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ATC210817: Report of the Select Committee on Health and Social Services on the Annual Performance Plan and Budget of the Department of Health; Dated, 16 March 2021

NCOP Health and Social Services

REPORT OF THE SELECT COMMITTEE ON HEALTH AND SOCIAL SERVICES ON THE ANNUAL PERFORMANCE PLAN AND BUDGET OF THE DEPARTMENT OF HEALTH; DATED, 16 MARCH 2021

 

The Select Committee on Health and Social Services (hereinafter, the Committee), having considered Budget Vote 18,the 2020/21-2024/25 Strategic Plan and 2021/22Annual Performance Plan (APP) of the Department of Health(the Department), reports as follows:

 

  1. 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 summarisesa presentation received from the Departmentfocusing on its Annual Performance Plan and Budget for the 2021/22 period. The report entails the deliberations, observations and recommendations made by the Committee relating to Budget Vote18.

 

On16 March 2021, the Select Committee on Health and Social Services engaged the Departmenton itsAnnual Performance Plan (APP) and Budget for 2021/22.

 

  1. OVERVIEW OF KEY POLICIES AND STRATEGIES

 

The Department aims to improve the health of all South Africans through the provision of services that are geared at promoting healthy lifestyles and, preventing illness and disease;and by focusing on access, equity, efficiency, quality and sustainability.

 

The Committee’s engagement with the national Department of Health ((hereinafter the Department) occurs a year since the coronavirus (COVID-19) pandemic hit the South African shores. Since its incidence the impact of health on all aspects of society are self-evident. Economies have been severely affected. Excess deaths and unemployment have increased globally due to the pandemic, and the resultant lockdowns. As with other countries, South Africa has begun procuringCOVID-19 vaccineswith the aim to achieve herd immunity or population immunity.The World Health Organization (WHO) supports this strategy, which would minimize the number of cases and deaths.[1]All this is occurring in a context of a virus, which continues to mutate. Variants of the virus have been found in different parts of the world, and more are expected to emerge. South Africa has not been spared. A new variant (known as 501Y.V2) was discovered to be the dominant variant in the country. This hampered South Africa’s vaccination rollout as the vaccine procured (AstraZeneca) was found not to be effective against this variant, and other vaccines had to be procured.

 

In order to navigate the many challenges, the country faces it is imperative that Government uses its dwindling available resources effectively and efficiently. The Department aims to provide leadership and coordination of health services to promote the health of all people in South Africa through an accessible, caring and high-quality health system, based on the primary health care (PHC) approach.[2]

 

Over the medium-term, the Department’smain focus will be to respond to the COVID-19 pandemic throughout the various stages of the vaccine rollout strategy. The Department will also continue its focus on the following:

 

  • The phased implementation of the National Health Insurance (NHI);
  • Prevention and treatment of communicable and non-communicable diseases; and
  • Investing in health infrastructure and supporting tertiary health care services.[3]

 

At a time when ideal spending on health would increase, “Cabinet has approved reductions on the Department’s baseline amounting to R15 billion”[4] over the medium-term (2021/22 – 2023/24).

 

 

  1. The Basis and Context of the Department’s Strategic Plan and APP

 

The national Department of Health derives its Strategic Plan and APP from the following strategies and policy initiatives:

 

  • Government’s National Development Plan (NDP): Vision 2030 and the United Nations (UN) Sustainable Development Goals (SDGs).
  • Medium-Term Strategic Framework (MTSF) 2019-2024.
  • NHI policy directive of government, including the consultations on the NHI Bill led by Parliament.
  • 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.
  • Monitoring 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 the data collection burden on facilities.

