Questions and Replies

Reply:

No, I was not aware of any refusal by the Witbank TB Specialised Hospital to treat newly diagnosed TB patients and directing them to Bongani Regional Hospital.

The Mpumalanga Province has been reorganising the service platform, due to demands in the Province. This has resulted in the repurposing of Witbank TB Specialised Hospital to be the internal medicine unit to support Witbank Provincial hospital. The repurposing of the hospitals means that Bongani Hospital is the new DR-TB referral site to take over the clinical management of complicated DR-TB patients for the entire province. All district hospitals are still responsible for the management of the DS-TB patients.

END.

Reply:

I would first like to set the record straight that as much as there are challenges in Health sector, it should be noted that the health sector has not collapsed.

a) I have been informed by the Gauteng Department of Health that it is unable to place junior doctors who are bursary holders due to budget constraints. However, there is a process underway to prioritize the human resources needs to place them in institutions across Gauteng.

b) Due to general budget cuts that affects the Cost of Employment (CoE) in the public health sector, there is a systematic process of approving funding and advertisements of posts by Accounting Officers in consultation with Provincial Treasuries supersedes filling of vacant posts to avoid exceeding Cost of Employment (COE) budgets. Therefore, the Department prioritised the filling of the critical and scarce skills within the available budget.

Across all provinces, both clinical and non-clinical posts are continuously identified and vacancies are filled through block adverts and recruitment throughout the year in response to the service demands.

END.

Reply:

I am aware that there were concerns raised by communities regarding provision of ambulances services around Botshabelo and Mangaung in 2022 in Free State. I am also aware that the MEC of Health in the Free State has also responded to some of the communities and have acceded to some of these challenges in this regard.

Pertaining to this particular incident in the Mangaung Metropolitan Municipality where an ambulance did not arrive to collect a patient when an emergency call was made to the Emergency Communication Centre, I was not informed of this. The lack of details on this particular matter makes it difficult to make an enquiry.

I have however been informed by the province that the Public Emergency Medical Services in Mangaung Metropolitan Municipality currently operates with 26 ambulances distributed as follow:

• Bloemfontein 11
• Botshabelo 6
• Thaba Nchu 5
• Wepener 1
• Dewetsdorp 2
• Soutpan 1

The public also has an opportunity to report the matter through the Free State Department of Health’s complaints system.

END.

Reply:

1. According to the information received from our Provincial Departments of Health, no medico-legal cases have been referred to the Health Sector Anti-Corruption Forum (HSACF) since it was established in 2018.

2. Not applicable.

END.

Reply:

a) There has been minimal disruption to the delivery of health care services in all flood affected provinces within the public sector. However one private hospital in Komani, Eastern Cape was severely affected by flooding where our public sector Emergency Medical Services assisted with transferring of in-patients to nearby healthcare facilities.

The rendering of Primary Health Care services continued unaffected and assistance was also provided to the displaced community members in temporary shelters where necessary. Temporary shelters were inspected daily to monitor for water-borne diseases. No outbreaks or cases of food borne illness directly attributable to the floods were reported. Medication distribution was also not affected.

b) The Department of Cooperative Governance and Traditional Affairs (COGTA) through the Disaster Management Act of 2002 is responsible for disaster management however the Department of Health has also put several health measures in place at national, provincial and district levels to mitigate for the impact of floods as follows:

i) Governance

• The National Department of Health(NDOH) participates in the inter-sectoral national structures, the National Disaster Management Centres (NDMC); linking with the provincial Departments of Health for national oversight and support.

• The provincial Departments of Health are represented at Provincial Joint Operation Centres (ProvJOC), Provincial Disaster Management Centres (PDMC) and/or local Disaster Management Centres, as activated within the respective provinces for effective and efficient response.

• EMS is placed on high alert to provide emergency response as and when required. EMS from unaffected provinces gets mobilized to assist affected provinces when needed and this is facilitated by NDOH.
• Urban search and rescue teams are on standby to assist affected provinces with rescue and medical personnel.

ii) Hospital Services

iii) Both public and private hospitals are alerted to receive patients in all affected areas in case of diversions as and when needed. If necessary, inpatients will be transferred to unaffected hospitals.

iv) Primary Health Care(PHC) Services If a PHC facility is affected, patients will be directed to an unaffected PHC facility, or mobile clinics will be utilized. PHC services may also be provided in temporary shelters.

v) Environmental Health Services (EHS)

National and Provincial EHS officials provide oversight and support. The respective local government EHS will undertake water quality monitoring and ensure appropriate sanitation measures are adhered to. Temporary shelters, if established, will be inspected by teams from the Environmental Health Units daily.

vi) Communicable Disease Control, COVID-19, Malaria and Zoonotic Diseases

• The respective Outbreak Response Teams at district, provincial and national, are placed on high alert to monitor affected areas and are on standby to respond to any water borne / communicable disease that may arise.

• The National Institute for Communicable Diseases (NICD) heightens surveillance for COVID-19, malaria and zoonotic diseases in the affected areas.

vii) Health Promotion & Nutrition

Awareness on water safety and communicable diseases is initiated within the communities as needed. Small scale water purification, safe food handling and keeping and monitoring of food is also done to ensure prevention of food poisoning and communicable diseases.

viii) Food Control

• Food Control makes food safety Information Education and Communication(IEC) material available to respective EHS and Health Promotion teams to create awareness as needed.

