Department of Health 2021/22 Annual Performance Plan; with Deputy Minister

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Health

07 May 2021
Chairperson: Dr S Dhlomo (ANC)
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Meeting Summary

Video: Portfolio Committee on Health

Annual Performance Plans

The Committee convened virtually to receive a briefing from the Department of Health (DoH) on its Annual Performance Plan for the financial year 2021/22. The Deputy Minister was in attendance.

Before the briefing, the Members agreed that a meeting should be set up between it, the Health Department and the Department of Finance to discuss the disturbing report that the Portfolio Committee received from the Auditor-General (AG) the day prior.

The Department said that one of its main targets for the financial year is to get 500 Covid-19 vaccination sites registered to use the Electronic Vaccination Data System (EVDS); developing the Alpha version of the networked Tuberculosis /HIV Plus Information System.

The Department said that the conditions under which it functions are difficult. There has now been a full-year cycle of the COVID-19 pandemic. The 2020/2021 financial year has mostly been consumed by trying to manage the pandemic. For the first time in a few days, the number of positive cases has exceeded 2 000, after a period of hovering at the 1 000 mark. This indicates that there may be some more difficulty again.

Vaccines from Johnson & Johnson, Pfizer and COVAX have been secured and amount to 41 million vaccines, currently. The Department hopes to vaccinate about 67% of the population, but is actually planning to cover more than that, thus, a minimum of 40 million, but the plan is to vaccinate more than that. With the vaccination programme, the Department is hoping that the infection rate will reduce and that the symptoms for those who do get infected will be less severe. The Department is also hoping for fewer fatalities and fewer hospital admissions. That is what will be ramped up over the next few days and weeks. This will allow time for the country’s health services to restore.

On the other hand, a lot of ground in terms of basic health services was lost – for example, sexual and reproductive health as well as the prevention and management of HIV/AIDS. The rollout of anti-retroviral treatment was hampered. Detection and treatment of Tuberculosis (TB) and other non-communicable diseases was also hampered. Resources were diverted to laying out field hospitals and expanding testing and treatment for COVID-19. All this did affect the implementation of the Department’s plans over the last financial year.

An EFF Member had a passionate response to the presentation, saying that the Department was misleading the country on its vaccination targets. She also denounced the broader corruption issues surrounding the procurement process around COVID-19, encouraging Members to be as robust in eradicating the corruption. After another Member from the ANC called her behaviour abusive, she said she refuses to be policed in her discourse. The exchange became heated continued until the Chairperson instructed the technical support staff to remove the EFF Member from the meeting.

The Committee’s main concern was the cuts to the Department’s budget. Budget cuts will also result in cuts to staff – reducing frontline workers at a critical time. The Members felt that they did not get a clear sense on how the Department is going to cope with the budget cuts. How will the decline in the primary healthcare programme’s budget affect service delivery? How will the district health services be affected by the reduction in budget? Can the Department create a report explaining how this will actually affect the country’s emergency medical services? How does a decline in the budget for human resources for health programmes affect service delivery? Which services will be affected and how?

How is the country preparing to deal with the other covariates of COVID-19 and the possible third wave? What strategies and plans are in place to prevent or limit future global pandemics affecting the country?

Meeting report

The Chairperson opened the virtual meeting, greeting everyone and said that the day would be longer than anticipated, as there was more than one meeting to attend.

Mr P van Staden (FF+) asked if he could be excused at 13:00 should the meeting go beyond that time.

The Chairperson said that he had sent a letter to the Minister on the previous day so that the Committee could deal with the issue of the Minister’s budget vote and have a separate meeting to deal with the issues. It is an under-performance plan. He said that he had a meeting with the Chief Whip of the majority party on the previous day, who said that there will be a long constituency break from 04 June until sometime in August 2021. Some portfolio committees have requested to do some work during that time. The Chief Whip was amenable to that, but no more than two days per week should be used for those activities. While the budget votes are ongoing, oversights will continue to take place. Invitations will be sent off by the end of the week to the first batch of those who will be presenting to the Committee. All meetings will be virtual.

The Chairperson welcomed the Department of Health (DoH). The delegation would be led by Deputy Minister (DM), Dr Joe Phaahla. There was an incident in Limpopo and so the Minister is supporting the province with that and unable to attend the meeting. The DoH will be presenting its Annual Performance Plan (APP).

Ms Vuyokazi Majalamba, Committee Secretariat, did the roll call and apologies. She indicated that there was an apology received from Ms M Sukers (ACDP), who was still with the Basic Education oversight, and from Mr A Shaik-Emam (NFP), who had prior engagements.

The Chairperson asked the DM to introduce those who were supporting him in the meeting.

Deputy Minister’s Remarks

DM Dr Phaahla thanked the Chairperson. He indicated that the delegation would be led by the Health Department’s Director-General (DG), Dr Sandile Buthelezi. The DG will indicate the delegation from the Department.

Briefing by the Department of Health

Overview by the Director-General

The DG thanked the Minister and greeted the Committee. He said he was accompanied by Mr I van der Merwe, Chief Financial Officer (CFO); Dr N Makhanya, Acting Deputy Director-General (Acting DDG); Ms A Cele, Acting DDG, as well as Ms T Zondi, Chief Director: Planning, Monitoring and Evaluation, who would be leading the presentation. Also present in the virtual meeting were Mr T Matheza, Chief of Staff; Mr S Sodladla, Head of the Office of the DG, as well as Ms C Gcasamba, Parliamentary Liaison Officer.

The Committee Chairperson thanked the Minister and the DG and said that the Committee was at the tail-end of presentations made by various entities that work for and report to the Department. Certain things have been raised by the Financial and Fiscal Commission (FFC) – some positive things and some real challenges facing certain entities and the Department. Some of the Committee Members know about those issues and the Department will have to respond to some of them today.

He said that the Committee received a very disturbing report from the Auditor-General (AG) on the previous day. He wrote and spoke to the Minister on the previous day and a meeting should be set up where the AG presents and the Committee asks questions. The Minister of Health, Deputy Minister of Health, the DG and all DDGs, MECs of all nine provinces and Heads of Department (HODs) of all nine provinces should be at the meeting. The report is very concerning. It will probably not change the Department’s APP, but it is a post-mortem that needs to be done in order to understand how things came to be how they are. The report will be on the procurement and storage of PPEs in various provinces, with pictures of areas that were very concerning. The request for that meeting is mandated by the Portfolio Committee to take place within 14 days. Some Committee Members requested that it be seven days, but he felt that seven days would just be too little time because all the various leaders all over the country have to be brought together and the Minister is preparing for the Budget Vote.

