ATC140328: Report of the Portfolio Committee on Health on its activities undertaken during the 4th Parliament (May 2009 – March 2014), dated 12 March 2014

REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON ITS ACTIVITIES UNDERTAKEN DURING THE 4TH PARLIAMENT (MAY 2009 – MARCH 2014), DATED 12 MARCH 2014

Key highlights

1. Reflection on committee programme per year and on whether the objectives of such programmes were achieved

Over the last five years, the committee managed to achieve the following:

- Processed the Mental Health Care Amendment Bill and the National Health Care Amendment Bill. The latter resulted to the formation of the Office of Health Care Standards

- Ensured that the public was at the centre of many of its processes especially while considering oversight to assess their state of readiness to deliver health services.

- The Committee also managed to visit all nine provinces while the country was preparing for the 2010 FIFA World Cup.

- Closely monitored the spending patterns of the department together with its entities.

1. Committee’s focus areas during the 4 ^th Parliament

- Considering legislation

- Oversight visits

- Briefings with the Department on key health priorities

2. Key areas for future work

- Strengthen oversight role

- Monitoring and influencing the budget of the Department and its entities

- Strengthen relationship with key stakeholders and improve public participation

3. Key challenges emerging

- The key challenge was that there were constant changes on the Parliamentary programme which affected the committee’s programme. More often, the time allocated to committees was insufficient. As a Committee focusing on health and as a priority of government, more of oversight activities should be prioritised.

- Members serving in other committees

4. Recommendations

- Intensify oversight on performance and financial reporting of the national department and provincial departments and entities.

- Committee to follow-up on reports on issues which were not attended to during the five year period.

- Creating enough space in its programme, for oversight visits. Such visits should encompass a mix of both remote areas of South Africa and the peri -urban areas in order to enable the committee to determine if indeed health services are reaching the rural poor and disadvantaged sector of our society.

- Ensuring that oversight visits should be followed by follow-up activities to ensure that the findings of the committee are dealt with by the Department/Entity. Such follow-up activities may include return visits to same sites to ascertain progress made by government.

- The committee should be given an opportunity to learn more about NHI so that it can take an informed decision when the NHI becomes legislation.

- The committee should Insists on timeframes for submission of reports or briefing documents to the committee in order to avoid late submission which affects the committee’s ability to critically and effectively engage in discussions about the subject matter under consideration.

- The committee should closely monitor the Compensation Commissioner for Occupational Diseases (CCOD) to ensure that it delivers on its mandate.

- The committee should ensure that findings of the commission investigating prices of the private sector are presented in Parliament.

1 Introduction

The aim of this report is to provide an account of the Portfolio Committee on Health’s work during the 4 ^th Parliament and to inform the members of the new Parliament of key outstanding issues pertaining to the oversight and legislative programme of the Department of Health and its entities.

This report provides an overview of the activities the committee undertook during the 4 ^th Parliament, the outcome of key activities, as well as any challenges that emerged during the period under review and issues that should be considered for follow up during the 5 ^th Parliament. It summarises the key issues for follow-up and concludes with recommendations to strengthen operational and procedural processes to enhance the committee’s oversight and legislative roles in future.

1.1 The role and mandate of committee:

Parliamentary committees are mandated to:

1. Monitor the financial and non-financial performance of government departments and their entities to ensure that national objectives are met;

2. Process and pass legislation; and

3. Facilitate public participation in Parliament relating to issues of oversight and legislation.

The Portfolio Committees carries out its mandate through:

1. Meetings (encouraging public participation)

2. Oversight visits

3. Processing of legislation

1.2 Department/s and Entities falling within the committee’s portfolio

The Portfolio Committee on Health has a mandate to conduct oversight over the Department of Health and its entities (Council for Medical Schemes, Medical Research Council, National Health Laboratory Service and the Compensation Compensation Commissioner for Occupational Diseases in Mines and Works and the Medical Bureau for Occupational Diseases).

The core mandate of the Department of Health is to improve the health status of South Africans through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the health care delivery system by focusing on access, equity, efficiency, quality and sustainability.

