Questions and Replies

Reply:

The Department of Health does not keep a database of unemployed health professionals including the nurses. However, all health professionals, including nurses, whether employed or unemployed, are required to remain registered with their relevant statutory health councils, this being the South African Nursing Council in the case of nurses.

END.

Reply:

1. The Department has, in terms of governance, developed and gazetted the “National Environmental Health Norms and Standards for Premises and Acceptable Monitoring Standards for Environmental Health Practitioners” in 2015. In terms of these Norms and Standards, the Department has since 2016 included the “Assessment of Municipalities” in its Annual Performance Plan (APP) to monitor the 1:10 000 ratio of EHP per population in the country. The reports generated from the assessments play a vital role in providing municipalities with evidence to use to motivate for additional human resources at their respective Municipal Councils.

2. The following table reflects the details in this regard.

YEARS	NUMBER OF VISITS TO ECDs
2019	48035
2020	29376
2021	39913
2022	52561
2023	54533

 

END.

Reply:

According to the National Health Laboratory Service (NHLS):

a) (i) There is no backlog of toxicology cases at the Durban FCL.

The Durban FCL does not offer a full toxicology service. Postmortem cases referred from the Kwazulu-Natal and regions of the Eastern Cape provinces that require analysis for carbon monoxide testing only are processed and completed at the Durban FCL. These comprise a small number of samples and no backlog has developed.

(ii) There is no backlog of toxicology cases at the Durban FCL.

(iii) The Durban FCL receives on average 12 carbon monoxide cases for analysis per month and completes these cases each month.

b) There is no backlog of toxicology cases at the Durban FCL.

END

Reply:

a) The National Department of Health requirements is that each facility should have clean running water. All clinics that are constructed in the Northen Cape province, particularly around Kimberley are having water, and also provided with back up water system through boreholes. Most of the old facilities are getting water from municipalities and those that don’t have borehole are prioritised in 2024/25 to get back up water.

b) No clinics have been closed as a result of poor water supply or quality.

c) Provision of water is the competency of municipalities, the Department interacts with other departments like Water and Sanitation and municipalities to ensure that communities have access to safe clean water. The challenges of unsafe water negatively impact on the health of communities. Random samples are taken to check safety of water at laboratories if there is a sudden increase of diarrhoea cases at certain areas as a precautionary measure.

The tap water in Carnavon was tested and results were positive faecal organisms and therefore not fit for human consumption. Information from District Health Information System (DHIS) for Carnavon CHC and Carnavon clinic for the past six month showed only 1 new case of diarrhoea reported. The matter is dealt with Water and Sanitation Department and outbreak response team has been activated for health education in the community.

END.

Reply:

Responses as received from the provincial departments of health.

a) (i) Gauteng Department of Health underspent the total allocated budget with R2.7 billion of which R937 million was for provincial equitable share and R1,7 billion for conditional grants,

The reasons for underspending are -

• Late receipt of invoices and claims from suppliers that are subjected to a verification process.
• The reduced number of nursing students enrolled for the academic year and delays in the submission of Non-Profit institution's claims.
• Claims for the South African Cuban Doctor programme was received and subjected to reconciliation and review and could not be processed for payment at year-end.
• Slow construction and contractors abandoning sites due to poor contractors performance.
• Underspending on conditional grants was due to the unavailability of contracts, and probity audit processes towards procurement of high-value medical equipment that could not be delivered and paid at year end.
• Underspending was also incurred due to price reductions of antiretroviral drugs, non-contracting of general practitioners performing voluntary medical male circumcision (VMMC) and shortage of condoms within the country.

Rollover application of R582.2 million was submitted and R279 million was approved as follows;

• National Tertiary Services Grant R515.8 million requested and R226.8 approved
• District Health Services Grant (HIV/AIDS component R38.4 million requested and R32.8 approved and
• Statutory Human Resources component R27,9 million requested and R19.4 approved

b) (i) (ii) The following table reflects the details in this regard:

Name of the province	Underspending in 2022/2023 FY R’million	Reasons for underspending
Eastern Cape	R62,2 R31.7 Conditional grants R30.5 Voted funds	Delays in the payment of medico-legal settlement due to Trust registration delays by plaintiff attorneys. The rollovers amount to R24,8 million for the National Tertiary Services Conditional Grant and R6,1 million for the District Health Programme Conditional Grant (Comprehensive HIV Component) has been approved.
Free State	-R’4.4 R85 Conditional grant -R89 voted funds	The underspending on the grant totalling R85 million was as a result of the process of reconciliation for payment at year end and could not be finalised. The roll over amount of R84 million on Health Revitalization Grant was requested and approved to be spend in 2023/2024
Kwa Zulu Natal	R’000	The Province spent the total allocated budget in 2022/23 financial year.
Limpopo	R103,5 R49.3 Conditional grant R54.2 voted funds	The unspent budget of R103 million is attributable to delayed deliveries of medical equipment caused. The Department successfully secured R78 million through roll over request to be paid during 2023/2024 financial year.
Mpumalanga	R25,3 R12.8 conditional grants R12.5 Voted funds	Department experienced delays in the procurement of equipment due to revised Public Procurement Regulations.
Northern Cape	R141,4 R131.3 conditional grants R10.1 Voted funds	Underspent funds due to delay in the supply, delivery, installation and commissioning of the linear accelerator. National Health Insurance grant rollover amount was requested and R47,484 million was approved to be spent in 2023/24 financial year. National Health Revitalisation Grant underspent by R82,211 million, attributed by the delay in the monitoring and implementation of infrastructure projects.
North West	R4.8 R200.6 conditional grants -R209 voted funds	Delays in submission of invoices by service provider, late delivery of medical equipment (Catheterization and Lab Thyroid Stimulating Hormone). Rollovers were requested and approved to be spent in 2023/24 financial year, Health Facility Revitalisation Grant - R178,9 million, National Tertiary Services Grant - R1,9 million and National Health Insurance Grant -R15 million
Western Cape	R180 R14.4 conditional grants R165.6 voted funds	Savings on approved post list due to delays in the filling of funded vacancies and in-year attrition rates. Delayed in the implementation of contracts with training providers resulting in training that could not be implemented as planned. The use of covid-19 rapid ag tests instead of the more expensive laboratory based PCR tests and decrease in audit fees and legal fees.

END.

Reply:

a) The disclosure/ declaration of financial interests by employees in the public service is regulated by Regulation 18 of the Public Service Regulations, 2016, which requires designated employees to submit particulars of their financial interests to their respective heads of departments and non-compliance in this regard is handled in line with the provisions of Section 16A of the Public Service Act, which require the head of the department to take appropriate disciplinary steps against an employee who does not comply with a provision of a regulation.

b) Some of the reasons for failure to comply with the disclosure processes include forgetting the personal log-in details (usernames and passwords). In some instances, it is with regard to properties that employees acquired a long time ago and are no longer in possession of, but those properties are still registered in their names. As a result, they are of the view that they are not required to disclose such properties, while that is not the case.

c) Ethics Officers inform designated officials that are required to disclose their financial interests timeously before the period of disclosure starts and they are constantly reminded about the process of disclosing their financial interests. There are also dedicated officials who are responsible for providing assistance and technical support to all officials who are experiencing challenges in accessing the e-disclosure system.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

a) Toxicology tests are conducted at three of the four Forensic Chemistry Laboratories namely, Cape Town, Johannesburg, and Pretoria. The toxicology tests are supposed to be tested within 90 days from the date the samples are registered in the testing laboratory. Any test that has not been completed and authorised within 90 days is classified as backlog. Multiple factors have contributed to the backlogs that developed at the three laboratories, including incomplete information on the request forms, inadequate infrastructure, aging analytic equipment, interruptions in power supply, inadequate water supply, the COVID-19 epidemic, and shortages in human resources.

