National Health Bill

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National Health Bill
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Purpose of National Health Bill (NHB)

• Legislative and Regulatory framework for delivery
  of health services
• Creates uniformity by establishing norms and
  standards
• Preamble
• Firmly entrenched in the Constitution
• Clearly states intention of Bill
• Emphasizes women and children

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Definitions

• Complex
• If appears once, defined in the chapter
• Most complex
• Municipal Health Services
• Emergency Treatment
• Cannot define what constitution has not defined
• Emergency treatment too complex advised that it
  should be defined in regulations

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Constitutional Complexity
S85(2) President Cabinet exercises executive
authority -implementing national legislation,
developing and implementing national policy,
preparing and initiating legislation, performing
any other executive function provided for in the
Constitution or in national legislation etc
S125 Premier MECs exercise executive authority
-implementing national legislation within Sch 4
5 functional areas
Schedule 4 Part A Health services a functional
area of concurrent national and provincial
legislative competence
National sphere
154(1) The national and provincial governments,
by legislative other measures, must support and
strengthen the capacity of municipalities to
manage their own affairs, exercise their powers
perform their functions.
S125(5) Subject to section 100, implementation
of provincial legislation in a province is an
exclusive provincial executive power
Provincial sphere
S151(4) The national or a provincial government
may not compromise or impede a municipality's
ability or right to exercise its powers or
perform its functions.
S151(3) municipality has the right to govern, on
its own initiative, subject to national and
provincial legislation.
Municipal sphere
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Frameworks in the Bill
6. Health establishments 7. Human Resources 8.
Human Tissue 9. National Health Research 10.Hlth
Officers Compliance 11. Regulations
2. Rights duties of users and providers 3.
National health structures 4. Provincial health
structures 5. District health system
Constitution
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Ch 1 - Objects

• Clearly states intention of creating national
  health system, encompassing public and private
• Within available resources
• Responsibility vested in Minister as member of
  Cabinet
• Categories of persons eligible for free health
  services

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Ch 2 Users Rights

• Emergency treatment is mandatory
• User to be fully informed of health status by
  provider (s6)
• Users right to participate in decisions even if
  someone else must give informed consent (s8)
• Provision for treatment with and without informed
  consent (s7 9)
• Discharge reports must be given to the user

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Ch 2 Users Rights

• Users must be adequately informed if health
  services are for research or experimental
  purposes (s11)
• Duty to disseminate information (s12) on health
  services at national, provincial and local level
• Health records to be created and maintained by
  health establishments (s13)
• Confidentiality of health records (s14)
• Access to health records (s15,16 17)
• Complaints procedures to be put in place by the
  MEC (18)

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Co-operative Government

• Section 41 of the Constitution
• All spheres of government must exercise their
  powers and perform their functions in a way that
  does not encroach on the geographical, functional
  or institutional integrity of government in
  another sphere

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Co-operative Government

• Spheres of government must co-operate with
  one another in mutual trust good faith by
  fostering friendly relations assisting
  supporting one another, informing one another of,
  consulting one another on, matters of common
  interest co-ordinating their actions
  legislation with one another adhering to agreed
  procedures avoiding legal proceedings against
  one another.

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Ch 3 National Structures

• Functions of national department of health (s 20)
• National Health Council (MINMEC) (s21)
• NHC functions as an advisory body
• National Health Advisory Committee (PHRC) (s23)
• NHAC reports in to NHC, co-ordinates policy
  implementation etc (s24)
• National health plans prepared by DG (s25)
• National Consultative Health Forum must meet at
  least once every two years (s26)

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National - Schematic
Minister
National Health Council (NHC) Minister, MECs, 1
Municipal Councillor (SALGA), DG and DDGs, HODs,
official of SALGA, SAMHS. Advises the Minister on
health policy, health of the population. May
consult with anyone. Minister to convene first
meeting within 60 days
National Health Advisory Committee (NHAC) DG,
DDGs HODs SAMHS, number of SALGA reps to be
determined by NHC. Must at the request of NHC
investigate consider health matters, report
findings to NHC, make recommendations to NHC,
co-ordinate policy implementation, ensure
integration of national and provincial health
plans etc
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Ch 4 Provincial Structures

• Functions of provincial health departments (s27)
• Provincial Health Council consists of MEC,
  municipal councillors, HOD (s 28)
• Advisory function to MEC (s29)
• PHAC consists of HOD, SALGA rep and reps from
  local government (s30)
• Provincial health plans to be prepared by HODs
  (s32)
• Provincial consultative bodies must be
  established by MEC (s33)

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Provinces - Schematic
MEC
Provincial Health Council (PHC) s 28 MEC, 1
councillor from each metropolitan and district
municipality in province, HOD, not more than 3
SALGA officials. Advises MEC on inter
governmental policy within the province, proposed
legislation on health matters, guidelines for
management of health districts, implementation of
national health policy, etc
Provincial Health Advisory Committee (PHAC)
s30 HOD, 1 SALGA rep, number of local
government reps. Must investigate consider any
health matter report findings to PHC, makes
recommendations to PHC on health matters,
co-ordinates implementation of intergovernmental
policy, ensures integration of national and
provincial health plans etc
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Ch 5 District Structures

• Boundaries of health districts coincide with
  district and metropolitan municipal boundaries
  (s34)
• Health districts may be divided by MEC into
  sub-districts with the concurrence of MEC for
  local government (s35)
• MEC to establish district health councils for
  every health district (s 36)
• Provincial legislation must provide for
  functioning of district health councils etc (s
  36(4))

