Report of the
Portfolio Committee on Health on an oversight visit to the
The Portfolio
Committee on Health having undertaken an oversight visit to the
1. EXECUTIVE SUMMARY
HIV/AIDS and
Tuberculosis have played a major role in increasing the mortality rate of
mothers and children and still continue to account for a significant burden of
diseases in
As its
oversight role, the committee therefore decided to conduct oversight at various
public health facilities in the
This report
presents a summary of information on the various health facilities,
achievements and challenges they are facing. From the collected information, it
draws conclusions on the challenges faced in the health system of the
2. BACKGROUND
The Portfolio Committee
on Health conducted oversight over different health facilities in the
3. OBJECTIVES
The objectives
of the oversight visit were to:
4. DELEGATION
Ms MC Dube
- (ANC)
Ms TE Kenye
– (ANC)
Dr A Luthuli – (ANC)
Ms Segale
Diswai – (ANC)
Mr E
Sulliman – (ANC)
Ms E More –
(DA)
Mr M Waters –
(DA)
Mr DA Kganare
(COPE)
Ms HS Msweli –
(IFP)
Ms V Majalamba
(Committee Secretary)
Mr Zubair Rahim
(Committee Researcher)
Ms S Bawa
(Committee Assistant)
5. VISITED HOSPITALS
6.
DELEGATION FROM THE HOSPITAL
Rampane S
Moeketsi: Clinical Manager/Acting CEO
Mr NA
Mashinini: Administrative
Assistant Manager
Mr MC Lerore: Administrative Assistant
(Nursing)
The hospital
has 110 usable beds, and is linked to 32 clinics through a referral
system. The hospital was also
responsible for the outreach services to these clinics and in different
disciplines. The hospital refers patients
to
The hospital
renders medical, surgical, paediatrics, maternity, frail care, rehabilitation,
social work, oral health, radiographic, mental health, domestic violence,
clinic and emergency services. Elizabeth
Ross is the only hospital in the
With regard to
HIV/AIDS the hospital has started with counselling and testing and the initiation
is done at the ARV sites. Patients who were initiated on Highly Active
Anti-Retroviral Therapy (HAART) presented themselves at the hospital without
treatment, and the pharmacists arranged with the sites to provide treatment. The Prevention of Mother to Child
Transmission (PMTCT) is rendered in partnership with Elizabeth, Glaser,
Paediatric Aids Foundation (EGPAF).
There was a
dedicated infection control personnel that was overseeing the infection control
of the hospital. Swabs for culture were also
taken once a year.
6.1 CHALLENGES FACED BY THE HOSPITAL
v
Replacement of fleet,
v
Power Supply
v
Equipment shortages
v
46% of vacancy rate,
v
Accommodation for Health Professionals at
the hospital,
v
Slow Hospital revitalisation,
v
Geographical location of the hospital,
and
v
There is no proper Mental Health care.
v
Medical Depot not supplying on time
6.2 WALK ABOUT AT THE HOSPITAL
6.2.1 MATERNITY WARD
On the day of
the visit, there were only three professional nurses on duty and they
highlighted that they were short staffed and sometimes nurses have to attend
meetings and also escort patients to
The nurse in
charge informed the committee that they were handling more than 300 deliveries
a month. They had 207 and 217 deliveries
in June and July 2010 respectively.
The sister in
charge also informed the committee that they needed ambulances with mobile
incubators as it was very difficult for them to transport pre-term babies from
Elizabeth Ross to Manapo hospitals.
The other
challenge that was highlighted was the lack of resources and sometimes they had
to use the ordinary sellotape for an IV line.
6.2.2 DELIVERY ROOM
The delivery
room was not well equipped as there were no medical consumables like gloves and
the hospital had to get assistance from other institutions.
6.2.3 POSTNATAL WARD
The postnatal
ward has six beds and it was overcrowded on the day of the visit.
6.2.4 FEMALE WARD
The female ward
has 24 beds. There were only four
professional nurses responsible for the ward. Two professional nurses worked on
a day shift and two on a night shift.
When the sister in charge was asked of how they were coping with the
work load, she informed the committee that sometimes they were assisted by
nurses from other wards and were also using nurses provided by nursing agencies.
6.2.5 MALE WARD
The male ward has
24 beds. They admit and/or accommodate
both medical and surgical patients. There were only two professional nurses on
night duty and five on day duty. The
committee noticed that the male ward was under-staffed.
