Questions and Replies

Reply:

Workplaces in different sectors of the economy, other than essential services which have been operating during Level 5, are preparing for return to work in line with the Department of Employment and Labour directive (GN 43257 issued on 29 April 2020) and the Department of Public Service and Administration circular (Circular No. 18 of 2020 issued on 1 May 2020).

Symptom screening interventions and targeted testing of employees are proposed in the different notices. The national Department of Health and the NICD has provided guidelines on symptom screening and testing of all employees. The national Department of Health is not involved in the screening and/or testing of the frontline staff in the other departments and at local government level.

END.

Reply:

(a) Treatment demand data from the South African Medical Research Council collected through the South African Community Epidemiology Network on Drug Use (SACENDU) and reported once in six months shows that the number of persons admitted for treatment across 84 treatment centres/programmes between July and December 2018 were 8,486. Between January and June 2019, 9,268 persons were admitted for treatment.

(b) The data from the SACENDU Project shows that the primary substances of use for all persons seeking treatment for substance use problems were the following:

• Cannabis;
• Alcohol;
• Heroin/Nyaope;
• Methamphetamine;
• Mandrax;
• Cocaine;
• CAT;
• Over the Counter and Prescription Medication (OCT-PRE);
• Cannabis/Mandrax (White pipe); and
• Inhalants.

END.

Reply:

a) The following hospitals are currently being upgraded and repurposed for COVID-19:

Province	District	Facility
Eastern Cape	Alfred Nzo	Planning Field Hospital
	Amathole	Bhiso Hospital
		Old Cecilia Makiwane Hospital
		Frere Hospital
		Grey Hospital
		Victoria Hospital
		Butterworth Hospital
		Planning Field Hospital
	Buffalo City Metro	ABSA Stadium
	Chris Hani	All Saints Hospital
		Planning Field Hospital
	Joe Gqabi	Maclear Hospital
		Aliwal North Hospital
		Planning Field Hospital
	Nelson Mandela Bay Metro	Livingstone Hospital
		Port Elizabeth Provincial Hospital
		PE Stadium
		PE VW
	OR Tambo	St Lucy's Hosptial
		St Patrick's Hospital
		St Barnabas Hospital
		Zitulele Hospital
		Taylor Bequest Hospital
		Planning Field Hospital
	Sarah Baartman	Humansdorp Hospital
		Midland Hospital
		Planning Field Hospital
Free State	Fezile Dabi	Parys
		Tokollo
		Boitumelo
	Lejweleputswa	Bongani
		Winburg
	Mangaung	Pelonomi
		Botshabelo
		Univerisitas
		JS Moroka
		Pelonomi
		Univerisitas
	Thabo Mofutsanyana	Senorita Nhlabathi Hospital
		Dihlabeng
		Elizabeth Ross
		MM Mopeli
		Phekolong
		Nketoana
		Itemoheng
		Senorita Nhlabathi Hospital
		Mantsopa Hospital
	Xhariep	Albert Nzula Hospital
		Diamant
		Itumeleng CHC
Gauteng	City of Tshwane	Steve Biko Hospital Cluster
		Steve Biko Hospital
		Tshwane District Hospital
		Dr George Mukhari Cluster
		Dr George Mukhari
		Jubilee Hospital
	Ekurhuleni	Tembisa Hospital
	City of Johannesburg Metropolitan Municipality	Charltte Maxeke Hospital Cluster
		Charltte Maxeke Hospital
		Bertha Gxowa
		Chris Hani Baragwanath Cluster
		Christ Hani Baragwanath
		Kopanong Hospital
		Nasrec
		Ashanti Gold Hospital
KwaZulu-Natal	uMgungundlovu	Grey's Hospital
		Doris Goodwin TB Hospital
		Richmond Chest Hospital
		Edendale Hospital
		Northdale Hospital
		Appelsbosch Hospital
		Townhill Hospital
		Umngeni Hospital
		Fort Napier
	eThekwini	Clairwood Hospital
		Addington Hospital
		Prince Mshiyeni Hospital
		King Edward VIII Hospital
		Inkosi Albert Luthuli Central Hospital
		Mahatma Gandhi Hospital
		King Dinuzulu Hospital (District)
		King Dinuzulu Hospital (EMS & Infr. Hub)
		King Dinuzulu Hospital (MDR)
		Hillcrest Hospital
		Ekuhlengeni Hospital
		St Marys Hospital
		Don McKenzie Hospital
		Charles James
		Wentworth Hospital
		RK Khan Hospital
		Pixely Isaka ka Seme
		Royal Show Grounds
		Durban Exhibition Centre
		Clairwood Field Hospital
	Ugu	Murchison
		St Andrews
		Port Shepstone
		GJ Crookes
	iLembe	Umphumulo Hospital
		Untunjambili Hospital
		General Justice Gizenga Hospital
		Montebello Hospital
		Stanger Hospital field hospital
	Harry Gwala	EG&Usher Memorial Hospital
		Rietvlei Hospital
		Christ the King Hospital
		St Apollinaris Hospital
		St Margaret Hospital
	Harry Gwala	EG&Usher Memorial Hospital
		Rietvlei Hospital
		Christ the King Hospital
		St Apollinaris Hospital
		St Margaret Hospital
	King Cetshwayo	Ngwelezana Hospital
		Ethembeni
		Queen Nandi Hospital
		Eshowe Hospital
		Ntambanana Clinic
		Nkandla Hospital
		St Marys Hospital
		Mbongolwane Hospital
		Ekhombe Hospital
		Catherine Booth Hospital
		Ngwelezana Hospital Field
	Amajuba	Niemeyer
		Newcastle
	uMzinyathi	Greytown Hospital
		COSH
		Dundee Hospital
		CJM Hospital
	uThukela	Ladysmith Hospital
		Emmaus Hospital
		Escourt Hospital
		St Chad’s CHC
	Zululand	Siloah Lutheran Mission Hospital
		Nongoma Private Hospital
		Phongola Private Hospital
		St Francis Hospital
Liimpopo	Capricorn	Pietersburg Hospital
		Mankweng Hospital
	Mopani	Letaba
	Sekhukhune	St Ritas
		Philadelphia
	Vhembe	Tshilidzini
	Waterberg	Mokopane
Mpumalanga	Nkangala	Witbank Hospital
		Greenside CHC
		Middleburg hospital
		KwaMhlanga hospital
		Mmametlhake hospital
		Impungwe Hospital
		Impungwe Field Hospital
		KwaMhlanga Field hospital
	Gert Sibande	Standerton TB
		Mbhejeka CHC
		Bethal hospital
		Piet Retief hospital
		Ermelo Hospital
	Ehlanzeni	Rob Ferreira Hospital
		Themba Hospital
		Barberton TB Hospital
		Tonga hospital
		Mmametlhake hospital
		Shongwe hospital
		Barberton Hospital
		Matikwane Field Hospital
		Mmametlhake Field hospital
		Tonga Field Hospital
Northern Cape	Frances Baard	Robert Mangaliso Sobukwe Hospital
		Prof ZK Matthews Hospital, Barkly West
		Harstwater Hospital
		Harmony Home
	Namakwa	Springbok Hospital
		Louriesfonteing
	Pixley ka Seme	De Aar Hospital
		Manne Dipico Hospital, Colesberg
		Prieska Hospital
	JT Gaetsewe	Kuruman Hospital
		Tshwaragano Hospital
	ZF Mgawu	Dr Harry Surtie Hospital, Upington
		Postmasburg Hospital
		Keimoes
		West End Old Mental hospital
North West	Bojanala	Job Shimankana Hospital
		Moses Kotane
		Koster Hospital
		Brits Hospital
		JST Field Hospital
		2 Mine Hospital
	Dr. Kenneth Kaunda	Klerksdorp-Tshepong Tertiary Hospital
		Nic Bodenstein
		Westvall Hospital
		Duff Scott
		Potchefstroom Hospital
	Dr. Ruth Segomotsi Mompati	Taung Hospital
		Christiaana Hospital
		Ganyesa Hospital
		Joe Morolong Memorial Hospital
	Ngaka Modiri Molema	Zeerust Hospital
		Mafikeng Provincial Hospital
		Lehurutshe Hospital
		General De La Rey Hospital
Western Cape	Cape Winelands District Municipality	See attached spreadsheet
	Central Karoo District Municipality
	City of Cape Town Metropolitan Municipality
	Garden Route District Municipality
	Overberg District Municipality
	West Coast District Municipality
		ICC Convention Centre
		Bracengate Warehouse

b) We have not received the detailed costing from all the provinces as yet;

c) Budgets available to the Provinces are their Provincial Equitable Share Funds and the Direct Infrastructure Grant;

d) (i) Yes;

(ii) An amount of R1,1 billion could be potentially reprioritised from the Direct Grant to COVID19 projects. Provinces can also request for a change in their Business Plans to accommodate these upgrades;

(e) Virements are allowed between main divisions of the vote of up to 8%. This can be approved by the Accounting Officer and be ratified in the adjustment budget after the adjustment allocation letter has been issued.

END.

Reply:

1. The competence to assist Small Businesses is a constitutional mandate of the Department of Small Businesses. The Department of Health is mandated in terms of the National Health Act to provide a framework for structured uniform health system for South Africa. The Department does therefore not grant financial relief or resources to Small Businesses.

2. The raised question does not fall under the mandate of the Department of Health, but having said that the Department with National Treasury encourage all small businesses to register their details on the Central Supplier Database to be able to be contacted to for supplies of inter alia Personal Protective Equipment. To date more the database contains more than 7,000 registered suppliers.

END.

Reply:

1. The 2017 White Paper on NHI states that NHI will cover comprehensive health care services that are determined by The Benefits Advisory Committee. These services will be delivered through certified and accredited health care providers located closest to the covered population. South Africans will be able to access personal health care services to achieve allocative efficiency, affordability and sustainability using a Primary Health Care (PHC) Approach. Currently there is no package of benefits that is being offered through NHI to intended beneficiaries. The reasons for this are as follows:

a) The package of health care benefits must first be determined by the Benefits Advisory Committee as outlined in Clauses 4(1) and 7(1) of the NHI Bill. The NHI Fund, in consultation with the Minister must purchase health care services, determined by the Benefits Advisory Committee, for the benefit of users. Clause 6 (a) further outlines that intended beneficiaries can receive necessary quality health care services free at the point of care from an accredited health care provider or health establishment upon proof of registration with the Fund. Clause 25(5)(a) of the Bill further outlines that the Benefits Advisory Committee must determine and review the health care service benefits and types of services to be reimbursed at each level of care at primary health care facilities and at district, regional and tertiary hospitals.

b) The intended beneficiaries of NHI are yet to be concluded but as outlined in Clause 4 (4) of the Bill, must be registered as a user of the Fund as provided for in Section 5 of the Bill, and must present proof of such registration to the health care service provider or health establishment in order to secure the health care service benefits to which he or she is entitled. Currently this has not materialised as it is still awaiting the approval of the Bill by Parliament;

Therefore, the package of benefits can only be determined and offered once the Benefits Advisory Committee has been established for intended beneficiaries that have been registered with the NHI Fund.

2. The National Department of Health is undertaking preparatory work with specific reference the development of the NHI Information Platform as outlined in section 40 of the NHI Bill and section 57 (2) (iii) on transitional arrangements. This is also guided by section 74 (1) and (2) of the National Health Act, that stipulates how coordination of the Health Information Systems must be undertaken. Further to the above the integration of existing and future health records of all patients will take into account the provision of the Protection of Personal Information Act number 4 of 2013.

The integration of patient records will require a digital platform that uses a Health Normative Standards Framework for Interoperability supported by a Health Information Exchange. Interventions to achieve this are outlined in Pillar 9 of the Presidential Health Compact and include:

(a) The development of procedures and systems for the identity verification of users of the health system.

(b) Establishment of a patient registry through the implementation of a Master Patient Index.

3. The preamble of the NHI Bill states that the objective of NHI is to ensure continuity and portability of financing and services throughout the Republic.

Section 40 (6) (b) of the NHI Bill states that the information platform and architecture must facilitate the portability and continuity of health care available to users. This will be facilitated by the development and implementation of a shared Electronic Health Record (EHR).

The key components of a shared Electronic Health Record, that also include accurate medicine records, are the Master Patient Index, Interoperability Norms and Standards and the Health Information Exchange as referred to in the response( 2) above.

4. The country will achieve the integration of records by the creation and implementation of a digital platform and architecture for a shared Electronic Health Record.

The Department has published the Digital Health Strategy 2019-2024 which guides intervention towards the integration of Health Records. The focus areas include:

• a complete Electronic Health Record, which will improve patient management
• the digitisation of health systems business processes
• establishing an integrated platform and architecture for the health sector information system, which will ensure interoperability and linkage of existing patient-based information systems
• the development of digital health knowledge workers

END.

Reply:

1. The total cost to the Department for attending the Public Hearings on the NHI Bill is R841,521.64;

2. (a) The table below gives the provincial breakdown of the cost to the Department for attending the public hearing on the NHI Bill;

(b) The breakdown to municipal level is complex as travel and accommodation was arranged at central locations and in most cases not in the specific locations of where the hearing was conducted. Thus making it difficult to ascribe specific costs to individual municipalities.

Table 1.

