Questions and Replies

Reply:

The Honourable Member to note that the National Treasury, in consultation with the Provincial Treasury, had provided support to three of the four municipalities, as required by the Municipal Finance Management Act. Support is provided to those municipalities that commit to implementing the reforms required to address the audit findings. The time required to address all of the institutional, governance, and administrative weaknesses go beyond one financial cycle.

Moreover, the full commitment of both the municipal council and its administration is required to address the negative audit findingsas the primarily responsibility and accountability resides with the municipality.

Therefore, the support included a reviewing and revision of support plans for the financial management grant programme, rendering of technical support through audit specialists, assistance in the development and reviews of audit action plans,capacity building of internal audit units, audit committees and municipal officials to address audit findings. Additional support was provided to review the draft annual financial statements, supporting audit files, correction of previous technical errors, assistance in responding to audit findings, and appropriate responses. The following details relate to the support provided to the municipalities mentioned above.

a) Bojanala Platinum District Municipality

The following support was provided:

• Reviewed the post audit action plan and annual financial statements (AFS) preparation plan and schedule. 
• Meetings with Management to discuss AFS preparation plan and adviceon audit preparation.
• Reviewed interim financial statements.
• Escalated initiatives for training to address irregular expenditure. 
• Reviewed prior period error note on draft financial statements and submitted recommendations.
• Advised training and capacitation of internal audit unit. 

b) Ngaka Modiri Molema District Municipality

Thefollowing support was provided:

• Reviewed the post audit action plan and provided feedback to the municipality.
• Advised the CFO and internal auditor on AFS readiness.
• Reviewed and provided feedback on AFS preparation. 
• Followed up on progress made in addressing common audit findings pertaining to roads and water services that had an impact on local municipalities in the district.
• Supported the municipality at audit steering committee meeting with the Auditor-General  

c) Madibeng Local Municipality

The following support was provided:

• Reviewed the post audit action plan and provided feedback to the municipality.
• Attended audit steering committee meeting to render advice. 
• Advised the municipality on tracking and maintaining records, and copies of documentation required for audit purposes.  

d) Mamusa Local Municipality

The National Treasury could not provide support to this municipality due to institutional instability which was referred to the province for further intervention.

In conclusion, the Honourable Member could request the Legislature to perform additional oversight, especially to all those municipalities that received a disclaimer or an adverse audit opinion, to ascertain progress made and consequence measures taken.

Reply:

Yes, the Minister has considered the offender’ profile for possible placement on parole wherein he approved that the profile of offender Nxumalo be submitted for reconsideration after 31 January 2022.

In the interim the offender will be subjected to the following interventions:

• The offender to undergo insight orientated psychotherapy to deal with his anti-social personality disorder and loss of his mother;
• A risk assessment by a non-treating psychologist to be conducted;
• The offender to be encouraged to improve his vocational skills to assist him with prospects of obtaining employment once he is placed on parole.

END

Reply:

(1) The Department will not offer any form of COVID-19 relief to small businesses, as its Departmental mandate is on Defence of the RSA, and the function does not include funds or resource allocation to businesses.

(2) (a) The Department provides small business the opportunity to supply the Department with goods and services as required. BBBE companies are also assisted in respect of compliance to National Treasury Regulations and other legislative prescripts. (b) No Covid-19 financial and/or other relief will be made available to small businesses in line with the answer provided in paragraph (1) above.

Reply:

1. (a) The Government Employees Pension Fund (GEPF) does not administer the AIPF. The AIPF is administered by the Government Pensions Administration Agency (GPAA), a government component in terms of the Public Service Act, 1994, and as provided for in Government Gazette No.33051 of 26 March 2010 which specifically establishes the GPAA for the purposes of the administration of, inter alia, the AIPF.

(b) The Director-General of the National Treasury is responsible for the business of the fund. The funds of the AIPF are invested via the Public Investment Corporation (PIC) in terms of an approved investment mandate.

(2) The GEPF currently has a fully functional Board of Trustees in place and has had such a Board of Trustees in place since 2005 already.

Reply:

The Public Investment Corporation did not invest in a company to construct student accommodation near the University of Venda. However, the PIC did invest in a company that has projects in Polokwane and near the University of Limpopo.

Rest of the question falls away.

Reply:

1. It is important to highlight that there was no relief sought against the Minister of Finance or that a finding was made against the Minister of Finance or the Regulations as administered by the Minister of Finance. After the Blue Nightingale judgement, two similar judgements were made against KwaDukuza and Mamusa Municipalities. National Treasury assessed the application of Regulation 32 by various municipalities and deemed it necessary to issue a Circular to elaborate on the principles captured in regulation 32. The Circular is available on the National Treasury website as Circular No.96 under MFMA Circulars. The Circular considered the principles in the Blue Nightingale and KwaDukuza judgements.

2. In terms of Circular No. 96, the accounting officer of the participating municipality or municipal entity must utilise the process of reporting as contained in SCM regulation 6, to also include any procurement through SCM regulation 32. The treasuries may request further information in terms of section 74 of the MFMA. The participating accounting officer must also publish the details of the participation contract award on the municipality or municipal entity’s official website in line with section 75 of the MFMA. Therefore, this information is in the public domain, however, there is no specific obligation placed on the municipality or municipal entity to report to the National Treasury or the Minister of Finance with regards to these provisions.

Reply:

a) At the beginning of the 2020-21 financial year, National Treasury had 103 vacant positions from a staff establishment of 1076. The department is continuously recruiting for critical positions as and when approved by EXCO and replacement of new vacancies. The same process will apply in the 2021-22 financial year.

b) All the divisions within the National Treasury have identified critical posts that need to be filled.

c) National Treasury does not directly collect revenue from any taxes, as this is the responsibility of SARS. National Treasury proposes tax and other policies to generate revenue, as outlined in the annual Budget, and outlined in great detail in the Budget Review and subsequent tax legislation to give effect to the Budget. The actual administration and collection of revenue from taxes is the responsibility of SARS, which also reports to the Minister of Finance.

Reply:

We have no recollection of mention being made during the briefing by a representative of the Bank of any instance of mismanagement. What we are able to confirm is that the Chairman of the Board, Mr. Moloto, did say, in response to a suggestion that the Bank’s liquidity challenges may have been attributable to corruption, that the Land Bank prides itself on the governance processes in place and that in the face of any corporate governance lapses, the Board does not hesitate to take disciplinary action and dismiss individuals where necessary. He emphasised that the Land Bank prides itself in maintaining the highest ethical standards.

We would much appreciate it if you could furnish us with specifics as to what may have been said by representatives of the Land Bank which led to this enquiry so that we can accurately respond to the question.

Reply:

1. The review of the existing procurement regulatory framework through the Public Procurement Bill is a measure that will be put in place to prevent the mass looting that takes place in the Government’s supply chain management processes. The Draft Public Procurement Bill makes the following provisions:

• A directive to all Accounting Officers and Accounting Authorities on what measures to put in place within their respective institutions to prevent the abuse of the supply chain management system;
• A chapter on procurement integrity which outlines code of conduct for officials, bidders and suppliers, including measures for handling any contravention of the code of conduct; and
• That institutions must ensure that all planned procurement is aligned to the institution’s budget and plan.

2. The National Treasury, furthermore, proposed to the DPSA, the following Key Government Focus Areas (KGFA) and Key Focus Area Activities (KFAA) to be included in the Performance Agreements of Head of Departments:

Key government focus areas: Supply Chain Management System

KGFA	KFAA[1]	Suggested Weight	Target Date	Indicator/Target	Baseline Data
Develop and implement effective and efficient supply chain management system	Elimination of wasteful and fruitless expenditure	20%	Annual	70% elimination of wasteful and fruitless expenditure from baseline 2019 [2]	2018 Baseline
	Reduction of irregular expenditure	20%	Annual	65% reduction of irregular expenditure from baseline 2019[3]	2018 Baseline
	Reduction of qualified audits	20%	Annual	Unqualified audit opinion with 25% fewer findings than 2019/20[4]	2018 Baseline
	Ensure that procurement planning is managed	15%	Annual	The finalisation of tender awards within an average of 100 days	Average number of days to award tenders
	Ensure that SCM risk management is performed	5%	Annual	Risk response plans for the top 5 SCM risks developed	Risk response mitigation plans
	Ensure that the department pays all compliant supplier invoices within 30 days of receipt of invoice	20%	Annual	100% of compliant supplier invoices paid within 30 days of receipt of invoice	Average supplier payment days

1. All KFAAs are compulsory ↑

2. This indicator should be incremental so that by 2024/2025 the target is 100% elimination ↑

3. This indicator should be incremental so that by 2024/2025 the target is 75% elimination ↑

4. This indicator should be incremental so that by 2024/2025 the target is Clean Audit ↑

Reply:

(1) The Public Investment Corporation (PIC), as an operating entity, does not have any budget allocation to support local government infrastructure.

(2) Falls away.

Reply:

1. National Treasury does not recommend that municipalities provide relief from property rates beyond what is already provided for in existing municipal policies (such as exemptions for indigent households). Municipalities face lower revenues due to a combination of lower demand for services such as electricity and water, and significantly higher non-payment rates for municipal bills. At the same time, they are faced with additional costs in responding to the pandemic. This would not be an appropriate time for municipalities to reduce their property rates.

2. The Supplementary Budget Review tabled on 24 June 2020 discussed the decline in municipal revenue collection and noted that, “The extent to which municipal bills are paid in the months ahead will depend on the duration of restrictions on economic activity, the pace of recovery and the application of revenue collection measures.” No further statements on municipal revenue collections as they relate to the COVID-19 pandemic are planned at this stage.

Reply:

DEPARTMENT OF HUMAN SETTLEMENTS:

The National Department of Human Settlements purchased goods and/or services below the amount of R 500 000 connected to the Covid-19 pandemic as indicated below:

Order number	(b)Transaction amount	(c)Service/or product	Deviation
DH-026965	R 8 000.00	Empty Plastic bottles	No
DH-026966	R 25 400.00	Hand Sanitizers	No
DH-026967	R 82 400.00	Cloth Face Masks	No
DH-026968	R 104 550.00	Covid -19 Tests	No
DH-026970	R 174 464.00	Deep cleaning and sanitizing of buildings( 240 JMS; 260 JMS and Struktura)	No.
DH-026980	R 78 000.00	Face Shields	No
DH-026982	R 8 250.00	Foot Operated Hand Sanitizer Stand	No
DH-027009	R 4 800.00	Hand Sanitizers	No
DH-027017	R 41 000.00	Hand Sanitizers Construction gloves Face Shields Cloth Face masks	No
P No. 2420131	R 38 812.50	Hand Sanitizers Sanitizer Dispensers	No
P No. 2420302	R 77 833.00	Nurses appointed to screen employees and visitors	Yes (only two quotations were received).
P No. 2419856	R 242 213.00	Disinfect the DHS buildings for Covid -19 and fumigation of pests.	No
P No. 2419679	R 31 500.00	Face masks and surgical gloves	No
P No. 2419632	R 1 998.00	Thermometers	No
P No. 2419632	R 2 940.70	Surgical masks 3 ply	No
P No. 2419393	R 1935.00	Disinfecting wipes	No
P No. 2419393	R 1 527.60	Sterile gloves	No
P No. 2419393	R 2 491.95	Hand sanitizers	No
P No. 2419393	R 1 981.20	Hand sanitizers and wipes	No

(2)

(a) Yes, there was a deviation concerning the procurement of nursing services as shown in the table above. 

