Department of Health 2022/23 Annual Performance Plan; with Minister & Deputy Minister

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Health

22 April 2022
Chairperson: Mr K Jacobs (ANC)
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Meeting Summary

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Health

The Portfolio Committee on Health (the Committee) in the National Assembly convened in a virtual meeting for a briefing by the National Department of Health on the Annual Performance Plan (APP) and Budget for the 2022/23 financial year.

A budget of R64.5 billion was allocated to the National Department of Health to fulfil the mandate of quality health care and to improve the life expectancy of all South Africans. The effects of the Covid-19 pandemic impacted the ability of the Department to achieve most of the targets set for the previous financial year. Improved outcomes are expected for the current financial year despite the limited financial and human resources.

The Ministry was managing the impact of the floods in the KwaZulu-Natal (KZN) province in collaboration with all other stakeholders to ensure continuation of health care services to patients.

The Department was closely monitoring the recent increase and trends in Covid-19 infection rates. Members were assured that an adequate supply of vaccines is available in the country to treat the next wave of variants.

Meeting report

The Chairperson confirmed the attendance of the Ministry in the meeting. After reading the housekeeping rules to Members, he invited the Minister, Dr Joe Phaahla, to make introductory remarks.

Opening comments by the Minister
The Minister informed the Committee that the Deputy Minister, Dr Sibongiseni Dhlomo, was on the frontline in KwaZulu-Natal (KZN) supporting the efforts in the flood disaster. The last two years had been dominated by the Covid-19 pandemic. Most of the resources had been directed towards pandemic health measures and the rollout of the vaccine programme. He was hopeful that the 2022/23 financial year would be different and would bring more stability. The Omicron variant identified in the last quarter of the 2021/22 financial year was highly transmissible but less severe, partly due to the high immunity levels as a result of vaccinations and natural immunity. The Department lost some ground on programmes in terms of financial and human resources.

The Minister observed worrying signs in the rise of Covid-19 infection rates and would be reporting back to the Committee once the trends had been analysed. He hoped that the new wave would not disrupt the programmes of the Department. The health sector was carrying a huge burden of diseases and the finances were never sufficient. Although the country had a dual health care system, the largest burden was on the public health care system.

The Minister informed the Committee that he had visited the Prince Mshiyeni Hospital that had been affected by the floods in KZN. As a result of broken water pipes, the hospital did not have access to water. In the midst of the disaster and without adequate water supply, between 1 500 and 1 800 outpatients visited the hospital on one day. This was an indication of the workload at the hospital. The Department would endeavour to do its best with the allocated resources to discharge the responsibilities and remained committed to providing a long and healthy life to all citizens.

Department of Health (DoH) presentation

Dr Sandile Buthelezi, Director-General (DG), DoH, introduced Ms Milani Wolmarans, Chief Director: Policy Coordination and Integrated Planning, to present the 2022/23 APP. Mr Andre Venter, Chief Financial Officer, presented the budget in support of the APP.

Ms Wolmarans presented a summarised version of the key focus areas in the APP based on six programmes.

Programme 1: Administration

The Case Management System, to manage medico-legal claims, was implemented in four of eight provinces in the previous year. The target for the 2022/23 financial year is to roll out the system to the remaining four provinces. The Western Cape is excluded as the province had its own system. The allocation for this programme was more than R 781 million or 1.2% of the total budget.  

Programme 2: National Health Insurance

The NHI targets for the 2022/23 financial year were to register 5.5 million patients on the central chronic medication dispensing and distribution (CCMDD) programme, to fill 70% of the posts in the NHI organogram and to have 3 850 health facilities available. More than R1, 5 billion or 2.3% of the total budget was allocated for the NHI targets.

Programme 3: Communicable and Non-communicable Diseases

The Department set an 85% TB treatment success rate for the 2022/23 financial year and planned to have 400 clinicians who have completed at least one of the sexual and reproductive health (SRH) curriculum modules. The targets for Covid-19 vaccinations were set at 75% for adults 50 years and older, 65% for adults between 35 and 49 years and 60% for young people between 12 to 34 years. The allocation for this programme was more than R26 billion or 41.7% of the total budget.
 
