National Health Laboratory Services 2019/20 Annual Report; National Health Amendment Bill: rejection

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Health

10 March 2021
Chairperson: Dr S Dhlomo (ANC)
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Meeting Summary

Video: Portfolio Committee on Health

Annual Reports 2019/20

ATC210311: Report of the Portfolio Committee on Health on the National Health Amendment Bill [B29 – 2018], dated 10 March 2021

The purpose of the virtual meeting was for the Committee to be briefed by the National Health Laboratory Service (NHLS) on its Annual Report for the 2019/10 financial year. A further item on the agenda was for Members to consider a Motion of Desirability on the National Health Amendment Bill, a Private Member’s Bill.

The NHLS told the Committee that its mandate was to provide cost-effective and efficient health laboratory services, support health research, and provide training for health-related education.

The NHLS generated a surplus of R1.08 billion for the 2019/20 financial year, with a reported turnover of R9.3 billion.  At the end of the financial year, the NHLS reported a cash balance of R4.1 billion, which greatly assisted with its response to the COVID-19 pandemic. The NHLS was ready to deal with a third wave of the pandemic. The Committee was informed that the financial situation of the NHLS improved significantly in the 2019/20 financial year. Through extensive negotiations, provinces had substantially reduced their historic debt to the NHLS.

The NHLS obtained an unqualified audit for the 2019/20 financial year, showing the improved internal controls and financial record-keeping of the entity. It achieved 77 percent of its set targets, resulting in the completion of 37 out of 48 targets for the 2019/20 financial year. Areas where targets were not achieved included the ICT-sector, human resources, the National Institute for Communicable Diseases, academic and research affairs, and laboratory services. All targets were achieved relating to financial management, governance and compliance, and occupational health-related aspects.

The NHLS requested an additional meeting with the Committee to discuss its work done during the COVID-19 pandemic, and the large investments made by the NHLS to ensure that laboratories could function efficiently throughout the pandemic.

The NHLS reported that it employed 7 532 employee staff during the 2018/19 financial year. Staff turnover stood at 3.1 percent, indicating that the NHLS was an employer of choice for professionals in the pathology sector. The entity’s vacancy rate was at 8.9 percent, and emphasis was placed on filling critical positions. The NHLS was still the largest training provider for registrars, medical scientists, medical technologists and laboratory assistants across the country.

The Committee welcomed the comprehensive report from the NHLS and appreciated the unqualified audit opinion. The NHLS was commended for reducing monies owed by provinces, but Members urged it to improve collection of the R4 billion still owed. Members were concerned that the entity might incur millions in expenditure relating to litigation costs, and that this would have an impact on its liquidity. The NHLS reassured the Committee that this issue would not be a problem.

In response to questions about a backlog in forensic services, the NHLS said it would take over the forensic chemistry laboratory services that were currently located with the Department of Health. These four laboratories would take over work relating to toxicology and the testing of blood-alcohol levels for the criminal justice system, as well as additional matters relating to food chemistry.

The Committee considered a Motion of Desirability on the National Health Amendment Bill, which was sponsored by one of its Members. The Bill proposed amendments to the National Health Act which would require public sector clinics to provide health services for 24 hours a day and seven days a week.  Members referred to the cost implications and described the Bill as premature in the light of pending National Health Insurance legislation. They voted against the motion.

Meeting report

The Chairperson convened the virtual meeting and welcomed Members and the delegation from the National Health Laboratory Services (the NHLS).

The purpose of the virtual meeting was for the Committee to be briefed by the National Health Laboratory Services (NHLS) on its Annual Report for the 2019/20 financial year. A further item on the agenda was for Members to consider a Motion of Desirability regarding the National Health Amendment Bill.  

The Chairperson invited the NHLS to make a presentation.

Briefing by the NHLS on its 2019/20 Annual Report

Prof Eric Buch, Chairperson, Board of Directors, NHLS, presented the briefing to Members. He stated that the purpose was to brief the Committee on the achievements and progress, as well as the financial performance of NHLS during the past financial year.

