Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698929962192.pdf (South Africa)
Thursday, 24 May 2018] 1 No 68—2018] FIFTH SESSION, FIFTH PARLIAMENT PARLIAMENT OF THE REPUBLIC OF SOUTH AFRICA ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS THURSDAY, 24 MAY 2018 TABLE OF CONTENTS ANNOUNCEMENTS National Assembly 1.

Membership of Committees ................................................................. 2 COMMITTEE REPORTS National Assembly 1.

Appropriations ...................................................................................... 3 2.
Cooperative Governance and Traditional Affairs ................................ 6 3.

Health.................................................................................................. 15 4.

Finance................................................................................................ 33 5.

Health.................................................................................................. 36 National Council of Provinces 1.
Appropriations .................................................................................... 50 Finance................................................................................................ 52 2.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 2 [Thursday, 24 May 2018 ANNOUNCEMENTS National Assembly The Speaker 1.
Membership of Committees (1) The following changes to Committee membership have been made by the African National Congress: Portfolio Committee on Basic Education Discharged Appointed Dirks, Mr MA Mkhize, Dr HB Portfolio Committee on International Relations and Cooperation Appointed Mkhize, Dr HB Portfolio Committee on Water and Sanitation Appointed Botes, Mr A [ALTERNATE] ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 3 COMMITTEE REPORTS National Assembly 1.
REPORT OF THE STANDING COMMITTEE ON APPROPRIATIONS ON THE CONTRACT EXTENSION OF THE DIRECTOR OF THE PARLIAMENTARY BUDGET OFFICE, DATED 24 MAY 2018 1.

The Parliamentary Budget Office Section 15 of the Money Bills Amendment Procedure and Related Matters Act, Act No.

9 of 2009 (the Act), establishes the Parliamentary Budget Office (PBO).

The PBO must provide independent, objective and professional advice and analysis to Parliament on matters related to the budget and other money Bills.
A Director must manage the PBO.

The Director must be appointed by resolution of both Houses of Parliament, after a recommendation of the committees on finance and appropriations of both Houses.

In terms of subsection 15(7) of the Act, any committee considering making such recommendation contemplated in the Act must do so in an open and transparent manner.

In addition, the aforementioned committees must also recommend to the Houses of Parliament the conditions of service for the appointee.

2.
2.

Appointment of Director On 26 April 2013, the Standing Committee on Appropriations adopted a report recommending the appointment of Professor M I Jahed as the Director of the PBO for a period of five years.

Thereafter, the Report was tabled and considered by the National Assembly.

Since May 2012, Professor M I Jahed was seconded from the Development Bank of Southern Africa (DBSA) to assist Parliament in the process of setting up the PBO.
The project led by Prof. Jahed was able to outline and clarify the functions and scope of the Office, design an operational structure, establish networks with external stakeholders and engage political parties and relevant Committees.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 4 3.
The ATC Referral [Thursday, 24 May 2018 The contract of Professor Jahed is coming to an end on 3 June 2018, and Parliament has – on 16 May 2018 – tabled a referral in the Announcements, Tablings and Committee Reports (ATC) to the Standing Committees on Appropriations and Finance and the Select Committees on Appropriations and Finance to consider the matter of the expiring contract of the Director of the PBO and to report by 28 May 2018.

4.
4.

Committee’s deliberations On Thursday, 24 May 2018, the Committee deliberated on the contract expiry of the Director of the PBO as referred to it on 16 May 2018.

The Committee considered the matter, taking into consideration the principles of continuity and stability together with the PBO output since its establishment, the contribution of the PBO to the stimulation of economic and financial debates in Parliament, and Prof. Jahed’s profile, and reached a conclusion on the matter.
Before arriving at a conclusion on the matter, the Committee also took into consideration the substantive interactions that Prof. Jahed has had with the different Committees, political parties and with individual Members, his extensive expertise in finance and economics, and the degree of professionalism with which he has conducted his work over the past five years.
The Committee further considered the relevance of section 15(15) of the Act which stipulates what should be done when the position of the Director is vacant.

Moreover, the Committee deliberated and resolved that the Money Bills Act was silent on the process that should be followed when re- appointing the Director of the PBO.

Based on the above points, the Committee resolved that Prof. Jahed is still a suitable candidate to head the PBO.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 5 5.

Conclusion and Recommendation In accordance with subsections 15(5) (a) and (b) of the Money Bills Amendment Procedure and Related Matters Act, the Standing Committee on Appropriations recommends as follows: 5.1 That Professor M I Jahed, be re-appointed as the Director of the Parliamentary Budget Office, for a period up to three months after the 2019 national elections.
5.2 That the re-appointment of the Director of the Parliamentary Budget Office be subject to an agreement that the conditions of service (including salary and allowance) would remain substantially the same as those of the top rank of the public service as per subsection 15(5)(b) of the Act, as agreed with Prof Jahed.

Report to be considered.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 6 [Thursday, 24 May 2018 2.
REPORT OF THE PORTFOLIO COMMITTEE ON AND TRADITIONAL AFFAIRS ON STUDY TOUR TO CHINA, 02 – 09 DECEMBER 2017 COOPERATIVE GOVERNANCE 1.

INTRODUCTION From 02 December to 09 December 2017, the Portfolio Committee on Cooperative Governance and Traditional Affairs undertook a study tour to the People’s Republic of China (PRC).
This followed an invitation from the State Ethnic Affairs Commission of the National People’s Congress (NPC), which had visited the Parliament of the Republic of South Africa and the Portfolio Committee in August 2017.

The NPC is the highest organ of state power in China, and has the right to amend the Constitution, enact laws and decide on major issues concerning the country – a role similar to that of the Parliament of the Republic of South Africa.
The Portfolio Committee’s visit was a follow up on the key themes emerging from the meeting of the Committee and the Commission, particularly those concerning poverty alleviation and economic development in the context of cooperative government and traditional affairs.

The Committee delegation to China consisted of six members: Hon.

Richard Mdakane (Chairperson); Hon.

Enoch Mthethwa (ANC); Hon.

Joyce Maluleke (ANC); Hon.

Xolani Ngwezi (IFP); Hon.

Kevin Mileham (DA); and Hon.

David Matsepe (DA).


Ms. Shereen Cassiem (Committee Secretary) and Mr. Andile Sokomani (Committee Researcher) supported the delegation.

Mr. Lebohang Tekane (Parliamentary Liaison Officer for the Department of Cooperative Governance and Traditional Affairs) was also present.

Hosting the delegation for the duration of the trip in China were, • Mr. Li Jingtian - member of the Standing Committee of the NCP as well as the • Chairperson of the Ethnic Affairs Committee of the NPC.
• Mr. Wu Shimin - member of the Standing Committee of the NPC as well as Vice- • Chairman of the Ethnic Affairs Committee of the NPC.

• Mr. Su Xiaoyun - member of the Standing Committee of the NPC as well as member • of the State Ethnic Affairs Commission of the NPC.

• Mr. Hao Guicheng - Director of the Administrative Office of the State Ethnic Affairs • Commission of the NPC.

• Ms. Zhang Jie - sub-inspector of the Administrative Office of the State Ethnic Affairs • Commission of the NPC.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 7 • Liu Li - official of the Administrative Office of the State Ethnic Affairs Commission of the NPC.

• • Mr. Duan Baorui - official of the Research Office of the State Ethnic Affairs Commission of the NPC.

• Mr. Zhang Bo (Mr. Xiaoyun’s secretary) and Mr. Liu Wanli (interpreter).

2.
2.

MONDAY 04 DECEMBER 2017: BEIJING The Committee’s most substantive engagements and high-level meetings took place in Beijing, the political and administrative capital of China.

2.1.

Morning: Meeting with LGOP Officials The first meeting of the Portfolio Committee was with officials from the State Leading Group Office of Poverty Alleviation and Development of China (LGOP) at their headquarters in Beijing.
The LGOP is responsible for coordinating surveys and research projects; drafting guidelines, policies and plans for economic development in poor areas; coordinating solutions for key issues in poverty-alleviation development; supervising poverty-alleviation work; and organising exchanges of experience.
Representing the LGOP delegation were Mr Chen Zhigang (LGOP Vice-Minister); Mr Zhang Liang (Deputy Director-General of the Office of LGOP); Mr Zuo Changsheng (Director-General of the International Poverty Centre in China), Mr Zhao Dongwen and Mr Wang Kai (Programme Officers of the LGOP).

2.1.1.
2.1.1.

Remarks by Vice-Minister Chen Zhigang In his opening remarks, Vice-Minister Chen Zhigang extended a warm welcome to the South African delegation, stressing South Africa and China’s common mission of improving the livelihoods of their peoples, and emphasizing that China also has much to learn from South Africa’s experience with poverty alleviation.
The Vice-Minister noted that since 1979, when China began reforms that prioritised poverty alleviation, the poverty rate has decreased to below four percent.

This translated to lifting approximately 700 million people out of poverty – contributing to about 70% of global poverty alleviation.
The Vice-Minister attributed this success to China’s experimental and incremental approach to reform, which he described as ‘socialism with Chinese characteristics.’ The Vice-Minister was confident that, with this approach, China would achieve its goal of eliminating extreme poverty in all its counties by 2020.

This would be ten years ahead of the United Nations goal of eliminating global poverty by 2030.
Guiding China’s poverty alleviation efforts - the Vice-Minister noted - was the ideal of building a moderately prosperous society, which is the substance of the political report of the 18th National Congress of the Chinese Communist Party (CPC) held in 2012.
This includes achieving, by the centenary of the CPC in 2021, an average per capita monthly income of ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 8 [Thursday, 24 May 2018 RMB 4000 (approximately R8000 rand), free health care for the indigent and subsidized health care for 85% of each provincial population, promoting industries, leveraging the household impact of quality training in every household, and administered infrastructure development.
least one individual to at The Vice-Minister reiterated the extreme importance to which the Communist Party of China and its various levels of leadership, attached to poverty alleviation work.

During its 19th Congress, which concluded just before the Portfolio Committee’s visit, the Party resolved to give focused attention to every poverty-stricken household.
The Party will continue to stress reform and innovation, such as investment in solar energy and the introduction of a scheme where corporate councils rent farmland on poor farmers’ behalf.

It will also encourage everyone to embrace the central government’s poverty alleviation vision, and to take responsibility for their own development.

There were 13 policy documents guiding the poverty work in China, and local governments have developed over 200 implementation plans based on these documents.
The resources mobilised in this regard amounted to RMB 270 billion over the last five years, with contributions from provinces, prefectures and local governments.

Banks also provided interest-free loans.

More than 34 000 companies, including public enterprises, have also assisted more than 30 000 villages towards poverty alleviation.

