Department of Health 2019/20 Annual Performance Plan: Committee Researcher briefing and analysis

Meeting report

The Chairperson consulted Members of the Democratic Alliance (DA) and Economic Freedom Fighters (EFF) for their availability for the next meeting. It was agreed that 10am would be the meeting time.

He indicated that the adoption of the report that would be compiled the next day would be considered tomorrow. He outlined his plan and suggested that Wednesday would probably be the day to adopt the report.

Annual performance plan: Briefing

Mr Zubair Rahim. Committee Researcher, started by briefing Members on the policy priorities, focusing on the three issues which also were highlighted in the President’s State of the Nation Address (SONA):

• The shortage of health professionals;
• Improving ambulance care; and
• The Presidential health summit, which was still undergoing compilation.

The Department of Health (DoH) was guided by the National Development Plan (NDP) 2030. Nine goals had been identified. These were:

1. Increasing life expectancy;
2. TB prevention and cure;
3. Maternal, infant and child mortality reduced;
4. Reducing the prevalence of non-communicable chronic diseases;
5. Injuries, accidents and violence reduced by 50% from 2010,;
6. The completion of health system reforms:
7. The deployment of primary health care to provide care to families and communities;
8. Achieving universal health coverage; and
9. The placement of skilled committed and competent individuals in vacant posts.

Mr Rahim moved on to the DoH’s strategic goals. The Department had not tabled its five-year strategic plan, but had submitted its annual performance plan (APP), which was a one-year plan. He read out the five-year strategic goals which were included in the slides.

Referring to the Department’s budget analysis of 2018/19 and 2019/20, he explained that although the nominal budget increase was 9.2%, the real percentage change was only 3.8% when one took inflation into account. The DoH needed to speak to Members about their budget structure change.

The two largest programmes listed were Programme 3 (communicable and non-communicable diseases0, which received a R23.1 billion budget, and Programme 5 (hospital systems), which received a R20.4 billion budget. These two jointly constituted 84.3% of the total budget allocation. The bulk of the budget consisted of transfers and subsidies to provinces and municipalities, and departmental agencies and accounts.

Mr Rahim took Members through each programme. The first programme was administration, where he highlighted the new medico-legal claim management system. The budget for the Eastern Cape province alone amounted to R23 billion. This was a national government issue, and it was important for the Department to demonstrate how it was going to manage claims.

Programme 2 dealt with the national health insurance (NHI) scheme. He explained the purpose of the programme, the previous name of the programme, as well as the programme’s budget increase. The DoH wanted to introduce the NHI bill to Parliament in 2019, and also to establish the NHI office. It intended to register 50 million people by 2021/22. The Department was implementing the new early warning system, an e-Prescription and e-Dispensing system, as well as an electronic medicine catalogue. Mr Rahim emphasised that it was important for the Committee to find out from the Department about this early warning system and how it functions. One of the successes of the Department was the Centralised Chronic Medication Dispensing & Distribution (CCMDD) programme, which aimed to have three million people receiving chronic medication, although there had been uneven success with this programme in the different provinces.

Programme 3 was previously titled “HIV and AIDS, TB, Maternal and Child Health Programme.” Non-communicable diseases had recently been added. This was a very important programme for service delivery. The purpose of the programme was to develop and support the implementation of national policies, guidelines and norms and standards. It aimed to decrease morbidity and mortality associated with communicable and non-communicable diseases, and to develop strategies and implement programmes that reduced maternal and child mortality.

Mr Rahim briefed the Committee of some of the key indicators, emphasising their importance because TB was one of the major diseases in the country, so they needed to look at how this programme was going to be implemented. Other aspects included under this programme were women’s maternal mortality, neonatal mortality and childhood diseases.

Mr Rahim’s fellow researcher, Mr Moses Mncwabe, briefed the Committee on the HIV issue, explaining why HIV/AIDS was a critical aspect of South Africa’s health agenda. He explained the causes, such as the perpetuation of detrimental social practices such as stigma, discrimination and gross violation of human rights, the straining effect on the economy, and the overwhelming burden placed on the health system, as well as its role in disrupting families and the extra pressure placed on the national budget.

For 2019/20 financial year, R36.5 billion had been allocated for core departments. Members were told that in 2018, 7.2 million South Africans were HIV-positive compared to 4.25 million in 2002. This increase could be attributed largely to the rise in teenage pregnancies. The DoH’s response to dealing with teenage pregnancy would be instrumental in reducing the incidence of HIV. A key list of policies and interventions, such as the national strategic plan for HIV, TB, sexually transmitted infections (STIs) and the NDP), were all directed to address the HIV increase.