Over the five year period, the health sector focused on the implementation of the following priorities:

• The 10 Point Plan for 2009-2014;
• Millennium Development Goals 2000-2015;
• Health Goals from the National Development Plan (NDP) 2030; and
• The Health Sector Negotiated Service Delivery Agreement (NSDA) - Government’s outcome-based approach to service delivery. The Health sector is responsible for the achievement of Outcome 2 which is “A long and healthy life for all South Africans”.

Over the five years, health sector priorities set out in the SONA included the need to address:

· HIV and AIDS and access to treatment (2009-2013)

· Improving health indicators and meeting millennium development goals (2009-2013)

· Non-communicable diseases (2012)

· Reintroduction of school health programmes (2010)

· Revitalisation of nursing colleges, hospitals and clinics (2009-2011)

· National Health Insurance (2009-2013)

· Improve human resources for health (2009,2011)

Department’s spending trends over the five year period (2009/10 – 2013/14)

R billion	2009/10 Outcomes	2010/11 Outcomes	2011/12 Outcomes	2012/13 Outcomes	2013/14 Estimates
NDoH	19 168.6	22 520.3	25 712.8	27 898.9	30 706.7

Health spending increased from R19.2 billion in 2009/10 to R27.9 billion and expected to increase to R30.8 billion in 2013/14. From 2009/10 to 2013/14 the Department received unqualified audit opinions from the Auditor-General.

1.3 The public entities under the Department of Health

1) Council for Medical Schemes (CMS)

The council’s vision for the medical scheme industry is that it is effectively regulated to protect the interests of members and promote fair and equitable access to private health financing.

2) National Health Laboratory Services (NHLS)

The role of the NHLS is to provide cost effective and efficient health laboratory services to all public sector health care providers, other government institutions and any private health care provider in need of its service, support health research and provide training for health science education.

3) Medical Research Council (MRC)

The objectives of the MRC are to promote the improvement of health and quality of life through research, development and technology transfer. Research and innovation are primarily conducted through council funded research units located within the council and in higher education institutions.

4) Compensation Commissioner for Occupational Diseases (CCOD)

The CCOD is responsible for administering the Mines and Works Compensation Fund to compensate ex-miners who have been certified to be suffering from occupational lung diseases.

2 Key statistics

The table below provides an overview of the number of meetings held, legislation and international agreements processed and the number of oversight trips and study tours undertaken by the committee, as well as any statutory appointments the committee made, during the 4 ^th Parliament:

Activity	2009/10	2010/11	2011/12	2012/13	2013/14	Total
Meetings held	14	26	28	24	22	114
Legislation processed	None	None	1	1	None	2
Oversight trips undertaken	1 (Eastern Cape)	5 (Eastern Cape, Free State, KwaZulu- Natal, Gauteng and North West)	2 (Limpopo and Free State)	2 (Eastern Cape and KwaZulu- Natal)	2 (North West and Mpumalanga)	12
Study tours undertaken	None	None	1 (Thailand)	1 (UK, London)	None	2
International agreements processed	None	None	None	None	None	0
Statutory appointments made	None	None	None	None	None	0
Interventions considered	None	None	None	None	None	0
Petitions considered	None	None	None	None	None	0

3 Briefings and/or public hearings

For the period under review, the Committee allowed for public participation and also took briefings on broad health issues. The Committee engaged the department and its entities on their strategic plans, budget votes, annual reports, policy and legislation. The Committee also held briefings with other bodies including the Health Professions Council of SA, SA Nursing Council, Hospital Association of SA, South African Medical Association, Health Systems Trust, Statistics SA, Human Sciences Research Council and Council for Scientific and Industrial Research and other stakeholders. Briefings, public hearings and oversight within and outside Parliament, as contained in respective programmes of the Committee focused on the Department’s strategic goals, health sector priorities as well as pieces of legislation which were referred to the Committee. The Department’s strategic goals spoke to increasing life expectancy, reducing maternal and child mortality rates, combating HIV and AIDS and decreasing the burden of disease from tuberculosis and strengthening health systems effectiveness. These put the Department of Health in line with government’s National Development Plan which highlights the need to address social and environmental determinants affecting health and disease; strengthen the health system; preventing and reducing disease burden and promoting health; and financing the health system.