Programme 4: Primary Health Care

The Department set a target to trace 350 000 clients lost to TB and HIV treatment through the follow up done by community health care workers. The assessment for compliance with Environmental Health Norms and Standards of 26 municipalities will be done during the current financial year. All nine provinces will be assessed for compliance with Emergency Medical Services Regulations. More than R5 billion or 7.9% of the total budget was allocated for this programme.

Programme 5: Hospital Systems

The maintenance or refurbishment of 120 public health facilities, including clinics hospitals, nursing colleges and EMS base stations is set as the target for the 2022/23 financial year. The allocation for this programme was more than R22 billion or 35.1% of the total budget.

Programme 6: Health System Governance and Human Resources

The target for the 2022/23 financial year is to develop training plans for nurse or midwife specialists at nine nursing colleges and to improve the quality and safety of care at 2 200 public health facilities. More than R7 billion or 11.6% of the total budget was allocated for this programme.

The vote baseline has been increased to provide for the effects of a possible wage agreement and cash gratuity payments. The Compensation of employees ceiling was reduced by 7% due to the shifting of the Forensic Chemistry Laboratories from the Department’s core budget to the National Health Laboratories Services transfer payment.

On goods and services, the allocation for Covid-19 was reduced by 52% from the 2021/22 financial year to 2022/23 (from R4.3 billion to R2.1 million). Allocation for National Health Insurance indirect grant was reallocated to the National Health Insurance and Human Resources and Training direct grants.

(See Presentation)

Discussion
The Chairperson said although the presentation was a bit long, he was not going to be restrictive about the number of questions that Members wanted to raise. He however called on Members to prioritise the questions and to be mindful of the time constraints.

Ms H Ismail (DA) asked if the programme under the Outcome; maternal, child, infant and neonatal mortalities reduced, would be removed as there were no targets for the 2023/24 and 2024/25 years in the APP. She asked about the number of new hospitals being planned for the 2023/24 and 2024/25 financial years considering the backlog of forensic and psychiatric evaluations for State Patients in detention centres who were waiting on hospital admissions. The performance estimate of the Mental Health Policy Framework for the current year was not applicable. She asked if the Department had finalised the framework or if it was still being developed.

She asked about the programmes and budget for the prevention and treatment of substance and alcohol abuse as stated in the Sustainable Development Goals. The oncology improvement and obstetrics services plans were particularly important in Gauteng due to patients not receiving adequate treatment because of the fire at the Charlotte Maxeke Hospital. She asked about the Department’s cancer campaign and how it had been affected by the Covid-19 pandemic.

She asked if the increase in the grant would prevent cases of interns and community workers not being placed in the current year. She asked how lessons learnt during the Covid-19 pandemic could be incorporated into the design and management of NHI.

She requested an update on the progress of registering medical aid beneficiaries on the Health Practitioners Registration System (HPRS), how the number of five million registered patients was achieved and if it had been done in compliance with the Protection of Personal Information (POPI) requirements.

The Department was asked to share information about the 70% funded filled posts on the NHI organogram and to provide a report on the spending of the NHI grant. The budget for primary health care increased significantly. She asked if the programme had been adequately capacitated in terms of human resources to deliver services.

She requested a report on the training of nurses and the establishment of nursing colleges. She queried if the changes in the curriculum affected the outcomes and whether the new training model included mental health care considering the impact of Covid-19 on the mental health of many citizens.

She enquired if the Department had a long-term strategy in place to invest in and support vaccine development.

She asked how the Department was measuring the effectiveness of the HIV/AIDS and TB campaigns and how the programmes had been affected by the pandemic.

She enquired if the Department had been working with the Department of Mineral Resources (DMR) and Department of Correctional Services (DCS) to address the challenges of people living with TB.

She asked if a cross-sectoral approach was being followed in conjunction with the Department of Social Development (DSD) and Department of Basic Education (DBE) to address the major problem of malnutrition.

Ms A Gela (ANC) appreciated the good work and commitment of the Department despite the challenges that it had been facing. She welcomed the consistent advancement of the NHI policy and the efforts of the Ministry to strengthen the country’s health system.

