THE NATIONAL HEALTH BILL (2003)

1. THE NATIONAL HEALTH BILL (2003) Duane Blaauw

2. Presentation • The framework of health legislation • Origins of the NHB • Status of the NHB • Objectives of the NHB • Overview of the NHB • Key provisions of the NHB • Conclusions

3. The Framework of Health Legislation • NON-HEALTH LEGISLATION • Constitution • Local government legislation • Labour legislation • Public service legislation • Occupational Health • OHSA 1993 • MHSA 1996 • COIDA 1993 HEALTH LEGISLATION • Other • MRC Act 1997 • Provincial Acts • Specific Issues • Mental Health Act 2002 • Child Care Act 1983 • Choice on TOP 1996 • Sterilisation Act 1998 • Tobacco Products Control Act 1998 • Environmental Health • Hazardous substances Act 1973 • Foodstuff, cosmetics & disinfectants Act 1972 • International health regulations • National Health Bill 2003 • Private Medical Schemes • Medical Schemes Act 1998 • Health Professions • Health Professions Act 1974 • Nursing Act 1959 • Pharmacy Act 1974 • Drugs • MRSCA 1997

4. Origins of the NHB ANC Health Plan 1994 Towards a NHS 1995 Health White Paper 1997 National Health Bill 2003 Public Health Act 1919 Health Act 1977 Human Tissue Act 1983

5. 1995 § 2001 20 Jun Policy development and drafting starts § Introduced into parliament 2003 18-19 Aug § Public hearings 27 Aug § Amendments by Health Portfolio Committee 30 Sep § Amendments by Social Services Select Committee 18 Nov § Passed by NCOP 26 Nov § Passed by National Assembly § Referred to President for signature 2004 ?? § National Health Act Status of the NHB

6. Objectives of the NHB • Fulfil the Constitutional obligations of government with regard to rights related to health care services • Establish an integrated National Health System based on: • Cooperative governance • Decentralised management • Co-operation between public and private sectors • National norms and standards

7. Overview of the NHB • Eligibility for free health care services • Rights and duties of users and providers • Organisation and functioning of the national health system • Allocation of functions • Functioning of health establishments • Creation of new structures • Importance and coordination of planning • The use of human tissue • Health research and health information • Compliance and inspection • Regulatory powers

8. Eligibility for Free Health Care • Determined by Minister of Health in consultation with Minister of Finance • After considering: • Existing criteria for free health care • Impact on access to health services • Needs of vulnerable groups • Nevertheless stipulates • Pregnant women & children under 6 years • TOP services • PHC services for people receiving compensation for occupational diseases (Excluding members of medical schemes)

9. Rights of Users / Duties of Providers • Emergency medical treatment • Information about their health and treatment • Participation in decisions about their health and treatment • Not to be treated without informed consent • Confidential medical records • Discharge reports • Complaints procedure

10. Duties of Users • Adhere to the rules of the establishment • Provide health care providers with accurate information about their health status • Cooperate with health care providers • Treat health providers with dignity and respect • Sign release of liability if refuse treatment

11. Rights of Providers • No unfair discrimination on account of their health care status • But may have conditions imposed on their service • Can refuse to treat users who: • Are physically or verbally abusive • Sexually harasses them

12. Promote, protect, improve and maintain the health of the population • Promote the inclusion of health in socio-economic development planning • Ensure the provision of essential health services • Equitably prioritise State health services • 23 functions, including: • Plan development of public andprivate hospitals • Provide specialised hospital care • Quality control • Support districts • 12 functions, including: • Identify national goals & priorities • Develop norms & standards • Coordination • Promote community participation • International liaison • Provide municipal health services • Water & sanitation • Food control • Health surveillance • Vector control • Assignment of additional functions by Service Level Agreement (SLA) National NDoH Minister Provincial PDoH MEC District DDoH • Require Certificate of Need (CON) • Operate, establish or modify a health establishment or health agency • Issued by NDoH DG • Stipulated criteria • Stipulated procedures • Lasts < 20 years Local LGDoH Mayor Private Sector Facility AHC H GP H C The National Health System

13. National NDoH Minister Provincial PDoH MEC District DDoH Local LGDoH Mayor Facility AHC H C The National Health System • National Health Council • Minister • Deputy Minister • 9 Provincial MECs • 1 SALGA Clr • National DG & DDGs • 9 Provincial HODs • 1 SALGA Official • Head of SAMS • National Health Consultative Forum • Appointed by Minister • Must include relevant stakeholders • Meet yearly Civil Society • Provincial Health Council • MEC • Clr from each Metro • Clr from each DC • Provincial HOD • 3 LG Managers • ? Others • Provincial Consultative Bodies • Appointed by MiEC • Must include relevant stakeholders • Meet yearly District Health Council Person representing MEC Member of Metro or DC Member of each LC 5 MEC appointess • Hospital Board • Appointed by Minister / MEC • NDoH / PDoH rep •  3 community reps •  5 staff / Mx reps •  5 technical experts • Clinic Committee • Require provincial legislation • Must include: • > 1 local Clr • > 1 community rep • Head of clinic

14. Health Planning • Integrated strategic + medium term health and HR planning • National: DG • Provincial: DG • District: District health manager • Obligations on NHC for national HR planning • Establishment of Forum ofStatutory Health Professional Councils Chairpersons + registrars of professional councils 2 NDoH reps 3 Community reps 2 University reps

15. The Use of Human Tissue • Control of the removal, use, transplantation and sale of human tissue: • Organs • Blood and blood products • Gametes • Establish single national blood transfusion service • Prohibition on human cloning • Criteria for post-mortems

16. Health Research • Establish National Health Research Committee •  15 people appointed by Minister • Identify national health research priorities • Coordinate research of public health authorities • Each health institution conducting research to have a health research ethics committee • Review research proposal • Grant approval for all research projects • National Health Research Ethics Council established • Register and audit institutional ethics committees • Set norms and standards for health research

17. Compliance and Inspection • Provincial Inspectorate for Health Establishments • Monitor compliance by health establishments • National Office of Standards Compliance • Set quality standards • 3 yearly inspection of every health establishment • System of health officers • Routine inspections • Environmental health investigations • Entry and search powers

18. Regulatory Powers • 23 areas • Including: • Fees and pricing of services • Notifiable diseases • Essential drugs list • Public-private partnerships • Health information • Emergency medical services • Health technology • Health research

19. Conclusion • Finally have new Health Act!? • Fulfill objectives? • Constitutional obligations • Integrated National Health System • Fragmentary legislative framework • Limited scope for public participation • Capacity to implement?