Health Sector overview; Fifth Parliament Legacy Report

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Health

28 August 2019
Chairperson: Dr S Dhlomo (ANC)
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Meeting Summary

Legacy Reports

The Committee Secretary briefed the Committee on the Legacy Report which is a reflection of the key activities and challenges of the Portfolio Committee on Health during the Fifth Parliament, matters remaining for consideration in the Sixth Parliament and recommendations to strengthen operational and procedural processes to enhance the Committee’s oversight and legislative role.

The Director General of the National Department of Health provided an overview of the public health sector. She spoke about the programmes and policies the Department has put into effect and if they have been successful. She noted the challenges NDoH faces. These include the litigation against the Health Department. Various law firms are claiming exorbitant amounts of money from the Department. The current model of resource allocation is centralised and she spoke about how this negatively affects the operation of hospitals. She noted the dissatisfaction with the services rendered in the public sector in general.

Thereafter she looked at the five health entities responsible for the quality of health that the state provides. She outlined their strategic objectives, achievements and the risks and challenges they face.

Meeting report

Legacy Report of Fifth Parliament Committee
Ms Vuyokazi Majalamba, Committee Secretary, on the Legacy Report which is a reflection of the key activities and challenges of the Portfolio Committee on Health during the Fifth Parliament, matters remaining for consideration in the Sixth Parliament and recommendations to strengthen operational and procedural processes to enhance the Committee’s oversight and legislative role.

The Committee engaged all provincial Departments of health on the state of health and hospital services in the country. The Committee deliberated on the following Bills:
• The Medicines and Related Substances Amendment Bill [B6-2014]. Status: Act has commenced .
• Medical Innovation Bill [PMB1-2014]. Status: Concluded Bill was not desirable.
• National Public Health Institute of South Africa Bill [B16-2017]. Status: Bill was adopted.
• National Health Laboratory Service Bill [B15-2017]. Status: Act has commenced.
• Choice on Termination of Pregnancy Amendment Bill [B34-2017]. Status: Bill was not desirable.

Legislation implementation that need to be followed up included:
• Monitor South African Health Products Regulatory Authority (SAHPRA), a newly established entity.
• Ensure Office of the Health Ombud resource constraints are addressed.
• Monitor National Health Laboratory Service (NHLS) to ensure improved governance.
• Monitor establishment of National Public Health Institute of South Africa (NAPHISA).

Oversight visits included Mpumalanga, Free State (two visits), Limpopo, Eastern Cape, North West, Gauteng, KwaZulu Natal and the National Health Laboratory Service. The Committee undertook a study tour to Cuba and the lessons learned there included:
• Primary healthcare is in line with the foundation of South Africa’s National Health Insurance.
• Polyclinics are fully-equipped and serve as primary platform for treatment and training.
• There is coordinated use of complementary medicine at primary healthcare level.

Outstanding matters included:
• Communities of Spa Park and Koppewaai in Ward 9 in Bela-Bela, Limpopo, requested Parliament facilitate the urgent re-opening of the local clinic which was closed in 2015.
• NHI Evaluation Report from the National Department.
• There was supposed to be a joint workshop between the Departments of Health, Labour and Mineral Resources to facilitate the amalgamation of the compensation legislation.
• The Committee did not visit all entities in the different provinces.
• National Department needed to address the legislation confusion to address independence of Health Ombud as Ombud cannot be budget dependent on the body that it is meant to investigate.

Fifth Parliament Committee concerns and recommendations included:
• National Department budget spending not in line with service delivery performance with high budget expenditure but poor performance against set targets in some programmes.
• There is a lack of consequence management for poor performance and transgressions.
• They wanted a revival of the Global TB Caucus and establishment of the Joint Committee on HIV/AIDS.
• It recommended enhanced working relationships with other Portfolio Committees.
• It recommended training of Committee members and staff is essential for effective oversight.
There were 23 recommendations in all (see Legacy Report).

Discussion
The Chairperson asked Members to view this Legacy Report as homework. Members must look at it and see what they want to be continued and communicate that in the next meeting.