There is a database of all the poverty-stricken areas in China and government has sent millions of officials to visit these places.
The largest of these is the Tibet region, which, together with similar regions, has been a particular focus of the central government.

The Vice-Minister noted that the government of China would continue to ensure that there are consequences for officials, at all levels of government, who fail to meet its poverty alleviation targets – including dismissals and local demotions.

Central government would continue government and apply appropriate sanctions where performance fails to meet expected standards.
Supervision involves use of objective criteria such as hiring experts to assess and evaluate a county’s performance in reducing poverty.

to supervise With this approach, China has lifted more 130 million people out of poverty annually since 2013.

During this period, incomes in poverty-stricken areas have risen considerably.

Infrastructure construction has afforded more than 58% of rural households access to potable water, and 98% have access to telephones.
However, there were still 335 million poverty-stricken people.

As an economic growth rate of below ten percent (6.8 percent at the time of writing) has become the new norm in China, President Xi Jinping has placed emphasis on promoting agriculture as a key poverty alleviation strategy in China’s rural areas.

The Vice-Minister then gave the Chairperson of the Portfolio Committee, Hon.

Richard Mdakane, an opportunity to make some input.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 9 2.1.2.

Remarks by Hon.

Richard Mdakane Hon.

Mdakane contextualised the study tour visit in terms of the many areas of cooperation that currently exist between China and South Africa through the Five-to-Ten Year Strategic Programme for Cooperation signed between the two countries in 2014.

He then congratulated the country for the successful 19th Congress of the Communist Party of China.

Hon.
Hon.

Mdakane expressed appreciation for the effort the Chinese government put at implementing its policies, contrasting this against South Africa’s poor record of implementing its generally well considered ideas.

He noted that almost half of South Africa’s population lives in poverty and that at the micro (family) level, the country seemingly had little impact on poverty alleviation.

Hon.
Hon.

Mdakane revisited the concept of self-development and asked the Vice-Minister to elaborate further on how to encourage people to take responsibility for their own development, including starting their own businesses.

He also allowed an opportunity for Portfolio Committee members to pose questions.

Hon.
Hon.

Kevin Mileham observed that a multi- inherent party democracy, unlike China’s governance model, has constraints in respect of the range of measures at a government’s disposal to ensure strict compliance with its dictates.

He asked the Vice-Minister if he had any suggestion on how to transplant the Communist Party’s ability to enforce compliance with its poverty alleviation agenda into a multi- party democracy context.
In reply to these questions, the Vice-Minister reiterated the importance of self- development – stressing that it is easy for people to regress to poverty if they rely solely on government assistance.

In this regard, the Chinese government strives to ensure that at least one person from every household is trained and equipped to be self-reliant.

Farming is one example where government offers training and then assists the emerging farmers to find a market for their produce.
In response to the question of tackling poverty in a multi-party democratic context, the Vice-Minister pointed out that China was a multi-party democracy, with eight other parties besides the ruling Communist Party.

In this way, the Communist Party was also obliged to consult and cooperate with the other parties in all its decision-making processes.

At this point, the Vice-Minister adjourned the meeting, as the Committee’s schedule did not allow time for further engagement.

2.2.
2.2.

Noon: Meeting with Officials of the State Ethnic Affairs Commission From the LGOP offices, the delegation shuttled to the headquarters of the State Ethnic Affairs Commission (SEAC) of the National People’s Congress of China to meet with the Commission’s officials.

Some of the Committee members and Commission officials recognised each other from the meeting of 29 August 2017 in Cape Town.

(Please refer to the Report’s introduction for the Commission officials’ names and designations).
The Commission’s Chairperson provided an overview of the SEAC, including its functions and composition.

The Chinese government established the Commission in 1949 (the founding year of the People’s Republic of China) with a mandate to ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 10 [Thursday, 24 May 2018 take charge of China’s ethnic affairs and champion the interests of China’s 56 ethnic minority groups.
The State Council assigns all the Commission’s responsibilities in respect of ethnic minorities.

China’s ethnic policy rests on four pillars: • Treating all ethnic groups equally, regardless of history, population size or level of development.

This entails non-discrimination and respect for all ethnic groups, their costumes, languages and ways of living.
• Fostering solidarity among the Han (the majority ethnic group) and the minority ethnic groups, as well as solidarity among the 56 ethnic minority groups.

• Encouraging regional ethnic autonomy and balancing this autonomy against the ideals of co-existence and solidarity, and • Creating prosperity for all ethnic groups.

The Chairperson then afforded Hon.

Mdakane an opportunity to provide a brief introduction into the South African government’s ethnic policies.
In his overview of the ethnic situation in South Africa, Hon.

Mdakane highlighted the country’s diversity in terms of the official and ‘unofficial’ languages spoken, as well as government’s policy initiatives in respect of Khoi and San minorities.

He also cited the Constitution of the Republic of South Africa whose founding principles of human dignity, non-racialism, non-sexism, and the rule of law guaranteed the protection of ethnic minority rights.

Hon.
Hon.

Mdakane observed that at 23 years of democracy, South Africa was a relatively new nation compared to China’s 70 years of existence as a united nation – and that South Africa’s greatest challenge was poverty.

The Commission’s Chairperson concluded the meeting by stressing the importance of strengthening relations and exchanges between China and South Africa.
He noted that although there are many formal agreements between the two countries at various levels, the State Ethnic Affairs Commission had no formal agreements with any public institution in South Africa.

The Commission therefore had no formal channel to contribute to the friendship and prosperity of the two nations.

2.3.
Afternoon: Courtesy meeting with the Vice-Chairman of the Ethnic Affairs Commission In his brief welcoming remarks to the delegation, the Vice-Chairman of the Ethnic Affairs Commission, Mr Wu Shimin, recapped on the Commission delegation’s visit to South Africa, and expressed his high regard for the concept of the ‘rainbow nation.’ He noted China and South Africa’s remarkable achievement in terms of high-level exchanges and bilateral ties in the context of the G20 and the BRICS, as well as the cooperation agreements flowing from the 2013 Summit held in Johannesburg.
Mr Shimin also noted that December 5, 2017 would mark the 20th anniversary of the diplomatic relations between China and South Africa.

In conclusion, Mr Shimin stressed that the Commission attached much importance to legislative cooperation and that the study tour visit marked an improvement in this area.

He then wished the delegation a successful visit to China.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 2.3.1.

Remarks by Hon.

Mdakane 11 Hon.


Mdakane thanked the Vice-Chairman for the welcoming remarks and appreciated the high regard for South Africa, which was a relatively small power compared to China.

He once again congratulated the Communist Party of China for its successful 19th Congress and noted that he had listened to President Xi Jinping’s keynote address, and was studying the Congress’ resolutions.

Hon.
Hon.

Mdakane highlighted the resolution relating to taking approximately 400 million people out of poverty by 2020 and was curious to learn how this will materialise, as this would provide a critical lesson for the Portfolio Committee.

He noted the proven capacity of the Chinese government to implement its decisions, and was keen to learn from China about effective programme implementation.

Mr Shimin reiterated that he was confident that China would eliminate poverty by 2020.
He expressed the hope that deepened cooperation between China and South Africa’s legislative bodies would enhance the capacity of these bodies to make laws.

2.4.

Late Afternoon: Meeting and Banquet with Mr Li Jingtian, Chairman of the Ethnic Affairs Commission Mr Jingtian began the meeting by reflecting on the experience of their six- member delegation visit to South Africa, and expressed gratitude for their reception.
He hoped that the Portfolio Committee would experience the same warmth during its visit, and wished the Committee delegation well.

On the Committee’s behalf, Hon.

Mdakane welcomed Mr Jingtian’s sentiments.

He noted that the cooperation between the Chinese State and its private sector on poverty alleviation was encouraging.

Hon.
Hon.

Mdakane was keen to understand how China ensures that its local governments implement the central government’s directives; how it governs large cities such as Shangai in order to create wealth; and why it had achieved faster development.

Mr Jingtian replied that choosing the right leadership, and the right way to pursue development, was the foundation of China’s development progress.
The Communist Party of China was the right leadership and ‘socialism with Chinese characteristics’ was the most appropriate development framework for China.

The CP was the right leadership because it was the choice of the majority of people, dating back to the civil war against the western sponsored National Party of China.
This war witnessed millions of people pledging the last bowl of rice, the last of piece of fabric and the last child to the CP’s one million troops, which was a tiny contingent compared to the National Party’s 80 million troops.

The CP’s popular legitimacy was instrumental to the defeat of the National Party, which is now the ruling party of Taiwan.

The will of the masses was the basis for the establishment of the People’s Republic of China in 1949.
Today, approximately 89 million Chinese people in China are members of the CP.

Mr Jingtian then noted that China’s developmental trajectory in the last 70 years confirmed that socialism with Chinese characteristics was the right development path for China.

Having had no prior experience of running a country, the Communist Party was at first compelled to learn from the Soviet Union.
The realisation that China could not fully transplant the ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 12 [Thursday, 24 May 2018 Soviet Union experience led the CP to explore China’s own path of development, a process that began around 1956.

This process involved experimentation with various strategies, including a ten-year Cultural Revolution between 1966 and 1976.

These not only failed, but also brought the country disasters.
Subsequently, Deng Xiaoping emerged to lead the CP to explore the idea of socialism with Chinese characteristics.

This culminated in the reforms that began in 1978, which have seen China emerging as the second largest economy in the world.

The outcomes of these reforms have proved that socialism with Chinese characteristics was the correct path for China.
Mr Jingtian stressed that China did not encourage the exportation of its development model, as it would not necessarily work for other developing countries who must embark on the difficult task of poverty alleviation.

However, he noted that it was important for central governments to have the power and capacity to instruct other levels of government to implement decisions.
Fighting poverty in China has involved local governments mobilising resources within local communities, the private sector and other sectors of society; as well as rich areas and charity organisations subsiding and supporting poorer areas.

While this has lifted hundreds of millions out of poverty since the 18th Congress of the CPC in 2012, the Party still faces the difficult task of lifting approximately 400 million people out of poverty.
Focusing on increasing financial support to the poverty-stricken areas, and relocating those living in places that are not fit for human habitation, is now the top priority of the CP.

localities; contributions from their 3.

TUESDAY 05 DECEMBER 2017: CULTURAL TOUR OF BEIJING Besides being China’s political and legislative capital, Beijing is also the country’s cultural centre, as it owns more cultural heritage items than any city in China.
The delegation visited two of Beijing and China’s iconic cultural heritage sites: the Great Wall and the Forbidden City.

3.1.

Morning: Cultural tour of the Great Wall of China The delegation visited a section of the Great Wall of China, approximately an hour’s drive from Beijing.

A masterpiece of military defence work whose construction began in the 7th century B.C, the Wall meanders 21 000 kilometres across China’s kaleidoscopic landscape like a giant dragon.
A guide took the delegation through some characteristic features of the Wall, as the team made its way up to some observation towers from inside the Wall.

