Questions and Replies

Reply:

The Honourable Member is kindly referred to the attached Annexure 1, containing the response to the same question asked by Honourable Christians of the DA.

END.

Annexure 1

NCOP

QUESTION: 187

FOR ORAL REPLY

DATE: 06 SEPTEMBER 2023

DATE OF PUBLICATION IN INTERNAL QUESTION PAPER: 25 AUGUST 2023

(INTERNAL QUESTION PAPER NO. 30)

Ms D C Christians (Northern Cape: DA) to ask the Minister of Health:

(a) What is the current surgery backlog at Robert Mangaliso Sobukwe Hospital in Kimberley and (b) to what extent are elective surgeries taking place as opposed to emergency operations? CO724E

REPLY:

a) According to the Northern Cape Department of Health, the current surgical backlog at Robert Mangaliso Sobukwe Hospital in Kimberley is standing at 6000 cases as at 31 August 2023. This backlog was accumulated during the Covid-19 period. The following table shows the breakdown per specialty field:

Area	Surgery backlog	Type	Waiting time
Urology	471	Multiple type of operations	20 months
General surgery	201	Multiple type of operations	4-5 months
Orthopaedics	Emergency – 41 Elective – 481 Arthroplasty – 509 Hands – 131 Wards – 59 Total = 1221	Multiple type of operations	2-3 months
Ear-Nose-Throat (ENT)	977	Multiple types of operations	6 months
Ophthalmology	Cataract – 2060 Other – 634 Total 2694	Blind patients Partially sighted Pterygium Oculoplastic and strabismus Children with squint	2-3 months
Plastic Surgery	52 electives	Multiple type of operations	No waiting time
Oral and Maxillo-Facial	65 patients	Multiple type of operations	No waiting time
Obstetrics and Gyneacology	250 patients	Multiple type of operations	Gynae 6 months

b) Robert Mangaliso Sobukwe Hospital has the possibility to operate in 8 theatres, but due to severe speciality nursing staff shortage the hospital can only operate in 3 theatres on a daily basis Monday to Friday. One operating theatre is reserved for elective surgeries which are performed daily from 08h00 - 16h00 Monday to Friday.

Emergency surgeries are done daily on a 24/7 surgical list basis. During weekends the hospital only performs emergency cases. The average number of emergencies per week is 105 cases.

 

END.

Reply:

The approach to improving safety and security in all public health facilities is to ensure provision of adequate security infrastructure. Security assessments were previously conducted by the Ministerial Task Team at all public health facilities and the following recommendations were made:

• Improve security infrastructure like perimeter fencing and security guard rooms.
• Installation of security technology like CCTV cameras system, access control and alarm systems at hotspot facilities.
• Effective security contract management to hold Service Providers accountable.
• Regular security patrols at public health facilities by SAPS especially in hotspot facilities.
• Deployment of police reservists at hotspot public health facilities.
• Implementation of intelligence driven security measures at hotspot facilities
• Escort of EMS by SAPS to hotspot communities.

In this regard, a Memorandum of Agreement was entered into between SAPS and NDoH to ensure regular patrols and deployment of Police Reservists. The local hospital management take primary responsibility to provide patients and health care users as safe environment.

END.

Reply:

In each of the past five years,

(a) The Department of Health monitors the incidence of severe acute malnutrition which represents the number of children under five years of age who are diagnosed with severe acute malnutrition (SAM) per 1,000 children in this age group. Increases in the incidence may represent a real increase in cases or better case detection as a result of intensified case-finding and early identification and intervention.

Provincial figures for SAM incidence for the past five financial years are shown in the table below:

	2018/2019	2019/2020	2020/2021	2021/2022	2022/2023
South Africa	1,9	1,9	1,5	2,0	2,4
Eastern Cape	0,7	0,9	1,6	2,0	2,7
Free State	4,9	5,9	4,2	5,5	6,4
Gauteng	1,6	1,4	1,1	1,6	1,9
KwaZulu-Natal	2,1	2,0	1,3	1,6	1,9
Limpopo	1,2	1,1	1,5	2,2	2,9
Mpumalanga	1,6	0,8	0,7	1,0	1,3
Northern Cape	5,5	6,9	4,6	6,1	6,2
North West	3,7	4,2	2,1	2,7	3,7
Western Cape	1,7	1,6	1,0	1,3	1,5

The following provinces have reported an increase in the incidence of SAM over the past five years: Eastern Cape, Free State, Gauteng, Limpopo and Northern Cape.

(b) The percentage increase (or decrease) in SAM incidence in each province per financial year is shown in the table below.

	2018/19	2019/220	% increase	2020/21	% increase	2021/22	% increase	2022/23	Over five year period
South Africa	1,9	1,9	0,0%	1,5	-21,1%	2,0	33,3%	2,4	26,3%
Eastern Cape	0,7	0,9	27,1%	1,6	79,8%	2,0	25,0%	2,7	285,7%
Free State	4,9	5,9	20,4%	4,2	-28,8%	5,5	31,0%	6,4	30,6%
Gauteng	1,6	1,4	-12,5%	1,1	-21,4%	1,6	45,5%	1,9	18,8%
KwaZulu-Natal	2,1	2,0	-4,8%	1,3	-35,0%	1,6	23,1%	1,9	-9,5%
Limpopo	1,2	1,1	-8,3%	1,5	36,4%	2,2	46,7%	2,9	141,7%
Mpumalanga	1,6	0,8	-50,6%	0,7	-15,2%	1,0	49,3%	1,3	-18,8%
Northern Cape	5,5	6,9	25,5%	4,6	-33,3%	6,1	32,6%	6,2	12,7%
North West	3,7	4,2	13,5%	2,1	-50,0%	2,7	28,6%	3,7	0,0%
Western Cape	1,7	1,6	-5,9%	1,0	-38,8%	1,3	32,7%	1,5	-11,8%

(c) Interventions implemented in the past five years:

Eastern Cape	A mother and child development programme forum was established, facilitated by the Department of Social Development to foster collaboration by all departments to play their part in addressing child malnutrition. Growth monitoring at community level by the Ward Based Outreach Teams (WBOT’s) with periodic door to door campaigns in areas identified with high malnutrition incidence. Implementation of a multi-sector action plan to address prevention and management of acute malnutrition.
Free State	Provision of nutrition supplements to eligible children to improve their nutritional status. Immediate reporting of children with SAM to the district nutrition managers to conduct disease surveillance for further management. Community health workers conduct tracing and tracking of SAM patients who are treated at home. Ongoing efforts on screening, assessments and referrals of malnourished children for care and support. Collaboration between Health, Social Development and Agriculture to ensure that identified malnourished children benefit from social protection support measures on malnutrition, hunger and food insecurity.
Gauteng	Implementation of the food supplementation programme in all registered ECD in collaboration with the Department of Basic Education Continuous capacity building of health workers on infant and young child feeding, nutrition assessment classification and support.
KwaZulu-Natal	Implementation of poverty eradication focusing on the most deprived municipalities (Operation Sukuma Sakhe). Ongoing online training and competence assessment for all clinicians on inpatient management of severe acute malnutrition, led by the provincial office. Capacity building has been conducted on infant and young child feeding to prevent malnutrition in children under 5, and optimise nutritional status. A draft multi-sectoral Food and Nutrition Security Plan 2022-2025 has been developed and implementation is monitored and reported on quarterly.
Limpopo	Provincial Child health and Nutrition Strategy for 2023-2027 was developed. Nutrition assessment counselling and support at all facilities including Primary Health Care and hospital level. Monitoring of the SAM incidence at all levels of the province, district, sub-district and facility
Mpumalanga	Anthropometric equipment (length boards and height metres) were procured for all hospitals. Annual capacity building of clinicians on the Integrated Management of Common Childhood Illnesses (IMCI) was conducted in all districts which include growth monitoring and promotion and management of children with SAM, as well as ongoing Breastfeeding and Infant and young child feeding training at district level. Nutrition assessment counselling and support at PHC and hospital level. Implementation of the provincial multi-sector Food and Nutrition Security Plan to address malnutrition, hunger and food insecurity.
Northern Cape	Community nutritional screening and classification through community outreaches and outreached to ECD centres for early identification of acute malnutrition and referral for care and support. Severe acute malnutrition is included as discussion point at perinatal mortality meetings. Auditing and reporting of all SAM deaths to identify factors influencing the occurrence of malnutrition to inform prevention strategies. Malnutrition and early identification has been included in the Provincial multi-sector Food and Nutrition Security plan that is still being finalized.
North West	Community-based nutritional screening of all children under 5 years of age by CHWs Continuous capacity building of front-line staff in the initial management of children with SAM including on emergency triage and treatment. Collaboration between the districts WBOT’s with other government departments such as DSD, DHA, SAPS and SASSA to address social determinants of health. Implementation of Food and Nutrition Security plan to address malnutrition in collaboration with other Departments.
Western Cape	Continuous capacity building of front-line staff in the initial management of children with SAM including on emergency triage and treatment. Nutrition assessment counselling and support at PHC and hospital level Community Based growth monitoring using MUAC tapes. Skills development for facility-based staff to improve growth monitoring practices and frequency. Endorsement of District trainers to cascade growth monitoring and promotion (GMP) training in the districts. Training of health care workers Implementation of Nutrition Therapeutic Programme across the service platform including in secondary and tertiary hospitals. Implementation of the Multi-sectoral plan to address food insecurity, malnutrition and hunger.
Cross-provincial interventions implemented	In 2020-2022, the National Department of Health in collaboration with centre for Rural health, University of KwaZulu-Natal supported five Districts in Gauteng (City of Johannesburg, Ekurhuleni and Tshwane) and KwaZulu-Natal (Zululand and Umzinyathi) to roll-out a pilot project to build capacity of community health workers to train mothers to screen for acute malnutrition at household level to encourage early health seeking behaviour. This project has been formally evaluated. The 2 provinces developed plans to scale up this intervention in other districts.
	6 districts (Ekurhuleni, City of Johannesburg and Tshwane), North West (Dr Ruth Sekgomotsi Mompati), Eastern Cape (Oliver Tambo) and KwaZulu-Natal (eThekwini) are currently conducting an evidence-based planning bottleneck analysis to analyse barriers in scaling up and delivery of quality services for maternal and child malnutrition and plan interventions to address the gaps with support from National Department of Health and UNICEF.

