ATC200604: Report of the Portfolio Committee on Health on Budget Vote 18: Health, Strategic Plan and Annual Performance Plan of the Department of Health, Dated, 28 May 2020

Health

Report of the Portfolio Committee on Health on Budget Vote 18: Health, Strategic Plan and Annual Performance Plan of the Department of Health, Dated, 28 May 2020

The Portfolio Committee on Health (the Committee), having considered Budget Vote 18: Health, together with the 2020/21-2024/25 Strategic Plan and 2020/21 Annual Performance Plan (APP) of the Department of Health(the Department), reports as follows:

INTRODUCTION

Section 5(2) of the Constitution of South Africa (No. 108 of 1996) and section 27(4) of the Public Finance Management Act (No.1 of 1999) sets out the role of Parliamentary committees in overseeing the performance of government departments and entities. Furthermore, the Money Bills Amendment Procedure and Related Matters Act (Act No. 9 of 2009), provides for for the National Assembly, through its committees to assess the budget votes of departments and its entities with their respective strategic and annual performance plans.

1.1.Purpose of the report

This report summarisesa presentation received from the Departmentfocusing on its 2020/21-2024/25 Strategic Plan, Annual Performance Plan (APP) and Budget for 2020/21 as well asallocationsover themedium-term expenditure framework (MTEF) period. The report details the deliberations, observations and recommendations made by the Committee relating to Budget Vote18.

1.2.Process

On 13 May 2020, the Portfolio Committee on Health engaged with the Auditor-General of South Africa on their analysis and assessment of the Strategic Plan, APP and budget of the Department of Health and its entities.

On 20 May 2020, the Portfolio Committee on Health and the Select Committee on Health and Social Services engaged the Departmenton its Strategic Plan,APP and budget for 2020/21.

1.3.Briefing by the Auditor-General of South Africa

The Auditor-General of South Africa (AGSA) noted thaton its review of the Department’s APP, certain procedures were not performed given that the Medium-Term Strategic Framework (MTSF) was not submitted with the draft APP as the preparation of the document was still in process. As a result, the AGSA could not test the relevancy of the indicators to MTSF and the completeness of indicators to cover all MTSF outcomes.

Some of the audit findings related to the Strategic Plan included:

A misalignment of principles outlined in the revised framework for strategic plans and annual performance plan.
Differences between the outcome indicators in the strategic plan and indicator titles in the technical indicator descriptions (TIDS) in the strategic plan.
Differences between the source of data described in the TIDS of the strategic plan and those described in the APP.
The target linked to the indicator is not measurable because the denominator was not specified in the calculation method.

The AGSA further noted that APPs for the South African Health Products Regulatory Authority (SAHPRA), Medical Research Council (MRC) and the National Health Laboratory Services (NHLS) were not reviewed.

On conditional grants, the AGSA reported that 51% of the budget goes to the Comprehensive HIV and AIDS, TB and Community Outreach Services Grant; 29% National Tertiary Services Grant (this was a decrease from the previous year); 13% Health Facility Revitalisation Grant; 6% Health Professional Training and Development; and 1% to Human Papillomavirus (HPV).

On transfers to entities, it was highlighted that the NHLS received 44%, MRC 39%, SAHPRA 9%, OHSC 8% and 1% for CMS.

On the outcomes of the status of records review (SoRR)conducted in the third quarter ending 31 December 2019, the following findings were highlighted:

The basics on the financial health of the Department of Health were in place, as no concerns were identified. This is an improvement from last financial year’s findings.
Concerns identified relate to some key focus areas including, oversight and monitoring, performance management, procurement and contract management and human resources. The AGSA noted that these findings remained unchanged.
Other key focus areas that were of concern that required the accounting officer to urgently intervene to prevent audit failures were on financial management, compliance management and Information Technology management.

The SoRR outcomes for provincial departments includes the following:

Slow response from the accounting officer and senior management to implement action plans and effectively address significant deficiencies in internal controls on financial, performance and compliance reporting.
Reconciliations for 1 April 2019 to 30 September 2019 between the District Health Information System (DHIS) registers and input forms were not prepared and reviewed and this may continue to result in material findings being reported on performance objectives.
Poor contract management may lead to extension of contracts which could result to irregular expenditure being incurred.
Investigations into irregular, fruitless and wasteful expenditure are being delayed or have slow progress or are not yet started at all.
The sector has instances of payments not made within 30 days that may be material findings at year end.

