Questions and Replies

Reply:

(a) In 2018, the Minister of Health, the Member of Executive Council (MEC of Health) Limpopo and the Minister of Police met to discuss safety and security challenges emanating from the incident where a doctor was shot in Limpopo at Letaba Hospital. It was resolved that an Inter-Departmental Task Team should be established comprising of the SAPS, the Private Security Industry Regulatory Authority (PSIRA), Department of Labour and Employment, Department of Home Affairs, State Security Agency and all Health Provincial Security Managers.

The Task Team in collaboration with National Joint Operational and Intelligence Structure (NATJOINS) developed a plan with the following deliverables:

• Development security infrastructure norms and standards

• Memorandum of Agreement between SAPS and Department of Health

• Deployment of Police Reservist at identified hot spot hospitals

• Development of a Health Security Dispensation

• Physical assessment of Hot Spot Hospitals

• Normalisation of Hot Spot hospitals

• Safety of Emergency Medical Services practitioners

(b) The following plans are put in place to curb robberies and incidence of violence in both specified and others across the public healthcare facilities:

• Improving and maintaining physical security infrastructure by implementing security guidelines from Infrastructure Unit Support System (IUSS) across all public health facilities.

• Intensifying private security contract management and access control.

• Deployment of Police reservists on public health hot spot facilities to conduct security compliance inspection at public health facilities with SAPS, PSIRA, State Security Agency, Department of Labour and Employment and Department of Home Affairs.

(c) Security interventions are being implemented in all provincial departments of health and the maintenance thereof is continuous. The Task team meets monthly and has also included organised labour.

 

END.

Reply:

(1) Firstly it is important to correct the question from the Honourable Member, that there is no structure called the National Health Committee in the National Department of Health. The acronym NHC stands for the National Health Council.

It is also our understanding that based on the content of the question, the Honourable Member could be referring to the National Health Research Committee (NHRC), and therefore our response will deal with this particular structure.

(a) The current NHRC members are listed below with their institutions:

1. Prof Mahmood Ally (University of Pretoria)
2. Prof Nicolaas Gey van Pittius (Stellenbosch University)
3. Ms Glaudina Loots (Department of Higher Education, Science and Innovation)
4. Prof Joyce Tsoka-Gwegweni (University of Free State)
5. Prof Heidi Abrahamse (University of Johannesburg)
6. Dr Mapitso Molefe (Council for Scientific and Industrial Research)
7. Dr Anthony Hawkridge (Western Cape HRC)
8. Prof Christo Heunis (University of Free State)
9. Prof Angela Mathee (South African Medical Research Council)
10. Prof Mushi Matjila (University of Cape Town)
11. Prof Taryn Young (Stellenbosch University)
12. Prof Moses Mbewe (University of Mpumalanga)
13. Prof Panjasaram Naidoo (University of KwaZulu-Natal)

     14. Ms Thulile Zondi (National Department of Health)

Prof Mahmood Ally currently chairs the NHRC as per the regulations relating to the National Health Research Committee.

(b) (i) The members were appointed on 24th April 2020, by the former Minister of Health, Dr Zwelini Mkhize for a term of three (3) years. The end of term for the current members is on 24th April 2023.

(ii) The Members of the Committee, appointed by the Minister in terms Section 69 (2) and Regulations Relating to the Establishment of the National Health Research Committee, 2010, are constituted as follows:

• A person with extensive experience and knowledge in health research;

• A representative of the community;

• A representative of the National Department of Health;

• A person appointed on account of his / her knowledge in law; and

• A representative of the Department of Science and Technology.

(c) The Director-General (DG) approves the publication of an advertisement for appointment of new Members to the National Health Research Committee (NHRC) according to Government Communication and Information System (GCIS) government regulations and policy. A notice relating to nominations of members of the committee is published in the government gazette and at least one national newspaper. The applicants use a nomination form and submit a recent Curriculum Vitae.

(2) The Minister appoints NHRC members after as required by National Health Council (NHA) section 69(1) of the National Health Act, 2003 .

(3) (a) Public health qualifications, as well as extensive experience and knowledge in health research is required. In addition, least one person in the NHRC is required to have knowledge of law, and also representation from NDoH and Department of Science and Technology

(b) The committee is required to meet four times per annum.

(c) The committee members remuneration levels are determined by National Treasury Regulation which are revised annually. The NHRC falls under category A, sub-category A2 of the 2019 remuneration levels which stipulates that the chairperson receives R4646 per day (R581 per hour); the vice chairperson receives R3778 per day (R472 per hour) and other members receive R3669 per day (R459 per hour).

 

END.

Reply:

1. (a) There are three dedicated grants allocated.

(i) Human Resources and Training Grant (HRTG) and National Tertiary Services Grant (NTSG) to appoint critical clinicians.

(ii) National Tertiary Services Grant and Health Facility Revitalisation Grant (HFRG) to equip theaters.

(b) Total amount allocated as per Division of Revenue Act for NTSG amount to R14.3 billion, HRTG R5.4 billion and HFRG R6.7 billion.

(c) The hospital that amount allocated:

(i) Nationally as per Division of Revenue Act as gazetted the NTSG amount to R14.3 billion, HRTG R5.4 billion and HFRG R6.7 billion

(ii) Provincially as per the National Tertiary Services Grant.

Provinces	Facility	NTSG
	R Thousand
Eastern Cape	Livingstone Hospital	R341,228
	Nelson Mandela Hospital	R371,288
	Frere Hospital	R330,102
	Fort England Hospital	R77,072
	Provincial Head Office	R29,263
	Total	R1,148,953
Free State	Universitas Hospital	R771,870
	Pelonomi Hospital	R453,326
	Total	R1,225,196
Gauteng	Charlotte Maxeke Hospital	R1,109,010
	Chris Hani Baragwanath Hospital	R957,851
	Dr George Mukhari Hospital	R960,333
	Steve Biko Academic Hospital	R1,003,943
	Kalafong Hospital	R270,668
	Helen Joseph Hospital+1	R239,180
	Thembisa Hospital	R210,713
	Nelson Mandela Childrens Hospital	R299,000
	Sterkfontein Hospital	R5,804
	Tara Hospital	R5,840
	Wits Oral Health	R4,496
	Medunsa Oral Health	R5,904
	Pretorial Dental Hospital	R5,040
	Weskopies Hospital	R6,104
	Total	R5,083,886
Kwazulu Natal	Inkosi Albert Luthuli Hospital	R909,961
	Greys Hospital	R538,866
	King Edward VIII Hospital	R469,945
	Ngwelezane Hospital	R125,952
	KZN Provincial Office	R1,130
	Total	R2,045,854
Limpopo	Pietersburg Hospital	R342,889
	Mankweng Hospital	R135,687
	Provincial Office	R2,475
	Total	R481,051
Mpumalanga	Rob Ferreira Hospital	R73,387
	Witbank Hospital	R71,998
	Total	R145,385
Northen Cape	Robert Mangaliso Sobukwe Hospital	R420,514
North West	Klerksdorp/Tshepong Complex	R219,015
	Job Shimakana Tabane Hospital	R64,741
	Mahikeng Hospital	R59,252
	Provincial Office	R11,155
	Total	R354,163
Western Cape	Groote Schuur Hospital	R1,497,693
	Tygerberg Hospital	R1,497,693
	Red Cross Childrens Hospital	R397,536
	Diagnostic Related Group	R8,135
	Total	R3,401,057
TOTAL NATIONALLY	R14,306,059

(c)(i)(ii) As per Health Facility Revitalisation Grant an amount of R6.7 billion has been allocated for the 2022/23 financial year of which R3.4 billion has been set aside for the implementation of hospitals projects across the nine provinces.

(c)(i)(ii) As per Human Resources and Training Grant total amount allocated Nationally amount to R5.4 billion and for each province total amount allocated for Eastern cape R578.8 million, Free State R264.0 million, Gauteng R1.8 billion, KwaZulu-Natal R754.8 million, Limpopo R372.7 million, Mpumalanga R274.3 million, Northern Cape R155.6 million, North West R277.2 million and Western Cape R899.4 million.

2. Total budget allocated towards equipment Autoclaves and consumables Nationally and Provincially for Assistive devices, medical and allied equipment and certain consumables, the provinces tap into the overall budget indicated as the need arises.

Province	(a) Autoclave Equipment when need arises the province tap into the overall allocated budget indicated	(b) Certain Consumables: when need arises the province tap into the overall allocated budget indicated
	R Thousand	R Thousand
Eastern Cape	R193,369	R7,546
Free State	R37,644	R3,050
Gauteng	R33,000	R5,089
KwaZulu-Natal	R59,958	R968
Limpopo	R5,200	R6,255
Mpumalanga	R10,563	R93
Northern Cape	R19,000	R168
North West	R42,183	R1,717
Western Cape	R293,086	R29,125
National (Total)	R694,004	R54,011

 

END.

Reply:

(1) (a) The National Department is not aware of any mismanagement and/or misspent of funds by any of its officials on this programme. The funds are assigned to the programme and transferred to the Department of International Relations and Corporation and Cuba when received from the Province for students in Cuba.

In South Africa they are transferred to Universities by the National Department of Health for students.

(2) (a)(b)(i)(ii) There are no audit investigations we are aware of relating to the mismanagement or misspent of money for the Nelson Mandela Fidel Castro Collaboration Programme in the Department of Health.

END.

Reply:

(1) (a) The reasons will be established through a formal investigation.

(b) The staff involved will be subjected to a formal investigation in line with the Labour Relations Act and other labour related legislation and prescripts. Recommendations of investigation reports will be implemented.