She enquired about the plans of the Department to close the infrastructure gap and the lack of health care workers which would be required for the NHI. She asked how the Department was drawing from the experience of the NHI pilot projects to get the public health system NHI ready. The recent Auditor-General (AG) report reflected a skewed increase in the costs of medico-legal cases in the Eastern Cape compared to other provinces. She sought clarity on the specific weaknesses in the Eastern Cape and how the Department was planning to address the anomaly. She asked for an explanation of the decline in the performance target on the management of medico-legal cases from seven provinces in the 2021/22 financial year to four provinces in the current financial year. She requested feedback on the management of cases in the seven provinces in the previous financial year.

Mr T Munyai (ANC) stated South Africa is a unitary and not a federal state in which all provinces are required to implement the national government policies. He, therefore, questioned the exclusion of the Western Cape from implementing the medico-legal Case Management System.

The Department identified YouTube as a target for 2023/24 and TikTok for 2024/25 as platforms for the 100 health promotion messages on premature mortality. He drew attention to the risk of these platforms becoming outdated within two years and recommended that all social media platforms, including YouTube and TikTok, should be used without delay in the current year to spread the 100 health promotion messages. He asked for specific detail about the targeted reach of the health promotion messages. He enquired about the number of uptakes reached for the establishment of Ketlaphela, the state pharmaceutical company and how the Department was planning to position the company as a critical provider for medicine and other medical products to encourage domestic capabilities. He asked about the impact of the Find and Treat people with TB disease programme, relevant to the risk of TB prevalence in the country. He held the view that TB was the biggest killer of our people other than Covid-19. The Side-by-Side radio shows had been very important in promoting child health and nutrition.

He asked why the Department was discontinuing the radio shows in the outer years and which other means would be used to promote child health and nutrition to prevent stunting.

He enquired about the interventions of the Department to achieve the doubling of the vaccination target for the 12 to 34 year age group. He welcomed the interventions of the Department relative to programmes in the APP but was mindful that resources were not limitless.

He would have wanted to see more money being allocated for the NHI but understood the fiscal position and the debt burden of the country. The Department would do the country proud if it could implement the programmes as anticipated in the APP despite the limited resources.

Ms M Clarke (DA) sought clarity on the 2022/23 target to develop legislation for the management of medico-legal cases. She asked for an indication of how effective the management of cases had been to reduce claims. She enquired if a regulatory framework was in place in terms of the appointment of legal teams to deal with these claims. She wanted to know if legal charges were capped at a certain rate. She asked if the prevalence of fraud had been curtailed through the management of these cases, how many disciplinary cases had been instituted, how disciplinary cases were being managed and what the monetary value was in terms of these cases. She wanted to know if consequence management had been put in place to address corruption during these processes. She asked what the biggest causes of medico-legal claims were and how these claims impacted the budget of the Department.

The Department planned to have 6.5 million registered patients by 2024/25. She argued that if the NHI were to be implemented by 2025, not even 50% of the population would have been registered. She asked if unregistered patients would be denied access to the package of services that would be offered. According to the APP, a target of 3 874 health facilities would be available by 2024/25. She asked if a costing model had been done in terms of the staffing of these facilities and how the Department would be dealing with critical care considering the shortage of 21 433 nurses in health care facilities. She enquired if the many skilled nurses, who were employed during the height of the Covid-19 pandemic, would be absorbed into the system. She wanted to know if proper costing had been done in line with the social impact study to substantiate the R1.5 billion NHI budgeted. The Minister of Finance did not indicate any NHI allocation in his budget speech and according to National Treasury, the country would not be able to afford what was required for the implementation of the NHI. She asked what plans were in place to change the trajectory of the increase in maternal mortality rates. She noted a resurgence in the number of Covid-19 cases with the approach of winter and an increase in the statistics over the last few weeks. She requested an update from the Department on the factors that were causing the increasing numbers. She asked how the Department was planning to achieve the Mental Health targets if mental health facilities were not being capacitated and how the facilities would be strengthened to achieve the planned outcomes. She asked for an explanation on how the NHI grant was spent in the last financial year and the amount returned to National Treasury due to non-spending.

Mr P van Staden (FF+) asked what the plans were to eradicate the vacant posts of more than 10 800 nurses and 1 339 doctors in state hospitals as reported on 17 March 2022 by the Minister. He wanted to know what the plans of the Department were to eradicate corruption as it impacted on the capacity of the national and provincial departments. He enquired about the plan to get more mental health facilities up and running to address the mental health challenges in the country. He asked for the latest statistics on legal claims against the Department and the amount spent on legal claims. He requested an update on the number of facilities affected by the KZN floods.

