National Health Insurance (NHI) Bill: Clause 37 to 39 deliberations

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Health

07 September 2022
Chairperson: Dr K Jacobs (ANC)
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Meeting Summary

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NHI: Tracking the Bill through Parliament

In this meeting, the Committee deliberated on the NHI Bill from Clause 37 to 39 – which were all supported by the ANC with some proposals for amendments. The DA raised concerns about the constitutionality of most of these clauses and the fact that a feasibility study has not been done. The EFF rejected all of the clauses. The FF+ raised concerns that the clauses could have a negative impact as South Africa is not ready for such a bill. The IFP requested more context/clarity on the wording of certain clauses.

Clause 37 Contracting Unit for Primary Health Care
The ANC supported clause 37(1) because it delineates the contracting unit for the primary healthcare functions, which are crucial for the NHI to give contracts to structures that provide services on the ground. Without these structures, it will be difficult to identify the services provided on the ground. The ANC supported clause 37(2)(a)(i) because the NHI Fund at a sub-district level will be a single player, single purchase identity and will not have multiple funds holding structures at the sub-national level. The DA was worried about the constitutionality and feasibility of this clause. The EFF rejected this clause because it is an admission or evidence of the fact that primary healthcare prevention education is outsourced. It is viewed as an equivalent to making an admission that they have failed in their primary mandated obligation. The FF+ was concerned the country is not ready for such a clause. The IFP raised its concerns on the vagueness of the wording in the clause.

Clause 38 Office of Health Products Procurement
The ANC supported this clause because it is important for the Office of Health Products Procurement (OHPP) is able to review and update products along with reducing their prices. The National Health Fund and the OHPP will be organs of the state and will be primarily funded from the public. The location of the centralized function of the OHPP is within the NHI, as it tightens the grip on procurement processes to prevent fraud and corruption. The DA wanted to know what it is that the OHPP will be doing and whether it will replace other working conjunctions. The DA and IFP were concerned why the Minister has to be involved here. The EFF was concerned about health establishments that do not register as service providers. Concern was raised that users might be isolated from their basic human right to quality healthcare. The FF+ said that it did not see the relevance of this clause.

Clause 39 Accreditation of service providers
The ANC supported clause 39. The NHI Fund is designed to ensure that healthcare services are assessed at the appropriate levels that comply with referral pathways and the health needs of users. These users will have access to healthcare establishments and the services they provide. The Fund is there to ensure that quality is assured and the intention is to create a harmonized legislative, regulatory, and administrative framework. This framework will ensure that all providers in both the public and private sector are held to the standard for healthcare benefits that are purchased by the Fund. The licensing of healthcare professionals with the relevant statutory councils will ensure that the Fund actively identifies and accredits contracts, as well as purchases appropriate health care services from suitably capable healthcare professionals. There are health establishment that are struggling to meet the norms and standards and they must not be excluded or penalized for contracting with the Fund. They must be supported through a developmental process to meet accreditation requirements and must be undertaken through the conditional accreditation process to meet the definition section that will be reviewed within a five-year period. The DA said that the criteria for accreditation are unclear and the clause is non-specific about many aspects such as the appropriate level of care. The DA raised a concern why the Minister should be involved in the day-to-day running of healthcare providers. There was no mention of the Health Ombuds or its role. The EFF rejected the clause because of concern that if health establishments do not meet the norms and standards that accreditation will not be given to them. The Bill does not make provision for what will happen in this case. The IFP said that there was little evidence to show that the Fund will have the ability to carry out this ambitious task of ensuring the accreditation of healthcare service providers.

Meeting report

[PMG draft report}
Clause by clause deliberations

Clause 37 Contracting Unit for Primary Health Care
This stated that:
“(1) A Contracting Unit for Primary Health Care established in terms of section 31B of the National Health Act—
(a) manages the provision of primary health care services, such as prevention, promotion, curative, rehabilitative ambulatory, home-based care and community care in a demarcated geographical area; and
(b) is the preferred organisational unit with which the Fund contracts for the provision of primary health care services within a specified geographical area.
(2) A Contracting Unit for Primary Health Care must be comprised of a district hospital, clinics or community health centres and ward-based outreach teams and private providers organised in horizontal networks within a specified geographical sub-district area, and must assist the Fund to—
(a) identify health care service needs in terms of the demographic and epidemiological profile of a particular sub-district;
(b) identify accredited public and private health care service providers at primary care facilities;
(c) manage contracts entered into with accredited health care service providers, health establishments and suppliers in the relevant sub-district in the prescribed manner and subject to the prescribed conditions;
(d) monitor the disbursement of funds to health care service providers, health establishments and suppliers within the sub-district;
(e) access information on the disease profile in a particular sub-district that would inform the design of the health care service benefits for that sub-district;
(f) improve access to health care services in a particular sub-district at appropriate levels of care at health care facilities and in the community;
(g) ensure that the user referral system is functional, including the transportation of users between the different levels of care and between accredited public and private health care service providers and health establishments, if necessary;
(h) facilitate the integration of public and private health care services within the sub-district; and
(i) resolve complaints from users in the sub-district in relation to the delivery of health care services.”

Mr N Xaba (ANC) said that clause 37(1) delineates the contracting unit for the primary healthcare functions which are crucial for the NHI to give contracts to structures that delivers services on the ground. Without these structures, it will be difficult to identify the services that are provided on the ground. In addition, it allows decentralisation in the decision relating to funding for services and to be provided based on community needs. It was recommended that clause 37(1) the contracting unit for primary healthcare be established because the rationale for this amendment is to be provided with such a unit. They must also present at a sub-district level and there should be split arrangements. This will further ensure that accredited public and private sector providers are identified. Further proposals to clause 37(1)(b) is the preferred organisational unit with which the Fund contracts should be within a specified geographic area.

Mr T Munyai (ANC) supported clause 37(2)(a)(i) based on the following reasons that COP is a component of the NHI Fund and is a sub-district level. The NHI will be a single player with a single purchase identity and will not have multiple fund-holding structures at the sub national level. The COPS will interact with credited service providers on behalf of the Fund at the sub-district level to manage the contracting arrangements at the healthcare level. The COPS must not be established as a fund holder but as a service planning unit for the Fund within a sub-district. The COPS will manage their contracts entered into with clinics, community health care centers, ward based outreach teams and private providers organized in residential networks within a specified geographical sub-district area around district hospitals. There will be checks and balances because it is a diverse network. It is unlikely to promote corruption because service providers within the different interests are part of the body.

