Parliament, Wednesday 15 March 2023 – The Portfolio Committee on Health was briefed by the Parliamentary Legal Services and the State Law Advisors on the National Health Insurance (NHI) Bill.
This committee briefing forms part of the legislative processes for the NHI Bill. The briefing forms part of the process the committee must undertake to ensure that the Bill goes through the proper parliamentary processes. The committee has conducted a public participation process of provincial and virtual public hearings. Following that, the committee received inputs from the Department of Health (which is the sponsor of the Bill) responding to the inputs and recommendations received during the public participation process. Thereafter, the committee conducted clause by clause deliberations of the Bill.
Committee Chairperson Dr Kenneth Jacobs said the briefing today provided the committee with a legal opinion on the Bill. Further engagement will resume next week when the members meet to discuss the legal practitioners’ input.
The NDoH official policy communication on vaccination 5 July outlines how the adjusted vaccination rollout. It differs from the original PHASE 2 rollout hence the use of “adapted.” It is not explicitly linked to phase 2 but it is hard to see where else it fits. Missing are those with comorbidities like NCDs, including diabetes and cancer.
1.4 Every vaccination site (public or private) must have a pro-active plan for managing walkins for vaccination.
Age group (+40) and congregate responsibilities government supported by private ;
Essential workers according to government sector “vertical” rollout
Workers by priority “economic” sector (mining, automotive industry, taxi operators) rollout via companies. Not clear if limited to the above sectors.
A general caveat about using EVDS to register all who are vaccinated.
NDoH & provincial DOH (PDoH) collaboration with private sector responsibilities
1.1 Vaccination registration & administration by age groups (5 subpoints around EVDS and reimbursement). 1.2 Working group 1: capacity analysis including underserved areas for the attention of PDoH, presumably with the prospect of solving problems (members NDoH/Business for SA). 1.3 Working group 2: NDoH equity monitor of demand in districts/municipalities to resolve coverage issues & look at rollout to 40+. 1.4 Walkins are OK & every vaccination site (public or private) must have a pro-active plan for walkins. (6 subpoints) 1.5 Congregate settings: homes for people with disabilities, old age homes and later on prisons (correctional facilities) remains PDoH / privates sector responsibility.
2 Roll-out of essential worker programme public sector
2.1 “Vertical” rollout with key government “sector” “projects” departments (9 subgroups) 2.2 PDoH not responsible for the above except “DBE project and around 220,000 people from 6 categories. 2.3 Vaccination of remaining health care workers (HCWs) according to V4HCW registration site and these also include “private employers.” (5 items) 2.4 Police (SAPS) is managing its own vaccination project. 2.5 Department of Defence and Military Veterans for the SANDF programme due to start on 8 July. 2.6 A number of government services still to be finalisied e.g. correctional services vaccination.
3 Prioritised sectors of the economy
3.1 President listed these previously mining, automotive manufacturing and taxi operators. 3.2 Many private sector companies have started vaccination of employees and contract workers. 3.3 Companies using in-house or outsourced health services.[/vc_column_text][vc_column_text]
4 EVDS-related issues
Four caveats about the importance of registering via EVDS in all circumstances.
On 20 July 2021, the SA NCDs Alliance is co-hosting and coordinating a people’s consultation on universal health coverage (UHC). This is especially for you if you use government health services.
The South African version of UHC is called “national health insurance” or NHI. But are we talking about the same thing? There are some big differences. What do you think?
The event is a virtual focus group lasting 2 hours with 30 participants. You can only participate if you apply. We want to hear your voice especially if you are part of a vulnerable or hard-to-reach group that uses public or government health services. So you need to complete that application form and showing us why your participation is important.
People who are left behind or have trouble having their health needs met before or during COVID-19?
Civil society participants, breakout group facilitators or note-takers.
We want to make sure that we hear from you, the people, and especially if you are in that “seldom heard” and vulnerable group. We can help a few selected participants with data package to participate on the day.