Members were advised to look at the budget allocations to core departments for HIV and TB in the 2019/20 financial year, as well as the funding for HIV/AIDS from the 2017/18 financial year to 2021/22. The funding came from two sources -- government funding, and donor funding provided by the international community.

Members were given some suggestions of questions they could ask the Department at the meeting next day. Firstly, the DoH needed to clarify the discrepancy between the actual amounts distributed and those reflected, the lack of intervention strategies for teenage pregnancies, the lack of reporting at the provincial, district and local council levels, and a need for business to clarify its role in reducing HIV/AIDS. There was also a need for an update on the establishment of Ketlaphela, the state-owned pharmaceutical company supplying anti-retrovirals (ARVs).

Mr Rahim commented that SA had one of the largest ARV programmes in the world, with four million people receiving treatment. The aim of Programme 4 (primary health care) was to develop and implement a uniform district health system and to develop a policy for district health services. The DoH planned to introduce a National Health Amendment Bill, and would also seek feedback from users of the health system via the Patient Experience of Care survey. It aimed to have a number of primary health care (PHC) facilities qualify as ideal clinics and ideal hospitals. These ideal clinics and hospitals would have a checklist to tick, in order to qualify. Environmental health would be improved by auditing a number of municipalities against environmental health norms and standards. The Department was also planning to improve Emergency Medical Services (EMS), and Members needed to ask about the progress with the EMS regulations.

He explained that Programme 5 (hospital systems) was to improve the quality of services at hospitals through the Ideal Hospital Programme, by building new ones and improving the quality of existing health infrastructure. It planned to revitalise 36 hospitals and build one new hospital. The maintenance of health infrastructure was a key issue.

Programme 6 (health systems governance and human resources) would involve publication of a Human Resources for Health (HRH) strategy. Human resource (HR) regulations for Section 52 of the National Health Act 2003 would be drafted. The policy for community service would be reviewed and the placement process for medical interns and community services personnel would be improved. Ten nursing colleges would be accredited and the backlog for blood alcohol tests would be eliminated or reduced. The Committee was given a breakdown of the budget allocated for the programme.

Mr Rahim also raised the issue of food safety in light of the listeriosis outbreak that happened not long ago.

Among issues to be considered were the number of targets achieved from 2014/15 to 2018/19. The number of indicators and achieved targets had decreased over the years. When the Auditor-General (AG) came to audit, it was usually found that the quality of data was inadequate. This was a key issue that needed attention. There was a pattern of high spending levels, but poor performance related to targets actually being fully achieved.

Discussion

Ms P Dyantyi (ANC) wanted more information from the DoH about the NHI pilot project.

The Chairperson said he hoped that the slides for teenager pregnancy could be improved. The figures of mortality figures needed to be properly reconciled. Regarding Ketlaphela, the state-owned pharmaceutical company supplying ARVs, he asked who was responsible for the running and monitoring of the company, because DoH was a customer. Programme 1 had to be clarified, while Programme 2 needed revision.  The briefing indicated that three million people would receive treatment, but what was the base line currently in the country? Regarding the elimination of malaria, he asked what the progress was, since there were still outbreaks in some provinces.

Ms S Gwarube (DA) said that the NHI project was known to be long overdue, and now the new budget for the financial year was under way. She therefore asked in which phase the project was, and whether it was a success or a failure.

Ms T Munyai (ANC) said that since the NHI project was already being implemented, it was important that the research group evaluate the project in addition to the Department’s report. It was also important to do quality checks of those companies that were importing meat. She commented on the disparities of figures in the presentations, and queried the researchers’ qualifications and whether they were capable of doing research in the health sector.

Dr S Thembekwayo (EFF) asked about the prevalence of pilot programmes. She commended the presentation and recommended that the Committee should continue working like this. It gave Members the time to think and to better serve people with well thought out, deliberated questions.

Mr K Jacobs (ANC) suggested that it would be better to use percentages than actual figures to help Members to understand the health budget. He would like do an extrapolation of the prevalence of HIV, and suggested there should also perhaps be a correlation established between the decrease in deaths and the increase in prevalence so that the Committee could be informed of where the country was heading. The same logic could be applied to teenage pregnancies.

The meeting was adjourned.