4 Legislation

The following pieces of legislation (Annexure 1) were referred to the committee and processed during the 4 ^th Parliament:

· National Health Amendment Bill (2011/12)

The objectives of this piece of legislation were to establish of the office of health standard compliance as a national quality management and accreditation body. The amended bill is aimed at improving the quality of health care in the public sector. The Amendment Bill was referred to Parliament in 2012. Briefings and public hearings were held in Parliament. The bill was approved by both houses of Parliament.

· Mental Health Care Amendment Bill (2012/13)

The objective of this legislation was to amend the Mental Health Care Act 2002, so as to insert a new section that provides for the delegation of powers by the head of the National Department of Health. The amendment was aimed at enabling the Director-General of the National Department of Health to delegate certain powers to official within the Department in relation to the care of involuntary healthcare users. The Amendment Bill also aimed to repeal the remaining chapter of the 1973 Act. The Amendment Bill was referred to Parliament in 2012. Briefings and public hearings were subsequently held in Parliament and adopted the amended bill on the 12 ^th of November 2013.

4.1 Issues for follow-up

- The new Committee should follow -up on progress of regulations of the Mental Health Act.

- The new Committee should monitor the operations of the Office of health standard compliance to ensure its independence.

5 Oversight trips and study tours undertaken

The following oversight trips were undertaken (Annexure 2):

Oversight visit to Free State Province (3-6 August 2010)

The purpose of the visit was to assess their infection prevention and control strategies, management of the HIV, and the control of MDR and XDR Tuberculosis. The Committee found that there was no infection control policy on the institutions; human resources shortages in all institutions; long waiting times; and ambulance shortages. The Committee recommended that all the issues and findings be addressed by the Department.

Oversight visit to Eastern Cape Province (12-13 August 2010)

On 12-13 August 2010 the Portfolio Committee visited the Eastern Cape to assess the quality of health service delivery, the state of health facilities and access to health. Pertinent findings during this visit included the shortages of staff; lack of infrastructure in clinics; lack of patients transport and ambulances.

Oversight visit to Eastern Cape, Free State, Gauteng, North West and Limpopo Provinces

During 2010 the Committee visited different provinces to assess the state of readiness in the host cities in preparation for the 2010 FIFA World Cup.

Oversight visit to Charlotte Maxeke Academic Hospital, Gauteng Province (21 May 2010)

The Committee visited Charlotte Maxeke Academic Hospital following the death of six infants in the neonatal ward in May 2010. The Committee aimed to assess the situation and evaluate the strategies used by the hospital in handling the infection to prevent further spread. The Committee found that infection and prevention strategies were lacking and recommended that the Department embark on a community immunisation campaign and the need to strengthen the quality of neonatal care through improved infection and prevention strategies.

Oversight visit to Cecilia Makiwane Hospital, Eastern Cape Province (28 March 2011)

Following an infection outbreak in Cecilia Makiwane Hospital which resulted in 29 infant deaths by the end of February, the committee embarked on an oversight visit to assess the status of the hospital, possible causes of the infection and infection control strategies utilised by the hospital.

Oversight visit to Gauteng (29-31 March 2011)

The Committee visited different health care facilities in Gauteng Province to assess the quality of health services, the state of health facilities and progress made in meeting the MDGs related to health.

Oversight visit to Limpopo Province (10-12 August 2011)

On this oversight visit, the committee aimed to assess infection control strategies and quality of health services; gain insight into the functioning of the healthcare system in the province; observe women and maternal programme in line with the MDGs; get a report on circumcision procedures and guidelines; as well assessing the safety of patients and staff in health facilities.

Oversight visit to Mpumalanga Province (15-16 September 2011)

The purpose of the visit was to assess the quality of health services in preparation for the People’s Assembly.

Oversight visit to Eastern Cape (18-22 June 2012)

The Committee aimed to assess spending of the health infrastructure grant.

