ATC200608: Report of the Select Committee on Health and Social Services on the Strategic Plan, Annual Performance Plan and Budget of The Department of Health; Dated, 03 June 2020

NCOP Health and Social Services

REPORT OF THE SELECT COMMITTEE ON HEALTH AND SOCIAL SERVICES ON THE STRATEGIC PLAN, ANNUAL PERFORMANCE PLAN AND BUDGET OF THE DEPARTMENT OF HEALTH; DATED, 03 JUNE 2020

The Select Committee on Health and Social Services (hereinafter, the Committee), having considered Budget Vote 18,the 2020/21-2024/25 Strategic Plan and 2020/21 Annual Performance Plan (APP) of the Department of Health(the Department),together with the Portfolio Committee on Health, reports as follows:

INTRODUCTION

Section 5(2) of the Constitution of South Africa (No. 108 of 1996) and section 27(4) of the Public Finance Management Act (No.1 of 1999) sets out the role of Parliamentary committees in overseeing the performance of government departments and entities.

This report summarise sa presentation received from the Department focusing on its 2020/21-2024/25 Strategic Plan, Annual Performance Plan and Budget for 2020/21 and allocations over the medium-term expenditure framework (MTEF) period. The report entails the deliberations, observations and recommendations made by the Committees relating to Budget Vote18.

On 20 May 2020, the Portfolio Committee on Health and, the Select Committee on Health and Social Services engaged the Department on its Strategic Plan Annual Performance Plan and budget for 2020/21.

OVERVIEW OF KEY POLICIES AND STRATEGIES

The Department aims to provide leadership and coordination of health services to promote the health of all people of South Africa through an accessible, caring and high quality health system based on primary health care approach.

The Basis and Context of the National Department of Health Strategic Plan and APP

The National Department of Health derives its Strategic Plan and Annual Performance Plan from the following strategies and policy initiatives:

Government’s 2030 vision outlined in the National Development Plan (NDP) 2030 and Sustainable Development Goals (SDGs).
Medium-Term Strategic Framework (MTSF) 2019-2024.
Recognizes the National Health Insurance (NHI) policy directive of government, noting the consultations on the NHI Bill led by Parliament.
Responds to key diagnostics provided by the Presidential Health Summit Compact; recommendations from the Lancet quality commission; recommendations by the Health Market Inquiry; and the South African Demographic and Health Survey.
Rationalized the number of indicators to be monitored in the APP 2020/21 through the National Indicator Data Set (NIDS) in line with the revised 2020-2024 strategic objectives and the growing need to reduce data collection burden on facilities.

1. State of the Nation Address (SoNA)

The 2020 SoNA highlighted the following main health-related issues:

Health is a fundamental condition for growth and development.

South Africa continues to be impacted by HIV and AIDS. About 6.8 million South Africans were tested. Approximately 5 million people have been initiated on antiretroviral treatment, and as a consequence, the HIV viral load of 4.2 million people is undetectable.
In preparation for NHI, more than 44 million people at over 3,000 clinics have been registered on the electronic Health Patient Registration System (HPRS), and are now implementing this system in hospitals.

National Development Plan Vision 2030

The National Development Plan forms an integral part of policy plans within all government departments to chart a path to prosperity and improving the lives of all South Africans within various sectors. The Department is guided by the goals, indicators and actions of Chapter 10 of the NDP which highlights the need to reduce the disease burden, strengthen the health system and addressing the social and environmental determinants of health to improve the life expectancy of the country’s citizens. The nine goals for the health sectorthat must be reached by 2030 are as follows:

Increase life expectancy at birth to 70 years.
Improve evidence-based preventative and therapeutic interventions for HIV.
Progressively prevent and treat tuberculosis (TB).
Reduce maternal, infant and child mortality.
Reduce theprevalence of non-communicable/chronic diseases by 28%.
Reduce injury, accidents and violence by 50% (from the 2010 levels).
Strengthen the district health system.
Provide care to families and communities through primary health care teams.
Fill health posts with skilled, committed and competent individuals.

