Health Budgetary Review and Recommendations Report

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Health

02 December 2020
Chairperson: Dr S Dhlomo (ANC)
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Meeting Summary

Tabled Committee Reports
Video: PC Health, 2 December

The Portfolio Committee on Health held a virtual meeting to consider and adopt its Budgetary Review and Recommendations Report (BRRR) in its final meeting of the year before Parliament rises.

It considered an additional recommendation that was not included in the report. This was addressed specifically to the Committee, recommending that it meet regularly with the Auditor-General (AG) to assess whether it was happy with the Committee’s progress, and to ensure that the Committee did not receive a once-off report on the failures of the National Department of Health. Members agreed to the recommendation and acknowledged the importance of the Committee meeting with the AG and the Department on a quarterly basis so that it could hold the Executive to account.

There were concerns that Members’ inputs and comments had not been adequately captured in the report. The Chairperson clarified that there were some issues that had not been included, as the report was still a work in progress. The inputs and comments of the Members were being taken to strengthen the content and the recommendations of the report.

There were contrary views on the adoption of the BRRR. The ANC proposed its adoption, the EFF rejected it, and the DA and FF+ said they reserved their rights pending further discussions with their caucuses. It was agreed that work on the report would continue so that it could be brought back to the Committee by midday on Thursday, with all the amendments and inputs, and be ready for the meeting on Friday.

Meeting report

Chairperson’s introductory comments

The Chairperson said the Committee would discuss one item -- the consideration of the Budgetary Review and the Recommendations Report (BRRR). The Committee would focus on the recommendations in the report which was sent about two days ago.

He had thought about adding one recommendation, but subject to this meeting. He said that in the previous BRRR, the Committee had tasked itself to regularly meet with the Auditor-General (AG) on its own to check if it was happy with the Committee’s progress so that it did not get a “once-off post-mortem report” on the inadequacies of the National Department of Health (NDOH). The Committee had not included this recommendation in the report, and he asked if it could be included, as that recommendation was to the Department. This recommendation would be addressed specifically to the Committee. The Committee could include this, as it had still to consider the invitation from the AG, who was going to assist it.

The Chairperson indicated that this was the Committee’s last meeting of the year before Parliament rises. He had written to the Speaker on the discussion that had taken place in the Committee to consider beefing up the team that was working on the National Health Insurance (NHI) report since there had been a decision on using internal resources and personnel. This had been sent to the Speaker, and the Committee would await further direction from her. He explained that he was in touch with Mr Dennis Bandi, a parliamentary unit manager for the committee section, and he was still awaiting a further response.  

The Committee would consider the inputs made by Members who had pointed to some of the gaps in the NHI report, and forward these to the team. He had checked with the team last night, which had confirmed that this work was still in progress and that it was not completed to bring back to this Committee. He asked the Committee to grant the team and himself more time to work on this report so that it could deliver a good report that did not have many gaps.

The Chairperson said he had been speaking to the House Chairperson yesterday, who had indicated that if the Chairperson sent work requests to him, he would have to process it properly with the Whips of all the political parties in the National Assembly if Parliament rose this week. He asked the Members, through virtual meetings, to stay in touch especially because of COVID-19 updates and, in late January, to consider getting a start on the 121 organisations that wanted to present to the Committee.

He said the Committee would not complete a decision at this meeting as Members were coming from various political parties, and a request to the House Chairperson would not be complete without a voice from the leaders of these parties, as there might be requests to consider not attending the virtual meeting towards the end of January to start this process.

He explained that he was reporting on the matter that was in process and that as Members made inputs, they could comment if it was something that they would consider. This issue had to be resolved soon, but this would depend on how quickly the Committee could deal with the matters that were on its desk. Members’ considerations and inputs would be welcomed as the report was discussed.

He asked Members to comment on his recommendation that was put forward to the Committee before it would move on to discuss the adoption of the report.

Comments on the BRRR

Ms A Gela (ANC) agreed with the Chairperson that the Committee must add recommendations on the report that it had received from the AG so that the Members could do oversight and correct where necessary. The report and the AG’s recommendation needed this Committee’s attention to ensure that it worked with the Department. She proposed that the Committee meet with the AG and the Department.