END.

Reply:

1. (b) (c) (d) No, the Department of Health has not commissioned any studies and or live monitoring to assess the current extent of electromagnetic pollution in urban and rural areas.

1. -(ii) The South African Products and Regulatory Authority (SAPHRA), which is an entity of the National Department of Health is responsible, from the viewpoint of human health, for regulating electronic products producing non-ionising electromagnetic fields (EMF), i.e. where the frequency of such EMF is less than 300 GHz. In carrying out this responsibility, SAPHRA has been utilising the World Health Organization’s (WHO) International EMF Project (www.who.int/peh-emf/en/) as its primary source of information and guidance with respect to the health effects of EMF. The International EMF Project was established by the WHO in 1996 to (i) assess the scientific evidence for possible adverse health effects of non-ionising electromagnetic fields on an on-going basis, (ii) initiate and coordinate new research in this regard, and (iii) compile health risk assessments for different parts of the electromagnetic spectrum. The Department of Health has been a member of the International Advisory Committee of the International EMF Project since 1998.

In June 2005 the International EMF Project hosted a workshop that was specifically aimed at considering the possible health consequences of the emissions from cellular base stations and wireless networks. The findings of this workshop were summarised in a 2-page Fact Sheet (http://www.who.int/peh-emf/publications/facts/fs304/en/). The following extract from this Fact Sheet is still considered by the WHO as a summary of the findings to date, i.e. “Considering the very low exposure levels and research results collected to date, there is no convincing scientific evidence that the weak RF signals from base stations and wireless networks cause adverse health effects.”

Another WHO Fact Sheet was published in June 2011 and reviewed in October 2014, i.e. Electromagnetic fields and public health: mobile phones. This Fact Sheet can be found at http://www.who.int/mediacentre/factsheets/fs193/en/) and the conclusion is stated as follows: “A large number of studies have been performed over the last two decades to assess whether mobile phones pose a potential health risk. To date, no adverse health effects have been established as being caused by mobile phone use.”

The WHO recommends utilising internationally recognised exposure guidelines such as those published in 1998 by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) and reconfirmed in 2009 for the frequency range 100 kHz – 300 GHz (i.e. including all the frequencies employed by the cellular industry). The Department of Health likewise recommends the use of these ICNIRP guidelines to protect people against the known adverse health effects of EMF.

The numerous measurement surveys, which have been conducted around the world and in South Africa, have shown that the actual levels of public exposure as a result of base station emissions invariably are only a fraction of the ICNIRP guidelines, even in instances where members of the public have been really concerned about their exposure to these emissions. At present there is no confirmed scientific evidence that points to any health hazard associated with the very low levels of exposure that the general public would typically experience in the vicinity of a cellular base station. The Department is therefore satisfied that the health of the general public is not being compromised by their exposure to the microwave emissions of cellular base stations. This also means that local and other authorities, in considering the environmental impact of any particular base station, do not need to and should not attempt, from a public health point of view, to set any restrictions with respect to parameters such as distance to the mast, duration of exposure, height of the mast, etc.

The Department of Health is not able to make any pronouncements about the specific levels of EMF that a member of the public would experience at any particular base station site when it is in operation. However, generally-speaking unless a person would climb to the top of a mast (or other structure supporting an antenna) and position him/herself not more than a few meters away right in front of the active antenna, such a person would have no real possibility of being exposed to even anywhere near the afore-mentioned ICNIRP guideline limits. Since these base stations are typically cordoned off by means of barbed wire fencing and locked gates/doors in order to protect the sensitive and expensive technology, getting to a mast and actually climbing it despite the afore-mentioned security measures would certainly not be considered responsible behaviour. Even then the only real threat to the health of the person would be falling at any height from the structure in question. Based on the results of numerous global and local surveys, the experience has been that the exposure to base station EMF at ground level is typically in the range of between 0.001 – 1.0 % of the afore-mentioned ICNIRP guideline limits. Against this background of available data, there would be no scientific grounds to support any allegation that adverse health effects might be suffered by a responsible member of the public due to the EMF emitted by a base station.

Although the Department of Health currently neither prescribes nor enforces any compulsory exposure limits for electromagnetic fields, the Department does advise all concerned (whether they be a government department, the industry or the public) that voluntary compliance with the afore-mentioned ICNIRP exposure guidelines is the recommended and science-based way to deal with any situation involving human exposure to the non-ionising electromagnetic fields emitted by cellular base stations and handsets.

In addition, the National Environmental Management Regulations, 2014, as amended, published under the National Environmental Management Act 1998 (Act 107 of 1998), is the national legislation prescribing requirements for Environmental Impact Assessment to be conducted for various activities, prior to their commencement, depending on their scale and their potential to result in environmental and health impacts. The installation and use electromagnetic of Internet Wi-Fi [5G], Low Earth Orbit satellites, mobile phone towers and Internet fibre cables have not been identified as activities with a potential to result in significant pollution to the environment and therefore do not require an EIA to be conducted.

END.

Reply:

The public hospitals and forensic pathology mortuaries have continuous backup generator capacity. This helps mitigate the potential of mortal remains decomposing. There are continuous discussions with ESKOM to exempt public hospitals and Forensic pathology mortuaries from loadshedding. Most of the decomposed bodies are received by forensic pathology mortuaries mostly due to these bodies being discovered in public spaces after a longtime.

1. Measures taken to trace families for both public hospitals and forensic pathology mortuaries.

• In relation to Forensic Pathology Mortuaries, all unclaimed bodies are managed according to (i) the regulations for rendering Forensic Pathology Services (No R341 of 2005) – Section 43, 44, and 45 and (ii) the National Code of Guidelines for Forensic Pathology Practice in South Africa – Chapter 13 Section 460 to 464.
• It is the mandate of the South African Police Service (SAPS) to manage all unidentified cases from both the public hospitals and Forensic Pathology Service facilities. The SAPS has the competency of identification and tracing of families.

(b) Steps taken by the Department of Health to trace the families of the deceased?

The Department of Health collaborates with the SAPS, Department of Home Affairs (for finger prints), Department of Social Development (for tracing of families) and local municipalities (for paupers’ burial where families are not successfully traced).

The steps are as follows:

• In case of an unclaimed body where there are addresses provided, their next of kin are contacted.
• Tracing is also done by the social worker using details provided by the hospital.
• Community development/health workers are also used in tracing at last address that was given on the deceased patient’s file.
• The unclaimed deceased details and photos also get published through public media outlets.
• Should the tracing not be successful, the deceased’s DNA is extracted and sent to the SAPS Forensic Science Laboratory for storage in the database for future reference. It is only at this stage that the Department of Health makes an application to the Municipality for a Pauper burial.  

END.

Reply:

1. According to the Compensation Commissioner the campaign to compensate former miners with Tuberculosis and/or Silicosis began in 2014 and is ongoing.. The programme has received renewed attention in the past 8 years.

1. The total number of persons who were assisted in the past three years is indicated in the table below:

Details	1 April 2020 to 31 March 2021	1 April 2021 to 31 March 2022	1 April 2022 to 31 March 2023	Total
Number of TB claims paid	3 264	3 900	4 742	11 906
Amount of TB paid	R32 126 827	R33 696 731	R46 106 033	R111 929 591
Number of Silicosis claims paid	1 419	1 034	1 236	3 689
Amount of Silicosis paid	R121 276 176	R88 201 178	R102 547 449	R312 024 803

1. The Deputy Minister of Health, (Hon) Dr Sibongiseni Dhlomo, working closely with the Deputy Ministers of Employment and Labour and Mineral Resources and Energy, provincial and neighbouring country governments, other social protection and class action settlement funds, trade unions and the ex-miners’ associations. has been leading the programme on outreach activities for former miners There is also a call centre (080 100 0240) that former miners can call to query their claim status.