The current backlog at the Cape Town Forensic Chemistry laboratory is 6,792 cases with Johannesburg and Pretoria laboratories at 15,358 and 16,824 cases respectively

 

b) The measures taken by the NHLS to eradicate the backlog include:

• • Increasing laboratory processing capacity to analyse samples and ensuring the optimal use of resources within the laboratories.
  • Acquiring additional laboratory space in Pretoria to process both the toxicology and blood alcohol samples.
  • New posts for toxicology analysts were created for the new laboratories in Pretoria.
  • The new toxicology laboratory will analyse new cases and the old laboratory will focus on the backlogged cases only.
  • Similar plans are in process to increase laboratory capacity for toxicology cases at the Johannesburg and Cape Town laboratories and to offer a toxicology service at the Durban laboratory.
  • The NHLS, in conjunction with the Forensic Pathology Services (FPS) in the Department of Health, is developing strategies to address ageing samples in the backlog and how to best manage these samples.

c) Each toxicology case that is registered in the laboratory may include a varying number of biological specimens that were taken during the autopsy and each specimen may require to be tested more than once or on different sets of instruments, depending on the test requirements. In the pre-analytic stage, specimens may require specialised preparation, depending on the tests that will be conducted.

As a result, it is difficult to quantify the number of toxicology tests that are processed in a day as tests run concurrently and completion periods differ vastly between cases. Hence, Toxicology cases are allocated in batches of 15 cases per analyst per month.

d) It is difficult to estimate when the backlog will be eradicated, however, the NHLS remains committed to improving service delivery at all four Forensic Chemistry Laboratories and to accelerating the reduction of the toxicology backlogs at these laboratories.

END.

Reply:

a) The position of the department is to implement the recommendations of the Public service Commission (PSC).

b) The department has implemented some of the recommendations which have no financial implications, the implicated employees are still in the employ of the department and the findings have not been challenged by the implicated employees and/or the PSC reports have not been taken on judicial review.

 

END.

Reply:

Infrastructure and capacity to treat adults with cancer are variable throughout the country and thus Gauteng Province has the additional responsibility of rendering oncology services to its neighbouring Provinces. However, comprehensive oncology services in the Gauteng Department of Health (GDOH) are currently only rendered by Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Steve Biko Academic Hospital (SBAH). This places a huge burden on service delivery for these two centres which according to the 2020 National Cancer Register (NCR) of South Africa are estimated to ensure that the 23 634 new people with cancer in the public health facilities in Gauteng Province are treated. With only two Central Hospitals rendering a comprehensive oncology service, long waiting times for diagnosis and treatment leads to disease progression and poorer cancer related outcomes. Lack of infrastructure and lack of human resources are also additional contributory factors to the extreme waiting times. The Department is thus outsourcing radiation oncology services to reduce the current radiotherapy waiting times at both CMAJH and SBAH.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

a) (i) Blood Alcohol tests are conducted at all four Forensic Chemistry Laboratories in Cape Town, Durban, Johannesburg, and Pretoria. These test requests comprise the bulk of services delivered by the FCLs (more than 80% of all test requests received). The blood alcohol tests are supposed to be tested within 90 days from the time the samples are registered in the testing laboratory. Any test that has not been completed and authorised within 90 days is classified as backlog. There are no backlogs recorded at the Durban FCL and backlogs that were previously reported at the Cape Town and Pretoria FCLs have been cleared. The remaining backlog in blood alcohol tests is recorded at the Johannesburg FCL and is currently at 35,176 cases.

(ii) The Measures taken to eradicate the backlog include the following:

• Additional space and analytic instruments have been acquired at the new Pretoria laboratory that accommodates the Pretoria Blood Alcohol section.
• New samples for blood alcohol testing are referred to the Pretoria laboratory to reduce the number of samples referred to the Johannesburg laboratory.
• Shift systems are in use for analysts at the Johannesburg FCL and a 30.5% reduction in the backlog has been achieved from 01 April 2023 to 31 January 2024.
• A new building has been identified that will accommodate further expansion of the Johannesburg FCL and the procurement of new analytic instruments is underway for the Johannesburg FCL.

(iii) Blood alcohol samples in the Forensic Chemistry Laboratories are processed in batches of 150 samples per week per analyst. Each test is processed on two separate instruments as required for quality purposes and additional fluoride analysis is performed to confirm the validity of the sample. On average, 4000 samples are completed per month.

 

b) The backlog is expected to be cleared by over 8 months from 01 March 2024, with the current staff and instrument capacity.

END.

Reply:

According to the National Health Laboratory Service (NHLS):

1. The NHLS is currently in the process of procuring additional analytical equipment and all vacant positions are being filled to ensure an effective staff complement.

a) Cape Town: the NHLS is in the process of procuring additional instruments to increase testing capacity;

​b) Johannesburg: a new building has been identified that will accommodate further expansion of the Johannesburg FCL and the procurement of new analytic instruments is underway for the Johannesburg FCL; and

c) Pretoria: new positions have been created in the new Pretoria laboratory, toxicology section, and the posts are currently being filled. All new toxicology samples will be referred to the new facility while the existing one focuses only on processing backlogged toxicology samples only.

2. (a) The NHLS is still in the process of identifying a suitable facility for the Durban Forensic Chemistry Laboratory that would accommodate a new toxicology section;

(b) the Durban FCL will start with toxicology testing as soon as the laboratory has relocated to a new suitable premise.

END.

Reply:

a) The options are as follows:

1. Permanent method
2. Long-Acting Reversible Contraceptives
3. Short term hormonal contraceptives
4. Barrier methods
5. Emergency contraceptives

b) Name and method:

1. Permanent method Sterilizations (Vasectomy and Tubaligations)
2. Hormonal (Oral Contraceptive (OC), Subdermal implants and Injectables)
3. Barrier (Intra uterine contraceptive device (IUCD) and Condoms)
4. Emergency (Combined Oral Contraceptives and IUCD)

END.

Reply:

According to information received from the Provincial Departments of Health, the responses are as follows:

EASTERN CAPE

a) One robbery and two-armed robberies.

b) (i) Empilweni TB Hospital, Helenvale and Zigidlo Clinic.

(ii) 1

(c) At Empilweni TB Hospital, the Security Company on-site decided to re-imburse its own personnel for the loss of their belongings (Security Officers). The criminal cases were opened at SAPS with CAS Number 11/09/2023 and 16/2/2024.

FREE STATE

a) The Department has not experienced any robberies in the past six months.

GAUTENG

a) Three robberies.

b) (i) Zola Clinic, Sebokeng Clinic and Rahima Moosa Hospital

(ii) 1

c) All robberies were reported to law enforcement agencies for further investigation.

KWAZULU NATAL

a) One-armed robbery.

b) (i) Ndlangubo Clinic

(ii) 1

(c) SAPS was contacted and called to the crime scene and the criminal case was opened at SAPS with CAS Number 222/09/2023.

