OHSC, SAMRC, Office of the Health Ombuds & Compensation Commissioner for Occupational Diseases Annual Report 2021/22

Meeting report

Office of Health Standards Compliance (OHSC) 2021/22 annual report

Dr Molefe Kenoshi, Chairperson, OHSC, said that the entity's operations had reverted to pre-Covid-19 days. It was seriously impacted by the Covid-19 lockdown, because the inspectors who inspect the facilities could not travel during the hard lockdown. As a result, in 2020 and most of 2021, the performance of the OHSC in terms of its inspections was limited. The OHSC was quickly recovering in dealing with the backlog of inspections of facilities. It had a huge responsibility, as it was mandated to inspect and certify public and private health establishments, so that the health establishments could be accredited by the National Health Insurance (NHI) Fund when it was set up. The OHSC had mapped out its work and identified the need to double up its efforts and the need to decentralise its offices to some of the provinces. All of the efforts were aimed at increasing inspections and managing the backlog of complaints.

Dr Siphiwe Mndaweni, Chief Executive Officer (CEO), OHSC, presented the 2021/22 annual performance report. The 2021/22 financial year was fairly good for the OHSC. Like all other entities, it was affected by the Covid-19 pandemic, which slowed its processes and the undertaking of inspections. The pandemic had exacerbated some of the weaknesses already pre-existing in the health care system. The OHSC had taken the lessons learnt from the pandemic to propel the organisation to be better in terms of the regulatory work that it undertook.

(See presentation attached for further details)

Audited financial information

Mr Julius Mapatha, Chief Financial Officer (CFO), OHSC, presented a summary of the financial information.

• A clean audit was achieved.

• The revenue of the OHSC increased by 15%, and the expenditure increased by 12%. 67% of its expenditure was for the compensation of employees, due to the nature of the work that relied on human resources to conduct inspections and necessary investigations.

• The surplus was mainly due to the additional revenue from investment interest; no private sector inspections in 2021/22; most stakeholder engagements were held virtually because of Covid-19; additional revenue from National Treasury was received at the end of the financial year; and the salary increases were less than budgeted for.

• Expenditure was expected to increase with the volume of activities during 2022/23, due to the complete easing of lockdown restrictions.

Discussion

Ms H Ismail (DA) said that government had allocated R6 million to boost capacity within the Compliance Inspectorate programme. She asked what the current capacity needs within this programme were, and when these positions would be filled. She noted that the administration programme had overspending since the 2019/20 financial year, and asked what measures had been put in place to prevent this overspending from continuing.

There had been social media reports about the fires and lack of generators at public hospitals, as well as whistle-blowers who had complained about the working conditions at public health care facilities. She asked how the OHSC had been dealing with these issues.

She recalled that one of the reasons given for the under-performance of the Complaints Management and Office of the Ombuds programme was the delays and lack of responses from health establishments for requested information. She said this was unacceptable, and asked what plans the OHSC had put in place to address this issue, because it directly impacted its performance. She asked whether the OHSC felt it would reach the intended targets to have most of the health establishments certified as being complaint, in preparation for them to be functional under the NHI Fund.

She noted that the OHSC was mandated to certify health establishments, and asked what would happen in a situation where certification was given to an ideal hospital or clinic, but that same hospital or clinic complained that it was short-staffed or did not have the capacity to operate in an ideal way.

Ms M Clarke (DA) congratulated the OHSC on its clean audit. She asked whether the Information Communication Technology (ICT) service providers also provided a maintenance contract if necessary. How did the OHSC plan to address its limited investigation capacity? She noted a shortage of eight environmental health inspectors, four waste audit practitioners and about 63 complaints officers, which would make the job of the OHSC incredibly difficult. Did the Department intend to fund any of these posts, because the hospitals were currently not in a good state, which meant that the OHSC had to deal with many complaints?

She asked why only 33% of targets were achieved for the certification and enforcement programme -- what remedial measures would be put in place to deal with this? How many backlog cases were there, and what was the envisaged timeline for resolving the backlog? She asked about the root causes for the non-compliance with inspection -- after re-inspection, had the OHSC found that these hospitals or clinics complied with the resolutions that had been put in place?

In the last five years, the complaints to the OHSC have increased by 332%. She noted that in 2017, the OHSC had spent R9 billion of the R12 billion budget and still managed to inspect 696 facilities; in 2018, the inspections had decreased to 234 facilities, but the budget had been increased to R50 billion, with R49.7 billion spent. She asked the OHSC to comment on this.

She reiterated Ms Ismail’s question on whether the OHSC felt that the current health environment could support what was expected under the NHI Fund. On the Compliance Inspectorate programme, only 25% of the targets were achieved -- what consequence management was put in place to address the performance of this programme?

Mr P van Staden (FF+) referred to the 119 of 123 funded posts that were filled, and asked whether this was sufficient. If not, what would be a sufficient number of staff members? Was there enough funding for extra staff members, if needed? He sought clarity on whether the OHSC had only 42 certified inspectors, as he recalled that in 2019 the OHSC had reported that it had 44 inspectors countrywide.

He asked how many complaints the OHSC had received from the public and private sectors respectively. He noted that 189 health establishments had been certified, and asked whether the safety audits of hospitals in all nine provinces also fell under this category. If not, he asked the OHSC to provide the current status of the safety audits for hospitals and clinics in all nine provinces. Did the OHSC have sufficient funds to perform its duties properly?

Ms A Gela (ANC) congratulated the OHSC on its clean audit. She wanted to raise the issue of overspending, but it had already been raised. She asked that the OHSC update the Committee on the process of revising its own organogram, and how much was set aside for its implementation.

How did it plan to address the underperformance of the Complaints Management and Office of the Ombuds programme as a result of the lack of responses from health establishments?

Dr S Thembekwayo (EFF) read that the mandate of the OHSC was to provide “consistent, safe, and quality healthcare for all.” She referred to the maternity unit that was evacuated at the Dora Nginza Hospital in Nelson Mandela Bay, where the nurses who were on strike prevented the doctors from helping pregnant women, with the result that the maternity unit was shut down. She said that even though the strike was unprotected, the nurses were striking over genuine matters. She asked the OHSC about its contribution to ensuring safety of workers and patients. She asked whether it was involved in solving the problem at Dora Nginza Hospital, and, if not, why it was not involved.

She asked for an update on the draft inspection tool that was going to be used in the private hospitals, as well as the tool that was currently being used in the private hospitals. She recalled that the presenter had said that a report that addressed the issues under the Compliance Inspectorate programme would be provided in the “near future,” and asked what the anticipated date was that this report would be received.

She noted that the backlog of cases was a result of the delayed responses by health establishments for requested information. She said that this was not supposed to happen, and asked how the OHSC intended to solve the problem of delayed responses. It was its responsibility to establish healthy relationships with the health establishments. She asked for a description of the historic backlog cases, and the measures to resolve them. Were the strikes that happened at hospitals reported as complaints to the OHSC, and did they form part of the backlog cases?

Mr T Munyai (ANC) congratulated the OHSC for its unqualified audit. He said that under-expenditure was a crime, and over-expenditure was irregular expenditure. The Department and its entities should use the money from the approved budget and should not be allowed to perpetually continue with irregular expenditure. He was very happy that the Ministry was attending to the issue of the Health Ombud standing alone, which was consistent with the law and other best practice internationally. The OHSC had done well overall, but he does not tolerate irregular expenditure. Any organisation that continued with irregular expenditure undermined National Treasury regulations, which was not right. The organisations must work according to their approved budgets.

Ms E Wilson (DA) referred to the AGSA report on the certification and enforcement programme, where only 33% of the targets were achieved. She said that the Covid-19 pandemic did impact these targets, but it was a serious situation, because the purpose of the certification and enforcement was to certify compliance of health establishments, and to take enforcement action against non-complaint health establishments. Enforcement must be considered when health establishments are found to be non-complaint with the norms and standards. The non-achievement of targets could result in citizens receiving poor quality of health care in the health establishments. The quality of health at 90% of this country’s health establishments was horrendous and appalling -- the situation at Dora Nginza Hospital was merely one example that could be cited.

She noted that the AGSA report said that the target over the next couple of years was to increase the checking on 22% of facilities for compliance. 22% was a very small number, but she understood that the OHSC was hindered by staff shortages and the lack of inspectors. She asked how this would work, because the NHI Fund could not work if facilities were non-compliant. It was not just a case of being complaint, but specific standards needed to be met to be registered as a health facility under the NHI Fund. There had also been discussions that the facilities under the NHI Fund would be registered against a World Health Organisation (WHO) standard, and she believed that there was probably only a handful of facilities in the country that would meet that standard at the moment. These issues must be addressed by this Portfolio Committee very quickly and at the highest level, because the situation in the country was dire.

Ms M Hlengwa (IFP) said she had a specific issue with the backlog of cases, because she had lodged a complaint concerning an occurrence at the Edenvale General Hospital in Gauteng on 19 June 2021. The complaint was regarding a patient who had died. The OHSC had sent a letter of acknowledgement of the complaint to the deceased's family, but did not inform the Committee or the person who had lodged the complaint.

She asked how the projected inspections for the next three years lined up with comments about the 52 000 health establishments that needed to be investigated once every four years.

The Chairperson referred to the number of targets that were achieved per programme. He noted that there was a challenge with the vacancy rates, and that the overspending was due to the short-term contracts, yet there was still a problem with the vacancy of posts. He asked what plans were in place to improve filling vacancies in the immediate future, as well as the possible causes of these vacancies. He reiterated Mr Munyai’s comment about money allocated for particular purposes, as this should also assist the economy to employ more people, particularly in funded posts. 

