19 April 2005
Ten of the 12 chapters of the National Health Act (Act No 61 of 2003) will come into effect either completely or in part on May 02, 2005 after the Act was proclaimed by President Thabo Mbeki in the Government Gazette published yesterday.
This Act replaces the last trace of apartheid in health policy – the Health Act of 1977. It also provides a framework for a structured uniform health system in order to unite the various elements of the national health system in a common goal to improve universal access to quality health services, taking into account the obligations imposed by the Constitution.
This Act rests heavily on the Constitution which, amongst other things, requires the State to take reasonable legislative and other measures to progressively achieve the right of access to health care services, and reproductive health care, within its available resources. The Act covers various issues contained in the Bill of Rights including:
The National Health Act is regarded as the single, most important piece of legislation for the health sector. It is framework legislation, which means that it sets out broad legal and operational principles that must be fleshed out in regulations.
Today’s proclamation puts into effect mainly those sections that do not require regulations for them to be implemented. The sections that come into effect on May 02 are the following:
Chapter 1 which identifies the objects of the Act andsets out the responsibility of the Minister of Health to maintain stewardship of the National Health System and to protect, promote and maintain the health of the population. It further consolidates the principle of free health care to those who cannot afford it, in particular, women, children, older persons and persons with disabilities.
Chapter 2 brings in some of the transformative elements of this Act which aim to restore the dignity of every user of health services. This chapter gives emphasis to:
This Chapter is proclaimed with the exception of section 11, because regulations and guidelines have to be developed to set parameters and criteria for conducting experimental and research work in health establishments.
Chapter 3 describes the general functions of the national Department of Health and the Director General. It establishes the highest policy body in health which comprises the Minister of Health, the MECs for Health and representatives of local government. This body which used to be known as the Health MinMec will now be called the National Health Council.
Under this chapter a National Consultative Health Forum must also be established by the Minister of Health. The Minister will consult with this forum of stakeholders in the health sector to promote and facilitate communication and the sharing of information on national health matters, thus giving meaning to the people’s contract that government is promoting in all sectors of society.
Chapter 4 establishes provincial health services and outlines the general functions of provincial health departments. It establishes Provincial Health Councils in all the provinces. Each MEC for health is required to establish a consultative body in each province that is the provincial equivalent of the National Consultative Health Forum.
Chapter 5 establishes the District Health System based on the principles of primary health care. The district health system provides for health service delivery by the municipal sphere of government through the use of district health councils. Every metropolitan and district municipality is required to ensure that municipal health services are provided in their areas. In addition they are required to continue to provide the health services they had provided previously until agreements are concluded with the provincial health authorities as to how health service delivery should be divided between the provinces and municipalities. To give effect to these principles, this chapter provides for a planning framework for health services, governance and consultative structures.
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.
This chapter is proclaimed with the exception of section 50 and 51 which provides for the establishment of a Forum for Statutory Councils and academic health complexes. These bodies will not be established until these sections are brought into effect at a later stage.
Chapter 9 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 proclamation excludes section 71 which, for its implementation, requires regulations that prescribe conditions under which research on a living person may be conducted. This chapter also requires the establishment of a comprehensive national health information system data for which will be drawn from national, provincial and local government and the private sector.
Chapter 10 provides for the appointment of health officers within all three spheres of government to monitor and enforce compliance with the Act. The proclamation excludes a significant section of this chapter dealing with infrastructure that must still be set up, including the establishment within the National Department of Health of the Office of Standards Compliance and establishment by the MECs of provincial inspectorates.
Chapter 11 also comes into effect on May 02 because it empowers the Minister to make regulations on many of the issues covered by the Act.
Lastly , Chapter 12 empowers 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. It comes into effect only partially in order to allow for certain sections of the Health Act of 1977 to remain in place until government is ready to implement the replacing sections of the National Health Act.
Chapters that are not yet proclaimed are chapters 6 and 8.
Chapter 6 deals with one of the most innovative elements of the National Health Act – classification of health establishments, the certificate of need, the establishment of boards for hospitals, clinics and community health centres, the relationship between the public and private health establishments. The objectives of this chapter are:
The draft regulations relating to this chapter are going to be published for public comment. We urge all health stakeholders and other interested parties to submit their comments to ensure that their input is considered when these regulations are finalised. We are committed to ensure that this becomes an inclusive process that assists us to achieve our health objectives as a country.
Chapter 8 deals with complex issues such as the control of use of blood, blood products, tissue and gametes in humans. The draft regulations relating to this chapter are being processed and will be published for public comment in due course before this chapter is proclaimed by the President.
The proclamation of the National Health Act is an important step forward in the transformation of the South African health sector. We therefore intend to use this Act to achieve our policy objectives and improving access to quality health care services for all.
Contact: Sibani Mngadi @ 0827720161