• EHS gets also support in terms of inspection of donated foodstuffs to ensure safety, and record keeping as and when required.

ix) Forensic Pathology Services (FPS)

FPS function is to remove bodies of flood victims in close collaboration with SAPS in affected areas.

x) Pharmaceuticals

Medication distribution will be monitored for disruptions and alternate distribution methods are applied.

xi) Risk Communication and Community Engagement

Media releases are undertaken on all platforms as and when required. Monitoring of local media clips, news and social platforms is also ongoing.

Additional technical expertise is also available and gets deployed where needed.

END.

Reply:

The shortages of human resources for health are a global phenomenon and South Africa has not been spared from this challenge. The human resources challenge was particularly glaring as the country grappled to manage and contain the Covid-19 pandemic.

The human resource for health shortfall is well recognized by the country’s 2030 Human Resources for Health (HRH) Strategy which makes a strong case for significant additional investment in the health workforce to improve health services access, quality, and equity.

In increasing the pool, the HRH Strategy provides some insights into the additional numbers of health workers needed Hence a case is also made for aligning health workforce education and training with the health system’s needs.

Specific to a pool of nurses, a baseline audit to quantify gaps between existing supply and existing needs for all categories of nurses including nurse specialists has been concluded. This will guide areas of training required to increase the pool.

In order to enhance services in the overstretched public health sector, particularly with regard to South Africa’s response to the Covid-19 Pandemic, the department appreciated the introduction of the Covid-19 Grant and was able to inject an additional 6 688 health care workers (that included 3 460 nurses and 409 doctors) into the System on a contract basis

A further 7 583 (with 2 605 Nurses and 2060 Doctors) health professionals were allocated to do community service in health facilities to commence duty from 1 January 2023.

END.

Reply:

Various scientific institutions and groups have been involved in the collaborative work on the cure for the Human Immunodeficiency Virus (HIV) and the Acquired Immunodeficiency Syndrome (AIDS). All scientists agree that finding a cure is far more complex because no one has ever been cured of HIV and AIDS and as such correlates of protection are not known. There is some other work towards a cure that include people who go on structured treatment interruption after receiving some intervention and South Africa is involved in these studies. There is also an investigation of the use of Indigenous Knowledge System (IKS) or products derived from indigenous plants that have antiviral activities and claims to cure HIV. There is, further, an on-going work that is designing appropriate studies to investigate many claims of cure for HIV and AIDS, which will probably be structured treatment interruption based.

In the meantime, South Africa has participated in various HIV vaccine efficacy studies such as Phambili, Uhambo, Imbokodo, and Antibody Mediated Prevention (AMP). The outcomes of these studies have found that the vaccines that were tried are not effective against the virus. These trials were critical to our endeavor to find an effective HIV vaccine, hence their findings have led us to pursue two alternative pathways:

• A programme of experimental HIV vaccine trials to improve immunogenicity using an approach to iteratively develop and improve both bnAb and T-cell targeting vaccines and that.
• The next (5) five years the country will be assessing the role of utilizing broadly neutralizing monoclonal antibodies as part of HIV prevention strategy.

We are also evaluating these vaccine approached in HIV exposed uninfected infants to try and prevent breastmilk transmission.

It is critical to collaborate with international partners because the costs of these trials are prohibitive.

While these efforts are ongoing, everyone must be mobilized to support the Antiretroviral programme which has demonstrated achievement in viral suppression when and where there is a strong adherence to treatment.

END.

Reply:

An evaluation was conducted and finalised in August 2019, just prior to COVID-19.

The report found that:

“The evaluation findings suggest that the Central Chronic Medicines Dispensing and Distribution (CCMDD) is overwhelmingly believed to be the National Department of Health’s (NDoH’s) most successful intervention implemented during NHI Phase 1. This has been identified as a flagship programme, and for this reason, there are numerous valuable lessons to be learned from its implementation. These lessons will only apply to the continuation of the CCMDD programme but can be useful for the continued implementation of other interventions. Specifically, lessons around the issues of contracting private service providers, which has been communicated by the NDoH to be a key component of NHI Phase 2.”

“On balance, it is evident that CCMDD has indeed achieved its immediate aims of decongesting facilities, which helps improve the availability of Health Care Practitioners’ time and, as a result, improve health outcomes. The success is largely reflected in the successful scale-up of the programme beyond the pilot districts and beyond the expectations of NHI Phase 1 implementation plans.”

“Stakeholders also observed this intervention was well integrated with other interventions, and this integration was evidenced by information sharing between the CCMDD programme and the WBPHCOTs.”

Like any other programme, funding is critical to the success of CCMDD. While the programme had limited donor funding initially it is now funded mostly from a portion of the NHI conditional grant.

During COVID-19 patients were able to collect their chronic medication from CCMDD Pick-up-Points (PUPs) outside of health facilities without undue exposure to the virus. During that time script periods were extended and patients were required to return less frequently to collect their medicines. This lesson has been adopted as current practice to extend the capacity of the CCMDD and to improve access to medicines for patients.

END.

