Questions and Replies

Reply:

(1) (a) The National Health Insurance (NHI) will fund health care for 60m people. The Fund will be established once the Bill is enacted. The current spending on healthcare in the country is R554bn, which is split as follows:
 

FY21/22
Rand (bn)	%
Total public sector health	265 844	48,9%
Total private sector health	277 402	51,1%
543 246

Donors contribute R11 095bn, bringing total spend to R554 341bn

The NHI Bill provides that the bulk of the public sector health spend will be allocated to the NHI Fund by the normal appropriation route through Parliament.

(b) There is a provision in section 49 of the Bill for progressive introduction of taxes to move voluntary contributions into the Fund. In 2021/22 financial terms around R500bn is the equivalent funding of the present health system and it is these funds that will constitute the resource available to the NHI. This is in the order of 8,5% of GDP. Funds for non-personal health services, and capital for infrastructure development, will remain with the provincial departments.

(2) (a) The sources of funds that are presently spent in the health care system are as follows:

GOVERNMENT DEPARTMENT AND ENTITY	R (millions)
National Department of Health core	12 947
National Department of Health Indirect Conditional Grants	85
National Department of Health Direct Conditional Grants	60 000
Provincial Departments of Health Provincial Equitable Share	175 892
Defence (SAMHS)	5 474
Correctional Services	1 216
Local government (own revenue)	5 138
Workmen's Compensation contributions	* 3 502
Road Accident Fund levies	** 1 675
Compensation for Occupational Injuries and Diseases (COIDA)	***?????
Medical schemes (Employer contribution public service)	230 618
Medical schemes (Employer contribution private employer)
Medical schemes (Employee contribution)
Out of pocket	38 653
Medical insurance	5 501
Employer private (including Occupational Health)	2 630
Donors	11 95

* Unclear what portion is for medical expenses as opposed to other benefits
** Unclear what portion is for medical expenses as opposed to other benefits
*** Unclear what portion is for medical expenses as opposed to other benefits

(b) The public health system will continue to receive the present budget allocation but once the NHI is established the route of funding will change from te current route of Provincial Equitable Shares (PES) via block allocations to provincial governments and managed by provincial treasuries, through the National Vote to the Fund (as the South African Medical Research Council, Council for Medial Schemes and other entities are funded presently). The Fund will pay for the benefits and services provided. The leverage of the monopsony will obviate the challenges of patients moving between provinces and will allow for national interventions to communities that are under-funded (through strategic purchasing). By setting prices nationally the Fund will be able to control excessive pricing and purchase more care with the same funds.

(c) The Fund will also purchase benefits (patient care) from private providers who are presently not accessible to people who do not have medical scheme cover. This will increase the footprint of available services and improve accessibility.

END.

Reply:

The Department is not implementing the National Health Insurance (NHI) Bill in a rushed manner. The Department is following the provisions outlined in the approved 2017 NHI White Paper that provides for the NHI to be implemented in a phased manner. Section 309 of the White Paper provides for Health Systems Strengthening initiatives to continue being undertaken concurrently as the finalisation of the legislative process and the establishment of institutional arrangements for the NHI Fund are undertaken.

Furthermore, Clause 57 in the NHI Bill makes provision in the Transitional Arrangements where-in Clause 57 (1)(a) states that despite anything to the contrary the NHI must be implemented over two phases. Clause 57 (1)(b) states that National Health Insurance must be gradually phased in using a progressive and programmatic approach based on financial resource availability. Clause 57 (2) further provides health system’s strengthening initiatives such as addressing of infrastructure challenges to be undertaken during the transitional period.

It is indisputable that public hospitals do need infrastructure maintenance and investment. The Department quantified the anticipated cost at close to R200bn, which is clearly not going to be available in the short to medium term. There are nonetheless projects that are being attended to within the limits of available budget.

END.

Reply:

(a) Total number of cancer awareness campaigns:

1. Nine (9) provincial cancer awareness programs were conducted for Traditional Health Practitioners on identifying and referring the most common cancers in collaboration with CANSA.

2. One (1) cancer awareness campaign on breast, cervical and prostate cancer was conducted in Upington in Northern Cape in collaboration with Pink Drive.

3. Five (5) lung cancer awareness programs were conducted in collaboration with CANSA in KwaZulu-Natal.

(b) Cancer centres:

1. Three (3) Regional Breast Units were established.

2. There are twelve national oncology centers in the public health sector which provide access to cancer care for all citizens nationally. One of these has been established the last two years. This is the Mpumalanga medical oncology center. There are an additional eight centers across the country that are in various stages of being built. This will bring the total number of national oncology centers to 21 throughout the country.

END.

Reply:

The department has no evidence that adolescents are more likely to stop TB treatment compared to youth and adults. Given that this speculation is not backed by any scientific evidence, the department does not have specific programmes that are focused at preventing TB treatment interruption among adolescents, instead, the National TB Programme, through TB recovery plan, is aimed at essentially finding people with TB, linking them to care and retaining them in care until they finish their treatment, irrespective of age.

(1) Considering data at our disposal, there is no justification for such a programme, as we have a comprehensive programme.

(2) There are no research findings to share with Ms. H Ismail, because no research has been conducted by the National Department of health regarding prevention of treatment interruption among adolescents. END.

Reply:

The Department of Health provides bursaries that are administered by Provinces for students in the medical field to ensure supply of these professionals for the sector. In addition, funding of undergraduate training in the health sciences is subsidized by the Department of Higher Education through allocations to higher education institutions.

Admission to an undergraduate medical training programme is the prerogative of a medical school where the student has applied. Each provincial Department of Health would then evaluate its ability to support such students. The Minister encourages the provincial Departments of Health to provide funding assistance to undergraduate students in the medical field as much as possible.

END.

Reply:

Mental health facilities are being renovated as part of the Health Facilities Revitalisation Grant (HFRG) projects. Provinces also make renovations to health facilities including mental health facilities utilising their equitable share. Furthermore, mental health units are being built in general hospitals in compliance with the Mental Health Care Act, 2002 (Act No 17 of 2002) which prescribes integration of mental health into the general health services environment. Attaching mental health units to general hospitals is also relieving pressure on specialised psychiatric hospitals as these units provide mental health care, treatment and rehabilitation services and only refer to specialised psychiatric hospitals, those persons who require specialised and complex mental health interventions. The table below shows mental health infrastructure projects that are currently underway and funded through the HFRG.
 

Province	Facility	Project	Stage
Gauteng	Weskopies Specialised Psychiatric Hospital	Forensic mental observation unit	Tender stage
	Sebokeng Hospital	Attaching a new mental health unit	Design stage
Limpopo	Hayani Specialised Psychiatric Hospital	Forensic mental observation unit	Tender stage
	Evuxakeni Specialised Psychiatric Hospital	Hospital revitalisation	Clinical brief stage
	Thaba Moopo Specialised Psychiatric Hospital	Forensic mental observation unit	Design stage
Mpumalanga	KwaMhlanga Hospital	Attaching a new mental health unit	Tender stage
	Witbank Hospital	Revitalisation of the mental health unit	Design stage
	New facility	Building a new mental health hospital	Clinical brief stage
KwaZuluNatal	Benedictine Hospital	Attaching a new mental health unit	Design stage
	Bethesda Hospital	Attaching a new mental health unit	Design stage
	Estcourt Hospital	Attaching a new mental health unit	Design stage
	Ladysmith Hospital	Attaching a new mental health unit	Design stage
	Murchison Hospital	Attaching a new mental health unit	Design stage
	Northdale Hospital	Attaching a new mental health unit	Design stage
	Port Shepstone Hospital	Attaching a new mental health unit	Tender stage
	Prince Mshiyeni Hospital	Attaching a new mental health unit	Design stage
	RK Khan Hospital	Attaching a new mental health unit	Design stage
	Stanger Hospital	Attaching a new mental health unit	Tender stage
	Umphumulo Hospital	Attaching a new mental health unit	Design stage
	Umzimkhulu Hospital	Forensic mental observation unit	Design stage
North West	Bophelong Specialised Psychiatric Hospital	Building the general psychiatry section	Tender stage
	General De La Ray Hospital	Attaching a new mental health unit	Design stage
	Itsoseng Hospital	Attaching a new mental health unit	Design stage
Western Cape	Swartland Hospital	Attaching a new mental health unit	Design stage
	Belhar Hospital	Attaching a new mental health unit	Design stage

END.

Reply:

(a) (i) As on 02 December 2022 a total of 48 claims were received.
(ii)(aa)-(bb) To date none of the claims were assessed.

(b) (i) The adjudication panel has been appointed and assessments of claims will be conducted.
 

(b)(ii)	Types of vaccines administered	Age groups of people affected
	(aa)	(bb)
	Johnson & Johnson	Pfizer	Age group	Number
	21	27	80+	3
			70-79	2
			60-69	11
			50-59	8
			40-49	9
			30-39	2
			20-29	7
			12-19	6

Reply:

There are no current systems-wide shortages of medication in health facilities although facilities do run out from time to time owing to operational reasons.

It is the Departments of Health’s policy to ensure equitable access to quality healthcare through availability of safe, effective and cost-effective medicines at the appropriate level of care. The National Department of Health manages contracts of approximately 1 200 essential medicine items. Contracts are awarded to suppliers (manufacturers) following an open tender process in accordance with the Public Finance Management Act. Provinces procure medicines directly from contacted suppliers. Note that the public sector services the healthcare needs of 84% of South Africa’s population.

The NDOH continuously engages with the contracted suppliers to identify any possible supply challenges, to adjust the demand forecast (where necessary) and to work together to mitigate the risks. Furthermore, the NDOH established a decision-making forum where all provinces are represented; to identify interventions aimed at addressing any medicine supply challenges, to improve medicine availability and to reduce the potential impact of stock outs.