Ms A Gela (ANC) thanked the Secretary for the presentation and said it put things into perspective. She wanted to follow up on the outstanding matters. These matters need to be relooked at so that they can be taken forward. On the oversight visits of the previous Committee, she asked if these would be followed up on by the current Committee.

Mr M Sokatsha (ANC) welcomed the clarity of the report. He did mention that the use of acronyms should be limited as it is confusing for Members and the mistake of using one for the other could occur.

Dr S Thembekwayo (EFF) commented that the Health Ombud matter must be looked into and the NHI outstanding matter, especially since there are still so many unanswered questions about the NHI. The new Parliament needs to address these.

Mr P Van Staden (FF+) noted that an important item was budget spending not being in line with service delivery targets. He asked about Life Esidimeni – now that the Ombud has released its report on the matter, is the Committee going to do anything? This matter was particularly traumatic for the people of Gauteng, it is a matter that the Committee should consider addressing. On NHI, the same should be done.

Ms M Hlengwa (IFP) agreed with the Members that this Committee should follow up on some of the recommendations by the previous Committee. She wished for clarity on the time frame for the Bills the Committee would deal with in the future.

Mr K Jacobs (ANC) said there are 23 recommendations and they are all important recommendations. He suggested that there should be another meeting where Committee is educated on these as these will be important for Members especially when it comes to oversight responsibilities.

The Chairperson remarked that the NHI Evaluation Report has to have more information. It should document the pilot project in all eleven districts on all levels of healthcare. The Committee must decide when it will have a strategic planning session on what it is going to do going forward. Possibly it should have a meeting with the Gauteng Department of Health on the state of healthcare in the province especially after the Life Esidimeni scandal.

General State of Department of Health
Ms Malebona Precious Matsoso, NDoH Director General, explained that the Department has just finished a appraisal report on the past 25 years of development in the Health sector. The reason is to look at past mistakes to see the kind of changes the Department can make to be in line with sustainable development and the National Development Plan. The data in this report is demographics sensitive. There is an NHI Evaluation Report which will be made available to the Committee, so it will be possible to read it with the appraisal report to make better sense of the NHI.

She talked about how the demographics of the country shape the kind of interventions that the Department undertakes. The Department looks at gender to see who is the most affected and how best to intervene. For interventions, this is important as it notes group projections and how to best to curb any negative projections. The good news is that life expectancy has been increasing, this is largely due to the HIV/AIDS programme. The province with the highest life expectancy is Western Cape followed by Gauteng. There are social determinants for life expectancy around service delivery and the Free State seems to be suffering from these the most. The maternal mortality rate was expected to be far less than it is now. For that to happen by the end of 2024 the DoH is going to have to implement aggressive interventions. Where the Department is doing well is paternal mortality. Another area of concern is nutritional data on children. The demographic health survey taken in 2003 in comparison to the most recent study shows that stunting has not changed, this should be a matter of concern.

On the burden of disease relative to social determinants, what was found was that if you look at the stages of development of a child, it is not the health sector response that is to blame but rather a government wide response that is failing to address these matters. These include unemployment, access to schools, formal training, piped water, and sanitation.

There has been a steady decline in HIV/AIDS in the country. With TB, there is not as much progress as is necessary. The Western Cape has one of the worst records when it comes to follow ups. The DG said that it would be interesting to see the reason for this, is it because of migration perhaps? The highest rates, however, are in the Free State. The DG reiterated that even in this situation it is a matter of other social determinants that affect how bad these results are. The country had been doing very well with malaria, in fact the country even received an award in 2008 for its efforts in combating it. However, in 2017 it seems to have resurfaced again. A case surfaced in Limpopo even though the area had never had a case of malaria before. Treasury has made funds available for the training of people, so the Department is back on track.

