District Health Systems: Department of Health briefing; South African Social Security Agency 2014 Strategic Plan

Meeting report

After noting apologies from the Minister and Deputy Minister of Health, the Chairperson read the apology letter sent by the Department apologising for the delay of the team responsible for the presentation and for the postponement of the meeting. The Members accepted the apology and moved on with the agenda of the day.

Department of Health briefing on District Health Systems

Ms Jeanette Hunter, Deputy Director General of the Department of Health said South Africa had made much progress with regard to the DHS since the South African Government of National Unity. The adoption of Reconstruction and Development Programme (RDP) in 1994 committed itself to the development of a District Health System based on the Primary Health Care approach as enunciated at Alma Ata in 1978. A National Health System based on this approach is concerned with keeping people healthy and caring for them when they become unwell. The concepts of “caring” and “wellness” were promoted most effectively and efficiently by creating small management units of the health system, adapted to cater for local needs. The DHS played a pivotal role in supporting primary health care on the one hand and being a gateway to more specialist care. Small district hospitals have no less than 50 beds and no more than 150 beds, medium large district hospitals with no less than 300 beds and no more than 600 beds. In some circumstances primary health care services were rendered where there was no alternative source of care within a reasonable distance. The expenditure reviews for district hospitals presented a clearer picture of funding, distribution and use of health resources in the district and the province. There was a diagnostic tool to assess to what extent allocation (budget) and use of resources (expenditure) advance the district and province objectives of Access, Quality, Efficiency, Equity and Sustainability.

Discussion

Mr M Khawula (IFP, Gauteng) asked the status of subsidiary hospitals which were not district hospitals in terms of infrastructure and personnel were also doing well. He asked if DOH was taking any measures to combat the issue of nurses migrating from rural areas to urban areas and whether the problem was exacerbated by salary related issues.

Ms L Zwane (ANC, KwaZulu Natal) asked the source of the soup budget whether it came from the government or from a private organization. She asked if there were provisions for nurses to work after hours in situations of emergency, recalling a time when she was working with people with disabilities in UGU (KZN) when one delegate collapsed and was refused attention by nurses who mentioned that the clinic had closed.

Mr D Stock (ANC, Northern Cape) asked the extent to which DOH was taking measures to ensure that new equipment was being maintained at the recently opened state of the art hospital in the Northern Cape. He asked measures that were put in place to ensure that rural hospitals were secure, remembering a time when 2 nurses were raped after work. He sought clarity on the issue of volunteers who help at various hospitals not getting paid whilst the government makes funds available to the NGOs concerned to pay these volunteers.

Ms T Mampuru (ANC, Limpopo) asked the practicality and implementation of the Department’s policies mentioned in their presentation especially in her province in Limpopo at Elim Hospital   where of the NCOP findings were not implemented and that there were still challenges in terms of infrastructure, shortage of staff, and transfers among other issues

Ms Hunter replied that due to time constraints, it could not fully give their presentation on the issues in all area. The root causes of the problems were in the management and administration and in the caliber of the people appointed in critical instead of appointments based on qualifications. During the visit by the Department to that area, some competent people were appointed to key vacant positions in the finance Department despite the absence of CFOs andthis assisted in the turnaround of the situation. It was provided that there was need for change like this at districts as well if people were to be trained well

Ms T Mpambo-Sibhukwana (DA, Western Cape) asked if the Department was taking any steps to prevent and to retain nurses from seeking employment overseas after only serving a year in the country.

The Chairperson expressed concern over the depressing challenges in the Mpumalanga Province. People requiring medical care were queuing for long periods of time or even up until midnight hours without getting any treatment and the attitude they get from the staff was not good.  She sought answers to the appalling conditions at Ehlanzeni clinic. The Committee had received a number of presentations but in reality nothing was done on the ground and that it was reported that in certain hospitals in the Western Cape patients were resorting to sleeping on the ground and their files getting lost. At the situation at Rob Ferreira Hospital, patients were still waiting to undergo medical operations since December due to lack of doctors and broken equipment. She asked the roles played by ward councilors as she and never came across them during the period of her term in the municipality. She asked why the DOH spends so much money in employing other people who are not doing their work instead of home-based volunteers who are helping and taking care of the patients without getting any remuneration. The standards of  clinics in her province have deteriorated since the time they came under the provincial administration as opposed to the time they were thriving under the management of  municipalities, for example in Mbombela where the municipality managed seven clinics whose  standards have now depreciated.

