Department of Health on its 2012 Strategic Plan

Meeting report

The Chairperson stated that the Committee was satisfied with the work of the Department and its strategy to reduce underspending.

Department of Health (DoH) 2012 Strategic Plan
Dr Precious Matsoso, DoH Director-General, presented the Annual Performance Plan and Budget 2012/13-2014/15 which highlighted the main thrust of the outcomes-based approach to service delivery adopted by Government.

She summarised the four main outputs identified as: increasing life expectancy, decreasing maternal  and child mortality, decreasing the burden of disease of communicable and non-communicable diseases and strengthening health system effectiveness.

The Department's major accomplishments included the Office of Health Standards Compliance Bill which aimed to regulate health standards by an independent body.  R48.5 million had been allocated for setting up the Office for Health Standards Compliance. All facilities including National Health Insurance pilot sites had been fully accredited and audited.

The next step in preparation for the National Health Insurance was to prepare the legislative framework for public consultations. The phased implementation of National Health Insurance started off with the implementation of ten pilot sites in selected districts during 2012/13. No White Paper would be drafted until all public consultations had been completed.

Dr Matsoso stated that Ms Milani Wolmarans, DoH Director: Strategic Planning, was appointed to conduct site visits to every province to assist in aligning monitoring and evaluation outcomes to the strategic plan and the quarterly report. She explained that spending patterns had improved significantly and that the Department was currently in a position to explain how money was spent. She added that the under expenditure amount of R200 million had to be viewed in the context of a significant increase in budget allocation which reflected that 99% of the budget was spent. She also cited an example of an analysis conducted on the infrastructure expenditure patterns of the North West province which indicated that the province was performing very well.  It was, however, later discovered that the pricing of goods and services was in fact inflated which required the Department to broaden the scope of the analysis. She also mentioned that 127 accounting graduates would commence training on 1 May 2012 on Government accounting systems. The training aimed at improving departmental audit outcomes.

Dr Matsoso highlighted that a Memorandum of Understanding (MOU) was signed between the universities and the National Department of Health. Specialist nurses had been appointed to commence work on 1 June 2012. The Department had pledged an additional R48 million to universities to increase the intake of doctors.

Dr Matsoso recognised the challenges which resulted from the inadequate provision of transport and communication support services for Community Health Care Workers and explained that a costing exercise was initiated by the Department.

Dr Matsoso reminded Members that the Minister of Health would embark on road shows on the National Health Insurance (NHI) and spend three days in each province. She encouraged Members to participate in the road shows in their respective provinces. The budget would be debated on 24 April 2012.
(See document for more details)

Discussion
The Chairperson stated that the Committee was satisfied with the work of the Department and its strategy to reduce underspending. He further informed Members that they would be expected to adopt the budget aimed at ensuring a well resourced strategic plan.

Ms P Kopane (DA) asked how the plan assisted provinces to implement the strategy of the National Department of Health.

Dr Matsoso replied that Ms Melanie Wolmarans was appointed to conduct site visits to every province to assist in aligning monitoring and evaluation outcomes to the strategic plan and the quarterly report.

Ms M Segale-Diswai (ANC) thanked the officials for distributing the documents under discussion timeously which facilitated the Committee in carrying out its oversight role, but requested further clarity on the approach to primary health care.

The Chairperson noted that the budget allocation for the provision of Primary Health Care Services programme amounted to R730 million while the provision for the Tertiary Health Services and Human Resource Development programme amounted to R15.963 billion.

Dr Matsoso responded that an integrated model was required since some primary health care services are the responsibility of municipalities while other services remained the function of provinces. However 5 000 Community Health Care Workers had been trained.

Ms Kopane asked how the Department addressed the underexpenditure of the budget of the previous financial year reported by the Auditor-General and why the budget for primary health care had been reduced.
Dr Matsoso explained that spending patterns had improved significantly and that the Department was currently in a position to explain how money was spent. She added that the under expenditure amount of R200 million had to be viewed in the context of a significant increase in budget allocation which reflected that 99% of the budget had in fact been spent. She also cited an example of an analysis conducted on the infrastructure expenditure patterns of the North West province which indicated that the province was performing very well.  It was, however, later discovered that the pricing of goods and services was in fact inflated, which required the Department to also assess the quality of spending patterns in relation to the budget. Dr Matsoso also mentioned that 127 accounting graduates would commence training on 1 May 2012 on Government accounting systems. The training aimed at improving departmental audit outcomes.

