SA National Council on Alcoholism and Drug Dependence (SANCA) plans and priorities for 2010
Chairperson: Ms Y Botha (ANC)
Date of Meeting: 22 March 2010
The South African National Council on Alcoholism and Drug Dependency presented their plans and priorities for 2010, their challenges with regards to substance abuse and on how the Committee could assist them in their activities. SANCA was in the process of standardising practices and processes across the eight portfolios. In terms of treatment, there was an extensive process of accreditation of all SANCA organisations in order to ensure compliance with minimum norms and standards set by the national office. An In-house Treatment Outcome Evaluation Tool would be completed during the course of 2010. SANCA was in the process of developing a national research policy to approve, screen and monitor research. Six manuals were developed to use in SANCA awareness and prevention programs. A Community Development Manual was developed as well as a Human Resources Manual in addition. SANCA had developed a database and standardised statistical forms. An internal accreditation system for SANCA staff was in the final stages of development. SANCA was also in the process of implementing a new financial policy.
The Members asked questions about the footprint of SANCA nationally, and to what extent people in the rural areas had access to its services. Acute emphasis was placed on the role that SANCA had to play in the anti-drug awareness campaign in schools and members asked several questions about it. Members asked questions about the implications of the new Prevention of and Treatment for Substance Abuse Act, and how long it would take before the Regulations would be finalised so that it could become law. Funding was a huge challenge to SANCA and Members asked questions about how SANCA planned to sustain itself in the long run, how it was funded and whether there were other funders except for government. Recruiting and retaining the social workers and nursing staff was a major challenge for SANCA and Members wanted to know how they were going to overcome these challenges.
An area of special focus was the FIFA 2010 Soccer World Cup Tournament. Members asked questions about how prepared the country and SANCA was to deal with the expected escalation of incidents of drug abuse and human trafficking during the World Cup. Questions were asked about how prepared SANCA was to assist with heroin addicts needing methadone treatment. It emerged from the discussion that South Africa did not have a Harm Reduction Policy. Other questions centred around how SANCA would link up with the different government departments to field the challenges expected to be generated by the World Cup.
South African National Council on Alcoholism and Drug Dependency (SANCA) presentation
Rev J L Smith, National Chairperson of SANCA informed Members that the presentation would be made by Ms Shamim Garda, National Executive Director: SANCA, Ms Carol Du Toit, SANCA treatment expert and Dr Sipho Mathe, SANCA expert in community development.
Ms Garda commented that SANCA was funded by the Department of Social Development (DSD) and as partners, they should work symbiotically and hopefully strengthen the discourse on substance abuse.
She referred to the Biennial Report as containing a detailed report on the work done in all the provinces over the last two years and the achievements to date. The presentation would highlight only the most important aspects of this report.
In the report there was a graphic to show the SANCA footprint. SANCA had 31 outpatient facilities throughout the country and counting the National Office there would be 32 service points. The National office administrated the network of facilities and liaised with the DSD around policy and legislation. There were ten inpatient facilities and 40 satellite service points in the country. The footprint graphic was compiled six months previously, which meant that there might be small differences, but broadly speaking there would be almost 70 service points nationwide. There were four adolescent inpatient facilities. The service points were clustered around the cities, but the satellite services were reaching out to the rural areas and making services available there. The DSD, at all three tiers of government, assisted SANCA tremendously in reaching the remote rural areas.
In the Biennial Report and the Provincial Report, eight portfolios were reflected: Treatment, Research, Prevention, Community Development, Marketing, Human Resources, Training and Finance. These were the engines that drove the work of SANCA as they did the implementation, generated the work and executed the programmes and tasks.
SANCA had started the Strategic Plan exercise in 2003 and brought out a Biennial Report every two years recounting the work done, achievements and challenges over the period.
SANCA was in the process of standardising practices and processes across the eight portfolios. In terms of treatment, there was an extensive process of accreditation of all SANCA organisations in order to ensure compliance with minimum norms and standards set by the national office. An In-house Treatment Outcome Evaluation Tool would be completed during the course of 2010.SANCA was in the process of developing a national research policy to approve, screen and monitor research. Six manuals were developed to use in SANCA awareness and prevention programs. A Community Development Manual was developed as well as a Human Resources Manual in addition. SANCA had developed a database and standardised statistical forms. An internal accreditation system for SANCA staff was in the final stages of development. SANCA was also in the process of implementing a new financial policy.
Other achievements were the launch of the SANCA National Toll Free Number as well as the three-year Behaviour Change Campaign, and the Gold Rush Campaign.
An area of special focus in the presentation was the upcoming 2010 FIFA Soccer World Cup Tournament and SANCA Week from the 21 -26 June 2010.
Ms Garda said that in the light of the DSD being a partner of SANCA, she wanted to explain what SANCA was planning to do during the month in terms of awareness raising. She asked the assistance of the DSD and Portfolio Committee to gain access to Stadiums and Fan Parks in order to run public awareness campaigns on substance abuse and the impact it had on especially young people’s lives. The school holidays would be extended which meant that the youth would be unsupervised for the most part, which would cause many of them to become involved in substance abuse. SANCA would be running holiday programmes, but there would be groups of children and youth vulnerable to human and drug trafficking. Many SANCA Clinics were preparing for an increased caseload of drug and human trafficking in conjunction with the local South African Police Service offices and related role players.
There would be a focus during the month of the tournament on disadvantaged communities and the rural areas. SANCA would use Drama, Exhibitions, and the Gold Rush Campaign. SANCA was waiting on the theme from the United Nations, for International Substance Abuse Awareness Day. The common international theme would be tied in with the programmes already planned. There would be wellness days in the corporate sector during the month and especially during SANCA week. There would be intense networking and partnership with government, local authorities, churches, NGOs, CBOs, the DSD and Portfolio Committee.