OVERVIEW OF KEY POLICIES AND STRATEGIES

The Department aims to provide leadership and coordination of health services to promote the health of all people of South Africa through an accessible, caring and high quality health system based on a primary health care (PHC) approach.

The Basis and Context of the National Department of Health Strategic Plan and APP

The National Department of Health (herein, the Department) derives its Strategic Plan and Annual Performance Plan from the following strategies and policy initiatives:

Government’s 2030 vision outlined in the National Development Plan (NDP) 2030 and Sustainable Development Goals (SDGs).
Medium-Term Strategic Framework (MTSF) 2019-2024.
Recognizes the National Health Insurance (NHI) policy directive of government, noting the consultations on the NHI Bill led by Parliament.
Responds to key diagnostics provided by the Presidential Health Summit Compact; recommendations from the Lancet quality commission; recommendations by the Health Market Inquiry; and the South African Demographic and Health Survey.
Rationalized the number of indicators to be monitored in the APP 2020/21 through the National Indicator Data Set (NIDS) in line with the revised 2020-2024 strategic objectives and the growing need to reduce data collection burden on facilities.

1. State of the Nation Address (SoNA)

The 2020 SONA highlighted the following main health-related issues:

The President recognised health as being a fundamental condition for growth and development.
South Africa continues to be impacted by HIV and AIDS. About 6.8 million South Africans were tested. Approximately 5 million people have been initiated on antiretroviral treatment, and as a consequence, the HIV viral load of 4.2 million people is undetectable.
The President noted the supportreceived from South Africansduring the National Health Insurance (NHI) public hearings. Government is in the process of setting up mechanisms for the NHI implementation, following the conclusion of the parliamentary process.
In preparation for NHI, more than 44 million people at over 3000 clinics have been registered on the electronic Health Patient Registration System (HPRS), and are now implementing this system in hospitals.

National Development Plan Vision 2030

The National Development Plan forms an integral part of policy plans within all government departments to chart a path to prosperity and improving the lives of all South Africans within various sectors. The Department of Health is guided by the goals, indicators and actions of Chapter 10 of the NDP which highlights the need to reduce the disease burden, strengthen the health system and addressing the social and environmental determinants of health to improve the life expectancy of the country’s citizens. The nine goals for the health sectorthat must be reached by 2030 are as follows:

Increase life expectancy at birth to 70 years.
Improve evidence-based preventative and therapeutic interventions for HIV.
Progressively tuberculosis (TB) prevention and treatment.Reduce maternal, infant and child mortality.
Reduce theprevalence of non-communicable/chronic diseases by 28%.
Reduce injury, accidents and violence by 50% (from the 2010 levels).
Strengthen the district health system.
Provide care to families and communities through primary health care teams.
Fill health posts with skilled, committed and competent individuals.

Sustainable Development Goals (SDGs)

The Department of Health is also committed to working towards achieving the health-related UN SDG targets Goal 3 (Ensure healthy lives and promote well-being for all at all ages). It is envisaged that this would be achieved through the following:

Putting in place social protection systems and measures.
Reducing maternal mortality to less than 70% per 100,000 live births.
Ending preventable deaths of new-borns and children under 5 years of age;and epidemics such as AIDS, TB and malaria.
Reducing one-third of premature mortality from non-communicable diseases.
Strengthening the prevention and treatment of substance abuse, including the harmful use of alcohol.
Improving road safety for all, and halve the number of deaths and injuries caused by road traffic accidents.
Ensuring access to sexual and reproductive health care services, and rights.
Attaining universal health coverage.
Maintaining ecosystems, and reducing the number of death and illnesses caused by hazardous chemicals and pollution.

