National Health Bill: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
4 August 2003
NATIONAL HEALTH BILL: BRIEFING BY DEPARTMENT

Chairperson: Mr. L. Ngculu (ANC)

Documents handed out
National Health Bill [B32-2003]
Department Powerpoint Presentation

SUMMARY
The National Health Bill was finally introduced to the House for deliberation. The Department briefed the Committee on the salient features of the Bill and commenced with legislative work of the House. The Committee was informed on the Bill before the public was invited to make submissions whereafter the House would proceed with formal deliberations. The Bill is slated for public hearings on the 18 and 19 August 2003 and formal deliberations should be held between the 25 and 27 August.

MINUTES
The Chair informed members that the purpose of the Departmental briefing was to introduce the Bill to the house and help members gain a general understanding of its contents. The House would host a joint seating with the NCOP so that common issue would be ironed out together. He indicated that the Bill is slated for public hearings on the 18 and 19 August and then formal deliberations would be held between the 25 and 27 August.

National Health Bill Briefing
Dr Chetty, Chief Director - National Department of Health informed the House that the Bill seeks to establish a legislative and regulatory framework for the delivery of health services throughout the country. The Bill would effectively deal with health care provision by creating uniformity across the nation. The Bill would establish norms and standards for better health care management and establish frameworks and national policies that would guide health care providers in their work.

Dr Chetty took the House through the Bill in general noting that members would gain a better understanding during the proposed workshop. She noted that Chapter 1 contains provisions regarding the objects of the Bill, responsibility for health and the eligibility for free health care services. Chapter 2 contains provisions regarding the rights and duties of users of health services and health care providers. Chapter 3 on the other hand makes provisions relating to the national department whilst Chapter 4 contains provisions in relation to provincial health departments. Chapter 5 establishes a district health system for the republic based on certain key principles and that Chapter 6 on the other hand makes provision in relation to health establishments.

Dr Chetty informed members that Chapter 7 of the Bill seeks to address the contentious issue of human resource planning and academic health complexes. Chapter 8 makes provisions in relation to the control of the use of tissue, blood, blood products and gametes in humans. Chapter 9 makes provision in relation to surveillance, research and information whilst Chapter 10 deals with health officers and compliance procedures. Chapter 11 empowers the Minister to make regulations on a wide range of issues relating to health matters while Chapter 12 empowers the Minister to appoint advisory or technical committees in order to achieve the objects of the Act.

Discussion
Ms Jacobus (ANC) sought clarity on the definition of the EMS (emergency medical and rescue services) which she said appeared to invite many interpretations.

Dr Chetty explained that EMS definitions do indeed come in various versions depending on the kind of emergency one was dealing with. The Department had opted for a much shorter definition to avoid instances where it would necessitate an amendment to the Constitution in order to give effect to the desired objects.

Ms Jacobus pointed out that the National Health Council is a state institution and wondered how government would be in a position to advise itself.

Dr Chetty explained that the National Department carried the mandate of setting clear norms and standards and that therefore the National Health Council would be better placed to advise on this particular activity.

The Chair noted that definitions are problematic and hoped that more light would be shed on different the definitions around the EMS service during the workshop.

Ms Baloyi (ANC) expressed joy that the Bill had finally found its way to the House noting that it was one piece of legislation that members had been longing for. She said that she had picked up many queries but preferred to wait until the time of the workshop where hopefully most of the sticky issues would be ventilated. What was the status of a blood transfusion facility owned by the Western Cape government in view of the policy implications of the Bill?

Dr Chetty explained that the intention of the Bill is to ensure that there is a single blood transfusion service for the entire country and that the Minister would issue authority. The Western Cape government would have to adjust its structures to suit this new policy framework.

Ms Baloyi asked how the Bill seeks to integrate public health institutions with the private sector.

Dr Chetty explained that the imperative of integrating public institutions with the private sector did not imply the nationalization of private facilities but that it speaks of closer co-ordination, co-operation, human resource development and planning.

Ms L Johnson (from the KZN parliament) noted that some provinces had ordinances that deal with issues covered in the Bill and sought clarity on what would become of these provisions.

Dr Chetty pointed out that many of the provincial ordinances would be integrated into the National legislation since the latter took precedent over the former.

Ms L Johnson asked if the Bill made provision for mechanisms to ensure that all organs were taken back after a post-mortem had been performed on a dead person. She noted that non-medics carried out these procedures and that there had been complaints about missing organs.

Dr Chetty replied that the Bill covers all these concerns noting that the post-mortem procedures had to be prescribed by a medical practitioner and that he/she has to certify that all organs were in place.

Dr Jassat (ANC) asked if there was any cross-subsidization of health services by the private sector.

Dr Chetty pointed out that the main aim of the Bill was to address provincial inequities and that the question of cross-subsidization had not been factored into the equation.

Dr Jassat asked if the Bill made provision for punitive measures against those who turned away critically ill people for lack of finance.

Dr Chetty pointed out that the government had acknowledged the existence of such malpractice and that was why it was looking at setting up compliance systems under the Health Professions Council.

Dr Cachalia (ANC) expressed doubt that such compliance mechanisms would be effective since the Health Professions Council required adequate evidence of reported malpractice before it could act.

Dr Chetty explained that under the EMS there were already adequate mechanisms in place to for reporting to the Health Professions Council.

Dr Nel (NNP) wondered what role and function the National Consultative Health Forum would serve if it was slated to meet once in two years as is provided for under section 26 of the Bill.

Dr Chetty explained that the National Consultative Health Forum is not a statutory body but an organ set up by the Minister and that the reason for the spaced meeting was due to logistical considerations.

Ms Vilakazi expressed concern that many provisions in the Bill seemed to encroach on the provincial mandate and hoped that the workshop would help to allay these concerns.

Dr. Chetty concurred that issues of corporate government would better be dealt with at the workshop where detailed specifics would be discussed.

The Chair pointed out that the Bill would be extensively discussed at the forthcoming workshops.
Kindly note that a three day workshop was held for MP's only on 5, 6 & 7 August 2003.

Meeting was adjourned.