OHSC's response

Dr Mndaweni said that the OHSC had noted the questions, and welcomed the general comments and suggestions. A number of Members had raised questions as to whether the OHSC would reach the target for the NHI, or whether it would be able to inspect and certify health establishments in both the public and private sectors so that they could participate in the NHI Fund. She assured the Committee that the OHSC was definitely up to the task insofar as the NHI Fund was concerned. However, it had been open and acknowledged the current weaknesses it had been experiencing, particularly with the staff shortages. There had recently been a strategic planning session with the OHSC board to discuss and brainstorm the different approaches and activities it would need to undertake in preparation for what needed to be done.

About a year ago, the OHSC approved an organogram which would assist the organisation in decentralising its functions and activities to other provinces. It did have an organogram with a staff complement that should assist in expanding the inspection coverage. It was also important to note that funding for this organogram was necessary. Although there were surplus funds during this reporting period, the only thing that the OHSC could do was to get contractual staff to assist with some of its activities. She added that contractual staff could not be committed to full-time employment, because the OHSC did not know whether it would have funds available for this.

She reiterated that the planning for the NHI Fund had started internally. The OHSC was aware that it needed an increase in its staff complement. As it interacted with health establishments and other stakeholders, it shared and discussed some of the issues that the health establishments needed to pay attention to regarding compliance. The mandate of the OHSC was to monitor and enforce, and one of its critical functions was to facilitate compliance with norms and standards. It would agree and admit that it was a concern that the compliance rate was slow and low. It had been working with the Department at various levels, and with the provinces at a district level, as well as with the Quality Learning Centres to have a concerted effort to assist facilities in complying with the standards, although the role of the OHSC would be as a regulatory function. It was ready for the NHI Fund, but it would be fully ready only once it had the accompanying resources that would enable it to take the processes forward.

One of the major activities it would need to undertake was decentralising its functions. The OHSC would not be able to expand its inspection coverage and certification coverage with the current model that it was implementing to deliver its services. It was therefore crucial and imperative for it to decentralise, so that it was able to reach more facilities.

On Ms Ismail’s question regarding the certification of the ideal hospital or clinic, she replied that there were two processes in terms of what the OHSC did and what the Department did that were very important and interdependent. The ideal hospital and clinic framework was a quality improvement process that would go beyond what the OHSC looks at as a regulator. It would look at other aspects of quality, and this was supposed to be a sustained process and ongoing. As a regulator, the OHSC determined whether a hospital or clinic was complaint or non-compliant. The OHSC also provided feedback to the health establishments on the findings, so that the health establishments could take those findings and incorporate them into the ideal hospital and ideal clinic framework. This would comprise of a quality improvement process, whereas the OHSC had a quality assurance process, but the two processes were interdependent, as the one process fed into the other, but the one process was much more comprehensive.

As to whether the Department intended to assist with the funding of posts, she replied that this issue had been raised and the Department was very aware of the challenges the OHSC was facing. On various platforms, it indicated the need for capacitating the OHSC. During the reporting period of 2021/22, the OHSC received additional funds to assist with the inspectorate functions, particularly in the Quality Learning Centres. There was a general understanding in the health sector that there needed to be funding for the OHSC. It had also started a revenue generation process that was still in its nascent phase. It would be taken through the necessary steps so that the OHSC could start to generate revenue based on the work that it undertakes. However, it would still require funding from the national fiscus so that it could undertake all of its activities. Expanding its work was always at the topmost agenda of the OHSC board, so that it could meet its mandate for the NHI and for the entire health care system, in terms of improving the quality of services.

She agreed that the 33% was low for certification. The OHSC was working with the provinces and districts to address the elements based on the inspection findings that should be taken care of, or where the focus should go, so that the health establishments were assisted in complying. It submits reports and interacts with health establishments to facilitate compliance with the norms and standards. There was also a responsibility at the service delivery level for both the public and private sector to incorporate these findings. The OHSC would always remain available when a stakeholder wants to engage further or seek guidance on how to comply with the norms and standards.

She said that currently, the ground was laid for the OHSC to be able to move to the next phases of the implementation of the NHI, but other qualifying factors needed to be considered.

Referring to the 42 certified inspectors, she said the OHSC did not have an adequate number of inspectors and would not be able to reach the entire country with the number it currently had. For this reason, the decentralisation of the OHSC was very important, as well as increasing the inspectorate component within the entity to expand. Once it had inspectors located within regions or provinces, it would be easier and much quicker for them to reach the facilities, and this would also shorten the inspection periods.

On Dr Thembekwayo’s question regarding the inspection tools, she replied that when the OHSC had developed these tools, one thing that it wanted to ascertain was that these tools adhered to the standards so that even though it would inspect the various levels of care, both public and private, there should be no differentiation. In terms of the 2021/22 reports that would be available in the “near future,” she clarified that there was a draft annual report and that the OHSC had given the health establishment the required period, as was stipulated in the regulations. This report would definitely be shared soon.

The OHSC did have a new organogram. The board and management team had worked on developing a business case that outlined what needed to happen in the next five years. When developing the business case, it considered the implementation of the NHI, the OHSC footprint in the private sector, and expansion in the public sector. This business case took the OHSC through a framework and a path of what it needed to do, given the necessary and required resources over the five-year period.

She confirmed Ms Hlengwa’s comment that 52 000 health establishments would need to be investigated once every four years. It was a far cry when looking at what the OHSC needed to do, but it was confident that once it had decentralised and had teams that were able to do inspections at the local level, it would be much easier to expand and accelerate the inspectorate work. The Department had agreed to give the OHSC full access to the 52 000 health establishments, and it would have a framework for reaching these health establishments at least once every four years. She indicated that for 2022/23, the OHSC had increased its targets based on some efficiencies that had been realised internally.

Referring to the nurses’ strike at the Dora Nginza Hospital, she replied that the OHSC would most often hear about such instances after the incident had happened, either because it was reported to the office or because it was picked up by its early warning system. Thereafter, the OHSC would interact with the facility and, where necessary, conduct an inspection or request a report. It did react to these incidents when they were reported.

Mr Mapatha referred to Ms Ismail’s question on the R6 million allocation given to the OHSC, and said that the amount had been transferred to the OHSC one month before the end of the financial year, so that amount could not be used in the one month. What had since happened was that the amount was part of the surplus for which approval was requested from National Treasury, and this had been approved. Currently, 26 temporary employees assisting in the inspectorate unit are being funded from this amount. The amount was currently underused, as approved by National Treasury for retention.

On the overspending in the administration programme, he said that the OHSC had noted a limitation on the template from the National Treasury that it had used. A portion of that over-expenditure was actually funded from the surplus that had been approved in 2020/21. The template did not allow for an alteration to indicate how much the original budget was versus what expenditure had been incurred. This had given the impression that there was over-expenditure, but this had actually been covered by the surplus received.

On Mr Munyai’s comments, he agreed that the OHSC was careful about over-expenditure and monitored it very closely.

On Ms Clarke’s question about the ICT maintenance, he replied that in terms of the equipment that the OHSC procured -- for example, the server infrastructure -- the contract came with very stringent requirements for maintenance. The service provider or the suppliers would be required to maintain the equipment to certain standards. The equipment came with a maintenance component to ensure that it was maintained to certain requirements.

Regarding the unfunded posts, he said the OHSC was currently using the surplus funding to fund the unfunded posts to boost capacity where it was generally required. It had received a letter from the National Treasury in September in which it had approved the retention of the surplus. The letter had also indicated that the OHSC was advised to be cautious around permanent appointments, noting that the surplus funding was once-off. It had therefore made only short-term plans.

On Mr van Staden’s question about the staffing and funding, he replied that the OHSC had had an engagement with National Treasury during August, where it had raised the issue of the staffing and funding to address the shortfalls that it was experiencing, as well as indicating the expectations on the amount of work that still needed to be done.

Mr Phiri, Acting Director: Inspectorate Compliance, referred to the question about the nurses’ strike at Dora Nginza Hospital. He said the incident had been reported in the media on 18 August. When it was reported, the OHSC sought information and wrote to the head of the institution to get information on the issues raised in the media. At the time when the OHSC wrote to the institution, the CEO of Dora Nginza Hospital was off sick, and had asked for an extension to gather the information to fully respond to the questions that the OHSC had identified. The response came back only on 26 September. The OHSC was now engaging with the Dora Nginza management and was dealing with the issues that had resulted from the strike. He noted that Dora Nginza did not have a CEO for quite a long time, and was operating with an Acting CEO, and some of the challenges were a result of that.

In its analysis, the OHSC had not fully finished engaging with Dora Nginza’s response. When one looked at where the hospital was situated, and how the district operated, it provided the only maternity care in that area. All of the maternity cases in that area were referred to the Dora Nginza maternity unit, which was a 30-bedded institution, but it took up to 70 cases, where some of the patients were found lying in the corridors. The question was where they should send these patients, because they could not send them back home. The maternity unit at Dora Nginza was flooded because of the way that the system operates. The OHSC had its hands on the pulse, and was aware of what was happening at the institution. There were engagements with the Dora Nginza management to try to iron out the challenges that they were facing. The provincial government and other stakeholders had also been called to try and assist the health establishment with its challenges.

