Total	1250	1138		18 delivered

2. Yes, all are procured through local suppliers;

a) 1120 Ventilators are still to be delivered;

b) Local suppliers are SSEM Mthembu, Mbuso Medicals, Phoenix Neomed, Drager, Marquet, Medhold and Respiratory Care Africa;

c) Delivery dates are expected from end June to August 2020 and between January and March 2021.

END.

Reply:

1. No, the Department has not undertaken any investigations on the effects of wearing masks for long periods as there is substantial published research on this important topic. The wearing of cloth masks by the general public for long-periods is commonplace in several countries prior to Covid-19. Similarly, the wearing of surgical masks by healthcare personnel for long periods is standard practice and has been found to be safe. Cloth masks are better tolerated than surgical masks or N95 respirators used by healthcare workers. Fainting may occur when the mask is worn incorrectly such that the nose and mouth are occluded, but as far as we have been able to ascertain, there are no peer-reviewed scientific reports of this. There are anecdotal accounts of people passing out from long-term use of N95 respirators;

2. Wearing of cloth masks has been shown in many reports to reduce community transmission of the virus and therefore is a necessary intervention like hand hygiene and social distancing. The National Department of Health will ensure that whether the person wears a mask or not, anyone in respiratory distress will be provided the best possible care in our healthcare facilities. 

END.

Reply:

1. We release data on Covid-19 daily. The following information is contained in the data daily reports to the public:

• Cumulative number of tests conducted by public and private sector laboratories;
• Daily new number of tests conducted by public and private sector laboratories;
• Cumulative number of positive cases identified by province;
• Cumulative number of recoveries by province;
• Cumulative number of deaths per province, including age and gender distribution of deaths; and
• We will indicate the issue of race classification later.

2. I am willing to make a statement in the House in this regard.

END.

Reply:

(1) (a) As of 3 June 2020, 15,224,792 individuals have been screened for COVID19. The provincial breakdown is tabulated below:

Province	Number of Individuals Screened
Eastern Cape	1,419,988
Free State	1,914,289
Gauteng	1,835,140
KwaZulu-Natal	1,755,049
Limpopo	3,098,840
Mpumalanga	1,889,989
North West	1,892,341
Northern Cape	838,831
Western Cape	580,325
National	15,224,792

(b) The community screening campaign started on the 8th of April 2020 and continues to date, however a shift to a more targeted screening strategy commenced on the 18th of May 2020;

(c) The screening activities focussed in areas with confirmed CODIV-19 cases such as townships, villages, farms, suburbs including vulnerable groups such as old age homes, prisons, supermarkets etc. The number of people screened is highest in Limpopo Province as a result of careening even in districts with no confirmed COVID-19 cases. The list of areas where community screening was done received from GP,NW, EC and LIM is attached. Some provinces did not respond to the request on the areas covered through community screening;

(d) There is no evidence on the time it will take to physically screen every person in the country as this will be influenced by the distance and travel time between households, demographic structure, the number of household members per household and the working hours per each person doing screening. In order to reach others an application called Healthcheck was deployed. It can be used by anyone with a mobile phone to check and report symptoms. Between April 13 to June 3,922,626 users screened for symptoms through Healthcheck.

2. Statements are made on the screening activities as part of the media release on COVID-19.

END.

Reply:

(1) (a) The total number of outstanding tests fluctuates on a daily basis, mainly due to the increased community screening that was undertaken in the provinces with corresponding increase in demand for testing for persons under investigation. The number of outstanding COVID-19 tests as at 16 June 2020 in the public sector is currently 54 901, obtaining data from the private sector is proving difficult. The weekly outstanding tests are tabulated below, with backlogs being cleared:

	09/05/20	14/05/20	21/05/20	25/05/20	28/05/20	04/06/20	09/06/20	10/06/20	11/06/20	16/06/20
Total	49 550	58 930	101 000	96 480	83 767	81 069	70 219	63 244	57 034	54 901

(b) Currently the outstanding tests are about 107 hours old, this is approximately 4 and a half days.

(c) (i) The outstanding tests started in the first week of May 2020 when demand exceeded supply, this was due to:

• A global shortage of extraction and high throughput kits for undertaking the tests;
• Logistical issues – interruptions with production, flights cancellations, customs delays;
• The number of tests allocated to the country is not determined by what the country ordered or needs but by what the supplier can provide.

(ii) The Republic has the capacity to undertake 30 000 tests per day, the key challenge being faced is the supply of chemicals and reagents to undertake the testing. Testing will be prioritised in the hotspot areas especially among the vulnerable persons (greater than 60 years of age and those with underlying medical conditions).

END.

Reply:

a) Yes, several studies have been done internationally on the effects of 5G radiation and published in accredited scientific journals. Some of these studies are:

(i) Towards 5G communication systems: Are there health implications? International Journal of Hygiene and Environmental Health (2018);

(ii) 5G Radiation and COVID-19: The Non-Existent Connection. International Journal of Research in Electronics and Computer Engineering (2020);

(iii) 5G Wireless Communication and Health Effects—A Pragmatic Review Based on Available Studies Regarding 6 to 100 GHz. International Journal of Environmental Research and Public Health (2019);

(iv) 5G wireless telecommunications expansion: Public health and environmental implications. Environmental Research (2018);

(v) Adverse health effects of 5G mobile networking technology under real-life conditions. Toxicology Letters (2020);

The World Health Organisation (WHO): 5G mobile networks and health (February 2020) acknowledges two international bodies that have produced electromagnetic fields exposure guidelines that countries need adhere to: a) The International Commission on Non-Ionizing Radiation Protection (2020) guidelines for limiting exposure to Electromagnetic Fields; and b) The Institute of Electrical and Electronics Engineers, through the International Committee on Electromagnetic Safety has produced guidelines for radiofrequencies up to 300 GHz, including the frequencies under discussion for 5G.

b) According to the International Commission on Non‐Ionizing Radiation Protection 2020 Guidelines, 5G is safe. These Guidelines are the revision of the 1998 Guidelines and provide protection for humans from exposure to Electro-Magnetic fields from 100 Kilo Hertz to 300 Giga Hertz. The only substantiated adverse health effects caused by exposure to radiofrequency Electro-magnetic Fields are nerve stimulation, changes in the permeability of cell membranes, and effects due to temperature elevation. Kostoff et al (2020), and Russell (2018) have argued that radiofrequency radiation (RF) used in 5G is increasingly being recognized as a new form of environmental pollution, and adverse systemic health effects beyond skin and eyes.