He indicated that Committee Members have suggested a joint meeting with the National Council of Provinces (NCOP) Select Committee. The NCOP could assist this Committee. He would have to go back and check what the FFC was saying about the Department and its entities. The AG’s report did not look at the whole spectrum. It focused on work in provinces on procurement, distribution, use and storage of the PPE. Some Members even said that it was a damning report. Let the Members in today’s meeting not get into that issue until there is time and space.

The Committee will have to understand that the Department, as a part of government, had no choice but to accept the budget and budget cuts it was given. It will strengthen the Committee’s resolve to meet separately with the Minister of Finance. The Committee has already requested to do so; it is now a matter of when. The Committee wants to see the Minister of Finance because it is not sure that the country is not being short-changed on the allocation of vaccines. However, after looking at the budget plan in the APP, now it looks like the problem is bigger than that. Comments on this will be allowed at the end of the meeting. He asked the presenter to try to keep the presentation within 45 minutes to allow for more discussion time.

The DG thanked the Chairperson and greeted the Committee Members. The Department values the opportunity to present to the Portfolio Committee. Even before the COVID-19 pandemic, the country was experiencing difficult economic circumstances with declining revenue. This will surely be discussed further in the kind of meeting the Chairperson has alluded to.

The APP is for the financial year of 2021/2022. The conditions are difficult. There has now been a full-year cycle of the COVID-19 pandemic. The 2020/2021 financial year has mostly been consumed by trying to manage the pandemic. There have been two waves: in the middle of 2020 and then at the end of 2020, with more transmissibility, more casualties and more fatalities. There is now a plateau. There are warning signs of increasing positivity rates. For the first time in a few days, the number of positive cases has exceeded 2 000, after a period of hovering at the 1 000 mark. This indicates that there may be some more difficulty again.

One thing that is different this time is that there are vaccines that have been proven to be safe and effective. The Department has started to administer the vaccines. The Department started slowly after the disappointment of the initial consignment of Astra Zeneca, which was found to be ineffective against the dominant variant. The Department was able to start with the Johnson & Johnson trial vaccine. Healthcare workers’ vaccines are busy being completed now. On 05 May 2021, the Department received the first consignment of the Pfizer vaccines – 325 000 of them. Just over a million of the Johnson & Johnson vaccines are expected to be delivered in the next few days.

The Department hopes to vaccinate about 67% of the population, but is actually planning to cover more than that, thus, a minimum of 40 million, but the plan is to vaccinate more than that. With the vaccination programme, the Department is hoping that the infection rate will reduce and that the symptoms for those who do get infected will be less severe. The Department is also hoping for fewer fatalities and fewer hospital admissions. That is what will be ramped up over the next few days and weeks. This will allow time for the country’s health services to restore.

A lot of ground in terms of basic health services was lost – for example, sexual and reproductive health as well as the prevention and management of HIV/AIDS. The rollout of anti-retroviral treatment was hampered. Detection and treatment of Tuberculosis (TB) and other non-communicable diseases was also hampered. Resources were diverted to laying out field hospitals and expanding testing and treatment for COVID-19. All this did affect the implementation of the Department’s plans over the last financial year.

The Department hopes that with the rollout of the vaccination programme, the core programmes can receive more focus. This includes the implementation of universal health coverage, hopefully supported by the passing of the National Health Insurance (NHI) Bill. The Department aims to improve the quality and capacity of the country’s health services.

For the financial year of 2021/2022, the total budget is just over R62.5 billion. Almost all programmes have been affected by budget cuts. There has been improvement in the management of COVID-19.

The DG thanked the Minister and said that Ms T Zondi would lead the presentation and then hand over to the CFO for the financial information of the APP.

Annual Performance Plan 2021/22

Ms Zondi reported that the Department’s six programmes have been detailed in the presentation document, including their targets for the Medium-Term Expenditure Framework (MTEF). Most relevant for 2021/22 are the MTEF targets for programme three (communicable and incommunicable diseases): getting 40 million persons vaccinated against covid-19 throughout the country; for 98 hospitals to obtain 75% and above on the food service policy assessment tool; for 500 medical officers and professional nurses to be trained in order to improve their skills in clinical management of mental disorders.

Under programme six, some of the targets are: getting 500 Covid-19 vaccination sites registered to use the Electronic Vaccination Data System (EVDS); developing the Alpha version of the networked TB/HIV Plus Information System.

Mr van der Merwe presented the financial information. He said that the total budget for the Department’s six programmes, including contributions from the voted budget, earmarked allocation as well as the NHI (National Health Insurance) direct and indirect grant, is R62.543 billion. The baseline has been decreased across all the economic classifications due to economic pressures as a result of the Covid-19 pandemic. The compensation of employees ceiling was reduced with 12%, resulting in reductions across all the programmes.

Under goods & services, about R4.35 billion was allocated for the procurement of Covid-19 vaccines. The allocation for indirect NHI grants under Programmes two and five has been materially decreased. Additional funds have been allocated under Programme one to fund the related expenditure due to the relocation of the Department to another building.

For transfers and subsidies, the allocations for conditional grants and transfers to non-profit institutions were reduced with three percent and thirteen percent, respectively, across all the applicable programmes. SANAC (South African National Aids Council) received a once-off increase of R10 million, while allocations for the other Departmental Agencies have been decreased.

In the purchase of capital assets, the NHI Indirect Grant for the construction and refurbishment of health facilities under Programme five have been reduced with R107 million. The allocation for the procurement of machinery and equipment of the indirect NHI grants under Programmes two and five has been decreased. The capital allocations of all the units across all the programmes have been increased once-off to make provision for procurement of computer equipment and/or furniture due possible damage because of the relocation to another building.

The overall reduction on indirect grants for 2021/22 is 16.3%, which without the new Covid allocation for vaccines. This means that the 21% increase is artificial due to new Covid-19 funding for vaccines. The major reduction is under Infrastructure indirect grant with 19.6%, followed by non-personal services with 15.6%. The reduction will have a negative impact on nationally managed programmes, especially infrastructure projects. Some planned projects will need to be postponed due to limited funding. The current infrastructure backlog will continue to grow. The Department is in the process of establishing oncology services in underserved provinces, but this process will be delayed due to budget cuts.

The overall reduction on direct grants for 2021/22 is 3.4% or R1.8 billion and this is growing over MTEF period. The major reduction is under NTSG (National Tertiary Service Grant) of R1 billion and HIV component of R1.6 billion. This will have serious service delivery implications as this will require: rationalisation of services; maintenance of current services; all the current initiatives to modernise the tertiary services and establishment of new services will have to be postponed. Cross-border referrals will continue, which will have a direct effect on patients. However, the Department will continue to put measures in place to ensure current services are not tempered with.