 

  1.  
  2.  
    1. State of the Nation Address (SONA)

 

The February 2021 SONA highlighted the following main health-related issues:[5]

 

  • Defeating the COVID-19 pandemic and facilitating the rollout of the vaccination programme. The President highlighted the comprehensive response to overcome the pandemic.  By restricting movement and activity via the lockdowns, preparing health facilities, and implementing basic health protocols, government prevented potentially greater devastation by the pandemic.
  • The need to intensify prevention efforts and strengthen the health system. The President highlighted that a massive vaccination programme will be rolled-out with millions of vaccines having been procured and being delivered. The President applauded the scientists who lead research that discovered the AstraZeneca vaccine, which was procured, was ineffective against a new variant (known as 501Y.V2) that is dominant in South Africa.
  • Continuing to use a science-driven approach.The President emphasised the important role the South African Health Products Regulatory Authority (SAHPRA) plays in relation to all medication imported into the country.
  • The importance of collaboration between all sectors of society including business, labour, the health industry and medical schemes in implementing the mass vaccination drive.
  • Implementation of the National Anti-Corruption Strategy. The Special Investigating Unit (SIU) was authorised to investigate COVID-19 related procurement by all state bodies. The SIU released a report in February detailing alleged personal protection equipment (PPE) corruption.[6] Over R13.3 billion worth of tenders were investigated, in respect of 189 State institutions and entities, with allegations still being received.
  • Rolling out of broadband to hospitals and other government facilities. This will be important to modernise administration and filing systems and in preparation for the NHI which will require all users/patients to be registered on the Health Patient Registration System (HPRS).

 

  1. National Development Plan:Vision 2030

 

The National Development Plan (NDP) identifies demographics, burden of disease, health systems and the social and environmental determinants of health as the key areas for intervention required to improve the health system in the country. Nine goals for health have been identified in the NDP. These are:

 

  • Increase the average male and female life expectancy at birth to 70 years;
  • Progressively improve tuberculosis (TB) prevention and treatment;                                                                                                                                                                                                                                                                                                                       
  • Reduce maternal, infant and child mortality;
  • Significantly reduce prevalence of non-communicable chronic diseases;
  • Reduce injury, accidents and violence by 50% from 2010 levels;
  • Complete health system reforms;
  • Deploy primary health care (PHC) teams to provide care to families and communities;
  • Achieve universal health coverage achieved; and
  • Fill health posts with skilled, committed and competent individuals.

 

  1. Sustainable Development Goals (SDGs)

 

The Department is committed to working towards achieving the health-related United Nations (UN) Sustainable Development Goal (SDG) targets. The particular focus of the Department is 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.

 

In addition to these, the Department is also guided by the health sector Ten Point Plan.

 

  1. THE DEPARTMENT OF HEALTH FIVE-YEAR STRATEGY

 

The Department’s Strategic Plan consists of two impact statements derived from the MTSF[7] 2019-2024, which are linked to 18 outcomes.[8]As shown in Table 1, five outcomes relate to the quadruple burden of disease; and 13 outcomes relate to health system strengthening and NHI.

 

Table 1: Department of Health Five-Year Strategic Goals

MTSF PRIORITY 3: EDUCATION, SKILLS AND HEALTH

IMPACT STATEMENTS

OUTCOMES

A. Life expectancyof South Africans improved to 66.6 years by 2024, and 70 years by 2030

1. Maternal, Child, Infant and neonatal mortalities reduced

2. HIV incidence among youth reduced

3. The 90:90:90 targets for HIV AIDS achieved by 2020 and 95:95:95 targets by 2024/25

4. Significant progress made towards ending tuberculosis (TB) by 2035 through improving

5. Premature mortality from Non-Communicable Diseases reduced by 10%

B. Universal health coverage for all South Africans, progressively achieved and all citizens  protected from the catastrophic financial impact of seeking health care by 2030

6. An equitable budgeting system progressively implemented and fragmentation reduced

7. Resources are available to managers and frontline providers, with flexibility to manage it according to their local needs

8. Financial management strengthened in the health sector

9. Management of Medico-legal cases in the health system strengthened

10. Package of services available to the population is expanded on the basis of cost-effectiveness and equity

11. Integrated services delivered according to the referral policy, at the most appropriate level, to ensure continuity of care

12. Quality and safety of care improved

13. Staff equitably distributed and have right skills and attitudes

14. Community participation promoted to ensure health system responsiveness and effective management of their health needs

15. Environmental health strengthened by contributing to improved quality of water, sanitation, waste management and food services

16. Financing and Delivery of infrastructure projects improved

17. Adaptive learning and decision making is improved through use of strategic information and evidence

18. Information systems are responsive to local needs to enhance data use and improve quality of care

Source: Adapted from the Department of Health Strategic Plan 2020/21 – 2024/25

 

An extra outcome has since been added due to the pandemic: Morbidity and mortality due to COVID-19 reduced. The Department will be reviewing its Strategic Plan during a mid-term review and the MTSF 2019–2024 will also be updated accordingly.

