Department of Health on Quarter 1,2 & 3 2016 performance; mom Connect in improving health of pregnant women & reducing maternal & neonatal & infant mortality; Health professionals: placements
Health
07 February 2017
Chairperson: Mr A Mahlalela (ANC) (Acting)
Meeting Summary
The National Department of Health presented to the Portfolio Committee. According to the Chairperson, the Health Ombudsman released a report related to the death of mentally-ill patients. The Chairperson said that the report was very disturbing. Last year 36 mentally-ill patients were reported to have died in various NGO facilities. According to the report 94 patients actually died. At the time when the former MEC reported that 36 patients had died, the report confirmed that over 77 had actually died. According to the Chairperson, the Ombudsman reported provisional numbers of patients, as more may still be discovered in the process.
Members agreed that the Ombudsman should brief the Committee on the findings of the report. However they also recommended that a holistic investigation of all the mental health centres and facilities should be conducted, especially regarding Esidimeni and the role it played in the tragedy and the relocation of patients. It was explained that the mandate of the Ombudsman was to investigate the deaths and it appeared that more people passed-on at the Esidimeni facility than the other NGOs combined. If the Committee was provided with these details, they would have a holistic impression of the actual situation. Members said that it was not acceptable that Supply Chain Management (SCM) was still a main challenge. They recommended that the National Department of Health (NDoH) selected individuals from the provinces, granted them training and expertise in SCM and deployed them for specific posts. The Department needed to solve the problem by creating the SCM experts it required.
The Chairperson said that he did not believe that the NDoH, as a National Department, was making any efforts to intervene and rescue the provinces that were challenged by the current situation. He said that since 2014, procurement and SCM were reported as reasons for financial and target related underperformance by the NDoH. He asked where the problem lied, and whether the issue of under-spending on conditional grants would be addressed and resolved. He then spoke to the issue of overspending on SAPHRA and asked the Department how it was possible, if the job description of the CEO of SAPHRA was still being finalised and the draft appointment of the Board and Committees was still not complete. He reiterated that in essence, SAPHRA did not have a Board, yet the entity contributed to overspending, which the Committee could not understand. He asked the NDoH to elaborate on the matter and the relation between the performance and the over-expenditure. He noted that the Department committed that SAPHRA would be up and running by 1 April 2017 in a meeting with the Portfolio Committee last year. He asked what the progress on SAPHRA was, and whether the Committee can expect SAPHRA to be functional by 1 April 2017.
The Uniform Payment Fee Schedule (UPFS) was costed and formed the basis on which fees should be charged. However, each Provincial Legislature may decide to levy an alternative fee for a particular procedure. An agreement was made with the MECs at the National Health Council to Gazette the UPFS as the basis for which all the provinces would determine fees.
The Chairperson spoke to issue of under-spending as a result the high vacancy rate within Environmental areas of specialisation. He said that unemployed students with degrees specialising in Environmental areas engaged the Committee. He wanted to know what specific area of speciality the NDoH required, and what the unemployed graduates with Environmental Sciences did not have that was required. He noted that the Director-General said that the Department did not have the capacity to employee these graduates. He requested clarity. The DG said that she would make interventions based on the numbers provided by the Committee.
In relation to revenue, the provincial Departments of Health were not collecting revenue relative to their potential to collect revenue, as no incentive to collect revenue currently existed. The only province which was able to effectively collect revenue and retain it was the Western Cape, owing to an agreement with the Provincial Department of Health and Provincial Treasury, to retain a portion of the revenue for the infrastructure of facilities.
The infant mortality rate (IMR) reduced from 35 per 1 000 live births in 2009 to 27 in 2015 (Rapid Mortality Surveillance – MRC). The main contributing factors to IMR were neonatal deaths, HIV, diarrhoeal disease, malnutrition and pneumonia. MomConnect provided mothers and caregivers with information about immunisations, breast feeding, healthy diets for infants, PMTCT and danger signs. By giving mothers information and knowledge and impacting on their behaviour, MomConnect contributed to reducing all the contributing factors to IMR. Cumulatively, 1.36 million women (since 2014) have received twice weekly messages about their pregnancy and about the health of their infants post-delivery to year one. A total number of 1 126 spontaneous complaints were received since 2014 and in the same period 7 738 compliments were received.
Mr Andrew Crichton, Chief Director: Human Resources, National Department of Health, explained that the foreign national interns who were employed by the Department at the beginning of last year were employed as part of an extended agreement with SADC countries whereby medical students were also exchanged across countries. A total of 37 foreign interns were employed by National Department for one year and then transferred to the provinces who would continue their employment; 14 interns were from Botswana, 4 from Mauritius, 1 from Namibia, 1 from Nigeria, 4 from Swaziland, 1 from Zambia and 12 were from Zimbabwe. The Department would provide the Committee with a brief assessment report. The deadline for the report regarding the placement of nurses to be submitted to the Committee was 24 February 2017.
Meeting report
Election of the Acting Chairperson
According to rule 159, if the Chairperson was unable to fulfil his or her functions, the Committee had to elect one of its members as Acting Chairperson, until such time as he or she was able to resume his or her functions. Ms N Ndaba (ANC) nominated Mr A Mahlalela (ANC) to be the Acting Chairperson of the Committee. The nomination was seconded by Dr P Maesela (ANC). There were no objections by members. Mr Mahlalela was elected as the Acting Chairperson for the Portfolio Committee on Health.
Discussion
According to the Chairperson, the Health Ombudsman released a report related to the death of mentally-ill patients. The Chairperson said that the report was very disturbing. Last year 36 mentally-ill patients were reported to have died in various NGO facilities. According to the report 94 patients actually died. At the time when the former MEC reported that 36 patients had died, the report confirmed that over 77 had actually died. According to the Chairperson, the Ombudsman reported provisional numbers of patients, as more may still be discovered in the process.
The Director-General (DG) requested not to attend the meeting as one of the recommendations from the Ombudsman was that the Minister established a team. The team was appointed over the weekend, and commenced duties yesterday. The senior management of the Department of Health in Gauteng was suspended as a result of this, and the Deputy DG was attempting to assist and debrief the team which was appointed by the Minister.
It was indicated that what was discovered since work commenced yesterday, was disturbing. The Chairperson said that despite the closure of some of the centres in Gauteng, almost all of the centres were still operational and attending to patients. The team was assisting to ensure that all of the NGO facilities were closed, and that patients were then transferred to various psychiatric hospitals, and where possible, be returned to life “as it were” outside of the facility. The centres had beds for approximately 600 patients; however the number of patients exceeded this amount. Therefore, patients had to be allocated to other psychiatric facilities. The Committee issued a statement, and the intention for the meeting was to determine the Committee’s reactions to the report, and the way forward. According to the Act, the ombudsperson reported to the Minister and the Minister tabled the report on an annual basis.
However, the issues at hand were a tragedy, and therefore the Committee could not wait for the annual report to be tabled and therefore had to identify how to address the issues, over and above the report being tabled. The Minister was expected to report on the implementation of the recommendation within 45 days.
The Chairperson apologised for the manner in which the public hearings were handled last week. The Committee was not informed of the process. The Committee was included in the hearing process at a very late stage, and without prior Committee consultation regarding the policy matter regarding the implementation of the strategy for non-communicable disease, and the extent to which the Committee provided clarification. Next week, the final round of public hearings would be held. The response to the hearings was immense, with approximately 70 individuals and public institutions wanting to participate in the hearings. A decision had not been taken yet, and would be made when the Minister tabled the Finance Bill, which would introduce a tax on sugar beverages. Next week there would be a second round of public hearings, in relation to the issue.
Mr W James (DA) spoke to the issue of 94 deaths which was included in the report prepared by the Ombudsman Dr Mogoba, and said that the Ombudsman distinguished himself by preparing such a thorough, concise report. The Minister also distinguished himself by revealing what happened at the institutions. He recommended the Portfolio Committee request for Dr Mogoba to table the report to the Committee. He also recommended that the Committee suggest to Parliament that a national debate be held.
Ms C Ndaba (ANC) requested to leave the meeting early, and tendered her apology, as she had an Ad Hoc Committee meeting to attend. She said that the Committee was shocked with the report presented by the Ombudsman. She recommended that the Committee invite the Ombudsman to make a presentation to the Committee on the findings of the report. She also recommended that the Committee conducted oversight to compare with the findings in report by the Ombudsman. She did not discount the accuracy of the report; instead she suggested that the Committee has first-hand insight into the facilities themselves.
Mr Maesela agreed that the Ombudsman should brief the Committee on the findings of the report. However, he also recommended that a holistic investigation of all the mental health centres and facilities should be conducted, especially regarding Esidimeni and the role it played in the tragedy and the relocation of patients. He explained that the mandate of the Ombudsman was to investigate the deaths and it appeared that more people passed-on at the Esidimeni facility than the other NGOs combined. He said that if the Committee was provided with these details, they would have a holistic impression of the actual situation.
The Chairperson said that the Committee would request the Ombudsman to table the report officially and brief the Committee on the findings. He recommended that the Committee request the Minister to table the report, as it was received from the Ombudsman. Once the report was officially tabled, the Committee may request debate in the House. He said that the report was officially handed over to the Minister, and he must ensure that the recommendations were implemented. The House would be sitting from next week, and therefore the Committee would look into the matter and ask the speaker to give it the necessary priority.
Mr James said that it would be valuable for the Committee to engage Dr Mogoba, as well.
The Chairperson said that the Committee would request that the Minister tabled the report this week. The Committee would engage Dr Mogoba next week Wednesday. He said that the full investigation into the state of the psychiatric health system in the country may arise after the presentation on the report by Dr Mogoba.
Annual Performance Plan 2016/17: Quarter One to Quarter Three Performance Progress Report
Ms Gail Andrews, Chief Operating Officer (COO), National Department of Health presented an updated Quarter One, Two and Three Performance Report.
The report was presented per the following programmes:
- Programme 1: Administration
- Programme 2: Health Planning and Systems Enablement
- Programme 3: HIV & AIDS, TB and MCWH
- Programme 4: PHC Services
- Programme 5: Hospitals, Tertiary Services and Workforce Development
- Programme 6: Health Regulation and Compliance Management
Programme 1: Administration
The strategic objective for the Annual Performance Plan (APP) was to ensure effective financial management and accountability by improving audit outcomes. The first indicator for the objective was an audit opinion from Auditor-General. The annual target was an Unqualified Audit Opinion for the 2015/16 Financial Year. In Quarter 1 the NDoH received an Unqualified Audit Opinion, in Quarter 2 Financial Plans were implemented to address the Department’s emphasis and the audit findings of 2015/16 and in Quarter 3 Financial Improvement Plans were implemented to address the Department’s emphasis and the audit findings of 2015/16.
The second indicator was the number of Provincial Departments that demonstrated improvements in Audit Outcomes or Opinions. The annual target was four provincial DOHS. In Quarter 1, three provinces obtained Unqualified Audit Opinions for 2015/16 and by Quarter 2 all provincial DOHs submitted Financial Improvement Plans to address the audit findings for the 2015/16 financial year.
The next strategic objective was to ensure efficient and responsive Human Resource Services through the implementation of efficient recruitment processes and responsive Human Resource support programmes. The first indicator was the average turnaround times for recruitment processes which were six months (biannually). In Quarter 2 and 3, the average turnaround period was four months. The second indicator was the NDoH vacancy rate. The annual target was less than 10% and the target for Quarter 2 was less than 10% (biannually) as well. By Quarter 3 the NDOH achieved a vacancy rate of 4.4%.
The third indicator was the percentage of Senior Managers that have entered into Performance Agreements with their Supervisors. The annual target was 98%. In Quarters 1 to 3 the percentage achieved was 97%. The fourth indicator was the percentage of employees accessing Health and Wellness Programmes. The target for Quarter 1 was 8% of 1993, the target for Quarter 2 was 16% of 1993 employees (cumulative) and the target for Quarter 3 was 24% of 1993 employee (cumulative). In Quarter 1 the percentage achieved was 16.95% of 1993 employees. In Quarter 2 the percentage achieved was 39.4% of 1993 employees and in Quarter 3 the percentage was 78.9% of 1993 employees.
Another strategic objective of the Department was to coordinate the development and implementation of the Departmental Business Continuity Plan by the 31st of March 2020. The first indicator was to have the Departmental Business Continuity Plan (BCP) was developed. The target for Quarter 1 was a signed contract between service provider and the Department on BCP development and to conduct workshops with the targeted functional areas. The target for Quarter 2 was for business processes to be developed and systems identified for HR and ICT. In Quarter 3 the target was to prioritise the identified business processes, data, applications and hardware technology in terms of criticality to the operations of targeted functional areas. In Quarter 1, the draft contract between service provider and the NDOH on BCP was developed but not finalised as the new business approach was developed and workshops were postponed to Quarter 3. In Quarter 2 the Department commenced the review of business processes, and identified Champions. In Quarter 3 the Department reviewed business approved Champions appointed in each branch, and BCP workshops for orientation commenced.
The final strategic objective under this Programme was to provide support for effective communication by developing an integrated communication strategy and implementation plan. The target for all three Quarters was 13 communication interventions implemented per Quarter. In Quarter 1, 16 communication interventions were implemented, in Quarter 2, 20 communication interventions implemented and in Quarter 3, 25 communication interventions were implemented.
Programme 2: Health Planning and Systems Enablement
A strategic objective was to achieve Universal Health Coverage through the phased implementation of National Health Insurance (NHI). The first indicator was the White Paper on NHI. The target was for the public comments on the NHI White paper to be reviewed in Quarter 1 to Quarter 3. In Quarter 1, the public comment period closed on 31 May 2016 and in excess of 150 comments were received. Reviewing of comments started and a summary list of all comments was prepared. In Quarter 2, the reviewing of comments was underway and in Quarter 3 comments were reviewed, the report was compiled and a White Paper was ready for submission to Parliament.
The second indicator was the legislation for NHI, The annual target was for the NHI Bill to be drafted. In Quarter 1, it was decided that the NHI Bill would be drafted once the White Paper has been finalised. The third indicator was the establishment of the National Health Insurance Fund. The annual target was a funding Modality for the NHI fund including budget reallocation for the district primary health care updated. In Quarter 1, the White Paper on NHI included options on Funding Modalities. In Quarter 2, preparatory work was done by Work Stream 1 to establish NHI fund as public entity and in Quarter 3, preparatory work was underway for the NHI Fund.
Another strategic objective under Programme 2 was for the Department to establish a national stock management surveillance centre to improve medicine availability. The first indicator was the number of hospitals implementing an Electronic Stock Management System (ESMS) for the detection of stock outs of medicines. The target for Quarter 1 was to have ESMS implemented at 10 central, 17 tertiary and 25 regional hospitals. The target for Quarter 2 was 10 central, 17 tertiary, 15 district and 25 regional hospitals. In Quarter 3, the target was 10 central, 17 tertiary, 35 district and 25 regional hospitals. With regards to actual performance, in Quarter 1, ESMS was implemented at 100% of target hospitals. In Quarter 2, ESMS was implemented at 100% of target hospitals with an additional 8 regional hospitals. In Quarter 3, ESMS was implemented at 100% of target hospitals with an additional 15 district hospitals and an additional 21 regional hospitals.
The second indicator was the number of PHC facilities implementing an electronic system for the early detection of stock outs of medicines. The target was for electronic system for the detection of stock outs to be functional in 1350 clinics in Quarter 1, 1500 clinics in Quarter 2 and 1650 clinics in Quarter 3. In Quarter 1, it was implemented in 2808 PHC clinics. By Quarter 3, it was implemented in a total of 3121 PHC clinics.