Ms Segale-Diswai wanted to know how under capacitated and resource constrained local municipalities would be assisted to address environmental health issues.

Dr Matsoso replied that the function of environmental health presented an area of conflict and should be reviewed by Cabinet to ensure that it resides within the mandate of the Department of Health.

Ms B Ngcobo (ANC) questioned how the Department aimed at increasing the intake of doctors and nurses while also ensuring the better utilisation of medical school graduates.

Dr Matsoso stated that a Memorandum of Understanding (MOU) was signed between the Universities and the national DoH. Specialist nurses had been appointed to commence work on 1 June 2012. The Department had pledged an additional R48 million to universities to increase the intake of doctors.

Ms Segale-Diswai expressed concern that the Department did not reflect how it addressed the lack of available transport for supervisors who conducted site visits at municipal level.

The Director-General responded that the Department recognised the challenges which resulted from the inadequate provision of transport and communication support services for Community Health Care Workers and explained that a costing exercise was initiated by the Department.

Ms Ngcobo asked how the unemployed would be integrated into the Community Health Care worker programme.

Dr Matsoso responded that Community Heath Care workers were trained and allocated.

Mr Kgangare commented that it was necessary to establish an independent and credible Office of Health Standards and Compliance and capacitate the body with skilled staff. He asked if the strategic plan addressed this imperative since the allocated funding seemed inadequate.

Dr Matsoso agreed that the Office of Health Standards and Compliance should be well resourced but explained that the legislation had not been passed. The amounts allocated could be reviewed and amended once legislation was passed. 

Ms Segale-Diswai  requested clarity on the strategy to improve school health programmes.

Dr Matsoso stated that the introduction of Sexual Reproductive Health Rights programmes at school level remained the subject of debate. The Department had, however, collaborated with the Department of Basic Education and identified schools that fell within the lower quintile group.

Ms Kopane asked how the Department aimed at addressing the training requirements of medical practitioners and staff.

Dr Matsoso replied that a joint task team had been established between the departments of Health and Higher Education and Training. She noted that South Africa produced the same amount of doctors per annum irrespective of the burden of disease, therefore 160 doctors would be trained in the current financial year.

The Chairperson questioned how the R48 million directly assisted students if it was disbursed to universities instead of bursary programmes.

Dr Matsoso replied that the conditions of the grant compelled universities to source students from rural areas.

Ms Ncgobo questioned how the Department aimed to address the challenges that existed within the National Health Laboratory Services (NHLS).

Dr Matsoso concurred that a problem existed in the operationalisation of the NHLS and that an Amendment Bill would be presented to Parliament in the forthcoming week that aimed to address the shortcomings.

Mr D Kganare (COPE) asked if service level agreements had been concluded between the Departments of Health and Public works to deliver on infrastructure development at tertiary hospitals.

Dr Matsoso affirmed that a Memorandum of Understanding (MOU) was signed between the National Department of Health and the Department of Public Works.

Ms Ngcobo questioned the strategy of the Department to address the challenges presented by non-communicable diseases.

Dr Matsoso replied that the Minister would launch a campaign to encourage healthy lifestyles to mitigate the impact of non-communicable diseases.

Ms Segale-Diswai commented that it was not clear how the maintenance and revitalisation of the infrastructure would be addressed while noting that this might not be a competency of the health portfolio.

Dr Matsoso responded that the Norms and Standards on Infrastructure assisted Members in exercising the necessary oversight.

The Chairperson asked if Members could avail themselves to adopt the budget on 19 April 2012 at 3pm.

Dr Matsoso reminded Members that the Minister of Health would embark on road shows on the NHI and spend three days in each province. She encouraged Members to participate in the road shows in their respective provinces. The budget would be debated on 24 April 2012.

The Chairperson reiterated that the purpose of the meeting was to ensure Members understood how the National Department of Health spent its allocated funding.

The meeting was adjourned.