Department of Health 2023/24 Annual Performance Plan

Meeting report

Department of Health Annual Performance and Budget Vote 2023/24
Dr Sandile Buthelezi, DoH Director General, provided the basis and context of the National DoH Strategic Plan and APP. He said there had been significant improvement in health outcomes in South Africa over the past 10 years, with a positive impact on the health status of South Africans, who now live longer than before due to reductions in premature mortality.

However, services must still be more cohesive between the public and private sectors. Universal health coverage needs to be realised and supported by reducing the relative cost of private medical care and improving public health's human capacity and systems.
           
MTSF Impact Statements for Health
- Universal Health Coverage for all South Africans will be progressively achieved, and all citizens will be protected from the catastrophic financial impact of seeking health care by 2030 through implementing the NHI Policy.
- Life expectancy of South Africans will improve to 66.6 years by 2024 and 70 years by 2030:
- Recognizes notable progress made on NHI legislative process with public consultation on the NHI Bill and the clause-by-clause review completed by the Portfolio Committee.
- Responds to critical diagnostics provided by Presidential Health Summit compact as well as recommendations from Lancet quality commission, Health Market Inquiry and South African Demographic and Health Survey.

Annual Performance Plan 2023/2024
The performance indicators were outlined for each of the DoH programmes:
Programme 1: Administration
Programme 2: NHI
Programme 3: Communicable and Non-Communicable
Programme 4: Primary Health Care
Programme 5: Hospital Systems
Programme 6: Health System Governance and Human Resources

Annual Budget Vote 2023/2024
The baseline allocation has been decreased due to non-allocation for Covid-19 Vaccination Programme in 2023/24 and the reduction in District Health Programmes Grant.

Compensation of employees:
Decrease under CoE is due to transferring the Port Health Services function to BMA, effective 01 April 2023.

Goods & services:
There is no allocation for Covid-19 Vaccination Programme in 2023/24 hence the reduction of 52% from the 2022/23 under Goods & services.

Transfers & subsidies:
Decrease in transfers is due to the reduction of R1.957 billion in the allocation for the District Health Programmes Conditional Grant: District Health Component.

Purchase of capital assets:
The Health Facility Revitalization Indirect grant's capital funds decreased by 5% from 2022/23 to 2023/24.

Minister of Health Dr Joe Phaahla emphasised the various pillars to strengthen the health system to deal with communicable diseases, particularly HIV/AIDS, TB, and STIs. Provincial support for human resources and infrastructure had been prioritised.

Discussion
The Chairperson thanked the Department and added that presentations by provincial departments of their APPs and budgets would follow.

Ms D Christians (DA, Northern Cape) referred to the HPRS and that approximately 50 million people are registered. She asked DoH to outline about the awareness-raising process for the public to register on the HPRS database.

She was concerned about the poor management of patient files at the Robert Sobuwe Hospital (RSH) in the Northern Cape. A patient registered with the hospital since 2019 experienced the loss of her medical file on four occasions. Would DoH update the patient registration system at the hospitals in the Northern Cape?

She referred to the recent finding of a legal medical case where poor administration was cited as the main factor for the negligence. It results in substantial expenses as DoH must settle out of court. She asked DoH to explain how medico-legal matters are addressed.

On the backlog of forensic mental observations, she noted that 1 423 people await these reports. She requested an update on the plans and timeframes to address this backlog.

Severe and acute malnutrition is a significant challenge in the country. She asked DoH to advise on the measures to combat the challenge. What are clinics doing to assist parents in feeding their children?

She referred to the DoH plans to conduct unannounced visits to facilities. She asked if Robert Sobuwe Hospital would be included.

Ms Christians highlighted the RHS obstetrics challenges. She provided four examples of women awaiting cancer treatment at the hospital since 2019. The four women recently slept in the hospital's passage for four days while awaiting surgery, as no beds were available. The women were provided beds and prepped for surgery on the fifth day. However, the surgeries were not conducted and the women were discharged. There were various reasons for this such as a lack of staff, facilities and medical materials.

She asked for an update on the expenditure on the Covid vaccinesin Programme 6. Is there a database tracking the ongoing usage and expiration of the vaccines?

She referred to an increase in non-communicable diseases such as hypertension. How will the DoH address this increase and capacitate clinics?

The District Health programme budget to address TB and malaria was reduced. How will the decreased funding be addressed? How will provincial departments be supported to improve expenditure rates and outcomes?

Ms S Luthuli (EFF, KZN) asked how DoH would address future strikes in the public health sector following the March 2023 strike.

She noted concerns about the distribution of medical supplies and treatment in the rural areas. Most persons residing in rural areas must travel long distances to collect medication.

She proposed that DoH conduct unannounced visits to the KZN rural clinics and health centres.

She asked DoH to update them on the funding provided for infrastructure.

Ms N Ndongeni (ANC, Eastern Cape) said the NHI performance indicators decreased from four to two. This needs to be revised due to the budget allocated and to cover the NHI programme’s scope. She requested an update on the NHI grant deliverables, outputs and outcomes.

She asked DoH to provide lessons learnt from the Covid pandemic and how these will be incorporated into its operations. What was the impact on HIV and TB, and what steps were undertaken to address the implications?

She asked for an update on the registration of beneficiaries on the HPRS.

Mr M Bara (DA, Gauteng) said that the Auditor General recently found the DoH Annual Report contained unreliable performance information. Besides removing specific performance indicators, what steps were taken to prove the reliability of performance and expenditure information?