In terms of Clinical Services, clinics were gearing themselves up for short-term interventions during this period. There was the capacity at the service points to do brief assessments and referrals in case it was needed. In and outpatient treatments could be offered. Relapses could be handled as well as aftercare and support for the families of substance abusers. During the past two months, SANCA had received queries about methadone substitute treatment and visitors bringing the medication along. SANCA was equipped to advise prospective clients about this.
If SANCA were to get access to the stadiums and fan parks it would need to screen, train and deploy many volunteers to execute its programmes at these venues. John Hopkins University had invited SANCA to partner with them on their Wellness Programme in the Fan Parks in KwaZulu-Natal, the Free State and the Western Cape.
All these planned activities would need to be financed. At this stage it was an enormous challenge. There was a huge substance abuse problem in South Africa as it was. It was expected to be exacerbated by the World Cup Tournament. Thus far there had been no communication between SANCA and FIFA as to how these challenges were going to be addressed. If not the stadiums, SANCA definitely needed access to the Fan Parks in the remaining six provinces.
A challenge that was expected to present itself was the language and cultural barriers between SANCA and its prospective cosmopolitan clientele during the World Cup Tournament. Another challenge was networking and partnership with relevant role players. Ms Garda expressed the hope that this presentation would forge closer cooperation with the DSD and this Committee. The other institutions with which SANCA needed to network, included substance abuse forums, NGOs and CBO.
Ms Garda said that this was an exciting time for SANCA to meet with the Committee and expressed hoped that the Committee and DSD would include SANCA in its plans as it would strengthen the latter’s cause.
Ms Carol Du Toit, SANCA treatment expert, mentioned that SANCA had started its strategic planning process in 2003. Strategic Plans needed to change and be adapted as the environment in which they were executed changed. During the last two years, SANCA realised that drastic change was needed, which was why it changed to a longer term strategic plan from 2010 to 2020. One of the reasons for the change was that there was a huge change in the demand for the services that SANCA had traditionally rendered. In order to remain relevant, SANCA had to adapt to the changing need. Furthermore, with South Africa having been accepted back into international community, with more trade moving through the airports and harbours, more drugs were finding its way into the country. According to an article in the latest Sunday Times, the drug lords were stockpiling for the World Cup. She believed that this was reliable information.
The core areas that SANCA planned to focus on during the following ten years was outlined. SANCA would strengthen its liaison and networking, not only with funding organisations, but especially with emerging community organisations to equip them to deal with substance abuse effectively, because the scale of the problem was too big for one organisation to deal with it effectively.
The development and expansion of services had to be a priority, because as was shown by the graphic of the current footprint, there were large areas which were under serviced in the country.
SANCA had to strengthen financial sustainability by being fully accountable for all the money that it received. It had a reputation as a reliable organisation and by being accountable it would protect and defend its credibility.
SANCA had to continually asses its structures and communication channels for efficacy and if and where needed, changes had to be made.
The structure for Directors of the 32 service points of SANCA had fallen away, but was re-instated, as it was felt that it was a forum where they could communicate, share information and learn from each other as well as communally maintain the standardisation of services in the different organisations.
Financial sustainability was a huge threat. Different categories of funding were needed. Firstly funding was needed for maintaining the organisations. Secondly, funding was needed for specific projects and thirdly SANCA needed to look at income generation in order to be sustainable.
Another core area was a succession plan with regards to staff at the various clinics, as well as the management boards. The people that served on the management boards were professional people and they were all volunteers who donated their time and expertise to SANCA. They needed to be replaced when they leave, and finding replacements with the same commitment and level of expertise was a challenge.
This Strategic Plan was mooted at the Biennial General Meeting in February 2010 and was still in its draft phase. It went down to grassroots level and to the provinces for input. The plan would be finalised and approved at the next National Board meeting in August 2010.
Ms Du Toit outlined the medium to long-term objectives of SANCA. Amongst others there was the objective to strengthen SANCA`s recognised brand of services. It was important for SANCA to remain close to its basic function, which was to treat alcohol addiction. With all the new addictions which had surfaced, it was possible to shift the focus away from the original function, but the need for this was emphasised by the fact that during the past financial year, in the SANCA Youth Treatment Centres, 35% of adolescents between the ages of 13 and 18 indicated that alcohol was their drug of choice.
Another important objective was to implement a recruitment and retention plan for professional staff. Professionals with scarce skills like nursing personnel and social workers were difficult to recruit and retain, because SANCA could not afford to pay competitive market-related salaries.
The presentation looked at the challenges faced by SANCA.
A major challenge was the gap in services. Amongst other there was the need for a long-term treatment facility for the 18 – 30 year old age group. The reason for this need was that many addicts started using drugs very early. As addicts they do not go through the natural developmental stages and their schooling suffered, thus, by the time they were in their twenties, they were emotionally and academically underdeveloped. These people needed to be assisted to gain skills in order to be able to successfully integrate into society and for that longer term treatment facilities were needed.
The changing patient profile and needs in the fields of addiction was another challenge. Children were experimenting with drugs at a younger age, therefore SANCA`s clients were becoming younger. Treatment programmes had to be adapted to suit the age of the client, in some cases 9 year-old children. Young children were always treated as outpatients. The trend was also for young people to be channelled into diversion programmes instead of going to jail. The National Institute for Crime Prevention and the Reintegration of Offender (NICRO) and SANCA partnered very well on these diversion programmes and then shared the cost.