THE DEPARTMENT OF HEALTH’S FIVE-YEAR STRATEGY

3.1.Strategic Goals 2020/21-2024/25

The Department’s Strategic Plan is firmly grounded in strengthening the health care system and improving quality of care. The strategic outcome-orientated goals for the next five years are:

Strategic Goal 1:

Increase life expectancy, improve health and prevent disease – Improve health outcomes by responding to the quadruple burden of disease in South Africa; and address the social determinants of health through inter-sectoral collaboration.

Strategic Goal 2:

Achieve universal health coverage by implementing NHI Policy – Progressively achieve universal health coverage through NHI.

Strategic Goal 3:

Quality improvement in the provision of care– Improve quality and safety of care; provide leadership and enhance governance in the health sector for improved quality of care; improve community engagement and reorientate the system towards PHC through community based health programmes to promote health; improve equity training and enhance management of Human Resources for Health (HRH); improve the availability of medical products and equipment; and ensure robust and effective health information systems to automate business processes and improve evidence based decision making.

Strategic Goal 4:

Build health infrastructure for effective service delivery – Execute the infrastructure plan to ensure adequate, appropriately distributed and well maintained health facilities.

Impact Statements and Outcomes

The Department of Health contributes directly to the realisation of Priority 3 (Education, Skills and Health) of Government’s 2019-2024 MTSF. The following impact statements are derived from the MTSF 2019-2024 and the outcomes identified for 2020/21-2024/25

Impact Statement A: Life expectancy of South Africans improved to 66.6 years by 2024 and 70 years by 2030.

Outcomes

Maternal, Child, Infant and neonatal mortalities reduced.
HIV incidence among youth reduced.
The 90:90:90 targets for HIV/AIDS achieved by 2020 and 95:95:95 targets by 2024/25.
Significant progress made towards ending TB by 2035 through improving prevention and treatment strategies.
Premature mortality from Non-Communicable disease reduced by 10%.
An equitable budgeting system progressively implemented and fragmentation reduced.
Resources are available to managers and frontline providers with flexibility to manage it according to their local needs.
Financial management strengthened in the health sector.
Management of medico-legal cases in the health system strengthened.

Impact Statement B: Universal Health Coverage for all South Africans progressively achieved and all citizens protected from the catastrophic financial impact of seeking health care by 2030.

Outcomes

Package of services available to the population is expanded on the basis of cost-effectiveness and equity.
Integrated services delivered according to the referral policy, at the most appropriate level, to ensure continuity of care.
Quality and safety of care improved.
Staff equitably distributed and have right skills and attitudes.
Community participation promoted to ensure health system responsiveness and effective management of their health needs.
Environmental health strengthened by contributing to improved quality of water, sanitation, waste management of their health needs.
Financing and delivery of infrastructure projects improved.
Adaptive learning and decision making is improved through use of strategic information and evidence.
Information systems are responsive to local needs to enhance data use and improve quality of care.

ANNUAL PERFORMANCE INDICATORS FOR 2020/21

Some of the key performance indicators under each programme are as follows:

Programme 1: Administration– The purpose of the administration programme is to provide support services to the NDoH. These (services) include: human resources development and management, labour relations, information communication technology, property management, security services, legal services, supply chain management and financial management.The Department plansfor the current financial year (2020/21) are:

Progressively implement an equitable budgeting system and reduce fragmentation.
Review the equitable share model for financing health, as well as conditional grants of the health sector.
Obtain an unqualified audit opinion for 2020/21 and six provincial departments to achieve improvements in audit outcomes with no significant matters.
Strengthen the management of the medico-legal cases in the health sector.
Ensure that resources are made available to frontline managers and providers with flexibility to manage in line with local needs.

Programme 2: National Health Insurance(NHI)– The purpose of the NHIProgramme is to improve access to quality health services through the development and implementation of policies to achieve universal health coverage and health financing reform.Under Programme 2, the Department plans to achieve the following:

Expand the package of services available to the population on the basis of cost-effectiveness and equity. This will include ensuring that 46 million people are registered on the Health Patient Registration System.
Ensure information systems that are responsive to local needs to enhance data use and improve quality of care by developing an electronic platform for the Master Health Facility List.
Improve the monitoring of the availability of medicine by ensuring that 3765 health facilities are reporting stock availability at national surveillance centre.
Improve quality and safety of care by ensuring that 3.5 million patients are registered to receive medicines through the centralised chronic medication dispending and distribution (CCMDD) system.

