Department of Health Strategic Plan & Budget 2007/08 briefing

SOCIAL SERVICES SELECT COMMITTEE
23 May 2007
DEPARTMENT OF HEALTH STRATEGIC PLAN & BUDGET 2007/08 BRIEFING

Chairperson: Ms J M Masilo (ANC, North West)

Documents handed out:
Presentation on strategic plan & budget 2007/08 – 2009/10
National Department of Health budget and report [available at www.health.gov.za]

SUMMARY
The Chairperson announced that the Health Professionals Amendment Bill was still being finalised and proofread and it should be ready by 29 May.

The Department of Health briefed the Committee on its strategic plan and budget for 2007/08. The major goal of the DOH in promoting healthy lifestyles remained. Ten key priorities for 2004 – 2009 were outlined, which included also governance and maintenance of the National Health System, improvement of hospital quality care, improvement in management of disease and strengthening internal management issues. The achievements across all programmes were detailed. Five hospitals had been completed on the hospital revitalisation programme. Primary health care visits had increased. A countrywide human resources plan had been developed. Challenges included poverty, unemployment, low education levels, poor transport infrastructure and social cohesion. The triple burden of disease, lack of skilled and sufficient human resources at both clinical and management levels and inadequate health infrastructure were further challenges. The priorities for the forthcoming year under the national health scheme were described. The budget for health was increasing at 11.9% average. The allocation for 2007/08 was R734,7 million and conditional grants of R12.6 billion were anticipated. The budget included provision for the new remuneration structure for health professionals, 30 000 additional personnel, emergency medical services, hospital revitalisation and modernisation of tertiary services for radiology and cancer.

Members asked numerous questions, only some of which were answered in the meeting, and the Department was asked to produce written responses by 30 May. These questions included the exchange of nurses, training of nurses, remuneration issues, schools’ health programmes, monitoring of HIV and drug-resistant TB, service delivery in some provinces, human resources planning and skills shortages, the plans for further oncology units, plans for rural hospitals, hospital revitalisation programmes and per capita spending across provinces. Further issues were raised around medication pricing, the lower budget for cervical cancer, regulation of circumcisions, and the number of vacant posts and staff holding acting positions.
 
MINUTES
Finalisation of the Health Professionals Amendment Bill
The Chairperson stated that the final copy of the Health Professionals Amendment Bill had been delayed as it still needed to be finalised and properly proofread. Clarification on clause 12 and other clauses was still needed. It was decided that a meeting would be arranged between the Health Professionals and the State Law Advisor to finalise any changes. The Bill needed to be finalised by the 29 May 2007.

Strategic Plan 2007/08: Briefing by the National Department of Health (DOH)
Dr Yogan Pillay, Chief Director: Strategic Planning, DOH, apologised for the absence of the Director -General, Mr T Mseleku, who was attending a summit.  He emphasised that the goals of the DOH since 2004 in promoting healthy lifestyles had not changed.

Dr Pillay outlined the DOH’s Ten Point Plan key priorities for 2004-2009. These included the governance and management of the National Health System, promotion of healthy lifestyles, improvement of hospital quality care, improvement of the management of communicable and non-communicable diseases and the strengthening of various internal management issues as well as international relations.

Dr Pillay described the achievements in each of the programmes. With regard to the Administrative Programme, Dr Pillay emphasised that five new pieces of legislation were processed.  All the provinces had produced Service Transformation Plans (STPS) and this strengthened the culture of planning. On the National level strategic plans were reviewed and the Draft Bill reviewing the Medical Schemes Act been submitted to Cabinet. Communication on the National and Provincial level had improved, 18 imbizos were held and a range of publications produced.  Key Cabinet decisions regarding Social Health Insurance were also made.

With respect to the Strategic Health Programmes the Integrated Management of Childhood Illnesses (IMCI) project was taken to 136 of 284 local municipalities, and 60% of health workers seeing children were trained in IMCI. Choice of Termination of Pregnancy Services, was provided by 60% of approved facilities and 88% of facilities offered Voluntary Counselling and Testing. 72% of districts were providing phase 1 of School Health services. Medicine pricing regulations were being reviewed. 24 000 applications for compensation for ex-miners were processed.

The Health Service Delivery Programme achievements were detailed.  Primary Health Care (PHC) visits by the public had increased and all nine provinces had delegated authority to Hospital Managers. The transfer of forensic laboratories and mortuaries to Department of Health was now complete. The National Infection Control policy was finalised.  Five hospitals on the Hospital Revitalisation Plan were completed, and further hospitals were added.

The Human Resources Management Programme of the DOH had developed a countrywide HR plan. The Skills development Policy was adopted and draft regulations for Community Health Workers (CHWS) were developed.  11 958 Health Workers were trained to implement the comprehensive plan for HIV & AIDS. The interim Traditional Health Practitioner Council was established.

Challenges faced by the DOH included poverty, unemployment, low education levels, poor transport infrastructure and social cohesion.  The triple burden of disease (communicable, non-communicable, injuries and trauma) as well as the lack of sufficient and skilled human resources for health at clinical and management levels, and inadequate health infrastructure were further challenges.

