Health BRRR

Meeting report

The Chairperson opened the virtual meeting, greeting Members and guests in attendance.

The Committee noted the apologies of Ms H Ismail (DA) and Ms M Sukers (ACDP). Ms Ismail indicated that her daughter was in a car accident and in hospital.

Dr S Thembekwayo (EFF) indicated that since she was at a by-election event, her unstable network signal might log her out. She wished to put it on record in advance that, in her absence, Ms N Chirwa (EFF) would record the EFF’s objection to the Budgetary Review and Recommendations Report (BRRR).

The Chairperson noted the EFF’s objection.

The Chairperson reminded Committee Members of the virtual platform rules and relevant parliamentary rules.

The draft BRRR was displayed on screen.

Since the report contained 55 pages and it was impractical to go through every single page, the Chairperson outlined the structure of the report, since he assumed that Members had read the report already. He only went through the key parts of the report.

Find full report here https://pmg.org.za/tabled-committee-reports/

Deliberation
Ms A Gela (ANC) indicated that the report was a true reflection of the meetings and engagements that had taken place between the Committee and the different entities as well as the Department of Health (DoH). As the ANC, she proposed to adopt the report as presented. She also appreciated the good work done by the Chairperson, the DoH and the entities.
 
Ms Gela supported all the recommendations in the BRRR report.

Ms Gela raised the issues raised by Ombudsman, and suggested that the Committee should do oversight visits, especially in the Eastern Cape. After the Eastern Cape, the Committee should check the hospitals in other provinces and identify those existing challenges. Ms Gela proposed to conduct this visit from 04 November 2022 and hoped her colleagues would support her suggestion.

Ms Gela pointed out that the NHI (National Health Insurance) matter was not included in the report. As the country is moving towards implementing the NHI, she believed the issue should be included in the BRRR report. She further indicated her support of the NHI, which she described as a good tool to address all the challenges in the health system. Her view was shared and supported by the Health Ombudsman, who also agreed that the NHI was a good move for South Africans to move forward and catch up with some of the best international health systems in the world.

Ms Gela pointed out that Members needed to inspect the medical-legal claims as highlighted in the report.

Mr P Van Staden (FF+) commented that he had no problem with the BRRR’s recommendations overall, but he made the following inputs:

On point 8.1 regarding the DoH’s audit outcomes, he added that the DoH should provide the Committee with 1) a report on the measures to combat corruption, mismanagement and maladministration; 2) a report on the reasons why a qualified audit was received, and its proposed measures for turnaround strategies; 3) reports on why the Eastern Cape, Free State, KZN, Limpopo and the Northern Cape received qualified audits and their turnaround strategies.

On the DoH’s overall performance and reporting, Mr Van Staden proposed to add that the DoH should provide the Committee with: 1) an update on the cancellation of operations due to a lack of maintenance in state hospitals, and the proposed timeframe to resolve those problems; 2) a full list of the 121 facilities that were upgraded, revitalised and were newly-built; 3) a report on the DoH’s negotiation with Eskom to provide electricity to all state hospitals and clinics during load shedding hours.

Mr Van Staden wanted the DoH to provide a report on all medical-legal claims against the DoH.
On point 8.2.4, Mr Van Staden proposed that the DoH provide a report on all the medical aid funds at risk of collapse.

On point 8.2.5, regarding the health ombudsman, Mr Van Staden suggested engaging with the Minister of Health to discuss budgetary constraints on the entities under this portfolio, to assist those entities to be fully capacitated to deliver on their mandates.

Ms M Clarke (DA) suggested adding the following to the recommendations: On 8.1, she suggested requesting the DoH furnish the Committee with a report on the officials who had been found guilty of corruption or misconduct related to fruitless expenditures. It must include an indication of whether the disciplinary cases had been instigated against those officials, and the status of those cases.

On medical-legal claims, Ms Clarke suggested the Committee include in the recommendation that the DoH should provide detailed plans and timeframes on how it planned to roll out to all the provinces.

On the last point of the OHSC (Office of Health Standards Compliance), Ms Clarke suggested adding that the DoH provide the Committee with inspection reports so that it could assist Members in conducting effective oversight at NHI-certified clinics and hospitals.

Ms Clarke suggested requesting the DoH to provide a detailed plan and timeframe on the roll-out of the DoH’s plan to increase the output of nurses.

