National Health Bill: briefing

Meeting report

SELECT COMMITTEE ON SOCIAL SERVICES
9 September, 2003
NATIONAL HEALTH BILL 2003: BRIEFING

Chairperson: Ms L Jacobus (ANC)

Documents handed out
National Health Bill 2003 (Amended version)
PowerPoint presentation by the Department

SUMMARY
The Department briefed the Committee on the salient features of the National Health Bill and amendments effected by the National Assembly. The Bill sought to establish a legislative and regulatory framework, create equity in service provision and establish norms and standards for better health care management.

MINUTES
The Chair noted that some members had attended the Committee briefings and also the education workshop on the Bill, so she asked the Department to highlight the Committee's amendments. The entire week following the briefing would be spent in provinces where public hearings would debate the Bill. Between 26 and 29 September, the debate on negotiating mandates would be finalised. On 11 October 2003 the final mandates would be accepted and passed.

Department briefing
Chief Director, Dr Chetty, said the Bill sought to establish a legislative and regulatory framework, create equity in service provision and establish norms and standards for better health management. She then went slowly through the Bill, noting the substantial amendments.
Chapter 1 contained provisions regarding the objects of the Bill, responsibility for health and eligibility for free health services.
Chapter 2 contained provisions regarding the rights and duties of service users and providers.
Chapter 3 made provision for the national department while Chapter 4 referred to provincial health departments.
Chapter 5 established a district health system based on key principles.
Chapter 6 made such provisions for health facilities.
Chapter 7 addressed the contentious issue of human resource planning and academic health complexes. Chapter 8 provided for the control of the use of tissue, blood, blood products and gametes.
Chapter 9 related to surveillance, research and information.
Chapter 10 deals with health officers and compliance procedures.
Chapter 11 empowers the Minister to make regulations on a wide range of issues relating to health.
Chapter 12 empowers the Minister to appoint advisory or technical committees.

Discussion
Dr Neil referred to subsection 4(3)(b) and asked whether people without medical aid were disqualified from accessing health services.

Dr Chetty said this section empowered the Minister to make appropriate adjustments to tariffs.

Dr Sibeko acknowledged Dr Neil's concerns and pointed out that the Department was restructuring the system to enable those without medical aid to access health facilities at an affordable cost.

Ms Lydia Johnson (ANC KZN) referred to sections 5 and 6 and sought clarity as to why the term "health worker" and "health care provider" were both used.

Dr Chetty replied that that a health care provider was typically a health professional who delivered medical services, as opposed to a health worker in the category of support staff.

Ms Johnson (ANC) noted that mineworkers were provided with free health care at work but this facility was not available to them at home, and wished to know what the Department was doing about this disparity.

Dr Sibeko reported that the country was currently moving towards compulsory health insurance where all workers would be covered in order to remove the disparity in access to health services.

Adv. Pearmain pointed out that the Department was not currently empowered to compel people to belong to medical schemes. Miners not on medical scheme would be covered in the Bill just like any other person.

Dr Neil referred to section 18 and queried the procedure here, noting that complaints against medical practitioners should be filed with the Health Professions Council.

Dr Chetty agreed but pointed out that there were some areas not covered under the Health Professions Council Act that the current provision sought to address.

Dr Neil singled out subsection 18(3)(a) and asked whether the proposed notice took language diversity into consideration.

The Chair said languages fell within the competence of provincial jurisdiction. Each province had a language policy that guided its information and communication activities.

Dr Neil asked the Department to explain why the original definition of the Emergency Medical Services (EMS) was abandoned at the National Assembly stage.

Adv. Pearmain said there had been a heated debate on the issue of the EMS in the Committee hearings as the definition hinged on a fundamental constitutional issue. The Constitution provided that a person could not be denied health services but the counter question was how universal care could be provided when not everyone subscribed to medical aid. It was decided that the law should not be prescriptive but rather "appropriate provision" should be inserted to empower the Minister to make recommendations.

Mr. Tlhagale (UCDP) noted that during debate in the National Assembly, various political parties took specific positions on the Bill. The Department should pinpoint these areas of concern to enable the provincial representatives to consider whether to pursue positions.

The Chair said NCOP delegates would take the Bill to the provinces provincial legislatures could comment. She ruled that this was not the forum to start debating contentious issues raised in the National Assembly.

Mr. Kgware (ANC) concurred and asked members to seek assistance on technical difficulties from the Committee's research unit.

Mr. Mkhize (ANC Gauteng) agreed with the Chair's position, noting that asking the Department to highlight points of controversy in the National Assembly would severely derail members' understanding of the germane issues in the Bill.

Dr Neil asked the Department to comment on the rumour that municipal health services would be re-allocated to provincial structures.

Adv. Pearmain replied that the truth was quite the opposite. The government considered primary care to be an essential service that should be easily accessible. The best delivery point was at the municipal level and therefore policy was moving towards achieving this goal.

Ms Vilakazi (IFP) noted that she had voiced similar concerns as those raised by Dr Neil during the Portfolio Committee deliberations. It would be difficult for provinces to accept the Bill if the delivery of primary health care was taken away and allotted to municipal authorities.

Mr. Mkhize (ANC) said that provincial powers should devolve to the municipalities and therefore there was nothing wrong in municipalities providing primary health care.

Ms Johnson said she understood that municipalities currently providing primary health care service would continue to do so until service level agreements were signed to formally assign this function to municipalities.

Dr Chetty noted that the matter revolved around an important policy question and that a system based on primary health care was recognised internationally. The need to bring health services closer to the people dictated that municipalities with capacity get involved, but not to the exclusion of provincial government. The latter should provide supervision that service delivery is of the right quality. It was within the provincial competence to provide essential health care services where municipalities lacked capacity.

Adv. Pearmain underscored that section 26 of the Constitution vested executive power in the provincial government but that the three spheres of government should work together.

Ms Vilakazi insisted that the constitutional position was not clearly defined in the Bill and that this was a recipe for confusion in implementation.

The Chair referred Ms Vilakazi to page 7 of the definition section where she said municipal services were clearly defined. Nothing would be added or taken away from the provincial structures unless and until service level agreements had been completed.

Dr Neil singled out Section 32 (2), which he said has restated what the Constitution already provides, and wondered whether it was necessary to have it there in the first place.

The Chair replied that the Bill contained many cross-references and that there was no harm in re-articulating provisions in the Constitution to avoid doubt.

Adv. Pearmain concurred and pointed out that the provision was deliberately added for purposes of certainty.

Ms Vilakazi noted that provisions on the certificate of need would generate controversy since it obligates one to seek permission from the National Department that was a cumbersome and entirely unnecessary procedure.

Dr Neil concurred and pointed out that there were thousands of private practitioners. To require the DG to issue certificates and also investigate fake certificates was a Herculean task that would sap all his energies.

Dr Sibeko explained that the introduction of the certificate of need was necessitated by the government's concern about equity. Most health professionals were in the private sector yet only served a minority of the populace. Two health systems co-existed and the best equipped serviced the minority rich while the poorly equipped serviced the majority poor.

In reply to Dr Neil's concerns on the capacity of the DG, Dr Sibeko noted that the DG was only the point of reference for accountability. The D-G had a brigade of officers to execute this mandate.

Ms Johnson sought clarity the term "reasonable" in subsection 38(4), to which Adv. Pearmain replied that it was legal terminology defined by the circumstances of each case.

Dr Neil sought clarity on the scope of section 59, to which Dr Chetty explained that the tissue in question could only be taken out within the scope of the practitioner's work and not otherwise.

The meeting was adjourned.