LIMPOPO

a) One-armed robbery.

b) (i) Zebediela Hospital.

(ii) 1

c) The criminal case was opened at SAPS with CAS Number 97/09/2023. Furthermore, the physical infrastructure of the guard house is being improved to include bullet proof and one way mirror from the inside only and the Hospital has been included in the SAPS patrol list.

MPUMALANGA

a) One-armed robbery.

b) (i) Nkangala District, Empumelelweni CHC

(ii) 1

(c) The criminal case was opened at SAPS with CAS Number 135/11/2023. Furthermore, the Infrastructure Unit fixed the palisade fence that was broken.

NORTH WEST

The Department has not experienced any robberies in the past six months.

NORTHERN CAPE

The Department has not experienced any robberies in the past six months.

 

WESTERN CAPE

a) One armed robbery. (b) (i) Khayelitsha CHC in Site B (ii) 1 (c) Immediately after the incident, the Department deployed the Provincial Security Team to safeguard the facility to provide additional support to the onsite security officers. Counselling Services and wellness debriefing were made available to staff based at the facility. The CCTV camera system at the facility is currently undergoing upgrade and maintenance to include remote monitoring capabilities. The Department is in the process of re-constructing the entrance into the facility. The new entrance will include a double gate vehicle lock system as well as turnstiles.

END.

Reply:

a) According to Gauteng Department of Health,

• South African Police Services (SAPS) has been alerted of the incident and the Department has also requested regular patrols along the hospital boundaries.
• Hospital security is also patrolling an additional 50 metre radius outside the hospital gates especially during shift changes.
• The local community policing forum has also been involved to assist with pro-active policing and community patrols in the hospital vicinity

b) The Local Community Policing Forum has been involved to assist with proactive policing and community patrols in the vicinity of the hospital.

c) The hospital management is investigating the costs of setting up a mobile police unit outside the main gate of the hospital. The hospital is also engaging companies on modern access and key control system. The hospital has CCTV cameras in strategic places inside and outside the hospital, to ensure that staff and patients’ privacy is not compromised.

 

END.

Reply:

According to the National Health Laboratory Service (NHLS):

1. The NHLS is currently working and communicating with the Provincial Departments of Health to collect all outstanding funds owed to the NHLS. Limpopo, Mpumalanga, Free State, and Western Cape have cleared the debt owed for the previous financial years and are paying their current debt timeously. North-West has cleared most of its historic debt and is paying towards the current debt. Gauteng has settled most of its historic debt and they are paying for the current debt but not in full. KwaZulu-Natal is paying its current debt in full. The NHLS is working closely with KwaZulu-Natal to come up with a solution regarding the outstanding disputed amount for the debt prior to the 2016/17 financial year. Therefore, most of the provinces are paying for the services rendered by the NHLS.

The NHLS acknowledges that fiscal constraints will impact negatively on the financial status of the provinces and the NHLS. However, the NHLS has implemented tight financial controls to maintain its financial stability.

(2) The National Treasury does provide funding to the National Institute of Communicable Diseases, National Institute of Occupational Health, Forensic Chemistry Laboratory Services (FCLS) and National Cancer Registry. However the funding is inadequate to meet the service demands so the NHLS has been cross-subsidizing the budgetary requirements for the Institutes and the Forensic Chemistry Laboratories to ensure an optimal staff complement and functional work environment to manage the current workload. The NHLS is not able to report on how challenges in service delivery experienced by the FCLs may have impacted the work of the SA Police Service.

END.

Reply:

According to the Health Ombud:

a) Since the inception of the Office of the Health Ombud (OHO) in 2016, there have been inadequate investigative human resources to support optimal functionality. Commencing with two senior investigators in 2017, OHO had only five investigative staff between 2018 – and 2023 (Two senior investigators and three investigators). Due to the severe staff shortages, the two senior investigators were tasked with administrative, management, and operational responsibilities, in addition to their technical investigative responsibilities. Therefore, only three investigators were attending to the complaints lodged. During this period, the OHO received 307 high and extreme-risk complaints. Despite the enormous workload, 148 complaints were resolved during this period, and a total of 159 complaints remain unresolved.

b) The OHO budget constitutes an average of 13% of the OHSC overall budget from 2016/17 to 2022/23. The OHO's budget increased by an average of 7% per year. The provision of short-term relief in the form of surplus funding from 2018/19 to 2023/24 was made to remedy this predicament. This funding was used to enable the hiring of contract staff on 12-month contracts during the 2023/24 financial period. Although the ad hoc funding helped to reduce the number of backlog cases, there remains a large number of unresolved cases, in addition to new cases.

In 2024/25 the OHO will work towards converting the current contracted staff into permanent employment to boost the number of investigators from the additional R10 Million allocated over the MTEF. However, additional funding will still be required to appoint permanent staff to augment the capacity and ensure that the mandate of OHO is fulfilled.

c) In 2022 a Health Ombud Bill was developed to address the governance challenges experienced by the Ombud. The Bill sought to establish the Health Ombud Office as an autonomous entity.

The Ombud Bill served at the Social Protection, Community and Human Development Cluster (SPCHD). The National Treasury raised concerns with the financial implications of creating a Schedule 3A Public entity considering the current economic and fiscal challenges.

The National Treasury recommended that the Department explore alternative options that would establish the independence of the Ombud – one such structure recommended was the Tax Ombud or a shared service option.

While the two options are being explored, the department has earmarked the budget of the OHO for the 2024/25 financial year. This approach would provide greater financial certainty to the Ombud so that the budget for human resources, equipment and other goods and services can be effected.

 

END.

Reply:

a) Response teams in all the affected areas were activated and investigations commenced immediately to try and establish the type of food consumed by the affected people.

• Specimens were collected and sent to National Health laboratories to detect and identify the chemicals/organisms in the samples.
• The Gauteng Provincial Public Health Directorate further established the Incident Management Team that meets twice a week to monitor the progress of the outbreak and the response by each thematic area such as Environmental Health, Communicable Disease Control, Surveillance Officers, South African Police Services and Consumer Services.

(b)-(c) Steps and initiatives:

• Routine inspections are being conducted at food premises.
• Routine food and water samples are being taken for microbiological and chemical analysis.
• Joint operations are conducted with the following stakeholders: local councillors, consumer protection, metro police, border management, home affairs, and SAPS.
• Health education and awareness are provided to all formal and informal food operators and surrounding community on food preparation, storage, and handling, including chemical poisoning handling. This intervention is especially focussed on food vendors close to schools.
• Prohibition notices and fines are issued to owners of non-compliant premises.
• All suspected food samples are taken to the laboratory for analysis.
• All non-compliant foodstuffs were and will continue to be seized and disposed.
• Radio health talks are done on different community radio stations to create awareness.
• Health education and awareness campaigns are ongoing on food safety. This is being done on multimedia platforms e.g. TV, radio stations, social media and newsletters.
• Draft SOPs have been developed with all relevant stakeholders on how to deal with foodborne illness.
• Support visits are done to Early Development Centres to raise awareness.
• Information sharing with relevant stakeholders is ongoing.

END.

Reply:

The details of the food contract is as follows:

Tender Number: HEDP021/19/20

Duration: 01/07/2023 to 31/04/2024

Contract description: Supply and delivery of perishable provisions at all hospitals in the Limpopo Department of Health for 36 month.

