With regards to lowering costs in the health sector, the Department reported that the work of the Competition Commission currently underway will assist in finding ways of lowering health care costs. In addition, in order to realize spending efficiencies and value for money in procurement, the Department had instituted the adoption of national drug list and a national equipment list. The Committee had in discussions with stakeholders including the FFC and SALGA raised concerns with the efficacy of the intergovernmental relation framework in ensuring effective service delivery. The Department of Health reported that it had encountered challenges specifically at ensuring national imperatives are realized in multi-sphere funding allocations. For example, in many instances the procurement of goods and services and the associated budgets are not always aligned to national policy priorities. However, a notable success had been the realization of the most affordable ARVs globally through centralized procurement following the co-operations of the other spheres of government.