Progress Made with Implementation of Ministerial Medical Task Team recommendations to address challenges in South African Military Health Services: Department of Defence briefing

Meeting report

Chairperson’s introductory remarks

The Chairperson apologised for the meeting commencing late. Last week the Portfolio Committee had had the same problem with the venue for its meeting, and had had to relocate without any prior notice or preparation. Today’s meeting venue had been double booked, and this issue had to be raised with the Committee Section because the Portfolio Committee also had a task to fulfil, and its role was not to run around looking for venues. The Committee would ask the researchers to look at the venues of the Defence Force within the proximity of Parliament so that the Committee might use them in future. Defence Force venues would be beneficial to the Committee because it could also play an oversight role while making use of them.

Briefing on progress to address challenges in SA military health services

The Chief Human Resources Directorate, Department of Defence said that the briefing would be presented in three segments, covering human resource (HR) related issues, infrastructural challenges within the medical services, and the medical services themselves.

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During the year of 2013 certain complaints had been raised in the media, emanating from the Department, which made specific reference to health care professionals such as doctors, nurses and pharmacists. The Minister of Defence had then decided that there was a need to appoint a Ministerial Medical Task Team which consisted of nine independent health care professionals. The main objective of the task team had been to conduct research and look into the complaints, and then to give recommendations to the Minister on what needed to be done.

The Minister had divided the recommendations in two different groups. The first covered the investigation into the factors that influenced the optimal functioning of level one, two and three military hospitals. The second dealt with the assessment of the medical support that was provided to the National Defence Force (SANDF) in places of training and where troops were deployed.

The task team had come up with seven broad recommendations, and ten specific recommendations, and the Department had divided these recommendations into two broad categories. It had submitted its final report to the Minister of Defence and Military Veterans on the 16 October 2014.

The Department said that in relation to human resources (HR), that there was a perception that Occupation Specific Dispensations (OSDs) were not being properly implemented and were thus affecting the salaries of members, and that the issue of members working overtime was also in question. The task team had therefore recommended that the Department look into these issues. The Department said that they had looked into them and discovered that the SANDF had introduced the OSDs in terms of policies, but implementation had been lacking. As a result, the Department had conducted an audit of members, checking whether they were being properly managed in relation to their careers and whether the grading system was being properly implemented as prescribed by policy.

The Department said it was also training its members within the health care system. The audit had been done to capacitate staff to manage members according to policy and also to deal with progression, and for OSDs to be done correctly. In relation to the audit files, the Department had had to deal with 1 984 files of members who were health care professionals within the SANDF. Since October 2014, it had concluded 88% of the files. Members had had the opportunity to give feedback if they were not happy with the audit results. As of end of February 2016, the Department had only 240 files to conclude.

The audit had resulted in members receiving corrected remuneration. Thus far it had cost the Department about R63 million which had been paid back to members due to the audit, which indicated that members had not been remunerated properly.

Regarding infrastructural conditions, 1 Military Hospital had been designed in 1982, and the design of the first floor did not comply with the current regulations related to theatres, casualties and sterilizing units. The key challenge had been that the Department could not fix one floor and leave the rest of the hospital. It would have had to look at how the repair work could be done appropriately and ensure that it complied with safe working conditions. The hospital had been demolished and the Department had saved up to R2.5 million. It had also saved about R5 million by not outsourcing the demolition of the hospital.

Clinical meetings had been established in three military hospitals, but expansion to allow different specialisations had been needed in the meetings. Morbidity and mortality meetings had been established in three military hospitals as well. Continuous supervision had been carried out by the Director of Medicine and the Chief Director (CD), (MHFP).

The Department said it had to conform with the requirements set out in the National Health Insurance (NHI) White Paper. Recommendations to progress salaries had been given to the Surgeon General.

Recommendations regarding military skills for the deployment of health care professionals had been concluded. In addition, the Military Health Training Formation was conducting training for members and the curriculum had been revised to meet international standards. More instructors were in the process of qualifying for level two and three military hospitals.

The recommendation to broaden participation of leadership was on-going and participation between health care professions and the command element existed. The Department was also in the processing of forming a medical military academy, and engagement had begun with the University of Pretoria.

The recommendation to have one streamlined research medical entity was on-going and was a medium term goal.

