Questions and Replies

Reply:

The HPCSA is an independent organisation, as such, it has a legal obligation to adhere to all Constitutional and relevant legislative prescripts in the exercise of its mandate. The implementation of the recommendation made in the Ministerial Task Team Report on the Health Professions Council of South Africa (HPCSA) is therefore subject to adherence to these prescripts. I am being kept informed by the HPCSA on the progress in this regard.

  (a) At this point, I have not been informed by the HPCSA that any of the recommendations of the Ministerial Task Team have been rejected;

   (b) Not applicable;

     (i) Not applicable;

     (ii) A final implementation report is expected by the end of April 2016

END.

Reply:

According to the Eastern Cape Provincial Department of Health, an ambulance GGX 952 EC has been stationed at the Dutywa Community Health Centre (CHC) since April 2015. Prior to that, a vehicle from Butterworth used a satellite at Dutywa CHC on an ad hoc basis due to the shortage of personnel. In April 2015, eight (8) staff members were appointed for the Mbashe area as a result the ambulance is permanently based at Dutywa CHC.

END.

Reply:

The Department of Health administers the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54, 1972), as amended in 2007. There are a number of Regulations published in terms of this Act to ensure that all foods are safe for human consumption in South Africa. All foodstuffs imported into the country are subject to inspections by Port Health Officers (PHOs) who are deployed by the Department of Health at the designated commercial ports of entries throughout the country and responsible for import control of foodstuffs. This includes inspection of these products, and where necessary at their professional discretion they may take samples randomly. If the samples are taken they are submitted for analysis at the Forensic Chemical Laboratories of the Department of Health in Pretoria and Cape Town to conduct tests as requested to ensure compliance. The food products should also be correctly labelled in compliance with the Regulations relating to Labelling and Advertising of Foodstuffs, No. R. 146 March 2010.

All the foodstuffs manufactured in South Africa are inspected and monitored by the Environmental Health Practitioners (EHPs), employed by the Municipal Health Services of the metro and district municipalities. In the event of non-compliance to any of the Regulations under the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54 of 1972), municipalities will serve notices on the manufacturers and/or sellers concerned, allowing them an opportunity to comply with the relevant requirements. In the event of non-compliance persisting, further steps could be considered, including prosecuting the person(s) concerned in the area of "jurisdiction", where a Magistrate's Court shall have jurisdiction to impose any "penalty". The Laboratories mainly test only what the EHPs have requested and are mostly guided by the Labelling Regulations for enforcement of regulations published under the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54 of 1972).

Furthermore, all complementary medicines, which include health supplements, were called up for registration under the call-up notice R. 870, Government Gazette 37032 of 15 November 2013, which details the amendment to the Regulations in terms of section 35 of the Medicines and Related Substances Act, 1965 (Act 101 of 1965) (Medicines Act). Health supplements are further described in Government Notice R. 716, Government Gazette 37995, 15 September 2014.

These products have to be submitted in accordance with the published road map and are being evaluated for compliance with prescribed requirements for safety, quality and efficacy. The labelling has to comply with the requirements of Regulation 8 to the Medicines Act.

The Law Enforcement unit in the department investigates complaints regarding medicines including health supplements and also check compliance with labelling requirements. These inspectors may also take samples and send them for analysis to Forensic Chemical Laboratory of the Department of Health in Pretoria or the WHO certified laboratory (CENQAM) at the North-West University, Potchefstroom.

END.

Reply:

1. Yes. The recruitment of foreign nationals as medical doctors to work in South Africa is regulated by the foreign recruitment policy adopted by the National Health Council in 2010. The policy does provide for recruitment of health professionals and exchange programmes through government-to-government agreements for experienced medical doctors and lecturers to come to South Africa to impart their skills to our local doctors and undergraduate students in medicine. An example of this is the Cuba/South Africa agreement. In recent years, a number of lecturers from highly renowned universities abroad also came to South Africa to contribute to the training of our young doctors and the Department is still processing applications on an ongoing basis from countries all across the globe to perform volunteer services for shorter periods of time in South Africa.
2. There is adequate provision in the Health Professions Act for the Health Professions Council of South Africa (HPCSA) to recognise qualifications in medicine from countries where the education is of international standard. All foreign nationals who wish to reside in South Africa are also subject to the country’s immigration law where there are provisions to ease up the recruitment of critical skills for the public health sector.

END.

Reply:

No.

END.

Reply:

1. The latest population wide data for maternal mortality ratio was published in 2015, by the Medical Research Council. The report contained data up to 2011

The National Committee on Confidential Enquiries into Maternal Mortality (NCCEMD) investigates all maternal deaths in health facilities annually and publishes triennial and annual reports. The table below reflects the data for 2014 by province.

 (a) Institutional maternal mortality ratio per province, 2014 (NCCEMD)

Province	2014
Eastern Cape	174.15
Free State	203.26
Gauteng	149.75
KwaZulu-Natal	127.82
Limpopo	149.32
Mpumalanga	119.54
North West	180.08
Northern Cape	120.68
Western Cape	66.50
NATIONAL AVERAGE	140.81

 (b) Slightly over sixteen percent (16.4%) percentage of maternal mortality was attributed to haemorrhage in 2014.

(2) (a) To understand these huge differences, we need to understand the causes of maternal mortality in our country. The NCCEMD noted that the causes of maternal mortality can be classified into 5 H’s, i.e –

    (i) HIV/AIDS;

    (ii) Haemorrhage;

    (iii) Hypertension in pregnancy;

    (iv) Health Worker; and

    (v) Health System.

50% Of Maternal mortality is attributable to HIV/AIDS. The Free State Province is number three (3) in the country in terms of prevalence of HIV and AIDS and the Western Cape Province has the least prevalence of HIV and AIDS in the country.

(b) The Free State began to address its high maternal mortality ratio:

(i) I will be travelling to the Free State to meet the Premier and the Executive Council to ask for strengthening of their HIV and AIDS Programmes;

(ii) Free State province has trained 63 professional nurses in advanced antenatal care who will support clinics to improve the quality of antenatal care;

(iii) Active rollout of training in on the management of obstetric emergencies;

(iv) Since 2013 significant efforts have been made to saturate the province with training; and

(v) District clinical specialist teams established at all districts as a measure to improve clinical governance, including appointment of a provincial obstretrician/gynaecologist.

END.

Reply:

No, there are no frozen vacant posts in the National Department of Health.

 (a) Not applicable;

 (b) Not applicable;

 (c) Not applicable.

END.

Reply:

According to the KwaZulu Natal Provincial Department of Health, RK Khan has a Mammography Unit however the image processor is non-functioning and cannot be repaired as the technology is obsolete.

The Department of Health is in the process of replacing all Image Processors province-wide with CR Readers.

Two CR Readers have been earmarked for RK Khan Hospital as per the plan in place.

Due to this being a new technology, it necessitates infrastructural requirements to accommodate the CR Readers, which process is currently being finalised. This will facilitate the smooth installation of the CR Readers.

Currently patients are referred to the surrounding Hospitals such as Inkosi Albert Luthuli Central Hospital, King Edward VIII Hospital, Prince Mshiyeni Memorial Hospital and Addington Hospital.

END.

Reply:

1. (a) Post Mortem  

           (i) Pretoria

The post mortem blood alcohol blacklog –

• 31 January 2014: 2 422
• 31 January 2015: 3 890
• January 2016 to date: 1 564

(Decrease from 2 422 in 2014 to 1 564 to date = reduction of 35%)

        (ii) Cape Town

• 31 January 2014: 3 527
• 31 January 2015: 869
• January 2016 to date: 1 222

(Decrease from 3 527 in 2014 to 1 222 to date – reduction of 65%)

        (iii) Johannesburg

• 31 January 2014: 989
• 31 January 2015: 2 837
• January 2016 to date: 369

(Decrease from 989 in 2014 to 369 to date = reduction of 63%)

(b) Toxicology

    (i) Pretoria:

The Toxicology backlog was 6023 on 31st January 2014, 6 537 on 31st January 2015, and 5 013 on January 2016. (Decrease from 6023 in 2014 to 5 013 to date = reduction of 17%)

    (ii) Cape Town:

The Toxicology backlog was 3 658 on 31st January 2014, 3 406 on 31st January 2015, and 2 878 on January 2016. (Decrease from 3 658 in 2014 to 2 878 to date = reduction of 21%)

    (iii) Johannesburg:

The Toxicology backlog was 7 658 on 31st January 2014, 8 007 on 31st January 2015, and 7 843 to date.( Decrease from 7 658 in 2014 to 7 843 to date = increase of 2%).

(c) Drunken driving

     (i) Pretoria:

The drunken driving backlog was 11 890 on 31st January 2014, 19 841 on 31st January 2015, and 6 074 on January 2016. (Decrease from 11890 in 2014 6 074 to date = reduction of 49%)

    (ii) Cape Town:

The drunken driving backlog was 25 933 on 31st January 2014, 12 856 on 31st January 2015, and 2 360 on January 2016. (Decrease from 25 933 in 2014 to 2 360 to date = reduction of 90%)

    (iii) Johannesburg:

The drunken driving backlog was 29 589 on 31st January 2014, 26 117 on 31st January 2015, and 30 376 to date. (Decrease from 29 589 in 2014 to 30 376 to date = increase of 3%)

2. (a) The process of relocating the Pretoria FCL to the SABS premises in Groenkloof is currently receiving priority.

(b) Staff members in all the FCL’s are competent and they are trained on a regular basis in order to keep up with developing technology.

(c) Since the permanent appointment in April 2013 of seventy unemployed individuals who underwent a 12-month full-time internship, the FCL’s are not experiencing a shortage of manpower. These analysts are currently fully competent and working independently.

END.

Reply:

1. Analysis of this blood sample has been completed. For the record, the correct reference numbers are: Brits CAS 489/07/2015 and Brits mortuary DR 274/2015 and seal number PMK 206017/8.
2. (a) The Johannesburg Forensic Chemistry Laboratory (FCL) has an ante-mortem blood alcohol analysis backlog. The post-mortem blood alcohol, backlog has been wiped out.