The third indicator was the number of facilities reporting stock availability at national surveillance centre to monitor medicine availability. The target was to have the national surveillance centre and reporting stock availability at 10 central, 17 tertiary and 25 regional hospitals and 1350 PHC clinics in Quarter 1. In Quarter 2, the target was 10 central, 17 tertiary, 15 district and 23 regional hospitals and 1500 PHC clinics. In Quarter 3 the target was 10 central, 17 tertiary, 35 district and 23 regional hospitals and 1650 PHC clinics. In Quarter 1, the target achieved was 10 central, 17 tertiary and 33 regional hospitals and 2497 PHC Clinics. In Quarter 2, the target achieved was 10 central, 17 tertiary, 15 district and 33 regional hospitals and 1500 PHC Clinics. In Quarter 3, the target achieved was 10 central, 17 tertiary, 35 district and 41 regional hospitals and 3121 PHC Clinics.
The next strategic objective under Programme 2 was to improve contracting and supply of medicines. The first indicator was the number of Provincial Medicine Procurement Units (PMPU) for the management of direct delivery of medicines established. The target for Quarter 1 was to have the project plan developed for the rollout of PMPU for KwaZulu-Natal. The target for Quarter 2 was for PMPU in KwaZulu-Natal to be functional. The target for Quarter 3 was for the project plan for the rollout of the PMPU to be developed for the North-West. In Quarter 1, the Provincial Medicine Procurement Unit was implemented and all identified facilities were included in the PMPU system. In Quarter 2, the PMPU in KwaZulu-Natal was functional. In Quarter 3, the project plan for the rollout of the PMPU was developed for the North West.
The second indicator was the number of patients receiving medicines through the centralised chronic medicine dispensing and distribution system. The target for Quarter 1 was 562 500 patients, for Quarter 2 the target was 600 000 patients and in Quarter 3 the target was 625 000 patients. In Quarter 1, the number of patients receiving medicines through the centralised chronic medicine dispensing and distribution system was 511 061, in Quarter 2, the number of patients was 735 079 and in Quarter 3 the number of patients was 984 335.
The third indicator was the percentage of pharmaceutical contracts awarded at least 8 weeks prior to the expiration of the outgoing contract. The target for Quarters 1 to Quarter 3 was 100% pharmaceutical tenders awarded at least 8 weeks prior to expiration of outgoing contract. In Quarter 1, the contract which was due for award in Quarter 1 was awarded on 1 August 2016 (100%), in Quarter 2 the contract which was due for award was awarded on 1 October 2016 (100%). In Quarter 3, the contract which was due for award in Quarter 4 for activation on 1 March was awarded on 21 December 2016 (100%).
Another strategic objective was to implement the strategy to address Antimicrobial Resistance (AMR). The indicator was for the National AMR Strategy (AMS) to be implemented. The target for Quarter 1 was to have the Draft AMS guideline circulated for comment. The target for Quarter 2 was to review comments on the Draft AMS guideline. The target for Quarter 3 was for the AMS guideline to finalised and published. In Quarter 1, the Draft AMS guideline was circulated for comment. In Quarter 2, the comments on the Draft AMS guideline were reviewed. In Quarter 3, the AMS guidelines were updated following the review of comments.
The second indicator was the Council for Traditional Practitioners being established. The annual target was staffing for the interim Council for Traditional Practitioners. In Quarter 1, the Department received approval for the temporary creation and filling of the post of the Registrar. In Quarter 2, the post was created. In Quarter 3, the post was advertised and interviews were conducted.
A strategic objective under Programme 2 was to strengthen revenue collection by incentivizing hospitals to maximise revenue generation. The indicator was the Revenue Retention Model (RRM) at central hospitals. The target for Quarter 1 was to incorporate feedback from the Fiscal and Financial Commission (FFC) on the draft discussion paper on RRM. The target for Quarter 2 was to present the revised RRM to the CFO Forum and NHCC. The target for Quarter 3 was to incorporate feedback from the CFO Forum and NHCC and present the refined discussion paper to NHC Tech. In Quarter 1, the FFC was consulted on 22 June 2016 and a formal report from the FFC was expected. In Quarter 2, the initial RRM model was revised following discussions with the FFC, Provincial Treasuries (which includes CFOs) and other revenue stakeholders. In Quarter 3, the FFC report was being reviewed.
Another strategic objective was the implementation of the eHealth Strategy of South Africa through the development of the system design of patient information systems. The first indicator was a complete System design for a National Integrated Patient based information system. The annual target was for the Health Normative Standards Framework (HNSF) Implementation protocol to be developed for Basic Health Information Exchange (HIE) for piloting integration with Patient Based Information Systems (PIS). In Quarter 1, the requirements for a Hospital Patient Information system were defined and the call for interest on the assessment of Hospital Information Systems was published. In Quarter 2 the assessment of PIS for use in hospitals was underway and in Quarter 3, the assessment for PIS to be used in hospitals was completed, as part of the HNSF implementation.
The second indicator was the number of PHC health facilities implementing improved patient administration and web based information systems. The annual target was 1 450, and 700 additional, PHC facilities. The milestone for Quarter 2 was 200 additional facilities and another 200 facilities in Quarter 3. In Quarter 1, 8 129 units of Computer Hardware were purchased, 3 193 (39%) units were delivered to identified PHC facilities and 2 760 (34%) were installed. The ePHC Programme experienced expansion in three additional Districts in the Free State, and two additional Districts in Mpumalanga. In Quarter 2, there were 10 22 PHC facilities (cumulative). In Quarter 3, there were 1 505 Facilities (cumulative).
The next strategic objective was the domestication of international treaties as well as the implementation of multilateral cooperation on areas of mutual and measurable benefit. The first indicator was the number of International treaties implemented. The annual target was to have three international treaties implemented, as well as have an audit on progress of ratification of a treaty completed. In Quarter 1, the WHO technical meeting on the framework convention on tobacco control took place from 27 to 29 April 2016. Additionally, the workshop on the plain packaging of tobacco products took place from 7 to 9 June 2016. In Quarter 3, the Department of Health participated in six high level meetings namely the High level panel on Access to Medicines, High level commission on HEEG, AMR High level meeting, Foreign policy and Global Health, Stop TB and Independent Oversight and the Advisory Committee on Emergencies.
The second indicator was the number of multilateral frameworks implemented. The target for Quarter 1 was to coordinate participation in the 69th WHA, the 140th Executive Board meeting and the African Union (AU). The target for Quarter 2 was to participate in the United Nations (UN) General Assembly. The target for Quarter 3 was to participate in WHO AFRO and SADC Ministers of Health. In Quarter 1, the Elimination 8 Ministerial Committee Meeting was held on the 20th May 2016 in Geneva, along the side-lines of the World Health Assembly. Also, the Chairing of meetings to finalise revision of expired Health Policy Instruments of the African Union Commission (AUC) took place and the Department also participated in the 69th WHA and the Executive Board in Geneva. In Quarter 2, four activities were coordinated and in Quarter 3, the Department participated four in high level engagements to support multilateral framework implementation on tracking ex-miners, TB, HIV and AIDS and Malaria.
Another strategic objective under Programme 2 was to develop and implement a national research strategic plan. The indicator was the implementation of the National health research plan. The target was to convene a consultative meeting with key stakeholders. The target for Quarter 1 was for the SADHS Fieldworkers for data collection to be recruited. The target for Quarter 2 was to produce the first draft research plan and commence data collection. The target for Quarter 3 was to complete the SADHS data collection. In Quarter 1, the integrated national strategic framework for health research in South Africa’s first draft was produced. SADHS Fieldworkers were also recruited and trained. In Quarter 2, the integrated national strategic framework for health research in South Africa’s second draft was produced. SADHS fieldwork commenced and was underway. In Quarter 3, the national strategic framework for SADHS data collection completed health research in South Africa and finalised it and the draft implementation plan was also prepared.
Another strategic objective was to develop and implement an integrated monitoring and evaluation plan aligned to the health outcomes and outputs contained in the Health Sector Strategy. The indicator was the implementation of the Integrated Monitoring and Evaluation plan. The target for Quarter 1 was to review the NHI white paper and NHI monitoring. The target for Quarter 2 was for the NHI M&E draft document to be produced and the target for Quarter 3 was the identification of appropriate NHI indicators. In Quarter 1, the literature review was conducted and a draft outline of the M&E Framework was prepared and circulated internally. In Quarter 2, the First Draft Framework with indicators was developed and in Quarter 3, the Draft Framework with indicators was developed and circulated internally for comments.
The final strategic objective under Programme 2 was the implementation of bilateral cooperation on areas of mutual and measurable benefit. The first indicator was the number of bilateral projects implemented. The target for Quarter 1 was the implementation of one strategic bilateral project, the target for Quarter 2 was to have two bilateral agreements reviewed and the target for Quarter 3 was to have four bilateral agreements reviewed. In Quarter 1, the NDoH coordinated a visit to South Africa by the technical delegation from Zimbabwe Ministry of Health and Child Care (MoHCC) as well as Ministry of Primary and Secondary Education to learn how the national school health programme was being implemented in South Africa during May 2016. Also in Quarter 1, the Department facilitated the South African task team visit to Sierra Leone and Liberia to undertake a pre deployment assessment on Post Ebola Recovery during 6 to 10 June 2016. In Quarter 2, 13 activities were coordinated and facilitated on bilateral protects and agreements. In Quarter 3, 13 activities were coordinated and facilitated with the UK, Namibia, Botswana, China, Zambia and others on bilateral protects and agreements.
The second indicator was to develop a national electronic system to monitor supplier performance. The annual target was to produce performance reports of all contracted pharmaceutical suppliers. In Quarter 1, 2 and 3 performance reports of all contracted pharmaceutical suppliers were produced. The third indicator was a forum to promote transparency and multi-stakeholder engagement regarding medicine availability. The target for Quarter 1 was to develop the Draft Terms of Reference. The target for Quarter 2 was to approve the Draft Terms of Reference. The target for Quarter 3 was to shortlist Forum members. In Quarter 1, the Draft Terms of Reference were developed. In Quarter 2, the Terms of Reference were submitted to the NHC TAC for approval (Meeting of 27 and 28 October 2016). In Quarter 3, the Department requested nominations for appointment to the Forum submitted for the Minister’s consideration.
The fourth indicator was to have the Single Exit Price Adjustments published and implemented annually. The annual target was to have the 2016/17 Annual Price Adjustment gazetted and published. In Quarter 1, 100% of all submissions received from the pharmaceutical industry were processed within the stipulated 30 working day period, from the date of receipt and in Quarters 2 and 3 all SEPA submissions were processed. The fifth indictor was the development of the Regulations pertaining to the Uniform Patient Fee Schedule (UPFS). The target for Quarters 1 and 2 was the presentation to the State Attorney General’s recommendations to the NHC tech regarding tariffs applicable to foreign Nationals (Refugees, asylum seekers and undocumented foreign nationals). The target for Quarter 3 was to Gazette the tariffs applicable to foreign nationals. In Quarter 1, the recommendations of the State Attorney General's and draft regulation guidelines for foreign nationals were presented to Tech NHC and the NHC. In Quarter 2, Draft regulations were submitted to Legal Services. In Quarter 3, Draft regulations were submitted to the State Law Advisor.
The sixth indicator was the Central Repository for the funded and unfunded patients. The target for Quarter 1 was consultation with the Council for Scientific and Industrial Research (CSIR) regarding the minimum requirements (specifications) according to the eHealth – National Health Normative Standard framework (NHF). The target for Quarter 2 was consultation with the Human Rights Commissioner and international agencies regarding the NHC recommendations of tariffs applicable to refugees, asylum seekers and undocumented foreign nationals. The target for Quarter 3 was Ministerial approval to engage with medical schemes regarding access to patient information. In Quarters 1, the Council for Medical Schemes was consulted regarding the medical scheme beneficiary data. In Quarter 2, consultation of key Principal Officers of group Medical schemes was held. In Quarter 3, engagement with medical schemes on patient information was underway.
The seventh indicator was the number of Provincial Annual Performance Plans (APPs) aligned to the National Health System Priorities. The target by Quarter 3 was the review of Draft 1 APPs of nine provincial DoHs. By Quarter 3, consultations were held and feedback was provided to nine Provincial DOHs. The eighth indicator was the Integrated Planning Framework for the National Health System. The annual target was for the Integrated Planning Framework for National Health System to be developed and presented to the NHC. In Quarter 1, the Department produced a discussion paper on Integrated Planning which was tabled at the National Strategic Planning Committee of 7 and 8 June 2016. In Quarter 2, the final Integrated Provincial / District Planning discussion paper was finalised and circulated to members of National Strategic Planning Committee. It was subsequently tabled at the National District Health Services Committee (NDHSC) and Tech NHC.
The ninth indicator was the Patient Experience of Care self-assessment survey tool. The annual target was the implementation of the Patient Experience of Care (PEC) self-assessment survey in 1 200 clinics. In Quarter 1, a draft was presented to the National Planning Committee. The draft was also presented to SMT/MC Meeting of NDOH on 2 August 2016. In Quarter 2, the draft PEC Guideline and Tool was endorsed by the Management Committee. In Quarter 3, the draft PEC Guideline and Tool was approved by Tech NHC and would be presented to the NHC for approval.
The tenth indicator was the National Survey to measure Patient Experience of Care. The annual target was for the National Survey to measure Patient Experience of Care in selected PHC facilities. In Quarter 1, HST finalised the survey protocol. The survey protocol was to be presented to SMT/MC and Tech NHC. In Quarter 2, HST finalised the National Patient Experience of Care Survey proposal. The proposals were submitted for ethics approval by the Research Ethics Committee. In Quarter 3, The Protocol was approved by the Ethics Committees and 21 fieldworkers were recruited and trained. Data collection commenced in January 2017.
The eleventh indicator was the National Policy to manage Complaints, Compliments and Suggestions for the Public Health Sector of South Africa. The target to be achieved by Quarter 3 was the implementation of the policy with rollout to provinces. In Quarter 1, the first draft was completed and circulated to various stakeholders. Feedback was received and incorporated, and the final policy was circulated to stakeholders. In Quarter 2, the Draft Policy was presented to and endorsed by the Executive Management and Management Committee. In Quarter 3, the Draft Policy was presented to Tech NHC at its meeting of 28 and 29 October 2016. The Draft Policy was tabled at the NHC.
The twelfth indicator was to develop a national electronic system to monitor supplier performance developed. The target for Quarter 1 to Quarter 4 was to produce performance reports of all contracted pharmaceutical suppliers. In Quarter 1, 2 and 3, performance reports of all contracted pharmaceutical suppliers were produced.
The thirteenth indicator was the forum to promote transparency and multi-stakeholder engagement regarding medicine availability. The target for Quarter 1 was to develop the Draft Terms of Reference. The target for Quarter 2 was to approve the Draft Terms of Reference and the target for Quarter 3 was to shortlist Forum members. In Quarter 1, the Draft Terms of Reference were developed. In Quarter 2, the Terms of Reference were submitted to the NHC TAC for approval (Meeting of 27and 28 October 2016). In Quarter 3, the Department requested nominations for appointment to the Forum submitted for the Minister’s consideration.
Programme 3: HIV & AIDS, TB and Maternal and Child Health
The first strategic objective was to reduce the maternal mortality ratio to under 100 per 100 000 live births. The first indicator was the Antenatal first visit before 20 weeks rate. The target for Quarter 1 was 60%, 62% in Quarter 2, and 63% in Quarter 3. In Quarter 1 the achieved rate was 63.7%. In Quarter 2 the achieved rate was 66.5% and in Quarter 3, the rate was 66.8% (October and November). The second indicator was the mother postnatal visit within 6 days rate. The target for Quarter 1 was 73%, Quarter 2 was 75% and Quarter 3 was 77%. In Quarter 1, the rate achieved was 68.5%. In Quarter 2, the rate achieved was 71.4% and in Quarter 3, the rate achieved was 73% (October and November).
The third indicator was the Maternal Mortality in facility Ratio. In Quarter 1, the target was 116 per 100 000 live births, 115 per 100 000 live births in Quarter 2 and 115 per 100 000 live births in Quarter 3. In Quarter 1, there were 98.9 per 100 000 live births. In Quarter 2, there were 120 per 100 000 live births and in Quarter 3, there were 108.7 per 100 000 live births (October to November).