Where supply constraints are identified, the NDOH works with the provinces to identify and implement interventions to minimize stock outs and impact on patients. These interventions are informed by the cause of the supply challenge:

Where the supply constraint is due to operational matters e.g., machine breakdown, labor unrest, theft, post importation testing, etc. the NDOH would source products from alternative local suppliers with registered products using the quotation process.

Should the supply constraint result in a longer term supply challenge, such as regulatory matters including amendments to the dossier that requires approval from South African Health Products Regulatory Authority (SAHPRA), including a change/addition of an active pharmaceutical ingredient source and/or manufacturing site, the transfer of ownership of dossiers which results in a change of marketing authorization, delays in the issuing of the permits for imported medicines, manufactured products requiring additional quality checks by SAHPRA, etc. and no alternative local suppliers with registered products are available; an application would be made to SAHPRA for the acquisition of unregistered medicines for human use in terms of Section 21 of the Medicines and Related Substances Act.

With regard to antiretroviral medication, there are no wide-spread supply challenges. As on 05th December 2022,

Overall medicine availability across all facilities is 87.1%
Availability of antiretrovirals is 91.1% Availability of 1st line antiretrovirals is 97.4%

END.

Reply:

The National Department of Health can confirm that from the total of 3 510 posts for porters, 3 193 are filled. The 148 posts were filled during the current financial year 2022/2023 in the nine (9) Provincial Health Departments, respectively, as recorded in the PERSAL date set of 31 October 2022.

Due to financial constraints, Provinces have implemented a systematic process of approving funding and advertisements of both health related and administrative posts by accounting officers in consultation with Provincial Treasuries. This process, supersedes filling of vacant posts to avoid exceeding Cost of Employment (COE) budgets. END.

Reply:

In line with the Primary Health Care Package Norms and standards, clinics operates 8 hours a day and 5 days a week and a Community Health Centres (CHC) operates 24 hours a day and 7 days a week. For the PHC facility to qualify to operate for 24 hours, the following criteria need to be met:

• Annual facility head count should be ± 120 000
• Monthly average headcount of 10 000.

According to the District Health Information System (DHIS) Annual Report 2021/2022, the head count for the Clinic in Extension is 22 779 which is far below the required head count, whilst monthly average headcount was 1898. For the current year, the monthly average headcount is 2170. In addition, acceptable travelling distance to the nearest facility is 5 km. The Clinic in question is within 3.8 km radius to the Khutsong CHC which is open for 24 hours and 7 days a week. The Clinic in Extension 3 therefore does not meet the criteria to operate for 24 hours and 7 days a week.

END.

Reply:

The Honourable Member is requested to indicate the levels of the positions she is referring to. The manner in which the question is phrased is very broad as there are many categories and levels.

END.

Reply:

The responsibility and process for receiving and reviewing requests and granting permission for new clinics to be developed is with provincial and district health management.

(a) In the case of a private health facility, applications for new facilities are made to the district management. District management then makes a recommendation to a provincial committee and the provincial committee will make a decision based on documentation received from the district. The provincial committee will make a recommendation to the accounting officer of the provincial health department to approve or not. The district recommendation will be based on the following:

(i) A detailed explanation of why the facility is required
(ii) Is an existing building considered or is a new building required
(iii) Size of population to be served
(iv) Proximity and utilisation rate of facilities in the same catchment area.
(v) Human Resource Plan
(vi) Stakeholder inputs

In the case of a public health facility, a decision will be made based on the size of the community to be served and the proximity and utilization rate at the nearest existing health facilities. If after considering the above factors, it is found that the community does need a new clinic, the construction of the clinic will be planned for in terms of the availability of land, and human and material resources.

(b) In the case of a private facility, it can take up to 90 days since provincial review meetings generally take place once a quarter. In the case of a public facility, the community will be involved in discussions through local community leaders and the district health council. Through these structures continual feedback is provided with regard to progress.

(c) In the case of a private facility communication will be in writing. In the case of a public facility, the community will be informed through community and district structures, whether the building of a clinic has been approved or not, and if approved for which year its planning has been entered into the provincial department’s infrastructure plan. Should community members engage Department’s in writing they should receive responses in writing as well.

Reply:

The department of Health, in collaboration with the Department of Basic Education provides integrated school health program (ISHP) to learners in schools, to among others prevent barriers to teaching and learning. Some of the service include provision of spectacles to learners who are visually impaired. The service provided through this programme include visual assessment which may result in referral of the learner to the next level of care for possible provision of spectables.

(a) the number of learners who have been provided with glasses through the specified programmes and

The actual number of learners who were provided with spectacles are in provinces and Districts as the programme implementerand are reflected here below:

 

Province	Data Element	Apr 2020 to Mar 2021	Apr 2021 to Mar 2022	Apr 2021 to Sep 2022	Totals to date
Eastern Cape	Spectacles issued to child - total	160	362	264	366
Free State	Spectacles issued to child - total	33	401	23	142
Gauteng	Spectacles issued to child - total	1 284	3 405	2 109	3 091
KwaZulu-Natal	Spectacles issued to child - total	3 374	4 620	3 466	3 912
Limpopo	Spectacles issued to child - total	329	494	590	732
Mpumalanga	Spectacles issued to child - total	213	659	469	703
Northern Cape	Spectacles issued to child - total	28	56	27	36
North West	Spectacles issued to child - total	21	188	127	218
Western Cape	Spectacles issued to child - total	384	3 511	1 702	3 184
South Africa	Spectacles issued to child - total	5 826	13 696	8 777	12 384

 

(b) The programme is a school health-based intervention, which is tailor-made for the learners only, due to limited number of school health nurses, hence the modality is delivered for specific grades and not all learners in a school. Citizens can still visit their nearest health care facilitities, where they can be screened for vision and referred to Optometrist for further diagnosis and provision of spectacles if indicated.

 

END.

Reply:

Yes, the department does have an oversight mechanism for all healthcare clinics in the country irrespective of the area of location. The district health system of the country has been set up to take supervision of health facilities closer to where they are, and to ensure a fair and realistic management workload. The provinces have gone a step further in ensuring responsive supervision and support to all clinics and community health centers including rural clinics by dividing the 52 health districts into subdistricts. In addition, the clinics committees comprising members from the communities play a vital oversight role for service delivery in each primary health care facility.

END.

Reply:

(1) Since 2006, there has been 4 lead poisoning cases that were notified to the National Institute for Communicable Diseases (NICD) nationally. Two (2) cases were reported in 2017, one from Free State Province and the other one from Mpumalanga province. The other two (2) cases were reported in 2022, one from Eastern Cape province and the second one from Western Cape province.

According to the World Health Organization (WHO), clinical diagnosis of lead poisoning is difficult, as a result, it can be misdiagnosed. The reason being most lead poisoned individuals are often asymptomatic and even when signs and symptoms are present, they are difficult to differentiate and relatively non-specific poisoning symptoms such as anorexia, nausea, vomiting, abdominal pain, constipation, poor concentration, headache, fatigue, language and speech delay, behavioral problems, etc. Lack of clear history of exposure, also contributes to difficulty in making a clinical diagnosis. Laboratory investigation which can only happen based on the clinician/medical practitioner`s perception of the need for it, is the only reliable way to diagnose leadexposed individuals (WHO. 2011.Brief Guide to Analytical Methods for Measuring Lead in Blood; WHO.2010. Childhood Lead Poisoning).

(2) (a) Education and training on lead poisoning is part of doctors and nurses undergraduate education and training and there are continual in service initiatives that are ongoing to raise awareness and improve the knowledge on lead poisoning and other related matters.

(b) The fact that nurses and doctors receive under-graduate training plus the continuous awareness programmes that are currently underway, means that all health facilities should be able to act (get patients tested/refer for tests) on suspicion. Tests from health facilities are done at the National Health laboratory Services.

(3) (a) The 0.009% lead content limit in paint is not yet in force. The relevant government Gazette Notice where this 0.009% lead content limit was legislated was published for public comments and comments are in the process of being incorporated. Therefore, the current lead in paint declaration as a hazardous substance law, Gazette Notice No. 801 of July 2009, is still applicable until repealed by the new law. The lead paint law is monitored by Environmental Health Practitioners (EHPs) at national, provincial and at municipal level. Chemical safety and hazardous substances control functions fall within the work scope of EHPs in terms of the Scope of Profession for Environmental Health, R888 of 26 June 1991. Monitoring is done through inspections, sampling, seizure and detaining paint products and subjecting suspected or randomly selected sampled paint product to laboratory analysis and taking any further necessary legal action.

(b) The consequences of contravening the Hazardous Substances Act, Act 15 of 1973; range from a fine to imprisonment for a period between 6 months and 10 years depending on the offence or to both a fine and such imprisonment.

(4) The Department does not remove lead from buildings. According to WHO, as long as the paint on painted wall surfaces remains intact, the lead content is not a hazard unless it deteriorates or ages showing peeling, chipping, chalking or cracking as it releases lead into dust (WHO. 2020. Global elimination of lead paint: Policy brief). It is the responsibility of each building owner to ensure that its building paint is in intact condition.

(5) (a) The South African Medical Research Council (SAMRC) started its education campaign on lead in 2004.

(b) The campaign has developed a number of lead hazards awareness raising materials, including training toolkit in collaboration with the Department of Health. The leaflets embraced various lead exposure sources and pathways such as paint, painted surfaces, toys, cookware, lead bullet ammunition, and melting fishing sinkers. It has also shared information on lead exposure, research findings and recommended intervention measures for government and communities in various government events and academic platforms through presentations, exhibitions, and lectures, targeting various health and education professionals and students.

END.

Reply:

(a) The expenditure that has been ascribed to National Health Insurance (NHI) money has been used to fund efforts to strengthen the health system’s performance in preparation for NHI and not on the actual functions of the NHI Fund. This funding has been allocated through the NHI Grant and has been used to develop and test provider payment mechanisms, expanding the national insurance beneficiary registry, and purchasing and providing a prioritised set of health services. The funding has also been allocated for quality improvement initiatives within the non-personal services component of the NHI indirect grant with the aim of helping facilities meet the envisaged standards required for NHI accreditation.