(b) The FCL’s do not provide reports to family, only to the client, which in this instance is the Brits mortuary. .

END.

Reply:

1. Payments to contractors for the removal and disposal of waste to state hospitals and clinics is collated in Annexure A by province and by payment date. Facility data is not provided as service providers cover a range of facilities and are remunerated as such. Where specific payment dates are not available an annual cost is provided. Departments of Health in provinces do not deal with the disposal of laboratory waste.

1. The amounts paid to contractors and outstanding amounts for the financial years 2013-14; 2014-2015 and from 1 April to October/November 2015 are also outlined in Annexure A.

END.

Reply:

1. Yes, the intentions of the strategy to address air pollution in dense and low-income settlements are supported.

The effects of indoor air pollution to human health as a result of the use of solid fuels remain of grave concern to the Ministry of Health. Many households still cook and heat their homes using wood, coal and even dung, in open fires and leaky stoves, and these practices contribute to premature death and illness from respiratory and cardiac conditions and also results in burns, injuries and poisoning from fuel ingestion. We support an approach that addresses the social determinants of health and sustainable development.

The Department aligns with strategies that ensure healthy air in and around the household. The Department of Health supports programmes for clean household energy in contributing towards addressing child and maternal health as a core preventative public health measure.

The intersectoral approach, including roles for critical departments and national, provincial and local government, is supported to address air pollution effects and the Department of Health will continue to partake in programmes aimed at addressing such effects.

2. Yes.

The Department of Health is involved with the assessment and control of biological agents in the environment and improving social concerns and thereby addressing the ongoing health impacts of domestic fuel burning through ongoing Environmental Health programmes. Environmental Health Practitioners are trained on monitoring of Indoor Air Quality and capacitating members of the public through awareness creation. Health awareness campaigns focus inter alia on improved ventilation and lighting.

Within the National Department of Health, Environmental Health has recently been elevated into a Chief Directorate to prioritize prevention of ill health that is caused by environmental factors. The relevant Manager has been tasked with engaging with the Department of Environmental Affairs as well as Non-Governmental Organizations to address the environmental determinants of ill health. Government is committed to the increased use of renewable/subsidized residential housing. It is acknowledged however that more is required to effectively respond to the dangerous energy sources burned in dense low-income communities.

While we collectively work with our partners to prevent ill health caused by environmental factors my Department will also ensure that good health care is provided to poor communities that are forced by poverty to continue burning unsafe fuels that cause ill health.

END.

Reply:

1. We launched the Academy for Leadership and Management in Health Care (the Academy) in December 2012 and tasked and Advisory Committee to guide its establishment. The Academy has not yet been established. The organizational model and governance structure of the Academy has been approved by the National Health Council Technical Advisory Committee on 14 October 2015 and will be presented to the next National Health Council meeting for approval.
2. For the reason stated above, the Academy has not been functional formally since it has not as yet been formally established. The Advisory Committee has been supporting the National Department of Health with induction programmes for new CEOs and further training for CEOs. The Advisory Committee has also worked with the Department of Health to develop the prototype of a unique training methodology, the “Knowledge Management Hub”. The Advisory Committee has also worked with the Department of Health to develop competency frameworks for District Managers and Hospital CEOs.

The Advisory Committee submitted its recommendations for establishing the Academy to the Director-General of the Department of Health and the National Health Council Technical Committee (NHC-TAC) in May 2015. The recommendations of this were followed up in August 2015 by a presentation to the NHC-TAC on the concept of the Academy’s Knowledge Hub and the prototype for use.

3. The activities of the Advisory Committee were originally funded by the Department of International Development (DFID) and subsequently by the Public Health Enhancement Fund. These organizations have their own financial reporting systems. Financial information can be obtained from these organizations.

END.

Reply:

National Department of Health

1. (a) and (b) (i) - Nil

(2) R7 299 000.00

Western Cape Department of Health

1. (a) and (b) (ii)

	CLAIMED	PAID OUT
2011-12	R38 065 710.00	R15 900 800.00
2012-13	R16 577 812.00	R6 197 147.05
2013-14	R156 742 059.90	R22 587 000.00
2014-15	R66 537 807.64	R17 311 080.30

(2) R71 401 million

(3)

Year	Top 5 most common
2013-14	Neonatal encephalopathy Delayed diagnosis of illnesses Maternal / labour complications Failure to diagnose and treat
2014-15	Neonatal encephalopathy Maternal /labour complications Failure to diagnose and treat

(4)

Hospital	Number of claims	How much paid in 2014-15
Groote Schuur	3	R775 000.00
Tygerberg	3	R790 000.00
Mowbray Maternity	2	R836 600.00
Worcester	2	R4 867 615.00
Karl Bremer	1	R200 000.00
Hanna Coetzee clinic	1	R1 227 660.00
Retreat MOU	1	R220 000.00
Clanwilliam	1	R100 000.00
Delft CHC/Tygerberg	1	R7 829 205.30
IdasValley clinic	1	R45 000.00
False Bay	1	R200 000.00
Paarl	1	R220 000.00

Eastern Cape Department of Health

1. (a) and (b) (ii)

Financial Year	Amount Claimed	Amount paid
2011/2012	R331 728 678.64	R25 336 038.35
2012/2013	R393 108 094.28	R44 743 495.84
2013/2014	R198 207 500.00	R49 513 I08.93
2014/2015	Information not furnished	Information not furnished
Since 1 April 2015	R2 304 490 306.10	R147 861 438.84

(2) The Eastern Cape Department of Health does not allocate a budget for legal claims settlements, however when a settlement obligation arises from a medico legal claim, funds are reprioritized from within the departmental allocation to pay for such obligation.

(3) In the Eastern Cape, for both years, the 5 most common complaints for which compensation was claimed were:

• Obstetrics and gynaecology;

• Paediatrics;

• Orthopaedics;

• Trauma; and

• Family medicine.

(4) The top 10 litigated hospitals in the Eastern Cape and corresponding claims paid in 20 14/ 15 is presented in the table below as follows:

NO	NAME OF INSTITUTION	NUMBER OF CLAIMS 2014/15	AMOUNTS CLAIMED (not finalised) these matters are still active and pending, as they are not settled)	AMOUNTS PAID
1	Butterworth Hospital	86	R278 042 265.00	RO.OO
2	Frere Hospital	56	Rl87 245 594.10	RO.OO
3	Cecilia Makiwane Hospital	41	R88 572 625.00	RO.OO
4	Dora Nginza Hospital	39	R193 951 117.00	RO.OO
5	Mthatha General Hospital	48	R217 625 555.44	RO.OO
6	All Saints Hospital	19	R171 363 625.00	RO.OO
7	Nelson Mandela Academic Hospital	32	R123 279 284.00	R8 000 000.00
8	Bedford Orthopaedic Hospital	14	R5 425 000.00	RO.OO
9	St Barnabas Hospital	13	R45 050 000.00	RO.OO
10	Livingstone Hospital	12	R20 30I 325.52	RO.OO

1. The following interventions are being implemented in the Eastern Cape to address the high number of medico legal claims in the province:

• The department held a medico legal summit and invited all affected role players to look at ways of managing medical litigations in the province;

• The department is finalizing the appointment of the Medical Ombudsman for the Province;

• The department is also appointing a panel of medical legal experts to assist with preparation for the cases before they appear in court, and in same terms strengthening its legal representation; and

• The department is continuously strengthening the quality of health care services and ensuring adequate retention of patient records; including direct interventions focused specifically in management of medico legal trends.

KwaZulu-Natal Department of Health

1. (a) and (b) (ii)

Financial Year	No of new matters received	Amount Claimed	No of matters settled	Amount paid
2011/2012	81	R326 342 322.68	30	R41 357 533.80
2012/2013	165	R992 272 280.20	28	R49 400 941.94
2013/2014	309	R1 596 517 823.74	49	R123 885 303.21
2014/2015	404	R3 046 136 920.80	61	R212 851 030.87
2015/2016 (as at 11 September 2015)	194	R1 456 528 457.00	17	R68 852 267.54

(2) The Department has not budgeted for litigation matters, as it is difficult to predict possible liabilities.

(3)

Year	Top 5 most common
2013-14	Obstetrics and gynaecology Paediatrics Surgery Orthopaedics Misdiagnosis
2014-15	Obstetrics and gynaecology Paediatrics Surgery Orthopaedics General (refers to claims to cover non medical errors resulting in litigation against the Department ranging from maintenance, security & operational issues)

(4)

District	Hospital	No. of claims 2014/15	Amounts paid
eThekwini District	Prince Mshiyeni Memorial Hospital	121
	Addington Hospital	77
	King Edward VIII Hospital	69
Amajuba District	Mahatma Ghandi Memorial Hospital	69
	Charles Johnson Memorial Hospital	68
	Inkosi Luthuli Central Hospital	34
	Total amount paid for eThekwini District		R85 704 607.21
uMgungundlovu District	Edendale Hospital	44
	Northdale Hospital	44
	Total amount paid for uMgungundlovu District		R10 796 165.80
Ugu District	Port Shepstone Hospital	34
	Total amount paid for Ugu District		R1 375 000.00
Amajuba District	Madadeni Hospital	34	RO.OO
	Total amount paid for Amajuba District		R67 714.83

The Department is planning a Medico-Legal Summit to discuss and address the Medical negligence claims in the Province.

Mpumalanga Department of Health

(1) (a) and (b) (ii)

The following table represents the amounts claimed for medical negligence:

Financial Year	Amount Claimed for medical negligence
2011/2012	R131 538 785.00
2012/2013	R93 194 265.00
2013/2014	R95 375 306.00
2014/2015	R 562 210 541.00
April 2015 to June 2015	R130 536 500
TOTAL	R1 012 855 397.00

(b) The amounts paid out for claimed medical negligence, in Mpumalanga is listed as follows:

(aaa) During the 2011/12 financial year, a total number of eight (8) medical negligence claims were paid at a cost of R5 056 370.00.

(bbb) During the 2012/13 financial year, a total number of three (3) medical negligence claims were paid at a cost of R220 000.00.