6.2.6 STEP DOWN AND STEP UP WARD
There were six
beds for females and six for males in the ward.
The sister-in
charge of the ward welcomed the committee. She came across as very passionate about
her work. She informed the committee
that the ward takes care of the critical ill patients and those awaiting social
workers and had no place to go to. She
also told the committee that patients’ condition improved and continued leaving
their normal lives.
The ward was
short staffed and they made use of volunteers.
Before working in the ward, volunteers were trained first for 59
days.
7.
DELEGATION FROM THE HOSPITAL
The clinical
support provided by the hospital is ophthalmology clinic, renal unit, pharmacy,
clinical psychology, speech and audiology, occupational therapy, physiotherapy,
social work and dietetics services.
The institution
is the nerve centre and coordinates activities for the district. It also serves as a specialist clinic for
ARV’s. There is dedicated staff for HIV
Counselling and Testing (HCT who comprised of 2 professional nurses, 1 lay
councillor and 1 data capture for the district.
The district targeted 241 577 people for HIV testing and only tested
3226 people. The institutional target
was 3660 people but only managed to test 424 persons. In efforts to meet the
target, the hospital has made the following plans:
v
Specialist clinic for catchment areas
v
HCT to be done in OPD and in the wards
v
Daily HCT information session in OPD
and in the clinic
v
Form part of district plan for campaign
and social mobilisation and out reach
v
Proposed partnership with the
Department of Social Development for counselling.
7.1 TUBERCULOSIS (TB) MANAGEMENT
The hospital
followed the national and provincial policy guidelines on the management of
TB. There was a dedicated HIV and TB
coordinator for the institution. Patients
are screened for TB and there were dedicated cubicles for TB patients. The co-ordinator conducted training for staff.
The in-house laboratory enhanced
diagnosis. MDR and XDR cases were
referred to specialised hospital in Thaba Nchu.
In addressing
infection control, the hospital was follows the national and the provincial
policy guidelines. There is a dedicated
infection control officer who also is a member of the institutional risk and
quality assurance management committee.
There is an infection control program for the institution and an
infection control committee which represented all units.
Staff is
trained on infection control. There is monitoring and evaluation of
infection control practices. A validation
of monthly audit is done. Spot checks
for compliance are undertaken randomly.
7.2 THE INSTITUTION HAS SET THE FOLLOWING PRIORITIES:
v
Provision of 9 basic clinical disciplines,
v
Recruitment and retention of health
professional,
v
CHOSASA accreditation,
v
Compliance with ministerial priorities,
v
Meet the HCT target, and
v
Accelerated maintence program.
7.3 MAJOR INFRASTRUCTURAL PRIORITY PROJECTS FOR 2010 WERE AS
FOLLOWS:
v
Upgrading of lifts starting in August
2010,
v
Procurement and replacement of medical
equipment which is budgeted for R5 million,
v
Erection of the fence,
v
Replacement of emergency generators,
and
v
Replacement of steam water pipes.
7.4 CHALLENGES FACED BY THE HOSPITAL
v
Provision of a 24 hour medical coverage
in some disciplines,
v
Recruitment and retention of medical
officers in the catchment areas,
v
Finalisation of OSD for Doctors and
nurses,
v
The infrastructure has depreciated, and
v
Budget limitations which made it difficult
for the hospital to deliver on its mandate.
v
Medical Depot not supplying on time
7.5 WALK ABOUT AT THE HOSPITAL
7.5.1 MALE SURGICAL WARD
Not all beds
were utilised in the male surgical ward on the day of the visit. The surgical ward is a 34 bed unit. It renders circumcision and amputation
services. The sister in charge informed
the committee that HIV prevalence is very high in the area and is the main
cause of deaths.
7.5.2 FEMALE SURGICAL WARD
The female
surgical ward is also a 34 bed unit. On
the day of the visit, there was only one professional nurse who informed the
committee that the ward admits diabetic, TB, and HIV patients. The critical HIV cases are isolated.
7.5.3 POSTNATAL WARD
The postnatal
ward was severely understaffed.
7.5.4 RENAL UNIT
The renal unit is
well equipped. One of the challenges the staff mentioned is that they are also
servicing people from
7.5.5 INTENSIVE CARE UNIT (ICU)
The ICU has six
beds and is short staffed. There is no
qualified doctor running it. There is no
equipment, especially the ventilators and monitors.