Ascending and descending just a few meters of that section of the Wall was a test of physical endurance and a lesson in hard work, discipline and mental fortitude - values that seemed to permeate the Chinese national character.

3.2.
3.2.

Afternoon: Cultural tour of the Forbidden City In the afternoon, the delegation embarked on a guided tour of the Forbidden City – an old but well-preserved Grand Imperial Palace.

This housed the emperors of China’s last two dynasties (the Ming and the Qing dynasties who had 24 successive emperors in total) who ruled the country for over 500 years.
The emperors forbade access to outsiders, even high-ranking officials, unless authorised – thus giving rise to the term ‘forbidden city.’ ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 13 The delegation explored the various courtyards, halls, chambers, towers, pavilions, and gardens of the imperial palace complex, with the tour guide explaining the historical significance of these structures and answering questions.
This was a direct experience of the Forbidden City’s lingering ancient grandeur.

4.

WEDNESDAY 06 DECEMBER 2017: WUHAN, HUBEI PROVINCE On Wednesday morning, the delegation boarded a high-speed train from Beijing to the City of Wuhan, the capital city of Hubei province in central China.

This was a four-hour journey.

In Wuhan, the delegation visited the South Central University for Nationalities, which is under the direct administration of the State Ethnic Affairs Commission.
For the Chinese government, the university represents a national model for ethnic unity and progress, as it enrols students from all 56 ethnic groups in China, with ethnic minority students making up 60% of the total.

The university campus hosts an Ethnographic Museum, the first of its kind in universities in China, which documents the history of Chinese ethnic groups.
The delegation went through a guided tour of the Museum and witnessed brilliant displays of various cultural artefacts associated with different ethnicities.

The delegation also received a fascinating overview of the evolution of Wuhan from a sparse ancient city into a bustling modern metropolis.

The rendering of the city into a gigantic life-like artificial model that could simulate day and night, was a mesmerising technological feat.
The delegation also marvelled at the exceptionally forward-looking vision guiding the city’s planning.

In the evening, the delegation received a welcoming banquet from the leadership of the People’s Congress of Hubei Province, who informed that the Province keeps a close relationship with South Africa, both in terms of economic and education cooperation.
Madam Li, who led the Congress representatives, noted that the study tour visit would promote the cooperation further and invited the delegation to visit more places in the province.

The Hubei Province was at the heart of China and accounted for approximately 6% of the Chinese population.

There were 800 000 minorities in the province or 4.5% of the Hubei Province population, half of whom did not have fixed jobs.
The Communist Party of China invested in this Province more than any other province, with RMB12 billion pledged in the 12th Five Year Plan on village roads and highways in every county.

Through its ethnic policies, China was able to lift 1 million people out poverty in the Hubei Province.

Madam Li was also keen to know about the South African experience in protecting the culture of ethnic groups.

5.

THURSDAY 07 DECEMBER 2017: WUHAN, HUBEI PROVINCE AND GUANZHOU, GUANGDONG PROVINCE 5.1.
Cultural tour of the Yellow Crane Tower On Thursday morning, the delegation visited the Yellow Crane Tower, which was a further education on ancient Chinese history and culture.

The Tower is dedicated to legends in Chinese mythology who rode on yellow ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 14 [Thursday, 24 May 2018 cranes.

Warfare and fire have destroyed the original Tower twelve times since AD 223, the original date of construction.
The City Government of Wuhan completed the current structure in 1985.

A guide led the delegation through the various floors of the Tower, from which the delegation enjoyed magnificent views of the city.

In the afternoon, the delegation departed Wuhan for the City of Guangzhou, the capital city of the Guangdong province in southern China.

This was another four-hour journey by high-speed train.

In Guanzhou, the climate had changed to summer, a testament to China’s vast land mass.
Mme Luo Juan, Vice Chairwoman of the Standing Committee of Peoples’ Congress of Guangdong Province, welcomed the delegation into Guangdong Province.

The Committee is, among other things, responsible for supervising the work of the Provincial People’s Government – an oversight function.

Mme Luo Juan provided an overview of the Province in terms of land mass, economy, social and political developments.
She noted that KwaZulu-Natal was among the foreign states and provinces, with which the Guangdong province has forged a sister-relationship – effective from 29 August 2016.

6.
6.

FRIDAY 08 DECEMBER 2017: GUANGZHOU, GUANGDONG PROVINCE On Friday morning, the delegation visited the Golden Flower Service Centre, which exemplifies the Guangdong Province’s social assistance programmes, including services for retired citizens, registration for the unemployed and small business start-ups, and the mobility needs for the disabled.

The Central Government funds the Centre, with assistance from Non-Governmental Organisations (NGOs).
The Centre management informed the delegation they often invite local residents to supervise and assess the performance of Centre staff, giving credit where it is due.

The delegation also met the Local Committee of the Communist Party as well as the Local Secretary of the Communist Party in Guangzhou.

The delegation concluded the visit to Guangzhou with a tour of the Guangzhou Tower – a 600-metre structure that briefly held the title of the tallest tower in the world.
The delegation flew back home at midnight.

7.

CONCLUSION The Portfolio Committee left China with profound respect and high regard for the organisation and administration of the country.

The hospitality and administrative efficiency of the State Ethnic Affairs Commission, the Portfolio Committee’s host for the duration of the trip in China, were particularly outstanding.
The Committee drew much inspiration from China’s poverty alleviation drive, its transformation of 56 different ethnic groups into a socially cohesive society, its pride and investment in its vast cultural heritage, and its forward-looking urban planning.

In the main, the Chinese experience has challenged the Portfolio Committee to find solutions to South Africa’s development challenges internally, as opposed to importing foreign development models.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 15 3.

REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON THE STATE OF HEALTH CARE SERVICES IN SOUTH AFRICA DATED 25 OCTOBER 2017 1.

INTRODUCTION The Portfolio Committee on Health was briefed by nine Provincial Departments of Health (Eastern Cape, Western Cape, Free State, Limpopo, North West, KwaZulu-Natal, Mpumalanga, Northern Cape and Gauteng) on 16 to 18 August 2016.
The purpose of these engagements was to enable discussions with provincial departments and establish the state of health services in the country.

Furthermore, it was to get responses from provincial departments on findings and recommendations of the Committee’s oversight visits during 2014/2015.
Matters that were carefully considered included the following: • Human resource management with emphasis on Community Health Workers (CHWs); Infrastructure management; • • Supply chain management and financial management including issues raised by the Auditor General; and • The implementation of the Ideal Clinic Initiative.

2.

REPORTS OF PROVINCIAL DEPARTMENTS 2.1.

EASTERN CAPE 2.1.1.
EASTERN CAPE 2.1.1.

ECDoH obtained an unqualified audit opinion for 2015/16 financial year an improvement from qualified audits in previous financial years.

2.1.2.

The two issues of concern were with regard to irregular expenditure, and fruitless and wasteful expenditure.

The irregular expenditure was currently R212 million, but it was ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 16 [Thursday, 24 May 2018 based on a previous review, dating back to 2010/2011.
R90 million was recorded on unauthorized expenditure in the previous financial year.

2.1.3.

ECDoH reported on receiving quite a number of medico-legal claims and this had a negative impact on the department as these had not been budgeted for.

The average medico-legal settlements paid in the last four years was R52 million per annum.

In 2015/16, total medico-legal settlements paid amounted to R266 million.

2.1.4.
2.1.4.

ECDOH’s budget for this financial year was an average of R1.4 billion, allocated to the eight critical programmes.

About R233 million had been spent in the first quarter (17% of expenditure).

The provincial department had derived R3.8 million from the Expanded Public Works Programme.

2.1.5.

On supply chain management (SCM) and procurement, the majority of the large contracts awarded were in respect of medical equipment.

2.1.6.
2.1.6.

Local procurement was on security, waste removal, patient food, cleaning services and furniture.

The idea behind local procurement was to have services provided by the local communities with the aim of boosting the local economy.

2.1.7.

On human resources, the ECDoH has a vacancy rate of 12.9%.

ECDOH was currently prioritising the appointment of core service delivery posts or clinical posts.

2.1.8.
On the number and progress of medical students in Cuba: • There were nine students at the first year level, and their completion date was 2022; • 90 students at the second year level, with a completion date of 2021; • 97 third year students, with a completion date of 2020; • 84 fourth year level students, with a completion date of 2019; • 11 fifth year level students, with a completion date of 2018; and ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 17 • Five final year students who would qualify in 2017, as they were currently doing the South African aspect of their medical studies.
2.1.9.

Challenges regarding the community health workers programme Inadequate reporting system; related to: • The formal employment of community health workers; • • Lack of home care kits, identification uniforms and badges; • Clear job descriptions for CHWs; and • The absence of debriefing sessions for the CHWs to address bottlenecks.

2.1.10.

On infrastructure, 118 projects had been recorded for the first quarter of 2015/16.

2.1.11.
2.1.11.

Infrastructure performance was below planned levels due to delays in the awarding of health technology contracts and delays in the awarding of contracts.

2.1.12.

Some progress had been made in terms of infrastructure capacity building.

Some positions that had been filled including the post of the general manager; mechanical and electrical engineers; quantity surveyors; civil engineers; three architects; and five clinical engineers who dealt with medical equipment.

2.1.13.
2.1.13.

Regarding the procurement of medical equipment, there were six categories of equipment that were currently being procured: imaging equipment; critical or life support equipment; diagnostic and rehabilitation equipment; medical furniture equipment; office furniture and cleaning equipment; and surgical instruments and linen, or clothing.

2.1.14.

On Ideal Clinic, 241 PHC facilities were targeted.

A total of 15 clinics achieved Ideal Clinic status.

Observations and Findings 2.1.15.


With regard to the revision of the organogram, a detailed report containing the cost breakdown for filling the vacant posts was requested by the Committee.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 18 [Thursday, 24 May 2018 2.1.16.
The Committee noted that the ECDoH’s 12.9% vacancy rate was concerning and seem not to give a true reflection of the actual vacancy rate in the province, seeing that during the Committee’s oversight visit to the province, it had encountered a huge outcry over the issue of vacancies.

In terms of plans to address the high vacancy rate, the provincial department has an annual recruitment plan with an improved post list which was currently being filled.

2.1.17.
2.1.17.

On Ideal Clinic, the Committee noted that only a few of the 241 clinics had been able to achieve Ideal Clinic status.

2.1.18.

Details on infrastructure backlogs and a turnaround strategy to address such backlogs were requested by the Committee.

2.1.19.

The Committee noted that there were 6 305 CHWs in the province.

The categories include home-based care, lay- counsellors, care givers and peer educators.

2.1.20.
2.1.20.