Discussion

The Chairperson wanted to pick up on a few things raised by the FFC on the budget. There is a comparison between the last and this financial year. The Department says that the difference between the budgets shows a policy shift in the fiscus for the year ahead and contextualises it. National Treasury (NT) is not really providing answers. What NT is raising is the process of employment. The number of people that the Department has is being cut down. If the Department cannot provide answers, the Committee will have to find space and time to speak to the Minister of Finance.

The total number of people registered in the NHI project has increased from 46 million to 50 million. However, the Government does not provide insight on how the registry integrates data from other data systems across the private and public sectors to ensure information aligns between systems, for efficiency of national health care services. The FFC has raised these issues.

Mr T Munyai (ANC) said that Parliament broadly approved the broad budget that Minister Tito Mboweni presented. The Committee should really support the Department’s budget here. The Committee will have to request a meeting with Minister Mboweni to further engage on some areas, especially those to do with budget cuts. Let the Committee welcome the R10 billion in vaccine funding. COVID-19 has really brought some unprecedented consequences. The Department’s efforts should be welcome.

He said that the Chairperson’s aims to request a meeting with the Department of Finance should be supported. The key programme areas should be supported, especially the NHI and sustenance. There is progress in training more than 200 graduates, which happened last year, of Dr Nelson Mandela and Dr Fidel Castro. Cuba is the undisputed leader of primary health care. The NHI will help to strengthen the weaknesses that have been exposed during the pandemic. That is the spirit in which the Committee needs to approach the budget debate.

The Committee needs to persuade the Minister of Finance to strengthen the support of the key programme areas that there is concern over. Going forward there should be a reprioritisation of the NHI and any other progressive areas. The ANC is behind the budget with the concerns raised.

Ms A Gela (ANC) welcomed the report and aligned herself with Mr Munyai on the matter of the NHI. She said that the ANC totally supports the implementation of the NHI, as it will help address all the challenges that the health system faces.

She agreed with the Chairperson about the need for a meeting with the Minister of Finance and the need to look into the budget cuts in the Department. Health is a very important entity.

How has the pandemic affected the National Department of Health? Some programmes have not been implemented because of the pandemic, as indicated in the presentation. Is there a way to recover what has been lost?

The number of targets has been reduced compared to last year’s APP. Why is that?

How has the Department addressed issues raised by the AG’s findings? The misalignment of the principles outlined in the revised framework for strategic plans.

How is the Department going to deal with the infrastructure backlog?

Treasury has cut the Department’s budget due to the pandemic. The Department actually needs more money in order to implement all its key programmes set as a target for the financial year.

Slides 33 and 34 of the presentation are very important to the country. The issues of reduction under NTSG (National Treasury Services Grant), the R1 billion and the HIV components are really frustrating. The Committee needs to engage the Minister of Finance so that some of the issues can be corrected. The Committee hopes that the Department will address all of the findings raised by the AG.

Ms N Chirwa (EFF) said that vital programmes have essentially been defunded. This will come with regression. Regression in the DoH was imminent even before the pandemic, in particular with the TB and HIV programmes. This regression means more infections and more deaths. The funding of these programmes is vital to curb the spread of these diseases. People need to be ensured access to medication. This is going to be impacted, but that has not been communicated.

For example, the Department spent R82 million on digital things like social media. Yet, on Twitter and Facebook there is a term called ‘Geu’ that keeps trending and it feeds into the stigmatisation of HIV all over again. The Department has not responded to this. The Department has not navigated around the conversations that are happening, that have been proven to regress everyone further, despite the fact that the funding for this kind of thing is already there. The modus operandi has not changed to function like a department that is facing a catastrophic situation of being defunded.

The Department has not come to tell the Committee how it plans to manage the new circumstances. The circumstances are not going to change anytime soon. It is as if the Committee is just receiving things as they come and just hoping for the best. Hoping and aspiring for things does not cut it anymore. The Committee needs tangible efforts by the Ministry. The Department should come with solutions. Real challenges are being faced. If there is nothing that can be done, that must also be communicated, instead of waiting for a catastrophic event to happen and only then seeking and taking recommendations. How has the modus operandi changed to match the circumstances that the Department is in?

There is talk that 40 million people will be vaccinated and Treasury has allocated R10 billion for vaccines, but it is clear that that amount of money will not cover that number of people. Why is this not being communicated to the public? Why is this not being communicated honestly? The Department keeps saying at press briefings that its plan is to vaccinate 40 million people by 2022 knowing very well it does not have the money to do that. Where is it going to come from?

The EFF already wrote to the Committee Chairperson, asking for the Finance Minister (FinMin) to meet with the Committee last year. It is frustrating that this is something that is still being talked about because it means that political allegiance for this Portfolio Committee has weighed heavier responsibility than actually holding the Department accountable. Even if the Committee raises the issues of the AG, the Committee must also take heed on how it has fallen short to applaud Ministers and provincial executives, knowing very well about the work they are bringing to the Committee’s table. It is insufficient, unsustainable and very concerning.

The Committee has raised the need to put the Eastern Cape under administration because of issues of maladministration, corruption and of mismanagement of funding. The Minister rejected that heed and then the AG came to tell the Committee that things have gone south. The Committee only acts concerned now. It is faking its concern. This concern was raised in 2020 already in front of the Minister. Various Committee Members asked for the Eastern Cape to be put under administration. Was this done? No! This is a very serious issue because there is only a response when it is already on the ground. These issues have been raised consistently. This Portfolio Committee has defended MECs who come to present mediocre work. The Committee has defended, applauded and thanked them. The same was done for the Minister of Health.

The Chairperson interrupted Ms Chirwa to ask if she had a response to the presentation. Is the last part that she raised for the Department to respond to?

Ms Chirwa said that the last part was part of her comments to the Minister and to the Portfolio Committee. She said she would appreciate not being policed in what she could say as these were things that she felt needed to be said. She said that if it makes some people uncomfortable it is hard luck. One must continue. The Committee will do as it has been doing all along and take her out of the meeting because other Members are feeling uncomfortable.

Another problem is that more than 200 qualified medical interns still do not have posts despite the Department saying that this will be resolved by early April. It has not been resolved nor even brought up. What will be done? It means that the Department has misled the Committee on timeframes and targets, time and time again. The failures of the DoH and the Minister are being shielded. The Committee has continuously raised the same issues that the AG has, such as poor coordination, finances in Mpumalanga, Gauteng and the Eastern Cape. These problems were raised on 26 October 2020. The Minister took no heed. The Minister has been complicit in the regressive behaviour by being cheerleaders of provinces. The Minister presented mediocre work right here. The Committee wants to feign concern over the AG report, when these concerns were already raised.

