Questions and Replies

Reply:

(a) (i) and (ii) EMS is established in the Provinces as a mobile health facility and as such has infrastructure specifically for EMS which may or may not be attached to a health facility. The number of ambulances operating from health facilities and those operating from independent ambulances stations are detailed below.

(b) Given that this is not standard practice for EMS to be attached to a specific health facility, it is not possible to advise on the extent of shortage of ambulances at fixed health facilities

Table 1

PROVINCE	Number of ambulances operating from EMS Stations attached to hospitals and clinics which are managed by EMS	Number of ambulances operating from EMS Stations not attached to hospitals and clinics
Eastern Cape	58	28
Free State	133	11
Gauteng	275 and a further 100 new ambulances will be available.	52
		402 are operated from Metropolitan Municipalities
KwaZulu-Natal	344	191
Limpopo	292	97
Mpumalanga	0	98
North West	66	0
Northern Cape	80	55
Western Cape	137	135

Going forward, it is recommended that future planning and construction of hospitals and clinics should include provisions for EMS Stations to enhance integrated healthcare.

END.

Reply:

(1) The World Health Organisation (WHO) provides a guideline threshold of 2:10 000 ratio of health workers (doctors, nurses and midwives) per population. Countries with a density below this threshold generally fail to achieve a targeted 80% coverage rate for skilled birth attendance and child immunisation. A population-based threshold for doctors has been extrapolated from the WHO of 0.55 doctors per 1000 population, but this cannot be applied to hospitals;

(2) (a) 1,939 is the total enrolled students studying towards medical qualification in eight medical institutions across the country;

(b) See attached spreadsheet (please note that this is only public sector data).

(3) There are no published WHO guidelines to adhere to. For the public health sector, the National Department of Health has adopted the Workload Indicator for Staffing Norms (WISN) methodology for determining staffing norms, which has been applied across Primary Health Care facilities. The methodology has not yet been launched at hospitals.

END.

Reply:

(1) EMS in Ekurhuleni Metropolitan Municipality is provided at provincial level by Gauteng Emergency Medical Services as well as at local government level by Ekurhuleni Metropolitan Municipality.

(i) An average of 25 of a total pool of 45 ambulances owned and managed by Gauteng Department of Health Provincial EMS are operational per shift for specific functions within Ekurhuleni Metropolitan Municipality.

(ii) An average of 63 of a pool of 167 ambulances are operational per shift within the boundaries of Ekurhuleni Metropolitan Municipality - 83 of the 167 ambulances are owned by Gauteng Department of Health Provincial EMS and 84 of the 167 are owned by Ekurhuleni Metropolitan Municipality. The day-to-day operations of these vehicles are managed by Ekurhuleni Metropolitan Municipality.

The total combined fleet available for operations within Ekurhuleni Metropolitan Municipality is 212.

(2) (a) The national normative ratio (which is used as a guide) is one ambulance per 10 000 people (1:10 000);

(b) The number of people in Ekurhuleni Metropolitan Municipality is estimated at 3 178 470 as per StatsSA June 2016

(3) (a) (i) The minimum number of registered EMS personnel to work on an ambulance is two (2);

(ii) The basic equipment that is supposed to be on an ambulance at all times is as per Annexure A;

(b) In terms of the Health Professions Act of 1974 all personnel are required to practice within their respective scopes of practice as per their registration categories. All personnel must hold a valid Professional Driving Permit (PDP) and all ambulances are required to be registered as such in terms of the National Road Traffic Act. Furthermore, all Emergency Medical Service providers will be required to comply with the Emergency Medical Services Regulations when promulgated by the Minister of Health. The EMS Regulations prescribe the application and accreditation processes, as well as the minimum standard of staffing and equipments for all categories of pre-hospital vehicles in South Africa in both public and privates services.

END.

Reply:

(a) No.

(b) No.

END.

Reply:

The Table in Annexure 1 provides the details in this regard, as provided by the KwaZulu Natal Provincial Department of Health.

END

Reply:

END.

Reply:

Forensic Investigation was commissioned by the Department of Roads and Public Works in the 2015/16 Financial Year. The report has since been forwarded by GOBODO to the HoD of the Department of Roads and Public Works. This Department was informed that the GOBODO Report was forwarded to the Special Investigations Unit for review and recommendations.

END.

Reply:

(a) The amount spent by the National Department of Health on eGovernment related services during 2016- 17 financial year is R 67,749,994

(b) The projected expenditure on e-Government related services for the 2017-18 financial year is R120,808,930.98

END.

Reply:

END.

Reply:

The estimated average financial cost per case (based on modelled estimates) of Severe Acute Malnutrition (SAM) with complications is R65,826. The median length of in-patient days for SAM cases with Severe Acute Malnutrition is 30 days (7 days - stabilisation phase and 23 days - rehabilitation phase). The composition of the unit costs includes foodstuffs, medicines and hospital overheads.

