ATC171025: Report of the Portfolio Committee on Health on the State of Health Care Services in South Africa dated 25 October 2017

Health

REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON THE STATE OF HEALTH CARE SERVICES IN SOUTH AFRICA DATED 25 OCTOBER 2017
 

1.INTRODUCTION

 

The Portfolio Committee on Health was briefed by nine Provincial Departments of Health (Eastern Cape, Western Cape, Free State, Limpopo, North West, KwaZulu-Natal, Mpumalanga, Northern Cape and Gauteng) on 16 to 18 August 2016. The purpose of these engagements was to enable discussions with provincial departments and establish the state of health services in the country. Furthermore, it was to get responses from provincial departments on findings and recommendations of the Committee’s oversight visits during 2014/2015.

 

Matters that were carefully considered included the following:

• Human resource management with emphasis on Community Health Workers (CHWs);
• Infrastructure management;
• Supply chain management and financial management including issues raised by the Auditor General; and
• The implementation of the Ideal Clinic Initiative.

 

1. REPORTS OF PROVINCIAL DEPARTMENTS

 

1. EASTERN CAPE
   1. ECDoH obtained an unqualified audit opinion for 2015/16 financial year an improvement from qualified audits in previous financial years.
   2. The two issues of concern were with regard to irregular expenditure, and fruitless and wasteful expenditure. The irregular expenditure was currently R212 million, but it was based on a previous review, dating back to 2010/2011. R90 million was recorded on unauthorized expenditure in the previous financial year.
   3. ECDoH reported on receiving quite a number of medico-legal claims and this had a negative impact on the department as these had not been budgeted for. The average medico-legal settlements paid in the last four years was R52 million per annum. In 2015/16, total medico-legal settlements paid amounted to R266 million.
   4. ECDOH’s budget for this financial year was an average of R1.4 billion, allocated to the eight critical programmes. About R233 million had been spent in the first quarter (17% of expenditure). The provincial department had derived R3.8 million from the Expanded Public Works Programme.
   5. On supply chain management (SCM) and procurement, the majority of the large contracts awarded were in respect of medical equipment.
   6. Local procurement was on security, waste removal, patient food, cleaning services and furniture. The idea behind local procurement was to have services provided by the local communities with the aim of boosting the local economy.
   7. On human resources, the ECDoH has a vacancy rate of 12.9%. ECDOH was currently prioritising the appointment of core service delivery posts or clinical posts.
   8. On the number and progress of medical students in Cuba:

• There were nine students at the first year level, and their completion date was 2022;
• 90 students at the second year level, with a completion date of 2021;
• 97 third year students, with a completion date of 2020;
• 84 fourth year level students, with a completion date of 2019;
• 11 fifth year level students, with a completion date of 2018; and
• Five final year students who would qualify in 2017, as they were currently doing the South African aspect of their medical studies.
  1. Challenges regarding the community health workers programme related to:

• The formal employment of community health workers;
• Inadequate reporting system;
• Lack of home care kits, identification uniforms and badges;
• Clear job descriptions for CHWs; and
• The absence of debriefing sessions for the CHWs to address bottlenecks.
  1. On infrastructure, 118 projects had been recorded for the first quarter of 2015/16.
  2. Infrastructure performance was below planned levels due to delays in the awarding of health technology contracts and delays in the awarding of contracts.
  3. Some progress had been made in terms of infrastructure capacity building. Some positions that had been filled including the post of the general manager; mechanical and electrical engineers; quantity surveyors; civil engineers; three architects; and five clinical engineers who dealt with medical equipment.
  4. Regarding the procurement of medical equipment, there were six categories of equipment that were currently being procured: imaging equipment; critical or life support equipment; diagnostic and rehabilitation equipment; medical furniture equipment; office furniture and cleaning equipment; and surgical instruments and linen, or clothing.
  5. On Ideal Clinic, 241 PHC facilities were targeted. A total of 15 clinics achieved Ideal Clinic status.