The WHO (2020) conclusion on 5G mobile networks and health was that no adverse health effect has been causally linked with exposure to wireless technologies. Health-related conclusions were drawn from studies performed across the entire radio spectrum but, so far, only a few studies have been carried out at the frequencies to be used by 5G. Tissue heating was identified as the main mechanism of interaction between radiofrequency fields and the human body. Radiofrequency exposure levels from current technologies resulted in negligible temperature rise in the human body. As the frequency increases, there is less penetration into the body tissues and absorption of the energy becomes more confined to the surface of the body (skin and eye). Provided that the overall exposure remains below international guidelines, no consequences for public health are anticipated.

END.

Annexure: Reply to Question No. 1101 References

Reference	Abstract	Findings
1. Di Ciaula, A. (2018). Towards 5G communication systems: Are there health implications? International journal of hygiene and environmental health, 221(3), 367-375.	Preliminary observations showed that MMW increase skin temperature, alter gene expression, promote cellular proliferation and synthesis of proteins linked with oxidative stress, inflammatory and metabolic processes, could generate ocular damages, affect neuro-muscular dynamics. Further studies are needed to better and independently explore the health effects of RF-EMF in general and of MMW in particular. However, available findings seem sufficient to demonstrate the existence of biomedical effects, to invoke the precautionary principle, to define exposed subjects as potentially vulnerable and to revise existing limits.	RF-EMF exposure is rising and health effects of are still under investigation. Both oncologic and non-cancerous chronic effects have been suggested. 5G networks could have health effects and will use MMW, still scarcely explored. Adequate knowledge of RF-EMF biological effects is also needed in clinical practice. Underrating the problem could lead to a further rise in non-communicable diseases.
2. Uthman, M., Shaibu, F. E., Bara’u Gafai Najashi, I. F., Labran, A. S., & Umar, U. S. A. (2020) 5G Radiation and COVID-19: The Non-Existent Connection. International Journal of Research in Electronics and Computer Engineering, Vol. 8 Issue 2 Apr.-June 2020	This paper presents an overview of the 5G mobile technology alongside an overview of coronavirus diseases and demonstrate that there is no connection between them by providing the scientific evidence of research carried out by international organizations in charge of 5G technology.	From all the discussions it has been established that coronaviruses are not new disease pathogens but there have been various outbreaks of the disease over the years with various strains. The latest of which is COVID-19. 5G technology is still in development and has not been fully deployed around the world yet. As such, there is no correlation between COVID-19 and 5G technology. COVID-19 originate from animals (bats) and are transmitted to humans and subsequently spread from human to human, certainly not through 5G radiation.
3. Simkó, M., & Mattsson, M. O. (2019). 5G Wireless Communication and Health Effects—A Pragmatic Review Based on Available Studies Regarding 6 to 100 GHz. International journal of environmental research and public health, 16(18), 3406.	This review analyzed 94 relevant publications performing in vivo or in vitro investigations. Each study was characterized for: study type (in vivo, in vitro), biological material (species, cell type, etc.), biological endpoint, exposure (frequency, exposure duration, power density), results, and certain quality criteria.	In order to evaluate and summarize the 6–100 GHz data in this review, it draws the following conclusions: Regarding the health effects of MMW in the 6–100 GHz frequency range at power densities not exceeding the exposure guidelines the studies provide no clear evidence, due to contradictory information from the in vivo and in vitro investigations. Regarding the possibility of “non-thermal” effects, the available studies provide no clear explanation of any mode of action of observed effects. Regarding the quality of the presented studies, too few studies fulfil the minimal quality criteria to allow any further conclusions.
4. The International Commission on Non‐Ionizing Radiation Protection (ICNIRP) Guidelines (2020)	The Germany-based scientific body that assesses the health risks of radio broadcasts, called for new guidelines for millimetre-wave 5G, the most high-frequency version of the telecommunications standard.	5G is safe, according to the international body in charge of setting limits on exposure to radiation.
5. Russell, C. L. (2018). 5G wireless telecommunications expansion: Public health and environmental implications. Environmental research, 165, 484-495.	This article will reviews relevant electromagnetic frequencies, exposure standards and current scientific literature on the health implications of 2G, 3G, 4G exposure, including some of the available literature on 5G frequencies.	5G technologies are far less studied for human or environmental effects. It is argued that the addition of this added high frequency 5G radiation to an already complex mix of lower frequencies, will contribute to a negative public health outcome both from both physical and mental health perspectives. Radiofrequency radiation (RF) is increasingly being recognized as a new form of environmental pollution. Like other common toxic exposures, the effects of radiofrequency electromagnetic radiation (RF EMR) will be problematic if not impossible to sort out epidemiologically as there no longer remains an unexposed control group.
6. International Commission on Non-Ionizing Radiation Protection. (2020). Guidelines for limiting exposure to Electromagnetic Fields (100 kHz to 300 GHz). Health Physics, 118(5), 483-524.	This document presents the revised guidelines, which provide protection for humans from exposure to EMFs from 100 kHz to 300 GHz.	The only substantiated adverse health effects caused by exposure to radiofrequency EMFs are nerve stimulation, changes in the permeability of cell membranes, and effects due to temperature elevation. There is no evidence of adverse health effects at exposure levels below the restriction levels in the ICNIRP (1998) guidelines and no evidence of an interaction mechanism that would predict that adverse health effects could occur due to radiofrequency EMF exposure below those restriction levels.
7. Kostoff, R. N., Heroux, P., Aschner, M., & Tsatsakis, A. (2020). Adverse health effects of 5G mobile networking technology under real-life conditions. Toxicology Letters, 323, 35-40.	This article identifies adverse effects of non-ionizing non-visible radiation (hereafter called wireless radiation) reported in the premier biomedical literature.	Identifies wide-spectrum of adverse health effects of non-ionizing non-visible radiation. Most laboratory experiments were not designed to identify the more severe adverse effects reflective of real-life conditions. Many experiments do not include the real-life pulsing and modulation of the carrier signal. Vast majority of experiments do not account for synergistic adverse effects of other toxic stimuli with wireless radiation. 5G mobile networking technology will affect not only the skin and eyes, but will have adverse systemic effects as well.
8. World Health Organisation (5G mobile networks and health 27 February 2020 | Q&A)	Two international bodies produce exposure guidelines on electromagnetic fields. Many countries currently adhere to the guidelines recommended by: The International Commission on Non-Ionizing Radiation Protection and, The Institute of Electrical and Electronics Engineers, through the International Committee on Electromagnetic Safety These guidelines are not technology-specific. They cover radiofrequencies up to 300 GHz, including the frequencies under discussion for 5G.	To date, and after much research performed, no adverse health effect has been causally linked with exposure to wireless technologies. Health-related conclusions are drawn from studies performed across the entire radio spectrum but, so far, only a few studies have been carried out at the frequencies to be used by 5G. Tissue heating is the main mechanism of interaction between radiofrequency fields and the human body. Radiofrequency exposure levels from current technologies result in negligible temperature rise in the human body. As the frequency increases, there is less penetration into the body tissues and absorption of the energy becomes more confined to the surface of the body (skin and eye). Provided that the overall exposure remains below international guidelines, no consequences for public health are anticipated.