DATE	PROVINCE	AIR TRAVEL	ACCOMODATION	GROUND TRANSPORT CAR HIRE	S&T CLAIMS	KILOMETRE CLAIMS	TOTAL
25-29 Oct 2019	Mpumalanga N = 8	35,866.77	44,000.00	12,743.05	66,434.04	5,266.37	164,310.23
1- 4 Nov 2019	Northern Cape N = 6	24,600.00	27,000.00	26,500.00	52,260.00	-	130,360.00
15-19 Nov 2019	Limpopo N = 6	6,756.00	27,439.58	20,696.11	40,313.72	429.24	95,634.65
22-26 Nov 2019	Kwa-Zulu Natal N = 5	2,901.00	10,260.50	31,051.74	41,069.23	429.24	85,711.71
29 Nov-03 Dec 2019	Eastern Cape N = 6	23,449.32	31,029.43	26,872.28	40,324.36	214.62	121,890.01
27 Jan- 01 Feb 2020	Free State & North West N = 5	10,398.52	14,266.10	31,093.05	79,209.78	-	134,967.45
04- 09 Feb 2020	Western Cape N = 6	13,408.32	33,330.00	-	39,982.88	-	86,721.20
21-23 Feb 2020	Gauteng N = 6	-	-	20,000.00	-	1,926.39	21,926.39
	Total	117,379.93	187,325.61	168,956.23	359,594.01	8,265.86	841,521.64

N = Number of Participants

END.

Reply:

(1) No, fibroids are common but do not necessarily pose a health problem unless it is associated with any other underlying condition such as infertility or abnormal vaginal bleeding.

(2) Fibroids do not necessarily need treatment. Women are often diagnosed with fibroids when they are investigated for other gynaecological symptoms they are presenting with. The treatment is therefore symptomatic and will range from management of anaemia, surgical intervention to treat infertility and pain management with antibiotics to treat lower abdominal pains.

(3) No, because fibroids were not counted routinely as one of the leading causes of maternal morbidity and mortality. They are asymptomatic thus it’s not easy to identify and there is no routine screening and management protocol just for fibroids.

END.

Reply:

1. The National Department of Health, together with the Provincial Health Departments have embarked on a number of intervention strategies to help curb the ongoing attacks on Emergency Medical Services (EMS) Workforce. To this end we have established a National EMS Safety Forum and have since developed a National EMS Safety Guideline for all provinces to implement based on their specific needs (Annexure A). These comprehensive guidelines have four main areas, namely Focus on Staff, Community, Technology and Management. The National Department of Health is also in the process of introducing a 2-day course aimed addressing increasing safety awareness to enhance EMS personnel skills in identifying hostile environments, dealing with such situations, undertake evasive action and protection of the patient/s.

2. Yes. The National Department of Health has engaged with the South African Police Services (SAPS), National Joint Operations and Intelligence Structure (NatJOINTS), to highlight the ongoing attacks on EMS workforce and to escalate the matter with the Justice, Crime Prevention and Security Cluster (JCPS Cluster), with recommendation to the Department of Justice and Constitutional Development to deal with perpetrators more stringently. As a result, the NatJOINTS has issued a NatJOINTS Instruction to SAPS Provincial Commissioners to work closely with Provincial EMS managers. The aim of the collaboration is to provide the necessary security services to EMS workforce and to prioritise all cases reported.

In addition, this matter has been carefully deliberated upon by the National Health Council and a decision was taken to have Izimbizos within the affected communities in order to create awareness and to advocate for the support of EMS by the communities. Should Izimbizos in the affected areas fail, then EMS would be forced to withdraw services from danger areas to avert loss of life or injury.

Intervention strategies at both National and Provincial levels, but are not limited to, are listed below:

• Participation and keynote address by Deputy Minister, Dr J Phaahla, at the National EMS Safety Symposium held at Cape Peninsula University of Technology in late 2018, involving all stakeholders which culminated in the development of an EMS Safety Position statement (Annexure B);
• Denouncement of such attacks by the Minister of Health at the launch of National EMS Day in 2019;
• Radio and television interviews;
• Interaction with staff at grass roots level;
• Participate in demonstrations and marches denouncing attacks on EMS staff;
• Interact with the community in the affected communities; and
• Feedback to National and Provincial parliamentary structures.

Intervention strategies by the EMS Managers and Senior Officials of the Provincial Health Departments include:

• Regular stakeholders meeting with the Community Police Forum (CPF) in the identified affected areas;
• On receipt of an emergency call, the EMS Communication Centre verifies the call with the CPF, who immediately respond to the location and confirm the emergency;
• The EMS team respond to a safe area within the Red Zone (declared by SAPS) and are then escorted to the patient by SAPS;
• Ongoing discussions with the labour caucus, CPF, SAPS and EMS management, have resulted in a decision to train CPF members in emergency medical care (First Responder Course) so as to provide the patients with immediate medical care upon the arrival of EMS; and
• In addition, the media are invited to ride along with EMS to report first hand of the experience, challenges and difficult situation faced by the emergency services on a daily basis, EMS management and staff are regularly interviewed by the media to highlight the dangers and challenges EMS is confronted with, when serving such areas.

Interaction with the Department of Justice and Constitutional Development, EMS Management and the Safety and Security Cluster continues, to ensure that:

• Legal counsel employed by the state follows up the investigations to ensure prioritisation and possible conviction; and
• Expert witness testimony by senior EMS manager on impact to EMS staff, EMS management, the community and service delivery.

3. I, as the Minister of Health, along with Deputy Minister of Health, Dr J Phaahla and senior managers of the National Department of Health have made several statements in this regard in the past and will continue to denounce such attacks going forward. It must be noted that there are a number of interventions implemented at multiple levels of government, yet, the attacks continue. No matter what we do, it is never enough, but we must continue to try, as we deal with this largely socioeconomic challenge. The National Department of Health together with our sector departments and provincial counterparts will continue to look for additional ways to address this serious challenge.

END.

Reply:

(1) These hospitals were the designated hospitals for managing Ebola cases therefore they were already in a state of preparedness. Each of the said hospitals, were re-assessed to determine their current state of readiness and each of them showed that they were compliant for isolating and managing Coronavirus patients.

(2) The National Department of Health (NDoH) has always collaborated with the private sector. The official representative for the private sector is part of the national team responding to the Coronavirus outbreak. The private sector follows the NDoH guidelines and protocols. The private sector has supported the NDoH with developing training materials and sponsored video recording of training workshops for use by relevant health care professionals.

(3) All the selected hospitals are ready to receive and manage patients. Charlotte Maxeke Academic Hospital and Steve Biko Hospital were added to the initial list as they are also able to isolate and manage Coronavirus patients.

(4) (a) Protocols are in place to deal with patients from the time of them being suspected, through transport, to hospitalisation and isolation. Training is ongoing at the provincial level to strength management and care of possible Coronavirus infected patients.

(b) The designated hospitals are referral hospitals and offer quality care, with skilled personnel, using the best health care management practices.

(5) The Minister is willing to make a statement in the House.

END.

Reply:

1. (a) The number of registered medical schemes was 76 as at Quarter 3 of 2019 (compared to 79 as at December 2018);

(b) (i) The 2019 numbers have not been audited and will only be available on 1st April 2020;

(ii) As at Quarter 3 of 2019 the number of principal members was 4 067 003 (compared to the audited number of 4 039 705 at December 2018);

(iii) As at Quarter 3 of 2019 the number of beneficiaries including dependents was 8 954 814 (compared to the audited number of 8 916 695 at December 2018);

2. The Council for Medical Schemes (CMS) is currently not collecting this information routinely;

3. Yes I am willing to make a statement on the matter.

END.

Reply:

The following tables provide the details in this regard:

Name of health facility that offers Choice of Termination of Pregnancy (CTOP) in the Republic	Province in which facility is located
(a)	(b)
Adelaide Hospital	Eastern Cape
All Saints Hospital	Eastern Cape
Andries Vosloo Hospital	Eastern Cape
Bambisana Hospital	Eastern Cape
Bedford Hospital	Eastern Cape
Bhisho Hospital	Eastern Cape
Butterworth Hospital	Eastern Cape
Cala Hospital	Eastern Cape
Cecilia Makiwane Hospital	Eastern Cape
Civic Centre Clinic (Mthatha)	Eastern Cape
Cloete Joubert (Barkley East) Hospital	Eastern Cape
Cofimvaba Hospital	Eastern Cape
Cradock Hospital	Eastern Cape
Dora Nginzi Hospital	Eastern Cape
Duncan Village CHC	Eastern Cape
Elliot Hospital	Eastern Cape
Empilisweni Hospital	Eastern Cape
Empiliweni Gompo CHC	Eastern Cape
Frere Hospital	Eastern Cape
Frontier Hospital	Eastern Cape
Glen Grey Hospital	Eastern Cape
Hewu Hospital	Eastern Cape
Humansdorp Hospital	Eastern Cape
Idutywa Village CHC	Eastern Cape
Lady Grey Hospital	Eastern Cape
Laetitia Bam CHC	Eastern Cape
Lanti Clinic	Eastern Cape
Marie Stopes Port Elizabeth Clinic	Eastern Cape
Midland Hospital	Eastern Cape
Motherwell CHC	Eastern Cape
Mthatha General Hospital	Eastern Cape
New Rest Clinic	Eastern Cape
Ngqwaru Clinic	Eastern Cape
Nompumelelo (Peddie) Hospital	Eastern Cape
Nontyatyambo CHC	Eastern Cape
Nqamakwe CHC	Eastern Cape
Port Alfred Hospital	Eastern Cape
Settlers Hospital	Eastern Cape
SS Gida Hospital	Eastern Cape
St Elizabeth's Hospital	Eastern Cape
Rafalofefe Hospital	Eastern Cape
Tayler Bequest Hospital (Elundini)	Eastern Cape
Tayler Biquest Hospital (Matatiele)	Eastern Cape
Uitenhage Hospital	Eastern Cape
Victoria Hospital	Eastern Cape
Xhora CHC	Eastern Cape
Albert Luthuli Memorial Clinic	Free State
Albert Nzula District Hospital	Free State
Botshabelo Hospital	Free State
Bren Health Care Clinic	Free State
Dr JS Moroka Hospital	Free State
Dr Moeti Surgery	Free State
Elizabeth Ross Hospital	Free State
Fezi Ngumbentombi Hospital	Free State
Karabo Clinic	Free State
Katleho Hospital	Free State
Kgotsong (Welkom) Clinic	Free State
Mediclinic Welkom Hospital	Free State
Molemo Healthcare Clinic	Free State
National District Hospital	Free State
Phekolong Hospital	Free State
Tokollo Hospital	Free State
Bertha Gxowa Hospital	Gauteng
Carletonville Hospital	Gauteng
Chiawelo CHC	Gauteng
Chris Hani Baragwanath Hospital	Gauteng
Dr George Mukhari Hospital	Gauteng
Dr Yusuf Dadoo Hospital	Gauteng
Heidelberg Hospital	Gauteng
Jabulane Dumane CHC	Gauteng
Johan Heyns CHC	Gauteng
Jubilee Hospital	Gauteng
Kalafong Hospital	Gauteng
Kgabo CHC	Gauteng
Kopanong Hospital	Gauteng
Laudium CHC	Gauteng
Lenasia South CHC	Gauteng
Leratong Hospital	Gauteng
Phedisong 4 CHC	Gauteng
Protop Women's Clinic (Vereeniging)	Gauteng
Sebokeng Hospital	Gauteng
Soshanguve CHC	Gauteng
Steve Biko Academic Hospital	Gauteng
Thelle Mogoerane Regional Hospital	Gauteng
Vaal Woman's Choice Clinic (Evaton)	Gauteng
Vaal Woman's Choice Clinic (Vereeniging)	Gauteng
Zola CHC	Gauteng
Addington Hospital	KwaZulu-Natal
Appelsbosch Hospital	KwaZulu-Natal
Benedictine Hospital	KwaZulu-Natal
Bethesda Hospital	KwaZulu-Natal
Catherine Booth Hospital	KwaZulu-Natal
Charles Johnson Memorial Hospital	KwaZulu-Natal
Christ the King Hospital	KwaZulu-Natal
Dannhauser CHC	KwaZulu-Natal
Dundee Hospital	KwaZulu-Natal
Edendale Hospital	KwaZulu-Natal
eDumbe CHC	KwaZulu-Natal
Emmaus Hospital	KwaZulu-Natal
Eshowe Hospital	KwaZulu-Natal
Estcourt Hospital	KwaZulu-Natal
General Justice Gizenga Mpanza Hospital	KwaZulu-Natal
GJ Crooke's Hospital	KwaZulu-Natal
Greytown Hospital	KwaZulu-Natal
Hlengisizwe CHC	KwaZulu-Natal
Inanda C CHC	KwaZulu-Natal
Itshelejuba Hospital	KwaZulu-Natal
Khululeka Clinic	KwaZulu-Natal
KwaDabeka CHC	KwaZulu-Natal
KwaMagwaza Hospital	KwaZulu-Natal
Ladysmith Hospital	KwaZulu-Natal
Mahatma Gandhi Hospital	KwaZulu-Natal
Manguzi Hospital	KwaZulu-Natal
Marie Stopes Durban Clinic	KwaZulu-Natal
Marie Stopes Isipingo Clinic	KwaZulu-Natal
Mbongolwane Hospital	KwaZulu-Natal
Montebello Hospital	KwaZulu-Natal
Murchison Hospital	KwaZulu-Natal
Ndwedwe CHC	KwaZulu-Natal
Newcastle Hospital	KwaZulu-Natal
Nkandla Hospital	KwaZulu-Natal
Nkonjeni Hospital	KwaZulu-Natal
Northdale Hospital	KwaZulu-Natal
Nseleni CHC	KwaZulu-Natal
Phoenix CHC	KwaZulu-Natal
Pomeroy CHC	KwaZulu-Natal
Port Shepstone Hospital	KwaZulu-Natal
Prince Mshiyeni Memorial Hospital	KwaZulu-Natal
Queen Nandi Regional Hospital	KwaZulu-Natal
Rietvlei Hospital	KwaZulu-Natal
RK Khan Hospital	KwaZulu-Natal
Rose Clinic (Durban)	KwaZulu-Natal
St Andrew's Hospital	KwaZulu-Natal
St Apollinaris Hospital	KwaZulu-Natal
St Chads CHC	KwaZulu-Natal
Sundumbili CHC	KwaZulu-Natal
TLMSM Health Care Clinic	KwaZulu-Natal
Tongaat CHC	KwaZulu-Natal
Turton CHC	KwaZulu-Natal
Umphumulo Hospital	KwaZulu-Natal
Untunjambili Hospital	KwaZulu-Natal
Vryheid Hospital	KwaZulu-Natal
Wentworth Hospital	KwaZulu-Natal
Botlokwa Hospital	Limpopo
Buffelshoek Clinic (Blouberg)	Limpopo
Burgersfort Clinic	Limpopo
Dendron Clinic	Limpopo
Dilokong Hospital	Limpopo
Donald Fraser Hospital	Limpopo
Dr CN Phatudi Hospital	Limpopo
Elim Hospital	Limpopo
Ellisras Hospital	Limpopo
FH Odendaal (Nylstroom) Hospital	Limpopo
George Masebe Hospital	Limpopo
HC Boshoff CHC	Limpopo
Helen Franz Hospital	Limpopo
Jamela Clinic	Limpopo
Jane Furse Hospital	Limpopo
Kgapane Hospital	Limpopo
Lebowakgomo Hospital	Limpopo
Letaba Hospital	Limpopo
Letsitele Clinic	Limpopo
Levubu Clinic	Limpopo
Louis Trichard Hospital	Limpopo
Makhado CHC	Limpopo
Malamulele Hospital	Limpopo
Mamotshwa Clinic	Limpopo
Mankweng Hospital	Limpopo
Mariveni Clinic	Limpopo
Mashishimale Clinic	Limpopo
Matlala Hospital	Limpopo
Matoks Clinic	Limpopo
Mecklenburg Hospital	Limpopo
Mokopane Hospital	Limpopo
Mookgophong CHC	Limpopo
Nancefield Clinic	Limpopo
Nchabeleng CHC	Limpopo
Northam Clinic	Limpopo
Philadelphia Hospital	Limpopo
Rapahlelo Clinic	Limpopo
Ratshaatshaa CHC	Limpopo
Rethabile CHC	Limpopo
Sekororo Hospital	Limpopo
Seloane Clinic	Limpopo
Seshego Hospital	Limpopo
Siloam Hospital	Limpopo
St Rita's Hospital	Limpopo
Thabazimbi Hospital	Limpopo
Tiyani CHC	Limpopo
Tshilidzini Hospital	Limpopo
Tshilwavhusiku CHC	Limpopo
Voortrekker Memorial (Potgietersrus) Hospital	Limpopo
Warmbaths Hospital	Limpopo
WF Knobel Hospital	Limpopo
Willows Clinic	Limpopo
Witpoort Hospital	Limpopo
Zebediela Hospital	Limpopo
Amajuba Memorial Hospital	Mpumalanga
Barberton Hospital	Mpumalanga
Bernice Samuels Hospital	Mpumalanga
Bethal Hospital	Mpumalanga
Bhuga CHC	Mpumalanga
Carolina Hospital	Mpumalanga
Embhuleni Hospital	Mpumalanga
Empumelelweni CHC	Mpumalanga
Ermelo Hospital	Mpumalanga
Evander Hospital	Mpumalanga
Ezamokuhle Clinic	Mpumalanga
Kabokweni CHC	Mpumalanga
Kanyamazane CHC	Mpumalanga
KwaMhlanga Hospital	Mpumalanga
Lebohang CHC	Mpumalanga
M'Africa CHC	Mpumalanga
Mapulaneng Hospital	Mpumalanga
Matsulu CHC	Mpumalanga
Mmametlhake Hospital	Mpumalanga
Naas CHC	Mpumalanga
Nelspruit CHC	Mpumalanga
Phola-Nzikasi CHC	Mpumalanga
Piet Retief Hospital	Mpumalanga
Sabie Hospital	Mpumalanga
Standerton Hospital	Mpumalanga
Thulamahashe CHC	Mpumalanga
Tintswalo Hospital	Mpumalanga
De Aar (Central Karoo) Hospital	Northern Cape
Dr Harry Surtie Hospital	Northern Cape
Galeshewe Day Hospital	Northern Cape
Postmasburg Hospital	Northern Cape
Robert Mangaliso Sobukwe Hospital	Northern Cape
Tshwaragano Hospital	Northern Cape
Atamelang CHC	North West
Bafokeng CHC	North West
Bapong CHC	North West
Brits Hospital	North West
Ganyesa Hospital	North West
Gelukspan Hospital	North West
General de la Rey Hospital	North West
Hartebeesfontein Clinic	North West
JB Marks CHC	North West
Job Shimankana Tabane Hospital	North West
Joe Morolong Memorial Hospital	North West
Klerksdorp-Tshepong Tertiary Hospital	North West
Klipdrift Health Post	North West
Koster Hospital	North West
Letlhabile CHC	North West
Mabeskraal CHC	North West
Mahikeng Provincial Hospital	North West
Makapanstad (Seaparankwe) Clinic	North West
Mamusa CHC	North West
Mogwase CHC	North West
Moses Kotane Hospital	North West
Nic Bodenstein Hospital	North West
Potchefstroom Hospital	North West
Ramabesa Health Post	North West
Schweizer-Reneke Town Clinic	North West
Taung Hospital	North West
Annie Brown Clinic	Western Cape
Bergsig Clinic	Western Cape
Bredasdorp Clinic	Western Cape
Caledon Clinic	Western Cape
Caledon Hospital	Western Cape
Cape Town Reproductive Health Centre	Western Cape
Ceres CDC	Western Cape
Ceres Hospital	Western Cape
Clanwilliam Hospital	Western Cape
Cloetesville CHC	Western Cape
Cogmanskloof Clinic	Western Cape
De Doorns Clinic	Western Cape
Dr Abdurahman CDC	Western Cape
Eerste Rivier Hospital	Western Cape
Elim Satellite Clinic	Western Cape
Empilisweni (Worcester) Clinic	Western Cape
False Bay Hospital	Western Cape
George Hospital	Western Cape
Grabouw CHC	Western Cape
Great Brak River Clinic	Western Cape
Groendal Clinic	Western Cape
Groote Schuur Hospital	Western Cape
Guguletu CHC	Western Cape
Hanover Park CHC	Western Cape
Happy Valley Clinic	Western Cape
Harry Comay TB Hospital	Western Cape
Heidelberg Clinic	Western Cape
Helderberg Hospital	Western Cape
Hermanus Hospital	Western Cape
Idas Valley Clinic	Western Cape
Karl Bremer Hospital	Western Cape
Khayelitsha Hospital	Western Cape
Klapmuts Clinic	Western Cape
Knysna Hospital	Western Cape
Kraaifontein CHC	Western Cape
Kuyasa CHC	Western Cape
Lady Michaelis CDC	Western Cape
Life Bay View Private Hospital	Western Cape
Life Kingsbury Hospital	Western Cape
Mbekweni CDC	Western Cape
McGregor Clinic	Western Cape
Mediclinic Cape Gate Hospital	Western Cape
Mediclinic Cape Town Hospital	Western Cape
Mediclinic Constantiaberg Hospital	Western Cape
Mediclinic Durbanville Hospital	Western Cape
Mediclinic George Hospital	Western Cape
Mediclinic Hermanus Hospital	Western Cape
Mediclinic Paarl Hospital	Western Cape
Mediclinic Worcester Hospital	Western Cape
Michael Mapongwana CDC	Western Cape
Mitchells Plain CHC	Western Cape
Mitchells Plain Hospital	Western Cape
Montagu Clinic	Western Cape
Montagu Hospital	Western Cape
Mossel Bay Hospital	Western Cape
Nduli clinic	Western Cape
New Somerset Hospital	Western Cape
Nkqubela Clinic	Western Cape
Nolungile CDC	Western Cape
Otto Du Plessis Hospital	Western Cape
Oudtshoorn Hospital	Western Cape
Paarl Hospital	Western Cape
Patriot Plein Clinic	Western Cape
Prince Alfred Hamlet Clinic	Western Cape
Radie Kotze Hospital	Western Cape
Railton Clinic	Western Cape
Robertson Hospital	Western Cape
SAMHS 2 Military Hospital	Western Cape
Site C Youth clinic	Western Cape
Stellenbosch Hospital	Western Cape
Suurbraak Clinic	Western Cape
Swellendam Hospital	Western Cape
Swellendam PHC Clinic	Western Cape
TC Newman CDC	Western Cape
Thembalethu CDC	Western Cape
Touws River Clinic	Western Cape
Town 2 CDC	Western Cape
Tulbach Clinic	Western Cape
Tygerberg Hospital	Western Cape
Vanguard CHC	Western Cape
Victoria Hospital	Western Cape
Villiersdorp Clinic	Western Cape
Vredenburg Hospital	Western Cape
Vredendal Hospital	Western Cape
Wellington CDC	Western Cape
Wesfleur Hospital	Western Cape
Wolseley Clinic	Western Cape
Worcester CDC	Western Cape
Worcester Hospital	Western Cape
Zolani Clinic	Western Cape

(Source: DHIS)

END.

Reply:

1. The Civitas building requires significant maintenance which must be facilitated by the Department of Public Works. The key areas that require maintenance are the air-conditioning, water proofing of the roof and the repair and replacement of the lifts.

When the air-conditioning does not function optimally, temperatures in offices can become unbearable. We have therefore allowed staff to leave early in such circumstances until the air-condition is repaired. It would be incorrect to refer to this as a “health hazard”. If these areas of maintenance are not addressed, then a “health hazard” may occur. At this stage the repairs to the air-conditioning system are underway and expected to be completed by mid-March 2020.

2. The Minister uses the Civitas building as his office and holds meetings in the building regularly.

(3) A maintenance company has been appointed to repair the air-conditioning and sprinkler systems and this is expected to be completed by mid-March 2020. The Department monitors and tracks the progress related to the maintenance of the building with special attention to addressing the recommendations of the Inspector of the Department of Labour.

Progress in addressing the identified defects is as follows:

- new chillers have been procured and installed, to address the Heating, Ventilation and Air-conditioning (HVAC). They will be commissioned by end of March 2020.

- work is still underway related to addressing the sprinkler system and is expected to be completed by end of March 2020.

- roof water proofing project has been completed. A new deficiency has emerged related to the storm water system when there are heavy rains as recently experienced in Gauteng.

- the lifts project has been completed and currently on a maintenance status.

The revised completion date for other maintenance work by the contractor pending approval is 23 June 2020, which might be extended due to the phased approach of NDoH providing access to limited floors to the contractor, considering that the work is done while the building is occupied.

The maintenance project completion timelines are currently behind schedule in the region of 102 days due to unforeseen delays which include non-payment of invoices for work done, by DPW. Since the commencement of the project in April 2019, DPW has not paid any of the claims from the contractors.

(4) (a) The Department is currently participating in an acquisition and procurement process with the Department of Public Works regarding the process of moving to new premises. A formal and written indication was communicated to the DPW by NDOH on 10 February 2020 regarding the preferred building for the relocation. DPW has informed NDOH that they are still attending to procurement processes, including getting the necessary Treasury approvals. DPW has estimated the commencement of the move to a new building to be from October 2020.

(b) In Pretoria.

(5) A statement was issued on 4 February 2020 related to the relocation of the National Department of Health from the Civitas building.

END.

Reply:

(1) (a) The appointment of the Chief of Staff in the Health Ministry was done in line with the Public Service Regulation 66.

(b) The Chief of Staff is not a family member of the Minister.

(2) Regulation 66 explains the process of filling of posts in the Office of an Executive. Regulation 66 (2) states that the Minister is not required to follow the normal recruitment  process as set out in Regulation 65. It should however be recorded that the person has the necessary qualifications, skills and experience to occupy this position.

(3) All employees of the National Department of Health are required to implement the NHI strategy. Furthermore all staff members in the Executive’s office are also required to provide support in ensuring that the mandate the Executive is required to fulfill in terms of his portfolio is achieved. NHI is part of this mandate and the specified person will play a role as required by her job description.

END.

Reply:

(1) (a)-(b) Officials from the National Department of Health (NDoH) met with the hospital team responsible for managing the outbreak. The major causes of the outbreak related to overcrowding (there are too many patients and insufficient beds in the neonatal ward. The following recommendations were made:

(i) Diversion of patients to other hospitals to ease the overcrowding at Tembisa Hospital;

(ii) A national plan to strengthen infection control and prevention initiatives at health facilities (including training, reporting and rapid responses) with support from the National Health Laboratory Services (NHLS) and National Institute of Communicable Diseases (NICD) has been developed and is being implemented;

(iii) The NICD is in the process of strengthening its surveillance system through both routine and sentinel site surveillance.

(c) Tembisa Hospital allocated six (6) additional nurses to the neonatal unit to increase the staffing level in the unit.