What is going to be done? Is the Committee now going to pretend that the idea to contact the Minister of Finance comes now, when it actually came in 2020? The Minister of Health does not have the prerogative. The Committee already called for the Minister of Finance. How does the Portfolio Committee and its Chairperson respond to that? It is already May. Most importantly, why does the Department continue to communicate that 40 million people will be vaccinated in this particular financial term when it knows it does not even have half the money to vaccinate 20 or 30 million people? Why is this still being communicated on public platforms, TV, radio as the plan?

Dr K Jacobs (ANC) called for a point of order. He said he was very concerned about the manner in which Ms Chirwa was allowed to vent in the way she was venting. He said that he found Ms Chirwa to be abusive and that this should not be the case on public platforms. He would like the Chairperson to intervene, pointing out that the same verbal abuse happened previously. It is not correct to speak to others that way. The Minister is not present to be able to respond to Ms Chirwa and the same debate took place in Parliament on the previous day. He thanked the Chairperson.

The Chairperson said that abusiveness needs to be dealt with outside of Committee meetings. This is not the first time this kind of irrational and abusive behaviour has been present in a meeting. The Committee has requested it be sorted out somehow. He said that he could not instruct an adult how to behave properly and address people with cordiality.

Ms Chirwa interrupted the Chairperson to say that of course he would not intervene because he does not even tell provinces to stop being corrupt. Provinces steal money from the people and the Chairperson does not get upset. He gets upset when Ms Chirwa says the Ministry is misleading the Committee. What is cordial about corruption? What is cordial about misleading the nation into believing that 40 million people will be vaccinated when there is no money to do that? What is cordial about PPE corruption that has been evident?

Everyone in the Committee feigned concern. People are dying. Corruption is murder. These issues do not deserve cordiality when people are being refused access to primary healthcare. Vaccinations are primary healthcare. It is mandatory and an obligation of the DoH that is not being fulfilled. This Portfolio Committee is watching it happen. How is it uncordial to raise it? If her problem was her tone, the Chairperson should say it. If her problem was her emotiveness, that should be raised. “Say that you are uncomfortable, not that she is telling a lie or that she is being abusive.” There is nothing abusive about telling the Ministry that it is not doing a good job, because it is not. The AG says that as well. The Committee agreed with the AG yesterday, even asking the AG to come back, but today she is uncordial by raising the very same points? She exclaimed that is an emotive issue because people are dying. There will not be vaccines because there is no money for it. People are being misled.

The Chairperson told Ms Chirwa to get to her points and to stop the debate.

Ms Chirwa told the Chairperson that his discomfort was not an issue. People do not have vaccines. The Ministry is misleading the Committee by saying that it will vaccinate 40 million people with R4 billion. That is not going to happen. She told the Department to go and change the presentation to show what is tangible and to stop presenting intangible things to the Committee. She told the Department to stop telling the Committee that all medical interns will be absorbed by early April, when 200 have still not been absorbed. Is that not abusive? Is that not the Ministry abusing South Africans? That is abusive. But now the Committee must talk about how its Members feel about how she is talking.

Mr Jacobs interrupted Ms Chirwa to tell the Chairperson that he had asked him to intervene. He called a point of order.

Ms Chirwa told Mr Jacobs that his emotions were not that important.

Ms Chirwa and Mr Jacobs shouted over each other for a few moments.

Ms Chirwa started telling everyone to be sick and tired of corruption.

Mr Jacobs said that he was sick and tired of Ms Chirwa’s rudeness and abuse.

The Chairperson said that he instructed the Committee’s support staff to take Ms Chirwa out of the meeting. She would not be part of the meeting anymore. He told the support staff to not let Ms Chirwa back into the meeting at any point.

Ms H Ismail (DA) thanked the Department for its presentation and greeted everyone. She asked how the decline in the primary healthcare programme’s budget will affect service delivery. How will the district health services be affected by the reduction in budget? Can the Department create a report explaining how this will actually affect the country’s emergency medical services? How does a decline in the budget for human resources for health programmes affect service delivery? Which services will be affected and how?

Can the Department create a report on the backlog of forensic chemistry laboratories? As highlighted by the South African Nursing Council (SANC), when will the Minister be appointing an Appeals Committee for the SANC, as stated in the Nursing Act? This process has been delayed for a number of years.

How is the country preparing to deal with the other covariates of COVID-19 and the possible third wave? What strategies and plans are in place to prevent or limit future global pandemics affecting the country?

The report is very dismal with regard to fiscal management. The reductions in the budget are quite perturbing. What methods does the Department use to place community service doctors at locations? There is a reduction in budget so there will be a loss of health personnel, and community service doctors are thus going to be essential. But community service doctors are complaining and saying that their voices are not being heard and are being placed in areas where they are not happy. Even when they communicate with the necessary provincial departments, they are not getting assistance.

Can the Department explain how and why married couples are separated? What measures are being put in place to prevent this in the future? Families are being separated and this is negatively affecting them. Many doctors have not been placed at all. What measures are being put in place to assist these doctors as soon as possible? When can results be expected? Some of the community service doctors have not been paid. How many married couples have been separated and how many have been relocated to their preferred locations?

Forensic pathologists have highlighted that one of their main concerns is the stagnation of the forensic structure by the DoH. Even the Labour Court ordered the finalisation of this matter, yet there is no finalisation after four years. Can the Committee please get a report on when this matter will be finalised and a report on where the matter stands right now?

Ms Ismail asked the DM how South African students were assisted in Cuba. The last known fact was that a flight was going out to Cuba and parents were requested to fill 23kg bags with necessities. She said that she has been in communication with some of the students in Cuba and they say the bags have not reached them and they are getting no assistance from the Department. She asked the DM to provide feedback on this.

Ms S Gwarube (DA) said that there is a reduction of about 3.4% from the budget. This is obviously to do with the pandemic, meaning a reprioritisation of a lot of the programmes, particularly around infrastructure. There is a massive problem of vacancy rates in many facilities. There are a number of people who are simply acting for a number of years. Very basic posts cannot be filled. It seems that there is a problem of a bloating of administration at a provincial level at the expense of frontline-serving employees. It is known that there are financial problems, but what is the way forward? Because without staff, a health service cannot be rolled out.