Reply:

a) The development of an integrated portable Electronic Health Record (EHR) for Public Health Facilities will cost an estimate of R300 million per annum over the next five years. This solution will be available to all public and private health establishments and will result in a common portable health record for all users of the entire health system. The costs associated with the roll-out and implementation at scale inclusive of the ICT Infrastructure and change management for the users of the solution still need to be costed with the required detail. Based on industry practices it can be estimated that roll-out and implementation at scale, bare similar costs as the development of the HER software solution.

b) It will take approximate 5 years to develop the full solution and phased implementation, pending funding availability. The process will be governed through the National Health Information Systems Committee which is a multistakeholder sub-committee of the National Health Council.

END.

Reply:

a) The National Department of Health has conducted few studies focusing on the condition assessments of the health facilities in line with the requirements of the Government Immovable Asset Management Act. The studies also covered few recommendations. Firstly, the study recommended that a certain portion of the capital budget for be hospitals must be set aside for the routine maintenance. Secondly, the study recommended that a certain portion of the capital budget for the hospitals should be set aside for the urgent redress of the major (and often dangerous) poor conditions of the identified hospitals. Thirdly, the study recommended that a certain portion of the capital budget should be set aside for the new infrastructure for the Primary Health Care; Level 1; Level 2 and Level 3 capacity and infrastructure for specialities.

b) Based on the recommendations mentioned above, a ten-year infrastructure plan of the health facilities for 2015 – 2025 was developed and signed off at the beginning of 2015 by the National Department of Health. The ten-year infrastructure plan covers the following areas:

1. priority sites that requires the access improvement;
2. condition of existing infrastructure;
3. illustrate relative capital (replacement) value;
4. maintenance estimate;
5. refurbishment estimate;
6. technology value estimate; and
7. timelines for the maintenance activities and refurbishment work.

The total budget implication over ten years was estimated to be in the order of R31bn. The breakdown of the recommended projects for hospital bed capacity improvement:

• Build Value R23,86bn
• Refurbish Value R2,57bn
• Technology Estimate R4,6bn
• Total R31bn

END.

Reply:

Adverse Events Following Immunisation (AEFI) and safety concerns in terms of contraindications, special precautions and warnings are reviewed and included in the product Information leaflet. All potential risk factors are outlined in the product information leaflet and the clinician/health care provider prescribing the vaccine is thereby informed. If there are critical concerns/risks, the product will not be registered and will not be made available to public.

The responsibility for pharmacovigilance and surveillance is ultimately with the regulator, SAHPRA. All clinicians and the public themselves have been encouraged to report both side effects and adverse events. There is ongoing assessment of safety of all medicines and vaccines. This information is shared globally so that all countries can combine their experiences and determine actions where appropriate.

In the case of the Covid-19 vaccines in use in the country there is a great deal of information available, it is included in the product information. There are known rare adverse events, just as rare side effects are known for all medicines. The evidence is that no elements of the two Covid-19 vaccines may put the lives of persons at risk any more that another medicine. There is however evidence that the vaccines improve immunity and protect the vaccinees from severe infection.

END.

Reply:

(a)-(b) At Primary Health Care level, the department has an Ideal Health Facility tool that is used to determine the number of health facilities that have functional piped water and the number of health facilities that have emergency water supply.

Each health facility is required to have both functional piped water and emergency water supply kept in water tanks connected to the water reticulation system in the health facility. There is also further arrangement with municipalities that in case of the emergency water tankers running empty during drought seasons, the municipality brings water by means of water tanker trucks to fill up emergency water tanks at the health facility.

END.

Reply:

(a) According to the KZN Province, Dr Shaheem Seedat who was employed at Mahatma Gandhi Memorial Hospital in eThekwini, KZN, was suspended and charged for allegedly negligence (causing the death of a motor vehicle accident patient).

On 18 March 2016 he was then charged and subsequently found not guilty.

On 25 February 2019, Dr Seedat issued summons (claim) against the Department of Health, KZN for reputational damage in the sum of R20 650 000.00. In his summons he alleged that during 2016 the MEC for Health made a statement to various media /news that he was suspended and being investigated for the charge of misconduct. According to him such newspaper or social media statements were wrongful and defamatory, causing reputational damage.

The Provincial Department of Health defended the case through the office of the state attorney. The Parties have exchange pleadings. The state attorney reports that the Plaintiff (Dr Seedat’s attorneys) wanted to amend their summons.

At this stage there is no date for the trial yet. The Plaintiff (Dr Seedat) will have to apply for it. The notice to amend is still awaited.

(b) The Department of Health, KZN (the employer) is obliged to investigate any alleged misconduct by its employees. The acquittal does not mean that misconduct did not occur. According to the Department of Health, KZN, the claim for damage in the sum of R20 650 000.00 by Dr Seedat is not justified and as such must be defended.

END.

Reply:

Steps the department has taken to raise awareness amongst the public about the prevention and management of cholera.

After the WHO reported that the cholera outbreak had occurred in Malawi and Mozambique, and other countries in the SADC regions, the National Department of Health alerted all the provinces about the cholera outbreak. The provinces were requested to use the risk assessment and contingency plan tools to assess their capacity for preparedness and readiness for cholera outbreak. The National Department of Health met with the provinces to discuss the plans and actions required in preventing and controlling the spread of cholera. Steps that were taken to raise awareness amongst the public about the prevention and management of cholera are outlined below as follows:

a) Prevention and Control

The National Department of Health has activated the Multisectoral National Outbreak Response Teams (MNORT), which includes members from the National Department of Health, National Institute for Communicable Diseases (NICD), provinces and the World Health Organization (WHO). The focus areas include surveillance; water, sanitation and hygiene; social mobilisation; Risk Communication and Community Engagement. The MNORT meetings are held on weekly basis (Fridays) to discuss the ongoing cholera outbreak in the country.