On the nature of the relationship between the WBOTs and CHWs, the Committee noted that there were potential overlaps and these will only be addressed by a national policy.

2.1.21.

A detailed response was requested on how the ECDoH was addressing the challenges of medical equipment as the Committee had been informed on its oversight visit on challenges related to the non-availability of equipment.

2.1.22.
2.1.22.

The Committee noted with concern that irregular expenditure had been a challenge in terms of qualifications which had arisen as a result of the weaknesses in SCM processes.

2.1.23.

With regard to the issue of insourcing and outsourcing, the Committee observed that the provincial department was considering the outsourcing of some services such as food and security.

2.2.

FREE STATE 2.2.1.

FSDoH has 221 PHC facilities.


A total of 100 facilities had been enrolled into the Ideal Clinic programme in 2015/16.

Forty-six (46) facilities out of the 100 enrolled facilities were assessed.

Twenty-two (22) of the 46 enrolled facilities attained Ideal Clinic status, however diamond status was not reached, only platinum and gold status was reached.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 19 2.2.2.
FSDoH reported that some of the lessons learnt to improve the Ideal Clinic programme such as the need to prioritize budgets for the Ideal Clinic programme, strengthening SCM processes, as well as carrying out a weekly progress monitoring.

2.2.3.

On HR, FSDoH reported that 17 680 posts had been filled, with 3 760 vacant posts, resulting in a vacancy rate of 18%.

About R5.8 billion had been budgeted for compensation of employees for the current financial year.

2.2.4.
2.2.4.

The posts status of Albert Nzula District Hospital was particularly highlighted, as it had recorded only three filled posts with 194 vacant posts.

The reason for this was because it was a new facility, and was yet to be commissioned.

The process of appointing staff for this facility was already in progress.

2.2.5.
2.2.5.

On CHWs programme, nine (9) non-governmental organisations (NGOs) had been awarded contracts to manage the administration and HR issues of CHWs, including stipend payments, monitoring and supervision of activities.

2.2.6.
2.2.6.

A total of 915 community care givers (CCGs) were receiving a stipend of R1 850 per month, in accordance to the Ministerial determination; 594 CHWs were receiving R1 900 per month; and 104 enrolled nursing assistants and 44 enrolled nurses that provided clinical support to CHWs were receiving R3 000 per month.

2.2.7.

The training plan for CHWs had been designed according to the need for coverage of family health teams in the wards.

Training had commenced in the districts in 2011.

2.2.8.
2.2.8.

On infrastructure management, the adjusted budget for 2015/16 was around R589 million and the budget for 2016/17 was R516 million.

2.2.9.

On financial management, FSDoH alluded to the increase in accruals which demonstrated the inadequacy of the budget.

The AG had given the FSDoH a qualified audit, noting that the completeness of the accruals could not be determined.

2.2.10.

FSDoH has received a qualified audit opinion in areas such irregular expenditure, accrued revenue and commitments.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 20 [Thursday, 24 May 2018 2.2.11.

Some SCM imperfections identified included poor planning and ineffective implementation of procurement plans; a prolonged turnaround time in the procurement of goods, services and works; cost effectiveness and non-realisation of value for money; ineffective contract management; and shortage of human resources.

Observations and findings 2.2.12.


The Committee noted that the provincial department’s state of finances is concerning and that annual budget increases were still not sufficient.

2.2.13.

The Committee noted the increase in accruals, and the need to put in place measures to mitigate the recurrence of accruals.

2.2.14.

The number of WBOTs the province and the wards covered by these teams was unclear.

2.2.15.

Budget allocation to the nine contracted NGOs was not clarified.

2.3.

NORTHERN CAPE 2.3.1.


On HR, the total staff establishment of NCDoH was 6 735.

NCDoH reported to having more clinical posts than non-clinical.

NCDoH highlighted the number of vacant posts, 477 vacant posts for health professionals, and 227 vacancies for administration and support.

A total of 1 616 vacant unfunded posts had been abolished.

These posts were mainly support posts, rather than critical service delivery posts.

2.3.2.
2.3.2.

On the Cuban programme, NCDoH reported that 205 students across all five districts of the province were in the programme.

Some of the students were still undergoing training.

A total of 33 doctors from the Cuban programme were currently working within the province.

2.3.3.

With regard to the CHWs prograame, NCDoH reported that there had been an outcry for the absorption of CHWs, however the department was faced with the challenge of budget constraints.
The projected budget for absorbing of the current ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 21 2 592 CHWs at level three, was R485 million.

The 2 592 CHWs had been sourced from 30 NGOs and 56 retired nurses.

A stipend of R2 500 per month is paid to CHWs, resulting in a budget of about R97 million per annum.

2.3.4.
2.3.4.

CHWs were integrated into WBOTs and they conduct household assessments, provided health information, supported chronic patients, and assisted with the CCMDD programme in certain areas.

All 38 wards in Pixley Ka Seme district were covered with ward-based outreach teams.

2.3.5.

On infrastructure management, NCDoH indicated that the new De Aar Hospital had been handed over to the provincial department, and was ready for operationalization.
Other completed projects included the upgrade of a 36-bed mental health unit in West End Hospital, which would be ready for operationalization by October 2016; upgrading of the EMS station at Calvina; and the provision of fencing and guard houses for clinics, hospitals and community health centers (CHCs).

2.3.6.

With regard to the status of the new mental health hospital, NCDoH indicated that the hospital had reached 87% completion.

The projected completion date was July 2017.

2.3.7.
2.3.7.

NCDoH had received a qualified audit opinion, with emphasis on issues such as movable, tangible and intangible assets; accruals and payables; accrued departmental revenue; commitments; irregular expenditure; and SCM, procurement and compliance.

2.3.8.

In relation to the Ideal Clinic programme, there are 36 PHC facilities in the NHI pilot district that had been targeted to reach Ideal Clinic status by 31 March 2017, as well as 30 PHC facilities in other districts.

2.3.9.
2.3.9.

Three clinics out of the 36 PHC facilities in the NHI pilot district had achieved Ideal Clinic status.

Of the additional 30 PHC facilities in other districts, two clinics had achieved Ideal Clinic status in the previous year.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 22 [Thursday, 24 May 2018 2.3.10.
NCDoH alluded to the challenges faced in achieving Ideal Clinic status to include inadequate budget, lack of vital equipment, infrastructural challenges, HR challenges, and challenges with security services.

Measures had been developed to address these challenges.

Observations and findings 2.3.11.


On the operation of air ambulance services in the province, the Committee observed that service providers would be identified and contracted as and when needed in order to avoid incidents of payment for air ambulances that are not used.

National Treasury had advised provinces to make use of the deviation procedure for air ambulance services.

2.3.12.

In light of the vastness of the province, the mobility of CHWS to certain remote areas was a concern.
Details were sought on CHWs conditions of service and benefits they are entitled to.

2.3.13.

The Committee observed that 1 616 posts were abolished as budgets were moved around for the compensation of employees (COE) and areas of inefficiencies were identified within the provincial department, whilst ensuring that operational managers and critical posts were accommodated.

2.3.14.

There seem to be instability at senior management level in the NCDoH.

2.3.15.
2.3.15.

Financial management remains a challenge, an area of concern relates to accruals.

2.4.

GAUTENG 2.4.1.

On CHWs, GDoH reported that historically, the provincial department funded NGOs to pay and manage CHWs.

However, in 2012 GDoH decided to rationalize the CHWs programme.
This however resulted in protest action by CHWs alleging that NPOs were paying stipends below the department’s prescribed rates, delayed payments and that NPOs were arbitrarily dismissing them when they challenged the state of affairs.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 23 2.4.2.

GDoH alluded that CHWs demanded to be employed permanently by the Department.
However, GDoH had indicated that it had not been in a position to absorb all of the CHWs, due to budget and post availability constraints.

2.4.3.

GDoH had received an unqualified audit opinion in 2015/16.

GDoH indicated to that it had engagements with the South African Institute of Chartered Accountants (SAICA) to assist it with its financial matters.

2.4.4.
2.4.4.

Irregular expenditure (R466 million in 2015/16) issues were being addressed, however the bulk of the expenditure was from court orders for medico-legal claims against the provincial department.

2.4.5.

GDoH reported that 73 health facilities had met the assessment criteria and achieved Ideal Clinic status.

Observations and findings 2.4.6.

There are many concerns relating to CHWs in GDoH including the contracting of Smart Purse to pay stipends to CHWs.
These requires the intervention of National Department of Health.

2.4.7.

Progress in relation to infrastructure projects was unclear.

2.4.8.

In ensuring uninterrupted power supply for central hospitals, this was being addressed with the Department of Infrastructure Development.

2.4.9.

The payment of service providers within 30-day period remains a challenge for GDoH, currently working with the Provincial Treasury to develop systems to ensure that service providers are paid timeously.

2.4.10.
2.4.10.

On PHC infrastructure maintenance, there were 116 clinics that there were going to have generators installed in the financial year.

The plan was that all health facilities would be fitted with generators and water tanks by the end of 2019.

2.4.11.

The Committee noted with concern the dispute between GDoH and the National Health Laboratory Services (NHLS), as GDoH submitted to the Committee that a commissioned report indicated that the NHLS owed the provincial department R1 billion.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 24 [Thursday, 24 May 2018 2.4.12.

On medical legal claims, the Committee observed that the provincial department had terminated the services of the State Attorney to private attorneys for medico-legal cases.

GDoH was of the view that the State Attorney did not defend cases that had merit to be defended and kept settling.

2.5.

MPUMALANGA 2.5.1.


With regard to HR, MPDoH indicated the challenges related to the recruitment and retention of specialists which were attributed to the rurality of the province and the lack of a medical university.

2.5.2.

MPDoH reported that the intervention had been to partner with the University of Pretoria to train nurses and specialists and Emergency Medical Services (EMS) personnel, and training of medical officers in Cuba.

2.5.3.
2.5.3.

Other HR challenges relate to accommodation for health professionals, and the intervention was that all future infrastructure plans must include accommodation for health professionals.

In the meantime, health professionals were being offered an accommodation allowance.

2.5.4.

MPDoH reported on a challenge with the translation of 255 nurses, of which 63 had been approved.

The intervention was to move the nurses to facilities where there were funded and vacant posts.

2.5.5.
2.5.5.

On the Cuban programme, ten students had been recruited in 2015/16.

A total of 223 students are currently in the programme, of whom 18 were doing their final year in South Africa.

2.5.6.

On infrastructure management, projects included five hospitals that had been identified for high-tech refurbishment and renovations.

There were clinics that had been identified for the Ideal Clinic programme.

These included the Kanyamazane, Oakley and Balfour clinics.
A new paediatric ward had been added at Witbank hospital, and an x-ray unit had been added at Themba Hospital.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 25 2.5.7.