If there is a medico-legal claims problem, massive vacancy rates will only exacerbate that. There seems to be a vicious cycle that is never-ending. There are budget cuts, posts are not being filled and there are massive medico-legal bills. The Department has to come up with some kind of strategy. Financial problems are going to remain for a long time. It seems that the answer lies in reducing top management and a bloated administration at the expense of frontline-serving employees.

Another issue is around the infrastructure budget. How is the Department going to make sure that it is also dealing with maintenance issues? Going around the country to various facilities, facilities are saying that they are not asking for new facilities or massive capital projects; they are simply asking for the ability to fix a broken window or to make sure things are running alright. These are basic things.

Ms Gwarube asked if the target for 40 million vaccinations has been pushed out to 2021, 2022 or 2023. What is the actual target? It seems that the realistic target the Department has set itself is for around 16 million people. It is only fair that this is communicated. If targets have shifted, the Department should communicate it.

Are primary health care facilities ready to vaccinate? The hospitals seem jacked up, but a lot of the clinics do not seem to have sufficient cold storage capacity. So, how is this being addressed?

There are ten days until the start of the vaccine rollout. It seems that there has not been a concerted effort from the Department to raise awareness for people to get registered. It is not enough to talk about it in these meetings. Messages need to reach people where they are. Have community radio adverts been placed? Have community newspapers been utilised? How much money is being spent on notifying people on how and where they need to register? This is what is needed in order for this phase to be a success. The Department is spending millions on dubious communication contracts, but nothing tangible has been seen yet.

Mr Van Staden greeted the DM. He then asked what the current total budget shortage is. The Committee hears about wonderful targets but never hears how they are going to be reached. The Committee also never hears how the huge problems at hospitals are going to be eradicated, such as service delivery problems; the halting of operations due to COVID-19; the shortage of doctors and nurses; interns not getting placed or paid; a shortage of medicines and equipment; water shortages; hospitals burning down; a shortage of hospitals and clinics; the massive litigations against the Department; infrastructure problems at hospitals and clinics and patients dying because of these problems. Reports on all these matters are needed urgently. When will concrete plans to eradicate these problems be seen from the Department? These problems are destroying everything in the public healthcare services.

The Department is currently spending millions and millions of Rands on an NHI system, but it cannot be launched unless all of the above problems are completely eradicated. Rather use the millions of Rands that are being wasted on the NHI programme, that actually cannot be afforded at the moment, to sort out the problems in the public health system or to buy more vaccines. The Committee needs to see concrete recovery plans from the Department.

Lastly, according to the DM, when will the target of 40 million vaccinations be reached?

Ms E Wilson (DA) thanked the Chairperson and the Department for the presentation. She said that the Committee has been sitting in meetings the whole week and the proceedings have been depressing. She thought that she could not get any more depressed than she was on the previous day. She had been too hopeful. This report is the most depressing and disturbing report seen in a long time.

Most of the people in the Committee were present at the NHI public hearings. In almost every hearing, the Committee heard the complaints about failing infrastructure, lack of staff, lack of equipment, lack of medicine and lack of electric and magnetic fields (EMF) services. Those are all critical to the health system. These are the biggest concerns of the voters in this country. Yet, today’s presentation says that the staffing has got to be cut in a system that is already seriously understaffed.

The grant for construction and refurbishment has been reduced in a day and age where infrastructure and buildings are collapsing, where there is not equipment or equipment is not working. It is desperately disturbing. As the CFO said, the situation is not sustainable. The lives of South Africans are at stake. Without health, South Africa is nothing. Without health, the lives of millions of people are not sustainable. She said that she was really worried.

Now, one has to look at the rationalisation of services. But of what services is the rationalisation? A lot of the services are not even there in the first place and now the Department wants to rationalise further.

Ms Wilson said that she did not have any questions, just a comment to say that the situation is disturbing and heart breaking.

Dr Jacobs said that the country has come a long way in ensuring that more doctors and other healthcare workers are being trained. There is a problem of students not being able to find employment. COVID-19 has highlighted the importance of those positions being filled because people will not get care without healthcare workers being employed. Now there is about a three-percent reduction of compensation to employers on a year-on-year basis. What is the envisaged impact of all of this? Will it impact services? Will it impact retrenchments? Will it mean that vacancies will not be filled? At the reduction of R1 billion under the NTSG and of the HIV component of R1.6 billion, it is noted that it will result in implications of rationalisation of services. It is a big challenge and cause for concern. There needs to be a proper explanation. Can the Department explain the reduction of a number of targets – for example, the maintenance, repairs and refurbishment of healthcare facilities went from 150 to 120?

There were challenges in programmes two, five and six. How has the Department addressed those issues? This is a difficult question that the Department might have to answer in writing.

Ms M Hlengwa (IFP) said the report was very comprehensive. What steps is the Department going to take to address the provinces that did not have a clear report on what they are doing about this money? Secondly, to seek clarity about the NHI, she asked if the provinces have enough infrastructure and capacitation to use this grant. That is why it is a question of clarity.

Thirdly, on medical aid schemes, there is fraud when it comes to using medical aid schemes. Has the Department intervened? The Committee is pleading for the Department intervention.

Fourthly, there are community caregivers (CCG’s). They go directly to the people, give them medicine and take care of them. Some people cannot even cook for themselves and the CCGs help with that. These people are doing that. The Department absolved them so that they can get something when the CCG dies. If he dies at the end of the month, he has that end of month times 1.5 only, and there is nothing else. That is a cry. In Ms Hlengwa’s area, there is a clinic that has a full service, including doctors, and she thanked the Department for that.

Mr M Sokatsha (ANC) welcomed the DoH’s report. The report is appreciated but also raises a number of concerns. He said that there are many ways to make a point, but being rude and disruptive is not the correct way. It is a way of making sure that a meeting is going to end. This Committee should raise points sober-minded and get answers.

He agreed with the Chairperson about calling a meeting with the Minister of Finance. This is the appropriate time. The Committee supports this budget but is raising concerns. There are so many budget cuts to key programmes, which concerns the Portfolio Committee. He agreed with Mr Munyai and Ms Gela on the issue of the NHI.

The R1.6 billion that has been cut from the HIV/AIDS programme means that no new patients will be put on the Antiretroviral Treatment (ART) programme, which is a problem.

Agreeing with Ms Gwarube and Mr Jacobs, the Department’s inability to appoint new staff is a real issue. The Department has got critical staff, such as doctors and nurses. What is the status of relations? The USA has been donating funds to HIV/AIDS programmes. Is that donation still available?