On medical-legal claims, Ms Clarke suggested including the suggestion, as mentioned in the previous week, that the Committee should ensure that a planned workshop be put in place for discussion, and what the strategies should be after that.

On OHSC, she suggested requesting an inspection report of the certified clinics and hospitals, which must be done before the NHI could be considered. The report must be presented before the end of the financial year.

Ms Clarke suggested requesting the CMS to provide a list of legislated Prescribed Minimum Benefits cases.

Ms Clarke suggested requesting the completion of a feasibility study on the social impact of the NHI, given the current financial climate. Furthermore, the Minister of Finance must present a funding model to the Committee on the NHI before the end of the financial year.

Mr T Munyai (ANC) commended the BRRR, and described it as a wonderful report. He thanked the Committee Secretary and all the people who had assisted in this report.

Mr Munyai was of the view that the requests that were made by Members to the Minister and Department’s entities can be made outside of the BRRR report. He did not believe that those requests were relevant to BRRR. He personally had never seen anything like that. Mr Munyai reiterated his unequivocal support of the BRRR, and proposed to adopt the report.

He commended the progress that the entities under the portfolio had made. Specifically, he was happy to know that two organisations had received clean audits and two received unqualified audits, which meant they were en route to clean audits. He indicated that the efforts of those organisations must be supported.

Ms N Chirwa (EFF) pointed out that there were many missing elements of Committee Members’ contribution in the current BRRR report. For instance, there is not a single comment regarding the Minister’s lack of performance, which she believed was a concern. She pointed out that those sentiments were not only shared by one political party and thus should be included and reflected in the BRRR report.

Ms Chirwa drew the Committee’s attention to the financial management of the DOH. She suggested including a recommendation of conducting some criminal investigations to look into the Department’s wasteful expenditure. She described the Tembisa Hospital saga as a blatant crime that also involved the nephew of President Ramaphosa.

Dr Thembekwayo reiterated the objection of the EFF on the BRRR.

Mr E Siwela (ANC) supported his colleagues, Ms Gela and Mr Munyai, that the report represented the Committee’s view and must be adopted.

Mr Van Staden supported the oversight visit, which Ms Gela had mentioned. He indicated that there were still four provinces to be visited – the Eastern Cape, Limpopo, Mpumalanga and the North West.

Mr N Xaba (ANC) supported the adoption of the report as it was. He supported Ms Gela’s suggestion that the Committee do an oversight visit to the Eastern Cape upon the revelation of the Ombudsman.

Mr Xaba agreed with Mr Munyai’s view that the recommendations of the current version should be retained because some of the work that his colleagues had just mentioned can be plans of the Department. He said that Members needed to differentiate plans and reports.

Mr Xaba explained to the Committee that it is not the job of the Committee to assess the Minister of Health because the Minister is appointed by the President.

Ms Chirwa raised a point of order. She did not understand how the Minister, as the political head, could be left out of the report. She insisted that the recommendations in the BRRR should reflect the view of the Committee, which were made of different political parties.

Mr Xaba raised a point of order and disagreed with Ms Chirwa’s point.

Dr Thembakwayo said that the Chairperson must rule on the issue since there were already disagreements on the adoption of the BRRR amongst Members.

The Chairperson sought advice from Members, because the Committee was facing a problem, as Members disagreed on whether the BRRR report should be adopted as it was or include the inputs made by Members just now.

Mr Xaba suggested that Members should vote on the adoption of the report.

Mr Munyai supported Mr Xaba’s suggestion and insisted that this report be adopted as is.

Ms M Hlengwa (IFP) had a connectivity issue earlier and returned to the virtual platform. She observed that some provinces obtain qualified audits as a legacy issue, which she described as very disappointing. She suggested that the matter be escalated to the Office of the Health Ombudsman to closely monitor those provinces on what they were doing with communities’ money. She firmly believed that consequence management should be implemented in those provinces.

Ms Hlengwa expressed her concern over Pfizer and its tragic impact on the community, where it caused death in some extreme cases. She questioned whether the Committee should request SAHPRA to review Pfizer.

Because of the argument that was continuously going on between those that wanted to include their own inputs in the recommendations of the BRRR report and those that believed the report should be adopted as it was, the Chairperson noted many hands that were raised by Members.