 

  1. ANNUAL PERFORMANCE INDICATORS FOR 2021/22

 

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 key Department plans for the 2021/22 financial year are:

 

  • To attain an unqualified audit opinion for 2021/22 and for 6 Provincial departments to achieve improvements in audit outcomes with no significant matters.
  • Utilise amedico-legal claim management system in 7 provinces, to manage new medico legal claims.
  • Broadcast approximately 100 health promotion messages on social media, to help reduce premature mortality due to non-communicable diseases to 26% (this is a 10% reduction).

 

Programme 2: National Health Insurance (NHI)

 

The purpose of the NHI programme 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:

 

  • Attend Portfolio Committee and National Council of Provinces (NCOP) public hearings on the NHI Bill.
  • Register medical aid beneficiaries on the HPRS. Develop aproject plan in partnership with the Council for Medical Schemes (CMS) in this regard.
  • Complete the service benefits framework for PHC.
  • Register 4.5 million patients to receive medicines through the centralised chronic medicine dispensing and distribution (CCMDD).
  • Ensure that 3830 health facilities report stock availability at the national surveillance centre.

 

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 2021/22 financial year include the following:

 

  • Vaccinate 16.6 million people against COVID-19 (This is a new indicator).
  • Ensure that 98 Hospitals obtain 75% or more on the food service quality assessments.
  • Ensure that 1600 PHC facilities haveyouth zones.
  • Develop and publish the National Strategic Plan (NSP) for non-communicable diseases.
  • Approve and partially implement the NSP for tobacco control.Admit 75 state patients admitted into designated psychiatric hospitals.[9]
  • Train 500 medical officers and professional nurses to improve their skills in clinical management of mental disorders (They would work in units that are listed to conduct 72-hour assessments, and psychiatric units attached to general hospitals.
  • Approve maternity care guidelines.
  • Approve neonatal care guidelines.

 

Programme 4: Primary Health Care (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 2021/22 financial year include the following:

 

  • Implement the National Quality Improvement Programme in100 PHC facilities and 80 hospitals.
  • Ensure that 2200 PHC facilities qualify as Ideal Clinics.
  • Approve and commence implementation of the policy and implementation guidelines on Traditional Medicine.
  • Ensure that 18 Ports of entry comply with international health regulations (IHR).
  • Test the monitoring system for measuring effectiveness of clinic committees in 200 clinics.
  • Trace 250,000 clients lost to follow-up for treatment through community health workers (CHWs).
  • Ensure that 1250 PHC facilities haveWard Based Outreach Teams (WBOTs).
  • Assess 11 metropolitan and district municipalities for adherence to environmental norms and standards.
  • Assess all 9 provinces for compliance with Emergency Medical Services (EMS) Regulations.

 

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 2021/22 under Programme 5 are to:

 

  • Construct or revitalise 40 PHC facilities.
  • Construct or revitalise 21 hospitals.
  • Maintain, repair and/or refurbish 120 public health facilities (That is: clinics, hospitals, nursing colleges, and emergency medical services base stations).

 

Programme 6: Health Systems Governance and Human Resources

 

The purpose of this programme is threefold, namely:

 

  1. To achieve integrated health systems planning, monitoring and evaluation and research.
  2. 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.
  3. To conduct oversight over public entities and statutory health professional councils, and ensure compliance through applicable legislative prescripts.

 

Targets under Programme 6 for the 2021/22 financial year include the following:

 

  • Publish the community service policy.
  • Allocate 90% of eligible students to health facilities for community service.
  • Register 500 COVID-19 vaccination sites on the Electronic Vaccination Data System (EVDS).
  • Produce revised National Health Research priorities.
  • Develop an alpha version of the networked TB/HIV Plus Information System.