More and more patients presented with dual diagnosis for example drug/alcohol dependence as well as psychiatric illness. SANCA did not have the facilities to accommodate psychotic or very aggressive patients. SANCA also saw more patients that were very ill because of HIV. Drug use caused high risk sexual behaviour and many addicts became infected with HIV. The staff had to be trained in pre- and post test counselling and some SANCA service points were registered as voluntary counselling and testing (VCT) sites.
The demand for the services of SANCA was on the increase and there was a need to coordinate services amongst sector partners.
Ms Du Toit said in conclusion that SANCA was doing what was necessary to make itself more effective in its mission of fighting the scourge of drugs and alcohol dependence in society. It intended to empower emerging organisations with its experience and expertise and maintain and strengthen strategic partnerships.
Ms S Kopane (DA) asked what SANCA was doing to monitor the mushrooming rehabilitation centres that appeared all over the country. Most of the people managing the centres were not skilled to do rehabilitation work and did not have a structured programme. Some people owning/managing rehabilitation centres had been accused of selling drugs themselves.
Ms Garda referred to the Noupoort Rehabilitation Centre in the Northern Cape as an example of the phenomenon of mushrooming rehabilitation centres. SANCA asked to go in with the DSD when it visited the centre. SANCA offered advice. The management did not want anything to do with SANCA. She agreed that these practices had to be stopped, because they did not subscribe to the norms and standards as prescribed by government, nor did they deliver a quality rehabilitation service.
Ms Conny Nxumalo, Chief Director: Substance Abuse, DSD, said that there were gaps in the legislation that governed the monitoring and compliance of these treatment centres, and the new Prevention of and Treatment for Substance Abuse Act was not operational yet. The Regulations were being finalised.
Ideally centres were not supposed to operate without registering; they posed a risk to their clients. The DSD decided to publish the names of all registered treatment centres in a resource directory so that people could know which were registered and which not.
In the law as it existed the monitoring function was centralised nationally, but in the new Act, some of the power of monitoring was delegated to the provinces in order to close the gaps in monitoring and compliance.
The Regulations for the new Act had been developed, but was still in the draft phase. It would be finalised within the next financial year which started in April and hopefully the legislation would be promulgated for implementation.
The Chairperson agreed with Ms Kopano on the issue of the mushrooming rehabilitation centres, charging exorbitant amounts of money for treatment that was not really treatment. She felt that there was a shortage of inpatient facilities, countrywide, because people were sent to the Western Cape from other provinces for inpatient treatment. Unless this situation was remedied, the country was heading for trouble. New drugs were introduced all the time and new treatment programmes and aftercare had to be devised to respond to these. If the country did not stay current in terms of responses to the challenges, it would be in deep trouble a few years from now.
The Chairperson said that the DSD should note that the Committee and the public would like to see some action around this phenomenon of mushrooming treatment centres. There was a need to make an example of some of them. The Act could be enforced without the regulations, but the finalisation of the regulations should be speeded up.
Ms H Lamoela (DA) asked what effect single parent households had on the propensity for children to use drugs.
Ms Garda replied that SANCA did place a focus on single parent and at risk families. The parents and children were given skills training to cope with the challenges and not fall victim to substance abuse.
Ms Du Toit added that a study that had been carried out showed that single parent families were high risk, but even in a two-parent home where the father was emotionally absent, the children were at risk of abusing drugs.
Ms Lamoela asked for a full list of all SANCA organisations. She also suggested that the Committee visit the SANCA centres nationally.
The Chairperson pointed out that the Biennial Report handed out had the list of SANCA service points on the back cover.
Ms Garda added that the satellite centres were not listed, but the centres listed would put one in contact with the satellite centres.
Ms W Nelson (ANC) said that all agreed that Social Work was a scarce skill. The DSD had a scholarship programme for Social Work students and were producing qualified Social Workers. She asked why Social Workers were not taken up in learnerships within SANCA institutions.
She also asked the presenters to elaborate on the fact that once Social Workers received the training and experience, they left for greener pastures.
Ms H Makhuba (IFP) referred to the phenomena of Social Workers leaving SANCA for greener pastures. She asked how SANCA planned to overcome this challenge
Ms Garda replied that SANCA called itself jokingly the University of Substance Abuse Social Worker Training because SANCA gave social workers practical work experience and training and then they left for either the DSD or the corporate sector where the remuneration was much higher.
Ms Du Toit added that because Social Worker students on the DSD scholarship were known to leave as soon as they could get a more lucrative position, in certain areas in KZN and the Western Cape, NGOs (not SANCA) had collectively taken a decision not to place these students in their organisations anymore.
Ms Maria Mabetoa, Deputy Director-General: Welfare Services, DSD, said that all students had a contract with government because the scholarship was government funded. The expectation was that once they were in their fourth year of study, to get practical experience, they would work for government and in the NGO sector Thereafter they had contracts to work for government for two years. Social Workers could be seconded to work for an NGO. Generally the salaries were lower than in government, but some young Social Workers did not mind earning less. This issue of disparities had the attention of the Minister and the Department would intensify efforts to standardise funding across the board.
Ms Mabetoa added that with NGOs through allocations, the salaries of social workers could be raised. The Department was focusing on transfers to NGOs to make sure they could meet their commitments towards their professional staff. There were disparities amongst NGOs and between NGOs and the provinces and amongst provinces. The DSD was changing the costing model so that when the DSD was subsidising treatment facilities everything would be standardised in terms of staff, equipment, facilities, so that the disparities would disappear. Treasury would be approached to provide funding in accordance with the new costing model.