(b) The breakdown of the NHI Grant allocation is based on both the Direct and Indirect Grants allocated as follows:

Find here: National Health Insurance Direct Grant

Reply:

NW4823E

a) The National Department of Health is still consulting with Provincial Departments of Health to verify the figures in each province. This information will be furnished to the Honourable Member as soon as it is received from Provinces.

b) The table below illustrates the steps taken to address the backlog

Province	(b) What steps have been taken to address the specified backlog
Eastern Cape	Information not yet received
Free State	Increased number of days for Elective slates: from 2 days (2021) to 4 days (2022) theatre allocation. Prioritized emergency surgery within first 6 to 12 hours. Developed quality improvement plan to monitor theatre utilization and efficiency via Theatre User Committee Meeting. Expedite appointment and transfer of two Theatre trained nurses form KZN and other areas by 31 October 2022 Submission to temporarily use four agency nurses from 1 November 2022 Appoint one medical officers by 01 January 2023. All the backlog patients have elective dates for surgery. Emergencies done daily. Gynaecologist electives are reduced with seven (7) operations weekly. Obstetric electives or backlogs are reduced with ten (10) operations weekly. Electives will stop on 31 December 2022, and resume 2nd week of January 2023.
Gauteng	Procurement of Brachytherapy machines and rental of mobile units as an interim measure. Filling of critical posts at institutional level. Setting up surgical camps within clusters. Extending sessional work to private sector staff to assist to reduce surgical backlogs at public hospitals. Utilising the Public Private Partnerships to address the backlogs, depending on the budget. Working with Eskom to exempt most facilities from load shedding schedules. Working with Johannesburg water to exempt facilities from water shedding. Maximise the referral pathways and channel the patients to the appropriate level of care for surgical procedures by down referring and up referring patients. Working with Department of infrastructure to strengthen maintenance issues at facility level.

KwaZulu Natal	Catch-up has been done by increasing theatre times. Elective slates done over the weekend to catch up. Camps have also been planned. Using after-hours to reduce backlog. Elective theatre slates run after hours. Maximum utilization of theatres with added slates on weekends. An elective marathon is planned to further reduce the backlogs. Cataract camps are regularly conducted. All slates have re-commenced with increased theatre times and using after-hours to reduce backlogs.
Limpopo	The Outreach Surgical Services occur monthly rotating in the five districts to ensure that specialised clinical and surgical operations are conducted at district hospitals. Teams of specialists allocate each other for seven days a month to conduct these surgeries, thus address the backlog. Limpopo Department of Health has a Public Private Partnership with three private hospitals, wherein some of the elective surgery like hysterectomies, hip replacements, urology and general surgery cases are conducted for an agreed fee
Mpumalanga	Rob Ferreira Hospital: A sessional Orthopaedic Surgeon was appointed during the second quarter and operating days has been increased to four days in a week. Additionally, the orthopaedic team also operates in Barberton District Hospital four days in a week. Witbank Hospital: Expanded outreach to Ermelo, Evander, Middelburg and Kwa Mhlanga. Increased operating times for orthopaedics from office hours to after hours and weekends. Improved efficiencies in orthopaedics by streamlining its functions into responsible units. Theatre time during office hours, was increased. Ermelo Hospital: Appointed fulltime orthopaedic surgeon with effect from 01 October 2022. Mapulaneng Hospital: Appointed fulltime orthopaedic surgeon who conduct surgeries and does outreach to surrounding district hospitals.
	Themba Hospital: Increased theatre time by opening the 4th theatre.
Northern Cape	Information not yet received
North West	Currently Klerksdorp/Tshepong theatres are undergoing revitalisation and multiple theatres are being renovated. Most of the theatres are likely to be handed over back by the end of the year. However, all efforts are made to make theatres functioning efficiently to reduce backlog. Weekend blitz is planned next year once theatre renovations are completed. Outreach to Moses Kotane Hospital. First round started 13 October 2022. General Surgery recruited a Surgeon commencing on 01 October 2022 In Ophthalmology weekend blitz was started on 22nd October 2022 Urology specialist employed and planned outreach to start as soon as new ordered equipment is delivered In Gynaecology number of theatre days have been increased Ear, Nose and Throat Specialist was recruited starting on 01 November 2022 Daily optimization of operations thus increasing output during working hours. Doctors on call to perform minor procedures whilst on call. Every weekend, 2 doctors on call with an intern to continue with some cases from the backlog.

	First part of the recruitment of additional nursing staff required for maximum theatre utilization has been completed, and the process of other staff member is underway. Utilization of other facilities for referring minor cases such as cataracts. Planned weekend marathons have been started particularly in orthopaedic cases. Procurement of autoclave and sterilising machines underway.
Western Cape	Operations increased by dedicated budget increase and efficiency gains. Operations increased by outreach support and efficiency gains.

END.

Reply:

(a) The Limpopo Provincial Department of Health has confirmed that there was no new ICU that was recently constructed for the Bela Bela hospital because the existing ICU is still in good condition.

(b) The existing intensive care unit is fully functional.

 

END.

Reply:

The National Department of Health is still consulting with the Eastern Cape Provincial Department of Health to gather all the information required to respond to this Question. The full response will be furnished to the Honourable Member and Parliament as soon as all details have been received from the Province.

 

END.

Reply:

A total of 213 hospitals has been submitted to Eskom to be considered for possible exclusion from loadshedding. About 67% of these hospitals are supplied by municipalities while Eskom supplies about 33% of the identified hospitals. Out of the 213 hospitals, 76 hospital has been exempted of which 25 are directly supplied by Eskom and 50 by Municipalities. The number of hospitals exempted to date have doubled since the meeting held on 22 September 2022 between Eskom and National Department of Health. It is still work in progress.

END.

Reply:

According to information received from the Gauteng Provincial Department of Health, the response is as follows:

a) (i)–(ii) The total budget and/or grants provided to the South Rand Hospital in Johannesburg in the past three fiscal years and from 1 April 2022 to date

VOTED FUNDS
	Budget allocated	Expenditure	Over/Under spending
i) Voted funds 2019/20
i) Voted funds 2020/21	R 302,152,000.00	R 318,170,000.00	-R 16,018,000.00
i) Voted funds 2021/22	R 310,035,000.00	R 339,099,000.00	- R 29,064,000.00)
ii) Voted funds 2022/23	R 328,027,000.00	R 161,235,000.00	R 166,792,000.00
CONDITIONAL GRANTS
	Budget allocated	Expenditure	Over/Under spending
i) HIV Conditional grant 2019/20
i) HIV Conditional grant 2020/21	R 16,309,000.00	R 14,517,018.22	R 1,791,981.78
i)  HIV Conditional grant 2021/22	R 22,150,000.00	R 15,300,366.32	R 6,849,633.68
ii) HIV Conditional grant 2022/23	R 21,653,000.00	R 10,892,673.01	R 10,760,326.99

	Budget allocated	Expenditure	Over/Under spending
i) COVID-19 Conditional grant 2019/20
i) COVID-19 Conditional grant 2020/21	R 5,199,000.00	R 6,694,786.78	-R 1,495,786.78
i) COVID-19 Conditional grant 2021/22	R 18,641,000.00	R 20,064,170.97	-R 1,423,170.97
ii) COVID-19 Conditional grant 2022/23	R 1,305, 000.00	R 1,497, 383.80	-R 192,383.80

b) The hospital conducts the mandate as stipulated by the strategic objectives of Gauteng Department of Health. It shares the vision of a responsive, value-based and people centred health system.

The hospital also ensures delivery of highest level of health care by strengthening clinical governance and building a culture and practice that ensures that quality assurance, patient safety and accountability are a priority.

To realize clinical effectiveness, the hospital’s management continue to monitor annual performance plan clinical indicators and make appropriate adjustments within the available human, material, and financial resources to ensure delivery of services.

c) (i) The current staff vacancy rate is s at 4% and is derived from the following:

• Funded posts - 655
• Filled posts - 629
• Funded vacant posts – 26

(ii) All vacant posts are in the process of being filled and are at various stages of the recruitment and selection process.

iii) The provision of essential services continues despite the vacant posts within the hospital. The hospital renders effective and efficient health services with the available resources while awaiting the formal appointment of the officials in all the critical vacant posts.

iv) The process is currently at various stages of the recruitment and selection. Filling of the posts depends on a number of processes and cannot be definitely calculated at this stage. However, it is envisaged that a number of these posts will be filled by the first quarter of 2023.

d) It takes an average of 3 months to complete the recruitment and selection process for a position. The hospital will fill all the funded vacant posts by the first quarter of 2023.

END.

Reply:

(1. a) The National Department of Health has one Corporate Bursary Programme which targets only employees of the National Department of Health and its satellite offices.

(b) (i) The funding allocation for audited years:

Audited Year	Allocation	Expenditure
2020/21	R1,200,000.00	R408,240.88
2021/22	R1,500,000.00	R746,040.45

(ii)

The department has only 1 Corporate Service Bursary programme.

(c) Employees who received bursaries are as follows:

Audited Year	Number of beneficiaries
2020/21	06
2021/22	16
2022/23	The Study Assistance Committee is finalizing the adjudication process

(d) The department did not encounter any irregularity for the audited financial years and as such did not lose any money. The programme is audited on a regular basis and no findings were flagged during the audited financial years.

(2) (a) there are no officials that were suspended, disciplined and/or dismissed because there has not been any reported irregularly in relation to the bursaries offered by the National Department of Health.

(b) based on the response in part (a) above, the question is therefore not applicable

(c) based on the response in part (a) above, the question is therefore not applicable

(d) based on the response in part (a) above, the question is therefore not applicable

(3) There are no officials that were suspended, disciplined and/or dismissed because there has not been any reported irregularly in relation to the bursaries offered by the National Department of Health

 

END.