Sustainable Development Goals (SDGs)

The Department of Health is also committed to working towards achieving the health-related United Nations SDG targets Goal 3 (which is to ensure healthy lives and promote well-being for all at all ages). It is envisaged that this would be achieved through the following:

Putting in place social protection systems and measures.
Reducing maternal mortality to less than 70% per 100,000 live births.
Ending preventable deaths of new-borns and children under 5 years of age;and epidemics such as AIDS, TB and malaria.
Reducing one-third of premature mortality from non-communicable diseases.
Strengthening the prevention and treatment of substance abuse, including the harmful use of alcohol.
Improving road safety for all, and halve the number of deaths and injuries caused by road traffic accidents.
Ensuring access to sexual and reproductive health care services, and rights.
Attaining universal health coverage.
Maintaining ecosystems, and reducing the number of death and illnesses caused by hazardous chemicals and pollution.

THE DEPARTMENT OF HEALTH FIVE-YEAR STRATEGY

3.1.Strategic Goals 2020/21-2024/25

The Department’s Strategic Plan is firmly grounded in strengthening the health care system and improving quality of care. The strategic outcome-orientated goals for the next five years, which are in line with Government’s 2019-2024 Medium-Term Strategic Framework (MTSF),are:

Strategic Goal 1: Increase life expectancy, improve health and prevent disease – Improve health outcomes by responding to the quadruple burden of disease in South Africa; and address the social determinants of health through inter-sectoral collaboration.

Strategic Goal 2: Achieve universal health coverage by implementing NHI Policy – Progressively achieve universal health coverage through NHI.

Strategic Goal 3: Quality improvement in the provision of care– Improve quality and safety of care; provide leadership and enhance governance in the health sector for improved quality of care; improve community engagement and re-orientate the system towards PHC through community-based health programmes to promote health; improve equity training and enhance management of HRH; improve the availability of medical products and equipment; and ensure robust and effective health information systems to automate business processes and improve evidence-based decision making.

Strategic Goal 4: Build health infrastructure for effective service delivery – Execute the infrastructure plan to ensure adequate, appropriately distributed and well maintained health facilities.

ANNUAL PERFORMANCE INDICATORS FOR 2020/21

Some of the key performance indicators under each programme are as follows:

Programme 1: Administration– The purpose of the Administration programme is to provide support services to the Department. These (services) include: human resources development and management, labour relations, information communication technology, property management, security services, legal services, supply chain management and financial management.The Department plansfor the current financial year (2020/21) are:

Progressively implement an equitable budgeting system and reduce fragmentation.
Review the equitable share model for financing health, as well as conditional grants of the health sector.
Obtain an unqualified audit opinion for 2020/21 and six Provincial departments to achieve improvements in audit outcomes with no significant matters.
Strengthen the management of the medico-legal cases in the health sector.
Resources are made available to frontline managers and providers with flexibility to manage in line with local needs.

Programme 2: National Health Insurance(NHI)– The purpose of the NHIprogramme is to improve access to quality health services through the development and implementation of policies to achieve universal health coverage and health financing reform.Under Programme 2, the Department plans to achieve the following:

Expand the package of services available to the population on the basis of cost-effectiveness and equity. This will include ensuring that 46 million people are registered on the Health Patient Registration System (HPRS).
Ensure information systems that are responsive to local needs to enhance data use and improve quality of care by developing an electronic platform for the Master Health Facility List.
Improve the monitoring of the availability of medicine by ensuring that 3765 health facilities are reporting stock availability at national surveillance centre.
Improve quality and safety of care by ensuring that 3.5 million patients are registered to receive medicines through the centralised chronic medication dispending and distribution (CCMDD) system.

Programme 3: Communicable and Non-Communicable Diseases– The purpose of the programme is to develop and support the implementation of national policies, guidelines, norms and standards and the achievement of targets for the national response needed to decrease morbidity and mortality associated with communicable diseases (HIV, TB, malaria, influenza and others) and non-communicable diseases (mental health, cancer, hypertension, diabetes and others). This programme is also responsible for developing strategies and implementing programmes that reduce maternal and child mortality. The targets under Programme 3 for the current financial year (2020/21) include the following:

Reduce maternal, child, infant and neonatal mortality through the launch of the Side-by-Side radio campaign promoting child health; and the monitoring the implementation of Early Childhood Development (ECD) programmes.
Ensure that 98 hospitals obtain 75% or more on the food service quality assessments.
Reduce HIV incidence among youth by ensuring that 800 PHC facilities has youth zones.
Reduce premature mortality due to non-communicable diseases (NCDs) by 10%, by marketing 100 health promotion messages through social media; and ensuring the development of implementation plans for the National Strategic Plan for Non-Communicable Diseases by the nine provincial departments.