(ccc) During the 2013/14 financial year, a total number of nine (9) medical negligence claims were paid at a cost of R44 193 741.66.

(ddd) During the 2014/15 financial year, a total number of five (5) medical negligence claims were paid at a cost of R2 773 768.00

(bb) For the period April 2015 to August 2015, the department has paid three (3) medical negligence claims at a cost of R10 099 248.63.

(2) The Mpumalanga Department of Health has been allocated with a budget of R22 212 000.00 for claims against the state and R34 737 000 for legal fees, that are paid to state attorneys and private attorneys.

(3) The most common complaints in Mpumalanga for which compensation was claimed in 2013/14 and 2014/15 financial years, were obstetric cases due to birth injuries where period of labour has been prolonged and resulted in the child suffering from cerebral palsy and orthopaedic cases as a result of motor vehicle accidents.

(4) (a) The Top Ten hospitals in Mpumalanga with highest claims in 2014/15, are:

• Tinswalo Hospital

• Matikwana Hospi

• Themba Hospital

• Mapulaneng

• KwaMhlanga Hospital

• Witbank Hospital

• Rob Ferreira Hospital

• Shongwe Hospital

• Sabie Hospital

• Evander Hospital

(i) Number of claims made against them

• Tinswalo Hospital	13
• Matikwane Hospital	13
• Themba Hospital	12
• Mapulaneng Hospital	07
• KwaMhlanga Hospital	04
• Witbank Hospital	04
• Rob Ferreira Hospital	04
• Shongwe Hospitals	03
•-- Sabie Hospital -­	03
• Evander Hospital	02

(ii) Total amount paid out of each specified claim in 2014/15

• Tinswalo Hospital None

• Matikwane Hospital None

• Themba Hospital None

• Mapulaneng Hospital None

• Kwa Mhlanga Hospital R430 000.00

• Witbank Hospital R2 411 432.00

• Rob Ferreira Hospital None

• Shongwe Hospitals None

• Sabie Hospital None

• Evander Hospital None

Free State Department of Health

1. (a) and (b) (ii)

	CLAIMED	PAID OUT
2011-12	R39 201 030.30	R5 473 097.00
2012-13	R145 406 892.00	R2 935 534.00
2013-14	R177 408 892.65	R673 373.00
2014-15	R322 449 863.07	R15 090 000.00
2015-	R259 771 498.92	R12 725 427.59

(2) R10 000 000.00 was budgeted for the 2015/2016 financial year.

(3)

Year	Top 5 most common
2013-14	Cerebral Palsy Botched Operations Misdiagnosis leading to complications Perforation of uterus during delivery
2014-15	Cerebral Palsy Botched Operations Misdiagnosis leading to complications Perforation of uterus during delivery

(4)

Hospital	Number of claims
Pelonomi Hospital	9
Bongani Hospital	8
Thebe	5
Universitas	4
Fezi Ngubentombi	3
Boitumelo	3
Manapo	2
Elizabeth Ross	2
Botshabelo	1

No payments have been made yet, all matters still pending.

(5) A medico legal expert panel, consisting of medical doctors from various medical disciplines has been appointed. One of their responsibilities is to draft a Litigation Prevention Strategy, the strategy is still a in a draft format.

Limpopo Department of Health

1. (a) and (b) (ii)

	CLAIMED	PAID OUT
2011-12	R161 228 792.79	R11 394 831.08
2012-13	R130 155 032.44	R4 114 165.00
2013-14	R299 181 456.14	R22 033 040.50
2014-15	R656 940 666.77	R31 364 817.07

1. The budget and revenue unit make availability of the funds for payments on claims against the State and litigation matters.

1. The most common complaints that the department receives:

• Loss of a child during labour/delivery
• Foreign objects left inside the patients after the operation
• Cerebral palsy
• Maternal death
• Amputations

1. (a) The Limpopo province is divided is divide into 5(five) districts namely; Mopani, Capricorn, Waterberg, Sekhukhune & Vhembe District. The hospitals that have a large number of cases are as follows:

• Philadelphia
• Polokwane
• Maphutha Malatji
• Mankweng
• Nkhensani
• Sekororo
• Seshego
• Malamulele
• Tshilidzini
• Letaba

 

(b) (i) This are the claims that have been made against each hospital for the financial year 2014/15 are:

• Philadelphia = 12
• Polokwane = 12
• Mapjutha Malatji= 09
• Mankweng = 08
• Nkhensani = 07
• Sekororo = 06
• Seshego = 04
• Malamulele = 04
• Tshilidzini = 03
• Letaba = 03

 

(ii) For the financial year 2014/2015 the Department has paid R23 805 262.72

1. In respect of Limpopo Province the Department of Health has established a specialized unit which is the Medico Legal unit separate from the Legal Services unit which functions includes:

• Identification of overt claims, potential claims and monitoring of medical negligence cases,
• Consultation with state attorney,
• Rebuttal of claims,
• Settlement of claims and
• Closure of cases.

North West Department of Health

1. (a) and (b) (ii)

	CLAIMED	PAID OUT
2011-12	R733 602.57	R753 602.57
2012-13	R144 470 255.72	R7 899 232.50
2013-14	R207 601 325.00	R12 959 528.18
2014-15	R499 577 250.00	R19 978 582.00
Since April 2015	R142 886 250.00	Nil

(2) R5 409 525.00

(3) Most common complaint that the Department receives:

Obstetric complications

END.

Reply:

(1) The Department of Health has worked and continues to work with the SAPS, State Security Agency (SSA), South African National Defence Force, PSIRA and various stakeholders when such incidents occur. These interventions include, entering highly volatile areas with SAPS escorts, having safe pick-up points for members of the public and engaging with the applicable communities through their community leaders advising on the role of Emergency Management Services (EMS) and the need for their safety while serving the community. EMS personnel are taught and advised to withdraw immediately if there are any signs of danger. In this regard, there are safety and security coordinators (senior police officers) in all Provinces at Cluster level, Police Stations and at Sector level to coordinate safety and security related challenges in the public health sector

Emergency Medical Services Management has also engaged with ward councillors and the communities in an attempt to address attacks on EMS personnel.

A Security Services Ministerial Task Team was established in 2011 after first reported incident which works with the departmental heads of security for the nine provincial departments. The Ministerial Task Team will continue working with the national security cluster in ensuring that the occurrence of such incidences are minimised.

(2) Details of specific incidents where (a) medical officers and (b) paramedics were victims of the specified incidents whilst in the course of duty in the 2014 - 15 financial year are as follows:

KWA ZULU-NATAL PROVINCE

DATE	AREA	DESCRIPTION OF INCIDENT
26/10/2014	KwaMakutha Ethekwini	13h45 PPT Unit was hijacked whilst undertaking a transfer from KwaMakutha clinic to Prince Mshiyeni Memorial Hospital. The driver escaped while the ambulance assistant together with the 2 patients and one escort was abducted. The vehicle was abandoned 30 minutes later and the patients, the attendant and escort was not harmed however the vehicle keys were taken by the hijackers.
25/03/2015	Eshowe Mbongolwane Uthungulu District	During the labour unrest in EMS 2 calls were logged at the call centre and ambulances were dispatched to two different locations which were Eshowe and Mbongolwane – Uthungulu District. The staffs from both ambulances were met by the so called guides and were led away. They later realised that they were being hijacked. The perpetrators removed the personal belonging and released the staff unharmed. Both ambulances were burnt completely.

WESTERN CAPE PROVINCE (CAPE TOWN)

DATE	DISTRICT	DESCRIPTION OF INCIDENT
3/4/2014	Tafelsig Southern Div	While loading a patient into the ambulance a member of the community opened the passenger door, and stole a cell phone of the crew member, the man had a long knife.
4/5/2014	Mannenberg Southern Div	While the crew were inside the house treating the patient, members of the community broke into the ambulance and stole medical equipment.
05/5/2014	MPDH Southern Div	While collecting a patient at the day hospital, the father of the patient became verbally abusive to the crew when they explained that a minor cannot be transported without adult supervision.
14/8/2015	Khayelitsha Eastern Div	A crew responded to a call in Khayelitsha and upon arrival, the crew were ambushed by a group of men. Both staff members were robbed of their personal belongings, were physically assaulted and sustained head injuries.
15/8/2014	Khayelitsha Eastern DIV	While attending to a child on scene, 4 males entered the back of the ambulance and produced various weapons (guns and knives) and robbed the staff of their belongings
14/9/2014	Tafelsig Southern Div	While treating a patient on scene in Tafelsig Mitchells Plain the crew member was stabbed in the back by one of the gang members. Mr Labuschagne had a bullet proof vest on at the time of the incident and did not sustain any injuries.
14/9/2014	Mannenberg Southern Div	While the crew were waiting for the escort to show them where the patient was, two men approached the crew exposing their firearms to the crew. Before the men could gain entry to the vehicle, the driver managed to drive away.
30/9/2014	R300	While the crew were returning from the AMS base they drove into a group of people on the R300 who were throwing stones - vehicle damaged
23/9/2014	Heideveld Southern Div	A crew had loaded a patient into the ambulance, and as they drove off two gunmen approached the ambulance and held a gun to the drivers head and tried to force the ambulance door open. No one was injured during the incident
5/10/2014	Browns Farm - Western Div	While attending to a call, the vehicle was stoned, sudden violence broke out and police drew their firearms and began chasing an unknown male.
21/10/2014	Langa Western Div	While driving to a call, a group of people started throwing stones and bricks at the ambulance. The brick entered through the driver's side window and struck the driver above the right eye.
3/3/2015	Tafelsig Southern Div	Staff were held at gunpoint and robbed of personal possessions ie wallets and GPS.
7/3/2015	Macassar Eastern Division	Staff member was physically assaulted.
28/3/2015	Du Noon Western Div	Staff were threatened by a large crowd of people. SAPS assistance was requested but none arrived.
31/3/2015	Capricorn Western Div	Staff member was robbed of her bag while attending to a patient.