Ms H Ismail (DA) said clause 37 refers to contracting units for primary healthcare and primary healthcare in the NHI is stated but it does not mention where psychologists will fit into all this. Clause 37(2)(d) needs to be more specific to deal with suppliers of goods and services. It is important to know whether legislation with regard to the Public Finance Management Act and specifics to be stated in this particular clause. Clause 37(2)(g) refer to monitoring the disbursements of funds to healthcare service providers out of establishments and suppliers within the sub-district. She raised a concern about taking away the mandate of provinces. It is suggested that the legal advisors check this and ensure that it correlates with the sections of the Constitution of the Republic of South Africa, 1996.

Ms M Clarke (DA) said that the primary contracting units need to be abandoned in total and be replaced with the national framework for regional and district authorities at a provincial level. This would be consistent with the constitutional role of national government in relation to provincial health services, as a national framework would have been established that would not involve the centralization of functions that should be managed at a level of government that is closer to the ground. The prescribed feasibility study is required for any consideration of government components as required by the Public Service Act of 2007. It is disconcerting that proposals have been made for poorly governed national entities without the required statutory evaluations. This is particularly needed as the image pilot appraisals indicated that nothing was learned concerning any proposed contracting units or health district structures. How well will these ward base teams’ function? From experience, many ward-based pilot projects were not successful at all. So, how would they function and what difference would they make? When the locations have been established, would there be a study done to ensure that blue areas have easy accessibility to healthcare needs?

Mr E Siwela (ANC) and Ms X Havard (ANC) supported the concerns and proposed amendments made by the other ANC members.

Ms N Chirwa (EFF) asked what the systemic numerical capacity of the envisioned units that has been proposed in this particular clause are. What are the day-to-day roles for this operational function? Where does this particular count to? What is their order? This is a subliminal intention tool centralized procurement coordination and delivery in this particular aspect and will pose an issue for accountability. This clause is rejected because it is basically an admission or evidence of the fact that primary healthcare prevention education is outsourced. This is viewed as an equivalent to making an admission that they have failed in their primary mandated obligation. These sentiments have been shared before, which showed that the Minister had failed to mainstream and provide primary healthcare provision in education to the people of this country. Local and web-based public facilities should be established by healthcare facilities. Infrastructure must be prioritized and the workforce in the public healthcare should be increased. The particular aspect of NHI in a world that wants to build state capacity would have been directed at coordinating the quest towards primary healthcare prevention and education. The private sector will never be a legitimate vanguard for the healthcare of people. It is important to realise this because this clause speaks on the outsourcing or the tendering system and the fact that we are tendering primary healthcare and prevention and education as the state is something that the EFF rejects. Building state capacity for permanent systems so in the instance that the private sector no wants no longer wants to work with the state. The public healthcare sector should not collapse. It should continue to be built and strengthened. These conflicts have an opportunity to arise in the future. This is problematic because the public healthcare sector is not being capacitated in the interim despite the fact that the population is growing gradually.

Ms E Wilson (DA) said that there are absolutely no feasibility studies that point to a set of proposals. Normally, feasibility studies should accompany a set of proposals that proposed to substantially disrupt pre-existing public and private health sector, health coverage or regimes. Have these studies been made? If so, it has to be made public. Reforms cannot be proposed and overhaul an entire system and there is nothing to show for it. There must be a technical review that clearly establishes the coverage failures in the current framework. There is nothing stopping anyone from going to any health facility and primarily seeking help and that is needed at any time of the day. South Africa principally comply with universal health coverage. It is important to understand what the universal health coverage gap requires. A report of 2017 from the International Labour Organisation (ILO) found that there was no coverage gaps in South Africa. Why is there an overhaul of the current system if no gaps were identified? Primary healthcare is the most important function of any health department. The unit for primary healthcare must have a dignified accredited public and health service providers at primary care facilities. Accredited facilities must meet the standards in South Africa. Access information on the disease profile in a particular sub-district that would inform the design of the health care service benefits for that sub-district, this is a sad statement. In rural facilities, there are no computers and telephones. It has been stated this week that Zimbabweans records are not even captured. Therefore, we have no idea what those disease profiles are, therefore. There is no feasibility in justifying this clause.

Dr S Thembekwayo (EFF) said she supported Ms Chirwa’s reasons for the rejection of clause 37. There is an omission to include clinical psychologists. Clinical psychologists have a passion for working with people or patients. They possess the unique diverse of each uniqueness of every person and have tailored skills to meet unique individual needs. The psyche is a complicated combination of thoughts, emotions experiences, and internalized relationship, and it must be treated with care and respect. For this reason, a request is made for the explicit inclusion of psychologists in clause 37.

Ms M Hlengwa (IFP) said it is unclear what kind of public structure the contracting unit is. What are the criteria that will be used for this? The parliamentary legal advisor should be able to guide the Committee on the possible scenarios and be brought in to consider the legal nature of the fund. Public management finances can be abused.

Mr P Van Staden (FF+) wanted to draw the Committee’s attention to the NHI pilot projects that have not brought any success. In a publication in July 2019, it was said that the interventions have faced a number of challenges to varying degrees. This included inadequate planning, lack of resources, inconsistent communication, lack of coordination, and insufficient mechanisms. It will be very problematic if this came into law.

Ms Ismail requested that the legal advisors go over the Bill clause by clause. There should be a legal assessment of the constitutionality of the redirection of the provincial equitable share (PES) to the national government, the image collation of the powers allocated to the provinces in terms of schedule 4A and 4B of the Constitution through national statute and the redirection of funds through national structures and lastly the prohibition of parallel coverage through medical schemes and out of pocket purchases without any specified order. Such prohibitions do not exist anywhere else in the world.

Mr Munyai said that state law advisor should be involved before the Department can pass the Bill. All the issues should be considered and if the Bill does not pass the Constitutional Master, it will not even reach Parliament.

The Chairperson proposed that the words ‘manages the provision of primary health care services’ in clause 37(1)(a) be removed. It is suggested that it should be read as follows: for the funding of primary health care services such as prevention promotion curators’ rehabilitators and military home based care and community care in a democratic geographical area through accredited and contracted public and private healthcare providers. The reason being that COPS must represent the Fund and a sub-district level as part of the purchaser provider split arrangements.