Overview of the NHLS’s financial situation

The Committee heard that the mandate of the NHLS was to provide cost-effective and efficient health laboratory services, support health research, and provide training for health-related education.

Members were told that the NHLS generated a surplus of R1.08 billion for the 2019/20 financial year, with a turnover of R9.3 billion. At the end of the 2019/20 financial year, the NHLS reported a cash balance of R4.1bn, which greatly assisted with the NHLS’s response to the COVID-19 pandemic. The NHLS obtained an unqualified audit for the 2019/20 financial year, showing the improved internal controls and financial record-keeping of the entity.

The NHLS reported that it had implemented a settlement agreement with the Gauteng Provincial Department of Health that was signed on 22 February 2018. This had resulted in the reduction of a long outstanding provincial debt and enhanced the NHLS’s cash flow for the 2019/20 financial year. Creditors’ days improved from 30 days to 28 days, showing an improvement from the NHLS’s already-low baseline, which illustrated the entity’s continued commitment to the timely payment of suppliers for goods and services rendered. In addition, debtors’ days improved from 127 days to 105 days, which pointed to improved measures of debt collection in conjunction with the improved provincial payments. It was important to note that the debtors’ days did not include a disputed amount for the KwaZulu-Natal Provincial Department of Health or the Gauteng Provincial Department of Health settlement agreement. 

Overview of the NHLS’s non-financial performance

The Committee was told that the NHLS acted swiftly in preparation for the COVID-19 pandemic. Testing commenced on 8 March 2020, after the first positive case was reported in South Africa. At the start, only two laboratories were resourced to conduct COVID-19 testing, but by the end of March 2020, eight laboratories were operational for the purposes of testing for COVID-19. During the 2019/10 financial year, 19 new laboratories were accredited resulting in a total of 80 accredited laboratories of the NHLS. The accreditation of regional and district laboratories by the SA National Accreditation System (SANAS) far exceeded the targets set. The NHLS published 632 articles in peer-reviewed journals, showing an overachievement of the set target of 600 publications.

The NHLS achieved 77 percent of its set targets, resulting in the completion of 37 out of 48 targets for the 2019/20 financial year. Areas where targets were not achieved included the ICT-sector, human resources, the NICD, academic and research affairs, and laboratory services. All targets were achieved relating to financial management, governance and compliance, and occupational health-related aspects.

The NHLS held a successful Pathology Research and Development Congress in the year under review, with 513 delegates attending. The Division for Biosafety and Biosecurity (DBB) successfully commissioned and fully operationalised a newly constructed biosafety laboratory at level no. 3. The laboratory represented the most advanced biocontainment infrastructure in Africa. The sequencing core facility at the National Institute for Communicable Diseases (NICD) generated the first SARS-Cov-2 genome in South Africa and was assisting other African countries in this regard. The NHLS also acquired the intellectual property of the Occupational Health and Safety Information System (OHASIS) that supported surveillance and ensured compliance with the relevant occupational health legislation.

Governance of the NHLS and strategic overview

The Committee heard that Impending changes in the legislative environment applicable to the NHLS would have an impact on it. The entity’s governance would be enhanced by the reconfiguration of its Board of Directors and representation of its members. The Board of Directors served as the entity’s accounting authority in terms of the Public Finance Management Act (PMFA), and was responsible for providing strategic direction and leadership, ensuring good corporate governance and ethics, and determining policy and agreeing on performance criteria. The Board of Directors was supported by seven sub-committees. 

The NHLS reported that its key initiatives included the following:

  • The NHLS continued to offer high quality, affordable services with proven value for money.
  • The entity was focused on improving its service delivery, as evidenced by the improved turnaround times for COVID-19 testing.
  • The entity’s financial sustainability and performance had been greatly improved, and there was evidence of improved relations with organised labour. 
  • The NHLS continued to improve its internal operational efficacy, procurement-related systems, and policies and ICT-systems were being put in place to modernise the entity.
  • The NICD continues to play an exceptional role in healthcare surveillance, and the NHLS was committed to building and maintaining strategic relationships with relevant stakeholders.