(2) The nurse who was on duty when this incident occurred has not been suspended yet, because she has been on sick-leave ever since the incident. She will be served with the required disciplinary process communication instruments on her return. Should her absence be prolonged, the Eastern Cape Department of Health will serve her with these instruments while at home.

END.

Reply:

The challenge with the question in respect of Retshidze is that it is general and as such it is difficult for the department to respond in a specific way. The table here below provides general responses in line with the areas that were covered by the Retshidze report.

 

a) The plans of the department concerning Free State Health Issues and (b) date to address the issues of access to health care are in the table below:

Item	Challenge raised by Ritshidze	Plans of the department	Date
Shortages of staff	79% of facilities again reported being understaffed and unable to meet the needs of public healthcare users this year	There currently are budget pressure and as such the department is not able to appoint a new staff	The department will prioritize critical post for 2023/24 budget and over the MTEF
ART	66% of PLHIV would like to collect ARVs closer to their home (66% last year)	The department is planning on increase pick up points for the ARVs so that the patients can collect their treatment closer home The department will also reopen more adherence clubs that were affected during COVID19 Districts have developed differentiated of care models and welcome back campaigns towards reach 95-95-95	March 2023 extended to April 2023 for budget in the new financial year.
Infrastructure and cleanliness	90% of facilities need some additional space 25% of public healthcare users reported that facilities were “dirty	The infrastructure unit has received approval to allocate additional funding to maintenance and refurbishment of facilities earmarked for ideal clinic programme The department has appointed EPWP to assist with cleaning at health facilities to argument the current shortages	March 2023
Waiting times	4:31 hours was the average waiting time after the facility	The department planned to decant more patients who are more stable on treatment to reduce backlog waiting time	The department plans to appoint staff in the MTEF period
Men specific services	9 sites had no male specific services at all	The department plan to pilot a men’s clinics to HIV and testing, , male medical circumcision and other services	April 2023
Availability of medication	13% of respondents said they had left or knew someone who left empty handed (8% last year)	There are currently no shortage of ARV and monitored weekly using SVS Facilities are implementing and monitoring redistribution to ensure sustainability of medicine .	Ongoing
Key population	0% facilities report any key population specific services at all	The department has employed 25 peer educators to promote access for access for key population Also do demand creation for key population The plan is to expand the peer educators service over the METF to insure accessibility to key population	April 2023

Some of the key general activities and plans

• Welcome back strategy was started in 2020/ 21 financial year but not fully implemented due to the COVID-19 pandemic.
• The department planned to re- train all categories of staff.
• To strengthen adherence to treatment through reviving adherence clubs.
• Implementation of the track and tracing Standard Operating Procedure (SOP).
• Monitoring of Medicine availability is done through Stock status report.

END.

Reply:

1. All appointments in the public health sector are advertised in accordance with job specifications that outlines required qualifications and the job description that assists in (a) monitoring that only qualifying applicants are recommended by the interviewing panel. Applicants are also required to submit their certified copies of qualifications prior to commencement of duty to the employer. This monitoring is further supported by a functionality on the PERSAL System that requires the employer to capture the qualifications of the incumbent against the position in question, (b) assuring that the recommended candidate has the right qualification and caries the required relevant skills and attributes that enables him/her to perform specialized jobs in the public health care sector.

2. There is 0 number of unqualified personnel employed in the (a) National and (b) Provincial public healthcare sector since 1 January 2022.

 

END.

Reply:

1. Based on the figures below (revenue that National Treasury received from the Levy), it can be estimated to be about 2.2 %.

“In the revenue year 2021/22, the Health Promotion Levy (colloquially referred to as the sugar tax) contributed a total of R 2,259,832,000.00* in the revenue collections that were reported by the South African Revenue Service. The R 2,259,832,000.00* collected reflects R2, 182,323,000.00* in domestic levy and R77, 510,000.00* in an import levy. Overall the FY2021/22 collections represent a growth of 6.92% on the FY2020/21 collections of R2, 113,606,000.00 (R2, 046,177,000.00 domestic levy and R67, 429,000.00 in import levy). “

* All figures for FY2021/22 are preliminary pending auditing processes.

The following are the actual amounts that the Department received:

• R50m in 2018/19
• R40m in 2109/20
• R49 699m in 2020/21
• R53.5 in 2021/22
• R48 366 00 in 2022/23

2. (a) The Department spent the HPL as follows

• 2018/2019 :

• • Wellness Campaign to create awareness and screen for HIV, TB, Hypertension and Diabetes in all provinces (Cheka Impilo).

• • Events in provinces to raise awareness on Cancer and to introduce the provinces to the Breast and Cervical Cancer Strategy which was approved in 2017.

• 2019/2020:

• • Funds were spent on expanding the scope and coverage of Cancer Awareness Campaigns to all provinces.

• 2020/2021:

• • Spending on Campaigns was not possible due to Covid-19 restrictions. However, funds were directed toward public education and awareness programs on Covid-19.

• 2021/2022:

• • There was a continuation in the allocation of funds for public education programs on Covid-19.

• • Funds were spent on phase one of the National Dietary Intake Survey

• • SABC Side-by-Side Campaign on Child Health.

• • Planning for the National Non-Communicable Diseases Campaign

• 2022/2023:

• • The HPL is being used to fund Phase two of the National Dietary Intake Study (NDIS).
  • National Non-Communicable Diseases Campaign. Funds will be used for the purchases of screening devices, consumables and community health worker training material for the Campaign. The key objective is for CHWs to screen for hypertension and diabetes and link patients to care.
  • Launch of the National Strategic Plan for NCDs and the commemoration of the World No Tobacco Day

(b) Hundred percent (100%) of the HPL levy is spent for health promotion, awareness, disease/injury prevention and disease related research.

3. (a) Non-communicable diseases (hypertension, diabetes, cancer, mental health), communicable diseases (HIV, TB, Covid-19, water and vector borne diseases), Violence and Injury

(b)

• In 2021 PRICELESS reported evidence-based gains from the HPL, including

• • The national urban household purchases of taxable beverages by

volume fell by 51% (Kantar) with a 29 % decrease in sugar intake.

• • In a self-reported Langa survey of young adults ( 18- 39 y), on taxable

beverages showed a 37% reduction by volume and 31% decrease in sugar intake

• • In a Soweto Study of teenagers , young adults, and older adults, the frequency of Sugar Sweetened Beverages intake amongst heavy consumers fell from 10 beverages per week pre HPL to 4 beverages per week one year post HPL
• As at August 2022, the country achieved 94% of the target population knowing their HIV status as part of the 90-90-90 targets. The achievement can be attributed to the Wellness Campaign (Cheka Impilo) that influences health seeking behaviour, including condom distribution and treatment adherence.

• In 2022, the Department approved the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022 – 2027 (NSP NCDs) which adopts an integrated person centered approach and is inclusive of population level interventions. The NSP NCDs aims to promote wellness, reduce modifiable risk behaviour, enhance management and control of non-communicable diseases in particular hypertension and diabetes and empower communities, patients and their families.

• The 2022/23 Annual Performance Quarter 1 and Quarter 2 Reports confirm increased heath seeking behaviour as the total screened for diabetes for Q1 was 2 550 479 which increased to 6 242 487 in Q2 and Total screened for hypertension for Q1 was 2 654 572 which increased to 6 366 095.

4. (a) (i) The Department commenced the Dietary Intake survey in 2019 but it could not be completed due to the Covid-19 pandemic.

     (ii) The Department completed the Global Adult Tobacco Survey (GATS) in 2021.

(b) (i) The results of the Dietary Intake Survey will become available in June 2023.

(ii) The GATS results provide statistics on tobacco use, cessation, second hand smoke, economics and the role of other players in the environment including the media. This survey is available on the internet.

(c) Results from surveys (international and national) are used to inform strategies for combating burden of disease conditions.

.

END.

Reply:

The National Department is consulting with the Provincial Departments of Health to get the full details and figures on this question. The response will be ready in a week or two and will be furnished to the Honourable Member as soon as it is ready.

END.

Reply:

The procurement of COVID-19 vaccines followed a two-step process:

1. Availability of clinical evidence from randomised controlled clinical trials which formed the basis of the Advisory from the Ministerial Advisory Committee on Covid-19 vaccines. This advisory is available on the SA Coronavirus website.

2. Procurement following prescripts of the Public Finance Management Act made available from National Treasury.

The procurement prescripts, available on the National Treasury website, are applicable to all government departments and are not unique to the NDoH.

END.

Reply:

Based on the recent feedback from Steve Biko Academic Hospital, a service provider was appointed at the beginning of October 2022 for the servicing of the chillers including air conditioners. The hospital has 5 out 6 chillers currently running at optimal levels. The two broken air conditioners has been fixed and the temperatures are now perfect in their theatres. And they are being monitored on a daily basis by the recently appointed service provider.

END.

Reply:

1. (a) There are 3369 students recruited to the programme since inception.

b) A total of 2617 has graduated from the Programme.

c) The total of 2 617 students mentioned in (b) above, after completion of their integration in South African local universities are/were allocated to various health facilities for a two-year medical internship and then proceed to fulfil a one-year Community Service Programme in rural and underserved areas.

d) The National Department of Health has requested the numbers that are currently still employed form Provincial Departments of Health, since the PERSAL System does not have a functionality that provides such granular data since inception of the Nelson Mandela Fidel Castro Programme.

2. (a) The doctors from the Nelson Mandela Fidel Castro Programme assume appointment to the department as qualified medical doctors like any other doctor trained in South Africa, this also include termination of employment. The termination of duty is therefore based on grounds that are deemed necessary for termination in terms of the scope of practice of medical doctors or it may be voluntary as is the case with any other employee.

