DRAFT REPORT: SELECT COMMITTEE ON SOCIAL SERVICES OVERSIGHT VISIT TO NORTH-WEST, 14 - 16 FEBRUARY 2005
The purpose of the study tour by the Select Committee on Social Services to the North-West Province is for the Committee to exercise its oversight function as delegated to it by the National Council of Provinces. The primary objectives of the provincial visits included:
To conduct oversight over the management and quality of services rendered in respect to health, social development and home affairs.
To inspect various health, social development and home affairs facilities, in order to determine the state of physical infrastructure and equipment.
Bojanala District Municipality
Department of Health
The Regional Deputy Director of Health did the presentation. (Ms Diswai)
The presenter stated that the strategic goals of the region are in line with the Health Care Act and the Ten – Point Plan of the National Department of Health. She stated that the presentation will focus mainly on the MEC’s budget speech and this is to give information regarding the District during the MEC’s Roving Exco.
Primary Health Care Special Programmes
TB cure rate
With regard to the TB cure rate the norm is 85% and the district average is 56%. The number of VCT sites established in the district increased at some hospitals e.g. in the 3rd quarter 2003/4 Moses Kotane had 20 sites established and in the 3rd quarter 2004/5 it doubled to 40, but in Odi in the 3rd quarter 2003/4 it decreased from 14 to 10 in the 3rd quarter 2004/05. Rustenberg is the worst hit by TB, the reason being that in the area there are many mines and at these mines there many immigrants, with the result that they don go the full cycle. The district does have a strategy in place to deal with the situation but it is difficult.
VCT and PMTCT sites
The district are experiencing problems, because there is a stigma attached to HIV/Aids, but the Department promotes that people should come forward.
Care to disabled:
Batho Pele monitoring waiting time in Odi, George Stegman is within the norm and Jubilee improved. Brits and Koster need to improve. The question of patient satisfaction survey George Stegman and Jubilee are doing well on this indicator. It was stated that surveys should be done 6th monthly.
The bulk of the budget went for personnel.
Termination of Pregnancies (TOP)
The presenter stated that all district hospitals perform TOP. She further added that nurses could refuse to do TOP, due to religious reasons. The district does have a Waste Management service in place to properly dispose on TOP. There are containers for TOP and these are not disposed with other products.
Comments from Department of Health
All except Koster perform TOP. Not all nurses are performing TOP, because of various reasons e.g. religious reasons and most of the nurses who are trained, leave the service. There are containers in clinics, where TOP is properly disposed of. The district does have special containers and a Waste Management strategy in place.
The question on the motivation of staff e.g. incentives (rural allowances, scarce skills allowances) will encourage staff. Rustenberg Provincial Hospital is not seen as rural, i.o.w they do not qualify for rural allowances, they are presumed to be urban. Nurses do get night duty allowance and scarce skills allowance, however salaries in the public sector cannot compare with that of the private sector.
The delivery of pharmaceuticals to clinics is outsourced.
The Strategic goals of the district are linked to the Ten-Point Plan of the Department of Health and the goals have been put according to the legislative framework.
The district is not reaching its targets, the reason being that most clinics do not have the PHC Package. There still is a shortage of staff and equipment.
The staff establishment is determined nationally; there is nothing the district can do about it. The establishment has to be revised.
The district had to motivate why they wanted funds for security, the reason being that the province approves the budget. Personnel are the biggest expenditure and what is left is divided to other items.
The VCT increase at Madibeng was due to the fact that they got 2 clinics from Odi District.
Department of Social Development
The Regional Manager of Social Development did presentation
The budget for Social Development in the region is overspent. Social Development is busy trying to improve pay points. Officials at pay points received cell phones and a laptop budgeted for by the Department for easy communication in case of emergencies. The pay points will be a challenge because some of them require tents, chairs and other facilities. The department did allocate money for renovations in 2002. The Department did award a tender, to a Mr T, where he has to supply tents and chairs at various different pay points.