Items covered in the tender:

• Fresh fruits and vegetables
• Bread
• Chicken Breast and Wings
• Fish
• Full Cream Milk/ Low-fat milk
• Eggs
• Cheese
• Yogurt plain low-fat
• Mageu

END.

Reply:

According to the SAHPRA:

a) SAHPRA has the mandate of regulating the efficacy safety and quality of medicines and thus the information supplied in a license application does not include information about the financial implications of not having a license ;

b) There are various reasons licenses are not granted but in essence applicants must comply with the criteria for Good Manufacturing Practice (GMP) and Good Warehousing Practice (GWP). This is done in accordance with the General Regulations to the Medicines Act, Regulation 23(3) and Regulation 23(4). Noncompliance with the criteria for licensing will result in a license not being issued. In some cases applicants decline an inspection when they are contacted for assessment of their license application.

However, there were delays in finalisation of inspections due to capacity constraints in the Inspectorate unit.

c) In the 2022/2023 financial year, SAHPRA approved all new license applications that were evaluated however there are delays in the inspection of applicants due to limited inspection capacity.

END.

Reply:

1. All medical doctors eligible for community service have been placed as of January 2024. This number excludes those who lodged appeals against the areas that they were placed at.

2. National Department of Health can confirm that all medical doctors that were eligible to commence community service started work on 01 January 2024. Only those who are deemed as not eligible or are late starters (i.e., completing their community service later than 31 December 2023) have not been placed. They will be placed upon completion of their community service.

END.

Reply:

As reflected during the media briefing hosted on 05 February, fiscal challenges facing the country and also impacting on the health care system are acknowledged. The Provincial Departments of Health continue to actively engage their Provincial Treasuries to find ways of addressing the unemployment of health professionals, including medical doctors. According to the 09th February 2024 PERSAL print out, 425 Medical Officer appointments were captured for January 2024. Of these, 371 are Medical Officer Grade 1 category.

As reported in Parliament during the State of Nation Address (SONA) Debate on 13th February 2024, working with the Minister of Finance, a solution to address the current challenge of doctors wishing to stay in the public service is being worked out. The details will be furnished after the Minister of Finance’s Budget Speech on 21st February 2024.

There is no documented evidence that links the choice to emigrate with the delayed employment by the state. Contrary to that is the demonstration of aspirations to serve the South African Public Health system as expressed by the recent outcry by the “unemployed doctors”.

END.

Reply:

(a) The Provincial Departments of Health have advertised available funded posts for the various health professional categories including medical doctors and nurses. These are at different stages of recruitment.

(b) National Department of Health will provide guidance to provinces in line with the announcement that will be made by the Minister of Finance in his budget speech on 21 February 2024.

END.

Reply:

(a) All hospitals have backup power in a form of generators to provide back-up electricity during outages. Some hospitals also have uninterrupted power supply (“UPS”) units inbuilt as part of their power supply backup. However, the generators and UPS units are not designed to run for longer periods of time than usually anticipated, as has been experienced in the recent frequent and longer instances of loadshedding.

(b) There are maintenance plans in place for all generators to ensure that they are operational and that there are diesel suppliers on standby to ensure that the generators are fully functional at all times.

END.

Reply:

According to Gauteng Department of Health:

1. Phahameng Clinic is one of the 40 clinics in the City of Tshwane (CoT) that is still owned and operated by COT. The provincial government through the Tswane Health District Office assists with the staffing shortage by seconding staff to some of these clinics. There has been a moratorium placed on the filling of vacant positions since 2019 to date, due to budget constraints. The CoT and the Tswane Health District Office are in the process of considering a list of critical positions to be filled during the 2024/25 financial year, within available budget.

2. (a) Facility Level: Phahameng clinic is resourced with personnel from both the City of Tshwane (CoT) and Gauteng Department of Health (GDoH).

The clinic has the following vacancies:

• 1 Chief Community Health Nurse (CoT)
• 1 Nursing Assistant (CoT)
• 1 Community Health Nurse (GDoH)
• The above positions have been vacant for less than 2 years.

b) Data is awaited from Gauteng Department of Health and will be provided as soon as we receive it.

3. Yes, budget constraints experienced by COT and the provincial government, impede the process of filling vacancies. The CoT and Tswane Health District are in the process of considering a list of critical positions to be filled during the 2024/25 financial year, within available budget.

END.

Reply:

The departmental statement referring to some medical doctors rejecting placement in rural facilities is based on historic trends that led to delays with recruitment for rural hospitals as well as the recent Internship and Community Service Placement (ICSP) statistics. During the 2023/2024 cycle, the Department received 109 appeals against placements for Community Services Medical Officer posts with majority being posts in rural facilities.

However, the Department can confirm that there are medical doctors in all hospitals and healthcare facilities that are designated to have medical doctors as part of the workforce, including those in rural areas.

END.

Reply:

The National Department of Health (NDoH) was aware of the shortages of biocides, hand sanitizer and hibiscus (hibiscrub) hand soap in the facilities across the Eastern Cape.

a) There are interventions that the NDoH implements to ensure that there are no supply shortages at facilities. These interventions are informed by the cause of the supply challenge.

• Where the supply constraint is due to operational matters, e.g. machine breakdown, labour unrest, theft, post importation testing, etc., the NDOH would source products from alternative local suppliers with registered products using the quotation process.
• Should the supply constraint result in a longer term supply challenge, such as regulatory matters including amendments to the dossier that requires approval from South African Health Products Regulatory Authority (SAHPRA), including a change/addition of an active pharmaceutical ingredient source and/or manufacturing site, the transfer of ownership of dossiers which results in a change of marketing authorization, delays in the issuing of the permits for imported medicines, manufactured products requiring additional quality checks by SAHPRA, etc. and no alternative local suppliers with registered products are available; an application would be made to SAHPRA for the acquisition of unregistered medicines for human use in South Africa Act use in terms of Section 21 of the Medicines and Related Substances Act.

b) Health facilities in the Eastern Cape place their orders with the depot on a weekly basis, and the depot processes these orders efficiently with a lead time of a week.

In most cases including the recently reported case, the medicines supply challenges are transient in that an item may be reported as out of stock and soon after the item is back on stock.

Currently, there are no the shortages of biocides, hand sanitizers and hibiscus hand soap in health facilities across the Eastern Cape. The table below shows the current availability of the items in the Eastern Cape health facilities including the depots:

Item Description	Quantity on stock	Stock Provision in Months
Hibiscus (Hibiscrub) Hand Soap 500ml	6 826	2.5 months’ supply
Hand sanitizer without emollient 500ml	8 590	4 months’ supply
Biocide 100s	6 060	2 months’ supply

Table 1. Stock on hand of selected items as at 12 February 2024

END.

Reply:

According to the Eastern Cape Department of Health (ECDoH):

The clinic supervisor that was overseeing seven (7) clinics in the local area of the Mhlonlo Sub-district of OR Tambo District in the Eastern Cape (EC), retired in 2021, and the appointed operational manager for Malepelepe Clinic who was the most senior professional nurse in the area, was delegated to oversee the seven (7) clinics as a clinic supervisor.

Since, as per Department of Public Service and Administration Regulations, the post of operational manager of Malepelepe Clinic was still filled by the person who was appointed acting clinic supervisor, the acting operational manager for Malepelepe Clinic could not receive an acting allowance.