(b) There were no service providers/agencies registered in the National Treasury Central Supplier Database for the supply of nursing services. The Department of Human Settlements identified three agencies, (i.e. Mab Agency; Mednurse and Medwell). Requests for quotations were sent to the three agencies, but only two (Med nurse and Medwell) responded. A deviation was thus approved for procurement to be done based on two quotations.

(3) Goods and services were purchased from service providers with the lowest acceptable quotes. In instances where the value of goods procured was below R 2000.00, petty cash was used and therefore no requests for quotations were sent out. This practice is in line with the Supply Chain Management prescripts.

(4) My Department is available to brief the Portfolio Committee on Human Settlements, Water and Sanitation.

DEPARTMENT OF WATER AND SANITATION:

(1) The Department of Water and Sanitation (DWS) purchased personal protective equipment (PPE). The information relating to expenditure on PPE and other measures to combat the spread of Covid-19 and the suppliers where the PPE were procured from is attached as Annexure A. In addition, the various suppliers used are on the Central Supplier Database.  

(2) No, the DWS did not deviate from the standard Supply Chain Management procedures.  

(3) The reasons for procuring the goods from specific companies was to enable the department to combat the spread of the COVID-19 pandemic through:

• Provision of PPE to employees
• Facilitating the screening of employees at the Head office and Regional Offices
• Disinfection of Office buildings (including Fumigation, Deep Cleaning and Fogging of offices)   

(4) My Department is available to brief the Portfolio Committee on Human Settlements, Water and Sanitation.

Reply:

1. The department procured the following goods and services connected to the Covid-19 pandemic.

(a) Name of company	(b) Amount	Method of procurement	(c) Service and/or product that each company rendered
Lechoba Medical Technologies	R182 263.50	Three quotations	Hand sanitizers
Masana Hygiene Services	R156 302.26	Three quotations	Hand sanitizers liquid dispensers
	R121 446.00	Three quotations	Building decontamination
	R3 801.00	Three quotations	Building decontamination
	R10 500.00	Three quotations	Building decontamination
Nesoscope Holdings (Pty) Ltd	R54 275.88	Emergency deviation on existing contract	Surface sanitizers
MPM Enviro Enterprise	R293 250.00	Three quotations	N95 masks and latex gloves
Class Three Medical Solution	R12 128.82	Three quotations	Thermometers
Tsuamo Civils (Pty) Ltd.	R9 000.00	Three quotations	Building decontamination
	R1 900.00	1 quotation amount below R2000.00 SCM threshold	Building decontamination
	R75 950.00	Emergency deviation memo approved	Building decontamination
	R80 850.00	Three quotations	Building decontamination
Khulanathi Black Ginger	R135 125.00	Three quotations	Cloth masks reusable
Benixo Utility Services	R98 640.00	Three quotations	Building decontamination
Techcon Systems Pty Ltd	R332 062.50	Three quotations	Rental, supply, installation, replenishing and maintenance of foot operated hand sanitizer dispensers.
TOTAL	R1 567 494.96

2. Two emergency deviations were approved.

(a) Immediate sanitization of all surfaces, kitchens, utensils, door handles on regular basis to prevent infections. This was done by the incumbent service provider.

(b)The department experienced positive Covid-19 cases. The building had to be evacuated and there was an urgent need to decontaminate buildings immediately.

(3) The Department’s COVID-19 Committee established the need for the goods and services to manage and contain the spread of infections.Request for quotations were issued to various companies and lowest quotations were accepted in each instance.

(4) N/A

Reply:

Honourable Member, I have been informed that challenges relating to the borehole in Nyanyukani B have been resolved. This was confirmed after a site visit was undertaken by staff of the Department’s Regional Office in Limpopo on 11 May 2020 to the area.

The borehole in Nyanyukani B was initially connected to the community (household) electricity supply. ESKOM resolved that the borehole should have its connection where a transformer was to be installed. The Mopani District Municipality (DM) found the costs of installing transformers to all boreholes to be unaffordable and the borehole was legalized by Eskom without having a transformer.

In 2019 Eskom disconnected all boreholes in the Mopani District without transformers as they were considered to be illegally connected. The Mopani DM submitted a new electricity application for the borehole in 2019.

Upon consultation with the Mopani DM, the Department of Water and Sanitation was informed that the electricity supply to the borehole in Nyanyukani B had been restored and the borehole was back in operation.

Reply:

The information provided on this response is based on data provided by SAA and BA (two of the airlines that provides Business Class Cabins in the country).

The following assumptions apply:

1. The values are total Rand value and total number of single trips (legs) for calendar year 2019.
2. The values include all government institutions that uses the government deal codes as per the National Treasury’s centrally negotiated discount rates (including Parliament).
3. The data provided was not provided per individual (compliance to POPI Act), hence only total amounts are used.
4. The values exclude other domestic and international airlines. The data is not readily available.
5. SAA Economy class Average Price per Ticketwas calculated based on the average price of full Y-class tickets on all the routes. (R6181.00)
6. The values are exclusive of airport taxes and inclusive of VAT

Observations

If all Business Class tickets for 2019 were to be converted to Full Y Economy class tickets, on the two mentioned airlines only, Government could have saved R12 672 956.

	COST ANALYSIS FOR FLYING BUSINESS CLASS COMPARED TO ECONOMY CLASS
	British Airways	South African Airways
	Total cost (2019)	Total # Legs	Average price per ticket per leg	Total cost (2019)	Total # Legs	Average price per ticket per leg
Business Class	R23 676 021	8967	R2 640	R83 320 961	12873	R6 473
Economy Class (Full Y)	R53 511 915	32509	R1 646	*	*	R6 181
Difference between Business Class and Economy class ticket			R994			R292
Estimated saving per Airline			R8 915 759			R3 757 196
Total Estimated Saving	R12 672 956
	Notes:
	* Not provided

Conclusion

The pronouncement made by Minister of Finance to cut Business Class travel will yield the desired outcome.

Reply:

1. The National Treasury monitors the submission of municipal asset registers together with the annual financial statements, each financial year.

a)  The Honourable Member to note that whilst municipalities are required to record movements of assets on an ongoing basis as part of their recording and accounting process, for acquisition, upgrading or disposal. Theseare generally checked annually, when the Annual Financial Statements are prepared. Since the introduction of Generally Recognised Accounting Practices (GRAP), we have consistently encouraged municipalities to undertake this reconciliation on an in-year basis.

b) All 257 municipalities have asset registers as they are all reporting in terms of the GRAP standards.

2. Each municipality, through the Accounting Officer, is responsible for the management, safeguarding and maintenance of assets, as contained in section 63 of the Municipal Finance Management Act (MFMA), Act 56 of 2003. To assist municipalities in complying with this provision, the National Treasury has issued frameworks, guidelines, circulars, tools and conducted training on asset management, accounting and reporting thereof. The National Treasury has also rendered additional support to municipalities on asset management. The strength of a municipality’s asset management practices (including the completeness of its asset register) is measured by the quality of the information reported in its annual financial statements, which is also audited by the Auditor-General.

Reply:

(1)(a) There are no details available of the due diligence measures that were taken at the time of the transaction. The transaction was concluded on 11 January 1994 by the then Public Investment Commissioners.

(1)(b) The purpose of the loan was to assist Madibeng Local Municipality (Madibeng) with the repayment of a number of short-term loans.

(1)(c) The current matter relates to the remaining three Coupon Certificates (others were settled), and their respective numbers are BR20, BR25 and BR26. The interest rate on BR20 was 13.29%; BR25 was 12.47% and BR26 was 12.47%. The PIC waived the respective interest rates and charged a flat interest rate of 10% in respect of each certificate.

(1)(d) The loan repayment dates and amounts are as follows:

• BR20 – 30 November 2003 – R37 million
• BR25 – 30 June 2003 – R83 million
• BR26 – 30 November 2003 – R87 million

(2) Madibeng will be in a better position to reply to this question, however, they have and continue to make provision for this debt in their financial staments and have not pleaded that they will not be able to repay the PIC. The PIC also made an offer to the Municipality to effect the payment over a period of time, which they declined.

(3) Yield to maturity; final yield on redemption dates; repayment to be effected at par on the redemption date on each certificate.

(4) The reasons are all of a technical nature. Madibeng admitted that they have received the loan amounts and that they owe the money to the PIC. However, they first raised a technical point that they were not authorised to raise the loan and issue the certificates. When they lost on this point, they appealed to the Supreme Court of Appeal (SCA) where they lost the appeal as well. The matter was remitted to the Court of First Instance for hearing on the merits and the quantum. Madibeng raised another technical point that the debt has prescribed. They lost again and have once more appealed to the SCA . PIC is currently awaiting for a hearing date from the SCA.

(5)(a) The current Court Order, which Madibeng is appealing, is for payment of the sum of R162,639,962,00 plus interest at the reduced rate of 10% per annum. This is after taking into consideration the payments that Madibeng effected after summons was issued.

(5)(b) National Treasury will be in a better position to reply to this question.

Reply:

The GEPF has not received the proposal by the Congress of South African Trade Unionsfor consideration to write down Eskom debt.

Reply:

(1) Yes the suppliers involved in the concealed best before date have been identified. The companies are not yet blacklisted as the legal process must first be finalised. However the Department issued the companies involved with a warning letter, and no awards/invitations for the supply of patrol ration packs have been made to these companies since the incident. The suppliers are currently barred from doing business with the Department of Defence (DOD) pending the outcome of the investigation.

(b) The matter is under investigation

Reply:

An initial payment to support provinces in responding to the COVID-19 pandemic was made at the end of the 2019/20 financial year (before the full magnitude of the pandemic and its impacts was known). Details of further allocations and reprioritisations for the COVID-19 response in the 2020/21 financial year will be published when the Minister of Finance tables a supplementary adjustment budget on 24 June 2020.

On 25 March 2020, National Treasury approved the release of the amounts shown in Table 1 to provinces from the 2019/20 allocation for the Provincial Disaster Relief Grant. These funds were transferred to provinces by the National Disaster Management Centre to fund the initial costs of purchasing additional personal protective equipment and other medical equipment needed by provincial health departments to respond to the pandemic.

Table 1: Provincial Disaster Relief Grant allocations, 2019/20

R'000	2019/20 allocations
Eastern Cape	44 551
Free State	12 429
Gauteng	115 996
KwaZulu-Natal	138 918
Limpopo	42 449
Mpumalanga	33 993
Northern Cape	6 224
North West	18 540
Western Cape	53 292
Total	466 392

Reply:

a) 8 957 taxpayers requested PAYE Tax Deferments thus far and 4 taxpayers requested deferrals of excise duties.

b) The rand value for the PAYE Tax Deferments is R334m.

Deferral for the payment of excise duties on alcoholic beverages and tobacco products

Excise duties on alcoholic beverages and tobacco products are payable by manufacturers and the liability for excise duty is assessed and collected on a Duty at Source (DAS) basis - i.e. as close as possible to the point of domestic manufacture when goods achieve their excisable character or the point of importation of similar excisable products.

The liability to account for excise duties and the payment thereof therefore rest with the manufacturer with payment periods following the end of the accounting month ranging from 30 to 130 days depending on the product and the period between the time of manufacture and final sale.

The outbreak of the COVID-19 pandemic resulted in the President declaring a national state of disaster and instituting a nation-wide lockdown with effect from Thursday, 26 March 2020. As a result, the sale of alcoholic beverages and tobacco products was first restricted and has since been prohibited.

