Northern Cape Psychiatric Hospital: progress report; National Public Health Institute of SA Bill: response to submissions

Meeting report

The Chairperson welcomed all Members and the delegates from the Northern Cape Department of Health and the Department of Public Works. She said she found out through television that there were still problems with the hospital project for the mentally challenged in the Northern Cape and therefore the Committee decided to call the leadership of the Northern Cape Department of Health. The Committee required honesty from the delegates and the country was sensitive to the issue and would like people to take responsibility. She encouraged the leadership of the Department to be sincere with the Committee as it would be important to find a solution to the poor state of health infrastructure in the province.

Health infrastructure report

Dr. Lesetsa Mabowa, Acting Director:  Infrastructure, Northern Cape Department of Health said the proposed hospital comprised of 31 blocks and 286 beds of which 9 blocks had been completed. The initial completion date had been scheduled as the 27th January 2014. The completion date had been revised to 30 November, 2017 and the contractor again requested to move it to March 2018. He said 98% of the budgeted amount had been spent.  Block M which was dedicated to mental health services was targeted for completion in February 2018. He showed pictures of the Forensic Core Block M1 which he said the internal work has been completed and Block M3 scheduled for snagging on the 13th of February 2018. Physical verification and confirmation by consultants are always carried out before payments approvals are made. The joint management team was formed by members from the National Department of Health, Northern Cape Provincial Departments of Health and Public Works and the Project Steering Committee was appointed to assist with daily contractual and technical operations.

Mr Mxolisi Sokatsha, Health MEC, Northern Cape Department of Health, said the Department would not deliberately hide information from the Committee because he was aware that withholding information in the context was a criminal offence. The fact that the project had lingered for more than a decade was a concern to the Department. The mandate of the Department to provide quality health care for the citizens would not be compromised. The report that would be presented was based on the state of infrastructure and the financials presented in the presentation only covered the figure of the second contractor. There was an ongoing investigation concerning the first contractor.

Northern Cape Department of Public Works presentation

Ms Onkemetse Gill, Chief Director, Northern Cape Department of Public Works, said the Department would also like to make a presentation on the current completion status of the hospital and to provide relevant information that should be known by the Committee

The Chairperson confirmed that the second presentation was not available to Members and she proposed a five minutes break to allow members get copies.

Ms Gill said the committee shift in the completion date was due to the issues experienced by the subcontractors which impacted negatively on the speed of the project. The performance guarantee would be amended to reflect a change of name to Mota Engil Construction South Africa and would be valid until the final payment certificate was issued.  The contractor was required to complete the work by zones. Work had been completed in blocks B, C, D and F, while blocks A, H and K are being de-snagged. Zone 3 required more work to be done.  It was important for the Department of Public Work to work with the Department of Health in bringing its equipments to the buildings. The contractors and subcontractors are both managed very closely to ensure the commissioning of the hospital. The contractor was committed to the end of March 2018 while the Department of Health was expected to start installing their medical equipments and other furniture from April 2018.

Ms N Mazibuko, Chief Director: District Health Services, Northern Cape Department of Health, highlighted that about 113 more nurses would be required to run the hospital when it opened. There was a three years roll out plan from 2018 to 2021 and there was no need for large equipments in the hospital because the tertiary hospital that had this equipment is in close proximity. She said there was a need for PC networking which would be set up soonest.

Discussion

Mr S Jafta (AIC) welcomed the presentations. He noted that there are no clear indications to the causes of the delays in the completion of the hospital. He asked if the Departments concerned are happy about the progress of the work so far. He asked for the reason for variation in the budgeted amount and the amount certified till date.

Dr S Thembekwayo (EFF) expressed her disappointment over lack of information in the presentation. She said the amount certified till date was R670 million while the second presentation said it was about R635 million. She asked if there were penalties for the first contractor’s failure to meet the deadline and what was the penalty. She asked how accessible the hospital would be to the people.