Reply:

1. The oversight measuring tools to strengthen health system effectiveness based on the use of cost-effective interventions that are rendered at an appropriate level of the health system, the Provincial Health Departments report monthly, quarterly, half yearly and annually to National Department as per Public Finance Management Act No.1 of 1999 as amended, section 40. The reports entails In-Year Monitoring, Division of Revenue Act (Conditional Grants) and Pre-determined sets of Non Negotiables.

The reports are tabled and discussed through the National Health Chief Financial Officers Forum, Technical National Health Council and National Health Council.

2. Yes, the allocated funds were used adequately.

The Provincial Departments of health spending for the past three years are as follows;

EASTERN CAPE

ll Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Financially Unqualified	Financially Unqualified	Financially Unqualified	Qualified
APPROPRIATION STATEMENT
Total Final Appropriation	24 026 752	22 337 081	20 650 214	19 033 530	17 714 926
Actual Expenditure	24 472 665	22 275 458	20 506 290	18 957 776	17 549 854
Employee Compensation	15 980 940	14 558 949	13 454 333	12 562 282	11 576 335
Goods and Services	6 110 829	5 784 042	5 206 207	4 522 995	4 595 261
Capital Assets	1 287 172	1 236 256	1 277 587	1 280 152	1 020 742
UIFW EXPENDITURE
Unauthorised Expenditure	-	-	-	-	90 403
Irregular Expenditure	295 570	176 117	241	946	91 209
Fruitless & Wasteful Expenditure	1 224	998	6 855	2 161	1 819
HUMAN RESOURCES
Posts Approved	48 005	52 246	45 140	45 140	43 210
Posts Filled	41 519	40 424	40 282	40 225	39 216
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report

FREE STATE

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Financially Unqualified	Financially Unqualified	Qualified	Qualified
APPROPRIATION STATEMENT
Total Final Appropriation	10 381 697	9 738 931	9 043 067	8 728 675	8 327 177
Actual Expenditure	10 238 606	9 801 950	9 077 195	8 694 952	8 293 755
Employee Compensation	6 678 866	6 262 519	5 814 798	5 539 463	5 258 723
Goods and Services	2 586 120	2 647 858	2 365 315	2 375 189	2 287 592
Capital Assets	686 059	654 221	714 398	621 435	648 642
UIFW EXPENDITURE
Unauthorised Expenditure	-	140 791	67 634	31 814	11 167
Irregular Expenditure	359 511	324 525	300 966	56 055	16 707
Fruitless & Wasteful Expenditure	32 910	1 171	662	691	7 966
HUMAN RESOURCES
Posts Approved	22 902	21 629	21 596	20 952	23 930
Posts Filled	17 781	17 371	17 329	17 810	17 916
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report

GAUTENG

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Financially Unqualified	Financially Unqualified	Financially Unqualified	Financially Unqualified	Qualified
APPROPRIATION STATEMENT
Total Final Appropriation	47 543 133	42 739 750	38 192 111	35 816 383	32 015 230
Actual Expenditure	46 010 560	42 013 459	37 440 067	34 864 555	31 005 212
Employee Compensation	26 902 299	25 085 331	23 289 574	20 648 000	18 654 909
Goods and Services	15 229 603	13 583 390	11 078 374	11 257 325	9 735 281
Capital Assets	1 572 106	1 476 113	1 582 158	1 481 189	1 031 499
UIFW EXPENDITURE
Unauthorised Expenditure	-	-	-	-	-
Irregular Expenditure	2 292 068	1 352 204	1 860 020	493 155	-
Fruitless & Wasteful Expenditure	26 682	37 918	-	7 433	159 759
HUMAN RESOURCES
Posts Approved	72 244	71 943	72 894	73 199	n/a
Posts Filled	63 962	66 124	67 467	65 118	n/a
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report

KWAZULU-NATAL

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Qualified	Qualified	Qualified	Qualified
APPROPRIATION STATEMENT
Total Final Appropriation	42 850 312	40 228 250	37 337 104	34 213 586	31 409 398
Actual Expenditure	42 549 830	39 911 321	37 026 397	34 110 724	31 245 510
Employee Compensation	26 336 189	24 614 793	23 354 896	21 793 160	20 014 422
Goods and Services	13 342 400	12 343 292	11 382 844	10 105 233	8 895 999
Capital Assets	1 758 330	1 592 882	1 106 314	1 257 629	1 505 879
UIFW EXPENDITURE
Unauthorised Expenditure	14 248	-	18 997	147 119	127 693
Irregular Expenditure	2 977 103	1 464 342	1 325 084	1 257 484	708 803
Fruitless & Wasteful Expenditure	6 089	3 186	5 763	5 117	3 033
HUMAN RESOURCES
Posts Approved	n/a	74 080	79 087	78 669	81 226
Posts Filled	n/a	68 125	69 924	72 078	71 257
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report

LIMPOPO

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Qualified	Qualified	Qualified	Financially Unqualified
APPROPRIATION STATEMENT
Total Final Appropriation	19 801 784	18 609 439	17 300 715	15 501 794	14 618 588
Actual Expenditure	19 722 686	18 389 158	17 217 613	15 432 088	14 526 110
Employee Compensation	14 199 041	12 978 967	12 218 486	11 352 270	10 336 806
Goods and Services	4 839 161	4 259 771	3 785 515	3 012 337	3 122 861
Capital Assets	425 597	457 016	421 877	499 136	493 679
UIFW EXPENDITURE
Unauthorised Expenditure	-	-	-	-	-
Irregular Expenditure	80 243	165 956	217 342	259 062	544 881
Fruitless & Wasteful Expenditure	1 728	3 523	3 378	15 901	43 356
HUMAN RESOURCES
Posts Approved	64 343	63 460	63 640	63 460	63 460
Posts Filled	32 908	33 848	34 613	35 552	35 202
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report