 

 

  1. BUDGET ANALYSIS

 

  1. Consolidated Health Budget 2021/22

 

The public health budget spans across the national department, its entities and the provincial departments of health. The consolidated budget for 2020/21 totals R248.8 billion, up from R229.7 billion in the previous financial year. Table 2 provides a summary breakdown of the 2021/22 budget, by functional and economical classification.

 

Table 2:Consolidated health summary by functional and economic classification, 2021/22

CLASSIFICATION

CONSOLIDATED HEALTH

R Billion

Percentage (%)

Compensation of Employees (CoE)

150.7

60.6

Goods and Services

80.1

32.2

Capital Spending and Transfers

12.2

4.9

Current Transfers and Subsidies

5.8

2.3

Interest Payments

0.0

0

TOTAL

248.8

100

Source: National Treasury (2021)

 

Table 2 shows the following:

 

  • A significant segment of the consolidated health expenditure (60.6% down from 63.2% in 2020/21) is dedicated to Compensation of Employees (CoE), which totals R150.7 billion, up from R145.1 billion.
  • Consolidated health expenditure on Goods and Services totals R80.1 billion, which constitutes 32.2% of overall health expenditure.
  • Consolidated health expenditure also makes provision for R12.2 billion (4.9%) allocated to Capital Spending and Transfers, and R5.8 billion for Current Transfers and Subsidies (2.7%).
  • There is no allocation for Interest Payments.

 

  1. Department of Health Budget (2021/22)

 

For the 2021/22 financial year, the Department has been allocated R62.5 billion. This represents an increase of 7.7% in nominal terms (3.4% in real terms) compared to the R58.1 allocation of the 2020/21 financial year.

 

Table 3:  Budget allocation by programme for the 2021/22 financial year

Source: Adapted from the National Treasury (2021)

 

The two largest programmes, namely Programme 3: Communicable and Non-Communicable Diseases (receives R32.6 billion) and Programme 5: Hospital Systems (receives R21.3 billion), jointly constitute 86.3% of the total budget allocation to the Department.

 

Three programmes show real decreases in budget allocations for the year under review. These are:

 

  • Programme 4: Primary Health Care – This programme’s budget shows a real decrease of R64.5 million (or 23.2% in real terms), from R277.8 million in 2020/21 to R222.3 million in the 2021/21 financial year. It also receives the smallest allocation (which is less than half a per cent (that is, 0.4%) of the Department’s budget.

 

  • Programme 5: Hospital Systems – The programme receives a budget of R21.3 billion for 2021/22 which shows a nominal increase of R152.7 million (or 0.72%). However, when the inflation rate is considered, the programme’s budget shows a real decrease of R708.8 million (or -3.34%).
  • Programme 6: Health System Governance – This programme’s budget allocation shows a real decrease of R597.7 million from R6.5 billion in 2020/21 to R6.1 billion in the 2021/22 financial year. 

 

Economic classification:

 

The bulk of the Department’s budget (R54.1 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 R7.3 billion, which represents 11.7% of the total budget allocation. R845.3 million, down from R928.3 million (11.6% of the current payments budget) is allocated to Compensation of Employees.
  • However, most of the current expenditure (R6.5 billion) is allocated to Goods and Services, constituting approximately 88.4% of the total current payments.
  • The lion’s share of expenditure (R4.4 billion)goes to Inventory: Medicine. 
  • Expenditure items that also receive a large share of the Goods and Services budget are Contractors at R797.9 million; Consultants: Business and Advisory Services at R256.4 million; agency and support/outsourced services at R133.6 million; and operating leases at R151.0 million.
  • Travel and subsistence at R153.6 million is higher than operating leases (R151 million).
  • Capital assets is allocated R1.2 billion. Buildings and other fixed structures are allocated R935.7 million, and machinery and equipment is allocated R243.6 million.

 

Spending priorities for 2021 MTEF:

 

Over the medium-term, the Department will focus on responding to the COVID-19 pandemic, including the vaccine rollout strategy. It will also continue to focus on the phased implementation of NHI, prevention and treatment of communicable and non-communicable diseases, supporting tertiary health care services and investing in Public Health Infrastructure.