Programme 4: Primary Health Care Services (PHC)– The purpose of the Primary Health Care (PHC) Service programme is to develop and oversee the implementation of legislation, policies, systems, and norms and standards for a uniform well-functioning district health system, including emergency and environmental health services. The targets for Programme 4 for the 2020/21financial yearinclude the following:

Improve quality and safety of care at health care facilities by ensuring that 350 PHC facilities and 50 hospitals are implementing the National Quality Improvement Programme.
Improve quality and safety of care at clinics by ensuring that 2,100 PHC facilities qualify as Ideal Clinics.
Improve quality and safety of care by ensuring that 25 ports of entry are compliant with international health regulations.
Ensure improved quality of water, sanitation, waste management and food by ensuring that 16 metropolitan and district municipalities are assessed for adherence to environmental norms and standards.
Ensure that services are integrated and delivered at most appropriate level, with continuity of care and appropriate referrals by ensuring that 10 districts have integrated referral system.
Promote community participation to ensure health system responsiveness and effective management of health needs by developing training material for public hospital boards; tracing of 600 000 patients by Community Health Workers (CHWs) and linking them to care; and ensuring that 2,000 PHC facilities have Community Outreach Services.

Programme 5: Hospital Systems– The purpose of this programme is to develop national policy on hospital services and responsibilities by level of care; provide clear guidelines for referral and improved communication; develop detailed hospital plans; and facilitate quality improvement for hospitals.

Further, the programme is responsible for the management of the National Tertiary Services Grant and, ensures that planning of health infrastructure meets the health needs of the country. The targets for 2020/21 under Programme 5 are to:

Improve the financing and delivery of infrastructure projects by ensuring that 78 public health facilities are constructed or revitalised; and 150 are maintained, repaired and /or refurbished.
Improve quality of care by ensuring that nine provinces are compliant with Emergency Medical Services (EMS) Regulations and have developed quality improvement plans.
Ensure that resources are available to managers and frontline providers, with flexibility to manage according to their local needs by ensuring that organisational structures for tertiary, regional and specialised hospitals are developed.

Programme 6: Health System Governance and Human Resources– The purpose of this programme is threefold, namely:

To achieve integrated health systems planning, monitoring and evaluation and research.
To develop and monitor the implementation of health workforce policies and ensure effective health workforce planning, development and management in the national health system, as well as alignment of academic medical centres with health workforce programmes and training of health professionals. It assists the government to achieve the population health goals of the country through nursing and midwifery, through the provision of expert policy and technical advice and recommendations on the role of nurses in attainment of desired health outputs.
To conduct oversight over public entities and statutory health professional councils, and ensure compliance through applicable legislative prescripts.

Targets under Programme 6 for the current financial year (2020/21) include the following:

Improve quality and safety of care by ensuring that nine public nursing colleges are accredited and registered to offer basic nursing and midwifery programmes; and the clinical governance system is assessed and implementation plans for three provinces are developed.
Ensure that staff is equitably distributed and have right skills and attitudes by:

Ensuring capacity for Human Resources for Health (HRH) policy development, planning and monitoring.
Implementing HR information system at national and provincial head offices.
Reviewing and publishing the Community service policy.
Implementing and monitoring of OSD (Occupational Specific Dispensation), commuted overtime and RWOPS (Remunerative Work Outside the Public Service) policies.
Developing the implementation plan for an automated employees time management system (with biometrics and automated notifications) for all health establishments.

Implementation Guideline on the use of the Health Patient Registration Number (HPRN) on clinical stationery in public health facilities published.
Revised version of the Interoperability Norms and Standards for Digital Health published and two priority cases for applying standards identified.
Performance dashboards for national, provincial and district levels completed.
National Health Research priorities published.
90% of blood alcohol tests completed within 90 days.

BUDGET ANALYSIS

5.1.Consolidated Health Budget

The public health budget spans across the national department, its entities and the provincial departments of health. The consolidated budget for 2020/21 totals R229.7 billion, up from R222.6 billion in the previous financial year.

Economic classification:

A significant portion of the consolidated health expenditure 63.2%, down slightly from 63.3% in the previous financial year, is dedicated to Compensation of Employees, which totals R145.1 billion, up from R140.8 billion.
Consolidated health expenditure on Goods and Services totals R67.1 billion, up from R64.7 billion, which constitutes 29.2% of overall health expenditure.
Consolidated health expenditure also makes provision for R11.4 billion (4.9%) allocated to Capital spending and transfers, and R6.1 billion for Current transfers and subsidies (2.7%).

