Adjustments Appropriation Bill: Departments of Health and Social Development briefings; with Ministers and Deputy Minister

Meeting report

Minister of Health’s opening remarks

The Chairperson welcomed Mr Zweli Mkhize, Minister of Health, and expressed his appreciation for the presence of the full team at the meeting.

The Minister thanked the Chairperson for the invitation and welcomed his delegation, which included Dr Joe Phaahla: Deputy Minister of Health, Dr Sandile Buthelezi, Director-General (DG): National Department of Health (NDOH), and Mr Ian van der Merwe: Chief Financial Officer (CFO), as well as senior officials from the Department.

The COVID-19 pandemic required a wholesale reprioritisation of budgets at the national, provincial and municipal levels. To this end, National Treasury (NT) had embarked on a process of reprioritisation, and provinces were requested to redirect R130 billion in favour of the pandemic. The NDOH had reprioritised R2.6 billion from its direct and indirect grants and voted funds for COVID-19 relief programmes. The R1.9 billion from the conditional grants had been mostly redirected within digital services. The R2.9 billion from NT would form part of the COVID-19 component, and the HIV grant would be redirected to the provinces. Reprioritised funds would be used to fund personal protective equipment (PPE), screening equipment, information communication technology (ICT) infrastructure, the Port Health Services and the Cuban Brigade.

The Chairperson asked whether a presentation was available for the benefit of the Members.

The Committee Secretary confirmed that the presentation was ready to be shared after the opening remarks of the Minister.

The Minister said that the R37 billion requested from National Treasury was based on a conservative estimate. Although it exceeded the R21.5 billion that had been allocated to the health sector, it would go a long way to address the challenges associated with the pandemic. The need was much bigger, which meant the effective use of resources was very important. There was a possibility that current activities could be affected, but the reprioritisation was done in areas where the impact was minimised. Provinces were granted flexibility within conditional grants, should the need arise.

The Minister presented to the Committee the adjustments in line with the Bill that had been presented by the Finance Minister on 24 June 2020.

Department of Social Development

Situation overview

Mr Linton Mchunu, Acting Director General, Department of Social Development (DSD), said the Department was represented by officials from the DSD, the South African Social Security Agency (SASSA) and the National Development Agency (NDA). The DSD was guided by the Standing Committee in terms of the areas that needed to be covered in the presentation, although a lot more information could have been included. The presentation was split between the Chief Director of the DSD, and the chief executive officers (CEOs) of SASSA and the NDA.

Mr Mchunu said that to mitigate the challenges posed by COVID-19, suitable measures had been implemented to adapt to the “new normal,” while considering the safety of staff. A rigorous process, guided by science, had been followed to adjust the budget and to determine if targets could be implemented. Face-to-face services had been slightly amended, having considered the safety of health workers. The implementation of social grants to the 18.3 million beneficiaries had been done in terms of a staggered approach to reduce congestion at access points. The elderly and people with disabilities were paid monthly on the third and fourth, while everybody else was paid three days later. Restrictions had been lifted on some institutions, which had prompted the Department to work on readiness programmes for the opening of Early Childhood Development (ECD) centres, such as providing support measures like PPE. However, old-age homes remained closed, as the elderly were most affected by the pandemic.

To ensure continuity of service, a hybrid model of work had been introduced, where some staff would work from home and others worked at the office on a rotational basis. The Department was working more closely with provincial departments through the District Development Model (DDM) and had broadened cooperation with business, civil society and ordinary citizens to extend the reach of essential services. With limited resources, some of the funds had been allocated to prioritise and respond to the three key areas -- food insecurity, high levels of unemployment and gender-based violence (GBV) programmes. Funding had been allocated for the implementation of the R350 social relief of distress (SRD) grant payment for the unemployed, top-ups of the existing social grant payments and the scaling up of the food distribution programme. To date, R540 million had been spent to feed more than 6 million people.

For the next few months, the focus would be on hotspots. For the next three months, R860 million was required to provide food parcels at a cost of R750 per parcel. Non-governmental organisations (NGOs) and other donors were playing an important role, and assisted the Department with food relief programmes. The NDA employed 580 volunteers who promoted the issue of behavioural change in communities through advocacy programmes. The Ministerial Advisory Committee also used the volunteers to assist with the distribution of food parcels.