The Board of Directors had strengthened the NHLS at executive and management levels. Key personnel were appointed for the positions of Chief Executive Officer, Chief Financial Officer, and Chief Information Officer. The NHLS had improved on all its functions and processes to enable it to carry out its mandate more effectively and efficiently.

Performance highlights

The NHLS reported that ICT had been improved through the digitisation of its laboratory operations which allowed for the more consistent and accurate identification of patients. The Central Data Warehouse continued to be the strategic source for laboratory tests data. This assisted NHLS to effectively use data and analytics to drive innovation, improve efficiency, and enable evidence-based decision-making processes and policies.

Regarding service delivery, it was reported that the NHLS conducted 97 million diagnostic tests for the 2019/20 financial year, amounting to an average of 265 000 tests conducted every day. During the 2019/20 period, 5.7 million viral-load tests were performed, showing an increase of 9.45 percent from the previous financial year. The NHLS acted swiftly in preparation for the COVID-19 pandemic. Testing commenced on 8 March 2020, after the first positive case was reported in South Africa. At the start, only two laboratories were resourced to conduct COVID-19 testing, but by the end of March 2020, eight laboratories were operational for the purposes of testing for COVID-19. In addition, the NHLS devoted resources to assist with the country’s preparedness for the COVID-19 pandemic and diagnostic activities. This enabled several work streams to be established, including the establishing of standardised panels for evaluation of COVID-19 antibody and antigen rapid test kits, sourcing reference material for validations and quality assurance, and for assessing academic institutions for COVID-19 testing.

Regarding the surveillance of communicable diseases, the HIV Virology section continued to support pre-clinical vaccine development, and to define the determinants of broadly neutralising antibodies, which was widely assumed to be the key for an HIV-vaccine. The Centre for Emerging Zoonotic and Parasitic Diseases continued to play an important role in supporting the malaria control and elimination programmes. Several surveillance-linked research projects provided the basis for tackling residual malaria transmission within South Africa. The results of the National Tuberculosis Prevalence Survey provided the first direct measurement of the burden through active case-finding, and identified a higher burden than currently reported. The National Cancer Registry published key research in cancer epidemiology. It also examined national cancer trends and risks. The Notifiable Medical Conditions Surveillance System, designed for real-time data reporting, continued to expand across the country and received over 7 500 monthly notifications from the laboratories of the NHLS.

Human resources

The NHLS reported that it employed 7 532 people during the 2018/19 financial year. This consisted of top management (8 employees), senior management (49), professionally qualified staff (716), skilled staff (3 016),  semi-skilled staff (2 617), unskilled staff (794) and interns (332).  The personnel expenditure for the financial year under review amounted to R3.9 billion, 46.94 percent of the total expenditure. The average personnel cost per employee was R520 725. It was reported that 5 880 employees attended technical and non-technical short learning programmes and conferences during the financial year. In addition, 12 scholarships and bursaries were awarded to disadvantaged students studying degrees related to biomedicine and healthcare. A total of 328 bursaries were also issued to staff of the NHLS to pursue further studies for career development.

Staff turnover stood at 3.1 percent, indicating that the NHLS was an employer of choice for professionals in the pathology sector. The entity’s vacancy rate was at 8.9 percent, and emphasis was placed on filling critical positions. The NHLS was still the largest training provider for registrars, medical scientists, medical technologists, and laboratory assistants across the country.

Regarding employment equity, the NHLS reported that it employed 1 791 African males (against the target of 2 340), 168 coloured males (against the target of 226), 143 Indian males (against the target of 144), and 172 white males (against the target of 231). The NHLS employed 3 593 African females (against a target of 3 562), 404 coloured females (against the target of 422), 337 Indian females (against the target of 340), and 511 white females (against the target of 524).

Conclusion

The NHLS said implementation of its projects had accelerated during the financial year under. Cost containment would remain one of the core focus areas during the current and upcoming financial years, along with a focus on operational efficiency and effectiveness. The COVID-19 pandemic was the biggest challenge that the country and the NHLS had faced thus far.

