Department of Health on its 2015/16 Annual Report

Meeting report

The Chairperson noted the meeting started on a bad note, considering the deaths of the 94 psychiatric patients from Esidimeni. She noted apologies for the absence of the Minister and the Deputy Minister who were involved in other engagements. NDOH expenditure for 2015/16 was 99.4% which did not match the 64% of actual work done and requested NDOH in their presentation to give an adequate explanation for that.

Ms P Samka-Mququ (ANC, Eastern Cape) expressed her disappointment at the absence of the Minister and Deputy Minister considering the importance of the meeting.

National Department of Health (NDOH) 2015/16 Annual Performance Report
Ms Gail Andrews, Chief Operating Officer: NDOH, said that although, some of its targets were not achieved, substantial progress has been made when compared to the last financial year.

Programme 1: Administration
NDOH achieved 5 targets, but 8 were not achieved. It targeted on improving its audit outcomes, ensuring an efficient and responsive Human Resources Services, providing support for effective communication and developing a national health litigation strategy. Its achievements included improving its audit outcome; holding induction workshop for Port Health employees in the provinces of Gauteng, KwaZulu-Natal, Free State, Mpumalanga and North West; developing and implementing 15 communication kits and adopted a national health litigation strategy.

Programme 2: Health Planning and Systems Enablement
NDOH had targeted to achieve Universal Health Coverage through phased implementation of the National Health Insurance (NHI); establish a national stock management surveillance centre to improve medicine availability and also improve contracting and supply of medicines. It has substantially achieved its targets as electronic stock management system has been implemented and a national surveillance centre is functional, control towers in Eastern Cape and Free State established and all pharmaceutical contracts were in place 8 weeks prior to expiration of the outgoing contract. Other achievements were appointment of the Ministerial Advisory Committee (MAC), achievement of the targeted percentage of the review process of the PHC Essential Medicines List (EML) and IT hardware equipment was purchased for an additional 1 200 facilities. However, only 396 567 patients are receiving medicines through the centralized chronic medicine dispensing and distribution systems as against the targeted 500 000 patients, while 657 PHC facilities are implementing the web based health Patient Registration System while the target was 700 facilities.

Programme 3: HIV and AIDS, Tuberculosis, Maternal, Child and Women Health
In terms of increasing life expectancy, the NDOH had targeted to reduce the maternal mortality ratio, neonatal mortality rate, improve access to sexual and expand the reproductive health services and the PMTCT coverage to pregnant women by ensuring that all HIV positive antenatal clients are placed on ARVs.

NDOH met its targets for neonatal mortality rate reduction, number of targeted antenatal clients initiated on ARTs, target for measles 2nd dose coverage, school grade 1 screening coverage, HPV 1st dose coverage, increased the TB MDR treatment success rate and scaled up the combination of prevention interventions to reduce new infections including HCT, medical male circumcision and condom distribution. However, NDOH did not meet the target for reducing the maternal mortality in facility rate, couple year protection rate, cervical cancer screening coverage, immunization coverage under one year.

Programme 4: Primary Health Care Services
Under this programme, NDOH successfully improved district governance and strengthened management and leadership of the district health system; increased the number of primary health care facilities with functional clinic committees, exceeded the targeted number of functional WBPHCOTs; achieved the targeted number of municipalities that met environmental health norms and standards in executing their environmental health functions; established an operating framework for National Health Commission; exceeded the targeted number of national departments oriented on the national guide for healthy meal provision in workplaces; exceeded the targeted number of people screened for high blood pressure and raised blood glucose level; and claimed improved access to quality mental health services in South Africa.

Programme 5: Hospitals, Tertiary Services and Workforce Development
NDOH substantially achieved its targets for maintaining and refurbishing facilities, constructing clinics and doctors’ rooms. 117 facilities were maintained and 81 facilities upgraded. Also 49 clinics and CHCs were constructed and revitalized against the 2015/16 target of 35 clinics and 78 doctors’ rooms constructed and it complied with the target of 37 new facilities. NDOH developed an infrastructure monitoring system and revised the Emergency Medical Services (EMS) regulations incorporating all stakeholders’ inputs and the missing annexures. It exceeded its target on the number of food tests carried out and established 5 Regional Training Centres (RTC).

In terms of professionalised nursing training, a National Policy for Nursing Educational and Training was developed and presented to the National Health Council while a programme/curriculum for capacity development for nursing and midwifery educators was developed.

Programme 6: Health Regulation and Compliance Management
Under this programme, NDOH achieved the promulgation of the Amendment Act and developed the transitional plan for the Medicines Control Council (MCC) to be replaced by the new regulatory authority, the South African Health Products Regulation Authority (SAHPRA). The Institute for Regulatory Science (IRS) project team was appointed and business plan finalised.

To provide for occupational health and compensation services through development of One Stop Services Centres in provinces, local organizing committees have been set up in two districts to support the setting up of One Stop Service Centres.

NDOH has developed and implemented a standardized performance management system. A standardized performance management system for board members have been developed and implemented in line with its target.

Discussion
The Chairperson said that she was still not convinced at the explanation rendered by the Director General as regards the disparity between the expenditure and the actual work done. She advised that for clarity and accountability, NDOH should always note the projected expenditure for a particular project for each financial year.