NORTH WEST PROVINCE:

DATE	DISTRICT	DESCRIPTION OF INCIDENT
1/10/2014	Matlosana klerksdorp DKK	Two ambulances were dispatched to a call. When the ambulances arrived the crews were assaulted
1/10/2015	Matlosana klerksdorp DKK	Staff assaulted. As above

EASTERN CAPE PROVINCE: (PORT ELIZABETH)

DATE	DISTRICT	DESCRIPTION OF INCIDENT
3/2/2014	PE	Ambulance was stoned
5/2/2014	PE	Ambulance was stoned
6/2/2014	PE	Ambulance was stoned
15/2/2014	PE	Ambulance tyres slashed
12/4/2014	PE	Crew threatened and robbed
7/10/2014	PE	Ambulance was stoned
17/10/2014	PE	Ambulance side mirror damaged
26/10/2014	PE	Ambulance was stoned
11/1/2015	PE	Attempted high jacking of ambulance
12/4/2015	PE	The crew were threatened and assailants threatened to burn the ambulance

Provinces with no incidences:

Limpopo, Gauteng, Mpumalanga and Northern Cape Province

END.

Reply:

1. (a) Cape Town

(aa) The unprocessed post-mortem blood alcohol samples at 31 December 2014 were 13280.

(bb) The unprocessed ante-mortem blood alcohol samples at 31 December 2014 were 1169.

All the post-mortem and ante- mortem blood alcohol samples that were received as at 31 December 2014 have been processed.

(b) Pretoria

(aa) The unprocessed post-mortem blood alcohol samples at 31 December 2014 were 3730.

(bb) The unprocessed ante-mortem blood alcohol samples at 31 December 2014 were 19683.

All the post-mortem blood alcohol samples that were received as at 31 December 2014 have been processed. Of the 19683 ante- mortem samples that were received as at 31 December 2014, 17080 (87%) samples have been processed.

(c) Johannesburg

(aa) The unprocessed post-mortem blood alcohol samples at 31 December 2014 were 3031.

(bb) The unprocessed ante-mortem blood alcohol samples at 31 December 2014 were 27767.

All the post-mortem blood alcohol samples that were received as at 31 December 2014 have been processed. Of the 27767 ante-mortem samples that were received as at 31 December 2014, 11401 samples have been processed. However, it should be noted that, in Johannesburg, in addition to the 11401 samples processed, all the backlog samples of 2011, 2012 and 2013 have all been completed.

(d) Durban

The question does not apply to Durban since the laboratory was not yet opened during this period in question.

2. Cape Town

a) The new blood alcohol samples received in 2015 are 19447;

b) The number of new blood alcohol samples that were received in 2015 which has been processed are 17866(92%)

Pretoria

a) The new blood alcohol samples received in 2015 are 14255;

b) The number of new blood alcohol samples that were received in 2015 which have been processed are 3835. The total number of samples, including the backlog, which has been processed in 2015, are 24645. Therefore, there were 10390 more samples processed in 2015 than the number specimens received in 2015.

Johannesburg

a) The new blood alcohol samples received in 2015 are 27860;

b) The number of new blood alcohol samples that were received in 2015 that have been processed are 5487. However, the total number of samples processed in 2015, including the backlog, is 19919(71%). However, it should be noted that, in Johannesburg, all the backlog samples of 2011, 2012 and 2013 have all been completed.

Durban

a) The new blood alcohol samples received in 2015 are 13184;

b) The number of new blood alcohol samples that were received in 2015 that have been processed are 12507(95%).

END.

Reply:

No.

(a) The brining of poultry meat is being dealt with under amendments to the Regulations regarding control of the sale of Poultry Meat by the Department of Agriculture, Forestry and Fisheries (DAFF).

(b) The final amendments to the Regulations have not been published as yet. The date of publication will be determined by the Minister of Agriculture, Forestry and Fisheries.

END.

Reply:

1. The ongoing maintenance and renovations of Sizwe Hospital was essential to comply with the Occupational Health and Safety legislative requirements, the National Core Standards of the Office of Health Standards Compliance as well as Quality Improvement Standards.

At any rate the Department of Health never had it in mind that the Hospital should be relocated. It is another government department which took that decision and promised that the Company that needs that space will relocate at their own expenses, meaning that whatever has been spent cannot be lost.

2. How so? The relocation is done at the expense of whoever needs to take over that space. The Department of Health or the government is going to pay nothing.

END.

Reply:

According to the Gauteng Provincial Department of Health -

(a) Specifications have been completed;

(b) The scope and project plan is still to be finalised. This will provide the specifics with regard to the envisaged time-frames to complete the renovations. It is however, expected that it will be completed before the end of this financial year.

END.

Reply:

1.The Prescribed Minimum Benefits under the Medical Schemes Act,131 of 1998 make provision for minimum benefits for people with physical disabilities such as:

(a) Mobility impairments

Included in the PMBs is rehabilitative therapy such as physiotherapy and occupational therapy up to level of functional plateau; i.e. up to a point where no additional significant improvement from continued therapy is reached. No monetary limit is placed rather a therapeutic value threshold is set. This is a critical clinical intervention to improve the mobility of the physically disabled patient. Additionally, equipment to assist with mobility is included in the PMBs such as wheelchairs. This is dependent on the cause of immobility being a consequence of a PMB condition.

(b) Visual impairment

Currently the PMB package only provides for visual aids such corrective optometry devices. If a member suffers a PMB condition which threatens their vision, the PMB entitlements first include interventions that will prevent the visual loss and secondarily, will reverse such any degree of visual impairment. Thus the PMB package with regards to the visual system is predominantly a secondary and tertiary prevention package, and is highly aligned with National Policy (e.g. cataract surgery and treatment algorithms for Glaucoma). With regards to other supportive health technology such as walking sticks for those with complications for PMBs aligned with national policy and included in their management is corrective medical and surgical interventions.

(c) Hearing losses

Preventative care: Common conditions that cause hearing loss are included in the PMB package and their early and effective management is included as PMB level of care. These include early management of otitis media, rupture of eardrums post-trauma or infection etc. Supportive care for hearing loss as a complication of PMBs is not precluded when other means of restoration such as tympanoplasty have failed.

The PMB framework enables Medical Schemes to institute Managed Care principles in order to ensure members of medical schemes have access to quality healthcare at affordable prices. Bringing down the cost of care via these mechanisms would allow for a more equitable disbursement of risk pool funds to both disabled and non-disabled members of medical schemes.

It is important to note that the PMBs are not an exhaustive and comprehensive list. The Medical Schemes Act, however, provides for a regular revision to the PMB package to identify and proactively address some of the current deficiencies. The revised package under consideration contains a preventative and curative components in line with National policy. It further does not neglect wholesale the supportive measures for irreversible disabilities, albeit with plenty of room for improvement. The PMB package revision is a work in progress with an emphasis on trying to bring it into closer alignment with current national priorities and policy.

2. (a) (i) Public hospitals do provide mobility enhancing equipment (assistive technology) to persons with physical disabilities in the form of crutches, walking aids and wheelchairs (manual and motorized),

(ii) Public hospitals do provide refractive services and issue the relevant visual enhancing equipment in the form of spectacles or readers. In certain instances where refractive services are not available in a public facility, arrangements are made for this to be provided by a service provider from an NGO or private sector,

(iii) Public hospitals do provide audiology services which include testing for hearing loss, and fitting and training on the use of hearing aids.

(b) There are no further relevant details.

END.

Reply:

(1) Operation Phakisa Ideal Clinic is an ongoing programme that involves improving current weaknesses in primary health care facilities as well as ongoing maintenance pertaining to the 10 components of the programme. The cost estimate has not been completed.

(2) No. We are currently in discussions with National Treasury about this.

END.

Reply:

According to the Gauteng Provincial Department of Health -

1. Specifications have been completed;
2. The scope and project plan is still to be finalised. This will provide the specifics with regard to the envisaged time-frames to complete the renovations. It is however, expected that it will be completed before the end of this financial year.

END.

Reply:

No, there are presently no plans to renovate the Dental Departments in any government hospital.

The Department is in the process of developing norms and standards for Oral Health Services for the country. Once these norms and standards have been finalised, plans for renovations will be developed in line with the norms and standards.

END.

Reply:

1. (a) The 2014/15 District Health Barometer provides information regarding deaths from diarrhoea, pneumonia and Severe Acute Malnutrition (SAM) amongst children under five years of age. (see below) is taken from the District Health Barometer. The table shows that the number of deaths due to these conditions, as well as the associated case fatality rates (the proportion of children who are admitted to hospital who die during that admission), have declined substantially since 2009/10.

Table 1: Deaths and case fatality rates from diarrhoea, pneumonia and SAM in children under five years of age, 2009/10 – 2014/15[1]

	Diarrhoea	Pneumonia	SAM
	No. of deaths	Case Fatality Rate	No. of deaths	Case Fatality Rates	No. of deaths	Case Fatality Rates
2009/10	3 008	7.1%	2 769	6.6%	2 345	19.3%
2010/11	2 558	7.0%	2 287	5.8%	2 114	16.4%
2011/12	1 550	4.6%	1 796	4.2%	1 605	13.3%
2012/13	1 526	4.3%	1 395	3.8%	1 642	12.7%
2013/14	1 775	3.9%	1 532	3.5%	1 672	11.3%
2014/15	1 513	3.3%	1 411	2.9%	1 852	11.6%

(i) All public sector hospitals report on the number of deaths from these conditions amongst children under five years of age on a monthly basis. The Department uses these numbers to identify provinces, districts and hospitals with a high number of deaths or high case fatality rates, so that remedial action can be taken.

Deaths from these conditions were from all provinces during 2013/14 and 2014/15 are shown in . Deaths from diarrhoea declined in all provinces except Limpopo and Mpumalanga, and deaths from pneumonia declined in all provinces except Gauteng. Deaths from SAM increased in a number of provinces, and in the country as a whole. As noted in the District Health Barometer, this may reflect better identification of cases, but needs to be carefully monitored. The Department is currently implementing strategies to reduce the number of deaths from SAM.

