1. 1 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

2. 2 STRUCTURE OF THE PRESENTATION 1. Purpose 2. Organisation of Health Care Services in the Public Health Sector 3. Health infrastructure 4. Health Personnel 5. Distribution of Health Care Professionals in the Public Health Sector (2010) 6. Packages of care 7. The National Health Act of 2003 8. Health Services and Benefits to Military Veterans 9. Conclusion

3. 3 1. PURPOSE To present inputs from the National Department of Health on the Military Veterans Bill [B1-2011].

4. 4 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. 4

5. 5 5 3. HEALTH INFRASTRUCTURE Public sector has over 4,300 Public Sector Facilities, classified as follows: Type of Health FacilityNumber of Facilities Clinic 3595 Community Health Centre332 District Hospital264 Regional Hospital53 Provincial Tertiary Hospital14 National Central Hospital9 Specialised Psychiatric Hospitals25 Specialised TB Hospitals41 TOTAL4,333

6. 6 6 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. 6

7. 7 5. DISTRIBUTION OF HEALTH CARE PROFESSIONALS IN THE PUBLIC HEALTH SECTOR (2010) PROVINCE PROF. NURSES (2009) MEDICAL DOCTORS (2010) PHARMACISTS (2010) CLINICAL PSYCHOLOGISTS SANC REGISTER PUBLIC SECTOR HPCSA REGISTER PUBLIC SECTOR SAPC REGISTER PUBLIC SECTOR HPCSA REGISTE R PUBLIC SECTOR EASTERN CAPE 13 6977 7612 1491 32377525236256 FREE STATE 7 3971 8941 55957738111223832 GAUTENG 29 0228 46211 5242 48029177513136176 KZN 23 39112 1235 6703 058150240170968 LIMPOPO 8 6266 84393796234429710250 MPUMA- LANGA 5 4223 5051 81970945526623418 NORTHERN CAPE 2 0741 217403321 13789 15215 N. WEST 7 3513 140631480443130409 W. CAPE 14 3194 39470861 39214796601 33874 TOTAL 111 29949 34136 91211 30912 2182 9967 037498 % IN PUBLIC SECTOR 44,3%30,6%24,5%7,1

8. 8 6. PACKAGES OF CARE 8 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.

9. 9 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 least include 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.

10. 10 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.

11. 11 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 six years, 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.

12. 12 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.

13. 13 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

14. 14 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.

15. 15 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)

16. 16 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.