 

Observations and Findings

1. With regard to the revision of the organogram, a detailed report containing the cost breakdown for filling the vacant posts was requested by the Committee.
2. The Committee noted that the ECDoH’s 12.9% vacancy rate was concerning and seem not to give a true reflection of the actual vacancy rate in the province, seeing that during the Committee’s oversight visit to the province, it had encountered a huge outcry over the issue of vacancies. In terms of plans to address the high vacancy rate, the provincial department has an annual recruitment plan with an improved post list which was currently being filled.
3. On Ideal Clinic, the Committee noted that only a few of the 241 clinics had been able to achieve Ideal Clinic status.
4. Details on infrastructure backlogs and a turnaround strategy to address such backlogs were requested by the Committee.
5. The Committee noted that there were 6 305 CHWs in the province. The categories include home-based care, lay-counsellors, care givers and peer educators.
6. On the nature of the relationship between the WBOTs and CHWs, the Committee noted that there were potential overlaps and these will only be addressed by a national policy.
7. A detailed response was requested on how the ECDoH was addressing the challenges of medical equipment as the Committee had been informed on its oversight visit on challenges related to the non-availability of equipment.
8. The Committee noted with concern that irregular expenditure had been a challenge in terms of qualifications which had arisen as a result of the weaknesses in SCM processes.
9. With regard to the issue of insourcing and outsourcing, the Committee observed that the provincial department was considering the outsourcing of some services such as food and security.

 

1. FREE STATE
   1. FSDoH has 221 PHC facilities. A total of 100 facilities had been enrolled into the Ideal Clinic programme in 2015/16. Forty-six (46) facilities out of the 100 enrolled facilities were assessed. Twenty-two (22) of the 46 enrolled facilities attained Ideal Clinic status, however diamond status was not reached, only platinum and gold status was reached.
   2. FSDoH reported that some of the lessons learnt to improve the Ideal Clinic programme such as the need to prioritize budgets for the Ideal Clinic programme, strengthening SCM processes, as well as carrying out a weekly progress monitoring.
   3. On HR, FSDoH reported that 17 680 posts had been filled, with 3 760 vacant posts, resulting in a vacancy rate of 18%. About R5.8 billion had been budgeted for compensation of employees for the current financial year.
   4. The posts status of Albert Nzula District Hospital was particularly highlighted, as it had recorded only three filled posts with 194 vacant posts. The reason for this was because it was a new facility, and was yet to be commissioned. The process of appointing staff for this facility was already in progress.
   5. On CHWs programme, nine (9) non-governmental organisations (NGOs) had been awarded contracts to manage the administration and HR issues of CHWs, including stipend payments, monitoring and supervision of activities.
   6. A total of 915 community care givers (CCGs) were receiving a stipend of R1 850 per month, in accordance to the Ministerial determination; 594 CHWs were receiving R1 900 per month; and 104 enrolled nursing assistants and 44 enrolled nurses that provided clinical support to CHWs were receiving R3 000 per month.
   7. The training plan for CHWs had been designed according to the need for coverage of family health teams in the wards. Training had commenced in the districts in 2011.
   8. On infrastructure management, the adjusted budget for 2015/16 was around R589 million and the budget for 2016/17 was R516 million.
   9. On financial management, FSDoH alluded to the increase in accruals which demonstrated the inadequacy of the budget. The AG had given the FSDoH a qualified audit, noting that the completeness of the accruals could not be determined.
   10. FSDoH has received a qualified audit opinion in areas such irregular expenditure, accrued revenue and commitments.
   11. Some SCM imperfections identified included poor planning and ineffective implementation of procurement plans; a prolonged turnaround time in the procurement of goods, services and works; cost effectiveness and non-realisation of value for money; ineffective contract management; and shortage of human resources.

 

Observations and findings

1. The Committee noted that the provincial department’s state of finances is concerning and that annual budget increases were still not sufficient.
2. The Committee noted the increase in accruals, and the need to put in place measures to mitigate the recurrence of accruals.
3. The number of WBOTs the province and the wards covered by these teams was unclear.
4. Budget allocation to the nine contracted NGOs was not clarified.

 

