National Public Health Institute of South Africa Bill [B16B-2017]: negotiating mandates & department response

Meeting report

The Chairperson opened the meeting and welcomed everyone present. She thanked Committee members and the Department of Health for the support given to the Provinces. She noted that the Committee would discuss the negotiating mandates of the Provinces on the National Public Health Institute of South Africa Bill and requested the Provinces to read out their negotiating mandates.

Provincial Negotiating Mandates
Eastern Cape Provincial Legislature (ECPL)
Ms P Samka-Mququ (ANC; EC) said that the Province voted in favour of the Bill and mandated the further negotiation on the issues of Provincial representation on the Board and on the issue of the removal of a Board member on grounds of abstention from two consecutive meetings.

Gauteng Provincial Legislature (GPL)
The Chairperson, on behalf of Ms D Ngwenya (EFF;GP) as submitted to the Committee Secretary said that the province voted in favour of the Bill and made recommendations on Clauses 3 and 5 that there should be Provincial representation on the Board (i.e. 3 representatives from clustered Provinces) and representation of 1 organized labour union. The Province also recommended that NAPHISA focus on more healthcare preventative systems of certain diseases.

Free State Provincial Legislature (FSPL)
The Chairperson also pointed out that the Province voted in favour of the Bill without any proposed amendments.

KwaZulu-Natal Provincial Legislature (KZNPL)
Ms L Zwane (ANC; KZN) said that the Province supported the National Public Health Institute of South Africa Bill [B16B-2017]; and proposed amendments to Clauses 3(1)(b), 3(1)(d), 3(1)(g), 3(1)(h), 3(1)(m), 3(1)(u), 3(1)(w), 3(1)(x)(i), 3(1)(r) and 3(1)(v). On Section 3(1)(r) the Province recommended that it must include community organizations and NPO’s and in Section 3(1)(v) there must be a reference to community exposure to environmental health hazards.

Limpopo Provincial Legislature (LPL)
Ms T Mampuru (ANC; Limpopo) said that the Province agreed with the objects of the Bill but proposed amendments to Clauses 2(1) and 3(1). On Clause 3(1), the Province proposed that the Bill should add divisions that deal with Maternal and Child Health, Public health and Medicine, and death statistics. On Clause 3(1) it proposed that (v) should be amended to read “NAPHISA must... strengthen the capacity of the workforce in environmental health in all spheres of government.”

Mpumalanga Provincial Legislature (MPL)
The Chairperson said that Mpumalanga supports the National Public Health Institute of South Africa Bill [B16B-2018] and confers on the Permanent delegate representing the Province of Mpumalanga in the National Council of Provinces, the mandate to vote in favour of the Bill with the proposed amendment that Provinces be represented on the Board, if not individually, the Province can be Clustered- with one representative per Cluster.

Northern Cape Provincial Legislature (NCPL)
Mr D Stock (ANC; NC) noted that the Northern Cape Province supported the National Public Health Institute of South Africa Bill [B16B-2018]. The Province made inputs on the Bill which included that provision should be made for Provincial representation on the Board and that the term of office of the Board should be five years.

North West Provincial Legislature (NWPL)
Mr C Hattingh (ANC; NW) said the North West Province supported the National Public Health Institute of South Africa Bill [B16B-2018] without any proposed amendments.

Western Cape Provincial Legislature (WCPL)
Ms T Mpambo-Sibhukwana (DA; WC) said the Western Cape Province Supported the National Public Health Institute of South Africa Bill [B16B-2018] with amendments to Clause 1, Clause 2(1), Clause 3(1), Clause 3(3)(f), Clause 5(c), Clause 14 and Clause 19 (4). The Province also noted with concern that there was a lack of representation of the Provinces on the Board and recommended that 3 representatives from the Provincial health Departments should form a part of the Board.

The Chairperson called for responses from the Department of Health (DOH).

Input by the Department of Health (DoH)
Ms Precious Matsoso, Director-General, DoH, appreciated the Committee and the Provinces for their responses to the Bill. She explained that the establishment of the National Public Health Institute was to be perceived within the context of a body which supports the Department of Health to educate the public, train professionals, engage with disease outbreaks in order to prevent them, and attend to disasters (such as nuclear disasters) rather than one which replaces it.

On the mandate of the Eastern Cape she acknowledged their concern about the issue of composition and provincial representation and stated that the Department’s resolution is not to subject the issue to debate (in principle) so as to “understand the issues raised by the Provinces” and understand the “provincial voice” in order to act.