Based on this estimated cost, the approximate costs of inpatient care for all children with SAM for the last four financial years are shown in the table below:

Financial years	SAM inpatient admissions	Approximate Costs
2013-14	14,947	R491,950,611
2014-15	15,910	R523,645,830
2015-16	15,537	R511,369,281
2016-17	14,910	R490,732,830

END.

Reply:

(a) The Provincial Departments of Health plan and provide training to nurses to provide termination of pregnancy services;

(b) The Provincial Departments of Health plan and provide training to midwives to provide termination of pregnancy services;

(c) The Provincial Departments of Health plan and provide training to doctors to provide termination of pregnancy services

END.

Reply:

a) Kimberley Mental hospital project is a priority to National and Provincial department of Health. In 2017/18 financial year the department put aside R279, 7735, 062 million from Health Facility Revitalisation Grant.

b) The budget indicated in (a) will take the project to practical completion which is expected to be reach in November 2017.

END.

Reply:

Yes, a signed inventory for each hospital will be provided but this will take us a long time to compile. The Honourable Member will then have to be patient.

END.

Reply:

1.(a) (b) (i) (ii) (iii)

There is currently no regulation, which requires the phasing-out of all defibrillators and replacing them with AEDs. The Automated External Defibrillators (AEDs) are the recommended cardiac resuscitation equipment in areas where there is high possibility of witnessed cardiac arrest and can be used by a trained lay rescuer. That is why the department is ensuring that they are acquired for clinics and identified areas in hospitals. However, defibrillators continue to be the preferred cardiac resuscitation equipment in other medical sections in hospitals as they offer more options including pacing and pulse monitoring.

The department acknowledges the proven advantages of using Biphasic defibrillators over monophasic defibrillators and therefore continue to replace monophasic defibrillators with biphasic defibrillators, which provide results with less energy and are more efficient. The department has also ensured that those life support equipment are available on transversal contracts (RT4 and RT2) through National Treasury to provide end-users easy access to acquire. I.e. AEDs and Biphasic defibrillators (with AED mode).

(2) Application specialist training is arranged for every life-support equipment procured by the department therefore employees are trained on the current biphasic defibrillators in hospitals.

END.

Reply:

(1) The upgrading of the existing Edendale Accident & Emergency (A &E) is being done in phases in order to avoid the disruption of services:

• Phase 1: Resuscitation Area, SOPD & MOPD have been successfully commissioned and are fully operational.
• Phase 2: Construction is still underway for the rest of the OPD Area & Radiology Section, and it is projected for completion in this current 2017/18 Financial Year.

NB: It must be noted that no deaths of patients have o0ccured as a result of this on-going upgrading of the A&E, and in the event where the need arises, the Department continues make the necessary arrangements where patients are referred to other convenient and alternative facilities of care.

(2) (a) (i) The Department has put measures in place such as the utilisation of both the Provicnial and National Period Contracts/ Tender in order to fast –track the procurement of the outstanding medical equipment.

It is to be noted that the CT Scanner at Edendale is fully functional.

(ii) The commissioning of the A& E is projected for completion within the current 2017/18 Financial Year as per response 1 above.

(b) Steps by the Department -

• The Procurement of the Essential Equipment has been accommodated in the current 2017/18 Financial Year and a monitoring system has been put in place where progress is reported on a weekly basis.

• The Department has a Procurement Plan, Procurement Schedule and an Oversight Committee that oversees the procurement process.

• The Committee meets every month to track the progress of the Procurement Process.

• The Department of is in the process of engaging Service Providers for Service Level Agreements on Periodic Contracts to expedite maintenance/repairs to medical equipment.

END.

Reply:

The Security Services paid for by the State falls under the responsibility of the South African Police Service and is not for our personal use. Hence, neither the Deputy Minister nor I use the service for our personal use. Staff members also do not use the service for their personal use.

I am reliably informed by our public entities that they do not use such services for their personal use.

END.

Reply:

(1) (a) The following entities reporting to the Minister of Health have a board in place, namely;South African Medical Research Council (MRC), Office of Health Standards Compliance (OHSC),Council for Medical Schemes (CMS) and National Health Laboratory Service (NHLS);

(b) The South African Health Products Regulatory Authority does not have a board in place. The entity is newly established and the enabling legislation in this regard was proclaimed effective 01 June 2017.

(i)