Oversight visit to the North West Province (29 July – 2 August 2013)

The purpose of the visit was to assess health care delivery in general, with special emphasis on quality of health services, infection prevention and control, the referral system, functioning of the primary health care system, roll out of ARVs and drug availability, achievements and challenges with regard to the roll out of the National Health Insurance Pilot Project. The visit also aimed at gaining insight into the functioning and recruitment of retired nurses, how they are compensated and their scope of work. The Committee recommended that the Department looks into issues of patient waiting times, equipment shortages, staff shortages, and infrastructure maintenance.

Oversight visit to Mpumalanga Province (16-17 September 2013)

The purpose of the visit was to assess infection control strategies and the quality of health services, the referral system and the functioning of the primary health care system, roll out of ARVs and drug stock outs, achievements and challenges with the roll out of the National Health Insurance Pilot Project. The Committee also wanted to gain insight into the functioning and recruitment of retired nurses, how they are compensated and their scope of work. The Committee also wanted to assess revitalisation projects and their functionality as well get a report on the deaths of initiates. The Committee found that the district battled with issues related to high HIV and AIDS prevalence, high infant and under five mortality .

The following study tours were undertaken (Annexure 3):

(The findings and the recommendations of the above mentioned oversight visits are incorporated in the committee’s oversight reports)

Study tour to Bangkok (23-27 January 201?)

The Committee decided on the study tour pre-empting the piloting of the NHI in various areas of South Africa, as well as health care services in general. The NHI will reshape South Africa’s health care system. Also, it decided on Thailand as a country which is perceived to have one of the good health care system . The learning therefore from the Thai government healthcare system will assist Members of Parliament (MPs) in their future oversight activities.

Study tour to London (2-9 December 2012)

The key objectives of the study tour were to review and learn lessons from features of the NHS where current pending South African policy and legislation has drawn heavily on the UK experience, to understand better oversight functions as Parliamentarians monitoring the delivery of healthcare and to network and develop partnerships with other Parliamentary organisations based in the UK such as the Commonwealth Parliamentary Association.

5.1 Challenges in relation to oversight visits and study tours

· Planned oversight visits to provinces usually not properly communicated by the province to the relevant health facilities.

· Applications not approved on time to allow the committee enough time to prepare.

· Parliamentary programme which does not always allow for committees to undertake their oversight visits or study tours as planned.

· Members not attending

5.2 Issues for follow-up

· The Committee should visit more countries as to enable itself to learn about the National Health Insurance.

· The Committee should conduct follow-up visits to ensure that recommendations tabled by the Committee to the provincial departments are implemented.

6 International Agreements:

For the period under review, the committee did not consider any international agreements.

7 Statutory appointments

For the period under review, the committee did not conduct any statutory appointments.

8 Interventions

No interventions were referred to the committee for the period under review.

9 Petitions

The committee did not consider any petitions.

10 Obligations conferred on committee by legislation:

No obligations were conferred to the committee.

11 Summary of outstanding issues relating to the department/entities that the committee has been grappling with

The following key issues are outstanding from the committee’s activities during the 4 ^th Parliament:

· Eastern Cape health crisis – Committee to request a progress report explaining how the Eastern Cape Health Department is addressing the challenges the department is facing.

· Committee to participate in Pan African Parliament’s working group or sub-committee on health issues.

· Committee to receive reports on private health care costs issues based on the enquiry by the Competition Compensation.

· Committee to receive a report on progress made in addressing the issue regarding the deaths of initiates in Mpumalanga Province.

12 Recommendations

12.1 Governance

· Ensure that concerns expressed by the previous Committee emanating from briefings and oversight reports are addressed.

· Ensure that the various health sector priorities raised in the SONA (2009-2013) as these should be addressed by the new Committee.

12.2 Hospital revitalisation and service delivery

· Continue to monitor challenges regarding hospital revitalisation and infrastructure projects by requesting the Department to report on this matter on a quarterly basis.

12.3 Staffing issues and quality of care

· The Committee to follow-up with the Department on revised strategies regarding staffing and staff retention.

12.4 Strategies and general healthcare

· The Committee to ensure that the Department fast-track progress of the PHC re-engineering programme.