Dr Aaron Motsoaledi, Minister of Health addressed the issue of removal of a member of the Board for non-attendance of meetings and expressed concern that the policy will not serve the purpose intended by the Province. He suggested that the removal of a Board member be rather based on being absent from several meetings over a period. The Minister also added to the context given by Ms Matsoso on the role of the National Public Health Institute, stating that the institution will provide intelligence Services on health for South Africa as a whole, comparing it to the Centre for Disease Control in the United States of America (USA) and the African Centre for Disease Control and Prevention (Africa CDC) of the African Union (AU).

Ms Matsoso welcomed the support of the Free State Province on the Bill.

Ms Matsoso acknowledged the issue of representation expressed by the Gauteng Province and maintained the Department’s sentiments in the regard. On the need to focus on health care preventative system on certain diseases, she stated that there no need for a specific provision in the amendment reflecting the suggestion as that is one of the reasons why the National Public Health Institute was created, and the amendment may only be limiting the National Public Health Institute’s functions.

On the mandate of KwaZulu-Natal the Department welcomed the Province's support of the Province on most parts of the Bill as well as on the proposed amendments to include environmental health to many of the Clauses in Section 3. The Department however stated that the suggestion on 3(1)(r) will be problematic and difficult to implement unless health professionals within the context of the sentence is confined to only relevant health-related community organizations.

The Minister explained further that the problem in clause 3(1)(r) is first the usage of the word ‘must’ and then the “widespread of NGO’s”, because it imposes a duty on the State to training on health issues which can bog the institution’s functionality and put the State at the risk of overspending its resources. On the suggestion on Community exposures to environmental health hazards in Clause 3(1)(v) the Department stated that the original context referred to workplace hazards, and it allowed the National Public Health Institute’s to investigate issues around workplace hazards. She said the suggestion has to be examined against the Hazardous Substances Act dealing with hazards in the society and advised the legal team to examine the Act for the possibility of adding a clause specifically looking into community-related health hazards and exposures to enable the National Public Health Institute to act on it.

She highlighted that the Department expressed concern that the mandate of the Province of Limpopo to add ‘Maternal and child health’ may lead to exclusion of Men and emphasized the need to be cautious to prevent out an implied exclusion. On death statistics, the Department said the Statistics South Africa generally handles this information and not the National Public Health Institute.

The Department welcomed the support of Mpumalanga and maintained the sentiments earlier expressed on the issue of representation. The Department also welcomed the support of the Northern Cape and the North West Province.

She pointed out that the Minister clarified on the issues raised by Limpopo and stated that those 6 sections were all-encompassing and to add anything else may destroy the structure of the Bill.

On the Western Cape, the Department expressed its support for the recommendation to improve on the definition of public health. The Department clarified that the concept of public health does not necessarily only mean public health sector but it means the health of the public as opposed the health of an individual, so it covers both public and private. On the amendment in Clause 1 line 12 the Department stated that it will be problematic to change the definition of surveillance form the way it is, whereas the suggestion on the amendment to Clause 2(1)(e) on Injuries and Violence Prevention was accepted and noted. The proposal in Clause 3(1)(e) to provide support in disease and injury surveillance and outbreak response was also supported.

Discussion
The Chairperson gave the opportunity to the Committee to comment on the reply by the National Department of Health (DOH).

Ms Zwane thanked the Chairperson and the Department for responses and advice. She stated that Kwazulu-Natal had no problems with the amendments as accepted by the Department and asked for clarification of the Department on the third proposal on (i.e. Clause 3(1)(r)) in the negotiating mandate of the Province.

Ms Matsoso responded that the clause recommended to be amended it was specific to health hazard and workplace related hazards and in order to include community-related hazards, research into the Hazardous Substances Act must be made by a legal adviser to see if that Act has a sufficient clause to deal with Community-related hazards (and also to avoid a conflict). If this was found to be absent, a separate clause dealing with community-related hazards may be included in the Bill.

Ms Mpambo-Sibhukwana indicated that she will convey the sentiments expressed by the Minister on the ‘may-must’ semantics around Clause 3.1 to her Province.

The Chairperson asked for other comments from the Committee.

The Minister asked for the issue of environmental health hazards to be revisited because the term environmental health hazards may have a wider connotation than is imputed in the Bill. He recommended that the legal team takes it into consideration.

The Chairperson asked for the opinion of the legal person on the deliberations and the proposed amendments.

Input by Parliamentary Legal Adviser
Ms Sueanne Isaac, Legal Adviser, stated that amendments are policy questions and more within the abilities of the Department to comment rather than legal questions. She added that the issue of provincial representation may however be deliberated by the Committee, and if the Committee agrees on the need for provincial representation then it may go ahead in deliberation on how it will work out.