The capacity of the infrastructure unit in the department had been increased through the appointment of staff and artisans.

2.5.8.

MPDoH has obtained a qualified audit for this financial year.

2.5.9.
2.5.9.

MPDoH reported to have appointed the Director: Supply Chain Management who had commenced duties on 15 August 2016, and that the provincial department would realize a turnaround in procurement.

This would also include efforts to pay suppliers within 30 days.

2.5.10.

On the Ideal Clinic programme, the provincial department had been planned to have 46 clinics meeting ideal clinic status in this financial year, based on the funds available.

However, the plan had been reviewed in March 2016.

2.5.11.
2.5.11.

MPDoH reported that data management remained a problem in the province, and the roll-out of e-health would assist in keeping patients records and/or files.

Observations and findings 2.5.12.

The Committee observed that CHWs included home-based carers and that there were 8 811 CHWs in the province, who were linked to the ward-based outreach teams.

There was a regional training centre at Gert Sibande District that was accredited to train CHWs.
MPDoH funded 269 NPOs, and a breakdown per district and sub-district would be provided to the Committee.

The stipend given was R1 200, which was below the Ministerial determination.

The Department was working on ways to increase the stipend.

The CHWs were not given any benefits besides their stipend.

2.5.13.

On infrastructure, the Committee observed that the leaking issue at Rob Ferreira had been addresses as well as the air conditioning.
There are maintenance plans for the Ideal Clinics, however budget constraints remained a challenge.

2.5.14.

The cause of incurred irregular expenditure was unclear.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 26 [Thursday, 24 May 2018 2.6.

NORTH WEST 2.6.1.

NWDoH reported that CHWs in the province were paid a stipend ranging between R2 000 and R2 500 per month.

There were a total of 8 001 CHWs in the province.

2.6.2.
2.6.2.

The challenges relating to CHWs were that they were demanding an increase in the stipend and to be permanently employed by the provincial department.

2.6.3.

Infrastructure projects had a budget of R463 million allocated to rural villages and small towns in a deliberate attempt to improve access to health care facilities in the province.

2.6.4.
2.6.4.

On infrastructure, NWDoH reported to have conducted conditional assessments of health facilities in the province and priority projects had been identified, which would require roughly R400 million to be successfully addressed.

Only high priority issues would be dealt with in the current financial year.

As the infrastructure budget would not allow all identified projects to be addressed.

2.6.5.

NWDoH has obtained a qualified audit report, largely due to commuted overtime and medico-legal claims.
2.6.6.

There had been no unauthorised expenditure in the 2015/16 financial year, fruitless and wasteful expenditure was largely on accruals on interest from previous financial year’s projects.

2.6.7.

NWDoH submitted that it had achieved a reduction in accruals.

However, medico-legal claims continued to increase due to cases of medical negligence and emergency care services.

2.6.8.
2.6.8.

On Ideal Clinic programme, 109 PHC facilities have completed their status determination in May 2016 and none of them had achieved Ideal Clinic Status.

2.6.9.

NWDoH indicated that challenges identified during the Ideal Clinic assessment were related to the non-availability of tracer medicines; certain essential equipment; water tanks and generators; and external signage.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] Observations and findings 27 2.6.10.
The Committee noted with concern the audit outcomes of the NWDoH, it has regressed from unqualified to qualified in this financial year due to irregular expenditure.

2.6.11.

On infrastructure and the court order by a contractor, the Committee noted that it had been the result of disagreements between the provincial department and the contractor.

It had since been resolved and the contractor had returned to the site.

2.6.12.
2.6.12.

On Ideal clinic, the issue of water tanks and generators at clinics was being addresses and procurement processed had been finalized.

It was envisaged that by the end of the financial year, all clinics would have water tanks and generators.

2.6.13.

Details were sought on the total budget for CHWs stipend in the province and the role of the provincial department in the training of CHWs.

2.7.

WESTERN CAPE 2.7.1.


WCDoH submitted that CHWs are contracted through NPOs which then employs and manage the budget allocated to CHWs.

2.7.2.
2.7.2.

Infrastructure priorities for the 2016/17 period are to: • Strengthen and improve the PHC infrastructure in all districts with a specific focus on the metro; • Modernise Emergency Centres at hospitals; • Provide or upgrade Acute Psychiatric Units at hospitals; • Focus on Maintenance and Fire Compliance at existing health facilities; and • Improve efficiency, economy, and effectiveness of Procurement Strategies.

2.7.3.
2.7.3.

WCDoH reported that a total of 31 posts under infrastructure have been filled and funded from the Health Facility Revitalization Grant.

2.7.4.

Infrastructure challenges, include continuously reduced infrastructure budget allocation over the past few years, which necessitates the on-going reprioritisation of projects as well as the scarcity of built environment, engineering and health technology skills.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 28 [Thursday, 24 May 2018 2.7.5.
On financial management, WCDOH received an unqualified audit opinion with no material findings for the 2015/16.

There has been a 56% reduction in irregular expenditure.

2.7.6.

WCDoH pointed out that there are inefficiencies within the SCM system caused by the lack of integrated systems which create duplicated or inconsistent information and processes.

Systems are not geared towards current SCM reforms and there is poor contract management for national contracts.

2.7.7.
2.7.7.

Some of the measures implemented to address SCM imperfections and improve contract management include the implementation of the Demand Management Planning and Procurement Plans and regular training interventions.

2.7.8.

On Ideal Clinic, WCDoH formally adopted the Ideal Clinic Initiative in April 2016.

A total of 227 facilities in the Western Cape have completed their status determination.

2.7.9.
2.7.9.

Some of the challenges around the implementation of the Ideal Clinic initiative are that some elements do not apply to very small clinics and connectivity in some facilities results in data capturing challenges.

Observations and findings 2.7.10.

The strategy to address the scarcity of built environment engineers and technologists, the provincial department was offering a bursary scheme called Sakhisizwe.
The graduates are then absorbed into the system, however it was difficult to match the salaries offered by the private sector.

2.7.11.

The Committee observed that the Ideal Clinic programme was adopted only in April 2016, the provincial department had to first ascertain that other essentials such as staff and medication are available.

Some of the things required in the Ideal Clinic are things that the provincial department has identified before and implemented.

2.7.12.
2.7.12.

The Committee noted that there are between 3000 and 3800 CHWs that are supported through the NPOs.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 29 2.7.13.

The Committee observed that the infrastructure budget maintenance is around R385 million with most of the funding going to maintenance.

2.8.

KWAZULU-NATAL 2.8.1.


KZNDoH reported that in 2010 the department took a decision to terminate contracts with the NGOs and opted to fund the community care givers (CCGs) directly.

Each CCG is allocated 60 households in a ward and is required to visit 3-5 households per day.

Each CCG is linked to a clinic/health facility within the catchment area.

2.8.2.

There are 1 456 CCGs consisting of 576 nutritional advisors, 820 enrolled nurses and 60 health promoter’s assistant.

2.8.3.
2.8.3.

On infrastructure management, the Health Infrastructure Programme was allocated a budget of R1.55 billion for 2015/16 and R 1.58 billion for the 2016/17 financial years.

Because of the high reduction of an equitable share allocation, almost all projects were transferred to the Infrastructure Grant.

2.8.4.

KZNDoH received a qualified audit opinion for 2015/16.
The qualification was a result of movable tangible capital assets and minor assets, irregular expenditure, and commuted overtime allowance.

2.8.5.

On supply chain management and procurement, KZNDoH pointed out that systems need to be improved.

Audit Improvement Plans are to be developed, and plans are to streamline Demand Management processes in order to identify and implement improved sourcing methods guided by leading practices in strategic sourcing.
Standard Operating Procedures have been finalised and training has been given to all institutional management teams.

2.8.6.

With regard to progress and challenges on the Ideal Clinic programme, of the 204 facilities assessed in KZN, three (3) facilities received silver status and four facilities received gold status.

Challenges are around water and electricity back-up systems in rural areas, network connectivity challenges in the rural facilities, and budgetary constraints for clinic maintenance.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 30 [Thursday, 24 May 2018 Observations and findings 2.8.7.

The Committee noted that CCGs get a 2-year contract and that others had been on career path to become nurses and nutrition advisors.

2.8.8.

It was clarified that the CCGs are part of the ward-based outreach teams.

2.8.9.

The Committee noted that there were challenges with district clinical specialists with a difficulty to recruit anaesthetists.

2.8.10.
2.8.10.

On SCM, the provincial department was currently building capacity in the SCM unit.

Internal training was developed and rolled out in the previous financial year and have sourced the help of National Treasury.

2.8.11.

The Committee noted that discussions were held on the provincialisation of the Ideal Clinics.

2.8.12.

On unfilled key senior positions, the Committee noted that filling the position of CFO was being challenge.

2.9.

LIMPOPO 2.9.1.


LDoH reported that CHWs are recruited through NPOs funded by the provincial department.

2.9.2.

For the 2015/16, LDoH received a qualified audit opinion.

Qualifications were relating to movable tangible capital and minor assets; accrued departmental revenue; and employee costs and benefits.

2.9.3.
2.9.3.

With regard to SCM, LDoH has enforced compliance, with the development of procurement plans by all institutions within the department and revised the existing SCM delegations to give powers to CEOs.

2.9.4.

Infrastructure challenges are around ageing and inappropriate infrastructure and equipment; non-utilisation of facilities after practical completion; limited capital and maintenance budgets versus the needs; and lack of equipment maintenance contracts.

2.9.5.
2.9.5.

On the Ideal Clinic programme, LDoH has identified 248 health facilities to be scaled up for Ideal Clinic in the current financial year.

Two clinics in Sekhukune District has already reached Ideal Clinic status.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 31 2.9.6.
Challenges around the implementation of the Ideal Clinic Insufficient funds and delays in SCM processes; initiative include: • • Lack of buy-in from developmental partners in districts; • Non-compliance to patient record keeping, filing and archiving compliance is only at 9% due to insufficient space; • Signage from the main road to the facility is available for only 12% of the facilities; • 64% of the PHC facilities experience physical space and routine maintenance challenges; • 48% of redundant and non-functional equipment at the PHC facilities has not been removed; • 8% of the PHC facilities have functional back-up electrical supply; and • Availability of protocols and guidelines have been implemented at only 30% of PHC facilities.
Observations and findings 2.9.7.

On issues regarding the NPOs and CHWs, the provincial department was deliberating on whether to start administering the funds to CHWs as it had identified the mismanagement of funds by some of the NPOs.

2.9.8.

The Committee noted with concern the audit outcomes of the provincial department as it has regressed from unqualified to qualified audit opinion in this financial year.

2.9.9.
2.9.9.

The Committee noted that the vacancy rate was very high and that the challenge was funded graduates were not willing to work in rural areas.