Dr S Thembekwayo (EFF) asked if a long-term strategy was in place to invest in vaccine development and how the department was supporting vaccine development on the African continent.  She enquired about the plans of the Department to deal with other Covid-19 variants.

She wanted to know if an assessment had been concluded on the impact of the KZN floods on the health system in the province.
She asked how the HIV/AIDS programmes had been affected by the Covid-19 pandemic and if the Department modelled the impact of fewer people being evaluated and receiving treatment over the past year.

She enquired about a cross-sectoral approach with the DSD and DBE pertaining to the strategy of the Department to combat severe malnutrition.

Dr X Harvard (ANC) enquired about the effect of health care treatment of undocumented immigrants on the planning and budgeting of the Department. She wanted to know how the Department was planning for servicing undocumented immigrants and what effect it had on the health capacity of the country. She asked what programmes were being implemented in relation to digital transformation. She wanted to know if the spectrum release would increase connectivity and thereby create capacity to digitise the health care management system and other technology innovations.

Ms M Hlengwa (IFP) drew attention to the high mortality rates in KZN and questioned the closing of some of the clinics and hospitals such as the St Francis Hospital.

She enquired about the plans of the Department to address primary health care issues such as HIV and TB treatment in schools. A group of about 400 nurses were trained to assist with the Covid-19 pandemic.

She wanted to know which provinces the nurses came from as a large number of them had not been absorbed in the system. She enquired about the status of the group of community health care workers who did door-to-door visits to help sick people but who had subsequently been rejected in KZN although they had been at the forefront to provide health care.

She called on the Department to intervene by absorbing the young community health care workers into the system and sending them for nursing training.

Ms N Chirwa (EFF) requested the Department to report on the obstetric services improvement plan in relation to the issue of forced sterilisation.

She asked for an update on the victims of forced sterilisation whose names and contact details had been sent to the Department. She asked if any of the victims had been contacted and if services were offered to them.

She questioned why the compensation for victims of forced sterilisation had not been forthcoming. She had been raising the issue of surgical and transvaginal mesh for a while and requested an update on the matter as the use of transvaginal mesh had been revoked in other countries.

She said the issue of obstetric violence was not being taken seriously by the Department. In terms of reports by the AG and the Commission of Gender Equality (CGE), pregnancy termination was not accessible in three provinces including the Eastern Cape. She sought clarity on how the Department was planning to resolve the matter.

She requested an update on the insourcing of cleaners and security guards. She enquired about the restoration of services at the Charlotte Maxeke Hospital following reports of a cancer treatment crisis as a result of the fire at the hospital. She wanted to know what was being done to mitigate the impact of the fire on health care services. She questioned the lack of detail in the NHI plan on the issue of sustainable practices for the development of new buildings and infrastructure. Even with the NHI, people in townships and informal settlements would still be required to use the current health care infrastructure. The government needed to intervene on a national level to fix the infrastructure in townships and informal settlements.

Mr E Siwela (ANC) hoped the Department would be able to achieve all the targets it set out in the APP. He asked what lessons had been learnt from the experience of the pandemic to improve the public health care system. He wanted to know how the Department was supporting the use of domestic healthcare products and innovation in the healthcare supply chain. He asked how the Department was supporting the Nelson Mandela / Fidel Cuba collaboration programme and what the impact of the programme was for health skills development in the country.

He enquired about the timelines for the executive bills, i.e. the Control of Marketing of Alcohol Beverages Bill, Liquor Amendment Bill, Cannabis for Private Purposes Bill, Traditional Health Practitioners Amendment Bill, Health Ombud Bill and the Office of the Health Ombud Bill.

Ms M Sukers (ACDP) asked what steps had been taken to improve the quality of services at health facilities given that it was a priority in the last financial year. She reported receiving complaints on a monthly basis about the quality of health care services at hospitals in her constituency. She requested an explanation of the indicator to reduce the drug and substance abuse targets and asked if an inter-sectoral plan was in place to address the problem. An increase in mental health cases had been observed while the capacity of institutions remained low.