2020 Special Adjusted Budget

Mr Thabani Buthelezi, Chief Director: DSD, said that R33 million of the R56 million operational budget had been reprioritised to facilitate the appointment of social workers on a temporary basis, and R23 million was used for the procurement of PPE. The conditional grant of R64.5 million had been repurposed to prepare for the opening of ECD centres.

The additional request by SASSA to fund the top-up of social grants and the new R350 SRD grant, had been declined. The NDA budget was not adjusted.

He explained that SASSA was responsible for the administration and payment of grants. Poverty alleviation, building capacity and other means of assistance was the responsibility of the NDA.   

The adjustment budget had a limited impact on the mandate of the Department. It was able to use technology optimally, and had amended the food distribution model.

Governance structures were in place to strengthen oversight functions. The three entities met regularly for approval of revised plans and budget adjustments. The internal audit function was in place to ensure internal controls were operating effectively.

Mr Buthelezi said that of the 7.5 million applications received for the special COVID-19 R350 SRD grant, 2.1 million had been declined. An appeals process was in place to deal with the declined applications.

The DSD was not the only player in the space of food distribution. To date, 1.2 million parcels had been distributed that reached over six million people with the assistance of other entities, including non-profit organisations (NPOs) through the Solidarity Fund and the Department of Environment, Forestry and Fisheries (DEFF). The Department appreciated the contribution of businesses and ordinary people, who were all important players in the food distribution process.

The increase in unemployment would add to the demand for food parcels. It was projected that R868 million would be needed to provide 1.5 million food parcels for the next three months.

The NDA employed 580 volunteers to support the distribution of food parcels and to help with social distancing during grant payments.

The procurement of PPE had been done according to Treasury instructions. SASSA had paid almost R150 million in the first quarter to black-owned businesses for the provision of food parcels on short-term contracts.

DSD, SASSA and NDA: Fourth quarter performance

The overall performance of the DSD and its entities during the fourth quarter of 2019/20 was not exceptionally good. The portfolios recorded targets against objectives as follows: DSD – 70%, SASSA – 71%, and NDA – 71%. Incomplete targets had had to be shifted to the next quarter.

The finances of the three portfolios reflected the following results in terms of expenditure at the end of the fourth quarter: DSD – 108%, SASSA – 90%, and NDA – 100%. Deviations in the spending patterns had been due to disaster relief measures that needed urgent implementation. Not all commitments had been fully realised, and the outbreak of the pandemic had compounded the challenges. The demand for services had had an impact on the planned commitments of the DSD portfolio.

Amongst the key lessons learnt was that the government needed to be ready to act in the event of a disaster. The investment in ICT needed to be scaled up significantly to facilitate real time data gathering, to ensure evidence-based decisions. Expanding the research agenda included input on the R350 grant, youth perceptions and the evaluation of food distribution programmes. Valuable lessons had also been learnt from partnerships with NGOs and the business sector.

The DSD portfolio recommended that the Committee take note of the significant changes to the budget to facilitate the funding of COVID-19 interventions.

Discussion

Ms N Ntlangwini (EFF) asked why a fully digitised programme for food distribution was not in place. Most people had cell phones which could be used for messages on where to collect money – for example, at Boxers or Shoprite stores. It seemed that there was a reluctance to move into the digital space. She asked how much work had been done to become fully digitised. The current way of doing things was not helping. As public representatives, Members received complaints from the public about the R350 SRD grant. Some applicants had been declined while others had received the first payment, but no follow up payments were made. She asked where such cases could be reported to.

Mr Z Mlenzana (ANC) questioned why social workers were appointed on a temporary basis only. Would it not create a challenge for their re-employment in future? He requested that the work of the advocacy campaign be made public, and asked for details about the performance on social relief grants after the involvement of ward councillors had been stopped. He asked what the Department was doing at schools regarding the psychological problems such as drug and alcohol abuse. The people in the rural areas had found it difficult to access the sophisticated digital platforms for the R350 grant. He wanted to know whether there would be a second round of applications for people who had lost out in the first round.