In order tominimise cash flow difficulties for the manufacturers of alcoholic beverages and tobacco products, the revised Disaster Management Tax Relief Bill, 2020 proposes that the manufacturers in these industries continue to submit their excise duty accounts on time but that the payments due to SARS be deferred for a period of 90 days without incurring interest or penalties.

Manufacturers will qualify for such deferment provided they have no outstanding excise accounts or payments unless an arrangement has been made for such payments. The proposed deferral, as set out in the proposed amendments to Rule 19A.11 to the Customs and Excise Act No. 91 of 1964, will apply to payments due in the months of May and June and will be for a period of 90 days.

The table below provides the detail of tax deferral measures approved to date in this regard.

Table A: Tax deferral measures relating to the payment of excise duties on alcoholic beverages and tobacco products

Province	Taxpayers Approved	Amounts deferred
Gauteng	1	R546 000 000
KwaZulu Natal	1	R933 000 000
Western Cape	2	R1 073 659 864

Reply:

a) The number of deaths of children under five years of age in public sector hospitals for the period 1st April to 30th June 2020 is shown in the table below. For comparison the number of deaths for the same period during 2018 and 2019 are also shown in the table. The number of child deaths was lower during the period April to June 2020, than during the corresponding period in each of the preceding two years. It should be noted that the majority of deaths occurred in the neonatal period (from birth to 28 days) with fewer deaths occuring in children aged between one month and five years.

	Deaths
	0 – 28 days	1 month – 5 years	Total U5
1st April – 30th June 2020	3,087	855	3,942
1st April – 30th June 2019	2,948	1,321	4,269
1st April – 30th June 2018	2,901	1,407	4,308

The number of under-five deaths which occurred in each public sector hospital from 1st April – 30th June 2020 is shown in Annexure A.

b) The majority of deaths in the newborn period are due to prematurity, infection and birth asphyxia. The leading causes of death in children aged between one month and five years are diarrhoea, pneumonia and septicaemia with HIV infection and malnutrition as important underlying conditions. As deaths due to diarrhoea and pneumonia decline, the proportion of deaths due to congenital disorders and non-natural deaths (as a result of accidents/injuries) is rising. Detailed information on cause of death as recorded on the death certificate is collated by Statistics South Africa, but this information is not immediately available.

Annexure A:

Province	Level	Hospital	Deaths
			0 – 28 days	1 month – 5 years	Total U5
Eastern Cape	District	Aliwal North Hospital	1	0	1
		All Saints Hospital	0	2	2
		AndriesVosloo Hospital	1	0	1
		Bambisana Hospital	1	0	1
		Bedford Hospital	0	1	1
		Bhisho Hospital	1	0	1
		Burgersdorp Hospital	1	0	1
		Butterworth Hospital	5	1	6
		Canzibe Hospital	3	0	3
		Cathcart Hospital	1	0	1
		Cradock Hospital	1	0	1
		Dordrht Hospital	1	0	1
		Dr MalizoMpehle Memorial Hospital	3	0	3
		Empilisweni Hospital	3	3	6
		Glen Grey Hospital	2	1	3
		Grey Hospital	0	1	1
		Holy Cross Hospital	3	2	5
		Humansdorp Hospital	4	1	5
		Indwe Hospital	1	1	2
		Isilimela Hospital	1	1	2
		Lady Grey Hospital	1	0	1
		Maclear Hospital	1	2	3
		Madwaleni Hospital	1	0	1
		MadzikanekaZulu Memorial Hospital	5	0	5
		Midland Hospital	0	2	2
		Mjanyana Hospital	0	1	1
		Molteno Hospital	0	1	1
		Mount Ayliff Hospital	7	1	8
		Nessie Knight Hospital	2	0	2
		Nompumelelo (Peddie) Hospital	1	0	1
		Port Alfred Hospital	2	1	3
		Sipetu Hospital	1	3	4
		St Barnabas Hospital	3	1	4
		St Patrick's Hospital	12	4	16
		Stutterheim Hospital	1	1	2
		Tafalofefe Hospital	1	1	2
		Tayler Bequest Hospital (Elundini)	1	1	2
		Tayler Bequest Hospital (Matatiele)	4	2	6
		Uitenhage Hospital	7	1	8
		Victoria Hospital	4	0	4
		Wilhelm Stahl (Middelburg) Hospital	0	1	1
		Zitulele Hospital	2	3	5
	Regional	Cecilia Makiwane Hospital	15	2	17
		Dora Nginza Hospital	26	7	33
		Frontier Hospital	8	0	8
		Mthatha General Hospital	15	0	15
		St Elizabeth's Hospital	12	0	12
	Provincial Tertiary	Frere Hospital	9	6	15
	National Central	Nelson Mandela Academic Hospital	32	19	51
	TOTAL	206	74	280
Free State	District	Botshabelo Hospital	2	0	2
		Dr JS Moroka Hospital	1	0	1
		Elizabeth Ross Hospital	0	1	1
		FeziNgumbentombi Hospital	5	0	5
		Katleho Hospital	6	1	7
		Mohau Hospital	1	1	2
		Nala Hospital	1	1	2
		Thusanong Hospital	1	1	2
		Tokollo Hospital	0	1	1
		Winburg Hospital	0	0	0
	Regional	Boitumelo Hospital	9	1	10
		Bongani Hospital	40	3	43
		Dihlabeng Hospital	14	2	16
		MofumahadiManapoMopeli Hospital	14	5	19
	Provincial Tertiary	Pelonomi Hospital	1	3	4
	National Centrals	Universitas Hospital	16	4	20
	TOTAL	111	24	135
Gauteng	District	Bertha Gxowa Hospital	5	2	7
		BhekiMlangeni District Hospital	5	0	5
		Carletonville Hospital	3	1	4
		Dr Yusuf Dadoo Hospital	4	0	4
		Heidelberg Hospital	4	1	5
		Jubilee Hospital	15	3	18
		Kopanong Hospital	4	2	6
		Odi Hospital	7	2	9
		Pretoria West Hospital	3	0	3
		South Rand Hospital	2	0	2
	Regional	Edenvale Hospital	10	0	10
		Far East Rand Hospital	13	6	19
		Leratong Hospital	17	4	21
		Mamelodi Hospital	35	4	39
		Pholosong Hospital	11	2	13
		RahimaMoosa Hospital	33	7	40
		Sebokeng Hospital	17	1	18
		Tambo Memorial Hospital	8	6	14
		ThelleMogoerane Regional Hospital	35	2	37
	Provincial Tertiary	Kalafong Hospital	22	2	24
		Tembisa Hospital	52	8	60
	National Central	Charlotte Maxeke Hospital	41	14	55
		Chris Hani Baragwanath Hospital	90	11	101
		Dr George Mukhari Hospital	76	5	81
		Steve Biko Academic Hospital	18	13	31
	TOTAL		530	96	626
KwaZulu-Natal	District	Appelsbosch Hospital	3	0	3
		Benedictine Hospital	31	3	34
		Bethesda Hospital	5	0	5
		Catherine Booth Hospital	3	0	3
		Ceza Hospital	1	0	1
		Charles Johnson Memorial Hospital	2	5	7
		Christ the King Hospital	3	4	7
		Church of Scotland Hospital	6	3	9
		Dundee Hospital	1	0	1
		East Griqualand and Usher Memorial Hospital	6	0	6
		Ekhombe Hospital	2	1	3
		Emmaus Hospital	10	2	12
		Eshowe Hospital	2	0	2
		Estcourt Hospital	4	0	4
		GJ Crooke's Hospital	6	1	7
		Greytown Hospital	4	1	5
		Hlabisa Hospital	9	0	9
		Itshelejuba Hospital	9	1	10
		KwaMagwaza Hospital	2	0	2
		Manguzi Hospital	2	0	2
		Montebello Hospital	0	1	1
		Mosvold Hospital	4	0	4
		Mseleni Hospital	4	0	4
		Murchison Hospital	1	4	5
		Nkandla Hospital	2	1	3
		Nkonjeni Hospital	8	2	10
		Northdale Hospital	8	2	10
		Osindisweni Hospital	3	1	4
		Rietvlei Hospital	7	4	11
		St Andrew's Hospital	10	2	12
		St Apollinaris Hospital	6	1	7
		St Mary's Hospital (Mariannhill)	9	0	9
		Umphumulo Hospital	3	4	7
		Vryheid Hospital	10	8	18
		Wentworth Hospital	3	0	3
	Regional	Addington Hospital	9	2	11
		Edendale Hospital	23	5	28
		General Justice GizengaMpanza Hospital	15	7	22
		King Dinuzulu Hospital	6	0	6
		Ladysmith Hospital	18	2	20
		Madadeni Hospital	0	1	1
		Mahatma Gandhi Hospital	30	3	33
		Newcastle Hospital	24	7	31
		Port Shepstone Hospital	20	5	25
		Prince Mshiyeni Memorial Hospital	22	5	27
		Queen Nandi Regional Hospital	45	12	57
		RK Khan Hospital	18	5	23
	Provincial Tertiary	Grey's Hospital	8	3	11
		King Edward VIII Hospital	15	6	21
	National Central	Inkosi Albert Luthuli Central Hospital	6	9	15
	TOTAL		448	123	571
Limpopo	District Hospital	Botlokwa Hospital	2	1	3
		Dilokong Hospital	8	3	11
		Donald Fraser Hospital	6	4	10
		Dr CN Phatudi Hospital	2	0	2
		Elim Hospital	4	11	15
		Ellisras Hospital	2	1	3
		FH Odendaal (Nylstroom) Hospital	3	0	3
		George Masebe Hospital	2	1	3
		Groblersdal Hospital	9	0	9
		Helene Franz Hospital	7	3	10
		Jane Furse Hospital	6	4	10
		Kgapane Hospital	13	3	16
		Lebowakgomo Hospital	4	3	7
		Louis Trichardt Hospital	1	0	1
		Malamulele Hospital	11	4	15
		Maphutha L Malatjie Hospital	5	4	9
		Matlala Hospital	3	0	3
		Mklenburg Hospital	2	2	4
		Messina Hospital	2	0	2
		Nkhensani Hospital	4	2	6
		Sekororo Hospital	6	0	6
		Seshego Hospital	10	6	16
		Siloam Hospital	3	0	3
		Van Velden Memorial (Tzaneen) Hospital	9	0	9
		Voortrekker Memorial (Potgietersrus) Hospital	3	2	5
		Warmbaths Hospital	2	0	2
		WF Knobel Hospital	3	1	4
		Witpoort Hospital	1	0	1
		Zebediela Hospital	1	0	1
	Regional	Letaba Hospital	20	2	22
		Mokopane Hospital	18	1	19
		Philadelphia Hospital	0	4	4
		St Rita's Hospital	11	0	11
		Tshilidzini Hospital	18	7	25
	Provincial Tertiary	Mankweng Hospital	66	9	75
		Pietersburg Hospital	7	13	20
	TOTAL		274	91	365
Mpumalanga	District Hospital	Barberton Hospital	1	1	2
		Bernice Samuels Hospital	4	1	5
		Bethal Hospital	3	1	4
		Carolina Hospital	1	0	1
		Elsie Ballot Hospital	1	0	1
		Embhuleni Hospital	18	0	18
		Evander Hospital	14	1	15
		HA Grove Hospital	1	1	2
		KwaMhlanga Hospital	5	3	8
		Lydenburg Hospital	4	0	4
		Matibidi Hospital	5	0	5
		Matikwana Hospital	7	3	10
		Middelburg Hospital	2	0	2
		Mmametlhake Hospital	4	2	6
		Piet Retief Hospital	7	3	10
		Sabie Hospital	0	0	0
		Shongwe Hospital	5	4	9
		Standerton Hospital	3	0	3
		Tintswalo Hospital	11	5	16
		Tonga Hospital	5	3	8
	Regional	Ermelo Hospital	12	0	12
		Mapulaneng Hospital	13	3	16
		Themba Hospital	23	0	23
	Provincial Tertiary	Rob Ferreira Hospital	11	7	18
		Witbank Hospital	34	3	37
	TOTAL		194	41	235
North West	District Hospital	Brits Hospital	13	1	14
		Christiana Hospital	1	0	1
		Ganyesa Hospital	2	1	3
		Gelukspan Hospital	7	3	10
		General de la Rey Hospital	5	0	5
		Koster Hospital	1	0	1
		Lehurutshe Hospital	1	2	3
		Moses Kotane Hospital	2	3	5
		NicBodenstein Hospital	2	1	3
		Schweizer-Reneke Hospital	0	1	1
		Taung Hospital	8	1	9
		Thusong Hospital	0	2	2
	Regional	Joe Morolong Memorial Hospital	6	3	9
		Mahikeng Provincial Hospital	0	7	7
		Potchefstroom Hospital	0	0	0
	Provincial Tertiary	Job ShimankanaTabane Hospital	46	5	51
		Klerksdorp-Tshepong Tertiary Hospital	35	5	40
	TOTAL		129	35	164
Northern Cape	District Hospital	De Aar (Central Karoo) Hospital	1	1	2
		Hartswater (Connie Vorster) Hospital	1	0	1
		Kakamas Hospital	2	0	2
		Kuruman Hospital	6	2	8
		Postmasburg Hospital	1	1	2
		Springbok (Dr Van Niekerk) Hospital	1	1	2
		Tshwaragano Hospital	2	1	3
	Regional	Dr Harry Surtie Hospital	11	1	12
	Provincial Tertiary	Robert MangalisoSobukwe Hospital	14	10	24
	TOTAL		39	17	56
Western Cape	District Hospital	Beaufort West Hospital	2	0	2
		Caledon Hospital	1	1	2
		Ceres Hospital	1	0	1
		Citrusdal Hospital	1	0	1
		Eerste River Hospital	0	1	1
		Helderberg Hospital	2	0	2
		Hermanus Hospital	1	0	1
		Karl Bremer Hospital	5	0	5
		Mitchells Plain Hospital	4	0	4
		Oudtshoorn Hospital	2	0	2
		Prince Albert Hospital	0	1	1
		RadieKotze Hospital	1	0	1
		Riversdale Hospital	0	1	1
		Robertson Hospital	4	1	5
		Stellenbosch Hospital	1	0	1
		Vredenburg Hospital	1	0	1
		Vredendal Hospital	3	0	3
	Regional	George Hospital	4	1	5
		Mowbray Maternity Hospital	17	0	17
		New Somerset Hospital	6	0	6
		Paarl Hospital	6	2	8
		Worcester Hospital	16	5	21
	Provincial Tertiary	Red Cross War Memorial Children's Hospital	6	11	17
	National Central	Groote Schuur Hospital	23	1	24
		Tygerberg Hospital	29	20	49
	TOTAL		136	45	181