Mr C Hattingh (DA, North West) asked about the status of a hospital in North West that was completed two years ago but has yet to be opened and another hospital that had its roof collapse only one year after completion. He asked if these instances were peculiar to the North West Province.

Ms P Samka-Mququ (ANC, Eastern Cape) stated that it is the responsibility of the Director General to ensure that the target for the completion of the performance agreements for Senior Management Staff was met and all documents signed before the three month deadline. She requested further explanation on the irregular expenditure.

Ms T Mpampo-Sibhukwana (DA, Western Cape) asked the Director General to specifically address the challenges in psychiatric hospitals in the nine provinces as well as the challenges with medication in these hospitals. She asked NDOH what the approximate waiting time for admission was for each of the provinces with specific regard to Western Cape Province.

Ms M Moshodi (ANC, Free State) asked about the cause for delay in appointing staff to fill the vacancies noted in the report.

Ms D Ngwenya (EFF, Gauteng) stated that her late receipt of the Annual Report document made it impossible for her to review it before the meeting. She asked why there was a very slow improvement in fighting infant mortality and the Department’s plan for its improvement. She asked if the number of WBOTs needed based on the ratio of the 1:1500 household norm was feasible and if it would make any change. She asked about the recruitment process into the team considering the alarming number of vacancies and people needed to fill it. She asked for the Department’s explanation about a new clinic in West Rand that has been completed but yet to be occupied. She was told that the opening date for the clinic would be 10 February 2017 but the clinic was not opened on that date.

The Chairperson apologized for the late receipt of the Report by some members as the Report was forwarded by NDOH two days before the meeting. She noted that no attention was paid to the importance of breastfeeding and about off-the-shelf baby foods considering that these contribute to infant mortality and shaping the future of the children of South Africa.

On the Beitbridge clinic that has been closed, the Chairperson said that she would send further information to the DG for immediate action considering the importance of the clinic at the border of South Africa.

On the Ideal Clinic Initiative, the Chairperson asked for confirmation that all the listed clinics have met the standard of the Ideal Clinic. She asked what had caused the hospital built in Northern Cape 11 years ago not to have been put to use to date.

Ms Malebona Matsoso, Director-General: NDOH, further explained that the disparity between the expenditure and the actual work done was as a result of the under-performance of some of the provinces. The expenditure on infrastructure is never linear because of the tenure of some of the projects and that NDOH can only confirm the budget extended to the provinces but cannot monitor the provinces on how the money was spent. It was not solely the responsibility of NDOH to account for the expenditure but the provinces should be able to render accounts of their expenditure since the bulk of the budget (R121 billion) was remitted to the provinces who can disburse the funds with no recourse to NDOH while NDOH can only account for the R33 billion national budget. Until the current fiscal framework is reviewed, the issue of accountability of expenditure would always reoccur.

On non-recruitment of staff, she noted that the contributory factor to this had been lack of funds since the bulk of the budget was usually ploughed into capital projects.

On Northern Cape mental health institutions, she said that that there was an ongoing investigation and the findings would be presented to the Committee at the completion of the investigation in order not to compromise the findings.

She replied that the senior management staff that did not meet the deadline for submission of their performance appraisals were not paid their bonus for failure to meet the target of the Department.

She said that considering the importance of breastfeeding as highlighted by the Chairperson, it would be included in the Annual Performance Plan (APP). She noted that a clinic would be dedicated at the Beitbridge point.

Ms Jeanette Hunter, Deputy Director-General: Primary Health Care Services at NDOH, said that a clinic in a community can be turned into an Ideal Clinic as long as the clinic is of the right size. However, the slow pace on Ideal Clinics was mainly because of the need for increased structure, budget to equip the clinics, staffing of the clinics and the supply chain management.

Mr Yogan Pillay, Deputy Director-General: HIV/AIDS, TB and Maternal, Child and Women’s Health at NDOH, said that although the rate of exclusive breastfeeding was low in the last reporting year, it is expected to increase to 60% in this reporting quarter. He said that the cause of infant mortality rate had generally declined and pediatricians have been hired to further review the cause of the mortality rate in order to further reduce it.

Mr Anban Pillay, NDOH Deputy Director-General: Health Regulations and Compliance, said that pharmacists had been encouraged to refer the patients to the nearest pharmacies for drug collection. He said that there is no shortage of space for psychiatric patients in psychiatric hospitals.

Ms Valerie Rennie, NDOH Deputy Director-General: Corporate Services, said that the performance appraisals must be duly completed in the 2017/18 appraisal year.

Ms Gail Andrews, NDOH Chief Operating Officer, on the question of the Beitbridge hospital, an earlier survey carried out showed that people using the clinic were not registered with the South African Census. She said that a mobile hospital now attends to people in that area so that the maintenance of a hospital will not be a burden to the province.

The Chairperson asked NDOH to investigate the health facilities at all border towns and furnish the Committee with a report.

The Chairperson thanked NDOH for their presentation. She said that if members wished to ask more questions, they should direct them in writing to the Deputy Minister and the questions that were not answered must be forwarded in writing to the Committee.

The meeting was adjourned.