Ms Nelson asked what SANCA's experience was in terms of funding in the different provinces.
Ms Kopano asked how much money SANCA had raised over the last three financial years, in terms of attaining financial sustainability
Ms Garda replied that funding was a huge problem. SANCA was surviving, but needed more funding. SANCA was funded by DSD, corporate companies, national and international donors and was managing with what it received, but was always appealing for more funding.
She said that SANCA would like to know what percentage of the national substance abuse budget it received. She asked whether somebody could tell SANCA what the national budget was and what went to the provinces. SANCA relied on subsidies from the state which was constant and reliable as well as private national and international funding which was not constant.
Ms Du Toit replied that she or Ms Garda could not give a figure because there was non-uniformity across the provinces in the methods of subsidisation. She assured the meeting that a great deal of effort went into finding alternative sources of funding.
In the majority of provinces SANCA was not subsidised by the Department of Health (DoH) at all. The DSD subsidised differently in the different provinces; in some cases it subsidised posts, while in other cases it subsidised programmes but not the medical component.
The fact that the DoH did not subsidise SANCA at all conflicted with the fact that the DoH stipulated the stringent medical norms and standards which a facility had to fulfil if it wanted to be registered as an inpatient treatment centre.
Ms Mabetoa said that substantial amounts of money had been given to SANCA already. In the Eastern Cape R3, 2 million was given to SANCA and R 9.9 million was spent on substance abuse. In Mpumalanga, R5,7 million was given to SANCA and a total of R6 million was spent on substance abuse. The provinces were funding according to the Financial Awards Policy. The DSD needed to deal with disparities.
Ms Nelson asked when SANCA hoped to have the two policies, the financial policies and the one on screening, monitoring and research, in place.
Ms Garda replied that all of SANCA’s policies were available at any SANCA office. The National DSD took copies when it did site visits, so it was available. Those policies still in development would be available when they were finalised.
Ms Nelson asked what SANCA’s take was on the fact that young people were so fond of smoking hubbly-bubbly water pipes. She found it disturbing.
Ms Du Toit said that SANCA strongly discouraged the use of water pipes by the youth. Whether it was with or without substances was irrelevant. The behaviour was problematic. If they smoked the water pipe, they would easily take the next step and smoke an illegal substance.
Ms H Makhuba (IFP) said that SANCA needed to communicate with other state departments like the Police, Health, Education and Home Affairs. She asked whether any of those departments had approached SANCA to be part of their programme as everybody expected the need for the services of SANCA to increase over this period of the Soccer World Cup.
Ms Garda said that the DoH was a huge role player as well as the Department of Education and the Department of Correctional Services. DSD subsidised SANCA, but not Health or any of the others. All these departments, together with SANCA, should work together and it would be wonderful if SANCA could be subsidised by the other departments as well.
Ms Garda replied that SANCA did liaise with other departments and had them in place regarding preparations for the Soccer World Cup. SANCA appealed to them and asked how it could dovetail with what the other departments were doing. SANCA worked with the SAPS, DSD and DoH on their various substance abuse programmes, but there was a need to intensify the relationships with all the departments.
Ms Makhuba asked whether SANCA received assistance from the private sector as it would also be affected by the escalated drug problems.
Ms Garda replied that at this stage the only other entity SANCA was going to work with during the Soccer World Cup was the John Hopkins University.
Ms H Malgas (ANC) thought that it was good that SANCA wanted to get involved in the 2010 World Cup, but she felt that the focus of their campaign should be on the schools. There was a need to speak to the principals and the children to prepare them for what was going to happen. In the constituency that she was from, Port Elizabeth, they involved the South African Police Service (SAPS). There were Safer Schools Committees, operating in schools. She asked how SANCA was liaising with these committees. She said that there should be Safer Street Committees and asked what the nature was of the relationship between SANCA and the different departments.
Ms Malgas asked how SANCA`s relationship was with the Sector Education and Training Authorities and Higher Education.
Ms Adams said that schools were like battlefields where many substances were abused. Together with the Education Department and SAPS, SANCA should place the emphasis on schools. Prevention was better than cure. Which preventative measures was SANCA instituting?
Mr M Waters (DA) from the Health Portfolio Committee, agreed that the ground war should be fought at school level. He asked how many schools, high and primary, SANCA visited per year.
Ms Garda replied that every SANCA office worked closely with the schools around it in terms of an ongoing campaign of awareness, prevention and education. SANCA involved the schools in activities such as exhibitions and drama around the theme of staying drug free.
Ms Du Toit said that across provinces, the SANCA information officers spent the bulk of their time at schools raising awareness and teaching prevention.
Ms Du Toit added that there was no consistency across provinces. In Western Cape and some other provinces there was a big campaign against drugs and crime and weapons. If there was a Safer Schools campaign and it was found thst SANCA was not involved, alert the closest SANCA organisation and they would certainly make an effort to have a presence. Also keep in mind, realistically it was impossible to be everywhere due to capacity limitations.
Ms Malgas said that she had visited Nerina House Secure Care Centre in Port Elizabeth, where NICRO and DSD were running diversion programs. She asked how SANCA was involved there.
Ms Nxumalo said in previous Committee meeting that the Child Justice Act would become law on 1 April. Diversion was an important component of that law and in the treatment it prescribed for children abusing substances and in conflict with the law. SANCA would play a key role in diversion when the Act became law. SANCA was already doing the diversion programmes, but in terms of the new law its programmes would become formalised and accredited according to the new norms and standards required, as would the programmes of NICRO, Khulisa and others.
Ms C Dudley (ACDP) asked which issues were turning up with the new legislation? How has it improved?