END.

Reply:

1. There are standing Public Health and Social Development Bargaining Council (PHSDSBC) Resolutions 1 and 2 of 2018/19 and 2019/20 pertaining to standardizing Community Health Worker (CHW) remuneration at R3,500 per month. These Resolutions also highlight the need for processes to guide the employment, placement, remuneration, skills development and other processes related to conditions of employment for CHWs. The extension of Resolution 1 of 2018/19 to 2019/20 will allow the Department to engage all relevant stakeholders to guide the processes on conditions of employment for CHWs. Currently, the recruitment and remuneration for CHWS is enforced through these Resolutions, which do not make allowances for permanent employment, other than renewable of annual contracts. Furthermore, this matter is currently before the Bargaining Council wherein the Department engages with Labour Unions on possible interventions.

2. (a) There are 49,526 CHWs contracted across all Provinces.

(b) There are 49 526 CHWs who are on contract employment.

(c) The Department is not aware of the number of CHWs employed permanently. The Department became aware of the Gauteng Province (GP) intentions to employ CHWs permanently following the announcement by the Health MEC, Dr Masuku, stating that as of 1 July 2020, the Gauteng Department would have finalised the translation of 8,500 CHWs as Level 2 employees and the Department will complete the remaining number by 31 July 2020. There has not been any formal communication to the Director General (DG) for Health in this matter however, the DG has written to GP Head of Department seeking clarity on the matter. For this reason, we cannot confirm the number of CHWs employed permanently by Gauteng Province.

END.

Reply:

1. (a) (i) The total number of vacant posts that were available across the Republic for nurses, doctors and other healthcare workers in February 2020 was 33 398.

(ii) A total number of 17150 health professionals (i.e. nurses, doctor and other related health care professions) have since been appointed from February to June 2020. This accounts for 34%of the 33 398 vacancies listed above.

(b) The National Department of Health used the Model of Demand based on the projected number of infections per district to determine the Surge Capacity demand during the Covid-19 Pandemic. The Model is applied to the population and Covid-19 caseloads using 85% of Public hospital general beds and 100% of ICU and High Care beds for Covid-19 care. The Model, estimates that the Public Health Sector will require an additional 1 200 Doctors and 18 000 Nurses of various categories.

(2) A total of 7 416 health professionals were already contractedacross the provinces to fill the gap in the HR requirements. A database for workforce candidates containing 942 doctors and 1 261 as well as 144 other categories of staff is accessible to provinces to recruit staff from and some provinces also have databases with potential candidates available. Recruitment is continuing.

Based on the directions issued by the Minister of Health in April, the recruitment process should be shortened by advertising a post and effecting appointments within a period of a week

Budget motivations are submitted to Provincial Treasuries and to NDoH for consideration.

Other sources for healthcare workers include the following:

• Health Professionals working in the private sector can be appointed on sessional basis
• 176 health professionals from Cuba is assisting South Africa in the response to COVID-19. The necessary registrations have been completed and they have been deployed across all provinces. They are authorised to work in any province. Since the projected peaks differ between provinces, this cadre could be deployed to areas with the highest need
• Volunteers: Provinces placed advertisements for volunteers to assist in the response to the COVID-19 pandemic.
• Foreign nationals: The Foreign Workforce Management Unit (FWM) of the National Department of Health is facilitating the recruitment and placement of all “Foreign Health Workers” who present themselves for employment and study opportunities in South Africa. Policy guidelines for registration and employment of foreign qualified health professionals in South Africa are in place.
• Final year students: NDoH engaged with Deans of Health Sciences Faculties and Principals of Nursing Colleges to facilitate deployment of final year students to assist with care of COVID-19 patients e.g. in field hospitals. Postgraduate nursing students returned to workplaces to support the COVID-19 response. Final year nursing students will write examinations by the end of August and will thereafter available for the surge capacity.
• Interns and Com Serve: There is an existing ICSP database. Health professionals in this category that are not currently employed or due to complete their terms, can be contracted to supplement the surge capacity
• Retired health professionals: Based on the directions issued by the Minister of Health in April, all retired personnel may be requested to fill in positions on a temporary basis to assist in responding to the pandemic. Retired employees can be deployed to low risk areas to relief staff to attend to COVID-19 patients.

The following additional areas are pursued to expand the resource base:

• Non-Governmental Organisations and Community based organisations: The directions issued by the Minister of Health in April also makes provision for community service personnel, extended public works programme workers, CBOs and NGOs to fill in positions on a temporary basis to assist in responding to the pandemic. Provinces can engage with these sectors to identify possible capacity. Possible down referral of patients to suitable sectors should be considered as well as increasing the capabilities of homebased caregivers and Community Health workers to strengthen home care.
• South African Military Health Services (SAMHS): SAMHS can support Provinces in the response to COVID-19 in terms of the role of the South African Defence Force (SANDF) in Disaster Management. Provinces should liaise with SAMHS in the province.

The following measures are implemented to reduce the demand on human resources during the pandemic:

• Provincial Health Departments are reprioritising health care services. This can include the identification of routine and elective services that can immediately be deferred or moved to other settings or non-affected areas or identification of alternative service providers e.g. from hospitals to PHC settings, private sector or NGOs.
• Co-ordination with the private sector is done to optimise all the resources available in the province. Discussions at National level resolved to contract the private sector on a global fee inclusive of beds, hospital staff, equipment and consumables where additional capacity is needed, especially for critical care beds. A Service Level Agreement (SLA) template is available.
• In provinces with metros, metros are engaged to identify services that can be redirected from provincial facilities to municipal clinics and health centres to free up provincial staff for the COVID-19 response. Alternatively, metro staff can be seconded to the field hospitals or other COVID-19 settings.
• Alternative service delivery mechanisms are to be considered, e.g. allowing pharmacists to extend ordinary prescriptions for people with chronic conditions provided they are controlled on treatment.

END.

Reply:

The intervention team has submitted a report to the Eastern Cape Department of Health, the Office of the Premier, and the Office of the Minister of Health.

The report submitted covered the analysis and the state of the COVID-19 response in the Eastern Cape for the period, 29th June 2020 until 10th July 2020. The report recommended nine areas of intervention. The recommendation made by the Strategy Team is following the key strategic areas as outlined by the WHO-COVID-19 response guideline as tailored to the provincial needs.

(a) The recommended interventions

1.1 Coordination between Tertiary, Regional and District hospitals is inadequate and should be addressed through the revised command and control structure.

1.2 Given the busy schedule of the SG, it would benefit the Province to have a Project Manager for COVID19 with the necessary authority to fast track actions.

1.3 While the metros have mobilised reasonable infrastructure to meet the surge, the Eastern Cape Department of Health (the Department) needs to give attention to the scaling-up of service delivery requirements such as the adequate provision of oxygen, equipment, human resources, and medicines necessary for the management of the Pandemic.

1.4 Certain hospitals are currently overwhelmed (Doran Nginza in NMB in particular) by the patient demand, and lack of infrastructure, equipment and human resources to meet the clinical care demand which the Department needs to address.

1.5 Labour relations is a matter that requires a dedicated action plan to normalise service delivery.

1.6 Historic arrangements for drainage areas, resource allocation, and referral routing are not addressing the significant surge in patient numbers, particularly in underserved, vulnerable populations.

1.7 Emergency Medical Services and patient transport services require intervention to ensure continued function.

1.8 Within the Province, the oxygen separation plants are located in the Nelson Mandela Bay Metro. The distribution of the oxygen is, therefore, a challenge for areas furthest from the Metro.

1.9 Implementation of a comprehensive data system to capture the parameters of the COVID-19 response.

(b) How far each of the recommendations has been implemented

1. Coordination between Tertiary, Regional and District hospitals is inadequate and should be addressed through the revised command and control structure.

The Intervention Team assisted the Department to establish its Command and Control structure which was adjusted from the Department’s strategic documents.

The structure is divided into three layers, Provincial, district and facility specific. Each structure has adopted an incident management approach (WHO-COVID-19 Guidance) with daily command and control meetings covering the following areas:

• Epidemiology and Surveillance
• Community engagement for prevention, contact tracing and testing
• Laboratory support and result reporting
• Treatment and Care including facility surge capacity
• Infrastructure and equipment
• Logistic support - pharmacy, consumables and personal protective equipment
• Emergency Services
• Psycho-social support to health workers
• Port Health

The strategic area of Port Health is not given a daily focus as Port Health is a national competence. The PMU is vigilant around Port Health issues and receives reports relevant to the Province from the National Department of Health.