It must be noted that the majority of former miners are in labour sending areas such as the Eastern Cape, Lesotho and Mozambique and thus the outreach campaigns assist in bringing services closer to the towns / districts where the former miners live. In the last five months of 2023, outreach activities were undertaken in two districts in KwaZulu-Natal and three districts in the Eastern Cape. Former miners can also access compensation claims services at fixed hospital facilities in Mthatha, Carletonville, Kuruman and Burgersfort.

END.

Reply:

1. It is not true that Mahikeng Provincial Hospital does not have enough beds and space for the newborn babies. The hospital has enough bed space to accommodate the new babies who were placed in boxes. The babies were not placed in the cardboard boxes because of the shortage of beds and/or space.

1. The details of intervention steps are:

1. The hospital has started with the procurement of additional medical equipment; enforcement of referral policy, diversion of patients who need treatment at some other facilities, to ease up the pressure from the hospital, improved proactive planning based on the workload that determines and anticipates the sudden increase in deliveries.

1. The hospital managers are advised to make provision for sudden increase of the workload such as the one of increases deliveries. The situation will be attained through proper planning based on the health service information. The hospital managers are also encouraged to ensure that they enforce optimal utilisation of available resources and sharing of resources within the catchment area.

END.

Reply:

The Honourable Member is advised that this Question is a repeat of the Honourable Member’s Question 2046 on the same matter, which we have already responded to. The Honourable Member is referred to that response accordingly.

END.

Reply:

(a) According to the report from the North West Provincial Department of Health, there are 5 staff members who were involved in the incident where newborn babies were placed in cardboard boxes.

(b) The consequence management process is under way and the steps to be taken will be determined after the completion of the investigation.

END.

Reply:

1. Table 1 below indicates the current status of overcapacity in state mortuaries, as provided by provinces.

 

Table 1:

Province	Total number of State Mortuaries with over capacity
KwaZulu Natal	None
Limpopo	3
Mpumalanga	None
Northern Cape	1
Northwest	None

 

1. Even though all facilities in provinces have a back-up generator capacity, there are however, there increased expenditure costs due to diesel and maintenance of generators and this has an impact somewhat.

1. Table 2 below indicates the current status of unclaimed bodies at state mortuaries as provided by provinces.

Table 2

Province	Total number of unclaimed bodies
KwaZulu Natal	1362
Limpopo	136
Mpumalanga	54
Northern Cape	51
Northwest	174

1. No. There is continuous are discussions between Forensic pathology service, local municipalities, South African Police service with regards to unclaimed bodies.

Responses are still awaited from the Eastern Cape, Free State, Gauteng and Western Cape Provinces. The updated information will be submitted as soon as it is received from these Provinces.

END.

Reply:

(a) (i) Table 1 below indicate the response.

Table 1:

Province	Total Number of state mortuaries
Eastern Cape	22
Free State	11
KwaZulu Natal	25
Gauteng	11
Limpopo	12
Mpumalanga	20
Northern Cape	11
Northwest	7
Western Cape	17
National	136

 

(ii) There are no crematoriums operated by the state, as state hospitals do not cremate corpses on site. From the information received from Provinces, Persons that pass on in hospitals are transferred to private mortuaries or crematoriums by family members, and other human remains such as stillborn babies are disposed off as anatomical waste and the disposal thereof is handled as part of the health risk waste contracts outsourced to various private companies in all 9 (nine) provinces.

(b)(c)(d) Names, locations and capacity of state mortuaries are attached as Annexure A.

 

ANNEXURE A

State Mortuaries Names, locations and capacity are reflected below

EASTERN CAPE PROVINCE
	Facility(b)	Town(c)	Capacity(d)
1	New Brighton	New Brighton	60
2	Mount Road	Mount Road	44
3	Gelvandale	Gelvandale	18
4	Grahamstown	Grahamstown	48
5	Graaff-Reinet	Graaff -Reinet	40
6	Woodbrook	Woodbrook	35
7	Mdantsane	Mdantsane	33
8	Bizana	Bizana	12
9	Butterworth	Butterworth	32
10	Bhisho	Bhisho	12
11	Queenstown	Queenstown	32
12	Adelaide	Adelaide	9
13	Aliwal North	Aliwal North	32
14	Middelburg	Middelburg	9
15	Mthatha	Mthatha	96
16	Mount Fletcher	Mount Fletcher	10
17	Mount Frere	Mount Frere	32
18	Molteno	Molteno	12
19	Lusikisiki	Lusikisiki	32
20	Port Alfred	Port Alfred	9
21	Uitenhage	Uitenhage	12
22	Joubertina	Joubertina	6
FREE STATE PROVINCE
No	Facility(b)	Town(c)	Capacity(d)
1	Bloemfontein	Bloemfontein	248
2	Botshabelo	Botshabelo	9
3	Jagersfontein	Jagersfontein	16
4	Bethlehem	Bethlehem	16
5	Harrismith	Harrismith	9
6	Ficksburg	Ficksburg	9
7	Smithfield	Smithfield	16
8	Phuthaditjhaba	Phuthaditjhaba	21
9	Welkom	Welkom	72
10	Kroonstad	Kroonstad	22
11	Sasolburg	Sasolburg	40
GAUTENG PROVINCE
No	Facility(b)	Town(c)	Capacity(d)
1	Johannesburg	Johannesburg	3000-4500
2	Roodepoort	Roodepoort	1000-2000
3	Germiston	Germiston	3000-4500
4	Carlentonville	Carletonville	250-500
4	Springs	Springs	1000-2000
5	Heidelberg	Heidelburg	250-500
6	Diepkloof	Diepkloof	2000-2500
7	Sebokeng	Sebokeng	2000-2500
8	Pretoria	Pretoria	2000-2500
9	Bronkhorstspruit	Bronkhorspruit	250 – 500
10	Garankuwa	Garankuwa	1000-1500
KWAZULU NATAL PROVINCE
No	Facility(b)	Town(c)	Capacity(d)
1	Phoenix	Phoenix	540
2	Pinetown	Pinetown	124
3	Park Rynie	Park Rynie	177
4	Port Shepstone	Port Shepstone	112
5	Harding	Harding	12
6	KwaDukuza	KwaDukuza	102
7	Pietermaritzburg	Pietermaritzburg	433
8	New Hanover	New Hanover	22
9	Howick	Howick	18
10	Richmond	Richmond	15
11	Ladysmith	Ladysmith	25
12	Estcourt	Estcourt	51
13	Dundee	Dundee	100
14	Greytown	Greytown	53
15	Newcastle	Newcastle	85
16	Madadeni	Madadeni	56
17	Dannhauser	Dannhauser	6
18	Kokstad	Kokstad	48
19	Ixopo	Ixopo	12
20	Umzimkulu	Umzimkulu	9
21	Bulwer	Bulwer	12
22	Nongoma	Nongoma	24
23	Paulpietersburg	Paulpietersburg	06
24	Vryheid	Vryheid	12
25	Pongola	Pongola	12
26	Richards Bay	Richards Bay	136
27	Eshowe	Eshowe	150
28	Richards Bay	Richards Bay	136
29	Mkhuze	Mkhuze	Hospital facility
30	Mosvold	Mosvold	Hospital facility
31	Manguzi	Manguzi	Hospital facility
32	Nkandla	Nkandla	Hospital facility
33	Ulundi	Ulundi	Undertaker holding facility
LIMPOPO PROVINCE
No	Facility(b)	Town(c)	Capacity(d)
1	Polokwane	Polokwane	72
2	Lebokwakgomo	Lebowakgomo	48
3	Bela Bela	Bela Bela	60
4	Elim	Elim	54
5	Maphutha Malatjie, Phalaborwa	Phalaborwa	54
6	Nkhensani, Giyane	Giyani	24
7	Kgapane, Tzaneen	Tzaneen	78
8	Tshilidzini	Thohoyandou	66
9	Letaba, Tzaneen	Tzaneen	54
10	St Ritas	Glen Cowie	54
11	Mokopane	Mokopane	60
12	Groblersdal	Groblersdal	102
MPUMALANGA PROVINCE
	Facility(b)	Town(c)	Capacity(d)
1	Standerton	Standerton	18
2	Balfour	Balfour	15
3	Carolina	Carolina	18
4	Bethal	Bethal	24
5	Witbank	Witbank	36
6	Delmas	Delmas	15
7	Belfast	Belfast	15
8	Mmamethlake	Mmametlhake	36
9	KwaMhlanga	KwaMhlanga	21
10	Middelburg	Middelburg	32
11	Tonga	Tonga	24
12	Themba	Themba	66
13	Mapulaneng	Mapulaneng	12
14	Tintswalo	Acornhoek	18
15	Barberton	Barberton	18
16	Lydenburg	Lydenburg	18
17	Volksrust	Volksrust	18
18	Evander	Evander	30
19	Ermelo	Ermelo	30
20	Embhuleni	Elukwatini	18
21	Piet Retief	Piet Retief	30
NORTHERN CAPE PROVINCE
No	Facility (b)	Town(c)	Capacity(d)
1	Kimberley	Kimberly	30
2	Upington	Upington	36
3	De Aar	De Aar	18
4	Kuruman	Kuruman	36
5	Calvinia	Calvinia	15
6	Springbok	Springbok	13
7	Postmasburg	Postmansburg	12
8	Hartswater	Hartswater	6
9	Douglas	Douglas	6
10	Prieska	Prieska	6
11	Victoria West	Victoria West	6
NORTHWEST PROVINCE
No	Facility(b)	Town(c)	Capacity(d)
1	Phokeng	Rustenburg	80
2	Vryburg	Vryburg	44
3	Klerksdorp	Klerksdorp	50
4	Lichtenburg	Lichtenburg	20
5	Brits	Brits	100
6	Potchefstroom	Potchefstroom	20
7	Mafikeng	Mafikeng	15
WESTERN CAPE PROVINCE
No	Facility(b)	Town©	Capacity(d) Outstanding
1	Salt River	Salt River
2	Tygerberg	Tygerberg
3	Paarl	Paarl
5	Vredendal	Vredendal
6	Malmesbury	Malmesbury
7	Vredenburg	Vredenburg
8	Worcester	Worcester
9	Wolseley	Wolseley
10	Hermanus	Hermanus
11	George	George
12	Laingsburg	Laingsburg
13	Mossel Bay	Mossel Bay
14	Knysna	Knysna
15	Oudtshoorn	Oudtshoorn
16	Beaufort West	Beaufort West
17	Riversdale	Riversdale