Mr Waters asked the DSD when the Regulations for the new Act would be ready. The Act had been passed in 2008 already.
Ms Du Toit replied that the new legislation was better and broader. It included outpatient and community based services, as well as prevention. It also got rid of old impractical stuff. It was progressive.
Ms C Dudley (ACDP) asked what kind of volunteerism was helpful and what was not helpful. People were contacting her to volunteer their services, because they knew that children would be vulnerable during the long school holiday. She wanted to know whether she could channel them in the direction of SANCA and whether SANCA would be able to utilise them in its programs.
Ms Garda said that volunteers were enthusiastic in the beginning, but maintaining them without a stipend was difficult. With a stipend they stayed much longer.
Ms Du Toit said that SANCA was running holiday programmes for kids, for example, Teenagers- against- Drug-Abuse to raise awareness. It provided an additional focus on schools.
Ms Nxumalo said that the DSD was working on a policy to standardise the treatment, management and remuneration of volunteers.
Mr. V Magagula (ANC) asked why a succession plan was necessary. Why did the Board consist of volunteers? The presentation mentioned financial problems. If SANCA had financial problems, did they have money to recruit more staff? Why did SANCA not just pay the board so that they could stay on and work?
Ms Du Toit said that there were financial problems, but when a Social Worker left there was a post open that continued to be subsidised. SANCA could thus recruit a replacement. Volunteers were working in a completely different category of staff. Members of the board were volunteers and did not get paid at all. This category of volunteer was very hard to replace when lost. Volunteers that were recruited to execute programmes received stipends if the stipends were costed into the project funding.
Rev Smith explained that SANCA tried to make sure that there were trained staff members who could take the place of outgoing management staff because those senior staff members were needed for the organisation to function. There was a succession plan in place but with problems. There was also a succession plan for the management board.
Ms Garda said that the Board consisted of 75% volunteers and 25% staff.
Mr Waters asked how SANCA fitted into the Ke-Moja anti-drug campaigns run by the DSD.
Ms Lamoela said that for the Ke-Moja anti-drug campaign, trainers and implementers were trained in 2006/7. Were they taken up in SANCA`s projects.
Ms Garda replied that at the outset SANCA contributed hugely to the Ke-Moja Manual in terms of sharing of information and training. SANCA was still working with DSD on Ke-Moja anti-drug campaign in most of the provinces.
Ms Du Toit added that SANCA organisations were involved in training people for the Ke-Moja program. The programme was gaining in momentum again. It married well with SANCA awareness programs. The master trainers were still with SANCA and were still being utilised to train SANCA staff and volunteers as well as people from other NGOs.
Ms Nxumalo said that for the Ke-Moja anti-drug awareness campaign master trainers were trained to facilitate the program. It was the only national branded campaign that existed. She appealed to NGOs to help and strengthen it for the sake of the youth.
Ms Makhuba said that it was illegal to sell liquor to children under the age of 18. Was this restriction effective and being adhered to? Did it assist SANCA in its work?
Mr Waters asked whether SANCA thought about approaching the DTI and the DoH about installing regulations similar to the ones for smoking, against the background of children experimenting with alcohol and drugs at a much younger age.
Ms Garda said that for shebeens in townships and informal settlements it was a business. They did not care about age, so they were selling liquor to children and underage drinking was a huge problem for SANCA.
Ms Nxumalo said that there were policy gaps in the way that liquor outlets were registered and monitored as the law stood at the moment. The DSD wanted to raise the legal drinking age to 21.The way that advertisements were structured was clearly with the intention of making very young people and children consumers of alcohol. The Central Drug Agency (CDA) would have to become involved to advice government properly.
Mr Waters said that in other countries substance abuse fell within the ambit of the Department of Health. He asked for the personal view of the presenters on whether the prevention side should not fall under DSD, and the treatment side under DoH. Did SANCA feel that it was well placed within the DSD or would it be better placed under Health.
Ms Du Toit said that her opinion was that it was a combined function. There were clear functions for both departments.
Ms Lamoela asked whether SANCA had statistics on awaiting treatment clients.
Ms Du Toit said that the stats for people awaiting treatment for inpatient treatment were not longer than two weeks. Outpatients could start immediately. If somebody was waiting to be admitted he/she could be treated as an outpatient in the meantime.
The waiting period was long for state inpatient facilities and these patients could also be accommodated as outpatients with SANCA while waiting.
Ms Lamoela said that most centres were clustered around towns; the rural areas were under serviced. Were there satellites in the rural areas, and did rural populations, especially the schools, have access to SANCA`s services?
Ms Garda replied that the Cape Town offices did work in the outlying rural areas. In terms of resources, SANCA could not be in every area.
Ms Garda added that in the Western Cape Branch of SANCA there was a programme targeting the unhealthy drinking culture on farms. For more information, the Branch could be contacted.
Ms P Adams (ANC, Northern Cape) said that there was a huge problem with alcohol addiction in the Northern Cape, especially amongst farm workers and in the rural areas. How actively was SANCA working in the Northern Cape on this issue? She also asked how SANCA went about establishing new centres. What were the criteria for establishing a new centre?
Ms Garda replied that in the Northern Cape there were only SANCA branches in Upington and Kimberley. The Northern Cape was vast and SANCA needed more resources to reach out into the rural areas. SANCA would depend on the DSD in the Northern Cape and other provinces to assist it to set up more branches.
Ms Adams asked how SANCA was marketing itself.
Ms Garda did not understand the question.
Ms Adams asked whether and how SANCA was dealing with children sniffing glue that did not attend school.
