01 Sep 2024

Assistant Minister for State President, Honourable Boitumelo Gofhamodimo has told Parliament that a task force is in place to relocate some aspects of primary healthcare services to the Ministry of Local Government and Rural Development.

Ms Gofhamodimo said this when contributing to a debate on the motion which was recently tabled before Parliament by Takatokwane MP, Mr Friction Leuwe, which requested government to consider relocating primary health care services from the Ministry of Health to local government.   

Ms Gofhamodimo said the task force encompassed officials from both the ministries to explore the modalities and aspects of services that could be transferred.

Giving a detailed background relating to the relocation exercise, she said a government notice of March 30, 2022 was published in the Government Gazette dated April 22, 2022 that primary health care services be restored back to local government and rural development ministry.

“The gazette was announcing the decision relating to rationalisation of government portfolio responsibilities. The change was to be effected on April 1, 2022. However, the decision was yet to be put into operation, as subsequent to the above decision variations were proposed and some were approved following representations from some ministries regarding allocation of some responsibilities,” she said.

She said the move led to issuance of another Presidential Directive in September 2022, varying some of the original decisions.

She added that the Ministry of Health was among those that submitted a varied recommendation, proposing to retain primary health services so as to maintain a continuous health care delivery coordinated under one entity to enable sharing of the limited resources at all levels of care.

“The decision of the Ministry of Health was influenced by that primary health care by nature was broad, encompassing so many aspects including community health services which was looking at issue of disease control and surveillance, environmental health and school health,” she added.

She further said the other element of primary health care was integrated health which included issues of Sexual Reproductive Health (SRH), nutrition, oral and dental health, community rehabilitation and punitive services.

Another area under primary health care, she said covered clinical support services such as laboratory services, pharmacy, among others.

“Health professionals are similarly broad based including cadres that deliver public health, clinical care and supportive functions such as radiology, pharmaceutical, dental and medical laboratory services. Hence it is perceived at the time to be an ill-conceived decision which was difficult to operationalise,” she said.

Nonetheless, she said with the new developments that took place recently, particularly the decentralisation policy, there had been some re-consideration of the matter in line with what the motion was proposing.

She said in 1978, government adopted primary health care strategy as the main approach to delivering health care services in the country. She said the strategy was deployed through the two ministries.

“The Ministry of Health was responsible for health policies formulation, development of standards care and guidelines and provision overall oversight of all health matters in the country,” she said.

She added that all public hospitals, be it referral, district and primary hospitals were under the direct supervision and management of the health ministry.

“In addition to the above functions, the Ministry of Health also served as an important link between all the international and regional organisations and agencies for alignment of policies on all matters relating to health. In accordance with the health policies and guidelines developed by the Ministry of Health, the then Ministry of Local Government and Lands through its districts, cities and town councils was responsible for planning, evaluation and providing basic health services for people resident in their respective areas through the Department of Primary Health Care Services,” she explained.

The ministry, she said was responsible for general coordination and supervision of all health services provided at the local level and also had the responsibility to employ and develop health professionals in accordance with identified health service delivery needs at the local level as well as provide the required infrastructure and all other related resources.

Furthermore, she said district health services were coordinated and managed by the Department of Public Health in councils under the supervision of the chief executive officer, being the council secretary.

“At that time, it was public clinics, health posts and mobile stops only that were under the then Ministry of Local Government and Lands,” she said.  

She said since then, primary health had evolved over time and had become broad with specialties and professionals under the many different areas that it encompassed.

However, she said in 2010, through a Presidential Directive, the said primary health services were transferred to the Ministry of Health, mainly to create a single health authority in the country and improve overall health service delivery.

Under the new dispensation, she said clinics, health posts, mobile stops, hospitals and all districts came together and formed District Health Management Teams (DHMTs) under the Ministry of Health. She said since then, primary health care delivery had been provided by the Ministry of Health at all levels of primary care, secondary care, tertiary care and quaternary care.

Therefore, she supported the motion, but proposed that it be amended to consider relocating clinics, arguing that primary health care services was broad.

Minister of Local Government and Rural Development, Honourable Kgotla Autlwetse, also supported the motion and reiterated that a task force was working on the issue. 

Assistant Minister of Health, Honourable Mr Sethomo Lelatisitswe said proposed amendment to the motion was to direct it to focus on the concerned aspect, which was clinics and the services that they provided. Ends