Dr Donna Jacobs, Executive Manager: Complaints Management and Ombud, said several Members had raised questions regarding the non-responsiveness of health establishments or provinces to the requests for information. She replied that this had considerably improved over the previous year, as opposed to two or three years ago. The OHSC was getting more timely responses to its queries. To improve this, it intensively engaged with the provinces as a way to maintain communication. It had implemented procedural regulations six and seven, which asked for a contact person or a person in charge with whom the OHSC could communicate directly. This has immensely helped to improve the response time. The OHSC had also engaged in a series of provincial visits, where it had engaged with the heads of departments and Members of the Executive Councils (MECs) of the respective provinces. There had been discussions on both the successes and challenges within the respective provinces, which had been quite beneficial in hastening the responses to the OHSC requests. It did experience challenges with this in some provinces. For instance, there was a high-profile case that had taken it nearly three months to get an appointment to interview a hospital CEO, which then delayed the resolution of some of the cases.

She said that two years ago, the OHSC had a total of 323 backlog cases, 112 of which were medium-risk cases and 185 were high or extremely high-risk cases. Over the last year, the OHSC had resolved all of the 112 medium-risk cases, and had also resolved at least 20 high-risk cases, and was left with 161 backlog cases - all of which were high-risk or extremely high-risk complaints. To address this, the OHSC developed a project plan disseminated among the three investigators. The OHSC had to comply with the relevant legislation while resolving high-risk and extremely high-risk complaints. Therefore, some of the complaints required a long time to resolve, as it would have to interview between 50 and 70 complainants, staff or various witnesses to reach a resolution. It would also have to ensure that all of its findings would stand up in court. If the complainants were unsatisfied with the findings of the OHSC, then they had the right to request an appeal through the Minister of Health, and an appeals tribunal was then constituted.

She referred to Ms Hlengwa’s comment on the response to the complaint that she had lodged – it appeared as if the OHSC had only one email address of the primary complainant, the person to whom the team had responded. Ms Hlengwa could inform the secretariat if an alternative person must be communicated with, as the OHSC would certainly respond.

On Mr van Staden’s question about the number of complaints received over the fiscal year; she replied that the OHSC had received 3 317 complaints over a 12-month period from both public and private sector facilities, or from complainants who had used these facilities.

In response to Dr Thembekwayo, she clarified that the OHSC had not received any formal complaints on the nurses’ strike at the Dora Nginza Hospital.

Ms Winnifred Moleko, Executive Manager: Health Standards Design, Analysis and Support Assessment, referred to the question about the root causes of health establishments not complying, and replied that the OHSC could only indicate the gaps that it had found. She said that most of the health establishments that the OHSC had inspected were clinics, and most non-performances were linked to the clinic managers. The inspectors would then refer to the clinic manager service area and look at all the documents that were related to the running of the clinic. In most instances, the OHSC would find that the clinics did not have dedicated operational or facility managers. Where there were operational managers or facility managers in place, they were also expected to be providing the services.

The common areas of non-compliance that the OHSC had identified were with the service level agreements. Most of the services were currently outsourced, such as security and waste management services. The OHSC would ask about the service level agreement to ensure that the services that had been contracted were able to be provided according to the requirement in the service level agreement. Unfortunately, in most instances, service level agreements did not exist, and where they did exist, there was a lack of monitoring of the activities provided.

She said that standard operating procedures (SOPs) were important when it came to the management of patients. In most instances, the OHSC would find that the SOPs or the guidelines were not in place.

Other common areas of concern were with the emergency trolleys. In most instances, it was found that the emergency trolleys were not stocked according to the list that was provided to guide the health establishment. There were also instances where health establishments were found without oxygen cylinders, or where the oxygen gauge did not meet the minimum requirement levels. Such concerns contributed to health establishments not meeting the requirements for certification, because some of the requirements were non-negotiable and must be addressed to ensure that patients were not compromised in terms of the quality care they deserved.

Further discussion

Mr Van Staden said he did not think that his question about the current status of hospital safety audits had been answered.

Dr Mndaweni replied that there was a difference between the “ideal clinic audits” conducted by the Department and what the OHSC did when inspecting hospitals. The audits of the OHSC were based on the regulations. The OHSC could provide a list of the 189 health establishments certified in 2021/22.

South African Medical Research Council (SAMRC) 2021/22 annual report

Prof Glenda Gray, President and CEO, SAMRC, referred to the entity's appointments by race and gender. She said that the SAMRC was committed to transformation and had many processes that worked towards the transformation agenda of medical science in South Africa, in addition to looking at its broad-based black economic empowerment scorecard.

Mr Philip du Plessis, Divisional Manager: Project Management and Accounting Office, SAMRC, presented a summary of the financial information:

• For the 2021/22 financial year, the total revenue increase was about 8%, from R1 169 592 562 to R1 267 978 551.

• Operating expenses increased by 16%, from R1 128 036 885 to R1 306 199 153.

• The investment income showed an increase of 31%, from R19 638 086 to R25 729 929, due to an increase in the cash and cash equivalents, as well as the increase in interest rates.

• The net effect for the year was a surplus of R6 021 260, versus a surplus of R79 218 334 in the prior year.

Performance information

Dr Mongezi Mdhluli, Chief Research Operation Officer (CROO), SAMRC, noted that the SAMRC had achieved a clean audit for the past couple of years. More money was spent on research than administration, and it had been able to achieve most of its targets.

Prof Gray said that in terms of a strengths-weaknesses-opportunities-threats (SWOT) analysis on the historically disadvantaged institutions (HDIs), the SAMRC had noticed a lot of movement of staff, and very poor laboratory and research infrastructure. The SAMRC would need to work very hard with these campuses, and had already developed a laboratory infrastructure at the University of Zululand for malaria control. The SAMRC would be working with the University of Zululand to increase its research intensity.

In terms of translating knowledge into practice, the SAMRC should be very proud of its ability to influence international and current guidelines and its representation in national and international bodies. The SAMRC funded scientific conference seminars and ensured it got its knowledge out. She also addressed the SAMRC's funding priorities, which were committed to a range of programmes.

(See presentation attached for further details)

Discussion

Ms Ismail congratulated the SAMRC for the achievement of an unqualified audit. However, she noted that the report referred to an over-performance of the performance targets. She asked whether the SAMRC would consider increasing its targets going forward -- since it was doing such a great job, maybe more could be achieved.

She tried to understand the Council's dispute with the South African Revenue Service (SARS) regarding the amount of value-added tax (VAT). She asked what had resulted in the legal fees incurred against the National Education, Health and Allied Workers’ Union (NEHAWU), and if this was related to any labour disputes.

She was proud to hear of the scholarship students who had graduated, and asked whether they would be incorporated into the field after they had graduated. She expressed concern about the number of interns and community service doctors waiting long before being allowed to do internships and community service at public hospitals.

She requested more information on the Pox-Protein Public Private Partnership for HIV vaccines commenced in 2016. She asked how far along the HIV vaccine was, recalling that it was previously said that the vaccine was in the pipeline and should be prepared very soon. She also asked for research findings on HIV/AIDS, tuberculosis (TB) and gender-based violence and femicide (GBVF).

Mr Munyai congratulated the SAMRC on its clean audit. He said this was the only organisation that had not dropped the ball. It was building a new generation of scientists and empowering even the less privileged, as seen through the consideration of demographics. He noted that the organisation was mostly black Africans, followed by the Coloureds and a white minority. He encouraged the organisation to retain its efforts with transformation, as well as its skill capabilities. He said that Prof Gray had demonstrated her ability as a great leader and president of this organisation. He was certain that this organisation was the epitome of science, development and innovation in this country. This organisation should get a lot of money and resources, because it was quite developmental for the country and its people. The SAMRC also focused on broad areas of research, and no other organisation in this country could compare to it.

He was impressed with the presentation. He noticed that the presentation included an image with graduates from the University of Cape Town, and asked what the qualifications of these graduates were.

Regarding the research that the SAMRC had shared with the Committee, he noted that the Committee would soon work on the Tobacco Products Control Amendment Bill, which had much to do with capacity.

Ms Clarke thanked the SAMRC for what they did, and congratulated them on the clean audit. She referred to the wastewater surveillance programme, and asked which provinces this was conducted in, and how successful it had been. She recalled that one of the provinces it had been conducted in was the Western Cape, where it had been a success.

She noted that an HIV prevention project had been rolled out at the Verulam Clinic in KwaZulu-Natal, and asked whether there was any intention for this project to be rolled out in different sites in the country and within different provinces, based on the outcomes of this clinical trial.

She asked why there was a huge difference in the surplus recorded -- R79 218 334 in the 2020/21 financial year, as compared to the R6 021 260 in the 2021/22 financial year. What caused the laboratory costs to increase by 192%, the consultancy costs by 142%, and the audit costs by 127%?

She asked if the SAMRC had a target with regard to the percentage of the population that needed to be Covid-19 vaccinated, and whether this was reasonably expected to be achieved. During the lockdown the focus had shifted towards Covid-19 and away from HIV and TB programmes -- had the SAMRC done any studies regarding the impact of this and would anything would be done to address this?

She asked the SAMRC about its focus on malaria diagnosis and prevention, and the research being done on mental health in South Africa.

Ms Wilson said that the SAMRC had done a good job. The country was the poorest that it had ever been, with people unable to get work, survive on grants, and the cost of living had shot through the ceiling due to the Russia-Ukraine war, amongst other things. People were not getting the proper diet, and were lucky to get one meal a day, and there was more and more stunting among children. She had a huge concern about the current cost of living in South Africa and how it impacted the overall health of the nation, particularly with cancer, HIV, AIDS, diabetes etc, that were very much connected to diet. She asked whether the SAMRC had done any research on this, because it was very quickly becoming a big problem in South Africa.