Reply:

(a) According to the South Rand hospital management the current staff complement in the hospital is six-hundred and twenty-nine (629) with a vacancy of twenty-six (26).

(b) (i)(aa)(aaa) Table 1 below indicate absentee record in each month for financial year 2020/21

Financial year 2020/21	Absentee record (raw number)	Absentee record (percentage) (N=629)
April	19	3%
May	31	5%
June	38	6%
July	57	9%
August	25	4%
September	38	6%
October	31	5%
November	25	4%
December	25	4%
January	25	4%
February	25	4%
March	19	3%
Annual average	31	5%

(b) (i)(bbb) Table 2 below indicate absentee record for financial year 2021/22

Financial year 2021/22	Absentee record (raw numbers	Absentee record (percentage) (N=629)
April	19	3%
May	25	4%
June	57	9%
July	31	5%
August	31	5%
September	25	4%
October	13	2%
November	31	5%
December	57	9%
January	38	6%
February	16	2.5%
March	19	3%
Annual Average	31	5%

(bb) Table 3 below indicate absentee record for financial year 2022/23

Financial year 2022/23	Absentee record (raw numbers	Absentee record (percentage) (N=629)
April	25	4%
May	25	4%
June	31	5%
July	38	6%
August	25	4%
September	25	4%

(c) The hospital has processes, procedures and mechanisms to always ensure staff attendance

• All employees are required to record their attendance in the Z8 register daily by entering the time they report for and leave work.
• The leave register is also used to manage staff attendance for both sick and vacation.
• Shift supervision in each department to verify employee attendance during all required working hours.

END.

Reply:

After consulting with the Provincial Departments of Health, the Minister is convinced that Provincial Departments of Health have developed efficient and effective plans to ensure that despite financial challenges they encounter within the Cost of Employment (COE), viable plans have been developed to sustain service delivery across all nine Provinces. This is substantiated by the information in the table below:

Question	EC	FS	GAU	KZN	LIM	MPU	NW	NC	WC
1(a) what steps has his department taken to fill such posts	The Department has approved its Annual Recruitment Plan for 2022/23 which comprises 1057 critical posts (including nursing) to be filled. The funding emanated from equitable share and conditional grants. Advertisements are published monthly and posts have been filled, whilst others are still in selection phases.	Due to the current pressure on the compensation of employees, the department has appointed a Recruitment Task Team that looks at reprioritization of critical posts in line with the available budget	As of the 30th September 2022, there were 4 392 unfunded vacant nursing posts in the organisational structure of the Gauteng Department of Health. The Department has requested for additional funds to fill the critical vacant nursing posts.	As at 31 October 2022, the Department has prioritized filling of 426 Nursing posts: Professional Nurses 176 Staff Nurses 164 Nursing Assistants 86	The Department has advertised professional nurses’ posts, already shortlisted and interviews have been conducted.	The Department Annually identifies critical posts and demands that need to be filled throughout the year. The Department has the following posts with no funding to fill them however, identified to be critical to ensure continuity of quality health care in the province.	The Department identified critical vacant nursing posts vacated prior to 01 April 2022 to be filled during the 2022/23 financial year within the available compensation of employees' budget. Posts are filled as soon as possible considering the Department of Public Service and Administration (DPSA)'s prescripts in terms of advertising, shortlisting, interviews and verification processes	The Department prioritised the filling of the critical and scarce skills within the nursing fraternity. The HR Plan addresses the need as a priority for the 2022/2023 financial	Vacancies are filled on a continuous basis through block adverts and recruitment throughout the year in response to the service demands.
1(b)(i) in which provinces will the specified vacancies be filled and (ii) what number of the total number of vacant posts will be filled)	The department prioritized the filling of 867 posts (i.e. 230 permanent vacant posts in different categories, including Operational Managers, Professional Nurses: General, Professional Nurses: Specialty, Staff Nurses and Nursing Assistants and 637 Professional Nurses: General under the Vaccination Programme for a contract period of twelve (12) months).	The department prioritized the filling of 477 nursing posts dependant on availability of the budget	Awaiting for approval of additional funds	The department prioritized the filling of nursing posts in levels of care as they become vacant	A total of 254 posts ranging from Nursing Manager to the level of Nursing Assistant will be filled	A total of 155 staff Nurses for various hospitals and PHC Centres and 142 posts that are vacated, earmarked to be filled by Specialised nurses in the following fields of speciality: Oncology, Trauma, Advanced Midwifery, Surgery, Ophthalmic, ICU, Theatre, and Nephrology.	A total of 233 nursing posts will be filled (Professional Nurses for District Health Services = 147and Professional Nurses for Hospital and Clinical Support Services = 86)	The department is prioritising the filling of speciality and supervisory/managerial posts. The following total number per category will be filled; Operational Manager General/Speciality – 30, Assistant Managers General/Speciality – 20 and Professional Nurse General/Speciality – 30. Total - 80	As at 17 October 2022, the Western Cape had 808 vacant funded nursing posts that are being in the process of being filled.

2. Eight Provincial Departments of Health conduct their own advertisement and recruitment processes; and do not involve any other Employment Services. Only the Western Cape has partnered with agency personnel to supplement its capacity details of which were not provided in the response.

END.

Reply:

1. (a) The National Department does not have any agreement with Temporary Employment Services (TES) in terms of the training of nurses. The Department does not form partnerships with labour brokers or agencies for the training of nurses.

Prospective providers for Nursing Education programmes have to register with Department of Higher Education and need to apply for accreditation from the South African Nursing Council (SANC) and the Council on Higher Education (CHE). Applications are done per programme leading to registration in any of the prescribed categories of nursing according to the Nursing Act, 2005 (Act No 33 of 2005). The SANC accredits nursing education institutions and programmes in terms of professional integrity, standards of education, clinical training and placement in appropriate health facilities. SANC also consider whether programmes demonstrate relevance, responding to a specific population’s health service needs. The CHE accredit programmes based on the academic standards of Higher Education.

(b) Induction is done by the health establishment for every cohort of new recruits, focussing on, amongst other subjects, national-, provincial-, and the health establishment’s policies. Health professionals are additionally inducted on the health establishment’s standard operating procedures for the professional group. This function cannot be outsourced, as it forms an integral part of orientation of new employees to a workplace and is seen as letting new employees feel welcome and appreciated by their employers.

2. (a) The National Department of Health has no plans to utilize TES for medical training. Medical training is the exclusive domain of medical schools.

(b) The Department has not established the accreditation status of the TES training programmes

(3)(a), (b) (i), (ii) See reply to (1) (a) here above.

 

END.

Reply:

SHORT-TERM INTERVENTIONS

1. The National Department of Health has provided Eskom with a total of 213 hospitals to be considered for possible exclusion from loadshedding. About 67% of these hospitals are supplied by municipalities while Eskom supplies about 33% of the identified hospitals. Out of the 213 hospitals, 76 hospital has been exempted of which 25 are directly supplied by Eskom and 50 by Municipalities. The number of hospitals exempted to date have doubled since the meeting held on 22 September 2022 between Eskom and National Department of Health.

MEDIUM-TERM TO LONG-TERM INTERVENTIONS

2. The preliminary network analysis that has been conducted reveals that 25 hospital in various provinces can be excluded from loadshedding by building new infrastructure at the indicative cost of approximately R101 million rand. For hospitals deeply embedded in the Municipalities networks, Eskom will support the Department of Health in exploring possible options and can offer containerized PV(PhotoVoltaics) solutions where possible.

3. The National Department of Health in partnership with CSIR (Council for Scientific & Industrial Research) is currently conducting a due diligent exercise for the installation of solar panels at all our health facilities as a first or second or third power back-up mechanism (first being generators; second being solar panels; and third being Uninterrupted Power Suppliers). This due diligent exercise is inclusive of solar PV + battery storage as backup for the critical areas of the following hospital types based on an estimated demand profile

• Clinics both 8 & 24 hours
• Community Health Centres (CHCs):
• District Hospitals
• Regional Hospitals
• Tertiary Hospitals
• Central Hospitals
• Specialized Hospitals

The purpose of the study is to identify a critical consumption for critical areas of each health facility so that the department can be able to roll-out the relevant solar energy for each health facility.

 

END.

Reply:

1. (a) In line with Mental Health Care Act, 2002 as well as the World Health Organization’s approach to mental health services delivery, mental health is integrated into the general health services environment from primary health care level upwards. This is because individuals with a mental health problem often have other comorbidities as well. The budget for mental health is therefore integrated into other health services budget and cannot be singled out. The only clear cut mental health budget is that of specialised psychiatric hospitals, subsidies to community based mental health services, contracted mental health services budget, Mental Health Review Boards budget and the recently allocated conditional grant for mental health. The table below depicts the budget for mental health per province in the past five financial years as provided by the provinces.

Province	2017/18	2018/19	2019/20	2020/21	2021/2022
Eastern Cape	R776 812 825	R814 343 561	R842 019 615	R677 232 329	R685 291 223
Free State	R383 350 000	R373 432 000	R389 396 100	R374 545 000	R421 315 000
Gauteng	R270 849 000	R391 061 000	R505 703 059	R610 018 600	R664 723 555
KZN	R858 384 455	R922 424 520	R965 369 481	R1 002 502 520	R954 083 000
Limpopo	R517 009 000	R547 850 000	R567 535 000	R584 614 000	R611 386 000
Mpumalanga	R48 693 000	R53 692 707	R59 510 701	R65 118 946	R78 647 305
Northern Cape	R54 871 000	R85 205 000	R108 547 000	R119 510 000	R127 371 000
North West	R482 452 366	R506 307 086	R503 906 430	R542 408 696	R602 446 383
Western Cape	Figure not provided	R921 445 000	R984 102 000	R992 619 000	R1 042 290 000
Total	-	R4 625 760 874	R4 926 089 386	R4 968 569 091	R5 189 492 466

(b)(i) The Department of Health’s Norms for Severe Psychiatric Conditions require a minimum of:

• 1x psychiatrist for acute inpatient mental health services per 100 000 fifteen (15) years and older population.
• 0.1x psychiatrist for medium to long stay inpatient mental health care per 100 000 fifteen (15) years and older population.
• 0.25xpsychiatrists for ambulatory mental health services per 100 000 fifteen (15) years and older population.