2.9.10.

The Committee sought further details concerning infrastructure management, particularly on Musina Hospital, as during the Committee’s oversight visit it was concluded that the hospital was not habitable.

2.9.11.
2.9.11.

The Committee expressed concern about the audit outcome of the provincial department that it has regressed, and wanted to know whether the department had a turnaround plan to improve audit outcomes.

2.9.12.

With respect to medico-legal claims the Committee noted that the provincial department was not doing well.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 32 [Thursday, 24 May 2018 3.
RECOMMENDATIONS Having made the above-mentioned observations, the Committee recommends that the Minister of Health should: 3.1.

Finalize the Community Health Care Workers Policy to provide clarity on the management of CHWs.

3.2.

Ensure that the WISN report recommendations are implemented in order to improve staffing levels at primary health care facilities.

3.3.

Monitor the timeous filling of vacant funded posts by provincial departments.

3.4.
3.4.

Assist provincial departments in strengthening financial management planning aimed at dealing with continuous audit findings on accruals and irregular expenditure.

3.5.

Assist provincial departments to improve and maintain audit outcomes.

3.6.

Assist provincial departments to address SCM challenges, to reduce wastage, improve procurement turnaround time, and improve contract management.

3.7.
3.7.

Provide infrastructure technical support to provincial departments in order to develop their capacity to plan and manage health infrastructure delivery.

3.8.

Continue to support provincial departments in implementing the Ideal Clinic programme.

3.9.

Engage the Department of Justice and Correctional Services to develop and implement a national strategy to deal with rising medico-legal claims as they pose serious risk to provincial departments budgets.

3.10.
3.10.

Engage the National Treasury and provincial Treasuries on resolving the disputes on historic NHLS debts.

A progress report should be presented to the Committee on a quarterly basis.

3.11.

Ensure the roll-out of broadband connectivity in all PHC facilities.

Report to be considered.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 33 4.
REPORT OF THE STANDING COMMITTEE ON FINANCE ON THE CONTRACT EXTENSION OF THE DIRECTOR OF THE PARLIAMENTARY BUDGET OFFICE, DATED 24 MAY 2018 1.

The Parliamentary Budget Office Section 15 of the Money Bills Amendment Procedure and Related Matters Act, Act No.

9 of 2009 (the Act), establishes the Parliamentary Budget Office (PBO).

The PBO must provide independent, objective and professional advice and analysis to Parliament on matters related to the budget and other money Bills.
A Director must manage the PBO.

The Director must be appointed by resolution of both Houses of Parliament, after a recommendation of the committees on finance and appropriations of both Houses.

In terms of subsection 15(7) of the Act, any committee considering making such recommendation contemplated in the Act must do so in an open and transparent manner.

In addition, the aforementioned committees must also recommend to the Houses of Parliament the conditions of service for the appointee.

2.
2.

Appointment of Director On 09 May 2013, the Standing Committee on Finance adopted a Report recommending the appointment of Professor M I Jahed as the Director of the PBO for a period of five years.

Thereafter, the Report was tabled and considered by the National Assembly.

Since May 2012, Professor M I Jahed was seconded from the Development Bank of Southern Africa (DBSA) to assist Parliament in the process of setting up the PBO.
The project led by Prof. Jahed was able to outline and clarify the functions and scope of the Office, design an operational structure, establish networks with external stakeholders and engage political parties and relevant Committees.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 34 3.
The ATC Referral [Thursday, 24 May 2018 The contract of Professor Jahed is coming to an end, and Parliament has – on 16 May 2018 – tabled a referral in the Announcements, Tablings and Committee Reports (ATC) to the Standing Committees on Appropriations and Finance and the Select Committees on Appropriations and Finance to consider the matter of the expiring contract of the Director of the PBO and to report by 28 May 2018.

4.
4.

Committee’s deliberations On Thursday, 24 May 2018, the Committee deliberated on the contract expiry of the Director of the PBO as referred to it on 16 May 2018.

The Committee considered the matter, taking into consideration the principles of continuity and stability together with the PBO output since its establishment, the contribution of the PBO to the stimulation of economic and financial debates in Parliament, and Prof. Jahed’s profile, and reached a conclusion on the matter.
Before arriving at a conclusion on the matter, the Committee also took into consideration the substantive interactions that Prof. Jahed has had with the different Committees, political parties and with individual Members, his extensive expertise in finance and economics, and the degree of professionalism with which he has conducted his work over the past five years.
The Committee further considered the relevance of section 15(15) which provides what should be done when the position of the Director is vacant.

Moreover, the Committee deliberated and resolved that the Money Bills Act was silent on the process that should be followed when re-appointing the Director of the PBO.

Based on the above points, the Committee resolved that Prof. Jahed is still a suitable candidate to head the PBO.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 35 5.

Conclusion and Recommendation In accordance with subsections 15(5) (a) and (b) of the Money Bills Amendment Procedure and Related Matters Act, the Standing Committee on Finance recommends as follows: 5.1 That Professor M I Jahed, be re-appointed as the Director of the Parliamentary Budget Office, until three months after the 2019 national and provincial general elections.
5.2 That the re-appointment of the Director of the Parliamentary Budget Office be subject to an agreement that the conditions of service (including salary and allowance) would remain substantially the same as those of the top rank of the public service as per subsection 15(5)(b) of the Act, as agreed with Prof Jahed.

The Democratic Alliance (DA) objected to the report.

Report to be considered ` ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 36 [Thursday, 24 May 2018 5.
REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON THE STATE OF MENTAL HEALTH CARE SERVICES, DATED 25 OCTOBER 2017 1.
INTRODUCTION In the light of the 2017 Health Ombuds Report into the circumstances surrounding the deaths of mentally ill patients in Gauteng Province, the Portfolio Committee on Health (the Committee) considered it vital to assess the state of mental health services in eight Provincial Departments of Health (Eastern Cape, Western Cape, Free State, Limpopo, North West, KwaZulu-Natal, Mpumalanga and Northern Cape).
The Committee was subsequently briefed by Provincial Departments of Health on 07 to 15 March and 07 to 14 June 2017.

2.

REPORTS OF PROVINCIAL DEPARTMENTS 2.1.

EASTERN CAPE 2.1.1.

ECDoH reported that there are 150 beds for acute patients at Nelson Mandela Academic, Cecilia Makiwane and Dora Nginza Regional Hospitals.

2.1.2.

The province has a 1600 bed shortage with most of the beds concentrated in the western part of the province.
Plans to mitigate this challenge, include opening 30 beds for acute patients in Libode (St Barnabas Hospital) thus prioritising the eastern part of the province.

2.1.3.

There are 60 beds with two NGOs and 700 beds for chronic patients with Life Esidemeni.

2.1.4.

Mental health challenges in the Eastern Cape are exacerbated by the recent radical increase in substance abuse, making social service rehabilitation a critical need.
There are only two public facilities in the Eastern Cape that deal with substance abuse.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 37 2.1.5.

With regard to forensic patients, there are currently 94 state patients awaiting admission and 261 awaiting observation.

To address this need and to improve on waiting time, 30 beds will be added at Komati Psychiatric Hospital and also use Komati for observation.

2.1.6.
2.1.6.

On human resources, there are 1606 filled posts, with 239 that remains vacant (vacancies for psychiatrists, social workers, etc.).

ECDoH reported on the difficulty to retain mental health professionals, particularly occupational therapists.

ECDoH was of the view that increasing bursaries will serve as a recruitment and retention strategy.

2.1.7.

There are three, Mental Health Review Boards each consisting of three members in the Eastern Cape.

Observations and Findings 2.1.8.


The Committee expressed concern on the high vacancy rate and infrastructure challenges particularly the shortage of beds.

2.1.9.

The Committee was of the view that there was insufficient focus on advocacy on promotion and prevention, particularly on substance abuse amongst young people.

2.1.10.

The Committee pointed out the need to strengthen intersectoral collaborations to combat this scourge.
The Committee raised a question about the availability of a signed Memorandum of Understanding (MoU) between the ECDoH and the Department of Social Development.

2.1.11.

The Committee pointed out the need for mechanisms and systems to monitor and evaluate mental health services in order to prevent challenges.

2.2.

WESTERN CAPE 2.2.1.

WCDoH reported that it welcomes a review of the Mental Health Care Act as concerns have been raised numerous times around red tape and resources that are severely taxed.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 38 [Thursday, 24 May 2018 2.2.2.

Mental health care service provision in the Western Cape has historically been vertical, specialised and curative focused, leading to poor prevention programmes, limited services on primary health care and consequent increase in numbers of admissions at district hospitals and other hospitals.

WCDoH is making an effort to integrate mental health care into a whole health care system as opposed to a vertical system.
2.2.3.

In the Western Cape, community-based facilities providing mental health care service are licensed by the Head of Department (HOD) before they can operate.

2.2.4.

There are 750 state patients across the four psychiatric hospitals in the province, providing 2000 beds between them.

There are 351 private beds.

2.2.5.

WCDoH reported to having the highest lifetime prevalence of mental illness in the country and high substance abuse problem (mainly alcohol and tik).

2.2.6.
2.2.6.

WCDoH highlighted the need to strengthen adolescent and mental health support in perinatal period, interesectoral solution and strengthening the empowerment of mental health care users.

2.2.7.

There is a Mental Health Review Board in the province that is independent and reports to the MEC.

The Board has developed a governance and operational charter, a user’s rights charts, brochures, internal reporting forms and snag sheets.

Observations and Findings 2.2.8.


The Committee probed whether there was a working relationship between traditional healers and medical practitioners on mental health.

The Committee was of the view that traditional healers may play a vital role in addressing mental health care needs.

2.3.

FREE STATE 2.3.1.


FSDoH reported that private facilities licenced to provide mental health services in the province are mainly based in Mangaung metro (three facilities) and two in Lejweleputswa and Thabo Mofutsanyana districts.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 39 2.3.2.
Priority will be given to the establishment of a fully functional Mental Health Directorate by allocating R3.9 million to compensation of employees and R2 million for goods and services.

2.3.3.

There is a district mental health specialist team in the Free State currently serving Thabo Mofutsanyana district.

Similar teams will be rolled out in the remaining four districts subject to funding availability.

2.3.4.
2.3.4.

The Free State Psychiatric Complex is the only specialised psychiatric hospital in the province.

There are 877 beds, 760 in use.

2.3.5.

Adolescents recovering from substance abuse will be catered for in the 40-bed half-way house in Clarens, managed by the Department of Social Development.

2.3.6.

There are 61 NGOs registered with the Department of Social Development.

2.3.7.
2.3.7.