The Chairperson congratulated the SAMRC on the clean audit. He noted that it had spent more of its funds on research than on administration, which was always good. It reported on the studies it promotes and funded in terms of research in South Africa. He asked how the SAMRC decided on which research it did -- if this decision was based on requests, or decisions taken by the board, or if it was based on the prevalent conditions at a particular time. For example, the research on wastewater surveillance was to track SARS-CoV-2 viral RNA in wastewater, as an indicator of Covid-19 presence in communities. He assumed that the research would enable the SAMRC to always be informed of the conditions on the ground and the challenges at any particular time. Another example was that the Department had requested a study on the Jagersfontein mine disaster. It was quite worrisome that there were traces of arsenic in the soil and lead in the water. He asked that the SAMRC provide the specific levels of arsenic and lead found at the Jagersfontein site. He asked if it had considered doing similar research on other dams and mines that would extend beyond Jagersfontein.

He noted that there were four new extramural research units. He would like to see much more focus on current research. He congratulated the SAMRC for the leadership that it provided in South Africa.

SAMRC's response

Prof Gray referred to the Chairperson's question on how the SAMRC decided on its research, and replied that this was a collective effort. The SAMRC looked at the ten most common causes of mortality and morbidity in South Africa. It also worked with the Department on their focus, as well as the National Health Research Committee, and while working together it focused on the current problems and what could be future problems that needed to be addressed. The National Health Research Committee would meet in early November to set the strategy for health research in the country. The SAMRC attended these meetings and was on the committee. It ensured that its research was aligned with what the Department required regarding what the country had put forward as a research agenda. It was a very collaborative approach based on the burden of disease, the Department's priorities and what came from the National Health Research Committee. When looking at the ten most common causes of mortality, the SAMRC held research priority meetings with various stakeholders to come up with important strategies that it could afford to fund. For instance, it spent a lot of money on developing TB diagnostics.

The SAMRC had a commitment to environmental health, including work that was done on climate change. It has done some work on temperatures in schools and clinics on how temperatures over time affect child health, particularly in schooling. It spends a lot of time working on the research priorities within the country and because it had so little money, it looks at the research coming out and decides on what could be done better or how it could do more. For instance, the SAMRC had done a lot of successful TB diagnostic programmes which were being used in the country, but there was not enough focus on developing TB vaccines. Based on the mRNA technology South Africa now had, the SAMRC was working with scientists in South Africa to develop a TB vaccine using mRNA technology.

To assist young people, the SAMRC had self-initiated research grants anyone could apply for. There were two streams -- one was for early-stage investigators to help them develop, and the other was for more established researchers. She recalled the first research grant she received in 1993, which had been R40 000 from the SAMRC. These grants were the catalysts for clinician scientists and scientists in the country to advance their research careers. It was a highly successful programme that had been running for many years.

On other ways of setting up the research agenda, she said that the Department had also noted that it intended to eliminate malaria. Even though it was not among the ten common causes of mortality in the country, the SAMRC needed to work with the Department and be one of the first countries in Africa to eliminate it. The Department had also asked for a particular focus on the Jagersfontein mine disaster.

The SAMRC had grown its extramural research units, and it kept looking at the landscape to ensure that it focused on both current and future health problems in the country.

On Ms Ismail’s question about the graduates and whether they got jobs, Prof Gray replied that although this was not an indicator, the SAMRC did track the postgraduates. It was concerned about them because it invested a lot of money in their Masters and PhDs degrees. It created postdoctoral networking and internship programmes in South Africa so that these young people could stay research active and stay in jobs.

Regarding the Pox-Protein Public Private Partnership for HIV vaccines, she said it was very hard to create an HIV vaccine, because the virus replicated all the time and it was hard to find some of the non-variable areas so that immunogens could be made. The SAMRC worked very closely at a global level to try and find an HIV vaccine -- finding the Covid-19 vaccine had been easier. This continued to be an endeavour. At the moment, the SAMRC is working on a vaccine called PrEPVacc -- it looks at various vaccine strategies, together with pre-exposure prophylaxis (PrEP). The SAMRC would continue working on the HIV vaccines, and hopefully do some monoclonal antibodies using passive infusion of antibodies that protect against HIV acquisition, to try and eliminate breast-milk transmission, as well as preventing sexual acquisition of HIV. The SAMRC remained committed to developing an HIV vaccine, but it was a long journey. It was a global endeavour, but South Africa would be critical in helping to find the HIV vaccine.

The SAMRC had done a lot of work on TB diagnostics and was now focusing on TB vaccines. There has been a lot of investment in treatment strategies to try and shorten the course of TB and treatment for multi-drug resistance.

It had also worked on femicide, and had recently re-started another survey to see if there had been a year-on-year change in the femicide rates.

Responding to Mr Munyai’s question, she said that the SAMRC graduated people with Masters and PhD degrees from many universities, including the University of Cape Town. The SAMRC was very proud of all its graduates, working closely with them through mentorship and providing support.

The SAMRC had helped the Department with the Tobacco Products Control Amendment Bill. There was a concern that vaping amongst youngsters was a gateway to nicotine or tobacco use. It had also been working with the Department on the alcohol operating hours. One way to curb alcohol abuse was to regulate alcohol operating hours and where alcohol was sold.

She told Ms Clarke that the wastewater surveillance programme had been very successful, and there had been an expansion of capacity in this area.

The HIV prevention project that had been enrolled at the Verulam Clinic in KwaZulu-Natal was the PrEPVacc study, as well as looking at long-acting antiretrovirals to prevent HIV. The SAMRC had considered how this study could be scaled up, and had worked closely with the Department to operationalise the PrEP. There was oral PrEP, which had been rolled out in the country, and there would be long-acting PrEP, and hopefully, other interventions that young women could take.

The laboratory costs had increased because there had been a lot of research. The SAMRC has funded a lot of research on Covid-19, HIV and TB. The country has been getting back into the swing of doing research, as a lot of research had been slowed down during the Covid-19 pandemic.

Regarding the target of the population to be Covid-19 vaccinated, the SAMRC would continue to work with the Department to find ways of increasing the rate of population-based vaccination. Along with the Department, the SAMRC had recently published recent vaccine efficacy data in South Africa, which showed a need to boost vaccination. There was concern that people were complacent and did not want to get boosted, so there was a need to reiterate the importance of being boosted.

Covid-19 had impacted TB diagnostics and HIV treatment, but things were slowly getting back to the pre-Covid-19 levels, and there was huge commitment from the health system.

On Ms Wilson’s concern about health and the cost of living, she replied that the SAMRC had just established a health promotion and disease prevention cluster that would hopefully look at everything, from food sustainability to addressing the issues of diet, to try and counter stunting in the country. The SAMRC had the Healthy Life Trajectories Initiative (HeLTI) programme that worked with China, India, First Nations in Canada, and South Africa, which looks into preconception and in utero nutrition to try and improve childrens’ outcomes.

The SAMRC was also committed to the health of old people, as old people had been neglected in the country. It has been looking into innovative ways to reach old people -- for instance, those with blood pressure problems. It had also been looking into the polypill – in some countries, there was use of a cheap pill that addressed diabetes, hypertension, and cholesterol and could reduce strokes and the morbidity and mortality of people.

Ms Natalie Bingham-Jonkers, Divisional Manager: Finance, SAMRC, referred to Ms Ismail’s question about the legal costs, and replied that the legal costs were a result of a legal dispute in 2013/14, which involved a bonus dispute. The funds had been awarded by the High Court, which NEHAWU had not claimed. The SAMRC had not written off those funds -- NEHAWU was meant to claim them, so it was reflected in the financial statements.

On the question about VAT and SARS, she replied that several VAT matters were reflected in the financial statements. The one that was specifically on page 309 was related to interest that had been charged on a VAT return. The SAMRC received a refund and interest on that refund, and an assessment was done. The assessment reflected that the SAMRC would have to pay the money back to SARS, and interest had been charged on the assessment. In 2016, there was also a VAT assessment on an amount that needed to be paid to the Department. That amount was still in dispute and the information was reflected as a contingent liability on page 322, under contingencies.

She added that the increase in laboratory costs was due to the increase in activity on Covid-19 studies that had been undertaken, in addition to other studies on TB and HIV.

Mr Du Plessis referred to Ms Clarke’s question about the difference in the surplus for 2020/21 and 2021/22, and said the main reason was that in 2020/21, the SAMRC had received a Covid-19 allocation of an additional R150 million. During that year, requests for applications (RFAs) were put out, but not all the projects could be implemented, and many of those projects had been transferred to the 2021/22 financial year. Since the SAMRC did not spend that money in the previous financial year, it resulted in a surplus of 79 218 334, but it managed to complete many of those projects in the 2021/22 financial year.

Similar to the laboratory costs, he said that the increase in consultancy costs was also linked to the Covid-19 activities that were undertaken in the 2021/22 financial year.

Prof Angela Mathee, Executive Director: Transformation, SAMRC, said that the wastewater surveillance programme had a site in the Western Cape, where the SAMRC was the main partner. It also had a site in Gauteng, where it had partnered with the Sefako Makgatho Health Sciences University. In northern KwaZulu-Natal, it had partnered with the University of Zululand, and in Limpopo, it partnered with the University of Venda. In the Free State, it had partnered with the University of the Free State, and in the Eastern Cape, it had partnered with the Nelson Mandela University and the University of Fort Hare. The capacity development was under the leadership of Dr Mdhluli, and had been key to this whole programme. The SAMRC have provided equipment and supplies, as well as training on data analysis, quality control and drafting papers and proposals for new studies, based on wastewater surveillance. All of this has contributed to an excellent platform, and the SAMRC has started to think of ways to extend the value of this platform -- for instance, to track pollution and pharmaceutical products in the catchments of those wastewater treatment plants.

