Summary of the National Health Act, no. 61 of 2003

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This Act aims to realise the rights set out in the Constitution by providing a framework for a structured and quality uniform health system in South Africa. It outlines the laws that govern national, provincial and local government with regard to health services. The Act clarifies the State’s duty to do what it can to address the right to have access to health care services. It recognises that no person may be refused emergency medical treatment and that everyone has the right to an environment that is not harmful to their health.

The aim of the Act is to make sure that everyone has access to equal health services by building a national health system that governs both public and private health services. It sets out the rights and duties of all health practitioners, and protects the right of children to basic nutrition and health care, as well as the rights of vulnerable groups (e.g. women, older persons, and people with disabilities).

Contents

[edit] Who Has the Right to Free Health Services?

Eligibility for free health services varies, and the Ministers of Health and Finance will set conditions based on what services are available, who is already receiving free services, the impact that the condition will have on services and the needs of vulnerable groups. Generally, citizens who are not on medical aid schemes are eligible for free primary health care services (as determined by the Minister), and pregnant and lactating women and children under the age of six are eligible for free health services. All women are entitled to free termination of pregnancy services.

[edit] Rights and Duties of Health Care Workers and Establishments and Patients

Health care workers Patients Health establishment
Establishment rules Health practitioners may not be unfairly discriminated against because of their health status, unless their condition poses a threat to patients. All patients must adhere to the rules of the health establishment and treat health workers with respect. All medical establishments must take measures to minimise disease transmission and to protect workers against injury.
Health care workers have the right to refuse to treat a patient who is physically or verbally abusive towards them. No health care worker or establishment may refuse a person emergency medical care.
Records Any health worker who does not keep accurate and up-to-date records is guilty of an offence. Any patient who provides false information for medical records is guilty of an offence. All health care establishments must keep accurate records on all patients.
Confidentiality Health care workers have the right to disclose information to other practitioners and establishments for legitimate purposes (this includes further treatment and research). For research-related disclosure, consent is required for the release of the identity of the patient. Health establishments must set up measures to prevent unauthorised access to health records.
Treatment All health care workers must inform patients (in a language they understand) of the following:
  • their health status (unless this is thought to be contrary to their best interests),
  • the available treatment,
  • the benefits, risks and costs of treatment, and
  • the patient’s right to refuse treatment.
No service may be performed unless the patient consents to it (except in cases where the patient is unable to give consent, they lack legal capacity, and/or failure to treat them will result in a health risk to the general public). If an establishment cannot provide the necessary treatment, it must transfer the patient to another appropriate establishment that is able to provide treatment.
Research No experimental or research-based health service may be administered without the consent of the patient. Every institution must seek the approval of a health research ethics committee before conducting any research.
Discharge reports When patients leave health establishments, health care workers must provide them with discharge reports (on their treatment, prognosis and the need for follow-up treatment). Outpatients may receive verbal reports, but inpatients must receive a written report. Patients who refuse recommended treatment must sign a discharge certificate or release of liability.
Donations Health care workers may only use bodily fluids and parts withdrawn from a living person for prescribed medical purposes. Tissue, blood, a blood product or gametes may not be removed from a patient’s body without their written consent. Fees for donation or transplant services must not exceed the appropriate costs.
Only registered medical practitioners and dentists may remove tissue from living persons. A person may not sell or receive financial reward for any body part donation. It is, however, permissible to donate body parts. Donated parts may be used for health-related purposes only.
If a patient dies and has not expressed an objection to having their body donated, the family of the deceased may donate their body for medical purposes. Body parts removed from deceased persons may be used only for medical purposes (or to restore mutilated bodies during embalming).

[edit] What Does the Act Say About Complaints?

Any person has the right to lodge a complaint about the way they have been treated by health care providers, and the system for laying complaints must be visibly displayed by all medical establishments.

Each municipal area will have its own system for laying complaints. Private institutions must allow for lodging of complaints with the head of the establishment.

[edit] How Does the Health System Work?

According to the Act, the framework for the health system is based on a decentralised model. This means that power, authority and functions shift away from the national department of health to the provincial departments and then to the health districts.

[edit] National Health

[edit] The Health Minister

The Health Minister must try to protect, promote, improve and maintain the health of the population by determining policies that will ensure the provision of essential health services. This includes making regulations which ensure that adequate facilities are available for the training of human resources.

The national department of health also has a duty to distribute information on available health services (including the type and availability of service, the timetables for visits, the procedures for access and for laying complaints, and the rights and duties of patients and health care providers).