END

Reply:

1. The question on the operational issues related to the running of Crematoria in the Country should be directed to the Department of Cooperative Governance and Traditional Affairs, which is the relevant department responsible for the crematoria regulation and monitoring.

1. This question should also be referred to the Department of Cooperative Governance and Traditional Affairs.

1. The above-mentioned department would be in a better position to make a pronouncement on how the matters as questioned will be addressed.

1. The above-mentioned department would be in a better position to make a statement in this regard.

END.

Reply:

The incident is currently under investigation, the outcome thereof will be shared upon finalisation .

END.

Reply:

a) The National Department of Health has been informed by the Gauteng Department of Health about the stolen copper pipes/cables at Charlotte Maxeke, Steve Biko and Chris Hani Baragwanath Academic Hospitals. There were other similar incidents that were reported by the Free State Department of Health regarding copper pipes being stolen from the following hospitals:

1. Bongani hospital (Welkom)
2. Boitumelo hospital (Kroonstad)
3. Thebe hospital (Harrismith)
4. Monapo hospital (Qwa Qwa)
5. Elizabeth Ross hospital (Qwa Qwa)
6. National hospital (Bloemfontein)
7. Universitas hospital (Bloemfontein)
8. JS Maroka hospital (Thaba Nchu)
9. Mohau hospital (Hoopstad)

All these incidents were reported to the nearest police stations and case numbers were issued accordingly.

b) Minster of Health has appointed Ministerial Task Team for safety and security in all public health facilities. The purpose of the task team was to assess the effectiveness of security measures and make recommendations. The task team has conducted security assessments at all public health facilities. Subsequently reports were drafted with the following recommendations:

• Improve security infrastructure like perimeter fencing and security guard rooms.
• Installation of security technology like CCTV camera systems, access control and alarm systems.
• Development of standardised security framework.
• Effective security contract management to hold Service Providers accountable.
• Regular security patrols at public health facilities by SAPS especially in hotspot facilities.
• Deployment of police reservists at hotspot public health facilities.
• Implementation of intelligence driven security measures at hotspot facilities
• Escort of EMS by SAPS to hotspot communities.

In this regard, memorandum of understanding was entered into between SAPS and NDoH to ensure regular patrols and deployment of police reservists.

Ministerial task team meet on regular basis to monitor the implementations of the recommendations and to assist provinces with any required security intervention.

END.

Reply:

(a) (i) Floor plans are available for all our health care facilities. However, most of them are outdated due to the aging of many facilities. (ii) See below existing health facilities with adequate fire detection systems:

(b)-(c) Aging public health facilities remains a challenge and growing concern for the Department of Health. The short-, medium- and long-term focus is thus more on restoring many of these facilities to an acceptable state of operability. The National Department of Health is currently busy with the following interventions:

(i) CSIR is currently busy with an investigation into how to become more green in future and will include the OHS Compliance issues and fire detection systems for all the healthcare facilities.

(ii) Provinces have been requested to include the update of the floor plans and fire detection systems during the condition assessment audits of their facilities. This request is aligned with the requirements of the Government Immovable Asset Management Act (GIAMA).

In the same Act the User, which in this case is the Provincial Departments of Health, should annually revise its User Asset Management Plan (UAMP) in alignment with the guidelines provided by Public Works. The User Immovable Asset Management Plan (UAMP) for the Department of Health informs the budget allocation process in terms of the overall and annual strategic plans of the Department. The objectives of the UAMP are to:

• assess the utilisation of accommodation in terms of the Department of Health’s service delivery objectives.
• assess the functional performance of the accommodation.
• prioritise the need for repair, refurbishment or reconfiguration of all state-owned accommodation.
• plan for future accommodation requirements and
• secure funding for the acquisition and utilisation of assets according to the strategic objectives of the relevant department.

1. All major upgrades and new installations must cover the upgrading of the fire detection systems.

END.

Reply:

1. The COVID 19 Vaccination programme started on 17 February 2021. According to the Electronic Vaccination Data System the total number of COVID 19 vaccines administered for the period 17 February 2021 and 5 June 2023 are 38 977 115.

2. Yes, three deaths resulting from Guillain Barre Syndrome (GBS) following administration of the Janssen COVID-19 vaccine have been causality linked to the vaccine. The common adverse events following immunisation includes fever, pain at the injection site, pain, nausea, local reaction, headache, fatigue, dizziness and chest pain.

3. (a) An adverse event following immunisation (AEFI) can be reported three ways a) on the MedSafety app b) at any private or public health facility on the MedSafety app or on a paper-based form emailed to [email protected] c) on the COVID-19 hotline (now the National Health Hotline). The NDoH in collaboration with SAHPRA has widely communicated to the public how to report AEFI, including on social media, training of health care workers and on various webinars/media engagements. Only serious and severe AEFI are investigated; 3075 clinically significant AEFI have been reported and the investigations are either underway or concluded. It should be noted that the majority of AEFI are found to be related in time, but not causally linked, to immunisation.

(b) A total of 49 claims have been received by the Covid-19 Vaccine Injury No Fault Compensation Scheme. All the claims have been adjudicated by the Adjudication Panel and finalised.

Breakdown:

Claims – No evidence of temporary or permanent disability	30	R0.00
Claims – Death benefit (R150,000.00) each	3	R450,000.00
Claim – Permanent Disability	1	R171,000.00
Claims – Temporary Disability	2	R45,000.00
Claim – Private Doctor consultation	1	R5,600.00
Claims – re-directed to Sisonke Trial – vaccinate before 17 May 2021	6	R0.00
Claims – assessed – wait for additional information	6	R0.00
TOTAL	49	R671,600.00

END.

Reply:

1. Key intervention to ensure continuity of protein supply was to substitute meat with beans which is also a source of protein.

(2) (a) Only one hospital reported food shortages.

(b) Chris Hani Baragwanath Academic Hospital

3.(a) The initial cause was the supplier is contracted to supply a number of hospitals in Johannesburg South with the inclusion of Chris Hani Baragwanath Academic hospital and one of the facilities failed to make a payment on time and the supplier stopped food supply in all facilities, including those whose contractual obligations were met.

(b) A long term solution would be to have more suppliers who are having a mix of items on contract, rather than depending on one supplier for most items. Moreover to construct a cold-room to keep buffer stock for reserves rather than daily deliveries.

END.

Reply:

1. (a) (i) The following towns has functional clinics; Kamieskroon, Kharkams; Leliefontein ; Hondeklipbaai (Fixed clinics);

(ii) Towns (small settlements) with no clinics: Kheis; Lepelsfontein; Spoegrivier; Tweerivier; Klipfontein ;Soebatsfontein; Nourivier; Rooifontein; Kamassies and Paulshoek.

(b) The Health Professionals in mobile clinics visit these 10 smaller settlements twice a month.

2. (a) (i) Two (2) ambulances are allocated to Kamiesberg Local Municipality.

(ii) These ambulances service all towns within the municipality.

(b) All ambulances are stationed in Garries which is a centrally located town within the municipality.

3. (a) All ambulances are roadworthy and undertake roadworthy tests annually.

(b) All ambulances have valid licences.

END.

Reply:

Background to the reply: 

A hospital that has the deliveries of 56 babies at a time, would generally require a minimum of approximately 25 Midwives at a particular time to ensure maximum coverage. This means that these midwives would have to take care of the 56 newborn babies, while also continuing to monitor the new arrival and those mothers who are in the active stage of labour. In this situation these nurses must ensure that the mothers and their newborn babies receive quality clinical care which would not result in unnecessary litigations. At this hospital, the picture derived from the letter that was received from MEC about this incident, it means that this was the reality at the time. The nurses, like all workers, are at times faced with acute shortage of resources, because of the sudden (unexpected rise in service demands) and at times these sudden increases outstrip the actual resource envelope. The nurses at this time were faced with the hard choice of either leaving the babies on unrestrained on the beds, with a risk of them falling or creating safe mechanism of keeping them safe and unharmed/unhurt).  