Dr Michelle Mulder, Executive Director: Grants, Innovation and Product Development, SAMRC, referred to Ms Ismail’s question about the students, and said that the SAMRC supported students who applied for scholarships and career awards to assist them in developing proposals. There was also a programme that focused on mentorship. A number of the programmes required co-supervisors either within the SAMRC or universities, which allowed the students to get a breadth of experience and mentorship supervision to ensure the success of their studies.

On the question of what happened after the students graduate, she replied that there was no delay and that the graduates were generally immediately taken up by the same university. There was quite a large success rate in retaining those students within the same university. Within the SAMRC, they would go on to get research jobs within the same institution or move to other institutions. It showed that the graduates became quite marketable as researchers stemming from the award and their studies.

On Ms Wilson’s comment about health and diet, she said another thing that had come out of the HeLTI programme was an extensive investigation around the community social, behavioural, and mental health and other issues within the Soweto community, in which this cohort resided. A lot of important information had come out of this; for instance, the inability of women within that community to safely go out for a walk or to safely exercise or access food, because they were not always the ones making decisions about spending household income, etc. Some interventions were being tested, from preconception all the way to early childhood, to prevent stunting and childhood obesity, and to really address future non-communicable diseases that may affect these populations.

On Ms Clarke’s question about mental health, she replied that the SAMRC had specific programmes for mental health research. There was one specific programme with the Newton Fund and a co-investment with the Gabriel Foundation at the University of Cape Town on traumatic brain injury. It was currently looking into a new programme on genomics and mental health, which looks at the genomic link between certain mental disorders.

There was also a priority towards TB and HIV research. About six weeks ago, the SAMRC held a workshop with the leading TB researchers in the country, which looked at what was currently being invested in and identifying the gaps, which had formed the basis of a new TB investment programme that would largely focus on vaccines. A similar exercise would be done on HIV research, as the SAMRC still had its historical investments in HIV vaccines, which it would take forward while also making new investments in future.

Dr Mdhluli referred to the research into mental health, and added that about two years ago, the SAMRC had also initiated a study with the University of South Africa (UNISA), where it had invited other universities to participate in the mental health survey that was conducted by one of the early career scientists that were now an SAMRC employee. Of the 26 universities contacted, only 17 participated, with about 28 500 students involved in the study. A paper would be published on the results of the survey, which indicated that there were some common mental health illnesses, and there were no disparities between the historically disadvantaged and historically advantaged institutions. In addition, the SAMRC were now working with the University of Limpopo on research focused on mental health, so there was a wide spread of studies happening in the country.

On Ms Ismail’s question about considering increasing the targets, he replied that while working on the strategic plan in 2020, the SAMRC had set its targets over a five-year period. This took into account that there would be a decline in the baseline in the medium-term expenditure framework (MTEF), and the publications had to take the budget into account. Around 2022/23, it was seen that there might be a decline in the budget and therefore it could not put the targets much higher than it could afford. He agreed that the SAMRC should look at its targets continuously, and increase them where possible.

Prof Gray extended an invitation to the Members to attend the upcoming meeting with the National Health Research Committee in November.

The Chairperson said that it was always informative to listen to the SAMRC, particularly about all of the work it did to keep people healthy through research and innovation.

Briefing by South African Health Ombud

Prof Malegapuru Makgoba, South African Health Ombud, said that it was a privilege and honour to have this annual session with the Committee, and to present the work of the Office of the Health Ombud (OHO) as a complement to the presentation by the OHSC.

He would first like to present a progress report. In his last interaction and meeting with the Committee, there were discussions on the issue of the Health Ombud Bill, and it was then agreed that he would meet with the Minister and map a way forward. He informed the Committee that he had met with the Minister and his team, and they had concluded that it was an urgent matter to complete the Bill and the business plan for the OHO. The Minister had then appointed Dr Nicholas Crisp, the Deputy Director-General of the Department of Health, to prepare the Bill. He believed that the Bill was an improvement, in terms of the mandate, appointments and the objective of what the Ombud did, as well as the consequences of the Health Ombud’s work concerning the total national health system of the country.

The second point he would like to deal with the unit of complaints and assessments. This was the unit that received the complaints, and in total, over a period of six years, it had received 9 490 complaints. The majority of complaints, about 57%, had come from Gauteng. Most of these complaints were communicated via email, and were often a low-risk type of complaint. About 96% of the complaints had been resolved completely and within the prescribed time. Since 2016, there has been an annual increase of 24.8% in complaints. He commented that the complaints and assessment unit had been receiving positive feedback from the complainants, reflecting the speed and professionalism of the people that worked in the complaints and assessment unit.

His office had undertaken a project that twinned with the Parliamentary and Health Service Ombudsman of the United Kingdom (UK). This involved a series of projects articulated on pages 11 and 12 of the report. These were largely learning exchanges between the two offices, but more importantly, they involved programmes to benchmark the offices and know what the rest of the world was doing to keep up to speed. It was funded by the Better Health Programme through the British government. The areas that had been covered by the two Ombuds offices were an overview of the methodology, the prioritisation of the cases that it investigates, the quality assurance and the early resolution and mediation – which was why the OHO had resolved 96% of the low-risk complaints. It also covered areas such as communication with complainants, and case studies which showed how complex medicine had become. When investigating complaints, it was very useful for the OHO to require and call upon expertise, especially since most of its work was subjected to court reviews. The two Ombuds offices also exchanged clinical learning advice.

He recalled that when he was Vice-Chancellor of the University of KwaZulu-Natal, he had engaged with the former Public Protector, Adv Mushwana, to establish the African Ombudsman Research Centre (AORC) that was located at the University of KwaZulu-Natal. The AORC was now conducting seminars around leadership and was linked to the International Ombudsman Institute (IOI) and the African Ombudsman and Mediators Association (AOMA), which taught the offices how to handle complaints and was also internationally benchmarked to encourage improvements.

Prof Makgoba reflected on the end of 2021, when he had visited the Eastern Cape, because the Office of the Public Protector and the OHSC had investigated Livingstone Hospital, Dora Nginza Hospital and the Uitenhage Provincial Hospital. There were complaints that the quality of the service delivery was suffering. The findings of the initial reports produced by the Office of the Public Protector and the OHO were largely the same. A year later, he returned and engaged with all the relevant stakeholders to see whether the quality of the recommendations that both structures had made was being implemented. Although there were specific findings for each of the three hospitals, he had concluded that the relationships between the labour structures, the provincial department of health and the medical profession in the Eastern Cape were not really helpful. During the engagements with stakeholders, he had made it clear that the only stakeholders that suffered in this low-trust relationship were the poor quality of service they provided to the patients of the Eastern Cape. In their own words, the stakeholders described the service as “chaotic” and “in a mess.” At times the medical profession blamed the health department, the health department blamed the labour formations, and the labour formations blamed both the department and the medical profession -- all of them were at each other's necks.

Over the past 12 months, he had visited all the provinces, and found that the quality of the health delivery in hospitals was deteriorating. While preparing for the NHI Fund, it did not seem as if there had been an improvement in the standard of service which was delivered to the people of South Africa. Of the nine provinces he had visited, the only province that seemed to have got its act together was the Western Cape, as it understood its mandate and wanted to serve its people. The other provinces were really in difficulty, and needed to be called upon to jack up their work.

He concluded that this would be his final presentation to the Committee, as he would not be the Health Ombud from June 2023.

Discussion

The Chairperson thanked Prof Makgoba for the insightful presentation, as it had been very frank and open, particularly on the outcomes and challenges of his visits to the provinces.

Ms Gela said that although there were frustrations with the report that had been presented, it was also understood that there was room for improvement. Government was trying by all means to ensure that the Department was where it was supposed to be. She believed that it would be good for South Africa to move towards the NHI Fund to address the challenges that had just been raised and to be in line with the standards of other countries that had already implemented such a health system. She referred to Prof Makgoba’s oversight of the Eastern Cape, and suggested that it would be necessary for the Committee to visit the province to check on the progress that had been made since the Health Ombud’s visit.

She noted that Prof Makgoba had said that only the Western Cape’s health department had its act together, but added that perhaps there were one or two things that were also good in the Gauteng and Limpopo province.

Ms Ismail said that working with Prof Makgoba as the Health Ombudsman had been phenomenal. He had set a very good track record and she hoped that the next ombudsman would follow in his footsteps. She noted five vacant positions within the complaints’ investigation unit and asked if this was why the OHO could not optimally do its work. She asked how the vacancies affected the stipulated timelines for resolving complaints. When would these vacancies be filled?

She asked for an update on the appeal process related to the Tembisa Provincial Tertiary Hospital investigation report. There was recently a big hype on social media, and she thought it would be important for the Committee to get an update on this. She asked whether the Gauteng Department of Health and the Tembisa Provincial Tertiary Hospital had made progress in implementing the OHO's recommendations.

She said that it was really shocking to hear of the suspension of the hospital whistle-blower, Dr Tim de Maayer. She asked how the OHO had dealt with this matter in terms of the findings and resolutions, because this really set a precedent to say that whistle-blowers should be protected and not be treated in the manner that they had been. 

She asked whether the OHO had received any Covid-19 vaccine-related complaints of adverse side effects, and, if so, how it had handled such complaints.

