…….article dated 15 December 2020…...
Health department tries spin on its bad annuals….
The Department of Health (DOH) was heavily criticised in a parliamentary meeting for having little control and inadequate checks on the country’s enormous annual health allocations sent down the line to provinces. The Deputy Minister of Health was told that Parliament could not allow this state of affairs to continue unchallenged.
The Office of the Auditor General (AGSA), as a result of their audit on the DOH annual figures, had earlier accused the department of having shown little inclination to improve the bad situation which had developed over nine years. They also noted a failure to implement any form of consequence management down the line. Such had to be implemented, they said.
One step ahead
AGSA had presented its earlier findings on the DOH annual report for 2019/2020 to a joint committee on health a week before the DOH presentation in question. AGSA at that time had noted that irregular expenditure in 2019/2020 had increased by R32m to R69m compared with the previous financial year, with only 20 of South Africa’s municipal health departments receiving a clean audit out of 257.
AGSA had told MPs that this was despite the fact a good number of municipalities having spent a total of R1.26bn on consultants in the year under review in an attempt to stop the regress. Worse, AGSA said, was the fact that fruitless and wasteful expenditure was “out of control, a problem which persists year after year”. This was fierce comment.
It would appear that AGSA had undertaken audits on a number of municipalities on their annual health returns prior to dealing with the DOH annual figures.
From the total budget allocation received by the Department from Treasury, AGSA stated that “only eight percent (or R4.2bn) of the total budget was retained for DOH to execute their own operations, the balance of R51bn this year being transferred out to the provinces as health allocations.”
AGSA pointed their finger to this sum, saying “This is where the problem is. There is little accountability once the money leaves the department and goes down the line”. Basic accounting faults were becoming systemic, the AG’s office said, and nothing seems to get better over the years.
The AGSA meeting with Parliament concluded with the summation that in general there was no implementation of controls by DOH over daily and monthly processing and reconciling of transactions; a complete lack of review and monitoring of compliance with applicable laws and regulations and inadequate consequences for poor performance and transgressions.
Different show, different town
However, this was not the picture DOH tried to present to Parliament when reporting on their annual balance sheet a week later. The DOH team together with Dr Gail Andrews, their Chief Operating Officer, appeared before a joint portfolio and select committee on health to brief them officially on the financial statements for the 2019/20 financial year. Their annual report had been published.
The meeting was co-chaired initially by the Chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo and also by Natalie Gillion of the NCOP Select Committee on Health. Present at the meeting was new DG Dr Sandile Buthelezi but not seen until the end was Deputy Minister of Health, Joe Phaala.
In contrast to the earlier meeting with Auditor General’s office, a picture of “moderate progress” in handling the finances and meeting targets set for the year was presented by DOH. Dr Andrews said that the planned target for 2019/20 had been to have 45 facilities maintained, repaired or refurbished and this had been achieved at 39 facilities. In all, 16 hospital revitalisation projects had not completed been completed but would be shortly.
Ian van der Merwe, CFO, told MPs that DOH had maintained an unqualified audit opinion for the past nine years. Particular attention should be paid, he said, to the COVID-19 pandemic and its impact on the Department’s performance and ability to meet its targets. No adverse opinions were raised in the audit report, he said, “but only in the management report.”
Getting to the meat
The presentation on the annual report was remarkably short, after which Dr Dhlomo immediately threw the meeting over to questions from MPs. This amounted to a grilling lasting nearly two hours.
High amongst the critics was Naledi Chirwa (EFF) and Evelyn Wilson (DA) who both expressed their “total disgust” at the way the numbers were presented and the lack of depth in their reporting. Ms Chirwa said that regression in the performance of DOH was not reflected in the annual reports before them at all. “This Committee would not have known the true facts if it were not for the AGSA report in the previous week”, she added.
Ms Chirwa continued, “If anything, the department has regressed once again in 2019/20 to further a pattern of constant failure to meet targets, control of its finances, management responsibility and the build of human resources talent in DOH over the years. “Nothing is being done about this, she said. “Whilst the DOH public relations, management and communications personnel were very good at making the Department appear to be doing the work, on paper the facts indicate a totally different story.”
On the issue of the six major hospital refurbishments where 100% achievement of target was claimed by DOH, Naledi Chirwa demanded the names of the hospitals that had been rehabilitated so that the MPs on the Health Committee could carry out oversight visits.
“I have just done oversight on BJ Vorster Hospital, Eastern Cape, who were promised refurbishment this year”, she said. “The ceilings are falling down, the doctors are sharing office space with patients in the corridors and the state of some of the wards were horrifying”, she said.
Evelyn Wilson (DA) said “Sweet-talk and excuses could not change the reality on the ground”. She said her concern was the comment made by the AG’ s team earlier that DOH had no regard for compliance with the legislation governing financial statements.” No compliance with legislation was a serious issue, she said and added that this was the third time in a row this expression had been used by the AG’s office about DOH.
See what sticks
Another major concern, said Ms Wilson, was the so-called achievement of, say, 46.5% of the target but the spending of 99% of the budget in the process. “This is alarming”, she said.