Mr A Shaik Emam (NFP) said that a lot of money had been spent on the training of social workers, but they remained unemployed. He informed the Members about a WhatsApp group that had been formed by social workers where they shared similar experiences of being qualified but unable to find work. In light of GBV being on the increase, the need for social workers was increasing. A lot of money had been allocated for GBV programmes. He asked where the money had been diverted to. It was his view that GBV programmes dealt with the after-effects of societal problems. Social workers and field workers were better equipped to identify problems before they escalated. He requested a complete breakdown of PPE expenditure to see where over-charging was taking place. The lack of a database for the distribution of food parcels was problematic.

Mr D Joseph (DA) said that although it was good to talk about shocks and disasters, in his experience these challenges were brought on to the government by this Department. The DSD acknowledged that the assistance of the private sector and NGOs was needed, so it was important to let these entities know and not only admit it to the Committee.

Mr X Qayiso (ANC) said that while doing oversight in the Free State, he had observed that the DSD and SASSA did not seem to be doing well with organising food parcels. He welcomed the increase in the budget for GBV programmes following the increase in GBV incidents during the lockdown period. He asked what the status was of projects financed by the Solidarity Fund. He questioned why some people in disadvantaged areas were disqualified from receiving the R350 grant payment, based on the fact that they received donations for as little as R10 to R20 in their bank accounts from family members.

Mr Shaik Emam argued that the DSD did not have a mechanism to ensure that children, for whom grant payments were made, attended school. He asked how this matter was being dealt with by the Department.

Ms D Peters (ANC) reported that it had became cumbersome to interact with SASSA on the issues of food parcels and the R350 grant payments after the introduction of the clustering arrangements. She asked how the Department was dealing with people who qualified for the grant but did not get paid after the first payment was made. It was easier during the old system, where they had regional executive managers (REMs). For example, in the Northern Cape it was difficult to engage with SASSA on matters that affected the most vulnerable members of society, who depended on the state for sustenance such as the R350 grant for the unemployed and the problems of homeless people. She reported a case of two people who had been using a bus shelter since March 2020. No one seemed to know whether the responsibility for the homeless was with the municipalities or the DSD. She questioned whether the district model did not apply to SASSA and whether the plan was to cluster all the provinces. She supported the voucher system and the digitisation of the food parcel scheme, provided this was where network connectivity was not a problem.

The Chairperson welcomed Ms Lindiwe Zulu, Minister of Social Development, and informed her that the team delivered a good presentation. He asked for clarification about the relationship between SASSA, the South African Post Office (SAPO) and the DSD. It had been reported that if applicants missed collecting the first R350 grant payment, they did not qualify for subsequent payments. He asked whether it was true and why someone would be punished in this way. The majority of unemployed people were un-banked, and he questioned if payments were made to bank accounts. Local government was a constitutional structure, but there was a tendency to de-legitimise councillors. He acknowledged that instances of fraud happened at that level, but said that the problem must be dealt with at an individual level and that “the baby should not be thrown out with the bath water.”

Minister Zulu apologised for joining the meeting at this late stage, and explained that it was due to load shedding in her area. She thanked the Members for their input and questions. She agreed that the DSD had faced challenges before COVID-19, but the Department was on a good track. The DSD realised that it could not work in isolation, hence the portfolio approach had been introduced to coordinate resources and the different ways of working. The resources were needed to match the scale of the problem, and COVID-19 presented an opportunity to review the progress made by the Department. At the end of 2019, the Relief of Distress programme had been discussed with SASSA, but it needed to be re-engineered to address the needs of the people.

The Minister asked the officials to respond to the questions raised before she had joined the meeting. She would give concluding remarks afterwards.


SASSA on Covid-19 support

Ms Totsie Memela, CEO: SASSA, elaborated on the SASSA-related matters in the presentation.

She referred to the issue of the R350 grant which had been sharply raised by Members. To date, 7.5 million applications had been received. To prevent double dipping, the applications had been put through a rigorous process to check that income was not received from other sources, including from the Unemployment Insurance Fund (UIF), SASSA and the National Student Fiancial Aid Scheme (NSFAS). They were also checked against the South African Revenue Service (SARS) database to check the employment status of applicants. Instances were found of applicants receiving other grant payments. The initial UIF database included people not employed for three years. Based on a subsequent database, a million more people had qualified for the grant and were paid in May 2020. Late applications got paid according to the date of application. The NDA was deployed to rural areas to assist with online applications. The appeals process for declined applications was accessible on various platforms, including the WhatsApp number 082 046 8553.