Discussion:

The Chairperson thanked the NHLS and commended the entity for a detailed and comprehensive briefing. He was impressed with the NHLS’s timely submission of its report to the Committee, despite legitimate reasons that could have caused delays. He thanked them for their commitment.

Ms A Gela (ANC) welcomed the presentation by the NHLS. The COVID-19 pandemic was a difficult situation. The NHLS bore the brunt of it and must be commended for the work it had done. How had the COVID-19 pandemic affected the NHLS’s administrative programme? What measures had been implemented to further improve the entity’s achievement of the set targets? What had been done with the funds that were not spent relating to the vacant positions within the NHLS? When would the still vacant positions be filled? She asked the NHLS to provide the Committee with a timeframe for the filling of vacancies, and for clarity on the levels at which these vacancies were.

She welcomed the unqualified audit obtained by the NHLS from the Auditor-General of South Africa (AGSA). It was clear that the entity had been addressing the concerns of the Committee about financial management and non-compliance issues raised by the AGSA during previous financial years. She appreciated the role that the NHLS was playing in saving the lives of the people of South Africa. The NHLS must continue on its track of improvement.

Ms H Ismail (DA) asked for clarity on how many laboratories were currently functional in each province, and whether each laboratory had sufficient equipment and personnel. How many vacancies for epidemiologists were there currently within the NHLS per province? What measures were being taken to ensure that these vacancies were filled with urgency? She asked the NHLS to brief the Committee about the ongoing litigation relating to two staff members who sustained personal injuries on the job, amounting to claims of R328 million and R 4.8 million, respectively. What was the driving force behind the higher rate of disciplinary actions that had been taking place at the NHLS?

Ms N Chirwa (EFF) asked how the COVID-19 pandemic had impacted the NHLS’s ability to achieve the targets that had not been achieved. When targets were not achieved, it spoke to an issue of adequate capacity within the entity. She also asked for clarity on how many laboratories are currently functional in each province. What were the NHLS’s prospects for increasing its capacity? She recommended that the NHLS provide concrete recommendations to the Committee on what could be done to assist the entity in this regard.

She referred to an employee who was dismissed for committing theft at the NHLS for over 13 years. What systemic interventions or measures were in place within the NHLS to pick up these kinds of issues and crimes to ensure that corruption did not persist within the entity. She agreed with Ms Ismail’s question regarding the higher rate of disciplinary actions that had been taking place at the NHLS. She asked for clarity on the causes for these disciplinary actions, and whether they related to fraud and corruption.

What were the major challenges experienced by the NHLS in fulfilling its mandate, especially during the COVID-19 pandemic? She asked whether the NHLS still outsourced most of its services, such as cleaning and security. It was paramount that insourcing be considered by the entity.

Ms S Gwarube (DA) asked why the entity had such a significant under-expenditure, especially given the COVID-19 pandemic. Were there any reasons why the research programme of the NHLS continued to overspend its budget? Why did the NHLS not simply readjust its budget to avoid such overspending?

The reality of the COVID-19 pandemic was that none of the country’s healthcare entities would conduct business as usual. There was a need for a reconfiguration towards more stringent healthcare protocols and hygiene standards. How would  the NHLS adapt to this change? What had been the key lessons learned by the NHLS as a result of the pandemic? She asked for clarity on how the NHLS will adjust its operations to address these lessons to become a more resilient entity.

She agreed with Ms Ismail’s request for clarity on the NHLS’ litigation matters and asked that the Committee be informed what the nature of those proceedings were. The Northern Cape province did not have as many operational laboratories as the rest of the country, and she asked what the NHLS’ plans were for expanding its capacity within the province.

Mr P van Staden (FF+) welcomed the presentation by the NHLS. He asked the NHLS to confirm the number of medical scientists admitted and trained within the entity. What was the delay in the recruitment processes? He asked to be updated on the backlog of cases relating to the forensic laboratories of the SA Police Service (SAPS). Was there any possibility of enlisting universities to help get rid of this backlog?