(2) (a)-(b) The following infrastructure upgrades have been initiated since the Klebsiella outbreak that will have a positive impact on healthcare:

(i) Paediatric wards 4,5 and 6 have been upgraded by repairing the broken windows and doors;

(ii) Hand-wash basins and elbow action taps were installed;

(iii) Temperature gauges have been installed to measure both humidity and heat in the wards;

(iv) A contractor has been appointed to install park home containers that will cater for equipment storage; and

(v) The Milk room has been clinically cleaned.

END.

Reply:

The National Department is supporting and overseeing the Provinces in the handling of medico-legal cases. In this regard, the common approach is the public health defence with regard to future medical treatment. This is to ensure that future medical expenses must not be paid in monetary value but in kind by providing future medical treatment in public health facilities. This approach has been dealt with in the case of Zulu. The Zulu Case was confirmed by Judge Keightley in the Gauteng Local Division of the High Court in which the Court developed the common law by allowing that MEC for Health in Gauteng to provide services (future medical treatment) at Charlotte Maxeke Academic Hospital instead of paying a lump sum of money.

Furthermore, the State Liability Amendment Bill, 2018 is being revived to expressly provide for the provision of services (future medical treatment) at public facilities. In this regard, there are Gazetted health facilities in the implementation of the Bill.

The South Africa Law Reform Commission (SALRC) is also conducting an investigation into law reform in the field of medico-legal litigation in terms of Project 141. The Issue Paper was issued in May 2017 with due date of comments to 30 September 2017 which recommended the amendment to the State Liability Act. The SALRC is currently busy with the Discussion Paper.

Mediation is also being encouraged to Provinces as one of the intervention measures and aimed at the reduction of the legal costs and lengthy and costly court processes.

Further intervention relates to forensic investigations of suspicions cases. The investigations project commenced in December 2019 with a focus on identified cases in KZN and recently in EC; as well as investigations of the top law firms participating in the medico-legal cases at provincial leave. In addition, the services of the newly established Health Anti-Corruption Forum will be utilized. Partnership with the Special Investigating Unit (SIU) is also being forged as it is already a case in the Eastern Cape Province.

Provinces: As per the table below:

((a) number of claims of negligence have been submitted against the National Department and in each province in the past two financial years,

(b) details of each claim have been summarised in the third column in the table below per province;

(c) number of the claims paid out per province;

(d) total monetary value of claims per province.

2017-18 FINANCIAL YEAR
NAME OF THE PROVINCE	NUMBER OF MEDICO- LEGAL CLAIMS SUBMITTED (including letters of demand)	SUMMARY DETAILS OF EACH CLAIM	MEDICO- LEGAL CLAIMS ACTUAL PAYMENTS	TOTAL AMOUNT OF CONTINGENT LIABILITY MEDICO- LEGAL CLAIMS (not paid)
			No of claims	Total Amount paid
Eastern Cape	524	Cerebral Palsy; Surgical	59	R427 706 138.84	R7 741 496 122.24
Free State	52	Cerebral Palsy, Wrong diagnosis / medication, Surgical complications	5	R 14 150 000.00	R 584 222 853.00
Gauteng	386	Cerebral Palsy; surgical	74	R 243 250 339.32	R 3 660 646 406.20
Kwazulu- Natal	402	Obstetrics & Gynaecology; Surgical Oncology; Urology; Ophthalmology	151	R 134 436 666.80	R 2 978 441 462.30
Limpopo	275	Cerebral Palsy; Obstetrics & Gynaecology Orthopaedic Other Surgical	9	R 17 550.000.00	R 2 880 271 000.00
Mpumalanga	80	Maternity cases Orthopaedic cases Mental Health care user case	25	R 25 947 455.00	R 1 025 412 726.00
Northern Cape	23	Cerebral Palsy; Surgical	0	0	R 315 855 194.00
North West	77	Maternity cases; Orthopaedic cases	10	R 34 633 128.60	R 601 176 148.00
Western Cape[1]	92	Obstetrics, surgical, neurosurgery	50	R86 873 630.75	R614 857 118.09
TOTALS	1911		384	R 984 547 359.31	R 20 402 379 029.83

2018-19 FINANCIAL YEAR
NAME OF THE PROVINCE	NUMBER OF MEDICO- LEGAL CLAIMS SUBMITTED (including letters of demand)	SUMMARY DETAILS OF EACH CLAIM	MEDICO- LEGAL CLAIMS ACTUAL PAYMENTS	TOTAL AMOUNT OF CONTINGENT LIABILITY MEDICO- LEGAL CLAIMS (not paid)
			No of claims	Total Amount paid
Eastern Cape	459	Cerebral Palsy; Surgical	87	R 797 120 477. 00	R 6 673 891 443.79
Free State	67	Cerebral Palsy, Wrong diagnosis / medication, Surgical complications	7	R 10 400 258.25	R 873 494 171.00
Gauteng	120	Cerebral Palsy; surgical	70	R 378 983 765.88	R 1 357 938 619,11
Kwazulu- Natal	446	Obstetrics & Gynaecology; Surgical Oncology; Urology; Ophthalmology	86	R 444 129 604.90	R 2 636 105 361. 09
Limpopo	254	Cerebral Palsy; Obstetrics & Gynaecology Orthopaedic Other Surgical	6	R 9 800 000.00	R 2 329 815 300.00
Mpumalanga	132	Maternity cases Orthopaedic cases	18	R 25 597 039.12	R 2 170 079 941.43
Northern Cape	19	Cerebral Palsy; Surgical	2	R 3 600 000.00	R 176 438 110.00
North West	92	Maternity cases; Orthopaedic cases	7	R 34 027 549.00	R 513 958 416.73
Western Cape	46	Obstetrics, ophthalmology, neurosurgery	32	R 60 971 721.70	R 2 536 987 682.49
TOTALS	1 635		315	R 1 764 630 415.85	R19 268 709 045.64

As at March 2019, the Contingent liability submitted by provinces was at R100 billion over a period of ten years. There is currently a cleaning up process of the data and the amount to ensure that the contingent liability is only for medico-legal cases and does not include all litigation matters such as RAF; Procurement matters; non-payment of invoices due to disputes or budget issues etc. As at June 2019, the reduced amount was R68b and this is an ongoing process.END ↑

Reply:

1. The Department has embarked on a project to develop a risk and vulnerability assessment framework to be used for assessing the impact of climate change on health needs and services. This project was started in May 2019 after appointment of a service provider, this follows a number of engagements since July 2018 between the National Department of Health and the Department of Environment, Forestry and Fisheries. Funding for the project was sourced from the Department of Environment, Forestry and Fisheries (DEFF) through The Federal Ministry of the Environment, Nature Conservation and Nuclear Safety (BMU). The project managers are the Department of Environment, Forestry and Fisheries and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) who contracted the University of South Africa to develop the risk and vulnerability assessment framework. The final product is expected to be delivered at the end of February 2020. The framework will assist the Department in conducting the assessment on health needs and services.

2. Backlogs:

Following a meeting of the National Forensic Pathology Services Committee (NFPSC) with the previous Minister of Health on 25 February 2016, it was decided not to destroy the approximately 12,000 backlogged cases (multiple samples per case) without Case Administration System (CAS) numbers. A decision has been made to group the backlogged cases in certain year categories and to analyse them.

Resulting from this meeting, the Criminal Justice System Reform Committee (CJSRC) was tasked to perform an audit of all outstanding toxicology cases. Following this decision, during a third full audit of all outstanding cases during 2016 and 2017, they have provided the Forensic Chemistry Laboratories (FCLs) with a list of cases with SAPS CAS numbers where prosecution, and thus analysis, is still required. The list has been signed off by the Chair of the CJSRC on 31 March 2017. This list contained 3,112 cases before verification at the FCLs. Of these 3,112 cases, the FCL’s could only verify 754 cases that were still outstanding as at 31 March 2017.

Another verification in April 2019 has reduced the number of outstanding cases on the list to 705, which is used as the baseline list to monitor performance. The FCLs only analyse cases from this list, newly received cases to prevent them from becoming backlogged (as all have CAS numbers), as well as all urgent requests from pathologists (including insurance matters). The balance of cases without CAS numbers will only be tested once CAS numbers have been linked to them.

Table 1 below indicates the performance of the FCLs against reduction of the CJSRC baseline backlog list of cases where prosecution is still required. [APP target: Eliminate the backlog of toxicology tests by 2019/20 (70% by 31 March 2020)]

TABLE 1
2019/20 Financial Year	% Decrease in Toxicology backlog	APP Target (%)
Quarter 1	42.98	63
Quarter 2	43.26	65
Quarter 3	44.11	67
Quarter 4		70

The total number of blood alcohol samples older than 90 days for the four FCL’s that have not been analysed as at 31 March 2019, was 8,210.

The cumulative total backlogged samples completed for 2019/20, Quarter 1, 2 and 3 was 7,513 (91.51%) of the list of 8,210. The FCL’s have also tested newly incoming samples in order to prevent these samples from forming a backlog. Table 2 below reflects the FCL progress regarding the 2019/20 APP target [Eliminate the backlog of blood alcohol tests by 2019/20].

TABLE 2
2019/20		APP TARGET
	% DECREASE IN BA BACKLOG	% DECREASE IN BA BACKLOG
Quarter 1	75.42	25
Quarter 2	90.17	50
Quarter 3	91.51	75
Quarter 4	-	100

The Toxicology and blood alcohol analysis output has been negatively affected by procurement system problems during quarter three of this financial year, causing delays in equipment repairs and procurement of consumables and chemicals required for the analysis processes. The FCL’s also currently have 30 vacancies out of a total establishment of 174.

Low staff morale:

Low staff morale in the Pretoria Laboratory is as a result of the poor building conditions. Progress is made in terms of obtaining alternative work accommodation.

Infrastructure:

Only the Forensic Chemistry Laboratory (FCL) in Visagie Street, Pretoria, has challenges with regards to accommodation. The FCL in Durban is new (established in 2015), and housed in the Kwa-Zulu Natal Department of Health building. The FCL in Cape Town is accommodated in a private building that has been recently renovated. They also have sufficient space for staff and equipment. The FCL in Johannesburg has been extensively renovated, with the project completed around 2011/12.

Two previous tender processes initiated by the Department of Public Works (DPW) have failed. An offer for accommodation by the Department of Water Affairs and Forestry, as well as an offer by the South African Bureau of Standards, have not been successful.

The DPW advertised a tender in June 2013. This process has however not been successful, as no suitable building could be located. In late 2013 the National Department of Health informed the DPW about the Department of Water Affairs and Forestry (DWAF) building (Material Laboratory) in Carl Street in Pretoria West that has not been utilized since 2009. Initially the DWAF was willing to allow the NDOH to utilize this building for the FCL Pretoria activities, but withdrew the offer in June 2014. The DPW then informed the National Department of Health (NDoH) that they did not have any other buildings available that would meet the FCL requirements and that the initial space requirements needed to be decreased. A second tender was advertised in December 2014, and that was also not successful.

In January 2015 the Chief Director: Trauma, Violence, Emergency Medical Services and Forensic Pathology Services (as it was previously called) came in contact with the office of Mr Govender, Deputy Director-General and Head of Real Estate and Facilities Management at the Department of Public Works (DPW). The DPW subsequently undertook to prioritize this matter. Shortly thereafter space was identified at the South African Bureau of Standards (SABS) in Groenkloof, Pretoria. This facility was well situated, had ample parking space and had sufficient vacant floor space to be able to accommodate the FCL staff and equipment. In a meeting on 31 August 2016 where the Chief Financial Officer of the SABS was present, she informed all present that they were intending to commercialize the Groenkloof Campus, and that they might not be able to accommodate the FCL. This was followed by the DPW informing the NDoH team that they have been dealing with the wrong Department at the DPW from 2014 to 2016, and that the process had to be started from scratch.

In August 2017 a new needs and cost analysis were submitted to the DPW. Advertising of the needs for a new building has not proceeded, as the NDoH Infrastructure unit proposed to move the FCL into the CIVITAS building as an alternative. With current infrastructure challenges at CIVITAS, this is however no longer an option.

It has been established that there is laboratory, as well as office space available at the CSIR (Centre for Scientific and Industrial Research) campus on Meiring Naudé Road in Pretoria. The space will be suitable for the relocation of the Forensic Chemistry Laboratory, Pretoria – with the understanding that the space will have to be prepared accordingly. This will have cost implications.

3. The Ideal Clinic Realization and Maintenance (ICRM) programme is completing its fifth year of implementation in the 2019/20 financial year. The program is implemented in all the Primary Health Care facilities in the country. In the beginning of each year, the baseline status determination is conducted by Facility Managers in all facilities and confirmed by the District Perfect Permanent Team of the ICRM (PPTICRM). 

Since 2015/2016 to 2018/2019 the Department of Health had turned 1,920 primary health care facilities ideal. The preliminary results for 2019/2020 3rd quarter is 76 facilities that have achieve status. The breakdown per province is indicate in the table below.

Health facilities inspection tools for both Ideal Clinic and Office of Health Standards Compliance were recently aligned to ensure that they request same evidence for compliance with Norms and Standards by the health facilities. Provincial workshops were also conducted on the aligned tools. The effective date of implementation for aligned tools is the 1st of April 2020.

Table 1: Ideal Clinic Achievement by Province for 2015/16 to 2018/2019 and 2019/2020 (Quarter 3)  

Financial Years 

Province	2015/2016	2016/2017	2017/2018	2018/2019	2019/2020 (Preliminary results)
Eastern Cape	14	139	157	249	15
Free State	22	78	114	168	0
Gauteng	89	215	291	330	6
KwaZulu-Natal	141	288	383	461	19
Limpopo	27	51	121	165	1
Mpumalanga	19	66	87	133	3
Northern Cape	3	67	89	92	0
North West	7	92	121	141	9
Western Cape	-	41	144	181	23
TOTAL	322	1037	1507	1920	76

END.