Programme 3: Communicable and Non-Communicable Diseases– The purpose of the programme is to develop and support the implementation of national policies, guidelines, norms and standards and the achievement of targets for the national response needed to decrease morbidity and mortality associated with communicable diseases (HIV, TB, malaria, influenza and others) and non-communicable diseases (mental health, cancer, hypertension, diabetes and others). This programme is also responsible for developing strategies and implementing programmes that reduce maternal and child mortality. The targets under Programme 3 for the current financial year (2020/21) include the following:

Reduce maternal, child, infant and neonatal mortality through the launch of the Side-by-Side radio campaign promoting child health; and the monitoring the implementation of Early Childhood Development (ECD) programmes.
Ensure that 98 Hospitals obtain 75% or more on the food service quality assessments.
Reduce HIV incidence among youth by ensuring that 800 PHC facilities has youth zones.
Reduce premature mortality due to non-communicable diseases (NCDs) by 10%, by marketing 100 health promotion messages through social media; and ensuring the development of implementation plans for the National Strategic Plan for non-communicable diseases by the nine provincial departments.

Programme 4: Primary Health Care (PHC)Services– The purpose of the Primary Health Care (PHC) Service Programme is to develop and oversee the implementation of legislation, policies, systems, and norms and standards for a uniform well-functioning district health system, including emergency and environmental health services. The targets for Programme 4 for the 2020/21financial yearinclude the following:

Improve quality and safety of care at health care facilities by ensuring that 350 PHC facilities and 50 hospitals are implementing the National Quality Improvement Programme.
Improve quality and safety of care at clinics by ensuring that 2,100 PHC facilities qualify as Ideal Clinics.
Improve quality and safety of care by ensuring that 25 ports of entry are compliant with international health regulations.
Ensure improved quality of water, sanitation, waste management and food by ensuring that 16 metropolitan and district municipalities are assessed for adherence to environmental norms and standards.
Ensure that services are integrated and delivered at most appropriate level, with continuity of care and appropriate referrals by ensuring that 10 districts have integrated referral system.
Promote community participation to ensure health system responsiveness and effective management of health needs by developing training material for public hospital boards; tracing of 600 000 patients by Community Health Workers (CHWs) and linking them to care; and ensuring that 2,000 PHC facilities have community outreach services.

Programme 5: Hospital Systems– The purpose of this programme is to develop national policy on hospital services and responsibilities by level of care; provide clear guidelines for referral and improved communication; develop detailed hospital plans; and facilitate quality improvement for hospitals.

The programme is further responsible for the management of the national tertiary services grant and ensures that planning of health infrastructure meets the health needs of the country. The targets for 2020/21 under Programme 5 are:

Improve the financing and delivery of infrastructure projects by ensuring that 78 public health facilities are constructed or revitalised; and 150 are maintained, repaired and /or refurbished.
Improve quality of care by ensuring that nine provinces are compliant with Emergency Medical Services (EMS) Regulations and have developed quality improvement plans.
Ensure that resources are available to managers and frontline providers, with flexibility to manage according to their local needs by ensuring that organisational structures for tertiary, regional and specialised hospitals are developed.

Programme 6: Health System Governance and Human Resources– The purpose of this programme is threefold:

To achieve integrated health systems planning, monitoring and evaluation and research.
To develop and monitor the implementation of health workforce policies and ensure effective health workforce planning, development and management in the national health system, as well as alignment of academic medical centres with health workforce programmes and training of health professionals. It assists the government to achieve the population health goals of the country through nursing and midwifery, through the provision of expert policy and technical advice and recommendations on the role of nurses in attainment of desired health outputs.
To conduct oversight over public entities and statutory health professional councils, and ensure compliance through applicable legislative prescripts.