• A public announcement was made to inform and alert the public about the outbreak of cholera.
• All provinces received cholera guidelines and case investigation forms.

b) Community Engagement

Community engagements were conducted in all provinces, and distribution of Information, Education, and Communication (IEC) pamphlets and posters to teach the public about potential risks, symptoms of cholera, precautions to take to avoid cholera, when and where to report cases and to seek immediate treatment when symptoms appear continues to take place.

Awareness was raised about prevention through:

• Development and distribution of posters and flyers
• Giving health talks on community radio stations
• Cholera prevention and management messages were shared using departmental social media.
• Continuous health education is conducted in health facilities.

END.

Reply:

a) Infant Mortality Rate

Chris Hani Baragwanath Hospital -All Data	2020	2021	2022	Total
Death in facility 0-6 days	359	403	325	1087	59,6%
Death in facility 7-28 days	162	162	191	515	28,2%
Death in facility 29 days - 11 months	43	95	84	222	12,2%
Total infant deaths	564	660	600	1824	100,0%
DHIS data extracted 20th February 2022

(b)-(c) Chris Hani Baragwanath Academic Hospital (CHBAH) does not procure ambulances. Provision of ambulances is the responsibility of Gauteng EMS. Gauteng EMS does not have dedicated obstetric ambulances as all ambulances are equipped to treat and transport all emergencies including obstetric cases.

Gauteng EMS is piloting the Gauteng Scheduled Emergency Transport (G-SET) which is a scheduled transport system between high call volume facilities like CHBAH. We are encouraged by the improved response times and plan to expand G-SET during the new financial year subject to recruitment of additional staff.

(d) (i) Action plans to reduce avoidable mortality

• All Health care facilities should have monitoring and evaluation team that monitors perinatal mortality data using the Perinatal Problem Identification Program (PPIP) to exclude avoidable deaths.
• Integrate PPIP programme into M & E teams at all levels of care.
• Facility management should develop quality improvement plan focussing on avoidable factors of death and address them.
• Facility Management must ensure that all delivering institution discuss every death within 7 days, report on PPIP, develop and follow up on implementation of Quality Improvement Plans (QIP)
• Senior management must ensure that junior staff is provided technical support on the job and onsite corrective measures.
• Provincial Management to submit and verify their PPIP data to NDoH establish Provincial Perinatal Mortality Meetings Committee, NDOH, Provinces, MNCH cluster.

(ii) Promote the prevention, early identification, and comprehensive management of the stabilisation phase of children with Severe Acute Malnutrition (SAM)

• Strengthen the capacity of hospitals to identify and care for acutely sick children not limited to the following:

• Equitable allocation and non-rotation of staff
• Ensure effective triage system in hospitals.
• Strengthen daily ward rounds including on weekends.
• Sustain Outreach support to District Hospitals

• Empower households and strengthen community services to promote early entry into the health service and reduce barriers.

• Create a safe home and social environments for children to reduce non-natural deaths, such as burns prevention and road traffic accidents.

• Strengthen the capacity of community and primary health care services to address common childhood illnesses.

(e) The Department of Health reached the sustainable development goal set target of <12/1 000live births by 2030 for newborn nationally which is part of the infant mortality rate. The Department is therefore striving to sustain the performance not to regress below the current achievement, however.

The Infant Mortality Rate sustainable development goal which is also the Departmental goal is set at 20/1 000 live births by 2030.

(f) The Department of Health reached the sustainable development goal set target of <12/1 000live births by 2030 for newborn nationally and the infant mortality rate l recorded in 2020 was 23.6.

END.

Reply:

We are not aware of any deaths associated with the crisis of loadshedding as the question alleges. With regard to the details furnished by the Honourable Member, I am assured by the Gauteng Provincial Department of Health that there is no reported incident in Radiology relating to any death in CT/MRI due to loadshedding at the Chris Hani Baragwanath Hospital, as alleged. The Gauteng Provincial Department further confirms that the CT and MRI machines of the Hospital have uninterrupted power supply (UPS) and generators, which ensures the continuity of service during black-outs. It could be of great assistance if details of the abovementioned case can be made available to us for detailed investigation and response.

END.

Reply:

(1) According to the KwaZulu Natal Department of Health, Wentworth Hospital Gateway clinic has a backlog on issuing of spectacles to 300 patients. The reason for the backlog is that the institution exhausted the budget for spectacles in October 2022.

(2) There is no optometrist employed at Wentworth Hospital Gateway Clinic. However, the facility receives support from a visiting optometrist who visits the hospital once a week. There is one ophthalmic nurse employed at the clinic.

(3) The hospital has no budget to fill optometrist posts, however, the Department continues to advocate for enough funds to address this problem. The budget allocated to the hospital over the past years was insufficient to create new posts.

(4) The hospital has included the filling of the optometrist post in the budget bid for 2023/24. Additional funds for spectacles have also been requested.

