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

Legislative Mandate – Oversight Current Status of the Health Sector 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

Committees of Parliament facilitate the: 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

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

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

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

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

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).

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

ENTITIES SUPPORTING THE DEPARTMENT

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

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.

Financials controls (cont....) Audit outcomes of the health sector Unqualified with findings Qualified with findings Adverse/Disclaimed with findings 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).

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).

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