1.. The Minister of Health stated during the interview about this incident that the unfortunate incident of placing the newborn babies in the cardboard boxes instead of cribs is unacceptable and apologised to the families of the newborn babies. The position of the department, which is in line with standard clinical practice, is that not all the newborns delivered will require incubators. Incubators are used in situations where the new-born baby is sick and requires supportive machine or continuous oxygen for survival. Healthy new-born babies may require crip/ basinet, not a permanent arrangement but, as a backup support in case the mother is unwell to take care of the baby, need to take a bath or go to the toilet. In general, where both the mother and the baby are well, babies are safe to be kept on the mothers’ chest in what is called Kangaroo Mother Care (KMC).  

2. The Provincial Department of Health instituted the investigation on the matter and the details will be made available when the report has been finalised. 

3. Contingency plans are in place in all hospitals; however, contingency plans are developed based on the average delivery rates per facility.  The department has a plan in place for the procurement of essential equipment in all the hospitals, however there are times where the sudden increase in the number of patients such as admissions cannot be preplanned. The contingency measures in place include the enforcement of the referral system, which ensures that a hospital that cannot manage the situation for various reasons, including the lack of capacity such as equipment, human resources etc, such a hospital can refer the patients to the next facility which has capacity. The report from the province indicated that Mahikeng Hospital had a capacity of 16 incubators and 31 cribs and on the night in question, which is enough for the normal day to day management of the workload. The report from the province further indicates that on the day in question, 56 babies were delivered, thus outstripping the available capacity. This means that 47 babies had been placed in accordance with proper prescribed procedures, leaving the nurses to place 09 babies in cardboard boxes. It is reported that four babies were placed in card boxes and others were placed two babies in each crib.  

END.

Reply:

No. This is not an admission that management is not aware of the critical shortage of the hospital management is aware of the crucial shortages in their hospital. The hospital management relies on the subordinates who are responsible for day to day running of their sections to alert them if there is any crucial shortages of supplies and equipment in their respective sections. This is standard management practice. It is true that they become aware of the shortages when nurses inform them directly, through relevant management processes.

Reply:

The Honourable Member is kindly requested to specify what report she is referring to exactly (the proper name of the report), to enable the Minister to respond to this question appropriately.

END.

Reply:

The 2030 Human Resources for Health Strategy is available and can be accessed on the National Department of Health’s website on the following link:

https://www.health.gov.za/wp-content/uploads/2023/06/2030-HRH-Strategy-Final.pdf

Attached as Annexure 1 is a copy for ease of reference.

END.

Reply:

1. (a) (i) In accordance with the Persal data set as extracted for the month of May 2023 below is the table of the age demographics of all nurses employed in the public health sector and

(ii) Persal does not provide the breakdown percentage of each specialized category since they are all grouped under category specialty

(b) The data also specifies the Provinces in which they are employed-

Professional Nurse (Specialized) 2023
Province	25-34yrs	35-44yrs	45-54yrs	55-64yrs	*above 65
Eastern Cape	87	376	652	586	7
Free State	12	100	345	378	1
Gauteng	293	1105	1693	1448	28
KwaZulu-Natal	386	1975	2545	1689	12
Limpopo	109	527	1072	1160	8
Northern Cape	16	55	154	154	11
Mpumalanga	57	293	578	431	4
North West	59	282	535	406	14
Western Cape	225	673	912	631	6
Total	1244	5386	8486	6883	91

* Aged above 65 are regulated in accordance with the Public Service Regulation and Act- to employ professionals over the age of 65

(2) (a) Current vacancy rate for all the specified nursing specialties in each province and

Nursing Specialty Vacancy Rate
Province	Vacant	Vacancy rate %
Eastern Cape	498	13.0%
Free State	46	2.8%
Gauteng	1096	15.2%
KwaZulu-Natal	1984	22.7%
Limpopo	340	10.2%
Mpumalanga	170	9.1%
Northern Cape	120	33.0%
North West	318	19.1%
Western Cape	488	13.6%
Total	5060	15.7%

(b) The Department is unable to state the envisaged time frame to fill the vacant positions due to general budget cuts that negatively affects the Compensation of Employment (CoE) a specific date of when the specified challenges will be eradicated. However, it can confirm that measures are applied across Provinces to prioritize filling of vacant posts where the budgets permit.

END.

Reply:

The Minister was not informed about the 100 nurses who were offered employment at the Jubilee District Hospital during the recent cholera outbreak.

According to the Gauteng Provincial Department of Health, a group of 137 Nurses presented at the Hospital on the 22nd of May 2023. It is not clear who had made arrangements for the group to come to the hospital as there was no formal arrangement for them to come to the facility.

The group presented themselves to the Assistant Manager Nursing indicating that they have been instructions to report for duty. The Assistant Manager Nursing, without first verifying the status of the said nurses, allocated them to the wards where 41 of them commenced duties immediately. When the matter was brought to the CEO's attention some hours later the same day, the CEO immediately rescinded the allocation as the presence of the nurses at the facility could not be accounted for.

This matter is currently being investigated by the district. Once the investigations are finalized, details shall be provided, and the recommendations will provide the possible way forward.

END.

Reply:

1. The Figtree clinic is not dilapidated. A major renovation was last done in 2017 and minor maintenance is done as and when the need arises. The current challenges are that it still has a pit latrine and the fence that has become worn.

The clinic has an average monthly headcount of 2445 visits, which equates to an average of 122 patients per day. It has 4 consultation rooms and uses the nurses’ home as an extension to accommodate the facility manager’s office and HIV testing, screening and counselling services.

2. Mpumalanga Department of Health has identified forty (40) projects for comprehensive maintenance and Figtree Clinic is one of the clinics to benefit. The renovation of the first batch of health facilities started in April to June 2023. Fig Tree clinic is falling under the second batch which will start from July to September 2023.

END.

Reply:

No.

According to the Mpumalanga Department of Health, Goba in Ward 11 has an estimated population of 860. The nearest Primary Health Care (PHC) facility is 6km away in Mbangwane. The population size does not meet the norm of 8 000 - 10 000 which allows for a fixed PHC facility to be constructed. Currently, a mobile clinic is visiting the village once a month. The number of patients seen per visit are between 35 to 40.

END.

Reply:

According to the Gauteng Department of Health, the problem with the former service provider was resolved through the appointment of another service provider who ensured that the collection of medical waste is done in line with the Service Level Agreement, and the hospital also confirmed that they have never experienced similar problems since the appointment of the new service provider.

END.

Reply:

The response is based on an assumption that the term pre-trial psychiatric assessments refers to an enquiry into a mental condition of an accused in terms of Section 77, 78 and 79 of the Criminal Procedure Act, 1977 (Act No 51 of 1977) as amended.

(a) The Department is not aware of any negotiations regarding private hospitals admitting detainees needing pre-trial psychiatric assessment.

(b) Currently, private hospitals do not offer services for detainees needing pre-trial psychiatric assessment.

(c) Provincial Departments of Health contract psychiatrists and psychologists from the private sector to assist with pre-trial assessments in public sector facilities.

Enquiries into a mental condition of an accused in terms of the Criminal Procedure Act is a service that the Department of Health renders at the request by courts to assist the Criminal Justice System in evidence gathering and prosecution of accused as required by the Criminal Procedures Act, 1977. It is therefore not a health service, but a function of criminal justice. Furthermore, the budget for this function is with the Department of Justice and Constitutional Development who also remunerate the Department of Health as well as the professionals that are appointed by the courts to conduct the enquiries.

END.

Reply:

According to the Gauteng Provincial Department of Health, Edenvale Hospital did not award any tenders to Minzorex and its subsidiaries.

a) The Gauteng Department of Health has not awarded any tenders to Minzorex and its subsidiaries in the past twelve months.

b) The investigations by the Special Investigating Unit (SIU) are still in progress and the Department will implement the recommendations once investigation is concluded.

c) Suppliers been red-flagged by SIU are not prohibited to do business with government unless been blacklisted. The blacklisting of the suppliers such as Minzorex will be performed once the SIU have concluded their investigation. No provincial health department has contracted with Minzorex as per the confirmation received from the provinces.

END.

Reply:

a) According to Free State province, Batho clinic has been operating on extended service hours (07:00 -19:00) since 12 July 2022 after consultation was done with the clinic committees and local communities. Further awareness was done daily both to the internal customers and still continues. Batho clinic still operates 07:00 – 19:00 hours and the same operational hours are displayed on the service board at the clinic entrance.

b) The deceased was not refused healthcare services as he came after 19:00 when the clinic was already closed and there was no one (clinicians) on duty in the clinic. The security officials on duty who were  guarding the facility called Emergency Medical Services for the deceased.

c) The nearest health  facilities closer to Batho clinic are Mangaung and University of the Free State Community Partnership Program (MUCPP) and Pelonomi Hospital both are within 5km radius and operates 24hours. The awareness of the primary health care facilities operating hours is continuously done through local radio stations, media and displayed on the service board at the clinic and through clinic committees. The department of health management from the province and district offices visited the bereaved family at their home and provided redress on the matter (responding to media statement). The family was also encouraged to write a formal complaint so that the responses on the specific concerns can be given.