Entity	Board Members	Date of Appointment	Expiry of term of office
South African Medical Research Council	Prof Mike Sathekge	1 November 2016	31 October 2019
	Prof Quarraisha Karim
	Dr Rachel Chikwamba
	Prof Mark Cotton
	Ms Nafeesa Kadwa
	Dr Zilungile Kwitshana
	Prof Johnny Mahlangu
	Prof William Rae
	Prof Brandon Shaw
	Prof Linda Skaal
	Prof Tholene Sodi
	Prof Sithembiso Velaphi
	Dr Patricia Hanekom
	Prof Lindiwe Zungu
	Prof Elizabeth Bukubisi
Office of Health Standards Compliance	Prof Lizo Mazwai	1 January 2017	31 December 2019
	Dr Ethelwynn Stellenburg
	Prof Stuart Whittaker
	Mr Abdul Kariem Hoosain
	Ms Audrey Montshiwa
	Mr Bada Pharasi
	Dr Bandile Masuku
	Ms Sheila Barsel	29 May 2017	31 December 2019
	Ms Keitumetse Mahlangu
Council for Medical Schemes	Prof Yosuf Veriava	14 November 2014	30 November 2017
	Dr Loyiso Mpuntsha
	Ms Lunah Nevhutalu
	Prof Bonke Clayton Dumisa
	Prof Sadhasivan Perumal
	Ms Maboye Mosidi
	Mr Johan Van der Walt
	Mr Matlodi Steven Mabela
	Adv Harshila Khoosal Kooverjie
	Dr AquinaThulare	14 February 2017	30 November 2017
National Health Laboratory Service	Prof Eric Buch	29 November 2016	29 April 2018
	Dr SibongileZungu	20 April 2017	30 April 2018
	Prof Barry Schoub	20 April 2017	29 April 2018
	Prof Lawrence Obi	20 April 2017	19 April 2020
	Ms SphiweMayinga	20 April 2017	19April 2020
	Dr GerhardGoosen	1 November 2015	31 October 2018
	Mr MichaelManning	30 April 2015	29 April 2018
	Dr BalekileMzangwa	18 November 2016	17 November 2019
	Mr Stanley Harvey	1 February 2015	31 January 2018
	Ms NtombikayiseMapukata	1 February 2015	31 January 2018
	Prof Haroon Salojee	1 September 2015	31 August 2018
	Prof Mary Ross	1 September 2015	31 August 2018
	Prof Willem Sturm	1 September 2015	31 August 2018
	Ms NelisiweMkhize	1 September 2015	31 August 2018
	Mr Andre Venter	2 January 2015	1 January 2018
	Dr Patrick Moonasar	1 February 2015	31 January 2018
	Dr Timothy Tucker	1 January 2016	31 December 2019
	MrLungaNtshinga	1 January 2016	31 December 2019
	Mr Ben Durham	1 November 2014	31 October 2017
	Ms ZwelibanziMavuso	21 December 2016	20 December 2020
	Mr Michael Shingange	1 February 2015	31 January 2018
	Prof ShabirMadhi	10 April 2017	Acting CEO

(ii)

Entity	Total number in each board	Total number of females in eachboard
SAMRC	15	9
OHSC	9	4
CMS	10	5
NHLS	22	5

(2) (a) The Board of the South African Health Products Regulatory Authority is appointed by the Minister of Health and (b) will be appointed not later than October 2017.

END.

Reply:

Surgically designated facilities for the provision of terminations of pregnancy services comprise of 84% of all hospitals in South Africa.

END.

Reply:

The following table reflects the details in this regard, as sourced from the Provincial Departments of Health

Table 1

PROVINCE	NUMBER OF TERMINATIONS OF PREGNANCIES PERFORMED FOR YEAR
	2014	2015	2016
Eastern Cape	12 830	12 846	14 479
Free State	5 896	6 022	5 767
Gauteng	18 814	16 272	22 942
KwaZulu Natal	9 785	11 359	14 395
Limpopo	8 515	9 244	10 625
Mpumalanga	2 501	1 851	2 744
North West	8 274	7 131	5 951
Northern Cape	1 725	1 505	1 366
Western Cape	18 346	19 603	19 212

END.

Reply:

The Department of Health does not collect data on medical and surgical procedure separately.

END.

Reply:

(a) The Department of Health does not collect disaggregated data by trimester.

(b) After 20 weeks of gestation, if a medical practitioner, after consultation with another medical practitioner or registered midwife, is of the opinion that continued pregnancy would endanger the woman's life or if the pregnancy would result in severe malformation of the foetus, the pregnancy can be terminated.

END.

Reply:

(1) Provide safe terminations as part of comprehensive Sexual and Reproductive Health services which includes providing the full range of contraceptives.

(2) The Provincial Departments of Health are working together with the South African Police Service in dealing with illegal abortions in the country. However, the people who offer illegal abortions do not operate in clinics, they operate as mobile service providers where they make appointments with their clients to meet along the streets then take them to a house or a structure that is not easily identifiable and which are not permanent sites at which they offer these services.

END.

Reply:

The Department of Health does not keep unsafe abortion statistics as most often patients who present at the health care facilities do not disclose that information to the healthcare workers. Also, unsafe abortions are not happening within the health care facilities.

END.

Reply:

Since the psychiatric unit at Tshilidzini Hospital was burnt down and declared uninhabitable by the architects, mental health services at this hospital have been scaled down to provide only emergency admissions and 72 hour assessment of involuntary mental health care users. Designated cubicles in the medical ward (eight male and four female beds) are utilized for this purpose. Following the 72 hour assessment process, where further inpatient care treatment and rehabilitation is required, patients are transferred to hospitals that have functional mental health units such as Donald Fraser, Siloam, and Malamulela Hospitals.

The re-development of the entire Tshilidzini Hospital is in the planning phase and provides for the construction of a full psychiatric unit.