She said that everyone supported and believed in universal health care, but in a South African context, it was known that the NHI Fund required public health care facilities to comply with certain criteria. She asked Prof Makgoba whether he felt that his office and the OHSC would actually be able to inspect all of the country’s health establishments in preparation for the NHI Fund, and that most of the public health care facilities would meet the NHI prerequisites. She referred to the example of the National Health Service (NHS) in the UK which was experiencing challenges, but when the NHS was implemented, the UK had a much more functional healthcare system than South Africa's. She asked Prof Makgoba on his opinion of how the NHI would play out in South Africa, considering that a lot more work still needed to be done in the health care system.

OHO's response

Prof Makgoba said that he had worked in the NHS in the UK for a period of about 15 years, so the idea of universal health coverage had always appealed to him. He recalled that when Minister Motsoaledi had first introduced this idea, he had supported him through interviews and writing papers, with the opinion that South Africa deserved to implement the NHI as a system for universal health care. He strongly supported the NHI, because he believed it would bring health equity into the country and serve all members of society.

Regarding his observations when visiting the different provinces, he agreed that there were pockets of good happening in the provinces, but his mandate related only to the complaints that his office received. He said three provinces gave him headaches, including Gauteng and Limpopo. This was not to say that nothing good took place there, but most of the troubling complaints were from those provinces. He hardly ever received complaints from the Northern Cape, perhaps because it was situated in a desert, or maybe they had not caught up with what the OHO did, even though the OHO had spent time with its health department.

Prof Makgoba said the NHI was a necessary evil to be swallowed. He believed it was an important structure that the new government had undertaken and needed to be supported.

On Ms Ismail’s questions, he clarified that the five vacant positions in his office had not affected the work of the complaints and assessment unit, but the unit that was mainly constrained was the investigative unit. The investigative unit had experienced backlogs and currently had only three staff members. Due to the nature of the complexities of the complaints, the investigations often took too long.

On the Tembisa Provincial Tertiary Hospital matter, he said that on 27 January 2021, he had presented his report on the circumstances that had led to the death of Mr Shonisani Lethole. He noted that the appeal process required that the appeal be lodged within 30 days. He had identified 20 people that needed to undergo disciplinary processes, and two of these people had submitted an appeal to the Minister. The Minister had duly appointed a tribunal that requested all kinds of information, and it was as if they had wanted to revisit the investigation of the ombuds. All the documents in his office were kept on record, and he had provided the tribunal with everything they had requested. On 5 October 2021, the tribunal invited the OHO to make presentations, and thereafter it had not heard anything further until about a month ago, when the tribunal had informed the OHO that it would write to it by the end of September when it would make a judgement, but nothing had been received in September. This appeal process took place on 27 January 2021, and there was still no answer today. Justice delayed was justice denied for both parties.

On the issue of Dr Tim de Maayer, he replied that he had mounted an investigation into this matter and would be meeting with the CEO of the Rahima Moosa Mother and Child Hospital tomorrow. He also planned to meet with Dr De Maayer. He believed that, at some point, all whistle-blowers must be protected.

He said that the OHO had never received any Covid-19 vaccine-related complaints.

Regarding the inspectorate and the NHI, he had shared his opinion with the OHSC that it would need to set up a programme on how it planned to inspect and certify all of the health establishments. At this point, he did not think that the country was ready for the NHI, considering the level of inspections and certification that had been done so far. He suspected that most hospitals would not meet the high standard required for the NHI, but this did not mean that it should stop trying and put in an effort. He believed that the NHI Fund was an important project and that it would level the playing field for the country.

Further discussion

Mr Van Staden asked Prof Makgoba if there was enough funding for extra staff members in his office, and whether extra staff members were needed. He asked whether the OHO had sufficient funds to perform its duties properly. What were the exact reasons why the OHO had been receiving an increase in complaints over a period of time, or for this financial year?

Ms Clarke thanked Prof Makgoba for his office always being willing to assist when issues were brought to Members of the Committee. She did a lot of oversight on her own, and had done oversight at the Livingstone Hospital in July and at the Rahima Moosa Mother and Child Hospital. In addition to the issue of Dr De Maayer, there were also a lot of issues with the hospital itself that needed to be attended to. She had also made horrific observations during her oversight at Livingstone Hospital, and therefore agreed with Ms Gela’s suggestion that the Committee do oversight visits to these hospitals. She had found that the health cleanliness at Livingstone Hospital was terrible. There was faeces backed up in the toilets and baths, insufficient equipment or resources to perform orthopaedic surgery, doctors were resigning in droves, staff shortages, the medical staff were exhausted, supplies had not been paid for on time for about three years, IT equipment was not functional, the was no clean linen on the beds, and the theatre was not able to operate at full capacity.

The vacancies were concerning. She asked if there were any plans to fill the vacancies.

She asked how the Health Ombudsman intended to address the lack of response from health establishments to its queries, which resulted in low target achievements. What measures were in place to address the large backlog, and what were the envisaged timelines to address the backlog? She asked what the OHO would need to eradicate the backlog and ensure it timeously addressed new complaints. Was there a breakdown of the type of complaints received, and was there a common theme regarding those cases?

Prof Makgoba, responding to Mr Van Staden’s questions, made a comparison and said that the UK had a population of about 67 million, and South Africa had a population of about 60 million. The OHO did not really have enough staff to do the work that it was supposed to do. The Parliamentary and Health Service Ombudsman of the UK had 450 staff members -- his office had only three investigators and one manager. When needed, he had to borrow staff from the OHSC. This was one of the issues that had provoked the matter of the Bill. He said the OHO required a lot of extra staff and did not have sufficient funds, but it would make do with what it had. The OHO worked very well and smartly with the OHSC, which supported the OHO when needed and requested. However, the OHO did need several millions of rands which it did not have. He said that the health sector was huge, had many complaints, and required a number of issues to be addressed. The OHO could do with more staff and more funding to address all of the issues.

Generally, the complaints were related to the poor quality of service delivered to the patients, poor advice given to patients, or the delay in seeing patients. He observed that there was a new phenomenon in the types of complaints that the OHO had been receiving, perhaps due to poverty – there had been people who sought the OHO to provide them with a licence to sue doctors or to sue health establishments. Members could see that in his report, he had refused to get involved with such complaints, particularly when complainants tried to convince him of something so that they could sue the doctors.

Regarding Ms Clarke’s observations of Livingstone Hospital, he replied that he had been in the Livingstone Hospital area for three days, and he could not agree more. He recalled that when he was a medical student in the 70s, the Livingstone Hospital was the place where all medical students wanted to be for their training, but today he would not want his daughter, who was a doctor, to do her training there, because it was so filthy and disorganised. He agreed with the suggestion that the Committee do an oversight visit to this hospital.

He said that a team of his investigators had already visited the Rahima Moosa Mother and Child Hospital to do preliminary investigations. He would be visiting the hospital tomorrow to meet with its CEO, and would meet with the MEC on Monday. He planned to see the provincial head of the health department thereafter and Dr De Maayer. This hospital was clearly in big trouble. Following the preliminary investigation report that he had received from his colleagues, he would go and probe the questions that he had. It seemed as if this hospital was living in another world and not in line with the South Africa of today.

Ms Wilson said it was absolutely devastating that Prof Makgoba would leave the OHO in the next few months. He has been phenomenal in every meeting with the Committee, and the Committee has appreciated his honesty and transparency. She referred to the concerns and complaints about Limpopo, as she was from Limpopo and it was where she did most of her oversight, and the situation there was really horrific. Concerns had been raised about several clinics, particularly the Philadelphia Hospital, which was an absolute nightmare.

This morning she had received a video of a woman giving birth at the gates of Burgersfort Clinic, just before the clinic was due to open. The video showed a nurse shouting at everyone to keep quiet, while she slowly put on her gloves and the baby was due a few minutes later. The nurse did not open the clinic because the clinic was due to open only at 7am. There have been many situations like this, but it was very tragic to have a situation where medical personnel would have to deliver a baby on the grounds outside of the clinic because the clinic was supposed to open only at 7am. It blew her mind that a woman could be treated in such an undignified and inhumane manner, when the medical personnel could have opened the door and delivered the baby in a proper facility. 

Her biggest concern, which she had raised in many meetings before, was that the OHO was seriously understaffed. Despite the fact that this had been raised in several reports before the Committee, it appeared that this had not been dealt with. When there was a situation of R125 billion worth of medical-legal claims, she could only imagine what the OHO was going through and how difficult it had become. There was a continual decline in health and health facilities, and the medical-legal claims would probably rise considerably over the next few years. This would put the OHO under even more pressure, particularly if the medical-legal claims were in excess of the annual budget. This had become very problematic.

She mentioned a situation at Greys Hospital, where a doctor was meant to remove a cyst but instead had removed the patient's bladder. This also raised serious concerns regarding the standard of training that medical personnel were getting, which was fast becoming an issue. She was concerned that doctors would not want to enter public facilities. When there was a situation of R125 billion worth of medical legal claims, and the bulk of these came out of public health facilities, then the doctors, specialists, surgeons and nurses became very wary about going to work in these facilities, because they do not want to be at the back end of those claims. Such medical-legal claims were easy, because there was no infrastructure, a lack of staff, theatres, oxygen, linen, etc.

She said that Prof Makgoba had done an absolutely sterling and amazing job. She could not imagine the pressure he had been under, but the Committee was grateful for his work.

Mr Munyai agreed with the Members concerned about Prof Makgoba leaving the OHO, as it was too soon. He recalled that it was Prof Makgoba who had come to Parliament and said there should be a difference between the OHO and the OHSC. The Members were very happy that there would now be a Bill to liberate the Ombuds, so that they may be independent. He was sure that the necessary support was key, so there was financing for the capabilities of the Ombuds to be stronger. The Members would remember Prof Makgoba for his frankness and straightforwardness, because he was not biased.

