1. National Health Bill

2. Purpose of National Health Bill (NHB) Legislative and Regulatory framework for delivery of health services Creates uniformity by establishing norms and standards Preamble Firmly entrenched in the Constitution Clearly states intention of Bill Emphasizes women and children

3. Definitions Complex If appears once, defined in the chapter Most complex –Municipal Health Services –Emergency Treatment Cannot define what constitution has not defined Emergency treatment too complex – advised that it should be defined in regulations

4. Constitutional Complexity National sphere Provincial sphere Municipal sphere Schedule 4 Part A: Health services a functional area of concurrent national and provincial legislative competence S85(2): President & Cabinet exercises executive authority -implementing national legislation, developing and implementing national policy, preparing and initiating legislation, performing any other executive function provided for in the Constitution or in national legislation etc S125: Premier & MECs exercise executive authority -implementing national legislation within Sch 4 & 5 functional areas S125(5): Subject to section 100, implementation of provincial legislation in a province is an exclusive provincial executive power S151(3): municipality has the right to govern, on its own initiative, subject to national and provincial legislation. S151(4) The national or a provincial government may not compromise or impede a municipality's ability or right to exercise its powers or perform its functions. 154(1) The national and provincial governments, by legislative & other measures, must support and strengthen the capacity of municipalities to manage their own affairs, exercise their powers & perform their functions.

5. Frameworks in the Bill Constitution 6. Health establishments 7. Human Resources 8. Human Tissue 9. National Health Research 10.Hlth Officers & Compliance 11. Regulations 2. Rights & duties of users and providers 3. National health structures 4. Provincial health structures 5. District health system

6. Ch 1 - Objects Clearly states intention of creating national health system, encompassing public and private Within available resources Responsibility vested in Minister as member of Cabinet Categories of persons eligible for free health services

7. Ch 2 – Users Rights Emergency treatment is mandatory User to be fully informed of health status by provider (s6) User’s right to participate in decisions even if someone else must give informed consent (s8) Provision for treatment with and without informed consent (s7 & 9) Discharge reports must be given to the user

8. Ch 2 – Users Rights Users must be adequately informed if health services are for research or experimental purposes (s11) Duty to disseminate information (s12) on health services at national, provincial and local level Health records to be created and maintained by health establishments (s13) Confidentiality of health records (s14) Access to health records (s15,16 & 17) Complaints procedures to be put in place by the MEC (18)

9. Co-operative Government Section 41 of the Constitution: All spheres of government must exercise their powers and perform their functions in a way that does not encroach on the geographical, functional or institutional integrity of government in another sphere

10. Co-operative Government Spheres of government must co-operate with one another in mutual trust & good faith by fostering friendly relations assisting & supporting one another, informing one another of, & consulting one another on, matters of common interest; co-ordinating their actions & legislation with one another; adhering to agreed procedures & avoiding legal proceedings against one another.

11. Ch 3 – National Structures Functions of national department of health (s 20) National Health Council (MINMEC) (s21) NHC functions as an advisory body National Health Advisory Committee (PHRC) (s23) NHAC reports in to NHC, co-ordinates policy implementation etc (s24) National health plans prepared by DG (s25) National Consultative Health Forum must meet at least once every two years (s26)

12. National - Schematic Minister National Health Council (NHC) Minister, MECs, 1 Municipal Councillor (SALGA), DG and DDGs, HODs, official of SALGA, SAMHS. Advises the Minister on health policy, health of the population. May consult with anyone. Minister to convene first meeting within 60 days National Health Advisory Committee (NHAC) DG, DDGs HODs SAMHS, number of SALGA reps to be determined by NHC. Must at the request of NHC investigate & consider health matters, & report findings to NHC, make recommendations to NHC, co-ordinate policy implementation, ensure integration of national and provincial health plans etc

13. Ch 4 – Provincial Structures Functions of provincial health departments (s27) Provincial Health Council consists of MEC, municipal councillors, HOD (s 28) Advisory function to MEC (s29) PHAC consists of HOD, SALGA rep and reps from local government (s30) Provincial health plans to be prepared by HODs (s32) Provincial consultative bodies must be established by MEC (s33)

14. Provinces - Schematic MEC Provincial Health Council (PHC) s 28 MEC, 1 councillor from each metropolitan and district municipality in province, HOD, not more than 3 SALGA officials. Advises MEC on inter governmental policy within the province, proposed legislation on health matters, guidelines for management of health districts, implementation of national health policy, etc Provincial Health Advisory Committee (PHAC) s30 HOD, 1 SALGA rep, & number of local government reps. Must investigate & consider any health matter & report findings to PHC, makes recommendations to PHC on health matters, co-ordinates implementation of intergovernmental policy, ensures integration of national and provincial health plans etc

15. Ch 5 – District Structures Boundaries of health districts coincide with district and metropolitan municipal boundaries (s34) Health districts may be divided by MEC into sub- districts with the concurrence of MEC for local government (s35) MEC to establish district health councils for every health district (s 36) Provincial legislation must provide for functioning of district health councils etc (s 36(4))