1. NORTHERN CAPE
   1. On HR, the total staff establishment of NCDoH was 6 735. NCDoH reported to having more clinical posts than non-clinical. NCDoH highlighted the number of vacant posts, 477 vacant posts for health professionals, and 227 vacancies for administration and support. A total of 1 616 vacant unfunded posts had been abolished. These posts were mainly support posts, rather than critical service delivery posts.
   2. On the Cuban programme, NCDoH reported that 205 students across all five districts of the province were in the programme. Some of the students were still undergoing training. A total of 33 doctors from the Cuban programme were currently working within the province.
   3. With regard to the CHWs prograame, NCDoH reported that there had been an outcry for the absorption of CHWs, however the department was faced with the challenge of budget constraints. The projected budget for absorbing of the current 2 592 CHWs at level three, was R485 million. The 2 592 CHWs had been sourced from 30 NGOs and 56 retired nurses. A stipend of R2 500 per month is paid to CHWs, resulting in a budget of about R97 million per annum.
   4. CHWs were integrated into WBOTs and they conduct household assessments, provided health information, supported chronic patients, and assisted with the CCMDD programme in certain areas. All 38 wards in Pixley Ka Seme district were covered with ward-based outreach teams.
   5. On infrastructure management, NCDoH indicated that the new De Aar Hospital had been handed over to the provincial department, and was ready for operationalization.  Other completed projects included the upgrade of a 36-bed mental health unit in West End Hospital, which would be ready for operationalization by October 2016; upgrading of the EMS station at Calvina; and the provision of fencing and guard houses for clinics, hospitals and community health centers (CHCs).
   6. With regard to the status of the new mental health hospital, NCDoH indicated that the hospital had reached 87% completion. The projected completion date was July 2017.
   7. NCDoH had received a qualified audit opinion, with emphasis on issues such as movable, tangible and intangible assets; accruals and payables; accrued departmental revenue; commitments; irregular expenditure; and SCM, procurement and compliance.
   8. In relation to the Ideal Clinic programme, there are 36 PHC facilities in the NHI pilot district that had been targeted to reach Ideal Clinic status by 31 March 2017, as well as 30 PHC facilities in other districts.
   9. Three clinics out of the 36 PHC facilities in the NHI pilot district had achieved Ideal Clinic status. Of the additional 30 PHC facilities in other districts, two clinics had achieved Ideal Clinic status in the previous year.
   10. NCDoH alluded to the challenges faced in achieving Ideal Clinic status to include inadequate budget, lack of vital equipment, infrastructural challenges, HR challenges, and challenges with security services. Measures had been developed to address these challenges.

 

Observations and findings

1. On the operation of air ambulance services in the province, the Committee observed that service providers would be identified and contracted as and when needed in order to avoid incidents of payment for air ambulances that are not used. National Treasury had advised provinces to make use of the deviation procedure for air ambulance services.
2.  In light of the vastness of the province, the mobility of CHWS to certain remote areas was a concern. Details were sought on CHWs conditions of service and benefits they are entitled to.
3. The Committee observed that 1 616 posts were abolished as budgets were moved around for the compensation of employees (COE) and areas of inefficiencies were identified within the provincial department, whilst ensuring that operational managers and critical posts were accommodated.
4. There seem to be instability at senior management level in the NCDoH.
5. Financial management remains a challenge, an area of concern relates to accruals.

 

1. GAUTENG
   1. On CHWs, GDoH reported that historically, the provincial department funded NGOs to pay and manage CHWs. However, in 2012 GDoH decided to rationalize the CHWs programme. This however resulted in protest action by CHWs alleging that NPOs were paying stipends below the department’s prescribed rates, delayed payments and that NPOs were arbitrarily dismissing them when they challenged the state of affairs.
   2. GDoH alluded that CHWs demanded to be employed permanently by the Department. However, GDoH had indicated that it had not been in a position to absorb all of the CHWs, due to budget and post availability constraints.
   3. GDoH had received an unqualified audit opinion in 2015/16. GDoH indicated to that it had engagements with the South African Institute of Chartered Accountants (SAICA) to assist it with its financial matters.
   4. Irregular expenditure (R466 million in 2015/16) issues were being addressed, however the bulk of the expenditure was from court orders for medico-legal claims against the provincial department.
   5. GDoH reported that 73 health facilities had met the assessment criteria and achieved Ideal Clinic status.

 

Observations and findings

1. There are many concerns relating to CHWs in GDoH including the contracting of Smart Purse to pay stipends to CHWs. These requires the intervention of National Department of Health.
2. Progress in relation to infrastructure projects was unclear.
3. In ensuring uninterrupted power supply for central hospitals, this was being addressed with the Department of Infrastructure Development.
4. The payment of service providers within 30-day period remains a challenge for GDoH, currently working with the Provincial Treasury to develop systems to ensure that service providers are paid timeously.
5. On PHC infrastructure maintenance, there were 116 clinics that there were going to have generators installed in the financial year. The plan was that all health facilities would be fitted with generators and water tanks by the end of 2019. 
6. The Committee noted with concern the dispute between GDoH and the National Health Laboratory Services (NHLS), as GDoH submitted to the Committee that a commissioned report indicated that the NHLS owed the provincial department R1 billion.
7. On medical legal claims, the Committee observed that the provincial department had terminated the services of the State Attorney to private attorneys for medico-legal cases. GDoH was of the view that the State Attorney did not defend cases that had merit to be defended and kept settling.