Dr S Thembekwayo (EFF) raised the issue of temporary appointments in crucial vacancies, such as the NHLS’s appointment of an Acting Chief Financial Officer. These vacancies must be filled on an urgent basis. She stated that the majority of personnel were stationed in the Western Cape. What was the rationale behind the inequitable distribution of internal medical scientists and registrars across the country?

Ms M Sukers (ACDP) thanked the NHLS for the briefing. She asked for clarity about a report that was released in February 2021 regarding regulatory delays in South Africa relating to the spread of COVID-19.

Ms E Wilson (DA) commended the NHLS for improving the entity’s liquidity. How would the ongoing litigation matters impact the entity’s liquidity in the future? She stated that while it was commendable that the NHLS had made strides in reducing the outstanding debt from the provinces, the money still owed amounted to R4 billion, which remained a significant figure. She urged the NHLS to improve collection of the R4 billion still owed. What measures had been put in place to ensure that the outstanding debts continued to be reduced?

It was concerning that there was significant under-expenditure on several programmes of the NHLS. She asked whether the funding that was not used by the NHLS was returned to the National Treasury, as there were other government departments and entities in dire need of additional funding.

What preparations had the NHLS made for a third wave of infections relating to the COVID-19 pandemic? How many of the employees of the NHLS had been vaccinated so far, given their high risk of exposure?

Regarding the transfer of the SAPS’s forensic laboratory to the NHLS, she raised a concern about whether the NHLS would be able to cope with the backlog. She asked for clarity on whether the staff members of the forensic services at the SAPS would be transferred to the NHLS. What negotiations had been entered into in this regard? She agreed with Mr van Staden’s concerns about the backlog that must be addressed.

Ms M Hlengwa (IFP) welcomed the report from the NHLS. She applauded the commitment of the entity in reducing the outstanding debt owed by provinces. She noted that the NHLS was still the largest training provider for registrars, medical scientists, medical technologists, and laboratory assistants across the country. Did the entity intend to increase the number of bursaries it offered to students who were disadvantaged? What critical positions remained vacant, and how would the NHLS address this issue?

Mr T Munyai (ANC) asked whether there were agreements with the province of KwaZulu-Natal on settling its outstanding debt. Were the provinces honouring their settlement agreements with the NHLS? The financial position of the NHLS would continue to improve dramatically if the outstanding provincial debts amounting to R4 billion were settled urgently. He appreciated that during the 2019/20 period, 5.7 million viral-load tests were performed by the NHLS, showing an increase of 9.45 percent from the previous financial year. How did the number of viral tests conducted on COVID-19 patients contribute to this number?

Dr K Jacobs (ANC) enquired on the progress towards a vaccine for HIV/AIDS within South Africa and abroad. Had there been any progress and what were the timeframes in this regard?

Mr M Sokatsha (ANC) asked for clarity on the NHLS’s plan to employ and train more forensic pathologists. He commended the NHLS for its speed in improving its testing capabilities. The improved governance of the NHLS was welcomed by the Committee.

Responses

Prof Buch responded to the questions on issues of governance. He thanked Members for the questions and concerns raised and stated that it was always a valuable opportunity to present to the Committee and engage in a strategic way on the issues and progress of the NHLS. The success of the NHLS was thanks to the extensive and committed teamwork from its staff members, and the Ministry of Health on a national level. The Board of Directors of the NHLS had also diligently carried out its duties. He thanked the Chief Executive Officer of the NHLS, Dr Karmani Chetty, for her exceptional work in improving the entity’s performance across the board. He stated that the executive level employees are not employed on a permanent basis, but rather on a model of a five-year contractual agreement. The delays in filling the vacancies were a result of insufficient or inadequate applications received. Further interviews and recruitment processes were underway. One critical position that had been filled within the NHLS was the position of Chief Information Officer.