In terms of the 2022 midterm population estimates the population of 15

years and older is 43 593 223.

In line with these norms that are based on the World Health Organisation model for mental health human resources, an estimated minimum number of psychiatrists required to service the 43 592 223 South Africa population of fifteen (15) years and older is 589.

There are no norms to estimate the number of psychiatrists needed for the below 15 years old population.

According to the Health Profession’s Council of South Africa registers, South Africa has 930 psychiatrists.

(ii) The Norms for Severe Psychiatric Conditions measure the mental health service needs through the number of beds required as opposed to number of mental health facilities. In terms of the norms, a population of 100 000 fifteen (15) years and older population require an estimated minimum of 28 beds for acute mental illness, 10 medium to long stay beds and 20 beds for community based residential mental health services. In this regard, the 43 592 223 fifteen (15) years and older South African population require an estimated minimum total of 25 283 mental health beds:

• 12 206 beds for acute mental illness
• 4359 medium to long stay mental health beds
• 8718 community based residential mental health beds

According to the latest available statistics obtained from provinces South Africa has 19752 mental health beds.

(iii) Campaigning for increased awareness with regard to prevention of mental illness (adopting a healthy lifestyle), early detection and how to access mental health services when needed is a continuous process. The National Department and provincial health departments are currently doing so through door-to-door campaigns, pop-up stalls at events and in malls, community events, group and one-on-one counselling at health facilities, community radio slots and print media. These campaigns also focus on combating stigma that is associated with mental illness.

(2) Budgeting for health and other government services depends on the available resources. The World Health Organization recommends that countries allocate a minimum of between 5% and 10% of the country’s total health budget to mental health. The current estimates indicate that South Africa is spending 5% of its total health budget on mental health.

 

END.

Reply:

a) The supply constraints related to contraceptives have been resolved. Currently, there are no challenges related to the availability of contraceptives. As on 04 November 2022, availability of contraceptives across all facilities in the public sector was 91.3%.

b) It is the Departments of Health’s policy to ensure equitable access to quality healthcare through availability of safe, effective and cost-effective medicines at the appropriate level of care. The National Department of Health manages contracts of approximately 1 200 essential medicine items. Contracts are awarded to suppliers (manufacturers) following an open tender process in accordance with the Public Finance Management Act. Provinces procure medicines directly from contacted suppliers. Note that the public sector services the healthcare needs of 84% of South Africa’s population.

The NDOH continuously engages with the contracted suppliers to identify any possible supply challenges, to adjust the demand forecast (where necessary) and to work together to mitigate the risks. Furthermore, the NDOH established a decision-making forum where all provinces are represented; to identify interventions aimed at addressing any medicine supply challenges, to improve medicine availability and to reduce the potential impact of stock outs.

Where supply constraints are identified, the NDOH works with the provinces to identify and implement interventions to minimize stock outs and impact on patients. These interventions are informed by the cause of the supply challenge:

• Where the supply constraint is due to operational matters e.g., machine breakdown, labor unrest, theft, post importation testing, etc. the NDOH would source products from alternative local suppliers with registered products using the quotation process.
• Should the supply constraint result in a longer term supply challenge, such as regulatory matters including amendments to the dossier that requires approval from South African Health Products Regulatory Authority (SAHPRA), including a change/addition of an active pharmaceutical ingredient source and/or manufacturing site, the transfer of ownership of dossiers which results in a change of marketing authorization, delays in the issuing of the permits for imported medicines, manufactured products requiring additional quality checks by SAHPRA, etc. and no alternative local suppliers with registered products are available; an application would be made to SAHPRA for the acquisition of unregistered medicines for human use in South Africa Act use in terms of Section 21 of the Medicines and Related Substances Act

With regard to:

• Metformin – there were no supply challenges in the public sector.
• Betagesic – i.e. ibuprofen. There were no supply challenges as contracts were awarded to four different suppliers to ensure security of supply of ibuprofen.
• Napamol – i.e. paracetamol 500 mg tablets. There were no supply challenges as contracts were awarded to four different suppliers to ensure security of supply of paracetamol.
• Ponstan – i.e. mefenamic acid. This medicine is not an essential medicines and therefore there is no contract for this item.

The availability of ibuprofen and paracetamol at facility level as on 04 November 2022 was 92% and of metformin, 91.2%.

The question from the Honourable Ismail is reflective of stock outs experienced in the private sector over which the Department has no control. Private sector services the healthcare needs of only 16% of South Africa’s population.

Private sector pharmacies procure medicines from wholesalers based on Single Exit Price. In this context, there is no aggregation of demand. Furthermore, availability is dependent on market forces based on supply and demand. The situation makes the private sector vulnerable to supply challenges.

However, with the implementation of National Health Insurance, in the context of one health system, these supply challenges will also be addressed.

 

END.

Reply:

(1) The total number of Community Healthcare Workers(CHWs) across the Republic who are currently on contract is 49,086.

(2) A three-year agreement is in place at the PHSDSBC for the continued public sector contracting of CHWs. Meanwhile the National Department of Health is working with the Department of Labour and with National Treasury to find a solution with regard to employment conditions of community health workers.

(a) There are no community health workers who have been absorbed on permanent basis. The NDoH has been informed that Gauteng Department of Health has embarked on a preferred recruitment strategy that resulted in 8,253 Community Health workers being appointed into different vacant posts in the province.

(b) This depends on the outcome of the work being done by the National Department of Health in collaboration with the Department of Labour and with National Treasury.

 

END.

Reply:

a) Oakley Clinic is not a new clinic. It was operating in a 2 x 2 meter roomed structure since 1965 and later in 2016, it was operating in an Innovation Building Technology (IBT) structure. A new site was sourced for construction of an Ideal Clinic and construction started on 20 November 2017. The contractor completed the project and handed it officially over to the Department on 08 June 2020. On 09 June 2020 the clinic took occupation of the structure, and it is operated as an 8-hour facility as gazetted.

b) A feasibility study to operationalize the facility as a 24-hour facility, has been conducted. This exercise resulted in a recommendation that an open space inside the facility should be converted into a Maternity Obstetric Unit. This will be considered pending the availability of funds in the 2024-2025 financial year.

END.

Reply:

a) There were no posts advertised for Oakley clinic. The facility was operationalized using nurses from the old clinic.

b) Oakley Clinic only received one (1) COVID-19 Professional Nurse on contract and she never worked as a general worker.

 

END.

Reply:

1. As part of addressing the lack of human resources in hospitals and clinics, the Department of Health has developed and published (in February 2021), a 2030 Human Resources for Health Strategy that serves as a guideline of the Human Resources Agenda for the Public Health sector at various levels of care. The 2030 HRH Strategy modelling, indicates a current shortfall of skilled health professionals in South Africa and makes a call for investing in the Health workforce to address human resources deficits and inequalities across provinces and between private and public health sectors. However, due to stringent budgets, the implementation is at a snail’s pace.

Despite available limited resources, in the public service generally, the Department has managed put measures in place to close the vacancy-rate gap for health care related posts to 12.4% and administration positions to 11.80%, respectively, as at the 30 September 2022, across all the provinces.

In relation to Medical Equipment, the department has been experiencing budget cuts over the past few years impacting negatively on issues such as maintenance of equipment and facilities. However, new interventions in the form of conditional grants have been put in place to help provinces cope with revitalisation and maintenance backlogs.

The following are some of the conditional grants that have been introduced to help with acquisition, maintenance and revitalisation of facilities inclusive of Medical Equipment and are in addition to Equitable Share granted to provinces:

a) Health Facilities Revitalisation Grant (HFRG), Managed National Health, but transferred to provinces with conditions and oversight by National Health.

b) National Tertiary Services Grant (NTSG): Managed by National Health, but transferred to provinces for equipment gaps/shortages and repairs.

c) National Health Insurance Indirect Grant (In-kind grant): Managed and implemented under National Health through implementing agents.

Other interventions include:

a) Integration of maintenance plans and Service Level Agreements within transversal contracts administered under National Treasury to help ensure functioning equipment.

b) Development of Medical Equipment Maintenance Strategic Framework within the Office of the Chief Procurement Officer within National Treasury, and the related transversal Contract for Maintenance of Medical Equipment.

2. Provincial Departments of Health are implementing various plans that include the following:

1. Annual Recruitment Plan – with prioritisation of critical posts where funding permits
2. Utilisation of conditional grant funding where it allows for prioritisation of posts
3. Filling of approved replacement posts
4. Employment of health professionals on contract basis to strengthen capacity and where funding permits these contract employees are absorbed on permanent employment at the end of their contracts
5. Awarding of bursaries yearly to internal and external candidates to study further in various disciplines where there are shortages
6. Provision of internship and community service programme

 

END.

Reply:

The following table reflects the response in this regard.

The National Department of Health is still consulting on this Parliamentary Question to provide the correct and full details to the Honourable Member and Parliament. The information will be provided as soon as it is ready, in a short time.

END.

Reply:

a) The Department has prioritised Mental Health as an important aspect of health that is

crucial to the overall well-being of individuals and society. The Mental Health Care Act, 2002 (Act No.17 of 2002), its Regulations and guidelines as well as the National Mental Health Policy Framework and Strategic Plan 2013-2020 that is currently under review guide the efforts to address the mental health of our people.