7.5.6 X-RAY
Due to
infrastructural problems, part of the casualty unit is located in the X-ray
ward. There are five radiographers in the X-ray unit. They are using the X-ray for diagnostic
purposes. They are using advanced
equipment which is safe for use even by pregnant women. The only challenge is the dysfunctional tele-radiology
because Pelonomi has upgraded and synchronising of tele-radiology is taking
long.
7.5.7 LABOUR WARD
The labour ward
admits level two patients. They deal
with referred patients but faced with the challenge of self referrals. Patients that were unable to handle were
referred to Pelonomi hospital. The
labour ward is short staffed and there is no gynaecologist.
8.
DELEGATION FROM THE HOSPITAL
1. Ms Alida
Zwieqela: District
Director
2. Ms Dorothy
Johnson: Nursing Manager
3. Ms Cornelius
E Moshane: Client Service Manager
4. Ms WI
Hlanane: Chief
Medical Officer
5. Mr TJ Talane: Acting CEO
6. Ms Aha Lowe: Client
Service Manager
Bongani
hospital is a modern complex that was officially opened in 1994. The planning and building of the hospital was
a timeous and costly process which took approximately 14 years to
complete. The total number of beds is
460 with a staff compliment of 848. The
hospital serves the catchment areas of Katleho,
8.1 CHALLENGES FACED BY THE HOSPITAL
The challenges
were imposed by the limited resources and are exacerbated by the following
issues:
8.2 CHALLENGES FACED BY STAFF
v
Chronic staff shortages,
v
Retention of Medical Officers,
v
Outdated equipment,
v
Shortage of consumables,
v
Pressure of implementing unfunded
mandates like the HCT, and
v
Perception that management do not care
because they were not doing anything to change the situation.
v
Community Service doctors were used for
service instead of training
8.3 WALK ABOUT
AT THE HOSPITAL
8.3.1 X-RAY
There are four rooms that are supposed to be used for X-ray
and only two are working. The other two rooms
are not working since 2009 and nothing was done about it. There is equipment shortages and were using a
very old scanner that was purchased in 1994.
8.3.2 VASCULAR ROOM
The vascular room was not utilised as there is no
radiologists. The processors are old and
only one is working. When it breaks they have to close.
8.3.3 DENTAL
X-RAY
The room is full of old machines that are not working and could
not be repaired.
8.3.4 CASUALTY
WARD
Due to staff shortages, the casualty had to close. The selection of applicants was submitted
three months ago and they were still awaiting appointments.
8.3.5 NEONATAL ICU
The capacity of the neonatal ICU is 16 but sometimes they have
to admit 30 neonates. Each nurse takes
care of 4 to 5 patients at a time. There
were staff shortages and operations were done on a first come basis.
9.
DELEGATION FROM THE HOSPITAL
1. Dr KK Moeng: Acting CEO
2. Ms SRO Khokho: Executive Manager for
Strategic Health Programme and Medical Support Services
3. Mr E Pelelo: Acting
Executive Manager Provincial Health Services
4. Ms NC Mzozoyana: Chief
Financial Officer
5. Ms B Ramolula: Acting
Head
6. Mr GJ Kgasane: Head
Pharmacy
7. Ms LC Peens: Acting
Head Allied Health Services
8. Mr J Mbalula: Head
of Communications in the
9. Mr MW Fikizolo: Executive
Manager Resource Management Support
10.Mr LA Khiba: Head
Technical Support
11. Ms MC Molefe: Head
of Nursing
9.1 INTRODUCTION
9.2 HIGHLIGHTS FOR THE HOSPITAL
The hospital
was one of the hospitals that were designated for the FIFA 2010 World Cup and was
in Public Private Partnership (PPP) with Netcare during that time. The province
experienced a shortage of pharmaceuticals but that has improved because they
have 90% of medicals including medical consumables.
9.3 SERVICES CHALLENGES
v
The department was once managed by Treasury
which was one of the reasons there was a delay in the filling of posts which
resulted in a backlog.
v
There were restrictions due to budget
constraints
v
There were long delays in filling of
posts like cleaners and others. The
management also mentioned that they had a meeting two weeks ago to prioritise
posts and some personnel categories were outsourced but were going to absorb
them.
v
The hospital lifts were very old and
they could no longer get parts. The
management mentioned that they have issued a tender to replace all the lifts in
April and the tender was approved. The
Hospital was going to start with the replacement in August 2010.