END.

Reply:

The National Department of Health has not participated in any such programme. The Integrated Community Registration Programme (ICROP) is relevant to the Department of Social Development.

END.

Reply:

Studies have been done in areas of known or suspected high alcohol consumption by women. Studies in South Africa have found the following rates in these areas:

• Northern Cape

• • Upington 75/ per 1000 population
  • Kimberley 64/ per 1000 population
  • De Aar 119/ per 1000 population

• Western Cape

• • Saldanha Bay 67/ per 1000 population
  • Witzenberg sub-district 96/ per 1000 population
  • Aurora 100/ per 1000 population
  • Wellington 89/ per 1000 population.

• Gauteng

• • Parts of Johannesburg 26/ per 1000 population

END.

Reply:

Mifepristone is currently available to the provinces as a buyout product. The medicine will be available on tender after the currently published tender is awarded.

END.

Reply:

(a) (i) The research on MAX condoms was conducted by the Society for Family Health (SFH), on behalf of the Department of Health, through funding from the United Nations Fund for Population Activities (UNFPA) amounting to R420,000.

(ii) The production and distribution of the Max Condom is done on a tender basis. The current tender is for 3 years. It was awarded in July 2015 and is expiring in June 2018.

(b) The three-year contract was awarded to the following suppliers: Almika Trading, Barrs Medical, Bliss Pharmaceutical, Fulloutput, Medproc, RRT Medcon, SA Health Protecting services, Unitrade, and Medicore Technologies.

(c) (i) The budget allocated is R836,000,000.

(ii) The expenditure to date is R654,229,431.

(d) (i)-(ii) From the period: August 2015 to March 2017, the total number of MAX condoms produced and distributed to date is 1,333,121,613.

END.

Reply:

No, neither the Department nor entities reporting to it procured services and/or made payments to the company in question.

END.

Reply:

(1) Late joiner penalties (LJP) forms part of the regulations made in terms of the Medical Schemes Act, 1998 (Act No. 131 of 1998) ("the Act")). Regulations 11 and 13 of the said regulations, refer to instances where a member wants to join a medical scheme after the age of 35 and LJP is determined by the number of years that a person was not a member of a scheme (from the age of 21) prior to the application for membership of a medical scheme. The LJP is aimed at protecting the accumulated risk pool funds from being accepted by high risk late joiners who have not contributed to them. It is also meant to incentivize people to join a medical scheme at an earlier age so that the penalty can be mitigated/avoided. There are circumstances that prevent persons from joining a Medical Scheme at an early stage. For such persons a late joiner penalty is unjust.

(2) The application of the LJP is discretionary and a scheme can choose not to apply to a member after applying to join a medical scheme after the age of 35. The Department is currently in the process of preparing amendments to the Medical Schemes Act. The matter of the Late Jointer Penalty is being reviewed as part of this process.

END.

Reply:

(1) During the 2016/17 cycle for community service placements, there was a challenge in placing all Professional Nurses eligible for community service as some provinces had incorrectly stated their available posts. This impacted both provincial bursary holders as well as privately funded graduates.

(2) In accordance with Public Service Regulations, all provincial departments are compelled to contractually obligate bursars to serve their respective departments for a stipulated period of time. Failure to redeem the bursary obligation results in the money having to be paid back by the bursar. Approximately 76% of all Professional Nurses who required a community service placement in 2016/17 had a contractual obligation to serve in a particular public health facility, district or province.

(3) The National Health Council has reviewed the matter in-depth and has requested provinces to urgently avail the posts required for the remaining group. The National Health Council resolved on 12 May 2017 that this process should be completed by 31 May 2017. I, in consultation with the provincial Members of the Executive, has written to each province to request a specific number of posts per province, to accommodate all the waitlisted individuals.

The National Department of Health has also been tasked to investigate how to improve post co-ordination and funding to avoid such challenges going forward.

 

END.

Reply:

With regard to my reply to Question 406 on 27 March 2017, I wish to inform Honourable Member that since the beginning of May 2017, the 21 of the 26 patients mentioned in March have been moved to West End Psychiatric Hospital after completion of refurbishment of facilities there.

When they were still in correctional service facilities, on a waiting basis, they used to wait for an average of 4 years.

END.

Reply:

The Department has refurbished and equipped the West End Psychiatric Hospital state patients unit in the 2016/17 financial year.

(a) A vacated 36 bed ward at West End Hospital has been completely upgraded to make it suitable for involuntary male health patients. The male involuntary patients were transferred from the secure ward adjacent to the existing State Patient Ward. This vacated ward is also suitable for State Patients which allowed rapid transfer in early May of 21 State Patients from Kimberley Correctional Services.

(b) The ward is fully and appropriately equipped for State Patients.

END.

Reply:

Yes.