(b) This cannot be quantified specifically for the Nelson Mandela Fidel Castro Medical doctors.

(3) (a) Costs incurred when students in Cuba

The following are average costs incurred and are fixed cost per student per year, depending on the Rand/Dollar Exchange Rate at the time of transfer, is reflected below:

• Preparatory (one year) : $2000.00 per students
• 1st – 5th Year (per student) : $5000.00
• Stipend (per student per year) : $2400.00
• Additional costs include two return flight tickets during six years and additional flight ticket in case of death of immediate family member. The tickets cannot be costed as it also depends on the Rand/Dollar Exchange at the time.

Level	Tuition Fees	Meals & Acc.	Ave. cost Med. Ins.	Stipend	TOTAL
Preparatory	$6000.00	$6022	$450	$2400.00	$14, 872.00
1st – 2nd Year	$12, 500	$6022	$500	$2400.00	$21, 422.00
3rd – 4th Year	$11, 500	$6022	$500	$2400.00	$20, 422.00
5th Year	$13, 500	$6022	$600	$2400.00	$22, 522.00

b) Costs incurred for integration in the local Universities

Tuition fees charged by South African universities during the integration since inception until 2018 varied from one university to another. After the agreement signed with local universities, the cost of integration per student has been standardised since July 2018 and adjusted according to annual Consumer Price Index. Students have all to be in the clinical training platform for 18 months which translates into three (3) semesters. Additional costs include transportation of the final year students to local universities which depends on the mode of transport and distance to the university.

The following are the average costs incurred in South Africa:

• July 2018 – June 2019 : R231 325.00 per student (R115 662.50 per semester).
• July 2019 – June 2020 : R241 734.63 per student (R120 867.31 per semester).
• July 2020 – June 2021 : R252 612.68 per student (R126 306.34 per semester).
• July 2021 – June 2022 : R260 696.28 per student (R130 348.14 per semester).
• July 2022 – June 2023 : R277 641.54 per student (R138 820.77 per semester).

Amount outstanding are not readily available for both Cuba and local Universities as we are in a process of receiving and paying invoices for the 2021 to 2022 financial year for Cuba, and 2022/ 2023 Financial year for local Universities.

END.

Reply:

(1)-(2) The National Department of Health has identified a priority list of health facilities that requires an urgent exemption either from Eskom or local municipalities. The Department has provided Eskom with a total of 212 priority hospitals across the country to be considered for possible exclusion from loadshedding on a phased approach, and 67% of them are supplied directly by municipalities, while Eskom supplies the remaining 33%. The current number of hospitals excluded from loadshedding across the country, has increased from 37 to 72 since the last public announcement by Minister of Health Dr Joe Phaahla in September, while more efforts are being made to implement exemption of health facilities in all the provinces as a matter of urgency in line with the commitment made to ensure that no province is left behind. The updated list of exempted facilities per provinces is as follows: Eastern Cape (7), Free State (14), Gauteng (17), KZN (15), Limpopo (10), Mpumalanga (4), Western Cape (4) Northern Cape (1), and North West (0).

The preliminary network analysis conducted revealed that, 28 hospitals in various provinces can be excluded from loadshedding by building new infrastructure at the estimated cost of R100 million. However, the team is investigating possible load curtailment for bigger hospitals as well as other alternative solutions.

 

END.

Reply:

1. (a) Before students leave for Cuba, they get orientation about their stay and study in Cuba and the socioeconomic status in Cuba and some of the strengths of the medical training, this includes safety measures, living conditions. Upon arrival in Cuba, the Cuban authorities also orientate them about safety issues.

(b) Students from South Africa receive 200 USD per month to supplement their needs over and above what they are provided for by the Universities in Cuba. South African students are also provided with additional essential items when a need arise, an example is during the COVID-19 pandemic. The latest consignment was sent in June 2022 to alleviate challenges their challenges in Cuba.

(c) There are three support levels for students, from time to time, delegations from Provincial Health Departments including the MECs and Deputy Minister of Health, visit Cuba, and travel to various Provinces in Cuba to meet with the students. Where there is tragedy such as death of a student, or next of kin, Psychologist and/Psychiatrist are sent to Cuba where there are emergencies. All Provinces also provide online counselling of students from time to time. The Cuban authorities also provide psychological and psychiatric treatment for students, however where there is real need for students to come back home for further treatment, students are accompanied back home to receive that treatment.

(d) The following structures were also established to provide a support mechanism for integration of students from Cuba, these are:

i. The Ministerial task Team (MTT)

The MTT is comprised of Deans of Medical Schools/Health Sciences Faculties or their representatives, representatives from National Treasury and National Department of Higher Education and Technology. In developing an effective strategy for integration of large groups, the Minister of Health appointed the MTT whose terms of reference are:

• To co-ordinate and facilitate the process of engagement with all stakeholders in order
• To ddevelop comprehensive and detailed implementation plans for each province and associated university in order to ensure the successful re-integration of the students in the expanded Nelson Mandela-Fidel Castro Medical Collaboration Programme into the final year undergraduate medical programme.
• To pprovide oversight, monitoring, evaluation and support to Provinces and Universities to ensure that deadlines as determined within these implementation plans are adhered to and met.
• To develop and implement a Primary Health approach to under-graduate medical training and to ensure the transformation of undergraduate medical training to incorporate some of the strengths of the Cuban model of training.
• To provide oversight to the process to ensure that quality standards as required by the HPCSA as well as the Ministry of Public Health of Cuba are met.
• Facilitate communication and coordination between all stakeholders to overcome challenges and hurdles.

The MTT has a subcommittee Academic Review Committee (ARC) that:

• focuses on Academic performance of students in all the Medical Schools/Health Sciences Faculties where they are allocated on their return.
• All Universities participating in the Programme have appointed Academic Coordinators who are responsible for the day-to-day management of the programme.
• These coordinators also monitor academic performance of the students including clinical practice and provide interventions at an operational level in terms of academic progress of students.

The Academic Coordinators have a direct link with the Academic Review Committee (ARC) which focuses on the Academic performance of the students in South Africa relation to:

• students who are not progressing well and recommend remedial programmes
• monitor progress of all students in the different levels in Cuba
• Request for regular reports on students from all Universities
• Advocate for issues of standardization amongst participating universities
• Advocate for curriculum review, changes with focus on PHC & District Health Care through the Curriculum Subcommittee amongst others.

ii. Joint Academic meeting (JAM)

The JAM is an Academic structure is comprised of the Deans of Medical Schools/Health Science Faculties responsible for Medical Education in South Africa and the Medical Education University Deans in Cuba. It was established in 2010. Its function among others is to:

• conduct of oversight in relation academic teaching, training, and learning including discussion around curriculum development and alignment to prepare the students when they return in South Africa.
• share of experiences between the two countries in terms of academic performances of students but also looking at areas that need improvement.
• monitor performance of students when they are in Cuba and their performance in South Africa after their return.
• share and align policies, procedures applied in Cuba and where there is a need for alignment of review in the pursuit for academic excellence including good clinical practice amongst others.
• The JAM is held annually alternating between the two countries. The first JAM was held in Cuba in 2010 followed by the second in Durban 2011 and the in 2019 at Walter Sisulu University from the 3 to 4 July University. The JAM was supposed to be held in CUBA in 2020 but could not materialize due to COVID-19, however it was held in Cuba from the 23 to the 24 October in 2022.

iii. South African Committee of Medical Deans (SACOMD)

This structure has been existing however in terms of the integration Programme the NMFC Programme is also discussed at meetings of SACOMD some of which relates to:

• Expansion of the training platform for the re-integration process and future expansion.
• Move towards Primary Health Care approach in teaching and training.
• identify the requirements to expand the training platform.
• Collaborates with Department of Health to monitor Memorandum of Agreements (MOU) signed between Universities and the Department of Health.

2. (a) The bursary contract elements are standard for all bursaries for the Department of Health. In terms of the Nelson Mandela Fidel Castro Collaboration additional elements are added in the bursary contract:

• running costs such as, return air tickets twice (during second and fourth year) during their training in Cuba for vacations in South Africa,
• transportation costs for bereavement in SA (for close family members only), this is restricted to “immediate family member” referred to the parents/ legal guardian(s), brother(s); sister(s) and spouse of the bursar,
• stipend whilst in Cuba, expended by the Department on behalf of the bursar
• the bursar will be allocated to an authorised medical university on return to South Africa to complete his or her medical degree;
• the bursar will complete his/her study at the University of the Republic of Cuba for the first six years of the course, and a designated university in South Africa for the final year of the course.

(b) The only condition where the bursary can be declared null, and void is when it is a fraudulent document.

(c) (i) If it is a fraudulent document, it should be terminated when this is known and confirmed and

(ii) the student might be liable for paying back the money or legal action will be taken against the student

 

END.

Reply:

1. Yes, the NHLS has awarded a contract to ZaMlangeni Holdings for the transportation of blood samples and other medical specimen for a period of five years (05) years, with effect from 01 September 2022.

2. (a) The appointed service provider commenced with the service of collecting and transportation of medical specimen on 01 September 2022 and

(b) Delivered to all the laboratories for analysis. There was a seamless transition between the new and old service providers, however there were some teething problems on the first day in some areas. Management put interventions to resolve the challenges and avoid disruption of service. The services are currently running smooth in all areas across the country.

3. (a) The company has special purpose vehicles for the transportation of medical specimens and

(b) their drivers are all certified to transport dangerous goods. The pictures of the cars, licence discs and compliance certificates of the drivers are hereto attached.