Table 2: Deaths in children under-five years from diarrhoea, pneumonia and SAM by province for 2013/14 and 2014/15[2]

	Deaths as a result of:
	Diarrhoea	Pneumonia	SAM
	2013/14	2014/15	2013/14	2014/15	2013/14	2014/15
Eastern Cape	542	351	322	274	356	339
Free State	111	100	84	80	132	148
Gauteng	109	108	138	151	82	126
KwaZulu-Natal	387	347	305	300	337	405
Limpopo	239	246	283	232	288	291
Mpumalanga	163	189	201	198	144	233
Northern Cape	61	55	46	41	68	67
North West	151	105	126	103	251	225
Western Cape	12	12	27	18	14	32
South Africa	1 775	1 513	1 532	1 411	1 762	1 852

(ii) The numbers of child deaths by category of hospital during 2014/15 are shown in . The majority of deaths occur in district hospitals (which account for the majority of hospitals). Departmental interventions to improve quality of care therefore focus predominantly on these hospitals.

Table 3: Deaths in children under five years of age from diarrhoea, pneumonia and SAM by category of hospital for 2014/15[3]

	Deaths as a result of:
	Diarrhoea	Pneumonia	SAM
National Central Hospitals	53	116	25
Provincial Tertiary Hospitals	115	93	96
Regional Hospitals	343	404	513
District Hospitals	987	789	1 202
Totala	1 498	1 402	1 836

a Totals are slightly lower than in Table 2 as a small number of deaths are reported from Primary Health Care facilities

(b) Diarrhoea and pneumonia result from infections. Children with weakened immune systems (due to undernutrition or other conditions such as HIV infection) are more likely to acquire these infections, which are in turn more likely to be severe (and result in hospitalisation and/or death). Children whose nutritional intake is less than their nutritional requirements are at risk of developing severe acute malnutrition; this often results from a combination of poor food intake (due to unavailability of food and/or poor feeding) and repeated infections.

(c) The reduction in the number of deaths in children due to diarrhoea, pneumonia and SAM can be attributed to implementation of the following child survival interventions:

• Prevention of Mother to Child Transmission (PMTCT) of HIV.
• Inclusion of pneumococcal and rotavirus vaccines in the routine immunisation programme. In 2014/15, 89.8% of children under one year of age had received all the recommended immunisations.
• Promotion of breastfeeding as outlined in the Tshwane Declaration which commits the country to promoting breastfeeding, especially exclusive breastfeeding for the first six months of life. In 2014/15, 45.1% of children were reported to be exclusively breastfed at 14 weeks of age. This represents a substantial improvement, but further improvements are required.
• Provision of micronutrients through food fortification and Vitamin A supplementation. In 2014/15, 52.2% of children aged 1 – 5 years received the recommended two doses of supplementary Vitamin A.
• Monitoring of the growth of children using the Road-to-Health booklet and ensuring that children with growth faltering and mild or moderate malnutrition receive nutritional supplements.
• Correct management of children with diarrhoea, pneumonia and SAM at all levels of the health system. District Clinical Specialist Teams have been appointed in all districts. One of their key functions is to ensure the quality of clinical care provided in health facilities.
• Promotion of hand washing: the Health Promotion Directorate is currently implementing a hand-washing campaign.

2. Many other departments and stakeholders are involved in efforts to improve child survival and health.

Two of the most important departments are the Departments of Social Development (DSD) and the Department of Water and Sanitation (DWS). DSD has led the development of the Early Childhood Development policy, and also ensures that vulnerable children receive child support grants. The DWS plays a critical role in improving access to clean water and sanitation for children and their families.

The Department also works with a range of partners. These include United Nations Agencies (e.g. the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO)), other technical assistance partners (e.g. Save the Children, PATH, FH360), academic and research institutions (e.g. the Medical Research Council) and private sector partners (e.g. Discovery Health).

END.

1. Massyn N, Peer N, Padarath A, Barron P, Day C, editors. District Health Barometer 2014/15. Durban: Health Systems Trust; October 2015. ↑

2. Massyn N, Peer N, Padarath A, Barron P, Day C, editors. District Health Barometer 2014/15. Durban: Health Systems Trust; October 2015. ↑

3. District Health Information. Extracted 4th November 2015. ↑

Reply:

Yes.

Agreements reached with food manufacturers -

(a) The Department of Health is working closely with the Consumer Goods Council of South Africa (CGCSA), which is an organization where various groups of the food industry are affiliated. Through this collaboration the food industry have committed to support the drive by Government to reduce the prevalence of Obesity. The need to reformulate some food products was identified as one of the priority areas. In this regard, it is imperative to identify the ultra processed, frequently consumed foods in South Africa and to do this. the CGCSA and the International Life Sciences Institute (ILSI) South Africa, have commissioned a Dietary Intake Study which aims to identify these foods and beverages to target them for reformulation.

Furthermore, the Department promulgated the regulations relating to reduction of sodium in certain foodstuffs and related matters (R214) in 2013. It is stipulated in the Regulations, that as of 2016, there should be reduction of sodium content in various foodstuffs until the desired nutrient levels are reached in 2019.

(b) The Department of Health also collaborates with the Food Legislation Advisory Group (FLAG) which comprise of the industry, academia, research institutes and nutrition professional bodies. This collaboration has resulted in the development of a Nutrient Profile Model (NPM) for South Africa to provide a scientific evidence-based approach to determine the eligibility of foods to carry nutrient and health claims on their labels in South Africa. This Nutrient Profile calculator is a user-friendly electronic tool which has been made available to assist manufacturers on the formulation of new products or reformulation of their products where necessary and when they intend to make health or nutrition claims.

END.

Reply:

The Gauteng Department of Health agreed to the relocation of the Hospital subject to the developer undertaking to fund the relocation fully at their own cost. It is the duty of the developer to ensure that all approvals (including but not limited to Environmental Authorisation) are obtained prior to any developments and relocation taking place on the site where the Hospital is currently located. It is assumed that until such time that the developer and the Department of Cooperative Governance and Traditional Affairs (COGTA) and Human Settlements obtain approval to relocate the Hospital, the relocation will not take place.

The Department of COGTA and Human Settlements has since brought to the attention of the Gauteng Department of Health that the developer no longer wished to follow through with terms of relocation as was agreed upon.

END.

Reply:

Honourable Member will remember that the Cancer Register has just been established in our country to try and record such statistics about Cancer.

It is only in April this year that National Treasury has started funding it directly from the fiscus rather than through the National Health Laboratory Service (NHLS) as it were. But the training of Registers and reconstructive surgery is definitely going on.

END.

Reply:

a) The estimated cost of building the new hospital will be determined once the relocation of the existing hospital has been finalised and planning of the new hospital is complete. As part of the agreement with the successful bidder, the successful bidder will relocate the hospital and build new hospital at his own cost.

b) The expected completion date will be determined once the relocation of the existing hospital has been finalised and planning of the new hospital is complete.

c) The existing hospital has 266 usable beds. The bed utilisation rate is currently 60%. 150 patients are currently admitted with 116 beds empty. The hospital will be relocated with the same bed capacity of 266 beds.

END.

Reply:

1. Cash-paying patients, i.e those with no medical aid are classified according to UPFS (Uniform Patient Fee Schedule).

Patients in H1 category paying nothing.

Patient in H2 paying part of the fee and patient in H3 category pay full hospital fees.

2. When a patient on medical aid utilises public health facilities, they are not required to pay only extra cash above what the medical aid pay for them.

3. Honourable Member, death of a patient due to a deliberate action by employees and/or management of state hospitals to me means murdering such a patient – that is what deliberate action will mean to me.

We have never had a report of such.

4. Since the various litigations are directed at provinces and not at the Minister, and payments are done by provinces, I am still collecting this data.

5. Honourable Member, it will to a long way for you to be a bit specific about the deaths you are referring to, in order to help me answer your question.

Number of deaths from what? HIV/AIDS? TB? Pneumonia? Diarrhoea? Diabetes, Stroke, Cancer? Hepatitis? Meningitis? Heart failure? Liver failure? Prematurity?

And what type of injuries – motor vehicle accidents? Gunshots wounds? Assault? Stab wounds? Burn wounds? What exactly?

END.

Reply:

a) As the Department we understand Red tape as set of processes/ systems that requires excessive formality or routine to perform or execute functions that impediments the department to achieve its set objectives within a reasonable time period.

b) (i) The department holds monthly management meetings to address all challenges faced by the department. Furthermore, there are Forums in place and functional i.e. Chief Financial Officers Forums, Technical Advisory Committee to National Health Council and National Health Council.

(ii) (aa) (bb) (aaa) The Department has approved policies in place and fully implemented, are in line with national policies and regulations. The department has management tracking system register in place and fully functional to track and reduce the red tapes.

The public entities reporting to the Minister of Health defines red tape as follows:

• The Office of Health Standards Compliance: excessive regulation of external stakeholders (health establishments) and internal business operations which hinders flexibility in the business operations of the regulated stakeholders and internal business operations of the entity.

• The National Health Laboratory Service: excessive regulation and bureaucratic practices which hinder timeous decision making.

• The South African Medical Research Council: there is no legal / public policy instrument that gives an official meaning to the concept of “red tape”. However, the general understanding is that the concept would refer to an “unnecessary delay”.

- The Council for Medical Schemes: excessive regulation as well as rigid conformity to formal policies and procedures and as bureaucratic processes between the entity and the Executive Authority.

(b) (i) The specific interventions and/or (ii) systems implemented to identify (aa) and (bb) reduce red tape in the (bbb) entities reporting to the Minister of Health are as follows:

• The Office of Health Standards Compliance (OHSC): Regulates health establishments in the country through regulations which get processed for promulgation by involving stakeholders through publication of the draft regulations for public comments to identify through comments received, any provisions in the draft regulations which may be considered Red Tape by stakeholders. Review of the comments received provide the OHSC an opportunity to identify and reduce “red tape” by ensuring that provisions in the regulations allow for flexibility in how the regulated stakeholders conduct their business, but without compromising on the compliance requirements (public protection) to ensure quality in the provision of health services by health establishments.