The Chairperson believed it would not be in the Committee’s interest if Members dwelled on this subject for a prolonged period. He thus decided that he would take three hands from Members and would then make a ruling on how the meeting should proceed.

Ms E Wilson (DA) posted the following in the Zoom chat: “This report must address issues raised in the meetings. You cannot disallow inputs or alterations from this Committee...or recommendations. We hold the Minister and the entities to account. We are well within our rights to request these.”

She added: “You are denying the portfolio their constitutional rights. It is not acceptable. We have the right to add our discussion points, and these were made in the meetings. This report is a form of minutes.”

Ms Gela indicated that she would support putting this issue to vote.

Mr Van Staden posted the following in the Zoom chat: “We have an constitutional obligation regarding our oversight to amend the recommendations.”

Ms Chirwa expressed her deep frustration at how the issue was being handled and began shouting on the platform. She said that the BRRR report should not only reflect what the ANC believes but also include the views of other Members from other political parties. She said that adopting the report as it was would defeat the purpose of having this discussion. She hoped that the Chairperson would have the maturity and tolerance towards the different views of other political parties. Lastly, she reminded the Chairperson that Members of other political parties were also representatives of the people and that their constituencies sent them to sit on this Committee. It was unacceptable to have their views repressed. She lambasted this unfair process.

Mr Xaba called for a point of order for Ms Chirwa’s remark. Mr Xaba retaliated to Ms Chirwa’s point and said that what is unfair is not about political views but rather how Ministers should be assessed. It is not the Portfolio Committee’s job to assess the Minister of Health.  

Ms Clarke posted the following in the Zoom chat: “I must agree, Chair. Why do we spend hours working through these reports to participate as an oversight? This is our mandate as elected representatives.”

Dr Thembekwayo called for a point of order, but the Chairperson told her that she must not interject, and she must let him finish his words.

Dr Thembekwayo interjected and said that she could not accept that the view of her political party was not included in the BRRR. She supported the inputs made by her colleague, Ms Chirwa.

The Chairperson ordered all Members to abide by the rules and lower their hands. He expressed his thought on the matter, which was under heated discussion.

Firstly, he said that Members must acknowledge that the BRRR report before Members was not the ANC’s work but rather the Committee’s report that was compiled after a series of deliberations and presentations. He disputed some of the Members’ views that the BRRR report did not capture the view of other political parties, and suggested that Members should identify their own inputs from reading the report.

Secondly, when the report was presented to the Committee, Members wanted to add certain points to the recommendations of the report.

Thirdly, the Chairperson reminded Members of the hard work the entire Parliament team had to put in to put up this report. He believed that it would not be appropriate to cast the report aside. He also pointed out that Members cannot expect their inputs to be included in the report like that, without discussing all those points in the Committee.

The Chairperson ruled to put this issue to a vote on whether the Committee should adopt the report as it is or include the recommendations just suggested.

Ms Chirwa insisted that the Chairperson recognise her on a point of order.

The Chairperson refused to carry on the discussion.

The Chairperson, Mr Munyai, Ms Gela, Dr X Havard (ANC), Mr Siwela, Mr Xaba, and Ms Hlengwa voted to agree that the report should be adopted as it is.

Ms Clarke, Ms Wilson, Dr Thembekwayo and Mr Van Staden objected.

The report was adopted.

Ms Chirwa accused the Chairperson of bullying Members, and said the Committee minutes be updated to include the discussion that had just been had.

The Chairperson responded that Ms Chirwa may review the meeting recording, and emphasised the protocol of Committee minutes adoption over the years.

Ms Clarke indicated to the Chairperson that the DA would be leaving the platform because Members had put in enormous time in the report but now their constitutional rights are not being recognised.

The Chairperson said that all due processes had been followed on the matter. The DA Members may leave but should be on accord of disagreement.

Ms Gela supported the Chairperson and reassured him that he had the support of her and other Members, and that he must not be bullied.

Dr Thembekwayo, Ms Chirwa and Ms Gela began shouting and hurling insults at one another.

The Chairperson instructed the Secretariat to remove those three Members from the virtual platform.

Committee Minutes
The Committee meeting minutes dated 11 October 2022, 12 October 2022 and 13 October 2022 were adopted without amendments.

The meeting was adjourned.