There are other causes of mortality and the DG talked about non-communicable diseases such as cardiovascular diseases. It seems that cardiovascular diseases are on the decrease, diabetes is slightly increasing while cancer has remained the same. The DG commented that it would be interesting to know the causes of these changes in disease trends as currently DoH is seeing changes without understanding the reasons. Is it because of the success or failure of government interventions? When it comes to tobacco use there has been a decrease in both men and women. This could possibly be pinned to policy decisions about the tobacco industry. Alcohol, however, seems to be going up; among men it seems to be skyrocketing.

The DG talked about the state of South African primary healthcare. She said the country could be much better, in fact, it is struggling. The South Africa – Cuba programme is one of the steps DoH has taken to address this. Cuba is known for its great primary healthcare system. Students from South Africa are sent to Cuba to study medicine. The plan is to integrate them into the South African primary healthcare system to improve its efficiency. Normally upon completion of their studies students are placed in bigger hospitals. The DG said she wanted a balance, some of them have to go directly into primary healthcare. One of the reasons for this is that by the time patients especially children reach tertiary or regional hospitals, they are already too sick and this unnecessarily adds a burden to these hospitals. The second part to the efficacy of primary healthcare is the use of Community Healthcare Workers (CHW). They are important because they are an extension of the healthcare system. Many of them are hired for educational and monitoring purposes. However, for them to be actively involved in this work there has to be some kind of remuneration for them. Some of them want to be involved in their communities but cannot do so because they cannot afford to travel around the community. A transport stipend is something that needs to be considered for them.

The constraints that affect the health system:
• The first one is the fragmented healthcare system: This includes the lack of funds for the public sector in comparison to the private sector. As a result there are not enough resources for services in the public sector and this includes the retention of viable staff within DoH. This is bad as going into next year there will be budget cuts for all the provinces.

• Litigation that DoH is involved in. There are various law firms claiming exorbitant amounts of money against DoH. These need to be revaluated because there are many cases of lawyer fraud where lawyers sue DoH and make fraudulent claims against DoH. The DG talked about a lawyer recently out on bail in the Eastern Cape who had over R200 million in claims.

• The model for resource allocation is very centralised. There are challenges with emergency medical services because of how complicated the system is. There needs to be one system that regulates this kind of services. There needs to be standardised training for EMS. The manner in which resources are allocated is not proportional. There are places that get far fewer resources than others. Sometimes it is not that there are not enough resources but just that they are poorly managed. For example there are 5 000 EMS personnel.

• There is dissatisfaction with the services rendered in the public sector. Patients have spoken about the waiting time being way too long and not treated well by staff. Those who had received private healthcare in the past talk about how they treated with respect in private hospitals. There were complaints about cleanliness. Patients felt that their health centres were not clean enough to be treated in.

Discussion
Ms E Wilson (DA) talked about how DoH caters for 60 million people when it should in fact be catering for 80 million people. This is where problem arises because budget wise, we are not catering for the right number of people. This is particularly concerning for places like Belabela in Limpopo where there are large numbers of foreign nationals and some that are not even documented. She commented on appointment of community health committees in communities where CHWs work. What happens is that political parties appoint people that come from elsewhere. She understands the challenge surrounding remuneration, but she thinks that if there was more clarity on who and where those committees should come from, they would work better.

She referred to primary healthcare reform, saying it is wonderful that DoH has plans on placing the Cuban students directly into primary healthcare. However, the challenge here is the budget cuts. DoH cannot claim to do something when budget allocations suggest something different. The current framework is clearly not working. There are hospitals that have not been built or some who do not have the funds for the contracts that they need, to continue running the hospital. She made an example of the hospital in Belabela where nurses find themselves having to form part of the cleaning and catering staff because the hospital contracts for those services had lapsed.

The amount of liabilities that DoH has is alarming and this seriously needs to be looked into.

On the state of EMS, she said that there is so much that is lacking here. Now some EMS staff are not allowed to intubate patients even though they have years of experience. This is because the new policy states that if they do not have the required four-year training, they cannot intubate.

Ms M Sukers (ACDP) thanked the DG especially for the work done on mother to child transmission of HIV and the decrease in HIV in general. On the legal claims against DoH, she asked what risk mitigating plans DoH has especially as hospitals themselves do not have platforms where patients can voice their dissatisfaction. This could be a platform that would allow them to improve on their service.