MPUMALANGA

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Qualified	Qualified	Qualified	Qualified
APPROPRIATION STATEMENT
Total Final Appropriation	13 119 591	12 160 053	10 611 965	10 163 902	9 045 682
Actual Expenditure	13 055 943	12 083 013	10 579 880	10 080 392	8 879 292
Employee Compensation	7 662 953	7 217 105	6 686 678	6 102 017	5 537 663
Goods and Services	3 913 891	3 439 974	3 064 888	2 902 264	2 639 473
Capital Assets	1 028 712	1 057 356	509 496	595 955	434 074
UIFW EXPENDITURE
Unauthorised Expenditure	-	33 999	-	-	190 115
Irregular Expenditure	138 899	309 920	1 552 623	1 919 578	1 918 896
Fruitless & Wasteful Expenditure	487	317	2 306	1 007	3 614
HUMAN RESOURCES
Posts Approved	22 338	22 516	21 970	21 670	31 277
Posts Filled	20 412	20 421	20 288	20 090	19 244
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report
Note

NORTH WEST

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Qualified	Qualified	Qualified	Financially Unqualified
APPROPRIATION STATEMENT
Total Final Appropriation	n/a	10 600 197	9 681 617	9 199 705	8 184 743
Actual Expenditure	n/a	10 303 417	9 767 254	9 042 677	8 372 853
Employee Compensation	n/a	6 412 002	6 051 077	5 609 901	5 389 881
Goods and Services	n/a	3 005 112	2 802 201	2 581 210	2 286 569
Capital Assets	n/a	641 097	600 349	675 411	579 777
UIFW EXPENDITURE
Unauthorised Expenditure	n/a	-	99 647	-	262 564
Irregular Expenditure	n/a	880 911	682 777	696 654	763 834
Fruitless & Wasteful Expenditure	n/a	1 770	1 501	15 254	20 374
HUMAN RESOURCES
Posts Approved	n/a	21 809	21 357	21 334	21 103
Posts Filled	n/a	17 536	17 310	17 946	18 929
SOURCE	n/a	Annual Report	Annual Report	Annual Report	Annual Report
Note

NORTHERN CAPE

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Qualified	Qualified	Qualified	Qualified	Qualified
APPROPRIATION STATEMENT
Total Final Appropriation	4 858 837	4 631 443	4 494 185	4 228 961	3 758 130
Actual Expenditure	4 839 637	4 567 470	4 369 138	4 168 520	3 714 324
Employee Compensation	2 804 762	2 572 131	2 322 039	2 150 712	1 936 740
Goods and Services	1 627 617	1 452 145	1 479 782	1 317 295	1 150 049
Capital Assets	350 015	480 835	395 290	583 256	486 084
UIFW EXPENDITURE
Unauthorised Expenditure	1 261	100 296	51 576	92 790	91 636
Irregular Expenditure	714 939	412 379	574 183	805 906	537 169
Fruitless & Wasteful Expenditure	5 394	5 270	10 537	4 392	6 212
HUMAN RESOURCES
Posts Approved	7 533	7 196	7 703	9 020	8 929
Posts Filled	6 828	6 924	6 882	6 840	6 694
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report
Note

WESTERN CAPE

Financial Information

All Financial Values: R'000	2018/19	2017/18	2016/17	2015/16	2014/15
AUDIT OUTCOME	Clean Audit	Financially Unqualified	Financially Unqualified	Financially Unqualified	Financially Unqualified
APPROPRIATION STATEMENT
Total Final Appropriation	23 215 861	21 738 171	20 234 419	19 154 794	17 552 380
Actual Expenditure	23 045 811	21 498 184	20 080 640	18 740 193	17 307 548
Employee Compensation	13 515 392	12 660 391	11 833 864	10 949 652	10 072 353
Goods and Services	7 219 595	6 892 429	6 457 483	5 976 263	5 510 960
Capital Assets	1 004 040	751 434	784 560	747 064	746 805
UIFW EXPENDITURE
Unauthorised Expenditure	-	-	-	-	-
Irregular Expenditure	12 886	23 553	11 330	7 284	24 426
Fruitless & Wasteful Expenditure	-	-	7	-	-
HUMAN RESOURCES
Posts Approved	33 857	33 018	32 626	33 055	33 190
Posts Filled	31 914	31 549	31 463	31 432	31 267
SOURCE	Annual Report	Annual Report	Annual Report	Annual Report	Annual Report

END.

Reply:

1. The Department is not aware of any cases of Paediatric Multisystem Inflammatory Syndrome in South Africa. This is not unexpected. The condition remains very rare, and has only been documented in areas which have experienced a very high incidence of COVID-19 infection. In addition, most children have presented two to four weeks after the peak of the epidemic.

It is therefore likely that any cases which may occur in South Africa will present later in the year, during or after the expected peak in COVID-19 cases. It is however important that health care workers and parents remain alert as cases may be missed unless a high index of suspicion is maintained.

Any cases that are identified will be notified through the Notifiable Medical Conditions system, as well as to the World Health Organization clinical database.

(2) Evidence of past infection with coronavirus or exposure to someone with COVID-19 infection is part of the WHO case definition of the condition. The Department of Health currently uses the same case definition.

END.

Background

Most children with COVID-19 infection are asymptomatic or exhibit mild symptoms. However, in the last three months a small number of children have been identified who develop a significant systemic inflammatory response[1].

This rare syndrome shares common features with other paediatric inflammatory conditions including: Kawasaki disease, staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis and macrophage activation syndromes. It can also present with unusual abdominal symptoms with excessive inflammatory markers. Affected children may require paediatric intensive care and input from paediatric infectious diseases, cardiology, and rheumatology specialists.

This syndrome has been named Paediatric Multisystem Inflammatory Syndrome, and the World Health Organization has developed the following case definition[2]:

Children and adolescents 0–19 years of age with fever > 3 days AND two of the following:                                

1. Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).
2. Hypotension or shock.
3. Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP),
4. Evidence of coagulopathy (by PT, PTT, elevated d-Dimers).
5. Acute gastrointestinal problems (diarrhoea, vomiting, or abdominal pain).

AND

Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin. 

AND

No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.

AND

Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.

As data on this condition remains very limited, clinicians have been requested to submit details of identified cases to a Global COVID-19 Clinical Data Platform.