Detailed answers to questions (a), (b) and (c) are as follows:

Province	(a) Number of patients accommodated	(b) Prison facilities	(c) For how long
Eastern Cape	14	St. Albans	8-22 months
	14	Grahamstown	6-19 months
	43	East London	1-22 months
	1	Wellington	1month
	13	King Williams Town	1-11 months
	11	Fort Beaufort	10-18 months
	3	Cradock	14-21 months
Sub-total	99
Mpumalanga	2	Witbank	84 months
	6	Nelspruit	12-36 months
	1	Middelburg	12 months
	6	Ermelo	1-48 months
Sub-total	15
Total	114

The waiting list of patients in prison facilities in Mpumalanga province is due to the lack of a specialised psychiatric hospital to render this service. Plans are underway to build a hospital, and currently patients are referred to Weskoppies Hospital in Gauteng Province, when a bed becomes available.

END.

Reply:

No, neither the National Department of Health nor any of the public entities reporting to the Ministry of Health procured any services from the Decolonisation Foundation.

END.

Reply:

South Africa is implementing the International Health Regulations (2005) [IHR 2005] since its enactment on 15 June 2007. In February 2017, the National Department of Health completed a self IHR assessment using the Joint External Evaluation tool, with the participation of all relevant Government departments and key stakeholders. The National Department of Health officials assessed all the action packages, namely: prevention, detection, response, and IHR-related hazards as well as Points of Entry. The Department of Health is using the findings to develop an action plan aimed at further strengthening of South Africa's IHR capacity.

END.

Reply:

Honourable Member, this matter was raised and responded to during Plenary of this House during the session on the Decision of Question on Votes and Schedule to Appropriation Bill and during through a Motion moved by Honourable Maynier, on 4 November 2015. The matter was fully interrogated and the Honourable Member could refer to the Hansard of that session, for full details.

END.

Reply:

(a)-(b) Admissions and deaths due to severe malnutrition as recorded for periods mentioned below are: see the link:

http://pmg-assets.s3-website-eu-west-1.amazonaws.com/RNW534Table-170508.pdf

END.

Reply:

In the whole Life Esidimeni saga, there are different events and various facts that occurred and emerged and were learnt of at different times respectively.

Unfortunately, the honourable member's question is framed in such a way that it assumes that the events and the facts that subsequently emerged all occurred at the same time and hence were learnt of at the same time.

I will try my best to separate them because that is how in reality they occurred.

I first learnt of the intention of Gauteng Department of Health to terminate their contract with Life Esidimeni and move mentally ill patients to other facilities in November 2015, when section 27, on behalf of South African depression and Anxiety Group (SADAG), wrote to the National Department of Health, threatening to take the Gauteng Department of Health to court. They said they will cite the Minister and the Premier of Gauteng though no relieve will be sort from them.

The Director-General of the National Department of Health then contacted Gauteng to try and find out what this is all about as nobody in Gauteng Government ever informed the National Department of Health of any problem pertaining to mental health patients.

After being briefed, the Director-General felt that there is nothing that should provoke a court case and that the issues relating to mental health patients are straight forward and can be settled through a discussion.

The Director-General then facilitated a meeting between the HOD of Gauteng Department of Health, SADAG and Section 27. This meeting culminated into an agreement being signed between Gauteng Department of Health and SADAG whereby it was agreed that if patients have to be moved, they will be moved to facilities that do not offer an inferior service to which they were receiving at Life Esidimeni.

As it emerged later, Gauteng Department of Health unfortunately breached this agreement in every conceivable manner!

Part of the agreement was also that a detailed plan be prepared by the parties (Gauteng Department of Health, SADAG, Section 27) by the end of January 2016.

This agreement was an out of court settlement and hence SADAG withdrew its court case, which was due in court on 22 December 2015. The withdrawal happened on 21 December 2015.

It emerged later that Gauteng Department of Health did not put up a plan by the end of January 2016 as agreed in the out of court settlement.

In March 2016, Section 27 then rushed to court to interdict the Gauteng Department of Health but did not cite the Premier or the National Minister of Health, and hence there was no information forthcoming to the National Department in this regard.

Unfortunately, Section 27 lost the court interdict.

I then came to hear about the death of psychiatric patients who were moved from Life Esidimeni when the MEC for Health in Gauteng, in answering to a question in the legislature, announced that 36 mentally-ill patients died under the care of NGO's in and around Gauteng.

I was completely shocked and could not comprehend the whole thing. I immediately contacted the Health Ombuds person, Prof. Malegapuru Makgoba to investigate.

I subsequently learnt from his report that it was actually 94+ patients who died and not the 36 as earlier announced by the MEC in the Legislature. I also learnt from the Ombud's report that when they died they were under the care of 27 NGO's and that the NGO's were actually having invalid licenses issued by the Gauteng Department of Health. All these facts I only learnt when the Health Ombud presented to me a preliminary report in January 2017.

The MEC for Health in Gauteng had made her announcement in the legislature in September 2016 and the Health Ombud was asked by me to investigate in October 2016. The Health Ombud's final report was only released publicly on 01 February 2017.

END.