Ms Garda replied that SANCA worked with people with all kinds of addictions which included addiction to glue.
Ms Lamoela asked SANCA to say something about its successes
Ms Adams asked what the default rate was for people who completed rehabilitation. She also asked what kind of support there was for newly rehabilitated recovering addicts, when they had to return to their communities, to assist them not to relapse
Ms Garda replied that all the successes and achievements of SANCA were recorded in the Biennial Report
Ms Du Toit replied that the success rate of rehabilitation internationally was 28-35%. This figure was arrived at by looking at people attending aftercare sober or relapsed but still coming to aftercare . Both these categories counted as successes and for SANCA it was on average 60%. There was a high success rate if they remained in aftercare. The secret was structured aftercare programmes and sticking with it .The chances of long-term sobriety were much bigger. SANCA was in the process of developing a tool with which to measure the impact of both in and outpatient treatment regimes.
Ms Kopano said that she viewed SANCA as an organisation with specialist knowledge. Was SANCA acting as a mentor to other upcoming organisations that worked in the same field?
Ms Garda replied that SANCA had mentoring programmes for volunteers, for CBOs and for NGOs
Ms Garda added that SANCA was building relationships with NGOs and CBOs for the sake of cooperation during the Soccer World Cup. Normally SANCA and these other organisations were in competition for resources. Survival of the fittest was the mode of existence. The smaller organisations also preferred to do their own thing.
Ms Kopano said that all government departments had Employee Addiction Programmes (EAP) for civil servants struggling with addictions. Their addictions made them ineffective workers. How, if at all, did SANCA link up with the people managing these Employee Programs?
Ms Garda said that eight SANCA centres did have EAPs at huge corporate companies, in the motorcar industry mostly in the Eastern Cape. There was a huge request for EAPs for methadone patients. SANCA treated with Subutex.
The Chairperson said that the presentation was relevant in the current climate as it addressed a burning issue in society, that of substance abuse. She said that the DSD would respond to some of the challenges mentioned such as the gaps in services and the need for regulation by the DSD. She mentioned that the challenge of the recruitment and retention of staff and volunteers was a common experience for NGOs currently, because NGOs could not compete with the remuneration the formal sector could offer. At the same time there was an increase in the demand for the services of SANCA because of an escalation in substance abuse in communities. New drugs were introduced into communities of which the impact on individuals was not known. Heroin and heroin derivatives were becoming very prominent. Heroin addiction was treated with methadone. There would be a need for SANCA to provide pick-up points for needles and methadone, so that it was accessible to visitors and sites where these people would be able to inject themselves. In South Africa this treatment was done on a small scale, but the need would increase during the Soccer World Cup. Was the country ready to render these services? She wanted the DSD to respond to this question.
The Chairperson said that it would be important to have a presentation by SAPS and its Cluster on their state of readiness to deal with the challenges of the 2010 World Cup, amongst other, human trafficking.
The Chairperson said that the point raised about the need for treatment centres for adolescents who missed out on development and schooling was an important one. The state had an obligation to children up until the age of 18. This was linked to children`s rights. The state would have invested money to rehabilitate the child. If the child was sent back into society without skills, chances for relapse were greater. How developmental was that approach for people facing challenges. She wanted the DSD to respond to this question.
Ms Garda said that the issue of 20-something year olds being stuck in the 13 to 18 year old phase was being addressed in therapy.
Ms Nxumalo said that the DSD made a bid to Treasury to get funding for a long-term treatment facility during financial year 2006 -7. There was no response. The DSD was not giving up. The new Act would give increased impetus to lobby for funding for a long-term treatment centre.
The Chairperson asked DSD to explain to the Committee, describing a typical case, how services would be coordinated. The DoH would take over when a patient was psychotic or mentally ill. There was an Act that determined its role in that instance. For detoxification, the DoH would make available a bed or two within a provincial hospital, but there would not be whole wards available for this function. How would the different departments complement each other in responding to a challenge?
Ms Du Toit said that the lack of beds for detoxification was a challenge. In some provinces it worked well. The patient went for detoxification and continued the rest of the treatment regime as an outpatient. It was cost effective and it allowed the person to continue with his/her schooling or job .It was a combined function and SANCA would like to receive funding and advice from the DoH.
Ms Garda said that in South Africa heroin addiction was treated with Subutex. The international visitors would bring their own Methadone packs.
Ms Du Toit said that Methadone as a treatment regime was only recently registered in South Africa and was not widely used as yet. Something else was used instead, called Subutex. Harm reduction referred to was not defined and there was no one policy for the country. This matter would receive attention.
Ms Kopano asked when last time SANCA did an impact study to determine whether its services were relevant to the needs of the societies it was serving.
Dr Mathe, expert in Community Development, SANCA, said that research was geared towards needs assessment. People did not take prevention as a priority as long as their basic needs such as water and food were not met. After their basic needs were met, they would talk about drugs and where it was grown and hidden. This was why SANCA National had changed the strategy to prevention work and adopted a community development approach.
Community Development discovered that there were three principles that had to be adhered to: Felt needs of the people, Participation and Self Help. Due to a shortage of personnel, SANCA had to transfer ownership of the prevention and development.
In another study it emerged that most people with MDR TB were abusing alcohol. In the study, eight of the people who died used the TB drugs while abusing alcohol. They became untreatable. When sent to hospital to treat as an inpatient, it cost R25 000 to treat one patient. The research confirmed that partnership was very important. The DoH should be part of this program, because a huge section of the work funded by DSD should be co-funded by DoH.
