COMMENTS ON THE FFC’S SUBMISSION ON THE DIVISION OF REVENUE 2007/08 SELECT COMMITTEE ON FINANCE

1. COMMENTS ON THE FFC’S SUBMISSION ON THE DIVISION OF REVENUE 2007/08SELECT COMMITTEE ON FINANCE Dr Percy Mahlathi Deputy Director General: Human Resources 26 May 2006

2. General Comment • Appreciate opportunity to comment on FFC recommendations • Acknowledge previous engagement with FFC {focus on NTS & HPTD} • Emphasis on: policy intent, performance, sustainability & rationalisation • A central question is whether previous rationale remains valid today & in medium to long-term Comments on FFC Recommendations

3. National Tertiary Services Grant • Grant supposed to be strategic funding to enable provinces to plan, modernize, rationalise & transform tertiary service delivery in line with national health policy objectives with particular focus on improving access & equity • Concern over inflexible legislated norms • Advise benchmarking according to type of hospital but provide some flexibility catering for epidemiology Comments on FFC Recommendations

4. NTSG • Monitoring: areas of attention • monitor data submission as well as financial monitoring • regular reporting & interaction with provinces around data submission • Compliance • conditions need a rigid service specification (set of data for review) • conditions need to improve the NDoH’s ability to apply oversight (current framework makes NDoH DG accountable, but no mechanism enabling him to enforce compliance) • mechanism for withholding of funds may be necessary (possibly prospective quarterly transfers rather than every two weeks; make the possibility of withholding funding more real). Comments on FFC Recommendations

5. NTS Grant • Need to tie grant to some performance indicators & generallyagree with notion of tighter control • Health service plan integral to provincial strategic plans • Need to appreciate link of tertiary services to specialist training • Chief directorate solely for NTSG – managing grant part of overall financial management in dept (revised organogram recently approved) Comments on FFC Recommendations

6. Modernisation of Tertiary Services Must be seen as integral part of this discussion Critical to specialist training & health service delivery A ten-year plan for the modernisation & reconfiguration of public health sector tertiary & quaternary hospital services To provide SA population with equitable access to high-quality, cost-effective tertiary and quaternary care, in a manner which is affordable and sustainable long term Comments on FFC Recommendations

7. MTS (cont.) Major challenge - funding of the MTS plan Numerous funding requests to implement MTS have been part of Health’s budget bids in the past three years Last year funding for health equipment channelled through provincial equitable shares: concern about it not going where it was needed DoH however continuingto develop provincial implementation plans for MTS Comments on FFC Recommendations

8. Health Professionals Training & Development Support provinces to fund costs associated with training of health professionals Develop* and recruit* medical specialists in under-serviced provinces Support and strengthen undergraduate and post graduate teaching and training process in health facilities Enable the shifting of teaching activities from central to regional and district hospitals Comments on FFC Recommendations

9. HPTD • Need clear policy on education & training of health professionals (DoH, DoE & Treasury) • Need to clarify & show how concepts of health professional training and development are related & differ • Need to cater for the expansion of the teaching platform & impact on the service platform? • Impact of merger of HE institutions on health • May therefore need to review in detail purpose of grant Comments on FFC Recommendations

10. HPTD – specific comments • Technical capacity issue already attended to in HR branch (HR Policy, Research & Planning) • Standing committee – serious concern (will remove policy making power of government) • Consider using HR Chamber of NHCF • Norms for policy targets – caution against possibility of unfunded mandates • Serious concern regarding earmarked DoE subsidy – may remove flexibility in tertiary institutions Comments on FFC Recommendations

11. HPTD (cont.) • Conversion of HPTD – agree but separate or clarify better training from development issues • Pathology students – postgraduate issue, should be part of Tertiary Services not the general health professional education and training • Need to develop consensus on terminology and refined purpose • Policy proposal - directly link the grant to education & training of health professionals • Issue – how much should country spend in producing health professionals Comments on FFC Recommendations

12. Basis for NDoH comments • HPTD & NTS Grants – no firm policy framework on introduction • No firm policy yet on health professions education & training (working on this) • Education, training and service are very closely related in production of health professionals • National Human Resource Plan for Health – basis for planning and action • Sectoral planning approach advocated – national in character (link strategic health policy objective & use of funding) Comments on FFC Recommendations

13. Conclusion • Firm policy framework for grants necessary • National HRH Plan basis for planning • Beefing up of technical capacity at NDoH & provinces is critical factor • Draft policy on Health Professions Education & Training under internal DoH discussion • Focus on service quality improvement • Earmarking subsidy has crosscutting implications on education & training generally • Work with FFC in addressing some recommendations Comments on FFC Recommendations