Clause 38 Office of Health Products Procurement
This stated that:
“(1) The Board, in consultation with the Minister, must establish an Office of Health Products Procurement which sets parameters for the public procurement of health related products.
(2) The Office of Health Products Procurement must be located within the Fund and is responsible for the centralised facilitation and coordination of functions related to the public procurement of health related products, including but not limited to medicines, medical devices and equipment.
(3) The Office of Health Products Procurement must—
(a) determine the selection of health related products to be procured;
(b) develop a national health products list;
(c) coordinate the supply chain management process and price negotiations for
health related products contained in the list mentioned in paragraph (b);
(d) facilitate the cost effective, equitable and appropriate public procurement of health related products on behalf of users;
(e) support the processes of ordering and distribution of health related products nationally, and at the district level with the assistance of the District Health Management Office;
(f) support the District Health Management Office in concluding and managing contracts with suppliers and vendors;
(g) establish mechanisms to monitor and evaluate the risks inherent in the public procurement process;
(h) facilitate the procurement of high cost devices and equipment; and
(i) advise the Board on any matter pertinent to the procurement of health related products.
(4) The Office of Health Products Procurement must support the Benefits Advisory Committee in the development and maintenance of the Formulary, comprised of the Essential Medicine List and Essential Equipment List as well as a list of health related products used in the delivery of health care services as approved by the Minister in consultation with the National Health Council and the Fund.
(5) The Office of Health Products Procurement must support the review of the Formulary annually, or more regularly if required, to take into account changes in the burden of disease, product availability, price changes and disease management for approval by the Minister.
(6) An accredited health care service provider and health establishment must procure according to the Formulary, and suppliers listed in the Formulary must deliver directly to the accredited and contracted health service provider and health establishment.
(7) The provisions of this section are subject to public procurement laws and policies of the Republic that give effect to the provisions of section 217 of the Constitution, including the Preferential Procurement Policy Framework Act, 2000 (Act No. 5 of 2000), and the Broad-Based Black Economic Empowerment Act, 2003 (Act No. 53 of 2003).”

Mr Munyai said that the ANC supported clause 38(2)(h) because the challenge with high-cost prices and equipment is clear. The challenge with high-cost devices and equipment is exacerbated by low volumes and the uncertainty of the producers, importers, and suppliers. It is easier to establish better prices and secure availability if it is achieved with the existing national tenders and in those providers that use standardized tenders specification for equipment. The ANC also supports clause 38(5) because technology is not static. Technology is constantly changing and medical advances are rapid. It is important that Office of Health Products Procurements (OHPP) is able to review and update which product should be made available and how to reduce prices as patterns changes and volumes are more accurately determined. The disease burden also changes overtime. There must be a procedure for regularly updating all the procurement data. Clause 38(7) is also supported because the National Health Fund and the OHPP will be organs of the state and will be primarily funded from the public. It is essential that there are mechanisms which follow the Constitution and the laws of Parliament.

Ms Ismail said that nowhere is it specified whether the OHPP is going to be replacing several working conjunction. There are supposed to be some sort of specifications to ensure that the Committee knows what is happening here. It is not clear how the proposed procurement system will align with existing processes and systems in view of the establishment of the OHPP within the fund. Is there going to be some regulation of costs for healthcare services being purchased? Healthcare should not be commercialized. The clause is also unclear about the benefits provided by the fund. There are comprehensive healthcare services but no criteria on the limitation of the packages on the ground that are reasonable and that will determine the scope.

Ms Clarke said it is mention is clause 38(1) that the Board, in consultation with the Minister, must establish an OHPP which sets parameters for the public procurement of health-related products. Why is it necessary to consult the Minister? The Minister should not be able to influence the working of the board. Should these positions be advertised, what requirements and expertise will the members of the office be required to have in order to be competent to present all regulatory bodies? It also mentions some substantial additional powers which are not regulated in any way. There should be no centralization of decision. A government component can only be established if the prescribed feasibility study is conducted and its findings recommended the establishment of such a component. In terms of clause 38(6) where is the list? What does it contain? Who will be the suppliers? Will it be open to abuse with any supplier being chosen? Are there any regulations in place to avoid any price fixing within the supply chain?

Mr Xaba supported clause 38(1). The ANC supported the establishment of the OHPP because seeing the current programming system and other examples internationally there is a need for centralized function located within the inside. The responsibility for facilitating and coordinating all functions related to procurement of health-related products including medicines devices equipment and other products within the energy environment must be established to ensure seamless procurement of health goods and products including medicines. The Minister has an interest in how the OHPP executes its mandate and contributes toward National Health Policy and priorities including improving healthcare outcomes. The present cost of medicines and other health products is excessive partly because economies of scales are poor. This is especially the case in the private sector where volumes are fragmented and difficult to predict. The list of essential medicines and other products offered the system to benefit from the best possible places. Clause 38(4) is also supported by the ANC. The OHPP is important for the Fund because it is able to directly respond to the changing benefits lists. The benefits is as a result of standard treatment guidelines from which medicines and other products are identified and can be scooped into the single formulator and essential equipment list. The Department of Health will remain responsible for the development of standard treatment guidelines so that there is a clear separation of responsibilities and benefits. ANC supports clinical requirements for efficient, effective, and affordable patient care. The provision of this clause ensures that the absolute best practices can be achieved. The utilization patterns will be known and quantified to change. It is in the interest of patient user for their providers to use the form later in the formula and the essential equipment list items. It helps to keep costs as low as possible. However, there are always exceptions because health conditions do not follow standard or predictable trends. There always has to be mechanism in place for addressing these exceptions.

Mr Siwela said the ANC also supports clause 38(2) because they support the location of the centralized function of the OHPP within the NHS as it tightens the grip on procurement processes to prevent fraud and corruption. The ANC has seen how the lack of central coordination of procurement can lead to fraud, corruption, and malfeasance. Additionally, the opportunity for local corruption or collusion is minimized by centralizing the tender process. The procurement function should reside within the Fund to ensure optimization of the central procurement function and economies of scale. The OHPP must play an important role in setting parameters for public procurement of health-related products using affordable and cost-effective mechanisms. This will assist the Fund to be sustainable and that the population has access to quality health services without interruption. The NHI Fund will be managing the benefits if it has direct control of the formulary and that is required to deliver those benefits. It will be able to collect data and use those data to secure the best/lowest price to assist providers in managing their costs.