Ms P Kopane (DA) said the project had been ongoing for about 13 years. The Standing Committee on Public Accounts (SCOPA) had also insisted that people must be held accountable because it was discovered that the foundation of the hospital was not correct. The contractor took the Department to court but the Department won and all these were not mentioned in the presentation. The presentation highlighted that while 98% of the project fund had been spent only 9 out of 31 blocks had been completed and she asked how the project intended to raise funds to complete the project. She noted that it was promised that the project would be completed in December 2017, but it had been moved to March 2018 again. She asked how the Department would fill the positions, because there was a moratorium on the Northern Cape which would hinder its ability to fill the positions.

Mr A Shaik Emam (NPF) asked know how many officials has been there since the inception of the project. It was important to see if the people who had failed in the past were still on the project because there was no assurance that they would be able to deliver on the project. There should be a 10% retention fee, but judging by the presentation there was only about 6% of the funding left. He asked how the Department would get the 10% retention fee. He asked how ready the Department was in terms of staffing and where the Department would get money for the takeoff.

Dr P Maesela (ANC) said the Departments brought information it wanted the Committee to have and not what was important to the Committee. It was important to know the reasons why the hospital was not complete. The information was not sufficient and it was important to have a proper report.

Ms L James (DA) requested that the Department should mention the names of the contractors that robbed South African citizens of their money.  She asked if money was recovered from the previous contractor. She asked if there was any disciplinary action on the failure of the officials running the project. She asked when the Department planned to move patients into the hospital and how many patients would be catered for. The information provided was very scanty.

Mr A Mahlelela (ANC) said the Public Finance Management Act (PFMA) was drafted into law to prevent waste and corruption. If the Departments can say with authority that there was an economic use of resources and if it used the PFMA properly to eliminate waste and ensure that there were no corrupt practices. He asked what had been done to the people that violated the law under the project. Treasury only allowed a particular ceiling for variation, which should be about 20% of the original price. There was about 81% variation reported on the project and no explanation was made on the variation. He asked how the Departments arrived at the revised contract. He asked which law supported the Department action of revising a contract due to cash flow problems encountered by the contractor which was done at the expense of the State. Decisions cannot be taken on the basis of sympathy, but on the basis of the law and noted that it was not the first revision made by the Departments. He said the first revision was made from 27th January 2014 to 30th November 2017 which is about three years and again revised to March 2018. The Departments did not explain what was responsible for the revision and if there was a proper project management plan. He said if there was a project management plan prior to the tender, it should be provided so that the Committee can understand the point of deviation. He asked if there was a contract manager.  There had been a negative report from all provinces concerning public works and he asked what the National Department was doing to remedy the situation.

The Chairperson said the invitation letter sent to the Department indicated that it should highlight challenges faced by the Northern Cape Department of Health. Questions posed by Members had re-written the entire presentation made by the Departments. The sector had drawn lessons from a number of incidences, and mental health was one of the challenges of the sector. She expressed her disappointment on the volume and depth of information provided by the Departments and the Departments must tell the Committee what the challenges of the project are. The Department did not have money but it was promised to increase its staff number. She asked the MECs to explain what went wrong and why the project lingered. The Committee was not working to score points but to ensure that the services are provided to the citizens of the Northern Cape are given to them.  

Mr Sokatsha apologised and said he said he was the longest serving official and the Department would not hide information. The requested report was with the Hawks.

The Chairperson said the invitation requested that the Department presented its challenges to the Committee and the presentation did not respond to that request. It would have better if the Department had made a call to the Committee to clarify and the responses of the Department would rewrite the presentations because it currently had no of legal or technical challenges in its report.  

Dr Thembekwayo said the reason for the break was to give time for the Department to give a coordinated response to the questions that was asked.

Mr Sokatsha said all the report of the issues had earlier been shared with the Committee and even the plan to move forward had been shared. He said the presentation covered from the last presentation to the current time.

The Chairperson said herself and many of the Members were not present at the earlier meetings with the Committee. Therefore, all the current Members had not received the details. It was an assumption that the Members are aware of the challenges. The National Department of Health should take responsibility for the problem. The response will not be postponed and she said delegates should deliberate on how they would answer the questions after the lunch break.