Ms N Chirwa (EFF) asked when it comes to non-communicable diseases, why are some provinces doing extremely well on some diseases while neighbouring provinces are the inverse of that. What are the reasons for these differences? She asked the reasoning behind the differences in resource allocations for different provinces. She asked for clarity on the HIV decrease especially in men – from what DoH has witnessed what are the reasons for this decline. She pointed to slide 58 that notes that 70% of the systems put in place by DoH have tested below 50%. Why are we using them if their outcome is not what we them to be, especially if their outcome is due to their being non-operational.

Ms Gela addressed CHWs, saying something needs to be done. This can be in the form of transport stipend. An opportunity of this nature cannot be advertised only to people who live close to these clinics because people in the community at wide want to be involved but cannot because they live further from the clinic. It is important to encourage people to participate in this. If they do not have the means to do it, they will not be encouraged to do it. There are places that give these workers about R500 a month to help with transport; this is something that has to be considered on a wider scale.

Mr M Sokatsha (ANC) said the Nelson Mandela-Fidel Castro medical programme was a good idea. He asked about the number of students involved and the number of them that are back and working. When these students are deployed in primary healthcare centres, will these students be deployed to all provinces equally? What formula is there to ensure this happens well and they are sent to the places they are needed at the most. He liked the new DoH policy on nursing colleges which is standardising nursing education to curb against fake colleges.

Ms S Gwarube (DA) asked about the reorientation from Cuba to the south African healthcare system. What does this reorientation entail and how much is it going to cost? Has DoH considered if the training these students get in Cuba can be done domestically? She understands that the programme has been going on for years now but since there are financial constraints now, it might be something worth considering. On the accreditation of nursing colleges, she asked how this is going to affect the policy coming into effect in 2020 and if that is going to affect the number of nurses that are in fact trained. She questioned the national guidelines on sexual assault and asked what has come out of that relationship with the South African Police Service. On the financing programmes and the decentralising of funds to regional levels, she asked how this will align with the NHI because the NHI is more about centralising funds.

Dr Thembekwayo requested more information on the evaluation of the NHI because she believed that there are various stakeholders who might want to know that information but do not have because it is not made readily available. She asked about human resources in the health sector as there are a large number of vacancies within DoH as whole. She asked about the plans DoH has to fill up these vacancies especially those that relate to the NHI administration. Is this not adding problems to the ones that currently exist? Can we not fix the problem we have now before partaking in such a huge policy? Essentially this means that the NHI administration will have to be stellar for it to pick up. She commented DoH wants to build and refurbish all hospitals within five years, this is not realistic. Perhaps there could be some prioritisation on the ones that need help the most. DoH wants to move to e-records but the reality is that there are clinics that do not have electricity. How is this feasible? She questioned the studies conducted by DoH. She asked who the respondents for these studies are and from which hospitals they are because she thinks that patients are far more dissatisfied than the report shows.

Mr Van Staden said South Africa has a shortage of doctors and nurses but why does the training have to be done in Cuba and not here. There are universities that specialise in that. He asked the reason for the occupational concerns for employees and what DoH has done curb them. He questioned the private contractors that Department has hired to oversee digitisation of a certain platforms. Why does DoH not have its own IT department where this can be done? It will probably be cheaper. How many of these 5000 emergency vehicles are operational?

The Chairperson remarked about people not going to clinics to get tested. Can they not be tested where they are, such as at taxi ranks. This is especially possible because there are CHWs that can do this kind of work. He was sad to hear about malaria in Limpopo. He suggested there seems to be a shift in attention with more focus on communicable diseases at the expense of non-communicable diseases. We are doing extremely well in one epidemic but performing terribly on the other. He also asked about the possible training of students locally. He recalls that at some point universities were against taking in more students as they felt that they did not have the capacity to train bigger numbers. He asked if there is any change in attitude towards this. He asked who makes the decision on how much provinces should receive for budget allocations. DoH has not said much about the MomConnect initiative. It would be great if there has been any form of improvement since it has been introduced. The report shows that there are pregnant women who access clinics before they are five months pregnant. What is the reason for this. Is it CHWs that facilitate this or is it the women themselves that are motivated to do this?