2. Given the busy schedule of the SG, it would benefit the Province to have a Project Manager for COVID-19 with the necessary authority to fast track actions.

The Premier of the Province Hon. Mr. Oscar Mabuyane announced the establishment of the Project Management Unit for a comprehensive response to COVID-19. The Project Management Unit(PMU) has established the following structure (Fig. 1 below).

Dr Zungu leads the PMU. She works with Dr Monde Tom, a financial management expert with vast experience in both the public and private sector, leads the Business Continuity Workstream and Mr LauwrenceVanZuydam an experienced HR executive seconded from the Office of the Premier.

The project leader is responsible for directing all COVID-19 activities and for fasting track actions. The PMU has been integrated into the overall Eastern Cape Department of Health’s Covid-19 response and supports the HOD as the accounting officer.

The structure of the PMU and the related workstreams is depicted below.

4. Certain hospitals are currently overwhelmed (Doran Nginza in NMB in particular) by the patient demand, and lack of infrastructure, equipment and human resources to meet the clinical care demand which the Department needs to address.

This recommendation is specific to DorahNginza and Livingstone hospitals as there had been persistent negative media reports about the two facilities.

Dora Nginza Hospital

Maternity Services

The Department resolved the congestion of the maternity wards at DorahNginza by strengthening the peripheral clinics to operate their midwife services. They have also addressed the shortage of staff by fast-tracking the recruitment of doctors and nurses.

Upgrade of Dora Nginza Hospital- 100-bed wing

The Department upgraded a dilapidated wing of the hospital to provide a 100-bed wing to support the COVID19 peak. The project was part of the Province’s “Accelerated Construction Program” which meant that a project that would typically take four months, the constructors completed in two months. The Department handed over the site to DorahNginza Hospital on the 6th July 2020.

Oxygen Reticulation

The National Oxygen Team undertook an audit of the whole oxygen reticulation system of the Dora Nginza hospital. It found that the hospital has four Oxygen Manifolds with only one partially functional. Repairs to the system commenced on the 28th July. The local car manufacturing company has committed to the replacement of two manifolds, and the Department has ordered a further one. The full functionality of all the manifolds will ensure a continuous supply of oxygen at the correct pressure and volume.

Livingstone Hospital

Infrastructure

The Department undertook a project to upgrade the basement to provide an additional 68 Beds with Oxygen. The initiative is also part of the “Accelerated Construction Program”.

Leadership

The Department appointed an Acting CEO for the Livingstone hospital on 22nd July. Also, they have advertised the post of Nursing Service Manager and CEO. The processes will be fast-tracked.

Facilities Management

The hospital management set-up a short-term 6-month cleaning contract. The intention is to ensure that the staff at Livingstone hospital are reoriented into a deep cleaning routine and protocols. The washing machine has been repaired, resulting in improvement with the laundry services.

3. While the metros have mobilised reasonable infrastructure to meet the surge, the Eastern Cape Department of Health (the Department) needs to give attention to the scaling-up of service delivery requirements such as the adequate provision of oxygen, equipment, human resources, and medicines necessary for the management of the Pandemic.

6. Historic arrangements for drainage areas, resource allocation, and referral routing are not addressing the significant surge in patient numbers, particularly in underserved, vulnerable populations.

7. Emergency Medical Services and patient transport services require intervention to ensure continued function.

8. Within the Province, the oxygen separation plants are located in the Nelson Mandela Bay Metro. The distribution of the oxygen is, therefore, a challenge for areas furthest from the Metro.

We have addressed the recommendations 3, 6, 7, and 8 above through adoption of a service delivery model that rearranges the structure and resource distribution within the Eastern Cape health system to optimise service delivery.

Currently, the major urban areas contain all the critical care capacity, that is Nelson Mandela Bay and Buffalo City metros, Mthatha, and to a limited extent, Queenstown. The outer reaches of the western, central and eastern areas are more than three-hour drive time from existing critical care beds. In collaboration with the Provincial Department of Health, the PMU developed a Hub and Spoke approach to address the shortfalls. The purpose of the Hub and Spoke strategy is then to identify the hospital drainage (referral pathway) to existing and or expanded Critical Care capacity coupled with the estimated distance and travel times to reach a bed safely at the peak of the COVID19 Pandemic. The PMU has also determined the high-risk areas based on at least one of the following factors:

• Travel times between facilities
• Travel distance between facilities
• Quality of the road infrastructure
• Quality of hospital infrastructure between the referring hospital and the receiving hospitalCritical care bed saturation

The District team are in the process of confirming satellite hubs for the expanded distribution of COVID19 critical care beds to address the potential shortfall. The PMU will support the Province to optimise existing district hospitals based on minimal input but with a maximum return.

The Department of Health supported by the PMU has made the following progress:

Infrastructure: The following infrastructure projects are underway in the Province, to yield a significant increase in the general ward beds (n=2,022) and critical care beds (n=311). The addition of the infrastructure development from the baseline will address the NEC long-term projected peak demand for COVID-19 admission in the districts and Province. The Rev Dr Elizabeth MamisaChabula Hospital facility will receive an additional upgrade of the current Phase I priority three beds to include additional oxygen supply. The intervention will add 312 oxygen beds to meet the demand in the Nelson Mandela Bay Metro and surrounding districts.

Figure : Estimated General Ward Beds required to meet the demand for COVID-19, current and projects under construction.

Figure : Estimated critical care beds in the Province, and anticipated deficit but can be achieved through the implementation of Hub and Spoke service delivery model.

Equipment: During the reporting period, the PMU identified significant gaps in the availability of a wide range of equipment. Notwithstanding, the team has made substantial inroads into addressing the procurement and distribution of equipment. The following categories of additional equipment have been ordered and delivered according to a schedule that considers shipment and available stock:

• General Ward and ICU patient beds
• Ventilators (procured and USG Donation), CPAP, High-Flow Nasal Cannula Oxygen devices
• Patient monitors, ECG machine, dynamap blood pressure systems
• ICU equipment video laryngoscopes, syringe pumps, suction, oxygen flowmeters

The following table describes the details on procurement:

Emergency Medical Services: Supported by the National Department of the Health, the Provincial Department of Health has acknowledged that the Emergency Medical Services (EMS) and patient transport capabilities for the management of COVID19 are insufficient. The Intervention Team supported the Department in developing a comprehensive plan to strengthen an emergency and inter-facility transportation system to address the hub and spoke referral routing.

The Department has initiated an EMS pilot project which is a Command and Control Centre in the Nelson Mandela Metro. The Department has supported the plan by the appointment of additional EMS practitioners, drivers and patient transport vehicles. The team will now implement similar projects in other districts. The plan includes liaison with the private sector, identifying oxygen refill hubs, and equipping EMS vehicles with ventilation support equipment.

The Province has adopted the Vula Application which is a patient referral system to be used for inter-facility transfers.

Oxygen: A sufficient supply of oxygen is critical for the effective treatment of Covid19 patients. Before an intervention by the National Oxygen Working Group, the Province demonstrated acute shortage of oxygen at the hospital level. Different role-players have mitigated the problem through a range of interventions and contributions. The Province already has completed several oxygen projects essential for the introduction of the expanded critical care bed hub and spoke. Other site developments are still in process.

The prioritised facilities for oxygen upgrades are listed below.

• At Butterworth Hospital, a temporary oxygen tank has been installed while the plinth for the permanent tank is constructed. The installation of temporal tank has been completed.
• At Mthatha Regional Hospital, a temporary oxygen tank has been installed while the plinth for the permanent tank is constructed.
• The construction of the plinths for bulk oxygen supply for the following facilities will follow this sequence:
  1. Sir Henry Elliot Hospital
  2. St Barnabas Hospital
  3. Victoria Hospital
  4. Empilsiweni Hospital
  5. All Saints Hospital
  6. The reticulation Dora Nginza has started this week 28th July 2020 (1 week to complete).
  7. Adelaide next week (03rd August)
  8. Butterworth reticulation to start in two weeks (15th August)
  9. Stutterheim Hospital
  10. Grey Hospital Hospital
  11. MalizoMphehle Hospital
  12. Zithulele Hospital
  13. Holy Cross Hospital
  14. Madzikaneka Zulu Hospital
  15. St Barnabas Hospital
  16. All Saints Hospital
  17. Mpilisweni Hospital
  18. Aliwal North Hospital

The impact of the District Oxygen Supply can be summarised in the table below to demonstrate the increase in the improved oxygen supply.

Labour relations. Labour relations is a matter that requires a dedicated action plan to normalise service delivery

As noted in the report, the resolution of labour issues is key to the successful implementation of the recommendations. Labour relations is employer-employee relationship management with several actions required to resolve the outstanding issues falling into the realm of the Department of Health to resolve. The PMU has raised the issues identified to the DOH and Premier. In response, the Premier has seconded Mr Lawrence Van Zuydam to lead the effort to resolve these. The Minister of Health has met with the provincial leadership of the Trade Unions in Health in the Province, and the Member of Executive Council holding the ongoing engagement.

The PMU has provided a detailed analysis of the human resource requirements as assessed by the National Department of Health according to the Anaplan, aligned with the National Epidemiology Consortium long-term projection. The Provincial Department of Health is addressing the human resource requirements through the implementation of rapid recruitment strategies.

Implementation of a comprehensive data system to capture the parameters of the COVID-19 response.

Key to the interventions is the data collected in the NIDS, Dat.COV, Vula systems and comprehensively collated to ensure the number of beds available at the facility and per the strategic planning. As the epidemic evolves, the monitoring evaluation data is required daily to ensure that PMU is responding to the changing situation. The PMU is placing special attention of the data requirements for contact tracing, quarantine, isolation, hospitalisation and deaths.

The progress has focused on a review of the data collection capacity, human resources, connectivity and routine data reporting from each facility. An increase in the number of facilities routinely reporting data has been achieved. The M&E team will integrate the routine clinical data with the laboratory testing data, and mortality data to provide a comprehensive overview of the pandemic progress in the Province.

END.

Reply:

1. There are no regulations that allow for capping of prices in the private sector. Discussions have been held with the private laboratories to bring down their prices. The private laboratories were charging different prices, with some charging up to R1,400 per test. Following these discussions all private laboratories reduced their prices to R850 per test.

2. Free testing in the private sector will be difficult as private laboratories have to recover their costs. In the public sector patients do not pay if they are not on medical aid.

END.

Reply:

a) The initial recommendation from the World Health Organisation (WHO) for persons that tested positive for COVID-19 was 14 days.

Recent evidence has shown that this isolation period can be safely shortened.

The WHO, the United States Centre for Disease Control (US-CDC), Public Health England (PHE) and the European Centre for Disease Control (ECDC) have recommended shorter isolation periods.

These bodies recommend the following:

Guideline	Severity
	Mild	Severe	Asymptomatic
WHO (27 May 2020)	10 (+3) days after onset of symptoms	10 days after +ve test
US CDC (05 May 2020)	10 days after onset of symptoms
ECDC (8 April 2020)	8 days after onset of symptoms	14 days after onset of symptoms	Unclear
UK PHE (14 June 2020)	7 days after onset of symptoms	7 days after +ve test (or 7 days after onset of symptoms if symptoms develop)

The National Department of Health has taken the cautious approach and adopted the WHO’s recommendation on isolation duration.

b) The decision was based on the best available scientific evidence. The evidence shows that the median time for viral shedding is approximately 8 days.[1],[2],[3],[4] These studies use in vitro cell cultures as a surrogate measure for viral shedding, however have relatively small sample sizes.