She asked what was being done to improve mental health care services at the primary care level. She drew attention to the case, which she reported to the Committee in 2019, of a young doctor who for the past five years is being penalised for providing counselling services about pregnancy termination. She asked how the Department was ensuring the wellness of women.

She emphasised the need to track teens living with HIV/AIDS because they were struggling to stay on the treatment programme. She was aware of a case in 2020 of a teen who discontinued treatment due to the lack of confidentiality and sensitivity at the clinic. She asked what was being done to address the morale of staff at primary health care centres.

Ms E Wilson (DA) said it was easy to set targets but dealing with the conditions on the ground required everyone to be prepared to get out of their chairs. She described the situation at the Livingstone Hospital as a nightmare. Service delivery had stopped due to non-payment for services.

She drew attention to the plight of a four-year-old child who had been awaiting surgery for four days without being taken to the theatre. During this period, the child had been without food. The Philadelphia Hospital, which was providing services to three other hospitals in the province, reported the highest number of still-born cases. A woman lost her baby after complications with her uterus and the inability of the hospital to provide emergency care as the maternity ward does not have a theatre.

The oncology department at the Rob Ferreira Hospital had a backlog. The water from the borehole at the clinic was so badly contaminated that people who go there for health care services end up getting sick. Therefore, the medico-legal claims did not come as a surprise. The Department would be crippled if only 45% of claims were paid but no amount of money could bring back the lives lost. She requested reports on medical laboratory facilities.

She was disappointed that no responses were forthcoming on the cases of sexual harassment that had been referred to the Minister and the DG. She asked if the Department was aware of the number of women in service who were being subjected to harassment. She raised concerns about the dumping of medical waste which was becoming a serious problem. She questioned the amount of money being budgeted for NHI implementation considering that it was no way near the implementation stage as the clause-by-clause discussions still needed to be done. She wanted to know what the NHI allocated funds were going to be used for.

The Chairperson stated the infrastructure development projects and maintenance plan were part of key diagnostics provided in the Presidential Health Summit which was critical to health care service delivery. He asked how the Department could help to attract funding as a contribution to the public health care system. He wanted to know which programmes were receiving such support to mitigate the budget constraints. Compliance with environmental health norms and standards is set at 75%. He asked what the level of compliance was for all nine provinces.

He enquired about the number of clients lost due to lack of follow up for TB and HIV treatment and how the causal factors could be addressed beyond community participation. He asked about the impact of the community health workers on the TB and HIV treatment programmes. He enquired about the interventions in place to realise the 60% target for Covid-19 vaccination of people in the 12 to 34 year age group considering the low uptake by young people.

The Chairperson called on the Minister and officials of the Department to proceed with the responses.

The Minister requested the DG to allocate the questions to the appropriate officials for responses. The Minister would note the gaps and respond to them afterwards.

The DG replied to the sexual harassment case, stating it had been elevated to the Presidency. The case was being investigated by a special task team, which involved the relevant law enforcement agencies and an advocate from the Department. The Department had a zero-tolerance policy in terms of GBV in the workplace and took every case seriously. An update would be given once the high-level team had finalised their work.

The DG explained the rationalisation of services was an ongoing process in an attempt to remove duplication of services in all provinces. For example, the three hospitals in Pietermaritzburg were designated as district, regional and tertiary institutions. A similar exercise was done with the Newcastle Hospital which was designated as a mother-and-child hospital while the Madadeni Hospital was designated as a regional hospital to deal with all other cases. Similarly, the Queen Nandi and St Francis Hospitals were developed as mother-and-child hospitals while the other hospitals in nearby areas were designated as regional hospitals. Rationalisation also took place in terms of the management teams of these hospitals. Communication on these matters was important to ensure that stakeholders are aware of the changes. The DG assured Members that there was no plan to close the hospitals. It was a matter of rationalisation between the hospitals which are closely situated in the same area.