The next strategic objective was to reduce the neonatal mortality rate to fewer than 7 per 1000 live births. The indicator was the Inpatient Neonatal Death Rate. In Quarter 1, the target was 11 per 100 000 live births, 10 per 100 000 live births in Quarter 2 and 10 per 100 000 live births in Quarter 3. In Quarter 1, there were 12.8 per 100 000 live births. In Quarter 2, there were 13.3 per 100 000 live births and in Quarter 3, there were 12.8 per 100 000 live births (October to November).
A strategic objective was to improve access to sexual and reproductive health services. The first indicator was the couple year protection rate. The target for Quarter 1 was 58%, 61% for Quarter 2 and 63% for Quarter 3. In Quarter 1, 65.7% access was reported. In Quarter 2, 72.9% access was reported, and in Quarter 3, 71.4% access was reported (October to November). The second indicator was cervical cancer screening coverage. The target for Quarter 1 was 49% coverage. The target for Quarter 2 was 51% coverage and 53% coverage for Quarter 3 (October to November). In Quarter 1 there was 56.2% coverage, Quarter 2 there was 68.4% coverage and in Quarter 3 it was at 67.5% (October and November).
A strategic objective was to expand the PMTCT coverage to pregnant women, by ensuring all HIV positive antenatal clients were placed on ARVs and reducing the positivity rate to below 1%. The first indicator was the rate of antenatal clients initiated on ART. The target for Quarter 1 was 94% and 95.5% in Quarters 2 and 3. In Quarter 1, 93.7& was achieved, in Quarter 2 94.7% was achieved and 81.5% in Quarter 3 was achieved (October to November). The second indicator was the rate of infants’ first PCR test positive around 10 weeks. The target for Quarter 1 to Quarter 3 was 1.4%. In Quarter 1, the rate was 2.3%. In Quarter 2, the rate was 1.4% and in Quarter 3, the rate was 1.3% (October to November).
Another strategic objective was to reduce the under-five mortality rate to less than 30 per 1 000 live births by promoting early childhood development. The first indicator was the rate of cases of diarrhoea among children under 5 years. The target for Quarter 1 was 3.30%, 3.25% in Quarter 2 and 3.25% in Quarter 3. In Quarter 1, the fatality rate was 2.6%. In Quarter 3, the fatality rate was 1.7% and in Quarter 3, the fatality rate was 1.8% (October and November).
The second indicator was the child under 5 years pneumonia case fatality rate. The target for Quarter 1 was 2.6%. The target for Quarter 2, was 2.6% and the target for Quarter 2, was also 2.6% fatality. In Quarter 1, the pneumonia case fatality rate was 1.7%. In Quarter 2, the fatality rate was 2.3%. In Quarter 3, the fatality rate was 1.8% (October and November).
The third indicator was the child under 5 years severe acute malnutrition case fatality rate. The target for Quarter 1 was 10%. The target for Quarter 2 was 2.9% and the target for Quarter 3 was 3.9%. In Quarter 1, the malnutrition fatality rate was 9.5%. In Quarter 2, the fatality rate was 7.7% and in Quarter 3, the fatality rate was 7.0% (October and November). The fourth indicator was the confirmed measles case incidence per million total population. The annual target was less than 2 per 1 000 000. In Quarter 1, the total incidence was 0.14 per 1 000 000. In Quarter 2, the incidence was 0.9 per 1 000 000 and in Quarter 3, the incidence was 0.13 per 1 000 000.
The fifth indicator was immunisation coverage under 1 year. The target for Quarter 1, Quarter 2, and Quarter 3 was 92%, respectively. In Quarter 1, coverage was 79.7%. In Quarter 2, coverage was 81.9%. In Quarter 3, coverage was 80.1% (October and November). The sixth indicator was the rate of infants exclusively breastfed at HepB 3rd dose. The target for Quarter 1 was 50%. The target for Quarter 2 and 3 was 55% respectively. In Quarter 1, the rate was 36.1%. In Quarter 2, the rate was 43.3% and in Quarter 3, the rate was 46% (October and November).
The seventh indicator was the DTaP-IPV-HB-Hib 3 - Measles 1st dose drop-out rate. The target for Quarter 1 was 6%. The target for Quarter 2 was 2.6% and the target for Quarter 3, was 3.6%. In Quarter 1, the rate was -25.7%. In Quarter 2, the rate was -18.5% and in Quarter 3, the rate was -14.3% (October and November). The eighth indicator was measles 2nd dose coverage. The target for Quarter 1 was 82%. The target for Quarter 2 was 80% and the target for Quarter 3 was 79%. In Quarter 1, coverage was 93.7%. In Quarter 2, coverage was 105.5% and in Quarter 3, coverage was 92.6% (October and November).
The next strategic objective was to contribute to health and wellbeing of learners by screening for health barriers to learning. The first indicator was Grade 1 school screening coverage. The target for Quarter 1 was 42.5%. The target for Quarter 2 was 37.5% and the target for Quarter 3, was 13.5%. In Quarter 1, coverage was 50.6%. In Quarter 2, coverage was 15.8% and in Quarter 3, coverage was 42.6% (July and August). The second indicator was school Grade 8 screening coverage. The target for Quarter 1 was 18%. The target for Quarter 2 was 15% and the target for Quarter 3 was 5%. In Quarter 1, coverage was 30.8%. In Quarter 2, coverage was 25.6% and in Quarter 3, coverage was 16.9% (July and August).
A strategic objective was to protect girl learners against cervical cancer. The first indicator was HPV 1st dose coverage. The annual target was 87% coverage. The results would be available once the campaign had been undertaken in Quarter 3 and Quarter 4. The second indicator was HPV 2nd dose coverage. The annual target was 87% coverage. The results would be available once the campaign was undertaken in Quarter 3 and Quarter 4.
Another strategic objective was to increase access to treatment initiation to at least 90% of lab diagnosed DCTB and RR to TB patients. The indicator was the TB client 5 years and older initiated on treatment rate. The target for Quarter 1 was 91%. The target for Quarter 2 was 93% and the target for Quarter 3 was 95%. In Quarter 1, the rate was 93%. In Quarter 2, the rate was 94.7% and in Quarter 3, the rate was 95.4%.
The second indicator was the TB Rifampicin Resistant clients’ treatment initiation rate. The target for Quarter 1 was 77%. The target for Quarter 2 was 79% and the target for Quarter 3 was 82%. In Quarter 1, the rate achieved was 79%. In Quarter 2, the rate achieved was 114.1% and in Quarter 3, the rate achieved was 78%.
A strategic objective was to strengthen the system for retaining patients in treatment and care by reducing lost to follow up by 50% for MDR-TB and 40% for TB patients. The indicator was the TB client treatment success rate. The target for Quarter 1 was 83%. The targets for Quarter 2 and Quarter 3 were 84%, respectively. In Quarter 1, the rate achieved was 84.4%. In Quarter 2, the rate achieved was 84.7% and in Quarter 3, the rate was 84.2%. The second indicator was the TB clients lost to follow up. The target for Quarter 1 was 5.8%. The target for Quarter 2, was 5.6% and the target for Quarter 3, was also 5.6%. In Quarter 1, the rate was 6.1%. In Quarter 2, the rate was 6.2% and in Quarter 3, the rate was 4.9%.
The third indicator was the TB client death rate. The target for Quarter 1 was 6%. The target for Quarter 2 was 5.5% and the target for Quarter 3 was 4.5%. In Quarter 1, the TB death rate was 4.5%. In Quarter 2, the rate was 4.8% and in Quarter 3, the death rate was 6.1%. The fourth indicator was the TB MDR client loss to follow up rate. The target for Quarter 1 was 18%. The target for Quarter 2 was 17% and the target for Quarter 3 was 15%. In Quarter 1, the rate was 18.5%. In Quarter 2, the rate was 21.5% and in Quarter 3, the rate was 18.3%.
The fifth indicator was the TB MDR client death rate. The target for Quarter 1 was 13%. The target for Quarter 2 was 12.5% and the target for Quarter 3 was 11.5%. In Quarter 1, the TB MDR death rate was 22.6%. In Quarter 2, the rate was 20% and in Quarter 3, the rate was 22.4%. The sixth indicator was the TB MDR treatment success rate. The target for Quarter 1 was 52%. The target for Quarter 2 was 54% and the target for Quarter 3 was 56%. In Quarter 1, the TB MDR success rate was 54.4%. In Quarter 2, the rate was 51.4%. In Quarter 3, the rate was 49.2%.
A strategic objective was to increase the proportion of TB/HIV co-infected patients on ART to 90%. The indicator was the TB/HIV co-infected client on ART rate. The target for Quarter 1 was 78%. The target for Quarter 2 was 79%. The target for Quarter 3 was 81%. In Quarter 1, the actual rate was 79.6%. In Quarter 2, the actual rate was 79.9% and in Quarter 3, the rate was 81%.
Another strategic objective was to scale up combination of prevention interventions to reduce new infections including HCT, male medical circumcision and condom distribution. The first indicator was the number of clients tested for HIV. The target for Quarter 1, Quarter 2, and Quarter 3 was 2.5 million, respectively. In Quarter 1, the number of clients was 3 260 966. In Quarter 2, the number of clients was 3 669 604 and in Quarter 3, the number of clients was 2 416 149 (October and November).
The second indicator was the number of medical male circumcisions performed. The target for Quarter 1, was 150 000. The target for Quarter 2, was 250 000. The target for Quarter 3 was 150 000. In Quarter 1, 198 468 medical male circumcisions were performed, including 64 645 through PEPFAR, 4 500 through the private sector, 2 032 through Shembe and 3 866 through the Ingoma Forum. In Quarter 2, 138 350 (public) medical male circumcisions were performed. In Quarter 3, 110 604 were performed in October and November, including MMCs performed by PEPFAR, Shembe group, the private sector and EC.
The third indicator was the number of male condoms distributed. The target for Quarter 1 was 200 million. The target for Quarter 2 was 150 million and the target for Quarter 3 was also 150 million. In Quarter 1, 212 280 999 male condoms were distributed. In Quarter 2, 238 491 132 male condoms were distributed and in Quarter 3, 156 186 692 male condoms were distributed (October and November).
The fourth indicator was the number of female condoms distributed. The target for Quarter 1, Quarter 2, and Quarter 3, was 4.5 million, respectively. In Quarter 1, 6 103 705 female condoms were distributed. In Quarter 2, 7 146 259 female condoms were distributed and in Quarter 3, 4 677 779 female condoms were distributed (October and November).
A strategic objective was to increase the numbers of HIV positive people on ARVs. The first indicator was the total number of clients remaining on ART (TROA). The target for Quarter 1 was 3.9 million. The target for Quarter 2 was 4.1 million and the target for Quarter 3 was 4.25 million. In Quarter 1, the number of clients was 3 478 832. In Quarter 2, the number of clients was 3 587 573 and in Quarter 3, the number of clients was 3 607 345 (end of November).
The second indicator was Maternal, Neonatal and Woman’s health programmes using the standardised dashboard reports. The target for Quarter 1 to Quarter 3 was to produce quarterly performance reports with feedback provided to each provincial DoH. In Quarter 1, the report was prepared and feedback was provided to provinces. In Quarter 2, the Quarter 2 (2016/17) dashboard report was finalised and circulated to provinces. The Quarter 3 report would be finalised once all data was available in February 2017.
The third indicator was the remedial EMTCT plans developed with the Districts. The target was to identify districts with transmission rates above 2%. In Quarter 1, 17 districts with a transmission rate above 2% were identified. In Quarter 2, no districts with a transmission rate above 2% were identified and in Quarter 3, Districts in the provinces of KwaZulu-Natal and Limpopo were visited. Development of district remedial plans started during the third Quarter of 2016/17.
The fourth indicator was the number of Provincial DoHs with remedial plans to reduce SAM. The target was for the Provincial DOH Remedial Plan to be drafted. In Quarter 1, 2 Provincial DOH remedial plans were completed, namely for Mpumalanga and Limpopo province. In Quarter 2 the Mpumalanga DOH implementation plan was finalised and in Quarter 3, one provincial DOH plan was completed.
The fifth indicator was the switch from trivalent Oral Polio Vaccine OPV (ttOPV) to bivalent OPV (bOPV). The target for Quarter 3 was to conduct the switch. In Quarter 1, the switch was conducted and in Quarter 2, the Oral Polio Vaccine switch was conducted and the report was finalised and approved by the Minister. The sixth indicator was the Cervical Cancer control Policy and Guidelines. The target was the finalisation of the draft Cervical Cancer control Policy and Guidelines. In Quarter 1, a consultative meeting was held to discuss NHC Tech recommendations. In Quarter 2, an Audit was conducted in provinces and the report was being finalised. Costing was underway. In Quarter 3, Guidelines would be tabled to the NHC for approval.
The seventh indicator was the Breast Cancer Policy and Guidelines. The target was the finalisation of the Breast Cancer Policy and Guidelines. In Quarter 1, a consultative meeting was held to discuss NHC Tech recommendations. In Quarter 2, an audit was conducted in provinces and the report was being finalised. Costing was underway. The Guidelines would be tabled to NHC for approval.
The eighth indicator was the Annual National HIV Antenatal Prevalence Survey. The annual target was to publish the 2015 National HIV Antenatal Prevalence Survey. In Quarter 2, the 2016 survey was not implemented (data was not collected) since the demographic and the health survey was currently underway. In Quarter 2, the Survey approach was reviewed and a redesigned ANC survey would be conducted in 2017/18 financial year. The 2015 report survey data was being cleaned and analysed and the report would be available at the end of May 2017.
The ninth indicator was the monitoring of the implementation of child health programmes using the standardised dashboard reports. The target for Quarter 1 to Quarter 4 was to produce National Quarterly reports with recommendations. In Quarter 1, the report was prepared. In Quarter 2, the report was circulated to provinces. The Quarter 3 performance report would be prepared once the December 2016 report was available in February 2017.
The tenth indicator was the percentage of inmates screened for TB on admission. The target for Quarter 1 was 75%. The target for Quarter 2 was 76%. The target for Quarter 3 was 80%. In Quarter 1, the SSRs did not commence with activities, as the SLA had not yet been approved. In Quarter 2, the percentage was 74.2% (118347 inmates) and in Quarter 3, the percentage of inmates screened was 34.7%.
The last indicator was the percentage of controlled mines providing routine TB screening. The annual target was 85%. In Quarter 1, the SSRs did not commence with activities, as the SLA had not yet been approved. In Quarter 2, the percentage was 60% and in Quarter 3, the percentage achieved was 102.2% (252 mines were inspected. The target was 246 mines).
Programme 3: Performance Improvement Strategies
Hospitals were not collecting and/or reporting the data on mother post-natal care when new mothers were in hospital. Provinces were requested to activate this data element for the hospitals to collect and report on post-natal services provided within 6 days for women who were still hospitalised. The provinces of NC and WC had higher TB death rates and investigations were being done to establish the causes. DoH would deploy community-based linkage officers, with support from the Global Fund, to help trace TB patients lost to follow up. The global stock shortages of the hexavalent vaccine resulted in children not getting the full course of doses. Provinces have been requested to prepare improvement plans to address data quality and support visits to provinces would be done during the third quarter.
Programme 4: Primary Health Care
A strategic objective was to prevent avoidable blindness. The indicator was the Cataract Surgery Rate. The target for Quarter 1 was 11 000 Cataract operations. The target for Quarter 2 was 22 000 cataract operations (second quarter milestone). The target for Quarter 3 was 33 000 cataract operations (cumulative). In Quarter 1, 8 203 Cataract operations were performed. In Quarter 2, 26 241 operations were performed, and in Quarter 3, a total number of 41 079 operations were performed.
Another strategic objective was to eliminate Malaria by 2018, so that there were zero local cases of Malaria in South Africa. The indicator was Malaria Incidence per 1000 population at risk. The target for Quarters 1 to 3 was 0.2 (cumulative). In Quarter 1, the rate of incidence was 0.022. In Quarter 2, the rate was 0.008 (76 local cases) and in Quarter 3, the rate was 0.047, and 0.07 overall.