Targets under Programme 6 for the current financial year (2020/21) include the following:

Improve quality and safety of care by ensuring that nine public nursing colleges are accredited and registered to offer basic nursing and midwifery programmes; and the clinical governance system is assessed and implementation plans for three provinces are developed.
Ensure that staff is equitably distributed and have right skills and attitudes by:

Ensuring capacity for Human Resources for Health (HRH) policy development, planning and monitoring.
Implementing HR information system at National and Provincial Head offices.
Reviewing and publishing the community service policy.
Implementing and monitoring of OSD (Occupational Specific Dispensation), commuted overtime and RWOPS (Remunerative Work Outside the Public Service) policies.
Developing the implementation plan for an automated employees time management system (with biometrics and automated notifications) for all health establishments.

Publish the Implementation Guideline on the use of Health Patient Registration Number (HPRN) on clinical stationary in public health facilities .
Identify the revised version of the Interoperability Norms and Standards for Digital Health published and 2 priority cases for applying standards.
Complete the performance dashboards for national, provincial and district levels .
Publish National Health Research priorities.
Complete 90% of blood alcohol tests within 90 days.

Budget Analysis

5.1.Consolidated Health Budget

The public health budget spans across the national department, its entities and the provincial departments of health. The consolidated budget for 2020/21 totals R229.7 billion, up from R222.6 billion in the previous financial year.

Economic classification:

A significant portion of the consolidated health expenditure 63.2%, down slightly from 63.3% in the previous financial year, is dedicated to Compensation of Employees, which totals R145.1 billion, up from R140.8 billion.
Consolidated health expenditure on Goods and Services totals R67.1 billion, up from R64.7 billion, which constitutes 29.2% of overall health expenditure.
Consolidated health expenditure also makes provision for R11.4 billion (4.9%) allocated to Capital spending and transfers, and R6.1 billion for Current transfers and subsidies (2.7%).

National Department of Health Budget (2020/21)

For the 2020/21 financial year, the Department has been allocated a budget of R55.5 billion, up from R51.2 billion for 2019/20. This represents an increase of 8.4% in nominal terms (3.9% in real terms).

Table 1: Budget allocation by programme for the 2020/21 financial year

The two largest programmes, namely Programme 3: Communicable and Non-Communicable Diseases (R25.2 billion) and Programme 5: Hospital Systems (R21.8 billion), jointly constitute 84.6% of the total budget allocation to the Department. Programme 4: Primary Health Care Services, receives the smallest allocation (R238.3 million), which is less than half a percent (0.4%) of the Department’s budget.

Economic classification:

The bulk of the Department’s budget (R51.3 billion or 92.4%) consists of transfers and subsidies. This figure includes R49.3 billion to provinces and municipalities, R193.4 million to non-profit organisations (NPOs), and R1.8 billion to departmental agencies and accounts.

Current payments constitute a total value of R3.0 billion, which represents 5.4% of the total budget allocation. Approximately R905.8 million (30.1% of the current payments budget) is allocated to Compensation of employees.
However, most of the current expenditure (R2.1 billion) is allocated to Goods and Services, constituting approximately 70% of the total current payments.
Expenditure items that received the largest share of the Goods and Services budget are Contractors at R808.2 million; Consultants: Business and advisory services at R295 million; Agency and support/outsourced services at R192.2 million; Medical Supplies at R115.6 million; and Operating leases at R185.2 million; and Travel and Subsistence at R113.3 million.
Capital assets is allocated R1.2 billion. Buildings and other fixed structures are allocated R892.1 million, and Machinery and Equipment is allocated R343.2 million.

Spending priorities for 2020 MTEF:

Over the 2020 medium-term, the Department will continue to focus on the implementation of the NHI, HIV and AIDS, and TB treatment and prevention programmes, and investing in Public Health Infrastructure.