National Department of Health Budget (2020/21)

For the 2020/21 financial year, the Department has been allocated a budget of R55.5 billion, up from R51.2 billion for 2019/20. This represents an increase of 8.4% in nominal terms (3.9% in real terms).

Table 1: Budget allocation by programme for the 2020/21 financial year

The two largest programmes, namely Programme 3: Communicable and Non-Communicable Diseases (R25.2 billion) and Programme 5: Hospital Systems (R21.8 billion), jointly constitute 84.6% of the total budget allocation to the Department. Programme 4: Primary Health Care Services, receives the smallest allocation (R238.3 million), which is less than half a percent (0.4%) of the Department’s budget.

Economic classification:

The bulk of the National Department of Health budget (R51.3 billion or 92.4%) consists of transfers and subsidies. This figure includes R49.3 billion to provinces and municipalities, R193.4 million to non-profit organisations (NPOs), and R1.8 billion to departmental agencies and accounts.

Current payments constitute a total value of R3.0 billion, which represents 5.4% of the total budget allocation. R905.8 million (30.1% of the current payments budget) is allocated to Compensation of employees. However, most of the current expenditure (R2.1 billion) is allocated to Goods and Services, constituting approximately 70% of the total current payments.

Expenditure items that received the largest share of the Goods and Services budget are Contractors at R808.2 million; Consultants: Business and advisory services at R295 million; Agency and support/outsourced services at R192.2 million; Medical Supplies at R115.6 million; and Operating leases at R185.2 million; and Travel and subsistence at R113.3 million. Capital assets is allocated R1.2 billion. Buildings and other fixed structures are allocated R892.1 million, and Machinery and Equipment is allocated R343.2 million.

Spending priorities for the 2020 MTEF:

Over the 2020 medium-term, the Department will continue to focus on the implementation of the NHI, HIV and AIDS, and TB treatment and prevention programmes, and investing in public health infrastructure.

Over the MTEF, the non-personal component of the NHI Indirect Grant is allocated R2.2 billion to, amongst other things, strengthen health information systems, the Ideal Clinic initiative, as well as the CCMDD.
The Personal Services component of the NHI Indirect Grant is allocated R935.9 million over the MTEF, mainly to contract General Practitioners (GPs) to provide PHC services in their own practises. The GPs will be paid according to the number and risk profile of patients treated. Approximately R1.4 billion of this grant has been reallocated towards direct conditional grants, which are transferred to provinces. Of this amount, R900.1 million is reallocated to the Direct NHI Grant to fund the contracting of GPs to do sessional work in public PHC facilities, and R452 million is reallocated to provinces to strengthen mental health and oncology services.
The HIV, AIDS and STIs sub-programme of the Communicable and Non-Communicable Diseases programme is allocated R75.9 billion over the medium-term. Spending will increase with an additional R1 billion allocated in 2021/22, resulting in an increase from R20 billion in 2019/20 to R24.5 billion in 2021/22.
The new TB component of the HIV, TB, Malaria and Community Outreach Grant is thus allocated R1.6 billion over the medium-term.
The Malaria component of the HIV, TB, Malaria and Community Outreach Grant amounts to R345.4 million over the MTEF.
The Community Outreach component of the HIV, TB, Malaria and Community Outreach Grant aims to address the standardisation of training, performance monitoring and remuneration of Community Health Workers (CHWs). Approximately R800 million is reprioritised from the HIV and AIDS component to the Community Outreach Services component in 2020/21 to ensure the standardised stipend of R3 500 per month is implemented throughout the country for all CHWs.
The Human Papillomavirus (HPV) vaccine programme is allocated R701.7 million over the MTEF period.
The National Tertiary Services Grant is allocated R14.1 billion in 2020/21.
A developmental allocation is introduced from 2020/21 to increase equitable access to tertiary service with the aim of bringing services closer to patients in provinces such as the Eastern Cape, Limpopo, Mpumalanga and the North West.

**The budget analysis per programme is included in the Portfolio Committee on Health budget vote report, dated 28 May 2020.

5.3.Allocations to Provincial Departments

Provincial governments receive two forms of allocations from the nationally raised revenue, the equitable share and conditional grants. Sections 214 and 227 of the Constitution require that an equitable share of nationally raised revenue be allocated to provincial government to provide basic services and perform its allocated functions. The equitable share is an unconditional transfer to provinces and constitutes their main source of revenue. Due to their limited revenue-raising abilities, provinces receive 43% of the nationally raised revenue[1]. In addition, they receive conditional grants to help them fulfil their mandates. It is important to note that transfers to provinces account for over 90% of provincial revenue.