[edit] The Director-General

The Director-General must oversee the implementation of policy and liaise with health departments in other countries to promote adherence to health standards, services and training. The Director-General also sets national health goals and plans (which comply with national health policy), co-ordinates services during national disasters, promotes community participation in the planning and provision of health services, and facilitates pollution control.

[edit] The National Health Council

The National Health Council is an advisory body made up of a required number of experts and representatives. The main function of the Council is to advise the minister on health-related issues to help protect the health of the population. This includes targets and priorities and the means of establishing the effective co-ordination of health services. The Council may create committees to advise it on any matter and must strive to reach consensus on matters. If it cannot reach consensus, the majority decision is taken.

The Council must develop guidelines for the management of human resources, with the aim of achieving the appropriate distribution of health care workers and the provision of appropriately trained staff.

[edit] Forum of Statutory Health Professional Councils

This is a body made up of representatives from all the statutory health professional councils, as well as other health care representatives. The aim of the forum is to protect the interests of the public and to represent the interests of the different health professions in the development of policy. The body advises and updates the Minister on the practices of registered professions.

[edit] National Consultative Health Forum

This general function of this forum is to co-ordinate national health issues between the national department and other relevant organisations.

[edit] National Health Research Committee

This Committee determines the health research to be carried out at public health authorities, making sure that research is focuses on the health needs and problems of the country. The committee helps the Minister to implement an integrated national strategy for research.

[edit] National Health Research Ethics Council and Committees

The Ethics Council advises the Minister on the norms and standards for conducting research on human beings and animals, and every health establishment must have an ethics committee to monitor research proposals.

[edit] Academic Health Complexes

The Minister may establish academic health complexes to conduct research into health services and to train and educate health care practitioners.

[edit] National Blood Transfusion Services

The Minister must establish a single blood transfusion service by granting a licence to a non-profit organisation. Any person who provides blood transfusion without a licence will be guilty of an offence.

[edit] Provincial Health

The relevant member of the executive council must ensure that the national health policy is implemented in their province, and the province must provide specialised hospital services, oversee the funding and support of district health councils, conduct relevant research into health services and manage the development of human resources. The relevant members of the Executive Council are advised and assisted by provincial health councils and provincial consultative bodies on matters related to the health of the population.

Provincial legislation must provide for the functioning of district health councils.

[edit] The District Health System

The health system is further divided into various health districts, whose boundaries coincide with district and municipal boundaries. These districts may be further divided into subdistricts. The health districts are managed by district health councils, whose function it is to promote co-operative governance and to ensure co-ordinated planning by drawing up district health plans. Health services to be provided by municipalities

All municipalities must ensure that appropriate services are provided in their areas. The relevant province and each municipality must draw up a service level agreement, outlining which services the municipality must provide, which resources the State will make available to the municipality and the standards by which services will be monitored.

[edit] Health Establishments

The minister may classify health establishments into appropriate categories depending on their role, location and size, but no health establishment may provide services without a valid licence called a certificate of need.

The Minister of Health may determine the range of services to be provided by public health establishments, and can determine the criteria for admission and referral, as well fees. Fees will vary according to the category of patient and the treatment offered as well as the category of health department. Each hospital must appoint a representative hospital board. Provincial legislation must also allow for the establishment of a committee for clinics and community health care centres, and local government councillors and members of the community must be included in this committee.

[edit] Non-Health Establishments

Non-health establishments and public health establishments other than hospitals that provide health services (e.g. schools) are subject to minimum standards and requirements. The minister may determine what these standards and requirements are.

The Minister may also set the conditions under which circumcision may be performed as part of an initiation ceremony in communities.

[edit] Private Health Establishments

Private and public health establishments may work together in the delivery of health services and can enter into agreements to achieve the aims of this Act. Private health establishments must be sufficiently insured to compensate patients for potential damages suffered as a result of a wrongful act by the establishment’s employee.

Who checks on health establishments?

All health establishments must comply with the standards prescribed by the Minister of Health. This means that they must provide quality services in terms of human resources, technology, equipment, hygiene, business practices, safety, accommodation and all other aspects related to the delivery of health services. The Inspectorate for Health Establishments and the Office of Standards Compliance must monitor and make sure that these standards are met. Each province has its own Inspectorate, and provinces and health districts may appoint health officers to monitor and enforce compliance with the Act. Health officers may enter establishments at any reasonable time to inspect for compliance. They may also enter private premises with a police official (and a search warrant) if they suspect that important information is being held there.

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