The National Health Act

In the previous article we covered chapters 1 to 6. Anso Thom, reports for the Healthe News Service.

Chapter 7 deals with Human Resources Planning and Academic Health Complexes.

The Act mandates the National Department to develop a human resources policy and guidelines to ensure adequate distribution of health personnel, to provide for trained staff at all levels of the health system and to ensure the effective utilization of health personnel.

Section 50 provides for the establishment of a Forum for Statutory Councils. An informal statutory health council comprising of the chairpersons of all the professional health councils have been working on a transformation agenda.

Most of the statutory professional health councils have made significant progress to transform their councils in line with the objectives of a new national health system.

However, there will be a delay in the immediate establishment of the Forum of Statutory Councils as the various councils will have to convene meetings to elect their representatives on the Forum and make their nominations to the Minister.

Section 51 allows for the establishment of academic health complexes consisting of health and educational institutions working together to educate and train health care personnel and to conduct research in health services.

Academic Health Complexes, which the minister is mandated to establish in consultation with the Minister of Education, will be implemented towards the middle of 2005.

Section 52 mandates the National Health Council to develop policy and guidelines to monitor the provision, distribution, development, management and utilization of human resources within the national health system.

This will be implemented immediately.

There is another chapter, chapter 10, that deals with inspections of health establishments and compliance with basic norms and standards. The provinces are required to create inspectorates to monitor compliance with the provisions of the Act.

This chapter will be implemented immediately with the exception of Section 83 which deals with environmental health investigations.

Regulations still need to be drafted for this section to take into account the latest definition of Municipal Health Services and to attend to regulations dealing with disease surveillance and the notification of medical conditions. This section will come into effect next year.

The Director-General must create, within the Department of Health, an Office of Standards Compliance.

The Office of Standards Compliance will be responsible for monitoring and enforcing compliance with the quality requirements and standards prescribed by the Minister with regard to human resources, health technology, hygiene, premises where health services are delivered, business practices, etc.

In accordance with its nature as framework legislation, the Health Act regulates every aspect of health service delivery in South Africa.

It does not regulate health professionals in the area of their professional competence and skill because this is the role of the statutory professional councils.

It does, however, regulate the premises from which they practise and can also regulate the business or commercial aspects of their practice.

Chapter 8 deals with complex issues such as the control of use of blood, blood products, tissue and gametes in humans.

Tshabalala-Msimang stressed the importance of regulating this aspect of health care services as the department receives reports about the sale of human organs for transplantation in South African private hospitals and the purchase of human ova from young South African girls for implantation into foreign nationals so that they can have children.

The Act stipulates that criteria for the approval for organ transplant facilities must be prescribed by the Minister together with procedures to be applied for such approval.

Section 53 empowers the Minister to establish a national blood transfusion service and this section will come into effect as soon as possible in order to ensure a sustainable supply of safe blood and the availability of quality blood products nationally.

The minister stated that she did not want to see any commercialization of the blood transfusion service and therefore a license for providing this service would be granted to a non-profit organization.

This chapter also deals with the issue of human cloning. The manipulation of any genetic material for the purpose of reproductive cloning of a human being is prohibited. Cloning for therapeutic purposes is provided for in the Act but under controlled conditions.

The Minister may permit therapeutic cloning using adult or umbilical cord stem cells under prescribed conditions. Research on stem cells and zygotes which are not more than 14 days old may be conducted with the permission of the Minister and on certain conditions.

This section will be implemented around the middle of next year and in the meantime, the Tissue Act will remain in force until the new regulations are effective.

In Chapter 9, the Act provides for the establishment of a National Health Research Ethics Council and Health Research Ethics Committees at every institution, health agency and health establishment at which health research is conducted.

The section relating to the establishment of the National Health Research Ethics Committee and Health Research Ethics Committees will be implemented immediately after proclamation.

The Act provides for the co-ordination and establishment of a national health information system by the National Department of Health. The Minister may prescribe the categories of information that must be submitted to the Department and the manner and format in which the information must be compiled.

The National Health Act permits the regulation of health service delivery in a number of different respects.

It allows the department to put strategies into place to develop and retain human resources for the health sector.

It also gives the department a vehicle for the control of the quality, efficacy and safety of health practices and services.

Tshabalala-Msimang said this section would ensure that health research that is carried out is worthwhile and addresses the health priorities of the country.

The question of emergency medical treatment can be addressed from a number of different perspectives such as quality and safety but also in terms of licensing issues and the different levels of emergency medical services that may be rendered at different types of facilities.

Regulations can also be made on the processes and procedures to be implemented by the Director-General, in order to obtain prescribed information from stakeholders relating to - health financing, the pricing of health services, business practices within or involving health establishments, health agencies, health workers and health care providers, the form and extent of publication of various types of information, etc.

The idea is to expressly authorize the investigation of the health sector from the point of view of a wide range of business practices, including the setting of tariffs, in order to better inform the public and also the licensing process that is contemplated in the National Health Act.

Health establishments that are engaged in practices that are detrimental to consumers or that unjustifiably restrict access to health care services can expect to be dealt with under the licensing system provided for in the Act.

Perverse incentives add to the costs of health care without adding to the health care itself. In this sense, perverse incentives deprive people of health care because the resources that should have gone to expanding access to services have instead lined the personal pockets of a few individuals.

Chapter 11 will come into effect immediately after proclamation because it empowers the Minister to make regulations on many of the issues that have been mentioned.

Finally, chapter 12 will also come into effect on proclamation in order to empower the Minister to appoint advisory and technical committees, to assign duties and delegate powers and to prescribe transitional arrangements as may be necessary to effect a smooth transition and introduction of various provisions of this Act.