A strategic objective was to improve district governance and strengthen management and leadership of the district health system. The indicator was the number of districts with uniform management structures. The target for Quarter 1 was to consult with Organizational Development experts on a draft structure. The target for Quarter 2 was to receive and review the Organizational Development feedback report. The target for Quarter 3 was to submit the final Draft structure to NHC and NHC Tech. In Quarter 1, the OD expert was consulted and the report was compiled. In Quarter 2, the Organizational Development feedback report was received and reviewed. In Quarter 3, the DHMO report was presented to Tech NHC and recommendations were that guidelines for DHMO should be developed.
The second indicator was the number of primary health care facilities with functional Committees. The target for Quarter 1 was to audit 500 health facilities. The target for Quarter 2 was to audit 700 health facilities (cumulative) and the target for Quarter 3 was to audit 900 health facilities (cumulative). In Quarter 1, a total of 1 578 health facilities were audited to determine the functionality of the health facilities committees. In Quarter 2, a total of 1 997 health facilities were audited and in Quarter 3, 2 032 health facilities were audited to determine the functionality of clinic committees.
Another strategic objective was to access to community-based PHC services. The indicator was the number of functional WBPHCOTs. The target for Quarter 1, was 2 000 functional WBPHCOTs. The target for Quarter 2, and Quarter 3, was also 2 000 functional WBPHCOTs. In Quarter 1, there were 2 879 functional WBPHCOTs. In Quarter 2, there were 3 143 functional WBPHCOTs. In Quarter 3, there were also 3 143 functional WBPHCOTs.
The next strategic objective was to improve the quality of services at primary health care facilities. The indicator was the number of primary health care facilities in the 52 districts that qualify as Ideal Clinics. The target for Quarter 1 was to complete 100% of status determination for 3 538 facilities. In Quarter 1, 72% of clinics completed status determination (2 546 clinics). In Quarter 2, 81 clinics obtained Ideal Clinic status as follows: 23 Silver; 52 Gold; 6 Platinum. In Quarter 3, 267 clinics obtained Ideal Clinic status.
A strategic objective was to improve environmental health services in all 52 districts and metropolitan municipalities in the country. The first indicator was the number of municipalities that were randomly selected and audited against environmental health norms and standards in executing their environmental health functions. In Quarter 1, the Norms & Standards audit tool review and plan of action were developed, and implementation was in progress. In Quarter 2, 13 District and metropolitan municipalities were audited and in Quarter 3, 18 District and metropolitan municipalities were audited (cumulative).
The second indicator was to have the hand and hygiene strategy rolled out in nine provinces. The target for Quarter 1 was the submission of the National hand hygiene strategy, for approval. The target for Quarter 2 was to hold hand hygiene workshops for three Provincial DOHs. The target for Quarter 3 was to hold hand hygiene workshops for six Provincial DOHs. In Quarter 1, a hand hygiene national workshop was held during the Water Institute for Southern Africa (WISA) 2016 conference. In Quarter 2, costing of National Hand hygiene Strategy was completed. In Quarter 3, hand hygiene workshops were held in eight provinces namely, the Eastern Cape, KwaZulu-Natal, Mpumalanga, Limpopo Province, Gauteng, the Northern Cape, the North West and the Free State.
The third indicator was the Health Care Risk Waste (HCRW) Regulations. The target for Quarter 1 was to develop the Draft guidelines document. The target for Quarter 2 was to circulate the document to provinces and incorporate inputs, and for the final Guide to be developed and communicated. The target for Quarter 3 was the development of provincial plans, monitored and provinces supported. In Quarter 1, the literature review was conducted. In Quarter 2, the Draft guideline was circulated to provinces for comments and inputs. Feedback was received from Limpopo province only. In Quarter 2, the final guideline was developed and in Quarter 3, provinces were supported in developing provincial plans.
A strategic objective was to ensure the provision of IHR compliant port health services at all 44 commercial points of entry in South Africa. The indicator was the number of points of entry that provide IHR compliant port health services. The target for Quarter 1 was to finalise the Audit Tool and develop the Plan of Action for implementation. The target for Quarter 2 was for the audit to identify 10 ports of entry on the norms and standard and IHR requirements. The target for Quarter 3 was to audit 30 identified ports of entry on the norms and standard and IHR requirement (cumulative). In Quarter 1, the port health audit tool was developed and finalised. The plan of action was also developed and implementation was in progress. In Quarter 2, 10 identified Ports of Entry were audited and in Quarter 3, 32 identified Ports of Entry were audited on the norms and standards and IHR requirements.
Another strategic objective was to reduce risk factors and improve management for Non-Communicable Diseases (NCDs) by implementing the Strategic Plan for NCDs 2012-2017. The first indicator was the number of government Departments oriented on the National guide for healthy meal provision in the workplace. The target for Quarter 1 was 25. The target for Quarter 2 was 28 (cumulative), and the target for Quarter 3, was 33 (cumulative). In Quarter 1, the total number reached was 31 (cumulative). In Quarter 2, the number was 38 (12 additional) National Departments oriented on the National guide for healthy meal provision in the workplace and in Quarter 3, there were 38 Departments and 2 parastatals. No additional departments were orientated in Quarter 3.
The second indicator was the Guidelines on Nutrition for Early Childhood Development centres. The target for Quarter 1 was to collate the feedback received from the provincial DOHs on the Draft guidelines. The target for Quarter 2 was to circulate the revised Draft for final consultation to stakeholders. The target for Quarter 3 was to collate the inputs received from stakeholders, and to submit the final draft for approval. In Quarter 1, the Draft Guidelines were circulated to provincial Nutrition managers for inputs, and the inputs were collated. In Quarter 2, the revised draft was circulated for final consultation to stakeholders. In Quarter 3, inputs were received from stakeholders and analysis was underway.
The third indicator was to develop the Regulations relating to labelling and packaging of tobacco products and smoking in indoor and outdoor public places. The target for Quarter 1 was to review the Feedback report from the State Law Advisors on the Draft. The target for Quarter 2 was to revise and produce the Draft Bill, and submit it to the State Law Advisors. In Quarter 1, comments from the State Law Advisors were received, and the second draft was being prepared. In Quarter 2, the Draft Bill was submitted to the State Law Advisors for input and in Quarter 3, the Draft Bill was sent to the State Law Advisors.
The fourth indicator was the random monitoring of salt content in foodstuffs. The target for Quarter 1 was two categories. The target for Quarter 2 was six categories, and the target for Quarter 3, was ten categories. In Quarter 1, zero categories of foods were tested. In Quarter 2, 13 categories of foods were tested and in Quarter 3, 13 categories of foods were tested.
Another strategic objective was to establish a National Health Commission to address the social determinants of health. The indicator was the establishment of the National Health Commission. The target for Quarter 1 was to develop the Framework. The target for Quarter 2 was to have the FOSAD Framework approved. In Quarter 1, the Operational Framework was discussed at EMC. The revised document was completed. In Quarter 2, the Framework was approved by FOSAD and in Quarter 3 the Cabinet memorandum (including the Operating Framework) was submitted for consideration by Cabinet.
The next strategic objective was to improve access to, and quality of, mental health services in South Africa. The indicator was the number of District Mental Health Teams established. The target for Quarter 1 was to establish three teams. The target for Quarter 2 was to establish three teams. The target for Quarter 3 was to establish four teams. In Quarter 1, three District Mental Health Teams were established. In Quarter 2 and 3, seven District Mental Health Teams were established.
Another strategic objective was to improve access to disability and rehabilitation services through the implementation of the framework and model for rehabilitation and disability services. The indicator was the number of Districts implementing the National policy framework and strategy for disability and rehabilitation services. The target for Quarter 1 was three Provincial DOHs assisted to develop plans. The target for Quarter 2 was six Provincial DOHs assisted to develop plans (cumulative). The target for Quarter 3 was nine Provincial DOHs assisted to develop plans (cumulative). In Quarter 1, three out of nine provinces commenced on the development of provincial implementation plans namely, the Western Cape, KwaZulu-Natal and Gauteng. In Quarter 2, five out of nine provinces commenced on the development of provincial implementation plans namely, the Western Cape, KwaZulu-Natal, Gauteng, Limpopo and Mpumalanga. In Quarter 3, four provinces had implementation plans.
A strategic objective was to eliminate Malaria by 2018, so that there were zero local cases of Malaria in South Africa. The indicator was the number of targeted districts reporting malaria cases within 24 hours of diagnosis. The target for Quarter 1 was five Malaria targeted districts reporting malaria cases within 24 hours of diagnosis. The target for Quarter 2 was six Malaria targeted districts reporting malaria cases within 24 hours of diagnosis (cumulative). The target for Quarter 3 was seven Malaria targeted districts reporting Malaria cases within 24 hours of diagnosis. In Quarter 1, five of the districts were reporting within 24 hours through Malaria Connect, for the additional two districts implementation was scheduled to take place in Quarter 2. In Quarter 2, six of the targeted districts were reporting within 24 hours, through Malaria Connect. In Quarter 3, six of the targeted districts were reporting within 24 hours, through Malaria Connect.
A strategic objective was to strengthen the preparedness and core response capacities for public health emergencies in line with International Health Regulations. The indicator was the number of Provincial Outbreak Response Teams trained to respond to zoonotic, infectious and food-borne diseases outbreaks. The target for Quarter 1 was to develop the training material and finalise logistics. The target for Quarter 2 was to train three Provincial Outbreak Response Teams (cumulative). The target for Quarter 3 was to train six Provincial Outbreak Response Teams (cumulative). In Quarter 1, a National Task Team was formed and provincial Food borne illnesses training material was developed. In Quarter 2, seven provinces were trained namely, Limpopo Province, the North West, the Free State, the Eastern Cape, Mpumalanga, KwaZulu-Natal and the Western Cape and in Quarter 3, nine provinces were trained.
Another strategic objective was to improve South Africa’s response with regard to Influenza prevention and control. The indicator was the number of high risk population covered by the seasonal influenza vaccination. The target for Quarter 1 was 300 000 high risk individuals covered with seasonal influenza vaccination. The target for Quarter 2 was 600 000 high risk individuals covered with seasonal influenza vaccination (cumulative) and the target for Quarter 3 was 800 000 high risk individuals covered with seasonal influenza vaccination (cumulative). In Quarter 1, a total of 508 884 individuals were vaccinated. In Quarter 2, 859 787 individuals were vaccinated and in Quarter 3, a total number of 896 019 individuals were vaccinated.
Programme 4: Performance Improvement Strategies
The main challenge for the clinics to attain Ideal Clinic status related to supply chain management, especially on equipment, essential supplies and infrastructure. NDOH, provincial Departments of Health and National Treasury were addressing the supply chain weaknesses through a national catalogue for PHC equipment and through ensuring that transversal tenders existed for catalogue items.
Programme 5: Hospitals, Tertiary Services and Workforce Development
A strategic objective was the development and implementation of health workforce staffing norms and standards. The indicator was the Guidelines for HRH norms and standards using the WISN methodology. The annual target was the approval of the HRH Norms for District and the approval of specialised hospitals. A target was to develop HRH Norms for Regional, Tertiary and Central Hospitals. The target for Quarter 2 was the drafting of the HRH Norms for Regional, Tertiary and Central Hospitals. The target for Quarter 3 was for the HRH Norms for District and specialised hospitals to be presented to NHC Tech. In Quarter 2, consensus building workshops were held for district hospitals. About 40% achievement towards development of staffing norms for District and specialised hospitals to date. In Quarter 3, the DHIS was reviewed to obtain workload statistics for District hospitals.
The second indicator was the number of health facilities benchmarked against staffing normative guides. The target for Quarter 1, was 1 600, and 600 additional, PHC Facilities benchmarked. The target for Quarter 2, was 2 200, and 600 additional, PHC Facilities benchmarked. The target for Quarter 3 was 2 800 and 600 additional, PHC Facilities benchmarked. In Quarter 1, 1600 (600 additional) PHC facilities were benchmarked. In Quarter 2, 3 149 (1 549 additional) PHC Facilities were benchmarked. In Quarter 3, 3 149 PHC facilities were benchmarked (target achieved in the second Quarter). The third indicator was the establishment of nine RTCs. The target for Quarter 1, Quarter 2, and Quarter 3, was six RTCs. Targets for all three Quarters were achieved 100%.
A strategic objective was to ensure quality health care by improving compliance with National Core Standards at all Central, Tertiary, Regional and Specialised Hospitals. The indicator was the number of Hospitals that achieved an overall performance 75% (or more) compliance with the National Core Standards assessment. The target for Quarter 1 was seven hospitals. The target for Quarter 2 was 14 hospitals and the target for Quarter 3 was 7 hospitals. In Quarter 1, preparatory work was undertaken. In Quarter 2, the Ministerial Task Team visited Hospitals in Limpopo, Mpumalanga and the Eastern Cape. In Quarter 3, six hospitals that were assessed obtained 75% or more, namely Edendale hospital, King Edward hospital, Inkosi Albert Luthuli hospital which scored 87%, Mahatma Ghandi Hospital, RK Khan Hospital and Madadeni Hospital which obtained 65%.
Another strategic objective was to increase the capacity of central hospitals to strengthen local decision making and accountability to facilitate semi-autonomy of ten central hospitals. The indicator was the number of central hospitals with standardised organisational structure. The annual target was for the NHC to approve the structure for central hospitals. The target for Quarter 1 was the finalisation of the proposed organisational structure for central hospitals. The target for Quarter 2 was the costing of the current and proposed organisational structure for central hospital and the target for Quarter 3 was presenting the proposed organisational structure to NHC Tech and NHC. In Quarter 1, the organisational structure for central hospitals was developed. In Quarter 2, the Draft generic organisation structure for central hospitals was developed and tabled at NHC which recommended that the structure be costed. In Quarter 3, the current and proposed structure was costed. DPSA was to make the final presentation to NHC Tech and then NHC for approval.
A strategic objective was to improve access to and quality of mental health services in South Africa. The indicator was the number of District and Regional hospitals with mental health inpatient units established. The target for Quarter 1 was for the monitoring system to be drafted to measure the establishment of mental health Units. The target for Quarter 2 was the approval of the monitoring system. The target for Quarter 3 was four District hospitals and 1 Regional hospital. In Quarter 1, preparatory work was undertaken on the monitoring framework. In Quarter 2, the Draft monitoring framework was developed and forwarded to Provinces for inputs, before it could be tabled to NHC TECH for support and approval by NHC. In Quarter 3, two district and 14 Regional hospitals (six tertiary hospitals and three Central hospitals) were established.
Another strategic objective was to strengthen Nursing Education Training and Practice through implementation of the objectives of the Nursing Strategy. The first indicator was the development of the New basic Nursing qualification programmes and draft curricula. The target for Quarter 1 was the establishment of the Programme and curriculum development Advisory committee. The target for Quarter 2 was the development of the scope of new basic nursing programmes and curricula. The target for Quarter 3 was the presentation of the new basic nursing qualifications programme and draft curricula to the Executive and Management Committee. In Quarter 1, the programme and curriculum development advisory committee, called Technical Working Group (TWG), was established. In Quarter 2, the scope of new basic nursing programmes and curricula was developed. In Quarter 3, the new basic nursing programme and draft curricula was presented to the Management Committee.
The second indicator was the number of Nursing and Midwifery educators identified nationally and registered for training and development programmes. The annual target was 50 educators. In Quarter 1, communication and consultation was conducted to obtain buy-in from provinces. A meeting with the Forum of Provincial Directors of Nursing Practice was held on 19 April 2016. A meeting and workshop with Provincial Heads of Health and their senior support was held on 21 April 2016. In Quarter 2, Communication and consultation was conducted to obtain buy-in from remaining provinces namely, Gauteng, KwaZulu-Natal, the Northern Cape, Limpopo province and Mpumalanga. A consultation workshop was conducted with provincial nursing managers on 7 to 8 July 2016. In Quarter 3, 87 nursing and midwifery educators were identified nationally and were registered for training and development programmes.