He said Members knew that the OHO was overstretched, and that the challenges of the health care system in this country were too huge. Therefore, the OHO needed human capital and resources. He asked Prof Makgoba for his opinion on how many staff members the OHO should have. He was happy to hear of his experience of the NHS in the UK and the advocacy he had made in support of the NHI in South Africa. He believed it was important to do away with the two-tier system in South Africa, to address issues of inequity.

He wished Prof Makgoba well in his new endeavours, whether in retirement or another responsibility.

OHO's response

Prof Makgoba referred to Ms Wilson’s comments, and said he was also from Limpopo. He had a very strong passion, being from Limpopo, and he got quite upset when he found that things did not work there in places such as the Philadelphia Hospital, Jane Furse -- where he was born -- and so forth. The OHO did not expect anything extraordinary from the health professionals, but expected them to have a code of ethics, a code of practice, and to follow what they were taught to do in the most difficult circumstances. All that the OHO did was to question whether the health professionals had lived up to the code of practice that all medical schools had taught the nurses and doctors.

He said that when he had initially taken this position as Ombud, there were a few things he had wanted to do, which he had discussed with Minister Motsoaledi. One of these things was that if the health professionals did the minimum they were taught to do, there would not be the medical-legal claims that there were today in South Africa. In addition, if the OHO had been sufficiently resourced and staffed, it could alleviate this huge situation of legal-medical claims being made.

He would not be leaving until the end of his contract, which is at the end of May 2023. He would still be in South Africa, and always be available to his country, especially the Department of Health, and he would make inputs where necessary and required. He had been privileged and honoured to be given this position, and had enjoyed doing it. He would be happy to support his successor, as it was a unique opportunity, especially because it came before the country moved towards the NHI.

He explained that the UK went into the NHS had been poor at the time. Children in the UK suffered from malnutrition, and the country had just come out of World War 2. There was abject poverty in the UK. The British people had decided that it would invest all of its efforts and energy into the NHS. Although they still faced enormous challenges, it was still one of the strongest things that united the British people. The NHS made many countries like the United States envious of living in Britain. So much energy had been spent in South Africa debating whether it should have the NHI or not, which he found lamentable, but it was also the nature of democracy. He believed it would be important for the new government to stamp its authority to say that this was not negotiable, and that it would go ahead, because health was expensive anywhere and it was not going to get cheaper with time. People should not be allowed to wither away because they could not afford health care, because that would be a very sad and traumatic story.

Ms Hlengwa said that listening to Prof Makgoba’s wise words was always a pleasure. She informed him that she was the one who had complained in June last year about a patient that had died at Edenvale General Hospital, and that she had not received feedback. She pleaded with Prof Makgoba to look into the case.

She was concerned that there was a shortage of cancer treatment equipment in KwaZulu-Natal, particularly at Greys Hospital. Some patients were referred to Greys Hospital and travelled long journeys with their families by bus to receive treatment, only to find that there were no oncologists, equipment or medication, and they had to return home without being treated.

Prof Makgoba replied that Ms Hlengwa should provide him with her email address, so that his team could look into the case. He was unaware of the concerns related to the oncology unit at Greys Hospital, but he recalled that at some point, KwaZulu-Natal had a health ombud in its province. Every time he received a complaint from KwaZulu-Natal, he would have to refer it to the provincial health ombud to ensure that he did not cross boundaries. He was unaware of the concerns about oncology in KwaZulu-Natal, but he would follow up and provide a reasonable explanation.

The Chairperson said he was happy to hear that there had been progress with the development of the Bill, as it would resolve many issues. He was pleased to hear that the complaints and assessment unit had done so well to have resolved 96% of the low-risk complaints. He was also pleased to hear that the OHO called upon the knowledge of experts in the field, because during court processes, lawyers tended to ask, “is this your field of expertise?”

He noted that Prof Makgoba had strong support for the NHI, and that he had experience with the NHS in the UK. In all of his experience, Prof Makgoba had a tremendous understanding of health and health care, the plight of South Africa’s people and the need for its people to be able to access quality health care, at the nearest point closest to them. He quoted Prof Makgoba’s statement that the “NHI was a new strategy of government, and we must all support it.” He agreed that South Africa must embark on this journey, also being mindful that many countries lacked the money when they started their universal health care system. It was not going to be an easy journey and would have challenges, but in all fairness and for every citizen in South Africa, there should be an equal opportunity to have better health care. For everyone, it was about being healthy to be economically active and take care of their families.

He noted that Prof Makgoba had made many visits to the provinces, and was frank and open in his observations. The Committee had received a presentation about the medical-legal claims from the AGSA, which had indicated it was a big challenge and the problem needed to be identified and addressed. There would be specific meetings focused on the medical-legal challenges, and asked that any expert in this field should write to the Committee, particularly on how this could be addressed. For example, he recalled that there was an Essential Steps towards Managing Obstetric Emergencies (ESMOE) programme, which was a training programme for doctors. It seemed to have had a good effect at that time.

Prof Makgoba referred to Ms Clarke’s question on the backlog and whether the OHO had any plans to deal with it. He replied that there were backlogs in the investigative units, which often involved historical cases, and it was also compounded by the fact that there were only three investigators. Medical and health-related investigations were complex and took a long time. For example, in the investigation at the Tembisa Provincial Tertiary Hospital on the death of Mr Lethole, the OHO had to do 113 interviews in order to piece the whole issue together. In the investigations of high-risk matters related to health, the OHO was aware that its reports were subjected to court reviews, and it therefore required careful work. Since being provided with additional funds, the OHO have been able to acquire two or more additional people that had been able to assist the investigation unit to address this matter. It was not due to lack of trying, but it was due to the lack of capacity and funds, and it was also because of the nature of the court challenges that the OHO had to face. As far as he could recall, there had been no challenge to what the OHO did, but it always ensured that it wrote reports that were legally tight and factually correct.

He referred to the Chairperson’s comments, saying that human beings were not born with money, but with brains and a mind. Great nations succeeded and failed, not because of money, but because they lacked ideas and did not use their minds as best they could. He reiterated that when the UK went into the NHS in the early 40s, they had no money but had ideas. They were passionate about laying a foundation for a future society that would depend on the NHS, and they had done so for the past 70 years despite all the challenges they had encountered. It was great ideas and the passion to pursue those ideas that would deliver the NHI.

He thanked the Committee for the engagement, and asked if his colleagues from the OHO may also want to comment.

Dr Jacobs referred to the Chairperson’s comment about the ESMOE programme for alleviating maternal deaths, particularly in the intrapartum period. The ESMOE was a very useful programme, but it was unfortunately no longer in existence. She noted that the OHSC had received many complaints categorised as high-risk and extremely high-risk regarding maternal deaths.

Mr Douglas Mapheto, Senior Investigator: Legal Issues: Complaints, OHSC, referred to Ms Ismail’s request for an update on the Tembisa Provincial Tertiary Hospital investigation report, particularly regarding the 18 staff members who were recommended for disciplinary action. He said that the report received from the Gauteng provincial Department of Health was that it had drafted charges against the staff members for misconduct. This matter was still ongoing and the staff members had to appear before the disciplinary hearing for misconduct. The provincial Department had also instituted civil litigation through summons for medical negligence against other staff members. This matter would be handled by the state attorney assisting the provincial department.

Ms Helen Phetoane, Senior Investigator: Healthcare Complaints, OHSC, said that the breakdown of complaints that were investigated and resolved was reflected from page 8 to page 10 of the 2021/22 annual report. It also indicated the various provinces that had been investigated.

Prof Makgoba said that the 2021/22 annual report of the OHO should be read in conjunction with the report of the OHSC.

The Chairperson reminded the OHO to ensure that its 2021/22 report was shared with the Committee.

Ms Wilson said that there had been specific talk about the backlog in the cases that the OHO investigated, but one of the things observed in the reports of last week was the backlog of surgeries and the tremendous impact that this had on people who were in pain and agony. She asked Prof Makgoba to comment on this, and if he had been asked to be involved in this situation.

Prof Makgoba replied that he had not been involved in those backlogs.

Compensation Commissioner for Occupational Diseases (CCOD) Annual Report 2021/22

Dr Barry Kistnasamy, Compensation Commissioner, presented an overview of the annual reports for 2018/19 until 2021/22. For the 2021/22 annual report, he noted that the CCOD had obtained an unqualified opinion, with no material findings.

Mr Mishack Maswanganye, Director: Finance, CCOD, referred to the voted funds, and actual versus budgeted expenditure for the 2021/22 financial year.

• For compensation of employees, the budget was R36.3 million, and there was a total spending of R34.9 million, which was a 96% performance.

• For goods and services, the budget was R19.4 million. There was a total spending of R22.9 million, which was an over-expenditure of 18% due to the payment for Covid-19 quarantine sites.

• For transfers, which was the money received from the national Department of Health for the payment of monthly pensions, the budget was R1.4 million, for which there was 100% spending.

• For capital expenditure, there was no spending due to the carryover into the new financial year for the procurement of office computer equipment.

• Overall, total spending was R59 million against the R60 million budget -- a 98% spending, which was considered reasonable.

Mr Adrian Mallet presented the financial performance of the Mines & Works Compensation Fund.

Dr Kistnasamy provided an overview of the performance objectives, which included the amendments to the Occupational Diseases in Mines and Works Act (ODMWA), the update of the master/integrated database, the report on the certification and benefit payments, the report on the number of claims finalised (other than pensioners), the percentage of claims finalised within 90 days of receipt of all completed claim documents, as well as the report on the number of controlled mines and works inspected.

