ATC120605: Report Fourth Quarter Expenditure On The Forensic Pathology Services Grant In The 2011/12 Financial Year, Dated 05 June 2012

NCOP Appropriations

FIRST DRAFT

REPORT OF THE SELECT COMMITTEE ON APPROPRIATIONS ON THE FOURTH QUARTER EXPENDITURE ON THE FORENSIC PATHOLOGY SERVICES GRANT IN THE 2011/12 FINANCIAL YEAR, DATED 05 JUNE 2012

 

1. Introduction

 

The Select Committee on Appropriations (the Committee) conducted hearings on the spending levels on the Forensic Pathology Services Grant (FPSG) for the fourth quarter in the 2011/12 financial year. The FPSG was allocated R590 million in the 2011/12 financial year and this was divided amongst the nine provinces. The FPSG was introduced in the Division of Revenue Act for2006. The objective of FPSG was to assist with the transfer of medico-legal mortuaries from the South African Police Service to the health sector; and support the provision of comprehensive forensic pathology services for the criminal justice system.

 

The hearings were scheduled after the Division of Revenue Act 2011 had indicated that the FPSG funds would be added to the provincial equitable share as from the 2012/13 financial year.

 

The Committee resolved that, since this grant would be phased out, a final report on the FPSG should be made by the National Treasury and the National Department of Health. The meeting took place on 08 May 2012 in Committee Room M314 at the Parliament of the Republic of South Africa .

 

 

2. Terms of reference

 

The hearings formed part of the Committee’s ongoing interaction with national departments and provinces to monitor their spending patterns on conditional grants allocated to them. A framework for each grant sets out, among other things, the purpose of the grant, measurable objectives, conditions, allocation criteria, and past performance.

 

The National Department of Health was requested to report on the fourth quarter expenditure on the Forensic Pathology Services Grant in the 2011/12 financial year and to take into consideration the following:

• Fourth quarter expenditure of the grant in all provinces in the 2011/12 financial year;
• Successes and failures of the grant since its inception;
• Whether the grant met its objectives;
• Challenges that were identified with respect to the implementation of this grant;
• A brief assessment of the Department’s monitoring capacity for the 2011/12 financial year; and
• Under/over-spending and what capacity constraints impacted on these outcomes.

 

The National Treasury was also invited to brief the Committee on the subject. The focus was on expenditure patterns on the fourth quarter in the 2011/12 financial year.

 

 

3. Fourth quarter expenditure reports in the 2011/12 financial year

 

3.1 National Treasury

The National Treasury reported that the forensic pathology services function had been transferred from the South African Police Service to provincial departments of health with effect from 2006. The National Treasury explained that the Forensic Pathology Services Grant (FPSG) was envisaged to last five years and it was initiated in the 2005/06 financial year to support the function shift. The National Treasury added that, six years later, that is in the 2011/12 financial year, the function had been successfully transferred, thoroughly upgraded and improved under the provincial departments of health. Moreover, the National Treasury reported that the key objective of the grant had been to continue the development and provision of adequate forensic pathology services in all provinces. The National Treasury further reported that the FPSG’s main budget in the 2011/12 financial year had been R590.38 million. Treasury also added that the FPSG ended at 31 March 2012 and it was phased into the provincial equitable share with effect from 01 April 2012.

 

Table 1 (below) presents the FPSG allocation to provinces

 

Table 1: Forensic Pathology Services Grant preliminary expenditure by provinces as at 31 March 2012

 

Province	Main budget   000	Adjusted budget   000	Preliminary outcomes   000	Preliminary outcomes as % of adjusted budget	(Over) spending   000	Under spending 000	%(Over)/ under-spending of adjusted budget
Eastern Cape	73 506	87 018	92, 449	106.2%	-5, 431	-	-6.2%
Free State	39 451	39 451	38, 475	97.5%	-	976	2.5%
Gauteng	97 966	97 966	73, 979	75.5 %	-	23, 987	24.5%
KwaZulu-Natal	161 550	161 550	161, 550	100%	-	-	0.0%
Limpopo	42 308	43 279	37, 819	87.4%	-	6, 460	12.6%
Mpumalanga	53 114	55 607	53, 589	96.4%	-	2, 018	3.6%
Northern Cape	24 240	26 977	25, 585	94.8%	-	1, 392	5.2%
North West	28 019	28 019	28, 019	100%	-	-	0.0%
Western Cape	70 226	70 226	75, 204	107.1%	-4, 978	-	-7.1%
Total	590 380	610 093	586, 669	96.2%	-10, 409	33, 833	3.8%

 

The National Treasury reported that the conclusive fourth quarter report on the Forensic Pathology Services Grant would be submitted by the National Department of Health on 15 May 2012. The National Treasury reported that the FPSG did not perform well due to challenges relating to infrastructure and human resources. Regarding infrastructure challenges, the National Treasury reported that acquiring land to build new structures had been a challenge, including contract management issues. The National Treasury further reported that there had been a challenge with respect to the filling of vacant posts and the procurement of relevant equipment. This had been due to a shortage of professional and technical staff in forensic pathology in the country.