4. The NHLS has not concluded any agreement with the majority union, NEHAWU for the absorption or takeover of the transport companies as those companies are not part of the NHLS / NEHAWU bargaining forum.

END.

Reply:

(a) Cases of suspected transgression/misconduct are investigated in line with the Labour Relations Act and other labour related legislation and prescripts. Recommendations of investigation reports are implemented.

(b) Training and education on being sensitive to the needs of all patients is part of the undergraduate curricula of all health cadres. Inservice training on the management of sexual assault victims and gender-based violence is available to health workers.

 

END.

Reply:

1. The Health Sector as the user of health facilities required by GIAMA to produce User Asset Management Plan (U-AMP) which reflect the condition of the health facilities. This followed by development of Infrastructure Programme Implementation Plan (IPMP), which is a three-year costed plan, which indicates how these facilities will be attended, to bring them back to acceptable standard. The U-AMP table below is indicating that there are 265 hospitals and 1903 primary health care facilities that requires a certain number of upgrades and additions. However, it should be noted that all active health facilities are budgeted for maintenance and repair in every financial year through Equitable Share and Hospital Revitalization Grant.

Number of Facilities that register conditional rating of C3 (C3: urgent attention) as per 2020 U-AMP
Province	Hospital	Primary Health Care
EC	43	325
FS	29	12
GP	32	98
KZN	66	486
LP	2	385
MP	30	237
NC	14	71
NW	21	218
WC	28	71
TOTAL	265	1903

2. The current overall vacancy posts for all health care workers, which are providing both health related (16 070) and administration (4 764) functions/services in hospitals and clinics are 20834 posts, in the public health sector (i.e. in all 9 Provinces including the National Department of health) as recorded on the 30 September 2022 PERSAL System date set.

 

These recorded posts are both funded and unfunded posts in the System. Due to constrained budgets, a systematic process of approving funding and advertisements of posts by accounting officers in consultation with Provincial Treasuries is ongoing. This is to avoid exceeding Cost of Employment (COE) budgets.

 

END.

Reply:

(a) According to the Provincial Department of Health, there is no waiting time for first trimester clients, however the waiting time for second trimester clients is from one week to four weeks, and also there is no waiting time for both trimesters (first and second) for clients requesting ToP services.

(b) As part plan to ensure that women do not suffer the fate of carrying unwanted babies to term, due to the lack of access to termination services, the department has published information on the Termination of Pregnancy on various provincial websites, with the details of the facilities that offer the service. The facilities that provide the services further display the packages of services that are delivered including ToP.

END.

Reply:

The National Department of Health (NDOH) welcomes the initiative by SSP to investigate stockouts in the provinces and has considered the recommendations made in the SSP report. It should be noted that the overall medicine availability has improved significantly over the years, since 2014. In any supply chain, supply challenges do arise from time to time.

In the April to June 2022 period, the reporting period of the SSP report, contracted suppliers reported challenges impacting on the supply for some contraceptives. These challenges included Active Pharmaceutical Ingredient (API) shortages, production delays and quality control issues which affected the manufacture of both tablets and implants. Additionally, the contract for the implants was ceded from one supplier to another, which resulted in interruptions in supply until the process was complete.

The NDOH continuously engages the suppliers to identify any possible supply challenges, to adjust the demand forecast (where necessary) and to work together to mitigate the risks. Furthermore, the NDOH established a decision-making forum where all provinces are represented; to identify interventions aimed at addressing any medicine supply challenges, to improve medicine availability and to reduce the potential impact of stock outs.

Where supply constraints are identified, the NDOH works with the provinces to identify and implement interventions to minimize stock outs and impact on patients. These interventions are informed by the cause of the supply challenge:

• Where the supply constraint is due to operational matters e.g., machine breakdown, labor unrest, theft, post importation testing, etc. the NDOH would source products from alternative local suppliers with registered products using the quotation process.

• Should the supply constraint result in a longer term supply challenge, such as regulatory matters including amendments to the dossier that requires approval from South African Health Products Regulatory Authority (SAHPRA), including a change/addition of an active pharmaceutical ingredient source and/or manufacturing site, the transfer of ownership of dossiers which results in a change of marketing authorization, delays in the issuing of the permits for imported medicines, manufactured products requiring additional quality checks by SAHPRA, etc. and no alternative local suppliers with registered products are available; an application would be made to SAHPRA for the acquisition of unregistered medicines for human use in South Africa Act use in terms of Section 21 of the Medicines and Related Substances Act. For example, when the Medroxyprogesterone injection was unavailable, Section 21 was sourced to minimize impact on patients.

Since the publication of the report, the supply of all contraceptives has stabilized and the NDOH is not aware of any supply constraints for contraceptives at present. The overall medicine availability indicates that there is sufficient stock to meet the patient demand and is currently at 90.5%.

END.

Reply:

1. Yes, initial inspection was conducted on 07 October 2022 and a follow up on 24 October 2022 by health inspectors, now called Environmental Health Practitioners (EHPs) from Zululand District Municipality. The EHPs did not find any evidence of ants in food provided to patients. There is a pest controller providing pest control services in the kitchen. An inspection of food premises was done from the storage, preparation, transportation to the ward, to providing food to patients and was found to be complying with required prescripts. Patients were also interviewed to determine if there was any incident where food provided had ants and no patient witnessed that incident and no further complaint was received by the EHPs.

2. Yes, EHPs have visited the facility which was found to be in compliance with minimum standards as it is in possession of a valid Certificate of Acceptability issued for compliance with the provision of the Foodstuff Cosmetics and Disinfectants Act, 1972, as amended and its regulations. Furthermore, as a proactive prevention measure, a comprehensive report with recommendations to the facility on implementation of the clean-as- you-go principle including provision of rodent proof at the storeroom was compiled.

END.

Reply:

South Africa has procured vaccines from two manufacturers for use in the COVID-19 Vaccination Programme. Based on the current vaccination rate, South Africa currently has sufficient stock of COVID-19 vaccines to meet current requirements. There are thus no immediate plans to purchase additional vaccines. Both vaccines have demonstrated efficacy and safety based on clinical studies that have been undertaken, the results of which have been published in peer reviewed medical journals.

There is no legislation in South Africa that compels manufacturers to limit the sale of medicines and vaccines to government alone. The vaccine manufacturers may market their commodities in accordance with the Medicines and Related Substances Act, (Act 101 of 1965).

Therefore, all other vaccines registered by SAHPRA may be made available to the public should the applicant/manufacturer decide to market the vaccine. However, this is a decision that is made by the applicant/manufacturer.

 

END.

Reply:

Maternal mortality ration is internationally reported as ratio/ 100 000 live births.

a) The Department of Health collates the information on maternal mortality ratio through District Health Information System (DHIS) as a routine data collection system and also through the National Committee on Confidential Enquiries on Maternal Deaths (NCCEMD) process. DHIS collates information on the number of maternal deaths only and not the contributory factors to the cause of maternal deaths. This assists in reporting real time data on number of maternal deaths. The latest ratio is of maternal deaths is 110.7 maternal deaths per 100,000 live births according to Q2 (July to September 2022) Source DHIS Accessed 19/10/2022.

b) The report on total number of preventable maternal deaths is generated through the perinatal review meetings where the contributory factors to the maternal deaths is assessed. The information is then collated and analysed by the National Committee on Confidential Enquiries on Maternal Deaths (NCCEMD), referred here above. NCCEMD then generates the triennial report on number of preventable maternal deaths. The latest Saving mothers report was released for 2017-2019 triennium, which reported (613/982) 62.4 % rate of preventable maternal deaths.

END.

Reply:

The information is as follows, according to the Provincial Departments of Health:

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

Province	(a)	(b)	(c)	(d)(i)	(d)(ii)
EC	13 %	2x community members	R 5 187 471	0	N/A
FS	0%	N/A	R 412 000 The province has asked that in the adjustment budget, this amount be increased to R1 600 000	0	N/A
GP	0%	N/A	R12 000 000	0	N/A
KZN	25%	Legal person, Community member and a Mental Health Care Practitioners	R 11 399 000	1	Two resigned and one in the process of being filled after contract ended
LIMP	5%	Community Representative	R2 676 000	1	One member passed on
MPU	0	N/A	3 452 000	0	N/A
NC	0	N/A	R1 141 051	0	N/A
NW	0%	N/A	R1 220 000	0	N/A
WC	10%	Mental health care practitioner	R4 446 000	0	N/A

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

Province	2(a) (i)	2 (b)(i)
Eastern Cape	775	None
Free State	218	None
Gauteng	368	None
KwaZulu-Natal	611	None
Limpopo	482	None
Mpumalanga	291	None
Northern Cape	163	None
North West	315	None
Western Cape	333	None

Please note that the numbers for the clinics in the above table are confined to fixed full time primary health care facilities and excludes mobile and satellite clinics.

2. (a)(ii) The names of primary health care facilities offering mental health care services per province are attached.

(b) (ii) The names of primary health care facilities that do not offer mental health care services per province is attached.

END.

Reply:

1. Yes. The Department’s plan to improve screening is informed by the National Strategic Plan for the prevention and control of Non-Communicable Diseases 2022 – 2027 which includes implementation of the National Non-Communicable Diseases Campaign as well as to strengthen existing initiatives on screening. Some of the measures amongst others include screening for diabetes and other conditions during community events organised by the department. Screening is also conducted at facilities to identify those clients or patients who may be diabetic but are unaware of their condition and those who are diagnosed but are at risk of developing complications. Screening and management of patients are informed by evidence based clinical guidelines and tools including Adult Primary Care and Standard Treatment Guidelines which are updated on a regular basis. These clinical guidelines capacitate health care workers on provision of routine care, when and how to screen for complications and to refer patients, as required.