Ms E Wilson (DA) said she was confused, as she did not know what report the Chairperson was referring to. She agreed that the Committee must meet with the AG more often than it did. On the Chairperson’s letter to the Speaker about internal personnel, this Committee had had this discussion before. Provided that the Committee was given an assurance that there was no bias, no interference, and that it obtained details of every single thing that was submitted and that it was allowed to go through it by itself, it was getting to a stage where this process must move forward [in reference to the NHI]. It was also a process that could not be rushed, as it had to be done correctly, legally, and within the bounds. From this perspective, she did not have a major issue as she presumed that the Chairperson was not referring to the BRRR.

The Chairperson responded that he was raising the issue of the recommendation about the AG, because the report might appear as if it was directed to the Department, but it was also pertaining to the Committee. This report must also speak to the Committee and some of its expectations, especially on the recommendation by the AG. He was pleased that some of the Members welcomed this, and asked them to discuss the recommendations, as he would demarche those who had a responsibility and mandate from their political parties. From here, this report would have to go into the House.

He would have welcomed the input to start at this meeting, as the Committee would receive varied and collective views. This was an opportunity for Members to comment generally on the report, and for this Committee to consider adopting it into further processing into the House.

The Chairperson opened for comments from Members.

Ms N Chirwa (EFF) said she had gone through the BRRR, and she was disappointed that some of the Members’ contributions were not captured in the report. She referred to Programme 1 on the Council for Medical Schemes (CMS) regarding an issue that she had raised about management. She referred to a young black woman, who was 30, who was being prevented from being nominated to the Board because she had received flowers from a colleague. This woman was now said to be a “delinquent” and had a “conflict of interest.” This issue had not been included in the report, as Ms Chirwa had asked the Department to first investigate it, and said that it must be a managerial issue that was being looked into regarding how people abused power.

Her second issue involved Programme 3. The Committee required a detailed explanation of why the Department had failed to address the recommendations that were stated in the Commission for Gender Equality’s (CGE’s) report. The report did not capture why the Department had failed to address the recommendations in the CGE report. It had been given three months, but it had been almost ten months following that report, and the Department had still done nothing. She explained that that was the intention of the comment, and that not even a single recommendation had been implemented, taking into account the interest of justice for the victims. The Minister of Health had merely “trivialised” what the Department had done against black women who were HIV positive, by stating that it would investigate this. This was in the past week. She commented that “this was not even a timeframe,” nor an attempt to address the recommendations of the CGE, which was a Chapter Nine institution, and which had already done the investigation. She argued that the Minister was effectively undermining a Chapter Nine institution, “doing what Jacob Zuma did with the Nkandla report.”

Referring to Programme 3, she said that it was important to note that all the women were black. She argued that she had made this distinction very clearly, but this was not stated in the report, even when it had been intentionally been overtly mentioned in the previous meeting. She said that this was a crime against HIV-positive black women, and that there was a historical context to all of this which could not be ignored or even hidden. Its roots were cemented in eugenics, the “practices of white supremacists that hated black people and tortured black women subsequently.” 

In Programme 4, the report did not state that the Committee called for the permanent employment of community healthcare workers, and a follow-up on when this would be implemented by the Department across the country. She had made an example of the BJ Vorster Hospital in Kareedouw in the Eastern Cape, which was a hospital that could not function for 24 hours even though on paper, it was a district hospital that was open 24/7. It had been able to implement that capacity only after the employment of 16 community healthcare workers, whose contracts would be terminated in March 2021. She called for the permanent employment of community healthcare workers across the country, especially in facilities that were debilitated.

Ms Chirwa said these contributions from the previous meeting had not been included in the report. This was disingenuous, because the EFF Members were also part of this Committee, but their comments were always “subliminally made to vanish”, or were non-reflective of what the Members were truly saying, or were considered as a “by-the-way issue.” She asked if this problem could be addressed as it had also happened in the previous report, where Members’ comments and contributions had not been captured properly, and this was not because they were not able to be captured. She argued that in other recommendations and contributions, provinces that were mentioned had been stated but when the EFF Members mentioned particular matters, they were not captured verbatim.   