1. Royal College of Paediatricians and Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf. Accessed 1st June 2020. ↑

2. World Health Organization. Scientific Brief: Multisystem inflammatory syndrome in children and adolescents with COVID-19. Geneva, World Health Organization. 15th May 2020. https://www.who.int/publications-detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Accessed: 1st June 2020. ↑

Reply:

(1) There is variability in the average medicine collection rates overtime, taking into consideration public holidays and the number of months supplied to patients on chronic medication at various facilities. Based on the information available to the National Department of Health, the average rate of collection for the first four months of 2020 is depicted in the table below:

	Jan	Feb	Mar	April*
National	89.9%	92.6%	86.7%	84.8%
Eastern Cape	94.5%	94.4%	87.8%	87.0%
Free State	94.6%	96.9%	87.0%	75.9%
Gauteng	91.0%	96.2%	86.1%	81.6%
KwaZulu Natal	92.3%	94.4%	88.0%	85.5%
Limpopo	95.3%	96.2%	88.4%	81.5%
Mpumalanga	93.1%	97.2%	91.8%	87.5%
North West	95.6%	96.1%	83.1%	85.6%
Northern Cape	94.5%	93.4%	77.1%	78.9%

2. (a) Tracing of patients who defaulted on their medication

• Tracking and tracing (telephonically and in-person) of clients lost to follow-up is ongoing in the majority of our facilities. District supporting partners and Community Health Workers (CHWs) assist with community tracking and tracing of patients; a list of missed appointments is drawn weekly from Tier.Net and those who missed appointments are contacted via SMS (by District support partners) and in some cases are delivered to patients directly;
• The Department of Health has developed messaging for People Living with HIV (PLHIV) and people living with TB regarding the importance of treatment. These various messages have been circulated to clients through SMS and social media;
• The Adherence Guidelines SOP also provide the procedure to track and trace patients who defaulted.

(b) Distribution of medicines in each province

• The Department of Health has been implementing the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, a National Department of Health (NDoH) initiative to improve access to chronic medicines to stable patients by enabling them to collect their repeat medicines prescriptions from a convenient collection point near their home or place of employment.
• Eligible patients (i.e. stable on treatment) on ARVs and other chronic medication collect their medicines for free from a convenient contracted pick-up point such as Dis-Chem, Clicks, Pick-n-Pay, Pharmacy, or even a local Spaza shop. The majority of these service providers have been open during the National lockdown, allowing clients to collect their treatment without interruption.
• In health facilities, before and during the lockdown, all stable patients are given two months TEE supply and three months TLD supply of ARVs.
• The Department of Health has also strengthened in-facility processes and support to PLHIV on ART in order to maintain adherence.
• For TB patients, the Department of Health has made arrangements for home delivery of TB medicines by Community Health Workers. The Community Health Workers also collect sputum from patients who require follow up testing.

END.

Reply:

1. When private sites are procured to function as quarantine facilities, the rate negotiated includes all meals and forms part of the Service Level Agreement signed between the National Department of Public Works & Infrastructure and the facility. Where National or Provincial parks are being used, the park itself or tourism board provide catering. If such a site decides to outsource the service it is done based on their Supply Chain Management processes. For state-owned sites however, the processes for providing food is managed by the Provincial Department of Health and procured based on government Supply Chain Management processes;

2. There is an approved protocol agreement between the National Department of Public Works & Infrastructure and National Department of Health related to procurement of private facilities that include catering. Where the tenders or procurements are advertised for public facilities it would depend on the size of the contract and the normal Supply Chain Management processes the provincial departments follow;

3. (a) The service providers are procured as per standard Supply Chain Management principles;

(b) The budget for the provision of food is not fixed. It is need based and would vary based on the size of the site, the number of people that it needs to cater for, the duration that the food is to be supplied for and the basis for provisioning.

END.

Reply:

Measures have been put in place to allow all South Africans to be able to come back home, the below-mentioned is applicable to all countries including those listed (a) to (d):

Medical Evacuation processes have been developed to accomodate every person who requires to travel into South Africa for medical attention including foreign nationals. South Afrcians who are in need of medical attention may travel back into the country to obtain all necessary medical attention. This is managed through the embassies who then communicate through to the Department of International Relations and Cooperation (Dirco). Depending on the condition or nature of illness of the person, they are allowed to enter the country by means of an ambulance or general transportation in cases that do not warrant ambulance services. The application process for medical evacuation is facilitated by the referring health facility or directly from the embassy in the case of outpatients.

END.

Reply:

1. (a) In order to standardize stock control of Personal Protective Equipment (PPE) nationally, the Department of Health has taken measures as follows:

• Seventeen (17) PPE items were identified as minimum requirements for the prevention of the spread of COVID-19;
• Specifications for the identified 17 PPE items have been developed for use and adopted by Provincial Departments of Health and they are currently being used in procuring PPE equipment of acceptable quality;
• Prices were set for each PPE item in by National Department of Health in collaboration with National Treasury and issued under National Instruction Note 3 of 2020/21 and subsequently repealed and replaced by National Instruction Note 5 of 2020/21 in an attempt to prevent price exploitation or unnecessary price hike by manufacturers and distributors;
• The Department issued Infection Prevention Control (IPC) guidance to cover PPE use and change regimes. The correct use of PPE is key to forecasting PPE demand and ensure correct stock holding is secured at facilities;
• A Demand Forecasting Model was developed to ensure that the correct PPE items that are compliant with the set specifications are procured at the right price, right quantity and correct quality;
• Stock Visibility Systems (SVS) was expanded for it to cater for both PPE and Pharmaceutical products which is funded and procured by NDOH and distributed devices were rolled out to provinces. Currently facilities in the provinces can capture their stock levels using SVS;
• Another tool called PPE Reporting Tool (PPERT) was developed at National and was rolled out to provincial level to capture stock levels and order information of PPE at depot level;
• In cases of shortages, donations were used to augment stock levels at the facilities in the provinces;
• Training in the use of SVS were provided to provincial users and access to National Surveillance Centre (NSC) provided to empower provincial decision makers to access, interpret and take action regarding stock levels, distribution and logistics of PPE and sourcing and procurement of PPE items;
• A Supplier Mapping Portal was developed to provide Provincial Health departments access to information of PPE manufacturers and distributors available in their prospective provinces.