Reply:

1. (a) Clause 57 (1)(b) of the National Health Insurance (NHI) Bill states that NHI must be gradually phased in using a progressive and programmatic approach based on financial resource availability;

(b) Chapter 7 of the 2017 White Paper on NHI on Financing of NHI details expenditure projections and several new taxation options for sources of funding, including evaluating a surcharge on income tax, a small payroll-based taxes as financing sources for the Fund;

(c) As outlined in Section 8 of the Memorandum of Objects of the NHI Bill, NHI will be financed in various interrelated phases as determined in consultation with the National Treasury using general budget allocations. The costing/budgeting focuses on practical issues that focuses on three issues:

(i) Quality of care improvement programme: A new funding component is required to accelerate quality initiatives, to support a stronger response post OHSC audit and also to support progressive accreditation of facilities for NHI. In 2020/21 an amount of R25 million was prioritsed for this purpose. Subsequent funding will be dependent on the success of the current implementation

(ii) Establishment of NHI Fund Office: The preliminary allocations over the MTEF is 2020/21 R20 million, 2021/22: R40 million and 2022/23: R43 million. These should be seen as ideal and will probably be less given practical delays e.g. in passing NHI Bill.

(iii) Actuarial costing model: Treasury commissioned a simplified intervention based costing tool for NHI which provides simple estimates of costs of a set of 15 or so interventions.

These include for example removing user fees, extending chronic medicine distribution programme (CCMDD), extending ARV rollout, increasing antenatal visits, rolling out capitation model for General Practitioners (GPs), cataract surgery programme, establishing NHI Fund. The full set of interventions costs in the longer term around R30 billion per annum. The Department of Health will adapt the tool to find a set of priority interventions. Most of these interventions can be scaled up progressively as funding becomes available and does not need significant new funds in Budget 2020;

(iv) The Human Resources Capacitation Grant will be used to appoint staff to ensure implementation of NHI already increases to R905 million in 2019/20 and further to R1,052 billion in 2020/21 to R1,093 in 2021/22 and R1,1 billion in 2022/23. This should be focused in the first instance on statutory posts such as interns and community service, given problems in provinces funding these key posts and national interest in making sure these are fully funded;

(v) The NHI Indirect budget baseline amounts to R2,3 billion in 2020/21, R2,5 billion in 2021/22 and R2,6 billion in 2022/23.

(vi) In the next phase the NHI Fund and its Executive Authority will be able to bid for funds through the main budget as part of the budget process. Thereafter consideration will be given to shifting some of the conditional grants such as the National Tertiary Services grant and the HIV/AIDS and TB grant from the Department of Health to the Fund. Preliminary analysis suggests this will require legal amendments.

(d) In a later phase consideration will be given to shifting of funds currently in the provincial equitable share formula for personal health care services to the Fund. This will require amendments to the National Health Act, 2003. This will also depend on how functions are shifted, for example if central hospitals are brought to the national level.

2. No, this is not correct. The Portfolio Committee of Health has been informed of the initial estimated costs of implementation of NHI when the National Health Insurance (NHI) Bill, (Bill 11-2019) was introduced to Parliament on 8th August 2019. This is explained in Clause 57 of the NHI Bill as well as Section 8 of the Memorandum of Objects of the NHI Bill.

3. Stakeholders have been consulted to obtain their inputs.

(a) This was undertaken as part of the consultations on the 2011 Green Paper on NHI, the 2015 draft White Paper on NHI and the 2018 Draft Bill on NHI;

(b) The NHI Bill is currently in Parliament and going through public consultation process;

(c) As outlined in Clause 8.9 of the Memorandum of Objects, Chapter 7 of the 2017 White Paper on NHI on Financing of NHI details expenditure projections and several new taxation options for sources of funding, including evaluating a surcharge on income tax, a small payroll-based taxes as financing sources for the Fund. Due to the current fiscal condition, tax increases may come at a later stage of NHI implementation.

4. I am willing to make a Statement on the matter

END.

Reply:

1. Yes. I have been informed that Klopper Park Clinic does not have a registered pharmacist.

As a practice and a norm, not all the clinics have pharmacists and pharmacy assistants. Due to the shortage of these categories of workers, the decision was taken to prioritise Community Health Centers for allocation of pharmacists or pharmacy assistants; however, the process of having pharmacists or pharmacy assistants in clinics is ongoing until all clinics are covered.

2. Yes, I have been informed that Klopper Park clinic does not receive the assistance of a medical practitioner on a weekly basis to assist with consultations and medical needs of patients.

The contract for the Community Service Medical Doctor who was allocated to Klopper Park clinic to assist with consultations and medical needs of patients expired in December 2019, however the sessional Medical Officer was appointed in February 2020. The sessional Doctor works at the clinic every Thursday to assist with consultations and medical needs of patients.

3. (a) The clinic has not had telephonic and electronic communication for the past year due to infrastructure challenges. The new clinic was planned and it is currently on the CAPEX (capital expenditure) program. There is a weekly meeting with the ICT department to resolve the problem.

(b) The clinic has a mobile phone with the prepaid airtime available for emergency calls, whilst a permanent solution relating to infrastructure challenges is being sought.

4. (a) Ekurhuleni clinics receive ambulance services from both Ekurhuleni Metro and the Province. The Ekurhuleni ambulances collect clients / patients from home to different facilities, while provincial ambulances transfer clients / patients from the clinics to different hospitals.

(b) The turnaround time differs between urban and rural areas, and between obstetric and other emergency ambulances. For urban response, the turnaround time is 15 to 60 minutes. The obstetric ambulances’ turnaround time is less than 30 minutes.

END.

Reply:

Both the City of Tshwane Metropolitan Municipality and the City of Johannesburg Metropolitan Municipality have allocated mobile clinics/units according to the sub districts/regions; Ekurhuleni Metropolitan Municipality has fixed clinics that have mobile units/clinics attached to them.

Details on the number of clinics that have mobile units, as well as areas that are served by mobile units, are contained in Annexure A.

END.

Reply:

Public Clinics in Gauteng Province do not have mobile units, but the mobile units fall under sub districts and some of them are based at the clinics for overnight parking and refilling of medicines and medical commodities. All five districts have mobile units to assist with heath service delivery in sub-districts.

There are no clinics that have mobile units.

With regards to the areas that are served by the mobile units, the list is provided here below as (ANNEXURE A).

END.

Reply:

1. (a) The patient comes for assessment in the Endocrine Clinic by a muti-disciplinary team inclusive of Physicians and Psychologists. The patient is placed on hormonal treatment and when ready, then referred for transgender surgery.

(b) There is no dedicated budget allocated for the treatment of Transgender patients. The budget comes from voted funds under the Clinical and Surgery business unit and Pharmacy budget.

(2) No, there is no backlog. At present there are only 3 patients that are waiting for surgery.

END.

Reply:

a) The budget or grants for the 2019/2020 financial year, South Rand Hospital is as follows:

• Voted funds - R274 213 000
• Programme 8 - R 9 140 000
• HIV/AIDS Conditional Grant - R 21 719 000
• TB Conditional Grant - R 1 841 000

b) The hospital implements quality improvement programme that was initaited by the Premier of Gauteng called “deliverology”. Through this programme, the hospital is able to monitor staff absenteesim through attendance registers, monthly leave reports for both planned and unplanned leaves. This programme ensures that all staff are at service stations to ensure prompt service delivery.

Processes that exist to ensure that the highest level of service is provided at the hospital are as follows:

• Quality meetings. These meetings monitor patients complaints, patient waiting times and where problem areas are identified, corrective measures are put in place.
• Vetting committee (Bid and Adjudication committee at the hospital level) is used to ensure proper adherence to supply chain management process are followed and goods and services, equipment and the tools of trade are available in good quantities where required.
• Governance structures such as EXCO meetings, Clinical Executive meetings, hospital board meetings) are held to ensure accountability of the staff and these are aligned with the department’s APP.

c) The recruitment process is under way to fill the vacancies and the details are as follows:

• 13 Vacant posts
• 13 Advertised
• 10 Interviews held
• 7 candidates recommended

A total of 3 Posts will be readvertised due to inability to get the suitable candidates.

END.

Reply:

(a) There is a mobile clinic service called Gope Hope. The community in the Eastern Cape receives through the mobile clinic which visits monthly. There is no budget or plans for the construction of a clinic at mobile service point “Good Hope”.

(b) Not applicable.

END.

Reply:

(1) A copy of the independent report “Evaluation of the Phase 1 Implementation of the Interventions in the National Health Insurance Pilot Districts in South Africa. NDOH10/2017-2018. Final Evaluation Report. August 2019” is attached to this response as Annexure 1.

(2) (a) No specific facilities that have failed were identified in the report.

Overall, the implementation of the pilot interventions had mixed success across the pilot districts. None of the interventions can be considered “failures”, as all were implemented at scale.

Where successful, a few common factors were identified:

1. Strong political will;
2. Adequate human and financial resources for implementation;
3. Good coordination and communication; and
4. Good monitoring systems put in place at the time of implementation.

(b) The interventions also faced a number of challenges, and, to varying degrees, these factors hindered their success:

1. Inadequate planning;
2. Lack of resources;
3. Inconsistent communication;
4. A lack of coordination where necessary; and
5. Insufficient mechanisms to monitor progress to ensure course correction.

Reports regarding specific projects are contained in the Report and are summarized as follows:

1. Ward-based Primary Healthcare Community Outreach Teams (WBPHCOTS)

1. A total of 3 323 WBPHCOTs providing basic health services to children and adults were in place at the end of 2017/18.
2. These teams were able to successfully fulfil their mandate to provide outreach health services within the community.
3. WBPHCOTs completed community visits and were also able to report on the health status of the individuals at the households visited.
4. Teams often lacked the envisioned team composition, with many teams lacking outreach team leaders.
5. Data collection was insufficient to adequately monitor the effectiveness of the referral systems and follow up processes.
6. At times there were insufficient funds for transport and equipment; this impacted the team’s ability to successfully undertake their work.

2. Integrated School Health Program (ISHP)

1. A total of 4 339 875 learners had been screened through ISHP since 2012; of these 504 803 were identified to have various health barriers and referred for treatment.
2. The ISHP intervention was particularly successful in its ability to demonstrate good inter-departmental collaboration between the NDoH and Department of Basic Education (DBE).
3. There was a lack of data to support the effectiveness of the referrals and a lack of feedback mechanisms between school teams and facilities.
4. The lack of sufficient equipment, such as measurement scales and transport to travel to schools, often impacted negatively on the success of this intervention.
5. There was a lack of prioritisation and targeting of learners within this intervention.
6. Human Papillomavirus (HPV) vaccination campaign as part of the ISHP was launched in 2014. Of 2,289,699 girls in Grade 4, 1,934,635 received HPV vaccines.

3. General Practitioners (GPs) Contracting

1. A total of 330 General Practitioners (GP) had been contracted by end of 2017/2018.
2. Where contracting of GPs was implemented successfully, the access to doctors improved at PHC facilities. Patients also perceived that the quality of care improved at facilities due to the presence of GPs.
3. Inadequate monitoring of contracted GPs caused some challenges during implementation.
4. Unforeseen challenges including negotiations that were outside of the DPSA rates as well as inadequate monitoring of contracts resulted in GPs claiming substantially higher expenses than budgeted for.

4. Ideal Clinic Realisation Model (ICRM)

1. A total of 3434 facilities had been assessed of which 1507 had attained ideal clinic status at end of 2017/2018.
2. This project is deemed to have improved the ability of facilities to procure much needed equipment.
3. Where the ICRM was believed to have been implemented as planned, there was a perceived improvement in quality of care by both facility managers and patients.
4. One of the challenges identified was that ICRM limited flexibility and the ability for managers to adapt facilities to the local context and to the needs of the facilities at the time.
5. The changing manual and frequent change of standards in the ICRM made it difficult for managers to keep up with the changes and resulted in managers experiencing frustration.

5. District Clinical Specialist Teams (DCST)

1. At the end of March 2017, 45 of 52 districts in nine provinces had functional DCSTs with at least three members per team to provide specialist oversight within the districts.
2. The introduction of these teams was perceived by some stakeholders to have promoted clinical governance within the districts.
3. The team composition, which often lacked critical specialists, limited their ability to provide the envisioned training and support structures.
4. The lack of gynaecologist and paediatricians meant that DCSTs were not able to adequately improve child and maternal health as envisioned.
5. Not all specialists were seen necessarily as good mentors and they may have been unable to provide adequate support.
6. The DCST model was assessed to be a costly model and it stretched the limited specialist resources in the public sector.

6. Centralised Chronic Medicine Dispensing and Distribution (CCMDD)

1. A total of 2 182 422 patients enrolled on the CCMDD, collecting medicines in over 855 pick-up points (PUPs) at the end of 2017/2018.
2. The strong political leadership and will behind CCMDD contributed towards its successful implementation.
3. CCMDD was scaled up beyond target and the consistent monitoring of the programme contributed to the availability of reliable data to support continued implementation.
4. Changes of service providers threatened the intervention’s continuity.
5. The lack of sufficient integration between CCMDD pick-up points and facilities resulted in inadequate tracking of patients between the two systems.

