Overview of Health Sector in South Africa: Challenges and Progress

1. PRESENTATION TO THE PORTFOLIO COMMITTEE ON HEALTH 02 JUNE 2014 LINDOKUHLE NGOMANE THE OVERVIEW OF THE HEALTH SECTOR IN SOUTH AFRICA

2. Presentation Outline • Background • Legislative Mandate – Oversight • Current Status of the Health Sector • Mandate of the Department • Department’s Core Functions • Entities Supporting the Department • National Policy Priorities • Financial Controls • Key issues

3. BACKGROUND • Parliament conducts its constitutional obligations through the work of Committees. • Committees of Parliament facilitate the: • passing of legislation • approve annual departmental budgets • conduct oversight over departments falling within their portfolio

4. LEGAL FRAMEWORK - OVERSIGHT • SA oversight legislative framework comprises of the Constitution, PFMA & the Money Bills Act • Constitution • Mandates Parliament or legislative organs of state to scrutinise & oversee Executive actions to ensure accountability • Oversight mandate: Sections 55, 92 , 114 & 133 • Oversight processes: Sections 213, 214 & 215 • Public Finance Management Act (PFMA) • Passed to regulate the financial management of both the national and provincial spheres of government • Objective is to ensure transparency, accountability & sound management of the revenue, expenditure, assets & liabilities of all public institutions • Section 27 (1): The Minister must table the annual budget for a financial year in the NA before the start of the financial year • Section 27 (4): requires dpt. to submit to Parliament measurable objectives for each main programme in the department’s Budget Vote

5. Current status of the Health sector • South Africa has two types of health care systems • Public and private health systems • The private health system is costly and used mostly by middle to high income individuals and families • The public health care system is under pressure to deliver services to about 80% of the population

6. challenges facing the public health sector • The specific challenges faced by the health sector includes: • increasing demand for health services related to the complex and changing disease profile of the country • a greatly increased burden of disease (Prevention and treatment of HIV/AIDS and MDR-TB) • significant areas of weakness in health system management • Numerous barriers still exist in relation to quality and access to healthcare

7. challenges facing the health sector..... • Availability of health personnel in the public sector • The health system appears to be under‐performing with its given level of expenditure • Distribution of financing & spending • Leadership & innovation

8. MANDATE of the department • The legislative mandate of the Department is derived from the Constitution, the National Health Act, 61 of 2003 and other pieces of legislation passed by Parliament • Critical are the following sections and schedules of the Constitution: • Section 27(1)(a); Section 27(3); Section 28(1)(c); Schedule 4 • The national government and provinces are given certain constitutional competencies to perform certain functions at the spheres. • In some cases there are concurrent functions that both spheres of government have constitutional competency (schedule 4).

9. Core functions of the department • The health sector is responsible for the achievement of Outcome 2 of govt’s programme of action: “a long and healthy life for all South Africans” • The following key objectives of the Department are to: • Improve life expectancy • Reduce maternal and child mortality • Combat HIV and AIDS and decreasing the burden of diseases from tuberculosis • Improve the efficiency of public health

10. ENTITIES SUPPORTING THE DEPARTMENT

11. National policy Priorities • The health sector is also guided by the: • National Development Plan (NDP) 2030 • State of the Nation Address (SONA) • Negotiated Service Delivery Agreement (NSDA) • Health sector’s 10 Point Plan

12. Financial controlS within the sector • The Department had received an unqualified audit opinion for the past five years. • The previous Committee observed that there is improvement in the manner in which financial and predetermined objectives are managed. • The AG noted that unauthorised, irregular, fruitless and wasteful expenditure remains an area of concern for the health sector.

13. Financials controls (cont....) Audit outcomes of the health sector • The audit findings for the Health sector have shown little improvement over the last three years. • The number of disclaimers has however reduced to one remaining province (Limpopo).

14. Key issues • In order to enhance its performance the sector is aiming at: • Fast-tracking the implementation of a National Health Insurance scheme. • Strengthening the fight against HIV and TB, non-communicable diseases, as well as injury and violence. • Improving human-resource management at state hospitals and strengthening co-ordination between the public and private health sector. • Deploying "health teams" to communities and schools. • Regulating costs to make health care affordable to all. • Increasing life expectancy from 60 years to 70 years in 2030 (NDP 2030).

15. THANK YOU Thank You