 

  • Responding to the COVID-19 pandemic is ongoing and a matter of extreme priority. In 2020/21, the Special Adjustments Budget allocated approximately R20 billion to the health sector for COVID-19 interventions. The Department’s focus over the medium term will be on managing the COVID-19 pandemic by preventing the spread of the disease by non-pharmaceutical means, and providing vaccines to eligible persons in a phased vaccine rollout strategy. To fund the rollout, R9 billion has been added to the Department’s baseline- R6 billion in 2021/22 and R3 billion in 2022/23, that is:
    • R6.5 billion ring-fenced in the Communicable and Non-Communicable Diseases programme for vaccine procurement and distribution nationally.
    • R2.4 billion allocated to the COVID-19 component of the HIV, TB, Malaria and community outreach grant, which is transferred to provinces to fund the service delivery costs of administering the vaccines.
    • R100 million is allocated to the South African Medical Research Council (SAMRC) for COVID-19 research.
    • R1.25 billion was also allocated in 2020/21 for vaccines and vaccine research as per emergency provisions of the PFMA.[10]
    • If needed, the allocations for vaccines can be augmented by both government’s contingency reserve and with revenue from vaccines sold to the private sector for medical scheme members.
    • A further R8 billion is allocated to the provincial equitable share through National Treasury in 2021/22 to enable provincial health departments to continue their prevention, testing, and treatment interventions including managing a possible third wave of COVID-19 infections.

 

  • Phased implementation of the NHI will continue. The National Health Insurance Fund will be the established as the public entity – a key priority in the Department’s plans to implement NHI. R121.3 million over the MTEF is allocated to the NHI programme to strengthen the Department’s NHI unit which will be transferred to the entity when it is created. Over the MTEF, the National Health Insurance Indirect Grant is allocated R7.5 billion.[11] R986.3 million is allocated to the personal services component, which contracts health care services. R2 billion is allocated to the non-personal services component which funds projects that strengthen the health system in preparation for the rollout of NHI, and R4 billion is allocated to the health facility revitalisation component to fund infrastructure projects.

 

  • The HIV, TB, malaria and community outreach grant is allocated R82.6 billion over the medium term in the HIV, AIDS STIs sub-programme in Programme 3: Communicable and Non-Communicable Diseases. The grant has 8 components. The largest component is the HIV and AIDS component, which is allocated R69.3 billion over the MTEF period. This funds the antiretroviral treatment programme which aims to reach 6.7 million people by 2023/24, as well as HIV prevention services. The grants community outreach services component is allocated R7.7 billion over the MTEF to ensure better resourcing and management of the community health worker programme.

 

  • Investing in health infrastructure: The Health Facility Revitalisation Grant is allocated R20.6 billion over the medium term to be transferred to provincial health departments through the Health Facilities Infrastructure Management sub-programme in Programme 5: Hospital Systems programme. An additional R129.4 million is allocated to the grant for the construction of the Tygerberg and Klipfontein Hospitals in the Western Cape. Health Facilities Infrastructure Management sub-programme also contains the health facility revitalisation component of the NHI Indirect Grant, which is allocated R4.4 billion over the MTEF.

 

  • The National Tertiary Services Grant is allocated R13.7 billion in 2021/22, R14 billion in 2022/23 and R14 billion in 2023/24 in the Hospital Systems programme. The grant compensates provinces for providing tertiary services to patients from elsewhere. 

 

 

 

 

 

Reasons for Deviations:

 

The baseline budget has been decreased across all the economic classifications due to economic pressures as a result of the COVID-19 pandemic. This is outlined below:[12]

 

  • Compensation of employees (CoE):The COE ceiling was reduced with 12%, resulting in reductions across all the programmes.
  • Goods andServices:R4.35 billion was allocated for the procurement of COVID-19 vaccines.
  • The allocation for indirect NHI grants under Programmes 2 and 5 has been materially decreased. Additional funds have been allocated under Programme 1 to fund the related expenditure due to the relocation of the Department to another building.
  • Transfers andSubsidies:The allocations for conditional grants and transfers to non-profit institutions were reduced with 3% and 13% respectively, across all the applicable programmes. The South African National AIDS Council(SANAC) received a once-off increase of R10 million, while allocations for the other Departmental Agencies have been decreased.
  • Purchase of capital assets: The NHI Indirect grant for the construction and refurbishment of health facilities under Programme 5, have been reduced with R107 million.The allocation for the procurement of machinery and equipment of the indirect NHI grants under Programmes 2 and 5 has been decreased. The capital allocations of all the units across all the programmes has been increased once-off to make provision for procurement of computer equipment and/or furniture due possible damage because of the relocation to another building.