The key National Health Scheme (NHS) priorities for the coming year were stated.  These included developing provincial service transformation plans, strengthening human resources as related to the National Skills Development Strategy, improving the quality of health care, strengthening infrastructure and strengthening priority health programmes, which included the implementation of mass media campaigns to promote nutrition, to ensure that 60% of health districts had staff trained to implement the Reach Every District (RED) strategy, to strive for 5% reduction in smoking by adults and youth, and to support 85% of the institutions with maternity beds. Full details of each programme were explained.

Mr Gerrit Muller, Chief Financial Officer: DOH, highlighted that the Health budget grew by 11.9% over the period. He tabled new allocations for 2007 with respect to the rebuilding of the Department of Health’s Civitas building. Allocations for LoveLife (including evaluation), hospital revitalization, HIV & AIDS and for the National Tertiary Services Grant (NTSG) were tabled. The total allocation for the 2007/08 year was R734.7million and the total conditional grants were R12.6 billion. Full details were given of the breakdown across programmes, provincial health expenditure, personnel expenditure and capital expenditure. The budget made provision for the new remuneration structure for health professionals, 30 000 additional personnel, emergency medical services, hospital revitalisation and modernisation of tertiary services for radiology and cancer.

In conclusion, Dr Pillay stated that the Department faced a range of challenges.  Adequate resources and changes in the social contexts for the Health System were vital to the success of the implementation of the plans and intersectoral collaboration across government and with key stakeholders was crucial.  The National Treasury would be engaged for further resources.

Discussion
Ms N Madlala-Magubane (ANC, Gauteng) raised a number of questions, namely:
-How far the agreement between the exchange of nurses programme was progressing
-The earnings related to local and government clinic nurses
-How the schools Health Programmes were being run
-How the HIV levels of infection were being monitored
-Why the benchmarked countries for comparing medical prices were only the UK, Canada and Australia
-Why there was a difference in the amount of doctors on the Hospital Boards from province to province
-Why the committee were not receiving quarterly reports from the DOH
-Why the service delivery in the Gauteng area was so poor, as reported on the slide dealing with the service and infrastructure audit.

Mr M Thetjeng (DA, Limpopo) enquired why there were not more oncology units and what plan was being formulated to deal with this. Detailed results and figures were requested with regard to Human Resources planning and skills shortages, particularly on specific skills and qualifications. He also enquired as to how the more damaging strains of the drug-resistant TB were being dealt with.

Mr B Tolo (ANC, Mpumalanga) enquired as to the hospital policies on the bodies of stillborn babies and enquired as to why qualified nurses’ remuneration was not increased. He asked if there were sufficient nurses trained over the last year and if there was a plan to eventually acquire a building for the DOH as rental could become expensive.

Ms J Vilakazi (IFP, Kwazulu Natal) enquired as to the plans for the rural hospitals. She also enquired as to the rural allowances for nurses and the hospital facilities in the rural areas.

Dr Pillay responded to the questions on remuneration generally by stating that a different plan was in the process of formulation with regard to rural allowances, and this would include a new grading system for nurses and health workers. The exchange of nurses to the UK was a Gauteng specific pilot project.

Mr M Sulliman (ANC, Northern Cape) stated that clarity was needed on those hospital revitalisation projects that were stopped. Uniformity in the per capita spending in each province was needed.  He asked whether the qualified refugees from the surrounding African states could be absorbed into the nursing staff of this country.

Ms H Lamoela (DA, Western Cape) enquired if there were any imposed penalties on the delay in the revitalisation of some of the hospitals. She requested a break down of the schools per province that were involved in Health Promoting Schools programmes.

Ms Madlala-Magubane enquired as to why the benchmarked countries for medication prices did not include any African countries. She noted that the adjustment of the budget for cervical cancer was lower, and she asked the reasons. She enquired as to how far the DOH was on the regulation of traditional circumcisions.

The Chairperson expressed concern with regard to the vacant posts and the fact that those positions were filled by people that had been “Acting” directors for a number of years.

Dr Pillay replied in general to some of the questions. He made a general comment on government leverage of national policy, stating that the decentralisation, autonomy and the provincial treasuries did not all have the same priorities as the National government.
 
The Human Resources National Plan included what the plan of DOH was in the coming years. The pull and push factors were different for nurses. The push factors taking the nurses away from SA were that the management and remuneration were not adequate. Health professionals experienced “Irresponsible” behaviour by patients but health workers reported that they were not respected by their patients.

Dr Pillay stated that with regard to the hospital revitalisation programme, the budget bid was R3,6 billion over three years, but only R1,9billion had been allocated.  One third of the budget had been allocated for the rebuilding of hospitals, one third of the budget had been allocated for the rehabilitation of hospitals and the final third for maintenance of hospitals.  The lack of infrastructure arose through the shortage in building skills, a shortage of cement and a lack of capacity.  Other contributing factors included corruption and the projects could not be brought forward until the legal cases had been finalised.

Mr Muller replied that the per capita funding was R1,451 billion for 2007/08 and the report (slide 13 of financial presentation) showed that Limpopo, Mpumalanga and North West were less than the average. 

Dr Pillay (DOH) stated that there were two major goals for the country; a 50% reduction in HIV incidence and by 2011 to have care, support and treatment available to those that need it.

Ms Mazibuko suggested that the detailed answers to the other questions asked be put in writing.

The Chairperson concurred and asked DOH to submit the answers to the questions by the following Wednesday.

The meeting was adjourned.