(b) In order to standardize stock control of Personal Protective Equipment (PPE) provincially, the Department of Health has taken measures as follows:

Ensure that each province appoints a dedicated Provincial PPE coordinator who monitors stock level continuously from depot to facilities so that they can be able to track the following:

• Provincial visibility of stock on hand;
• Stock use, quality and specification of PPE;
• Storage and distribution;
• Demand forecasting;
• Allocation of PPE stocks.

(c) In order to standardize stock control of Personal Protective Equipment (PPE) in local clinics, the Department of Health has taken measures as follows:

• Stock Visibility System (SVS) has been expanded and rolled out thereof to local clinics.

2. The stock management systems differ per province and per facility depending on the IT infrastructure in so far as monitoring the following activities:

• storage capacity;
• distribution method of PPE;
• stock ordering system, and
• replenishment methods;
• stock count procedures; and
• controls of PPE.

END.

Reply:

The National Department of Health collaborated with the National Treasury and Department of Trade and Industry to identify local manufacturers and distributors to enable departments to procure locally manufactured Personal Protective Equipment (PPE) products. To this effect, the following initiatives have been concluded:

• Visibility of local manufacturers and distributors: A market intelligence tool was developed listing all local manufacturers and their distributors of the key seventeen (17) PPE items used in the prevention of the spread of COVID-19. The tool enables public sector buyers to inter alia identify manufacturers and their distributors as follows:

• • According to their provinces, cities, towns and districts;
  • It also provides information such as GPS coordinates of manufacturers and distributors;
  • Contact details of manufactures and distributors for ease of use
  • Information of where the PPE comes from such as country of origin and quality assurance;
  • It allows public sector buyers to identify exactly where the stock they are procuring coming from.
  • Local manufacturers’ information regarding BBBEE Level;
  • % Black Ownership;
  • Manufacturer information
  • Product Name
  • Product Price;
  • Shipper Pack Quantities; and
  • Product Category (Distinguishing between 17 Essential PPE Categories and Non-Essential PPE Product Categories).

(2) The National Department of Health and all provincial departments have allowed access to this tool for use in the sourcing of PPE items/products. The tool is available online and data / information is continuously updated with the information of new entry of service providers to PPE market.

• On Central Supplier Database (CSD) there are approximately 20 000 suppliers registered who have indicated that they are able to for deliver PPE items. On the basis of that information the National Department of Health collaborated with National Treasury to ask Treasury to do modification on CSD that will allow all service providers who are registered on CSD for the supply of PPE to be able to provide additional information such as stock-on-hand information;

• As at 7 June 2020, approximately 2600 suppliers have uploaded stock-on-hand information. This initiative will enable public sector buyers to be able to source PPE products with service providers who actually have stock;

• They can select service providers according to their province, districts and towns etc;

• They can further select service providers according to their BEE status, % black ownership, military veterans, black youth, black women, owned by black persons with disabilities, rural or township based business and SME status.

END.

Reply:

1. Policies are constantly reviewed to meet the demands of an evolving epidemic. Due to the global shortage of testing extraction kits, earlier policies that advocated repeat testing had to be revised. The National Institute for Communicable Diseases has aligned its recommendation to WHO Guidelines and national resources imperatives. Second tests are not conducted on persons who are negative and asymptomatic due to the shortage of testing kits.

2. (a) Those persons that test negative and are asymptomatic are not tested again, however those that are symptomatic- tests are repeated for these individuals, especially those that are at high risk.

(b) The health professional staff are not tested routinely except if they have symptoms of Covid-19 or fulfil the criteria of a high-risk exposure with a person who tested positive with Covid-19. They may after seven days of self-isolation be clinically evaluated and tested on day 8 with the possibility of early return to work if they have a negative test and are clinically well. They will continue to be monitored for symptoms till day 14 and are counselled on personal hygiene measures. Health professional staff are monitored daily through symptom screening. The rationale is that there are not enough test kits and targeted testing is needed. Risk assessments in health care settings, use of public health measures, personal hygiene, training on Covid-19 and personal protective equipment all contribute to a lowered risk of transmission exposure.

END.

Reply:

a) The World Health Organisation (WHO) Solidarity Trial is a global study that is evaluating therapeutic interventions to support the treatment of patients admitted with COVID-19. This protocol describes a randomised trial among adults (age ≥18 years) hospitalised for COVID-19 that randomly allocates them between four treatment arms, each to be given in addition to the usual standard of care in the participating hospital. Randomisation is proposed into the following 4 arms: a) Standard of care; b) Remdesivir; c) Lopinavir-Ritonavir with Interferon β1b; and hydrochloroquine. This trial will be subjected to South African research standards to protect human rights through regulatory approval for clinical trials and ethics, besides similar processes being undertaken at a global level. The ethical review is rigorous and robust in ensuring that a relevant Research Ethics Committee protects potential participants by taking into account potential risks and benefits for the community in which the research will be carried out. In line with ethical principles, the Ethics Committee ensures protection of individual autonomy through informed consent; protecting participants against grievous bodily harm, and justice in assessing risks and benefits of the study

The South African Health Products Regulatory Authority (SAHPRA) is statutorily obliged to ensure that medicines, drugs and other health care products available in the country comply with the requirements for safety, quality and efficacy. It is also authorised to terminate a trial when serious breaches of Good Clinical Practice (GCP) occur, and where participants in clinical trials have had, their safety or well-being compromised. To date, a number of clinical trials have been approved in South Africa to determine the effectiveness of different therapeutic interventions to treat and prevent SARS-CoV-2 infection. SAHPRA has reviewed and approved one COVID-19 vaccine trial application submitted by Professor Shabir Madhi who is one of South Africa’s leading vaccinology experts and is the director of Wits University and the Medical Research Council Respiratory and Meningeal Pathogens Research Unit (RMPRU). The proposed vaccine study will be undertaken by RMPRU, in partnership with the Wits Reproductive Health and HIV Institute and the Setshaba Research Unit, organised under the auspices of Wits University’s flagship vaccinology programme, the African Leadership in Vaccinology Expertise (ALIVE).

b) The South African Solidarity Trial Team is led by Prof Helen Rees and senior academics and clinicians from eight medical schools who have made major contributions to the study design. These researchers have been conducting community advocacy, as well as engaging communities and healthcare workers on the ground.