Ms Chirwa asked who facilitates the purchase of medicines, medical equipment and other medical devices for health facilities and other medical institutions? The impression is given that there will be an encompassing system for all persons, institutions and facilities but is not cognizant that this choice will still suffice, especially for the registration processes and the application process. This also includes the right of potential service providers and healthcare facilities and even users. There is still room for people to not register as users. What happens when users do not register? Or health facilities do not register as service providers? Who will regulate the relationship between these two as unregistered entities as they have these particular freedoms for the decisions? What happens when what is provided in the Bill is not followed through because there is no encompassing part in the Bill itself that enforces this particular relationship between the state and the private sector or between the state and potential users? Are these users than isolated from their basic human rights which is quality healthcare? The Bill only caters for the ideal aspirations and not the reality. The things addressed here are not catered for in the Bill. If the private sector is not nationalized as one of the strategic economic sectors, the state can never dictate its modus operandi, especially when there is room to not be a participant. The public sector is not being nationalised and therefore it is creating an outsourcing of a tender system where the public sector buys healthcare services which can be rejected by the public healthcare sector because this Bill does not impose a relationship between the private and the public sector. How will this particular situation be dealt with? There is no nationalisation of a strategic economic sector and the state is just detailing and hoping for the best kind of relationship between outsourcing for healthcare services from the private sector, which then leaves the public sector limping because the money that is meant to increase capacity in the public healthcare sector will then be flooded into the private healthcare sector. No study has been done to say how many of these 600 private hospitals are going to apply as service providers or how many private general practitioners in their communities are going to apply as service providers. If there is no certificate, will it be that a health facility must close down and they cannot be a participant or a service provider? This is tricky because the country might face this particular situation. The private sector will never choose the state over its profits. So, what will happen in this instance?

Ms Havard said that the ANC supports clause 38(6). The Fund will take the guidance from the approved benefits determined by the benefits committee. There is already an established process in both public and private sector for determining the products that are essential to the provisioning of benefit in the public sector. The ANC supported clause 38(3). The NHI founded through the OHPP will manage the procurement, but not buying storage and other logistics of the products is a formula in the formulary and essential equipment list. This reduces the risk for the Fund and transfers control overstock labels, storage requirements and monitoring of stock labels to providers based on the benefits that they are accredited to provide. Clause 38(5) is also supported because the board of the Fund must have full set of any matters that many have an impact on procurement of health-related problems so that they can respond proactively to any challenges that may arise.

Ms Hlengwa said one can again question why the Minister must be involved in the establishment of the office. Why is the not a function? Why is there not a function which can be completely established by the board? What is the meaning of the body if they cannot establish this office? There was great concern for corruption regarding the procurement of such health-related products. The establishment of the office must be clearly aligned with guidelines and regulations of such office. There must be transparency in the process of the procurement that National Treasury must adopt a contract for the procurement of such services.

Mr Van Staden said he does not see the relevant of clause 38. Why must a OHPP be established? Problems were already experienced in 2021 and outstanding accounts of many medical and medicine suppliers which is currently happening in provinces. When oversight was done at a hospital it showed new equipment that was just standing there and not being used. If the intention is to eradicate corruption and all of these things, the clause will not do it.

Ms Wilson said going back to the feasibility study of which there are no evidence of that being done. It was stated before that given the current costing parameters outlined in the white paper, the proposed NHI in its current format is unlikely to be sustainable unless there is sustained economic growth. The economic growth in South Africa has gone horribly backwards. It was also stated that overall the framework appears not to have been fully thought through, which would explain the general absence of any supporting research or evidence. The framework substantially undermines the constitutional powers such as health services. Legislation cannot take precedence over the Constitution. The Constitution cannot be circumvented by health, which is clearly the purpose of the NHI. There are several papers showing that successful models internationally involved local autonomous structures that are accountable for performance to communities through local government frameworks. There is no evidence to suggest that the performance failures in the public health system have resulted from the absence of a purchaser/provider/operated by a monopoly purchaser. In fact there is a lot of substantial evidence that the failures are actually attributable to governance weaknesses and the institutionalized systems of patronage that operates in eight of the nine provinces. This clause is just going to porch and back up the set patronage systems that are there already. The most appropriate and logical step forward to reform would be to establish authorities at a provincial level to finance plana, organize and deliver healthcare. The degree of concentrated powers that these clauses put into the hands of the politically appointed including the Minister is unprecedented. It presents a threat to the viability of the health system together with an existential threat to democracy. This Bill circumvents the Competition Commission. This clause in particular is going to create huge problems. Price fixing and corruption will not be prevented.

Dr Thembekwayo said that it seems that clause 38 presents a get-rich-quick scheme. This is so because there is no inclusion of how the settling of crisis by the OHPP will work in relation to negotiations of the prices by the Fund. Mention is made of comprehensive healthcare services but no criteria given on the limitations of the package as such deliberations should be made to determine the scope of the cover. There is further no classification of high-cost devices. Clause 38(3) has no information on what the procurement model is within the National Health Service (NHS). She supported Ms Chirwa for her reasons to reject clause 38.

Dr Jacobs said the ANC supported clause 38(3) because it deals with what happens in the public sector and the private sector with regards to tenders and pricing. The public sector uses standards to secure best prices, but these standards are not fixed for free experience. It is not possible to anticipate market changes in the tender periods. There are loss of pricing and discount benefit as the environment changes. As far as the private sector is concerned, the single exit price is set, but the prices are difficult to control because updating the volumes are unpredictable. The NHI Fund through the OHPP will have access to all of this data on prescriptions and prescribing a dispensing of medicines and various products as well as the use of other products. This will be tracked to determine trends and develop proactive interventions when necessary. This market helps to drive prices down and create certainty for all role players. Furthermore, the ANC supports the rest of clause 38(3) because the NHI Fund and the OHPP will have the big picture of the national demand. It will be best place to support the ordering and distribution of products whether for public providers or the networks of private providers benefits. This approach worked well during the COVID-19 pandemic for the procurement and distribution.

Ms Ismail said that outsourcing to suitable service providers should be considered. Some treatments are not approved on the National Health Service list and accredited facilities. It should maintain the ability to procure according to patient needs, in the interest of optimizing the most appropriate health outcomes. Access to these treatments options within alternative supplementary reimbursement mechanisms. It is important that no one is left out.