Over the MTEF, the Non-Personal component of the National Health Insurance Indirect Grant is allocated R2.2 billion to, amongst other things, strengthen health information systems, the Ideal Clinic initiative, as well as the CCMDD.
The Personal Services component of the National Health Insurance Indirect Grant is allocated R935.9 million over the MTEF, mainly to contract General Practitioners (GPs) to provide primary health care services in their own practises. GPs will be paid according to the number and risk profile of patients treated. R1.4 billion of this grant has been reallocated towards direct conditional grants, which are transferred to provinces. Of this amount, R900.1 million is reallocated to the Direct National Health Insurance Grant to fund the contracting of GPs to do sessional work in public primary health care facilities, and R452 million is reallocated to provinces to strengthen mental health and oncology services.
The HIV, AIDS and STIs sub-programme of the Communicable and Non-Communicable Diseases programme is allocated R75.9 billion over the medium term. Spending will increase with an additional R1 billion allocated in 2021/22, resulting in an increase from R20 billion in 2019/20 to R24.5 billion in 2021/22.
The new TB component of the HIV, TB, Malaria and Community Outreach Grant is thus allocated R1.6 billion over the medium-term.
The Malaria component of the HIV, TB, Malaria and Community Outreach Grant amounts to R345.4 million over the MTEF.
The Community Outreach component of the HIV, TB, Malaria and Community Outreach Grant aims to address the standardisation of training, performance monitoring and remuneration of Community Health Workers (CHWs). R800 million is reprioritised from the HIV and AIDS component to the Community Outreach Services component in 2020/21 to ensure the standardised stipend of R3 500 per month is implemented throughout the country for all CHWs.
The Human Papillomavirus (HPV) vaccine programme is allocated R701.7 million over the MTEF period.
The National Tertiary Services Grant is allocated R14.1 billion in 2020/21.
A developmental allocation is introduced from 2020/21 to increase equitable access to tertiary service with the aim of bringing services closer to patients in provinces such as the Eastern Cape, Limpopo, Mpumalanga and the North West.

5.3.Budget allocation per Programme (2020/21)

Programme 1: Administration

The budget for Programme 1 increases by 1.8% in nominal terms (decreasing by 2.5% in real terms) from R660.2 million in 2019/20 to R672.2 million in 2020/21. In terms of economic classification, 98.5% of the budget is allocated to current payments. Compensation of employees amounts to R268.5 million, while R393.7 million is allocated to Goods and Services. This includes R178 million for Operating leases, and R51.1 million for Travel and subsistence.

Table 2: Programme 1: Administration

The largest sub-programme is Corporate Services, of which the allocation increases by 0.8% in nominal terms, but decreases by 3.5% in real terms.
The largest increase is seen in the Ministry sub-programme, which increases by 31.6% in nominal terms (26% in real terms).

Programme 2: National Health Insurance

The Programme’s budget increases significantly by 27.2% in nominal terms (21.8% in real terms), due largely to increased funding for the Health Financing and NHI sub-programme which increases by 27.3% in nominal terms (21.9% in real terms).

All sub-programmes experience increases well above inflation, unlike the previous financial year when the Affordable Medicine sub-programme declined both in real and nominal terms.

Table 3: Programme 2: National Health Insurance

Programme 3: Communicable and Non-Communicable Diseases

The bulk of this programme’s budget (98.9%) is allocated to the HIV, AIDS and STIs sub-programme, amounting to R24.9 billion in 2020/21. This represents a nominal increase of 11.1% (6.5% in real terms). The remaining seven sub-programmes combined receive less than 1.1% of the programme’s budget.

Table 4: Programme 3: Communicable and Non-Communicable Diseases

The Tuberculosis Management sub-programme increases by 8.6% in nominal terms and by 4% in real terms.
The Women’s Maternal and Reproductive Health sub-programme is responsible for, amongst other things, reducing maternal mortality and improving access to sexual and reproductive health services. This sub-programme received less than 0.1% of the programme budget. It increases by R2.3 million in nominal terms from the R16.8 million received in the previous year, which represents an 8.9% real increase.
The Child, Youth and School Health sub-programme decreases significantly by 84% in nominal terms (declining by 84.7% in real terms) from R183.6 million to R29.4 million in 2020/21.
The Communicable Diseases sub-programme increases by R1.3 million in nominal terms (1% in real terms).
The Non-Communicable Diseases sub-programme is responsible for amongst other things, chronic non-communicable diseases, mental health and substance abuse. This sub-programme’s budget increases by R45.3 million or 67% in nominal terms and by 60% in real terms.
The Health Promotion and Nutrition sub-programme decreases by 8.9% in nominal terms and 12.7% in real terms.