The Division of Revenue (DoRA) sees revenue divided between the national, provincial and local spheres of government. The equitable share formula sees the largest percentage share going to national departments, followed by provinces and in a distant third, local government. In this regard, for 2020/21, national departments receive 49.2%, provinces receive 43.2% and local government receives 8.6%[2].

According to the 2020 Estimate of National Expenditure (ENE), the national transfers to provinces will increase[3]and, at an average annual rate of 6% to R730.7 billion in 2022/23, over the MTEF period provincial transfers will rise[4]. However, due to the outbreak of Covid-19, Government will be forced to reprioritise its resource allocation for the year under review. Subsequently, the Minister of Finance is expected to table an updated Budget[5] in order to deal with the effects of Covid-19.

Figure 1: The proportion of the equitable share budget allocations for provincial health

departments for the 2020/21 financial year

Of the R229.7 billion total budget of the public health sector, the provincial health departments receive a share of R224.7 billion (a 97.6 percent of the total health sector budget) in the 2020/21 financial year. The transfers to the provinces increases by R15.5 billion in 2020/21 from the R209.5 billion allocated in the previous financial year.

Figure 1 above indicates that Gauteng and KwaZulu-Natal receive the bulk of the provincial health budget, which is R55.7 billion and R48.2 billion for 2020/21 financial year respectively. These are followed by two provinces, Eastern Cape and Western Cape, which receive R26.5 billion respectively.

Mpumalanga, North West and Limpopo receive R15.5 billion, R13.2 billion and R22.1 billion for 2020/21 respectively. Whereas Northern Cape receives the smallest share of the budget, to the value of R5.5 billion for the 2020/21 financial year.

5.4. Direct conditional grants

As cited earlier, the 2020/21 budget allocation for the Department amounts to R55.5 billion of which R51.3 billion (92.4%) is transferred to provinces or other institutions to provide services on behalf of the Department. Transfers to provinces are in the form of conditional grants (direct and indirect grants).

For the direct conditional grants, the provincial health departments receive a share of R49.2 billion in 2020/21, up from R46.1 billion allocated in 2019/20 financial year. This is an overall increase of 7% or R3.1 billion from the previous year allocation.

Figure 2 shows the allocation of the Direct Conditional Grant, per province.

Figure 2: The division of the Direct Conditional Grant allocations per province for the 2020/21financial year

COMMITTEE FINDINGS, OBSERVATIONS AND RECOMMENDATIONS

Having considered the Strategic Plan, APP and the budget of the Department, this section summarizes the Committees’ findings, observations and recommendations.

7.1 Findings and Observations

The Committees welcomed the Strategic Plan and APP of the Department and indicated the need to understand how emerging issues due to the coronavirus (Covid-19) pandemic will be addressed. There are concerns regarding the impact of Covid-19 on the implementation of strategies and programmes of the Department.

The Committees flagged various concerns around the Covid-19 pandemic, particularly in the Western Cape, including:

General management of patients;
Testing capacity that is under strain;
Reduced capacity of nursing care in hospitals and its impact on the overall quality of care;
Occupational health and safety concerns of nursing staff;
Unavailability of personal protective equipment (PPE) for EMS personnel;
Factories not adhering to protocols; and
The need for inter-sectoral collaboration.

The Committeescommended the National Institute for Communicable Diseases (NICD) for the role it has played in the Covid-19 pandemic.

The Committees noted with concern the high number of Covid-19 infections coming fromprivate health facilities.

The Committees observed the concern highlighted by the Auditor-General regarding the Department’s stagnation in key control areas, including financial management, information technologyand compliance management.

On the performance of provincial departments, the Committeesobserved that the Auditor-Generalidentified eight (of nine) key control areas that needed to be addressed for improved audit outcomes.

The Committees noted with concern the Auditor-General’s continuous finding on the quality and reliability of performance information.

The Committees expressed concern that fruitless and wasteful expenditurein the health sector continue to rise.

The Committees wasconcerned that the programmes of the Department were not aligned to the organizational structure of the Department.

The Committees noted that health care facilities that meet quality standards are central to the achievement of universal health coverage. However, concernswere raised in relation tothe low target forhospitals (60%)to be certified by the Office of Health Standards Compliance (OHSC);and the 100% of PHC facilities that will only qualify as Ideal Clinics in 2024/25.