Ms Memela explained that councillors worked with other stakeholders on the ground, but were excluded from the distribution process after SASSA was had been accused of giving food parcels to politically connected citizens.

One of the Covid-19 Challenges was that in terms of a directive, any person receiving any income should not qualify for the SRD grant. SASSA was working with the banks to check for deposits of lump-sum payments over the past three months.

In response to the issue of raised by Ms Peters, the CEO replied that the consolidation of regions did not mean that structures did not exist. Despite the high-level structures, general managers were still operating in the regions.

Discussion

The Chairperson asked whether every SASSA region had a general manager.

Ms Memela confirmed that each region had a general manager with the core function of being responsible for engagement on grants. The clustering process was being piloted to make sure that the people were served.

Ms Peters asked whether SASSA, as an agency of the state, was reverting back to the demarcation of the apartheid government. She argued that the engagement on societal issues involved more than just grants. She asked for an explanation of the rationale for the clustering model, which she deemed to be problematic.

Ms Memela replied that the regions still had responsibility for the districts. Currently, there were three high-level clusters, and engagement with districts were on-going.


National Development Agency: Covid-19 interventions

Ms Thamo Mzobe, CEO: NDA, elaborated on the issues in the presentation that related to the responsibilities of the NDA. She said the agency was focussed on building capacity. A national database was kept of volunteers, including those employed by NGOs and NPOs. Capacity building involved advocacy and skills development initiatives to be shared with communities in their local languages. People in rural areas struggled to do applications on electronic gadgets. The unemployed youth came in handy to assist with online applications. On level five of the lockdown, volunteers had assisted with the distribution of parcels in communities. In the initial lockdown stages, R1.8 million had been allocated for the payment of stipends for the 580 volunteers, and fees for their deployment in 52 districts.

Discussion

Mr Mlenzana requested a breakdown of the R1.8 million costs.

Mr Mchunu explained that the distribution of food parcels was labour intensive and cumbersome, and that e-vouchers and digitisation were being considered as alternative options. A hybrid model was envisioned, consisting of a combination of e-vouchers and food parcels. The goal was to offer a variety of products and provide dignity to citizens by allowing them to use the vouchers at spaza shops that would contribute to the distribution of money within their communities. The Department was extending support measures, but was aware that the fiscus was under strain.

COVID-19 presented an opportunity to employ more social workers to help with the current challenges. The DSD was also working with NGOs for the redeployment of social workers. He agreed that it was imperative to have a database for food distribution, as it would help to prevent duplication. The Department was committed to improving the quality of life of citizens. The Preferential Procurement Policy Framework Act (PPPFA) regulations had been applied to procure from small businesses in all provinces, such as masks that were procured from cooperatives.

Minister Zulu reminded Mr Mchunu that the allocated time was running out, and she still needed to respond to some of the issues raised.

The Chairperson said that he would allow the Minister sufficient time for her closing remarks.

Mr Mchunu said that DSD worked closely with the Department of Cooperative Governance and Traditional Affairs (COGTA) on providing shelters where programmes for the homeless involved equipping them with soft skills, reunification with family members, and support for substance abuse. The stimulus package had been repurposed to provide additional support to ensure compliance with COVID-19 regulations for the opening of ECD centres.

Minister’s response

Minister Zulu said that the task of the DSD was made difficult due to the challenges of COVID-19. She was of the opinion that matters were being rushed, and suggested that more time was needed to respond properly to the questions from Members of the Committee. The DSD could not single-handedly deal with all the issues, and needed to strengthen cooperation with other entities. A lot of work was needed to empower provincial and local institutions who were at the front line of facing the challenges. Councillors played an important role in identifying the vulnerable, to redirect them through the appropriate channels and to provide a breakdown of the food distribution programme. It was not their role to be involved in the distribution of aid, as this created the opportunity for corruption.

The Minister said that she had a good working relationship with the Members of Executive Councils (MECs) in the Northern Cape, and that cooperation existed between SASSA and the NDA. However, working on the ground was a different story. The well-being of citizens was her responsibility, irrespective of politics. The cluster model did not mean that the existing system was irrelevant, but it was necessary to respond to changing circumstances.