2. Measures to improve screening coverage, particularly within rural areas are contained in the National Strategic Plan for the prevention and control of Non-Communicable Diseases 2022 – 2027. Through the National Non-Communicable Diseases Campaign, which is part of the Strategic Plan, screening is rolled out in all districts including those in rural areas. A key objective of the Campaign is to optimise the use of Community Health Workers (CHWs) who trained on Non-Communicable Diseases and who are being capacitated to screen for diabetes and hypertension at community and household levels and link patients to care.

END.

Reply:

The cited research estimated the direct healthcare costs associated with treatment of weight-related conditions which included cancers, cardiovascular diseases, diabetes, musculoskeletal disorders, respiratory diseases, and digestive diseases. The Department has strategies in place to address obesity and weight related conditions.

The strategy for the prevention and control of obesity in South Africa 2015 – 2020, has six goals dealing with intersectoral collaboration, importance of physical activity, prevention in early childhood, accessibility to healthy food choices, education of communities, and surveillance and monitoring and evaluation. This strategy has been reviewed using interrogation of the theory of change in line with South Africa’s international policy commitments and national legislation, policy and plans, a literature review of international and national good practices, wide stakeholder engagement through online survey, physical meetings, and a national workshop. The outcome of the review informed the drafting of the updated Obesity Strategy with set goals, specific objectives, and activities to reduce obesity rates in South Africa. The focus of the draft updated Obesity Strategy is on empowering South Africans to make healthy choices by enabling equitable access to healthy food, physical activity opportunities and a capacitated health care system that supports the prevention and management of obesity. The updated Obesity Strategy will be finalised by the end of this financial year (2022/23).

 

END.

Reply:

1. The National Department of Health adopted the Health Sector Drug Master Plan 2019-2025. Among interventions contained in the Health Sector Drug Master Plan are:

• To develop and implement Medication Assisted treatment, including Opioid Substitution Therapy
• To collaborate with other key departments in informing the public especially young people on dangers of substance abuse including Opioid use
• Fully participate in substance abuse initiatives as a member of the Central Drug Authority emanating from the Prevention of and treatment for Substance abuse Act 2008,(Act No. 70. of 2008) led by the Department of Social development

2. (a) - The department is in the process of developing an implementation plan that will encompass access to Opioid Substitution Therapy at Primary Health Care level

- Education messages are distributed using multimedia platforms to ensure that they reach as many people as possible, including those in low income areas.

(b) (i) Yes

(ii) The Department is not clear what is meant by non- professional approaches. The Strategy promotes use of evidence-based interventions for the recovery from Opioid addiction.

3. (a) The National department of Health collaborates on the Ke Moja campaign (A campaign that attempts to curb substance abuse by school children. English translation is “I’m fine without drugs”) as well as the drug awareness week activities as a member of the Central Drug Authority led by the Department of Social Development as a lead Department on substance abuse.

(b) After care role of the community in substance-abuse recovery is the mandate of the Department of Social Development in line with the Prevention of and treatment for substance abuse Act, 2008, (Act no 70 of 2008).

 

END.

Reply:

a) (i) The Department commenced the Dietary Intake survey in 2019 but it could not be completed due to the Covid-19 pandemic.

(ii) The Department completed the Global Adult Tobacco Survey (GATS) in 2021.

b) (i) The results of the Dietary Intake Survey will become available in June 2023.

(ii) The GATS results provide statistics on tobacco use, cessation, second hand smoke, economics and the role of other players in the environment including the media. This survey is available on the internet.

Results from surveys (international and national) are used to inform strategies for combating burden of disease conditions.

END.

Reply:

1. The introduction of the Medical Internship and Community Service Programme, has ensured a transparent, fair, and equitable process of facilitating the distribution of human resources for health to rural and under serviced areas, thereby improving access to primary health care services.

There are two allocation Cycles each year. Which is, the Annual cycle that allocates a sizeable number of applicants who are eligible by 30th of December to commence duty on 1 January of each year and the Midyear cycle that allocates applicants who could not take up positions in January allowing them to take up posts from July of that year.

The overwhelming demand of medical internship and community service positions since 2017, has put pressure on the public health sector Compensation of Employment (COE) under the stagnant equitable share budget. The matter was further aggravated by general budget cuts in the Public Service. As a result, CoE is negatively affected and Provinces were forced to freeze some of the posts including medical internship and community service posts. This further saw Provinces implementing stringent measures to control filling of positions including key line function posts to avoid over expenditure on CoE.

The growth is outlined in the diagrams below-

Demand growth-

	2016	2017	2018	2019	2020	2021*	2022**
Medical Intern	1500	1598	1595	1899	2369	2594	2625
% Change (Cumulative)***	0%	7%	6%	27%	58%	73%	75%
Medical Comm-Serv	1322	1218	1348	1406	1505	1775	2369
% Change (Cumulative)***	0%	-8%	2%	6%	14%	34%	79%

 

Due to increased demands, the Health Departments had to derive means to accommodate the additional demands, as it is a statutory obligation for South African Citizens and Permanent Residents that are eligible to perform medical internship and community services, prior to registering as independent practitioners.

The Department then created a Human Resources Training Direct Grant (HRTG) to accommodate the shortfall that cannot be covered through the equitable share.

The National Department has established a Ministerial Task Team on safety and security. To date the Ministerial Task Team has developed Security Infrastructure Norms and Standards to ensure a safe and secured work environment in all our public health facilities. Furthermore, we have entered into a Memorandum of Understanding (MOU) with the South African Police Services to assist the department in conducting security assessment in all public health facilities.

2. Due to all these challenges as listed above, the Department has taken an informed decision to commission the comprehensive review of the medical internship and community service Policies. The review will amongst others include:

• A review of the impact of Community Service placements on patient care outcomes (as part to the broader service delivery system), especially in rural areas, with limited resources;
• A review of the capability and skills development of the Community Service placements during their placement periods;
• The required pre-Community Service preparation (including curriculum structure and exit competencies across all health professional categories);
• The required support systems and administrative systems for a successful Community Service programme;
• The supply line of all graduates and their exit competencies (within the context of the need for a balanced supply line for all health care providers required as part of a multi-disciplinary health care team); and
• The remuneration scales within the context of human resource policy reform (which includes OSD, rural allowance, etc.) of all health care providers entering the health care system, and the medium-to long-term affordability and sustainability

It is desirable that there be alignment between the Community Service policy review and the Medical Intern programme review, within the context of the broader health service delivery and human resource policy context.

The review should recommend a pragmatic set of options to ensure effective and financially sustainable Medical Internship and Community Service programmes.

END.

Reply:

1. (a) Steps to remove all advertisements for backstreet abortions –

The Department of Health has been working with SAPS to arrest the people who paste illegal adverts and providing illegal Termination of Pregnancy services. Currently, the Department of Health has engaged Municipalities to strengthen the BYLAWS, and make it point that towns are clean. Furthermore, the Department of Health is working with Department of Justice to prosecute those who paste illegal adverts and provide illegal Termination of Pregnancy services in the country. On the other hand, The National Department of Health in collaboration with Provincial Department of Health, has started to place facilities providing Termination of Pregnancy on the Departmental website.

(i) from the cyber world and/or social media

The Department makes use of BWISE as the social media platform to share Sexual and Reproductive Health information including Termination of Pregnancy and information where the people can go to and what to do if one needs to Terminate the Pregnancy. The Department of health, through the Communication unit, monitors information on the social media platform that contributes to the mis-information to the public. Once the unit picks up any mi-information, it issues the correct information or label the mis-information as fake news and re-post the information to the social media platforms.

(ii) pasted illegally on infrastructure such as lamp posts and bridges

The Department of Health has started a campaign called “Action March Against Illegal advert on Termination of Pregnancy” in the country. The action march (actual removing of adverts) against illegal adverts is led by Deputy Minister of Health, Members of Executive Council, Mayors, Department of SAPS, Department of Justice, Traditional Leaders and Healers and other important Stakeholders. The Deputy Minister of Health, MEC, Mayor (District/Local), SAPS Commissioner share the platform on the day of the march, and they make joint statement against illegal Termination of Pregnancy. Furthermore, the Deputy Minister talks to young people/women on the issues that are central to the ToP, which respond to these questions: who is supposed to provide Termination of Pregnancy, where the ToP is supposed to be provided and when is the ToP supposed to be provided according to the ACT 92 of 96

(b) Stop the illegal sale of the abortion pill to women even into their 3rd term of pregnancy

The Provincial Department of Health introduced control book, whereby all ordered abortion pills are entered into the book. The pills are counted daily, in the morning and afternoon as part of stock management.

2. The Communications Unit in the Department of Health manages all misinformation posted on google regarding services provided by the Department. The Unit however does not have capacity to monitor and respond to general illegal google, phones and posting of illegal activity of selling an abortion pill to women.

(3) (a) The pills are not schedule 5 and above drugs, they are classified as over the counter medication in other countries, thus making them easily accessible for online purchase from different countries.

(b) The facilities providing ToP services count the pills daily in the morning and afternoon, the officials sign off the control book.

END.

Reply:

(1)(a)-(d) The Department of Health does not collect or collate the data of illegal abortions of babies who are aborted at seven to nine months. Any case of dumped or abandoned babies are reported to the police department as criminal records. The department, further does not classify babies that are seen at its facilities into how they were born, such that the record does exist of babies that were either found (a) landfill (b) dumping sites (c) dams (d) sewage or drains.