The leading hospitals in South Africa are:

• Livingston Tertiary Hospital and Dora Nginza Hospital (Nelson Mandela University)

• Dr George Mukhari Hospital (Sefako Makgatho Health Science University)

• Tygerberg Hospital (Stellenbosch University)

• Groote Schuur Hospital (University of Cape Town)

• Military Hospital, NHLS Universitas Hospital, Pelonomi Hospital and a private hospital with Mediclinic (University of Free State)

• King Edward Addington and Inkosi Albert Luthuli Hospital (University of KwaZulu-Natal)

• Steve Biko Academic Hospital (University of Pretoria)

• Baragwanath and Charlotte Maxeke (Wits University)

The candidate COVID-19 vaccine that has been approved for study was developed by Oxford University in the UK and is called ChAdOx1. The Oxford University vaccine developers have completed the early Phase 1 trials in the UK and have demonstrated that the vaccine is safe and immunogenic. There is now a second phase clinical trial being undertaken in the UK to determine the safety and efficacy of the vaccine. There are over 1200 participants already enrolled, and a further 9,000 participants to be enrolled over the next few months. Brazil and Kenya will also be involved in clinical trials of the same vaccine. In South Africa, it is proposed that 2000 volunteers will be recruited to join the study, with similar numbers to be enrolled in the study planned in Brazil. The ability of RMPRU to lead the proposed study has been assessed and approved by the governing regulatory authorities in South Africa.

COVID-19 vaccine development is proceeding at an unprecedented speed, with many of the world’s leading scientific institutions contributing to this effort. There are currently over 100 vaccines in development and clinical trials have been undertaken in the UK, USA and France. For products such as vaccines, it is critically important that studies are performed in Southern Hemisphere countries including in the African region, concurrently with studies in Northern Hemisphere countries. This allows evaluation of the efficacy and safety of candidate vaccines to be assessed in a global context, failing which the introduction of many life-saving vaccines into public immunization programmes for Low Middle Income Countries (LMICs) frequently lags behind that in High Income Countries (HIC). Furthermore, if South Africa participates in the development of a vaccine it places an ethical obligation on the vaccine developers to allow early access to that vaccine in the countries where the research was undertaken.

END.

Reply:

a) We cannot respond specifically on this question as it is a matter that was relating to The Presidency. It is best that this question is addressed to The Presidency;

b) As indicated above it is not clear what information The Presidency was referring to therefore we cannot provide more details in this regard;

c) The details are as follows:

(i) The Modelling consortium Incident Management Team has developed detailed projections and recommendations of the hospital requirements in all provinces including isolation beds, general beds and critical care beds;

(ii) A National Hospital Readiness Task Team has been established comprising of clinicians, disaster management experts and experienced hospital managers. The role of this team is to provide guidance and support to the provinces on all aspects of hospital readiness;

(iii) The Department has developed a surge strategy, which guides the provinces in various areas of health system support. The strategy also includes guidance on the management of the various categories of the covid-19 patients. Alongside this strategy, a detailed guidance has already been provided to all hospitals on all aspects of hospital readiness including in the form of Action Plans. Ten of these plans have already been provided to the hospitals covering: Preparation, Area allocation, Command and Control, Bed Statistics, Safety, Communication, Assessment, Decontamination, Surge capacity and Triage;

(iv) All hospitals have been provided with an on-line assessment of readiness including: equipment requirements, oxygen requirements, operational management, case management, infection prevention and control, human resources, infrastructure, medicines, linen, supply chain and support services;

(v) Hospitals have been provided with detailed clinical guidelines for the clinical management of patients;

(vi) Ventilators that were donated by the US Government have been distributed to hospitals in Gauteng, Western Cape and Eastern Cape Provinces;

(vii) All provinces have developed and have started implementing detailed hospital readiness strategies;

(viii) The bed allocation for the covid-19 response is as follows:

• General beds = 12 029;
• High Critical Beds = 2 309;
• High care beds = 13 129.

END.

Reply:

(1) (a) (i) The District Health Information System (DHIS) only collects nutrition-related data on severe acute malnutrition (SAM) in children under 5 years of age. The DHIS data is available for March and April 2020 and reflects that nationally 991 children were admitted in public hospitals for SAM in March 2020. In comparison 1220 children under 5 were admitted with SAM in March 2019. In April 2020 596 children under 5 were admitted to public hospitals with SAM compared to 1118 in April 2019. These data show that the number of children admitted with SAM were lower in March and April 2020 compared to the same period in 2019. Refer to Annexure 1.

(ii) According to the DHIS in March 2020 there were 83 SAM related deaths in public hospitals while in April 2020 there were 50. In comparison in March 2019 and April 2019 there were 91 SAM related deaths each month. As for SAM admissions, SAM deaths were lower in March and April 2020 compared to the same period in 2019. Refer to Annexure 1.

(iii) The DHIS does record the number of children or adults currently being treated for hunger-related diseases.

(b) The National Department of Health has no data from the private hospitals on number of people treated for hunger-related diseases, died from hunger related diseases or still being treated for hunger-related diseases.

(2) The statement has already been made on this matter.

END.

Reply:

The following table reflects the details in this regard

Limpopo Districts	(a)(i) Serviceable ambulances	(a)(ii) Fully equipped ambulances	In each (aa) district, (bb) local municipality in the public health sector in the Province	(b) Area in square kilometres each ambulance service
Capricorn	164	59	59	21 705
Waterberg		48	48	44 913
Sekhukhune		56	56	13 528
Mopani		73	73	20 011
Vhembe		64	64	25 597

END.

Reply:

The following table reflects the details in this regard

(a) (i) serviceable ambulances	(a) (ii) fully equipped ambulances (aa) in each district municipality	(a) (ii) (bb) in each local municipality in the public health sector in the Province	(b) Area in square kilometres each ambulance services
134	EHLANZENI =48	Mbombela = 20	Ambulances are not restricted to a service Area
		Nkomazi = 13
		Thaba Chweu = 8
		Bushbuckridge = 7
	NKANGALA = 40	Emalahleni = 10
		Steve Tshwete = 8
		Emakhazeni = 6
		Thembisile Hani = 4
		Dr JS Moroka = 8
		Victor Khanye = 4
	GERT SIBANDE = 46	Mkhondo = 3
		Albert Luthuli = 7
		Msukaligwa = 5
		Govan Mbeki = 12
		Pixley Ka Seme = 7
		Albert Luthuli = 4
		Lekwa = 4
		Dipaleseng = 4

END.

Reply:

The following table reflects the details in this regard

North West Districts	(a)(i) Serviceable ambulances	(a)(ii) Fully equipped ambulances	In each (aa) district, (bb) local municipality in the public health sector in the Province	(b) Area in square kilometres each ambulance service
Dr Ruth Segomotsi Mompati	119	17	17	43 700
Dr Kenneth Kaunda		18	18	14 642
Bojanala		11	11	18 333
Ngaka Modiri Molema		21	21	28 206

END.