 

When the Committee raised its concern with respect to provinces that had over- or under-spent on their allocations, the National Treasury replied that the provinces that had over-spent on the grant had used their equitable share to supplement the grant funds. Those provinces who had under-spent but had outstanding invoices to be paid, had submitted their applications for roll-overs. These roll-overs had not been approved at the time of reporting.

 

The National Treasury reported that where provinces had reported 100 per cent spending, their reports did not clearly indicate that their equitable share had been utilised.

 

 

3.2 The National Department of Health

 

The National Department of Health (NDoH) explained that the decision to transfer the medico-legal services from the South African Police Service to the provincial departments of Health had been taken in 1998. The NDoH added that section 25(2) (m) of the National Health Act, Act No. 61 of 2003, stipulated that t he head of a provincial department must, in accordance with national health policy and the relevant provincial health policy in respect of or within the relevant province, provide and co-ordinate emergency medical services and forensic pathology, forensic clinical medicines and related services, including the provision of medico-legal mortuaries and medico-legal services.

 

The NDoH reported that the following had been the agreed-on deliverables:

· Transfer of function from SAPS to provincial health departments;

· New mortuary facilities built and equipped, old mortuary facilities refurbished and equipped;

· Human resource organogram filled with qualified personnel;

· Acceptable productivity levels in mortuaries;

· Operational standards for mortuaries published and implemented; and

· Forensic pathology services system in all provinces.

 

The NDoH reported the achievements of the FPSG as follows:

· Personnel formerly employed by the South African Police Service had been successfully transferred to the provincial departments of health;

· New personnel with Grade 12 had been recruited for possible training to become Forensic Pathology Officers;

· The NDOH had started to interact with the Health Professions Council of South Africa to recognise these officers so that they qualified for Occupational Services Dispensation (OSD);

· Conditional grant spending in provinces had improved;

· Equipment and new fleets had been procured in all provinces;

· A Forensic Pathology Information System (FPIS) was operational in two provinces, Gauteng and the Western Cape . Gauteng had four operational facilities and the Western Cape had the FPIS operational in all its 18 facilities; and

· Old mortuaries had been refurbished and new mortuaries had been built.

 

With respect to service delivery achievement, the National Department of Health reported the following:

1. The Province of Eastern Cape (PoEC) had 14 bodies awaiting autopsy as at 30 November 2011. The waiting period for autopsy results in the PoEC was reported to be three to seven days. The waiting period for histology results was reported to be six months. One hundred and thirty six (136) bodies were reported to be awaiting pauper’s burial.

 

1. The Province of Free State (PoFS) had no bodies awaiting autopsy as at 30 November 2011. The NDoH reported that the average waiting period for autopsies in the PoFS was two to three days. The waiting period for histology results in the PoFS was reported to be longer than three months. Twelve (12) bodies were reported to be awaiting pauper’s burial.

 

1. The Province of Gauteng (PoG) had 16 bodies awaiting autopsy as at 30 November 2011. The average waiting period for autopsies was two to four days and the waiting period for histology results was six weeks. At the end of the 2011/12 financial year, the PoG had three hundred and sixty two (362) unidentified bodies awaiting pauper’s burial.

 

1. The Province of KwaZulu-Natal (PoKZN) had 10 bodies awaiting autopsy as at 30 November 2011. The average waiting period for autopsies was one hour to seven days and the longest was eight days. The NDoH added that the waiting period for histology results in the PoKZN was up to a year. Two hundred and seventeen (217) bodies were reported to be awaiting pauper’s burial.

 

1. The Province of Limpopo (PoL) had 33 bodies awaiting autopsy as at 30 November 2011. The average waiting period for autopsy was reported to be three to four days and the histology results waiting period was six weeks. One hundred and sixty-one (161) bodies were reported to be awaiting pauper’s burial.

 

1. The Province of Mpumalanga (PoMpu) had 15 bodies awaiting autopsy as at 30 November 2011. The average waiting period for autopsy was reported to be three to seven days. The waiting period for histology results was six months. At the end of the 2011/12 financial year, the PoMpu had one hundred and six (106) bodies were reported to be awaiting pauper’s burial.

