Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 1

SAMA AND SELF REGULATION OF DOCTOR’S Dr Fazel Randera Chairperson Health Policy Committee 16 Feb

 Prior to 1994 legislation under the South African Medical and Dental Act and the SA Medical and Dental Council– similar to legislation for nurses and pharmacists and other Professionals After the first Democratic Elections Interim Health Professional Council established in keeping with the need to transform a number of Health Professional Bodies It is noteworthy that whilst the intentions was to transform all professional bodies, the nursing professsion and the Pharmacy profession were allowed to retain their respect legislation and professional bodies  At this time and subsequently SAMA strongly expressed its reservations on a Health Professional Council representing many professional bodies and continued to support professional autonomy.  In 2007 the Health Professional Amendment Act was released for public comment and once again SAMA made comprehensive presentations to the Parliamentary Committee, to the House of Representatives (check whether I have the right name) and to the Provincial Legislatures Key Proposed Amendments  Significant change from legislation and Council that represented Doctors and Dentists and had Respect for Professional Autonomy  Ministerial Powers i.e. - the majority of members serving on professional boards appointed by Minister instead of elected representation as previously applied - empowerment of the Minister to make regulations “after” and “not” in consultation with the Council - Empowerment of the Minister to make regulations relating to unprofessional conduct. -this should be sole preserve of the Council. Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 3

WORLD MEDICAL ASSOCIATION Professional Autonomy and Self Regulation “As a corollary to the right of professional autonomy and clinical independence, the medical profession has a continuing responsibility to be self-regulating. Ultimate control and decision-making authority must rest with physicians, based on their specific medical training, knowledge, experience and expertise” “Medical Associations must do their utmost to promote and support the concept of professionally-led regulation amongst their membership and the public”. WMA Declaration on Professionally Led Regulation 4

SAMA survey on International Regulation & professional Conglomeration □ UK: GMC (Drs); GMC (dentists) □ USA: Medical Board in each state ; Dental Board in each state □ Canada: Medical Board per province; Dental Board per province □ India: Medical Council of India ; Dental Council of India □ Malaysia: Malaysian Medical Council; Malaysian Dental Council □ Singapore: Singapore Medical Council; Singapore Dental Council Findings: There are profession-specific regulators in countries. - Only UK has significant conglomeration of (two) professions under one body (GMC), ie Drs & Dentists. Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 5

SAMA conducted a comparative survey among Medical (and Dental) Councils of other countries: Countries: Ghana, Malawi, Singapore, India, Pakistan, Ireland, Canada Findings: in many countries, the majority of Council members are from the respective profession the Council seeks to regulate. Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 6

Other professions and Self Regulation -N-Nursing Council -P-Pharmacy Council The majority of council members are registered nurses or pharmacists respectively. In the amended respective Acts that have taken place since 1994, a number of members sitting on the respective Councils are appointed by the Minister. 7

Challenges with the functioning of the HPCSA ( a).The structural relationship between the HPCSA and the Medical & Dental Board (MDB) - The degree of DoH influence in appointments/composition of HPCSA/ MDB - General environment and Functioning: undermines representation of medical profession by MDB. (b). Preclusion of the MDB from having direct audience with the Minister of Health, even when imperative and necessary. (c). Multi- profession representation by HPCSA—dilution of the medical voice and marginalization of professional interests of Drs (and dentists) -Yet Drs pay disproportionally high annual registration fees (2 nd after psychologists) - Drs are the 2 nd biggest group in HPCSA, after Basic Ambulance Assistants (d) Lack of guidance, delays in responding & in correspondences, etc, on matters affecting medicine 8

ON HEALTH PROFESSIONS ACT -  Comprehensive written submission to Parliamentary Health Portfolio  Verbal presentations in Parliament  Direct audience with Chair of the Portfolio Committee on Health  Submissions to Provincial Legislature Directly with HPCSA and MDB  On Disciplinary sub-committee of the MDB being chaired by a non medical person  Several direct interactions with the HPCSA & the MDB More Recently  Discussion with Minister and submission made on Professional Autonomy i.e. post elections of 2008  Submission to Parliamentary Portfolio Committee on Health (post 2008 elections) SAMA Board indicated strong approval for a campaign towards establishment of a stand alone Council for Medical and Dental Professionals. SAMA Board indicated strong approval for a campaign towards establishment of a stand alone Council for Medical and Dental Professionals. Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 9

 Doctors (& dentists) continue to feel marginalized by the structure of the HPCSA and the authorities that regulate them.  Structure of the HPCSA continues to contradict the principle of self-regulation.  Professional and clinical autonomy is eroded  The greater interest of the patient suffers  Increased mistrust with current regulator  Doctors (and dentists) increasingly dissatisfied and frustrated in South Africa! Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 10

Understanding that the primary objective of the HPCSA is protect the to protect the public and to regulate the profession of doctors with respect to training, establishing standards, providing ethical and human rights direction and promoting professional autonomy We therefore appeal to the Health Portfolio Committee to re-evaluate the existing legislation for doctors and to consider the establishment of an separate, independent regulatory body for Doctors. We therefore appeal to the Health Portfolio Committee to re-evaluate the existing legislation for doctors and to consider the establishment of an separate, independent regulatory body for Doctors. This will allow - (i) the profession to directly run the professional affairs that affect them, without undue interferences and (ii) enable members of the doctor profession, to have professional autonomy over important issues of professional misconduct and clinical negligence. THANK YOU Presentation to Parliamentary Portfolio Committee on Health_ Cape Town 11