Date added: 22 May 1997

Medical, Dental and Supplementary Health Service Professions Amendment Bill, 1997

1. Introduction / Background

The Medical, Dental and Supplementary Health Service Professions Amendment Bill 35 of 1997 was introduced in Parliament by the Minister of Health on 8 May 1997. The Bill amends the Medical, Dental and Supplementary Health Professions Act, 56 of 1974. In summary, it provides for the establishment of the new Health Professions Council of South Africa and the Professional Boards for Health Professions. The Bill abolishes the Interim Medical and Dental Council of South Africa (INMDC) and provides for control over the training, registration and practices of health professionals.

The INMDC was established by legislation (Act 18 of 1995) in July 1995. This Act abolished the South African Medical and Dental Council (SAMDC) and similar councils which existed in the former homelands. The INMDC was directed to draft legislation for a new statutory body overseeing the health professions, outlining its structure and functions. It was charged with amending Act 56 of 1974, "in order to support the universal norms and values of the medical profession, with greater emphasis on: professional practice, democracy, transparency, equity, accessibility, and community involvement". The INMDC was given two years to draft this legislation.

2. Summary of the the contents of the Bill

2.1. Structure and composition of the new council

The Medical, Dental and Supplementary Health Professions Amendment Bill abolishes the INMDC. It outlines the structure and composition of the new council, which will oversee health professions. The new council will be named the Health Professions Council, and will be situated in Pretoria. The name change indicates a change in focus from an earlier council which focused primarily on medical and dental practitioners to one which looks at the interests of all health professions.

The structure of the proposed Council also seems to show this change in focus. Previously, the majority of INMDC members came from the medical and dental sector, and other professions were subsumed under the "Supplementary Health Service" category. The Bill does away with the Supplementary Health Service category and creates Professional Boards for all registered health professions. This bill will put all the health professions on an equal footing and allows each profession to be represented on the Council. Further, there is an increased contingent of public representation on the Council. Table 1 below, compares the structure of the South African Medical and Dental Council (in place until 1995), the INMDC, and the proposed Health Professions Council (HPC). Each member of the Council will hold office for 5 years, and will be eligible for redesignation or reappointment.

Table 1: Comparison of composition of SAMDC, INMDC & Proposed HPC

CATEGORY	SAMDC	INMDC	Proposed HPC
Registered Professions	(Appointed byMinister) - 4 Medical - 1 Dentist - 1 Prof. Board	(Appointed byMinister) - 1 Dentist - 1 Psychologist	(Designated by each Board) Proportional representationof Boards, with at least 1 Rep per registered profession (<25)
Appointed by Minister of Health
Department of Health	Director-General	Dir.-General	1
Provincial Health Authorities	1	9	9
University Academic	1	0	0
Person versed in law	0	3	1
Appointed by other Ministers/MECs
Department of Education	0	0	1
South African Medical Services(Minister of Defense appoints)	0	0	1
Community Representatives/Persons not registered	3 (appointed by Min. of Health)	9 (appointed by Min. of Health)	9 (1 per prov.) (Appointed by MEC for Health)
Appointed by other bodies
University Principals	- 4 Medical - 2 Dentists	- 4 Medical - 2 Dentists	1
Committee of Technikon Principals	0	0	1
College of Medince of SA	1	0	0
SA Nursing Council	1	1	0
SA Pharmacy Council	1	1	0
Other Councils	0	SAMD - 15 Transkeian MC - 3 Ciskeian MC - 3	0
TOTAL	21	53	49 Max.

The bill also outlines the establishment of Health Professional Boards, which will control and exercise authority over profession(s) falling under it. The Minister of Health, on recommendation of the Council, will make regulations relating to the establishment and regulation of these Professional Boards. All registered health professions will have a Professional Board, and a Board can represent one or more professions. The Bill makes provision for the basic structure of a Board. The majority of the Board members must be elected by the members of the profession(s) concerned. There has to be representation of relevant educational institutions, health authorities, and a person versed in law. More importantly, the Bill states that at least 20 percent of members of a Professional Board have to be persons representing the community.

2.2 Roles/Functions

The Health Professions Council will be an independent statutory body. The function of the Council is to co-ordinate the activities of the Professional Boards and to act as an advisory and communicatory body for these boards. The Council has to render financial assistance to the Professional Boards. The Council can also make recommendations to the Minister of Health in respect of regulations relating to the Professional Boards. The Council needs to consult with the Professional Boards before recommending changes which will affect their structure or functioning. Many of the functions of the previous Council have been devolved to the Professional Boards, including registration and disciplinary proceedings.