The Pensioner Committees at the various pay points also assists very well with order at these points. A challenge of the department will be the Foster Care Grant where there is a shortage of staff (Social Workers), which results in a delay in administration. Another challenge for the region will be HIV/Aids, where many children are orphaned (i.e. parents dying).
With regard to the Awaiting Trial Child there are 9 Probation Officers. There is one Secure center in Bojanala, which has place for 45 boys. For the next financial year the region submitted approval to build 2 more Secure Centers. The current situation is that these children are taken to police cells and the police ensure that they are separated. The police and the department ensure that the rights of the children are protected.
With regard to Food Security the region has lots of challenges. The food parcels are to assist those who receive less than R200 a month, or who has no income or hit by HIV/Aids. The challenge is that there are not sufficient food parcels to service everybody.
Comments from Department
At various different pay points, Service Managers have been appointed to assist in service delivery. Officials have been found to be corrupt and these cases are ongoing. With regard to Child Headed families, children under the age of 14 years do not qualify, but they may qualify for the Foster Care Grant. Recommendation is made that that the department link with other stakeholders e.g. Education and Health. The Municipality is busy with a list of poor families within its region.
There are delays in the Child Support grant and this occurs where there are no certificates and a recommendation is made that there will have to a link with the Department of Education and other departments. The department of Agriculture is assisting with regard to food parcels.
If child labour is reported the situation will be addressed as soon as possible.
At different pay points there are hawkers selling products and a recommendation is made that these hawkers sell their products outside a certain radius made by the department (e.g. behind a fence)
The Regional Department of Social Development is linking with other departments e.g. Education, Health. The Department of Agriculture are assisting with poultry farming and bricklaying. The department is not working in isolation but the activities have to be synchronized with other state departments.
The municipality is busy with a list of the poor families in the region
There are delays in the Child support grant in the situation where there are no certificates etc., with the result that the department have to communicate with the Department of Education.
There are volunteers at the different pay points.
Beneficiaries are reviewed once a year.
With regard to beneficiary not receiving money due to administrative problems, the beneficiary will receive his/her payment from the day the application was received.
The question on the motivation of staff e.g. incentives (rural allowances, scarce skills allowances) will encourage staff. Rustenberg Provincial Hospital is not seen as rural, i.e. they do not qualify for rural allowances, they are presumed to be urban. Nurses do get night duty allowance and scarce skills allowance, however salaries in the public sector cannot compare with that of the private sector.
Visit ACT/PMTCT/VCT clinic in Rustenberg
Classic House Clinic- Rustenberg
The Committee visited Classic House Clinic in Rustenberg on the 14th of February 2005. Classic House Clinic is situated in the CBD (Central Business District) of Rustenberg. It started 7 years ago and the building that is utilized is rented on a monthly basis. Previously it was a family clinic, but now it is a full-fledged Primary Health Care (PHC) Center. Constraints of the center are: the small holding area, they do not have a delivery room (these people are referred to the hospital), transport problems (to look for defaulters) and resignations.
The clinic has 8 professional nurses, 1 health promoter and 4 cleaners. The clinic sees about 55 people a day.
Doctors refer patients to Classic house Clinic, with the result that many people are coming in and leaving (this with regard to migrants).
People coming to the clinic are from different areas, because the clinic is in town. The Center is not 24 hours. There are no volunteers only health workers and the center is not as well organized and formed as clinics in other areas, but Life Line assists very well. There are cases where patients abuse the system. Not every clinic has a computer and most or all of the work has to be captured manually.
Rustenberg Provincial Hospital
The Select Committee had a tour visit of Rustenberg Provincial Hospital on the 14th of February 2005.
-Services rendered at Rustenberg Provincial Hospital:
-At Rustenberg Provincial Hospital they make use of volunteers.
-There are 5 lay councilors who were trained by Lifeline.
-There is a need in Rustenberg for another Level 1 Hospital
-There is a shortage of beds because of the number of patients.
-Rustenberg receives 120 patients a day
-80 patients per night
Moses Kotane Local Municipality
The Select Committee on Social Services had a meeting with the district Social Services and Health Departments at Moses Kotane Local Municipality.