7. Health Patient Registration System (HPRS)

1. At the end of 2017/2018, 2968 PHC facilities were using HPRS and there were over 20 million (20 700 149) people registered on the system.
2. Good communication and feedback loops are seen to have facilitated implementation success.
3. The poor connectivity at some facilities and challenges with hardware have contributed to the challenges experienced during NHI phase 1 implementation.
4. The lack of human resources and lack of capacity in some districts to implement affected the success of HPRS

8. Stock Visibility System SVS

1. At the end of 2017/2018, SVS was being implemented in 3167 clinics and community health centres (92% coverage).
2. The successful training of available staff led to an in-depth understanding of the system at facility level. The introduction of SVS led to reduced stock outs and improved efficiency at facilities.
3. The lack of reliable internet connectivity and hardware in some districts , impacted its success.
4. The minimal number of available pharmacists and pharmacy assistants limited facilities ability to ensure the smooth running of the system.
5. The sustainability of this intervention poses a challenge as implementation during NHI phase1 relied heavily on the support from external funders.

9. Infrastructure

1. Since 2013/2014, work in 139 of 140 identified CHCs and clinics has been completed through the NHI rehabilitation projects.
2. In 2017/2018 alone, 107 facilities were maintained, repaired and/or refurbished in NHI districts.
3. Where completed, patients perceived an improvement in the quality of care as a result. Small infrastructure changes had a positive impact on the overall environment at facilities.
4. Projects were rarely implemented or completed due to the lack of planning capacity to release the assigned funds.
5. Funds which were released were used mainly for new infrastructure projects
6. However, insufficient attention was paid to the maintenance of facilities, which is critical to both access and the provision of quality services and preventing unnecessary new-build costs due to deterioration because of a lack of basic maintenance.

10. Human Resources for Health

1. The introduction of Workload Indicators of Staffing Need (WISN) provided a standardised, evidence-based staffing needs assessment at facility level. These assessments were implemented widely across the pilot districts.
2. The resource constrained environment meant that hiring of staff had been frozen and as a result the WISN findings were not always implementable and caused further frustration among facility managers who had done the assessment.

END.

Reply:

Treatment of different types of cancer differ by province, facility and type of cancer The estimated waiting period for patients diagnosed with cervical cancer ranges from 6-11 weeks and for prostate cancer 11-28 weeks.

Waiting times at selected hospitals such as Frere Hospital, Nelson Mandela Academic Hospital, Livingstone Hospital, Polokwane Hospital ranges between 6 to 8 weeks. In Tygerberg, Groote Schuur and Universitas Hospitals the waiting times are between 12-14 weeks.

We are currently conducting an audit on cancer services and the outcome will be made available once the audit is completed.

END.

Reply:

(a) The Report was issued in February 2019 to the Limpopo Department of Health.

(b) Yes. The Preliminary report (for comments by the Limpopo Department of Health) is attached.

(c) (i) and (ii) Information is still awaited from the province and will be submitted once received.

END.

Reply:

(1) (a) The Nationally representative psychiatric epidemiological study, the South African Stress and Health (SASH) survey, found that 25,2% of participants with a mental disorder had sought treatment within the previous 12 months of which 5,7% with a mental disorder received mental health care.

(b) The national survey on the evaluation of health system costs of mental health services and programmes in South Africa undertaken by the University of Cape Town using the 2016/17 Financial Year provincial health budget expenditure found the following in respect of expenditure on Mental Health in 2016/17.

Province	2016/17 financial year total inpatient and outpatient mental health expenditure
	Millions
Eastern Cape	R806
Free State	R253
Gauteng	R2,334
KwaZulu-Natal	R1,831
Limpopo	R422
Mpumalanga	R178
Northern Cape	R177
North West	R296
Western Cape	R1,504

The above budgets does not include funds that are transferred to private health care providers who are contracted by some provincial departments of health to provide mental health services in provinces where such contracts exist.

(c)-(d) The budget for provision of mental health care, treatment and rehabilitation is not separated in terms of severity of mental health symptoms or type of mental health intervention. Available budget data separation is in terms of percentage spent on inpatient mental health care and percentage spent on outpatient mental health care as reflected in the table below.

Province	Total mental health budget	% of total mental health budget spent on inpatient mental health care	% of total mental health budget spent on outpatient mental health care
	Millions	%	%
Eastern Cape	R806	86%	14%
Free State	R253	88%	12%
Gauteng	R2,334	89.1%	10.9%
KwaZulu-Natal	R1,831	82.3%	17.7%
Limpopo	R422	70.2%	29.8%
Mpumalanga	R178	76.2%	23.8%
Northern Cape	R177	82%	18%
North West	R296	86.2%	13.8%
Western Cape	R1,504	90.5%	9.5%

The above budgets do not include funds that are transferred to private health care providers who are contracted by some provincial departments of health to provide mental health services in provinces where such contracts exist.

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

	Total number of public hospitals
	Province	Compliant with Mental Health Care Legislation	Providing 72 hour assess-ments	Have qualified child psychiatrists
		(a)	(b)	(c)
	Eastern Cape	7	39	0
	Free State	1	29	1
	Gauteng	13	17	5
	KwaZulu-Natal	27	56	1
	Limpopo	5	35	0
	Mpumalanga has 28 public health facilities providing mental health services BUT they do not meet the basic requirements prescribed	0	28	0
	Northern Cape	13	1	1
	North West	2	6	0
	Western Cape	11	31	3
	TOTAL	67	254	11

END.

Reply:

The establishment of the State-owned company Ketlaphela was led by the Department of Science and Technology. The initial plans were to establish a State-owned active pharmaceutical ingredients company producing the API’s for the widely used ARVs. After the expression of interest advert for companies to partner on API production, there was no economically viable proposal.

The project has since been taken over by NECSA with a change in focus towards medicines formulation and packaging as an initial step toward final API production. The business case in this regard suggests that this approach would be economically viable. The Department of Energy would be able to provide full details regarding progress with Ketlaphela given that it is now with that Department.

END.

Reply:

Information is still being sourced from provinces to enable us to respond to this question. The final response will be submitted to Parliament as soon as the relevant information has been received from provinces.

END.

Reply:

All primary health facilities are providing sexual and reproductive health services however the table below is for Termination of Pregnancy facilities:

Public Health Facilities Providing TOP services per Province

Eastern Cape
	Designated Facilities Providing TOP services
Cacadu District
	Andres Vosloo hospital
Nelson Mandela Bay
	1. Dora Ndiza hospital 2. Uitenhage provincial hospital
Amathole District
	1. Madwaleni hospital 2. S.S Gida hospital 3. Frere hospital 4. Cecilia-Makwane hospital 5. Empilweni-Gompo CHC 6. Elliotdale CHC 7. Ngqamakwe CHC
UKhahlamba
	1. Empilisweni hospital 2. Toylor-Bequest hospital
OR Tambo
	1. Umthata-General hospital 2. St Pats hospital 3. St Barnaba’s hospital 4. St Liz hospital 5. Nessie Night hospital 6. Qumbu CHC
Chris Hani
	1. Cofimvaba CHC 2. Cala Hospital 3. Elliot hospital 4. Cradock hospital 6. Glen Grey hospital
Gauteng
	Designated Facilities Providing TOP services
Ekurhuleni
	1. Natalspruit hospital 2. Tembisa hospital 3. Pholosong hospital 4. Far Eastrand hospital 5. Germiston hospital 6. Nokuthela-Ngwenya CHC 7. Jabulane-Dumane CHC 8. Pholopark CHC
Sedibeng
	1. Sebokeng hospital 2. Kopanong hospital 3. Heidelberg hospital 4. Johan Heyns CHC
Tshwane
	5.Kalafong hospital 2. George-Mokhari hospital 3.Odi hospital 4. Tshwane-district hospital 5. Phedisong 4 CHC 6. Laudium CHC 7. Soshanguve CHC 8. Kgabo CHC

City of Johannesburg
	1. Chris-Hani Baragwaneth 2. Charlotte-Maxeke hospital 3. Raheema-Moosa hospital 4. Edenvale hospital 5. Hilbrow CHC 6. Chawelo CHC 7. ZolaCHC 8. Lenasia South CHC
West Rand
	1. Leratong hospital 2. Dr-Yusuf-Dadoo hospital 3. Carltonville hospital
Free Sate
	Designated Facilities Providing TOP services
Lejweleputswa
	1. Bongani hospital
Thabo Mofutsanyane
	1. Elizabeth Ross
Motheo
	1. National hospital
Fezile Dabi
	1. Matsimaholo

Limpopo
	Designated Facilities Providing TOP services
Capricorn
	1. Batlokwa 2. Lebowakgomo 3. Mankweng 4. Polokwane 5. Seshigo 6. WF Nnobel 7. Ratshatsha CHC 8. Rethabile 9. Mamottshwa clinic
Mopani
	1. C N Phathudi 2. Kgapane 3. Letaba 4. Maphutha L Malatji 5. Nkhensani 6. Sekororo 7. Van Velden Duiwelskloof Clinic Duiwelskloof CHC Shilivane CHC Bolobedu Clinic Raphahleol Clinic
Sekhukhune
	Jane Furse Matlala Mecklenburg Philadephia
Vhembe
	Dolnald Fraser Elim Louis Tritchardt Malamulele Siloam Tshilidzini Makhado CHC Thohoyandou CHC
Waterberg
	Ellisras Hospital FH Odendaal (Nylstroom) Hospital Mookgopong CHC Voortrekker Memorial Hospital Warmbaths Hospital

Mpumalanga
	Designated Facilities Providing TOP services
Nkangala
	Mammethlake hospital Kwamhlanga hospital
Gert Sibande
	Bethal hospital

Northern Cape
	Designated Facilities Providing TOP services
Frances Baard
	Galeshwe CHC
John Taolo Gaetsewe
	Tshwaragano level 1 hospital
Siyanda
	Gordonia level 1 hospital Askam CHC

Kwa-Zulu Natal
	Designated Facilities Providing TOP services
UThungulu
	Ngwelezane hospital Mbongolwane hospital Catherine Booth hospital
Zululand
	Nkonjeni hospital
UMkhanyakude
	Bethesda hospital
UGu
	GJ Crookes hospital
EThekwini
	Prince Mushiyeni hospital Wentworth hospital Addington hospital
ILembe
	Maphumulo hospital
UMgungundlovu
	Edendale hospital Northdale hospital Applesboch hospital
UThukela
	Escourt hospital Emawusi hospital
Amajuba
	Newcasle hospital
Sisonke
	Christ the King hospital St Appllinaris hospital EG Usher hospital
North West
	Designated Facilities Providing TOP services
Dr K Kaunda
	Klerksdorp hospital Potchefstroom hospital Grace Mkhomo CHC Nic Bodenstein hospital
Dr RS Mopati
	Taung hospital Vryburg hospital Sweitzereneke hospital loemhof hospital
Dr M Molema
	Mafikeng hospital Gelukspan hospital Thusong hospital Ottosdal CHC Delareyville CHC Sannieshoff CHC Ratlou CHC Montshioa Stdt CHC
Bojanala
	Phokeng CHC Mogwase CHC Makapanstad CHC George Stegman hospital Lethlabile CHC JS Tabane hospital

Western Cape
	Designated Facilities Providing TOP services
Cape Town Metro
	Groote Schuur hospital Somerset hospital Wesfleur hospital False Bay hospital Victoria hospital 2 Military hospital GF Jooste hospital Michell’s Plain CHC Carnation-ward Lentegeur hospital Karl Bremer hospital Tygerburg hospital Eerste River hospital Helderburg hospital Michael hospital Mapongwana CHC Nolungile clinic Kuayasa clinic
West Coast District
	Clan William Hospital Swartland Hospital Vredenburg Hospital Vredendal Hospital
Cape Wine lands District
	Paarl Hospital TC Newman CDC Stellenbosch Hospital Ceres Hospital Worcester Hospital Montagu Hospital
Overberg District
	Caledon Hospital Hermanus Hospital Otto-du-Plessis Hospital

pap smears services

All primary health care facilities are providing Pap Smear services

Mammogram services

Province	Facilities
Limpopo	Pietersburg Hospital Mankweng Hospital
Mpumalanga	Witbank Hospital Rob Ferreira Hospital
Free State	Universitas Hospital; Pelenomi Hospital
North West	Klerksdorp Tshepong Complex Job Shimankane Tabane Hospital Mahikeng Provincial Hospital
Western Cape	Groote Schuur Hospital Tygerberg Hospital
Northern Cape	Kimberly Hospital
Eastern Cape	None
Gauteng	Chris Hani Hospital Charlotte Maxeke Hospital George Mukhari Hospital Kalafong Hospital Mamelodi Hospital Steve Biko Hospital Tembisa Hospital Helen joseph Hospital Rahima Moosa Hospital Sebokeng Hospital Thelle Mogoerane Hospital
KwaZulu Natal	Ngwelezane Hospital Addington Hospital Prince Albert Luthuli Hospital Ngwelezane Hospital Greys Hospital RK Khan Hospital Prince Mshiyeni Memorial Hospital

Annexure A: Current Facilities Providing Oncology Treatment and Availability of Equipment (NDoH Audit, 2017)

Province	Facility	Chemo-therapy	Radiation Oncology	Paediatric Oncology	Contracting	No of Linacs
Eastern Cape	Frere Hospital	X	X	X		1
	Nelson Mandela Academic Hospital	X			Yes
	Livingstone Hospital	X	X	X		2
Free State	Universitas Hospital	X	X	X		2
Gauteng	Steve Biko Hospital	X	X	X		3
	Charlotte Maxeke Johannesburg Academic Hospital	X	X	X		4
	Chris Hani Baragwabath Academic Hospital			X
	Kalafong Hospital	X
Kwa Zulu Natal	Greys Hospital	X	X	X		1
	Addington Hospital	X			Yes
	Ngwelezane Hospital	X			Yes
	Inkosi Albert Luthuli Central Hospital	X	X		Yes	3
Limpopo	Polokwane Hospital	X	X	X	Yes	1
Mpumalanga	Rob Ferreira Hospital	X			Yes
Northern Cape	Robert Mangaliso Sobukwe Hospital	X	X	X	Yes
Western Cape	Tygerberg	X	X			3
	Groote Schuur	X	X			3
	George Hospital	X	X		Yes
	Red Cross Hospital			X

END.