16. Ch 5 – District Structures Municipal health services to be provided by metropolitan and district municipalities (s37) SLAs to be entered into in terms of s156(4) of the Constitution, between provinces and municipalities for the provision of services by municipalities (s 37) District health plans to be prepared by district and metropolitan municipalities (s38) Transitional arrangements – service level agreements (s 39)

17. Ch 6 - Health Facilities Classification of health establishments by the Minister according to function, size etc (s40) Certificate of need (max 10 years) Regulations relating to CON by Minister (s44)) Provision of health services at public health establishments (categories of users; forms of treatment, revenue retention, user fees)(s44) Provincial legislation must provide for a committee for clinics & community health centres

18. Ch 6 - Health Facilities Minister may prescribe standards and requirements for the provision of health services at non-health establishments (s48(1)) Provincial legislation must provide for health services at health establishments in the province other than hospitals (s48(2)) Minister can regulate traditional circumcisions and traditional medical practice from a health perspective (s48(3) and(4))

19. Ch 7 – Human Resources NHC must develop policy guidelines for provision and distribution of human resources within NHS Minister determines guidelines for programmes for the appropriate distribution of human resources (s54) Forum of Statutory Councils created – regulates professional health councils, ombuds role (s55) Minister may establish academic health complexes in consultation with Minister of Education (s56) Regulations regarding human resources (s57 )

20. Ch 8 – Human Tissue National blood transfusion service established (s 58) by granting of a licence by Minister Authorised institutions may acquire & use tissue (s59) Prescribed conditions for the removal of tissue (s60) Prohibition on reproductive cloning (s62) Therapeutic cloning may be permitted under controlled conditions (s62) Control of removal, use & transplantation of tissue (s63) Trade in human tissue prohibited (s65)

21. Ch 8 – Human Tissue Allocation and use of human organs controlled by regulations (s66) Donation of bodies and tissue by a will, by DG (s67) Purpose of donations eg training, research, health science advancement, therapy (s69) Post mortem examinations regulated (s71) Provision for various regulations eg withdrawal of blood, acquisition & utilisation of tissue (s73)

22. Ch 9 – Health Research National Health Research Committee established (s74) NHRC identifies & advises Minister on health research priorities (s75) Regulation of research on adults & minors (s76) National Health Research Ethics Council established (s77) Every institution, health agency/ health establishment must have access to a health research ethics committee (s78)

23. Ch 9 – Health Research Provinces and municipalities and the private sector must establish, implement and maintain health information systems in order to create a comprehensive national health information system (NHIS) (s79) National department to facilitate and co-ordinate NHIS Minister can prescribe kinds of data, manner and format for NHIS (s79(2)) MEC must establish a committee for the health information system at provincial and local level (s80 )

24. Ch 10 - Compliance Inspectorates for health establishments to be created by MECs to monitor and evaluate compliance and submit quarterly reports (s82) MEC to submit annual report to Minister Office of Standards Compliance to be established by DG within national department (s83) OSC fulfils an advisory and monitoring function and interacts with provincial health inspectorates (s83)

25. Ch 10 - Compliance OSC must (s83 and 84) – Advise Minister on compliance with quality norms and standards Report on standards violations causing public health risks Conduct inspections re certificate of need conditions Institute processes for monitoring and ensuring quality control & advise on quality of care provided by health establishments Prepare an annual report to the Minister

26. Ch 10 - Compliance Minister & MEC appoint health officers (s85) Duty of health officers monitor & enforce compliance with the Act (s86) Routine inspections by health officers (s87) Environmental health investigations (s88) Entry and search of premises by health officers (ss 89, 90 & 91) Items seized to be given to police officials (s92) Offences eg obstructing a health officer (s94)

27. Ch 10 - Compliance Provincial Health Inspectorates (s82) Must monitor, evaluate & report to MEC on compliance with Act by HEs and HAs – operational issues National Office of Standards Compliance (s83) (or agents) must monitor and inspect HEs & HAs for compliance. Can instruct HOs to inspect HEs and has to investigate complaints and report to DG Health Officers (s85) Appointed by Minister, MEC to operate at national or provincial or district level. Must monitor and enforce compliance. Does routine and environmental health inspections (s88), entry, search and seizure (ss 89, 90, 91,92). Can be a member of SAPS

28. Ch 11 – Regulations (s95) Fees payable to Public Health Establishments Norms and standards for protective clothing EDL and medical and assistive devices Human resource development Emergency medical services and emergency medical treatment inside and outside of health establishments

29. Ch 11 – Regulations (s95) Health nuisances and medical waste Functions of persons who render voluntary or charitable services in Public Health Establishments Rehabilitation Health technology National health information system Communicable and non-communicable diseases

30. Ch 12 - General Minister may appoint advisory and technical committees (s96) Minister may assign duties and delegate powers to any person in the employ of the State or to any council or committee established in terms of the Bill (s97) Repeal of laws (s98) Minister may prescribe transitional arrangements to effect a smooth transition between the old laws and the Bill (s98)

31. Concluding Comments The most important Bill for governance in the health sector Truly embedded in the constitution Entrenches patients rights Facilitates services delivery Ensures quality standards and norms and effective compliance Reduces inequity through better integration and coordination between all roleplayers