The Chairperson responded on the CGE report. He said that Ms Chirwa had missed the meeting last week as she had not been well, and the Minister had briefed the Committee on the report. He explained that he had been invited by Umhlobo Wenene last Saturday, together with Dr Mathebula, who one of the authors of this report, and in her closing remarks, she had said she was pleased with the work that had been done, and with the progress it was making with the Department in responding to the report. The Chairperson said that this was a work in progress, which was why the issue was placed on the side, rather than included in the report.

On the issue of the young black woman who was not nominated because of the flower issue, the Chairperson responded that the Committee had not included it in the report, but that this was not because “it was shying away from asking the Department to process it,” It would form part of the managerial work, as it was a management report.

Ms Chirwa called a point of order. She said that this was exactly the issue that she was raising -- that the details of other recommendations and comments were included, but the comments that EFF Members made were not included in detail. She argued that the Chairperson had confirmed her statement.

On the CGE issue, she said that this was about the BRRR and the recommendations of the Committee in that particular meeting, and not in last week’s meeting. She argued that to date, the Committee was on different sides on this matter. The report did not reflect what the Commissioner of the CGE’s report had stated on the recommendations that it made. This was what the Committee should be following up on, especially because the victims of this very crime had even been fighting the CGE, as it was not protecting its own report in the way that “Thuli Madonsela did with the Nkandla report.” It was not defending its own report, and this was “obviously for political reasons, but this was beside the point” -- as a Portfolio Committee, it should be a matter of concern that none of the recommendations had been implemented. The Department had indicated that it would investigate, but it was ten months down the line, so this should concern them as Members of the Committee. This was not captured in the Committee’s report, even though it had been raised in this Committee.

Mr A Shaik Emam (NFP) apologised for his absence from many of the meetings due to his heavy workload. On the recommendations, he asked if the Department could provide the Committee with a comprehensive report on the NHI -- where it was at, where it was expected to go, what challenges it was facing, was it anticipated to be rolled out timeously so that together they could find common ground and solutions, so that ultimately it could provide universal health cover for all South Africans. His questions were based on what was seen and heard in the media and general speculation that the Committee was off target, and that there were serious problems that may not necessarily be true.

Mr Shaik Emam experienced some technical difficulties, and was cut off.

Ms S Gwarube (DA) asked if Mr Shaik Emam could repeat his questions.

Mr Shaik Emam responded that on the NHI, he requested a comprehensive report on its status, where the Committee was at, and the challenges that it was anticipating that it might experience in being able to implement it on target. This was so that the Committee could work together to address the problem so that ultimately the NHI could provide the intended universal healthcare.

Regarding the healthcare workers’ policy, he explained that when the Chairperson was the Member of the Executive Council (MEC) in KwaZulu-Natal, which was one of the provinces, together with the Eastern Cape,, that had started the process, it had been agreed to give these people full benefits, to recognise them, and to give them permanent contracts. He was unsure if this had been included, and apologised for his prior absence.  

He raised the problem of Addington Hospital, which was a very tall building with many floors, but the lifts never seemed to be working. There had been concerns raised over many years, and complaints of people having to carry patients up the stairs, but nothing had happened.

The Department was having some problems in reporting on new COVID-19 infections on a daily basis at the moment, especially with the Gauteng province not reporting, and as a result the Department was unable to give the Committee the statistics on a daily basis. He said that the Committee should request the Department to address this issue.

The Chairperson responded that Members’ concerns and recommendations were being noted as the report was being finalised.

Ms Gela supported the report that was being tabled for approval. She said Members understood that the Department had done good work despite the challenges that it had to address to correct the mistakes for the new financial year. For example, under item 4.2 dealing with provincial health departments, the AG had referred to those which did not submit their financial statements, and she proposed that the Committee had to ensure that the NDOH followed up on this and checked on progress to ensure that the financial statements were submitted.

