PROVINCE

NO

PROPOSED AMENDMENT

RESPONSE FROM DEPARTMENT

Gauteng

1

The only amendment that came from the Gauteng Legislature is the inclusion of the deputy minister in the national health Council.

This amendment is accepted.

Free State

2

The Committee proposes that a guardian should be included in the list of persons who may give consent on behalf of the user who is unable to give informed consent.

This has already been covered as the guardian may give consent in terms of section section 7(1)(a)(ii) which states that if the user is unable to give informed consent and such consent is given by a person …. authorized to give such consent in terms of any law or court order. Guardians are normally authorised in terms of such law. It must be noted that this includes customary law. It must also be noted that the intention of this section is to protect the user, but also to create a balance to allow extended families to provide the consent where parents are not available, but at the same time to ensure that it is not so wide that any person can claim the right to give consent as this may be prejudicial to the user.

3

Chapter 2 is administered by the National Department and deals with rights and duties of users and healthcare personnel. Although clause 89 of the Bill deals with offences, clause 89 does not indicate what follows in the event of noncompliance of chapter two.

State Law Advisor to comment

4

Clause 10(3) refers to ‘an outpatient’ and ‘a user who is not an inpatient’ seems to refer to the same thing. The committee proposes that from line 19 after outpatient to delete or ‘user was not an inpatient use’.

Accepted

5

Clause 15 (1) before ' has access’, to insert ‘that' and before 'may disclose' to delete 'and'

Accepted

6

Clause 19 (b) states that the user must provide accurate information about health status. The user must disclose any illness, the user must be aware of his or her health status. That requirement that the user must provide accurate information about his or her health status might be an undue burden on users who might not always be aware of their health status. Therefore the committee proposes that in line 25, to delete ‘accurate’ and to substitute ‘available’

From a policy perspective this might be difficult as it could lead to different interpretations on what is available information. The policy intentions is that accurate information should be given in order to ensure that appropriate treatment can be provided. If the patient does not have the information they will need to give accurate information on what is known. It must also be noted that this is subject to section 14 which pertains to confidentiality regarding health status, treatment or stay in a health establishment. It is recommended that the word accurate is retained.

7

Clause 21(2)(g) of national provision does not provide for the promotion of health and healthy lifestyles as in clause 25(2)(r) applicable to provinces

Accepted

8

Clause 21 (3) (a) to replace the word resources with the word resources'

The state law adviser will check with the state language services on whether this should be changed

9

Clause 23(1)(viii) in line 17 to delete nongovernmental and to substitute non-governmental

The state law adviser will check with the state language services on whether this should be changed

10

Chapter four, clause 25 (2) after paragraph (f) to insert 'coordinate health and medical services during provincial disasters’

Accepted

11

Clause 27 (1) (e) the committee proposes that after national to insert ‘and provincial’

Accepted

12

Clause 27 (2) it is proposed on page 17, line 42 after ‘timeframes’, to insert 'and guidelines’

Accepted, but recommended that guidelines is inserted after format

13

Clause 27 (7), before ‘nominee’ to insert ‘or her’

Accepted with thanks

14

Clause 32 (1) ' every metropolitan and district municipality must ensure that municipal health services are provided in the respective areas subject to subsection two

This is not be accepted as it changes in policy context of what is contained section 32 (1). The state your adviser will comment on this in further detail.

15

Clause 38 (2) (a), it is suggested that on page 2 in line 49 after, ‘were’ to delete ‘given’ and to insert ‘made known to the applicant or holder’

From an administrative point of view, is normally taken that the date of receipt is the date which will be used. If we insert ‘made known to the applicant or holder’ this might make it administratively very difficult to monitor. The state law adviser will advise further.

16

Clause 50 (3) (c), it is proposed that in line 40 after ‘writing’ to delete ‘and’ after ‘Minister’ to delete ‘accepts the resignation’

The section was written in this manner to prevent a situation where a person puts the resignation in writing, before the Minister has an opportunity to transition mechanisms in place. It is definitely not the policy intention that this will be used to prevent a person from resigning.

17

Clause 50 (5) (b), the word ‘advise’ should be deleted and the word ‘advice’ inserted.