Internally OHSC also has policies in place which provide guidance in terms of how decisions should be made to avoid “red tape”. The policies go through a rigorous process of review by OHSC governance structures (Management and Board Committees) before approval by the Board as the ultimate Accounting Authority. This review process is meant to ensure that any provisions in the policies of the entity which may be considered “red tape” are identified and reduced by considering flexible ways for decision making. The OHSC has a delegation of authority policy which also assists in dealing with “red tape” by ensuring that operational decisions are left for management to take and that only strategic decisions are reserved for the Board.  

• The National Health Laboratory Service (NHLS): The NHLS Board has clear mandate as outlined in the NHLS Act and Board Charter. These instruments allow the Board and Executives to make decisions within the confines of the delegated powers and authority. Issues requiring Ministerial approval are referred to the Department in writing and feedback is received timeously.

• The South African Medical Research Council (SAMRC): Due to the lack of legal / authoritative premise to support the concept, the SAMRC does not have a standing policy on identifying “red tape”. However, the SAMRC has the internal policies that guide it on delivering its mandate and engagements with other health / science cluster entities or with the ministry or the departments.

In particular, among others, the SAMRC uses the following processes to ensure that no unnecessary delays result from any of the SAMRC processes:

• A review of the key processes to identify bottlenecks and areas that can be improved from an efficiency perspective without compromising compliance with the relevant legislation; and
• Feedback from customers and staff.

The following interventions have been introduced to reduce delays”:

• Automated processes wherever possible to speed up transaction times and reduce manual intervention;
• The coordination of key processes in a shared services environment to ensure processes are consistent and as efficient as possible;
• Automated help desks in areas such as IT, facilities, finance and supply chain management to enable staff and customers to communicate problems quickly and enable their resolution to be tracked; and
• Service level agreements for departments with target turnaround times for services provided which are tracked and published to staff and customers.

Laws such as the Inter-governmental Relations Framework Act, existence of the Research Ethics Committee as well as the Significance and Materiality Framework agreed between the SAMRC and the Ministry of Health in terms of the Public Finance Management Act, form part of the regulatory regime the SAMRC utilises to manage its engagements.

• The Council for Medical Schemes (CMS): The CMS develops Memorandum of Understanding with entities it works with and departments within the CMS, this allows for more efficient processes to be followed. Policies and procedures are presented to the different governance structures within CMS where the policies are interrogated to ensure that they are not cumbersome and that CMS is able to carry out its mandate with minimal amount of “red tape”, it allows for flexibility without compromising CMS in terms of compliance with relevant legislation. Through its risk management process CMS is able to identify key areas where there are delays in processes that may hinder CMS in executing its mandate. Automated processes e.g. Real time monitoring of schemes financials have been introduced to stakeholders to allow for submission of regulatory information with as little “red tape” as possible. CMS deals with the Executive Authority through the office of the Health Regulation and Compliance division at the National Department of Health (NDoH) and further a task team has been established between CMS and NDoH in order to promote communication to avoid unnecessary “red tape”.

END.

Reply:

(a)-(b) We are aware of the provisions of the Births and Deaths Registrations Act (Act No 51 of 1992), which is the responsibility of the Department of Home Affairs. According to the Act a death below 26 weeks of intrauterine life, is not classified as a still-birth and thus does not qualify to receive a death certificate. Midwives and doctors provide counselling to the mother and her partner to come to terms with the still-birth and refer them for further counselling should this be necessary.

END.

Reply:

(1) (a) The investigation still underway.

(b) National Treasury is busy with the investigation.

(2) The investigation not yet completed;

(a) National Treasury is currently busy with the Investigation

(b) When National Treasury completes the investigation will be tabled in the National Assembly

 (i) Not yet tabled, investigation still in progress,

 (ii) Total costs of the investigation not yet determined as investigation still in progress.

END.

Reply:

(1) (a) The Academy for Leadership and Management in Health has not yet been established. The Public Health Enhancement Fund (which represents a grouping of companies operating in the private health care sector in South Africa), namely the Social Compact Forum, are assisting the Advisory Committee for the Academy for Leadership and Management in Health.

(b) (i) Funding and monitoring implementation of initiatives of the Advisory Committee of the Academy for Leadership and Management in Health to improve the management capacity and skills of health managers as well as the process to finalise the institutional framework for the establishment of the Academy for leadership and Management in Health.

(ii) The extent of their involvement is as follows:

• Receive recommendations from the Advisory Committee of the Academy for leadership and Management in Health;
• Ensure alignment and approval of these initiatives from the Department of Health;
• Consider and grant approval for funding; and
• Monitor progress and report back to the Social Compact Forum and the Department of Health.

(2) to (5) The Academy has not yet been established.

END.

Reply:

(a) No, there is no moratorium on health posts. The moratorium is on administration posts from 06 June 2015. The posts that are however exempted from this moratorium are on the appointments made against all the conditional grants.

(b) All vacant and funded non-clinical posts are affected by the moratorium. In cases, where these non-clinical posts are critical (e.g hospital managers/ CEO's), special motivation is made to the Head of Department for approval.

(c) The moratorium is reviewed by the Head of Department on quarterly basis, and will be uplifted when the Head of Department is satisfied that the financial position has stabilized and the potential over expenditure is averted.

END.

Reply:

1. The Chicken Pox vaccine is not part of the Expanded Programme on Immunisation (EPI) schedule in South Africa and is therefore not provided for in the public sector. The vaccine is provided for by the private sector where the shortage has been recognised.
2. Since it is not part of the schedule of vaccines provided for in the public sector, there is no need for any form of action from the Department.

END.

Reply:

(a) to (f) The table below indicates the provincial operational human resources, per category. Operational Emergency Care Orderlies are not employed by the Department.

PROVINCES	BAA	AEA	PARAMEDICS	ECT	ECP	TOTAL
Eastern Cape	1890	493	25	15	2	2425
Free State	1372	181	15	41	1	1610
Gauteng	976	115	35	103	0	1229
Kwa Zulu Natal	1254	715	72	15	8	2064
Limpopo	1184	627	21	11	1	1844
Mpumalanga	580	174	3	0	0	757
North West	377	175	2	122	3	679
Northern Cape	556	197	4	11	0	768
Western Cape	674	620	131	38	6	1469
Total	8863	3297	308	356	21	12845

Abbreviations:

BAA - Basic Ambulance Assistants

AEA - Ambulance Emergency Assistants

ECT - Emergency Care Technicians

ECP - Emergency Care Practitioner

(2) The current staffing target is derived from a figure of 1 ambulance per 10 000 population, and 10 personnel to man a single vehicle on a 24 hour basis. A study has been proposed to scientifically determine the norm for ambulances to population as well as the staffing norms which will be guided by the Human Resource for Health Strategy 2030.

END.

Reply:

a) Free State Province: There is an existing contract between the Provincial EMS and Buthelezi Ambulance Service.

North West Province: Private Emergency Medical Services are contracted for provision of services only when there are outstanding emergency calls.

 

b) (i) Free State Province: The contract with Buthelezi Ambulance Service is for three years, which commenced on 1 December 2013.

North West Province: The MOU with the private Emergency Medical Services is for a year, which is renewed on a yearly basis.

(ii) Free State Province: Buthelezi Ambulance Service is mainly used for inter-hospital transfers and benefits include:

• EMS ambulances are available for primary response community emergencies;
• Improved EMS response times;
• There is a positive impact on maternal and obstetric cases;
• The life span of the provincial ambulances is increased because of reduced kilometres being travelled. This has a direct impact on the on the monthly fleet expenditure;
• There is a reduction in overtime for EMS staff;
• Nurses do not leave their facilities during transfers.

North West Province: The MOU states that the private service will be used as and when the need arises and the services are rendered at the Uniformed Patient Fee Schedule rates.

The main benefit is that the response time to the Priority 1 patient (emergency) has improved.

END.

Reply:

(1) and (2) Please refer to Tables 1 to 9 below:

TABLE 1: EASTERN CAPE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	7812	9713	10747	9131	8763	6430
Gunshot wounds	515	515	586	937	641	509
Stabbings	2225	1018	2219	2169	2194	1598
Motor vehicle accidents	1467	1489	1449	1429	1337	1165
Drowning	319	486	340	368	306	208
Fires	377	372	303	273	263	188
Pedestrian deaths	371	365	280	229	252	218
Motorcycle accidents	4	8	7	1	3	2
Cyclist deaths	1	3	4	2	2	1

TABLE 2: FREE STATE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	4020	3799	4000	3086	3472	1853
Gunshot wounds	194	180	213	135	246	128
Stabbings	544	528	494	392	476	229
Motor vehicle accidents	1202	1056	1163	857	906	571
Drowning	151	137	137	90	154	64
Fires	148	139	151	164	169	92
Pedestrian deaths	218	186	218	188	207	108
Motorcycle accidents	21	23	22	27	32	10
Cyclist deaths	Included in motorcycle accidents	Included in motorcycle accidents	Included in motorcycle accidents	Included in motorcycle accidents	Included in motorcycle accidents	Included in motorcycle accidents

TABLE 3: GAUTENG
	2010	2011	2012	2013	2014	2015
Total bodies received in:	14761	14019	13602	14586	14866	6601
Gunshot wounds	Data not available	Data not available	1413	1552	1608	175
Stabbings	Data not available	Data not available	1097	1164	1257	115
Motor vehicle accidents	Data not available	Data not available	1881	1927	1707	206
Drowning	Data not available	Data not available	270	268	210	15
Fires	Data not available	Data not available	665	710	715	349
Pedestrian deaths	Data not available	Data not available	1212	1276	1193	541
Motorcycle accidents	Data not available	Data not available	148	177	188	20
Cyclist deaths	Data not available	Data not available	Included in the motor vehicle accidents	Included in the motor vehicle accidents	Included in the motor vehicle accidents	Included in the motor vehicle accidents