On 1 February 2024, the operational manager for Malepelepe Clinic, who was overseeing the seven (7) facilities, was appointed in the post of Clinic Supervisor, and the post of operational manager for Malepele Clinic became vacant. The person delegated to act as operational manager for Malepelepe Clinic will receive an acting allowance as from 01 February 2024 and the vacant post of operational manager for Malepele Clinic will be filled in line with government recruitment processes.

END.

Reply:

1. It is not a policy requirement to allocate ambulances to hospitals. Ambulances are allocated to EMS stations which are either stand-alone or co-located in hospitals, clinics, and other public facilities. The allocation is organized according to what is practically achievable within the budget allocation. The focus is on ensuring that these ambulances are accessible and respond on time when they are needed. Nationally, of the 483 public EMS Stations, 365 (76%) of are co-located at hospitals and clinics. The breakdown of EMS Stations per province is as follows:

PROVINCE	Total No. of Stations	No. of Stations Stand Alone	No. of Stations at Hospitals	No. of Stations located at Clinics	No. of Stations located at other sites
Eastern Cape	85	14	48	16	7
Free State	59	2	26	27	4
Gauteng	57	6	21	23	7
KwaZulu-Natal	71	22	26	19	4
Limpopo	57	10	26	18	3
Mpumalanga	37	7	16	5	9
North West	20	1	10	6	3
Northern Cape	48	4	8	36	0
Western Cape	49	12	25	9	3
TOTAL	483	78	206	159	40
PERCENTAGE	100	16	43	33	8
Other sites: Fire Stations, Local Govt Offices, SAPS

2. Access of ambulances to hospitals including emergency responses within the community are subject to demand and availability of ambulances at the time required. All calls, when received, are prioritized according to patient acuity needs, triaged and dispatched to the first available ambulance. This prioritization includes interfacility transfers.

END.

Reply:

(1) (a) The delegates are mandated to advance the interests of South Africa and of the Continent with regard to aspects that promote public health in relation to the control of tobacco and related products.

(b) South Africa is a signatory to the WHO Framework Convention on Tobacco Control (FCTC). The FCTC is a Global public health treaty which informs South Africa’s mandate in this regard.

(2) (a) Mandate on:

(i) combustible cigarettes

To ensure decisions made at COP will protect public health, reduce demand and supply and protect vulnerable groups and non-smokers and to identify new risk based on available scientific evidence.

(ii) non-combustible nicotine products

South Africa supports agenda items and decisions aimed at protecting public health. Our main objective to protect public health, reduce demand and supply and protect vulnerable groups and non-smokers against the harm caused by nicotine and to identify new risk based on available scientific evidence.

(iii) harm-reduction policies, technologies, and evidence led scientific findings

The Department of Health is not in support of the proposed promotion of harm reduction strategies and technologies, since what is proposed by the tobacco industry in this regard remain harmful to the public. The unregulated and uncontrolled use of nicotine poses a health risk and therefore, the Department is committed to the regulation of all tobacco and related products. The objective at all times is to promote public health and protect the vulnerable groups against the harm posed by the tobacco and related products.

(b) South Africa, in our pursuit to regulate all tobacco and related products, is guided by local and global studies that have provided significant evidence about the harm caused by both combustible and non-combustible tobacco and related products. These include the emerging products flooding the market worldwide.

END.

Reply:

(1) (a) The South African delegates were mandated to advance the interests of South Africa and of the Continent with regard to aspects that promote public health in relation to the control of tobacco products, electronic delivery systems and related products.

(b) The mandate is based on the fact that South Africa is a signatory to the WHO Framework Convention on Tobacco Control (FCTC). The FCTC is a Global public health treaty which informs South Africa’s mandate in this regard. The treaty is evidence-based and reaffirms the rights of all people to the highest standard of Health. In addition, South Africa is guided by local and global studies that have provided significant evidence about the harm caused by both combustible and non-combustible tobacco products.

(2) No, the public comment on the legislative process related to the Tobacco Products and Electronic Delivery Systems Control Bill has not been incorporated into the mandate, because legislative processes pertaining to the Bill has not been completed yet. Many of the COP issues are similar to the provisions of the Bill, and this is a justifiable coincidence since the two are dealing with the same subject matter at different levels. The Bill process is a law-making process at national level whilst COP deals with tobacco control and regulation at international level.

(3) The National Department of Health respects and values the legislative process that the Bill has to undergo and that includes the public participation process. The Bill before Parliament aims at regulating and controlling the tobacco and related products in the interests of public health. The WHO FCTC is a regulatory instrument on tobacco control at international level. Both WHO FCTC and the National legislation (Tobacco Products Act 83 of 1993), Tobacco Products and Electronic Delivery Systems Control Bill are dealing with the same subject matter namely the regulation and control of tobacco and related products, including electronic delivery systems. Therefore, you may find similar aspects covered in the Bill being discussed at COP as the body implementing the WHO FCTC. As a matter of course, the resolutions and recommendations of international bodies do influence the direction of national laws to the extent allowed by the Constitution of the Republic of South Africa, 1996.

END.

Reply:

1. (a), (b) (i) and (ii)

One official from the Department of Health was delegated to attend COP 10. No other officials from other entities were delegated by the Department to attend.

2. The cost for travel and subsistence for 1 person was R175 040.46. There was no other cost involved.

3. The cost is funded by the Department only.

END.

Reply:

a) The total number of Environmental Health Practitioners (Health Inspectors) per Province is as outlined in the table below under column 4:

b) The vacancy rate per Province as listed below in the table under column 5.

c) The department is not responsible for filling the vacancies of Environmental Health Practitioners (Health Inspectors) because these officials are working directly under 44 Districts and 8 Metropolitan municipalities. The mandate to appoint EHPs lies with the Districts and Metropolitan municipalities.

Table depicting the total number of EHPs and the vacancy rate:

Province	Population as per Census 2022	Required EHPs (Inspectors) Per Ratio of 1: 10 100	Number of EHPs (Inspectors) per Province	Vacancy Rate per Province (vacant Funded Positions)
Eastern Cape	7230204	723	203	8.86%
Free State	2964411	296	71	21.13%
Gauteng	15099422	1510	437	14.42%
KwaZulu Natal	12423908	1242	287	10.45%
Limpopo	6572720	657	129	3.1%
Mpumalanga	5143324	514	81	3.70%
North West	3804546	380	76	28.95%
Northern Cape	1355945	136	55	50.9%
Western Cape	7433019	743	373	2.42%
RSA	62027499	6203	1712

END.

Reply:

(a)-(c) No, neither the Minister, the Deputy Minister nor any official of the National Department of Health attended the Rugby World Cup final in France in October 2023.

(i), (ii), (iii) (aa), (bb), (cc) Not applicable.

END.

Reply:

1.  A CAS number is generated by the South African Police Service (SAPS);

2. The postmortem was conducted, and the histology analysis has also been concluded to confirm the cause of death;

3. The postmortem report is ready for collection by the Investigating officer for release to the family.

END.