Another fact that emerged from the research was that rural people regarded traditional homebrewed alcoholic drinks as food. When a person was drunk they said he had overeaten. They did not believe that a person could become an alcoholic as a result of eating his ‘food’. They drank other homebrewed concoctions containing battery acid which caused liver cirrhosis in many.
From research done in prisons most inmates admitted to abusing drugs before committing crime. There was a direct connection between drugs and crime.
Research was continuing on treatment modalities to check what types of skills were needed in SANCA.
SANCA had initiated a pledge, called the Youth Charter, for the youth to sign to promise themselves that they would participate in sports and not become involved in drugs. It was important for SANCA, once the skills of prevention and development had been transferred to community members, to transfer ownership of the project so that communities could take charge and steer the work in the communities themselves.
Ms Nxumalo said that the way in which the 2010 Soccer World Cup was planned with regards to security, was very restrictive. It was not in all host cities that the DSD had access to the stadiums or Venue Operational Centres (VOC). There was not enough space to accommodate all government departments that wanted access to the VOCs. It was highly unlikely the DSD would be able to arrange access for SANCA to the VOCs.
SANCA would play a major role in Fan Parks and public viewing areas. There were ten Fan Parks planned nationwide .The DSD in the provinces could draw in key NGOs that were specialists in children and substance abuse issues. DSD was partnering with UNICEF in manning Fan Parks in order to respond to the challenges expected.
The DSD saw its role in terms of Human Trafficking as supporting victims once they have been identified. There were 12 shelters nationwide which had been strengthened by the International Organisation for Migration (IOM) to beef up security, because current security measures were found wanting. The IOM was providing training and funding to prepare these centres to deal with the sophisticated methods of operation of international Human Trafficking syndicates.
The DSD asked its provincial offices to provide lists of all organisations that would work together in Fan Parks and public viewing areas. The DSD regards SANCA as a key stakeholder in these settings as well as at the community level. SANCA would serve as a referral point for all drug related matters.
Ms Nxumalo said that the Central Drug Agency was a structure that was established to coordinate all government structures and efforts as well as that of civil society to achieve a common goal. There were provincial forums and local drug action committees in existence. They were functioning at varying levels, but these structures were put in place to ensure the implementation of the National Drug Master Plan. These substructures were meant to draw up mini plans. The DSD could not decide whether all the substructures should implement their mini plans and just be monitored by the national body, or whether the mini plans should be used to draw up an integrated national plan which would be steered and monitored from the national office.
The DSD had initiated an interdepartmental committee to put forward a plan on prevention and treatment to then submit to the CDA.
Ms Du Toit said that International Harm Reduction conference 2013-14 would be held in South Africa. Currently SANCA had no policy in providing needles and would not do needle exchanges. Visitors could legally bring 30 days worth of methadone treatment into the country. If they arrived at SANCA centres they would be provided with clean needles.
Ms Nxumalo said that South Africa had no position regarding Harm Reduction and there was confusion about exactly what it encompassed. The CDA needed to draw up a Position Paper to submit to the Minister which would then submit it to Cabinet for approval. This process would be fast tracked, because it was imperative that South Africa had a clear policy in term of Harm Reduction.
The Chairperson called on the DSD to tell the Committee whether the Regulations would be ready for the 2010/11 financial year. The Position Paper on Harm Reduction had to be developed as a matter of urgency.
CDA must also play a bigger role with substance abuse. The CDA was not vocal about substance abuse. There was a need for improvement in the CDA’s communications.
In terms of services there should be uniformity. There should be no disparities in funding in provinces. It also meant that provinces did not prioritise substance abuse. The money allocated in the mentioned cases was still inadequate.
The Chairperson requested a package of manuals. She said that Members of Parliament had parliamentary offices. These offices could serve to spread information. SANCA could use them as points of outreach.
The Chairperson attended a conference on Best Practice where she had met Ms Garda and invited her to the Committee. Best Practice in handling substance abuse was of great interest to the Committee.
The Chairperson thanked SANCA for the presentation. They stated their challenges and vision. They created a clearer understanding in the minds of Members of their challenges. She said that SANCA was doing a good job. She said that volunteers do things for free. There was no obligation to pay them, but it was a challenge to retain professional volunteers in the NGO sector.
Ms Malgas reported back on the issue of the Enkuselweni Centre Secure Care Centre in KwaZakhele, Port Elizabeth that was in disrepair. By last week Wednesday, the provincial DSD was there to inspect the contractors that were to start on repair work.
The Chairperson said that this approach worked. If problems were brought before the Committee, it received attention.
Ms Garda said in a closing remark that the SANCA website was up and running and that all the relevant information was available on it.
Issues emanating from previous meeting:
National Development Agency list of live projects
Ms Lamoela revisited the issues raised in the previous Committee meeting about the list of live projects funded by the National Development Agency. She looked at the list that the National Development Agency (NDA) had given. She could not understand how projects could be asked to open bank accounts and then heard nothing further from the NDA. No money was ever deposited. She called the numbers supplied and spoke to somebody about the Tweefontein farm in the Witzenberg District, Tulbagh. The farm had been sold. There was no explanation about what happened to the money. Some projects were not sustainable because they waited too long for the funding from the NDA. Her concern was that if regular monitoring and evaluation happened, problems could be pre-empted. She reiterated that the Committee Members had to visit the projects to assess the state of things.
The Chairperson said that Members should pay unannounced visits to projects. Members should look at the mapping and visit NDA funded projects in their constituencies as per committee decision. Six provinces were represented in the meeting. Only Limpopo and KZN were outstanding. She urged Members to do the visits and collect the facts during the recess. The assessment and analysis would be done together as a committee upon return. The Committee could then compare its findings with what the NDA reported to the Committee. The NDA would them be called to account,
This process was the only way to clarify what was categorised as an active project. Some projects had closed down. The NDA had cut its losses moved on. Inaccurate data implied carelessness.