Accepted

18

Clause 50 (6) (b), it is proposed to delete the words ‘the majority’ and to insert the words ‘at least half’

Accepted

19

Clause 72 (4) it is recommended that in line 17 after ‘resigns or if’ to delete the words ‘requested by the Minister for good cause to resign’, and to substitute ‘the Minister terminates for good cause the term of office of such member’.

State law adviser to advise

Eastern Cape

20

Clause 5, the term emergency treatment should be clearly defined and appear on the definitions list

State law adviser and comment

21

Clause 7 (1) (b), the subclause does not take into account the role of guardians

See comment 2

22

Clause 14 (two) (a), the term serious threat should be clearly defined and the responsible person entrusted to determine the serious threat to illness should be known

It will be difficult to define serious threat as there are emerging diseases that may not be known. For example, SARS has only recently emerged. The director-general will be responsible to determine what is a serious threat and normally this would imply a threat to public health, which could lead to an epidemic.

23

Clause 26 (3), line 6 add ‘by the National and provincial organisation’

Accepted

24

Clause 41 (6) (a), and the functions and procedures

State law adviser to comment

25

Clause 41 (8), add must not exceed five representatives add

Accepted

KwaZulu Natal

26

No comments. Majority vote not obtained

Limpopo

27

No comments. Bill accepted

Mpumulanga

28

Emergency medical treatment, as envisioned in clause five must be defined

See number 20

29

Section (43) should make provision for the role of traditional healers at the initiation school

The section states that the Minister may, in the interests of the health and well-being of persons attending an initiation school prescribe conditions under which the circumcision of a person as part of an initiation ceremony will be carried out. The policy intention is to ensure the health and well-being of persons undergoing the initiation ceremony. Therefore traditional healers, cannot be involved in this process, as they themselves are involved in the initiation ceremony. However, the traditional healers will be able to comment on the regulations.

30

The Bill should prescribe enforcement mechanisms in case a user fails to discharge the duties provided for in clause 19

See comment 3

31

Because a member of the executive council derives the authority to assign any power or function to municipal council from section 126 of the Constitution, clause 32 (3) should refer to section 126 (a) instead of section 156 (4) of the Constitution

Section 126 refers to provincial functions, and therefore is not relevant here. Section 156 (4) is correct

32

Clause 79 (1), should authorise the Office of Standards Compliance or its agents to inspect every health establishment and health agency at least once every 12 months

This was included in the previous version of the Bill given to the portfolio committee. However, a number of inputs were given that this may be unrealistic because of the number of health establishments that exist.

North West

33

Emergency treatment should be defined

See number 20

34

Chapter 3, section 22, A head of provincial department means accounting officer or superintendent

According to the Public Service Act the head of a provincial apartment is defined . Therefore this cannot be mistaken for a superintendent

35

Chapter 3, section 23, the National Health Council shall also include the traditional healers

The National Health Council comprises members of the executive councils and officials and does not include other role players. It currently is the structure of the MinMec. Provision is made in the National Health Consultative Forum for other role players to be included. This is where the traditional healers will be included.

36

The structure of forums must cascade into the provinces as well as into the districts

Provision is made for provincial consultative bodies under section 28. However, because of the complexity of the district health system . it has not been included for the districts.

37

Under chapter 5, the district health system for the Republic committee proposed deletion of the Republic and section 29 (1) for the Republic should also be deleted

Accepted

38

Section 61 (3) of chapter 8, the committee proposed that authorisation in writing by the Minister might take long, in the interim life may be lost. We rather look into a structure that will shorten the authorisation

The section specifically deals with persons who are not South African citizens and most are non-urgent transplants. The policy intention is to ensure that South African citizens are given priority. It is also to prevent a situation where there is organ trafficking. Currently, this process is in place, and a team of experts evaluates the request according to defined criteria, before permission is given. Delays are not normally experienced and the process protects both the recipient and donor.

Western Cape

39

Abstains from voting on the Bill

Northern Cape

40

To insert after clause 35, the Minister shall establish tertiary and secondary health establishments in all provinces, based on the distance and location of communities

This will be difficult to as it could result in an unfunded mandate, as it compels the Minister to establish tertiary and secondary health establishment. Health establishment are normally classified according to the services that are rendered. If such services are not available in a particular province, provision is made for those services to be rendered by another province. The policy intention is to classify existing health establishments into different categories. Currently all provinces have both tertiary and secondary health establishments.