Due to the existing remuneration policy, the Department had lost about 47 doctors in a short space of time. The main reason for this was based on the comparison between public health care professionals and military doctors. The former were in most cases regulated to work for specific hours within a given period, but military health care professionals had to be available for 24 hours. The Department thus felt that the current OSD in relation to military health professionals must be looked at.

The Department concluded its report by stating that the morale of the deployed soldiers and their loyalty towards the SANDF continued to remain commendable.

Discussion

Mr S Marais (DA) said that factors leading to the resignation of medical practitioners also included the facilities available, access to facilities and technology. While the Department said that it was looking at the issue of losing members, what about the other issues that had not been mentioned and had not been fixed? The Department might fix two or more issues, but might lose more staff members if it did not look at others. The Department had said it was paying back R63 million -- where were the funds going to come from? The audit report had remained the same from 2014 to 2016, and he wanted to know what progress was being made and whether the 47 members who had resigned had had an impact on the audit report statistics. Lastly, he wanted to know the criteria for level one, two and three hospitals, and whether these criteria had been met.

Mr S Esau (DA) wanted to know the timeframes within the recommendations and the prospective date by which these timeframes would be met. When would the outstanding 240 audit files be concluded? He said that more money was being spent on outsourcing, and this was undermining the Department. The Department had had a disaster with the DPW, and the huge costs and waste of money had not been quantified. How much was lost through the DPW contracts? About R8 million had been saved, but the amount lost had not been divulged. The report had been concluded on 16 October 2014, but the Committee had not received it. He said there should be proper consultation with the Department in future, as this was in the best interest of the soldiers. He added that he had not seen reference to military veterans in the plan. The Department had no funds -- where would the funds for the upgrades of military hospitals come from?

Mr B Bongo (ANC) said that while Mr Esau had flagged many issues, he had not provided any solutions. He wanted to know about the agreement between the Department and the Department of Public Service and Administration (DPSA) in relation to OSDs. He commended the work formation for doing a great job and said that at a level four hospital he had seen great work being done, but he encouraged the Department to increase its pace with the upgrades. He was worried about the doctors that were leaving. The Department had to make a decision. The issue of OSDs was a problem across the board and the Department should consider bringing in the DPSA in order to try to change the structure of the OSD. He concluded that he was happy with the NHI requirements.

Mr D Gamede (ANC) said that the President had said that every Department should be able to empower the poor and underprivileged. In the event that the Department outsourced, how did it reconcile this with its other challenges, because it also had a role of empowering people. He appreciated the academy, but had a worry that the lack of medicines had not been mentioned in the report. How was the Department dealing with this issue?

The Department responded that the situation regarding the medicine and the academy at this point in time was a vision, and that it was not going to happen tomorrow. It was already in consultation with the University of Pretoria to come up with a curriculum for military medicine. The way in which medicine was distributed in public hospitals was different to how it was distributed in the defence force and in the field.

The availability of medicine was a global problem. Medicine was mainly imported, with little generated in South Africa. The medicine suppliers gave priority to private entities instead of government. The Department was engaging the private sector and the private sector was beginning to understand their need to serve the public entity as well.

On the issue of members leaving the Defence Force, the Department said that no doctors had left since the salary audits and grading of the OSD. The doctors who had left were now coming back to the Department. When the government had introduced OSD, the Minister of Defence had recommended that the Department implement the principles of the OSD in line with the DPSA structure. It was engaging the Surgeon General, because people should be remunerated for the job, and not for their certification.

The Department said that the funds for the upgrades would not come from the Department, and that it was engaging National Treasury. The main issue was that National Treasury was not allocating budget according to medical inflation, but that allocations were normal.

It would give priority to technology, particularly first floor upgrades, which would mostly be theatres. At this stage, it did not have enough theatres and therefore needed to outsource. Once military hospital upgrades were finished, this would reduce costs.

The Department said that the process of auditing files had started in 2014 and no changes to the statistics had been made. To date it had concluded 88% of the files’ audit and expected to conclude the remainder by the end of June 2016.

The Chairperson said that answers to any remaining questions would have to be given in writing as the meeting had to be adjourned due to time constraints.

Mr Esau requested that the Department should look into doctors who got bursaries and excelled in their academic performance, who wanted to be part of the Defence Force.

The Chairperson asked that the Department’s responses should be submitted before 22 March, and sent to all Committee Members.

The meeting was adjourned.