She was pleased with the recommendations that indicated that the Committee would have quarterly meetings to check and monitor the progress in correcting the issues of the Department. It was important for the Committee to do its oversight as. She supported the recommendation for the Committee to check and monitor where it was necessary, and the Chairperson’s recommendation that he had added, so that it checked from the AG’s report what happened and how it could moved forward to ensure that the Department did the right thing and that it complied with the regulations.

Ms Gela moved the adoption of the BRRR.

The Chairperson noted the Members’ support and the issues that were not included. He responded that the report referred to the AG’s statement on the unavailability of audit reports from the provinces. This had not been captured in the Committee’s recommendations, as it was just left in the air. He asked the Committee to capture this in response to what it was saying. The report must indicate that the Department had to inform the Committee on when it could get these reports sent to the AG.

Dr S Thembekwayo (EFF) supported Ms Chirwa’s statements and concerns. She had been cut off as she had experienced some technical difficulties. She repeated the issue of the omission of some of the EFF Members’ comments in the reports on what the Members were saying. Today it was about the adoption, but it had not captured what Members had said. This included the fact that Members were not satisfied with the CGE report by the Minister, and the fact that there was a lack of accountability by the Department itself and the irregular expenditure incurred. She did accept the Committee’s BRRR.  

Ms Gwarube said that the Members were going through the BRRR report that had been authored by the Committee, to ascertain whether it was of the view that their inputs in this budgetary process had been captured. Parties or Members could decide whether they wanted to support the substance of the report at another given time, or not at all. She argued that after examining the report in detail, there had been an effort to include a lot of the deliberations that had been made.

She said the report did include a section on the audit outcomes, but she was not entirely happy with the correlation between that section and the Committee’s recommendations. The reality was that the Committee had to take its own oversight role a lot more seriously. Where there had been audit regressions in the Department, as had been overtly stated by the AG, then the Committee needed to include recommendations in its report which indicated that the Committee itself also took this seriously. She explained that the audit outcomes of a department may be politically accountable to the Minister, but the Committee also had a role to play in ensuring that the Department did what it needed to do.

When the Committee talked about recommendations, she proposed that instead of stating that the “Portfolio Committee recommends that the Minister should consider the following”, its recommendations must rather state that “the Portfolio Committee would be having a meeting with the AG and the Department of Health every single quarter, to look at targets set, expenditure, and to also look at some of the concerns that the AG consistently raised.” There should not be a situation where at the end of the financial year, the AG could claim that it was never able to get hold of the Committee, and these were the deep concerns that it has, and where financial executives could argue that they did not agree with the assessment of the AG. She proposed that when the Committee sets down its recommendations this time around, it must state that it would summon them every single quarter, because there was a clear misalignment between what the AG was seeing in the Department and what the Department was saying about itself.

The Committee had a role to assess what the Department was doing about some of these issues. She referred to the example of the mental health targets, which were the first targets that the Committee had seen that were not being met. Her overarching input was that the Committee could not simply get these reports at the end of the year, or hear from the Department when it presented its annual report that the reasons why it was not meeting its mental health targets was because of a supplier, and so forth. This was not good enough, because it was also a reflection on the Committee. How could the Committee say to South Africans that it was holding the executive to account when it was not really doing this? All it was doing was becoming a passive recipient of a report at the end of the year.

She urged the Committee to rephrase the entire recommendations. The recommendations were not a suggestion to the Minister, but were things that the Committee was telling itself that it was going to do. It was not for the Minister and his Department “to consider.” The Committee must state that it would monitor the audit outcomes, and that it would ensure that every quarter it received regular reports from the AG and the Department simultaneously, which was the same as the strengthening of financial management. She was pleased that the Committee had included that the Department must provide this to the Committee, but she clarified that she wanted the spirit of this to be that the Department was the one accounting to the Committee, because this was not a mere suggestion “to consider”. The Committee had a role to play, and the Department needed to keep accounting because the picture that had been painted by the AG was very misaligned to the picture that the Department had painted in its annual report. The Committee had to keep an eye on this.  