Further information is awaited from the Province.

END.

Reply:

1. In accordance with information extracted from the PERSAL Data Set of 28 February 2023, a total of 8 employees are occupying positions in acting capacity on senior and/or executive positions in public hospitals in the Republic with no permanent contract on salary level six and higher.

The table below is the data as extracted from PERSAL and its accuracy is being verified with Provincial Departments of Health:

ACTING PERSONNEL WITHOUT PERMANENT CONTRACTS AS Feb 2023
POST CLASS DESC	ACTING PERSONNEL	EC	FS	GAU	KZN	LP	MPU	NC	NW	WC	Grand Total
DEP MAN NURS(LEV1&2)	ASSIST MANAGER NURSI	0	0	1	0	0	0	0	0	0	1
HEAD CLIN DPT MED	HEAD CLIN UNIT MED	0	0	0	1	0	0	0	0	0	1
HEAD CLIN DPT MED	MEDICAL SPECIALIST	0	0	1	0	0	0	0	0	0	1
HUMAN+SUPPORT SR10	HUMAN+SUPPORT SR8	0	0	0	1	0	0	0	0	0	1
LINE FUNC + SUP SR11	LINE FUNC + SUPP SR9	0	0	0	0	0	0	0	0	1	1
LINE FUNC + SUPP SR9	HEALTH AND SUPP SR8	0	0	0	0	0	0	0	0	1	1
MANAGE+SUPPORT SR10	MANAGE+SUPPORT SR9	0	0	0	0	0	1	0	0	0	1
MANAGE+SUPPORT SR13	LINE FUNC + SUP SR11	0	0	0	1	0	0	0	0	0	1
Grand Total		0	0	2	3	0	1	0	0	2	8

2. The table below indicates total number of senior staff in the employ of his department with a level 6 remuneration package or higher who have a disciplinary process and/or cases pending against them.

(2)(a)(i) total number	(ii)details of cases
Level 6=1	Theft
Level 8=1	Gross Absenteeism
Level 8=1	Corruption and maladministration
(b)disciplinary measures	Yes

END.

Reply:

I was made aware of Operation Dudula protesting outside public health facilities around Gauteng province including Johannesburg and Kalafong Hospital.

a) In Kalafong Hospital, Operation Dudula protest caused an obstruction of free access to the facility, hence the need to intervene, which was done in collaboration with the Gauteng Provincial Department of Health and Kalafong Hospital management.

b) (i) Gauteng Provincial Department of Health applied for an urgent court interdict against Operation Dudula. Subsequently, the Court order preventing disruption to free access to the hospital was granted. Over and above working with the Gauteng Provincial Department of Health, we prevailed with the South African Police Service to be more decisive in implementing the interdict, thus ensuring the protection and safety of all healthcare users, including foreign nationals. The court was applied mainly to prevent obstruction of healthcare facilities from being accessible to all users, including foreign nationals.

(ii) I, together with the Director-General gave the leadership of Operation Dudula an audience, who by the way also had other allegations against the Kalafong Hospital management. Operation Dudula leadership was informed that there are other ways of addressing their allegations against the hospital management. Having visited the Kalafong Hospital and assisting the Gauteng Provincial Department of Health and subsequently meeting with Operation Dudula leadership, was done as an attempt to open the lines of communication so that Operation Dudula are free to talk to us about specific matters they might have.

END.

Reply:

It is our considered view that visitations to healthcare facilities, especially hospitals, are properly arranged ahead of time, with the relevant authorities, for visitors to be accommodated in the schedule and operations of the facility. This is so because all staff in our healthcare facilities are extremely busy all the time and if the visitation is not pre-arranged or arranged in an orderly manner, the operations of the facility will be negatively affected. Honourable Members are very well aware that our facilities are overburdened with demand for healthcare services, while at the same time experiencing shortages of staff of various sorts. We therefore do not want the staff in these facilities to operate in an unplanned and uncoordinated manner as this could even result in the Honourable Members ending up not receiving proper attention being taken on walk-abouts or being attended to by staff during such visits. The risk is therefore that the same Honourable Members will as a result complain that they went on a visit and they were not attended to and that no one was available to answer their questions. Also, the Honourable Member will wonder around in the facility and have a risk of causing even more disruption. It is our considered view therefore that visits by everyone to our healthcare facilities, including public representatives, are pre-arranged, but that in the case of Members of Parliament, such visits are further coordinated under the auspices of the relevant Parliamentary Committee. In this way, the Honourable Members will make a positive contribution in improving the quality of healthcare service delivery in our healthcare facilities in particular, and in the entire healthcare system in general.

The Honourable Member is well aware that a healthcare facility is a very sensitive area and allowing uncontrolled access to any healthcare facility poses risks to staff and patients both in terms of security as well as infection control.

END.

