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PRESENTATION BY THE NATIONAL DEPARTMENT OF HEALTH (DOH) TO THE

PORTFOLIO COMMITTEE ON DEFENCE AND MILITARY VETERANS:

MILITARY VETERANS BILL

[B1-2011]

30 MARCH 2011

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STRUCTURE OF THE PRESENTATION

1. Purpose2. Organisation of Health Care Services in the Public

Health Sector3. Health infrastructure4. Health Personnel5. Distribution of Health Care Professionals in the Public

Health Sector (2010)6. Packages of care7. The National Health Act of 2003 8. Health Services and Benefits to Military Veterans9. Conclusion

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1. PURPOSE

To present inputs from the National Department of Health on the Military Veterans Bill [B1-2011].

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2. ORGANISATION OF HEALTH CARE SERVICES IN THE PUBLIC HEALTH SECTOR

Health is a concurrent function between National Department of Health and nine (9) Provincial Departments of Health.

Municipal Health Services are the responsibility of Local Government.

Public sector serves 84% of the population of 49,320,500. Private sector serves 16%, those with medical aid coverage.

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3. HEALTH INFRASTRUCTURE

Public sector has over 4,300 Public Sector Facilities, classified as follows:

Type of Health Facility Number of FacilitiesClinic 3595

Community Health Centre 332

District Hospital 264 Regional Hospital 53Provincial Tertiary Hospital 14

National Central Hospital 9Specialised Psychiatric Hospitals 25Specialised TB Hospitals 41TOTAL 4,333

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4. HEALTH PERSONNEL

More than 270 000 health personnel in the public sector;

However, majority of health care providers are based in the private sector.

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5. DISTRIBUTION OF HEALTH CARE PROFESSIONALS IN THE PUBLIC HEALTH SECTOR (2010)

PROVINCE

PROF. NURSES(2009)

MEDICAL DOCTORS (2010)

PHARMACISTS 

(2010)CLINICAL PSYCHOLOGISTS

SANCREGISTER

PUBLIC SECTOR

HPCSAREGISTER

PUBLIC SECTOR

SAPCREGISTER

PUBLIC SECTOR

HPCSAREGISTE

RPUBLIC SECTOR

EASTERN CAPE 13 697 7 761 2 149 1 323 775 252 362 56

FREE STATE 7 397 1 894 1 559 577 381 112 238 32

GAUTENG 29 022 8 462 11 524 2 480 2917 751 3136 176

KZN 23 391 12 123 5 670 3 058 1502 401 709 68

LIMPOPO 8 626 6 843 937 962 344 297 102 50

MPUMA-LANGA 5 422 3 505 1 819 709 455 266 234 18

NORTHERN CAPE 2 074 1 217 403 321

137 89152 15

N. WEST 7 351 3 140 631 480 443 130 40 9

W. CAPE 14 319 4 394 7086 1 392 1479 660 1 338 74

TOTAL 111 299 49 341 36 912 11 309 12 218 2 996 7 037 498

% IN PUBLIC SECTOR

44,3% 30,6% 24,5% 7,1

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6. PACKAGES OF CARE

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Packages of care exist for each level of the health system, which are as follows:

Comprehensive PHC Package District Hospital Service Package Regional Hospital Service Packages

A strategy for Modernising Tertiary Services has also been developed.

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7. THE NATIONAL HEALTH ACT OF 2003 (1)SECTION 3: Responsibility for Health

3. (1) The Minister must, within the limits of available resources-

(a) endeavour to protect, promote, improve and maintain the health of the population;

(b) promote the inclusion of health services in the socio-economic development plan of the Republic;

(c) determine the policies and measures necessary to protect, promote, improve and maintain the health and well-being of the population;

(d) ensure the provision of such essential health services, which must at leastinclude primary health care services, to the population of the Republic as maybe prescribed after consultation with the National Health Council; and(e) equitably prioritise the health services that the State can provide.

(2) The National Department, every Provincial Department and every Municipality must establish such health services as are required in terms of this Act, and all health establishments and health care providers in the public sector must equitably provide health services within the limits of available resources.

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7. THE NATIONAL HEALTH ACT OF 2003 (2)

SECTION 4: Eligibility for free health services in public health establishments

(1) The Minister, after consultation with the Minister of Finance, may prescribe conditions subject to which categories of persons are eligible for such free

health services at public health establishments as may be prescribed.

(2) In prescribing any condition contemplated in subsection (1), the Minister must have regard to-

(a) the range of free health services currently available;(b) the categories of persons already receiving free health services;(c) the impact of any such condition on access to health services; and(d) the needs of vulnerable groups such as women, children, older

persons and persons with disabilities.

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7. THE NATIONAL HEALTH ACT OF 2003 (4)

SECTION 4: Eligibility for free health services in public health establishments

(3) Subject to any condition prescribed by the Minister, the State and clinics and community health centres funded by the State must provide:

(a) pregnant and lactating women and children below the age of sixyears, who are not members or beneficiaries of medical aid schemes, with free health services;

(b) all persons, except members of medical aid schemes and their dependants and persons receiving compensation for compensable occupational diseases, with free primary health care services; and

(c) women, subject to the Choice on Termination of Pregnancy Act, 1996 (Act No. 92 of 1996), free termination of pregnancy services.

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7. THE NATIONAL HEALTH ACT OF 2003 (4)

SECTION 5: Emergency treatment

A health care provider, health worker or health establishment may not refuse a person emergency medical treatment.

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7. THE NATIONAL HEALTH ACT OF 2003 (5)SECTION 41: Provision of health services at public health

establishments

(1) The Minister, in respect of a central hospital, and the relevant member of the Executive Council, in respect of all other public health establishments within the province in question, may-

(a) determine the range of health services that may be provided at the relevant public health establishment;

(b) prescribe the procedures and criteria for admission to and referral from a public health establishment or group of public health establishments

(c) subject to subsection (2), prescribe schedules of fees, including penalties for not following the procedures contemplated in paragraph (b), for- 40(i) different categories of users;(ii) various forms of treatment; and(iii) various categories of public health establishments; and

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7. THE NATIONAL HEALTH ACT OF 2003 (6)

SECTION 41: Provision of health services at public health establishments

(d)in consultation with the relevant Treasury, determine the proportion of revenue generated by a particular public health establishment classified as a hospital that may be retained by that hospital, and how those funds may be used.

(2)When determining a schedule of fees, the fee for a particular service may not be varied in respect of users who are not ordinarily resident in a province.

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National DoH subscribes to the Fundamental principles recognised by the State, and policy objectives outlined in Section 3(1) and 3 (2) of the Bill.

The public health sector, led by the National Department will contribute to the following benefits for Military Veterans, as outlined in Section 5 (1) of the Military Veterans Bill:

(b) dedicated counseling and treatment to military veterans who suffer from post- traumatic stress disorder or related conditions;

(i) access to health care.

User fees at Primary Health Care (PHC) level have been abolished.

The Uniform Patient Fee Schedule (UPFS) is used at hospital level to determine ability to pay. The indigent are not required to pay.

8. HEALTH SERVICES AND BENEFITS TO MILITARY VETERANS (2)

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9. CONCLUSION The National DoH supports the Military Veterans Bill [B1-2011] and

subscribes to the Fundamental principles recognised by the State, and policy objectives outlined in Section 3(1) and 3 (2) of the Bill.

Provisions of the National Health Act of 2003 with regard to access to free health services have also been outlined.

Within its resource constraints, the public health sector is best placed to contribute effectively to the provision of services and benefits outlined in Sections 5 (1) (b) (i).

Where required, the health sector will consider new areas of policy development – also in partnership with other government departments.