FSDoH reported to having several challenges relating to serving Inadequate security; mental health patients such as: • Poor infrastructure (dilapidated facilities); • • • Poor retention of social workers due Occupation Specific Dispensation (OSD); Inadequate funding; to outstanding • Scarcity of professional nurses with advanced psychiatric qualifications; and • High vacancy rate of nurses and support staff.

2.3.8.
2.3.8.

FSDoH reported that posts were in the process of being filled and in discussions with the provincial training institution to offer advanced psychiatric course.

2.3.9.

FSDoH was in discussions on the establishment of patient electronic registration system.

2.3.10.

There is a Mental Health Review Board consisting of ten members, which is split into two teams, with one team covering the southern side and the other team covering the north and eastern Free State.
A total of 39 meetings were held in 2015/16 financial year.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 40 [Thursday, 24 May 2018 2.3.11.

There are five private facilities licenced to provide admissions of voluntary mental health care users in the province.

2.3.12.

FSDoH explained that there is a working relationship with the Department of Social Development to ensure provision and compliant mental health care services.
This relationship will be formalised once the two MECs meet and sign a MoU.

Observations and Findings 2.3.13.

The Committee sought details on the number of mental health facilities in the province, day-treatment centres, and community- based facilities.

2.3.14.

The Committee was concerned about the composition of the Mental Health Review Board, whose composition deviated from what is stipulated in the Mental Health Act.
There was concern about the number of meetings held by the Board as opposed to executing its duties.

2.3.15.

The Committee pointed out the need for mechanisms and systems to monitor and evaluate mental health services in order to avert challenges.

2.3.16.

The Committee sought details the role of outreach teams in relation to mental health services.

2.3.17.

The Committee sought clarity on whether research was conducted to determine the cause of mental illnesses in the province.

2.3.18.
2.3.18.

The Committee sought details on the timeframes for the establishment of a fully functional Mental Health Directorate as reported by the province.

2.4.

LIMPOPO 2.4.1.

LDoH reported that the annual hospital admission rate for mental health in public health facilities in the province was 300 per 100 000 population.

2.4.2.

In Limpopo, there are six general hospitals with psychiatric wards and three specialised psychiatric hospitals.
There are also two general hospitals with no functional psychiatric wards.

The three psychiatric hospitals (Hayani, Evuxakeni and Thabamoopo) has 234, 354 and 365 usable beds, respectively.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 41 2.4.3.

Forensic mental health services are provided at Hayani and Thabamoopo hospitals.

There are currently 78 panel cases and 171 single psychiatric patients awaiting trial and under observation in Thabamoopo hospital.

2.4.4.
2.4.4.

A state-of-the-art psychiatric facility is about to be commissioned at Letaba Hospital.

2.4.5.

There are also three community-based facilities under the Department of Social Services.

2.4.6.

There is no licensed acute psychiatric hospital, and child and adolescent outpatient units in the province.

2.4.7.

Half-way houses provide care, treatment and rehabilitation to patients who did not require hospitalisation.

2.4.8.
2.4.8.

LDoH reported that the vacancy rate in facilities is high, ranging from 60% to 100%.

2.4.9.

There are three functional Mental Health Review Boards, located in Capricorn, Vhembe and Waterberg districts.

Mopani and Sekhukhune districts Boards are yet to be established.

2.4.10.
LDoH reported to having several challenges relating to: Infrastructure which is not suitable for psychiatric services; • • Lack of childand adolescent psychiatric units; • Lack of forensic observation units; • Poor network connectivity at hospitals; • Inadequate budget; • Untraceable relatives; • Shortage of core and support staff; • Community stigma; and • Overcrowding in facilities as a result of accommodating patients from Mpumalanga province that does not have residential psychiatric facilities.
2.4.11.

The provincial Department of Social Development reported that all community-based facilities complied with minimum norms and standards.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 42 [Thursday, 24 May 2018 Observations and Findings 2.4.12.

The Committee was concerned about the alarmingly high vacancy rate.

Clarity was sought on progress in filling all the vacancies.

2.4.13.
2.4.13.

The Committee was also concerned about general hospitals which do not have psychiatric wards, and overcrowding in facilities coupled with the absence of outpatient child and adolescent units.

Clarity was sought on mitigation plans to address these challenges.

2.4.14.

The Committee sought details on advocacy programmes and monitoring and evaluation systems in place as well as a fully functional Mental Health Care Directorate in the province.

2.5.

NORTH WEST 2.5.1.


There are two specialised psychiatric hospitals (Witrand and Bophelong), two designated hospitals and two 72-hour assessment units in the North West province.

In addition, there are three licensed private hospitals that provide mental health services.

There are 464 community-based beds.

There are no NGOs licenced to provide mental health services.

2.5.2.

On human resources, the province has not established a Mental Health Directorate due to budgetary constraints.

2.5.3.
2.5.3.

There was a Mental Health Review Board consisting of four members whose contract expired on 31 March 2017.

A new Board was to resume on 1 April 2017, which will cater for all four districts.

2.5.4.

NWDoH reported to having challenges relating to: • • • • Inability to recruit and retain specialised staff; Inadequate funding; Infrastructure challenges; and Insufficient district mental health co-ordinators to lead preventive and promotion aspects on mental health care.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] Observations and Findings 43 2.5.5.

The Committee was concerned about the reported budgetary constraints, underspending and filling of vacancies, which compromise the provision of mental health care services.

2.5.6.

The Committee expressed concern around the insufficient district mental health coordinators.

2.5.7.
2.5.7.

The Committee sought details on strategies for promotion and prevention; intersectoral collaborations; monitoring and evaluation systems; the involvement of traditional healers; and the role of community health workers.

2.5.8.

The Committee raised a question on whether research was conducted to determine the causes of mental health problems in the province and progress made in developing an action plan based on the findings.

2.6.

MPUMALANGA 2.6.1.


There is no psychiatric hospital in Mpumalanga province.

As an intervention, the Department is working with the Mpumalanga Economic Growth Agency (MEGA) to fast-track the construction of a psychiatric hospital in the province.

2.6.2.

MPDoH submitted that general hospitals are used to deliver psychiatric services.

In light of this, adverse consequences have arisen, such as the mushrooming of unlicensed NGOs as well as compromised safety of psychiatric patients.

2.6.3.
2.6.3.

MPDoH has contracted Life Esidimeni for the provision of chronic mental health services, with 250 adults’ beds and 20 beds for children.

Forensic psychiatric services are conducted at two hospitals (Ermelo and Tintswalo) for both single and panel observations.

Mental health care users that need further management from designated facilities are referred to psychiatric hospitals in Gauteng.

2.6.4.
2.6.4.

Between 2014/15 and 2016/17 there were 315 mental health admissions for persons younger than 18 years and 8 686 for adults.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 44 [Thursday, 24 May 2018 2.6.5.

On human resources, there are numerous unfilled vacancies of psychologists, community psychiatric nurses, social workers, occupational therapists, etc.

MPDoH also indicated that most of the senior positions filled are on acting capacity.

2.6.6.
2.6.6.

There is one Mental Health Review Board that caters for the whole province.

MPDoH acknowledged that the workload of the Board is cumbersome and that there are plans to increase the number of Boards in the province.

2.6.7.

Over the medium-term, MPDoH plans to deliver 314 beds from six hospitals.

The building of a specialised psychiatric hospital is expected to be completed in 2025/2026.

Observations and Findings 2.6.8.


The Committee was concerned about the mushrooming of unlicensed NGOs and highlighted that this requires urgent attention in order to avert similar tragedy that happened in Gauteng, as it was partly attributed to unlicensed NGOs.

2.6.9.

The Committee also raised a concern about the high number of vacant positions particularly for psychiatrists, community psychiatric nurses and occupational therapists.
Clarity was sought on whether the province had a strategy in place to recruit and retain these professionals.

2.6.10.

The Committee sought details on a number of issues relating to the role of community health care workers in mental health care provision; interesectoral collaborations; mental health awareness programmes and advocacy; and the monitoring of NGOs that provides mental health services.

2.6.11.
2.6.11.

The Committee expressed concern about the long overdue establishment of the Mental Health Directorate.

2.6.12.

The Committee sought clarity about mental health care users from Mpumalanga being referred to Limpopo as reported by LDoH.

2.6.13.

The Committee was concerned about the admission of mental health care users to general hospitals, as it meant patients are admitted and seen by general health-trained health professionals.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 2.7.

NORTHERN CAPE 45 2.7.1.

Mental health in the Northern Cape is provided by government and there is one licenced private psychiatrist hospital and one NGO providing limited disability services.

Non-complicated mental illness cases are managed at primary health care facilities.

There are no community-based facilities for clients with mental illness or profound disability.

2.7.2.
2.7.2.

NCDoH reported that oversight and hospital coordination was provided by a provincial coordinator, while district mental coordinators are responsible at district level.

A limited outreach service to the districts is provided in West End Hospital.

This hospital is the main source of support and referral for acute mental illness and is also the only referral source for state patients, forensic patients and child and adolescent mental health services.

2.7.3.
2.7.3.

NCDoH reported that many of the general hospitals are not meeting the 72-hour deadline for assessment as per the national policy.

This was attributed to capacity constraints.

2.7.4.

In terms of infrastructure, the province has made funds available for hospitals refurbishment this financial year.
The refurbishments are planned for 20 beds in Kimberley Hospital, 32 beds in Old Gordonoa and Upington, 10 beds in Tshwaragano and four beds each in De Aar, Hartswater, Springbok, Calvinia and Postmansburg.

2.7.5.

On the new Northern Cape Psychiatric Hospital, construction is expected to be completed in 2018.

Once completed it is expected to provide 199 beds.

2.7.6.

There is a Mental Health Review Board consisting of five members that caters for the whole province.

2.7.7.
2.7.7.

NCDoH acknowledged the mental health personnel capacity challenges and was being addressed through the registrar programme with the University of Free State.

The psychiatrists’ shortage was being addressed by rotating the medical officers from the district to the West End Hospital in-service training.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 46 [Thursday, 24 May 2018 Observations and Findings 2.7.8.
The Committee expressed concern about the high number of personnel in acting capacity in the Department, including an acting HOD.

The Committee was of the view that the appointment of a permanent HOD would bring stability and reduce some of the challenges the Department faces.

The Committee indicated that this matter should be prioritised.

2.7.9.
2.7.9.

The Committee pointed out that according to the mental health policy, a fully functional Mental Health Directorate should have been established, clarity was sought on the status of this directive in the province.

2.7.10.

The Committee raised a question on whether NCDoH had approached Treasury for additional funding to fill vacancies.

2.7.11.
2.7.11.

The Committee sought details on budget allocation to mental health; advocacy, promotion and prevention programmes; the causes of mental illnesses; intersectoral collaborations; and monitoring and evaluation systems and mechanisms.

2.8.

KWAZULU-NATAL 2.8.1.