END.

Reply:

1. Yes, the Minister is implementing the remedial actions from the Public Protector’s report guided by prescripts of the law. As such, the DPSA are dealing with the issue of Occupational Specific Dispensation (OSD) through a process lead. DPSA has commissioned Price Waterhouse Coopers (PWC) to conduct a Personnel Expenditure Review (PER), that includes the review of OSDs in the public sector.

2. Yes, the National Department of Health has commenced discussions with relevant stakeholders to facilitate negotiations to address the Occupation Specific Dispensation (OSD) for Clinical Associates. The Department has held meeting(s) with the Department of Public Service and Administration (DPSA) to table issues pertaining to the conditions of service for the Clinical Associates as raised in the Public Protector’s report.

3. Fiscal constraints continue to be a limitation on the issue of creation of additional posts for all categories, including Clinical Associates posts within the public health system. Currently, Provinces are unable to fill existing vacant posts or create new ones, despite service delivery needs/demands. Instead, they are required to prioritize posts across all levels of care within the available budget.

END.

Reply:

1. According to the Health Professions Council of South Africa (HPCSA),

• Mr Naas Ferreira had lodged a complaint of unprofessional conduct against Drs Piek, Mostert and Laubser. At inquiry held by the Professional Conduct Committee of the Medical and Dental Professional Board (“the Committee”), Dr Piek and Dr Laubser pleaded guilty and were found guilty of unprofessional conduct.
• Dr Mostert pleaded not guilty. Mr Ferreira was then called as a witness against Dr Mostert and after cross examination, the HPCSA closed its case.
• Dr Mostert chose to exercise his Constitutional right to remain silent and not to testify in a case against himself.
• Dr Mostert legal representation applied for his discharge after HPCSA has closed its case.
• The Committee after deliberations found Dr Mostert not guilty of unprofessional conduct.
• Mr Ferreira was not happy about the Committee’s decision on Dr Mostert and complained why Dr Mostert did not testify in the case against himself and why his legal representative was the one testifying.
• The HPCSA explained to Mr Ferreria that Dr Mostert has a Constitutional right to remain silent and not to testify in a case against himself.
• It was also explained to Mr Ferreira that Dr Mostert’s legal representative has a right to represent him and that in doing so the legal representative is not giving evidence.
• There was therefore no maladministration or corruption on the part of the HPCSA in handling this case. It was dealt with in terms of the Constitution and the Health Professions Act, 1974.

2. HPCSA investigated the cases which were consolidated and was duly finalised by the Preliminary Committee of Inquiry in 2017, however, an error occurred on the system where one of the consolidated cases was not closed. The matter has since been resolved and the practitioner was informed accordingly. Registration subsequently issued a Certificate of Status in April 2023; and thus, based on HPCSA the matter is resolved.

END.

Reply:

• Diphtheria vaccine is part of routine childhood immunisation programme, and it is administered and recorded on the child road to health booklet.
• The department, in partnership with non-governmental organization (NGOs) and the United Nations agencies have developed the following strategies and interventions that address vaccine hesitancy with an intent to restores vaccine confidence among the members of the public. These interventions are aimed at improving uptake and coverage of routine immunisation: These are:
  • • The side-by-side campaign which is health information and education through SABC radio stations, aired on 11 radio stations and in in 11 languages, educating and sharing information on the importance of childhood vaccination. This includes phone-in programme where questions and answers are provided on the spot. Furthermore, the side-by-side campaign is using various advocacy strategies such as social media platforms (e.g., Facebook, twitter, Instagram etc.) where messages are posted to address vaccine hesitancy on an individual level and importance of vaccination is communicated to communities. Channels such as mobile audio-visual, social mobilisation trucks for awareness. The department also makes use of media engagement radio slots, as well as ongoing public announcements and shows to improve full coverage.

• • • A nationwide immunisation catch-up drive that was introduced at the end of 2020, 2021, 2022 and in 2023, which invites parents/guardians and caregivers to bring all eligible children who have missed their routine vaccination dates to be immunised. This will ensure that these children are fully immunised for age and fully protected against vaccine preventable diseases.

• • • The Ward Based Outreach Primary Health Care (WBOTPHC) check the children vaccination status through the road-to-health booklets (RtHB) during the routine household visits. This enables them to check on all children who have missed a dose and those who are found to have missed their dates, they are referred to the nearest health facilities to receive the missed doses.

• • • The department conducts health screening during the health events. On these days, professional nurses can check if mothers have taken their children for vaccination. This is done by the teams carrying vaccine cold boxes and all children who missed their doses are vaccinated onsite.

• • • The Health Promoters deliver health education messages in health care facility, and these messages include asking parents/caregivers/guardians about the vaccination status of their children.

• • • South Africa joins the whole of Africa to observe Annual Africa Vaccination Week (AVW) which is commemorated from 24-30 April. On these days, community members across all nine provinces are engaged and health workers make use of the opportunity to educate communities on the importance of people receiving vaccinations at regular and stated frequency. The further message that is shared during the vaccination week, is about educating members of the communities to avoid missing one or more doses within the national immunisation schedule.

• • • Implementation of immunisation recovery plan is ongoing to obtain additional insights from different stakeholders, such as caregivers, health workers and other decision-makers, on the barriers related to supply, demand, enabling environment for the immunisation programme. This plan focuses on the delivery of vaccination services to the provinces/districts with high number of unimmunised communities as well as their perspectives on what strategies might be used to overcome the barriers to the delivery of vaccination services and how to improve coverage and equity.
• These strategies are ongoing to address vaccine hesitancy and to increase immunisation uptake and coverage. The effectiveness of these strategies is evidenced by improved immunisation coverage comparatively, to prior embarking on the immunisation catch-up drives. These were also intensified again during the measles outbreak and the measles immunisation campaign that were recently conducted.

END.

Reply:

(a) Support the national Government afforded the City and the residents of Hammanskraal and surrounding areas

The national, provincial and respective district outbreak response teams were activated to coordinate the response to the outbreak. Ward-based Outreach Teams (WBOTs) were also activated to facilitate community-based interventions. The teams assisted with conducting contact tracing, active case finding linked to diagnosed cases within the community and visiting families of all the identified patients.

Two wards that were used for Covid at Jubilee Hospital were re-opened to serve as special wards for Cholera and Patients Under Investigation (PUI). This provided an additional capacity of 60 beds.

Surrounding hospitals were activated to receive stable patients who were referred to make space for diarrhoeal patients. Steve Biko Academic Hospital (SBAH) and Dr George Mukhari Academic Hospital accepted the referrals. Jubilee Hospital does not have Specialists since it is a District Hospital. A Gastro-Enterologist was mobilised from DGMAH to do ward rounds at Jubilee Hospital. This assisted to improve clinical management and outcomes of admitted patients. National Health Laboratory Services allocated a dedicated team within their DGMAH laboratory to deal with Jubilee Hospitals’ specimens to improve Turn Around Times (TAT).

Field Epidemiologists were activated from the World Health Organization (WHO) and Government. His team has expanded to include Specialists in Infection Prevention and Control (IPC), Case Management, Risk Communication and Community Engagement (RCCE). Community health workers were trained on hygiene packs and deployed to distribute the packs to the community, conduct health education and community surveillance. There is ongoing training of health care workers through webinars and refresher courses.

A field hospital was established in Kanana, Hammanskraal, to address the late presentation of sick patients which is a major contributor to the mortality. The field hospital started operating on 26 May 2023 and has since seen more than 100 patients. The utilization of the field hospital is constantly monitored.

A Task Team was established with all role-players involved in water quality monitoring; this includes the Department of Water and Sanitation, The City of Tshwane –Water Services and Environmental Health, the Department of Health (National and Province). Responsibility of testing of water has been distributed between role-players to avoid duplication and waste of resources. The Department of Water and Sanitation has engaged the Water Research Commission (WRC) and the Council for Scientific and Industrial Research (CSIR) to provide quality assurance for water quality testing.

The Department of Social Development obtained the list of deceased individuals from Jubilee Hospital to provide psychosocial support and social relief to their families. This was done in collaboration with local Councillors. By 30 May 2023, the Social Workers had visited 19 families to provide counselling and social relief.

Risk Communication and Community Engagement activities have been intensified to (1) ensure that everyone at risk for cholera is informed about how to reduce the risk of spreading the disease, take personal protective and preventive measures, and go to the health facility if they become severely ill (2) debunk rumours and misinformation by providing accurate information about how to recognise symptoms of cholera, how it is transmitted and what to do to encourage prevention and early treatment-seeking behaviour, and how to care for family members with diarrhoea, and (3) to facilitate community engagement and feedback through community radio and outreach activities, to ensure uptake of available services to prevent the spread of cholera.