Regarding the questions on the impact of the COVID-19 pandemic, he requested that an additional meeting with the Committee be held to discuss the work done during the COVID-19 pandemic, and the large investments made by the NHLS to ensure that laboratories could function efficiently throughout the pandemic. The NHLS had invested more than R2 billion in its response to the COVID-19 pandemic. The details of these investments and increases in capacity and service delivery could be presented to the Committee during another meeting.

Regarding the question on increasing the capacity of the NHLS, the Chief Executive Officer was closely monitoring the workloads in the various laboratories to ensure that there was a trend towards the mechanisation of the processes, and that there were sufficient staff to deal with the workload involved. The NHLS had spent R10 million on machinery to dramatically increase its capacity without requiring a dramatic increase in staff.

Prof Buch requested that the Committee recognise the role of the NHLS in the country, particularly when the time came for budget considerations as provinces faced significant fiscal constraints. The NHLS must be a priority debtor, particularly with regard to the magnitude of the outstanding provincial debts. It was of concern whether the NHLS would be able to keep up its improved performance if the outstanding provincial debts were not fully addressed, as the entity could not rely on higher billing to make up the difference in revenue given the COVID-19 pandemic and the dire need of the people of South Africa.

On the issue of outsourcing, he stated that the Board of Directors had decided to insource cleaners, messengers, and the security staff of the NHLS. The entity had embarked on a major insourcing programme and a move towards giving these insourced staff members the full benefits of being employed by the NHLS.

The NHLS will not be taking over all forensic pathology and laboratory testing in the country, but would only take over the forensic chemistry laboratory services that were currently located within the Department of Health. These four laboratories would take over work relating to toxicology and the testing of blood alcohol-levels for the criminal justice system, and additional matters relating to food chemistry. The expertise of the NHLS would be continuously aimed at ensuring the backlog was cleared within a reasonable time while maintaining the entity’s high standards of service delivery.

On the issues of liquidity and litigation costs, he responded that it was paramount that the NHLS maintain its level of liquidity, and this would be achieved by ensuring that provinces pay their bills in a timely manner. He confirmed that the province of KwaZulu-Natal had committed in paying the full amount for the NHLS’s services without incurring further historic debt towards the entity. He agreed with Members that the outstanding debt owed by provinces amounting to R4 billion remained significant and expressed the commitment of the NHLS to continuously work towards clearing this debt to maintain the entity’s liquidity.

Ms Sphiwe Mayinga, NHLS Board Member, noted that a major concern of the Committee was on whether the entity had any systemic interventions in place to detect and prevent maladministration, corruption, and fraud. The Board of Directors served as the accounting authority for the NHLS and was committed to addressing fruitless and wasteful expenditure. There was a need to put more concrete policies and frameworks in place. 

Dr Karmani Chetty, Chief Executive Officer, NHLS, agreed with Prof Buch that the success of the entity was a result of the teamwork and collaborative efforts of the executive management and the Board of Directors. Leadership provided by the former and current Minister of Health was one of the factors that contributed to the improvement of the financial situation of the NHLS, together with the staff and frontline workers within the entity that continued to work tirelessly in extremely dangerous conditions relating to the COVID-19 pandemic.

She noted that Members were concerned that the entity might incur millions in expenditure relating to litigation costs. She assured the Committee that this issue would not be a problem. The COVID-19 pandemic had an impact on the 2019/20 financial year because of the hard lockdown announced at the end of March 2020. However, some consequences had been managed by the NHLS’s preparations in January 2020 in anticipation of the COVID-19 pandemic. Nonetheless, issues of staff and the restrictions imposed had an impact on the achievement of the set targets for the entity. The effects of the COVID-19 pandemic would be fully felt in the 2020/21 financial year, and possibly in the succeeding years.

The amount that had been underspent by the NHLS must be returned to the National Treasury, and the entity must submit written motivations on why it should retain its surplus of funding.

The COVID-19 pandemic and budget constraints had hampered the NHLS’s ability to fill all vacancies over the past year. She stated that the NHLS had 231 laboratories that were fully functional, and various depots at these facilities. The NHLS continued to ensure that all of these laboratories were fully equipped, despite challenges experienced in the procurement of equipment in the midst of the pandemic. The work towards the automation and modernisation of the NHLS would help greatly in this regard.