Reply:

According to the Health Professions Council of South Africa (HPCSA), the HPCSA underwent major organisational changes with substantive configurations that took effect in 2019/20. Regrettably, a lot of information from financial years prior to 2019 is still to be collated through the Knowledge Management Process. Currently, information as it relates to the question asked is available from 2017 as follows:

a) (i) The total number of foreign qualified graduates that applied to the HPCSA between 2017 and 2023 was 3836, and

(ii) of these 2056 applicants did not write the exams for various reasons outlined below. A total of 1780 foreign graduates wrote the exams, 1066 passed and thus qualified for registration.

b) Applicants would not proceed to registration for a variety of reasons, including, but not limited to the following –

(i) Failure to provide compliant documentation, including information on curricula, notarized documentation, hours of training, domains covered, etc.;

(ii) Non-recognition of qualification by the designated entity, in this case, the Educational Commission for Foreign Medical Graduates (ECFMG); and

(iii) Failing, either the theory and/or board examinations.

END.

Reply:

1. (a) COP 10 did not take place in November 2023 as scheduled. It was due to take place in Panama but has since been postponed and indication is that it will probably take place in the first quarter of 2024. Ordinarily the delegates include a legal representative responsible for drafting legislations and an official responsible for policy formulation, that is the programme manager for health promotion in the Department.

(b) The legal representative has experience in public service and working on health legislation and subordinate legislation and a health promotion official with experience in health policy formulation and application with both academic and professional health experience. Their experience and expertise place them in good standing to contribute towards development and alignment of the South African legislation and policies that promote public health.

2. (a) The delegates are mandated to advance the interests of South Africa and of the Continent on aspects that promote public health in relation to Tobacco Control and related products.

(b) South Africa is a signatory to the WHO Framework Convention on Tobacco Control (FCTC), which is a Global public health treaty. The treaty is evidence-based and reaffirms the rights of all people to the highest standard of Health. It aims to protect present and future generations from the devastating health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke.

Therefore, Government’s participation as a member state, is to learn, contribute, and adopt policy that may advance public health in South Africa.

END.

Reply:

The National Department of Health organized an exhibition stand in collaboration with the South African National AIDS Council (SANAC) during the 11th SA AIDS Conference.

a) The exhibition stand was on display for three (3) days in line with the exhibition hall operational period.

b) The total cost for the stand was -

1. Total cost for three (3) days amounted to R1,055,951. The cost of the stand included booking of exhibition space at the Durban ICC exhibition Hall, Conceptualization, design, production and dismantling of an exhibition stand frame, panels, related items and Recording, production and editing of videography and photography of HIV/AIDS, STIs and TB interventions/programmes that were showcased during the exhibition.
2. Costs were not broken-down per day. According to the terms and conditions of the Conference Organisers, the Exhibition space is booked for the duration of the Conference, there are no daily rates applicable.

c) (i) The stand was utilised as a platform to popularise the current National Strategic Plan (NSP) for HIV, TB and STIs: 2023-2028, and showcasing the achievements of the country’s HIV response.

(ii) Return on investment is that the Department in collaboration with SANAC was able to provide a platform for engagement (dialogues) with various stakeholders on innovative interventions implemented to prevent new HIV infections. Furthermore, delegates had the opportunity to share lessons learnt, best practices and new scientific and behavioural developments in HIV response.

END.

Reply:

a) Public Services employees are entitled to 36 sick leave days over a 3-year cycle as part of their basic conditions of services. In addition, the Annual Report of the National Department of Health publishes leave usage statistics on a year-to-year basis. These leave days are captured on the Transversal system that is administrated by National Treasury (PERSAL). The statistics are as follows:

Year	Total Sick Leave Days	Number of Employees using Sick Leave	Average Days per Employee
2019	7578	984	8
2020	1036	339	3
2021	2374	425	6
2022	5924	796	7

b) The Labour Relations Act (LRA) defines a strike as “the partial or complete concreted refusal to work, or the retardation or obstruction of work, by persons who are or have been employed by the same Employer or by a different Employer, to remedy a grievance or resolve a dispute in respect of any matter of mutual interest between the Employer and Employees.

Furthermore, the section 64 of the LRA stipulates two procedural requirements that should be met for a strike action by employees to be protected and they are as follows: -

• Firstly, it requires that the issue in dispute should be referred for conciliation to a bargaining council or the CCMA.

• Secondly, If conciliation has failed or (thirty) 30 days period has lapsed from date in which the dispute was referred to the council or the CCMA. the employees in the private sector are required give the employer at least a 48 hours’ notice to embark on a strike, while the employees of the state required to give the state seven (7) days’ notice.

In the Department there was no strike action, rather there was a work stoppage due to non-compliance of the infrastructure/ building to Occupational Health Safety legislative framework.

END.

Reply:

1. (a), (b) and (c) The Department is concerned about the growing number of people diagnosed with diabetes. Type 2 diabetes accounts for about 90% of all cases and is associated with obesity, unhealthy eating habits and a sedentary lifestyle. Type 2 diabetes can be prevented or better managed when people make healthy lifestyle choices. It is for this reason that the Department is acceleration implementation of preventive programmes.

2. (a) The Department has taken and will continue to take serious steps to prevent and control diabetes. The intensity of the Department’s intervention in this regard, is amongst others demonstrated by the fact that the Department has for the past two years, used part of the Health Promotion Levy to provide tools to provinces to facilitate increased screening and focussed health education in the community and in primary health care facilities for non-communicable diseases (NCDs), including diabetes, and promoting physical activity and healthy eating.

(b) The Department has a directorate for NCDs, and national managers work with managers in provinces and districts to pursue the objectives of the programme. The programme is currently achieving its screening targets. Outcome targets will be measured though the WHO STEP survey which is scheduled to commence during the 2024-2025 financial year.

(3) No, it is not necessary to make a statement.

END.

Reply:

1. The Gauteng Department of Health (GDOH) requested the Gauteng Department of Infrastructure Development (GDID) to plan the renovation and refurbishment of the existing hospital infrastructure. The department was informed that the cost of renovations was comparatively too high as compared to the cost of building a new hospital. It was then decided that the existing hospital buildings should be demolished, site cleared, and a new hospital be built on the same site.

Further GDOH requested Gauteng Infrastructure Funding Agency (GIFA) to assist with the funding proposals for the demolishing and rebuilding of the new hospital. Currently GIFA is in the process of preparing Business Cases for submission to National Treasury to request alternative funding of the project under the Budget Facility for Infrastructure (BFI) Framework.

2. GDOH plans to reopen the hospital as a new district hospital to provide additional level 1 district beds needed within the Tembisa and Kempton Park area. Provision of additional district hospital beds at Kempton Park hospital will alleviate the pressure on the Tembisa Regional hospital and free bed space for level 2 and level 3 patients.

(3) The planning of the project was put on hold in 2019 to ensure funding is secured before the project can proceed. Consultations with local community were planned to take place once the funding of the project is secured and the project is ready to proceed.

4. The construction of a new level 1 Kempton Park district hospital will ensure that hospital aligns with the Departmental Long-Term Plan (LTP) to provide much needed level 1 district beds within the Tembisa and Kempton Park and the surrounding areas.

Tembisa hospital is a regional hospital with the proposed plan to increase the level of care to Tertiary and Regional levels. Currently Tembisa hospital is under severe pressure due to being the only government hospital catering for the uninsured population of Tembisa, Kempton Park and other surrounding areas.

Due to shortage of district beds in the area, Tembisa hospital is using level 2 beds for level 1 patients that are affecting the level 2 bed availability.

END.