The Chairperson reminded the Minister to respond to the issue of the relationship with the Post Office and the Post Bank.

Minister Zulu said that volunteers were the foot soldiers, and it was envisaged that they would connect with other structures including doing house-to-house visits with social workers. She thanked them, in their absence, for their bravery and their contribution. She acknowledged that the relationship between SASSA and the Post Office was a problem. The Post Office had problems with robberies, but the measures to address these challenges were inadequate. The President had requested a report about the situation.

The Chairperson said that they were working under strict timeframes, and apologised for the limited time allocated for responses. He acknowledged that these were big issues and that more time was needed to engage on the Post Office issue.

The Minister said that the DSD was considering all options to make it easier for people to access the R350 grant payment.

The meeting with the DSD was adjourned.

Department of Health: 2020 Special Adjustment Budget

Mr Ian van der Merwe, CFO: NDOH, explained that budgets were done at a specific point in time and required flexibility. The initial costed plan had been submitted to the National Treasury on 17 April. The model had been recalibrated and submitted to the NT on 27 May.

The Covid-19 summary bid reflected a breakdown of the R37.6 billion budget, including the elements of PPE. It also showed the allocation of R4.1 billion by National Treasury, which was far less than the budget.

Reprioritised areas to be funded through the COVID-19 component included PPE, critical care beds, laboratory tests performed by the National Health Laboratory Service (NHLS), and the procurement of thermometers. At a national level, funds had been allocated for COVID-19 communication, ICT needs, procurement of buffer stock for which a warehousing tender would be finalised on 17 May, Port Health Services to facilitate environmental initiatives, and the Cuban Brigade.

National Treasury had approved the reprioritisation of R2.6 billion for COVID-19 relief programmes. Most of the allocations were based on the needs as identified by the provinces. An additional R2.9 billion was allocated for the funding of COVID-19 relief programmes. R283 million had been ring-fenced for the Cuban Brigade.

Indirect grants of R200 million were reallocated for a field hospital in KwaZulu-Natal (KZN), and voted funds of R411 million for PPE buffer stock.

R3.4 billion of the conditional grant for HIV, tuberculosis (TB), community outreach services (COS), malaria and the human papilloma virus (HPV) had been reprioritised to COVID-19 components. The business plans from provinces were expected by the end of July 2020, and would be evaluated to determine which elements could be retained.

Referring to the way forward, Mr Van der Merwe said the provincial revised budgets needed to be collated to evaluate the reallocation of the R15 billion from the supplementary budget. Service delivery implications were the effect on the HIV programme – a delay in treatment may lead to complications and a higher level of care for recovery – and the infrastructure programme, as the postponement of new projects could worsen the backlog.
 
To make effective use of resources, National Treasury had established a framework for using COVID-19 funds to assist provinces. The in-year-monitoring (IYM) tools were used to ensure the validity of transactions.

Mitigating strategies for continued service delivery would involve a focus on the maintenance of existing facilities, rather than the building of new facilities.

For Broad Based Black Economic Empowerment (BBBEE), a point-scoring measure was being applied within the procurement and tender processes. Consideration had been given to the employment of local manufacturers, but there were challenges.

Although a number of fourth quarter targets had been achieved in all six programmes, action had been taken to improve the performance in terms of the annual performance plan (APP). The focus on the repurposing of funding for COVID-19 had resulted in the removal of some indicators and the combination of others.

Summarising the DSD’s financial performance, Mr Van der Merwe said that as at 31 March, 99% (R50.7 billion) had been spent. Among the many reasons for deviations, key areas included the late payment of Microsoft licence fees due to the lockdown, invoices for condoms had been received late, and there had been difficulty with the implementation of the new warehouse management system.

To date, 89% (R1.4 billion) of the revised National Health Insurance indirect grant budget of R1.5 billion had been spent.

Direct grant spending as at 31 March, was reported at 98% (R45.7 billion) of the adjusted budget of R46.3 billion. This was not the final position, and the provinces still had the opportunity for adjustments. All the funds allocated to direct grants had been transferred to the provinces, and the transfers were being monitored.