Social Development Service Delivery
1. Social Assistance/Security
This programme deals with administration of social grants, applications and payments. CPS (Cash Paymaster Service), Banks and the Post Office are companies that have been granted tenders to assist in the process of social grant payments and service level agreements have been signed with them.
Types of grants includes: Old Age, War Veteran, Disability, Care Dependency, Foster Care grant, Child support, Grant in Aid. Types of disability grant: Temporary disability, Permanent disability.
An outreach programme has been established which refers to applications by community members at their respective places/areas, where the official travels to the areas for processing of applications
Pay point development
The Department of Social Development is in partnership with district and Local Municipalities. Officials at pay points have cell phones and laptops, budgeted for by the Department for easy communication in case of enquiries. More than 10000 chairs have been distributed to different areas as per identified needs. The Department signed a contract with Mr T, where this Service Provider is to supply tents to areas where there are no structures. The Department undertook and investigation to different pay points to ascertain which pay points needed the resources.
2. Development and Support/Community Development
Projects supported here are meant for Poverty Alleviation
National Food Emergency Scheme
More than 3000 households have received food parcels (3 times) during the financial year of 2003/04. The number for 2004/05 has decreased to 1000.
Those qualifying for Social grants are referred to social security for applications and others to social work programmes.
Proposed projects for funding
Child and Family Care- This project was initiated by the area social workers in 2003. The project started as a result of high incidents of child abuse. Other forms of crimes as described by SAPS and broken/disorganized families also aggravated incidents. Achievements of the project: 18 Volunteers trained on the model, secured project site from tribal office, supervising social worker active, the project serves as referral source for social workers.
Crime Prevention, Rehabilitation - Center is in operation and offer service to victim of crime/domestic violence. Offers overnight accommodation, counseling and reinstate clients in to their families. A nurse from Dept of Health has been seconded to the center. Volunteers are trained on counseling.
Special needs programmes- Day care center for older persons. Older persons in their respective villages started service clubs as a way to keep them busy and these service clubs do offer home based care services
People with disabilities- there is a need for workshop /shelter for such group
Support group- program for disabled children whereby mothers of such children are grouped together to give each other support on how to cope with their children.
The question was asked whether Magistrates could assist each other in Bojanala District.
Further comments from the Department
Food Security: - with regard to the numbers it was so indicated by the provincial office and the local office do not have any insight or way to influence the process. The reason for the decrease was because of finances. People on Food Security should be linked to other projects, e.g. Dept of Health, Dept of Agriculture, because parcels are only given for 3 months.
Poverty Alleviation Project - there are currently more than 20 projects. The Department are monitoring the projects, but due to a lack of project managers and financial managers some of these projects collapsed in the past. The result of this is that currently project managers are receiving training.
With regard to Foster Care Rustenburg is the only one who has a Commissioner of Child Welfare.
Disability Grant - the applicant is informed about his/her renewal 3 months before the date of his/her benefits expires. This letter indicates when beneficiary should apply for renewal. The panel refers cases to the Department of Home Affairs where documents are lacking.
Trial -awaiting children - The only secure care facility is in Brits and the facility is overcrowded. The district does not have such a facility.
Child Headed families - if the eldest is older than 16 and he /she has an identity document than he/she will be responsible for the family.
Foster Care - there is a lack of social workers and no Commissioner of Child Welfare.
Child labour - there are no incidents of child labour in the district.
Indigent policy - the Department is working with the Municipality and the municipality refers cases to the Department
Old Age Home - there are no Old Age Home. Refer elderly to other areas where there are facilities. The elderly do not favor Old Age Homes.