Reply:

The National Department of Health opened the Internship and Community Service Programme (ICSP) application site from 4 October until 23 October 2023. Applicants and all relevant stakeholders including students representatives by the form of Unions and Associations were informed accordingly.

As a result, it is appreciated that a total of 10 495 applicants headed a call and applied for medical internship and community service positions.

a) (i) A total of 2 403 medical interns (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for medical internship positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

(ii) A total of 2 391 medical doctors community service (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for medical internship positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

b) (i) 2 354 applicants were eligible for placement based on the citizenship priority processes as mentioned above and have since been notified of their placement outcomes.

Some outcomes were unfavourable to the applicants with reasons as follows:

• 113 have been declared not eligible for this Cycle by HPCSA
• 6 applicants to commence duty from 1 July 2024
• 1 applicant retracted his allocation due to other commitments

(ii) 2 387 applicants were eligible for placement based on the citizenship priority processes as mentioned above and 2 158 have since been notified of their allocation. The remaining 229 applicants to commence duty from 1 March 2024 and will be allocated in January 2024

(c) The ICSP has two cycles, January and July intake, for allocation designed to accommodate applicants who complete and confirmed eligible at different intervals. As a result the department ensures that those that are eligible to assume duty on 1st January are duly allocated and appointed before commencing duty.

The department is considerate and mindful that the applicants need to make necessary arrangements, including travelling, hence ensuring that applicants are notified a month before the intake date.

END.

Reply:

The National Department of Health opened the Internship and Community Service Programme (ICSP) application site from 4 October until 23 October 2023. Applicants and all relevant stake holders including students representatives by the form of Unions and Associations were informed accordingly.

As a result, it is appreciated that a total of 10 495 applicants headed a call and applied for medical internship and community service positions.

a) A total of 2 036 nurses (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for professional nurses community service positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

b) 2009 applicants were eligible for placement based on the citizenship priority processes as mentioned above. All applicants have been allocated and notified.

c) The ICSP has two cycles, January and July intake, for allocation designed to accommodate applicants who complete and confirmed eligible at different intervals. As a result the department ensures that those that are eligible to assume duty on 1st January are duly allocated and appointed before commencing duty.

The department is considerate and mindful that the applicants need to make necessary arrangements, including travelling, hence ensuring that applicants are notified a month before the intake date.

The deadline to finalize all allocations cannot be specified as the process is not punitive, however it unfolds until all eligible applicants have been allocated to positions, and duly appointed by Provincial Departments of Health.

END.

Reply:

The National Department of Health opened the Internship and Community Service Programme (ICSP) application site from 4 October until 23 October 2023. Applicants and all relevant stakeholders including students representatives by the form of Unions and Associations were informed accordingly.

As a result, it is appreciated that a total of 10 495 applicants headed a call and applied for medical internship and community service positions.

a) A total of 470 physiotherapist (i.e. South African Citizens, Permanent Residents and Foreign Nationals) applied for community service positions. However, priority for allocation of the applicants is in accordance with the South African employment Regulations and Acts (i.e. including the Immigration Act of 2004, as amended) that prioritizes allocations to South African Citizens and Permanent Residents into funded positions.

b) 463 applicants were eligible for placement based on the citizenship priority processes as mentioned above. Of those 424 have been allocated and notified, with the remaining 39 applicants still confirming their actual commencement dates.

c) The ICSP has two cycles, January and July intake, for allocation designed to accommodate applicants who complete and confirmed eligible at different intervals. As a result the department ensures that those that are eligible to assume duty on 1st January are duly allocated and appointed before commencing duty.

The department is considerate and mindful that the applicants need to make necessary arrangements, including travelling, hence ensuring that applicants are notified a month before the intake date.

The deadline to finalize all allocations cannot be specified as the process is not punitive, however it unfolds until all eligible applicants have been allocated to positions, and duly appointed by Provincial Departments of Health.

END.

Reply:

In preparation for the busy festive season the following measures have been put in place in hospitals:

• Contingency plans for the festive season are in place for all hospitals and Emergency Medical Services as is done annually.
• Contingency plan is in place for extra personnel in Accident and Emergency units, surgical and orthopaedic wards throughout the festive period due to expected increase in the number of patients requiring surgical intervention.
• Elective, non-urgent surgical procedures are not booked during festive period and theatre space is provided on a 24hour basis for emergencies.
• Leave is strictly monitored, senior managers on call on a 24-hour basis to oversee operations in hospitals during this period.
• In case of disasters, all hospitals are in constant alert and the hospital disaster plans will be activated which includes recalling of staff on leave, at any given time.
• Interprovincial collaborations on transfers are arranged in case of disasters to respond appropriately.
• Stable patients on chronic medication have been given 2 months’ supply of medication to decongest the hospitals.
• Stable patients are discharged home to avail beds for acutely ill and emergency cases.
• Stable patients are given Pass-out should they wish so.
• The Medical Depot ordered buffer stock to accommodate any eventuality.
• Hospitals in the same or close geographical areas have a divert operational policy in place as a mechanism to ensure access to emergency medical services.

END.

Reply:

(a)-(b) According to the HPCSA they have no records of doctors employed and practicing in public hospitals or Clinics. It is important to appreciate that before a doctor can be employed in the public healthcare sector and paid in the public healthcare system he/she must be registered on the PERSAL system which would include a requirement that the doctor provides evidence of registration with the HPCSA as a doctor. Given that there are no reports of doctors without proper qualifications being employed in the public healthcare sector there would be no need to take action against any official in this regard.

END.

Reply:

According to the records as presented to Parliament responding to a similar parliamentary question number 3511, the table below provides (a) data of graduates from each medical school in the country for the 2018-2023 period.

South African Institutions of Higher Learning	2018	2019	2020	2021	2022	2023	TOTAL
University of Free State	114	130	179	176	167	173	939
University of KwaZulu Natal	159	78	229	150	281	130	1027
University of Limpopo			24	41	89	75	229
University of Pretoria	225	291	351	366	335	343	1911
University of Stellenbosch	231	295	294	310	306	295	1731
University of Witwatersrand	274	277	425	397	436	466	2275
Walter Sisulu University of Science and Technology	86	99	195	156	156	151	843
Nelson R Mandela School of Medicine (University of KwaZulu Natal)	5	143	77	178	64	200	667
Sefako Makgatho Health Sciences University	201	255	333	254	309	290	1642
University of Cape Town	191	237	213	207	231	241	1320
Total	1486	1805	2320	2235	2374	2364	12584

(b) The Department has it on record that all these graduates were placed for the mandatory community service, after completing their medical internship and were declared registerable as community service doctors by the Health Professions Council of South Africa (HPCSA).

(c) The table below provide a breakdown of new Medical Officer appointments per province for the period 2018 to 2023. The appointments, includes doctors who post their medical community service applied for appointment in the public service.

Medical Officer's appointed from 2018 - 2019 in the Public Sector
	2018	2019	2020	2021	2022	*2023	Total
EC	329	323	364	298	275	252	1841
FS	103	109	158	110	196	170	846
GP	328	421	587	605	658	568	3167
KZ	493	511	656	489	514	515	3178
LP	110	224	183	215	261	239	1232
MPY	62	59	150	55	112	124	562
NW	83	88	85	95	48	144	543
NC	34	20	167	46	190	54	511
WC	249	283	345	275	360	235	1747
Total	1791	2038	2695	2188	2614	2301	13627

*2023 Data is only available up to November 2023.