Discussion

Mr O Mathafa (ANC) asked which variables would suffer as a result of the reduction in the initial budget of R37 billion. He was concerned about the reduction of the HPV grant, as it would impact on young women being at risk of cancer. He was happy that the HIV grant was protected at the provincial level. He asked if the reprioritisation of the budget would impact on the TB grant. He was concerned about the unemployed graduates, and requested a breakdown of the number of vacancies and the timeframes for the restructuring process.

Mr Mlenzana commented that it was only recently that he became aware of the volunteers after the issue of them being mishandled by the police had been reported. He asked how long volunteers had been working in the Department, and why they were not employed on a permanent basis. He linked the reduction of the grant to the rolling out of the National Health Insurance (NHI) scheme, and raised the issue of the number of medical facilities that were not operating effectively, including the clinic in Mount Frere (which was now a hospital) and the Maluti Health Care Centre.  The provision of sub-standard PPE had been linked to the death of 38 health care workers in the Eastern Cape, and also to deaths in the education sector. Considering the deaths as a result of inadequate PPE quality, he asked what the status of the forensic laboratory at the Nelson Mandela Hospital was.

Ms Peters thanked the Minister, the Deputy Minister and the DG for their leadership. It was her view that the poor quality of PPE explained a number of deaths, which was of great concern. She asked the Minister to engage the South African Bureau of Standards (SABS) on quality control measures to ensure the safety of PPE. She questioned how the rape of a two-year old had been possible in a hospital where the child was quarantined. Society had barely recovered from the rape of the six-month old baby Tshepang. She asked how the safety of children would be protected, and said that the entire team at the hospital should be held accountable. The issues that were emerging from the Tembisa Hospital needed attention. Horror stories were reported about the treatment of patients, as if lessons had not been learnt from Life Esidimeni. The situation could not be allowed to go unattended, and needed the intervention of the DG and other health professionals, as the nurses were not coping.

Mr Qayiso asked whether the reprioritised budget would accommodate the intervention declared by the President to employ 12 000 health workers during this period. It seemed that the NHI was going to be affected by the reduction in the budget for infrastructure and maintenance. He asked whether Minister Mkhize agreed with the budget cut of R27 million, and if he were not concerned that it would affect the capacity to deliver the new health facilities.

Ms Ntlangwini said that the trauma that the rape of the two-year old had on the child and the family was unimaginable. The Department should take full responsibility, and she encouraged the family to take the Department to court. The rape culture was indicative that men had declared war on women. Hospitals were in dire need of repair, and were not fully operational. She requested a list of facilities that would be affected by the budget cut so that delayed projects could be monitored. Health workers were complaining about working conditions, and linked the sub-standard quality of PPE at quarantine sites to cases of students that were infected. She asked what the Minister planned to do about the manager and the state of mental health services at the Tembisa Hospital. Concerns had been raised about the manager, who was running the hospital as if it was his home, and who was demanding sex for jobs.

The Chairperson asked whether the PPE was locally manufactured or imported. The Department was responsible for spending large amounts of money. He challenged the Department to restructure and rejuvenate the economy so that the money could be redistributed in the country. The Committee was seized with the matter of the hazard that the bucket system was having, not only on the health of citizens, but also the indignity of the situation. He wanted to know what the Minister’s position was on the increasing number of claims against the Department.

DoH’s response

The Minister requested Members to forward a script on matters that his delegation might not be able to deal with at the meeting, due to time constraints. A written response would be provided at a later stage.

The CFO responded to the questions as follows:

R37 billion budget cut – it was addressed through the equitable share allocation.

Human resources matters – there were still some challenges in terms of the Cuban Brigade.
HPV Grant – it had not been reduced, but kept within the HIV/AIDS budget, bearing in mind that it was cyclical, and that vaccination was still needed.

TB Grant – it was still included in the conditional grant. It had not been reduced and no funds were added.

Facility Revitalisation Grants – the funds were reprioritised to fund quarantine facilities and field hospitals. Some projects would have to be delayed, which came with a risk due to contractual obligations that had to be addressed.

Cost of PPE – 17 items had been identified for testing to ensure that specifications were sound. The matter would be discussed with National Treasury, as it was an expensive process. Provinces were given guidelines for the cost per item, but it also depended on demand and supply.

NHI Grant – the R22 million was mostly allocated for the recruitment of general practitioners in Limpopo.