Ms Hunter acknowledged that the situation in Mpumalanga was very dire and since the beginning of the year they had changed four HODs with one only spending a maximum of three months. This was not an appropriate way of running the health care sector where HODs were changed within short periods of time without plausible explanations. Mpumalanga had no management team and no CFOs had been appointed. The Department resorted to using of their managers from the National team for example Dr Cater who is originally from the Western Cape to assist with the situation something she mentioned was not appropriate. The other issues emanated from the suspension of 2 DDGs and the person responsible for pharmaceuticals without replacement. Relaying information to those Departments was difficult since there was no other party in those positions to receive and give feedback on their work. To change the situation, radical action had to be taken starting from the executive so as to address such problems. If given time, the Department would give a comprehensive one with all the details of all the hospitals. There were 492 clinics in the former homelands where their conditions do not meet the demands of the general populace and the need to get funds to fix these before building new ones without having enough people to serve in them. To the school hospital, it was provided that the main focus of the Department was with quintile 1 and 2 only because the Department’s statistics show that for grade 1 only 54 000 learners have hearing and sight problems and such problems must be given attention before they are expected to excel in their academics. It was stated that the teachers in such classes would not know of these defects in these children therefore it was the role of the Department to ensure that they had data concerning children is used to address these problems. The vulindela initiative was given and it showed that there are 27 000 vacant posts in the Department most of which belong to nurses and doctors and especially audiologists and optometrists who must give attention to such children.

Ms Zwane enquired about the turnover of the top officials in the DOH in Mpumalanga due to the high numbers of suspensions of the HODs and the people responsible for affecting such suspensions. She was puzzled as to whether the issue was in the administration itself and other influential issues or if “kunabathakathibathakathayobabalekisa” these HODs since she expressed that she had never heard of such high turnovers.

The DG were appointed by the executive and the DDGs were appointed by the MECs with the former being selected by three ministers with the subsequent approval of the cabinet while the latter being selected by the minister with the assistance with other deputy ministers. These were high level appointment in which the MECs responsible must act and that the problem did not have anything to do with “ukuthakatha”.  She expressed concern with the suspension of the two DDGs were recruited especially from the KZN where the hospital services were successful in that area.

Ms Mampuru recommended that the Department encourage health institutions to consider the Department of correctional services in terms of assisting the Department with laundry.

Ms Hunter welcomed the recommendation and promised that they would go back and propose that other provinces emulate such initiatives as an example but she pointed that carefulness has to be exercised since the laundry from hospitals carry infections.

The Chairperson mentioned the issue of time constraints and proposed to engage with the Department on a deeper basis in terms of a fully-fledged workshop that would address all these issues and some unanswered questions

South African Social Security Agency (SASSA) key Strategic programs and Budget 2014
Ms Virginia Petersen, SASSA Chief Executive Officer, outlined SASSA’s mandate, mission, vision and values, and gave a description of the structure of the agency.

The key priorities for of SASSA were to reduce income poverty by providing social assistance to eligible individuals through the improvement of service delivery, internal efficiency and institutionalizing social grants. Over 15 000 000 people were benefitting from social grants and the target was to reach at least 1.1 million in new beneficiaries per annum. SASSA wished to increase the number of grants in payment from 15 000 000 to 16 000 000 by the end of 2014/15. The objective of SASSA was to improve the conditions under which beneficiaries were served through community outreach programs such as Mikondzo Project implemented throughout the country and the turnaround time for the processing of grant applications was on average of 21 days. The SASSA team was to progressively to reduce the turnaround time for processing of grants to an average of 10 days by 2016 and to acquire new local offices and service points in areas of high need and upgrading. This would eventually see the elimination of open space pay points especially in rural areas. SASSA also planned on implementing biometric physical access system for authenticating staff and beneficiaries through the development of in-house system for management of the beneficiaries’’ biometric information. They intended on developing scanning and storage of documents.