On the drafting issue raised by KwaZulu-Natal in section 3(1)(r) on the inclusion of community organizations and NPO’s, the legal adviser suggested that the inclusion instead be made under section 3(3) which will read as “National Public Health Institute of South Africa (NAPHISA) may provide training and technical information on health issues to community organization”. She said that this will be necessary to cancel out the risk of creating a mandatory obligation for the National Public Health Institute of South Africa (NAPHISA) but rather subject it more to discretion and necessity. The legal adviser objected to the recommendation by the Western Cape to changing the name of the division of violence and injury prevention as stated in Clause 2(1)(e), to ‘violence and injuries’ as it does not clarify anything. She maintained that the name of the division is correct and should remain as it is.

She also stated that the legal team will check the Hazardous Substances Act on the term ‘community exposure’ to see how it affects the Bill and National Public Health Institute of South Africa (NAPHISA). She stated that the Legal team will be waiting to know the official position of the Department on the amendments accepted and the legal issues around them before the legal team takes the matter from the Committee and effect the amendments.

She pointed out that the Minister said he will liaise with his colleagues of the Department of Health (DOH) to attend to the issues.

Discussion
The Chairperson wanted to know of the possibility of finalising the Bill next week.

The Legal Adviser stated that the draft can be ready before the end of the week if inputs are received on the amendments.

The Chairperson asked the Department on the reasonable size for a functional Board.

The Minister suggested that three would be fine in order to avoid a cluster.

The Chairperson asked Members to deliberate on the suggestion of three representatives for the provinces and also on the suggestion of the inclusion of unions.

Ms Zwane agreed with the representation of three representatives and further suggested having alternate memberships for instances where members are absent. She also said unions are so many and will create a challenge on deciding who will be members.

Ms Samka-Mququ added that unions will complicate things

Members agreed that unions should be left out.

The Chairperson asked for suggestions on how the provinces will be clustered in 3’s.

The Minister said this will not pose an issue as there already exist a National Health Council through which provinces can decide on the representatives for each cluster.

Members all agreed that Provinces will be represented by clustering.

The Minister appealed to members to take into consideration the initiative by the President to move to a system of 1 country 1 healthcare system and deal with the problems of referrals which create artificial borders, limits access to healthcare and causes immense hardship for people.

Ms Matsoso asked the Chairperson if there was any other clarification needed from the Department.

The Chairperson said she expects the Department to be prepared for the meeting next week.

The Legal Adviser asked for the opinion of the Committee on whether it agrees with the Minister’s suggestion on the issue of the removal of Board members for being absent at 2 consecutive meetings.

The Committee said it agreed with it as it was a fair means of assuring attendance at meetings.

Ms Zwane sought clarification from the Minister on how the suggestion will be structured such that it locks people into meetings

The Minister clarified that his position on the issue was not in support of it but that he rather expressed his that it may not achieve the intended objective of guaranteeing attendance. He asked for suggestions on different approaches to the issue.

The Chairperson threw the question to the legal team to find an alternative way to capture the provision.

Ms Kammy Chetty drew attention to the Committee to some specific words used in the clause “without leave of the Board” and explained that a person may lose his Board position only if a valid reason for abstention not is given.

Ms Zwane suggested that the clause be amended to compel members to be in attendance of at least 2 meetings every quarter.

The Chairperson asked the members of the Committee to go and think about it for further deliberations at the next meeting.

The Chairperson thanked the National Department of Health for attending the meeting.
 
Final Remarks
The Chairperson informed the Committee that the National Public Health Institute of South Africa Bill has to be finalised next week and that the negotiating mandates for the Property Practitioners Bill were to be discussed has to be shifted to the 29th March due to a request from Provinces like the Western Cape.

The Chairperson also asked Committee to keep in mind that elections are around the corner and if by that time Committee members are back to the Provinces, nothing can be done on the Bill. She stated that the goal was to finalize on the Bill before the house arises.

The Chairperson stated that there is another Bill from the National Assembly: the Civil Union Bill. She however stated that due to time constraints it will be unlikely that if the Committee starts deliberations on it will be concluded, she therefore asked that the Bill be excluded from the Committee’s schedule.

The Chairperson said the request from the Western Cape is too far as it is was taking the Committee into April and this will interfere with the Committee’s goal to complete work at the end of March before the house rises.

Ms Mpambo-Sibhukwana asked the Chairperson to write back to the Province on the issue so that if she goes back she has an electronic and hard copy of her response.

The Chairperson agreed to do so.

Mr Stock apologised for coming late, stating that his lateness was due to an incident with the aircraft he boarded. He suggested to the Chairperson that anytime a member comes late the Chairperson acknowledges that person to any Department who is before the Committee as a matter of courtesy.

The Chairperson concluded by thanking everyone for attending the meeting.

The meeting was adjourned.