(b) The Deputy Minister of Water and Sanitation, Deputy Minister of Health, MEC for Health in Gauteng, and MMCs from the City of Tshwane convened at Jubilee Hospital and agreed on the establishment of the Technical Coordination Committee lead by the Director-General for Health. This Committee consists of senior managers from the departments of Health, Water and Sanitation, Social Development and the City of Tshwane. The function of the Committee is to oversee the public health response, water quality monitoring, psycho-social support and social relief for distressed families, and Risk Communication and Community Engagement (RCCE)

As a health sector, all provinces through Heads of Health (Technical Committee of the National Health Council), were alerted of the outbreak and a physical meeting convened to ensure readiness of all the provinces. Cholera Incident Management Teams have been activated at national, provincial and district level and attended by multisectoral and multi-disciplinary stakeholders. Meetings are held to monitor the intervention strategies as well as the outbreak.

Risk Communication and Community Engagement is conducted at various media platforms for the South African community. The country is on high alert through the Provincial Departments of Health, National Health Laboratory Services. The department is continuously updating the public and stakeholders, especially focusing on high-risk areas with densely populated informal settlements, areas with unreliable water supply and sanitation.

END.

Reply:

According to the Free State Provincial Department of Health,

1. The incident happened at Boshoff Clinic, the theft of anti-retroviral medicine amounting to the value of R85 000. Only 1 facility (Boshoff clinic) is affected. The employee was arrested by the police. He was charged criminally (SAPS Case number 27/01/2023) and departmentally. The employee was suspended from the 2nd of March 2023 and is still on suspension awaiting the finalisation of the disciplinary hearing.

2. The facility has installed the burglar bars on both windows and is planning to install the intruder alarm system.

END.

Reply:

At this stage, it is premature to approach National Treasury to lobby for additional funding for the remedial actions from the public protector. The matters of conditions of service for Clinical Associates have been presented to the Department of Public Service and Administration (DPSA) and are being considered as part of the wider process of the Personnel Expenditure Review exercise that includes the review of OSDs in the public sector. Engagement with National Treasury will subsequently be informed by the outcomes of the DPSA process.

END.

Reply:

(a) (i) The satellite clinic in Ward 29 Makolokwe, Rustenburg, in North West started operating in 2002.

(ii) The satellite clinic in Ward 29 Makolokwe, Rustenburg was replaced by a mobile clinic since 2005. Currently, the mobile clinic station is at the community hall.

(b) (i) This structure, built by Bophuthatswana Government, was used as  a storage area for some of the Sub-district equipment, while awaiting equipment disposal. The equipment was removed by 1 April 2023. The building is currently not in use. The sub-district management is still to decide what the building will be used for going forward.

(ii) During the time that the equipment was stored at the building, security personnel were posted at the facility to secure the equipment. Since the equipment has been moved out of the building (1 April 2023), the security personnel have been posted to another health facility that urgently required additional security staff.

END.

Reply:

The National Department of Health does not have specific emergency funds in preparation for another global pandemic, the emergency funds are enshrined in the Disaster Management Act and is the competency of the Department of Cooperative Governance and Traditional Affairs through the National Treasury. Funds are released when the President of the Republic of South Africa declares a disaster through the Department of Cooperative Governance and Traditional Affairs.

END.

Reply:

Pre -, during and post-counselling services are an essential component of treatment of patients with cancer. Counselling is provided by their treating doctor, including the Medical and Radiation Oncologists, as well as the multidisciplinary palliative care team of which social workers are key team members. Counselling is prioritised in palliative care services which commences at the point of diagnosis of the cancer and continues throughout the continuum to ensure that the patient lives a quality life for as long as possible.

Counselling for Cancer Patients:

1. Diagnostic Counselling: Patients who receive cancer diagnosis undergo diagnostic counselling, which involves discussing the diagnosis, its implications, and potential treatment options. This counselling aims to provide emotional support, answer questions, and help the patient understand the next steps.
2. Treatment Decision Counselling: The Department recognises that cancer treatment often involves making important decisions. Patients are presented with treatment options counselling which including the benefits, risks, and potential side effects of each option. Health care workers may help the patient to weigh their options and make informed decisions based on their preferences and medical advice.
3. Emotional Support: Patients diagnosed with cancer are offered social service counselling through social workers/psychologist within the health care facility. Emotional support pre-counselling services includes emotional, and where available, spiritual support to help patients and their families cope with fear, anxiety, and stress related to their diagnosis. Counsellors may provide guidance on managing emotions, communicating with loved ones, and accessing additional support resources.
4. Post-Treatment Counselling: After completing cancer treatment, it is recommended that patients undergo post-treatment counselling. This counselling focuses on addressing the emotional and psychological effects of cancer, such as post-treatment anxiety, fear of recurrence, or coping with physical changes. The counselling provides a space for patients to discuss their concerns, learn coping strategies, and adjust to life after treatment.
5. Survivorship counselling: Some Tertiary Hospitals in collaboration with other Stakeholders, do offer survivorship programs that provide long-term support to individuals who have completed treatment. These programs may include counselling sessions to address survivorship issues, including emotional and spiritual well-being, managing risk behaviour, monitoring for late effects or complications of treatment, and transitioning back to daily life. These facilities include eg Steve Biko , Charlotte Maxeke, Inkosi Albert Luthuli, Groote Schuur, Chris Hani Baragwanath, Red Cross Memorial, Kind Edward VIII and Universitas Academic Hospitals).

Palliative Care: For patients with advanced cancer or those nearing the end of life, palliative care counselling can be provided in collaboration with palliative care Stakeholders (Hospice, Frail Care facilities, Home based palliative care services). This form of counselling focuses on improving quality of life, managing symptoms, discussing end-of-life preferences, and providing emotional support to patients and their families.

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Reply:

(a) In the quest to respond to the report emanating from the SA Human Rights Commission (SAHRC) three-day visit to the Free State in 2022, the FS Provincial Department of Health has informed that to date, a total of 862 critical health professionals posts (i.e. 774 medical doctors, 74 Specialists, 664 Nurses and 4 Paramedics) were filled.

These posts were filled despite general budget cuts that negatively affects the Compensation of Employment (CoE).

The Province has further introduced stringent control measures to manage the filling of positions which are:

(i) Prioritization of the posts in the Annual Recruitment Plan – where funding permits;

(ii) Prioritization of the posts for conditional grant funding;

(iii) Continuous engagement with Provincial Treasury for approval of filling of posts;

(iv) Filling of replacement posts considered and approved by-weekly; and

(v) Advertisements published National wide through print media.

(b) The Free State Provincial Department of Health is unable to state a specific date of when the specified challenges will be eradicated. However, it can confirm that incremental action plans (i.e. per facility) are being implemented. They are at various stages of implementation and are monitored closely by the Provincial Head Office.

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Reply:

A retrospective review of data from National Health Laboratory Service data shows that outbreaks occur approximately every three to six years. Mumps is considered a common and mild disease with few complications which does not pose a major public health threat to the country. The Department has responded by providing information to the public and other stakeholders. Individuals with mumps are advised to stay at home until symptoms resolve and to seek health care should they develop complications.

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Reply:

a) (i) According to the Free State Department of Health there was no time where patients were left without food. However, there were challenges with the supplier who partially delivered few stock items on large quantity order which was placed on the 26 October 2022.

This supplier also decided to verbally cancel the order and refused to write a cancellation letter when a follow up was done by the hospital. This impasse therefore led to the hospital being unable to place a new order as this order was still active.

(ii) This matter was reported to Provincial Treasury and the incident number was issued. The Provincial Treasury was also requested to cancel the order for the hospital to create a new order. A process for a new order was re-initiated.

However other surrounding institutions have been assisting with the provision of food supplies and the hospital management is regularly monitoring food supplies to ensure that patients are fed.

(b) The Free State Department of Health has the following plans to resolve general food supply concerns in the facilities in the province:

• In the current financial year 2023/2024,the Free State Department of Health will screen and contract suppliers with good track record in this area.

There will also be alternative reliable suppliers list that hospitals can rely on in the event the contracted supplier fail in their contract.

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Reply:

(a) (i) The Free State Provincial Department of Health has informed the Minister that it is engaging in a number of interventions to solve the shortage of specialists to address the orthopaedic surgery backlog. This amongst others includes:

• Creating of more nursing posts and headhunting of more Specialists with relevant experience is underway and it is envisaged that more staff will be recruited in the next few months;
• Requested the National Department of Health to recruited Orthopaedic Specialists through the Nelson Mandela Fidel Castro Government to Government Agreement;
• Improvement of appointment practices to minimise delays that could deter applicants (Reduced from 6 weeks to 2 weeks);
• Filling of critical posts to enable increased theatre time;
• Increased Theatre Capacity – from 3 to 5 elective Orthopaedic list;
• Outreach to neighbouring Hospitals both Orthopaedic Wards and Theatre immediately; and
• Increase pool of Specialists in the Province in conjunction with the Academic Hospital.

(ii) In solving the crisis of operating theatre times that also influences the orthopaedic surgeries backlog, the Province is/has-

• Rationalised the budget and prioritize relevant surgical equipment and services;
• Strengthen the Outreach Programme at Level 1 Hospital by increasing rate outreach to lower levels of care;
• Encourages the improvement on theatre time and usage;
• Increased the usage of back-up generators during load shedding or unscheduled power cuts;
• Surgical marathons or blitzes;
• Improved monitoring of the backlogs through an electronic system;
• Better management of Theatre time through improving efficiencies;
• Developed and implemented a Quality Improvement Plan (QIP) on optimum Theatre Utilization;
• Strengthened Theatre User Committee with attendance by Head Specialists and Matrons; and
• The budget for orthopaedic implants to continue these services and increase arthroplasties (Total Hip & Knee Replacements) has been increased in the current financial year.