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Ch 5 District Structures

• Municipal health services to be provided by
  metropolitan and district municipalities (s37)
• SLAs to be entered into in terms of s156(4) of
  the Constitution, between provinces and
  municipalities for the provision of services by
  municipalities (s 37)
• District health plans to be prepared by district
  and metropolitan municipalities (s38)
• Transitional arrangements service level
  agreements (s 39)

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Ch 6 - Health Facilities

• Classification of health establishments by the
  Minister according to function, size etc (s40)
• Certificate of need (max 10 years)
• Regulations relating to CON by Minister (s44))
• Provision of health services at public health
  establishments (categories of users forms of
  treatment, revenue retention, user fees)(s44)
• Provincial legislation must provide for a
  committee for clinics community health centres

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Ch 6 - Health Facilities

• Minister may prescribe standards and requirements
  for the provision of health services at
  non-health establishments (s48(1))
• Provincial legislation must provide for health
  services at health establishments in the province
  other than hospitals (s48(2))
• Minister can regulate traditional circumcisions
  and traditional medical practice from a health
  perspective (s48(3) and(4))

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Ch 7 Human Resources

• NHC must develop policy guidelines for provision
  and distribution of human resources within NHS
• Minister determines guidelines for programmes for
  the appropriate distribution of human resources
  (s54)
• Forum of Statutory Councils created regulates
  professional health councils, ombuds role (s55)
• Minister may establish academic health complexes
  in consultation with Minister of Education (s56)
• Regulations regarding human resources (s57)

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Ch 8 Human Tissue

• National blood transfusion service established (s
  58) by granting of a licence by Minister
• Authorised institutions may acquire use tissue
  (s59)
• Prescribed conditions for the removal of tissue
  (s60)
• Prohibition on reproductive cloning (s62)
• Therapeutic cloning may be permitted under
  controlled conditions (s62)
• Control of removal, use transplantation of
  tissue (s63)
• Trade in human tissue prohibited (s65)

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Ch 8 Human Tissue

• Allocation and use of human organs controlled by
  regulations (s66)
• Donation of bodies and tissue by a will, by DG
  (s67)
• Purpose of donations eg training, research,
  health science advancement, therapy (s69)
• Post mortem examinations regulated (s71)
• Provision for various regulations eg withdrawal
  of blood, acquisition utilisation of tissue
  (s73)

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Ch 9 Health Research

• National Health Research Committee established
  (s74)
• NHRC identifies advises Minister on health
  research priorities (s75)
• Regulation of research on adults minors (s76)
• National Health Research Ethics Council
  established (s77)
• Every institution, health agency/ health
  establishment must have access to a health
  research ethics committee (s78)

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Ch 9 Health Research

• Provinces and municipalities and the private
  sector must establish, implement and maintain
  health information systems in order to create a
  comprehensive national health information system
  (NHIS) (s79)
• National department to facilitate and co-ordinate
  NHIS
• Minister can prescribe kinds of data, manner and
  format for NHIS (s79(2))
• MEC must establish a committee for the health
  information system at provincial and local level
  (s80)

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Ch 10 - Compliance

• Inspectorates for health establishments to be
  created by MECs to monitor and evaluate
  compliance and submit quarterly reports (s82)
• MEC to submit annual report to Minister
• Office of Standards Compliance to be established
  by DG within national department (s83)
• OSC fulfils an advisory and monitoring function
  and interacts with provincial health
  inspectorates (s83)

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Ch 10 - Compliance

• OSC must (s83 and 84)
• Advise Minister on compliance with quality norms
  and standards
• Report on standards violations causing public
  health risks
• Conduct inspections re certificate of need
  conditions
• Institute processes for monitoring and ensuring
  quality control advise on quality of care
  provided by health establishments
• Prepare an annual report to the Minister

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Ch 10 - Compliance

• Minister MEC appoint health officers (s85)
• Duty of health officers monitor enforce
  compliance with the Act (s86)
• Routine inspections by health officers (s87)
• Environmental health investigations (s88)
• Entry and search of premises by health officers
  (ss 89, 90 91)
• Items seized to be given to police officials
  (s92)
• Offences eg obstructing a health officer (s94)

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Ch 10 - Compliance
National Office of Standards Compliance (s83) (or
agents) must monitor and inspect HEs HAs for
compliance. Can instruct HOs to inspect HEs and
has to investigate complaints and report to DG
Provincial Health Inspectorates (s82) Must
monitor, evaluate report to MEC on compliance
with Act by HEs and HAs operational issues
Health Officers (s85) Appointed by Minister, MEC
to operate at national or provincial or district
level. Must monitor and enforce compliance. Does
routine and environmental health inspections
(s88), entry, search and seizure (ss 89, 90,
91,92). Can be a member of SAPS
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Ch 11 Regulations (s95)

• Fees payable to Public Health Establishments
• Norms and standards for protective clothing
• EDL and medical and assistive devices
• Human resource development
• Emergency medical services and emergency medical
  treatment inside and outside of health
  establishments

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Ch 11 Regulations (s95)

• Health nuisances and medical waste
• Functions of persons who render voluntary or
  charitable services in Public Health
  Establishments
• Rehabilitation
• Health technology
• National health information system
• Communicable and non-communicable diseases

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Ch 12 - General

• Minister may appoint advisory and technical
  committees (s96)
• Minister may assign duties and delegate powers to
  any person in the employ of the State or to any
  council or committee established in terms of the
  Bill (s97)
• Repeal of laws (s98)
• Minister may prescribe transitional arrangements
  to effect a smooth transition between the old
  laws and the Bill (s98)

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Concluding Comments

• The most important Bill for governance in the
  health sector
• Truly embedded in the constitution
• Entrenches patients rights
• Facilitates services delivery
• Ensures quality standards and norms and effective
  compliance
• Reduces inequity through better integration and
  coordination between all roleplayers