· Even though the country is making considerable progress towards many of the Millennium Development Goals (MDGs), the country will not achieve some goals by 2015, the Committee together with the Department should review and set new targets for goals that are not met and craft strategies to address challenges post 2015.

· It is estimated that the TB incidence rates on gold mines are probably the highest in the world. Therefore, the Committee should monitor the implementation of the Mine Health and Safety Act, 1996 (Act 29 of 1996) which aims to provide for the protection of the health and safety of employees and other persons at mines.

12.5 NHI progress

· Committee to closely monitor spending on the NHI grant and request the NHI pilot sites to report on a quarterly basis.

· Committee needs to track progress on the publication of the White Paper on NHI.

12.6 Issues pertaining to entities

· Ensure the submission of reports by the Department’s entities (concerns were raised on non-submission of reports by the CCOD).

12.7 Provincial health issues

· The Committee to request a report from the Department regarding the Eastern Cape health issues.

· Committee to receive reports on all other provincial departments, with emphasis on management and control over grants by provincial departments.

12.8 Collaborations

· The Committee should consider joint briefings on cross-cutting issues and on spending by provincial departments

· Consider calling for public comments on strategic plans and annual reports.

· Committee should ensure that partnerships between public and private sector are strengthened to improve health care delivery.

Annexure 1: Legislation

Year	Name of Legislation	Tagging	Objectives	Completed/Not Completed
2011/12	National Health Amendment Bill	Section 76	The objectives of this piece of legislation were to establish of the office of health standard compliance, the board of the office and how the board will operate.	Completed
2012/13	Mental Health Care Amendment Bill	Section 76	The objective of this legislation was to enable the Head of Department to delegate his/her powers to any official in the department that he/she may see fit.	Completed

Annexure 2: Ov ersight visits undertaken

(Details of the recommendations are in the reports)