Reply:

(1) In response to the key messages of World Cancer Day 2016 – 2019 and theme, “We Can. I Can”, the Department has initiated or been involved in a number of innovations. For example

(a) “Prevent Cancer”: To reduce the number of deaths from cervical cancer the Department introduced the HPV vaccine in 2014 and with this an education campaign. Cervical cancer is the 2nd most common cancer experienced by women in South Africa and causes the highest mortality among Black women. Cervical cancer is preventable through the implementation of the HPV vaccine.

The programme targeted grade 4 girls who are 9 years and older in public and special schools. Approximately 550 000 girls in 17 000 primary schools have been targeted every year since then and a total of just over 1 million girls have been vaccinated. The first round of implementation in 2017 took place from 21 February – 28 March 2017

(b) “ Improve Access to Cancer Care” and “Shape Policy Change”: My Department is in the process of finalising the National Policy Framework and Strategy on the Prevention and Control of Cancer; National Policy on Breast Cancer and National Policy of Cervical Cancer and National Policy Framework and Strategy on Palliative Care. These policies inform innovative implementation of services and will create equitable access to cancer care at all levels of service delivery.

(c) “Make the case for investment” and “Inspire Action and Take action”:

My Department is collaborating with the Medical Research Council to develop a National Research Agenda for Cancer in the country. A Workshop hosted by the Medical Research Council on 23-24 February 2017 identified the urgency to establish evidence to make the case for investment in Cancer and identify the cost to government and patients and their families.

(2) (a),(b) and (c)

PROVINCE	NAME OF HOSPITAL	NAME OF ONCOLOGIST	NUMBER OF DAYS PER MONTH	NUMBER OF CANCER PATIENTS
Eastern Cape	Livingstone Hospital	Dr Adelaide De Freitas	Full time	14 350
		Dr van Emmenes	Part time at this hospital
		Dr K Thomas	Part time at this hospital
	Frere Hospital	Prof BP Pokhare	Full time	16 737
		Dr Z Jafta	Full time
		Dr van Emmenes	Part time at this hospital
		Dr K Thomas	Part time at this hospital
Gauteng	Steve Biko Academic Hospital	Prof L Dreosti	Full time	21 058
		Dr Khanyile
		Dr J Kempen
		Dr P Wessels
		Dr H van Vuuren
		Prof R Lakier
		Dr A Hocepied
		Dr K Pillay
		Dr L Hinson
		Dr M Esebeth
		Dr Seoloane
		Dr Westernink
	Chris Hani Baragwanath Academic Hospital	Prof Moosa Patel	Full time for Adult Oncologist 1 part time Dr for Paeds Oncologist	36 440
		Dr Atul Laka
		Dr Vinita Philip
		Dr Fadi Waza
		Dr Philippa Ashmore
		Dr Gita Naidu
		Dr Diane Machinnon
		Dr Biance Rowe
		Dr Rosalind Wainwright
		Dr Bassingthwaithe
		Dr Ngoakoane Machlachane
	Charlotte Maxeke Johannesburg Academic Hospital	Prof Ruff	Full time	39 604
		Dr Wadee
		Dr Demetriou
		Dr S Chan
		Dr R van Eden
		Dr R David
		Dr O Ogude
		Prof Sharma
		Dr Mahomed
		Dr T Mutsoane
		Dr J Kotzen
		Dr T Naidoo
		Dr B Rabin
		Dr B Singh
	Kalafong Tertiary Hospital	Dr Burger	Full time	1 549
		Dr Aung
		Dr Coetzer	Part time
	Tembisa Teriary Hospital	None	N/A	N/A
	Helen Joseph Tertiary Hospital	None	N/A	N/A
KwaZulu-Natal	Inkosi Albert Luthuli Central Hospital (IALCH)	Dr T Naidoo	Full time	7 911
		Dr S Kunene
	Greys Hospital	Dr O El-koha	Full time	4 336
		Dr S Cassimjee
		Dr L Stopforth
		Dr S Naicker
	Addington Hospital	No Oncologist assigned, patients are referred to IALCH		1 845 seen and referred
Limpopo	Pieterburg/Polokwane Hospital	Dr T Moyaba	Full time	9 399
	Mankweng Hospital	Patients seen by Gynaecologist who further refer to the Oncologist at Pietersburg Hospital		831seen and referred
Mpumalanga	None of the hospitals in the province provide oncology services and there are no Oncologists appointed in the department	N/A	N/A	All cancer patients from Mpumalanga are managed at Steve Biko Academic hospital
Northern Cape	Kimberley Hospital Complex	Dr O Foufie	Full time	9 997
		Dr S Ibrahim
	Kuruman Hospital	No Oncologists	N/A	170 seen and referred
	Dr Harry Surtie	No Oncologist	N/A	140 seen and referred
Free State	Universitas Hospital	Dr A Sherriff	Full time (- 2 days Dihlabeng Hospital)	30 396
		Dr K Vorster	Full time (-1 day Boitumelo Hospital)
		Dr H Napo	Full time (-1 Bongani Hospital)
		Dr P Piek	Full time
		Dr C Loots	Full time (-2 days Dihlabeng Hospital)
	Dihlabeng Hospital	Dr A Sherrif Dr C Loots	2 days per month 2 days per month	2040
	Bongani Hospital	Dr H Napo	1 day per month	1930
	Boitumelo Hospital	Dr K Vorster	1 day per month	1420