 

Tables 4 and 5 provide a breakdown of the Conditional Grants Direct and Indirect allocations.

 

Table 4: Direct Allocation ofConditional Grants 2021/22[13]

DIRECT CONDITIONAL GRANTS TO PROVINCES

R MILLION

Schedule 4, Part A

 

National Tertiary Services Grant

13 708.8

Schedule 5, Part A

 

HIV, TB, Malaria and Community Outreach Grant

27 585.5

Health Facility Revitalisation Grant

6 445.2

Human Resources and Training Grant

4 054.4

National Health Insurance (NHI)

268.7

Total

52 062.6

Source: Adapted from the National Treasury Division of Revenue (2021) pp.42 and 46

 

In terms of direct grants, the Department administers R52.1 billion in 2020/21. The largest grant is the HIV, TB, Malaria and Community Outreach Grant, which receives R27.6 billion; followed by the National Tertiary Services Grant (NTSG) and the Health Facility Revitalisation Grantwhich receive R13.7 billion and R6.5 billion respectively.

 

For 2021/22 there is an overall reduction on direct grants of 3,4% or R1,8 billion growing over MTEF period. The major reduction is under NTSG (R1 billion) and the HIV component (R1,6 billion). This is of concern as it will have a negative impact on service delivery: this will require:[14]

  • Rationalisation of services.
  • Maintenance of current services. For example, it will be difficult to initiate new patients on the antiretroviral treatment (ART) programme.
  • All the current initiatives to modernise the tertiary services and establishment of new services will have to be postponed.
  • Cross-border referrals will continue which will have a direct effect on patients.

 

However, the Department aims to continue to put measures in place to ensure current services are not affected.

 

CONDITIONAL GRANTS INDIRECT ALLOCATIONS

R MILLION

Schedule 6, Part A

 

National Health Insurance (NHI) Indirect Grant

2 117

Total

2 117

Table 5: Conditional Grants Indirect Allocations 2021/22

Source: Adapted from the National Treasury (2021c) Division of Revenue p. 51

 

With regard to the indirect grants, the National Health Insurance Indirect Grant is allocated R2.1 billion.

 

For 2021/22, the overall reduction in indirect grants is 16.3%.[15] This is without the new allocation for COVID-19 vaccines, which means that the 21% increase is due to new COVID–19 funding for vaccines. The major reduction is under the Infrastructure Indirect Grant with 19.6%, followed by Non-Personal Services with 15.6%. The reduction will have a negative impact on nationally managed programmes especially infrastructure projects. Some planned projects will need to be postponed due to limited funding. The current infrastructure backlog will continue to grow. The Department is in the process of establishing oncology services in underserved provinces, however, this process may be negatively affected due to budget cuts.

 

  1. COMMITTEE FINDINGS, OBSERVATIONS AND RECOMMENDATIONS

 

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

 

  1. Findings and Observations

 

  • The Committee welcomed the APP of the Department and indicated the need to understand how emerging issues due to the COVID-19 pandemic will be addressed. Concern was raised regarding the impact of COVID-19 on the implementation of strategies and programmes of the Department.

 

  • The Committee flagged various concerns around the budget decline and how that may affect the PHC programme in particular, and the general service delivery.

 

  • The Committee was interested in whether provinces are able to manage plans for disease management programmes, including COVID-19 interventions.

 

  • The Committee was interested in the state of emergency medical services (EMS) in the country, particularly in rural and peri-urban areas.

 

  • The Committee was interested in the impact of the COVID-19 pandemicon the HIV programme; and on the progress and maintenance of infrastructure projects.

 

  • The Committee was interested on the lessons the Department has attained through the COVID-19 experience, and how those (lessons) can be applicable for NHI implementation.

 

  • The Committee was interested in how the Department was addressing the audit findings by the Auditor General, and what it intends to do to improve the overall public health sector audit performance/outcomes.