 The risks and challenges faced by SASSA among others were the implementation of the constitutional court’s order which declared the payment tender awarded to CPS was invalid, the declining resources against SASSA’s future growth plans, fraud, theft and corruption. However some of the changes that were going to be affected included the preparations for universalization of Old Age Pensions and CSG and other social security institutions had begun engaging with SASSA in assessing the possibilities of SAA to administer their payment.

Discussion

Ms Mpambo-Sibhukwana asked SASSA about the measures it was taking to protect the elderly from loan-sharks predominantly in George in the Western Cape. She asked if the Department was taking any steps to combat dependency on grants specifically to teenagers who get pregnant to get the grants and bring awareness to the youth of the insufficiency of the child grant in covering all the basic needs of the child so as to mitigate the escalating rate of teenage pregnancy. She asked if SASSA was aware of incarcerated people who were still fraudulently benefiting from the grants and what steps it would use to detect and prevent this. She lastly sought clarity on the relationship between the DOH and the Department of Home Affairs in reducing the cases where deceased persons’ accounts and names were used to access grants and if they were doing enough to stop such acts.

Ms Tlake F (ANC, Free State) sought clarity on how the issue of reviews for eligibility and continuation for grants worked especially people with medical conditions who may have their grants cut back when in fact their medical conditions were deteriorating.

Mr Khawula said from the presentation the popular grant was the child grant but he was surprised that the disability grant would be the third popular since it has higher numbers in reality and he SASSA provides three types of grants for the disabled and they distinguished between the temporary grant and the permanent grant, the former has two periods of allocation namely after 6 and 12 months whilst the latter cannot be reviewed permanent disabilities are not expected to undergo any reviews.

On why the disability grant is ranked number 3 it was held that there has been exercise of quality assurance in order to detect and decrease the rate of fraudulent people who were not disabled but still accessed the disability grant. It made emphasis on the point that the rationale of the disability grant was not to curb unemployment but it was to assist in taking care of people living with disabilities. This was the reason why there was a decrease in the uptake of the grant as quality assurance measures were emphasized.

Ms Petersen said SASSA provided three types of grants for the disabled and they distinguished between the temporary grant and the permanent grant, the former has two periods of allocation namely after 6 and 12 months whilst the latter cannot be reviewed.

Ms Petersen replied that there was need to understand the definition of disability and distinguish cases where a person may have a lifestyle disease which immobilizes him or her and this may enable them to get a disability grant but not all of the people who have lifestyle diseases my qualify for the grant . Medical doctors were the only people who can recommend based on the applications of persons with disability if they qualify for the grant and not the agents issuing out such grants.

Ms Zwane asked about the criteria SASSA uses to determine the eligibility of the recipients of social grants.

The Chairperson raised the issue of the use of social grants by some senior citizens for gambling purposes. She also brought to the attention of SASSA the need to curtail loan sharks from benefitting from the social grants. She asked why the agency had taken so long to rectify the issue of pay points in the open and recommended that structures be built or formally approach municipalities and churches for the use of their halls so as to secure the safety of the elderly collecting their grants. There was bad attitude of the staff dealing with the issuing out of grants and they must practice care and courtesy.

Ms Petersen replied that it was a legacy issue as the numbers indicate a smaller percentage of these people due to age and that the people who participated in the World War 1 and 2 and the Korean War were the only eligible people.

On the issue of the pay points the SASSA team provided that they were in the contact with the local governments and traditional leaders to sign memorandums of understanding to allow them to use such secure facilities for the payment of these grants.

She sought clarity on the status and eligibility of war veterans for social grants and reiterated the issue of the increase of teenagers who access the child grant without actually living with the children and enquired about the measures to stop such practices.

Ms Zwane sought to know how to a dress the issue of the elderly who are too old to walk being dragged to pay points instead of making provisions whereby they can be provided with wheel chairs.

 In response Ms Petersen stated that it was possible for family Members of close people to the elderly to collect the grants on their behalf.

The Chairperson asked about the criteria ASSA uses to give grants to people living with HIV and AIDS and whether if it is still the CD4 count test since it has been abused in the past.

 In reply, Ms Petersen stated that it had abrogated the CD4 count test as a test for eligibility due to a number of diseases a person who suffers from HIV and AIDS may contract and complicate the condition

The meeting was adjourned.