(3) (a), (b) and (c)

PROVINCE	HOSPITAL	NUMBER OF PATIENTS WAITING
		BIOPSIES	CHEMOTHERAPY	RADIOTHERAPY	SURGERY
Eastern Cape	Livingstone	None	None	Number not available but 4 months waiting list	None
	Frere	None	None	Number not available but 4 weeks waiting list	Number not available but 4 weeks waiting list
Gauteng	Steve Biko Academic Hospital	None	96	220	71
	Dr George Mukhari Academic Hospital	N/A	N/A	N/A	N/A
	Chris Hani Baragwanath Hospital	None	30	5	267
	Charlotte Maxeke Academic Hospital	131	None	380	257
	Kalafong Tertiary Hospital	N/A	N/A	N/A	N/A
	Tembia Teriatry Hospital	N/A	N/A	N/A	N/A
	Helen Joseph Tertiary Hospital	N/A	N/A	N/A	N/A
KwaZulu-Natal	Inkosi Albert Luthuli Central Hospital (IALCH)	N/A (biopsies are done by the referring regional hospitals)	None	294	Surgery is performed according to the staging of the cancer
	Greys Hospital	None	None	140	Surgery is performed according to the staging of the cancer
	Addington Hospital	Biopsies are done at referring Primary Health Care clinics	Services have been provisionally combined with IALCH	24 (due to the current status of ADH, no new patients were booked all patients were booked at IALCH – these 24 patients have been rebooked at IALCH)	Surgery performed at IALCH
Limpopo	District	None	2	None	3
	Regional	300	98	114	453
	Tertiary	250	None	None	329
Mpumalanga	None of the hospitals in the province provide oncology services and there are not Oncologist appointed in the department	N/A	N/A	N/A	N/A
Northern Cape	Kimberley Hospital Complex	15 patients	20 patients	62 patients	15 patients per month
	Kuruman Hospital	N/A	N/A	N/A	N/A
	Dr Harry Surtie	N/A	N/A	N/A	N/A
Free State	Universitas Hospital	N/A	Number not available but 4 weeks waiting list	Number not available but 10 weeks waiting list	Number not available but 8-12 weeks waiting list
	Dihlabeng Hospital	N/A	Limited chemotherapy services due to resources	No radiation offered	N/A
	Bongani Hospital	N/A	Limited chemotherapy services due to resources	No radiation offered	N/A
	Boitumelo Hospital	N/A	Limited chemotherapy services due to resources	No radiation offered	N/A
North West	The Province yet to provide the information
Western Cape	The Province yet to provide the information

(4) (a) and (b)

PROVINCE	HOSPITAL	EQUIPMENT & MACHINES OUT OF COMMISSION	COST OF REPAIRING
Eastern Cape	Livingstone Hospital	Simulator (Obsolete) Linac machine (regular breakdown) Iview and EPID (Obsolete) Xio planning system (Nearing useful life)	R11 million R50 million R100 000 R5 million
	Frere Hospital	No machines out of commission	N/A
Gauteng	Steve Biko Academic Hospital	No machines not utilised 2 functional but depend on air-conditioning	Cost of air-conditioning R830 436.34
	Dr George Mukhari Hospital	None	None
	Chris Hani Baragwanath Hospital	None	None
	Charlotte Maxeke Academic Hospital	None	None
	Kalafong Tertiary Hospital	None	None
	Tembia Teriatry Hospital	None	None
	Helen Joseph Tertiary Hospital	None	None
KwaZulu-Natal	Inkosi Albert Luthuli Central Hospital	None	None
	Greys Hospital	None	None
	Addington Hospital	2 Linear Accelerators out of order	Department is engaging the Service Provider regarding repairs
Limpopo	Pieterburg Hospital	None	None
	Mankweng Hospital	None	None
Mpumalanga	None of the hospitals in the province provide oncology services and there are not Oncologist appointed in the department	N/A	N/A
Northern Cape	Kimberley Hospital Complex	Fluoroscopy machine	R650 000
	Kuruman Hospital	None	None
	Dr Harry Surtie Hospital	None	None
Free State	Universitas Hospital	2 Accelerators to be replaced. Due to equipment being more than 20 years old, parts are not available. 2 CT simulators older than 6 years needs replacement	Unknown
	Dihlabeng Hospital
	Bongani Hospital
	Boitumelo Hospital
North West	The Province yet to provide the information
Western Cape	The Province yet to provide the information

 

END.

Reply:

(1) Yes.

(a) There is currently a vacancy for the position of the Chief Executive Officer each at the Council for Medical Schemes (CMS) and the Office of Health Standards Compliance (OHSC);

(i) The position of CEO at the CMS has been vacant since January 2017 and since July 2015 at the OHSC;

(ii) The incumbent at the CMS passed on untimely. The vacancy at the OHSC occurred as a result of the Interim CEO's retirement.