Reply:

1. (a) Health Facilities

The Department has security guards in all the health facilities. The purpose is to protect both the staff and the patients on continuous basis. The security guards conduct patrol in the health facilities throughout the day. The Ideal Hospital Realisation and Management Framework and the Ideal Clinic Realisation and Maintenance as well as the Office of Health Standards Compliance, have measures compelling all health facilities to introduce safety and security features. The health facilities have been declared gun free ones. These are measured at regular intervals by means of inspections and reports being submitted.

(b) Emergency Medical Services Personnel

• Through engagement with the National Joint Intelligence Structures, a PROJOC instruction was issued that SAPS is required to escort ambulances to calls in volatile areas.
• Provinces are required to establish a response protocol to areas identified as hot zones.
• A comprehensive National EMS Safety Guideline is in place to ensure that the (EMS) personnel work in an environment consistent with accepted minimum safety and security standards. This encompasses the development of provincial EMS safety plans and of mainstreaming the individual and collective sense of security and safety awareness and responsibility.

• A National EMS Safety Forum has recently been considered to advise the National and Provincial Departments of Health on safety challenges, undertaking risk assessments and proposing risk reduction measures in addition to mitigating, developing, maintaining, updating and implementing safety protocols and standard operating procedures according to the changing situation, where necessary.

2. Each province is required to develop and implement their respective Safety Plan in line with the National EMS Safety Guideline depending on the level of threat/incidents in their respective provinces. The guideline is as follows:

STRATEGIC FOCUS	OUTPUT	ACTIVITIES	SUCCESS PERFORMANCE INDICATORS
Focus on Staff	Staff Preparedness	Promote staff operational readiness Staff are encouraged to take part in Wellness Initiatives.	Reduce the risk to staff member being targeted by criminals
	Staff Vigilance / Awareness	Staff members to be sensitised in vigilance and awareness of surroundings	Staff members have access to all information regarding high risk zones
	Staff Resilience	Regular debriefing and mental health training sessions to be attended by staff members	Mentally fit staff
	Staff Safety Course	A Safety course is currently being developed	Awareness & Preparedness of EMS in hostile situations
Focus on Community	Informal	Awareness campaigns within communities highlighting challenges with regards to limitations and barriers and implementation of red zones	Staff members will be familiar to community members and a level of trust can be built between all parties.
	Formal	Active participation in Community Police forums, neighbourhood watches and farm watches – meeting scheduled with agenda item tabled	Greater awareness within the community of incidents that have occurred. Also to provide support to staff that needs to testify
Focus on Management	Before the incident	Keep staff informed of all pertinent activities within their district so as to increase their vigilance and awareness.	Ensuring a fluid process during and after an incident
	During the Incident	Immediate response of officers to scene of incident if safe, or to place of safety	Ensuring staff support
	Post Incident	Staff wellness to investigate a more proactive and efficient external staff support service for ongoing management of individuals that have been subjected to traumatic incidents especially attacks on their person	Supported staff members will feel they are able to contribute to the service and this will assist in their recovery.
	Provincial	Regular stakeholders meeting with the Community Police Forum (CPF), Business South Africa, Private Security in the identified affected areas;	Regular feedback to staff on stakeholder meetings.
	National	Regular feedback to NHC -TAC on prevention and mitigation strategy to reduce the attacks on EMS.	Support from NHC-TAC. Monitoring on the implementation of the Emergency Medical Support in Hostile Environments) training. National and Provincial feedback on Health Care In Danger Project
Focus on Technology		Panic button located in the front and rear of vehicles to be tested on a regular basis to check their status Use of social media/ digital media, Use digital media to campaign with other platforms on the management of EMS Safety Vest specifications were approved at the National Committee for EMS meeting held on the 15th October 2019	Improved responsiveness and confidence in service capacity Ensure safety and protection for EMS personnel.

 

3. One EMS personnel was fatality shot in Gauteng Province in 2017, and one security guard in Limpopo province

END.

Reply:

Information is still being sourced from Provinces. The answer will be submitted to Parliament as soon as the information is received from Provinces.

END.

Reply:

1. (a) 161 clinics based on the Ideal clinic database (on the software) and

(b) 14 hospitals based on the regulation relating to categories of hospitals 2012 in the Northern Cape province.

2. (a) (i) Total doctors employed in hospitals in Northern Cape as at end October 2019

Medical Officer employed in Hospital as at October 2019
Northern Cape	Medical Officer	54
	Medical Officer (Community Service)	17
	Medical Specialist	1
Northern Cape Total		72

(ii) Total doctors employed in clinics in Northern Cape as at end October 2019

Medical Officers employed in Clinics as at October 2019
Northern Cape	Medical Officer	1

b) (i) Total nurses employed in hospitals in Northern Cape as at end October 2019

Nurse Professionals employed in Hospital as at October 2019
Northern Cape	Assistant Manager Nursing (Head Nursing Service)	3
	Clinical Nurse Practitioner (Prim H Care)	3
	Nursing Assistant	168
	Operational Manager Nursing (General)	11
	Operational Manager Nursing (Primary H Care)	1
	Operational Manager Nursing (Speciality Unit)	4
	Professional Nurse	250
	Professional Nurse ( Speciality Nursing)	37
	Professional Nurse (Community Service)	29
	Staff Nurse	64
Northern Cape Total		570

(ii) Total nurses employed in clinics in Northern Cape as at end October 2019

Nurse Professions employed in Clinics as at October 2019
Northern Cape	Staff Nurse	37
	Assistant Manager Nursing (Primary H Care)	3
	Professional Nurse	162
	Deputy Manager Nursing (Level 1 & 2 Hospital)	1
	Professional Nurse ( Speciality Nursing)	2
	Nursing Assistant	173
	Professional Nurse (Community Service)	20
	Operational Manager Nursing (General)	17
	Assistant Manager Nursing Area	1
	Operational Manager Nursing (Primary H Care)	89
	Clinical Nurse Practitioner (Prim H Care)	111
Northern Cape total		616

3. Good Hope is a mobile point in Flagstaff in the Eastern Cape province. The community from the village has been requesting the department to build a clinic for them. The department could not build it due to budgetary constraints. The community is being serviced through a mobile clinic which visits once per month.

(a) There is nobody who has been awarded a contract to build and/or upgrade the Good Hope clinic;

(b) Due to the fact that there was no tender awarded to anyone, there is no progress on the building/upgrade of the clinic.

END.

Reply:

The Northern Cape has 88 ambulances available for operations.

END.

Reply:

We have requested information from the Province to enable me to respond to this question. The response will be submitted as soon as the Province has sent us the details.

END.

Reply:

(1) The South African National AIDS Council secretariat is currently finalising the midterm report against activities and targets set in the National Strategic Plan, 2017-2022. Highlights of the review were presented, on 23 November 2019, to the SANAC Extended Plenary meeting, co-chaired by the Deputy President and Ms Steve Letsike representing civil society. Once the midterm report is finalised copies can be made available to Members of Parliament.

In brief, South Africa has made progress against the various pillars of Strategic Plan as reflected by data on reduction in new infections as well as access to antiretroviral treatment. With respect to HIV incidence, the number of new infections has fallen from 270,000 in 2012 to 222,000 in 2018. Whilst this reduction is welcome it is clearly too slow and more needs to be done to reduce new infections.

The mother to child transmission rates at 10 weeks postpartum have declined to 0.74% which means that fewer children are being born HIV positive. Although condom distribution has increased, condom utilisation is on the decline, particularly in the 15-24 year old age group. Combination prevention and differentiated service delivery, addressing the needs of each target population in a more holistic and comprehensive way, has been prioritised.

In terms of treatment, South Africa has reached the 5 million people on treatment. The majority of the patients are in the public sector (4.8 million) with the remainder in the private sector. With respect to the UNAIDS 90-90-90 targets (90% of people with HIV know their status, 90% of these on treatment, and 90% of those on treatment virally suppressed), the country has reached 91-71-88. This means that South Africa has achieved the 1st 90, and is steadily progressing towards achieving the 2nd and 3rd 90’s. Three districts (in KwaZulu-Natal) have reached the 90-90-90 targets with another 14 nation-wide likely to reach this target by March 2020.

We need to test and treat more men and young people and retention on treatment continues to be a challenge which government and its partners are working on. Internal and external migration together with a lack of an electronic information system across the health system are contributory to a higher than acceptable percentage of patients retained in care.

The burden of tuberculosis remains large with South Africa being one of the high burden countries. We have recently completed the first ever national TB prevalence survey and the results are currently being verified by the World Health Organisation. Once verified we will have a better understanding of the TB incidence and prevalence rates. The TB prevalence survey report can also be made available to Members of Parliament once finalised. From routine data we know that notifications are on the decline but that we are still missing an estimated 160,000 patients – as for HIV, we are missing young people as well as men. Efforts are underway to intensify screening, testing and initiation of young people and men on treatment and finding the missing TB patients.

(2) The Department intends addressing the issue of non-communicable diseases that have been identified as forming part of the quadruple burden of disease through the National Strategic Plan on Non-Communicable Diseases 2020-2035 which is in the process of being approved. This Strategy aims to strengthen existing initiatives on the prevention and control on non-communicable diseases (NCDs). Such initiatives include:

PREVENTION AND PROMOTION

South Africa has taken a number of legislative/regulatory/policy steps to prevent NCDs. Specific preventive interventions include (by main risk factors):

Tobacco

a. A new Draft Control of Tobacco Products and electronic Delivery Systems Bill has been tabled;

b. The key areas that the Bill will regulate are:

- restrictions on public smoking;

- the sale and advertising of tobacco products and electronic delivery systems;

- the prohibition on financial or other support;

- the prohibition of vending machines;

- the standardisation of the packaging and appearance of tobacco products; and electronic delivery systems; and

- restriction on the sale of products.

Diet

a. A regulation on Trans-fats in Foodstuffs was passed in 2011 (R127). According to this regulation the trans-fat content of any oils and fats cannot exceed two grams per 100 grams. Products with higher trans fats levels are prohibited from entering or being sold in the country.

b. A regulation on reduction of sodium in 13 categories of foodstuffs that are the most common source of sodium for the majority of South Africans was passed in 2013 (R214) and amended in October 2017.

c. A levy on sugar sweetened beverages (Health promotion levy) was passed in 2018. The levy is foxed at 2.1 cents per gram of sugar content that exceeds 4g per 100ml. Fruit juice is exempt.

d. South Africa adopted a Strategy for the Prevention and Control of Obesity in South Africa (2015-2020).

e. National Nutrition Week and National Obesity Week took place annually from 09 to 15 and 15 to 19 October respectively. For the past three years (2016, 2017 and 2018) the Department of Health campaigns focused on the importance of eating regular, healthy meals to prevent obesity and consequently non-communicable diseases and to promote health.

Physical activity

a. The Country commemorates the Move for Health campaign on an annual basis on the 10th of May. The campaign is led by the Sport and Recreation South Africa in collaboration with the Department of Health.

b. The Department of Sports and Recreation hosts an annual Big Walk on the first Sunday of October each year. The Big Walk is the South African version of the World Walking Day. Since 2012 it has taken place in all provincial capital cities with more than thirty thousand (30,000) participants in 2017.

c. The Cabinet of South Africa also declared the first Friday of October as the National Recreation Day since 2014. The campaign is targeting all Citizens to be physically active.

The Human Papilloma Virus (HPV) vaccination programme

a. The Human Papilloma Virus (HPV) vaccination programme was launched in 2014 by the National Department of Health in partnership with the Department of Basic Education, as part of primary prevention against cervical cancer.

b. The aim was to target an estimated 550,000 girls in grade 4, aged 9 years in 17,000 public and special schools, before they were exposed to HPV infection.

c. A bivalent vaccine (Cervarix) is given at five to six month intervals using a campaign approach implemented through the Integrated School Health Programme.

d. The first round is conducted during February to March and the second round in August to September of each year.

e. Between 2014 when this programme started and February 2019 a total of one million nine hundred and thirty four thousand six hundred and thirty five (1,934,635) Grade 4 girls had received Dose 1 and one million two hundred and seven thousand four hundred and seventy seven (1,207,4077) Dose 2.

HEALTH SYSTEMS IMPROVEMENT

a. An Integrated Clinical Services Management Model that incorporates all chronic diseases, whether communicable or non-communicable, was introduced through the Ideal Clinic initiative. This means that patients are seen for whatever chronic disease they have, including for multiple conditions, at the same visit. As of 2018, 97,2% of clinics had reorganized with designated consulting areas for management of chronic conditions and had patient appointment systems for people with chronic conditions (up from 87% and 73% respectively in 2017).

b. Medicine for many patients that are stable on Non Communicable Diseases medication are provided through the Centralised Chronic Medicines Dispensing and Distribution (CCMDD) model.

c. Together with the Affordable Medicines Directorate (AMD), concerted efforts have been made to improve drug availability at hospital and primary care levels and systems are in place to monitor medicine stock outs.