The third indicator was the implementation of the Nursing Strategy Monitored. The target for Quarter 1 was to commence the elements of the nursing strategy identified from the Nursing Strategy and the development of the monitoring system. The target for Quarter 2 was to draft the monitoring system to monitor the implementation of the Nursing strategy. For Quarter 3, the target was the finalisation of the monitoring system for monitoring the implementation of the Nursing strategy. In Quarter 1, the Nursing strategy was analysed and the elements to be monitored were identified. Development of monitoring system commenced. In Quarter 2, the monitoring system was drafted to monitor the implementation of the Nursing strategy and in Quarter 3, the monitoring system was finalised for monitoring the implementation of the Nursing strategy.
A strategic objective was to improve quality of health infrastructure in South Africa. The indicator was the number of facilities maintained, repaired and/or refurbished in NHI Districts. The annual target was 178 facilities. In Quarter 1, a total of 136 facilities were currently being maintained, repaired and/or refurbished in NHI Districts. In Quarter 2 and 3, 168 facilities were currently being maintained, repaired and/or refurbished in NHI Districts. Maintenance was completed in 67 facilities.
The second indicator was the number of facilities maintained, repaired and/or refurbished outside NHI pilot Districts. The annual target was 307 facilities. In Quarter 1, 34 projects on facilities were being maintained, repaired and/or refurbished outside NHI Districts. In Quarter 2 and 3, 263 projects on facilities were being maintained, repaired and/or refurbished outside NHI Districts and maintenance was completed in 123 facilities.
The third indicator was the number of clinics and Community Health Centres constructed or revitalised. The annual target was 44 clinics. In Quarter 1, a total 25 clinics and Community Health Centres were in construction or revitalisation. In Quarter 2, 25 clinics and Community Health Centres were in construction or revitalisation. In Quarter 3, 70 clinics and CHCs were revitalised (33 from HFRG, 13 from the In-Kind grant and 24 from ES).
The fourth indicator was the number of new facilities that comply with gazetted infrastructure Norms & Standards. The annual target was 52 new facilities. In Quarter 1, 21 facilities were in construction and 12 facilities were in the design phase. In Quarter 2, 21 facilities were in construction and 12 facilities were in the design phase. In Quarter 3, of 21 facilities, 5 facilities were reviewed in line with gazetted Norms and Standards.
A strategic objective was to strengthen the Monitoring of Infrastructure projects. The indicator was the Infrastructure Monitoring System. The target for Quarter 1 was to produce one consolidated quarterly National Monitoring report. The target for Quarter 2 was to produce one consolidated quarterly National Monitoring report. In Quarter 1, one consolidated quarterly National Monitoring report was produced. In Quarter 2, one consolidated quarterly National Monitoring report was produced. In Quarter 3, provincial reports were drawn from PMIS to develop one consolidated report.
Another strategic objective was to ensure access to an efficient effective delivery of quality Emergency Medical Services. The indicator was the number of provinces that were monitored for compliance with the EMS regulations. The target for Quarter 1 was to draft the checklist to monitor compliance with EMS regulations. The target for Quarter 2 was to present the checklist to the National EMS Committee. The target for Quarter 3 was to have the checklist to monitor compliance with EMS regulations, approved. In Quarter 1, the checklist to monitor compliance with EMS regulations was drafted. In Quarter 2, the checklist was to be tabled for approval at National Committee for EMS on 16/17 November 2016 and in Quarter 3, the meeting of the NCEMS did not take place however, members approved checklist by email.
A strategic objective was to eliminate the backlog of blood alcohol and toxicology tests by 2016. The first indicator was the percentage backlog eliminated for blood alcohol tests. The target for Quarter 1 was 25%. The target for Quarter 2 was 50%. The target for Quarter 3 was 75%. In Quarter 1, the percentage of backlog was 31%. In Quarter 2, the percentage of backlog was 67%. In Quarter 3, the percentage of backlog was 60%. The second indicator was the percentage of backlog eliminated for toxicology tests. The target for Quarter 1 was 25%. The target for Quarter 2 was 50%. The target for Quarter 3 was 75%. In Quarter 1, the percentage of backlog was 4%. In Quarter 2 and 3, the percentage of backlog was 5%.
A strategic objective was to provide food analysis services. The indicator was the percentage of food tests completed within normative turnaround time (30 days – perishable, and 60 days non-perishable). The target for Quarter 1 was 25%. The target for Quarter 2 was 50%. The target for Quarter 3 was 75%. In Quarter 1, the percentage achieved was 73%. In Quarter 2, the percentage achieved was 69% and in Quarter 3, the percentage achieved was 63%.
Another strategic objective was to improve management of health facilities at all levels of care through the Health Leadership and Management Academy. The first indicator was the number of managers accessing the coaching and mentoring programme. The annual target was 40 hospital CEOs and 200 PHC Facility Managers. The target for Quarter 2 was 10 hospital CEOs and 50 PHC Facility Managers. The target for Quarter 3 was 15 hospital CEOs and 75 PHC Facility Managers. In Quarter 2, there was no performance. In Quarter 3, the coaching and mentoring provider contract was signed with I-Tech in November 2016. Briefings on the coaching and mentoring pilot were conducted for the senior leadership of the 2 targeted Provinces. Briefing sessions were also conducted for two of the four targeted pilot sites.
The second indicator was the number of managers using the knowledge hub information system. The annual target was 200 hospital CEOs and 700 PHC Facility Managers. The target for Quarter 2 was 30 hospital CEOs and 200 PHC Facility Managers. The target for Quarter 3 was 70 hospital CEOs and 250 PHC Facility Managers. In Quarter 2, there was no performance. In Quarter 3, briefing sessions on the functionality of the Knowledge Hub were conducted for three Provinces, one Central Hospital and one District. Approximately 32 managers were briefed in total.
The third indicator was publication of the Regulations for the Rendering of Forensic Pathology Services. The annual target was for the Scope of Practice for the rendering of Forensic Pathology Services to be published for implementation. The target for Quarter 1 was for the scope of practice guidelines to be finalised and ratified by the NFPSC. The target for Quarter 2 was for the scope of practice guidelines to be published and distributed to all provinces and facilities rendering Forensic Pathology Services. The target for Quarter 3 was to draft and approve the checklist to monitor compliance with the scope of practice guidelines drafted and approved in collaboration with Forensic Pathology Service Managers in the nine provinces. In Quarter 1, the National Forensic Pathology Services Committee (NFPSC) did not finalise their input on the draft scope of practice guidelines. In Quarter 2, the National Forensic Pathology Services Committee (NFPSC) did not finalise their input on the draft scope of practice guidelines. In Quarter 3, the NFPSC decided on 9 and 10 November 2016 to only finalise this draft upon publication of the regulations.
The fourth indicator was the Health Facilities that were designated to render services for the management of sexual and related offences monitored. The target for Quarter 1 was to draft the monitoring system. The target for Quarter 2 was to consult with key stakeholders regarding the monitoring system. The target for Quarter 3 was to have the monitoring system approved. In Quarter 1, the monitoring template was developed for provinces to report number of designated facilities. In Quarter 2, consultation on the monitoring template was completed. In Quarter 3, the monitoring template was submitted for approval.
The fifth indicator was the policy on education and training of EMS Personnel. The target for Quarter 1 was to draft the Checklist for EMS education and training accreditation criteria in line with the policy. The target for Quarter 2 was to present the checklist on EMS education and training accreditation criteria in line with the policy, to NCEMS. The target for Quarter 3 was the approval of the checklist for EMS education and training accreditation criteria in line with the policy, by NCEMS. In Quarter 1, the checklist for EMS education and training criteria in line with policy was drafted. In Quarter 2, the checklist was to be tabled for approval at National Committee for EMS on 16/17 November 2016. In Quarter 3, the NCEMS approved the checklist.
The sixth indicator was the regulations for Emergency Care Centres. The annual target was to publish the Regulation on Emergency Care Centres for public comment. The target for Quarter 1 was to publish the Regulations relating to Emergency Centres for comment. The target for Quarter 2 was to consolidate the inputs and comments from published regulations. The target for Quarter 3 was to have the checklist to monitor compliance with regulations drafted and approved in collaboration with Emergency Specialists. In Quarter 1, the Draft regulation was submitted to EMSSA for input. In Quarter 2, the Draft regulation was submitted by EMSSA for finalisation and publication, for public comment. In Quarter 3, the Draft regulation was to be submitted to Legal Services for submission to the Office of the Chief State Law Advisor (OCS; LA) for input.
The seventh indicator was the regulations for EMS in Mass Gatherings. The annual target was for EMS in mass gatherings to be published for implementation. The target for Quarter 1 was for EMS in mass gatherings to be published for implementation. The target for Quarter 2 was for the checklist to monitor compliance with regulations presented to National EMS Committee and approved. The target for Quarter 3 was for nine provincial DOH monitoring to be produced. In Quarter 1, major revisions were undertaken following the public comment phase. In Quarter 2, the revised regulations were submitted to Legal Services for publication for public comment, again. In Quarter 3, feedback was received from the Office of the Chief State Law Advisor comments incorporated and would be translated into second official language in preparation for promulgation.
Programme 5: Performance Improvement Strategies
The NDOH is acquiring technical support to assist in speeding up progress on the coaching and mentoring programme for CEOs and facility managers. Registration of managers on the Knowledge Hub would run parallel with the coaching and mentoring pilot. The briefing, registration and credentialing of service providers would be prioritised in the fourth quarter. Regarding toxicology, testing Johannesburg and Cape Town were concentrating on increasing their blood alcohol output. The Head of JHB Toxicology post has to be short-listed, interviewed and post filled. The outstanding procurement of consumables at FCL PTA is receiving attention. The matter of Regulations for the Rendering of Forensic Pathology Services as well as Scope of Practice for the rendering of Forensic Pathology Services would be prioritised.
Programme 6: Health Regulation and Compliance Management
A strategic objective was to establish the South African Health Product Regulatory Authority (SAHPRA). The indicator was the establishment of SAHPRA as a public entity. The annual target was for SAHPRA to be listed as a public entity, and for the Board CEO and Committees to be appointed. The target for Quarter 2 was for SAHPRA to be listed as a public entity. The target for Quarter 3 was for the CEO of SAHPRA to be appointed, and for the Board of SAHPRA to be appointed. In Quarter 1, the SAHPRA Business Case and financial plan was being updated. A presentation about transfer of staff from DOH to SAHPRA was made at the Bargaining Chamber. A submission requesting proclamation of SAHPRA was submitted to Legal Services. The Draft Regulations to support SAHPRA approved by MCC at the 9 and 10 June 2016 meeting. In Quarter 2, the Draft Regulations to support SAHPRA was finalised and submitted to the State Law Advisor for vetting. The MTEF Budget was discussed with National Treasury in support of SAHPRA proclamation. Discussions with Bargaining Council and Chamber were initiated in support of staff transfer. IT support was advanced to allow transition to SAHPRA. In Quarter 3, the proclamation of SAHPRA was awaiting publication of the General Regulations. Draft Regulations to support SAHPRA were finalised for Stakeholder comment. The job description of the CEO was finalised. Draft adverts for appointment of board members were prepared.
Another strategic objective was to establish an occupational health cluster. The indicator was the establishment and functionality of the occupational health cluster. The target for Quarter 1 was the integrated management of NIOH, CCOD and MBOD and the agency agreement with compensation fund service providers. Another target was the integrated management of NIOH, CCOD and MBOD; develop agency agreement with service provider for claims management, medical assessments and compensation services. The target for Quarter 2 was to develop agency agreements with service providers for claims management, medical and compensation services. The target for Quarter 3 was to implement agency agreements with service providers. In Quarter 1, TORs for services providers were developed, and the bid evaluation and specifications committee was established. In Quarter 2, TORs for services providers were developed, and the bid evaluation and specifications committee was established. In Quarter 3, a MoU was developed between the Department of Health and Mining Companies.
A strategic objective was to establish the National Public Health Institutes of South Africa (NAPHISA) for disease and injury surveillance. The indicator was the Legal framework to establish National Public Health Institutes of South Africa (NAPHISA). The annual target was to have the comments on draft NAPHISA legislation considered and revised, and for the NAPHISA Bill to be submitted to Cabinet. No milestones were reported for Quarter 1. In Quarter 2, the revised Draft of the NAPHISA Bill was produced and submitted to the Chief State Law Advisor for the final certification opinion. In Quarter 3, the Cabinet memo to obtain Cabinet approval of the NAPHISA Bill for tabling in the Parliament was submitted for the Minister’s approval.
A strategic objective was to improve oversight and Corporate Governance practices by establishing effective governance structures, policies and tools. The first indicator was the number of Health entities’ and Statutory Health professional Councils fully functional and compliant to good Governance practices (structures, Finance, Human Resources and Supply Chain Management policies). The target for Quarter 1 was for all entities and statutory health professional council’s governance structures to be fully constituted and for vacancies to be filled within three months of notification. The target for Quarter 2 was for all entities and statutory health professional council’s systems and policies to be developed in accordance with the applicable legislation and corporate governance best practice. In Quarter 1, all public entities' Board/Council memberships were fully constituted. Two of the five statutory Health Professional Councils were fully constituted. Vacancies currently exist at HPCSA, SAPC and SANC. On Quarter 2, the Department published a call for nominations to fill Board/Council vacancies, on 25 September 2016. In Quarter 3, 80% of entities and statutory health professional council’s systems and policies were developed in accordance with applicable legislation and corporate governance best practice.
The second indicator was the performance management system for Board members. The target for Quarter 1 was to implement the performance management system for the Interim Traditional Health Practitioners Council of South Africa and the South African Pharmacy Council. The target for Quarter 2 was to implement the performance management system for the South African Nursing Council. The target for Quarter 3 was to implement the performance management system for the South African Dental Technicians Council, the Health Professions Council of South Africa, the National Health Laboratory Service and the Allied Health Professions Council of South Africa. In Quarter 1, the performance management system was implemented for the Interim Traditional Health Practitioners Council of South Africa and the South African Pharmacy Council. In Quarter 2, the performance management system was implemented for the South African Nursing Council. In Quarter 3, the performance management system was implemented for SADTC, HPCSA, NHLS and AHPCSA.
The third indicator was the number of newly appointed Boards which were appointed and trained. The annual target was for three new Boards to be appointed, inducted and trained (South African Medical Research Council and the Office of Health Standards Compliance and Allied Health Professions Council of SA). The target for Quarter 1 was for one new Board to be appointed. The target for Quarter 2 was for two new Boards to be appointed. In Quarter 1, calls for nominations were published for the following Boards/Councils: AHPCSA (a call for nominations on 2 February 2016), SAMRC (published a call for nominations; the closing date was 24 June 2016) and OHSC (a call for nominations was published on 19 June 2016 with the closing date being 29 June 2016). In Quarter 2, the performance management system for the South African Nursing Council was implemented. One new Board was appointed: the Allied Health Professions Council of South Africa, effective 1 September 2016. In Quarter 3, the performance management system was implemented for the following Boards/Councils: SADTC, HPCSA, NHLS and AHPCSA. One new Board was appointed.
A strategic objective was to improve oversight and Corporate Governance practices by establishing effective governance structures, policies and tools. The indicator was the number of entities and statutory councils monitored using dashboards for performance and compliance to legislative prescripts. The target for Quarter 2 was for the bi-annual dashboard reports to be produced to monitor performance and compliance of all entities and statutory councils. The target for Quarter 3 was for ten entities and statutory councils to be monitored using dashboards bi-annually. In Quarter 1, the compliance dashboards for all entities and statutory councils were developed. Dashboards were based on the entities/Council’s enabling legislation. In Quarter 2, bi-annual dashboard reports were produced to monitor the performance and compliance of all entities and statutory councils. In Quarter 3, entities/Councils were expected to submit updated bi-annual dashboards by the end of February 2017.
The second indicator was the standardised reporting template developed and implemented for Departmental representatives serving on the Board. The target for Quarter 1, Quarter 2, and Quarter 3 was for the Executive Authority’s feedback report on the Board’s/Council’s activities to be produced. In Quarter 1, the Draft Executive Authority’s feedback report on Boards/Councils was produced. In Quarter 2, the Executive Authority’s feedback report on Boards/Councils was produced. In Quarter 3, the Executive Authority’s feedback report on Boards/Councils was produced.