Department of Health
Mogwase Health Center
Moses Kotane Health Sub-district
Tour of Mogwase Health Centre
Admin. Staff section
Success Community Project 15 February 2005
Success Community Project received R350 000 in the 2002/3 financial year from the National Department of Social Development for their start-up. At Success they are currently busy with sewing and the manufacturing of chemicals. The sewing started in March 2004 and these include, school uniforms, tracksuits etc. The project was established to create employment for 100 people; currently there are less than 20 people. A major problem of the project is that there in no market for these products, both sewing and chemicals. The question was asked whether or not a feasibility study was made before investing in the project? Many institutions were approached to whom these products could be sold e.g. the mines, Sun City and the municipality. Success is registered as a Non-profit Organisation (NPO), but a recommendation was made that they change to a Close Corporation (CC) or a business. The products that are manufactured are SABS approved. The chemicals manufactured are not labeled, the reason being that it is too costly.
Institutions like Sun City and the SAPS promised to buy some of the products, but failed to do so. The Municipality are not buying any of the products either. Being an NPO has its disadvantages e.g. when you apply for work you need a SA Revenue Services registration number.
Saulspoort pay point
George Stegman Hospital
The Select Committee on Social Services had a meeting with the senior personnel of the George Stegman Hospital on the 15th of February 2005.
Overview- Presentation done by CEO of Hospital
Two Nursing Manager posts are to be filled before the end of the month and one Clinical Manager post to be advertised.
The physical infrastructure of the building creates problems because the structure is already 60 years old. Lots of the services will be outsourced in the future e.g. laundry.
George Stegman is not yet accredited, but it will be once they move into their new building. The hospital wants to keep the houses on current site for accommodation. The hospital did not have a maintenance plan, but a plan is now in place.
With regard to TOP the hospital are experiencing problems. The drug used for TOP was not available in the hospital, due to a communication problem the pharmacy and the Mafikeng. The hospital has thus far referred patients to Rustenberg.
The hospital has recruited staff from Moreteletsi to fill the vacancies and these staff members are to start the 1st of March 2005. According to the CEO the finances are managed well.
The State Accountant is responsible for the finances of the hospital. The management of the hospital have regular meetings to review the expenditure and needs of the hospital and the
Response from Management
The budget for 2004/5 was R36 million, and other than personnel and drugs, the entire budget was depleted by October 2004.
Hospital Board- there use to be a Hospital Board, but it was dissolved by the MEC in July/ August 2004. A new submission has been made for a new Board and the MEC indicated that it would be approved.
The hospital established a Complaints Committee to see to complaints.
Moreteletsi closed down because the physical structure was collapsing, because of the soil quality and the water supply also dried up.
With regard to the staff establishment there is not considerable vacancies. In the management 2 posts filled and 2 vacant, professional nurses are all filled, admin staff 2 posts vacant.
The recruitment of doctors is a major problem. The accommodation for doctors who has families is a problem; there is no accommodation for them. The doctors also claim that the rural allowance is not sufficient.
Synchronizing the management structure of the two hospitals, resulted in one management structure
Tour of George Stegman
The Committee had a meeting with the senior management and the Regional Director of Health of Odi Hospital on 16 February 2005.
The CEO of Odi Hospital did presentation
Odi Hospital does referrals to Garankuwa Hospital. At Odi there are 9 doctors, 161 Professional Nurses, 32 administrative staff and 89 support services staff. The staff establishment is 97%. After 4pm there are no OPD (Out Pasients Department) and patients are referred to casualty ward. There are 198 active beds at Odi Hospital.
Comments from Management
The hospital does have PHC, Maternity, Eye care; HIV/Aids clinic and a psychology unit The Budget for 04/05 was less than what was allocated. The reason for this is that the hospital is spending money that they do not have.
With regard to complaints by patients there is a book at the registration where patients can write their complaints in. It is management’s job to communicate with complainants and they should report within 3 days after receiving complaints. There are also suggestion boxes in the hospital.
The issue of the Hospital Board is that Board disbanded in November 2004. Names of new nominees have been submitted. The role of the board will be to ensure that new government structures are in place. The response from Councilors has not been good in assisting with this process. The Board is there to support and advice the hospital and community and to make reports and follow-up.
In order for ARV to be rolled out, needs to be accredited and nurses will have to be trained with regard to the rollout of ARV.