Programme 4: Primary Health Care

This Programme’s budget increases by 7.9% in nominal terms and 3.3% in real terms, increasing from R220.9 million in 2019/20 to R238.3 million in 2020/21.

The District Health Services sub-programme increases by 54% nominally (47.5% in real terms) from R20 million in the previous year, to R30.8 million in 2020/21.
Emergency Medical Services and Trauma increases by 1.1% in nominal terms (declines by 3.1% in real terms) from R8.9 million in 2019/20 to R9.0 million in 2020/21.

Table 5: Programme 4: Primary Health Care

Programme 5: Hospital Systems

The total budget for Programme 5 grows from R20.4 billion in 2019/20 to R21.8 billion in 2020/21. The budget for this programme increases by 6.6% in nominal terms, and 2.1% in real terms. About 93.9% of the programme’s funding is transferred to provinces through the National Tertiary Services Grant and Health Facility Revitalisation Grant.

Table 6: Programme 5: Hospital Systems

The 2020/21 allocation to the Health Facilities Infrastructure Management sub-programme increases by 6.3% in nominal terms from R7.2 billion in 2019/20 to R7.7 billion in 2020/21 (increasing by 1.8% in real terms).
The Hospital Systems sub-programme increases by almost R1 billion (R884.3 million) from R13.2 billion in 2019/20 to R14.1 billion in 2020/21, representing nominal growth of 6.7% and 2.2% in real terms.

Programme 6: Health Systems Governance and Human Resources

Programme 6 grows by 4.4% in nominal terms, from R5.99 billion to R6.3 billion in 2020/21. This programme overall remained abreast of inflation.

Table 7: Programme 5: Health Systems Governance and Human Resources

The Human Resources for Health sub-programme receives R4.2 billion, an increase of 8% in nominal terms from the previous financial year’s total of R3.9 billion.
The Public Entities Management sub-programme, receives R1.98 billion, decreasing by 2.9% in nominal terms (7% decrease in real terms) from the previous year’s allocation of R2 billion.
The Nursing Services sub-programme receives an increase by only 1.1% in nominal terms from R9.4 million to R9.5 million in 2020/21, a decrease of 3.2% in real terms.

COMMITTEE FINDINGS, OBSERVATIONSAND RECOMMENDATIONS

Having considered the Strategic Plan, APP and the budget of the Department, this section summarizes the Committee’s findings, observations and recommendations:

Findings and Observations

The Committee welcomed the Strategic Plan and APP of the Department and indicated the need to understand how emerging issues due to the coronavirus (COVID-19) pandemic will be addressed. There are concerns regarding the impact of COVID-19 on the implementation of strategies and programmes of the Department.

The Committee flagged various concerns around the COVID-19 pandemic, particularly in the Western Cape, including:

General management of patients;
Testing capacity that is under strain;
Reduced capacity of nursing care in hospitals and its impact on the overall quality of care;
Occupational health and safety concerns of nursing staff;
Unavailability of personal protective equipment (PPE) for EMS personnel;
Factories not adhering to protocols; and
The need for inter-sectoral collaboration.

The Committee commended the National Institute for Communicable Diseases (NICD) for the role it has played in the COVID-19 pandemic.

The Committee noted with concern the high number of COVID-19 infections coming fromprivate health facilities.

The Committee observed the concerns highlighted by the Auditor-General regarding the Department’s stagnation in key control areas, including financial management, information technology and compliance management.

On the performance of provincial departments, the Committee observed that the Auditor-Generalidentified eight (of nine) key control areas that needed to be addressed for improved audit outcomes.

The Committee noted with concern the Auditor-General’s continuous finding on the quality and reliability of performance information.

The Committee expressed concern that fruitless and wasteful expenditurein the health sector continues to rise.

The Committee wasconcerned that the programmes of the Department were not aligned to the organizational structure of the Department.

The Committee noted that health care facilities that meet quality standards are central to the achievement of Universal Health Coverage. However, concernswere raised in relation to the low target forhospitals (60%)to be certified by the Office of Health Standards Compliance;and the 100% of PHC facilities that will only qualify as Ideal Clinics in 2024/25.