Ms Wilson asked about people who want to license their clinic at the provincial level. There are people who want to set up clinics for their staff but cannot do so because there is no clear way of doing it.

Dr Thembekwayo said that there is a number of nurses who have qualified, even through universities, who do not have employment. Who should be contacted about this kind of challenge?

Responses
Ms Matsoso replied that when it comes to the population, it is difficult to be certain about illegal immigrants because as far as Home Affairs is concerned, they are not there because they cannot be tracked.

When comes to the formation of local community health committees, the Act is very explicit on how these committees should be appointed. Perhaps the questions to ask is what needs to be achieved, is it representation of the communities. There may be times where you might want people who are more specialised to see on how best to provide for certain communities. The Minister has suggested that perhaps there should be a user of these services as it is with school governing bodies because they can share their experiences.

On the centralisation of funds, the DG noted that this is not with regards to everything. Laundry services, catering and cleaning are matters that could be within the power of the CEOs of the different hospitals. Matters like how much should go to the different regions for example is something that should be centralised so that there can be a regulating body to ensure everyone follows the guidelines.

On medical litigation, DoH is waiting for the figures on how much is being spent on claims What was picked on was that some of the cases were fraudulent. There has been collusion between lawyers and some officials. Department of Justice has made a suggestion that there should be a mediation group that deals directly with families to decrease the amount spent on legal fees.

On EMS services and the change in policy, she said that there has been collaboration with Prof Watson from the University of Cape Town who is there to assist on the rollout and structure of the policy.

The Nelson Mandela-Fidel Castro programme is important. There still remains a need for a decentralised programme for the distribution of these students. There might be a hybrid system that includes both the current programme for students and one that prioritises training of students here in South Africa.

The use of “All” when referencing hospitals was meant to ensure that there is clarity on the amount of money that will be needed to do everything not just those that need to be built but those that need to be maintained as well.

Dr Yogan Pillay, Deputy Director-General: Communicable and Non-Communicable Diseases, replied that when it comes to cancer, there has been provision for a number of medical linear accelerators in Charlotte Maxeke and in the Northern Cape and Limpopo. Mthatha is now providing chemo and radiation in house. In general, DoH is increasing its investments on cancer treatment. Upon calculating how much it cost to do this, it went to Treasury to ask for money to do that. They said no to this request. When it comes to non-communicable diseases like diabetes, we are starting to see a reduction in consumption of sugar in general. DoH is working with the food and beverage industry to help people make better choices.

The DG responded that MomConnect is celebrating its fifth anniversary this year. The Minister will have an event to address some of the issues around the programme.

The DG replied that there is a drive to increase CHWs. There are going to be about 5 000 more CHWs added this financial year. The only challenge is mapping out the areas that need them the most so that resources can be allocated accordingly.

Public Health Entities
Ms Malebona Precious Matsoso, NDoH Director General, briefed the Committee on the entities responsible for the quality of health that the state provides. There are five public entities under the health mandate. All are listed as schedule 3A Public Entities in terms of the Public Finance Management Act (PFMA). She went to talk about them individually looking at their strategic objectives, budget for this financial year, their achievements and the risks and challenges they face.

Council for Medical Schemes (CMS)
CMS was established in terms of the Medical Schemes Act of 1998. It protects the rights and entitlements of all members of medical schemes particularly the activities and functioning of medical schemes and their administrators and brokers. The strategic goals are to promote access to good medical schemes; ensure medical schemes are regulated, governed properly, responsive to the environment in which they function while making sure that all this environment is fair, transparent, effective and efficient.