(b) The above-mentioned interventions are being implemented simultaneously to address the orthopaedic surgery backlog, even though a specific date of realizing the ultimate goal cannot be stated, the monitoring of the backlogs through the electronic system will be able to inform of progress being made.

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Reply:

a) The National Department of Health has developed a 10-year infrastructure plan regarding the needs of our health facilities. The programme is focusing on projects that are still in planning (pre-tendering phase) while projects that are already under construction and in the tender phase will continue in the processes that have already commenced. Facilities that require part or full rehabilitation or replacement and infrastructure that needs to be newly built lend themselves to management through this programme while routine maintenance needs to be the primary responsibility of provinces managed through other programmes. The quantification and sequencing of the need and financing requirements are based on the 10-Year Health Infrastructure Plan (YHIP). Initial focus will be on PHC facilities as these are the first points of contact for patients and scale can be reached easier and quicker while planning for hospitals is underway.

b) In the current financial year, the National Department of Health has put aside R7 119 867 billion through Health Facility Revitalisation Grant (HFRG) to be shared by the provincial health departments. The aim of this grant is to accelerate and improve on the conditions of the existing health infrastructures. The budget will also use to provide new health facilities which address population growth and changes in burden of diseases. And there are few large projects that are currently in construction and implemented by the National Department of Health funded through the National Health Insurance Indirect Grant: Health Facility Revitalization Component (In-Kind Grant). The budget for the grant in the 2023/2024 financial year is R1.4 billion. The needs of health infrastructure are funded through (i) the Equitable Share; (ii) HFRG; and (iii) In-Kind Grant. See below the allocations from the three funding streams for 2023/24FY:

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Reply:

1. According to the North West University (NWU), the B. Nursing curriculum outlay, the number of work-integrated learning hours as per accreditation document submitted and approved by the South African Nursing Council (SANC). The total required clinical hours over the 4 years, are 3000 hours. This is in line with South African Nursing Council’s Nursing-Education-and-Training-Standards, page 12, Bachelor degree (Regulation R174). The 3000 hours include laboratory hours for Anatomy, Physiology, as well as simulation laboratory hours for all the nursing modules and does not refer to clinical placements in accredited facilities only.

With regards to the NEHAWU strike earlier this year, the NWU nursing students were placed in facilities where there was no strike activities and their clinical hours were therefore not affected.

2. Students are allowed ample opportunities and are supported to catch up on any missed hours before they exit in December (not May) and graduate in March of 2024, according to the yearbook outcomes and academic calendar of the university.

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Reply:

a) According to the North West Provincial Health, they are not aware of the Public Protector’s Report and the anonymous reference number referred to in the question. They would like to request the Honourable Ms MD Hlengwa to provide them with this information in order to provide a proper respond.

b) Fruitless and Wasteful expenditure are disclosed in the Annual Report and presented to Parliament, however the North West Department of Health indicates that it is not aware of the reference (00254121_d ANONYMOUS (5) reflecting on the question.

The North West Provincial Department of Health further indicates that they are also not aware of the Public Protector’s Report on the appointment of private legal practitioners by the Northwest Department of Health in dealing with disciplinary proceedings.

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Reply:

(a)(b)(i)(ii)(aa)(bb)(iii) The Immigration Act, No. 13 of 2002 does not make provision for a nomad visa. As a result, there were no nomad visas issued by the Department for the periods mentioned above.

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Reply:

The National Department of Health is determined to implement National Health Insurance (NHI) as the only viable and sustainable intervention to effectively transform the South African health system into one that offers equitable, accessible, affordable and quality health care to all irrespective of their social or economic status. A tiered approach to the provision and access of needed health services is contrary to the values of the Constitution, specifically the rights of every South African as enshrined in the Bill of Rights.  

Concerning developments around the Low Cost Benefit Options (LCBOs), the Council for Medical Schemes (CMS), the statutory body responsible for regulatory oversight of all duly registered medical schemes, issued Circular 13 of 2023: Update on the status of the Development of LCBO Guidelines dated 28 March 2023. This Circular provides an industry update. In this Circular, it was indicated that through a series of industry consultative meetings initiated in 2015 with key government departments, regulatory entities and industry stakeholders, three Advisory Committees supported by technical work-streams were established by the CMS to work on developing draft LCBOs guidelines. The Committees produced the LCBOs Framework Report and Risk Assessment & Roadmap, together with the proposed LCBO guidelines, which were published in Circular 53 of 2022 for public comments and inputs.

Subsequently, at the request of stakeholders and other interested parties, Circular 57 of 2022 was issued, notifying the public of an extension for submitting comments. At the end of the public comments period, 44 submissions had been made to the CMS. The comments and inputs primarily covered three core areas, namely (i) legal and compliance matters; (ii) benefits and pricing issues; and (iii) the market and affordability of products.

The CMS is at the tail-end of thoroughly evaluating all comments so as to finalise the LCBO guidelines and recommendations. It is also crucial that appropriate policy options presented to the Ministry of Health are adequately evaluated and assessed to ensure they do not conflict with the purport, object and intent of the Medical Schemes Act, Act 131 of 1998 and the Department’s policy priorities, especially in relation to the phased implementation of NHI. To this effect, the CMS established an Internal Working Committee consisting of key business functions to provide further inputs on the recommendations of the Advisory Committee.

The purpose of the Internal Working Committee was to provide an independent and informed view on industry issues to the Minister of Health as per Section 7 of the Medical Schemes Act, Act 131 of 1998.

It must be noted that there is no intention for LCBO to be integrated into the NHI environment. Instead, the intention is to create an integrated health financing system that prioritises the health of all South Africans through ensuring access to a comprehensive set of personal health services. Within such a system, medical schemes would only play a complementary role as suggested in Clause 33 of the NHI Bill that is currently serving in Parliament. 

END.

Reply:

National Health Insurance (NHI) describes a totally reformed health system that strives to achieve equity in provision of services. The objective it to achieve Universal Health Coverage where every person gets the health care that they need, when they need it, where they need it and without incurring any financial hardship. NHI is designed to redress some of the worst inequities that characterize the South African health system. These inequities continue to significantly affect the most vulnerable, poor sections of our society, especially those that reside in rural, far-flung areas that continue to struggle to access and utilize needed health services.

It is because many communities, both remote areas and those who live in townships and informal settlements of urban areas, have poor access to health services that we need the NHI.

As the Bill provides for the NHI Fund will be mandated to use strategic purchasing to develop healthcare coverage and access that is equitable. This includes purchasing services from private providers whose facilities are in close proximity to communities that can presently not use those services. It also means changing the way that services are paid for so that providers find it more attractive to move to areas that are presently inhospitable to them because there is no advantage over working in an established urban community.

The introduction of capitation payments and contracting units for PHC will systematically shift resources to communities where resources are presently well below average and are unacceptable. Using a single set of benefits and common formulary the system will reduce overheads and duplications and make more of the existing funds available for services rather than administration and profit-taking.

These provisions are clear in the NHI Bill which has reached the point of the vote in the National Assembly.

The National and Provincial Departments of Health continue to implement a number of interventions directed at maintaining existing infrastructure (clinics, hospitals, CHCs, etc.); refurbishments as well as the commissioning of new ones to address quality and related challenges, with a strong focus on facilities located in mainly rural and disadvantaged areas.

The National Department of Health embarked on the development of a Health Integrated Portfolio System (HIPS) or previously known as the Ten-Year Infrastructure Plan. The system utilised Geographic Information System (GIS), topographical data, locations of current and future planned facilities, demographics and the road networks, to determine accessibility gaps. Projects identified via the gaps will be prioritised and executed as per the normal health infrastructure planning and delivery cycles. This will provide an objective tool to prioritise investments in Health Infrastructure. The first draft of the tool is already expected within the 2023/2024 financial year and will be utilised to guide allocation of funds hence forth. Further to the above the Department is focusing on addressing maintenance, refurbishment, upgrades, and/or replacements as well as new infrastructure in remote rural areas and informal settlements in preparation for the implementation of NHI.

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Reply:

a) The names of the mines that have been inconsistent over the past three years and/or not paid levies to the CCOD, either indefinitely or on time are:

1. Wearne Aggregate Quarries
2. Rhino Minerals
3. Manhattan Corporation Pty Ltd - Gravellotte Mine

b) Inspections are undertaken by the finance inspectors of the CCOD to assess the mines and works on accuracy of risk shifts and levy payments; the Deputy Director (Revenue) has written to the above mines and works requesting payment of the levies. Meetings are being set up with the Compensation Commissioner and the Chief Executive Officer of the above mines and works. As a last resort, the legal section of the department will be consulted to assist through the state attorney’s office to begin legal proceedings against the defaulting mines and works.

END.