Reply:

There are no state owned entities reporting to the Minister of Health. There are five public entities (Section 3A) reporting to the Minister of Health. (a) The table below depicts the salary of each (i) chief executive officer and (ii) top executive position in each public entity reporting to the Minister of Health

Name of Entity	(a) (i) the salary of each chief executive officer	(a) (ii) the salary of each top executive position in each public entity reporting to the Minister of Health
Council for Medical Schemes	R 2 736 815	Executive Manager: Office of CEO - R1 849 744 Chief Financial Officer - R1 881 000 Chief Information Officer (Vacant) - R1 881 000 Executive: Corporate Services - R1 881 000 Executive: Regulation - R1 881 000 Executive: Policy, Research & Monitoring - R1 849 744 Executive: Member Protection (Vacant) - R1 881 000
National Health Laboratory Service	R2 792 380	Chief Operations Officer: Strategic Initiatives - R2 117 754 Chief Financial Officer - R2 117 754 Executive Manager: Human Resources - R2 328 376 Executive Manager: Information Technology - R2 117 754 Executive Manager: Academic Affairs, Research; Quality Assurance – R2 703 158 Executive Director -NICD - R2 521 313 Executive Director -NIOH - R2 398 227
Office of Health Standards Compliance	R2 368 024	Chief Financial Officer - R1 431 623 Chief Operations Officer – R 1 814 443 Executive Manager: HSDAS - R1 370 070 Executive Manager: Compliance Inspectorate - R1 540 533 Executive Manager: Complaints Management - R1 586 413 Health Ombud - R2 354 061
South African Health Products Regulatory Authority	R3 005 567.25	Chief Operations Officer - R2 247 799.61 Chief Financial Officer - R1 898 253 Chief Regulatory Officer - R1 604 650.30 Executive Manager: HR - R1 394 372.70 Company Secretary - R1 196 010.90
South African Medical Research Council	R3 280 727	Chief Financial Officer - R3 149 585 Vice President: Extramural Research Units - R2 730 269 Chief Research & Operations Officer - R2 594 400 Executive Director: Grants, Innovations & Product Development - R2 153 086 General Counsel - R2 102 207 Executive Director: Human Resources - R2 050 558 Executive Director (part-time): Transformation - R1 107 064

(b) Executives of Section 3A public entities do not receive remuneration for the attendance of meetings of their organization.

END.

Reply:

The Honourable Member is referred to the response to Question 283 asked on the 17 February 2023.

END.

Reply:

It is important to remind Honourable Members that all these trips are in fulfillment of the obligations for the Portfolio for various representations of the country in various fora in the world, and further, that the international ones are strictly approved by the Head of State before they can be undertaken.

1. The details of the destination, total costs for accommodation, travelling and any other costs incurred for international trips for each Minister and Deputy Minister since 01 June 2019 are as follows:

• Minister R3 712 892.05
• Deputy Minister R1 919 384.33

(aa) The former Minster

The Current Minister

(bb) Former Deputy Minister

Current Deputy Minister

2. The total costs incurred for domestic air travel for each Minister and Deputy Minster since 01 June 2019 were as follows:

a) The total cost for domestic air travel incurred for Minister, Dr. ZL. Mkhize was R1 343 877.00 up to the year 2021, and cost incurred for the current Minister, MP Dr. MJ Phaahla amount to R310 271.79 to date.

b) Costs incurred for former Deputy Minister, Dr. MJ Phaahla since 01 June 2019 until 2021 amount to R616 929,28 and current Deputy Minister, MP Dr. S Dhlomo with effect from 2021 to date sits at R718 054.54.

END.

Reply:

(1) (a) No specific research has been conducted on the effect of Health Promotion Levy (HPL) on obesity, however, studies have been conducted on the effects of HPL on the consumption of Sugar Sweetened Beverages.

(b)-(c) Scientists have shown that the HPL is working, for example, evidence shows that in the first year after the introduction of the HPL, urban household purchases of sugary beverages fell by 51% (Stacey et al, 2021). Similar results were shown in young adults in Langa Cape Town (Essman et al, 2022) where a 37% in volume and 31% in sugar intake was demonstrated. In Soweto, the frequency of Sugar Sweetened Beverages (SSB) intake amongst heavy consumers fell from 10 beverages per week before the tax to 4 beverages per week one year later (Wrottesley et al 2020).

(d) The results on the effectiveness of SSBs on consumption are published papers that are accessible to the public.

(e) Not Applicable

(2) Yes, the research has been shared with National Treasury by the researchers.

(3) There has not been any discussion between the DOH and National Treasury on above mentioned studies by the Department since the researchers shared the results directly with National Treasury.

(4) There is currently no planned research focussing only on the impact of HPL on obesity. The Department is finalising the Dietary intake study which will reveal other foods including those with sugar that are consumed by South Africans. The information will assist the Department to identify additional interventions that should be taken to control obesity and reduce the risks of NCDs. Considering that Obesity is caused by multiple factors, with sugar being the major contributor.

END.

Reply:

(1) (a) Total backlog for FCLs is 35 776 tests (CPT, JHB and PTA labs

(b) Outstanding reports:

(i) 1-5 years = 11 948

(ii) 5-8 years=3 391

(iii) 8-9 years= 2 158

(iv) 9-10 years = 1 749

(v) more than 10 years = 2555

(c) Backlogs were cause by, amongst others:

● old laboratory equipment that constantly broke down.

● Insufficient goods and services

● Delays in procurement

● Shortage of skilled staff

The nature of the samples that must be tested, and the volume of new samples and a high incidence of urgent requests. There normally are multiple samples per case, thus one case can consist of blood, urine, stomach content, liver, bile and a drug which all linked to one body.

Additionally the import of Certified Reference Materials to confirm and quantify controlled substances, is a very lengthy process which delays laboratory testing.