He requested an update on the forensic laboratories’ backlogs, infrastructure needs, staff vacancies and morale.

He requested an update on the North West Health Department placed under administration in April 2018.

DoH responses
Dr Buthelezi replied about the support to provinces on audit outcomes. National DoH works closely with the provinces through the CFO Forum and SA Chartered Accountants Forum. Resources are deployed to provinces to ensure proper financial management. Recently a meeting was convened at the Office of the Auditor General to discuss generic issues leading to adverse outcomes.

The Limpopo Central Academic Hospital was supported by the deployment of a contractor to set up a site to commence the construction work. The project will be launched in 2028.

On Covid 19 vaccines, 21 million doses of the Johnson & Johnson vaccine and 7.6 million doses of the Pfizer vaccines are housed at the central depot. None have expired, and no new procurements were made. The total procurement cost was R9.1 billion.

Some of the NHI indicators depend on passing the Bill into an Act. This process depends on Parliament and not DoH.

Dr Aquina Thulare, DoH Technical Specialist on Health Economics for the NHI, reiterated that NHI indicators depended on the legislation’s approval. The AG had advised that the indicators were not SMART as there were too many dependencies. Thus, the indicators were amended accordingly and in line with audit requirements.

On registering medical aid members on the HPRS, she confirmed that these members are registered according to facility visits. There are discrepancies in the information gathered by DoH and the medical schemes.

Medical schemes do not approve the transfer of their members’ database information to the HPRS. It will attempt to address this lacuna in the amendment of the Medical Schemes legislation.

On conditional grant deliverables, plans are designed according to Treasury’s guidance on how grants should perform. Some of the grants are aimed at addressing improved administration and registration.

Medicine stock systems are under review to improve stock visibility and track shortages, especially in rural areas. Central Chronic Medicines Dispensing and Distribution (CCMDD) grants are in place to deliver medicines and reduce medicine shortages. Primary health care at clinics would be prioritised. Quality services are a significant deliverable.

Contracting for services at the primary health care level would be researched and designed to ensure proper implementation of the NHI. Lessons learnt from Covid will be incorporated into the NHI rollout. The health system must be unified.

Ms Milani Wolmarans, DoH Chief Director: Policy Coordination and Integrated Planning, responded to the outpatient registration questions. DoH prioritised the digitalisation of electronic health records. This requires intensive and ongoing training of staff.

A health-identifying number would be provided to patients. The technician would utilise the number to access the clinical results and treatment.

The intention is to provide the number to every patient in anticipation of the rollout of the NHI. DoH collaborates with the Department of Home Affairs  (DHA) to access documentation status and population information to verify the information for the database.

The National DoH is collaborating with the Northern Cape DoH to address the challenges at Robert Sobukwe Hospital.

The DoH would develop a fully-fledged electronic health record which is resource dependent. Connectivity, mainly due to load shedding, is a significant challenge.

Mr Ayana Dakela, DoH Head of Infrastructure, added about Limpopo Central Hospital that a contractor was deployed and a site work permit was approved. A budget of R2.9 million was approved. The site handover is scheduled for 10 May 2023. Job creation would be an advantage.

A budget was allocated for refurbishment and upgrades of hospitals. Funding was earmarked for monitoring expenditure by provinces. Monitoring of the procurement and performance of contractors would be prioritised to ensure proper oversight and compliance.

Ms Jeanette Hunter, DoH Primary Health Care and Hospital Management Systems, responded to the reduced primary health care  (PHC) budget. The DoH overall budget was reduced, and it reprioritised activities accordingly.

PHC would be the flagship of the health system. Thus the increase in the budget would be done on an eventual basis. The health promotion levy would be utilised to educate South Africans on health care and wellness. She advised that the DoH employs the use of the levy regularly.

On the forensic observations backlog, staffing is provided by the Department of Justice. DoH aids when required. The backlog was reduced, but the backlog will not be eradicated.

South Africa does not have a general shortage of medicines, but there may specific shortages in specific areas. She encouraged the Committee to submit the details of cases to DoH for follow-up.

The screening of non-communicable diseases is conducted by the community health workers in various areas. The workers advise on wellness education and make referrals to PHC facilities.

The primary health course provided integrated training for health staff on early detection and management.

The North West Hospital was placed under administration and report has been submitted to the NCOP. DoH awaits feedback from the NCOP if the administration will be concluded.

Mr Phaswa Mamogale, DoH CFO, replied that DoH regularly holds the CFO Forum to support provinces on audit action plans. The forum was convened to prepare for the audit in May 2023. The forum prioritised discussions on compliance inconsistencies as well as the guidance from the AG for compliance.

Dr Buthelezi noted that further information would be provided in writing on the backlog of obstetrics in the Northern Cape Province.

Deputy Minister Sibongiseni Dhlomo said that the DoH visited the Robert Sobukwe Hospital in Kimberley two weeks ago. He noted that there are suggestion boxes at the hospital. He recommended that Members encourage their constituencies to submit complaints and suggestions accordingly.

NCDs relate to the need for behavioural change. Members should encourage communities to live a healthy lifestyle.

Minister Phaahla responded about the prevention of further strikes. Freedom to strike is part of the labour dispensation. He emphasised that the law also protects health services. The Labour Court ruled that persons on the frontline of services should not be involved in the strikes. A risk counter plan should be provided to prevent strike action.

The Chairperson thanked the Department for their attendance.

The Committee adopted 25 April 2023 meeting minutes and the meeting was adjourned.