There are many risk factors for developing mental health problems, and these include living with a chronic condition such as HIV, tuberculosis, cancers, diabetes, cardiovascular diseases, women around childbirth and poverty. The Health Sector’s strategy is to focus on comprehensive efforts for prevention, early identification, early intervention and strengthening follow-up care for mental health problems at all the levels of the health care system as this would ensure that all at-risk populations are cared for. Among the plans that are in place to strengthen the efforts to address the mental health of our people, including those living with chronic conditions are the following:

• Progressive integration of mental health into the general health service environment

including primary, secondary, and tertiary level health establishments as envisaged by the Mental Health Care Act, 2002, to among others improve access to mental health services and reduce the stigma associated with mental illness.

• Improving skills and capacity of health care providers for early identification and

management of mental health problems at primary health care through training as well as complementing the numbers of available staff through contracting private mental health care providers (psychiatrists, psychologists, social workers and occupational therapists) to render mental health services at primary health care level.

• Strengthening clinical mental health skills among health care providers working in health

facilities listed to conduct 72-hours assessment of involuntary mental health care users as well as in mental health units that are attached to general hospitals.

• Screening and management for common mental disorders including depression, anxiety and alcohol and other drugs abuse at primary health care.

• Integration of mental health screening and referral in the school health programme as well as in the community health worker programme.

• Using various platforms and media to educate the public on mental health issues in collaboration with other stakeholders including civil society.

• Strengthening collaborations with other departments and stakeholders to ensure that the upstream determinants of mental health that lie within their mandates are addressed.

b) The updated National Health Sector HIV prevention Strategy (2020-2025), ensures that

combination HIV prevention strategies are employed for the people who inject drugs (PWID), and the strategy calls for capacity building and skilled health practitioners to deal with substance abuse disorders.

In terms of interventions to reduce transmission the following combination prevention interventions are available in the public health facilities for PWID:

Biomedical interventions: Collaboration with partners for needle exchange support programmes, male and female Condoms and lubricants, post-exposure prophylaxis for unintended exposure, and Pre-exposure prophylaxis (for prevention of acquisition), including monitoring of PrEP retention, HIV testing services (HTS) and referral to treatment for those who test HIV positive, STI management (screening and treatment).

Socio-behavioural interventions: Mental health screening, referral, and linkage to psychosocial support services. Accurate and appropriate sexual and reproductive health information and messages.

 

END.

Reply:

(a) In 2018, the Minister of Health, the Member of Executive Council (MEC of Health) Limpopo and the Minister of Police met to discuss safety and security challenges emanating from the incident where a doctor was shot in Limpopo at Letaba Hospital. It was resolved that an Inter-Departmental Task Team should be established comprising of the SAPS, the Private Security Industry Regulatory Authority (PSIRA), Department of Labour and Employment, Department of Home Affairs, State Security Agency and all Health Provincial Security Managers.

The Task Team in collaboration with National Joint Operational and Intelligence Structure (NATJOINS) developed a plan with the following deliverables:

• Development security infrastructure norms and standards

• Memorandum of Agreement between SAPS and Department of Health

• Deployment of Police Reservist at identified hot spot hospitals

• Development of a Health Security Dispensation

• Physical assessment of Hot Spot Hospitals

• Normalisation of Hot Spot hospitals

• Safety of Emergency Medical Services practitioners

(b) The following plans are put in place to curb robberies and incidence of violence in both specified and others across the public healthcare facilities:

• Improving and maintaining physical security infrastructure by implementing security guidelines from Infrastructure Unit Support System (IUSS) across all public health facilities.

• Intensifying private security contract management and access control.

• Deployment of Police reservists on public health hot spot facilities to conduct security compliance inspection at public health facilities with SAPS, PSIRA, State Security Agency, Department of Labour and Employment and Department of Home Affairs.

(c) Security interventions are being implemented in all provincial departments of health and the maintenance thereof is continuous. The Task team meets monthly and has also included organised labour.

 

END.

Reply:

(1) Firstly it is important to correct the question from the Honourable Member, that there is no structure called the National Health Committee in the National Department of Health. The acronym NHC stands for the National Health Council.

It is also our understanding that based on the content of the question, the Honourable Member could be referring to the National Health Research Committee (NHRC), and therefore our response will deal with this particular structure.

(a) The current NHRC members are listed below with their institutions:

1. Prof Mahmood Ally (University of Pretoria)
2. Prof Nicolaas Gey van Pittius (Stellenbosch University)
3. Ms Glaudina Loots (Department of Higher Education, Science and Innovation)
4. Prof Joyce Tsoka-Gwegweni (University of Free State)
5. Prof Heidi Abrahamse (University of Johannesburg)
6. Dr Mapitso Molefe (Council for Scientific and Industrial Research)
7. Dr Anthony Hawkridge (Western Cape HRC)
8. Prof Christo Heunis (University of Free State)
9. Prof Angela Mathee (South African Medical Research Council)
10. Prof Mushi Matjila (University of Cape Town)
11. Prof Taryn Young (Stellenbosch University)
12. Prof Moses Mbewe (University of Mpumalanga)
13. Prof Panjasaram Naidoo (University of KwaZulu-Natal)

     14. Ms Thulile Zondi (National Department of Health)

Prof Mahmood Ally currently chairs the NHRC as per the regulations relating to the National Health Research Committee.

(b) (i) The members were appointed on 24th April 2020, by the former Minister of Health, Dr Zwelini Mkhize for a term of three (3) years. The end of term for the current members is on 24th April 2023.

(ii) The Members of the Committee, appointed by the Minister in terms Section 69 (2) and Regulations Relating to the Establishment of the National Health Research Committee, 2010, are constituted as follows:

• A person with extensive experience and knowledge in health research;

• A representative of the community;

• A representative of the National Department of Health;

• A person appointed on account of his / her knowledge in law; and

• A representative of the Department of Science and Technology.

(c) The Director-General (DG) approves the publication of an advertisement for appointment of new Members to the National Health Research Committee (NHRC) according to Government Communication and Information System (GCIS) government regulations and policy. A notice relating to nominations of members of the committee is published in the government gazette and at least one national newspaper. The applicants use a nomination form and submit a recent Curriculum Vitae.

(2) The Minister appoints NHRC members after as required by National Health Council (NHA) section 69(1) of the National Health Act, 2003 .

(3) (a) Public health qualifications, as well as extensive experience and knowledge in health research is required. In addition, least one person in the NHRC is required to have knowledge of law, and also representation from NDoH and Department of Science and Technology

(b) The committee is required to meet four times per annum.

(c) The committee members remuneration levels are determined by National Treasury Regulation which are revised annually. The NHRC falls under category A, sub-category A2 of the 2019 remuneration levels which stipulates that the chairperson receives R4646 per day (R581 per hour); the vice chairperson receives R3778 per day (R472 per hour) and other members receive R3669 per day (R459 per hour).

 

END.

Reply:

a) Yes. Investigation report into alleged deleted email has been prepared. The National Department of Health has utilized the following emails to receive the comments and submissions per the published draft Health Regulations as per Gazette No 46048 and Government Gazette No: 46243:

Email used to receive commends	Regulation
1.1 [email protected]	National Health Act: Regulations relating to the surveillance and control of notifiable medical conditions: Amendment.
1.2 [email protected]	International Health Regulations Act: Regulations relating to public health measures in points of entry.
1.3 [email protected]	National Health Act: Regulations relating to the management of human remains.
1.4 [email protected]	National Health Act: Regulations relating to environmental health.

The Department uses the Microsoft Exchange online as the cloud-based email system, and the mimecast cloud solution for email backup, archiving and security. All emails are archived before they are received by each individual user account and each email is archived for 100 years. There is therefore no possibility of permanently loosing emails even for those that may have been erroneously deleted.

In general, the email system in the Department is designed based on good practices and common standards. These standards are used if an incorrect email is sent to the email system, where a standard notification will be sent back to the initiating email system and notify the sender of non-delivery and the reason for non-delivery is given and explained in the notice.

Similarly, this is the case for rejected emails. Rejected emails may be due to how the Cyber Security community have classified the email system of the sender and mostly emails are rejected when the email system of the sender is classified in one of the categories of cyber security threats, like being classified as the spam email system, which means that the emails may have been classified not as ethical or acceptable to other organizations. This category is classified as such by the ICT Security Industry and not the Department.

The Microsoft Exchange Cloud Platform used by the Department has data protection that allows all deleted emails of files on the cloud platform to be recoverable for at least a period of three months from the “Trash-Folder”. This is the build-in protection for any accidental deletion that may be experienced by individual users.

The Department established a team that worked on consolidating the received submissions and inputs. The team from the Information and Communication Technology Directorate met on 17th March 2022 and agreed on creating an email platform called [email protected]. This platform has provided access and relief to the colleagues who needed to work on the received submissions and inputs to unclog their individual email accounts.

Furthermore, a special folder was created in each of the email accounts that were published in the Gazette and all emails that were identified as submissions and inputs were moved to the created folder named [email protected]. This was done to ensure that the account holders of emails published in Gazette can attend to their day-to-day duties and are not affected by the massive amounts of received submissions, comments and inputs.

The Email-rules were created using “catch-phrases” to identify submissions and inputs and the rules forwarded all identified emails to the email address [email protected]. The rules were also used to identify emails from website platforms and forwarded accordingly.

The Department of Health confirms that all received emails are not lost and have been accounted for. A picture graph of all received emails from the published email accounts between 15 March 2022 until 21 April 2022 has been developed to record the email backup and the archive system. The Department also has the user activity log showing all actions each user undertook during the period of receiving the public comments. The records include all emails that were received, rejected, bounced, and the reports can be presented for audit purposes.

Rejected or bounced email messages maybe due to incorrect email address that does not exist in the system that the sender of the email might have used, and the email system will notify such user that the email was not delivered as the recipient does not exist. The Department is also in a position to track any email that may have been deleted, if the details of the sender and the date on which the emails were sent and time as well as date emails may have been deleted by Department of Health officials.

b) There is substantial progress in processing the public comments. This started with processing of raw comments from emails and other platforms used to submit the comments (meaning capturing, allocating to officials to capture them under the regulations they are commenting on). All comments received were directed to a central platform where they were consolidated and handed over to the team responsible for processing.