“Another example of wrong thinking is your annual target figures for the National Health Insurance (NHI) project. For 2018/9, the target was 27% but as a matter of fact for this year it was reduced to 12% because of budget restraints. For this project, DOH only managed to achieve a very low 8% but still spent 92% of the budget, nevertheless.” She called Dr Andrews’s figures “imbalanced and making no sense at all.”
No provincial returns
She noted that none of the provinces had at that point made no returns nor any form of reconciliation, asking at the same time how DOH could appear in Parliament with no accurate detail on how the allocations had actually been spent nor any facts on the outcomes.
The meeting continued for a further hour along the same vein and bearing in mind it was a joint health committee meeting of both houses, i.e. portfolio and select committee meetings, and accordingly some sixteen MPs fielded questions on the annual report, leaving little time for replies.
Esidimeni – a mess
In was also noted with concern by Ms Wilson (DA) that the entire mental health budget was spent, yet not one target out ten targets had been achieved in terms of the DOH Mental Health programme for the entire year. On mental health matters, she quoted the “absolutely shocking experience of Life Esidimeni, a matter still not concluded” and called for a meeting with both the Minister of Health and the Deputy Minister present to explain “the dismal performance by DOH in mental health generally”.
Dr Dhlomo called a halt to questioning at that point, suggesting that the committees need to find space and time for the Health Committees to be briefed on the mental healthcare situation in the country. Dr Dhlomo said mental health does not receive the attention it deserves. This was a worldwide problem, he said, and he asked that a whole meeting be put aside to address this issue with DOH.
Recently appointed health DG, Dr Sandile Buthelezi, then commented on a number of issues including the question of the threatened nursing strike. He told MPs that the National Health Council (NHC) would receive a report on 26 November on “how DOH proposed to address the matter once and for all.”
Dr Buthelezi, also referred to a composite report on the effect of COVID-19 on TB, HIV and immunisation services which would show, she said, how DOH would be able to pick up with many of these services, including immunisation, after the lockdown. A primary concern has been to overcome the problem that people were afraid to visit facilities because of lockdown regulations and the high risk of infection.
Regarding the high professional nursing vacancy rates countrywide, a new organisational structure for was now with the Department of Public Service and Administration for Cabinet approval but the challenge was that the budget cuts were getting worse, Dr Buthelezi concluded.
24-hours written responses
Co-chair Dr Dhlomo asked that in order that Deputy Minister of Health could respond directly on some of the issues, that many of the questions would have to be answered by DOH in writing by noon the following day. However, Dr Dhlomo noted that the overriding question was the conflict between the AG’s damming report on accountability in contrast to the presentation of the annual report by DOH, who described their performance as moderate to good.
He followed this up by bluntly stating that the Auditor General’s Office had told him earlier to the meeting “that if they had not written to DOH advising them to carry out some material adjustments, the Department would have moved from an unqualified to a qualified’ audit outcome. He said this was not acceptable as a situation. Dr Dhlomo asked the Minister to speak to this.
Deputy Minister Phaala responded that notwithstanding all the derogatory comments, DOH had now received a successful unqualified report and this waswhat was required by the PMFA. It would now be the task of the Department and the Ministry to deal directly with the underlying problems outlined by AGSA on the issues and which had led to the criticism in the meeting.
At this Naledi Chirwa interrupted angrily on a point of order stating that the AG had been reporting to Parliament and not to the Minister or DOH. Dr Dhlomo hastily intervened and said DOH would be answering all questions.
Boots not dirty
Minister Phaala repeated that of the R52bn in annual appropriation to provinces and NGOs, approximately R48bn was in straight transfers with only about R3bn being spent by the national department itself. He agreed with MPs that DOH should be judged on the performance as a composite with all the provinces, but the DoH system did not function in this way on individual issues nor could they be expected to know detail, since to run the functions was the responsibility of provinces and municipalities.
The Minister said that non-achievements of targets did not mean that nothing was done at all. In some cases, it may just be that the project was not brought to completion in time for the completion of the financial year but stood at 99%. In the eyes of AGSA, he said, that was non-achievement and tagged accordingly. Accordingly, DOH would be unable to get a completion certificate from AGSA, meaning the entire cost of the project was not concluded.
Hands off systems
If such functions were not completed, it was the Minister’s view that this was not necessarily a bad reflection on DOH since it would be impossible for DOH to take over these functions directly. The Minister said many functions, or whatever the task was and wherever it took place, was not always properly structured for the reporting system — for example, in the case of 650 students studying for an exam, if only 646 passed this was considered as a non-performance, or a target missed, he said.
The Minister said to get all these performance reports in from all provinces representing R52bn in expenditure in time for the DOH annual report was a major problem and discussions had to take place with AGSA on the system used to supply report-backs timeously and in line with accounting requirements.
On wasteful and irregular payments, he agreed this was a different matter and that situation could not be allowed to continue. He assured members that the CFO of DHO was to handle each and every question. He qualified this however buy saying it had been an unusual year “where it was unavoidable that certain things had to be done in emergency situations.”