9.4 PROGRESS REPORT ON HCT PROGRAM
The HCT program
is running for approximately one month, and is gaining momentum. Seventy rapid tests were done during the last
30 days.
9.5 CHALLENGES
PATIENT FACTORS
v
MIND SHIFTING: For years the sentiment
from the health department was not to encourage active screening for HIV. That policy has become entrenched in the
clinical settings. Turning the sentiment
around takes time and effort. Some
patients and doctors still have a subconscious notion of “no test, no trouble”.
v
The fear of being confronted by a
terminal illness was a serious issue and living in denial was making some sense
to some people.
v
Some patients had the notion that a
positive HIV result will make them second class patients.
v
The fear of social rejection and
financial hardship was also in existence.
9.6 PERSONNEL FACTORS
9.7 PLANS
9.8 WALK ABOUT AT THE HOSPITAL
9.8.1 BURNS UNIT
The burns unit is
a 23 bed unit which offers tertiary services.
The facility started seven years ago.
It caters for children and adults.
There are two doctors and one registrar in-charge of the unit. The unit was empty and weather related
conditions were stated as reasons for the empty unit.
When officials
were asked about water which was once a challenge in the hospital especially at
the burns unit, he informed the committee that the municipality was struggling
to push water up to the seventh floor but that has improved and they were no
longer struggling with water shortages.
The committee
was also shown a unit that was going to be used for burns patients. Due to
budget constraints they could not open the unit but they highlighted that it
was not expensive to open the unit and were considering ways of working on
opening it again.
9.8.2 HIGH CARE:
The high care
unit was opened in 2006 and was regarded as the best trauma unit in the
Southern part. It is a 24 hour service
and operates for seven days a week. It
admits patients from
9.8.3 LODOX ROOM
The lodox room
had the most advanced equipment used to scan the whole body in 13 seconds and
identifies injuries.
9.8.4 RENAL UNIT
The renal unit
was a 13 bed unit and functions well.
The staff highlighted staff shortages as their only challenge.
9.8.5 PPP
The Committee
was taken to the PPP. The partnership
was working very well and the only challenge that was highlighted was that
doctors were spending more time at the private part whereas they were employed
by the public sector.
10.
DELEGATION FROM THE HOSPITAL
1. Mr Jones
Nkhatho: Assistant Manager
(Nursing)
2. Mr Lebusa
Semela: Manager –
Administration
3. Ms Nomasundu
Nyangintsimbi: Assistant Manager
(Nursing)
4. Mr R Dreyer: Manager – Finance
5. Ms NE
Mathobisa: HIV
and AIDS and TB Coordinator
6. Ms Mohutsiwa
Tihogo: Senior
Manager
7. Ms Eona
Terblanche: Assistant Manager
– Human Resources
8. Dr Van Zyl: Head –
Clinical Services
9. Ms Nolwandle
Mashiane: Board Member
The CEO,
Reverend Musapelo welcomed the committee and informed the committee that in a
bid to support the Minister’s call of having all South Africans being screened
for HIV and knowing their status, Universitas Academic Hospital has established
a HCT Nerve Centre where the beneficiaries of the service will have themselves
tested. The HCT Nerve Centre was
designated clinic for HIV testing with permanent staff allocated to it.
Services that
were rendered included screening for diabetes mellitus, 2 rapid tests for HIV,
Anaemia, Hypertension, TB and Sexual Transmitted Infections.
The
responsibility of the Nerve Centre was to supply testing kits and condoms to
institutions like Pelonomi, Rosebank, Medi-Clinic, 3 military Hospitals and 4
tertiary training institutions, training
of staff on counselling and performance of HIV testing and interpretation of
results, consolidation of HCT statistics from all partners and support to
institutions during their wellness days.
10.1 MANAGEMENT OF HIV PREVALANCE, MDR AND XDR TB
v
All the wards and outpatient
departments are supplied with testing kits to offer rapid tests to admitted
patients.
v
Unit managers have been trained on how
to perform and interpret the results.
v
On the day of the visit, there were
only three professional nurses on duty and they highlighted that they were
short staffed and sometimes nurses have to attend meetings and also escort
patients to
v
All patients and visitors that test
positive for any of the abovementioned diseases, further tests are done to
confirm the diagnosis and are then treated and referred accordingly.
v
Although
v
Should results be available after a
patient has been discharged, the patient is contacted and treatment initiated
via the local clinic near his/her local place or residence. Those who still
have to come for follow up are called in and treatment initiated.
v
Upon discharge, patients are properly
referred to their local clinics.
v
There is a system in place for
reporting TB cases diagnosed in hospital to the district office and reporting is
done on monthly basis.
v
A ward was identified in the hospital
where TB and MDR patients are admitted.