The Professional Boards will control and exercise authority over the profession(s) falling under it, including issues of registration requirements and training. More importantly, the Professional Boards now have disciplinary powers and can institute inquiries into allegations or charges of unprofessional conduct against any person registered under it. Previously, this power was vested in the Council. The Boards have a final say on matters relating to professions falling under its ambit, and decisions made in this regard cannot be ratified by the Council.

2.3 Training and Registration

Each Professional Board determines the qualifications and training required for registration in professions falling under its ambit. The Minister of Health, on recommendation of the Council, will prescribe qualifications for registration.

The Professional Boards are also responsible for registration of persons. Previously, this was the task of the Council. Persons will need to apply for registration to the registrar, who is the CEO for the Council and the Professional Boards.

The certificate of registration is evidence of registration for one year, and thereafter the annual practising certificate will be regarded as proof of registration. Further, the Council can make rules regarding continuing education and training required for retaining registration.

The Bill also makes provision for registration of persons who qualified outside the Republic. Such persons need to be adequately evaluated before they can be registered and restrictions on his/her practise can be imposed, if deemed necessary. The Minister of Health, in consultation with the Council, is empowered to make regulations regarding registration of these individuals.

2.4 Other Issues

• The Council's power in regulating places of training has been widened to include technikons and other educational institutions. Previously, their power was restricted to universities only.
• Persons who are registered under this bill will be allowed to compound and dispense medicines. Licensing of such practitioners will be in accordance with the provisions of the Medicines and Related Substances Control Act, 101 of 1965.
• Persons registered under this bill are restricted from receiving any commission or other reward from a pharmacy in connection with any prescription given.
• A person may take the Council or Professional Board to court if he or she is dissatisfied with decisions made by these bodies.
• The Minister of Health has to consult with the council before making changes to regulations under this bill.

3. Some Issues Raised by the Bill

This Bill proposes considerable changes to the current Council, both in structure and functions. It increases democracy, accessibility and community involvement; however, some issues still need to be considered. These issues are raised under the broad categories of implementation and content.

3.1 Implementation

• The Bill lays out profound changes to the structure of the current system. It may take some time to establish and get the Professional Boards functioning. Is there a deadline by which the new Health Professions Council has to take over? What is the process of transfer of responsibilities from the INMDC to the HPC?
• The roles and functions of the Council have been profoundly changed. Particularly, more power and functions have been devolved to the Professional Boards. Will Professional Boards receive more funding and administrative resources given their new status? Will less advantaged Boards be given more funding in order to fulfill their functions effectively?
• The inclusion of community representatives on the Council and Boards should make these institutions more accessible to the public. For these members to be effective in their new roles, orientation and training needs to be provided. What process is envisioned for this? Also, how can it be ensured that these members will be truly representative of, and accountable to communities?
• Where will the Professional Boards be situated, and who has the discretionary power to decide on this? This is particularly important, given the new powers of the Boards. The issue of accessibility needs to be considered.

3.2. Content

• Are the new roles and functions of the Council agreeable to people and constituencies?
• The role and status of community health workers and traditional healers are not discussed in this legislation. Given the important role these practitioners play in the health sector, how are they envisioned to fit into the new structure? Will they become registrable? Will they be given representation on the Council or Boards?
• Members representing the community are part of "ad hoc disciplinary appeals" of the Council. Will these community representatives be present on disciplinary committees at the Professional Board level?
• Is the role of non-governmental organisations involved in health considered in this Bill?
• What recourse do members of the public have if they are not satisfied with the disciplinary procedures of the Boards or Council?
• What is the role of the Minister of Health in terms of making regulations? Is the Council autonomous and independent? Is the Council purely advisory? What weight will be given to the Council's recommendations?
• In respect of training, does the Minister of Health have final say over tertiary training requirements for health professions or does this responsibility fall to the South African Qualification Authority?

4. The way forward

The Portfolio Committee held hearings on the Bill on 19 May 1997. It heared submissions from the Department of Health and the INMDC on that day. Additional public hearings are scheduled for the 6 June, 08h30-13h30. Submissions can be made to the Portfolio Committee. The deadline for submissions is 2 June for oral applications, and 5 June for written submissions. The second reading and National Assembly vote is scheduled for 17 June. If passed, the Bill will be sent to the National Council of Provinces. Please contact the Health Portfolio Committee in each provincial legislature if you would like to make submissions at that level.

For more information, please contact Carnita Ernest at (021) 696-4873 or by e-mail at phila@wn.apc.org.
PHILA is supported by a grant from the Henry J. Kaiser Family Foundation.

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