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THE NATIONAL HEALTH BILL (2003). Duane Blaauw. Presentation. The framework of health legislation Origins of the NHB Status of the NHB Objectives of the NHB Overview of the NHB Key provisions of the NHB Conclusions. The Framework of Health Legislation. NON-HEALTH LEGISLATION
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THE NATIONAL HEALTH BILL (2003) Duane Blaauw
Presentation • The framework of health legislation • Origins of the NHB • Status of the NHB • Objectives of the NHB • Overview of the NHB • Key provisions of the NHB • Conclusions
The Framework of Health Legislation • NON-HEALTH LEGISLATION • Constitution • Local government legislation • Labour legislation • Public service legislation • Occupational Health • OHSA 1993 • MHSA 1996 • COIDA 1993 HEALTH LEGISLATION • Other • MRC Act 1997 • Provincial Acts • Specific Issues • Mental Health Act 2002 • Child Care Act 1983 • Choice on TOP 1996 • Sterilisation Act 1998 • Tobacco Products Control Act 1998 • Environmental Health • Hazardous substances Act 1973 • Foodstuff, cosmetics & disinfectants Act 1972 • International health regulations • National Health Bill 2003 • Private Medical Schemes • Medical Schemes Act 1998 • Health Professions • Health Professions Act 1974 • Nursing Act 1959 • Pharmacy Act 1974 • Drugs • MRSCA 1997
Origins of the NHB ANC Health Plan 1994 Towards a NHS 1995 Health White Paper 1997 National Health Bill 2003 Public Health Act 1919 Health Act 1977 Human Tissue Act 1983
1995 § 2001 20 Jun Policy development and drafting starts § Introduced into parliament 2003 18-19 Aug § Public hearings 27 Aug § Amendments by Health Portfolio Committee 30 Sep § Amendments by Social Services Select Committee 18 Nov § Passed by NCOP 26 Nov § Passed by National Assembly § Referred to President for signature 2004 ?? § National Health Act Status of the NHB
Objectives of the NHB • Fulfil the Constitutional obligations of government with regard to rights related to health care services • Establish an integrated National Health System based on: • Cooperative governance • Decentralised management • Co-operation between public and private sectors • National norms and standards
Overview of the NHB • Eligibility for free health care services • Rights and duties of users and providers • Organisation and functioning of the national health system • Allocation of functions • Functioning of health establishments • Creation of new structures • Importance and coordination of planning • The use of human tissue • Health research and health information • Compliance and inspection • Regulatory powers
Eligibility for Free Health Care • Determined by Minister of Health in consultation with Minister of Finance • After considering: • Existing criteria for free health care • Impact on access to health services • Needs of vulnerable groups • Nevertheless stipulates • Pregnant women & children under 6 years • TOP services • PHC services for people receiving compensation for occupational diseases (Excluding members of medical schemes)
Rights of Users / Duties of Providers • Emergency medical treatment • Information about their health and treatment • Participation in decisions about their health and treatment • Not to be treated without informed consent • Confidential medical records • Discharge reports • Complaints procedure
Duties of Users • Adhere to the rules of the establishment • Provide health care providers with accurate information about their health status • Cooperate with health care providers • Treat health providers with dignity and respect • Sign release of liability if refuse treatment
Rights of Providers • No unfair discrimination on account of their health care status • But may have conditions imposed on their service • Can refuse to treat users who: • Are physically or verbally abusive • Sexually harasses them
Promote, protect, improve and maintain the health of the population • Promote the inclusion of health in socio-economic development planning • Ensure the provision of essential health services • Equitably prioritise State health services • 23 functions, including: • Plan development of public andprivate hospitals • Provide specialised hospital care • Quality control • Support districts • 12 functions, including: • Identify national goals & priorities • Develop norms & standards • Coordination • Promote community participation • International liaison • Provide municipal health services • Water & sanitation • Food control • Health surveillance • Vector control • Assignment of additional functions by Service Level Agreement (SLA) National NDoH Minister Provincial PDoH MEC District DDoH • Require Certificate of Need (CON) • Operate, establish or modify a health establishment or health agency • Issued by NDoH DG • Stipulated criteria • Stipulated procedures • Lasts < 20 years Local LGDoH Mayor Private Sector Facility AHC H GP H C The National Health System
National NDoH Minister Provincial PDoH MEC District DDoH Local LGDoH Mayor Facility AHC H C The National Health System • National Health Council • Minister • Deputy Minister • 9 Provincial MECs • 1 SALGA Clr • National DG & DDGs • 9 Provincial HODs • 1 SALGA Official • Head of SAMS • National Health Consultative Forum • Appointed by Minister • Must include relevant stakeholders • Meet yearly Civil Society • Provincial Health Council • MEC • Clr from each Metro • Clr from each DC • Provincial HOD • 3 LG Managers • ? Others • Provincial Consultative Bodies • Appointed by MiEC • Must include relevant stakeholders • Meet yearly District Health Council Person representing MEC Member of Metro or DC Member of each LC 5 MEC appointess • Hospital Board • Appointed by Minister / MEC • NDoH / PDoH rep • 3 community reps • 5 staff / Mx reps • 5 technical experts • Clinic Committee • Require provincial legislation • Must include: • > 1 local Clr • > 1 community rep • Head of clinic
Health Planning • Integrated strategic + medium term health and HR planning • National: DG • Provincial: DG • District: District health manager • Obligations on NHC for national HR planning • Establishment of Forum ofStatutory Health Professional Councils Chairpersons + registrars of professional councils 2 NDoH reps 3 Community reps 2 University reps
The Use of Human Tissue • Control of the removal, use, transplantation and sale of human tissue: • Organs • Blood and blood products • Gametes • Establish single national blood transfusion service • Prohibition on human cloning • Criteria for post-mortems
Health Research • Establish National Health Research Committee • 15 people appointed by Minister • Identify national health research priorities • Coordinate research of public health authorities • Each health institution conducting research to have a health research ethics committee • Review research proposal • Grant approval for all research projects • National Health Research Ethics Council established • Register and audit institutional ethics committees • Set norms and standards for health research
Compliance and Inspection • Provincial Inspectorate for Health Establishments • Monitor compliance by health establishments • National Office of Standards Compliance • Set quality standards • 3 yearly inspection of every health establishment • System of health officers • Routine inspections • Environmental health investigations • Entry and search powers
Regulatory Powers • 23 areas • Including: • Fees and pricing of services • Notifiable diseases • Essential drugs list • Public-private partnerships • Health information • Emergency medical services • Health technology • Health research
Conclusion • Finally have new Health Act!? • Fulfill objectives? • Constitutional obligations • Integrated National Health System • Fragmentary legislative framework • Limited scope for public participation • Capacity to implement?