The infrastructure had been altered in such a manner that negative suction
is created to minimise the risk of cross infection. This was created through the installation of
extractor fans.
10.2 INFECTION CONTROL
Infection
control is the responsibility of the Prevention and Control Unit to ensure that
handwashing facilities are always available in the wards. There are hand wash
posters next to each basin as reminders to officials that the practice has to
be adhered to at all times. The unit also ensures personal protective clothing is
always available and appropriately used to protect staff as well as prevention
of cross infection.
There is close
collaboration between the Infection and Control Unit and the cleaning company
contracted by the institution and a checklist was developed which served as a
road map to the cleaning company regarding evaluation of their services.
In cases where
a patient is harbouring a communicable disease, she/he is nursed in
isolation.
The water
utilised by beneficiaries of the services is safe for human consumption and
free of pathogenic organisms. Sampling is done on a yearly basis to rule out
the possibility of water harbouring Legionella.
For 2010 the sampling was done on the 13th of April and
results were made available on the 28th April 2010. In all the departments where samples were taken,
tested negative for Legionella, except for water samples were taken from the
Paediatric Cardiology and Coronary intensive Care Units. The technical services section was alerted
and the water in all the hospital’s reservoirs is appropriately treated.
To render the
hospital free of pests and other insect vectors, Africa Pest Control had been
contracted by the institution to render the service and all areas within the
institution are treated at six weekly intervals.
10.3 WALK ABOUT AT THE HOSPITAL
10.3.1 PHARMACY
Pharmacy provides
a 24 hour service. There was 85% of
stock availability and the challenge that was highlighted was delay in getting
orders back from the medical depo and sometimes they had to get stock from
other institutions. The other challenge that is long waiting times which
sometimes take 3 hours to attend to patients.
10.3.2 ICU
The unit is an
8 bed unit but only used 6 and the 7th bed is only used if there is
an emergency. There is also an arrangement with Netcare to borrow a bed from
them when there was a shortage. The borrowed bed was subsequently taken back
when beds were available. They also have an arrangement with the private sector
to buy services. The ICU is a multi
disciplinary unit which admits medically related conditions. However, it does not
admit children. The staff mentioned that
they were coping with the equipment although it was old and it was not taking
them more than a week to get their machines fixed. They borrowed from Pelonomi Hospital when
there were stock outs.
10.3.3 PRE-TERM WARD
The pre-term
ward is a 12 bed unit. The infection in
the ward is lower than the national norms and sepsis which was the cause of
death to some babies was from outside.
The challenge the pre-term ward faced is the shortage of equipment like
monitors and transport incubators.
10.3.4 MARTENITY WARD
The maternity
ward is a 20 bed unit with 20 patients.
There were only 2 sisters on duty.
The maternity ward was short staffed and they were also struggling with equipment.
11. PROVINCIAL MEDICAL DEPO
The
responsibility of the medical depot was to order and keep stock for
institutions. It is also responsible for preparing contracts for
institutions. Its budget is not centralised at the
depo.
The challenges
that were mentioned at the medical depot were that institutions were not making
orders frequently which made it difficult for the depot to place orders on
time.
The other
challenge the depot was faced with was that institutions were not doing their
stock control which resulted in medication getting old at the depot.
There were late
payments of the depot by institutions.
12. FINDINGS BY THE COMMITTEE
1.
The primary healthcare was not
functioning well in the province.
2.
There was no infection control
policy on the institutions
3. There was no delegation of powers to hospital CEO’s and hospitals
could not even buy medical consumables like gloves.
4.
There was no Maintenance budget
at all hospitals, as well as provincial level.
5.
There was no monitoring between
the hospitals and the provincial department. (The PDMS of Hospital managers).
6.
There was no involvement of
hospitals in budgeting processes.
7.
There was no support given by
the province in supervising the health institutions and in supporting them with
the budget.
8.
Elizabeth Ross, Bongani, Manapo
and Pelonomi were not communicating with each other for benchmarking purposes.