 

  • The Committee was interested in receiving the Mental Health policy strategy and plans.

 

  • The Committee was interested in the status of the cancer registry.

 

  • The Committee asked for more detail on initiatives to fight TB, particularly TB drug resistance management.

 

  • The Committee asked how the youth will be reached for medical services (to ensure provision of, and accessibility to the services.

 

  • The Committee asked howprovinces have been assisted with catch-up plans due to budget cuts.

 

  • The Committee was interested in knowing whether all government departments are co-operating with the Department’s COVID-19 strategies, including the vaccination plan.More detail was sought on the country’s vaccine strategy, including information on the procurement of vaccines and the envisaged timelines for rollout to ensure herd immunity.

 

 

 

  1. Recommendations

 

The Committee recommends the following to the Department:

 

  • COVID-19 initiatives: The Department should continue to hold provincial workshops; strengthen communication strategies and clearly outline the next phase of the vaccination strategy – including timelines and how rollout will occur and be accelerated; and put systems in place to address potential challenges.

 

  • 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.

 

  • Entity preparedness:The Department should ensure that entities such as the National Health Laboratory Services (NHLS)including the National Institute for Communicable Diseases (NICD)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, to strengthen the accessibility and delivery of mental health services. The Department to forward the Mental Health Strategy to the Committee.

 

  • 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 are strengthened to prevent fruitless and wasteful expenditure at the national and provincial departments.

 

  • Monitoring: The Department should strengthen its monitoring of the implementation of the Auditor General’s findings on key areas of internal controls and financial management, and reporting thereof.

 

  • 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 negotiate with National Treasury so as to minimize challenges created by the COVID-19 pandemic.

 

  • Social determinants of health: The Department should present to the Committee, its plans that have been developed in collaboration with other government departments to addressthe social determinants of health. The plan should reflect an integration of communication strategies which include social media platforms for outreach.

 

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

 

  1. CONCLUSION

 

The Committee commendsthe 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 Committee’srecommendations in three months from the day the report is adopted by the House.

 

Report to be considered.

 

 

[1]WHO. 2020. Herd immunity, lockdowns and COVID-19 Retrieved from: https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19.

[2]National Treasury. 2021. Full estimates of National Expenditure. Retrieved from: http://www.treasury.gov.za/documents/National%20Budget/2021/Estimates.aspx.

[3]Ibid.

[4]Ibid.

[5]The Presidency. 2021. President Cyril Ramaphosa, State of the Nation Address 2021.   The Presidency, Pretoria. Retrieved from: https://www.gov.za/speeches/president-cyril-ramaphosa-2021-state-nation-address-11-feb-2021-0000#.

[6]Special Investigating Unit (SIU). 2021.Investigation into the procurement of, contracting for good, works and services during or in respect of the National State of Disaster report. p.18. Retrieved from: https://www.siu.org.za/wp-content/uploads/2021/02/R23_of_2020_Final_report_on_matters_finalised_for_public_release_05022021.pdf.

[7]Department of Planning, Monitoring and Evaluation (DPME). 2019. Medium Term Strategic Framework, 2019-2024. The Presidency, Pretoria. Retrieved from:

https://www.dpme.gov.za/keyfocusareas/outcomesSite/Pages/mtsf2021.aspx.

[8] DOH (2021) Presentation to the Select Committee on Health and Social Services, (16 March).

[9]State patients are defined as persons who allegedly committed a criminal offence due to mental illness and declared by the Court.

[10] Public Finance Management Act (Act No. 1 of 1999) Section 16.

[11] National Treasury. 2020. p. 269.

[12]Department of Health. 2021. Presentation to the Select Committee on Health and Social Services. s. 33-34.

[13]National Treasury. 2021. Division of Revenue Bill, B3-2021. Retrieved from: http://www.treasury.gov.za/legislation/bills/2021/[B3%20-%202021]%20(Division%20of%20Revenue).pdf.

[14]Department of Health. 2021. Presentation to the Select Committee on Health and Social Services. s. 38

[15] NDoH. 2021. Presentation to the Select Committee on Health and Social Services. s. 36

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