The DG reported that 66 facilities were affected due to roads leading to health care centres that were destructed. The Ministry, accompanied by the MEC of the province visited the affected areas. The infrastructure team had completed initial assessments and met with National Treasury to discuss systems that could be put in place. An important issue was the supply of water to the facilities which was being done by water tankers to ensure the continuation of services. The Department was engaging with municipalities and the Department of Water and Sanitation (DWS) to assist with the provision of water. Forensic services had to deal with an increased number of autopsies. The capacity to clear post mortems was increased through the assistance of the private sector. The Deputy Minister participated in providing outreach services to affected communities. Concerns were raised about the possible outbreak of waterborne diseases such as cholera, salmonella, typhoid fever and e coli-related diseases which are common after a flood. The Environmental Health teams of the Department were working with municipalities and the DWS to purify water to prevent the outbreak of diseases.

Dr Nicholas Crisp, Deputy Director-General (DDG), DoH, said an important lesson learnt from the Covid-19 pandemic is that we are one nation and not nine provinces. The public and private sectors needed to work together. Digital systems need to be integrated so that the public and private sectors could access the same dashboards. Managing a large volume of vaccines and the logistics of procurement was another valuable lesson.

The DDG confirmed the registration of medical aid beneficiaries was being legally challenged. The private sector established a health sector exchange but a lot of work still needed to be done to make it work smoothly. The organogram for the 70% of staff to support the implementation of NHI was still under development and will be shared with the Committee once it had been finalised. The bulk of the NHI spending had been approved by Parliament. It was intended to strengthen the health system through the improvement of primary health care including oncology services. He explained that patients on the HPRS system were people who registered themselves on their visits to the facilities. In addition, there was a correlation between the databases of the Department of Home Affairs (DHA) and DSD. The AG was monitoring the system. The registration of patients on the CCMDD programme was aimed at facilitating the delivery of chronic medication. The team involved in this specific programme won an innovation award for their work.

The Department of Science and Innovation was leading vaccine development through partnerships with Afrigen which is based in Cape Town, Biovac which is a partly state-owned company, Nant-SA which is an American based company owned by a South African born philanthropist and the Aspen plant based in Gqeberha. The Department of Trade and Industry participated in the establishment of the state-owned pharmaceutical company, Ketlapela. The process was not straightforward but discussions were ongoing.

The Department was closely monitoring the recent increase and trends in Covid-19 infection rates. The BA4 and BA5 Omicron sub-variants were identified as the dominant sub-variants in our region. The Johnson & Johnson and Pfizer vaccines, which were in abundance in the country, proved effective for treating the next wave of variants. It was important for the public to know that vaccine boosting creates a cellular immunity which was a longer-lasting immunity than the anti-body response from virus exposure. The DDG dispelled the idea that the NHI grant allocation was returned to National Treasury. The money was instead shifted to strengthen the fight against Covid-19. The programme on digital transformation formed a major part of what the Department was doing and which allowed the Department to have EVDS running so quickly. The Department was busy creating smaller computer programmes to deal with specific diseases. The aspiration was to have a single patient record that everybody could have access to but it needed time and connectivity. On reaching vaccination targets for younger age groups, the DG said adolescence in the 12 to 17 year age group may only use Pfizer but reaching them was a challenge. Young people between 18 to 34 years formed the biggest part of the population and the largest part of the working force. This group, in general, did not believe that Covid-19 would affect them badly although some with underlying conditions were at risk and consequently there was a big chance of them infecting other people and putting older family members at risk. The Department was constantly reviewing new ways to improve vaccines.

Ms Valerie Rennie, Head: Corporate Services, DoH, explained that the Control of Marketing of Alcohol Beverages Bill, Liquor Amendment Bill and Cannabis for Private Purposes Bill were the responsibility of other departments. The Department would be approaching Cabinet by the end of June 2022 to present the Traditional Health Practitioners Amendment Bill, Health Ombud Bill and the Office of Health Ombud Bill.

The Western Cape participated in the tender process for the medico-legal case management system but subsequently indicated that it had a functional system in place, hence the exclusion of the province. For the purpose of consolidation, data from the Western Cape DoH is submitted to the National DoH when required. The implementation of the case management system for medico-legal claims in the previous year had been dealt with in four of the eight provinces, i.e. KwaZulu-Natal, Northern Cape, Free State and North West. The rollout of the system in the current year was aimed at the remaining provinces, i.e. Eastern Cape, Gauteng, Mpumalanga and Limpopo. The Department was unfortunately not able to hire cleaners and security guards in the current financial year as the cost estimates for the insourcing of cleaning and security services proved that insourcing would be unaffordable.