(d) The NHLS is streamlining activities in this discipline and the focus is on improving productivity to reduce the backlog.

(2) The backlog developed since the National Department of Health did not have the expertise and resources to effectively address the backlog. The laboratories have now been transferred from the NDOH to the NHLS given the efficiency of the NHLS as a specialised laboratory service. NHLS is leveraging its resources and expertise to turn things around and strives to address the backlog.

Public private partnership is a legislated process which requires a defined procurement approach which requires Treasury approval. The NHLS will explore amongst others the possibility of a public private partnership.

END.

Reply:

The National Department of Health is expecting to start fixing the structural damages at the beginning of March 2023.

The implementation work going to cover the following areas:

Part 1 – The Remedial Works caused by the Boksburg LPG explosion;

Part 2 – Health Technology Equipment that were affected by the Boksburg LPG explosion;

Part 3 – Occupational Health and Safety issues (structural damages) that were identified in 2017.

The estimated date of completion is September 2024.

END.

Reply:

Since 1 June 2019 the department only bought one vehicle for the current Minister: Dr MJ Phaahla, MP, whilst he was the Deputy Minister as per the table below:

Members of Executive Authority	a) Make	b) Model	(c) Year of Manufacture	(d) Cost	(e) Purchase date
(i) Minister: Dr MJ Phaahla, MP	No Procurement was made	No Procurement was made	No Procurement was made	No Procurement was made	No Procurement was made
(ii) Former Minister: Dr. ZL Mkhize	No Procurement was made	No Procurement was made	No Procurement was made	No Procurement was made	No Procurement was made
(iii) Deputy Minister: Dr S Dhlomo, MP	No Procurement was made	No Procurement was made	No Procurement was made	No Procurement was made	No Procurement was made
(iv) Former Deputy Minister: Dr MJ Phaahla	Audi	Q5	2020	R756,489.83	10/5/2020

END.

Reply:

(a) A desktop review on studies related to the effect of sugar on obesity and increasing the severity of NCDs was conducted. In 2016, 31% of adult males, 67% of adult females, and 13% of children under five years old were either overweight or obese.

(b) Further studies conducted in South Africa post implementation of the sugar tax, highlighted a decline in the consumption of sugar sweetened beverages by about 29% in the purchase of SSB and 51% in the incidence of persons adding sugar to beverages. The studies were conducted by Wottesley et al, 2020; Essman et al, 2022; Hofman et al, 2021; and Boachie, Thsehla and Hofman 2022. To access these research articles, click the link HPL implications articles.

END.

Reply:

Yes, the Department relies on scientific evidence, when analysing South Africa’s risk factors to non-communicable diseases. Obesity is one of the risk factors.

(a) and (b) In this regard please see the two studies below:

1. Wandai M, Aagaard-Hansen J, Day C, Sartorius B, Hofman KJ. Available data sources for monitoring non-communicable diseases and their risk factors in South Africa. S Afr Med J, March 2017;107(4):331-337. doi: 10.7196/SAMJ.2017.v107i4.11438. https://www.ncbi.nlm.nih.gov/pubmed/28395686
2. Moodley G, Christofides N, Norris S, Achia T, Hofman KJ. Obesogenic environments in SA: A pilot study in Soweto. Preventing Chronic Disease. DOI: http://dx.doi.org/10.5888/pcd12.140559, 2015
3. South Africa Demographic and Health Survey 2016 https://dhsprogram.com › pubs › pdf

(c) Studies revealed that obesity levels in South Arica are on the increase. The NDHS also revealed that obesity in South Africa was on the increase and that 31% of adult males, 67% of adult females, and 13% of children under five years old were either overweight or obese.

(d) Copies of the studies are available from the links in (a) and (b) above.

END.

Reply:

1. (a) According to the information extracted from 2022/23 provincial User Asset Management Plan (U-AMP), all public healthcare facilities have been assessed in accordance with the requirements of GIAMA (Government Immovable Asset Management Act).

(b)-(d) Not applicable

2. (a) None of the facilities that were assessed need to be demolished.

(b) Not applicable.

END.

Reply:

1. (a) Hospital services

Total number of Hospitals is 394. The hospitals which conducted status determinations are 290. The total number of Ideal Hospitals at the end of 2021/2022 is 146 (37%). The summary of provincial status is as follows:

Province	# of Hospitals	Tot # of Hospitals with Ideal Status	% Hospitals with Ideal status	# of Hospitals with Silver Status	# of Hospitals with Gold Status	# of Hospitals with Platinum Status
Eastern Cape	90	20	22%	19	0	1
Free State	32	16	50%	16	0	0
Gauteng	37	30	81%	23	6	1
KwaZulu-Natal	73	22	30%	20	0	2
Limpopo	41	17	41%	16	0	1
Mpumalanga	33	11	33%	11	0	0
North West	20	10	50%	10	0	0
Northern Cape	15	0	0%	0	0	0
Western Cape	52	20	38%	18	0	2
South Africa	394	146	37%	133	6	7

 

(b) Primary health Care ( PHC) facilities (clinics and Community Health Centres)

The total number of number of PHC facilities are 3477. The total number of PHC facilities that conducted the status determination is 3477. The total number of Ideal clinics and community health centers at the end of 2021/2022 is 1928 (55%). The summary of provincial status are:

Provinces	# of Facilities	# Facilities with IC status REMAINED Ideal	# Facilities with NEW IC status	Total # Facilities with IC status	% of Facilities with IC status	TOTAL # of Facilities with Silver Status	TOTAL # of Facilities with Gold Status	TOTAL # of Facilities with Platinum Status
Eastern Cape	775	138	40	178	23%	27	67	84
Free State	218	123	20	143	66%	12	48	83
Gauteng	369	332	9	341	92%	58	107	176
KwaZulu-Natal	605	472	39	511	84%	40	138	333
Limpopo	482	123	44	167	35%	13	53	101
Mpumalanga	293	136	37	173	59%	20	60	93
Northern Cape	162	29	6	35	22%	10	12	13
North West	310	150	30	180	58%	43	68	69
Western Cape	265	187	13	200	75%	11	23	166
South Africa	3479	1690	238	1928	55%	234	576	1118

2. For a comprehensive report for each province on the stage that each hospital and/or clinic has reached on the ideal status please see attached annexures.

(3) The legislation on the National Health Insurance (NHI) has not been passed yet and NHI compliance of health facilities have therefore not been measured. Clause 39 of the NHI Bill provides for accreditation of all provider establishments, public and private. The regulations and standard operating procedures to achieve accreditation over the coming years is yet to be drafted, published, consulted and adopted.

END.

Reply:

The measles outbreak was in five of the nine provinces namely Limpopo, Mpumalanga, Gauteng, Free State in Thabo Mofutsanyane district only, and Northwest.

1. Yes.

(a) In response to the current outbreak and seeing that there is a need to increase the age group from 6 to 15 year, the department worked with the relevant role players to get enough vaccines for the purposes of interrupting transmission.

(b) There is enough stock to conduct a supplementary immunisation campaign for children aged 6 months to 15 years in all provinces. The number of doses procured by provinces for outbreak/campaign is 10 123 300 for the target population of 16,3 million. The doses referred to here above exclude the stock on hand in the province before the campaign and outbreak.

2. In provinces where there is Public Private Partnerships (PPP) exists, with Service Level Agreement, for private sector, their facilities are supplied with vaccines and trained to manage data and submit to the local sub-district for capturing, however PPP is not in all provinces.

3. No.

END.

Reply:

(1) Yes the adjudication committee has been appointed, trained and the 1st meeting was held on the 14 December 2022. The appeal committee is in the process of appointment 

(a)  82 cases have been linked to the use of the vaccine, and claims are being processed

(b) 3 claims have been approved for payment

  (c) 0

(2) No.

END.

Reply:

1. (a-b) Not all government facilities have been exempted from the load-shedding. However, 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 hospitals have been exempted of which 26 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.

1. (aa) See below the number of hospitals that are exempted to date across the country:

i. (bb) Clinics and Community Health Centres are going to be covered within the solar energy roll-out programme.

ii. 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

END.

Reply:

The procurement of the seven-year lease building was done by the Department of Public Works and Infrastructure. However, the National Department of Health has four times the staff compared to those of the Department of Cooperative Governance and Traditional Affairs. The square meterage that was required by the Department of Cooperate Governance and Traditional Affairs was far less compared to the one that was required by the National Department of Health due to the size of the Department. The rental price of the building is based on the required size of the square meterage.

END.

Reply:

a) The Thaba Tshwane building had enough space to accommodate the staff of the National Department of Health. And it was complying to all requirements of the Occupational Health and Safety Act.

b) The location of the building is not affecting the mission of the National Department of Health. The compliance of the building to OHS Act brings back the focus of the health staff, it is assisting the National Department of Health to put more focus on measures that can assist the provincial health departments to improve the health status through the prevention of illness, disease and the promotion of healthy lifestyles, and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

END.

Reply:

The Patient Information System implemented in OR Tambo Memorial Hospitals is owned and implemented by the Gauteng Department of Health. The Gauteng Provinces adopted the Modernisation Strategy aimed at improving the overall public services. “Gauteng health services will be modernized through effective management of information systems and the development and implementation of e-health strategies towards creating a paperless environment. The implementation of the new Patient Information Systems was to replace the two legacy systems used in the Gauteng facilities, being Medicom 2X and PAAB, the two systems were implemented in early 2000 and were no longer supported by their Original Software Manufacture (OSM).

The implementation of the system was expected to create queues only in the first two weeks of transitioning from the old system to the new system. This was due to data being migrated (data clean-up, data verification, data crossmatch, and data validation) from the old systems to the newly implemented system. To mitigate this expected issue, a change and adoption team was made available to the hospital to interact with patients while waiting in the queues and provided details on the new system and its benefits. The above intervention allowed the hospital to stabilise the system and transition from the old to the new system.

The hospital has a complaint and complement system in place which are monitored regularly. Based on the records for this system such complaints as per the question has not been recorded. The hospital also monitor patient waiting time for retrieval of files and this waiting time is within the benchmark waiting time of 30 minutes

Elderly patients have their own queues and should they come for a follow-up visit with a booking at the hospital, the files are retrieved the day before the booking. This significantly decrease waiting time for the retrieval of files at the administration.

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) 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:

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:

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:

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 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:

(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) 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:

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) 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:

(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:

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:

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.