9.
There was malfunctioning
management at Bongani Hospital
10.
There is no communication
between the medical depot and the hospitals.
11.
There were severe Human
Resources shortages in all the institutions.
12.
Budgeted posts were not filled
when they become vacant.
13.
There were severe shortages of
equipment in the province especially at Pelonomi.
14.
The Maternity ward at Pelonomi
Hospital was under tremendous pressure due to staff shortages and equipment
15.
There is no provincial strategy
for recruitment and retention of medical staff.
16.
The OSD was not working well
and it was causing animosity or friction between staff.
17.
There were unfunded mandates
especially at Bongani Hospital
18.
There were long waiting periods
for patients (especially at Elizabeth Ross, Bongani and Pelonomi).
19.
There were ambulance shortages
in the province.
20.
Community doctors were used for
service instead of training.
21.
Pelonomi Hospital seemed not to
be working with Universitas Hospital
13. DELEGATION
FROM THE PROVINCIAL DEPARTMENT
1. Dr
Sipho Kabane: Head of
Department
2. Ms
Khumo Mzozoyana: Chief Financial
Officer
2. Ms
MCL Mabitle: General
Manager
3. Ms
Yolisa Tsibolane: Senior Manager
13.1 RESPONSES FROM THE DEPARTMENT
A number of findings were highlighted during the
oversight trip by the Portfolio Committee. These were responded to by the
Department. Following below are detailed responses to some of the issues
highlighted:
Overcrowded Casualties wards are a reflection of
poor Primary Health Care (PHC). This is one of the weakest areas because of
over-referrals. This is a complex problem given the high burden of disease, the
rural nature of the province and high unemployment rate. Facilities appear small
for the population, however the province is “losing people” through migration
and there should be a greater emphasis on building Community Health Centres
(CHCs). The Hospital Revitalisation process looks at organisational
development, quality, systems, and many more. It is currently being carried out
at Pelonomi and Boitumelo. Others are still in the planning stage. The pace of
revitalisation is slow, but comprehensive, including both the equipment and
staff issues in a phased approach.
Personnel shortage is a serious problem given
the rural nature of the province, making recruitment and retention of health
care professionals difficult. For example, at Nala Hospital, which is an ARV
site, there are no doctors. The staff establishment was declining due to
declining funds allocated to staff salaries. Occupation Specific Dispensation
(OSD) has not assisted the situation. It often complicates matters by, for
example, requiring funds to be shifted away from vacant posts. The rural nature
of the province, especially in places like Qwaqwa where accommodation was
scarce, presented a challenge to attracting health care professionals.
Advertising was done via the centralised provincial government advertisements
and was no longer a departmental function. This posed a challenge in filling
posts quickly. A nursing school in Thaba Nchu was opened, addressing the
accommodation needs of nursing students.
There was a need to prioritise and balance staff and goods and services.
The department was currently reviewing the structure of the department which was
currently divided into four clusters: finance, resources, clinical (district)
and strategic programmes. There was a lack of proper co-ordination between the
Corporate Office and the districts, which the department claimed to be
correcting. In particular, the department was reviewing the large
administration staff (versus the need for clinical skills). The Performance
management system (PDMS) was faced with challenges. Health care workers wrongly
viewed this as a cash bonus or pay progression, whereas it was supposed to be a
performance- based bonus. In 2007/08 and 2008/09 the department had no cash for
the bonuses. A court order required the department to pay but due to financial
constraints this was not done- i.e. the department had not budgeted for it.
At 4 of the 6 institutions visited, there were
acting CEOs. According to the
department, acting CEOs of institutions tend to do the minimum required of them
because they know they were only acting and will be replaced. Greater
supervision was required from general managers especially when acting CEOs were
place. The Head of Department described Bongani Hospital as having “collapsed”,
with serious management issues. He also identified Pelonomi Hospital as having
management issues.
Delegations: The Head of Department stated that,
in the previous term, CEOs and district managers had certain powers (such as to
hire staff and procure medication) but these were removed in the new political
term. The challenge was to bring back those powers. The Executive Council had
approved a Policy Framework. Departments have customised and submitted to the
Premier’s office and were awaiting final approval. However the main challenge was
accountability and proper governance. The new delegations spelt out
requirements with regard to bid committee, finance, supply chain management and
personnel.