Rev Ramphelane Morewane, Acting DDG: Primary Health Care, DoH, confirmed the Department did not have activities under the Mental Health Policy Framework plan in the 2021/22 financial year. Development of the framework would proceed in the 2022/23 financial year. He acknowledged the weaknesses in providing mental health services. The Mental Health Care Review Board was introduced to work with service providers to protect mental health users against abuse. The Minister appointed the independent advisory committee, beyond the influence of officials of the Department. The Human Rights Commission (HRC) identified the lack of cooperation between entities. Subsequently, an inter-sectoral approach with the DSD and DBE was introduced. The integration of mental health services ensured the employment of skilled mental health workers.

The Acting DDG Primary Health Care stated the Health Sector Drug Master Plan was developed with the participation of all stakeholders to address the substance abuse problem. Through the cancer support programme, the Department was educating mothers about early detection methods at all primary health care facilities. Throughout the Covid-19 pandemic, nurses at primary health care facilities were at the forefront of supporting communities. He agreed that social media platforms were agile but ensured Members that the Department was making sure that health promotion messages were reaching as many people as possible through all the different gadgets. The strategy to address stunting was to educate mothers about childcare through the vaccination and immunisation programmes at clinics. The Department was ready for any resurgence of new variants and was in communication with all stakeholders to keep abreast of developments. The Department was working closely with academia on a National Climate Adaption plan. The Department want to ensure that all municipalities deliver services in compliance with the Environmental Health norms and standards. Of the 52 municipalities assessed, 24 reached the 75% level. The municipalities that fell below 75% were being further assessed for the factors that impacted the ability to reach the set target.

Dr Zukiswa Pinini, Chief Director: HIV/AIDS and STIs, DoH, stated 390 000 TB infections were reported annually but funding was based on an estimate of 200 000 infections, hence the shortfall. Factors affecting the difficulty to comply with treatment included the mobility of patients and patients with both HIV/AIDS and TB. Community workers were tasked to trace patients who disengaged from the treatment programmes. The treatment programmes had also been affected by the Covid-19 pandemic. The delivery of medication was managed through the assistance of partners in the health care sector.

Dr Pinini explained the DBE had an integrated school policy in cooperation with school governing bodies to assist learners living with HIV/AIDS. A youth-friendly service was available at clinics where trained health care workers assist learners. The Department had outreach programmes at universities with the support of partners who were developing strategies to educate young people in health care services. On the matter of obstetric services, she said reports of pregnancy terminations had been received from the Eastern Cape, proving that the services were being offered in that province.

Ms Chirwa asked if both the AGs and CGE reports about the three provinces not offering pregnancy termination services were incorrect.

Dr Pinini replied that the Department had received a report of a number of pregnancy terminations in the Eastern Cape. She further explained the standing operating procedures and guidelines for the use of transvaginal mesh were being reviewed and would be finalised within this financial year. The Department was monitoring the practices.

Ms Chirwa asked if the Department had investigated the transvaginal and surgical mesh crisis.

The Chairperson suggested that Ms Chirwa submit her concerns to the Department in writing.

Ms Chirwa said the request was unfair as she had previously raised the issues and was following up on the matters. It was clear to her that the Department did not investigate the issues. This indicated to her that obstetric violence against black women, who are suffering from a condition of leaking wombs, was not a concern to the Department.

Ms Gela interjected, stating that she was tired of the EFF disrupting the meetings. She agreed with the Chairperson that the matter should be submitted to the Department in writing.

The Chairperson interrupted the debate between Ms Chirwa and Ms Gela and requested that the sound be muted.

Dr Thembekwayo noted that it was unfair to only mute the sound of Ms Chirwa. She requested Ms Gela refrain from expressing her irritation with the EFF.

The Chairperson said points of order should be raised orderly. He would fairly allow time for a response. The Department should be given time to respond in writing if the answer was not readily available. It was incorrect to allow the meeting to descend into chaos.