Reply:

1. (a) To date the Republic of Cuba has availed 187 Medical Specialists who will be assisting South Africa in the response to Covid-19.

Epidemiology (Technologist)

Health Technology

Family Physician

Biostatistics Dr

Biotechnologist

Public Health Specialist

(b) The 187 Medical Specialists in the areas that the Country is unable to produce enough. These are qualified in Biostatistics, Epidemiologists, Family Physicians and Health Technologists

(c) Epidemiology (Technologist); Health Technology; Family Physician; Biostatistics, Biotechnologist and Public Health Specialist

2. All of them

3. The following table reflects the details in this regard

 

Activity	Number	Estimated Cost	Notes on the activities
Registration with the Health Professions Council of South Africa (HPCSA)	187	R734 100.00	It is a norm that the registration cost is paid by an individual health professional to the Council. However, as per the Government-to-Government Agreement, the South African pays the fee to the HPCSA and thereafter, deduct the full amount of registration from the individual health professionals’ first salary. This means there is no actual cost to be incurred by the South African Government, however it is a convenient process arranged to ensure that all of the professionals are registered accordingly.
Accommodation	187		Most Provinces have entered into agreements with providers for a 12 months period. Other provinces are only accommodating the brigade for May and June and then move them to hotspots Districts / communities. Therefore, the accommodation in these areas are still not confirmed, as negotiations are still underway. A table below shows the cost on accommodation where available. The Provinces will first consider Doctors quarters where the brigade will be stationed.
Salaries	187	R239 181 933	The estimated budget cost is informed by actual appointment levels of the Cuban Health Brigade as determined by their Registration category, which took into consideration years of experience. All the Family Physicians and Biostatisticians are appointed at Grade 2 of Medical Officer level and Epidemiology Technologists/ Health Technology and Public Health Specialists are at Deputy Director level while Biomedical Engineers are at ASD level. Table below give overall illustration of salary levels and numbers in each level.

 

ACCOMMODATION OF CUBAN BRIGADE IN PROVINCES

Province	Accomodation	Period	Costs
Eastern Cape	The brigade has been distributed in various Facilities across the Province. They are residing in B&Bs and should be accommodated for the full period of their contract	12 Months	R384 000.00
Free State	The brigade is currently accommodated at Premier Hotel in Bloemfontein, while going through orientation processes. They will be accommodated until end of June at Premier hotel. After which from 1 July 2020, they will be distributed to facilities across the Province and they will be staying in Facility accommodation	May-June July 2020-April 2021	R162 464.00 (R3500X17X10) R595 000
Gauteng	The Brigade are accommodated at Burgers Park till 30 June 2020 It is expected that they will be distributed across the Province from I July 2020 to April 2021. Accommodation will then to be Provided by Hospitals	15 May-30 June 2020 July 2020-April 2021	Negotiated rate at Burgers Park Hotel is R1000 per room include breakfast, lunch and dinner, laundry services and hand sanitation
KwaZulu-Natal	Information from the Province will be submitted in due course.
Limpopo	The brigade is currently accommodated at Zanami Lodge (Polokwane), while being orientated. It is expected that they will be distributed across the Province from I July 2020 to April 2021. Accommodation will then to be Provided by Hospitals	19 May 2020 to June 2020 July 2020-April 2021	R252 000.00 Not yet finalised
Mpumalanga	Information outstanding Want a formal letter to HOD	19 May-19 August
Northern Cape	The brigade is currently accommodated at B&B till June 2020 It is expected that they will be distributed across the Province from I July 2020 to April 2021. Accommodation will then to be Provided by Hospitals	May –June 2020 July 2020-April 2021	R320 000.00 (9X12000X11) R1 188 000.00 2 Doctors are at an Official Accommodation
North West	The brigades have been distributed across the Provincial districts staying in B&Bs and others in Hospital Accommodation	June 2020 – April 2021	R 2 016 000
Western Cape	The brigade is currently accommodated at B&B called Icon Luxury Apartments for 12 months.	12 months	R1 200 000 p/a

 

OVERALL - CUBAN BRIGADE HEALTH WORKFORCE
Qualification	Agreed Post Classification (DPSA)	No	Total cost
Family Physician	MO Gr 2	116	172,767,798
Health Technology (IM)	Deputy Director: Information Management	32	25,941,166
Epidemiology Technologists (IM)	Deputy Director: Information Management	18	14,715,735
Biostatistics (Medical Doctors)	MO Gr 2	13	19,566,449
Public Health Specialist	DPSA salary level 11 (NON OSD)	2	2,231,276
Biomedical Engineer	ASD Salary level 9	5	2,773,887
Nurse	Gr3	1	528,852
		187	239,181,933

END.

Reply:

The following table reflects the details in this regard

Eastern Cape Districts	(a)(i) Serviceable ambulances	(a)(ii) Fully equipped ambulances	In each (aa) district, (bb) local municipality in the public health sector in the Province	(b) Area in square kilometres each ambulance service
Alfred Nzo	447	65	65	10 731
Amathole		60	60	21 117
Buffalo City		45	45	2 750
Chris Hani		65	65	36 407
Joe Gqabi		45	45	25 617
Nelson Mandela Metro		40	40	1 957
OR Tambo		40	74	12 141
Sarah Baartman		53	53	58 245

END.

Reply:

The following table reflects the details in this regard.

Free State Districts	(a)(i) Serviceable ambulances	(a)(ii) Fully equipped ambulances	In each (aa) district, (bb) local municipality in the public health sector in the Province	(b) Area in square kilometres each ambulance service
Mangaung Metro	132	25	65	7 250
Xhariep		15	60	9 810
Lejweleputswa		29	45	11 880
Fezile Dabi		27	65	10 705
Thabo Mofutsanyana		36	45	12 640

END.

Reply:

The following table reflects the details in this regard

Gauteng Districts	(a)(i) Serviceable ambulances	(a)(ii) Fully equipped ambulances	In each (aa) district, (bb) local municipality in the public health sector in the Province	(b) Area in square kilometres each ambulance service
City of Ekurhuleni	915	240	240	1 975
City of Johannesburg		168	168	1 645
City of Tshwane		160	160	6 298
Sedibeng		118	118	4 173
West Rand		118	118	4 087

END.