Some of the challenges for CMS include creating a framework that will have low cost options, the Low-Cost Benefit Option (LCBO) Framework. CMS has been struggling when it comes to standardising the options available. It is a struggle to support cost reduction and quality improvements efforts in the health sector because in many cases cost reduction and quality schemes do not go hand in hand. It has been hard to coordinate efforts in the private health sector aimed at reducing fraud, waste and abuse. The other problem CMS has been facing is that poor governance and financial management of schemes have resulted in a number of schemes being placed under curatorship. There has been a decline in the number of schemes available from 83 in 2014 to 80 in 2017. This poor governance has seen CMS under immense pressure as the number of complaints lodged with CMS increased from 3 876 in 2014 to 4 667 in 2017.

Despite these challenges there have been some key achievements. Schemes have maintained an average solvency ratio of 33.2% compared to the statutory requirement of 25%. The review of the Prescribed Minimum Benefits (PMBs) currently underway is of a comprehensive nature that will lead to a service-based package instead of the current diagnosis-based list. The addition of a comprehensive preventive and primary healthcare-based service is a radical departure from PMBs. On how the NHI will affect these, the DG stated that there has been a significant alignment between NHI benefit package and future PMBs.

National Health Laboratory Service (NHLS)
The NHLS is established in terms of the National Health Laboratory Service Act of 2000 to provide a quality, affordable and sustainable health laboratory and public health service. It has 268 laboratories in nine provinces, linked to ten medical schools and universities of technology. It is highly acclaimed for its superior academic team, which conducts research specific to South African health matters such as tuberculosis, meningitis, malaria pneumonia, HIV aids and cancer. They train pathologists, scientists, medical technologists and medical technicians in conjunction with medical schools and universities of technology. It provides surveillance support for communicable diseases, occupational health and cancer. The DG stated that she is pleased with how much they have been able to achieve as a team.

She noted the main goals of the NHLS are to provide modernised and accessible laboratory services to make sure that regional hospitals or above are fashioned with a pathologist each. At places of higher learning they ensure academic excellence in training and research for highly competent health pathology professionals. They are tasked with the organisation for improved service delivery and implementation of NHI through the integration of resources, systems and the improvement of monitoring and evaluation.

The challenges NHLS faces have to do with historic constraints and inequities due to political structures of of the past regime resulting in a mismatch of services. This has led to an inheritance of multiple laboratories with variable levels of quality. Some leadership challenges have emerged. There are cases where there is duplication of services, resulting in wasteful expenditure. The lack of standardisation of laboratory information technology has led to ineffective national reporting of laboratory results. All of this combined has led to a failure to keep pace with international trends and norms in laboratory services. This is particularly alarming since the NHLS has more laboratories per capita than any other country in the world. The DG noted some key challenges about the workforce recruitment and retention of skilled professionals; fiscal constraints which impact on the filling vacancies; inequitable distribution of human resource between rural areas and urban areas within NHLS, and private sector and NHLS; and international migration of skilled professionals.

Despite this, the DG noted some key achievements such as NHLS managed to have 99 laboratories accredited by the South African National Accreditation System (SANAS). They have achieved their training, teaching and research mandate by training 9 epidemiologists, 57 registrars, 36 intern medical scientists, supervised 29 intern and registrars in occupational health and safety and 284 intern medical technologists. For the 2018/19 it published 792 articles in peer review journals. They have responded to all notified outbreaks within 24 hours and conducted 36 occupational and environmental health and safety assessments. Perhaps one of the more impressive achievements by the NHLS is how the board and management have stabilised and improved the organisation financially. Over the last two years there has been a turnaround from a R1.8 billion deficit to a R1.4 billion surplus for two years. For the first time creditors are paid within 30 days; debtor days have been reduced substantially and there is settlement of some of high value long outstanding debt. There has been an increase in revenue collection coupled with effective cost-containment resulting in better cash flow and a four month reserve (R2 billion) need to ensure stability. They have also put in systems to better control the investment made in equipment and infrastructure.