The Chairperson responded that Ms Gwarube’s motivation was noted. He indicated that she had expanded this matter, and that this would be rephrased because the Committee had left out meeting with the AG regularly, which had been in its previous BRRR. The Committee would insert it again, but in the strongest way, to indicate that the Committee would be monitoring and having regular meetings with the Minister and the AG.

He agreed with Ms Gwarube’s input that the Committee was unanimous on the matter in the AG’s report about the Department -- that there were “low hanging fruit” in the Department that it had to tap into. The AG had listed some of this, and stated it would be to the Committee’s and the Department’s advantage if they met more often. It was not in the report because he wanted this meeting to endorse and agree that that recommendation had to be included again, but more strongly. The Committee would be monitoring these quarterly meetings, based on the AG’s report and its findings.

Mr T Munyai (ANC) said that with the amendment of Ms Gwarube to include the comments of the AG, he moved to support the report. He said that the Committee was taking its responsibility seriously and that it needed to go forward as a collective – it could not proceed with a “so-called individual report.” The Committee must have a majority report, supported by the popular view. He proposed that the Committee should support this report. While there were some concerns, this would not be simply a “blanket approval,” as there were some weaknesses which, as Ms Gela had indicated, the Department was committed to address. He agreed with the AG, that those issues needed to be taken forward. He was supporting this report, with the amendment.

The Chairperson clarified there had been no intention from the staff that had worked with him, to target specific Members or political parties and to exclude their comments. There was no suggestion by the team that the report that had been put forward was 100 percent perfect. Ms Gwarube’s comments were suggestive of a report that was largely comprehensive but had certain issues that needed to be included. It needed to be looked at in the spirit that the report was never presented as what was considered to be perfect. It was a collective report by all, and therefore Members’ additions and comments were adopted to strengthen its content and the recommendations. There were certain issues that were a work in progress by the Department, and were not necessarily detailed in this report because they were still ongoing issues.

The Chairperson referred to Ms Gela’s proposal that the report be adopted, and the support of Mr Munyai to second the proposal. He also noted Dr Thembekwayo’s concerns, and that she would not support the report. He presumed that she was speaking not only on her own behalf, but also representing the Party.

Dr Thembekwayo responded that she would never speak on behalf of herself, as she was a representative of the EFF. She clarified that her rejection was as a representative of the EFF.

Ms Gwarube said that the DA would be reserving its support or rejection of this report until it had been discussed further, but that the process may continue, as had been the convention.

Mr P van Staden (FF+) said that the Freedom Front Plus also reserved its right to take a decision on this report through its caucus.

The Chairperson thanked the Members for the responses, and said that the meeting had now been concluded. He said he would update Members if he received any information from Minister Mkhize that was of significance to the Committee. He asked them to please stay available, perhaps for a short briefing, as it was dealing with a pandemic and therefore the Minister might update the Committee on any issues that were emerging. He said that Members would welcome this.

Ms Gwarube asked the Chairperson when the Committee would present the report for adoption in the House, because it seemed that most of the departments were populating the parliamentary programme with the BRRR report this week. When did he envision this would be done, or was it not possible for it to be done this year?

The Chairperson responded that he had had a discussion with the Committee’s secretary on the matter, and she had given him an impression that there may be some BRRR that were coming in next year, but he was not certain about this. The Chairperson asked the Committee secretary if she could make an input, or if the Committee could make a quick amendment that day and have it ready to go forward. He asked her for guidance and to comment on this, as he was not sure if it was on the agenda for Friday

The Committee Secretary responded that she had sent a request to Mr Bandi and informed him that the Committee would be adopting the report this week, and that it must therefore be on the programme for this week. She was not certain whether this had happened yet.

Ms Gwarube said she presumed that it might be included on Friday. She was looking at the programme, but that it had not been added at the time. She suggested that the secretary could update the Committee on this.

The Chairperson agreed that this was a work in progress, and said that he would work with the secretary and the team today as if the report was going through, and would bring it back by midday tomorrow with all the amendments and the inputs that were going through on Friday. The team would work flat out to ensure that it was prepared and to finalise the recommendations, as amended, to be included.

The meeting was adjourned.

 

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