Resumption after lunch

Mr Sokatsha indicated that a detailed document on the investigation would be submitted to the Committee within 14 days. He gave an overview of what had happened in the past.

The Chairperson said apart from the overview the HOD of the Public Works Department needed to answer questions directed to him by Members.

Dr Maesela asked the team to ensure that it attached the specific names of the companies and attach the report of the joint management committee to the detailed report it had agreed to submit.

Ms Gill indicated that the project financial summary of public works carried variations of R279 million and R46 million while the health department only had variations of R279 million.

Mr Mahlalela asked Ms Gill to state which document she was referring to and to explain the contradiction in the two documents.

Ms Gill replied that of R279 million and R46 million were variations that totaled R326 million, but the National Department of Health had not added the R46 million variation because it had not yet been approved.

The Chairperson remarked that Mr Mahlalela wanted an explanation because the figures captured in the two documents did not align with each other.

Mr Mahlalela asked the team to state the official document between the two.

Mr Mabona stated the cost variation of R279 Million was approved while that of R46 million was not yet approved.

Ms Kopane said that her responsibility as a Member was to have a detailed report to ensure that discussions can be carried out based on the report. it was not possible to have a meaningful discussion without the report.

The Chairperson said her understanding was that the report presented at the meeting was a brief and the team would provide a detailed report in 14 days. If Members felt the submission report date was not favourable, the Committee would ask for an appropriate date.

Mr Mahlalela observed that the more the Ms Gill tried to explain the cost variations, the more confusion was created. The figure from health did not align with the figure from public works. Also the Joint Management Committee (JMC) did not have consensus on the financial summary and the JMC came for the meeting unprepared.

Ms N Mazibuko explained the operational plans, the accessibility of the facility and the number of patients in the facility.

Mr Sokatsha said there was no moratorium because the issues of appointment needed to be managed, because the National Department of Health had limited funding.

Ms Valerie Tiny Rennie Head: Corporate Services, National Department of Health, said the Department had a forensic report that would be submitted in March 2018 that covered the first phase of the project. This report, would confirm if there was any irregular expenditure. A second phase of the forensic investigation was in progress.

Mr Steven Jonkers, HOD, National Department of Health stated that the investigation started in the 2014/15 financial year and gave an overview of the forensic investigation report. The majority of the variation was change of scope and all records of the JMC’s minutes of meeting were available and could be provided.

The Chairperson observed that the more the team spoke the more questions would be asked. The Committee would have asked the team to bring the documents immediately if the team was not located in the Northern Cape.

After conferring with Members the Chairperson resolved that the Committee would communicate with the team on when to submit the documents. She discharged the team.

Department of Health on the National Public Health Institute of South Africa (NAPHISA) Bill

Dr Anton Pillay (Health Regulations and Compliance Management) asked for guidance on how Members wanted to treat the NDoH’s responses to submissions on public hearing.

The Chairperson remarked that it would be treated on a line by line Clause basis after asking Members.

Dr A Pillay proceeded to state stakeholder’s comments and NDoH’s response.

Long title / purpose of the Bill

Stakeholders suggested that ‘research’ be qualified to minimise overlap in the mandate of the NAPHISA and the South African Medical Research Council (SAMRC) and indicated that the phrase ‘conduct related’ be inserted in front of the term’ research’.

NDoH indicated that NAPHISA would conduct research in relation to the core mandate of the NAPHISA Act once it was promulgated and the SARMC has defined areas of research in terms of the South African Medical Research Act. This limited the opportunity for any overlap. A comparison between the objects and functions of the SAMRC was provided for in the enabling legislation which resulted in clear distinct functions between the objects and functions.

Preamble

Stakeholders suggested that a third bullet be inserted to the preamble recognising the South African Medical Research Council's statutory mandate to conduct, fund, innovate and oversee health research; and that it was not the intention of the NAPHISA entity duplicate the mandate of the SAMRC.

NDoH indicated that, the mandate of NAPHISA was clear and it did not amount to duplication.

Stakeholders also suggested that ‘such as surveillance and research’ be changed to "such as surveillance and public health interventions.