Ventilators – the Department was engaging local suppliers and manufactures to supply the equipment.

Quality of PPE – the Department was working with the SABS to test the quality of equipment before it was distributed to provinces.

Dr Buthelezi explained that the restructuring process was at an advanced stage. It would be finalised within six weeks and submitted to the Committee once it was approved by the Department of Public Service and Administration (DPSA).

The National Health Council had decided to employ community health workers (CDWs), but it was never the intention to employ them on a full-time basis. Initially, CDWs were redeployed from NGOs. Subsequently, the Department had been working with the unions on issues affecting them.

The DG undertook to report back on the specific number of facilities that would be affected by budget cuts.

Guidelines had been issued to address the concerns about the use of PPE at facilities. In some instances, security guards were wearing PPE that should have been reserved for medical staff working in theatres.

To address the issue of unemployed doctors, resources were being shared with the private sector, based on an agreed tariff.

He would be providing a response on the issue at the Tembisa Hospital after discussions with his colleagues in Gauteng.

Dr Phaahla said the DoH was conscious of the risks concerning other health programmes, such as HIV/AIDS and TB. The situation had created fault lines in terms of communicable and non-communicable diseases, as new patients feared visiting facilities due to concerns about contracting the virus. The worry was that dealing with COVID-19 would cause deaths related to other health factors.

The high rate of deaths among health workers and in the education sector was attributable to various factors, including inappropriate PPE. The virus was contracted not only at places of work, but also in the communities where health workers lived. The concern was that health workers lowered their guard during their tea breaks. He vowed to make sure that proper investigations were done at the Tembisa and George Mukhari Hospitals, and said that preventive measures would be discussed with his colleagues. Exposing patients to extremely dangerous conditions was not good, and gave the Department of Health a bad name.

Minister Mkhize requested an opportunity to return at a later stage with more detailed responses. He said that services relating to other diseases were falling behind due to fear and the lack of transport during the first stages of the lockdown period. Services that were activated during level three were being monitored to close the gap concerning the treatment of other diseases.

The restructuring process was mainly focused on the organogram at Head Office level.

The community health workers were designated as volunteers to gather information and promote a good health lifestyle within communities, after which they were free to continue with their household duties. It was important that volunteers were familiar to, and accepted within, their communities. The challenge was that some of the volunteers became unionised, and then raised concerns about standards for health workers. A minimum wage had been agreed, as volunteers were not within the category of being absolved within the civil service.

He said he would follow up on issues about the health care facilities in the Mount Frere and Maluti areas. The reconstructing of the Luyengweni facility had to happen at an alternative site, as the clinic was too small and needed to be expanded.

The number of health care workers that were affected by the virus was a serious matter. They became affected through interaction with the community, their colleagues and patients. The Minister conveyed his condolences to the families of health care workers who had lost their lives.

He said training was the mainstay of the DoH, and there was a commitment to work with the unions in this regard.

He had requested a proper audit of PPE stock, to investigate the quality issue. Quality assurance was in place for most of the stock procured via the Solidarity Fund. However, when there was a shortage, people bought what was available, irrespective of the quality. He acknowledged that the cost of PPE was high. The Department followed the figures prescribed by National Treasury. Local production of PPE was encouraged, but required flexibility on some of the rules to accommodate local producers. The Department of Trade and Industry (DTI) and National Treasury had to be involved in the discussion on pharmaceuticals, as the granting of guarantees was presenting a challenge. The DoH had started procuring ventilators from the CSIR.

He had been briefed about the rape of the two-year old child. It was a serious crime, and the police needed to make sure that justice prevailed and that the law took its course. He would follow up on the complaints at the Tembisa Hospital, but required more information from Members.

Minister Mkhize advised other departments to make sure of the quality of the PPE that they procured. He asked for closer cooperation with the unions to promote safety and the training of staff who took care of patients.

The issue of health care in the Eastern Cape was a concern. In anticipation of the response to the increasing numbers of infections, a whole team had been delegated to bolster the management in the province to minimise the number of deaths and infections of people with co-morbidities.

The Chairperson acknowledged that the Minister and his team were very busy, and wished them well in their fight against the invisible enemy. He asked for a review of factors that constrained the local production of PPE, and urged Parliament to deal with the stagnating economy.

The meeting was adjourned.