Members of the public did not only use the communicated means of submission reflected in the published draft regulations but also used other email addresses of officials in the Department which were not published for this purpose. All these comments had to be harvested from the Department’s email system for processing. The Department continues to check and move such comments to the central platform of [email protected].

The above issues have affected the finalization of the number of comments received and the final number of received comments can only be confirmed once all the comments from other platforms, including personal emails of officials, have been moved to [email protected]. It must be noted that the processing of comments is ongoing and to date, a total of 446 067 comments have been received and accounted for. Furthermore, over 430 915 of these comments have been processed and about 15 152 of them are still outstanding, and the performance thereof is at 97%. The work of evaluating comments is continuing and the technical team is looking at the technical contents to either accept, propose rejection, discuss further, or seek guidance thereon prior to incorporating such comments into the final set of Regulations.

END.

Reply:

1. (a) There are three dedicated grants allocated.

(i) Human Resources and Training Grant (HRTG) and National Tertiary Services Grant (NTSG) to appoint critical clinicians.

(ii) National Tertiary Services Grant and Health Facility Revitalisation Grant (HFRG) to equip theaters.

(b) Total amount allocated as per Division of Revenue Act for NTSG amount to R14.3 billion, HRTG R5.4 billion and HFRG R6.7 billion.

(c) The hospital that amount allocated:

(i) Nationally as per Division of Revenue Act as gazetted the NTSG amount to R14.3 billion, HRTG R5.4 billion and HFRG R6.7 billion

(ii) Provincially as per the National Tertiary Services Grant.

Provinces	Facility	NTSG
	R Thousand
Eastern Cape	Livingstone Hospital	R341,228
	Nelson Mandela Hospital	R371,288
	Frere Hospital	R330,102
	Fort England Hospital	R77,072
	Provincial Head Office	R29,263
	Total	R1,148,953
Free State	Universitas Hospital	R771,870
	Pelonomi Hospital	R453,326
	Total	R1,225,196
Gauteng	Charlotte Maxeke Hospital	R1,109,010
	Chris Hani Baragwanath Hospital	R957,851
	Dr George Mukhari Hospital	R960,333
	Steve Biko Academic Hospital	R1,003,943
	Kalafong Hospital	R270,668
	Helen Joseph Hospital+1	R239,180
	Thembisa Hospital	R210,713
	Nelson Mandela Childrens Hospital	R299,000
	Sterkfontein Hospital	R5,804
	Tara Hospital	R5,840
	Wits Oral Health	R4,496
	Medunsa Oral Health	R5,904
	Pretorial Dental Hospital	R5,040
	Weskopies Hospital	R6,104
	Total	R5,083,886
Kwazulu Natal	Inkosi Albert Luthuli Hospital	R909,961
	Greys Hospital	R538,866
	King Edward VIII Hospital	R469,945
	Ngwelezane Hospital	R125,952
	KZN Provincial Office	R1,130
	Total	R2,045,854
Limpopo	Pietersburg Hospital	R342,889
	Mankweng Hospital	R135,687
	Provincial Office	R2,475
	Total	R481,051
Mpumalanga	Rob Ferreira Hospital	R73,387
	Witbank Hospital	R71,998
	Total	R145,385
Northen Cape	Robert Mangaliso Sobukwe Hospital	R420,514
North West	Klerksdorp/Tshepong Complex	R219,015
	Job Shimakana Tabane Hospital	R64,741
	Mahikeng Hospital	R59,252
	Provincial Office	R11,155
	Total	R354,163
Western Cape	Groote Schuur Hospital	R1,497,693
	Tygerberg Hospital	R1,497,693
	Red Cross Childrens Hospital	R397,536
	Diagnostic Related Group	R8,135
	Total	R3,401,057
TOTAL NATIONALLY	R14,306,059

(c)(i)(ii) As per Health Facility Revitalisation Grant an amount of R6.7 billion has been allocated for the 2022/23 financial year of which R3.4 billion has been set aside for the implementation of hospitals projects across the nine provinces.

(c)(i)(ii) As per Human Resources and Training Grant total amount allocated Nationally amount to R5.4 billion and for each province total amount allocated for Eastern cape R578.8 million, Free State R264.0 million, Gauteng R1.8 billion, KwaZulu-Natal R754.8 million, Limpopo R372.7 million, Mpumalanga R274.3 million, Northern Cape R155.6 million, North West R277.2 million and Western Cape R899.4 million.

2. Total budget allocated towards equipment Autoclaves and consumables Nationally and Provincially for Assistive devices, medical and allied equipment and certain consumables, the provinces tap into the overall budget indicated as the need arises.

Province	(a) Autoclave Equipment when need arises the province tap into the overall allocated budget indicated	(b) Certain Consumables: when need arises the province tap into the overall allocated budget indicated
	R Thousand	R Thousand
Eastern Cape	R193,369	R7,546
Free State	R37,644	R3,050
Gauteng	R33,000	R5,089
KwaZulu-Natal	R59,958	R968
Limpopo	R5,200	R6,255
Mpumalanga	R10,563	R93
Northern Cape	R19,000	R168
North West	R42,183	R1,717
Western Cape	R293,086	R29,125
National (Total)	R694,004	R54,011

 

END.

Reply:

The National Department of Health does not have this information readily available, it is consulting with the provinces to provide the details in this regard. The full response will be furnished to the Honourable Member as soon as it has been received from the Provinces.

 

END.

Reply:

According to information received from the Provinces, the response is as follows:

a) Screening of primary health care patients for mental disorders is conducted using the Adult Primary Care (APC) manual algorithms as well as a screening tool that was developed using the APC manual. Data on screening for mental disorders at primary health care was collected through the District Health Information System (DHIS) until March 2020 when the data element was dropped from the National Indicator Data Set (NIDS). Available data that is captured below is up to March 2020 for all provinces except for Free State Province as the only province that continues to collect data on screening for mental disorders at primary health care as part of their Provincial Indicator Data Set (PIDS).

	2018	2019	2020	2021	2022
Number of primary health care patients screened for mental disorders	38,470,755	44,964,174	12,321,412	228,132 (only Free State)	216,946 (only Free State)

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

PROVINCE	2018	2019	2020	2021	2022
Free State	2,494,565	2,867,434	780,069	228,137	216,945
Eastern Cape	3,711,637	4,816,564	1,412,852	Data no longer collected
Gauteng	10,192,937	11,958,945	3,207,381
KwaZulu Nata	11,308,313	12,383,715	3,355,876
Limpopo	5,416,012	6,328,129	1,733,645
Mpumalanga	3,276,454	3,966,918	1,074,509
Northern Cape	349,395	498,150	140,346
North West	1,721,442	2,144,319	616,734
Western Cape	Data not collected	Data not collected	Data not collected

END.

Reply:

1. According to the service package, Primary Health Care facilities are not required to have (a) psychiatrist, (b) psychologist and (c) child therapist in their facilities;

2. There is a total of 1,244 mental health nurses for every 1,000 patients in the Republic’s population;

3. The table below indicates the total number of a speciality per 1000 in the Republic’s population

 

Occupation Field	Ratio Per 1000 people/persons	Catchment/total population
(a) Psychologist	0.013	61402358
(b) Occupational Therapist	0.017	61402358
(c ) Social Worker	0.570	61402358
(d) Psychiatrists	0.001	61402358

 

 

END.

Reply:

a) The Department did not implement consequence management measures on officials for the underspending of R771 334 000 during 2021/2022 financial year. The underspending was due to moratorium placed by National Treasury which resulted in delays on procurement of services including cleaning services, security systems, other tools of trade amongst others.

Table below indicate the underspending per economic classification

Economic Classifications	Appropriated budget 2021/2022 R'000	Expenditure 2021/2022 R'000	Funds Available R'000	Percentage Underspending
Compensation of Employees	892 621	848 239	44 382	5%
Goods and Services	9 548 526	9 118 156	430 370	5%
Transfers	54 493 502	54 491 901	1 601	0%
Capital	965 761	670 780	294 981	31%
Losses	8 355	8 355	-	0%
TOTAL	65 908 765	65 137 431	771 334	1%

END.

Reply:

The National Department of Health is still consulting with Provincial Departments of Health to get the required information in this regard. The full response will be furnished to the Honourable Member as soon as the information is received from Provinces.

END.

Reply:

The Department does not intend to intervene in line with section 100 of the Constitution of the Republic of South Africa, 1996, as no provincial department of health has accrued up to 90% of their next financial year’s budget.

Below are the details of the provincial appropriated budget for 2022/2023 financial year against the accruals

Province and National	Appropriated budget 2022/2023 R'000	Accruals for 2021/2022 R’000	Percentage of Accruals to 2022/2023 Appropriation.
Eartern Cape	27 362 251	4 659 984	17%
Free State	12 711 441	619 971	5%
Gauteng	59 426 398	6 322 118	11%
Kwazulu Natal	49 609 770	1 485 045	3%
Limpopo	22 725 589	287 965	1%
Mpumalanga	16 824 794	449 601	3%
Northern Cape	5 893 603	397 234	7%
North West	15 186 040	1 322 914	9%
Western Cape	29 094 331	428 911	1%
TOTAL FOR PROVINCES	238 834 217	15 973 743	7%
National	65 000 031	113 459	0,2%

END.

Reply:

The Department has put in place processes to alleviate unnecessary waiting period for eligible applicants who are due to perform community service as doctors:

There are two annual allocation cycles. The first annual cycle allocates a sizeable number of applicants who are eligible by 30th of December to commence duty on 1 January of each year and the second (midyear) cycle allocates applicants who could not take up positions in January, thus allowing them to take up posts in July. The System ensures that there are no applicants who wait for a period of one year and/or longer to do community service, unless if the person voluntarily opts to wait longer due to personal reasons. Amongst other reasons, applicants state that they will wait to be allocated at their preferred cities, due to religious beliefs. This means they do not want to serve at rural and underserved areas defeating the purpose of the objective of the Community Service Policy. .