 

1. MPUMALANGA
   1. With regard to HR, MPDoH indicated the challenges related to the recruitment and retention of specialists which were attributed to the rurality of the province and the lack of a medical university.
   2. MPDoH reported that the intervention had been to partner with the University of Pretoria to train nurses and specialists and Emergency Medical Services (EMS) personnel, and training of medical officers in Cuba.
   3. Other HR challenges relate to accommodation for health professionals, and the intervention was that all future infrastructure plans must include accommodation for health professionals. In the meantime, health professionals were being offered an accommodation allowance.
   4. MPDoH reported on a challenge with the translation of 255 nurses, of which 63 had been approved. The intervention was to move the nurses to facilities where there were funded and vacant posts.
   5. On the Cuban programme, ten students had been recruited in 2015/16. A total of 223 students are currently in the programme, of whom 18 were doing their final year in South Africa.
   6. On infrastructure management, projects included five hospitals that had been identified for high-tech refurbishment and renovations. There were clinics that had been identified for the Ideal Clinic programme. These included the Kanyamazane, Oakley and Balfour clinics. A new paediatric ward had been added at Witbank hospital, and an x-ray unit had been added at Themba Hospital.
   7. The capacity of the infrastructure unit in the department had been increased through the appointment of staff and artisans.
   8. MPDoH has obtained a qualified audit for this financial year.
   9. MPDoH reported to have appointed the Director: Supply Chain Management who had commenced duties on 15 August 2016, and that the provincial department would realize a turnaround in procurement. This would also include efforts to pay suppliers within 30 days.
   10. On the Ideal Clinic programme, the provincial department had been planned to have 46 clinics meeting ideal clinic status in this financial year, based on the funds available. However, the plan had been reviewed in March 2016.
   11. MPDoH reported that data management remained a problem in the province, and the roll-out of e-health would assist in keeping patients records and/or files.

 

Observations and findings

1. The Committee observed that CHWs included home-based carers and that there were 8 811 CHWs in the province, who were linked to the ward-based outreach teams. There was a regional training centre at Gert Sibande District that was accredited to train CHWs. MPDoH funded 269 NPOs, and a breakdown per district and sub-district would be provided to the Committee. The stipend given was R1 200, which was below the Ministerial determination. The Department was working on ways to increase the stipend. The CHWs were not given any benefits besides their stipend.
2. On infrastructure, the Committee observed that the leaking issue at Rob Ferreira had been addresses as well as the air conditioning. There are maintenance plans for the Ideal Clinics, however budget constraints remained a challenge.
3. The cause of incurred irregular expenditure was unclear.

 

1. NORTH WEST
   1. NWDoH reported that CHWs in the province were paid a stipend ranging between R2 000 and R2 500 per month. There were a total of 8 001 CHWs in the province.
   2. The challenges relating to CHWs were that they were demanding an increase in the stipend and to be permanently employed by the provincial department.
   3. Infrastructure projects had a budget of R463 million allocated to rural villages and small towns in a deliberate attempt to improve access to health care facilities in the province.
   4. On infrastructure, NWDoH reported to have conducted conditional assessments of health facilities in the province and priority projects had been identified, which would require roughly R400 million to be successfully addressed. Only high priority issues would be dealt with in the current financial year. As the infrastructure budget would not allow all identified projects to be addressed.
   5. NWDoH has obtained a qualified audit report, largely due to commuted overtime and medico-legal claims.
   6. There had been no unauthorised expenditure in the 2015/16 financial year, fruitless and wasteful expenditure was largely on accruals on interest from previous financial year’s projects.
   7. NWDoH submitted that it had achieved a reduction in accruals. However, medico-legal claims continued to increase due to cases of medical negligence and emergency care services.
   8. On Ideal Clinic programme, 109 PHC facilities have completed their status determination in May 2016 and none of them had achieved Ideal Clinic Status.
   9. NWDoH indicated that challenges identified during the Ideal Clinic assessment were related to the non-availability of tracer medicines; certain essential equipment; water tanks and generators; and external signage.