Financial Report
Summary per Programme
The expenditure target was 75%. 70.83% of the adjusted budget for Administration was spent. 76.82% of the adjusted budget for National Health Insurance, Health Planning and System Enablement, was spent. 74.32% of the adjusted budget for HIV & AIDS, TB Maternal and Child Health was spent. 65.9% of the adjusted budget for Primary Health Care Services was spent. 75.24% of the adjusted budget for Hospitals, Tertiary Health Services and Human Resource Development was spent. 74.99% of the adjusted budget for Health Regulation and Compliance Management was spent. In total, 74.76% of the adjusted budget was spent.
Programme 1: Administration
The expenditure target for Programme 1 sub-programmes was 75% and of this a total of 70.83% of the adjusted budget was spent. The expenditure target was 75% per economic classification. 73.76% of the adjusted budget for Compensation of Employees was spent. 69.22% of the adjusted budget for Goods and Services was spent. 77.73% of the adjusted budget for Transfers was spent. 38.81% of the adjusted budget for Capital was spent. 153.13% of the adjusted budget for Losses was spent. In total 70.83% of the adjusted budget was spent.
Programme 1: Reasons for Deviation
Goods and Services
Under-spending was mainly on audits costs as the funds would be used for AGSA for the 2016/17 financial year audit.
· Bursaries would be paid during Quarter 4
· Delay in the maintenance of the security system now underway
Transfers and Subsidies
High spending was due to payments made for the outstanding fees for the previous financial year to HWSETA
Capital Payments
Lower spending was due to the delay in the procurement of data storage server hardware from SITA, in addition to back-up hardware
Programme 2: National Health Insurance, Health Planning and System Enablement
The expenditure target for programme 2 sub-programmes was 75%. 86.09% of the budget for the Office of the DDG was spent. 52.02% of the budget for Technical Policy and Planning was spent. 93.11% of the budget for Health Information Management, Monitoring and Evaluation, Sector-Wide Procurement was spent. 49.08% of the budget for Health Financing and National Health Insurance was spent. 57.2% of the budget for International Health and Development was spent. In total, 76.82% of the budget for programme 2 sub-programmes was spent.
Programme 2: Reasons for Deviation
Compensation of Employees: Over-expenditure
Higher expenditure was due to higher than expected foreign allowances paid to health attaches.
Transfers and Subsidies: Over-expenditure
The overspending was for unanticipated payment of leave gratuity to ex-officials.
Capital Payments: Lower Spending
The under spending was due to delays in the procurement process for office equipment.
Programme 3: HIV and AIDS, TB, Maternal and Child Health
The expenditure target for programme 3 sub-programmes was 75%. 68.05% of the budget for the Office of the DDG was spent. 74.72% of the budget for HIV & AIDS was spent. 60.82% of the budget for Tuberculosis was spent. 52.11% of the budget for Women’s Maternal and Reproductive Health was spent. 47.84% of the budget for Child, Youth and School Health was spent. In total, 74.32% of the budget was spent.
Programme 3: Reasons for Deviation
Goods and Services: Under-expenditure
Under-spending was due to funds reserved for World TB Day which would be in March 2017.
· Second dosages of HPV Vaccinations were scheduled for February/March 2017.
· The contribution to the Global Fund would be paid during Quarter 4.
Capital Payments: Under-expenditure
The delay in procurement of fridges for health facilities.
Programme 4: Primary Health Care Services
The expenditure target for programme sub-programmes was 75%. 81.96% of the budget for the Office of the DDG was spent. 50.09% of the budget for District Services was spent. 74.65% of the budget for Communicable Diseases was spent. 66.48% of the budget for Non-Communicable Diseases was spent. 67.69% of the budget for Health Promotion and Nutrition was spent. 66.82% of the budget for Environmental and Port Health Services was spent. In total, 65.9% of the budget was spent.
Programme 4: Reasons for Deviation
Compensation of Employees: Under-expenditure
The under-spending was due to the high vacancy rate on funded posts.
· Posts have been advertised, shortlisted and interviews conducted. The applicants were found not to be suitable and headhunting was unsuccessful. The post re-advertised and the Department is in the process of filling the vacancies now.
Goods and Services: Over-expenditure
Overspending was due to intensified and scaled-up activity in Communicable Diseases in pursuance of the MDG to eliminate Malaria by 2019 as well as mapping for Bilharzia in South Africa in order to determine the extent of the problem and how to effectively manage the disease.
Transfers and Subsidies: Under-expenditure
Payments to NGOs would be processed during Quarter 3 after the SLAs were finalised and the audited financial statements from the previous year were received.
Purchase of Capital Assets
Equipment and furniture were still in good condition. This funding would be allocated else-where.
Programme 5: Hospitals, Tertiary Health Services and Human Resource Development
The expenditure target for programme 5 sub-programmes was 75%. 60.62% of the budget for the Office of the DDG was spent. 77.24% of the budget for Health Facilities Infrastructure Management was spent. 74.4% of the budget for Tertiary Health Care Planning and Policy was spent. 81.82% of the budget for Hospital Management was spent. 74.9% of the budget for Human Resources for Health was spent. 82.09% of the budget for Nursing Services was spent. 59.2% of the budget for Forensic Chemistry Laboratories was spent. 75.83% of the budget for Violence, Trauma and EMS was spent. In total, 75.24% of the budget was spent.
Programme 5: Reasons for Deviation
Compensation of Employees
The overspending emanated from payment to foreign medical interns paid by the Department; however the provinces were in the process of reimbursing the Department.
Goods and Services: Under-expenditure
Agency services (for the infrastructure project) for the DBSA were still to be paid.
Capital Payments: Over-expenditure
More invoices for payment of upgrading health facilities were received than expected.
Programme 6: Health Regulation and Compliance Management
The expenditure target for programme 6 sub-programmes was 75%. 76.12% of the budget for the Office of the DDG was spent. 65.13% of the budget for Food Control was spent. 75.71% of the budget for Pharmaceutical Trade and Product Regulation 74.99% of the budget for Public Management Entities was spent. 74.79% of the budget for Compensation Commissioner for Occupational Diseases and Occupational Health was spent. In total, 74.99% of the budget was spent.
Programme 6: Reasons for Deviation
Goods and Services
Overspending was due to the establishment of SAHPRA. The funds to defray the expenditure were received during Adjustment.
Purchase of Capital Assets
Delays were experienced in the procurement of the specialised lung function equipment.
Conditional Grants Report
The presentation covered the Conditional Grants expressed as at 31 December 2016.
The total spending for Conditional Grants is at 74.9% or R25.6 billion against the total adjusted budget of R34 billion as compared to 72.7% or R23.5 billion spent in the same period last year.
The overall spending of provinces is within the current norm of 75%. However, major contributions to under-spending were:
· NHI (34%) due to supply chain inefficiencies.
· HFRG (66.3%) due to the slow performance of contractors and outstanding invoices.
NTSG, HPTDG and HIV/AIDS spent 77.9%, 73”% and 76.2% thus their spending is within the acceptable norm.
Grant Summary
· Health Profession Training and Development
· National Tertiary Services
· Comprehensive HIV and AIDS
· Health Facility Revitalisation
· National Health Insurance
The total grant expenditure was R25 631.41 (74.9% of the budget).
Health Professions Training
The grant expenditure was R1 814 537 (73.2% of the budget). The overall spending for the grant improved from 72.5% (2015/16) to 73.2%, which was within the acceptable norm. The Free State and the North West were over-spending as the funding was not enough to cater for all registrars and incorrect linkages, whilst Limpopo province, Mpumalanga and the Western Cape were spending within the norm. The other provinces were under-spending.
The under-spending in the Eastern Cape, Gauteng, KwaZulu-Natal and the Northern Cape was attributed to:
· Delays in the implementation of the amended business plan and the procurement of medical equipment.
· Awaiting of the intake for registrars in January
· The delays in the processing of invoices amounting to R15.7 million on machinery and equipment.
Remedial action for the Department was to speed-up the recruitment of registrars, the payment of invoices and the procurement of medical equipment.
National Tertiary Services
The grant expenditure was R8 487 362 (77.9%). The overall spending for the grant improved form 71.8% (205/16) to 77.9% and is above the acceptable norm. The Northern Cape and Limpopo province were over-spending due to incorrect persal linkages. KwaZulu-Natal and Limpopo province were spending within the norm. The other provinces were under-spending.
The under-spending in the Eastern Cape, the Free State, Gauteng, Mpumalanga and the North West, was attributed to:
· Delays in the finalisation of the decomplexing organograms for the Regional Hospitals which lead to the incorrect linkages.
· Delays in the payments of invoices and the procurement of medical equipment.
· Delayed payment of leave gratuity to two specialists who resigned in February 2016.
Remedial action was to expedite the finalisation of the organogram and outstanding payments.
Comprehensive HIV/AIDS and TB
The grant expenditure was R11 691 193 (76.2% of the budget). The overall spending for the grant improved form 74.1% (2015/16) to 76.2% and was within the acceptable norm. The Eastern Cape, Gauteng, KwaZulu-Natal and the Western Cape were spending within the acceptable norm
Limpopo province, Mpumalanga and the North West were over-spending due to:
· The payment of accruals on ARVS
· The increased number of patients
· The depot ordering more drugs in preparation for implementation of the universal test for the increased rate of testing in line with the UTT programme
The under-spending in the Free State and the Northern Cape was due to:
· Delays in the payment of NHLS and ARV depot invoices and delivery of condoms as well as recruitment challenges in RTCs.
Remedial action was to expedite the payment of invoices and the appointment of RTC staff.
Health Facility Revitalisation
The grant expenditure was R3 598 606 (66.3%). The overall spending for the grant declined from 71.2% (2015/16) to 66.3%, which is below the norm. The Free State and North West were over-spending bulk payments, and speedy progress on the construction of the Bophelong Staff Accommodation as well as the implementation of the Jouberton CHC. Mpumalanga was spending within the norm. The other provinces spent below the norm in the period under review.
The under spending in the Eastern Cape, Gauteng, KwaZulu-Natal, Limpopo, the Northern Cape and the Western Cape was attributed to:
· Delays in the appointment of scarce skills posts and this was common in Gauteng and the Western Cape.
· The slow procurement and delivery of medical equipment (HT) in all provinces.
· The slow performance by contactors and the payment of invoices in all under-spending provinces.
· Delays in the finalisation of the Master Plan in relation to hospital revitalisation projects (GP).
· Delays on the awarding of tenders and general SCM challenges in all provinces.
The remedial action was to closely monitor the performance of contractors and expedite the payment of invoices and procurement processes and improve turn-around times in all sections of SCM.
National Health Insurance
The total expenditure was R39 712 (37.4% of the budget). The overall spending for the grant declined from 55.1% (2015/16) to 37.4% which is far below the norm. All provinces spent below the norm.
The under-spending was attributed to:
· Eastern Cape: delays in the procurement of shelving and racking amounting to R800 000, as well as Ideal Clinic medicine fridges amounting to R1.8 million.
· Free State: delays in the delivery of equipment (JOJO Tanks) and the slow progress on projects. Commitments amounting to R2.3 million have not been realised.
· Gauteng: delays in the delivery of equipment and the slow payment of invoices.
· KwaZulu-Natal: procurement delays.
· Limpopo Province: awaiting the delivery of portable diagnostic sets with an ophthalmoscope and otoscope.
· Mpumalanga: delays in the SCM processes in relation to the specifications and quotations.
· Northern Cape: delays in the procurement process from the training programme.
· North West: delays in the delivery of medical equipment and the submission of invoices.
· Western Cape: delays in the payment of invoices and the non-filling of GPs, dentist and dentals assistant sessions.
The Department was still in the process of sourcing GPs, dental assistants, and ensuring the timeous payments of invoices (WC). Improve turnaround times on payments, and follow-ups with suppliers regarding the delivery of equipment. The Department relaxed grant purposes to include Ideal Clinic requirements which would expedite the spending on the grant. NDoH was in the process of visiting all provinces to ensure the acceleration of expenditure especially on problematic grants as aforementioned. The grant would be fully spent.
National Health Grant: Schedule 6 – Indirect Grant
The grant was spent by the National Department on behalf of the provinces. The grant expenditure was R849 543 (67.4%). The available budget was R184 864. NHI component (CCMDD and HP Contracting) was spending above the norm and it was expected that the grant would spend the full budget. The infrastructure component was spending below the norm however, after all the outstanding invoices were processed, the grant would break even.
The Ideal Clinic component was spending below the norm. The business plan was revised to cater for the procurement of equipment for provinces (Northern Cape and North West). Once the expenditure was realised, the grant would break even. Equipment would be procured using contracts and have already been identified. The HPV component was also spending below the norm but spending would drastically improve in Quarter 4 as R60 million was committed for vaccines, and had been delivered. R15 million for transport and R30 million worth of claims were being submitted by provinces. R17 million was already been received.
2017 Final Framework Challenges
· NTSG which included for funding for the Nelson Mandela Children’s Hospital (R100 million, R200 million and R300 million over the MTEF period)
· HIV/AIDS which includes TB allocation
· HFRG
· Introduction of the Information Systems Grant
· No changes in other Indirect Grant components
· The number of indicators had changes in most grants
Discussion
Mr James spoke to hospital revenue collection. He explained that one revenue stream was for hospitals to charge patients on medical aid for services rendered, and the difficulty was always that the Committee was not aware of what the services cost. He asked what the cost and incentive model was, and whether the cost problem was solved. He explained that he visited hospitals which charged very little for services, whereas others charged more. For this reason, a standardised package for providing for essential services was needed across the private and public sector. He then spoke to the issue of the NDoH not receiving data from the Office of Health Standard Compliance. He said that it was a very serious problem. He said that his experience with the Office of Health Standard Compliance was that it was a very slow and inefficient body, in addition to being passive and dolorous.
Mr James asked what the NDoH was going to do in terms of the poor performance in data provision. He said that the NDoH could not be hostage to poor performance in data provision. He also said that the fact that there was under-expenditure for NHI-related activities was a great concern. He asked why there was serial under-expenditure, and why provinces were not spending money from the allocated budget. Overall budget growth of the NHI was going to increase over the course of time. He asked who the foreign interns referred to in the presentation were, and specifically which country they originated from.
Ms D Senokoanyane (ANC) spoke to NDoH targets, and noted that although it appeared that the Department overachieved, the established targets were too low. She indicated that the targets for employees accessing health and wellness services were very low. She noted that the annual target for the number of midwifery educators identified nationally and registered for training and development programmes was 50, however in three Quarters the Department achieved 87. An indication was that the targets were too low. She referred to the target to review four bilateral agreements by Quarter 3, but the presentation did not provide a clear indication of what the Department intended to do. She recommended that instead of referring to “activities”, that the Department specified what the activities were.
Ms Senokoanyane spoke to the trend in terms of capital expenditure, and indicated that there was a recurring issue of under-spending which was a matter of concern. There appeared to be a serious problem in terms of spending on capital budgets. She referred to the percentage backlog illumination on toxicology tests, and asked if the Department was faced with the challenge of a shortage of toxicologists. If this was the case, then a serious problem existed. The issue required attention as the performance was 5% and the target was 75%. She also noted that under spending on programme 1 was due to the Auditor-General (AG) not being paid, and asked whether the AG was paid at the end of the financial year. She noted that the AG would question the Department on the under-expenditure.
Ms James spoke to the percentages on blood and alcohol toxicology, and requested that the Department provided the Committee with a report on the performance, staffing and technology for blood and alcohol toxicology tests for the four forensic chemical laboratories, in Cape Town, Johannesburg, Pretoria and Durban. He referred to the total number of primary health facilities in 52 districts and asked how many clinics there actually were, as districts also have sub-districts. He wanted to know what the relation was between the state of mental health facilities and the report produced by the Ombudsman. He also wanted to know what the progress on the Ideal Clinic was.