TABLE 4: KWA-ZULU NATAL
	2010	2011	2012	2013	2014	2015
Total bodies received in:	13330	12551	12643	12824	12718	6935
Gunshot wounds	Data not available	1450	1425	1418	1538	641
Stabbings	Data not available	1516	1560	1510	1534	615
Motor vehicle accidents	Data not available	3209	2997	2998	2908	1291
Drowning	Data not available	1703 (Asphyxial – drowning, hanging, etc)	1842 (Asphyxial – drowning, hanging, etc)	1730 (Asphyxial – drowning, hanging, etc)	1660 (Asphyxial – drowning, hanging, etc)	592 (Asphyxial – drowning, hanging, etc)
Fires	Data not available	Not specified	Not specified	Not specified	Not specified	Not specified
Pedestrian deaths	Data not available	Not specified	Not specified	Not specified	Not specified	Not specified
Motorcycle accidents	Data not available	Not specified	Not specified	Not specified	Not specified	Not specified
Cyclist deaths	Data not available	Not specified	Not specified	Not specified	Not specified	Not specified

TABLE 5: LIMPOPO
	2010	2011	2012	2013	2014	2015
Total bodies received in:	2401	2376	2277	2224	2321	3167
Gunshot wounds	221	201	194	186	217	175
Stabbings	238	230	283	267	304	209
Motor vehicle accidents	1660	1641	1509	1443	1465	1204
Drowning	151	168	143	181	177	81
Fires	131	136	148	147	158	101
Pedestrian deaths	Not specified	Not specified	Not specified	Not specified	Not specified	Not specified
Motorcycle accidents	Not specified	Not specified	Not specified	Not specified	Not specified	Not specified
Cyclist deaths	Not specified	Not specified	Not specified	Not specified	Not specified	Not specified

TABLE 6: MPUMALANGA
	2010	2011	2012	2013	2014	2015
Total bodies received in:	3855	3802	4271	4635	4561	3014
Gunshot wounds	221	245	355	470	448	138
Stabbings	279	258	258	288	333	222
Motor vehicle accidents	1090	1058	1224	1360	1095	493
Drowning	137	114	118	165	158	59
Fires	96	129	161	191	153	81
Pedestrian deaths	434	481	439	394	402	288
Motorcycle accidents	4	3	20	20	9	6
Cyclist deaths	3	2	3	7	2	5

TABLE 7: NORTHERN CAPE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	1626	1634	1713	1707	1803	705
Gunshot wounds	360	32	30	35	29	6
Stabbings	Included in gunshot wounds above	264	261	294	308	90
Motor vehicle accidents	390	318	304	254	356	114
Drowning	243	84	107	117	102	15
Fires	Included in above	85	79	71	79	30
Pedestrian deaths	Included in motor vehicle accidents	90	103	123	132	43
Motorcycle accidents	Included in motor vehicle accidents	3	2	3	4	2
Cyclist deaths	Included in motor vehicle accidents	9	20	7	5	4

TABLE 8: NORTH WEST
	(1)(i) 2010	(1)(ii) 2011	(1)(iii) 2012	(1)(iv) 2013	(1)(v) 2014	(1)(b) 2015
Total bodies received in:	3627	3539	3316	3695	3560	2678
Gunshot wounds	157	183	235	222	188	198
Stabbings	392	504	401	364	409	279
Motor vehicle accidents	914	936	883	813	856	755
Drowning	96	115	96	83	132	49
Fires	202	183	134	177	137	130
Pedestrian deaths	313	251	288	161	192	176
Motorcycle accidents	38	33	17	21	25	19
Cyclist deaths	34	15	25	41	25	7

TABLE 9: WESTERN CAPE
	(1)(i) 2010	(1)(ii) 2011	(1)(iii) 2012	(1)(iv) 2013	(1)(v) 2014	(1)(b) 2015
Total bodies received in:	9372	9394	9800	9989	10297	7692
Gunshot wounds	607	712	875	1045	1343	982
Stabbings	1265	1239	1330	1338	1402	962
Motor vehicle accidents	1451	1355	1279	1227	1289	943
Drowning	181	204	210	197	200	117
Fires	370	359	341	350	302	261
Pedestrian deaths	619	614	587	588	573	436
Motorcycle accidents	66	64	80	70	75	48
Cyclist deaths	23	40	28	22	27	19

END.

Reply:

The reply to questions (1) and (2) are summarized in Table 1 to 9 below: Forensic Pathology Service (FPS)

TABLE 1: EASTERN CAPE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	7812	9713	10747	9131	8763	6430
Motorcycle accidents	4	8	7	1	3	2
Cyclist deaths	1	3	4	2	2	1
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 2: FREE STATE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	4020	3799	4000	3086	3472	1853
Motorcycle accidents	21	23	22	27	32	10
Cyclist deaths	Included in a above	Included in a above	Included in a above	Included in a above	Included in a above	Included in a above
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 3: GAUTENG
	2010	2011	2012	2013	2014	2015
Total bodies received in:	14761	14019	13602	14586	14866	6601
Motorcycle accidents	Data not available	Data not available	148	177	188	20
Cyclist deaths	Data not available	Data not available	1881 Including Motor Vehicle Accidents	1927 Including Motor Vehicle Accidents	1707 Including Motor Vehicle Accidents	206 Including Motor Vehicle Accidents
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 4: KWA-ZULU NATAL
	2010	2011	2012	2013	2014	2015
Total bodies received in:	13330	12551	12643	12824	12718	6935
Motorcycle accidents	Data not available	Not specified	Not specified	Not specified	Not specified	Not specified
Cyclist deaths	Data not available	Not specified	Not specified	Not specified	Not specified	Not specified
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 5: LIMPOPO
	2010	2011	2012	2013	2014	2015
Total bodies received in:	2401	2376	2277	2224	2321	3167
Motorcycle accidents	Not specified	Not specified	Not specified	Not specified	Not specified	1
Cyclist deaths	Not specified	Not specified	Not specified	Not specified	Not specified	Not specified
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 6: MPUMALANGA
	2010	2011	2012	2013	2014	2015
Total bodies received in:	3855	3802	4271	4635	4561	3014
Motorcycle accidents	4	3	20	20	9	6
Cyclist deaths	3	2	3	7	2	5
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 7: NORTHERN CAPE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	1626	1634	1713	1707	1803	705
Motorcycle accidents	Included in c above	3	2	3	4	2
Cyclist deaths	Included in c above	9	20	7	5	4
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 8: NORTH WEST
	2010	2011	2012	2013	2014	2015
Total bodies received in:	3627	3539	3316	3695	3560	2678
Motorcycle accidents	38	33	17	21	25	19
Cyclist deaths	34	15	25	41	25	7
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

TABLE 9: WESTERN CAPE
	2010	2011	2012	2013	2014	2015
Total bodies received in:	9372	9394	9800	9989	10297	7692
Motorcycle accidents	66	64	80	70	75	48
Cyclist deaths	23	40	28	22	27	19
Aids	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Tuberculosis	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Other diseases	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths
Old age	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths	* FPS only conducts autopsies on unnatural deaths

END.

Reply:

a) A total of 2690 ambulances are currently registered for use in the country.

b) There is a total of 1431 fully operational and stipulated in the table below by Province:

Provinces	Total Ambulance Fleet	Number of Operational Ambulances
Eastern Cape	425	200
Free State	186	135
Gauteng	667	389
Kwa Zulu Natal	531	290
Limpopo	381	165
Mpumalanga	212	110
North West	120	59
Northern Cape	166	95
Western Cape	259	156
Total	2690	1431

END.

Reply:

a) Yes Honourable Member, we are trying our best to increase the number of doctors in public health facilities, especially in rural areas. We are even trying to contract Private doctors in NHI Pilot Sites to work in public clinics.

b) Yes we are planning to do so through Operation Phakisa.

c) Yes, Operation Phakisa aims to improve total infrastructure including roads, water supply, electricity, telecommunications, etc.

END.

Reply:

1. (a) (i) The department spent R 195 808 on travel costs for the Minister between Gauteng and Cape Town in the 2014/15 financial year.

(ii) Undertook 31 trips.

(b) (i) (aa) None Applicable. The National Department of Public Work provides Accommodation;

(bb) None Applicable. The National Department of Public Work provides Accommodation;

(ii) (aa) None Applicable. The National Department of Public Work provides Accommodation;

(bb) None Applicable. The National Department of Public Work provides accommodation

 

2. (a) (i) Spent R 185 335 on Deputy Minister's travel costs between Gauteng and Cape Town in the 2014/15 financial year.

(ii) Undertook 24 trips.

(b) (i) (aa) None Applicable. The National Department of Public Work provides Accommodation;

(bb) None Applicable. The National Department of Public Work provides Accommodation;

(ii) (aa) None Applicable. The National Department of Public Work provides Accommodation;

(bb) None Applicable. The National Department of Public Work provides accommodation

END.

Reply:

The National Department of Health conducted the quarter 1 review for the Comprehensive HIV and AIDS Conditional grant during August and September 2015 in line with the Annual Performance Plan and the relevant Conditional Grant Framework. All provinces were visited and the relevant reports are available.

END.

Reply:

(a) (i) The Human Papilloma Virus vaccines amounting to R200 million, are administered during September / October and February / March annually, therefore the costs relating to vaccines will flow mainly in the second and fourth quarters.

(ii) Expenditure regarding the South African Demographic Health Survey will be incurred in the 3rd Quarter.

(iii) A new tender for condoms has been finalized and orders will be placed soon.

(iv) The annual contribution amounting to approximately R22 million to the World Health Organization is to be paid in the last quarter of the financial year.

(v) Certain large annual projects are held in the late stages of the financial year, such as the HIV and AIDS campaigns during December, the National Tuberculosis day during March and the annual National Antenatal Sentinel HIV Prevalence Survey scheduled for September to January.

(b) (i) Human Papilloma Virus vaccines to the value of R68 million is ordered for the September / October 2015 doses.

(ii) The first payments for the South African Demographic Health Survey amounting to approximately R30 million are anticipated to flow in the latter half of the year.

(iii) The tender for condoms were concluded during August 2015. Condoms to the value of R120 million were ordered.

END.