These studies were also used to inform the recommendation made by the WHO, US-CDC, ECDC, and PHE.

END.

1. Wolfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Muller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020. ↑

2. Bullard J, Dust K, Funk D, Strong JE, Alexander D, Garnett L, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clin Infect Dis. 2020. ↑

3. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. N Engl J Med. 2020;382(22):2081-90. ↑

4. Van Kampen JJA, van de Vijver DAMC, Fraaii PLA, et.al. Shedding infectious virus in hospitalized patients with coronavirus disease-2019 (COVID-19):duration and key determinants. medRxiv. 2020;2019:2020.06.08.20125310. doi: 10.1101/2020.06.08.20125310. (Pre-print) ↑

Reply:

a) Foreign doctors are referred to as persons who hold qualifications not prescribed for registration and their registration is regulatedin terms the Regulations Relating to the Registration of Persons who hold Qualifications not Prescribed for Registration, which are regulations made in terms of section 25 read with section 15B(1)(c) of the Health Professions Act of 1974. As matters stand, the requirements for registration based on the same legislation and regulations which are still in force are as follows:

1. a certified copy of the applicant’s identity document or passport;
2. a copy of the degree certificate or other basic qualification, certified by a notary public, and a sworn translation thereof into English;
3. a certified copy of the official and detailed curriculum of the applicant’s course of study, the specific courses, the content of education (theory) and training (practical/clinical), and the duration and mode of examination/evaluation. For training/curricula which is not equivalent to those offered in South African institutions, applicants will be required to pass, to the satisfaction of the board, an examination or evaluation in terms of section 25(2) of the Act in the profession for which he or she applies for registration;
4. such verification of credentials as may be required by the board [Currently, through the Education Commission for Foreign Medical Graduates (ECFMG);
5. in the case of an application for registration in a profession for which internship training is a requirement, a certificate of completed training as an intern or of similar training or experience obtained elsewhere and the programme for such training;
6. in the case of an application for registration in the category of independent practice, proof of compliance with the requirements of section 25(3A) of the Act [which states that;
   • Despite section 24A, no person with a foreign qualification may be registered in the category independent practice unless he or she is a South African citizen or has attained permanent residence status in terms of the Immigration Act 2002, (Act No. 13 of 2002); and

• • The Council may exempt any person who has applied for exemption and is in the Republic for a temporary and particular purpose

7. an original certificate of good standing, which shall not be more than six months old [on submission of the application to the HPCSA], issued by the foreign registration authority where the applicant is or was registered;

8. a letter of endorsement issued by the National Department of Health for a registration in terms of regulation 2(1), (2), (3) or (4), confirming the employability or placement of the applicant, or a letter of endorsement issued by the prospective employer for a registration in terms of regulation 2(5), (7) or (8), or confirmation of enrolment for postgraduate studies issued by the educational institution concerned for registration in terms of regulation 2(6); and

9. the prescribed registration fee.

b) Compliant applications are normally processed within 72 hours however, applications that require board examinations can only be concluded once applicants sit and pass those exams, as and when offered by the HPCSA.

c) There are currently 346 applications received between October 2019 and July 2020.

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

New Applications	Awaiting Curriculum Review	Repeaters
Date	No. applications	Date	No. applications	No. applications
7-Dec-17	1	26-Feb-18	1	Information on date of application not available
6-Mar-18	1	25-May-18	1
9-Jul-18	1	15-Jan-19	6
21-Jan-19	1	16-Jan-19	4
22-Jan-19	1	17-Jan-19	1
23-Jan-19	1	18-Jan-19	1
31-Jan-19	1	23-Jan-19	1
19-Feb-19	1	28-Jan-19	1
3-Mar-19	1	4-Feb-19	1
18-Mar-19	1	17-Feb-19	1
20-Mar-19	1	25-Feb-19	1
2-Apr-19	1	16-Mar-19	1
7-Apr-19	1	26-Mar-19	1
10-Apr-19	2	28-Mar-19	1
26-Apr-19	1	11-Apr-19	1
3-May-19	1	10-May-19	1
29-May-19	1	17-May-19	1
11-Jun-19	2	24-Jun-19	1
21-Jun-19	3	25-Jun-19	1
24-Jun-19	1	15-Jul-19	1
2-Jul-19	1	16-Jul-19	1
11-Jul-19	1	29-Jul-19	1
12-Jul-19	3	30-Jul-19	1
16-Jul-19	2	8-Aug-19	1
22-Jul-19	1	14-Aug-19	1
30-Jul-19	1	21-Aug-19	1
1-Aug-19	2	26-Aug-19	1
2-Aug-19	2	28-Aug-19	1
7-Aug-19	1	9-Sep-19	3
8-Aug-19	1	25-Sep-19	2
15-Aug-19	1	30-Sep-19	1
16-Aug-19	1	1-Oct-19	1
22-Aug-19	2	4-Oct-19	2
28-Aug-19	1	11-Oct-19	1
2-Sep-19	1	14-Oct-19	2
5-Sep-19	3	24-Oct-19	1
16-Sep-19	1	25-Oct-19	1
20-Sep-19	1	28-Oct-19	1
27-Sep-19	1	29-Oct-19	1
1-Oct-19	1	14-Nov-19	1
14-Oct-19	1	19-Nov-19	2
23-Oct-19	1	9-Dec-19	1
24-Oct-19	1	20-Dec-19	2
25-Oct-19	1	13-Jan-20	1
28-Oct-19	1	20-Jan-20	1
5-Nov-19	4	22-Jan-20	2
11-Nov-19	3	27-Jan-20	3
14-Nov-19	2	28-Jan-20	1
17-Nov-19	1	29-Jan-20	1
20-Nov-19	1	30-Jan-20	1
27-Nov-19	1	8-Apr-20	1
28-Nov-19	1	30-Jun-20	1
2-Dec-19	4	8-Jul-20	1
6-Dec-19	3
7-Dec-19	1
9-Dec-19	1
11-Dec-19	1
12-Dec-19	2
18-Dec-19	1
23-Dec-19	1
9-Jan-20	1
22-Jan-20	3
27-Jan-20	3
29-Jan-20	1
31-Jan-20	1
5-Feb-20	1
12-Feb-20	2
13-Feb-20	1
18-Feb-20	1
26-Feb-20	1
28-Feb-20	2
9-Mar-20	1
10-Mar-20	1
11-Mar-20	1
20-Mar-20	1
31-Mar-20	1
9-Jul-20	1
13-Jul-20	1
20-Jul-20	2
21-Jul-20	1
4-Aug-20	9
Total	120		71	155

END.

Reply:

I have been furnished with a reply to the question submitted, by Ms Thabang Mampane, Commissioner of the National Lotteries Commission, which is reproduced below.

2019/20 Activities	Total Budget Spent
A summary of activities attached	a) Logistics	R 5 723 997.37
	b) Catering	R 1 509 085.20
	c) Venue hire	R 879 758.42
	d) Music hire	R 65 000.00
	e) Advertising	R 2 612 647.75

-END-

Reply:

a) A total of 28,000 beds that were announced are those that had been repurposed for use for COVID-19. All the 28,000 beds are additional to normal capacity, which have been adjusted from their normal use to respond to COVID-19 hospitalisation.

b) According to the approved Departmental surge strategy for Covid-19, 80% of the general beds and 100% of the ICU will be available for admission of Covid-19 patients at peak. This excludes Psychiatric, TB, highly specialised hospitals, Private Day Hospitals, Sub-Acute and StepDown facilities). The existing hospital beds during the peak are as shown in the table below:

Province	(i) Normal Capacity beds both Non-ICU and ICU	(ii) Additional capacity beds
	Non-ICU beds	ICU beds	Non-ICU beds	ICU beds
EC	12777	410	2993	312
FS	6573	235	642	40
GP	30152	2343	7309	2542
KZN	26358	1092	1930	163
LP	7905	113	93	70
MP	6848	203	874	302
NW	4624	187	1358	96
NC	2239	42	1582	182
WC	11327	991	1532	117
Sub Totals	108803	5616	18313	3824
Total	114 418	22 137
	136 555

c) The field beds that are allocated to the hospitals per province as additional bed capacity are reflected here below:

Provinces	No of field beds
EC	8200
FS	2352
GP	2500
KZN	1156
MP	2440
NW	1250
NC	200
WC	1268
National Total	19366

END.

Reply:

There is no policy for the testing of Members of Cabinet for Covid-19, the same testing criteria and protocols are used for all citizens.

a) The Department does not keep record of this information, the question should better be directed to each Member of Cabinet;

b) (i)-(ii) The Department does not keep record of this information, and also, test results are confidential and can only be shared by the Member concerned, on their own. Some Ministers have already done this and disclosed this information

c) The Department of Health does not keep record of this information.

END.

Reply:

According to the information received from Eskom

a) The total debt owed by municipalities as at June 2020 is R43.9 billion, of which R30.9 billion is overdue debt. The details of the age analysis of the total debt owed by each municipality to Eskom, as at June 2020 are set out in Annexure A.

b) (i) and (ii) The total debt of R43.9 billion, is made up of the capital amounts of R32.4 billion, interest of R6.7 billion and VAT of R4.8 billion. The makeup of total debt in terms of capital and interest for each municipality, as at June 2020 is set out in Annexure A.

c) (iii) The total Notified Maximum Demand (NMD) exceedance charge for June 2020 is R46.9 million and R104 million for the financial year to date. This is a penalty for NMD exceedance raised in terms of the NMD Rules approved by the National Energy Regulator of South Africa (NERSA) to discourage future exceedances and is included in the capital amount. The NMD exceedance charge, for each municipality as at June 2020 is set out in Annexure B.

Reply:

I have received a reply from the National Lotteries Commission requesting additional time in replying to the first part of the question (1), which I reproduce in full.I have advised the NLC that the shift to lockdown level 2 should enable them to commence immediately with collection of geo-coordinates.

In respect of the second part of the question (2), the NLC provided a reply that reflects the NLC position, and which has not been independently verified. As more information becomes available following the processes that I have initiated, these will in due course be made available:

1. NLC reply: “The NLC submitted a list of organisations that received R 10 Million or greater and top 50 organisations that received highest funding in the past 10 years. The list comprised of the name of the funded organisation, the amount funded, the province where the funded organisation comes from and the year in which the organisation was funded. The NLC list did not include the purpose of each grant and the details of the geo-coordinates of the location of each project including longitude and latitude coordinates.

In order to provide information relating to the purpose of each grant, the NLC will have to go through the individual project files to ascertain the purpose of each project which will take some time as some of the information is in the legacy Grant Management System (GMS) which is no longer used as requested information dates as far back as 10 years ago. The NLC is not in possession of information regarding the geo-coordinates of the location of each project including longitude and latitude coordinates. The NLC will have to travel to all locations of funded projects across the country to get the exact geo-coordinates. With the current nation-wide lockdown regulations, it will be a challenge for the NLC to visit all relevant projects that were funded within the past 10 years. The required geo-coordinates can be provided post the nation-wide lockdown.

In light of the above, the NLC would like to kindly request the extension for the submission of the information regarding the purpose for each grant as requested above to the second week of September 2020. The NLC further request that the submission of geo-coordinates of the location of each project including longitude and latitude coordinates be deferred to post nation-wide lockdown.”