(b) No ;

(c) No.

(2) The position of the CMS Registrar/CEO was advertised on 19 March 2017, whilst the OHSC's position for CEO was advertised on three occasions during 2015/16;

(a) The date for the interviews for the CMS Registrar/CEO is yet to be confirmed. The OHSC conducted interviews following each advertisement;

(b) It is expected that the CMS CEO position will be filled by July 2017. The OHSC will be embarking on the headhunting process as no suitable candidate could be identified. The date for interviews in this regard is yet to be determined.

(3) (a) The total number of persons who are currently employed in an acting capacity is as follows:

One (1) for the CMS appointed as acting CEO. One (1) for the OHSC appointed as acting CEO. Two (2) for National Health Laboratory Service (NHLS) - one (1) person to act in the position of CEO and the other to act in the position of Chief Financial Officer (CFO). The NHLS positions are owing to the precautionary suspensions of the CEO and the CFO.

(b) The period for which each person has been acting is - 1 February 2017 for the CMS, 1 August 2015 for the OHSC and 23 February 2017 for the NHLS.

(c) Only the acting CEO of the OHSC has previously applied for the specified position.

END.

Reply:

The North West Provincial Department of Health is implementing policy that gives accommodation to the interns, those appointed on country-to-country agreement and those who are doing community services as the first priority. See Annexure A, pages 5 and 6, as well as Annexure B sections 4.1.1 to 4.1.3.

The doctors referred to in the question are neither of the three categories. These doctors have been accommodated by the District but are refusing to pay for the accommodation that they are currently occupying. These doctors have been consulted and were given options that are provided for in the said policy, but they refused to take any of the options or even to pay for the accommodation.

END.

Reply:

(a) Yes, the Department of Health is part of the interdepartmental committee on the Sanitary towel project co-ordinated by the Department of Women in the Presidency.

(b) The Policy is at an early stage of development. Departments are in the process of providing inputs into a draft document.

END.

Reply:

(1) (a) and (b) No.

(2) (a) and (b) No.

END.

Reply:

No.

END.

Reply:

(1) The South African government in collaboration with various medical schools and the Health Professions Council of South Africa (HPCSA) is currently preparing for the reception of South African medical students being trained in Cuba, who are expected to start arriving in South Africa in July 2018 and subsequent years.

The Department is also working closely with the Health professions Council of South Africa’s Sub-Committee for Medical Internship who are responsible to identify and accredit additional sites and posts for doctors to perform internships.

(2) In July 2015, the National Department set in motion a process to improve the placement of community service professionals and medical interns. This included a new online application system called ICSP Online, which replaced the paper-based system in use since 1998. The system was introduced in 2016 for placement of 2017 Medical Interns and Community Service.

During the implementation of the ICSP programme various challenges were experienced with the key process activities, and the use of ICSP Online. An improvement plans has been developed to address these challenges. Copy of the improvement plan is attached for ease of reference.

END.

Reply:

The attached table reflects the information as received from the Provinces. 

 

END.

Reply:

(1) Roshnee clinic is a municipality clinic under the jurisdiction of the then Vereeniging/Kopanong municipality which was amalgamated to form Emfuleni Municipality in the year 2000.

The clinic had four consulting rooms and rendered municipal health services which were provided 8 hours a day, five days a week excluding weekends. The clinic has never operated for 24 hours. The reasons for the closure of the clinic in 2004 were the low utilisation rate as the clinic headcount was less than 400 per month.

The resolution to close an underutilized health facility was adopted to improve the efficient utilisation of available resources as patients were redirected to Rustervaal clinic which was a 1 kilometer away from Roshnee. The decision was taken with the consultation of the community of Roshnee.

(2) No, there are currently no plans to reopen the Roshnee clinic as the services that were rendered by Roshnee clinic are rendered at Rustervaal clinic through a comprehensive integrated Primary Health Care Package. The infrastructure at Rustervaal clinic was upgraded and staffing levels increased over the years to accommodate the PHC Package of Services and the current headcount of 3450 patients per month. When Roshnee clinic was closed down it was handed back to the community and utilized as a center for children with disabilities. The center in its current state is designed to suit the needs of children with disabilities and no longer suitable or compliant for utilisation as a health facility.

END.

Reply:

(1) The Department of Health undertakes annual assessments of health care professionals against possible infections, generally, through occupational health units located within health facilities. Recently, the Department has decided to put together an additional policy, to look at TB specifically. While the policy is still being developed, with reviews being undertaken by all relevant stakeholders including associations of health professional workers and legal units, it has already been determined that medical checks for TB will be undertaken more frequently. The policy will be implemented once it has been approved by the National Health Council (NHC);

(2) The Department of Health provides N95 masks to all health care professionals and surgical masks for the use of patients. These are however used more consistently in high risk (for infection) areas of health facilities. These masks are provided on the basis of a tender that has been awarded to a service provider, following negotiations for lowering of the masks' prices

END.

Reply:

The attached table reflects the information as obtained from the Provinces.

ANNEXURE 1

END.