The Department has also put in place financial means to ensure that all statutory community service posts for medical doctors are absorbed within the Provincial Equitable Share and the Human Resources Training Grant (HRTG) Budgets.

END.

Reply:

The Honourable Members is well aware that there are no such vaccines called ‘Bill Gates vaccines’ and the department procured vaccines from global manufacturers of vaccines.

a) At the start of the pandemic, there were no vaccines available globally as part of the armamentarium in the fight against Covid-19. You will recall that South Africa opted to purchase those vaccines where clinical efficacy and safety data was available, published in peer reviewed journals.

However, even prior to the availability of this information, wealthier countries, particularly in the Northern Hemisphere, concluded contracts with a multitude of suppliers to secure vaccines for their population in what is known as vaccine nationalism. This meant that poorer countries, such as ours, were pushed to the back of the queue and were not guaranteed access to vaccines. The kind of purchase commitments made by richer countries could not be made in our context in the absence of clinical evidence to purchase the best performing vaccines and without the necessary funding.

However, as soon as clinical evidence of safety and efficacy was made available, we moved with speed to conclude purchase agreements with suppliers. At the time, the aim was to achieve herd immunity, which the WHO recommends being 70% of the population. Along with the uncertainty of future availability of vaccines, the expected demand was extremely high as evidenced by the plethora of media reports.

It is in this dynamic context that agreements for vaccines were concluded. Contracts were finalised in early 2021 to receive 62 million doses of vaccine. No new contracts were entered into thereafter.

Based on current available evidence informing the vaccination schedules, South Africa purchased sufficient vaccines to fully vaccinate and provide booster doses for approximately 51% of our population.

b) Attempts are being made to donate doses that are unlikely to be used. Currently, there is a global surplus of vaccines, a situation that is in total contrast to what was occurring two years ago. Unused doses that reach manufacturers expiry date that are in central storage will be destroyed.

END.

Reply:

We are not aware of any designation of a ‘high clinic’ so we cannot respond to any assertion in this regard.

The National Health Insurance Bill makes provision for accreditation of service providers and for the Fund to conclude a legally binding contract with a health establishment certified by the Office of Health Standards Compliance and with any other prescribed health care service provider that satisfies requirements provided for in the Bill.

• Establishments will be required to obtain certification as compliant with a set of prescribed standards by the Office of Health Standards Compliance
• Individual providers (professionals) will be required to have proof of registration by a recognised statutory health professional council
• Providers will be required to:
  • deliver a minimum required range of personal health care services
  • allocate appropriate health care professionals to deliver the health care that they are accredited to provide
  • adhere to treatment protocols and guidelines, including prescribing medicines and procuring health products from the Formulary
  • adhere to health care referral pathways
  • submit information to the national health information system to ensure portability and continuity of health care services and performance monitoring and evaluation; and
  • adhere to the national pricing regimen for services delivered

a) The implementation of National Health Insurance will be a process over several years and budget cycles as contemplated in the transitional provisions. Engaging providers that will be paid by the Fund will evolve in accordance with guidelines and services specified by the Minister in consultation with the National Health Council and the Fund, and published in the Gazette from time to time as required.

All healthcare facilities (providers), both public and private, including those that do not, at the outset, reach the standards required by the National Health Insurance Fund for either standards compliance or accreditation will be part of quality improvement programmes, such as the Ideal Clinic Programme, that will allow them time to effect the necessary improvements. The phases and processes for the required improvements will be outlined in the Gazetted guidelines once the law is enacted.

b) The NHI Fund which will be established once the Bill is enacted will cover the cost of “medical care in the specified facilities in the private and public sectors”.

Clause 41 provides the framework for payment of health care service providers (mechanisms of payment) and clause 49 with the source of income. Over time as benefits are included, or amended as technology evolves, the Fund will manage the sole risk pool for everyone and will purchase the services from all available accredited providers in both public and private sectors.

END.

Reply:

The challenge with the question in respect of Retshidze is that it is general and as such it is difficult for the department to respond in a specific way. The table here below provides general responses in line with the areas that were covered by the Retshidze report.

 

a) The plans of the department concerning Free State Health Issues and (b) date to address the issues of access to health care are in the table below:

Item	Challenge raised by Ritshidze	Plans of the department	Date
Shortages of staff	79% of facilities again reported being understaffed and unable to meet the needs of public healthcare users this year	There currently are budget pressure and as such the department is not able to appoint a new staff	The department will prioritize critical post for 2023/24 budget and over the MTEF
ART	66% of PLHIV would like to collect ARVs closer to their home (66% last year)	The department is planning on increase pick up points for the ARVs so that the patients can collect their treatment closer home The department will also reopen more adherence clubs that were affected during COVID19 Districts have developed differentiated of care models and welcome back campaigns towards reach 95-95-95	March 2023 extended to April 2023 for budget in the new financial year.
Infrastructure and cleanliness	90% of facilities need some additional space 25% of public healthcare users reported that facilities were “dirty	The infrastructure unit has received approval to allocate additional funding to maintenance and refurbishment of facilities earmarked for ideal clinic programme The department has appointed EPWP to assist with cleaning at health facilities to argument the current shortages	March 2023
Waiting times	4:31 hours was the average waiting time after the facility	The department planned to decant more patients who are more stable on treatment to reduce backlog waiting time	The department plans to appoint staff in the MTEF period
Men specific services	9 sites had no male specific services at all	The department plan to pilot a men’s clinics to HIV and testing, , male medical circumcision and other services	April 2023
Availability of medication	13% of respondents said they had left or knew someone who left empty handed (8% last year)	There are currently no shortage of ARV and monitored weekly using SVS Facilities are implementing and monitoring redistribution to ensure sustainability of medicine .	Ongoing
Key population	0% facilities report any key population specific services at all	The department has employed 25 peer educators to promote access for access for key population Also do demand creation for key population The plan is to expand the peer educators service over the METF to insure accessibility to key population	April 2023

Some of the key general activities and plans

• Welcome back strategy was started in 2020/ 21 financial year but not fully implemented due to the COVID-19 pandemic.
• The department planned to re- train all categories of staff.
• To strengthen adherence to treatment through reviving adherence clubs.
• Implementation of the track and tracing Standard Operating Procedure (SOP).
• Monitoring of Medicine availability is done through Stock status report.

END.

Reply:

(1) (a) The National Department is not aware of any mismanagement and/or misspent of funds by any of its officials on this programme. The funds are assigned to the programme and transferred to the Department of International Relations and Corporation and Cuba when received from the Province for students in Cuba.

In South Africa they are transferred to Universities by the National Department of Health for students.

(2) (a)(b)(i)(ii) There are no audit investigations we are aware of relating to the mismanagement or misspent of money for the Nelson Mandela Fidel Castro Collaboration Programme in the Department of Health.

END.

Reply:

1. (a) There are 3369 students recruited to the programme since inception.

b) A total of 2617 has graduated from the Programme.

c) The total of 2 617 students mentioned in (b) above, after completion of their integration in South African local universities are/were allocated to various health facilities for a two-year medical internship and then proceed to fulfil a one-year Community Service Programme in rural and underserved areas.

d) The National Department of Health has requested the numbers that are currently still employed form Provincial Departments of Health, since the PERSAL System does not have a functionality that provides such granular data since inception of the Nelson Mandela Fidel Castro Programme.

2. (a) The doctors from the Nelson Mandela Fidel Castro Programme assume appointment to the department as qualified medical doctors like any other doctor trained in South Africa, this also include termination of employment. The termination of duty is therefore based on grounds that are deemed necessary for termination in terms of the scope of practice of medical doctors or it may be voluntary as is the case with any other employee.

(b) This cannot be quantified specifically for the Nelson Mandela Fidel Castro Medical doctors.

(3) (a) Costs incurred when students in Cuba

The following are average costs incurred and are fixed cost per student per year, depending on the Rand/Dollar Exchange Rate at the time of transfer, is reflected below:

• Preparatory (one year) : $2000.00 per students
• 1st – 5th Year (per student) : $5000.00
• Stipend (per student per year) : $2400.00
• Additional costs include two return flight tickets during six years and additional flight ticket in case of death of immediate family member. The tickets cannot be costed as it also depends on the Rand/Dollar Exchange at the time.

Level	Tuition Fees	Meals & Acc.	Ave. cost Med. Ins.	Stipend	TOTAL
Preparatory	$6000.00	$6022	$450	$2400.00	$14, 872.00
1st – 2nd Year	$12, 500	$6022	$500	$2400.00	$21, 422.00
3rd – 4th Year	$11, 500	$6022	$500	$2400.00	$20, 422.00
5th Year	$13, 500	$6022	$600	$2400.00	$22, 522.00

b) Costs incurred for integration in the local Universities

Tuition fees charged by South African universities during the integration since inception until 2018 varied from one university to another. After the agreement signed with local universities, the cost of integration per student has been standardised since July 2018 and adjusted according to annual Consumer Price Index. Students have all to be in the clinical training platform for 18 months which translates into three (3) semesters. Additional costs include transportation of the final year students to local universities which depends on the mode of transport and distance to the university.

The following are the average costs incurred in South Africa:

• July 2018 – June 2019 : R231 325.00 per student (R115 662.50 per semester).
• July 2019 – June 2020 : R241 734.63 per student (R120 867.31 per semester).
• July 2020 – June 2021 : R252 612.68 per student (R126 306.34 per semester).
• July 2021 – June 2022 : R260 696.28 per student (R130 348.14 per semester).
• July 2022 – June 2023 : R277 641.54 per student (R138 820.77 per semester).

Amount outstanding are not readily available for both Cuba and local Universities as we are in a process of receiving and paying invoices for the 2021 to 2022 financial year for Cuba, and 2022/ 2023 Financial year for local Universities.

END.