Clause 39 Accreditation of service providers
This stated that:
“(1) Health care service providers and health establishments accredited by the Fund in terms of this section must deliver health care services at the appropriate level of care to users who are in need and entitled to health care service benefits that have been purchased by the Fund on their behalf.
(2) In order to be accredited by the Fund, a health care service provider or health establishment, as the case may be, must—
(a) be in possession of and produce proof of certification by the Office of Health Standards Compliance and proof of registration by a recognised statutory health professional council, as the case may be; and (b) meet the needs of users and ensure service provider compliance with prescribed specific performance criteria, including the—
(i) provision of the minimum required range of personal health care services specified by the Minister in consultation with the Fund and published in the Gazette from time to time as required;
(ii) allocation of the appropriate number and mix of health care professionals, in accordance with guidelines, to deliver the health care services specified by the Minister in consultation with the National Health Council and the Fund, and published in the Gazette from time to time as required;
(iii) adherence to treatment protocols and guidelines, including prescribing medicines and procuring health products from the Formulary;
(iv) adherence to health care referral pathways;
(v) submission of information to the national health information system to ensure portability and continuity of health care services in the Republic and performance monitoring and evaluation; and
(vi) adherence to the national pricing regimen for services delivered.
(3) The Fund must conclude a legally binding contract with a health establishment certified by the Office of Health Standards Compliance and with any other prescribed health care service provider that satisfies the requirements listed in subsection (2) to provide—
(a) primary health care services through Contracting Units for Primary Health Care;
(b) emergency medical services; and
(c) hospital services.
(4) The contract between the Fund and an accredited health care service provider or health establishment must contain a clear statement of performance expectation and need in respect of the management of patients, the volume and quality of services delivered and access to services.
(5) In order to be accredited and reimbursed by the Fund, a health care service provider or health establishment must submit information to the Fund for recording on the Health Patient Registration System, including—
(a) national identity number or permit and visa details issued by the Department of Home Affairs, as the case may be;
(b) diagnosis and procedure codes using the prescribed coding systems;
(c) details of treatment administered including medicines dispensed and equipment used;
(d) diagnostic tests ordered;
(e) length of stay of an inpatient in a hospital facility;
(f) facility to which a user is referred if relevant;
(g) reasons for non-provision or rationing of treatment, if any; and
(h) any other information deemed necessary by the Minister in consultation with the Fund for the monitoring and evaluation of national health outcomes.
(6) The performance of an accredited health care service provider or health establishment must be monitored and evaluated in accordance with this Act and appropriate sanctions must be applied where there is deviation from contractual obligations as per the law.
(7) The Fund must renew the accreditation of service providers every five years on the basis of compliance with the accreditation criteria as reflected in subsection (2).
(8) The Fund may withdraw or refuse to renew the accreditation of a health care service provider or health establishment if it is proven that the health care service provider or health establishment, as the case may be—
(a) has failed or is unable to deliver the required comprehensive health care service benefits to users who are entitled to such benefits;
(b) is no longer in possession of, or is unable to produce proof of, certification by the Office of Health Standards Compliance and of proof of registration by the relevant statutory health professions council, as the case may be;
(c) has failed or is unable to ensure the allocation of the appropriate number and mix of health care professionals to deliver the health care services specified in the Gazette;
(d) has failed or is unable to adhere to treatment protocols and guidelines, including prescribing medicines and procuring health products from the Formulary;
(e) has failed or is unable to comply with health care referral pathways;
(f) for any reason whatsoever, does not submit to the Fund the information contemplated in section 34(3) timeously;
(g) fails to adhere to the national pricing regimen for services delivered;
(h) intentionally or negligently breaches any substantive terms of a legally binding contract concluded with the Fund;
(i) fails or is unable to perform as required by the terms of a legally binding contract concluded with the Fund;
(j) delivers services of a quality not acceptable to the Fund; or
(k) infringes any code of health related ethics or relevant law applicable in the Republic.
(9) If the Fund withdraws the accreditation of a health care service provider or health establishment, or refuses to renew the accreditation of a health care service provider or health establishment, the Fund must—
(a) provide a health care service provider or health establishment with notice of the decision;
(b) provide a health care service provider or health establishment with a reasonable opportunity to make representations in respect of such a decision;
(c) consider the representations made in respect of paragraph (b); and
(d) provide adequate reason for the decision to withdraw or refuse the renewal of accreditation to a health care service provider or health establishment, as the case may be.
(10) A health care service provider or health establishment who is dissatisfied with the reasons for the decision provided in terms of subsection (8)(d) may lodge an appeal in terms of section 43.
(11) The Fund may issue directives relating to the listing and publication of accredited health care service providers and health establishments.”

Mr Munyai said the ANC supported clauses 39(2), (7), and (8) but with some amendments. The NHI Fund is designed to ensure that healthcare services are assessed at the appropriate levels that comply with referral pathways and the health needs of users. These users will have access to healthcare establishments and the services that they provide. The Fund is there to ensure that quality is assured and the intention is to create harmonized legislative, regulatory, and administrative framework. This framework will ensure that all providers in both the public and the private sector are held to the standard regarding healthcare benefits that are purchased by the fund. This amendment is not to exclude the public sector providers that are struggling to meet the criteria set out by the fund. It is also not the intention to strengthen the advantage of private healthcare providers and their health establishments.
- The ANC supported clause 38(2)(b)(ii) because healthcare providers must allocate the optimum staffing members numbers and skills to ensure that they deliver the right type of the service. This should be informed by human resources for the health strategy through the publication of the Gazette by the Minister. The ANC supported clause 39(2)(b)(i) because there is an emphasize for all providers to provide healthcare services and for the users to receive such services at an appropriate level of care with a point of entry at a primary healthcare level. With upward or downward reference this will ensure that the users can access and utilize the services in a rational manner that is consistent with referral policies and applicable clinical guidelines and protocols as prescribed in the regulations. In the case of emergencies, the user will not be denied and will be in a position to access needed healthcare services. There was further support for the clause because the Fund must utilize the statistician’s certification status of any given providers as when concluding an accreditation and contracting arrangement with the specified healthcare service providers. This requires that the fund’s accreditation process take into account norms and standards with regard to appropriate and legally valid certification, as well as the legally binding contract that stipulates the reinvestment strategy that will be applied at the different levels of care. The legally binding contract must be reviewed on a regular basis considering the healthcare, the periodic tests allergies, and provide a performance list. An amendment is proposed to provide for conditional accreditations particularly for the providers and health establishment located in rural and underserved service areas. This should be included: ‘it is no longer in possession of and is unable to produce proof of registration by relevant statutory health professions council as the case may be, exception will be made to public health establishments in rural and underserved areas that have been granted conditional accreditations’.
- The ANC supported clause 39(8)(g) because the healthcare pricing committee outlines in the Bill that the process that they fund will apply in determination of applicable tariffs for a reinvestment of accredited and contracted providers and health establishments. The implementation of the national pricing regime is important to address the gaps and challenges associated with the current reinvestment in the health sector. These challenges include calculations balance and unaffordability of services. It should provide that health establishments contracted to primary healthcare services will be reimbursed using risk adjusted capitation, and those contracted to provide hospital services will be reimbursed using diagnostics.