NDoH indicated that, because the mandate of NAPHISA included conducting research in accordance with the objects and functions of the NAPHISA Bill hence this cannot be amended as proposed.

Stakeholders raised concerns that the NAPHISA Bill did not mention health promotion in the preamble and as such the preamble should recognise the importance of health promotion as a strategy to improve health of populations.

 This concern was not supported, because health promotion was not the core mandate of NAPHISA.

Definition

Stakeholders suggested that work place exposures should be inserted into the definition of surveillance, but NDoH indicated that the definition as is stands was inclusive of all risk factors including work place exposure.

Stakeholders suggested that because the NAPHISA Bill would deal with confidential patient and client information and would be required to share information and have access to information which may introduce legal impediments to the collection of information from national surveys of other organisations such as Statistics South Africa, the bill make need to make reference to the protection of personal information Act (PoP/ Act) and Promotion of Access to information Act (PAIA) to achieve its objectives. NDoH indicated that Reference can be made to applicable legislation instead of naming, as inclusion of one is the exclusion of the other.

Clause 2: Establishment of NAPHISA

Stakeholders suggested that clause 2(1)(c) be changed to ‘occupational and environmental health to incorporate concerns about the impact of water quality, air quality and climate change as it was environmental health essential to develop appropriate surveillance systems.

NDoH indicated that, occupational health included environmental factors that affected the health of workers in the work place hence environmental health should not be included. in Clause two (one) (c) .

Stakeholders proposed the addition of health care process improvement and health informatics divisions among the divisions of NAPHISA.

This proposal was not supported because NDoH indicated that the divisions were not part of NAPHISA’s mandate.

Stakeholders raised concerns that the current NAPHISA Bill did not adequately consider the provisions of Section 24 of the Constitution which provided for protection of the environment towards ensuring the health and well-being of individuals. It could lead to significant gaps in relation to research, monitoring and overall policy coordination within the Institute and between the Institute and other government departments.

NDoH did not support this argument because the Department of Environmental Affairs (DEA) was mandated to give effect to the right envisaged in section 24 of the Constitution. Furthermore, section 83 of the National Health Act, 2003 (Act No.63 of 2003), also gave effect to the right envisaged in section 24 (a) of the Constitution.

Clause 3: Functions of NAPHISA

Stakeholders suggested that clause 3(1) be amended to read ‘NAPHISA on its own consult with any entity it has concurrent statutory jurisdiction with.

 NDoH did not support this suggestion, because the functions of NAPHISA would be in accordance with the NAPHISA Bill and the Bill already made provision for collaboration with various stakeholders.

Stakeholders also proposed the functions of NAPHISA should be organised according to specific categories, but NDoH stated that since the functions as stipulated in the NAPHISA Bill were cross-cutting, the functions could not be categorised as proposed because it may not be consistent with legislative drafting.

It was proposed that phrase ‘and environmental Health and Safety’ be inserted but NDoH did not support this suggestion because of the reasons given in clause 2(1)(c).

The phrase ‘coordinate and where appropriate’ was proposed as an insertion in Clause 3 (1)(x), but was not supported because the core mandate of NAPHISA was to provide specialised and referral services

Stakeholders raised concerns on an inadequate coverage or recognition within the Institute's proposed functions and roles of the specific mechanisms that will be used to facilitate the coordination, dissemination, research and disease surveillance work in alignment. For instance, with the South African Government's open data commitments. Also the Bill did not adequately address modern data considerations and its governance structures did not incorporate the expertise of an ICT or open data expert.

NDoH did not support this argument, because it was operational and could not be written in law since the ICT policy was essential for all entities and must be developed by the Board and implemented by management.

Stakeholders raised concerns that one of the functions of NAPHISA should be to work with civil society organisations towards the establishment of an independent health promotion foundation but this was not listed under the functions of NAPHISA in clause 3. NDoH did not support this argument because NAPHISA was not intended to be a health promotion organisation. Clause 3 provided for strengthening advocacy, social mobilisation and partnerships with various stakeholders.