Office of Health Standards Compliance (OHSC)
The DG mentioned that this entity is relatively new and was established through section 79(a) of the National Health Amendment Act, 2013. Its main objectives are to protect and promote the health and safety of the user of health services by: monitoring and enforcing compliance by health establishments with norms and standards prescribed by the Minister; ensuring consideration and investigation of complaints on non-compliance in a fair, economical and expeditious manner. Its main obligations are to publicly demonstrate responsiveness and accountability. They are there to progressively improve the quality and safety of healthcare through effective communication and collaboration with users and providers.

Office of the Health Ombud
The Health Ombud is mandated to consider, investigate and dispose complaints about non-compliance with prescribed norms and standards in a procedurally fair, economical and expeditious manner. What they have to do is create of an accessible mechanism to lodge complaints with the OHSC through a fully functional call centre system. They are responsible for issuing findings and recommendations about complaints of non-compliance standards within six months.

One of its challenges is visibility which could be said to be correlational with its legitimacy. The DG slightly disagreed with this point as enough has been done by DoH to ensure they are visible. Perhaps, she noted they mean on the part of Parliament not enough has been done to make them more visible. Another challenge is human resources as there is not enough capacity and skills to deal with what is required by the Ombud. There are inadequate norms and standards for different types of health establishments. Mention was also made of mechanisms for the management of complaints from healthcare users and communities.

Albeit the challenges facing the Health Ombud a total of 730 inspections had been done, achieving the set target of 725 for inspections, using the applicable inspection tools. The call centre enables members of the public to lodge complaints. There have been public awareness campaigns in a form of road shows in health establishments and provinces. Between October 2018 and February 2019 there were a series of consultative workshops with public and private healthcare sector stakeholders to communicate its work and the required norms and standards regulations in all provinces.

South African Health Products Regulatory Authority (SAHPRA)
SAHPRA is the regulatory authority responsible for the regulation of health products intended for human and animal use, the licensing of manufacturers, wholesalers and distributors of medicines and medical devices, radiation emitting devices and radioactive nucleoids; and the conduct of clinical trials. It is derived mainly from the Medicines and Related Substances Act of 1965. They are there to evaluate the applications for sale of unregistered health products in accordance with defined standards.

Their main problems are digitising the core functions of SAHPRA to ensure that the backlog of cases is addressed, and operations are adequately supported to permit effective tracing, monitoring and evaluation. This is needed as the backlog negatively affects applicant businesses and as a result it creates a reputational risk for the Authority. To address this adequate funding is crucial and continued efforts to increase revenue generation to supplement funding from National Treasury is very important. It was noted that attracting and retaining qualified staff is hard, partly because there is a lack of a well-designed rewards and remuneration strategy.

Some key achievements include the 195 health products that were registered in 2018/19. The Authority digitised and automated section 21 of the Medicines and Related Substances Act, which regulates the sale of unregistered medicines. Also, of the 20 applications for cultivation of cannabis, SAHPRA has inspected 16, including three sites, which were inspected for a second time. Three sites have been approved and a cultivation licence will be issued.

South African Medical Research Council (SAMRC)
SAMRC was established in terms of the South African Medical Research Council Act of 1991 to promote the improvement of health through research development. They are the centre for scientific excellence and are the custodians of medical research in South Africa. They are there to develop the country’s scientific capacity for future researchers. The DG commented that considering how good they are, if an AIDS cure is to come, it will be through this Council.

Its key challenges are inefficiencies in corporate processes within human resources, supply chain management and contract management. A challenge that needs serious attention is the lack of transformation and diversity within the SAMRC. Another matter is that of sustainably growing funding for the Council as it needs it to grow and better the quality of its research.

The council has, however, done very well in producing and disseminating new scientific findings and knowledge on health. They have done well particularly when it comes to material that addresses Malaria, Tuberculosis (TB), Human Immunodeficiency Virus (HIV) and Cancer. Amongst others, they provide funding for health research innovation and technology development - develop new diagnostics, devices, vaccines and therapeutics. They have enhanced the long-term sustainability of health research in South Africa by providing funding for the next generation of health researchers – through bursaries, scholarships and fellowships funded for postgraduate study at masters, doctoral and postdoctoral levels.


 

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