 

1. The Province of North West (PoNW) had 15 bodies awaiting autopsy as at 30 November 2011 and the average waiting period for autopsy was reported to be two to seven days. The waiting period for histology results was up to a year. At the end of the 2011/12 financial year, PoNW had 152 unidentified bodies awaiting pauper’s burial.

 

1. The Province of Northern Cape (PoNC) had 8 bodies awaiting autopsy as at 30 November 2011. The average waiting period for autopsy was three days. The waiting period for histology results was three months. Nine (9) bodies were reported to be awaiting pauper’s burial.

 

1. The Province of Western Cape (PoWC) had 63 bodies awaiting autopsy as at 30 November 2011. The average waiting period for autopsy was three to seven days. The waiting period for histology results was six weeks. As at the end of the 2011/12 financial year, the PoWC had one hundred and thirty (130) unidentified bodies awaiting pauper’s burial.

 

The NDoH reported that, through the Forensic Pathology Services Grant, provinces had employed 250 officials, including doctors, forensic pathologists, forensic pathology officers, administrative officers, managers, and auxiliary officers. Table 2 (below) presents a breakdown per province of number of staff per unit as at 31 March 2012.

 

Table 2: Human Resources Status as at 31 st March 2012.

Provinces	Doctors	Forensic Pathologists	Forensic Pathology Officers	Admin Support	Managers	Auxiliary support	2011/12 financial year 4 th Quarter report Totals
Eastern Cape	17 (13 Permanent and 4 Sessional)	3	121	27	15	14	197
Free State	5	11	49	12	5	34	116
Gauteng	37 (10 are Sessional)	20	184	62	21	8	332
KwaZulu Natal	5 (2 are Contractors)	4	294	7	23	181	514
Limpopo	8	4	80	38	1	0	131
Mpumalanga	11 (7 permanent and 4 Sessional)	0	73	18	7	25	134
Northern Cape	2	0	36 (14 are contractors)	6	6	4 (3 are contractors)	54
North West	3	1	46	15	7	5	77
Western Cape	18	11	130	58	7	26	250

 

 

Table 2 (above) indicates that the provinces of Limpopo and KwaZulu-Natal had, through the FPSG, employed only four forensic pathologists each. The NDoH reported that, in the provinces of Mpumalanga and the Northern Cape , there were no practising forensic pathologists employed. The Province of Eastern Cape had employed three forensic pathologists; the provinces of the Free State and Western Cape had employed eleven (11) forensic pathologists each; and the Province of the North West had employed only one forensic pathologist. The Province of Gauteng was reported to have employed 18 forensic pathologists followed by the Province of the Western Cape which had employed 14 forensic pathologists.

 

Regarding the status of the number of infrastructure facilities, the National Department of Health reported that there were 147 mortuaries. Sixty-six (66) of these mortuaries were planned for refurbishment. Only 44 were refurbished and 22 were not finished. Moreover, there were 59 planned mortuaries of which 43 were completed in the 2011/12 financial year and 16 mortuaries were yet to be completed.

 

With respect to the challenges and failures experienced since the inception of the FPSG, the National Department of Health reported that the forensic pathology training programme had not been formalised into a full qualification for forensic pathology officers. The NDoH further reported that provinces had not been able to employ enough forensic pathologists due to low output levels by institutions of higher learning in the profession. The lengthy procedures in the criminal justice system were reported as a challenge. The Province of the Northern Cape was reported to have pending court cases. Poor workmanship on infrastructure projects, escalating building costs, and difficulty in acquiring land were also highlighted as challenges. The NDoH also reported that the moratorium placed on the Health Information Systems Programme had affected implementation.

 

Furthermore, the NDoH reported that infrastructure challenges had affected individual provinces with respect to building new mortuaries and refurbishing existing mortuary facilities. The NDoH further reported that the Province of Gauteng had had difficulty in acquiring land and none of the six planned facilities had been built. However, land had, subsequently, been acquired for mortuaries in Bronkhorstspruit and Springs. With respect to the Province of the Northern Cape , the NDoH reported that a court case was halting all projects and the matter had not been resolved at the time of reporting. Lack of funds in the Province of Mpumalanga had contributed to late completion of all new facilities. The NDoH reported that the Province of the Western Cape had not completed all their building and refurbishment projects due to lack of sufficient funding. An example was made of the new mortuary at Salt River which needed R134 million. With regard to the Province of the Eastern Cape , the NDoH reported that two holding facilities that had been part of the original plan had not been built due to lack of sufficient funding. Furthermore, the Supply Chain process was reported as being slow in the Province of the Eastern Cape . Affected projects included building of new mortuaries in Engcobo, Elliot, Cradock and Willowmore.