The NHLS had a great working relationship with its staff and was committed to ensuring that every employee was treated fairly and without prejudice.

Regarding the Province of the Northern Cape, she stated that the NHLS was currently engaging with the relevant stakeholders to ensure that capacity within the province was improved as a matter of urgency. The provinces had been very steadily making payments as agreed in the agreements to settle their historic debt.

She stated that the SAPS had its own forensic pathology services to aid in its investigations, and these were entirely independent from those services of the Department of Health. She concurred with Prof Buch that the NHLS would not be taking over all forensic pathology and laboratory testing in the country, but only the forensic chemistry laboratory services that were currently located with the Department of Health.

The NHLS thanked the Committee for the concerns raised. Its recommendations would be considered going forward, in preparation for a possible third wave of COVID-19 infections. Further unanswered questions would be responded to in writing, and it was requested that the NHLS have an additional meeting with the Committee regarding its work during the COVID-19 pandemic and litigation issues.


National Health Amendment Bill

The Chairperson stated that the National Health Amendment Bill was a Private Member’s Bill sponsored by Dr S Thembekwayo (EFF). It was tabled and referred to the Committee on 3 September 2018. The Bill sought to amend the National Health Act 61 of 2003 to provide that clinics in the public sector must operate and provide healthcare services 24 hours a day and seven days a week. The Committee met with the sponsor of the Bill on 7 October 2020 to receive a briefing relating to its contents and provisions. Subsequently, the Committee received input on the Bill from the Department of Health on 21 October 2020.

He stated that during these engagements, the Committee observed and noted the following input from the Department of Health:

There were financial implications to the National Health Amendment Bill and the government budget cycle determined the strategic objectives and the Annual Performance Plan to achieve the goal of the government of the day.

The National Health Amendment Bill in its current form would have massive financial implications for the Department of Health, and the quantification of costs must be done before the Bill could be considered.

The Department of Health had expressed its commitment to ensure that all primary healthcare facilities operated for 24 hours a day, and this goal was being achieved through progressive means as and when the resources became available.

The proposed legislation would likely not be the most appropriate mechanism to ensure that public healthcare facilities operate for 24 hours a day, as this was already the current state of affairs.

There was a need for comprehensive data on the factors informing the operation of 24-hour facilities, such as the human and other resources needed for expanded service delivery.

The Committee was of the opinion that there were primary healthcare facilities that were already operating for 24 hours a day, without mandating legislation. In addition, the Committee was currently progressing on the processing of the National Health Insurance Bill, which might have an impact on the proposed legislation.

It was of concern to the Committee that the country was currently under financial stress, and that the Department of Health would have great difficulty in adjusting its current budget against the health requirements resulting from the COVID-19 pandemic.

After due deliberations, a Motion of Desirability on the subject matter of the National Health Amendment Bill was placed before the Committee as required by the National Assembly Rules for Members to vote on. The Committee thanked Dr Thembekwayo for sponsoring the National Health Amendment Bill, and for giving the Committee the opportunity to engage in a continuous debate on the most appropriate healthcare system for the country.

The Chairperson asked Members to vote for or against the Motion of Desirability.

Ms Wilson said a Bill that would improve the lives of people was always a good Bill. However, the one before the Committee was premature. There was still too much work to be done on the NHI Bill. While she commended the work done by Dr Thembekwayo, she did not believe the Committee could support the Amendment Bill.

Other Members agreed that the Bill could not be supported at that point.

The Chairperson noted that the Motion of Desirability was opposed by the Committee.

Dr Thembekwayo stated that it was unfortunate that the Department of Health did not realise the importance of giving the National Health Amendment Bill enough consideration to even test its feasibility. It was the poor black majority of people in South Africa who suffered from inadequate healthcare services and long waiting times to obtain medical assistance. She expressed dissatisfaction that the Committee had rejected the Bill and further processing of the legislation.

The Committee adopted outstanding minutes, and the meeting was adjourned.


 

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