Mr Andre Fourie presented an example of the update on the master database.

(See presentation attached for further details)

Discussion

The Chairperson thanked the CCOD for the presentation and the progress made over the years. He congratulated the CCOD on its clean audit.

Ms Clarke referred to the R120 billion owed to South Africans, and asked whether any public awareness campaigns had been done to trace the people who ought to claim these funds. She asked whether the compensation claims management system was internal, or whether it had been outsourced. She asked about the current backlog of claims. The CCOD had been doing so much better. Were there any outstanding disciplinaries, and had any criminal cases been opened concerning fraud and corruption?

Ms Gela said it had been a good presentation, but it was depressing to hear of the mineworkers’ compensation system and the money owed to people. She noted that for the 2020/21 financial year, the AGSA had given an unqualified audit opinion, but the report had a material misstatement of a contingent asset identified by the auditors in the submitted statement, which had been corrected. She said there was an issue of leadership not exercising its oversight responsibility for financial reporting and compliance and internal control.

Referring to the ODMWA, she asked when the proposed amendment bill would be tabled in Parliament.

She asked if there was any update on the risk committee that was reported as not functioning optimally. Was the compensation claims management system internal, or had it been outsourced?

She hoped that there were efforts towards preventing occupational diseases.

Mr N Xaba (ANC) referred to the tracking tool developed by National Treasury concerning the mine claims. He asked how the Committee could assist in this process to ensure it happens even more quickly.

The Chairperson said that the Committee had received a number of presentations by the CCOD over the last couple of years, and it had noticed the progress that had been made, particularly with the number of claims finalised.

Mr Munyai said he was proud of the CCOD, as it was one of the organisations that had really pulled through with a clean audit. He recalled that at the beginning, the data was a mess at the Braamfontein office, but the data was eventually digitalised. The CCOD was now embarking on a comprehensive campaign to look for claimants, some of whom had been paid. He was excited about the progress of the CCOD, although the challenge remained to find the claimants and support them.

The Chairperson noted the challenges with the CCOD's work on the inspection of mines, and he hoped that the CCOD would be able to share the results with the Committee at some point. He also noted the advances which had been made in reaching the ex-mine workers. He said it was also important to stay in touch with the current mine workers so that the process did not neglect those who were affected due to their exposure to various elements. Whatever the causative effect, people should know where to go to get answers to their questions. The work of the CCOD was crucial to those who were affected while they were still alive, and it was also crucial to the beneficiaries of those who had passed on.

He would be coordinating a parliamentary working group, comprising the Portfolio Committees on Health, Mineral Resources and Energy, Employment and Labour, and the Standing Committees on Appropriations and Finance, to address the trust of the funds and to provide support to the CCOD that it would require in terms of the amendments to the ODMWA.

He was pleased with the progress made on the amendments to the ODMWA and the master/integrated database, particularly for those who were the actual beneficiaries of those funds. He asked Dr Kistnasamy to inform him if there was anything the Committee could do to assist the CCOD in attending to the challenges.

CCOD's response

Dr Kistnasamy referred to Ms Clarke’s questions, and replied that the unpaid funds could be categorised into three broad groupings. There were statutory funds regulated by law; there were a lot of pension and provident funds through the Financial Sector Conduct Authority (FSCA), which were managed through National Treasury; and then there was a group of insurance funds. The CCOD believed that it had done a fair amount of work from a collapsed system, to actually show that a difference could be made and that there was no need to hide under the Information Regulator. The Information Regulator was an important player, and he suggested that the Committee invite them to a joint Portfolio Committee meeting. However, one of the big issues with many of the funds was that they hid behind the Protection of Personal Information Act (POPI) when they stated that they could not provide personal information, which prevented people from tracking and tracing.

One of the issues was the question of how to unlock unpaid funds in terms of the database, with the tracking and tracing, the unique service delivery and ultimately paying the people.

Public awareness had been very fragmented. Dr Kistnasamy explained that when he first came to this Committee, he discovered an article in Business Day that stated that there were 20 people who had an unclaimed benefit. One of the things that the CCOD had embarked on was outreach campaigns on the ground and community radio, but it had tended not to give out names, because of other dynamics -- for instance, if someone knew that a person had money, then it could result in other problems.

On the compensation claims management system, Dr Kistnasamy explained that there was a memorandum of understanding (MOU) that was signed off after the intervention of Minister Motsoaledi and the Director-General at the time, Ms Precious Matsoso, so that the mining industry should work with him. The CCOD had requested support from the mining companies, and had then made technical resources available. The compensation claims management system was under very strong governance, but it was an outsourced service paid for by the Minerals Council of South Africa. It had gone through all of the checks and balances in terms of agreements and currently sat with one of the mining companies, but the Department of Health held the database.

There was no claims backlog, but the key area was that there were people who needed medical benefit examinations, certifications, etc. There had been funding constraints in terms of outreach activities. The CCOD had tried its best to reach out, but would need new ways of tracking and tracing in terms of this process. 

Replying to Ms Clarke’s question about fraud and corruption, he said that, unfortunately, with paying money, there were problems. There had not been losses to the fund, besides one or two instances where payments had been made to the wrong person, but there had been a follow-up on that. A significant input had been made by the Minerals Council of South Africa and the previous gold working group on this area of work. This money came from the mining sector or from their mining companies. He recalled that he had raised the question of how to protect this investment. The fund had grown from R2.8 billion in 2012 to R5 billion currently, and in the MTEF, it would be around R6 billion, notwithstanding payments and the increase in benefits and reduced levies.

There had not been fraud with the fund, but there had been issues with touts involving insider trading that affected the individual on the ground. The money could be paid only into the beneficiary's bank account, but the tout would go to the beneficiary and say that they could facilitate the claim. They would then organise the claims and the bank account, and when the money was paid into the bank account, there would be withdrawals. There were three of these cases registered in Limpopo, North West and Gauteng. He had had discussions with the Hawks and the National Prosecuting Authority (NPA), but there appeared to be backlogs and these cases needed to be resuscitated. Two or three insider trading collusion issues were also being investigated by the South African Police Service (SAPS) at the Hillbrow police office. The CCOD had tried to circumvent many of these issues through electronic systems, a proper database, and checks and balances with very strong internal controls. The public awareness campaigns had made very strong inputs with the relevant stakeholders to inform people on the ground that this was a free service.

On Ms Gela’s comment about the leadership issue, he replied that the issue had been that the CCOD did not submit its financials on time.

Internal audits were a transversal issue, as the funding for internal audits and the funding for much of the ICT and human resources came out of voted funds. Procurement processes were introduced to manage this, and there had been delays in the internal audit process. This was not really the responsibility of the CCOD, but it was unfortunately perceived that there was a lack of leadership and oversight. Fortunately, there was now a fairly good functioning internal audit.

There have been attempts to improve the risk committee. The risk committee was chaired by the Chief Inspector of Mines. The amendments to the ODMWA would propose a different form for risk assessments, and if there was governance, it would be totally in the control of the new compensation authority.

There were monthly reports on the compensation claims management system, so the CCOD could track the percentage of claims finalised within three months. It could also track the productivity of staff and service providers.

He agreed with Ms Gela’s comment about the prevention of occupational diseases. The true prevention tool came from the Mine Health and Safety Act, which sat with the Department of Mineral Resources and Energy. The true prevention tool in the work came from the Occupational Health and Safety Act, which sat with the Department of Employment and Labour. He unfortunately did not have prevention enforcement rights. The prevention intervention sat with two different legislative processes and two other departments.

On Mr Xaba’s comment about the tracking tool, he replied that he was not too sure of the tracking tool at the National Treasury, but the CCOD was in meetings with the FSCA. The CCOD had its own tools for targeted tracking.

Replying to the Chairperson’s comments, he said that while the CCOD had concentrated on the legacy project and the ex-mine worker database, it had not forgotten about the current mine workers. The CCOD had a project kicking off in January 2023, where the controlled mines and works would have to provide the CCOD with the name of every mine worker and contract employee. There would be a register of mines and works, a register of every mine worker, and a register of workers with risk work.

Dr Kistnasamy added that there was a special project he would convene with the Northern Cape and North West provincial governments on mesothelioma cancer that was identified at public facilities. Although the trust should have funds set aside for the treatment, at the moment, it was a sad indictment, because the treatment for many of these cancers, particularly the treatment for occupational lung diseases, was unfortunately paid for by the state.

There had been a South African Human Rights Commission (SAHRC) report on distressed mining communities, and the externalisation that mining had caused for communities. He would try to get hold of this report and share it with the Committee, because it raised substantive issues about mine tailings. The SAHRC report was very revealing about the post-mining problems in society. However, the CCOD had a narrow mandate to look after the health of the workers and the ex-workers regarding occupational lung diseases.

The CCOD was seriously looking for additional funding for its initiatives. The CCOD did not have time on its hands, because many of the ex-mine workers were dying and needed to be reached sooner rather than later.

The ODMWA reform process would hopefully be in the legislature by early next year.

Dr Kistnasamy welcomed the continued support from the Committee, and encouraged the constituency parties to be part of the CCOD outreach activities and awareness campaigns.

Mr Gert van Heerden, Office of the Tax Ombud, referred to Ms Gela’s comment about the misstatements, and said that there had been discussions with the AGSA where it had been noted that there was some recourse to National Treasury if it could not obtain or recover bad debts or if a payment was made in error. This had been disclosed under the contingencies note, so no further change to the financials had been made -- it was just added as a note to the financial statements.

The meeting was adjourned.