Because of the number of fridges broken down in the mortuary, the hospital has a relationship with private Funeral Burial companies to relieve some of the load of the hospital. These undertakers are: Gift Neo Undertakers, Bambi’s funeral and Bennies funeral.
Tour of Odi Hospital
There are directions at the Patient Registration to indicate to clients where they should go for which services, but there is no Charter of the Rights of Patients.
The dispensary is under lock and key. This is where medicines are issued to patients. The pharmacist indicated that there is no shortage of the supply of medicines. Intensive stocktaking takes place twice a year. There are medicines available in casualty for after hour’s patients if the dispensary is closed (dispensary not 24 hours). SMME’s assists the hospital to distribute pharmaceuticals to clinics.
In the casualty ward there is a consultation room, but there is not much privacy. During weekdays the casualty ward is not that busy. The casualty ward has 1 full time doctor and the hospital has 3 radiographers.
At the mortuary there are 5 fridges with 3 shelves each (15 in total) but 9 out of 15 does not work. The hospital gets assistance form private mortuaries.
The pest control is a major problem, the reason being that management questions the efficacy of the pest control that the company uses.
Visit Dolly Rathebe Old Age Home 16/02/05
Overview of Center
The Centre is being used as a crèche and a pay point for Social Grants. The National Department of Social Development is doing funding for the building. The Local Office of Social Development has not worked well with the center. With regard to funding it received funding from: the French Embassy and the Department of Social Development. The reason for the establishment of the center was for: poverty alleviation, a soup kitchen and free food to the old aged.
In one of the rooms the old aged are sewing and this is all done by hand, since there are no sewing machines. These products they sell at the pay points for Social Grants. Progress is being made on the building of a new crèche and funding received from the French Embassy is utilized for the building.
Disability Center 16 February 2005
Itireleng Workshop for the Blind 16 February 2005
Bojanala District Municipality- Department of Health:
Issues that had to be followed up on:
Whether the Strategic goals of the Municipality are linked to the Ten Point Plan of the Department of Health: The municipality will attend to this area, and for that matter we have referred the matter to them.
Report regarding the high turnover of doctors and nurses: This is a national problem, and our region is no exception. The major problem with us is that we lose these cadres to other provinces such as Gauteng, and Limpopo, because our region is bordering Mpumalanga, Gauteng, Limpopo and Gauteng. The department has a strategy on the recruitment and retention of health professionals and that is the one that allows us some way of retaining. With the advent of the community service for nurses we hope that we will continue receiving a good number. In the areas where the problem is caused by the lack of posts, the department is in the process of finalizing the staff establishment, which will address this area.
Number of doctors available – permanent doctors and community health doctors: There is a total of 81 doctors including both the interns and the community service doctors, and these doctors cover the 5 hospitals and the clinics as well as the community health centres (There is a total of 1244 beds in the hospitals and 138 clinics including health centres)
Report on Pharmaceutical issues: The delivery of medication to clinics (outsourced): The SMME have been contracted to deliver the medications to the clinics and the Community Health Centres, so much that there is no longer a problem of shortage of medications in the clinics, except in the case where there is general shortage in the province, in which case the central medical stores assists in addressing the problems
Short summarized report regarding shortage of ambulances: The department is the in the process of procuring the new fleet of ambulances to replace the ones that are repeatedly breaking down because of the bad road conditions, and the heavy workload. Bojanala will also benefit from the process of procurement of the ambulances after which the situation will improve.
List of NGO’s funded by government: The process of separating the NGO’s that are funded by the department and those funded by other departments is still being finalized through the social cluster extech and as soon as that is done we will send same to your good self; we hope to do before the 15th April 2005; this is made worse by the fact that there is a lot of cross subsidization and as such we need to have those that are funded for the health programmes only.