Stakeholders proposed that the definition of ‘referral services’ for the purposes of subsection (1) (e), be better placed under definitions, but NDoH stated the definition was specific to clause 3 (1)(e) hence it could not be placed in the definition section.

Clause 4: Governance and control of NAPHISA

Stakeholders proposed that it was advisable for clause 4 of the Bill to outline some basic eligibility criteria of the community members on the panel in order to ensure greater representation of marginalised groups and those advocating for the rights of women and children in particular.

NDoH did not support amendments because community representatives are selected based on the extent and nature of community involvement.

Stakeholders proposed that the recommendation that an oversight body be created in order to supervise expenditure within the Institute and to provide disciplinary proceedings if funds are spent in a way was inconsistent with the Act. NDoH did not support the proposal, because NAPHISA is a public entity and as such is accountable to the Executive Authority responsible for Health.

Clause 5: Composition of the Board

It was suggested that clause 5(1) (a) addressed distinctions between the voting rights of members of the board from the NDoH. NDoH indicated that since the official on the board has its own fiduciary roles in the NAPHISA Board, the NDoH official was expected to act in the best interest of the board at all times hence the official has a voting and deliberative vote in the board.

The South African Civil Society for Women's Adolescent's and Children's Health (SACSoWACH) proposed the addition of a women, child and adolescent health expert to join the composition of the NAPHISA board. This was not supported because NDoH was of the view that instead of having two community representatives, there should be formal processes of working with community organisations in accordance with Clause 3(1)(q) of the Bill which provides for strengthening advocacy, social mobilisation and partnerships.

Clause 6: Appointment of members of the Board

Stakeholders suggested that Clause six (4) be consistent with other research and council members of NAPHISA board should hold office for three years and the envisaged reappointment be limited to one term only. NDoH indicated that because NAPHISA board was not a research council the five year term was deemed appropriate because of the mandate of the entity.

Clause 33: Tagging the bill as a section 76 Bill

Stakeholders suggested that Clause 33 should give clarity on whether the NAPHISA Bill fell within national or provincial jurisdiction because it was a Section 76 Bill. NDoH indicated that the joint tagging committee had tagged the bill as a Section 76 Bill because it was a view that the Bill will affected provinces.

Discussion

Mr Mahlalela asked for clarity on the inclusion/exclusion of environmental health in clause 2 (1)(c) because NDoH claimed that it was covered under occupational health. He did not see how environmental health and occupational health could be the same thing based on the definition given.

The Chairperson asked for clarity on the involvement of communities, because NDoH had indicated that a forum would be created. She asked why a forum needed to be created instead of increasing the number of community representations.

Dr Pillay said that the World Health Organisation ((WHO) definition of environmental health in the workplace was considered in the context of the NAPHISA Bill because the Bill was limited to work place situations. The definition of environmental health was broader than the definition used. The view of NDoH was that organisational links to communities were based on structure hence the community representatives in the NAPHISA would be chosen based structured organisations.

Dr Karmani Chetty, Acting CEO, National Health Laboratory Services, gave an overview to avoid confusion between environmental health and occupational health.

Mr Mahlalela remarked that occupational health and safety was also a responsibility of the Department of Labour (DoL) hence NDoH needed to consider its inputs.

Dr Pillay agreed.

Mr Mahlalela asked which department was responsible for breakouts on environmental health issues.

Dr Chetty stated that when breakouts on environmental health issues occurred, a joint committee which deals with such matters is constituted and each department carries out its responsibility based on its mandates.

Mr Mahlalela remarked that NDoH should be responsible for health related issues that could arise.

Mr Lufuno Makhoshi, Legal Adviser, NDoH, indicated that the National Health Act covered health related issues that could arise.

The Chairperson observed that the team found it difficult to clarify that NDoH had a role to play on environmental health issues. She asked Members to state if they were comfortable with NDoH’s response to submissions made by stakeholders on the NAPHISA Bill.

Mr Mahlalela stated that he only wanted the definition to be more all-encompassing.

The Chairperson said that if Members were okay then the Committee could start with its processes.

The meeting was adjourned.