 

Observations and findings

1. The Committee noted with concern the audit outcomes of the NWDoH, it has regressed from unqualified to qualified in this financial year due to irregular expenditure.
2. On infrastructure and the court order by a contractor, the Committee noted that it had been the result of disagreements between the provincial department and the contractor. It had since been resolved and the contractor had returned to the site.
3. On Ideal clinic, the issue of water tanks and generators at clinics was being addresses and procurement processed had been finalized. It was envisaged that by the end of the financial year, all clinics would have water tanks and generators.
4. Details were sought on the total budget for CHWs stipend in the province and the role of the provincial department in the training of CHWs.

 

1. WESTERN CAPE
   1. WCDoH submitted that CHWs are contracted through NPOs which then employs and manage the budget allocated to CHWs.
   2. Infrastructure priorities for the 2016/17 period are to:

• Strengthen and improve the PHC infrastructure in all districts with a specific focus on the metro;
• Modernise Emergency Centres at hospitals;
• Provide or upgrade Acute Psychiatric Units at hospitals;
• Focus on Maintenance and Fire Compliance at existing health facilities; and
• Improve efficiency, economy, and effectiveness of Procurement Strategies.
  1. WCDoH reported that a total of 31 posts under infrastructure have been filled and funded from the Health Facility Revitalization Grant.
  2. Infrastructure challenges, include continuously reduced infrastructure budget allocation over the past few years, which necessitates the on-going reprioritisation of projects as well as the scarcity of built environment, engineering and health technology skills.
  3. On financial management, WCDOH received an unqualified audit opinion with no material findings for the 2015/16. There has been a 56% reduction in irregular expenditure.
  4. WCDoH pointed out that there are inefficiencies within the SCM system caused by the lack of integrated systems which create duplicated or inconsistent information and processes. Systems are not geared towards current SCM reforms and there is poor contract management for national contracts.
  5. Some of the measures implemented to address SCM imperfections and improve contract management include the implementation of the Demand Management Planning and Procurement Plans and regular training interventions.
  6. On Ideal Clinic, WCDoH formally adopted the Ideal Clinic Initiative in April 2016. A total of 227 facilities in the Western Cape have completed their status determination.
  7. Some of the challenges around the implementation of the Ideal Clinic initiative are that some elements do not apply to very small clinics and connectivity in some facilities results in data capturing challenges.

 

Observations and findings

1. The strategy to address the scarcity of built environment engineers and technologists, the provincial department was offering a bursary scheme called Sakhisizwe. The graduates are then absorbed into the system, however it was difficult to match the salaries offered by the private sector.
2. The Committee observed that the Ideal Clinic programme was adopted only in April 2016, the provincial department had to first ascertain that other essentials such as staff and medication are available. Some of the things required in the Ideal Clinic are things that the provincial department has identified before and implemented.
3. The Committee noted that there are between 3000 and 3800 CHWs that are supported through the NPOs.
4. The Committee observed that the infrastructure budget maintenance is around R385 million with most of the funding going to maintenance.
5. KWAZULU-NATAL
   1. KZNDoH reported that in 2010 the department took a decision to terminate contracts with the NGOs and opted to fund the community care givers (CCGs) directly. Each CCG is allocated 60 households in a ward and is required to visit 3-5 households per day. Each CCG is linked to a clinic/health facility within the catchment area.
   2. There are 1 456 CCGs consisting of 576 nutritional advisors, 820 enrolled nurses and 60 health promoter’s assistant.
   3. On infrastructure management, the Health Infrastructure Programme was allocated a budget of R1.55 billion for 2015/16 and R 1.58 billion for the 2016/17 financial years. Because of the high reduction of an equitable share allocation, almost all projects were transferred to the Infrastructure Grant.
   4. KZNDoH received a qualified audit opinion for 2015/16. The qualification was a result of movable tangible capital assets and minor assets, irregular expenditure, and commuted overtime allowance.
   5. On supply chain management and procurement, KZNDoH pointed out that systems need to be improved. Audit Improvement Plans are to be developed, and plans are to streamline Demand Management processes in order to identify and implement improved sourcing methods guided by leading practices in strategic sourcing. Standard Operating Procedures have been finalised and training has been given to all institutional management teams.
   6. With regard to progress and challenges on the Ideal Clinic programme, of the 204 facilities assessed in KZN, three (3) facilities received silver status and four facilities received gold status. Challenges are around water and electricity back-up systems in rural areas, network connectivity challenges in the rural facilities, and budgetary constraints for clinic maintenance.