Ms Kopane said that for many projects only cell phone numbers were provided. In most cases these numbers or the landlines provided did not work. Most of the physical addresses were in shopping complexes in town. The Committee needed to get the revised list of projects funded by the NDA.
Ms Lamoela suggested getting the revised list of NDA funded projects from the DSD before leaving for recess.
Ms Lamoela said that she had a list that was given to the Committee by Nestle. Nestle said that they were working in company with already existing projects. Most projects were in KZN and Gauteng where there were 33 projects. Most of the companies worked according to the principle that where they were in business, they supported and supplied developmental projects around them.
The Chairperson said that the Committee asked Nestle why it did not expand its footprint. Nestle asked the Committee what it had to offer towards that end.
The Chairperson said that the Committee should discuss its re-engagement with Nestle.
Ms Lamoela suggested that while the Members were going to visit the NDA projects, they should also visit the Nestle projects within their constituencies.
Ms Malgas asked whether the Members could have standardised questions to ask when visiting projects. She identified two projects that were situated in East London that she could visit.
Ms Nelson said that the whole country used Nestle products and not only people where the projects where. She suggested that if Members had travelling vouchers left, they could visit projects in constituencies other than their own.
Ms Lamoela asked about overnight stays. She said that she was going to use her own vehicle and could not claim for it.
The Chair said that the Members should indicate to the secretary which projects she/he intended to visit. The secretary would work out the logistics and the cost. There was a budget for committee work. Travelling expenses and accommodation could come from there. There was a claim form that could be filled in, in order to claim the expenses back.
Ms Lamoela said that she was never reimbursed for Committee work.
The Chair said in April the new financial year started. It would be a committee decision. It would be submitted to the House Chairperson for oversight.
Ms Nelson said that if one went to KZN, one would need a vehicle.
The Chairperson said to leave provinces out where the Committee had no members.
South African Social Services Agency appearance before Standing Committee on Public Accounts Ms Kopano was absent when the South African Social Services Agency (SASSA) had appeared before the Standing Committee on Public Accounts (SCOPA). She asked how it went.
The Chairperson said that the Deputy Director General told her that the SCOPA meeting went fairly well.
Ms Lamoela reported that the biggest concern were the issue of the mobile units. Why 40 were bought, but only ten were operational. Where were the others? R32 million was budgeted for the maintenance of 40 vehicles. SCOPA also wanted to know why only ten were working. The mobiles could not operate without satellite dishes Budgeting within SASSA was a problem. They did not have the funds to equip the remaining 30 vehicles so that they could be put to use. The main issue was satellites for remote rural areas.
The acting CEO managed very well. He could answer questions. Dormant accounts were another issue raised by SCOPA.
The Chairperson asked why SASSA did not have a board.
Ms Lamoela said that the secretary would get the report from the committee secretary of SCOPA.
The Chairperson asked how many DDGs SASSA had. SASSA had a DDG for every program. SASSA was responsible for an R86 billion account so there were many divisions.
The Chairperson said that it was good that the DDG took responsibility for whatever happened in his program. This was very good at senior management level. DDGs should take responsibility for wrong decisions and be nailed for it in the Committee. Not only accounting officers.
Ms Lamoela questioned whether SASSA was entitled to performance bonuses, when, to her mind they were not performing.
The Chairperson said that SASSA did perform and had reached its targets. Performance was measured to the degree that a department had reached its targets. For SASSA its main target would be to pay out grants to a targeted number of grant beneficiaries. It was easy to reach targets. Not even the DG could oppose bonuses
Ms Lamoela said that the percentage of the budget being paid to the agencies doing the payout hampered SASSA.
The Chairperson said that as grant beneficiaries migrated to the banks, the amount would decrease. In the mean time it was still escalating as the increases were built into the contracts.
Ms Lamoela commented that the asset register of SASSA was not in order yet after three years.
The Chairperson said that Gauteng, Western Cape and a third province were the first three provinces that handed in an intact asset register that had been audited by the Auditor General. Department of Land Affairs and Rural Development were dealing with assets of the country, but had no Asset Register. The point of the asset register was an important one.
The following meeting in terms of programme would be the Public Hearings on the Amendment to the Social Assistance Act. The hearings would be on one section only. It could be scheduled for April. The Committee did not need five days – three sessions should be enough. The Act has been workshopped in sections already. As it was a Section 76 Bill, the Chairperson felt obligated to have Public Hearings on it. She said that the Members would get the dates before they left for recess the following week.
The Chairperson said that the Committee would also be doing the Budget Vote of Social Development.
The Committee should also schedule a report back session on NDA. This meeting should happen before the Budget Vote.
Ms Malgas reminded the Chairperson about the meeting to hear the readiness of the cluster for the World Cup.
The Chairperson said that she wanted the NCOP Chairperson on Social Services, Ms Nomonde Rasmeni, there for the presentation on readiness for the FIFA 2010 Soccer World Cup.
Ms Nelson expressed concern about the safety of especially young girls during the World Cup.
The meeting was adjourned.
- PC SocDev: Briefing by South African National Council on Alcoholism & Drug Dependence (SANCA) on their plans for 2010 Part 2
- PC SocDev: Briefing by South African National Council on Alcoholism & Drug Dependence (SANCA) on their plans for 2010
- PC SocDev: Briefing by South African National Council on Alcoholism & Drug Dependence (SANCA) on their plans for 2010 Part 1