Mr Ayanda Dakela, Chief Director: Infrastructure and Facilities Management, DoH, said the 66 facilities affected by the KZN floods involved six districts, 34 clinics, three public health facilities and 23 hospitals. In addition, five other facilities including EMS stations were also affected. The R200 million budget required for rebuilding the affected facilities was quantified by an engineer. Complaints about the slow progress on fixing the Charlotte Maxeke Hospital had been forwarded to the Presidency. The Minister was then asked to intervene. In a meeting between the Minister and the Premier of Gauteng, it was decided to transfer the project to the National DoH. The plan was to open the emergency unit at the end of April 2022. Units in blocks one to five were scheduled for completion by the end of 2023 which was 36 months earlier than the original timeline of January 2027. The reduced project timeline would save the Department R305 million. The partnerships with universities in terms of projects at the Chris Hani Baragwanath, New King Edward, Dr George Mukhari, New Soshanguve and New Tygerberg Hospitals were being revised. These projects were related to teaching institutions and part of the requirements was to partner with universities that normally fund their own sections of the hospitals designated for teaching purposes.

Dr Crisp responded to the issue of alleged forced sterilisations by stating that an investigation had been done by a committee that had been appointed. A report was submitted to the Minister, however the response from the committee was beyond the scope of the question that was posed. The matter was subsequently referred it to the CGE. In the process of the investigation, the committee raised a raft of questions which are to be incorporated in all permanent structures of the Department. From the 48 women on the original list, 22 were traced and their detail was passed on to the heads of the provincial hospitals where the women reside, requesting them to continue with the clinical care of identified patients.

Dr Pakiso Netshidzivhani, Chief Director Medical Forensic Services and other Programmes, DoH, stated that ten nursing colleges were designated through government gazette to offer the new nursing programmes including higher certificates, diplomas and Bachelor degrees. These programmes were being offered at all colleges, effective January 2020. The Department was in the process of finalising accreditation for post graduate diplomas by the Council of Higher Education. She noted that the tenth college was the college for South African Military Health Services.

The Minister said the Department was available to deal with all matters including forced sterilisation. The CGE report indicated that a number of the allegations of forced sterilisation could not be substantiated in terms of access to records. The Department was receiving letters from lawyers on a daily basis hence the Committee should be made aware of people being instructed to raise particular issues on this platform.

Ms Chirwa raised a point of order.

The Minister asked for protection from the Chairperson as he was still making his point.

The Chairperson replied to the Minister that he was obliged to take a point of order.

Ms Chirwa said she took victims of forced sterilisation to the Steve Biko Hospital but they were not assisted. She demanded to know how the health issues of the victims had been dealt with.

The Chairperson asked Ms Chirwa to allow the Minister to answer the current situation.

Ms Chirwa insisted to know if the victims had been assisted. She chastised the Chairperson for attempting to respond on behalf of the Minister.

The Chairperson instructed the operator to remove Ms Chirwa from the platform.

Mr Munyai said the Chairperson should not allow the Minister to be disrupted when he was answering questions.

The Minister said while Members were free to raise issues, it should be done respectfully.

Dr Thembekwayo again interrupted the Minister and stated that Ms Chirwa should be allowed to listen to the Minister’s response to her questions.

Annoyed by the continuous interruptions, the Chairperson called on Members to not use the platform to create havoc. He said this had been an ongoing problem which he preferred to put on the back burner for now.

The Minister explained that systems were in place to manage particular medical conditions. A complaint linked to particular a province, where the alleged procedure took place and where the records could be located at the particular facility, should be referred to the provincial hospital where the issue could be dealt with.

Ms Chirwa again attempted to interrupt the Minister but was stopped by the Chairperson who gave the Minister one minute to conclude his response.

The Minister said staff shortages, as a result of the redeployment due to the Covid-19 pandemic, were persisting despite better resource allocation. The team would be asked to do a proper assessment on the issue of undocumented migrants which should include advice from the Committee. Some health care facilities, for example, in Gauteng were dealing with between 40% and 60% undocumented migrants who contributed significantly to the severe neonatal and maternal outcomes which placed a huge burden on the fiscus and the capacity of health facilities. The Minister promised to report back to the Committee on the matter.

The Chairperson said Members had other avenues to obtain oral and written replies from the Ministry to any of the unanswered questions. In light of the difficulty experienced toward the end of the meeting, he did not allow any further questions to be raised.

The meeting was adjourned.

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