Motsoaledi addresses hand, foot, and mouth disease concerns

Health Minister Aaron Motsoaledi, during a virtual briefing to the Parliamentary Portfolio Committee on Wednesday, addressed growing public concerns about the hand, foot, and mouth disease outbreak affecting schools in KwaZulu-Natal and other provinces.

“There’s been worry or panic because people all over the world are wary of pandemics because of what Covid did to us,” Motsoaledi explained.

“When they hear food and mouth disease going to people, they might think it’s a zoonotic disease, meaning diseases that move from animals to people. This is not a zoonotic disease.”

Hand, foot and mouth disease

Motsoaledi emphasised that hand, foot, and mouth disease affecting humans is caused by a different virus than the one affecting livestock.

“It affects mostly children the age of five and under. It’s a self-limiting disease that goes away on its own within a week or 10 days. The problem here is pain, so you treat only the symptoms because, as a virus, it doesn’t really have any treatment nor does it really need it.”

According to the latest statistics, KwaZulu-Natal has reported 120 cases in the eThekwini metro, 25 in iLembe district, 20 in uGu district, and three cases in another district.

Committee member Michelle Clark confirmed the minister’s description while sharing her personal experience.

“Both my grandchildren have this disease at the moment and many children in their school in Cape Town have been sent home for 10 days. It’s exactly what the symptoms are — blisters around the anal canal and on their legs, very painful to eat. But they’re not really sick from it, just very uncomfortable and painful.”

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Department’s performance overview

During the meeting, the Department of Health presented its performance for the first three quarters of the 2024 financial year.

Director-General Dr. Sandile Buthelezi reported that the department achieved an unqualified audit opinion in the previous period and aims for a clean audit in the next cycle.

The department exceeded targets for health promotion messages and ministerial facility visits, although it fell short on other targets.

Buthelezi acknowledged challenges in meeting employment equity targets, particularly for women at senior management level (47.5% against a 50% target), youth employment (well below the 30% target), and persons with disabilities (0.1% against a 2.5% target).

Portfolio committee members expressed concern about these figures, with MK party MP Patrick Motobatse stating: “We cannot be talking about us not meeting the targets [especially] on people with disabilities. I think that’s a shame on ourselves.”

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NHI progress

On the National Health Insurance (NHI) programme, Buthelezi reported progress on implementing various frameworks and systems necessary for its implementation.

He said the department is talking to the South African Medical Association regarding the capitation model for primary healthcare.

“The people that would be mainly affected in terms of the primary healthcare services are the GP groupings and representative bodies, hence the medical association, as we’ve already started with the consultation,” he explained.

The electronic medical record system has progressed to beta testing in multiple provinces, including Free State, Northwest, Northern Cape, and KwaZulu-Natal, initially focusing on HIV and TB modules.

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TB crisis continues despite being curable

Motsoaledi emphasised the severity of tuberculosis as a public health crisis, noting its devastating historical impact.

“TB is curable, but it has killed more people than all the infections added together. It has killed more people than HIV/Aids itself, than cholera, than ebola, than even Covid-19, yellow fever… TB killed more people than all of them,” the minister stated.

He explained that TB remains difficult to address because “it is a silent killer… it’s not a drama queen, it doesn’t come dramatically, it comes very slowly”.

This makes it challenging to generate public concern.

The department also reported a TB cure rate of only 67% for drug-sensitive TB, which portfolio committee members described as “shockingly low”.

Meanwhile, Buthelezi expressed concern about tuberculosis treatment outcomes, noting that both drug-susceptible and drug-resistant TB treatment success rates fell below targets.

He explained challenges in the diagnostic process. “Ideally, because we now use a GeneXpert to diagnose TB, a person gets a sputum test, you do the GeneXpert within three hours, you get the result, and you initiate the person on treatment. But the problem is that the GeneXpert is only available in hospitals.”

DA MP, Dr. Karl le Roux, suggested more aggressive approaches. “The biggest issue is that we’re not doing any active case finding. We’re doing very little household contact tracing and also very little campaigns like X-ray campaigns of people.”

To try and address these gaps, the department said it was implementing an SMS notification system to alert patients about their test results.

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Department of Health staffing challenges

Buthelezi revealed significant staffing gaps in the public healthcare sector.

As of 31 January, there were 3 433 unfilled doctor positions out of approximately 25 500 positions.

For nursing staff, 135 136 positions were filled out of the 157 000 that are available.

The employment of young healthcare workers remains challenging nationwide.

Buthelezi explained that provincial recruitment plans are developed annually but remain subject to budget availability.

Circular 49, issued by the Department of Public Service Administration (DPSA) and National Treasury in late 2023, has complicated recruitment efforts.

“For any position that gets vacated through whatever means of attrition, that position immediately gets frozen. Then you need to apply to DPSA to be able to unfreeze the position,” he explained.

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Department of Health financial performance

Chief Financial Officer Mamogale Phaswa presented the financial aspects of the report, noting that the department’s total budget stands at R62.2 billion.

By the end of the third quarter, overall expenditure was tracking at about 67% for compensation of employees, 53% for goods and services, and on track for conditional grants.

Phaswa explained the underspending on personnel: “By the beginning of the financial year, we had around 101 posts which were prioritised for filling, but due to austerity measures and the process that we then follow with the National Treasury and DPSA, only 60 posts were approved, and of those 60 posts, we managed to fill 51 posts.”

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The director-general concluded by presenting the department’s overall performance against its 43 indicators.

The achievement rate improved from 40.6% in the first quarter to 48.5% in the second quarter and 63.6% in the third quarter.

“We are working hard that in the last quarter, when we do our final report, we will be better than 63.6% in terms of achieving the targets,” Buthelezi assured the committee.

The Committee Chairperson Dr. Sibongiseni Maxwell Dhlomo noted that the National Health Laboratory Service (NHLS) had submitted its previously delayed annual report, which had been held up due to a cyberattack on their systems.

The committee agreed to schedule a separate session to review this report in the coming weeks.

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