2. NLC reply: “Grants made to Denzhe were not omitted from the supplied list. The list was provided per allocation in line with the set threshold of R10 million or above and top 50 highest funded organisation in the past 10 financial years. Denzhe funding of R17 million is on the list for organisations that were allocated R10 million or above in the past 10 years. The allocations for Denzhe are as follows:

a)  R 17 000 000 - October 2016 (Charities Sector)

b) R 5 000 000 - March 2017 (Sports and Recreation Sector)

c) R 4 666 658. 79 - January 2018 (Charities Sector)

d) R 918 966. 50 - January 2018 (Sports and Recreation Sector)

Grants for other organisations were not omitted. The list was provided per allocation in line with the set threshold of R10 million or above and top 50 highest funded organisation in the past 10 years.”

-END-

Reply:

(a)-(b) (i)-(ii) The department did not transact any disbursements to each province in response to COVID-19 pandemic. However, National Treasury (NT) did transfer the total amount of R466,392,000 to Provinces through the Provincial Disaster Relief Grant for immediate response to COVID-19 from Cooperative Governance and Traditional Affairs: National Disaster management Centre. The details of the funds are indicated on the attached approval from NT as Annexure A.

The total allocation in response to COVID-19 for the 2020/21 financial year amounts to R3,450,537,000 (Three billion four hundred and fifty million five hundred and thirty-seven rand) scheduled to be disbursed with effect from August 2020 until March 2021 to all Provincial Departments of Health as per attached Annexure B and Annexure C.

END.

Reply:

Provinces provided the following update on the Cuban Medical Brigade brigade :

a) Allocation per Province:

Eastern Cape

	Family Physicians	Biomedical Engineers	Epidemiologists	Biostatisticians
BCM	3	1	1	1
NMBD	3	1	1	1
Chris Hani	1	1	-	-
OR Tambo	1	1	-	-

Free State

	Family Physicians	Biomedical Engineers	Epidemiologists	Biostatisticians
Botshabelo	2	-	1	-
Mangaung	3	-	-	1
Thabanchu	1	-	-	-
MUCPP	1	-	-	-
Nzula	4	-	-	1
Pelonomi	-	3	-	-

Gauteng

District	Facility	Family Physicians	Clinical Engineer
Johannesburg	Nasrec isolation Centre	5	-
Sedibeng	Sebokeng Hospital	-	1
West Rand	GPG facilities	2	-
Ekurhuleni	Essellen Park	5	-
Tshwane	Pretoria West Hospital	3	-

KwaZulu Natal

	INSTITUTION	Family Physician	Health Technology	Information Management (Biostatistics)	Epidemiology Technologist
Amajuba	Dannhauser CHC	1	-	-	-
EThekwini	St. Mary's Marianhill	2	-	-	-
Harry Gwala	Christ the King Hospital	2	-	-	-
ILembe	Ntunjambili Hospital	2	-	-	-
King Cetshwayo	St. Mary's KwaMagwaza	2	-	-	-
UGu	GJ Crookes Hospital	1	-	-	-
uMgungundlovu	Edendale Hospital	1	-	-	-
UMgungundlovu	Pietermaritzburg	1	-	-	-
Umkhanyakude	Hlabisa Hospital	2	-	-	-
UMzinyathi	Dundee hospital	1	-	-	-
Uthukela	Ladysmith hospital	1	-	-	-
Zululand	Itshelejuba Hospital	2	-	-	-
King Cetshwayo	Ngwelezana hospital	-	2	-	-
uMgungundlovu	Greys Hospital	-	1	-	-
Wentworth	eThekwini	-	1	-	-
ILembe	Stanger Hospital	-	-	1	-
Uthukela	Ladysmith hospital	-	-	1	-
Amajuba	Madadeni Hospital	-	-	-	1
ILembe	Stanger Hospital	-	-	-	1
Uthukela	Ladysmith hospital	-	-	-	1

Limpopo

DISTRICT	INSTITUTION	Medical Officers	Clinical Engineering Technologist	Hygienist	Biostatisticians
Capricorn	Rethabile CHC	2	-	-	-
Sekhukhune	Dilokong Hospital	2	-	-	-
Waterberg	FH Odendaal/MDR-TB	2	-	-	-
Mopani	Kgapane Hospital	2	-	-	-
Capricorn	Head Office	-	3	1	1

Mpumalanga

District	Institution	Family Physician	Clinical Engineering	Epidemiology
Ehlanzeni	Rob Ferreira Hospital	-	1	-
GertSibande	Ermelo Hospital Clinical	-	1	-
Nkangala	Witbank Beatty Clinic	-	1	-
Ehlanzeni	Tonga District Hospital	1	-	-
Ehlanzeni	Shongwe District Hospital	1	-	-
Ehlanzeni	Tintswalo District Hospital	1	-	-
Ehlanzeni	Lydenburg District Hospital	1	-	-
Nkangala	Witbank/Impungwe District Hospital	1	-	-
Provincial Office	Provincial Office - CDC		-	-
Nkangala	Kwa-Mhlanga District Hospital	1	-	-
GertSibande	Piet Retief District Hospital	1	-	-
GertSibande	Evander District Hospital	1	-	-
Provincial Office	Provincial Office - Integrated Health Planning Unit	-	-	-

Northern Cape

	MEDICAL OFFICERS	DEPUTY DIRECTOR ADMI	ASS. DIR. ADMIN
JT Gaetsewe	2	-	-
Namakwa	1	-	-
Frances Baard	2	-	-
PixleyKaSeme	1	-	-
ZF Mgcawu	1	-	-
Provincial Office	-	2	2

North West

DISTRICT	INSTITUTION	Family Physician	Health Technology
Provincial Office	Mahikeng	-	-
NgakaModiriMolema District	Mahikeng (Lehurutshe/Zee rust Hosp)	2	-
Dr Ruth SegomotsiMompati District	Greater Taung Sub-district	1	-
Bojanala District	Rustenburg	2	2
Bojanala District	Madibeng	3	-
Dr Kenneth Kaunda District	Potchefstroom	1	-
Dr Kenneth Kaunda District	Matlosana	1	1

Western Cape

	MEDICAL OFFICERS	Health Technologists	Epidemiologists	Biostatisticians
CTICC	18	4	-	-
Directorate: Facilities Management	-	-	3	-
Directorate: Information	-	-	-	3

b) The Cuban Medical Brigade’s contribution to the Republic’s fight against Covid-19 in each of the locations includes but not limited to -

• Their deployment made a significant impact because the institutions are able to address issues of workload pressure because of Covid-19 pandemic.
• The Cuban Medical Brigade have been resourceful in the Primary Health Care as this is their specialty.
• Data analysis and information management team were tremendously instrumental in assessing the impact of the intervention.
• The Epidemiologic predictions of the peak of the pandemic are critical to District readiness.
• Hygienists and Epidemiologists are playing a key role in the research of the trends the pandemic is following and are providing advice on the projections.
• The Biomedical Engineers have been critical in the design, installation, adjusting, repairing or provision of technical support for biomedical equipment.
• The Cuban Medical Brigade are also involved in contact tracing and testing programme of the COVID-19 response.
• Other Brigades are deployed to Isolation and Quarantine sites
• They are also assisting with the implementation of the District SOP in the management of confirmed and suspected contacts (PUIs) in the District
• They are part of ward-based programme and Health Facility decongestion program

END.

Reply:

I am advised by the Department that the company referred to in the question has been approved for a R8 million grant funding for machinery and equipment, commercial vehicles and business development services, under the Black Industrialist Scheme in the 2016/2017 financial year. To date an amount of R4,89 million has been disbursed towards machinery and equipment. The project is still active with the balance of R3,1 million available.

-END-

Reply:

1. (a)-(ii)(iii) The table below reflect the absentee record (ii) in each month in the past three financial years in South Rand Hospital:

Month	Number of planned leave	Number of unplanned leave
Jul-18	64	94
Aug-18	64	120
Sep-18	49	99
Oct-18	70	110
Nov-18	58	161
Dec-18	43	226
Jan-19	30	181
Feb-19	112	43
Mar-19	171	55
Apr-19	124	45
May-19	171	55
Jun-19	120	45
Jul-19	135	39
Aug-19	271	39
Sep-19	313	60
Oct-19	131	44
Nov-19	160	18
Dec-19	99	33
Jan-20	132	59
Feb-20	141	50
Mar-20	159	81
Apr-20	67	20
May-20	135	38
Jun-20	151	48

(b) After the implementation of unplanned leave control measure, all annual leave that are applied for in advance, irrespective of how many leave days is regarded as planned leave.

• The unplanned leave control measures were effective from the 18th June 2018 and this is what HR is currently doing:
• HR is categorising all leave forms submitted to the office per directorate
• This is to allow identification and areas of the high number of unplanned leave per directorate
• A specific member with high number of unplanned leave will be identified
• Relevant supervisor will be informed with the request to investigate reason and provide measures to be instituted.
• HR has already developed a recording book, to record all received unplanned leave per name and department in order to identify the trends

2. (a) Currently there are 20 permanent vacant posts in South Rand Hospital.

(b) All 20 vacant posts have been advertised in May and June 2020.

(c) Shortlisting and interviews were done during the month of May, June & July 2020. The timeframe to fill the posts after posts became vacant is 4 months.

(d) Current staff do overtime to cover the staff shortage until the post is filled.

END.

Reply:

The concept of herd immunity is the indirect protection from a contagious infectious disease such as SARS-CoV-2 (Covid-19) and related corona viruses and the threshold is crossed when enough people are immune and the number of new cases is are declining. The effectiveness of herd immunity is dependent on several epidemiological principles which include the following:

• The disease must carry a substantial health risk.
• The risk of contracting the disease must be high.
• The vaccine must be effective.
• The vaccine must be safe.

The COVID-19 virus fits all the above principles, but there is currently no clinically proven vaccine against the virus. The immune response to Covid-19 is currently not yet fully understood and definitive data on post-infection immunity is also lacking.

South Africa has not published results of any immunological studies in response to the SARS-CoV-2 (Covid-19) threat. Such a research is normally conducted by research institutes such as through the Department of Science and Innovation’s research institutions and Councils including entities such as the South African Medical Research Council (SAMRC)and the Council for Scientific and Industrial Research (CSIR).

There are several studies initiated by the National Department of Health (NDoH), the National Institute for Communicable Diseases (NICD), the National Health Laboratory Service (NHLS), universities and institutes, including the South African National Blood Service (SANBS), that are currently under consideration to assist the country in understanding the immunological response to the COVID-19 disease and the level of antibody response at an individual level and on a population level. This work is ongoing, and results will be released as they become available.

END.

Reply:

In the letter addressed to the Chairperson of the Portfolio Committee on Trade and Industry on 15 June 2020, I advised that I have received various allegations of maladministration at the National Lotteries Commission, particularly relating to irregularities in respect of pro-Active Funding. When these allegations were brought to my attention, I requested an independent investigation on the matters. The ad-hoc release of information flowing from the current process may compromise the investigation and I will accordingly provide the additional information as soon as the processes warrant and permit it. I can confirm that the investigation commissioned is currently considering four projects.