Government will in the next financial year avail an additional R8 billion to the health system for the country’s COVID-19 pandemic response.
This will be in addition to the R20 billion the state allocated in the 2020/21 financial year, Finance Minister Tito Mboweni said on Wednesday, while delivering the 2021 Budget Speech, in Parliament.
In a Budget Review document, the National Treasury said the funds were to enable the sector to expand prevention, screening, testing and hospital capacity.
The R8 billion, which will be allocated to provincial health departments through the provincial equitable share, is expected to enable the sector to sustain these activities and respond to possible future waves of COVID-19 infection.
“Provincial governments receive an additional R8 billion in 2021/22 to continue the public health response to the pandemic, and the potential for additional waves of infection. Provinces can mitigate the negative impact of COVID-19 and the associated lockdowns on their revenues by improving efficiency, particularly in the procurement of health equipment,” said the Minister.
In total, the health expenditure function will over the medium term make up 14.2 percent of total government spending, declining from R247 billion in 2020/21 to R245 billion in 2023/24.
“Provincial health departments receive about 92 percent (R678.7 billion) of these medium-term allocations.
Reductions to the sector, mostly focused on compensation spending, are estimated at about R50.3 billion over the 2021 MTEF period,” the document reads.
To achieve this, other reductions would be required from health departments to increase efficiency. This included generating savings through centralised procurement of certain goods, reducing variations in unit costs in HIV programmes and improving management of overtime costs.
The COVID-19 pandemic has had a massive impact on the South African health system. As at 16 February 2021, the country had 1.5 million confirmed cases and over 137 000 excess deaths as reported by the South African Medical Research Council.
Over the MTEF period, R29.4 million is allocated to Tygerberg Regional Hospital and R100 million to Klipfontein Regional Hospital in the Western Cape through the health facility revitalisation grant.
President Cyril Ramaphosa, accompanied by Deputy President David Mabuza and Cabinet Ministers and the President’s Coordinating Council (PCC) met on Friday, 28 February 2020.
The extended PCC meeting included premiers of the 9 provinces, mayors of 44 district and 8 metropolitan municipalities. It convened to assess progress on the District Development Model (DDM) implementation. It resolved that all spheres of government must work together for efficient service delivery at a local level.
Definition – joining the dots in districts for integration
The DDM approach aims to improve integrated planning across government with the creation and implementation of ‘One Plan’ per district or metro. It brings together all partners to stop dysfunctional silos and to make a joint plan across departments with relevant stakeholders. Local partners include business, civil society, faith based communities and traditional leaders in a compact for development.
Piloted in 3 district municipalities (OR Tambo, Waterberg and Ethekwini) the DDM represents a paradigm shift in government’s efforts to build a coherent and coordinated state.
More than R70 billion of public sector investments have been made in the in the three pilot sites since August 2019. A further 20 districts are to be included by the end of 2020 with all districts covered by 2021.
An analysis of the lessons learnt so far confirms the enormity of the socio-economic challenges faced by districts. It also assisted government to direct spending to the areas of greatest need in a more informed and integrated way. Transparency and accountability at a local government level is a much anticipated outcome.
The pilot of the DDM at the three sites assisted to uncover potential sectors for growth which can be tapped into to improve the living conditions of the most vulnerable. When the DDM is fully operational it will ensure greater inclusivity through gender budgeting.
The PCC has thoroughgoing discussions on the implementation of economic reforms to drive inclusive growth and job creation, infrastructure investment and development, efforts being made to bolster youth employment through the Presidential Youth Employment Intervention and as a progress report on the provision of water services and human settlements.
The President called the PCC an historical meeting of leaders from all spheres of government to support a “joined up approach” that when it comes to development no district gets left behind in development.
The President called on all social partners take the lessons learnt into account and use further impetus to the DDM vision. This vision of capable unitary developmental state with a strong neutral bureaucracy and solid societal relations.