Mr Siwela supported clause 39(2) because insurance legislative and regulatory provisions are consistent between the requirements for accreditation of healthcare providers by the Fund that follows the certification requirements of health establishment by the Office of the Health Standards compliance, as well as the registration requirements of healthcare practitioners by statutory health professional councils such as the nursing, health professions, and pharmacy councils. The licensing of healthcare professionals with the relevant statutory councils will ensure that the Fund actively identifies and accredits contracts, as well as purchase appropriate health care services from suitably capable healthcare professionals. The accreditation process that is implemented by the Fund must consider the certification of their own norms and standards with respect to appropriate and legally valid certification health establishments. This will ensure that the Fund actively identifies accredited contracts and purchases appropriate healthcare services from health establishments and practitioners.
- The ANC supported clause 39(5)(b) because the information that will be provided to the NHI Fund will be supported by the national information system and it will monitor extensive coverage in all population sectors effectively ensuring portability of services. For example, when members of the population migrate from one part of the country to either on a temporary or permanent basis, the status to the population and production of disease profile data can be used in completing capital allocations, financial and management functions in the field, and the utilization of healthcare service. This information must be used to support planning and decision-making around contracting, purchasing, communication strategy with communities, and quality assurance programmes to ensure the production of reports for health facilities. These documents will help with recommendations by the benefits of advisory committee to the Minister.
- The ANC supports clause 39(5)(a)-(h) because the provisions are consistent with standard clinical and non-clinical information that will enable the NHI Fund to execute its strategic purchasing function. The information required to be submitted to the Fund will be critical for planning, decision-making, and resource allocation processes. The information will be critical for various technical and ministerial advisory committees indicated in the Bill that would be necessary for the fund to expand its functions and responsibilities. It is important that all accredited and contracted providers conduct their business in a way that is transparent, clear, and accountable at all times. Clause 39(5)(g) on providing reasons for non-provision or rationing of treatment is consistent with the provisions of the promotion of access to information and the promotion of administrative of justice.
- Clause 39(11) is supported because these provisions promote access to information for the public health users to enable the Fund and will allow users to have access to the list of accredited healthcare service providers. It will assist users to identify accredited providers from whom they can access needed services as per the Fund ’s protocols and procedures.

Ms Ismail said clause 39(1) does not identify any specifications as to how the Fund will determine the appropriate level of care. Clause 39(2)(b) and (3)(b) require absolute and unwavering adherence to treatment pathways by both providers and patients. However, there are no criteria on how to evaluate these when such adherence is unreasonable. This raises the issue of medical legal liability effectiveness without any criteria. Given the state of public healthcare facilities currently and many rural facilities which are characterized by infrastructure decay, what will happen to the facilities that do not meet the criterion. How will this affect health services in the communities on the ground? The criteria for accreditation is unclear. It is a concern that will be costly, time-consuming, and duplicate the work of other regulatory bodies. It seems almost impossible to achieve the conditions stipulated, considering the state of healthcare facilities right now. There is a lack of many specifications and criteria which need to be stipulated. There is no stipulation on how service delivery in the private sector will be created. Clause 39(8)(f) refers to information submission requirements for accreditation and reimbursement, with the reference to recording on the health patient registration system appearing to be too restrictive. It would be appropriate to use more consistent wording such as saying the National Health Information System. There is the assumption that there are adequate service providers and that those service providers will be accredited to provide the required services. However, there are no contingency plans in place. A particular concern would be facilities in rural and small areas. These facilities may not be adequately managed. If accreditation is required and currently only 0.7% of public healthcare establishments are certified compliant, then the timeline set for the implementation of the NHI is actually very unrealistic. Clause 39(4) talks about performance expectation but does not specify what is meant by this.

Ms Chirwa said that healthcare facilities, clinics, and hospitals have not been able to achieve their goals in the past few years. They fall short of what is required of them. How will this be dealt with? There are so many hospitals and clinics. In terms of clause 39(2)(b), what will happen if these standards are not reached? Will accreditation not be given to these facilities that have not met all the requirements? Currently, just above 300 clinics are considered ideal clinics in the country. Will the remaining clinics not receive accreditation? Will this process be different? If so, it should be stated in the Bill how it will be different in regard to the certification and passing the requirements for certification. Currently, the certificate is only valid for one year. The workforce is not adequately equipped to supervise and ensure the implementation of recommendations made in the public sector. The capacity of the NHI has to be increased, but what will the financial implications be? If it is increased to what number of personnel will this be? In contrast to the hospital-clinic ratio, what will the ratio then be? In the space that the Bill falls short to cover certain aspects, who will be responsible for this? The state pleads poverty whenever more funds are requested to increase its personnel in order to implement its role. The Committee always says that recommendations are made but are not defended. If it means using the court of law, it should be done, but these entities are not even financially able to defend. The health entities are at the brink of collapse. This part cannot be outsourced to the private sector because it will be equivalent to the private sector regulating and certifying itself. This clause is not feasible. It will not work under the current status quo. Most of the time laws are not implemented. In reality, people in this country suffer. This must come to an end, bills that will not be implemented should not be considered. There are lawmakers in this jurisdiction to evaluate bills and determine whether it will be implemented and help the people of the country. Bills cannot be brought to the Committee that will just dangle in the face of people and then systemically keep it away from them. This will mean that it was never about the people of this country in the first place. This clause is rejected.

Ms Clarke asked what happens if healthcare services do not have available resources or facilities to be able to provide a particular service. How will medical healthcare facilities be accredited? Because in previous years it has been shown by the Office of the Health Standard Compliance that only seven health establishments out of 696 hospital managed to achieve the 80% required for accreditation. How will this impact the NHI? Will there be establishments that operate unlawfully? There are only two provinces (Western Cape and Gauteng) that has achieved more than 50% clean audits by the Auditor-General. Where health providers do not receive accreditation, it is suggested that they will not be contracted to the NHI Fund. The need certificates have been ruled as unconstitutional and this clause is invalid at this stage. A legal opinion is needed on this section if the unconstitutionality is confirmed. What will then happen? This will make clause 39(3) and (4) invalid. Section 39(5) also raises constitutional issues. What happens if a patient, for various reasons, does not have an ID or visa? These reasons could include poor performance by the Department of Home Affairs of the Office or Asylum Seekers. Medical treatment should not be withheld. This can lead to discrimination from the healthcare providers if they are not treating foreigners or people without ID’s. How will public healthcare facilities apply if they do not have the necessary phones and working computers? Clause 39(5)(h), why would the Minister be involved in the day-to-day running of the healthcare providers? It should be for one of the committees or officers who determines the reimbursement. Clause 39(6), how would the provision be complied with given the departments failure to effectively monitor public hospitals? What will change to give effect to these monitoring and evaluation systems? Clause 39(7), how will this be monitored because it can become an administrative nightmare? Clause 39(8)(b), the majority of all health facilities already do not have certificates by the Office of the Health Standards Compliance. What will happen to this clause? Will there only be seven healthcare facilities around the country that are able to provide services? For clause 39(8)(c)-(k), how will this be implemented? Most government hospitals have massive staff shortages, insufficient supplies, no internet to keep online records, insufficient equipment, and poor conditions. Would this then disqualify every hospital from being accredited as a healthcare provider? This is a backlog of surgery that the country is facing. What is being done to be effective? In terms of filling, if outsourced service providers are being billed, does the Department have the capability to use an effective coding system?