Mr P Maesela (ANC) referred to the 3 143 functional WBPHCOTs mentioned for primary health care performance in Quarter 3. He asked is the 3 143 facilities were actually functional. He said that the Committee visits communities, however never see the officials that were supposed to be there. He said that these officials were represented in the presentation however, they were not “on the ground” and this has contributed to the ills currently faced. He also said that certain areas were not receiving medications because according to the Municipality, the vehicles allocated to medication were not working. For two weeks, people had to walk to the clinics to be told that there was no medication. He asked what the duty of the ward-based public health and outreach commons was, where they were and if they actually existed.
Mr Maesela noted that 267 clinics have obtained Ideal Clinic status based on their fulfilment of the requirements and by “ticking the boxes”, but to what extent they were in fact ‘ideal’. He asked what the mechanisms in place were in the instance that 120 people arrived at an Ideal Clinic which was able only to provide 20 people with care, and was therefore unable to receive treatment. He said that most of the clinics have been in existence for a long time, and asked why it would take so long to transform the clinics into Ideal Clinics. He said that there was an issue of some Ideal Clinics not being suitable, as patients were expected to queue outside the clinic where there was no shelter. He said that the issue needed to be addressed and that a deliberate programme should be developed to evaluate the functioning of Ideal Clinics.
With reference to mental health services, he asked the Department what preventative measures were implemented before the “calamity” was discovered, and why the issue which arose was not able to have been prevented. He asked whether the Department “believed what it was told, and never bothered to verify”. He asked what the District Mental Health Teams have been established to do, what they were currently doing, where they were doing the work, and what the work done by the team entailed. He said that if the Teams were in action, the calamitous situation currently faced by the NDoH could have been avoided.
Mr Maesela spoke to the main challenge of SCM, especially in equipment, essential supplies and infrastructure. He asked the NDoH why “main challenges” still existed in the 267 Ideal Clinics, let alone in other clinics. There should not be challenges in Ideal Clinics. He said that it was not acceptable that SCM was still a main challenge and recommended that the NDoH selected individuals from the provinces, grant them training and expertise in supply chain management and have them deployed for specific posts. He said that the Department needed to solve the problem by creating the SCM experts it required.
The Chairperson said that one of the challenges for the Committee was that the report “is just ticking the boxes”.
The Chairperson spoke to the issue raised by Mr Maesela regarding the District Mental Health Teams. He explained that the Committee visited approximately six provinces during oversight, and the picture on the ground did not match what was presented in the report. He also said that during oversight in Gauteng, the Committee discovered that the District Mental Health Teams was not operating for more than six months whilst the Committee was there, owing to the stalemate with the Department. As a result, the system had collapsed. He said the same discovery was made at the NHI Pilot Sites in the Free State. The difficulty was that some of the provinces experienced challenges related to the financial management system and as a result, the Departments were not financially sustainable.
The Chairperson said that each year the Department had huge accruals, which if paid, would amount to unauthorised expenditure. In essence, it should not be referred to as “accruals” as the accumulated amount was because payment was withdrawn for services. Many provinces were currently not paying for services, and have stopped paying for services in November 2016. During the December, January and February period the provinces did not pay for any services because there was not enough money. Instead provinces paid for services in the new financial year when they received more funds, but services were compromised.
The Chairperson asked what national monitoring system the NDoH had in place. He said that the issue persisted for too long, and that the irregular-expenditure and accruals was increasing each year. In many instance it was not possible to regularise expenditure as there was no justification for irregular expenditure. He said that he did not believe that the NDoH, as a National Department, was making any efforts to intervene and rescue the provincial Departments that were challenged by the current situation.
The Chairperson asked the Department if the White Paper included the final funding model of the NHI. He said that the funding model was not included in the previous report. He recommended that the NDoH include the final funding model of the NHI in the White Paper submitted to Cabinet. He then spoke to the issue of TB, and explained that while in Kenya in December, the Committee received and signed a report to establish a caucus. However, further steps were not taken with regard to establishing the caucus, whilst other countries have already held caucuses at Parliamentary level. Members would discuss how to contribute and take the process forward.
The Chairperson requested a list of mines where the work was being conducted. He asked the Department to specify the bilateral agreements and projects with the various countries, including the UK, Namibia, Botswana, China and Zambia, and explain what they entail. He spoke to the issue of neonatal deaths, and asked what the Department’s strategies to address the underperformance related to neonatal deaths was, in order for the Committee to monitor and extend oversight to include the strategy. The mines in the Northern Cape and Western Cape reported the highest TB-related death rate. He asked if the Department analysed the underlying causes of the high death rate. He asked what intervention would be implemented to address the TB death rate. He noted that the presentation focused on the mines in the North West and Gauteng, which was believed to have had the highest TB-related death rate. However, the Department has raised the point that the highest rates were in the Northern Cape and Western Cape.
The Chairperson said that the report was misleading and that the clinics have collapsed as he has never seen a ward in his constituency. He asked how the progress on clinics is tracked and reported on, and whether the data reported on was received from the provinces or if the actual implementation on the ground was observed. He also asked if the Department conducted random monitoring with regard to salt content, as well as which thirteen categories were evaluated and what the findings were for each category. He asked in which districts the District Mental Health Teams were deployed as well as what they were doing in practice. He asked if Teams have been established in Gauteng, and if so, why has the issue in Gauteng emerged.
The Chairperson referred to the 3 149 PHC facilities which were benchmarked in Quarter 3, and asked what the outcome of the benchmark was. He then referred to dependence on the Office of Health Standards Compliance regarding the performance of health facilities, especially mental health facilities. He reiterated that the Department was unable to meet the targets. He asked if a Memorandum of Understanding with the Office exists.
The Chairperson asked what the weaknesses were regarding the performance standards of hospitals, and what can done to address the issue. He wanted the Department to provide the Committee with a list of clinics which have undergone revitalisation, as well as their locations. He said that the list would allow the Committee to verify the information reading the clinics and community health centres from an oversight perspective. He referred to the 18 hospitals which were revitalised, and noted that some of the hospitals in the Eastern Cape were in a state of extreme dilapidation, and therefore the list was needed in order for the Committee to fully understand the actual situation.
The Chairperson asked the Department to explain the 15; 75 target for Quarter 3 for the number of managers accessing and caching the mentoring programme. He asked if nothing was achieved in Quarter 3 and indicated that “briefing sessions” as presented in the report, did not amount to access to coaching and mentoring programmes or use of the management knowledge hub. The Chairperson asked the Department to elaborate.
The Chairperson spoke to the issue of overspending on SAPHRA and asked the Department how it was possible if the job description of the CEO of SAPHRA was still being finalised and the draft appointment of the Board and Committees has still not been completed. He reiterated that in essence, SAPHRA does not have a Board, yet the entity has contributed to overspending, which the Committee cannot understand. The Chairperson asked the NDOH to elaborate on the matter and the relation between the performance and the over-expenditure. He noted that the Department has committed that SAPHRA would be up and running by 1 April 2017 in a meeting with the Portfolio Committee last year. He asked what the progress on SAPHRA was, and whether the Committee can expect SAPHRA to be functional by 1 April 2017.
The Chairperson asked what the outcome of the performance management system of all the Boards and Councils based on the NDOHs assessment was. He asked what the functioning and performance rate was on the Boards and Councils. The Committee has not conducted oversight on the Councils. He said that he could not recall the Department ever reporting on the performance. He said that underperformance by the NHI was a recurring problem which the Department was unable to address. He asked how realistic it as to attempt to implement NHI despite the inability to implement the limited budget for the pilot process. The Department claimed that the pilot projects were successful in its reports, when in fact they were not.
The Chairperson spoke to issue of under-spending as a result of the high vacancy rate of Environmental areas of specialisation. He said that unemployed students with degrees specialising in Environmental areas have engaged the Committee. He asked what specific area of speciality the NDoH required, and what the unemployed graduates with Environmental Sciences did not have that was required. He noted that the Director-General said that the NDoH did not have the capacity to employee the graduates. He requested clarity. The DG said that she would make interventions based on the numbers provided by the Committee.
The Chairperson asked how SLNAs were agreed upon and appointed in the absence of the service-level agreement. He said that one of the requirements for the appointment is the service-level agreement. He referred to the Organogram and asked how the Department was able to allocate budget to it before it had not been planned and costed. He said that the Department was meant to develop the plan, cost the equipment and then budget it to avoid instance whereby there challenges related to spending.
Ms Andrews spoke to the issue of reliance on the Office of Health Standards Compliance raised by Mr James, to report against some of the hospital indicators based on the assessments. She said that the Department has developed a strategy to address the issue. The Department would no longer be dependent on the Office of Health Standards Compliance. She explained that the indicator was included in the APP and addressed in the presentation.
Ms Andrews said that in order to facilitate service delivery improvements, the hospital cluster has decided to work with the patients experience of care and the patient and staff satisfaction surveys as well as clinical data from the DHIS and inspection reports and reports from the Auditor-General. The main strategy is to work with the Patient Experience of Care surveys and the Staff Satisfaction surveys to guide service delivery improvements.
Mr Andrew Crichton, Chief Director: Human Resources, National Department of Health, explained that the foreign national interns who were employed by the NDoH at the beginning of last year were employed as part of an extended agreement with SADC countries whereby medical students were also exchanged across countries. 37 foreign interns were employed by National Department for one year and then transferred to the provinces who would continue their employment. 14 interns were from Botswana, 4 from Mauritius, 1 from Namibia, 1 from Nigeria, 4 from Swaziland, 1 from Zambia and 12 were from Zimbabwe. The individuals would utilise provincial budgets as of the new financial year.
Ms Andrews spoke to the issue regarding blood toxicology tests and the backlog. She said that the NDoH adopted a new targeted “blue sky” approach to toxicology testing which was included in the previous APP, whereby only ten toxins were tested for. The list of toxins to be tested was being finalised, and once completed the approach would drastically reduce the number of tests that would conducted, as well as the turnaround time for results. She said that seemingly, there did not appear to be an issue reading staffing however, the NDoH would submit a status update report to the Portfolio Committee.
In relation to revenue, the provincial Departments of Health were not collecting revenue relative to their potential to collect revenue as no incentive to collect the revenue currently exists. The only province which has been able to effectively collect revenue and retain it is the Western Cape owing to an agreement with the Provincial Department of Health and Provincial treasury, to retain a portion of the revenue for the infrastructure of facilities.
The Department has persuaded Provincial Departments to do the same, however the Provincial and National Treasury need to be on board. The Department has approached the FFC for the policy proposal to be adopted by other Provincial Departments. The Departments is optimistic that the Provincial Treasury would adopt the proposal which allows the provincial Departments to retain a portion of the revenue collected, as an incentive.
The Uniform Payment Fee Schedule (UPFS) was costed and was the basis on which the fees should be charged. However, each Provincial Legislature may decide to levy an alternative fee for a particular procedure. An agreement was made with the MECs at the National Health Council to Gazette the UPFS as the basis for which all the provinces would determine fees.
Ms Jeannette Hunter, DDG: PHC, National Department of Health, explained that the implementation of the Ideal Clinic commenced in the 2015/16 financial year. According to Ms Hunter, the work before the commencement was planning. When the Health Systems Trust audit results were released, only one hospital in the country, located in the North West met health standards. She said that the wording for the APP target spoke to additional clinics, therefore the Department did not report on the 322 clinics identified in the 2015/16 financial year. As the financial year was not concluded, the 322 clinics would be added to the 267. The Department was positive that the year would end with more than 267 clinics in operation.
In response to the question of whether Ideal Clinics were “ideal”, Ms Hunter explained that the programme was being implemented jointly with the Department of Performance Management and Evaluation (DPME). She said that in the last Quarterly meeting, the Minister noted that he visited the clinics and many were not in fact “ideal”. Ideal Clinics were determined on weighted elements relating to the availability of oxygen and whether the staff was able to handle medical emergencies. She said that if the clinic staff were not trained on basic life support measures, they clinic may receive a score of 80% and it would not qualify as an Ideal Clinic.
Ms Hunter said that progress on the number of Ideal Clinics has been slow, and the Department is not satisfied with this performance. The system needed to be fixed, however there were serious challenges facing Ideal Clinics which have contributed to the base line being zero. The main challenge facing the NDoH was the state of clinic infrastructure, however it was also the area in which the Department performing best in in terms of health. The list of clinics which were refurbished and rebuilt would be submitted to the Committee. The NDoH had an extensive report on the clinics and their current status. The Department recently submitted the report to the DPFA. She said that panels of service providers were established to avoid lengthy tender processes. The service providers competed for the contract, and the Chief Procurement Officer’s Office gave the Department the go-ahead.
The second major challenge facing Ideal Clinics was Human Resources, which was more difficult to address than the challenge of infrastructure. WISEN for Primary Health Care was completed. There was a shortage of doctors, but more significantly shortage of cleaners, data capturers and grounds men. Professional nurses then assisted with cleaning, data capturing and other duties therefore it appeared as though there was a shortage of nurses, when in fact there is not. The process of staffing would be a difficult process but the Department would engage the Treasury to provide effective staffing.
The Ideal Clinic Framework was developed to hold the clinics accountable. She explained that the supply chain did not include medicine supply, as the supply of medicine in South Africa was good and South Africans were in fact “spoilt”, especially in Gauteng. She explained that the supply chain issue related to medical equipment, cleaning materials and surgical sundries such as for wound care.
Since the development of the Framework, the NDoH reported regularly to the National Health Council on which the HODs sat, to address the supply chain problems faced by the Department. The Department found out that one province did not have a supply chain structure at Provincial level or at District levels. The NDoH reported collaboration with National Treasury on a National Catalogue. The Department discovered that there were no transversal tenders available for the facilities to order the resources needed. Unfortunately, the Department had to monitor the access to resources and the reasons for the clinic not being suitable.
The Ideal Clinic Framework was a valuable tool and should be continued to improve the quality of clinics. Ms Hunter thanked the Committee for its support for the Framework in Provinces, and requested the Committees continued report. The Western Cape decided not to partake in the Ideal Clinic programme, however because of the engagement by the Committee, the programme was implemented in the Western Cape on 1 April 2016.
Ms Hunter said that the numbers reported on were received from the Provinces. Ms Hunter said that it was not the first time that the Committee raised the discrepancy between what it reported in the presentation with regard to the Outreach Teams and what existed on the ground during oversight visits. For this reason, the Minister instructed the NDoH to develop a database of every Community Healthcare facility which identified employees by name, ID number and work location.
The Department had a target of 2 000 Ward-Based Primary Healthcare Outreach Teams, however the Department has exceeded the target. The Department has identified the need for the improvement of conditions of service for the community healthcare workers. The Department is committed to improving the conditions and identify where the workers were stationed. The tracking system and monitoring and evaluation system needed to be implemented for staff. The Department engaged the unions who would be involved in the formalisation of the work conditions for community healthcare workers.
Ms Hunter said that the NDoH needs to be guided by the unions with regard to pitfalls. According to the Policy Framework and Strategy 2013/2020, the national health objective was that each NHI Pilot District should have a District Mental Health Team, consisting of a psychiatrist, a psychiatric nurse, an occupational therapist, a social worker and a psychologist. The Team did not consult with patients, but instead plan Public Health Services, such as with the deinstitutionalisation issue in Gauteng. She said that it was already defined in the Mental Healthcare Act, and tools have been designed against which to measure the compliance of facilities with regard to mental health users. Ms Hunter explained that the healthcare was not offered to sick patients, but to “intellectually-disabled individuals”.
Ms Hunter acknowledged that there was a problem with regard to not filling vacancies for community service and Environmental Health Officers. The posts were management posts in the District Health system in Government and therefore the NDoH has to follow the DPSA regulations in terms of post-graduate experience and years of experience. Unfortunately, the NDoH was unable to appoint suitable candidates and the post had to be advertised. She said that there was an agreement that the government would evaluate 13 categories of foodstuffs which had a very high salt content, and which South African frequently use in order to make a health impact. The list of foodstuffs to be monitored for salt content includes bread, butter and butter spreads, cured meat, uncured meat, cereal snacks, crisps, salt and vinegar chips, soups and soup powders and others. She said that in these areas of health promotion, the Department aimed to establish a balance between the legislation and South Africans as well as industry, to voluntarily comply. The Department set a deadline for the compliance evaluation for June 2016, before which time the compliance achieved was 50%. The Department was currently planning the remedial action for compliance together with the industry.