The Chairperson requested that Committee Members assist him with the rules when they raise a point of order, as meeting virtually is an extension of a Parliamentary seating. This, so that Members can be sent out of the meeting more efficiently. No one comes to these meetings with a plan to collapse them. People come to learn and engage. He said he has thrown Ms Chirwa out of these meetings several times because of the way she handles some issues.

The issue of the Finance Minister was initially raised about the funding of the vaccines. There was R10 million allocated for vaccines. Questions were raised about whether that would be enough or more could be got. The decision was made to top-slice all the departments by three percent. That amounts to a huge budget for the DoH. He said that he did not instruct the DoH to cut back on public service or NHI budget, etc. The Department did that on its own. The Portfolio Committee is not in those meetings. How does the Department not have the things raised by Ms Wilson? The Committee needs to be educated on how the Minister sees processes, going forward. If these go beyond what the Department can answer, the Committee will take it upon itself to invite the Minister of Finance to meet.

Responses

The DG thanked the Committee for its comments and questions. He said that the matter of budget cuts is problematic. Unfortunately, staffing is always the first component to be hit by the cuts. The Department will try to make sure the clinical staff is not affected. The administrative side, although equally important, will probably be affected more.

On the more than 200 interns that were not placed, the DG explained that the placements are done in January and July. All the interns that were eligible for placement in January were placed. There are 220 interns that have just become eligible now at the end of April. They are ready for placement in July. Placements are not done at any other time.

The allocation of interns and community service officers is a statutory function that needs to be fulfilled by the state. Just as interns are placed, so are community service officers. According to policy, community service officers should be placed in underserved and rural areas. There are people with special circumstances. It is mainly medical conditions that are prioritised, where people might need to be closer to specialised facilities. There are a lot of requests from people who are married or engaged to be married. Unfortunately, the Department cannot accommodate that. That would be breaking policy. Married couples cannot always be placed together. It is a difficult situation. The policy means that people need to be placed in underserved areas.

Post community service, people who qualify as medical professionals have a responsibility to apply for vacant medical officer positions. The Department tries as much as possible to absorb them. All the post community service doctors in the Eastern Cape were absorbed this year because there were positions available. It becomes problematic when some of them go into the private sector because they are already registered for independent practice.

On the vaccination programme, the DG said that the vaccination programme is presented every two weeks. There are exogenous factors, such as the delay that happened with Johnson & Johnson because of a global auditing issue. The first delivery was meant to be a week ago. The vaccines were packed and ready for delivery in Gqeberha but they could not be moved. The target will continue to be 40 million by February 2022. In the first phase there is a target for healthcare workers, second phase there is a target for essential workers.

A total of 31 million doses of the vaccine have been signed for with Johnson & Johnson. It is possible that there might be some wastage. There is a signed and sealed contract with Pfizer for 20 million, which means 10 million lives, as it is a two-dose vaccine. That amounts to 41 million. With COVAX, the Department has signed for 12 million doses, which amounts to six million lives. A deposit of $19.2 million has already been paid. There are still some negotiations going on.

The issue on the Appeals Board of the Nursing Council is receiving attention. It is going to be finalised very soon. It has already passed by the DG’s office. That will be sorted out as soon, as it has gone through the executive authority.

On the issue of the possible threat of the third wave, the Department is on high alert. The numbers for the last few days have been at about 2 000 new cases per day. There are a few worrying problems. Firstly, Gauteng is coming up quite strongly, followed by the Free State, the Northern Cape and the North West. The Department is watching the provinces on a daily basis and it is activating a number of response areas when it comes to the management of COVID-19.

Isolated cases have been reported in the country’s ports of entry, mainly marine ports of entry. Some vessels have come in with COVID-19-positive people. Quarantine, tracing and case-management have been activated for those people and the Department is ensuring that there is surveillance at the ports of entry. There is an advisory from the Minister Advisory Committee (MAC), on how the ports of entry are to be managed. Specifically with the Indian variant, the team at CRISPR (clustered regularly interspaced short palindromic repeats) that does genomic sequencing has recently briefed the Minister and the DM on the work it is doing. The Indian variant has not been picked up in South Africa yet. The same team has advised the Minister and the DM that the Indian variant is not as aggressive as the one that drove South Africa’s second wave.

Ms Zondi thanked the DG and the Chairperson. The engagements that have happened in terms of the integration of the databases have mainly paired with the public sector databases, including the Department of Home Affairs because the Department of Home Affairs has the main registry. The next phase, which is planned for this financial year, is going to assist the Department in coming up with the Standard Operating Procedures (SOPs) and the protocols around the private sector. The lessons that are coming out of the current electronic database for vaccines is that one of how the Department goes around the dance as opposed to people individually registering themselves. So, that is in the pipeline.

In terms of whether the Department is going to recover the service delivery levels, she said that it is challenging because of the budget issues. However, lockdowns and reduced service delivery have been common around the world. So as catch-up plans are developed, the Department is working with several partners, including the World Health Organization (WHO) and the United Nations (UN) around how the country deals with that.

Regarding the number of targets that have been reduced, she said that some of the cuts to the programmes were so that funds could be channelled to COVID-19 related programmes. It was partly in that light that some of the indicators were looked at and scrutinised. With that said, the essential services issues, such as the NHI or essential services in terms of communicable and non-communicable diseases, have been looked at and prioritised. She thanked the Chairperson.

The CFO thanked the DG and the Chairperson. He said that it is not the first time that there have been reductions to the tertiary services grant and HIV grant. There have been reductions for the past two financial years, although the reduction this year is much more. One way of looking at these grants is that the Department added the number of components within the grants to mitigate the issue of non-flexibility amongst components. There has been some success in that if a province underspends on one component to reprioritise to another component, it is much easier. That is part of the Department’s rationalisation programme. Rationalisation means looking at your package of services and looking at what is being offered. It might be the number of districts and hospitals giving certain services. That is the kind of rationalisation that the Department likes to see from a finance point of view.

The CFO said that he would not touch on anything that Ms Chirwa raised.

Quite a lot of issues were raised on the reduction of the budget by 3.4%. The Treasury guideline actually recommended a cut of about 5%. What makes it difficult at the national level is that some of these grants are there to assist with secondary provisions in terms of the placements of interns. As soon as that budget gets reduced, it makes it difficult to maintain the roll-overs or the carry-through costs of some of these salaries and wages. The maintenance issues are going to be affected to some extent. Provisions within the grant framework of infrastructure need to have a much bigger emphasis on maintenance within the provinces. New projects are being evaluated to see if they are really necessary or not. At the national level, one is moving towards looking at financing more major projects and start reducing interventions at maintenance matters at provincial level, given that provinces can now use most of their grants on infrastructure for maintenance.