Date	Area Visited	Objective	Recommendations	Responses to Recommendations	Follow-up Issues	Status of Report
12 – 13 August 2009	East London and Mthatha and East London. In Mthatha the delegation visited the following facilities: 1. Nelson Mandela Hospital Complex 2. Mbekweni Health Centre and 3. Ntshele Clinic In East London the following facilities were visited: 1. East London Hospital Complex: Frere Hospital 2. Empilweni Gompo Health Centre 3. DDT Jabavu Clinic	The objective of the oversight was for the Committee to conduct its oversight function by assessing the quality of health service delivery, the state of and access to health facilities used by the people of the Eastern Cape.				Report adopted
6- 14 April 2010	Eastern Cape (Port Elizabeth) Free State (Bloemfontein) KwaZulu Natal (Durban) Gauteng (Johannesburg) North West (Rustenburg) and Limpopo (Polokwane)	The objective of the trip was to assess the state of readiness for the host cities for the 2010 FIFA World Cup.				Report adopted
21 May 2010	Charlotte Maxeke Hospital in Gauteng	The committee visited the hospital following the death of six infants in the neonatal ward in May 2010. The committee aimed to assess the situation and see whether there was a threat of the infection spreading to other hospitals and provinces. The committee also aimed to evaluate the strategies used by the hospital in handling the infection to prevent further spread.				Report adopted
28 March 2011	Cecilia Makiwane Hospital	An infection outbreak at Cecilia Makiwane Hospital, culminated in a reported 29 infant fatalities by the end of February 2011 and the committee conducted an oversight to assess the status of the hospital and to ensure that the infection does not spread to other facilities.				Report adopted
29 – 31 March 2011	The Committee visited the following facilities in Gauteng: 1. Chris Hani Baragwanath Hospital 2. Leratong Hospital 3. Zola Health Centre	The purpose of the visit was to assess the quality of health service delivery, the state of and access to health facilities in Gauteng Province. The Committee aimed to assess models used for service delivery, infection prevention and control mechanisms, primary healthcare and safety in public health facilities. The Committee also intended to assess strategies used by the public health facilities in trying to meet the Millennium Development Goals (MDGs) related to health.				Report adopted
10 – 12 August 2011	The committee visited the following facilities in Limpopo: 1. Mankweng Hospital 2. Louis Trichardt Hospital 3. Madombidza Clinic	The following objectives underpinned the purpose of the visit, which was to: 1. Assess infection control strategies and the quality of health services; 2. Gain insights on the functioning of the tertiary, district and primary health services in the province; 3. Observe facilities for child-birth in line with the United Nations Millennium Development Goals (MDGs) 4 and 5. These Goals are to reduce infant mortality and maternal mortality respectively; and 4. Assess security in the above-mentioned public health facilities. Although there are few or no reported cases of initiates’ deaths in Limpopo, the Committee wanted to get a briefing on how best the province executes its circumcision procedures.				Report adopted
15- 16 September 2011	The Committee visited the following facilities: 1. Bongani Hospital 2. Kopano MDR Unit 3. Dr JS Moroka Hospital	The purpose of the visit was to conduct oversight by assessing the quality of health service delivery, the state of and access to health facilities used by the people of the Free State. The oversight was conducted in preparation for the People’s Assembly.				N/A
18-22 June 2012	1. Rietvlei Hospital 2. Nessie Knight Hospital ( Sulenkama )	The purpose of the visit was to conduct oversight function by assessing the quality of health service delivery. The Committee also wanted to assess how public health facilities were spending their infrastructure grant.
29 July – 2 August 2013	The delegation visited the following public health facilities in the North West Province: 1. Job Shimankana Tabane Hospital 2. Boitekong Community Health Centre 3. Moses Kotane Hospital 4. Pella Community Health Centre 5. Mafikeng Hospital 6. Lehurutshe Zeereust Hospital Complex 7. Klerksdorp/ Tsepong Hospital Complex 8. Tsepong MDR Hospital 9. Witrand Psychiatric Hospital	The purpose of the visit was to assess health care delivery, with special emphasis on quality of health services, infection prevention and control, the referral system, functioning of the primary health care system, roll out of ARVs and drug availability, achievements and challenges with regard to the roll out of the National Health Insurance Pilot Project. The visit also aimed at gaining insight into the functioning and recruitment of retired nurses, how they are compensated and their scope of work.
16 – 17 September 2013	The Committee visited the following health facilities in the Mpumalanga Province: 1. KwaMhlanga Hospital, 2. Verena Community Health Centre 3. Ermelo Hospital	The purpose of the visit was to assess infection control strategies and the quality of health services, the referral system and the functioning of the primary health care system, roll out of ARVs and drug stock outs, achievements and challenges with the roll out of the National Health Insurance Pilot Project. The Committee also wanted to gain insight into the functioning and recruitment of retired nurses, how they are compensated and their scope of work. The Committee also wanted to assess revitalisation projects and their functionality as well get a report on the deaths of initiates.

Annexure 3: Study tours undertaken

The following study tours were undertaken:

Date	Places Visited	Objective	Lessons Learned	Status of Report
23 – 27 January 2013	Bangkok in Thailand	The Committee decided on the study tour pre-empting the piloting of the NHI in various areas of South Africa, as well as health care services in general. The NHI will reshape South Africa’s health care system. Also, it decided on Thailand as a country which is perceived to have one of the good health care system . The learning therefore from the Thai government healthcare system will assist Members of Parliament (MPs) in their future oversight activities.	Most health facilities in Thailand are private and most health professionals do not fully understand what the National Health Insurance is.	Report adopted
2- 9 December 2012	London in the UK	The key objectives of the study tour were to review and learn lessons from features of the NHS where current pending South African policy and legislation has drawn heavily on the UK experience, to understand better oversight functions as Parliamentarians monitoring the delivery of healthcare and to network and develop partnerships with other Parliamentary organisations based in the UK such as the Commonwealth Parliamentary Association.	1. The UK’s Ombudsman is independent and is appointed by the queen. 2. The Ombudsman does not have an appeals process and their reports are final. 3. Everyone has a right to come and complain to the ombudsman but not every complaint gets investigated. 1. The Ombudsman is not responsible for monitoring norms and standards. 2. The primary health care in the UK is called a practise which and is run by general practitioners. 3. The hospitals in the UK are very clean and well maintained.	Report adopted