Ms Hunter said that there was no way that the Department was able to establish an outside organisation without an SLA, as the Department would not be able to pay them. The Department needs to ensure that the annual report and audited financial statements were in line with what the SLA. The budget allocated to SAPHRA was intended to support the entity in terms of resources in order to deliver its mandate more effectively. Treasury provided additional funds in order for SAPHRA to employ more people in order to address the number of applications received and the slow application time. However, funding was received late in relation to the timeframe expected by SAPHRA to employ more people.
The Department anticipated that National Treasury would have listed SAPHRA as a public entity by this time in order for the NDOH to advertise the positions of the Board. However, the Department was expected to appoint a CEO, a CFO, a Board and a Human Resources Manager before Treasury would be able to list SAPHRA as a public entity. Once the listing happens, the nominations for Board members would be advertised. The Department would aim to have SAPHRA running by 1 April 2017; however there was dependency relating to the requirements of Treasury.
The Performance Management System was derived from the operation of private entities in terms of the King Report and some of these indicators have been applied to performance management with the intention to improve the performance of Boards in the identified areas. The Department is able to share the report with the Committee. NHI spending was in fact exceeding the target, however in areas such as machinery and equipment, the expenditure was poor due to the facility access to machinery and equipment.
A proposal made to the Chief Procurement Officer was to develop a health equipment catalogue with negotiated prices, such as with the private sector, with in order for all facilities to purchase the required machinery and consumables. The catalogue would eliminate the need to go to tender.
According to the Chairperson, when the Committee visited the provinces including the NHI pilot sites, they claimed that there was no money or that they were not allowed to make procurements. The Chairperson asked where exactly the problem lied as the budget was not being utilised, however the provinces claimed they did not have the funds for the procurement of equipment. He said that most NHI facilities did not have the necessary equipment. The facilities which had the requirements were bound by the District and province, therefore when transfers took place they were allocated to the provinces, and the clinics were not aware that the funding existed because they were told otherwise by the provinces. The staff in clinics needed to know how to describe the equipment for the supply chain, and if they could not, challenges were experienced with regard to the procurement of equipment. The National Department could not procure equipment on behalf of the provinces; however the Department made efforts to assist with the orders.
Mr Maesela said that if the facilities did not have a supply chain system in place in 2017, then the facilities were not needed and should not be in existence. He agreed with the recommendation to develop a catalogue to purchase the equipment, as the provinces do not have the capability and capacity to. He said that this process would assist in terms of accountability. It would be easier to make a bulk purchase for the equipment. He requested that the NDoH agrees that the issue of procurement would be resolved even if it means that the Department should purchase the equipment itself.
The Chairperson said that Conditional Grants were based on the business plan which has been submitted to the Department. The facilities were being told that there was no funding which could be accessed and that according to the provincial CFO; the facilities were not able to make the procurements.
The CFO explained that some of the conditions in the Conditional Grant Framework were relaxed to allow the facilities to purchase the necessary equipment. In the previous year, the Department purchased R3.6 million worth of equipment despite the challenges. The NDoH visited each province and indicated how much funding was available. However, the bureaucracy within the provinces makes the process longer and logistically difficult. He explained that the SCM Forum was attached to the CFO Forum and the NDoH intervenes where it was able. He noted the Adjudication Committee which makes adjustments on tenders has not sat in the Northern Cape for more than nine months. He agreed that if entities were not in operation, then they should not exist.
The NDoH conducted Budget benchmarking exercise in all provinces, and the findings were that all provinces have close to 0 nominal growth, and lose 4.5% per annum, which made it difficult to ring-fence the budget. The fiscal pressure on the sector continues to grow. He said that Irregular expenditure and the existing audit outcome was currently being addressed by the Department.
Ms Hunter said that the DG sent letters with spread sheets and equipment lists to the provinces, after the CFO assisted them in understanding the budget. She said that the Department was hoping that the transversal levers were to the right specifications, as some of the equipment stops working shortly after, or in instances bedsteads collapse. She also said that the easiest way to not have to do something was to say that there was no money.
The Chairperson asked the Department to specify the seven mental health teams and where they were located in the 37 Districts.
Ms Hunter said that the teams were located at the nine pilot sites, with one in Tshwane. She said that she would confirm. The agreement between the Department and National Treasury was that the White Paper would cover the policy aspects of NHI in terms of service delivery and configuration. However, National Treasury would publish a document relating to revenue generation. The White Paper published by the Department would not include the sources of funding.
The Chairperson asked if the White Paper would not be costed. He said that there was an oral reply on the matter in the National Assembly and the Minister indicated that he implemented work streams to deal with the funding. The task team was expected to report to the Minister in October/November therefore, the work stream would have been reported on by now. He asked the Department to clarify. The Department was working with Treasury to determine how much NHI would cost based on how it would be structured. The issue of where the revenue streams would come together to create the funds would be published by National Treasury.
Dr Yogan Pillay, DDG: HIV, TB and MNWH, NDoH, noted that 24 March 2017 as World TB Day. The Minister said that the TB Caucus and formal launch of the South African Chapter would be raised with the Members in Parliament. It was agreed that World TB Day would be held in Mangaung in the Free State. There was a suggestion that the NDoH was not doing well with regard to TB, which Mr Pillay noted was partly true. He explained that the Department was not doing well with regard to MDR (Multi Drug Resistant) TB however; the Department was performing better with regard to Drug Resistant TB.
Mr Pillay said the Western Cape had a higher than usual TB death rate per the presentation, however in the presentation the defaulter rate (9.5%) and the death rate (3.1%) were erroneously swapped. He added that the Northern Cape is problematic, especially with regard to management. A new regimen for MDR TB treatment was anticipated to commence on 1 March 2017 from 18 months to 2 years. Two new drugs for a nine month regimen were anticipated for 1 March 2017. He said that the NDOH would provide the Committee with the list of the mines.
Mr Pillay explained that the Department was doing four things to address the issue of neonatal deaths. CPAT machines to assist the breathing of neonates were purchased on behalf of four provinces for 36 district hospitals and the Department would be purchasing another 30. The contractor was owed money by the provinces for their orders and the Department could not receive the 30 because the service provider was not paid. The second mechanism was to retrain nurses and doctors on helping babies to breathe, which as a WHO technique. The third was training on the management of obstetric emergencies. The fourth mechanism was the hiring of a paediatrician to attend the hospitals with a high number of neonatal deaths in order to provide guidance on the ground. The major challenges were prematurity, infections and asphyxia.
Mr Maesela explained that diagnostic tools which were efficient and can be used to diagnose TB with 99% accuracy. The Department was employed to ensure that health is functional, which included having to purchase the solutions. He said that it was a crime for children to die of malnutrition in South Africa and recommended that the National Nutrition Supplementary Project should be taken from the Department of Basic Education and handled by the National Department of Health, as children were not receiving the nutrition they required. Most often the food receiving from the school nutrition programme would be the only meal the children receivde, and often they may not have a meal because of food shortages and ineffective managed. He added that the no-go areas in the mines were incubators for TB.
Ms James asked how many clinics were in each district. She emphasised the need for health education and awareness to ensure that people knew how to avoid illnesses. She said that there was a need for Ideal Clinics which provided health education. There was currently no trained staff on drug abuse. She said that people did not have medical aid and were forced to go to these facilities. The Committee never received a commitment for a programme that would be developed and implemented. She added that the Department did not appear to be communicating the information to the public.
Dr Pillay said that the Department met the targets related to for acute malnutrition fatality rates, which declined from 9.5% to 7% in the last three quarters. He said that teams attended the hospitals to teach the doctors and nurses, as well as ward-based outreach teams. An international conference was held on the importance of breast feeding and the rates have increased. He said that performance increased as a result of the national initiative. There was currently an attempt by the Deputy President’s Office to co-ordinate government Departments around nutrition. He recommended that the Committee discuss the nutrition programme with the Committee on Basic Education. He also noted that 80% (4000) of the world’s population on Bidaculin for MDR TB were in South Africa.
Ms Hunter explained that the Mental Health Teams were in Tshwane, Limpopo all five districts) and the Free State. Health promoters were voluntary workers on stipends and did not find time for health promotion as the clinics were busy. The Department has completed a health manual for the health workers. The Ideal Clinics would provide Integrated Clinical Services whereby the nurse assesses the patient for all symptoms of related illnesses such as diabetes.
Dr Pillay explained that the Department launched a national communications campaign called PELA which addresses quadruple burden diseases. However, the Department has not communicated much on violence and trauma as yet.
Ms James asked where the national paediatrician would be stationed.
Dr Pillay explained that national paediatrician would assist provinces and hospitals focusing on the ones with the highest neonatal mortality rates. The highest number of neonates died in the central and tertiary hospitals.
The Department committed to address the concerns relating to low targets. The Department would submit the details pertaining to the infrastructure list, and the bilateral agreements to the Department.
MomConnect
Maternal Mortality
The maternal mortality ratio was falling annually and the current institutional MMR was 119.1 per 100 000 births (DOH annual report 2015/16). The APP target for 2019 was 100 and the SDG target for 2030 was 70.
Numerous factors impacted on the number of maternal deaths. These included patient behavioural factors such as early antenatal booking, eating a healthy diet, going to clinics if any risk factors arose (such as swelling of legs indicating hypertension; bleeding indicating possible antepartum haemorrhage), getting to delivery early and taking ARVs if HIV positive.
MomConnect shown in independent studies that mothers who received messages improved knowledge and attitudes in relation to risk factors. MomConnect has also been shown to impact on the supply side and through complaints from pregnant women regarding the stock outs of drugs (such as iron tablets) and vaccines (for other ones) has improved. NurseConnect (aimed at health professionals) would improve the quality of care offered.
Infant Mortality
The infant mortality rate (IMR) reduced from 35 per 1 000 live births in 2009 to 27 in 2015 (Rapid Mortality Surveillance – MRC). The main contributing factors to IMR were neonatal deaths; HIV; diarrhoeal disease; malnutrition and pneumonia. MomConnect provided mothers and caregivers with information about immunisations, breast feeding; healthy diets for infants; PMTCT; danger signs. By giving mothers information and knowledge and impacting on their behaviour MomConnect contributed to reducing all the contributing factors to IMR
Number of Women Receiving Messages through MomConnect
Cumulatively 1.36 million women (since 2014) received twice weekly messages about their pregnancy and about the health of their infants post-delivery to year one. 1 126 spontaneous complaints have been received since 2014 and in the same period 7 738 compliments have been received.
NurseConnect
Linked to MomConnect was NurseConnect to provide messages to midwives and nurses providing antenatal care. Since May 2016 over 14 000 nurses registered and receive twice weekly messages These messages were motivational as well as technical in nature, and the service was intended to support front line workers (a help desk was being developed to provide additional support to them).
Medical Internship and Community Service Placements: Medical Doctors, Pharmacists
and Professional Nurses
Medical Internships
Medical internships were a two year placement in Health Professionals Council accredited hospitals. Graduates from the various facilities were mixed using a simple ratio. Graduates from SADC countries could only apply after approval by their respective governments. Non-residents were subject to the Immigration Act as the DoH was only able to make offers to foreign applicants once all of the South African applicants were placed.
South Africans Applying for Medical Internships
A total of 1 499 applications were received for medical internships. Of these, 1 482 applicants were placed (99.9%), as 17 applicants declined placement and 1 application was pending as the application was referred to the HPCSA.
Non-South Africans Applying for Medical Internships
A total of 73 applications were considered and 48 applicants were placed (65.8%). The other 25 applications for placement were pending. Lesotho nationals were removed as requested by their government.
Doctors Applying for Community Service
South African Doctors Applying for Community Service
A total of 1 064 applications were received for Medical Officer Community Services, 1 064 offers were made and 1 057 applicants were placed (100%). 7 applicants declined placement.
Non-South African Doctors Applying for Community Service
A total of 75 applications were received for Medical officer Community Service but 63 applicants were placed (100%) and 12 applicants declined placement.
Pharmacists Applying for Community Service
South African Pharmacists Applying for Community Service
A total of 716 applications were received for community services but 713 applicants were placed (100%), as 3 applicants declined placement.
Non-South African Pharmacists Applying for Community Service
A total number of 79 applications were received and all 79 applicants were placed (100%).
Community Service Placement of Nurses (CSPNs)
Nurses were the largest single professional group for community service and placement had unique challenges. A total of 75.66% (2 375) of CSPNs had to serve in a specific province or facility due to a public service obligation (bursary). Completion dates of students ranged from January to April, resulting in an extended placement period. For CSPNs, 3 140 total applications were received, 2 873 candidates were placed and one placement was declined by the applicant. Non-South African Professional Nurses did not perform community service.
Finalisation of Placements
There were currently 266 placements pending applicants. A total of 52 applicants who studied at Gauteng College would only be placed from April 2017 due to delayed examinations. Several provinces requested re-allocations of nurses placed which increased numbers to be placed since 30 January 2017. A total of 47 late applications were received in January 2017 and those applicants would be placed in April.
Discussion
The Chairperson indicated that last year there was an outcry regarding the placement of medical doctors and pharmacists. He personally received a complaint from nurses who had not been placed, despite the Minister’s commitment to ensure that there would not be a shortage of placement vacancies. A list of the nurses was supplied to the Chairperson. He said that there were currently not enough health workers and he requested that the Department reported on how many doctors were produced, and how many of them have been placed and where. The same was applicable to pharmacists and professional nurses.
Mr Senokoanyane asked the Department what the reasons for applicants declining placements were and what the implications were. He asked what the reallocation of provinces entailed.
Mr Maesela said that the presentation was very scanting, and it mentioned statistics which were not included in the report. He said that MomConnect was a very useful tool. However, “one needs money to connect” and poor individuals may not be able to. He said that the major driver of ill health was poverty and that MomConnect could have been a basis for prevention but poverty mediated against this. He said that prevention was not prioritised in healthcare, and it was especially relevant to individuals in poverty.
Dr Pillay explained that the text messages were charged to the Department and not the patients.
Ms James asked if the Committee would receive updated presentations.
The Chairperson said that he received complaints from graduates who were not placed. He explained that the majority of applicants were on NSFAS and from TUT. They were promised since last year that they would be placed. However, Since January they were told stories by the officials, such as that Gauteng and Mpumalanga Departments of Health did not have the budget to place them, and therefore they should speak to the North West province. The North West district claimed not to know on the day of placements. The Chairperson noted that the list was forwarded to the department. He was told by the Office of the Minister that the number provided was not even a complete number and the number exceeded the number the chairperson received.
The Chairperson indicated that the Ombudsman asked three officials about the figures and all there officials produced different figures. He also asked how the issue of connectivity for MomConnect was addressed in rural areas as there was a deep frustration regarding access to healthcare in these areas.
Mr Andrew Crichton, Chief Director: Human Resources, National Department of Health, said that there were a large number of nurses that had to be placed for community service. Provinces which advertised nurse placements started withdrawing the posts. Gauteng was one of the first to withdraw other available posts as the bursars had been placed, whereas KwaZulu-Natal put 48 additional posts out to absorb students. The challenge was that provinces were now withdrawing the posts and asking for reallocations. The Department would provide the Committee with a brief assessment report. The deadline for the report regarding the placement of nurses was to be submitted to the Committee by 24 February 2017.
The meeting was adjourned.
Audio
- Department of Health on Quarter 1,2 & 3 2016 performance; mom Connect in improving health of pregnant women & reducing maternal & neonatal & infant mortality; Health professionals: placements 1
- Department of Health on Quarter 1,2 & 3 2016 performance; mom Connect in improving health of pregnant women & reducing maternal & neonatal & infant mortality; Health professionals: placements 2
Documents
Present
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James, Dr WG
DA -
James, Ms LV
DA -
Maesela, Dr P
ANC -
Mahlalela, Mr AF
ANC -
Ndaba, Ms CN
ANC -
Senokoanyane, Ms D
ANC
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