(d) The Department does not keep records of unemployment doctors after completing community service as they register as independent medical doctors and can opt to practice in the public service or the private sector.

END.

Reply:

The data as requested is drawn from the Persal System and was extracted on 30 November 2023. Unfortunately, records on the Persal System are not able to provide granule data of each specialization as Specialists are not captured per specialization but per Professional Category.

(a)-(b) The table below responds to question (a) and (b) which is the data available on the Persal system. We do acknowledge that the Professional Councils also keep data of all specialities but with a limitation of not being able to still distinguish between employment status (public or private) as well as current location of practice (Nationally or Abroad).

Row Labels	EC	FS	GAU	KZN	LP	MPU	NW	NC	WC
Medical Specialist	163	127	1026	569	81	51	113	29	749
Registrar (Medical)	97	186	1265	334	94	4	44	2	630
Senior Registrar (Medical)	1	0	10	0	1	0	0	0	48
Professional Nurse (Specialised)	1448	596	2834	3605	1539	775	1265	150	1416
Dental Specialist	0	1	60	2	3	2	0	0	5
Grand Total	1709	910	5195	4510	1715	832	1422	181	2848

(c) Not able to provide information of specialist currently in the private sector as the Department is currently not collecting the data but still improving our Human Resource Information System to be operable with private sector.

END.

Reply:

a) (i),(ii),(iii) Donor funds

b) Total per each investment

a) (i) (ii) (iii)
DONOR'S NAME	2019/20	2020/21	2021/22	2022/23	2023/24	Totals
b) Total: Centre for Disease Control and Prevention	492,075,883,56	366,677,054,80	42,708,867,45	20,730,070,29	26,843,267,28	949,035,143,38
b) Total: European Union	4,613,092,16	-	-	-	-	4,613,092,16
b) Total: Germany	5,455,047,89	877 636,52	-	-	-	6,332,684,41
b) Total: Global Fund	616,153,230,05	571 301 660,14	1,411,879,026,50	922 803 142,86	930 804 645,72	4,452,941,705,27

(c) The Centres for Disease Control and Prevention (CDC) financial and technical support through the existing Cooperative Agreement, assists the NDoH to incorporate results of programme evaluations into operational disease prevention and control programmes.

• In Financial year 2019/2020, The CDC supported Community Services.
• In financial year 2020/2021 CDC supported procurement of HIV Pre-exposure prophylaxis drugs and TB Prevention therapy drugs. The drugs were distributed to provincial depots in 2021/2022. To date, in addition to the programmatic supports, the CDC Cooperative Agreement has been supporting the NDoH with key personnel within its directorates. Funded personnel are responsible for their respective areas of expertise, and all efforts contribute to the fight against HIV/AIDS and TB in the country. Additional funds were used to support payment of key personnel appointed in the HIV/AIDS and TB as well as Maternal Child and Women Health clusters.

END.

Reply:

1. (a)(i),(ii) No Department within the Health Sector have blacklisted any company.

(b) Not applicable.

2. Not applicable.

END.

Reply:

South Africa’s representatives and negotiators working on the World Health Organisation (WHO) convention, agreement or other international instrument on pandemic prevention, preparedness and response (WHO Pandemic Agreement) have participated in the various iterations of the development of a draft negotiation’s text to prepare for the actual negotiations. The latest version of the document under discussion is titled the “Advanced unedited version of the WHO Pandemic Agreement” and is dated the 16 October 2023 (attached as Annexure to this response). The actual negotiations on the WHO Pandemic Agreement have not yet commenced as there is still no agreement on the negotiation’s text and there are divergent views on the language and contents of the WHO Pandemic Agreement by the WHO member states. The disagreements are on how the principle of Equity is to be operationalised throughout the Articles of the Agreement, to ensure that the mistakes made in responding to Covid-19 are not repeated as we move forward. The disagreements are based on developing countries requiring that lessons learnt for pandemic prevention, preparedness and response are provided for and that the provisions of the Agreement do not disadvantage member states from the global south. However, despite these divergent views, the following areas on sovereignty and conduct of pharmaceutical manufacturers are still being deliberated upon in developing a negotiations text for a future WHO Pandemic Agreement:

a) The “Advanced unedited version of the WHO Pandemic Agreement” has several articles addressing issues of protecting sovereignty of member states and on protecting members states against extortion by pharmaceutical manufacturers and other companies.

(i) On protection of sovereignty of state Parties to the WHO Pandemic Agreement, the Preambular section and Article 3 on General Principles and Approaches addresses these concerns.

1. The Preamble reaffirms the principle of sovereignty of States Parties in addressing public health matters.
2. Article 3 affirms that States have, in accordance with the Charter of the United Nations and the general principles of international law, have the sovereign right to legislate and to implement legislation in pursuance of their health policies.

(ii) On protecting members states against extortion by pharmaceutical manufacturers, other companies and member states, Article 10 on “Sustainable Production” and Article 13 on “Global Supply Chain and Logistics” is meant to provide for mechanisms that must be deployed by state parties to prevent extortionary practices by pharmaceutical entities and member states in which they are domiciled. It must however be noted that pharmaceutical companies are not state parties, but that member states in which they are domiciled will be the state parties to the WHO Pandemic Agreement and this is where the challenge of operationalising equity arises as the member states often invoke free market principles and their inability to intervene:

• 1. Article 10 makes provision for state parties to be self-sufficient in providing for health products by ensuring that in the inter-pandemic period, there is achievement of more geographically and equitably distributed global production of pandemic-related products, and that member states increase the timely, fair and equitable access to safe, effective, quality and affordable pandemic-related products, and thereby reducing the gap between potential demand and supply at the time of a pandemic.
• 2. Article 13 (3) makes provision for the establishment of the WHO Global Supply Chain and Logistics Network (the WHO SCL Network) which shall work with state parties to the agreement to ensure that it facilitates the negotiation and agreement of advance purchase commitments and procurement contracts for pandemic-related products; promotes transparency in cost, pricing and all other relevant contractual terms along the supply chain; and coordinates to avoid competition for resources among procuring entities, including within member states, regional organizations and/or mechanisms.
• 3. Articles 13 (5) and (6) further provide for each Party to the agreement to, at the earliest reasonable opportunity and in accordance with applicable law, make publicly available online the terms of government-funded purchase agreements for pandemic-related products in those instances in which the Party is directly entering into such purchase agreements and shall to the fullest extent possible and in accordance with applicable laws, exclude confidentiality provisions that serve to limit disclosure of terms and conditions of such purchases.

b) The provision for consequence management, including arbitration, should extortion occur, is described in Article 34 on “Settlement of Disputes” of the WHO Pandemic Agreement. This Article provides for parties to resolve disputes through diplomatic channels by negotiation or any other peaceful means of their own choice, including good offices, mediation or conciliation.

Failure to reach a solution by good offices, mediation or conciliation will not absolve Parties to the dispute from the responsibility of continuing to seek to resolve it. However, the pharmaceutical companies as previously stated are not state parties and will not be signatories to Agreement. This is where the drafting of the negotiating text has stalled as currently there are diverging views from advanced economies and countries of the global north where most of these pharmaceutical companies are domiciled on how to resolve challenges that may arise out of the conduct of these companies. This has resulted in the inability to reach consensus with the representative member states from the developed countries from the global north.

END.