The health budget has increased from 24% of the
provincial budget in 2009 to 29% in 2010. However, the increased mandates of
the HIV Counselling and Treatment (HCT) and Immunisation Campaigns had an
impact.
Medical Depot: The institutions visited raised a
number of issues about the Medical Depot, including not having stock of TB
medication and “basic medication”. At one institution, the pharmacist in charge
had to improvise medication using existing stock because TB syrup was not
available. However, according to the department the Medical Depot was operating
as it should. There was a lead time of 6-8 weeks and institutions were not
placing their orders timeously. Institutions were not supposed to wait till the
last of their medication was depleted before ordering. Also there were problems
with National tenders and there were times when the supplier was out of stock.
Furthermore, the Depot required timeous payment from institutions however this was
not always happening. The system needed review in terms of cash flow. R40
million was advanced to the Depot in June 2010 and, according to the
department, it was not experiencing major financial constraints. A new
management structure was proposed for the Depot and the department was also
considering outsourcing the Depot.
Emergency Medical Services (EMS) response time
remained a challenge. The province was faced with a shortage of personnel and
ambulances. According to the HOD, the national norm was 1: 100,000. Since the
province had a population of 2.9 million, it should have 290 ambulances, but
only had 120-130 functioning ambulances according to the department. In
October/November 2009 40 new ambulances were procured and in April 2010 an
additional 60. However, because of the age of the existing fleet many were
replaced and not added to. The department was leasing ambulances through the
government garage. Each ambulance needed 8 to 10 person crew. The department
planned to place certain ambulances in the districts but they needed additional
ambulances and personnel. The province had opened its own EMS College to deal
with the shortage of EMS staff in the province. The emergency helicopter
contract was currently being reviewed and might not be renewed, given the high
costs and limited service offered.
3-5% of the budget was set aside for
maintenance. A provincial level fund has been set up to deal with larger
maintenance problems.
Community
Doctors from Bongani Hospital raised the following issues:
Interns and Community Service doctors were used
for service provision as opposed to training. Community service doctors were
put on call without back-up supervision or assistance. They reported that the
Head of Department was not available for supervision and there were internal
management problems between doctors in charge. There was a lack of learning
opportunities as they were not rotated to the various wards. Casualty was used
as a polyclinic. There were gaps in the roster and there was no 24-hour doctor
available. Patients were not sorted to prioritised according to their health
status. They reported a shortage of equipment and lack of maintenance as vital
equipment was always out of order.
The HOD announced that Bongani Hospital had
“collapsed”. He indicated that managers hide what was happening at
institutions. The auditors had also noted problems at the institution. He announced
that the department was going to re-introduce staff indabas and that the HOD,
with relevant senior managers will spend one week at Bongani Hospital. He
further indicated that the hospital had sufficient doctors but were not
properly deployed and needed leadership. The Department would do the same at
Pelonomi Hospital. The Committee was concerned that the Department was only
going to respond now that the Portfolio Committee had visited whereas they were
aware of the problems even before the visit.
14.
RECOMMENDATIONS BY THE COMMITTEE
a) The province should revive the Primary Health Care.
b) There should be an infection control policy and strategies and
institutions should adhere to them.
c) The Delegation of powers to hospital CEOs be attended to as a
matter of urgency.
d) Human Resources challenges should be addressed urgently.
e) Acting positions to be filled as a matter of urgency especially at
managerial level.
f)
The Department should liaise
with Telkom to resolve the communication challenges.
g) The Provincial Department of Health should work with the
Department of Home Affairs to address the utilisation of South African Health
facilities by foreign patients.
h) There should be proper communication between the National Department
of Health and the Province to the staff of what OSD is.
i)
The Province should look at and
attend to the management issues at Bongani Hospital.
j)
The Province should relocate
the ambulances that were used during the 2010 FIFA World Cup.
k) Community Service Doctors should always be under supervision.
l)
Pelonomi and Universitas should
be brought together, rationalise services and specialise on different services.
15.
APPRECIATION
v
The Committee would like to
extend its gratitude to Sister Mohale who is responsible for the Step Down and
Step Up ward at Elizabeth Ross and who is passionate and committed to what she is
doing.
v
The Committee would also like
to appreciate the good work that is done by Mofumahadi Manapo Mopeli Hospital
with the little resources they have.
v
The Committee would also like
to appreciate the good work which is done by a doctor that was responsible for
the Emergency ward at Pelonomi Hospital.