Mr Xaba said the ANC supports clause 39(2)(a) should be enhanced by clause 39(2)(a)(i) that says be in a position to produce proof of certification by the Office of Health Standard Compliance and proof of registration by Statutory Health Professionals Council as the case may be. Insert clause 39(2)(a)(ii) that state be in possession of conditional accreditation for public health establishment that are struggling to meet norms and standards. There are health establishment that are struggling to meet the norms and standards and they must not be excluded or penalized for contracting with the Fund. They must be supported through a developmental process to meet accreditation requirements and must be undertaken through the conditional accreditation process to meet the definition section that will be reviewed within a five-year period. As outlined in clause 39(7), conditional aggregation will ensure that health establishment in rural underserved and deprived areas are not left behind and can access to healthcare services. The conditional accreditation is to be reviewed within a five year. The ANC support clause 39(2)(b)(i) because changes to the comprehensive healthcare services including diagnosis test covered under NHI and will be informed by changes in the burden of disease, the demographic profile of the population, evidence and cost effectiveness, efficacy treatment intervention or technology developmental locally and internationally. It is not advisable to legislate on healthcare benefits or performance criteria as they will require ongoing review. The provision of the minimum required range of personal healthcare services and the related changes and adjustment to the benefits of the service will be accompanied by a budget impact analysis. In addition to clause 39(2)(b) changes will be best expressed in regulations that will be published in the Gazette from time to time as determined by the Minister of Health in consultation with the Fund as advised by their benefits advisory committee. The ANC supported clause 39(2)(b)(iv) because it emphasizes the need for all providers and users to receive healthcare services at an appropriate level of care, but with upward or downward referrals. This will ensure that users are given access and utilize these services in a rational manner that is consistent with the referral policies and applicable clinical guidelines and protocols that are prescribed in regulations. In case of emergencies, users will not be denied care so that they can access the needed healthcare services at the most appropriate level of care. The ANC supports clause 39(7) because the provision is necessary to ensure that accredited providers retain and maintain compliance requirements on a regular basis, as stipulated and communicated by the Fund. It is important that contracted providers remain accredited and that this accreditation is renewed every five years to ensure that they comply with various requirements such as payment mechanisms, information and data submissions, as well as applicable clinical protocols and guidelines. A subclause 39(7)(b) should be added stating a public healthcare establishment in an underserved rural communities must be provided with conditional accreditation, as prescribed through regulations in clause 55(i) and (h). Clause 55(i) and (h) in this Bill makes provision for the accreditation of healthcare service providers and health establishment or suppliers. This will ensure that the health establishment in rural, underserved and deprived areas are not left behind. The ANC supports clause 39(8)(a) because accreditation must be valid for five years as envisaged by clause 39(7). It is critical that the Fund is adequately empowered to withdraw or refuse providers accreditation based on clearly stated criteria as indicated in subclauses (a)-(k) in this clause. Any provider who is not accredited or has the accreditation withdrawn or refused by the Fund cannot be paid for the services that they rendered to users or patients. He explained that clause 39(2) and proposed amendment to clause 39(7), that health establishments are struggling to meet the norms and standards and must not be excluded or penalized for contracting with the Fund but instead they must be supported through a developmental process to meet the accreditation requirements. The ANC supported clause 39(8)(a) and (g) because in circumstances where an accredited and contracted provider fails to deliver quality healthcare services to users. The Fund should set out relevant measures to correct the situation. Without this provision being in place, providers and healthcare establishments may offer standard and acceptable level of quality of care to users by making it difficult or impossible for the Fund to achieve its mandate of ensuring that all users have access to affordable and quality healthcare services. The ANC supports clause 39(9) because these provisions are consistent with the requirements of Promotion of Administrative Justice Act and section 33 of the Constitution which requires that everyone must be afforded the right to administrative action and that is lawful, reasonable and procedurally fair. Furthermore, everyone’s rights who have been adversely affected by an administrative action or decision that has been reached by the Fund, has the right to be given written and adequate reasons. The duration of the notice must be prescribed in the regulation, and the definition must be enhanced to explain what the reasonable opportunity implies. These requirements must also be uniformly applied to the accreditation requirements implemented by the Fund except of health establishments in deprived communities in line with the new proposed subclause.

Ms Hlengwa said that there is little evidence to show that the Fund will have the ability to carry out this ambitious task of ensuring the accreditation of healthcare service providers. What will happen when there is a delay of accreditation? Will this have an impact on the constitutional right to access healthcare services? The clause as it stands should provide clarity in the situation where there has been a delay in the accreditation. The clause is extremely vague as to the appropriate level of care users are entitled to.

Ms Havard said that the ANC also supported clause 39(2)(b)(vi) because it ensure affordability, buildability and sustainability of the Fund. The accredited contracted providers must render the specified healthcare benefits by using the applicable pricing rate regime. This means the Fund in consultation with the Minister is advised by the health benefits pricing committee which will lead its own pricing and reimbursement mechanism having undertaken appropriate budget impact analysis. Clause 39(4) is supported because the Fund must ensure that all accredited providers and health establishments adhere to the healthcare referral pathways. Clause 39(8)(h) is supported because accredited and contracted providers and health establishments must adhere to the terms and conditions of the contract. Any provider or health establishment that deliberately misleads the terms of the substance included in the contract must be adequately sanctioned. Clause 39(10) is consistent with the requirements of the Promotion of Administrative Justice Act and section 33 of the Constitution which requires that everyone must have the right to administrative action that is lawful, reasonable and procedurally fair.