(2) Department of Heath does not follow up on any of the specified cases into how the babies landed at the specified sites. South African Police Services is mandated to conduct any criminal activity of which dumping the baby is one of them.

END.

Reply:

1. The Covid-19 vaccines registered by SAHPRA:

Name of Vaccine	Applicant	Registration number	Date of registration
Covid -19 vaccine Janssen (Ad 26 viral vectors)	Janssen Pharmaceutica	550849	30/03/2021
Comirnaty (m RNA)	Pfizer Laboratories	560002	25/01/2022
Coronavac (Sinovac)	Curanto Pharma (Pty) Ltd	560232	14/06/2022
COVID-19 VACCINE MC PHARMA (Sinopharm BBIP)	MC Pharma (Pty) Ltd	560795	31/01/2022
COVID-19 VACCINE LHC (Sinopharm verocell)	LHC Pharmaceuticals (Pty) Ltd	560647	24/05/2022
Covovax (rS-protein)	Cipla (Pty) Ltd	561236	16/08/2022

2. Covid-19 vaccines which are part of the National Vaccine Programme are accessible to all citizens of South Africa, at both public and private sector facilities, at no cost to the vaccinee Given the breadth of the programme, the Department is thus fulfilling its mandate of ensuring equitable access to healthcare. The two vaccines available as part of the National vaccine programme are Pfizer Laboratory’s Comirnaty vaccine and Janssen Pharmaceutica’s Covid -19 vaccine Janssen. Both vaccines have demonstrated efficacy and safety based on clinical studies that have been undertaken, the results of which have been published in peer reviewed medical journals.

There is no legislation in South Africa that compels manufacturers to limit the sale of medicines and vaccines to government alone. The vaccine manufacturers may market their commodities in accordance with the Medicines and Related Substances Act, (Act 101 of 1965).

Therefore, all other vaccines registered by SAHPRA may be made available to the public should the applicant/manufacturer decide to market the vaccine. However, this is a decision that is made by the applicant/manufacturer.

The department has worked with a wide range of private providers, donors and non-government organisations to establish fixed and mobile vaccination sites, and to ensure that vaccines are available to the public.

END.

Reply:

The assertions made in the question have no substance since there has never been a COVID-19 vaccine procurement board and the Chair of SAHPRA has never been involved in vaccine procurement. The SAHPRA Chair is a member of the Ministerial Advisory Committee on COVID-19 Vaccines (VMAC).

(a) (b) (i) (ii) Not applicable

END.

Reply:

1. (a) The Industry Task Group is an industry group set up by industry itself. South African Health Products Regulatory Authority (SAHPRA) has no say in terms of its constitution. The SAHPRA/Industry Task Group Forum is a platform in place for SAHPRA to engage with the industry. This is Chaired by the Chief Executive Officer of SAHPRA.

(b) SAHPRA cannot comment in the constitution of the Industry Task Group.

2. No, These Forums are stakeholder engagement forums and are not private consultations

END.

Reply:

It is the Department of Health’s policy to ensure equitable access to quality healthcare through availability of safe, effective and cost-effective medicines at the appropriate level of care. The National Department of Health manages contracts of approximately 1 200 essential medicine items. Contracts are awarded to suppliers following an open tender process in accordance with the Public Finance Management Act. Barrs was appointed to supply morphine powder as the company submitted the highest scoring compliant bid.

(a) (i) morphine is currently available in different formulations from various manufacturers, i.e. morphine tablets, morphine injection and morphine powder. Aside from morphine powder, there were no supply constraints related to the other formulations. The Department has recently been notified of the availability of an oral liquid formulation of morphine which will be placed on tender in the next cycle. Provinces and facilities are able to source this formulation from the identified supplier on a quotation basis.

(ii) At the time of the supply constraint, availability of morphine powder at public sector facilities was 76%. To make up for the shortfall, the National Department of Health (NDOH) sourced the morphine powder from alternative local suppliers using the quotation process. Other formulations of morphine were also available. There was thus no crisis in the public sector. The impact of the supply constraint with morphine powder was felt more keenly in the private sector.

(b) The NDoH will continue to monitor supplier performance and implement actions in mitigation as appropriate based on the root cause leading to the supply constraint.

 

END.

Reply:

There are various Internship programmes offered in the health fields of studies. In most instances, the graduates are required to perform a compulsory one-year community service programme in accordance with the Community Service Policy, after completing their Internship Programme.

It is the responsibility of the Department of Health to provide these graduates with a platform to perform the required Community Service Programme. On completion of the said Community Service Programme, only graduates who are recipients of bursaries from the Public Services are given contract employments to work-back their bursary obligations in terms of their Bursary Contracts with the respective Provinces that offered them bursary.

All other graduates after completion of their community service, are given an ample opportunity to apply for available positions as advertised in the Public Service and/or the Private Sector and there is no automatic absorption.

END.

Reply:

The Department acknowledges that Theatre Nurses are amongst other imperative categories of Health Care Workers that are marginally available in the Health System, particularly in the Public Health Sector. This amongst others is due to the shortage in numbers and the competition of these resources between the Public Health Sector, Private Sector and Developed Countries.

Further to the above fact, the general budget cuts in the Public Service in the past three financial years (including the Cost of Employment) has negatively affected filling of posts. As a result, not all posts can be filled simultaneously. This has resulted in stringent measures implemented to control filling of positions including key line function posts to avoid over expenditure on CoE.

However, to ensure that services are at least not affected, the Department of Health has implemented the following strategies, amongst others:

• Prioritisation of the posts in the Annual Recruitment Plan – where funding permits
• Prioritisation of the posts for conditional grant funding
• Filling of replacement posts considered and approved weekly
• Employment of health professionals on contract bases to strengthen capacity
• Prioritization of these categories for contract employment and to permanent employment where funding permits at the end of their contracts

Awarding of bursaries yearly to internal and external candidates to study further in various disciplines including Theatre Nurses.

END.

Reply:

(1) (a) According to the SAHPRA the matter was responded to through a letter addressed to Medi-Q dated 06 October 2022 which was subsequently acknowledged by the Company through email on the same day

(b) The matter has been resolved.

(2) This matter was resolved in April 2020 following finalisation of an appeal in terms of section 24A of the Medicines and Related Substances Act, 1965 (Act No. 103 of 1965). In August 2022, Medi-Q requested a meeting and SAHPRA responded in October 2022 advising Medi-Q that, this matter was resolved when section 24A appeal was lodged and resolved.

END.

Reply:

a) From 17th May 2021 up to the 31th August 2022 a total number of  6731 AEFI (total minor and severe) following the use of either the Comirnaty or COVID-19 vaccine Janssen has been reported to the South African Health Products Regulatory Authority (SAHPRA)

b) 5241 (total minor and severe) AEFI related to the Comirnaty vaccine (28274053 doses administered) and 1490 (total minor and severe) AEFI related to the Janssen vaccine (8440418 doses administered)

c) Only severe and serious AEFI is investigated, a total number of 2771 investigations are either concluded or under way.

d) A multi-disciplinary team of health professionals in the district investigate all severe and serious AEFI.The purpose of investigating AEFI/AESI cases are as follows: 1. To confirm the reported diagnosis and/or propose other possible diagnoses as well as clarify the outcome of the medical incident comprising the AEFI. 2. To ascertain the particulars, circumstances and procedures around the vaccine used to immunise the affected recipient. Most importantly, identify any potential vaccine-related link to the given AEFI. 3.To review immunisation practices, logistics and other operational aspects of the programme to ensure programme related issues are not contributing to adverse events following immunisation, even if an event seems to be vaccine product-induced or coincidental.4. To determine whether a reported event was a single incident or one of a cluster and if it is a cluster, confirm that the suspected immunisations were indeed given and the individual vaccines that were used. 5. To determine whether unimmunised people are experiencing the same medical incidents. 6. To gather more information pertaining to the case to inform causality assessment. The process of AEFI investigation thus include visits to the vaccination site, interviews with relevant health care workers, interviews with family, care givers or the vaccine injured party if required. Throughout all relevant clinical records, previous medical history, all relevant lab results and diagnostic test outcomes is collected. In a few cases further clinical assessment or medical treatment may be advised.

e) The investigation is concluded when sufficient information has been collected to conduct causality assessment, or when investigation team confirm no further information is available.

END.

Reply:

The KwaZulu Department of Health indicates that the Honourable Member was informed of the difficulty to trace the complainant, as the contact number that the complainant was not reachable on the contact number that the Honourable Member had provided to the department. The hospital as well as the KwaZulu-Natal Provincial office contacted the complainant on several occasions to obtain additional information from the complainant as the information provided was not sufficient to facilitate investigation. Mr Thulani Bulose did not answer his cell phone every time he was contacted, the calls went to voicemail. The following information is required to enable King Edward hospital to investigate the complaint:

• Alternative contact details of the complainant, Mr Thulani Bulose (e-mail address or another cell number)
• ID number of patient (Mr Sipho Bulose)
• Hospital number of patient (Mr Sipho Bulose)
• Dates and ward/s at which patient (Mr Sipho Bulose) was admitted at King Edward Hospital
• Clarity on the assistance that is sought from King Edward Hospital

A request was made to the Honourable Member to provide alternative contact details of the complainant to enable the hospital to contact the complainant to obtain the additional information. The Honourable Member provided a prison number of the patient instead. The hospital could not trace the patient file using the prison number as prison numbers are not used as a unique identifier for filing of patient files. The complaint was therefore closed as guided by the National Guideline to manage complaints, compliments and suggestions (2022) that states the following: ‘When additional information is required from the patient or family/supporting person to enable further investigation of the complaint, the patient or family/supporting person should be contacted to obtain the information. In instances where the patient or family/supporting person could not be reached on the first attempt, he/ she should be contacted at least twice thereafter for two consecutive weeks. If the patient or family/supporting person could still not be traced, the complaint can be seen as resolved (closed). In such circumstance the dates and the methods used to contact the patient or family/supporting person should be documented. The same applies when a patient or family/supporting person cannot be traced to conduct redress.’