-END-

Reply:

1. The table below provides details of the steps taken by the Special Investigating Unit (SIU) for each proclamation made by the President in 2017:

Details of the Proclamation	Actions Taken	Civil Litigation	Disciplinary
1. Proclamation R19 of 2017	a) The SIU concluded all investigations and submitted a report to the Honourable President. b) Criminal matters were referred to the National Prosecuting Authority (NPA) c) Evidence obtained by the SIU resulted in the Hawks arresting eight (8) Municipal officials and one (1) private individual.	The SIU recommended that the Municipality cancel a contract of R2.5 million.	Evidence relating to misconduct against the Acting Municipal Manager, Head of Supply Chain Management and Chief Financial Officer was referred to the Honourable Mayor of Alfred Nzo District Municipality. The said officials resigned and no further action could be taken.
2. Proclamation R36 of 2017	a) The SIU concluded all investigations and submitted a report to the Honourable President. b) Criminal matters were referred to the NPA c) Seven (7) cases of Fraud d) One (1) case in terms of Section 173 of the Municipal Finance Management Act (MFMA) e) These matters are currently being investigated by the Hawks in the Eastern Cape.	Evidence relating to an undue benefit by the service provider amounting to R60.7 million was referred for purposes of civil litigation. Combined summonses were issued by the Special Tribunal. Pleadings not yet closed and a court date yet to be determined.	Evidence relating to misconduct against the Acting Municipal Manager was referred to the Honourable Mayor of Alfred Nzo District Municipality. The Acting Municipal Manager resigned and no further action could be taken.

2. The National Prosecuting Authority (NPA) has taken the following legal steps:

a) Upon receipt of the SIU’s referral of matters relating to the corruption of water supply tenders at the Alfred Nzo District Municipality to the NPA, case dockets were registered, and prosecutors as well as investigating officers were assigned by the NPA and the Directorate for Priority Crime Investigation (DPCI) respectively.

b) Case planning was done by the investigating team and prosecutors, whereby two (2) legs of investigations on the matters were undertaken.

c) Police investigations in respect of one (1) of the dockets have been finalised and the charge sheet has been drafted. The case is ready for enrolment and will be placed on the court roll by end August 2020, upon which the accused, who is the service provider to the Municipality, will face charges of fraud.

d) It is anticipated that the investigations, in respect of the other leg, will be finalised in the next two (2) months or so, after which the prosecutor will start to draft the charge sheet so that the case can be placed on the court roll.

Reply:

a) The key statistic that we have been monitoring is the rate of spread of new infections i.e. the 7 day rate of change in COVID-19 cases. While the total number of infections are useful, the key statistic is the number of active cases particularly the rate of change of these active cases and the location of new cases.

b) The spread of the infection in South Africa has not been specific to rural areas or townships. The spread of the infection has been driven largely by movement and interaction by persons that are infected. The infection is droplet spread which would spread much easier in densely populated areas. The areas that have been most severely affected are the large Metros such as City of Cape Town, City of Johannesburg, Buffalo City, Nelson Mandela Bay and eThekwini. The more rural areas have been spared to a large extent from widespread infection due to our restriction on movement during level 5 and level 4. You would note to date that the more rural provinces have had much lower rates of infection – Mpumalanga, Limpopo, Northern Cape and Free State. The infection in the Eastern Cape and Kwa-Zulu is concentrated in the urban centres not rural areas.

c) The infection spread within urban areas has affected both the suburbs and the townships. There viral infection has not spared any community in terms of its transmission.

 

The increase in cases from the 5thto the 18th March was 1088% (5 to 58 cases). On the 25 March 2020 when the 21 day lockdown was announced the rate of change for COVID-19 cases decreased to 526% (58 to 362) then to 24% (362 to 1232) then to 33% (1232 to 1641 cases)-coinciding with the 14 day lockdown extension. The relatively slow rate of increase averaged about 47% until lock down level 4. It then gradually started to increase. This data proved that the lockdown achieved the objective of slowing down the rate of increase of cases, thereby giving health care authorities an opportunity to prepare the health system for the anticipated COVID-19 peaks.

END.

Reply:

a) (i) Total number of complaints for 2018/19 and 2019/20

The National Department of Health (NDoH) has developed a web-based application to assist public health facilities to comply with the National Guideline to Manage Complaints, Compliments and Suggestions in the Public Health Sector. The number of complaints as set out in the tables below are according to the web-based application which came into effect on 1 April 2018. It is important to note that not all health facilities are reporting on the system yet, therefore the number of complaints reflect those health facilities that are reporting complaints on the web-based application.

Month	# Complaints received 2018/19	# Complaints received 2019/20
April	1934	2409
May	2065	2664
June	1720	2129
July	1859	2373
August	1973	2396
September	1875	2116
October	2053	2345
November	1961	1889
December	1219	1330
January	2058	2033
February	2164	2098
March	2118	1740
TOTAL	22999	25522

(ii) Total number of complaints from 1 April to 31 July 2020

Month	# Complaints received 1 April 2020 to 31 July 2020
April	960
May	1021
June	936
July	736
TOTAL	3653

b) (i) Measures and/or processes are in place to ensure complaints are addressed

The National Health Act (Act 61 of 2003) stipulates in Section 18 that, (i) any person may lay a complaint about the manner in which he or she was treated at a health establishment and have the complaint investigated. To this effect the National Department of Health (NDoH) published the National Guideline to Manage Complaints, Compliments and Suggestions in the Public Health Sector which came into effect on 1 April 2018. Provincial workshops were held in November and December 2017 to train staff on the implementation of the Guideline. According to the Guideline a complaint is defined as the dissatisfaction, displeasure, disapproval or discontent expressed verbally or in writing by any person about the specific health services being rendered and or care being provided within the health sector.

The National Health Act, 2003 was amended in 2013 to make provision for the establishment of the Office of Health Standards Compliance (OHSC). The objects of the Office are to protect and promote the health and safety of users of health services by:

• monitoring and enforcing compliance with prescribed norms and standards
• ensuring effective management of complaints relating to non-compliance with norms and standards through a Health Ombud.

The first Health Ombud, Professor Malegapuru William Makgoba, was appointed on 1 June 2016.

(ii) Time frames and deadline that have been put in place.

According to the National Guideline to Manage Complaints, Compliments and Suggestions in the Public Health Sector, complaints must be resolved within 25 working days.

The National Guideline stipulates that complaints should be lodged at the point of care, i.e. the public health facility where the incident took place. Should the complainant feel that the facility has not addressed his/her concern to their satisfaction, he/she may escalate the complaint in writing to the relevant District Office or the Provincial Health Department. As a last resort when complainants are still aggrieved with the outcome of the District Office or Provincial Health Department’s investigation, they can lodge their complaint with the Health Ombud within the OHSC.

END.

Reply:

The Honourable Member is kindly informed that the information being requested by this question is still being collated to enable the Minister to respond to the Question.

The full answer will be furnished to Parliament as soon as all the information has been received from all the relevant sources.

END.

Reply:

a) The Department of Health will provide ventilators to hospitals that have shortage of ventilators to assist with the COVID-19 spread and needs. The Department has collaborated with the Department of Trade and Industry (DTI) and Council for Scientific and Industrial Research (CSIR), to manufacture 10,000 ventilators. These ventilators will be allocated to hospitals that do not have enough ventilators. The table here below shows the production timelines for the ventilators.

Activity	Quantity	Date
1st Batch	250	31 Jul 2020
2nd batch	600	7 Aug 2020
3rd batch	600	14 Aug 2020
4th batch	1,500	19 Aug 2020
5th batch	1,500	21 Aug 2020
6th batch	1,500	24 Aug 2020
7th batch	1,500	26 Aug 2020
8th batch	1,500	28 Aug 2020
9th batch	1,150	31 Aug 2020
Total	10,000

b) The list of hospitals that will receive the ventilators is attached as Annexure A.

END.

Reply:

1. (a) The estimated costs for Bethal Hospital in Mpumalanga was estimated to be R629,901,000. That consisted of Professional Service Provider fees to the value of R60,901,000 and then Construction costs for phases 01 to 03 to the value of R569,000,000.00.

(b) The estimated final costs of the project is valued at R659,901,000.00

2. The discrepancy between the planned and actuals can be attributed to an approved variation order for procurement of medical equipment and furniture for the amount of R30,000,000.00.

3. The contract was awarded to Clear Choice Builders.

4. (a) The estimated completion of the project was the 30th of October 2020.

(b) Given an actual start date of the 10th of October 2016, Phase 1 and 2 of the project was completed in May 2020.

5. A sectional hand over was achieved for Phase 1 and 2 of the project. The project however is still in Phase 3 and not yet complete.

END.

Reply:

1. (a) A total of 77 645 test kits were supplied to Ekurhuleni District and this covered all hospitals and clinics.

b) The test kits were procured by the National Health Laboratory Service (NHLS), and supplied to the District.

c) Cost per test kit including forms, testing and courier services is R399.00.

2. (a) Backlog in all six NHLS testing laboratories as of 28 July 2020 was 891 with registered samples

(b) The two main hospitals that are supporting Ekurhuleni are Tambo Memorial and Charlotte Maxeke. Tambo Memorial is doing the tests for all in-hospital patients while Charlotte Maxeke does all clinic work.

3. (a) The district has a tracing backlog of nearly 23 481 contacts as at 25 July 2020.

(b) The district does not conduct visits to the communities for tracing because they are currently implementing telephonic and COVID-19 Connect tracing initiatives which make use of the telephone and messaging system.

(c) The District is implementing telephonic and COVID-19 Connect for tracking and tracing of contacts. A total of 164 Clinical Officials are currently deployed across the district to strengthen telephonic tracing initiatives.

4. All members of staff in clinics have been trained on COVID-19 safety measures. COVID-19 steering committees have been setup in facilities and they ensure adherence to measures such as social distancing, appropriate use of PPE and frequent hand-washing and sanitization of hands in all the clinics. Senior and Middle Managers undertake unannounced visits to facilities in order to observe and ensure adherence to COVID-19 safety measures.

END.

Reply:

Priority areas (hot-spots) have already been identified where the creation of surge capacity and additional bed-capacity was of critical importance. The National Department through its Emergency Health Infrastructure Unit is assisting the Provincial Departments of Health and provides capacity in order to create and implement additional surge and bed-capacity, by means of emergency repairs, upgrades, new installations, conversion of existing spaces and additional capacity through temporary emergency structures.

A Rapid Implementation Management team assists with the identification and assessment of sites in priority hotspot areas and assists with the planning and lay-out and utilization of the sites. The assessment and planning includes assessment from a clinical perspective but also architectural, electrical and mechanical engineering, health technology and other engineering services as may be required. Assessment reports of 28 facilities in Gauteng have been completed and various priority projects identified.

END.

Reply:

(a)-(b) On commissioning of Thelle Mogoerane Hospital, concerns were raised that the maternity and neonatal unit will not be large enough to accommodate the existing services due to the limitations of the building. In response the GDOH-Infrastructure commenced with planning to address these issues raised since the hospital was commissioned and a proposal was made to extend the existing maternity and neonatal wards. Due to challenges with the proposed size of the unit it was clear that it would not be possible to fit the unit on the existing site due to the size of the site and the dolomitic conditions identified in the earmarked areas. The Professional Service Provider team, that was appointed at the time, was requested to look at other sites in close proximity to the hospital. This commenced but the search was not conclusive. The project was thus placed on hold in 2018.

Since then the Neonatal unit was moved to Ward 1 and 14. These changes were made to support neonatal services and was completed in 2019 and early 2020. A new milk room was provided in Ward 14 and completed in early 2020. The conversion of a delivery room into an obstetric theatre commenced in March 2020 and is still in progress.

END.