(3) (a) Table 1: The provincial distribution of GeneXpert devices in South Africa

PROVINCE	GX4	GX16	GX48	GX80	Total
Eastern Cape	17	28	0	2	47
Free State	11	9	0	1	21
Gauteng	25	27	1	2	55
KwaZulu-Natal	25	51	0	1	77
Limpopo	19	25	0	0	44
Mpumalanga	3	14	0	1	18
North West	8	17	0	0	25
Northern Cape	2	6	0	0	8
Western Cape	17	13	0	1	31
Total	127	190	1	8	326

(3) (b) The National Health Laboratory Services (NHLS) laboratory were mapped in Figure 1 to show the coverage of laboratories in South Africa. This was generated using Global Positioning System (GPS) coordinates provided by the National Priority Programme (NPP).

Figure 1: The geographic coverage of NHLS laboratories across South Africa

(3) (c) (i)-(ii) The impact of GeneXpert has been:

- Early diagnosis of TB and initiation of treatment resulting in reduction in deaths from 33,300 patients (in 2011) to 16,133 (in 2017), a 51% reduction in deaths due to TB;

- The universal drug susceptibility testing for all patients has enabled early triage of patients with rifampicin resistant TB to appropriate second line treatment. This has resulted in a reduction in treatment failure from 5 062 (in 2011) to 934 (in 2017); and

- Reduction in number of patients hospitalised for DS and DR-TB, saving on hospitalisation costs.

Figure 2 summarises the progress of the GeneXpert program over time from March 2011 to September 2019. This was generated using the monthly data provided to the Research and Development team by the NPP. The figure shows a general decrease of both Mycobacterium Tuberculosis (MTB) detection (despite seasonal trends of increased MTB detection in the winter months) and Refampicin-resistant Tuberculosis (RIF) resistance. The “trace”/MTB Indeterminate rate is relatively consistent.

The yearly NPP reported figures for the GeneXpert program are shown in Tables 2 and 3. Table 2 shows the operational programmatic indicators for test outcomes. Table 3 shows the RIF outcomes for MTB detected tests.

Figure 2: The temporal progression of the GeneXpert program at national level. The figure shows the number of tests (for both Xpert MTB/RIF and Xpert MTB/RIF Ultra), the MTB detection rate, “trace”/MTB Indeterminate rate and RIF resistance rate.

END.

Reply:

a) 92

b) (i) Irregular expenditure

• Three (3) written quotations were not approved by the delegated official R63235
• Payment made to supplier is in excess of the quoted amount (difference R12, 750) R97750
• Supplier unqualified based on the awarding of the quotation was not fair, transparent, competitive and cost effective which is in contravention of Section 16A3 of the Treasury Regulation and the Preferential Procurement Policy Framework Act of 2000 which therefore results in irregular expenditure R1045800;

(ii) None

(c) (i) The Department has put in place the following mechanism to ensure that expenditure is in line with applicable legislation:

• The Minister has approved the SAHPRA Materiality and Significance Framework in terms of Sections 50 and 55 of the PFMA and Treasury Regulation 28.3, which define significant, material and parameters of transaction that the institution is authorised to approve. The purpose of the Framework is to regulate the disclosure of material facts by public entities to the Executive Authority. This includes information to be provided in terms of the Annual Report and financial statements, as well as requests for approval from the Minister to participate in certain significant transactions, and

• The Department monitors SAHPRA’s budget on a quarterly basis to ensure that the actual expenditure is aligned to the budget

(ii) The Department has put in place a mechanism to ensure that the SAHPRA report on quarterly basis on the level of compliance to the PFMA which includes the following:

• Ensuring that SAHPRA has a delegation of authority that define powers entrusted or delegated to officials within the organisation,

• Ensuring that SAHPRA takes appropriate disciplinary steps against employees of who have made or permitted irregular or fruitless and wasteful expenditure,

• Ensuring that SAHPRA has an appropriate procurement and provisioning administration system, which is fair, equitable, transparent, competitive and cost-effective, and

• Ensuring that SAHPRA has mechanisms in place to prevent irregular, fruitless, and wasteful expenditure.

END.

Reply:

(a)	Limpopo budget for vaccines (as allocated by Provincial Treasury)
	2017-18 (i)	2018-19 (ii)
	R268,920,000	R317,781,000

(b) The National Department of Health responded to a request for support from the Acting Head of Department of Limpopo Department of Health who asked for help as the province had run out of funds to procure vaccines.

(c)		Amount	Budget from which funds were taken and motivation
1.	R6,000,000	HIV/AIDS & STI'S: Male Condoms due to supplier being unable to supply male condoms and the National Department of Health did not project at that stage a condom shortage or stock outs.
2.	R9,000,000	HIV/AIDS & STI'S: Consultants. No tender for Mass Media communication was in order and expenditure were done through the three quotations process. Note: Mass Media Communication is budgeted for under Consultants on BASS.
3.	R16,000,00	Chronic Diseases: Health Promotion Levy part of Mass Media Communication that could not be spent as no tender was in place and expenditure were done through the three quotation system.

(d) Following the Presidential Health Summit Compact (2018) it was resolved that a budget planning process for pharmaceuticals be instituted and that National Treasury earmark funds for procurement of pharmaceuticals (ring-fencing of the budget). The National Department has embarked on a process to generate a budget for pharmaceutical products for FY2020-2021 for each of the provinces based on accurate demand forecasts. This was discussed at the National Health Council and will be submitted to National Treasury in line with budgeting processes.

END.

Reply:

In 2011, a base line infrastructure audit found a total of 958 health facilities with at least one type of asbestos building material (roof, ceiling, internal or external walls). Currently we have a total of 382 facilities with at least one component of asbestos out of the four components. A total of 576 facilities have been replaced to date and the plan is to eradicate the remaining ones within the next three financial years in line with available budget.

END.

Reply:

1. The Compensation Commissioner for Occupational Diseases (CCOD) is not a listed entity. The Compensation Commissioner is currently in discussions with National Treasury about the status of the Mines and Works Compensation Fund in terms of the Occupational Diseases in Mines and Works Act, No. 78 of 1973 and the Public Financial Management Act, No. 1 of 1999.

Section 61(1) of the Occupational Diseases in Mines and Works Act, No. 78 of 1973 (ODMWA) provides for the establishment of the Mines and Works Compensation Fund. Section 61(2) of the ODMWA states that the Compensation Fund shall be managed by the Compensation Commissioner for Occupational Diseases (CCOD).

2.  The Fund was listed as a Public Entity in terms of schedule 3A of the Public Finance Management Act, No. 1 of 1999. However, it was removed in terms of Gazette Notice 3366 of 2003 on 18 November 2003.

Since then, the CCOD was referred to as a trading entity or account of the National Department of Health and produces its Annual Financial Statements separately. The acronym the CCOD and the Fund has been used interchangeably.

The Fund should be classified as an Unlisted Public Entity as it is not listed in Schedule 3A of the PFMA and does not meet the definition of a Trading Account or Entity. The Compensation Commissioner is to apply to National Treasury to have the Fund re-instated as a Public Entity, once the current status as an Unlisted Public Entity has been confirmed by National Treasury. Correspondence in this respect is expected from National Treasury.

END.

Reply:

1. ​(a)-(b)      There are Twenty (20) hospitals in the Public Service that provide oncology services as reflected in the table below.

 

Facility	Chemo-therapy	Radiation Oncology	Paediatric Oncology
Frere Hospital	X	X	X
Nelson Mandela Academic Hospital	X
Livingstone Hospital	X	X	X
Universitas Hospital	X	X	X
Steve Biko Hospital	X	X	X
Charlotte Maxeke Johannesburg Academic Hospital	X	X	X
Chris Hani Baragwanath Academic Hospital			X
Dr George Mukhari Hospital	X
Greys Hospital	X	X	X
Addington Hospital	X	X
Ngwelezane Hospital	X
Inkosi Albert Luthuli Central Hospital	X	X

 

Facility	Chemo-therapy	Radiation Oncology	Paediatric Oncology
Polokwane Hospital	X	X	X
Rob Ferreira Hospital	X
Robert Mangaliso Sobukwe Hospital	X	X	X
Tygerberg Hospital	X	X
Groote Schuur Hospital	X	X
George Hospital	X	X
Red Cross Hospital			X
Klerksdorp Hospital	X	X

2. The details of the lack in oncology treatment in each province is not reflected in the National Cancer Registry. The National Cancer Registry is a pathology based registry which registers cancer incidence and not the status of treatment for cancer. 

Waiting times at selected hospitals such as Frere Hospital, Nelson Mandela Academic Hospital, Livingstone Hospital, Polokwane Hospital ranges between 6 to 8 weeks.  In Tygerberg, Groote Schuur and Universitas Hospitals the waiting times are between 12-14 weeks.

The National Department of Health are currently conducting an audit on cancer services and details will be made available on completion of audit.

Reply:

1. The table below reflects the total number of nurses who are employed at Middelburg Provincial Hospital, Mpumalanga.

2. (a) The table also indicates the vacant nursing posts and (b) Since each post was vacated at a different date, it is not possible to mention the specific date that a post will be filled, however, in accordance with the Department of Public Service and Administration directive on reducing the recruitment period and the vacancy rate in the public service dated 08 June 2015, a median period to fill a vacant funded post is six (6) months.

Table 1

Middelburg Hospital in Mpumalanga as at end September 2019	Filled / Vacant
Province	Profession: NURSE	Filled	Vacant	Grand Total
Mpumalanga	OPERATIONAL MANAGER NURSING (SPECIALITY UNIT)	2	0	2
	NURSING ASSISTANT	37	0	37
	OPERATIONAL MANAGER NURSING (GENERAL)	7	0	7
	PROFESSIONAL NURSE	117	1	118
	PROFESSIONAL NURSE (COMMUNITY SERVICE)	9	0	9
	STAFF NURSE	61	0	61
Mpumalanga Total		233	1	234

END.

Reply:

1. The Uniform Patient Fee Schedule (UPFS) is Ministerial approved annually, based on the MTBS (CPI).

2. A UPFS Technical Tariff Task team has been established and consist of both provincial and national representatives of which national facilitates the process and provide guidance;

3. The UPFS makes provision for three groups of users: Full paying, subsidized and free users:

• Full Paying

This category of users includes but is not limited to externally funded users, users being treated by their private practitioner and certain categories. They are liable for the full UPFS fee.

• Subsidised

Subsidised users are categorised based on their ability to pay for health services into four categories: H0, H1, H2 and H3. The fees payable by subsidised users are expressed as a percentage of the fees payable by full paying users as determined by the latest edition of the Uniform Patient Fee Schedule (UPFS).

• Free

There are certain circumstances under which users will receive services free of charge independently of their classification as full paying or subsidised users. These circumstances have a statutory basis and apply only to the episode of care directly related to the circumstances under which the user has qualified for free services.

4. The UPFS further makes provision for non subsidised services and the full UPFS tariff applies irrespective of the classification of the patient.

• Cosmetic Surgery (None Medical Reasons)
• Medical Reports
• Mortuary services
• Autopsies
• Port Health and Travel Medicine

MEDICAL REPORTS (Examinations)

This tariff is levied for the completion of a report for insurance or any other purpose e.g. medico-legal and / or procedure above that required for the purposes of the report are undertaken. If a clinical examination and/or procedure are undertaken in addition to the examination, the relevant categories of that particular tariff should also be charged.

The tariff fee is payable strictly in advance before any information is disclosed. This tariff grouping accommodates: the issue and/or the completion of original medical reports and the completion of certificates/forms; as well as the issue of copies of reports/records.

Current UPFS

The tariff payable by e.g. Medical Scheme, Insurance Company etc. is R620.00 for

the financial year 2019/2020

CODE	DESCRIPTION	BASIS	Professional Fee	FACILITY FEE
				LEVEL 1	LEVEL 2	LEVEL 3
			R	R	R	R

04	Medical Reports - 100%
0410	Medical Report – Facility Fee	Report		185	185	185
0411	Medical Report – General medical practitioner	Report	435
0412	Medical Report – Specialist medical practitioner	Report	435

Response from the Mpumalanga Health Department after consultation with Rob Ferreira Hospital on the process followed for Medical Reports and stamps:

The patient will request the completion of the medical report in writing or verbal. The Patient Accounts or Patient Admission will request payment upfront before the completion of the form, immediately payment is received, the form will be forwarded to the specific doctor for completion and the relevant section will stamp it after either Patient Admission or Accounts. The charging of the completion of the form is as per the UPFS tariffs regardless of the level of the hospital.

If is difficult to reply to the question as more information is needed on the patient and exactly what form is referred too to give a more defined answer

END.

Reply:

Information is still being sourced from the Province on this matter, it will be submitted as soon as the Province has supplied such information.

END.

Reply:

(a) It is not true that the clinic in Makolokwe, ward 29 is dysfunctional. It operates for limited number of days because it is not a fully-fledged clinic. It is a health post which is supported by Bethanie Clinic which is about 7km away and it provides 24 hour services. It is visited by a mobile clinic twice per week. Due to the small catchment population and its proximity to Bethanie Clinic the facility could not be made a fully-fledged clinic. The structure is a health post that was built in the 2004-2005 financial year.

(b) The costs for the structure at the time was approximately R 250 000.

(c) The departmental records do not show who the service provider was as it was built over 15 years ago and at the lowest costs at the time.

END.