There are 25 government funded NGOs involved in mental health care in KZN.

2.8.2.

Seven (7) hospitals provide specialised mental health care services in the province.
District hospitals cater for 5% of the total number of beds reserved for mental health care users and also offer 72-hour assessments.

2.8.3.

Challenges faced by the KZNDoH in the delivery of quality mental health include: • Shortage of psychiatrists; • Old and dilapidated buildings not fit to provide mental health care; • Limited budget; • Lack of community-based services; and • Rise in substance abuse.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 47 2.8.4.
KZNDoH reported to have taken some remedial actions to address the challenges such as: • Revising the mental health strategy and costs involved; • Lobbying for more budgets to support mental health; • Collaborations with universities to increase training; • Encouraging active participation of family members to support patients; and • Educating the public about the dangers and prevention of substance use.

Observations and Findings 2.8.5.


The Committee sought details on the number of beds for mental health care users; number of mentally ill patients per districts; mental health budget allocation; vacancy rate (mental health care professionals); intersectoral collaborations; prevalent mental disorders; and awareness programmes being implemented.

2.8.6.

The Committee raised a question on whether NGOs were capacitated and monitored continuously to ensure that they comply with policies.

3.
3.

RECOMMENDATIONS Having made the above-mentioned observations, the Committee recommends that the Minister of Health should ensure that: 3.1.

Human resources 3.1.1.

Provincial Departments revise their staff establishments to accommodate the establishment of fully functional Mental Health Directorates.

3.1.2.

All funded vacant mental health posts are timeously filled by Provincial Departments to increase the mental health care workforce.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 48 [Thursday, 24 May 2018 3.1.3.

Provincial Departments develop strategies to attract suitably qualified mental health professionals, particularly in rural areas.

3.1.4.

Provincial Departments ensure that general health professionals are capacitated to identify and treat mental disorders or mental illnesses on managing them and follow up care.

3.2.

Infrastructure 3.2.1.


Provincial Departments prioritises the refurbishment and maintenance of existing mental health infrastructure.

3.2.2.

Provincial Departments prioritises the construction of mental health hospitals in provinces that have no such infrastructure (e.g.

Mpumalanga and Northern Cape).

3.2.3.

National and Northern Cape Departments closely monitors the completion of the Northern Cape Psychiatric Hospital.

3.3.

Intersectoral collaboration 3.3.1.


Provincial Departments establishes strategic partnerships with line function departments (Social Development, Education, Human Settlement, etc.

), and other sectors at national, provincial and district levels in relation to mental health care services.

3.3.2.

Provincial Departments ensure that support is provided for community-based services by ensuring that community health workers and NGOs are capacitated to provide quality mental health services.

3.3.3.
3.3.3.

On unlicensed NGOs, Health and Social Development Departments monitors closely the processes and criteria used to select or grant licences to NGOs.

3.3.4.

Provincial Departments ensure that the accreditation process of NGOs is documented and legally authorised.

3.4.

Advocacy, mental health promotion and prevention 3.4.1.
Provincial Departments embarks on public education outreach programmes on mental health to aid recognition, management or prevention of mental disorders as well as to improve access to care and reduce stigma.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 49 3.5.

Research, monitoring and evaluation and oversight 3.5.1.
National Department develops and roll-out mental health information systems in provinces which will provide sufficient information to inform intervention decisions and assess quality improvements.

3.5.2.

National and Provincial Departments develops a mental health monitoring and evaluation policy together with implementation plans to strengthen monitoring and evaluation of mental health care services in order to mitigate adverse events.

3.5.3.
3.5.3.

National Department of Health addresses the disparities in the functionality and effectiveness of Mental Health Review Boards amongst provinces.

Report to be considered.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 50 [Thursday, 24 May 2018 National Council of Provinces 1.

REPORT OF THE SELECT COMMITTEE ON APPROPRIATIONS ON THE CONTRACT EXTENSION OF THE DIRECTOR OF THE PARLIAMENTARY BUDGET OFFICE, DATED 24 MAY 2018 1.
The Parliamentary Budget Office Section 15 of the Money Bills Amendment Procedure and Related Matters Act, Act No.

9 of 2009 (the Act), establishes the Parliamentary Budget Office (PBO).

The PBO must provide independent, objective and professional advice and analysis to Parliament on matters related to the budget and other money Bills.

A Director must manage the PBO.


The Director must be appointed by resolution of both Houses of Parliament, after a recommendation of the committees on finance and appropriations of both Houses.

In terms of subsection 15(7) of the Act, any committee considering making such recommendation contemplated in the Act must do so in an open and transparent manner.

In addition, the aforementioned committees must also recommend to the Houses of Parliament the conditions of service for the appointee.

2.
2.

Appointment of Director On 09 May 2013, the Select Committee on Appropriations adopted a Report recommending the appointment of Professor M I Jahed as the Director of the PBO for a period of five years.

Thereafter, the Report was tabled and considered by the National Council of Provinces.

Since May 2012, Professor M I Jahed was seconded from the Development Bank of Southern Africa (DBSA) to assist Parliament in the process of setting up the PBO.
The project led by Prof. Jahed was able to outline and clarify the functions and scope of the Office, design an operational structure, establish networks with external stakeholders and engage political parties and relevant Committees.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 3.
The ATC Referral 51 The contract of Professor Jahed is coming to an end, and Parliament has – on 16 May 2018 – tabled a referral in the Announcements, Tablings and Committee Reports (ATC) to the Standing Committees on Appropriations and Finance and the Select Committees on Appropriations and Finance to consider the matter of the expiring contract of the Director of the PBO and to report by 28 May 2018.

4.
4.

Committee’s deliberations On Thursday, 24 May 2018, the Committee deliberated on the contract expiry of the Director of the PBO as referred to it on 16 May 2018.

The Committee considered the matter, taking into consideration the principles of continuity and stability together with the PBO output since its establishment, the contribution of the PBO to the stimulation of economic and financial debates in Parliament, and Prof. Jahed’s profile, and reached a conclusion on the matter.
Before arriving at a conclusion on the matter, the Committee also took into consideration the substantive interactions that Prof. Jahed has had with the different Committees, political parties and with individual Members, his extensive expertise in finance and economics, and the degree of professionalism with which he has conducted his work over the past five years.
The Committee further considered the relevance of section 15(15) which provides what should be done when the position of the Director is vacant.

Moreover, the Committee deliberated and resolved that the Money Bills Act was silent on the process that should be followed when re-appointing the Director of the PBO.

Based on the above points, the Committee resolved that Prof. Jahed is still a suitable candidate to head the PBO.

5.
5.

Conclusion and Recommendation In accordance with subsections 15(5) (a) and (b) of the Money Bills Amendment Procedure and Related Matters Act, the Select Committee on Appropriations recommends as follows: ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 52 [Thursday, 24 May 2018 5.1 That Professor M I Jahed, be re-appointed as the Director of the Parliamentary Budget Office until three months after the 2019 national and provincial general elections.
5.2 That the re-appointment of the Director of the Parliamentary Budget Office be subject to an agreement that the conditions of service (including salary and allowance) would remain substantially the same as those of the top rank of the public service as per subsection 15(5)(b) of the Act, as agreed with Prof Jahed.

Report to be considered 2.

REPORT OF THE SELECT COMMITTEE ON FINANCE ON THE CONTRACT EXTENSION OF THE DIRECTOR OF THE PARLIAMENTARY BUDGET OFFICE, DATED 24 MAY 2018 1.
The Parliamentary Budget Office Section 15 of the Money Bills Amendment Procedure and Related Matters Act, Act No.

9 of 2009 (the Act), establishes the Parliamentary Budget Office (PBO).

The PBO must provide independent, objective and professional advice and analysis to Parliament on matters related to the budget and other money Bills.

A Director must manage the PBO.


The Director must be appointed by resolution of both Houses of Parliament, after a recommendation of the committees on finance and appropriations of both Houses.

In terms of subsection 15(7) of the Act, any committee considering making such recommendation contemplated in the Act must do so in an open and transparent manner.

In addition, the aforementioned committees must also recommend to the Houses of Parliament the conditions of service for the appointee.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 Thursday, 24 May 2018] 2.

Appointment of Director 53 On 09 May 2013, the Select Committee on Finance adopted a Report recommending the appointment of Professor M I Jahed as the Director of the PBO for a period of five years.

Thereafter, the Report was tabled and considered by the National Council of Provinces.
Since May 2012, Professor M I Jahed was seconded from the Development Bank of Southern Africa (DBSA) to assist Parliament in the process of setting up the PBO.

The project led by Prof. Jahed was able to outline and clarify the functions and scope of the Office, design an operational structure, establish networks with external stakeholders and engage political parties and relevant Committees.

3.
3.

The ATC Referral The contract of Professor Jahed is coming to an end, and Parliament has – on 16 May 2018 – tabled a referral in the Announcements, Tablings and Committee Reports (ATC) to the Standing Committees on Appropriations and Finance and the Select Committees on Appropriations and Finance to consider the matter of the expiring contract of the Director of the PBO and to report by 28 May 2018.

4.
4.

Committee’s deliberations On Thursday, 24 May 2018, the Committee deliberated on the contract expiry of the Director of the PBO as referred to it on 16 May 2018.

The Committee considered the matter, taking into consideration the principles of continuity and stability together with the PBO output since its establishment, the contribution of the PBO to the stimulation of economic and financial debates in Parliament, and Prof. Jahed’s profile, and reached a conclusion on the matter.
Before arriving at a conclusion on the matter, the Committee also took into consideration the substantive interactions that Prof. Jahed has had with the different Committees, political parties and with individual Members, his extensive expertise in finance and economics, and the degree of professionalism with which he has conducted his work over the past five years.
ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018 54 [Thursday, 24 May 2018 The Committee further considered the relevance of section 15(15) which provides what should be done when the position of the Director is vacant.

Moreover, the Committee deliberated and resolved that the Money Bills Act was silent on the process that should be followed when re-appointing the Director of the PBO.

Based on the above points, the Committee resolved that Prof. Jahed is still a suitable candidate to head the PBO.
5.

Conclusion and Recommendation In accordance with subsections 15(5) (a) and (b) of the Money Bills Amendment Procedure and Related Matters Act, the Select Committee on Finance recommends as follows: 5.1 That Professor M I Jahed, be re-appointed as the Director of the Parliamentary Budget Office, until three months after the 2019 general elections.
5.2 That the re-appointment of the Director of the Parliamentary Budget Office be subject to an agreement that the conditions of service (including salary and allowance) would remain substantially the same as those of the top rank of the public service as per subsection 15(5)(b) of the Act, as agreed with Prof Jahed.

Report to be considered.

ANNOUNCEMENTS, TABLINGS AND COMMITTEE REPORTS NO 68─2018