A new complaint will be opened to investigate the complaint lodged by Mr Thulani Bulose when the information requested as outline is submitted.

END.

Reply:

The Honourable Member is kindly requested to provide us with specifics of this question. The Honourable Member is also requested to utilize the available processes of Parliament in raising the issues with the department, in order to obtain the information and assistance required.

END.

Reply:

The National Department of Health is still working with the Provincial Departments of Health to source the full details required by this Question. A full report and response will be furnished to the Honourable Member and Parliament as soon as the information has been collated from all the Provinces.

END.

Reply:

The National Department of Health is still working with the Provincial Departments of Health to source the full details required by this Question. A full report and response will be furnished to the Honourable Member and Parliament as soon as the information has been collated from all the Provinces.

END.

Reply:

The National Department of Health is in consultation with the Eastern Cape Provincial Department of Health to establish the issues that the Honourable Member is raising in this Question. The full report and response will be furnished to the Honourable Member as soon as the full details are received from the Province.

END.

Reply:

The following table reflects the details as received from the Provincial Departments of Health

EASTERN CAPE
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
02	Yes	Nil	02	01 Dismissal
				01 Disciplinary on progress
FREE STATE
1(a)Total No. Corruption Case	(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
05	Yes	R24 259 970.00	1	Disciplinary case – employee was dismissed, 4 still under investigation
GAUTENG
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
21	Yes	R2 752 210.85	0	0 All the 21 still under investigations
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
04	Yes	R5 610 244.85	04	1 awaiting sanction. 1 dismissed. 2 still pending.
KWAZULU-NATAL
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
21	Yes	R2 864 840.00.	04	02 officials 3 month without pay
				01 Written warning
				01 official dismissed
				02 officials resigned before hearing. The remaining cases are is still pending.
LIMPOPO
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
0	0	0	0	0 Limpopo confirms that the cases they have are for Fraud not corruption.
MPUMALANGA
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
09	Yes	R 58 380 442.25	09	09 cases involved 9 people whose matters were finalized and 5 are pending sanctions.
NORTHWEST
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
7	Yes	R27 328 762	2	The two (2) disciplinary actions were for the Corruption cases, wherein One (1) was given two months without salary sanction, and the other One (1) was dismissed. Five (5) still in the investigation process.
WESTERN CAPE
1(a)Total No. Corruption Case	1(b)Corruption Case	1(c)Total Amount	2(a)No. of Disciplinary Case	2(b) Outcome
07	Yes	R357 954.80	17	6 Dismissal
				2 Final written warning
				1 written warning
				8 Disciplinary hearing in progress The 7 corruption cases involved 17 people, of which 9 were concluded and 8 still outstanding.

Information on the Northern Cape Province will be furnished as soon as it is received.

END.

Reply:

1. With reference to the Public Protector’s report on the National health Laboratory, dated 30 March 2022, what total number of officials have been;

Question	NHLS Response
(a)(i) implicated in allegation of conflict of interest	None of the NHLS officials
(a)(ii) implicated in allegations of misconduct	None of the NHLS officials
(a)(iii) implicated in allegations of maladministration	None of the NHLS officials
(b) what total number of officials have been charged	None of the NHLS officials
(c) what number of officials have been taken on review	None of the NHLS officials
(d) what number of officials have been suspended with pay	None of the NHLS officials

2. (a) Not applicable as no NHLS officials launched review proceedings;

(b) The NHLS board will, in exercising its oversight responsibilities over the NHLS’s affairs, effectively and sufficiently observe and apply the principles enunciated in Part 5 of the King IV Code on Corporate Governance. 

The NHLS board is implementing the following corrective measures arising from the Public Protector’s report:

• Strengthening the NHLS internal controls on the application of the NHLS Supply Chain Management (SCM) Policy and NHLS Remuneration Policy with a view to prevent a recurrence of the improprieties referred to in the Public Protector’s Report. 

• A training course or workshop in Public Procurement, with particular emphasis on fiduciary duties and general responsibilities of Accounting Authorities outlined in the PFMA, as well as a refresher course or workshop on the NHLS Board’s Terms of Reference and guiding principles in the King IV Code on Corporate Governance. 

• Strengthening the monitoring system in line with the guiding principles outlined in Part IV of the King IV Code to monitor procurement and HR processes in the appointment of service providers and individuals. 

• A training course or refresher workshop in public procurement with particular emphasis on sections 57 and 83 of the PFMA as well as section 217 of the Constitution.

• A course on protected disclosure to ensure the proper identification of the requirements for a protected disclosure case and the proper handling thereof. 

• A refresher course on labour relations processes relating to, discipline, in particular the code of good practice on suspensions and dismissals.

• A provision/strategy in the Board’s Terms of Reference to include a prerequisite for compulsory submission of pertinent recommendations for any job grading and/or salary scales. 

• Training on Treasury Regulations 16A9.1 and sections 50, 51, 54, 63, 83 and 84 of the PFMA to enhance oversight capacity over the NHLS affairs. 

• Inclusion of a clause in the Code of Conduct, for the Board to promptly inform the Minister of any changes in the position of Board members.

• Inclusion of a provision in the NHLS Code of Conduct that a member of the Board who discloses to the Board any direct or indirect personal or private business interest which that member may have in any matter before the Board, must withdraw from the proceedings of the Board when that matter is considered. 

• Review the existing policy or the policy provisions on managing conflict of interest to ensure there is no ambiguity. 

• Guidelines in line with Rule 11 of Chapter 2 of the NHLSGR, Rule A.2(c) of Part V of the NHLSGR, where appropriate, pertaining to special circumstances for deviation from implementing recommendations for the implementation of the job grading and remuneration. 

• Guidelines to deal with the ambiguity relating to the proper disposal of NHLS Board documents. 

• Ground rules and timelines within which allegations of fraud, corruption and recommendations of forensic investigation reports, ARC and Legal Services Unit should be dealt with. 

• Management team to take cognizance of the findings of maladministration and improper conduct and to take corrective action to prevent a recurrence of the improprieties referred to in this Report. 

• Formal contract or service level agreement with a contractor, legally sound to avoid potential litigation and to minimise possible fraud and corruption. Such contracts must include legal vetting and must be constantly managed to ensure that both the NHLS and the contractors meet their respective obligations. 

• A monitoring system that ensures that proper procurement in appointing service providers by the SCM and recruitment processes in appointing individuals by the Human Resources Department.

• Review the existing policy or the policy provisions on managing conflict of interest. 

• Evaluation the effectiveness of the NHLS’s internal controls and monitoring system and introduction of strict measures for compliance with lawful, reasonable, and procedurally fair labour practices.

END.

Reply:

It is not correct that the Department has contributed 13,65 Billion dollars towards the Global Fund for HIV/AIDS, TB and Malaria. In order to put the record straight. South Africa has pledged 13,65 million dollars to the Global Fund as a contribution towards the Global Fund for HIV/AIDS. This is part of the country’s role as a member the global community in making a contribution towards addressing the challenges that are faced by the world in the fight against HIV/AIDS and Malaria, which is 36,5% more than our previous pledge.

a) The Global Fund Pledge of US$13 million was sourced from the Department of Health budget under the HIV/AIDS allocation as part of the pledge to Multi-National and Regional bodies/structures (United Nations and SADC). The Department provides for this allocation under Goods and Services, Posting Item Code: Membership & Professional Bodies. The US$650 thousand portion of the pledge was contributed by the South African National AIDS Council sourced from the private sector, as one of their 17 Sectors that support the country in shaping and implementing the HIV/AIDS and TB response.

b) (i) The contribution will be used to support the global intervention in the fight against HIV/AIDS in order to meet the global targets of 95-95-95 and Malaria elimination.

(ii) The benefits are as follows: South Africa is an implementor of Global Fund supported projects. Currently, the country received US$515 million through 4 Primary Recipients for implementation of various projects and programmes addressing HIV/AIDS, TB and Malaria. Included in the above figure, the National Department of Health is awarded US$364,357 million to implement the health driven interventions. Through the support from Global Fund, we will increase our drive to institutionalize granular, targeted, and gender-sensitive data systems and community-led approaches to monitor and address new HIV infections, especially among key populations and younger populations. Further to the attainment of the HIV/AIDS targets, the country will continue to improve the fight against Malaria, as part of the 8 countries that are called Malaria Elimination 8 or called E8 for short. It is our view further that the Global Fund support for Malaria programme, will include the prevention, surveillance, and treatment.

END.

Reply:

According to the Eastern Cape Provincial Department of Health, where this hospital is located, the Provinces indicates that there are no plans in-source security services at this facility.

END.

Reply:

1. (a) District Health Services currently use the Ideal Clinic Framework’s indicators to assess district performance. The reason for using this framework is because it covers aspects of services that districts should provide to persons in the community setting, in PHC facilities to the level of referral to higher level care if needed. The Framework is a comprehensive evaluation measure and it’s elements cover administrative processes, aspects of clinical care, medicines supplies, access to laboratory tests, human resources, finance, security, cleanliness, referral, transport, EMS, infrastructure, health information management, internal communication, external communication, governance and intersectoral collaboration.