 

Observations and findings

1. The Committee noted that CCGs get a 2-year contract and that others had been on career path to become nurses and nutrition advisors.
2. It was clarified that the CCGs are part of the ward-based outreach teams.
3. The Committee noted that there were challenges with district clinical specialists with a difficulty to recruit anaesthetists.
4. On SCM, the provincial department was currently building capacity in the SCM unit. Internal training was developed and rolled out in the previous financial year and have sourced the help of National Treasury.
5. The Committee noted that discussions were held on the provincialisation of the Ideal Clinics.
6. On unfilled key senior positions, the Committee noted that filling the position of CFO was being challenge.

 

1. LIMPOPO
   1. LDoH reported that CHWs are recruited through NPOs funded by the provincial department.
   2. For the 2015/16, LDoH received a qualified audit opinion. Qualifications were relating to movable tangible capital and minor assets; accrued departmental revenue; and employee costs and benefits.
   3. With regard to SCM, LDoH has enforced compliance, with the development of procurement plans by all institutions within the department and revised the existing SCM delegations to give powers to CEOs.
   4. Infrastructure challenges are around ageing and inappropriate infrastructure and equipment; non-utilisation of facilities after practical completion; limited capital and maintenance budgets versus the needs; and lack of equipment maintenance contracts.
   5. On the Ideal Clinic programme, LDoH has identified 248 health facilities to be scaled up for Ideal Clinic in the current financial year. Two clinics in Sekhukune District has already reached Ideal Clinic status.
   6. Challenges around the implementation of the Ideal Clinic initiative include:

• Insufficient funds and delays in SCM processes;
• Lack of buy-in from developmental partners in districts;
• Non-compliance to patient record keeping, filing and archiving compliance is only at 9% due to insufficient space;
• Signage from the main road to the facility is available for only 12% of the facilities;
• 64% of the PHC facilities experience physical space and routine maintenance challenges;
• 48% of redundant and non-functional equipment at the PHC facilities has not been removed;
• 8% of the PHC facilities have functional back-up electrical supply; and
• Availability of protocols and guidelines have been implemented at only 30% of PHC facilities.

 

Observations and findings

1. On issues regarding the NPOs and CHWs, the provincial department was deliberating on whether to start administering the funds to CHWs as it had identified the mismanagement of funds by some of the NPOs.
2. The Committee noted with concern the audit outcomes of the provincial department as it has regressed from unqualified to qualified audit opinion in this financial year.
3. The Committee noted that the vacancy rate was very high and that the challenge was funded graduates were not willing to work in rural areas.
4. The Committee sought further details concerning infrastructure management, particularly on Musina Hospital, as during the Committee’s oversight visit it was concluded that the hospital was not habitable.
5. The Committee expressed concern about the audit outcome of the provincial department that it has regressed, and wanted to know whether the department had a turnaround plan to improve audit outcomes.
6. With respect to medico-legal claims the Committee noted that the provincial department was not doing well.

 

 

 

 

3.RECOMMENDATIONS

 

Having made the above-mentioned observations, the Committee recommends that the Minister of Health should:

 

1. Finalize the Community Health Care Workers Policy to provide clarity on the management of CHWs.
2. Ensure that the WISN report recommendations are implemented in order to improve staffing levels at primary health care facilities.
3. Monitor the timeous filling of vacant funded posts by provincial departments.
4. Assist provincial departments in strengthening financial management planning aimed at dealing with continuous audit findings on accruals and irregular expenditure.
5. Assist provincial departments to improve and maintain audit outcomes.
6. Assist provincial departments to address SCM challenges, to reduce wastage, improve procurement turnaround time, and improve contract management.
7. Provide infrastructure technical support to provincial departments in order to develop their capacity to plan and manage health infrastructure delivery.
8. Continue to support provincial departments in implementing the Ideal Clinic programme.
9. Engage the Department of Justice and Correctional Services to develop and implement a national strategy to deal with rising medico-legal claims as they pose serious risk to provincial departments budgets.
10. Engage the National Treasury and provincial Treasuries on resolving the disputes on historic NHLS debts. A progress report should be presented to the Committee on a quarterly basis.
11. Ensure the roll-out of broadband connectivity in all PHC facilities.

 

Report to be considered.