Report regarding Traditional Healers in the district. What is the situation? : The department has a sound relationship with the traditional healers in the management, care and support of those patients that are suffering from debilitating diseases such as TB, AIDS, Pneumonia etc. We meet with the traditional healers at the level of District and Local Aids Councils, which is where the planning, coordination of the intersectoral activities towards the management, care and support on the HIV and AIDS is being deliberated. Together with these colleagues we serve in the District Steering committee that is aimed at preparing and monitoring the implementation of the comprehensive plan on the roll out of the antiretroviral treatment programmes, and it is chaired by the Chief Executive Officer of Rustenburg Provincial Hospital.
What is being done to attain the assistance of private sector ambulances? There are very few private ambulances in this are especially due to the rural nature of our district, and these is only available in Rustenburg and Rustenburg, and they get called in the event of the major incidents/accidents that require life support.
Devolution of powers- patients bypass clinics and go straight to hospital: The devolution of powers is the competency of the Provincial head office, and as such we only act as and when directed and guided by the relevant proclamations and policy directives; Regarding the patients that go directly to the hospital, the problems is caused by the fact that there is no district hospital in Rustenburg, with a population 395000 people. Because of the mentality that the service is better at the hospital, there is very little we can do to stop the patients, but the gateway clinic that is there at the gate of the hospital is meant to address this problems minimally though as it is to small. The appointment of the Family Physician who has just started working with us and is doing a lot of work in the hospital will assist in addressing the problems of the non specialist cases that walk directly into the hospital.
Number of professional nurses involved in CTOP: There are a total of 22 nurses that have been trained in CTOP in various institutions.
Is there a decline in back-street abortions? There is a decline in the back street abortions, as a result of the access to the CTOP services, though the teenage pregnancy is still on the rise even for those that are coming for the second time for the CTOP services.
Disposals/incinerators is there a Waste management programme in place w.r.t. CTOP: The department has a waste management programme that has been outsourced to the Millennium Company. This company collects all medical wastes inclusive of those generated through the provision of the CTOP services. The incinerators that were installed in the clinics were not designed to incinerate the human tissues, and due to lack of proper explanation at the time of installation, people thought they were for that reason, and it is only now that those that are have been installed are used to incinerated the right staff, and there is no problem.
Number of persons returning for results of HIV/Aids testing? The percentage of the persons that return for their result is very low @ 35% in all the clinics where testing is done instantly, and this is attributable to the fact that there is still stigma, in spite of the counseling that is being done; the project of improving this is done in collaboration with the District Aids Council, and it is hoped that through social mobilization, the percentage will increase; it is only in the cases of voluntary counseling and testing that the results are available on the spot, and in this case it is 100%.
Process of monitoring PMTCT Programme? This programme is monitored as part of the mother Child and Women’s health in the facilities that are rendering the services, which are mostly those that are rendering 24 hours of services. There is however some difficulty in doing a complete monitoring as some of the mothers who enroll for the programme at the clinics and health centres do not come back to deliver at our facilities. Most of these mothers deliver at the private hospitals, some at the hospitals. All our district hospitals are running the programme on the PMTCT, but it becomes difficult for the stats to be realigned with that of the clinics, as unless the patient discloses, the nurses may not know, or may start the process all over afresh.
Formal report of Lawsuit against the Premier: This matter has been put to the formal investigation by the duly appointed investigating officers, in the name of Ms. K Taoana (Premier’s Office) and Dr Mphake (General Manager for Brits hospital). Given the complexity of the problem and the fact that it includes George Mukhari hospital, which is in Gauteng, The colleagues have not finalized the process but they are still busy with and the information will be furnished at the right time. These colleagues will give the report to the office of the premier, so much that this office may not know the progress made until the office of the Premier shall have received the report.
Annual Report and latest Quarterly Report: The annual report will only be available late this month of April, and we are of the opinion that in the mean time we should give the report of the last quarter of the calendar year which report was submitted in January 2005, and it shall be marked the third quarter report.
Mogwase Health Center:
Details on progress regarding Revitalization program: The tender has not been advertised as yet and the municipality has already allocated the site next to the Health Centre, which the site will be used for the construction of the centre. The Directorate in Head Office responsible for the capital/ physical structures handles this process.