(b) The specified assessments were conducted in the 4th quarter (January – March 2022) of the previous (2021/2022) financial year. Peer reviews and therefor the collation of data is done only once a year in the fourth quarter and the next review will be January to March 2023.

2. Details of complete list according to the 2022 review is in the table below:

• (a) Best performing district are from numbers 1 to 20; and
• (b) Worst performing districts are from numbers 35 to 52

Ranking No for 2021/22 financial year	Province	District	% of Facilities with IC status 2021/22
1	FS	Xhariep District Municipality	100%
2	GP	City of Ekurhuleni Metropolitan Municipality	100%
3	KZN	Amajuba District Municipality	100%
4	KZN	Zululand District Municipality	100%
5	KZN	Umzinyathi District Municipality	98%
6	GP	City of Johannesburg Metropolitan Municipality	96%
7	LP	Capricorn District Municipality	95%
8	WC	Garden Route District Municipality	95%
9	KZN	Uthukela District Municipality	95%
10	KZN	iLembe District Municipality	92%
11	KZN	uMgungundlovu District Municipality	90%
12	GP	City of Tshwane Metropolitan Municipality	89%
13	KZN	Harry Gwala District Municipality	85%
14	WC	City of Cape Town Metropolitan Municipality	85%
15	KZN	King Cetshwayo District Municipality	84%
16	GP	West Rand District Municipality	84%
17	FS	Thabo Mofutsanyana District Municipality	83%
18	GP	Sedibeng District Municipality	82%
19	MP	Gert Sibande District Municipality	81%
20	NW	Dr Kenneth Kaunda District Municipality	80%
21	EC	Nelson Mandela Bay Municipality	77%
22	FS	Mangaung Metropolitan Municipality	76%
23	KZN	eThekwini Metropolitan Municipality	74%
24	WC	Overberg District Municipality	74%
25	WC	Cape Winelands District Municipality	70%
26	KZN	Umkhanyakude District Municipality	69%
27	MP	Nkangala District Municipality	67%
28	NW	Dr Ruth Segomotsi Mompati District Municipality	63%
29	KZN	Ugu District Municipality	58%
30	NC	Pixley ka Seme District Municipality	58%
31	NW	Bojanala Platinum District Municipality	55%
32	FS	Fezile Dabi District Municipality	51%
33	NW	Ngaka Modiri Molema District Municipality	49%
34	MP	Ehlanzeni District Municipality	40%
35	EC	Sarah Baartman District Municipality	39%
36	WC	Central Karoo District Municipality	33%
37	WC	West Coast District Municipality	33%
38	LP	Waterberg District Municipality	30%
39	EC	Amathole District Municipality	28%
40	FS	Lejweleputswa District Municipality	26%
41	LP	Vhembe District Municipality	20%
42	EC	Buffalo City Metropolitan Municipality	20%
43	EC	Chris Hani District Municipality	20%
44	NC	Frances Baard District Municipality	20%
45	EC	Joe Gqabi District Municipality	19%
46	LP	Mopani District Municipality	17%
47	NC	Namakwa District Municipality	16%
48	LP	Sekhukhune District Municipality	10%
49	NC	Zwelentlanga Fatman Mgcawu District Municipality	10%
50	EC	Alfred Nzo District Municipality	9%
51	EC	Oliver Tambo District Municipality	7%
52	NC	John Taolo Gaetsewe District Municipality	2%

END.

Reply:

1. (a) It is the Departments of Health’s policy to ensure equitable access to quality healthcare through availability of safe, effective and cost-effective medicines at the appropriate level of care. The National Department of Health (NDoH) manages contracts for approximately 1 200 line items. During the contracting for medicines, it is a special contractual condition that suppliers provide the NDoH with information related to their buffer stock holding, plans within the pipeline and data related to deliveries made to facilities. The NDoH uses this information to manage supplier performance including the imposition of penalties where appropriate. Furthermore, the data is used for planning purposes including demand and supply planning.

Medicine availability is monitored using supplier and provincial level data and this allows visibility of stock availability and as such allows for risk mitigation by the National Department of Health.

However, the recent media reports are of shortages related to availability in the private sector. Availability of the medicines referred to in these reports was above 90% in the public sector. There were no public sector supply challenges of chronic medicines for first and second line agents as reported recently in the media.

(b) There are a number of interventions implemented to reduce supply shortages at facilities. These interventions are informed by the cause of the supply challenge.

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

• Should the supply constraint be due to operational matters, e.g. machine breakdown, labour unrest, theft, post importation testing, etc., the National Department of Health (NDOH) would source products from alternative local suppliers with registered products using the quotation process.

(c) In any supply chain, shortages can never be eradicated. However, actions can be taken to identify problems that could lead to a supply challenge and to deal with each challenge as it arises. See response in (b) above. Each case is treated individually depending on the root cause, and the magnitude of the supply challenge.

2. In the event that a supply challenge cannot be resolved, a circular is sent to all provinces indicating therapeutic alternatives as per the Standard Treatment Guidelines (STGs) which will guide clinicians to manage patients until supply is sourced.

END.

Reply:

1.(a) In terms of the regulations relating to categories of hospitals, there are 100 656 approved beds in the republic and as of July 2022 the total number of usable beds was 85 126:

Province	Approved beds as per regulations relating to categories of hospitals	Usable beds as of July 2022
Eastern Cape	15436	13201
Free State	5372	4786
Gauteng	18833	18000
Kwa-Zulu	26213	20512
Limpopo	10603	7660
Mpumalanga	5848	4747
Northwest	5738	4461
Northern Cape	2287	1785
Western Cape	10326	9974
South Africa	100 656	85126

(b) There is no backlog in terms of new bed capacity that must be provided in the public hospitals.

The total bed capacity is determined using the beds per population ratio (the difference between the current bed capacity (approved) of public hospitals and the optimal bed capacity). According to Statistic South Africa mid- year population estimates of 2019, the total population in South Africa was 58,606,416 and this translated into 1.7 beds per 1000 population. The international benchmark for optimal beds per population is 1.5.

While the overall number of hospital beds per 1,000 population is in line with international references, the distribution of beds across the districts and levels of care appear to be extremely unequal (District Health Barometer 2019/20).

The table below provides a breakdown according to provinces.

Province	Approved beds as per regulations relating to categories of hospitals	StatsSA mid-year population estimates	Beds per 1000 population
Eastern Cape	15436	6,533,465	2,4
Free State	5372	2,971,708	1,8
Gauteng	18833	15,099,801	1,2
Kwa-Zulu	26213	11,503,917	2,3
Limpopo	10603	5,853,193	1,8
Mpumalanga	5848	4,598,333	1,3
Northwest	5738	4,053,179	1,4
Northern Cape	2287	1,240,254	1,8
Western Cape	10326	6,760,561	1,5
South Africa	100 656	58,606,416	1,7

 

The value of the indicator decreased to a lesser degree (less beds/population) for Gauteng, Mpumalanga and North West.

(2) Below is a list of new hospitals in the pipeline to be constructed: 2 (a) and (b) (i) (ii)

PROVINCE	HOSPITAL NAME	NUMBER OF BEDS	STATUS	TOWN
Eastern Cape	Greenville District Hospital	100 Beds	Design	Bizana
	Sipetu District	100 Beds	Construction	Mount Frere
	Khutsong TB Hospital	124 Beds	Construction	Matatiele
	Bambisana District Hospital	100 Beds	Construction Started	Nyandeni
	Zithulele District Hospital	157 Beds	Construction Started	King Dalindyebo
	Nelson Mandela Academic	To be confirmed	Feasibility Study	Queberha
Free State	Managaung District Hospital	330 Beds	Clinical Brief	Bloemfontein
	Free State Psychiatric Hospital	877 Beds	Clinical Brief	Bloemfontein
	Parys Hospital	To be confirmed	Feasibility Study	Parys
	Dihlabeng District Hospital	212 Beds	Tender	Kroonstad
Gauteng	Lilian Ngoyi Regional Hospital	556 Beds	Tender	Johannesburg
	Soshanguve Hospital	400 Beds	Land Acquisition	Pretoria (Soshanguve)
	George Mukhari Academic Hospital	To be confirmed	Feasibility Study	Pretoria (Ga-rankua)
	Chris Hani Baragwanath Hospital	To be confirmed	Feasibility Study	Johannesburg (Soweto)
KwaZulu Natal	UMzimkhulu Mental Hospital	90 Beds	Design	UMzimkhulu
	King Edward 8th	To be confirmed	Feasibility Study	Durban
	Northern KZN Tertiary Hospital	To be confirmed	Feasibility Study	Durban
Limpopo	Limpopo Academic Hospital	488 Beds	Tender	Polokwane
	Siloam Hospital	244 Beds	Construction started	Siloam
	Tshilidzini Hospital	535 Beds	Design	Thohoyandou
	Elim Hospital	416 Beds	Design	Elim
Mpumalanga	Witbank Tertiary Hospital	400 Beds	Tender	Witbank
	Witbank Psychiatric Hospital	400 Beds	Design	Witbank
	Mapulaneng District Hospital	400 Beds	Construction	Bushbuckridge
	Middelburg District Hospital	200 Beds	Construction	Middelburg
North West	Bophelong General Psychiatric Hospital	244 Beds	Construction started	Mafikeng
Western Cape	Swaartland District Hospital	132 Beds	Design	Swaartland
	Belhar Regional Hospital	596 Beds	Design	Belhar
	Klipfontein (GF Jooste) Regional Hospital	To be confirmed	Design	Klipfontein
	Tygerberg Hospital	800 Beds	Feasibility Study	Cape Town

END.