National Health Amendment Bill: Dr Thembekwayo briefing

Meeting report

The Chairperson began the meeting by acknowledging apologies and outlining the format of the meeting, which included the Private Member’s Bill presentation, a discussion on the presentation, and closure of the meeting. The Chairperson said the Bill was supposed to be discussed in a sitting of the Committee during the Fifth Parliament however the necessary work was not completed.

The Chairperson went on to acknowledge the attendance of the delegation from the National Department of Health. The Minister and his Director-General were unable to attend due to an ongoing lekgotla.

National Health Amendment Bill briefing

Dr S Thembekwayo (EFF) briefed the Committee on her Private Member’s Bill.

The Bill seeks to amend the National Health Act, 61 of 2003, to provide that clinics in the public sector must open and operate for 24 hours, seven days a week. In its current format, Section 4 (3) of the National Health Act makes provisions for the kind of services clinics and community health centres must provide, but this does not include operating hours

Dr Thembekwayo used section 7, 10, 11 and 27 of the Constitution to motivate the need for the amendment and emphasised that a great amount of the general public rely on the public health care system and the demand for clinics is increasing. The current operating hours of clinics are not meeting up to that demand and constrains access to health care, and infringes citizens’ rights to health care.

Dr Thembekwayo displayed that the extension of operating hours for clinics is not an impossible by drawing on the resolution passed by the City of Johannesburg to extend their hours and open for 24 hours throughout the week. The restriction of hours translates to a restriction on the right to health care as the public cannot access it due to operating hours whereas health emergencies in reality are not restricted to certain hours.

The Bill seeks to amend Section 4 of the National Health Act of 2003, by adding a further subsection, which, in the case of the Act, would be subsection 4(4). This new subsection must read as follows: “Clinics funded by the state must provide the services referred to in subsection (3) 24 hours a day and seven days a week.’’

Ms N Chirwa (EFF) highlighted that the first impact of this Bill would be to increase the working public’s access to health care as most of them are at work during the current operating period. The second impact is that this will lessen the load on hospitals, which are often overburdened when people go to the outpatient sections of the hospitals for ailments that could easily be treated in clinics. Thirdly, it is the right of citizens to access healthcare as and when they get sick, and people get sick all the time - sickness is not limited to clinic operating times

On resource implications, it is indicated in the Bill that the passing of this Bill would require the Department of Health to employ additional staff. However, what the Bill purports to do easily counterweighs any cost constraints, and the Department must be in a position to progressively build into their budgets these additional posts. Over and above that, before COVID struck, in an answer to an EFF parliamentary question, the Department of Health said it was short of over 18 000 nurses, 2 250 doctors and 154 dentists in the public service. If the Department were to recruit all these healthcare workers, it would make the operationalising of 24 hour clinics easier.  

Discussion

Ms E Wilson (DA) commended Dr Thembekwayo for highlighting that the DA in Johannesburg had already implemented the proposed resolution to access of health care and stated that her concerns, and that of Ms H Ismail (DA), will be echoed by Ms S Gwarube (DA).

Mr P van Staden (FF+) raised issues regarding staff capacity, resources, and safety. He was further concerned with the implication of this Bill on the national budget given the current economic standing.

Dr K Jacobs (ANC) noted that this Bill has been raised previously in the national legislature but requested that it be raised in the provincial legislatures too as the Bill affects the provinces.  He also wanted to know whether a costing exercise been done on the implications of the Bill.

Mr T Munyai (ANC) wished to propose an opportunity to engage the Department of Health on a different day as the presentation did not contain any budget costing and chose to disagree with the argument that clinics serve better than hospitals on a qualitative and quantitative level. He emphasised the importance of financial consideration and said he cannot state whether the Bill is desirable or undesirable until consultation with the Ministry.

Dr P Dyantyi (ANC) requested a breakdown by province on which clinics, those in rural and urban areas, currently operate on a 24hour basis and another breakdown on how the Bill will affect the provinces.

Ms S Gwarube (DA) emphasised that we need to strive towards the realisation of this Bill. She aligned herself with the question raised by Ms Wilson and Mr Munyai and had a technical question directed towards the legal services of the Department of Health regarding the compatibility of the Bill with the current Act as the enactment of this Bill will have a large impact on the national Act.

Ms A Gela (ANC) pointed to the implementation of the National Health Insurance as a key to addressing several issues faced by the Department of Health.

Ms M Hlengwa (IFP) raised the issues of safety and lack of capacity hindering operations in clinics that currently operate on a 24hour basis in rural areas in KZN but the same cannot be said for clinics operating in urban areas in KZN. Regarding quantity - she requested to know whether all the clinics will be receiving funding. On restriction of services, clinics should not be restricted to certain heath care services but should rather extend to all primary healthcare should this Bill be passed. It was unclear whether consultation took place in regard to the necessity for the role out of all issues stated in section 3 of the National Health Act.

The Chairperson also raised concerns as to whether the presentation considered the facilities that the Department has already provided to provide assistance to people who work at night such as truck drivers, and health services provided at taxi ranks. He wanted know whether the presentation includes any provisions for communities that do not have 24hour clinics.

Dr Thembekwayo welcomed the questions asked by the Committee and showed appreciation for the positive feedback from certain Members of the Committee. To address matters of funding, the onus lies on the Executive to ensure the budget is adjusted accordingly as the matter at hand is of national importance and should not be hindered by operational concerns. Extra staff will not add pressure as already as it stands, and prior to the COVID-19 pandemic, there were already numerous vacancies for nurses and doctors. She was unable to give a clear answer on the questions concerning a breakdown of statistics on which rural and urban areas have clinics as she did not have the data yet, however the Department can supply the statistics.

Ms Chirwa emphasised the importance of access. On the issue of how may clinics already operate for 24hours, she stated that the presentation does cover this issue and reiterated the statistics as they stand in the presentation. She expressed concern on the comment raised by Mr Munyai that his support will be given based on the cost effectivity of the Bill as she believed the financial concern should be secondary.

Ms Chirwa disagreed with the implementation of the NHI as a solution to the issues addressed by this Bill. At the core of the issue of additional staff is the resolvable issue of unemployment in South Africa and oversupply of health care practitioners. She affirmed there is room for expansion of staff. She concluded by stating that the best legislative processes must be prioritised over resolvable squabbles.

Ms V Mente (EFF) said the state apparatuses are an important instrument in the process of doing away with repressive and ideological ways of oppression. She highlighted that there are loopholes in the healthcare system that urgently need to be closed and emphasised a prevention-focused approach over a cure- focused approach. The main goal is better access to healthcare - costing should not be a constraint.

The Chairperson brought the meeting to a conclusion by stating that the presentation was well articulated and was a starting point of a longer process.

He informed the Committee of a letter written to the Speaker accompanied by a memorandum from Nehawu that sought responses from various Committees, this Committee included.  The Committee would meet again the next day.

Meeting adjourned