Depending on the number of assumptions taken into account, the shortage is at least what was lost in baseline, plus about 5%; this conservatively makes it R3.2 billion for national health, excluding COVID-19-related expenditure. A previous analysis of budget shortages at provincial level saw it come to R9 billion to R10 billion, but in this case, it would exclude the COVID-19 allocation. So, it is quite a difficult guess to make.

Regarding the AG findings, the Department has seen them and has engaged quite a bit with them at a CFO forum. They relate to finance as well as performance issues. The Department has asked provinces to put together audit action plans on how to address them. They will hopefully be discussed prior to the engagement with the Committee and the AG going forward. The Department is trying to mitigate the reduction in the HIV programme, but with a big reduction of that, space to manoeuvre is very limited.

The CFO said that the issue with FFC reports has been some of the accuracy in the reporting. The CFO was part of the meeting for the first time this past Tuesday. The FFC say there is a reporting function to the Committee, but for the same measure, so does the AG. After the meeting, the CFO did have a discussion with the presenter from FFC and it should be agreed that reports of this nature could probably be discussed with the Department as well as some of the misconceptions and inaccuracies could easily be resolved. What the FFC reports to you is their business but to put energy into correcting some of their findings is counterproductive.

The Department has a very good relationship with the AG and there are meetings between the two regularly. The AG does give the Department some indication of what reporting will be done. If the relationship with the FFC could be streamlined going forward, it would be to everyone’s advantage. He thanked the Chairperson.

Dr Anban Pillay, DDG: Health Regulation and Compliance, DoH, greeted everyone and thanked the Chairperson. On the question relating to the forensic chemistry labs, Dr Pillay indicated that the Department has been working to clear the backlog and trying to support staff in doing that. The Department has also asked the National Health Laboratory Service (NHLS) to support the Department on the operations side. The NHLS has a better capacity when it comes to laboratory management. The Department is hoping the NHLS will bring some efficiency and help reduce backlogs.

On the question about the variants, anyone who enters the country is required to do a polymerase chain reaction (PCR) test and it needs to be negative before they enter. It is important to bear in mind that variants do not only come from the outside; they also develop in the country. The way variants develop is that as the virus continues to replicate and if there is uncontrolled infection and spread amongst people, as the virus replicates many times, it starts developing variants. It is a natural course of its replication. The key thing is to make sure the spread of infection is reduced. Once everyone is vaccinated, the consequence of variants will reduce. It is important to bear in mind that variants do not only come from the outside and can develop internally as well, based on the extent of the spread of infection.

On the community service placements, as the DG said, the intern placements happen twice a year. Anybody that had not passed exams for the end-of-year or January placement becomes eligible for the second cycle. So, it is not that interns have been forgotten; it is just that cycles are regulated. That is the way it has been managed for years.

It is the Department’s policy that married couples should be placed together. In order for that to happen, the Department requires the couple to indicate that they are married and that they would like to be placed together at the point of application. The system would then try to prioritise them. If the couple chooses an area where there is difficulty in placing two people then that becomes a challenge. After placements of married couples are done, the general applications are then addressed and everybody else is placed. So, if one comes after all of that and then wants to be placed in a particular place, it becomes difficult because those places have been taken up by other medical students. So, those are some of the challenges experienced in trying to satisfy everybody.

On the question about the high vacancy rate and bloated administration, he said that the Department recognised this a number of years ago. The National Department did do some work and made recommendations to the Department of Public Service and Administration (DPSA) around this as well as provincial departments, around the structure of the head office staff, which is what is considered a generic structure. There has been lots of discussion about it, but this is something the DPSA has to implement because the DoH does not have direct control over the posts that provincial departments create at head office or at the frontline. The Department would support the principle that frontline must be the area where more staff should be placed and should be prioritised over administrative positions.

On the readiness of the system for vaccines, there is a master facility list with guidelines about what each site should have. At each site there is a manager who confirms that all of the different elements that are required for vaccinations to take place are there, and they sign off on that. There are over 3 000 facilities across the country that are registered on the electronic vaccination data system (EVDS). This is in the public and the private system; it will continue to happen, as more facilities need to be created in areas where demand is required.

From a vaccine registration perspective, there are a number of people who have not necessarily received the message around how to register or have an understanding of it. There are campaigns across all of the provinces. The provinces have given the Department fairly detailed plans of their communication campaign of how they plan to reach these communities and get them to register. The community health workers have been armed to go out and register people. For example, they go to the South African Social Security Agency (SASSA) queues, where people wait for their grant monies, and make sure people are registered. That could be an easy point to reach many people.

In terms of the budget for vaccines, it is important to say that the Treasury budgeting process starts a long time before the budget is actually announced. While the budget currently reflects over R4 billion, it is important to recognise that National Treasury has given the Department a commitment that it will fund all the vaccines. The Department has a meeting with Treasury every week to indicate how much is required. The R4 billion that has been indicated is the indicative number, but where adjustments are required and where support is required from Treasury, Treasury will do so and any adjustments required in the adjustment budget will happen as well.

As the DG indicated, the 31 million vaccines as well as the 20 million vaccines that are secured will certainly cover the entire adult population the Department anticipates will need to be vaccinated. He thanked the DG.

The DG thanked the Chairperson and the Committee.

Dr Makhanya greeted the Chairperson, the Committee, the DM and the DG and thanked them for the opportunity to make some input. She responded to the question that was raised in terms of the status of the donor funding, which normally augments the departmental allocation. She said she would really like to highlight that as early as May 2020 there was a clear indication of the impact of the pandemic on clinical services, particularly on HIV, amongst other things. Catch-up plans were developed immediately and they were directed at addressing the gaps that were created because of the pandemic. They mainly focused on ensuring that case-finding through prevention-intervention linkages to care was accelerated.

When it was realised that there would be a new normal and there needed to be sustainable essential services in the pandemic, the catch-up plans were further refined and developed into service sustainability programmes that are now being implemented and monitored on a quarter-to-quarter basis at provincial level. The Department’s plans really focus on prevention and looking at HIV, the goal of prevention is to accelerate case-finding. That is being done through introducing the innovating testing methodologies, such as HIV self-screening in collaboration with the Department’s partners.

The Department is accelerating HIV case-finding through index texting, HIV self-screening, targeted testing and key entry points of all service delivery platforms. The Department is also ensuring consistent linkage to care. Self-testing kits have been distributed online in collaboration with the Independent Community Pharmacy Association (ICPA) as independent pharmacies stayed open as essential services. The HIV self-tests were also distributed to communities during COVID-19.

