Concurrent Nature of Governance of Health Services a Challenge Needing Urgent Attention

Parliament� The Select Committee on Social Services has urged the legislative sector to look at changing the concurrent nature of health services as it applies to the powers of national and provincial government, as this has presented challenges to the proper functioning of the health sector. The committee was today briefed by the Minister of Health, Dr Aaron Motsoaledi, of various issues in the department, including the Annual Performance Plan for the 2018/2019 financial year.

Through its many oversight visits to provinces, the committee has witnessed first-hand the challenge presented by the inability of the Minister of Health to intervene in provinces, due to national government’s lack of legislative authority in provinces. It is concerning that the Minister can only intervene at a much later stage, which impacts on dealing with challenges effectively.

While the committee understands why the legislative prescripts governing the sector are the way they are now, it is of the view that amendments have to be made to ensure a system that is fit for purpose, said Ms Cathy Dlamini, the Chairperson of the Committee.

The concurrent nature of health services also poses a challenge in the standardisation of delivery of infrastructure. In some provinces this is affected by lack of capacity, which then impacts on the overall delivery of services.

Furthermore, the delegation of authority especially in finances and the recruitment of human resources continue to present challenges, especially at the coal-face of service delivery. The committee reiterates its position that the approval of appointments only at provincial department level is cumbersome and unsustainable. As a remedy, the committee has recommended that the authority to appoint, particularly medical personnel, be devolved to hospitals. Also, the Minister must play an advisory role in the appointment of provincial heads of health departments to ensure that people with adequate skills are employed.

The chronic skills shortage in the sector is another issue requiring the department’s attention. The department must continue to engage institutions of higher learning to find solutions within a cooperative framework to solve the skills shortage.

The committee resolved in future to invite the national department together with provincial departments and their MECs to account on concurrent issues affecting the two spheres of governance. This will ensure that answers are heard from both at one time and will strengthen oversight.

Meanwhile, the committee welcomed the work done in ensuring that the shortage of medicines is no longer at crisis levels. When this committee was instituted, this problem was endemic within different provinces, but we appreciate the fact that this matter has to a large extend been resolved, Ms Dlamini said.

The committee also welcomed the improvement in provincial health departments’ audit outcomes, despite the fact that the North West provincial health department has regressed, when it was one of the best performers in previous financial years. The support given by national government in this regard is welcomed, as good governance represents the first pillar of quality service delivery.

The lack of adequate equipment in hospitals needs attention at both national and provincial level. Similarly, provinces must share best practice on how some are able to maintain infrastructure while others continue to struggle.

The committee has called for the completion of the National Health Insurance Bill, as this insurance will ensure equal and quality health services to all the people of South Africa.

Source: Parliament of the Republic of South Africa