Ms Wilson said she had more questions than the answers that she can get. What are the standards that are used to accredit health facilities? Are international standards being used or those of the World Health Organization standard? It has been stated before that the bulk of the facilities in South Africa cannot be accredited even on the most basic level. This whole accreditation process is simply laughable. There are facilities that are understaffed and underfunded, and under no circumstances can they do what they are required to do. What happens if accreditation is taken away? The situation is that there is a facility that are available to members of the public but their accreditation is taken away. In a case like Limpopo, the people might be referred to another province. There are so many problems with this. Where does the help of the Ombudsman fit into this entire scenario. The Ombudsman is the one that normally investigates failures. Where will the Ombudsman be during the accreditation process? It is suggested that the Ombudsman be included in these clauses of the Bill. She was concerned that there was no mention of the Health Ombudsman. What about medical legal fees and claims? Many of these claims are justifiable. There are billions worth of medical legal claims. There are no province besides the Western Cape that do not have medical legal claims. And 90% of these claims are due to poor doctors, facilities, and poor infrastructure. If there are no accredited facilities, where do people go? There is absolutely no way that this Bill can be passed.

Mr Van Staden addressed clause 39(2)(a) and (3). Public healthcare infrastructure has to be updated before a clause like this can be inserted in a Bill. The Office of Heath Standards Compliance has been a problem. They have appeared before the Committee before, where it was admitted that there were not enough inspectors to inspect the approximately 407 public hospitals, 203 private hospitals, 3800 public clinics and the 600 private clinics in this country. This was due to a lack of funds and other resources. This is shocking because there are only 44 inspectors who have to do all this work across the entire country. As a result, many hospitals and clinics are simply not inspected to ensure that they comply with the legal requirements to provide safe and high-quality healthcare to South Africans. In 2019 when an inspection was conducted in Gauteng all of the state hospitals failed their safety audits. What is the number now of the inspectors? This also explains why there are poor infrastructure at hospitals and why equipment is not maintained. There are simply no funds available to fill vacant positions in this office.

The Chairperson suggested additions to clause 39(2)(b). The Fund's accreditation and contracting requirements for health care service providers, public and private must be in line with ensuring that they are capable of providing the specified scope and depth of healthcare benefits as determined by the healthcare benefits advisory committee in consultation with the Minister. In addition to clause 39(2)(b) it must meet the needs of users and ensure service providers comply with prescribed specific performance criteria accompanied by a budget impact analysis. Providers must perform in accordance with prescribed performance criteria and budget impact analysis. This is essential to ensure that the NHI expenditure does not exceed the allocated budgets. It is essential that the set of healthcare benefits that meet the needs of users are regularly reviewed through an evidence-based process that is undertaken by the benefits advisory committee to meet the changing needs of the population and the changing technological advances that may present themselves from time to time. The ANC supports a prescribed regulated approach for determining the minimum required range of personal healthcare services that are regularly reviewed. This will be done in the health sector by the Minister in consultation with the National Health Council. The ANC also supports clause 39(2)(b)(iii). Detailed treatment guidelines must be based on available evidence. The most cost-effective interventions must be used to guide the delivery of the comprehensive healthcare services on medicine, surgical disciplines and health technologies. Accredited hospitals and specialists will be required to provide healthcare services in accordance with clinical protocols and referral guidelines. Specialists will be required to comply with guidelines, protocols that prescribe quality and the other standards, and prescribed referral pathway. This will provide guidance on the referral system and on what services should be rendered or performed at designated levels. All treatment guidelines will be routinely renewed to take into account the assessment and appropriateness of new technologies but the general public would be provided with relevant information. The ANC supported clause 39(2)(b)(vi) because providers who wish to contract with the Fund must comply with the stipulated pricing and reimbursement mechanisms. The Fund will pay providers using a price that creates the necessary incentives for efficiency, sustainability, and the provision of quality and accessible healthcare for all. The price will be implemented on a uniform reimbursement strategy without balance or split billing that is transferred to users. Users must not be expected nor requested to pay anything at the point of accessing and utilizing healthcare services covered by the Fund.
- The ANC supported clause 39(4) because it is important that the Fund implements a provider performance framework that states clear targets and metrics by which providers can be monitored and evaluated. This will contribute to ensuring that providers are effective, efficient and constantly able to provide quality healthcare services to users. Providers will be monitored and evaluated by the performance monitoring unit of the Fund.
- The ANC supports clause 39(6) with some amendments that have to be made. The Fund will implement a provider performance framework that says clear targets and metrics by which they can be monitored and evaluated. If providers do not meet the performance requirements and clearly indicated contractual obligations, they must be adequately sanctioned to ensure that there are fruitless and wasteful use of funds. This will contribute to ensuring that providers are effective, efficient and constantly able to provide quality healthcare services to users. The appropriate sanctions to be applied by the Fund when there is a deviation from any contractual obligations must be stimulated through regulations that must be gazetted by the Minister. It should be added that the performance of an accredited healthcare service provider or health establishment must be monitored and evaluated in accordance with this act and appropriate sanctions must be applied where there is deviation from contractual obligations.
- The ANC supported clause 39(8)(d) because for the Fund to be able to manage its operational costs effectively, efficiently and sustainably it is important that all accredited and contracted providers and health establishments comply with a stipulated treatment protocols and guidelines as well as making use of the medicines and related products as determined by the Office of Health Products Procurement outlining in clause 38 of the Bill. If any health establishment does not adhere to these requirements, they must take appropriate sanctions during termination of the contract should it be deemed necessary.
- Clause 39(8)(f) was also supported. The Fund must be able to execute these functions and responsibilities with access to accurate and valid information relating to all areas of its activities. This implies that the Fund must have data warehousing analytics and decision-making capabilities that ensures that the services it provides are relevant to the users’ needs and that they adequately address health sector priorities and objectives to achieve this. All accredited and contract providers and health establishments must submit the required data and information in a mannered format and on a regular basis as determined by the Fund. Providers must also submit the information contemplated by clause 39(5)(a)-(h).
- The ANC supported clause 39(8)(k) because, where relevant and applicable, the NHI Fund will liaise with the Statutory Health Professional Councils such as the Health Professions Council South Africa, South African National Council, South African National Nursing Council and the South African Pharmacy Council to give effect and implement necessary sanctions. Statutory councils regulate practitioners through a professional code of ethics, and then infringement is sanctioned by these bodies.

In discussing the programme, Committee members agreed that the Committee should finalise the NHI process and settle other matters.

The minutes of 1 and 8 June; 23 and 24 August 2022 were adopted.

The meeting was adjourned.

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