The Department has also increased its screening and contact-tracing, particularly using the Department’s core community healthcare workers that are already within communities that are now offering integrated screening services while they screen for COVID-19. They do the same for TB and for HIV.

The key intervention in terms of service continuity for linkage to treatment has been enrolled to clients that have been assisted to enrol on the central chronic medicine dispensing and distribution programme. This is used as a mechanism of decanting patients to differentiated modes of care so that they can collect treatment nearer places of work or home, without having to crowd or to go to health facilities. Patients are also encouraged to be initiated on treatment on the same day as they are diagnosed, so they are not lost after being diagnosed and before they are put on treatment.

Community ART initiation has been optimised to close the treatment gap for priority populations, particularly men, young people and children under the age of 15. There has also been a scale-up on the dispensing of ARVs. Currently, patients are getting a maximum treatment of a three-month supply. The Department is in the process of piloting a package of providing a six-month supply as a measure of making sure that people are continuously linked to treatment.

On care and support, there is a major campaign initiated in partnership with SANAC (South African National Aids Council) and civil society, which is framed as a welcome back campaign. It is jointly funded by a donor, PEPFAR (United States President’s Emergency Plan for AIDS Relief). This campaign is going to try to get people who have defaulted or missed appointments back by tracking and tracing. This is the key intervention to link people back with clinical management.

The same approach is used for TB management. The same principles of early diagnosis, linkage to treatment and treatment retention are used in the context of the catch-up plans and along the 19-19-19 targets that have been set. On early TB treatment, the Department is ensuring that TB testing and screening continues during this period. The TB screening tools have been integrated into the COVID-19 screening tools. People with symptoms are then tested for TB and COVID-19. This applies to all people presenting at health facilities and for screening of TB and COVID-19 contacts at community level. Community health workers are key because they conduct screening at the community level and collect specimens on site for referral to the nearest testing laboratories so they can be assessed.

Some people prefer to self-screen. Mobile applications for TB screening are provided under TB Health Check. It is available and there is quite an uptake in it because it uses the WhatsApp platform. People with symptoms are prompted to go for testing, following the self-testing mechanism. There are also mobile test X-rays that are currently being piloted in six districts, to provide screening services. This is intended to identify people who have TB but do not experience any symptoms. Routine TB testing using the GeneXpert machine irrespective of symptoms is also conducted for people who are living with HIV, at least once a year. When it comes to linkage to care for TB, the interventions include that people who test positive for TB are contacted and requested to come to health facilities for initiation of treatment. This is done via the phone by community health workers. There is a system of sending results to patients directly by the NHLS with a message to go to the nearest health facility for further treatment.

Other health solutions are also being piloted to ensure linkage to care, particularly for patients who have Multidrug Resistant (MDR) TB. The use of decentralised medication outlets in people’s communities is also used for MDR TB. To avoid multiple visits, there is month-to-month dispensing of TB medication, just like with ARVs for HIV. Most of these initiatives are supported by funding, by PEPFAR especially. For the 2021 operational plan, the funding planning is at quite an advanced stage, but even with donor funding there have been budget cuts. For instance, the allocation for the 2020 operational plan from PEPFAR was R523 million and the broad allocation for 2021 was reduced to R450 million. So, budget cuts are happening at the level of the donor funding too. The plans for allocation of donor funding are at quite an advanced stage including the funding that comes from the global fund.

The Chairperson said that during the meeting with the FFC, the FFC made a presentation and Ms Wilson asked the FFC if they had shared their report with the DoH and they said no. So, the Committee is not able to be prescriptive to the Chapter nine institutions. But what Mr van Der Merwe raised was fair – that for a constructive engagement like the DoH has with the AG, the report must be discussed together with the DoH.

The Chairperson said that when he was associated with the Department in the last 10 years, there was a flood of marriages in November, each year. People have not been married for some time. This results in an administrative nightmare at the end of the year.

The Department of Health has not really been able to say how it will handle the budget. The Committee supports the budget but the DoH is probably going to be under severe strain. The Committee will find a time to meet with the Minister of Finance. He thanked the DM for his efforts. The Committee will continue to seek support. Part of meeting with the Minister of Finance is to support the DoH and its programmes because the Department’s failures are severe failures of the country. People cannot go to work if they are sick or unhealthy. Mothers cannot deliver healthy babies if they are not being taken care of themselves. Health is so critical. Cutting the health budget is extremely concerning.

He invited the DM to make the closing remarks.

Deputy Minister’s Closing Remarks

The DM thanked the Chairperson and the Committee Members. He mentioned the issue of the medical students stuck in Cuba. Cuba is facing a number of challenges. It is not immune to the global economic situation. The Department has been in communication with its students. There was an arrangement with the Department of Defence, which also has students in Cuba. The aircraft that had intended to go to Cuba is no longer going there. There was then an arrangement to send some supplies to supplement some of the shortages. He said that he learned a day before this meeting that that arrangement seems to not be proceeding. He said he was sure that the team, under the leadership of the DG, would work on alternative ways for the basic consumables to be delivered.

The Department does understand the concern about whether the 40 million vaccines will be implemented in terms of the population immunity, but as the DG and Dr Pillay have said, this is quite advanced. The President instructed the Department of Health and the National Treasury to work together. With this partnership, it is possible, even where funds have been allocated up to a certain limit going into the next financial year. Because of the close working relationship, it is possible to make adjustments and that is why the contracts, as the DG indicated, are signed to provide for much more than 41 million, when you add the COVAX facility.

Once the funds are committed, with the approval of National Treasury, one could make orders even ahead of time. That is why the orders have been confirmed. The platform for vaccinations is ready, as indicated by Dr Pillay. The Department does have to catch up on registration, over and above self-registration. All provinces are now being encouraged to roll out outreach programs so that the people who are over the age of 60 can be registered. Once the Department goes into the industrial component, where people are in industrial settings, such as teachers, police officers or army members, uptake will be quicker.

The Department appreciates the Members’ concerns about the budget cuts and agreed that the cuts will indeed impact everything – for example, on the Department’s ability to hire frontline staff. But as mentioned by some Committee Members, the Department will be working with its colleagues in provinces to prioritise frontline health staff and reduce more on the administrative side. Infrastructure, equipment, consumables, information systems and many other services will be impacted. The Department counts on the support of the Committee. Health services must be spared from the difficult economic situation. He thanked the Committee for its support.

The Chairperson thanked the Members for attending the meeting, as well as the Deputy Minister and the Department for their presentation and engagements.

The meeting was adjourned.

 

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