The Committeesobserved with concernthe low budget allocation for PHCfor this financial year.

The Committees noted that mental health care remains a critical issue in South Africa, and highlighted the need for improved budget allocation to implement the Mental Health Policy Framework and Strategic Plan (2013-2020) in provinces, through improving mental health human resources, setting up District Mental Health Care Teams, improving mental health infrastructure and strengthening awareness campaigns.

The Committees raised the issue of the integration of CHWs into the public health sector workforce.

The Committees noted with concern the slow progress inmeeting targets of some of the key health indicators, in particular the reduction of mortality rates.

The Committees commended the Department in the provision of contraceptives in public health facilities, however, highlighted the need to strengthen sexual and reproductive health services amongst the youth.

The Committees observed the integration of grants, in particular the merging of the HPV grant with the HIV Grant and was concerned that this may impact on progress of the human papillomavirus vaccination (HPV) programme.

The Committeesraised the need for a collaborative approach to address the scourge of TB.

The Committees raised the need for efficient use of the Health Facility Revitalization Grant to address health infrastructure challenges.

The Committeesraised the need for plans to address premature mortality linked to social determinants of health.

The Committees raised the filling of vacant posts with suitably qualified personnel.

The Committees expressed a concern around the use of the Civitas Building bythe Department when it was found to be unsuitable.

Recommendations

The Committees recommend the following to the Department:

Response to Covid-19: The Department should ensure that the Western Cape is supported in its fight against the spread of Covid-19 and that progress is monitored and reported on timeously.

Cross-sectoral interventions on Covid-19: The Department should engage with relevant stakeholders in the fight against Covid-19 to ensure improved health care services.

Private health sector: The Department should ensure that private health facilitiesaremonitored and ensure that they comply with infectious control and preventionguidelines.

Entities: The Department should ensure that entities such as the NICD and the National Health Laboratory Services (NHLS)are strengthened and capacitated to ensure effective response to epidemics.

Mental health services: The Department should develop a Mental Health Monitoring Policy to monitor and evaluate the implementation of the Mental Health Policy Framework and Strategic Plan (2013-2020). Further, the Department should consider a collaborative approach to mental health care in order to strengthen the accessibility and delivery of mental health services.

Financial management in provinces: The Department should assist provincial departments to strengthen financial planning and management. In addition, the Department should monitor provincial budget expenditure against approved plans.

Audit outcomes: The Department should ensure that systems and measures are put in place and internal controls strengthened to prevent fruitless and wasteful expenditure at the national and provincial departments.

Monitoring: The Department should ensure oversight and monitoring of the implementation of the Auditor General’s findings on key areas of internal controls and financial management.

Community Health Workers (CHWs): The Department should provide the Committees with an update on the implementation of the National Community Health Care Worker Policy in ensuring the integration of CHWs.

Improving the quality of health care in the public sector: The Department should continue to work towards improving the quality of health care in the public health sector.

Primary Health Care (PHC): The Department should update the Committees on the extent of the implementation of norms and standards for PHC in ensuring that funding is sufficiently allocated for PHC services.Additionally, should continue to support provincial departments in implementing the Ideal Clinics programme.

Social determinants of health: The Department should present to the Committees, plans developed in collaboration with other government departments in addressing the social determinants of health.

Response to TB: The Department should ensure inter-sectoral collaborations for effective response to TB.

Health infrastructure: The Department should ensureimproved performance on health infrastructure spending through the prioritisation of critical infrastructure needs and facilities that require urgent revitalisation.

Human Resources for Health (HRH): The Department should finalize and monitor the implementation of the HRH Strategy and Plan 2019-2024, in ensuring that vacancies are timeously filled, including all clinical, non-clinical and senior level positions.

Civitas building: The Department should ensure that a suitable building is secured.

CONCLUSION

The Committeescommendthe hard work of the Minister, MECs, national and provincial Departments of Health in the country’s response tothe Covid-19 pandemic.

Unless otherwise indicated, the Department of Health should respond to the Committees’recommendations in three months from the day the report is adopted by the House.

Report to be considered.

[1]National Treasury (2020).

[2]Division of Revenue Bill (2020).

[3] Medium-Term Expenditure Framework (MTEF) sets out three-year spending plans of the national and provincial governments.

[4]National Treasury (2020).

[5] Ramaphosa, C. (2020a) 23 April 2020.

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