The trouble at the Health Professions Council of South Africa

What is the Health Professions Council?

The Health Professions Council of South Africa (HPCSA) is a statutory body established by the Health Professions Act 56 of 1974. It works with twelve professional boards which deal with specific types of health care professionals. The HPCSA determines standards of professional education and training, and sets and maintains standards of ethical and professional practice [1]. 

All individuals who practise any of the health care professions incorporated in the scope of the HPCSA are obliged by the Act to register with the Council. Failure to do so constitutes a criminal offence [2].

Issues

The HPCSA has been in the spotlight lately.

In March 2015 the Minister of Health (Minister), Dr Aaron Motsoaledi, launched an investigation into the HPCSA after receiving numerous letters alleging that the HPCSA has been involved in maladministration, irregularities, mismanagement and poor governance [3]. The team set up to investigate the HPCSA were comprised of medical, law, information technology and administration experts [4].

The team was given 60 days within which to conduct the investigation and produce a report. The investigation ended up taking six months [5]. The Minister was quoted having stated that the report was over 90 (ninety) pages. A nine page summary of its findings is available here.

The HPCSA wanted to set up an internal committee to investigate the complaints against it, but the Minister stated that “the weight of the allegations were such that an independent process would be more appropriate” [6].

The Investigation

The task team was appointed by the Minister in terms of section 6(g)(5)of the Health Professions Amendment Act, 29 of 2007 and was appointed on 25 February 2015 [7]. The report was finalised on 25 October 2015 [8] and was released by the Minister on 5 November 2015 at a media briefing held in Pretoria [9]. The task team was led by UCT’s Bongani Myosi.

The team reported that the HPCSA’s chief executive officer (CEO), Chief operating officer (COO) and the head of the legal services refused to meet and failed to co-operate with the task team [10].

The task team’s mandate

There were ten terms of reference for the investigative task team. These were [11]:

1. Interview and investigate various stakeholder regarding the complaints against the HPCSA
2.  Investigate and make findings on the governance responsibilities of the HPCSA
3. Investigate and make findings as to the procurement procedures including those with the ORACLE system
4. To investigate and make findings into the allegations of maladministration made by staff who have since left the employ of the HPCSA
5. To investigate and make findings into the allegations of the 30 submissions made to the President of the HPCSA regarding maladministration
6. To investigate and make findings into the fitness of the CEO and COO to hold office
7. To investigate and make findings as to whether the state of affairs has affected the effectiveness and efficiency of the HPCSA
8. T o investigate and make findings with regard to whether or not there has been any impact on the training of health professionals
9. To investigate and make findings with regard to the impact on the registration of the foreign workforce
10. To investigate and make findings as to whether or not a forensic audit needs to be conducted.

The task team conducted interviews with people with intimate knowledge of the HPCSA as well as with other stakeholders [12]. The other stake holders were also invited to comment through the HPCSA website. The task team also went through documentation and reports on previous investigations on the HPCSA.

Findings

These were the major findings in the task team’s report.

1. Evidence was found of administrative irregularities, mismanagement and poor governance at the HPCSA regarding procurements of tenders with ORACLE and without following the proper tender procedures [13]. The appointments of consultants were also found to be irregular. This was all documented in a KPMG report of 2011 which reports recommendations were not adhered to by the HPCSA.
2. There were ten areas which the HPCSA was found to lack effectiveness in carrying out its mandate. These areas are [14]:

a) registration of health professionals,

b) examination and recognition of foreign qualifications of practitioners,

c) professional conduct enquiries,

d)  approval of programmes in training schools, and

e) continued professional development.

(f) information communication technology,

 (g) data management,

(h) space management,

(i) human resource management and;

(j) risk management

3. It was found that both the Chief Executive Officer and the Chief Operating Officer were unfit to stay in office. Their performance amounted to misconduct, irregular expenditure and failure to efficiently manage operations [15].
4. It was found that the General Manager for Legal Services delayed investigations, prejudicing practitioners and members of the public. This official was also found to be unfit for office [16].
5. The HPCSA was found to lack proper leadership and failed to provide proper guidance to health professionals on numerous issues. “These issues include the harmonisation of competing regulatory frameworks in higher education (i.e., National Qualifications Framework, South African Qualifications Authority and Higher Education Qualifications Framework) pertaining to accreditation, registration and quality assurance, with the regulations of HPCSA” [17]. Also the HPCSA had not finalized the scope of practice of the different health professions.
6. The HPCSA was found to have structural problems. It is in charge of the administration of too many professional Boards and it is not working with them effectively. The team recommended that each profession manage its own affairs [18].
7. There are insufficient health professionals within the HPCSA to guide the health professions with their professional conduct queries. Lawyers within the HPCSA mainly deal with the issues but they need more health professional advice [19].

Recommendations

Firstly, the task team recommended that disciplinary/ incapacity proceedings be instituted against the CEO and COO and General Manager of Legal Services [20].

Secondly it was recommended that an interim executive management team be appointed to address the dysfunctional areas of the HPCSA [21].

Thirdly, a recommendation was made was that the incoming and future councils of the HPCSA should have a structured induction process to ensure an understanding and appreciation by all its members of their legal and governance obligations [22].

Fourthly, that the KPMG recommendations needed to be addressed within 6 (six) months of assumption of office by the incoming Council of 2015 [23].

Fifthly, a full organisational review and proposal of new governance and administrative structures for the future to be conducted [24].

Conclusion

The HPCSA regards the task team’s report as “advice or proposals and not binding”. The HPCSA has chosen to ignore the recommendations and set up their own investigation team [25]. The HPCSA stated that it would come to its own decision once the internal investigations are concluded and will not disrupt its operations in the meantime [26].

The HPCSA, in ignoring a report commissioned by the Minister of Health, defies accountability to him. Essentially, it claims to be judge in its own cause, even in the presence of the severe problems identified by the task team. That is completely unacceptable. The failure of the HPCSA to perform its functions properly puts the health care of the entire nation at risk.

We think there are grounds for strong Ministerial intervention here, and we urge that it take place immediately, if it has not already happened.

Arvitha Doodnath is Legal Researcher at the Helen Suzman Foundation.

This article first appeared as an HSF Brief.