 

 

Regarding monitoring and evaluation, the NDoH reported that its Forensic Pathology Directorate had only two officers managing the grant but all provinces had been visited. The provincial visits had been mainly conducted for the monitoring of progress with building and refurbishment projects, information gathering regarding human resource matters and assessing the quality of procured equipment. The NDoH further reported that the post of Director for the Forensic Pathology Services Programme had been left vacant for more that three years. The NDoH further reported that it had not been able to evaluate the status of the designated mortuary buildings and upgrading programme due to capacity problems. The challenges identified during site visits resulted in various newly built and refurbished mortuaries being visited more than twice, some had been visited up to seven times. The NDoH added that some provinces had submitted their monthly and quarterly expenditure reports late.

 

The National Department of Health reiterated that the Forensic Pathology Services Grant had been phased-out and added to the provincial equitable share with effect from the 2012/13 financial year. According to the NDoH, provinces had been briefed through policy structures to carry over the revitalisation of mortuaries from the equitable share funding. The NDoH reported that the National Health Act would be used to ensure that provinces provided quality forensic pathology services. The NDoH further reported that they were managing the Health Infrastructure Grant. The NDoH indicated that the refurbishment and building of mortuaries would be done under the Hospital Revitalisation and Health Infrastructure Grants.

 

4. Key Observations

 

During interaction with the National Department of Health and the National Treasury, the Select Committee on Appropriations observed the following:

4.1 Through the Forensic Pathology Services Grant, the function of managing the medico-legal mortuaries had been successfully transferred from the South African Police Service to the provincial departments of health.

 

4.2 Out of the nine provinces only two, Gauteng and the Western Cape , had operating Forensic Pathology Information Systems.

 

4.3 The provinces had not been able to recruit sufficient forensic pathologists. This had led to the shortage of pathologists in most provinces. The provinces of Gauteng and Western Cape had employed 32 pathologists between them. The shortage of pathologists had an effect on the waiting time for autopsies to be performed. In four provinces, bodies had to wait for more than seven days before an autopsy was performed.

 

4.4 The National Department of Health had not formalised the training programme into an accredited qualification for forensic pathology officers.

 

4.5 Projects in the Province of the Northern Cape had not been completed as at the end of the 2011/12 financial year due to the lengthy criminal justice system procedure which had delayed their implementation.

 

4.6 Some projects had not been finalised in three provinces due to lack of sufficient funding. In the Province of the Western Cape the Salt River project had not been completed due to insufficient funds. The project needed R134 million to be completed. The Provinces of the Eastern Cape and Mpumalanga had also not completed projects due to lack of sufficient funding.

 

4.7 The National Department of Health’s inability to employ enough personnel under the Forensic Pathology Unit had contributed to the lack of monitoring and oversight on this grant. This has, in turn, led to poor performance on this grant by provinces.

 

4.8 The refurbishment and building of new mortuaries would also be done under the Hospital Revitalisation and Health Infrastructure Grants.

 

5. Recommendations

 

Having considered the reports by the National Department of Health and the National Treasury on the spending patterns on the Forensic Pathology Services Grant in the fourth quarter of the 2011/12 financial year, the Select Committee on Appropriations recommends that the National Council of Provinces considers the following recommendations:

 

5.1 The National Department of Health should ensure that provincial departments of Health continue budgeting for the function of managing the medico-legal mortuaries.

5.2 The other seven provincial departments of health should follow the example of the Provinces of Gauteng and the Western Cape and install the Forensic Pathology Information System. The National Department of Health should ensure that this service is included in provincial business plans.

5.3 Provinces should continue offering bursaries to doctors who endeavour to be specialists in the field of forensic pathology in order to address the shortage of forensic pathologists.

5.4 The National Department of Health should, as on its priorities, continue to interact with the South African Qualifications Authority and ensure that the training programme for forensic pathology officers is formalised so that these officers could relieve the work load that is being faced by the forensic pathologists.

5.5 All funds meant for construction projects that had been delayed due to various issues, such as the court case in the Province of the Northern Cape , should be ring-fenced and be made available immediately when such issues have been resolved.

5.6 The provinces of the Eastern Cape , Mpumalanga , and the Western Cape should not abandon the projects that were not implemented due to lack of funding. The National Department of Health should work closely with these provinces and assist them until these projects are implemented.

5.7 The National Department of Health should strengthen its Forensic Pathology Services Unit in order for it to play an oversight role over provinces. The NDoH should ensure that all funded vacancies are filled within six calendar months after the adoption of this Report by the National Council of Provinces.

5.8 The National Department of Health should submit to the National Council of Provinces a written report explaining why and how it intends to utilise the Hospital Revitalisation and the Health Infrastructure Grants to build new mortuaries and refurbish old mortuaries. This particular explanation should indicate whether the Division of Revenue Act allows for this or not.

 

Report to be considered.