The Committee observed with concernthe low budget allocation forPHCfor this financial year.

The Committee noted that mental health care remains a critical issue in South Africa, and highlighted the need for improved budget allocation to implement the Mental Health Policy Framework and Strategic Plan (2013-2020) in provinces, through improving mental health human resources, setting up District Mental Health Care Teams, improving mental health infrastructure and strengthening awareness campaigns.

The Committee raised the importance of the integration of Community Health Workers into the public health sector workforce.

The Committee noted with concern the slow progress inmeeting targets of some of the key health indicators, in particular the reduction of mortality rates.

The Committee commended the Department in the provision of contraceptives in public health facilities, however, highlighted the need to strengthen sexual and reproductive health services amongst the youth.

The Committee observed the integration of grants, in particular the merging of the HPV Grant with the HIV Grant and was concerned that this may impact on progress of the human papillomavirus vaccination (HPV) programme.

The Committee raised the need for a collaborative approach to address the scourge of TB.

The Committee raised the need for efficient use of the Health Facility Revitalisation Grant to address health infrastructure challenges.

The Committee raised the need for plans to address premature mortality linked to social determinants of health.

The Committee raised theimportance of filling vacant posts with suitably qualified personnel.

The Committee expressed a concern around the use of the Civitas Building bythe Department when it was found to be unsuitable.

Recommendations

The Committee recommends the following to the Department:

Response to COVID-19: The Department should ensure that the Western Cape is supported in its fight against the spread of COVID-19 and that progress is monitored and reported on timeously.

Cross-sectoral interventions on COVID-19: The Department should engage with relevant stakeholders in the fight against COVID-19 and to ensure improved health care services.

Private health sector: The Department should ensure that private health facilitiesaremonitored and ensure that they comply with infectious control and preventionguidelines.

Entities: The Department should ensure that entities such as the NICD and NHLS are strengthened and capacitated to ensure effective response to outbreaks.

Mental health services: The Department should develop a Mental Health Monitoring Policy to monitor and evaluate the implementation of the Mental Health Policy Framework and Strategic Plan (2013-2020). Furthermore, the Department should consider a collaborative approach to mental health care in order to strengthen the accessibility and delivery of mental health services.

Financial management in provinces: The Department should assist provincial departments to strengthen financial planning and management. In addition, the Department should monitor provincial budget expenditure against approved plans.

Audit outcomes: The Department should ensure that systems and measures are put in place and internal controls strengthened to prevent fruitless and wasteful expenditure at national and provincial departments.

Monitoring: The Department should ensure oversight and monitoring of the implementation of the Auditor General’s findings on key areas of internal controls and financial management.

Community Health Workers: The Department should provide the Committee with an update on the implementation of the National Community Health Care Worker Policy in ensuring the integration of CHWs.

Improving the quality of health care in the public sector: The Department should continue to work towards improving the quality of health care in the public health sector.

Primary Health Care: The Department should update the Committee on the extent of the implementation of norms and standards for PHC to ensure that funding is sufficiently allocated for PHC services. Additionally, the Department continue to support provincial departments in implementing the Ideal Clinics programme.

Social determinants of health: The Department should present to the Committee, plans developed in collaboration with other government departments in addressing the social determinants of health.

Response to tuberculosis: The Department should ensure inter-sectoral collaborations for effective response to TB.

Health Infrastructure: The Department should ensureimproved performance on health infrastructure spending through the prioritisation of critical infrastructure needs and facilities that require urgent revitalisation.

Human Resources for Health: The Department should finalize and monitor the implementation of the HRH Strategy and Plan 2019-2024, to ensure that vacancies are timeously filled, including all clinical, non-clinical and senior level positions.

Civitas building: The Department should ensure that a suitable building is secured.

CONCLUSION

The Committee commends the hard work of the Minister, MECs, National and Provincial Departments of Health in the country’s response tothe COVID-19 pandemic.

Unless otherwise indicated, the Department of Health should respond to the Committee recommendations in three months from the day the report is adopted by the House.

Report to be considered.

Documents

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