Reply:

1. In July 2015, a total of 760,000 doses of BCG vaccine were received from Statens Serum Institute in Denmark (registered supplier in South Africa) and were distributed to provinces. Currently, the stock is in facilities and as such very difficult to quantify.
2. (a) The Department of Health applied for Section 21 Permit from the Medicines Control Council (MCC) to procure 166,000 vials which translates to 3,320,000 doses of BCG vaccine from Serum Institute of India;

(b) The BCG vaccine arrived in the country on the 28 September 2015;

(c) Serum Institute of India.

3. Statens Serum Institute of Denmark has informed the Department that 600,000 BCG vaccine doses will be delivered in October 2015 and 800,000 doses will be delivered in November 2015. In addition the Department will apply for another Section 21 Permit to procure more BCG vaccines as a further precaution.

END.

Reply:

1. The Supply Chain Management work stream focused on how to improve supply chain management system at clinic level. The first phase is focused on essential items (Pharmaceuticals). Once the roll out of the system is complete, functional and fully effective, non essential items (toiletry, cleaning material etc) will be introduced.

Details of the system and progress

a) Implement SVS (Stock Visibility System) in all clinics and develop additional functionality of SVS (namely order receiving). SVS is a device (like a cellphone) that is used by the clinic to update the stock received and stock issued. The system feeds the information to Rx Solution which calculates the number of items to be ordered. Orders are placed at a central point and delivery is done directly to the facility.

b) To integrate SVS data into Rx Solution to automate order calculation and generation – and automate sign off authority. Finalise delegations at facility, sub-district and district level. Authorization and delegations of authority need to be reviewed and tools developed to support the expediting of approvals.

c) Agree on products to load onto SVS (contract versus non-contracted items). Currently, only Pharmaceuticals are included.

d) Address sustainability and support for Rx – access source code. Unlock bottlenecks encountered with Rx Solution. Finalise the issue of ownership of Rx Solution.

e) The PMPU (Procurement Unit) will facilitate the procurement of items, ensure correct allocation coding linked on BAS, contract management.

f) Develop cross dock model and processes and trial – direct from manufacturer OR direct from wholesaler/”retailer”.

g) Decision still has to be made whether to convert the current Depots to cross docks.

h) Spend analysis needs to be carried out

(i) A categorization exercise needs to take place to identify which products we move to contract and which do we procure direct;

(ii) Decide on procurement model based on financial and non financial benefits (Contract with manufacturer wholesaler/retailer);

(iii) Contract terms need to be defined and measurements implemented;

(iv) Spend analysis needs to be carried out.

(v) Develop catalogue specifications (pricing, specifications and coding)

(vi) Supplier scorecard to be developed and published monthly

Below is a graphical representation of how the system will work

Challenges

a) Dependent on partners for implementation of processes and systems – sustainability;

b) SVS business model needs to be defined (Vodacom has financed it to date through their Foundation);

c) Facility compliance to reporting of stock on hand;

d) Authorization and delegations of authority need to be reviewed and tools developed to support the expediting of approvals;

e) Codification standard for all items

• 1. Adherence to contract procurement by facilities;

• 1. Monitoring systems to review contract/off contract spend at facility/PHC level

2. Yes, There is a progress in the project as the SVS has been rolled out to facilities in Limpopo, Eastern Cape, KwaZulu Natal and City of Johannesburg.

Summary of activity that are in progress and activities still to be initiated (as stated above)

1. Roll out of SVS (in progress)
2. Trial “informed push” model (in progress)
3. Develop cross dock model (not started yet)
4. Identify items for contracts (not started yet)
5. Develop SOP’s for push model (in progress)
6. Agree on delegations (not started yet)

It should be noted that once the system is fully effective it will be rolled out to all facilities and provinces and non essential items will be added.

As the system progresses, a determination will still be made as to whether this system will include the items such as maintenance of facilities and whether there the system be able to integrate with LOGIS to cater for Non Essential items.

A phased approach has been adopted to roll out the system and it is expected that by 2018/19, the system will be fully functional in all provinces and in all 3500 clinics in South Africa.

END.

Reply:

1. The average waiting times for Odi District Hospital in Mabopane for the 1st and 2nd quarter of 2015/16 are as follows:

(a) (i) Registration ( opening or retrieving of a file): 30 minutes

    (ii) Waiting time in OPD: 130 minutes

    (iii) Waiting time at the Pharmacy: 100 minutes

   (iv) Waiting time Casualty depends on the Priority of the Patient. The average of non serious patients is 120 minutes.

b) The following are measures that the hospital has introduced improve long waiting times:

(i) The CEO and Hospital management conduct daily walkabouts to check patient’s queues, but also how the hospital staff deal with clients/patients.

(ii) The hospital has in place courtesy managers who are always at the frontline to closely monitor queues and how clients/ patients are assisted

The following are future plans for the Hospital:

(iii) To renovate the Pharmacy by adding more dispensing windows

(iv) To add additional staff to records so that clients are assisted timely

(v) To engage and educate the community to use Primary Health Care and Community Health Centres and the importance of appropriate referral.

(2) Odi Hospital falls under Region 1 of Tshwane Health District. Currently there are Emergency Medical Services Stations in the region namely Odi, Rosslyn, Jabulani and Ga-Rankuwa. There are 24 ambulances which are operational however by end of September 2015, a total of 16 ambulances out of the 24 ambulances were operational. A total of 8 of the ambulances had either gone for regular service, breakdown repairs or accident damage.

(3) Gauteng Province EMS is currently in the process of procuring 160 ambulances for the 2015/16 financial year. These ambulances will be distributed equitably throughout the Province.

END.

Reply:

1. (a) Since 01 April 2015, the National Institute for Communicable Diseases (NICD), the National Institute for Occupational Health (NIOH) and the Cancer Registry have been directly funded;

(b) The proposal was discussed with the National Treasury. At the Budget Council meeting in January 2015, it was agreed that the Department of Health and National Treasury should work on a completely new funding model for implementation as of 01 April 2016;

(c) The National Treasury, in funding National Functions directly has made provision in the National Department of Health budget for a transfer payment to cover the costs associated with teaching and training undertaken by the National Health Laboratory Service (NHLS).

2. The Interim Management Team was appointed to investigate the billing issues reported. Below are the technical challenges that resulted in disputed debtor’s amounts:

• Unbundling of group tests (profile tests);
• Padding (grouping of tests);
• Wrong accounts (non Gauteng Department of Health and KwaZulu Natal Department of Health);
• Incorrect coding;
• Duplication of tests and billing;
• Multiple units billing (histology blocks);
• Missing demographics.

Unbundling of group tests

• This refers to the request for multiple individual tests instead of a group test resulting in the sum costs being more than the group test. The clinicians have an option to request some tests as a group or a single test. The approved Electronic Gate Keeping (EGK) rules state that the full profile of test can be done on admission of a patient then abnormal parameters to be repeated as required. The NHLS has also proposed that when individual or multiple tests within a profile are requested, and the cost of these tests exceeds the cost of the profile, the NHLS bill the profile cost to the Department of Health.

Padding of tests

• This occurs where an individual test that is included in a group test is billed with the group test. This should never happen under the normal circumstances. The NHLS has implemented measures to eliminate this error.

Wrong accounts (non Gauteng Department of Health)

• The NHLS and the Provinces are working together to identify and eliminate any incorrect locations billed through the reconciliation of monthly bills. Substantial progress has been achieved thus far.

Incorrect coding of tests

• This refers to the tariff codes used by the NHLS not being consistent with the coding lists of the Board of Healthcare Funders (BHF), the National Pathology Group (NPG) and the South African Medical Association (SAMA).

Duplication and Multiple units billing

• This relates to billing one test more than once on one specimen. Multiple units billing mainly happens in anatomical pathology where additional blocks of stains are made in order to get to the final diagnosis. This is an acceptable practice.

Missing Demographics

• These relate to invoices or tests done with missing demographic data. This creates problems in terms of verifying the information and could render the transactions invalid. The NHLS had already started the process of addressing this by determining the minimum clinical data sets (MCDS) required for NHLS to continue processing the specimen. The NHLS does not conduct tests if there is no compliance with MCDS.

3. The details are as follows:

• The status of debts receivable from Gauteng Department of Health and KwaZulu Natal Department of Health as at 18 September 2015 is totalling R5.1 billion;
• The breakdown is reflected in Table 1 below;
• This represents 95% of the total debts receivable from provinces amounting to R5.5 billion.

Table 1

Region	Outstanding amount 2015/16	Outstanding amount 2014/15	Prior amount outstanding	Total outstanding
Gauteng	197,419,209	328,955,740	922,495,933	1,448,870,882
KwaZulu Natal	110,053,771	702,643,913	2,866,174,418	3,678,872,101

4. The Bill has been prepared and it in the Cabinet process. It is pending approval by Cabinet, for it to be published for public comment.

5. The National Public Health Institute of South Africa (NAPHISA) Bill makes provision for the establishment of the Institute for Non-Communicable Diseases and Violence and Injury. These institutes will be established when the Bill is promulgated.

END.

Reply:

a) The process to develop the policy is currently underway.

b) Yes, the consultative meeting with stakeholders was held on 14 April 2015 in accordance with the annual performance plan.

Key relevant details discussed are as follows:

The stakeholder’s meeting was attended by clinical, technical and NHLS experts in cervical cancer.

In summary the team agreed that there should be three documents, namely:

• A policy document;
• Clinical guidelines; and
• Desk aid for nurses.

END.

Reply:

1. NHLS Headcount at end of August 2015

Job Title	Count
Total Staff Headcount	6776
Pathologist	210
Medical Technician	862
Medical Technologist	1385
Vacancies appearing as vacant on Oracle system today on 21 September 2015
Total	1246

2. YEAR	2 011	2 012	2 013	2 014	2 015
Pathologist	225	218	235	231	210
Medical Technologist	1 415	1 388	1 382	1 399	1 385
Medical Technician	652	639	771	810	862

3. There are 302 NHLS laboratories.

Province	Number of Labs
EC	67
FS	15
GP	43
KZN	56
LP	37
MP	21
NC	9
NW	15
WC	39
TOTAL	302

END.